Plant Medicine for Menopause: What Science and Ancient Healing Say Actually Works

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Suzanne Gilberg-Lenz, a board-certified OB-GYN, integrative medicine expert, and author with nearly 30 years of clinical experience, including training in Ayurvedic medicine spanning almost two decades. Dr. Gilberg-Lenz is the Chief Clinical Officer of Monarch, a membership-based healthcare practice built to restore what modern medicine has nearly eliminated: time, relationship, and trust between women and their clinicians. Dr. Haver and Dr. Gilberg-Lenz open with a question that sits at the heart of women's midlife health: why does the current healthcare system consistently fail to see women clearly? Dr. Gilberg-Lenz explains why the system is not built for humans but for shareholders, reimbursement structures, and productivity metrics that reward procedures over listening. She breaks down the difference between burnout and moral injury, why physicians are leaving traditional medicine in record numbers, and what it actually costs women when their doctors are structurally prevented from knowing them. The conversation traces how the 1910 Flexner Report reshaped American medicine, shutting down Black medical colleges, eliminating part-time schools where women trained, and marginalizing plant-based and indigenous healing traditions in ways that still define clinical practice today. Guest links: Dr. Suzanne https://thedrsuzanne.com/ Dr. Suzanne Gilberg-Lenz https://www.instagram.com/askdrsuzanne/?hl=en (Instagram) Dr. Suzanne Gilberg-Lenz https://www.youtube.com/user/askdrsuzanne/videos (YouTube) Dr. Suzanne Gilberg-Lenz https://www.linkedin.com/in/askdrsuzanne/ (LinkedIn) Dr. Suzanne Gilberg-Lenz https://www.facebook.com/askdrsuzanne/ (Facebook) Dr. Suzanne Gilberg-Lenz https://x.com/askdrsuzanne (X) Books: “Menopause Bootcamp: Optimize Your Health, Empower Your Self, and Flourish as You Age https://www.amazon.com/Menopause-Bootcamp-Optimize-Empower-Flourish/dp/0063143186,” by Dr. Suzanne Gilberg-Lenz “The Myth of Aging: A Prescription for Emotional and Physical Well-Being https://www.amazon.com/Myth-Aging-Prescription-Emotional-Well-Being/dp/B0FKN9WVMS,” by Dr. Arnold Gilberg “The New Perimenopause,” https://thepauselife.com/pages/the-new-perimenopause-book by Dr. Mary Claire Haver “The New Menopause,” https://www.amazon.com/New-Menopause-Mary-Claire-Haver/dp/1785045547 by Dr. Mary Claire Haver For full show notes, please click here https://thepauselife.com/blogs/the-unpaused-podcast/plant-medicine-for-menopause-what-science-and-ancient-healing-say-actually-works.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  The system is not set up for people to experience each other and for your doctor to experience you. We just don't even have time. So we don't get reimbursed by insurance for the amount of time that we're spending reading about this, thinking about you, calling you back, reviewing your labs, sitting and hearing your story. We get paid for how many people we saw that day. That does not lend itself to dealing with these kinds of issues and talking about stuff and recognizing patterns. It just doesn't.

• 0:43Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

• 1:01Dr. Mary Claire Haver?

  One of the things I've learned after years in medicine and talking to women in midlife is this: The system doesn't give them the time, space, or respect to be truly known. And yet, the problem is often framed as that women just don't know their bodies. My guest today deeply understands this. Dr. Suzanne Gilbert-Lenz has spent her career caring for women across every life stage, but especially in midlife, where complexity is the rule, not the exception. She's a clinician, an educator, an integrative medicine expert, and now the Chief Clinical Officer of Monarch, a membership-based healthcare practice designed

• 1:41Dr. Mary Claire Haver?

  to restore something modern medicine has almost completely stripped away: time, relationship, and trust between women and their clinicians. This conversation is important because the current healthcare system is failing on two fronts at once. It's failing women who need care that is nuanced, layered, and deeply human. And it's failing clinicians who are increasingly trapped in rushed visits, administrative burden, and productivity metrics that reward procedures over listening.

• 2:11Dr. Mary Claire Haver?

  The only groups consistently benefiting from this system are insurance companies and large corporations. Meanwhile, physicians experience what we now call moral injury, the distress of knowing how to care for patients but being structurally prevented from doing so. And the patients are paying the price. I'm so excited that Suzanne is here and we can talk about the hard questions about what good healthcare really looks like and who we are willing to fight for. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused,

• 2:54Dr. Mary Claire Haver?

  the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

• 3:09Dr. Mary Claire Haver?

  So Suzanne, welcome to UnPaused.

• 3:11Speaker 00

  Thank you for having me.

• 3:13Dr. Mary Claire Haver?

  We talk a lot about health span on this podcast.

• 3:15Speaker 00

  Yes.

• 3:15Dr. Mary Claire Haver?

  And on, God, on social media. I don't know if we're being fed the same stuff.

• 3:19Speaker 00

  I'm sure.

• 3:20Dr. Mary Claire Haver?

  But it is through a very male lens.

• 3:23Speaker 00

  Yeah, the whole biohacking and.

• 3:26Dr. Mary Claire Haver?

  It's exhausting. But how do you define health span for women?

