Lessons Learned: Simone Maybin, MD

Hello everyone, I'm Dr. Darsha Shah, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined, a podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in health care. Alright, what's up everybody, welcome to Medicine Redefined here. Got my buddy Dr. Altamash Raja, so Dr. Alt, what did you think of our latest episode with Dr. Simone Maven? It was awesome man, I was really excited to chat with her, obviously it had been a little while since we got the catch up, so that was obviously good, but I learned a lot, not only about her journey, but how gave me ideas of how I can continue to call autoboles and pivot and what I look at in my future practice and what it is that what gaps need to be filled in different ways we can go about it. That's what's cool about this is, again, both of us are still training and we've been obviously thinking about our future practice, but it's good to really speak with people who are actually doing that and then balancing ideas off them, so that was pretty fun. Yeah, I couldn't agree more man, you know, for me just launching into my intern year, you've been doing this for a while, you know, getting up for sports medicine, it's really refreshing for me kind of to see where I may end up and how I may practice, you know, emulating you guys, Dr. Simone, and just looking at the different avenues out there, right, and I think that's one of the biggest takeaways from our episode is that she's a physiatrist, she was really good hands-on sports medicine, she said, and typically when we think of somebody going into fellowship, you think of doing fellowship and something you're already good at, right, or something that you're interested in, but she chose to kind of do the opposite and said, hey, I'm not that great at injecting people in their back, I'm not that great at spine medicine, I want to get better at this. So let me go into a spine pain medicine fellowship at Hopkins, and so that she could fulfill that kind of quality and get better so that she could become more comprehensive. That was, you know, I've never heard of that or I've never seen anyone really do that. Yeah, I mean, we tend to all have an affinity towards what we like, what we're good at, because everybody likes being good, right, at some type of skill. And so, yeah, I'm sure there's people out there, but I agree with you. I think they're few and far between, and you know, one of the things that kind of really stuck out and resonated with me a little bit, as she was talking about her journey on how she got there and the decisions that she had to make, it's such an early, you know, early standpoint in our career, and it really got me thinking, and that, you know, as early as high school, I'm able to do this myself. I see, you know, people in college or high school or medical students who are kind of starting, and I'll ask them, oh, you know, what do you think you'll do with that? Do you have any interest in what you might want to study? And we're asking kids in sophomore year, if you're going to go to college, do you want to study biology in this? When they get to freshman year, they kind of have to select a major depending on which institution they're in. And it is challenging, and not everybody has it figured out, or the biggest part about it, not everybody has had the appropriate exposure to figure it out. And obviously, it's easier now with social media and everything, and you know, you're getting a lot of exposure, but still, the point that you made of how, you know, if you hadn't gotten the exposure to functional medicine, you might have not ever really known, hey, like, what do I truly love? And how neurosurgery's story is so funny because neurosurgery is better. But, you know, again, that's kind of what attracted you to PM&R, and it's also what attracted me to PM&R. For me, you know, the thing about physical medicine rehab was obviously I went into, I knew I wanted to do sports medicine, because athletes, I'm an athlete, I know I want to work with athletes, I feel comfortable doing that very much. So I'm in that first category, right? Not where she was, but then I learned about PM&R because I want to do a lot of non-surgical things. And then I was, okay, this is for me. But my third year, I got to work with this exceptional, amazing physiatrist, Dr. Jard Malanga, which we've talked about. And what was really cool is that his practice obviously is further developed than a lot of the folks that we're going to have on here, but he was doing a little bit of everything, right? Call it lifestyle medicine, a little bit of functional medicine, a little bit of integrative medicine. It was just like, you know, all of it together, ortho-biological, regenerative medicine. And in my mind, I was like, wow, this guy is not tied to any one philosophy. He's just trying to figure out what the best approach is. He's so open-minded. This, he was the one telling people at conferences, what do you think about osteopathic medicine? And this guy was trained at, you know what I mean? I was so impressed with that. Talking about treating scaleings for brichial plexopathy type stuff. And so in my mind, I was like, wow, this is how physiatrist think. This is definitely the decision I made. But so it was really cool that Simon was like, okay, you know, where she didn't know. And she was like, I'm good at sports. I've been an athlete. But what can I do to be more comprehensive in nature? And that's the hope that we have, right? I mean, so, you know, we were trying to get exposure to a lot of the young professionals, people in maybe undergrad or, you know, healthcare professionals who are early in their career to all these different avenues that they can go down and try to see what works best for them. Yeah, man, absolutely. And like, for me as a pre-med coach, you know, I'm dealing with 18-year-old, 20-year-old undergrads all the time telling me, hey, I want to be a cardiologist or I want to do this. And I always tell him, hey, you got to keep an open