• 3:29Speaker 00

  Well, I mean, I'm going to say something that I know you know, and I'm sure you've talked about many times on the podcast. I love the word health span as opposed to lifespan for obvious reasons. Because being alive but not doing well and not thriving.

• 3:42Dr. Mary Claire Haver?

  No, thank you.

• 3:43Speaker 00

  No, I think we all know how we feel about that. Nobody wants that. And we know that women live much longer than men and in much poorer health. So this idea of health span is unlocking that vitality, unlocking the opportunities, the inflection points that we have, and they are numerous. It's not like it's ever over, by the way. It's not like you missed the boat at 70. It would be better if you're working on it at 20.

• 4:09Dr. Mary Claire Haver?

  Look, I saw an influencer the other day who's got probably a PhD, I think it was a PhD, and she was talking about osteoporosis. She's like, Kind of coming down on, on the osteoporosis movement and all the talk about it because you've reached your maximum bone density at 30.

• 4:23Speaker 00

  Right.

• 4:23Dr. Mary Claire Haver?

  You need to be talking to 25 year olds.

• 4:25Speaker 00

  Right.

• 4:25Dr. Mary Claire Haver?

  She's not wrong.

• 4:26Speaker 00

  Right. But that doesn't mean that we never.

• 4:28Dr. Mary Claire Haver?

  It's never too late.

• 4:28Speaker 00

  No, 100%. So listen, I even look, and I'm a person who's been, you know, a fitness person my whole life, but I'm at risk for osteoporosis for a number of reasons. I'm a small person, I had breast cancer, I, whatever, blah, blah, all the different things. And this is a good example. I doubled down in the last year on really getting to the heavy weights and like, not just talking the talk, but walking the walk. I've been on hormones now for, I don't know, like, almost two years.

• 4:55Dr. Mary Claire Haver?

  Okay, but you know, people's heads just exploded.

• 4:58Speaker 00

  Oh, because, well, they don't, we didn't talk, because I'm a breast cancer survivor who's on.

• 5:02Dr. Mary Claire Haver?

  You know, I forget that about you from time to time.

• 5:04Speaker 00

  Because it's not my whole personality.

• 5:05Dr. Mary Claire Haver?

  You're in the thick of it. It's your whole personality.

• 5:07Speaker 00

  Yeah.

• 5:08Dr. Mary Claire Haver?

  But go back to that, because I think we have several pre-vivor survivors, you know, you have people in, in the world of having to deal with.

• 5:14Speaker 00

  Yep.

• 5:14Dr. Mary Claire Haver?

  The potential or having had breast cancer or precancer cells and all the things. Because you rarely talk about it.

• 5:21Speaker 00

  I mean, I do sometimes, but I mean, I don't know, I don't, I don't focus on it a lot. I mean, that's a whole story in and of itself. But when you talk about health span, that's a great example. So I was diagnosed with breast cancer at 47. And of course, it was devastating and traumatizing and all sorts of things, and it changed my life forever. Now, in the end, I am grateful for it, it, because it forced me to really look at like, who I was and how I wanted to live. But you could take that diagnosis and say, okay, your lifespan is particularly, it may be shortened, so what is going to be my health span? What, how do I want to live my life? It's not just like, taking hormones and lifting weights and whatever biohacking thing

• 6:04Speaker 00

  we're talking about for women, because I think you and I are on the same page, that dealing and managing our menopause appropriately, which is something that we have to.

• 6:14Speaker 00

  Decide for ourselves in consultation is 100% going to impact your health span. And I'm not saying I didn't have those moments, I did. But it's also joy, it's also curiosity, it's also what is, what do I have in front of me right now? How do I want to live right now? And how does that set me up for so many other opportunities? Because when you are open to yourself, this is where I get really into the philosophy of stuff. When you're open to you, your authentic self and who you want to be and you're expressing that. Wow, you draw the right friends, you draw different opportunities, you see your world differently. It's that's to me, that's vitality, that's health span.

• 6:56Dr. Mary Claire Haver?

  What I see is that women, the medical system is set up to force this breast cancer diagnosis or potential breast care diagnosis to be their whole personality.

• 7:06Speaker 00

  Oh, yes. Because it's all about what you can no longer do.

• 7:10Dr. Mary Claire Haver?

  Of that, like you can or cannot, because there's a potential that one cell may become, you know, and, and the whole rest of their body, their lives, their happiness, their fulfillment, their love, their sex life is ignored.

• 7:21Speaker 00

  Yeah. The only thing that exists is the breast cancer diagnosis. This is a human being. And I will say that some of it's just my personality. I'm an optimist. Some of it is what I had done to work on healing myself, you know? I had been doing yoga and meditation for, I don't know, about 10 years before my diagnosis. And I will never forget going into the MRI, I had the biopsy that I had, you know, breast cancer. Now I had to go into the MRI and see like where else is it, what is going on? Whew, and I got into that MRI machine and it is so overwhelming.

• 7:59Dr. Mary Claire Haver?

  Yeah.

• 7:59Speaker 00

  You're literally surrounded and knowing like, okay, my fate is right. And I said, no, your mantra to get through this. Very uncomfortable experiences. This is not who I am. This is happening to me. That's literally what I just, that's what popped into my brain. And that's what I did. And I did that for 45 effing minutes in that machine.

• 8:21Dr. Mary Claire Haver?

  Bop, bop, bop, bop.

• 8:22Speaker 00

  Oh, my God.

• 8:24Dr. Mary Claire Haver?

  If anybody's had an MRI, that's what it sounds like.

• 8:26Speaker 00

  It's not fun.

• 8:27Dr. Mary Claire Haver?

  Yeah.

• 8:28Speaker 00

  And that's what I said to myself. I said, you know what? You're not gonna wallow in self pity. You're gonna, you get some time to be sad. And I was freaked out. My kids were so freaked out.

• 8:37Dr. Mary Claire Haver?

  Mm hmm.

• 8:37Speaker 00

  Oh, my God. And I said, no, you're not gonna adopt this as who you are. That was my decision.

• 8:42Dr. Mary Claire Haver?

  Yeah. You've talked about perimenopause.

• 8:45Speaker 00

  Yes, I have.

• 8:46Dr. Mary Claire Haver?

  Before, it was like even a word that the internet knew how to say.

• 8:49Speaker 00

  Right.

• 8:49Dr. Mary Claire Haver?

  I feel like, and I'd love to hear your opinion, that perimenopause is kind of where menopause was three years ago.

• 8:56Speaker 00

  Yeah, I agree. People are starting to really understand, like, it's not, it's not about that final menstrual period only.

• 9:03Dr. Mary Claire Haver?

  Mm hmm.

• 9:04Speaker 00

  It's about the decade that you spend leading to that. The people don't realize, like, is happening.

• 9:11Dr. Mary Claire Haver?

  What do you think women should be doing during that decade?

• 9:13Speaker 00

  Well, first of all, we have to be talking about it more so that younger women and younger men, they have women in their lives, understand the experience. It's, it's like a very prolonged puberty. And it can be quite discombobulating and very disconcerting. And people feel not like themselves. We know, we talk about this. When I talk to patients and I teach about it, if I were to characterize it in one term, I'd say it's a loss of resilience.

• 9:44Dr. Mary Claire Haver?

  Yeah.

• 9:45Speaker 00

  On all levels. Emotional, spiritual, psychological, physical. It's really rough. So if we don't prepare ourselves and our patients and our colleagues for this experience, people are gonna be searching for a solution that may not fit what the actual issue is. And I'm not calling it a problem on purpose. I'm not saying it's not problematic. But let's also, can we reframe this? This is physiology. So if we understand it as an expected shift in physiology and we treat it as such, we have more appropriate opportunities to intervene in a more precision manner. What is your personal history? What are your goals? What's your family history? What's, what are your risk factors? What are your data points?

• 10:31Speaker 00

  We have to kind of combine it, the art and the science of medicine in here. And women are going to have to advocate for themselves because they're ahead of the medical community on this. They just are. We know this because you and I have been seeing these people for a very long time who are now on polypharmacy, antidepressants.

• 10:50Dr. Mary Claire Haver?

  Polypharmacy for our listeners is on multiple medications. So it is not unusual to have a woman in perimenopause who's been given sleeping pills for her insomnia. She's been giving anti-anxiety meds. She's been giving antidepressants. She's on something for her fibromyalgia, something for her irritable bladder.

• 11:08Speaker 00

  Her fibromyalgia, which I'm going to go ahead and say is just perimenopause.

• 11:10Dr. Mary Claire Haver?

  Musculoskeletal syndrome of menopause. Yeah.

• 11:13Speaker 00

  All sorts of weird, you know, random diagnoses which may or may not be accurate. It's also a time where because of this loss of resilience, we see things that are big risks that get uncovered if we're looking.

• 11:28Dr. Mary Claire Haver?

  Yeah.

• 11:28Speaker 00

  So again, it is on, unfortunately, it's on us as women to understand enough to ask the right questions and to also understand that we might be, I'm going to use an old analogy. If you go to the hardware store looking for milk, you can keep going back to the hardware store and you are never going to find milk there. So you might be going to a clinician who just does not understand it, does not grasp it.

• 11:58Dr. Mary Claire Haver?

  Because they weren't taught.

• 11:59Speaker 00

  For whatever reason, and it's going to have to be time to move on.

• 12:02Dr. Mary Claire Haver?

  Yeah. So you were practicing obstetrics until very recently. So there's something we get a ton of questions on.

• 12:10Speaker 00

  Yes.

• 12:11Dr. Mary Claire Haver?

  And, and I just read the statistic last year that women now over 40, more women over 40 are having babies than under 20.

• 12:21Speaker 00

  Yeah.

• 12:21Dr. Mary Claire Haver?

  That was the first time in history. We've seen that switch. And so talk to me. Now, I stopped doing OB. I was doing emergency care only since 2018. So I stopped my full OB practice in 2018. So almost 10 years ago. And I was aging along with my patients. I was starting to see it, but I didn't know enough about perimenopause to recognize it. So like, so many questions about the shift from postpartum directly into perimenopause. What does that look like? And women are like, heads are exploding right now.

• 12:51Speaker 00

  Well, I will say that I feel like I owe an apology to many of my patients.

• 12:56Dr. Mary Claire Haver?

  Sweet girl. Same.