mind, right? Like, for me, I thought GI because of the microbiome and the whole feel and the boom. But then again, fell in love with PM and R, once I really saw it. But it's tough with the medical education system that we're in because we often always are having to choose something before we even get exposure. And once you kind of go down that rabbit hole once you choose, it's very tough to kind of, you know, get out of it and then choose something else. Although people have done it, right? In their intern year, they choose surgery and they say, you know, surgery's not the life for me. I'm going to go into internal medicine or something else. So it's possible. But it's really tough to strike that balance. And for the people listening to this, especially if you are in premed or medical school, my biggest advice would be like, go out and try different things and get as much interest out there as possible. Go check out radiology, check out general surgery, check out all these things as much as possible during your first two years of medical school or even your elective time during your third year. If you're premed, take those gap years, do more shadowing. But I just, there's not enough time that I feel wherever you can really delve in and see, this is exactly what I want to do for the rest of my life. So I just think that was the biggest takeaway was having enough time, right? And just having enough experience to really choose what we really want to go into. Definitely, man. So, you know, I'm currently in the middle of this book called Decisive. I'm not sure if you're familiar with the Heath Brothers. Yeah, yeah, Dan and Tim. Yeah, exactly. Yeah, we're talking about one of the other books. Yeah. And you know, it's definitely interesting. And the concept that this one concept you talk about is called Ucheng. I don't know why they renamed this, but basically what it is is talking about dipping your toe in the water to see what the temperature is like before you decide to take a plunge, right? The classic example for us, you shadow before you decide you want to go to medical school. You don't just decide that you want to jump into medical school, take tons of debt out and commit three plus, you know, four plus another three or five years of your life. That's not a good idea to do it. But in other places, you want to take a jump. And that's exactly what you're talking about, right? And hey, check out all these things before you ultimately decide, hey, this is the one for you. Obviously, cardiology, neurology, these things are so common and that everybody knows about a cardiologist just because they're as important. But that doesn't mean that's it. So that's that's really cool. What else? What else do you remember that kind of really sticks with you that you took the work take home points for you? Yeah, I was going to say real quick talking about books too. So I started reading so good, they can't ignore you, right? By Kell and you. And what he says, right, is gather up those skills more than your passion, right? Like you got to figure out to become comprehensive, figure out what makes you different. And when I look back at what Simone was saying, you know, choosing to do spine because she wasn't good at it, that's exactly following that advice from the book and and becoming great at everything so that they can't ignore you. Exactly. Yeah, yeah. Yeah, I'm excited for you to finish that book so we can talk a little bit more about it. Yeah, I'll get there. I took some rigorous notes on that one. Yeah, yeah, and try to like go back. But yeah, and what's interesting now, I'm not going down this path. This is not a book with you. You know, another thing that I really enjoy talking with her about was how she's actually incorporating some of these practices and her health coaching, right? That was obviously super inspirational for me. You know, clearly she had an advantage where Vanderbilt was offering this course. So I think a lot of the folks will have limitations that they don't have this type of opportunity. But that doesn't mean that they can't seek that out if that's truly what they're passionate about. So, you know, one of the things that's really important is, you know, we can get all these certification, we can read all the books like you're talking about, but if you don't actually put into practice, it doesn't mean anything. So it was, it was important for me to know how she's actually implementing the the health coaching stuff into her practice and a quote that kind of resonated with me that she talked about is, you know, we have to prescribe personal training or thread training and this type of stuff just like we prescribe medicine. Right? And I mean, how often have you heard just people talking about if we could put exercise into a pill and give it to people, it would literally be the single best drug ever for so many different ailments, right? We're talking about mental health, physical health, cardiovascular, oh my god, unbelievable. And that's how she truly views it. But, obviously, it's really hard to do because everybody knows they need to exercise at some level, but not everybody is. And obesity, race, or just through the roof every single year, they're getting worse and worse and worse, and we're just headed in the wrong direction. So, you know, the coaching aspect, I think that over the last couple of years, that's where I've shifted to try to be a better coach. That's what I talked about during my interviews with sports medicine that, you know, hey, physicians or coaches, just like personal trainers are, just like nutritionists are, just like that, you know, all that stuff. And so, how do we connect with the individual? How do we get them to buy in? Obviously, you know, we've had a conversation with other people since, and so I know we're going to talk a little bit more about this, but, you know, the interesting thing was that she said that initially when she had learned, she's trying to stick a step back and try to make it more behavior