• 12:58Speaker 00

  Because I didn't really get it myself. And here I was, like, doing OB for a long time. I was really had entered into the menopause space quite early through my, actually, my breast cancer experience. I was seeing all these young breast cancer survivors, and they were going through menopause early. That's actually how I started in menopause. So now, I, you know, I'm in Los Angeles. A lot of women have babies over 40. I had a lot of women in perimenopause getting pregnant and having young children. And we were telling them, like, look, you're 42 with a two-year-old, you know? Of course, you're tired.

• 13:35Dr. Mary Claire Haver?

  Yeah, it's just so much harder.

• 13:37Speaker 00

  I mean, which is true. But like, one of the reasons it's true is they're in perimenopause, and nobody knows it. So I owe an apology. But I think that, once I started realizing, like, oh, wait a second, this is something more than that. Why is nobody talking about this? This is enormously important, because it's affecting not only people's fertility, but it's affecting their postpartum experience. So they're having a much more difficult time with sleep disruption, with mood disorders. I mean, we know that a pregnancy-

• 14:07Dr. Mary Claire Haver?

  Baby's sleeping through the night, but mama isn't.

• 14:08Speaker 00

  Exactly. Yeah. And like, all this anxiety, and is it really postpartum anxiety? Or is it really perimenopausal, PMDD, that's showing up, you know, severe mood disorders? All these things that we know that are happening in the perimenopausal population, it's like on steroids, if you've just had a baby. And it's really this confluence of a lot of unpredictable hormonal fluctuations, right? You're going from this-

• 14:33Speaker 00

  Really high level, really steady state of estrogen and progesterone. And it is just dropping precipitously postpartum. And it's plummeted you into an era where you're not even going to be going back to regular cycling necessarily anyways. So you're about to

• 14:49Dr. Mary Claire Haver?

  Yeah, she may nurse for a year.

• 14:50Speaker 00

  High highs, low lows, and you just, you feel like a truck hit you. I mean, these are women that really deserve our attention.

• 14:57Dr. Mary Claire Haver?

  Yeah, and I, there's almost no papers on it.

• 15:00Speaker 00

  No.

• 15:01Dr. Mary Claire Haver?

  I rarely see it in the academic literature.

• 15:03Speaker 00

  No, I haven't, I haven't really seen it.

• 15:04Dr. Mary Claire Haver?

  I see it on social because, again, women are around the social water cooler. And finally talking about it, oh my God, that was me. And, but I think, you know, we owe that population, we owe women thousands of years of research.

• 15:18Speaker 00

  Of course, of course.

• 15:19Dr. Mary Claire Haver?

  They are particularly, because they're, they're becoming more and more common now. And we're not preparing them for this.

• 15:24Speaker 00

  No, and this is people's lived experiences.

• 15:26Dr. Mary Claire Haver?

  They're so vulnerable.

• 15:27Speaker 00

  Yeah, very much so. And again, this is a really big opportunity to understand, like, to support them through it so that they understand the impact that this could have on the rest of their life and on their health. Rather than, again, I don't want to sound anti-medicine. I use medicine, I prescribe medicine, but it is not, there's not, this is like a not a pill for every ill situation. Like, everybody does not need to be medicated, they need to be supported. Or they need to understand what the medicine is for and why we're using it. Rather than just, like, I have seven minutes to see you and I don't have time to unpack this. Which, as you know, I have a lot of compassion for our colleagues that are living in that system.

• 16:07Dr. Mary Claire Haver?

  Yeah, we lived in it, you know, for decades.

• 16:10Speaker 00

  Yeah, many decades. But, you know, if you don't have the time and there's no literature on it and it's not being pushed in the guidelines, it doesn't exist.

• 16:18Dr. Mary Claire Haver?

  It doesn't, we don't have time to make it exist.

• 16:29Dr. Mary Claire Haver?

  Why is time, why has it become such a critical and endangered resource, especially for women and women's healthcare?

• 16:38Speaker 00

  You know, if you look at the systems under which we are trained, the systems in which we work, we're navigating something that really isn't set up for humans. It's set up for shareholders. It's set up for reimbursement structures. It's set up for workflows, not necessarily for the excellent, connected practice of clinical medicine. That requires that we talk to each other, that we, as clinicians, have the bandwidth to listen and then to apply our knowledge. If we are being forced to work for RVUs and-

• 17:21Dr. Mary Claire Haver?

  What's an R V U?

• 17:22Speaker 00

  It's a relative value unit. Okay, even just that, it sounds like you're working in a factory.

• 17:28Dr. Mary Claire Haver?

  That is how, that is how our time is valued. It is called a relative value unit. And it is decided by a room full of crusty dusty, mostly male, mostly surgeons, who decide-

• 17:44Speaker 00

  The relative value of our work.

• 17:45Dr. Mary Claire Haver?

  The relative value of your work is.

• 17:48Speaker 00

  So the work of the mind is not reimbursed?

• 17:52Dr. Mary Claire Haver?

  No, only the work of the hands.