focused. And again, us in medicine, I think we are all very guilty of being outcome focused, right? Did I get the A or not, right? Did I get the 100? If you were in the gym, or did I get this significant personal record or the weight and stuff like that. So I need to continue working on the behavior focused type stuff. Yeah. I mean, when it comes to her coaching, right? Like, it's more than 70 hours or 70 sessions, she said that she's more and each session could be more than an hour. So she's definitely put in the work to add not just a certificate, but a board, right? Board certified health coach. And I think having that title, right, when a patient comes to see you, add so much more influence, because like you said, physicians are also coaches. And I've been totally my thumbs here talking to my wife, Mira, saying, Hey, you know, I really want to be a life coach. I think it's something I want to do, especially as I go down this path towards integrated functional medicine. And it's funny because I only know of life coaching. And for somebody like me who's really into this space, I feel like I should be knowing about all these other programs out there. But it's almost like they're so hidden from us. And so to our listeners, I know a bunch of pre-meds out there, I talked to a bunch of medical students as well, saying that they want to be more preventative, that their goal should be having their patients not come into the hospital. And I couldn't agree more. But I think we also need to learn how to become better coaches. And so, you know, we need to start Google searching more about these programs that we can get certificates that we can understand how to do modification when it comes to our own practice and having more of a team-based approach. Yeah. I mean, it's continuing education, right? I forget where I heard this or if I'm the one who said it honestly, because I've said it a couple of times, but I don't, yeah, I got to Google it to say so I can give credit. But I mean, that's why it's never, when you talk about physicians, it's called the practice of medicine. Yeah, despite being an expert, you are always learning, you are always practicing. And I think traditional sense when people talk about CME and the medical curriculum, it's about going to conferences, it's about attending these medical lectures. But again, it goes back to, if you keep going to these medical conferences and medical lectures, you're just getting better at what you already know. How about, how about we start going to some nutritional courses? How about we start going to some, you know, strengthen conditioning courses, stuff that's outside our realm, you know? I think that that's also what we have to stick a step back and somebody else said, check our ego, leave it at the door. And be okay with going to these conferences and learning from people who perhaps haven't done as, put as many years into education as we have, but our experts, our teachers know ahead of us. I remember my dad telling me once, your teacher is just anybody who knows more than you or is just like further ahead of you in that specific. It does not matter. You could be 50 years old and like a professor at a prestigious institution and then this could be a medical student or just an undergrad in a different class, like that's your teacher, right? So I think we just have to humble ourselves in that regard too. And clearly, I was, I mean, she had done that and she's spectacular about just collaborating and learning. You know, another one, and I think this is probably a huge take-home point. Both of you and I have so many interests. We were just talking offline about how, man, which would go obviously we like orthobiologics, we like learn to learn about sleep, learn about nutrition. And I remember you asked her about the role of the primary care physician, you know, with all these things. And you know, in a nutshell, her response was that you have to put the right team around you, right? Get the nutritional coach because she doesn't have time to be able to do that. Even though she wants to, she's capable, she qualified, especially with the health coaching, but maybe her efforts are better suited. Like if it's a comprehensive visit, you know, she comes in like, will you Sally comes in and you know, she sees Sally for the pain, but she understands that Sally needs that nutritional count or excuse me, the couch, her coaching for a smoking cessation. She doesn't have time in that visit. We have to do that. However, before you leave today, the visit, you're going to make a stop next door over with Peter and Peter is going to talk about that. And then you're going to make, you know what I mean? So ultimately, I think that obviously there's a lot of reformatting that needs to happen with your model as well. But that's good too. So when I think about that, I'm so excited and interested in learning more about musculoskeletal ultrasound, but I can't see a patient in the way that we have set up our traditional medical model in a 30 minute, if we're lucky, 30, 40 minute visit and get a good history and physical, get a, do a good diagnostic scan and then also treat them, do some OMT and then also talk about nutrition and then teach them some home exercises. There's just no way before our visit. Yeah, like that's not going to happen. So that's where putting our teammates and finding the right teammates. So we all bounce off each other. I mean, these are simple things, right? Dude, these are so simple, but for some reason it's not happening. I don't know why. I'm starting to see wellness centers start to use that model a little bit. I agree. Where they go like one after the other, OMT, to their actual medical doctor, to the nutritionist's dietitian and in all words, PT, what not. And I think that's just, it's the model that works, is just how do we infiltrate the whole healthcare system and get this team-based approach? Because as our listeners will see in future episodes, it's not just physicians talking to physicians. It's