• 17:53Speaker 00

  Yeah, and look, I'm a surgeon and I did a lot of procedures. And I mean, I did them for the right reason. Believe me, I wasn't making enough money to be doing surgery on you just to make, trust me, I was losing money in the office. That's a whole other thing. So the system is, it's not a whole other thing. It's, it's related. The system is not set up for people to experience each other and for your, for your doctor to experience you. We just don't even have time. So we don't get reimbursed by insurance for the amount of time that we're spending reading about this, thinking about you, calling you back, reviewing your labs, sitting and hearing your story. We get paid for how many people we saw that day. That does not lend itself to dealing with these kinds of issues

• 18:38Speaker 00

  and talking about stuff and recognizing patterns, you know?

• 18:41Dr. Mary Claire Haver?

  Yeah.

• 18:42Speaker 00

  It just doesn't.

• 18:43Dr. Mary Claire Haver?

  And also, when you even look at procedures, procedures, if you look at equivalent procedures done on women

• 18:49Speaker 00

  Women versus men.

• 18:50Dr. Mary Claire Haver?

  Versus the equivalent procedure done on men, because we have, especially in urology, right? We have autologous body parts. So the clitoris is the equivalent to the head of the penis. So if you look at these procedures, men are reimbursed like three to five times higher for the equivalent procedure. I remember learning, because you know, when you work for a corporation, they are controlled by this model

• 19:12Speaker 00

  Yeah.

• 19:12Dr. Mary Claire Haver?

  of as many patients that you can see in the clinical setting and do as many procedures as you can. And that's where the money is made. They are a slave to the same system, the same reimbursement system.

• 19:22Speaker 00

  Yeah.

• 19:23Dr. Mary Claire Haver?

  And it is, it's heartbreaking. So nine months of care for OB.

• 19:27Speaker 00

  Right.

• 19:28Dr. Mary Claire Haver?

  Dozens of, over a dozen visits usually. And then, God forbid, she has some condition that needs to bring her in. Ultrasounds, you know, and then delivery, which might take five minutes, might take 50 hours, you know?

• 19:41Speaker 00

  And you have two patients.

• 19:42Dr. Mary Claire Haver?

  And you might, yeah.

• 19:43Speaker 00

  You're responsible for two humans. Or maybe three or four, depending on how many there are in there.

• 19:49Dr. Mary Claire Haver?

  And when you look at what the reimbursement rates were for that.

• 19:51Speaker 00

  It's insanity.

• 19:52Dr. Mary Claire Haver?

  Versus, you break your leg and you go to an orthopedic surgeon and they put a pin in it and, you know, which is a complicated procedure and, you know.

• 20:00Speaker 00

  Yeah.

• 20:01Dr. Mary Claire Haver?

  But the reimbursement is like 10 to one.

• 20:02Speaker 00

  But tell me you don't care about women's lives, you know? It's like, wow.

• 20:07Dr. Mary Claire Haver?

  Yeah.

• 20:07Speaker 00

  I did it as long as I did because I loved doing it. I love my patients so much. And then I just got tired and old.

• 20:13Dr. Mary Claire Haver?

  And I did. Yeah, I really had a, you know, we're going to talk about this some more, but I had a moral crisis when I was like deciding to leave the traditional reimbursement system. Um, because that's what I was brought up in. But actually, at the very beginning of like medical school, it wasn't that bad. And in residency, we operated under a charity system.

• 20:36Speaker 00

  Uh huh, yeah.

• 20:37Dr. Mary Claire Haver?

  So we took everybody.

• 20:38Speaker 00

  Yes, yes.

• 20:39Dr. Mary Claire Haver?

  We saw everyone in the state would just write checks, right? That stopped.

• 20:43Speaker 00

  Yeah.

• 20:44Dr. Mary Claire Haver?

  And by the time I became faculty.

• 20:45Speaker 00

  Yeah.

• 20:46Dr. Mary Claire Haver?

  And we were turning people away.

• 20:49Speaker 00

  Yeah.

• 20:49Dr. Mary Claire Haver?

  Who we could cure their disease. We could cure their cancer. They were having stage one in a metrial.

• 20:54Speaker 00

  Yeah.

• 20:55Dr. Mary Claire Haver?

  Turning them away because they didn't have insurance and couldn't find coverage from their county or whatever. And I wanted to die as faculty signing off on that chart.

• 21:05Speaker 00

  Yeah.

• 21:05Dr. Mary Claire Haver?

  But the hospital was like, unless it's an emergency.

• 21:09Speaker 00

  Yeah. Yeah.

• 21:10Dr. Mary Claire Haver?

  We're not gonna do it.

• 21:11Speaker 00

  Mm hmm.

• 21:11Dr. Mary Claire Haver?

  And. See, I.

• 21:13Speaker 00

  That's not why we signed up, to take care of human beings. We.

• 21:16Dr. Mary Claire Haver?

  And we used to, like, had she had her cancer five years ago.

• 21:19Speaker 00

  She would have gotten care.

• 21:20Dr. Mary Claire Haver?

  Not thought twice about it, you know, at a teaching institution.

• 21:23Speaker 00

  Yeah, I had a similar, I mean, I think we trained at the same time. Um, I had a very similar experience because I started at a county hospital in medical school. So literally all comers, and I mean, it was wild. And I learned a ton. I'm so grateful to those patients. And then I went to Cedars-Sinai Medical Center, which is sure, it's, you know, hospital to the stars. But also at the time, we took all comers. I mean, obviously through the emergency room, it's a federal violation not to accept anybody. But if it's not an emergency, but we took everybody and we had a, one of the reasons it was such a great training program is that we had an enormous number of patients who were either indigent or were coming in through like emergency medical.

• 21:59Dr. Mary Claire Haver?

  Mm hmm.

• 22:00Speaker 00

  And that all shifted.

• 22:02Dr. Mary Claire Haver?

  We had this, pregnancy is different.

• 22:04Speaker 00

  Yes, yes.

• 22:05Dr. Mary Claire Haver?

  We could get anything covered in pregnancy, but I'm talking about like the GYN gynecologic stuff.

• 22:09Speaker 00

  Yeah, it all shifted and that was very scary and sad.

• 22:13Dr. Mary Claire Haver?

  It was horrible.

• 22:13Speaker 00

  Mm hmm.

• 22:14Dr. Mary Claire Haver?

  So horrible.

• 22:15Speaker 00

  Yeah.

• 22:15Dr. Mary Claire Haver?

  So when I was 25 weeks pregnant, I was a second year resident.

• 22:19Speaker 00

  Mm hmm.

• 22:20Dr. Mary Claire Haver?

  And all my girlfriends had had their babies or were about to deliver. And I was walking around my brother in law and his wife had come to visit. And we're Galveston and it's, you know, old streets, cobblestones. And I'm walking in these cute little wedges, like trying to be cute at 25 weeks. And I twist my ankle stepping up on a curb. And I kind of stumbled back. My brother in law caught me like basket catch under the arms. And I remembered this like stabbing pain in my foot, like this sharp like, whoa. So I couldn't walk on it. I couldn't bear weight. They bring me home. Of course, we call our friend, the orthopedic surgeon resident. He comes over, he's like, yeah, it's probably broken. You need to go to the ER. Okay. I'm in a ton of pain and I can feel my tummy getting tight.

• 23:01Speaker 00

  Oh, wow.

• 23:03Dr. Mary Claire Haver?

  And we go to the ED and they all freak out because I'm pregnant and ortho comes and they're like, oh, she's pregnant. You know, like, so they get the monitor, I'm contracting. Okay.

• 23:12Speaker 00

  Of course.

• 23:13Dr. Mary Claire Haver?

  And they're like, are you in pain? And I was too scared. To tell anyone how much I was hurting because I thought they would label me as a drug seeker or whining.

• 23:23Speaker 00

  Whoa, just because, do you think that was because of your own experiences as a resident? And how people treated women coming in with pain?

• 23:30Dr. Mary Claire Haver?

  And like, we were taught, you need to minimize your symptoms.

• 23:32Speaker 00

  Wow.

• 23:33Dr. Mary Claire Haver?

  Yeah, I was, I had a

• 23:35Speaker 00

  My god.

• 23:36Dr. Mary Claire Haver?

  Wound in my foot that had snapped in two. The pain was so severe, I was in preterm labor.

• 23:41Speaker 00

  Oh my god.

• 23:42Dr. Mary Claire Haver?

  And I was too scared to admit it. Because I was worried I would get labeled as a drug seeker.

• 23:47Speaker 00

  But that's also like, medical training too. I mean, I think, you know, as we get further into our careers, I don't know, I've just gotten more into, I was always introspective, but I'm very introspective now. I have more time to do it. And I think about this stuff that we subjected ourselves to, because I didn't realize like, we were that parallel, because I was pregnant my whole residency also. And sucked it up so hard, because I didn't want people to feel like, she got pregnant and she got lazy, and she didn't carry her weight, and we're taking more call because she got pregnant, you know, and whatever. And I was like, oh my god, I was a pregnant intern. At night, you would have to cover the whole house, right? The whole hospital. So I had four pagers, I don't even know how I had my, how my scrubs weren't falling off.

• 24:31Dr. Mary Claire Haver?

  Staying up.

• 24:32Speaker 00

  You look like a clown, right? The scrubs are tied up here. I had the gynonk pager, I had the emergency room, I had labor and delivery, I had the floor, and we had those old, remember those humongous, huge ultrasound machines?

• 24:44Dr. Mary Claire Haver?

  Oh yeah, yeah.

• 24:45Speaker 00

  And we were like, I'm pushing them, and I'm pushing it down the hall, and I'm like, oh my god, sciatica, and I mean, what the hell? No normal pregnant woman would do this, and nobody else who worked with a pregnant woman would let her do it. They were fine, I was the intern, she's doing her job. I mean, I would never have complained. It's so crazy.

• 25:04Dr. Mary Claire Haver?

  It's so crazy.

• 25:05Speaker 00

  It's so not normal.

• 25:06Dr. Mary Claire Haver?

  Yeah.

• 25:06Speaker 00

  I don't know. And then, you know, then you come out, and of course, you're like, if you're, if you're an empathic person, your response would be like, I would never subject anybody else to that. But people are people, and they're like, I did it, why can't she do it?

• 25:21Dr. Mary Claire Haver?

  Yeah, and

• 25:22Speaker 00

  And that's how they treat their patients and their colleagues.

• 25:24Dr. Mary Claire Haver?

  That's, yeah.

• 25:25Speaker 00

  It's not good.

• 25:26Dr. Mary Claire Haver?

  I worry.

• 25:27Speaker 00

  No.

• 25:28Dr. Mary Claire Haver?