also physicians talking to strength coaches, talking to physical therapists, talking to dietitians, because they are experts in their field. And that is also medicine, right? It's also what our patients need, not just pills, not just a doctor talking to them. So yeah, man, I'm with you. I just, you know, that type of practice is what we need to see more and more of. 100 percent, man. I mean, yeah, obviously that's like above our pay grade and we're hoping people smarter than people figure it out. But here we are doing our part. And, you know, a lot of people think like this. And yeah, I agree with you. The whole wellness center thing is starting to pick up. And every time I have this conversation with somebody, because obviously they know I'm so enthusiastic about all these different things. And they bring it up to me, you know, whether it's at an institution, they're like, yeah, we're looking to kind of incorporate this whole holistic lifestyle medicine thing. I mean, it's there. It's there. You can't deny it. It's just a matter of like how do we do that at the same time, making sure that, you know, reimbursements and all that good stuff. So yeah, I'm just excited to get people here and continue to learn about how we can keep redefining it. Absolutely. Yeah. The other thing that Dr. Maven talked about that she especially talks about in her podcast, Healthy 365 is walking the walk and having, you know, us as doctors, whatever we're preaching that we must live by as well. And while yes, physicians are just humans, right? We're just like everyone else, like she says, engineers to mechanics to whatever it may be. We have a duty to show our patients what it's like to be healthy. It's like going to the gym and having a trainer who is out of shape. You're not going to can't affect a workout. You're also not just probably going to listen to them because you know, they're not walking the walk. And I think it goes, you know, it's it's hand in hand with physicians as well, especially when she said that stat about 23 to 30% of physicians are obese. It's a scary statistic, though, thinking about it. I mean, obviously, it's better than the general population, but it's still something that says, hey, our healthcare system is being run by, you know, one out of every five people who is also not healthy, but telling me to become healthy. But then if they don't understand hell, if they don't understand the importance of exercise and diet, what are they going to teach me? And it's most likely probably going to be in the form of pills, right? In the form of that easy fix. So that was that was just one of the biggest things that I also just tell all my students on Instagram is that you need to live the life that you would tell somebody else to live. And it's tough to do, but again, it it comes down to looking at your why, looking at your passion, looking at the person you want to become, and really just hammering it in there, hammering it down and getting to work so that you can help others. Yeah, I mean, for some reason, do as I say, not as I do, doesn't doesn't quite work well with intelligent people, right? No. Yeah, go figure on that one. Yeah, man, spot on. And I think that's just kind of why, you know, we connected real well because obviously, you know, we met, but we've been following each other and collaborating now because I think, yeah, walk in the talk like she says is super important. And also for an experimentation standpoint, I mean, you are your own end a lot of times when you are, you know, looking at these things, because I can't tell you so many times when it comes to, you know, from strength conditioning perspective, there's stuff that I do from a rehab related perspective. I mean, you know, my inspiration to pursue sports medicine really started with my own injuries, right? And what we had talked about earlier. And so a lot of things I know have worked for me, sometimes I have to wonder why. Same thing with diet and all that stuff. Sometimes, you know, a lot of my own experimentation happens with me. And so there, when I have that discussion with patients, it's because I, you know, I've tried some things, whether it's through intermittent fasting or high carb, whatever it might be. So that's another reason for you to. And also gives you empathy for your patients, you know, because I mean, that's the most important thing we can have when we're talking patients is empathy. So if I'm talking to a patient about time-restricted eating or if I'm talking to a patient about losing weight or, you know, cutting back on carbohydrates, cutting back on sweets, but because I'm genetically blessed and I can eat all that bad stuff and quote unquote bad stuff, I'll do it that way. And I don't know what it's like. That might be challenge. So same thing with sleep. I'm not sleeping because I live in a high stress and I'm trying to, trying to counsel a patient about trying to prioritize sleep. But I don't know what that's like, you know, with three children who are like less than four years old. It's hard. It's hard to have empathy in that regard. And so, yeah. Absolutely. Can you agree more? Cool. All right. Well, I think, you know, that was a great recap or first one. If you guys want to reach out to Simone Maibin, just Google her name, Simone Maibin. She's on Instagram. She's got a podcast called Healthy 365. And she's open to all your inquiries. So that's it for us. Hopefully, see you guys at the next episode. Take care, guys. Well, guys, that's a wrap. We hope you enjoyed this episode of Medicine Redefined, but just as a reminder, everything in this podcast is for general information only. It does not constitute the practice of medicine and we are not providing any medical advice. No physician patient relationship is formed and anything discussed in this podcast does not represent the views of our employers. So if you liked it, please make sure to subscribe and share it with all your loved ones or anybody you know who might benefit from this. Until next time.