  What do you see when a woman finally feels, and I've experienced this? In my clinic, certainly I had wonderful moments under the old system.

• 25:37Speaker 00

  Yeah, of course.

• 25:37Dr. Mary Claire Haver?

  You know, of course. I just, you know, it was getting so bad at the end. The moral injury, the administrative burden, you know, the paperwork, the fighting with insurance companies, more people being hired to tell me what to do at the hospital I was at and just not feeling like this was the best medicine I could practice. And then leaving that system and going into building a new system. I didn't know how to open a medical practice. I'd always been employed my whole life. I showed up with my stethoscope and they gave me a room and I stuck her charts, you know?

• 26:11Speaker 00

  Right, right.

• 26:12Dr. Mary Claire Haver?

  And I went to work.

• 26:12Speaker 00

  Right.

• 26:13Dr. Mary Claire Haver?

  And so I literally like got the idiot's guide to opening a medical practice. Like, like I didn't know the rules, like, do we, do we charge taxes? Like, what, how do you, I had to incorporate and do all this stuff. But we decided to do fee for service and that, that worked for us. But like, for the first time in my career, other than sitting bedside with someone in labor, right, when I was on my own time and just visiting with a patient, I had a whole hour to spend with a patient and really get to know her and really understand her goals, her needs, her wants. And I just, within the first month of practice, I, I just realized I never felt that good consistently.

• 26:52Speaker 00

  Yeah.

• 26:52Dr. Mary Claire Haver?

  You know, not everybody had a happy outcome. A lot of survivors would come to me because they had nowhere to go and I, you know, couldn't fix everyone's exact problem, but I could give them the gift of time and give them the gift of my, my heart and not feel so fractured and having to choose my family over my work.

• 27:09Speaker 00

  Yep.

• 27:09Dr. Mary Claire Haver?

  And it was just unbelievably magical. Like, what's that been like for you?

• 27:14Speaker 00

  Oh, my God. Exactly what you're saying. I mean, that, that word fracture really resonates with me because my stress level was so high. Like, I'm thinking about it now and I, it gives me a little bit of chest pain, just like running from room to room or knowing like, oh, my God, I'm running over because she's crying and I can't, I, she needs me, I cannot walk out right now. I can't be like, you know, or your hand's on the door and you know there's three rooms full and now that's when the real question emerges. And you're just like, oh, my God, what? No, I can't. I I don't feel that at all anymore. But it's really interesting because I remember initially when I started. So I left a 20 plus year career in a very large prestige practice here in Beverly Hills,

• 27:58Speaker 00

  where we had very high volume and did everything and prided ourselves on doing everything. And it just for me, I just, it wasn't, it wasn't me. It wasn't what I needed to do or what I wanted to do. I wanted to spend the time and I was always running late. And even when I started the new practice, I remember being nervous like, oh, my God. I mean, how am I gonna, how are we gonna fill 45 minutes? Oh, my God, it's like so not hard. It's so not hard. You just sit back, you sit back and listen and you get all the information you need and more. You get to really engage. I really knew my patients, I think, pretty well, considering. And I had patients for decades who stayed with me and children I delivered,

• 28:42Speaker 00

  who then became my patients, you know, multi generation families. I was connecting, but I was doing it at a big, actually a really huge cost to myself. Yeah, me too. Because I was giving, giving, giving, and I had no time to like relax and think. And also, I felt like so pressured that I'm gonna make a mistake. I'm gonna harm somebody unintentionally because I don't have enough time. It was just, I was so insane. Looking back on it, I don't know how I did it as long as I did. But I will say I was initially nervous, like, how can I do this? A year in, I just completed my first year of my practice. It has just been enormously gratifying. And I can't tell you, you know, the end of the year, I had a lot of patients come in with a lot of gratitude,

• 29:27Speaker 00

  telling me how I changed their lives because I had more time to thoughtfully order those labs and pick up on things that I wouldn't have had time to address. I was taught very old school, don't do labs that you can't act on results with. So even if I knew what the path forward would be, I'm, I really, when somebody would say to me, hey, can I just do my, my, you know, blood test here? I'd be like, oh, cringing because I thought, oh, my God, because there's gonna be more stuff I'm gonna have to address, honestly. Then again, I just didn't have the time. I have all the time in the world. They get on the body composition, I do their labs, I do a deeper dive into lipid. I mean, just by adding. Lipolittle A.

• 30:06Dr. Mary Claire Haver?

  LP Little A.

• 30:07Speaker 00

  Yep.

• 30:07Dr. Mary Claire Haver?

  And Apo B.

• 30:09Speaker 00

  I cannot tell you between that and body composition, looking at

• 30:12Dr. Mary Claire Haver?

  Oh, my God.

• 30:13Speaker 00

  their fat, their visceral fat and their muscle.

• 30:15Dr. Mary Claire Haver?

  It's

• 30:15Speaker 00

  It is a game changer.

• 30:16Dr. Mary Claire Haver?

  It's a game changer in

• 30:18Speaker 00

  It is

• 30:18Dr. Mary Claire Haver?

  helping someone plan the next 30 years of their life.

• 30:21Speaker 00

  Because I think people knew me here in LA as like, you know, she does menopause, she wrote this book, she's, you know, on social media, whatever, but it's not really just the hormones. I mean, sure, it's the hormones.

• 30:30Dr. Mary Claire Haver?

  Yeah.

• 30:31Speaker 00

  But it is not, it's that this is the moment in time, whether you're, and I'm thinking about specific people, whether you're 47 or you're 69, whatever moment in time you come to me, there is something that we can do for you. And I'm seeing massive results. These are women who are really, really high functioning, successful, sophisticated people. And they were running all over town, getting no help, couldn't figure it out. All they needed was that, being able to sit, tell their story, we can unwind it. That's also when some of the secrets come out, things that they never told anybody, that they had a history of abuse, that they have a substance problem,

• 31:13Speaker 00

  that they are trying to work on their eating, that they have all this stuff that has big health consequences, mental health and physical health consequences, that they're not telling people. Because you're not going to walk in and say, hey, I have a history of an eating disorder and I'm really worried about my bone density.

• 31:32Dr. Mary Claire Haver?

  Right.

• 31:33Speaker 00

  Who says that? They don't. But you know what? You spend a couple of hours with people, they feel safe.

• 31:39Dr. Mary Claire Haver?

  Yeah, to open up to you.

• 31:40Speaker 00

  You can do the real work.

• 31:41Dr. Mary Claire Haver?

  Do you think that our, the way we deliver healthcare in this country for most patients is broken?

• 31:47Speaker 00

  Yeah. It's just not human. It's not human scale. It's not human size. It's not human for any of the humans. You and I are humans.

• 31:54Dr. Mary Claire Haver?

  How would you fix it?

• 31:56Speaker 00

  I mean, I'd blow it up.

• 31:59Speaker 00

  That's what I do. I think we need healthcare for all.

• 32:01Dr. Mary Claire Haver?

  Because it's been insidious and we've lived through the change, right?

• 32:04Speaker 00

  Oh, yeah. We've watched it.

• 32:06Dr. Mary Claire Haver?

  We've watched it.

• 32:07Speaker 00

  We've been, I think, in a slow mo implosion.

• 32:09Dr. Mary Claire Haver?

  I think the most, and Dr. Mike had put this graph up, super popular medical educator on social media. He's a family medicine doc. And he put the graph up that I've seen multiple times. When you look at physician

• 32:21Speaker 00

  Yeah.

• 32:22Dr. Mary Claire Haver?

  payment over time, which has grown under the cost of living.

• 32:26Speaker 00

  Yeah, yeah. Oh, yeah.

• 32:28Dr. Mary Claire Haver?

  And then you look at administrative costs.

• 32:30Speaker 00

  Oh, yeah. It's insane.

• 32:30Dr. Mary Claire Haver?

  And literally, it is like a skyrocket that has gone. Like, we basically, healthcare costs have increased because of the cost of administering healthcare, not

• 32:39Speaker 00

  Yeah, and our outcomes are not better.

• 32:41Dr. Mary Claire Haver?

  clinicians who are delivering the healthcare and the outcomes are

• 32:43Speaker 00

  I mean, in OB, in OB specifically, maternal mortality?

• 32:46Dr. Mary Claire Haver?

  We've lost ground.

• 32:47Speaker 00

  Yes.

• 32:47Dr. Mary Claire Haver?

  We've lost ground.

• 32:48Speaker 00

  Yeah.

• 32:49Dr. Mary Claire Haver?

  In so many areas. And I've watched it reshape the way medicine is practiced, which is really scary to me.

• 32:58Speaker 00

  Tell me, tell me, like, what are your impressions about how they've been, it's been reshaped?

• 33:02Dr. Mary Claire Haver?

  Well, one, that we used to take care of curable cancers. We used to take care of these things for all the patients who walked in. But, but really, being so hamstrung

• 33:14Speaker 00

  Yeah.

• 33:14Dr. Mary Claire Haver?

  by the time constraints.

• 33:15Speaker 00

  Yep.

• 33:16Dr. Mary Claire Haver?

  So like this administrator breathing down your neck.

• 33:19Speaker 00

  Yeah.

• 33:20Dr. Mary Claire Haver?

  Not only to see thirty, forty patients in one day.

• 33:23Speaker 00

  Yeah.

• 33:24Dr. Mary Claire Haver?

  But to get all five stars from every patient.

• 33:28Speaker 00

  Exactly. Right.

• 33:30Dr. Mary Claire Haver?

  So our pay

• 33:31Speaker 00

  And then they tell us what we can and can't do

• 33:33Dr. Mary Claire Haver?

  Was getting deemed.

• 33:34Speaker 00

  To take care of these patients.

• 33:35Dr. Mary Claire Haver?

  And then the patient is frustrated because insurance won't cover. You know, they're all coming in on multiple different insurance plans and there was no method for a long time. There's a better one now of me being, have any idea of what their insurance is going to cover.

• 33:49Speaker 00

  Right.

• 33:49Dr. Mary Claire Haver?

  You know, and then if you look at the rate of prior authorizations and how that has skyrocketed. I mean, it is a racket built to destroy patients and their clinicians trying to take care of it.

• 33:59Speaker 00

  A hundred percent.

• 34:00Dr. Mary Claire Haver?

  So.

• 34:00Speaker 00

  Yeah. I mean, they don't want to spend the money that you invested.

• 34:04Dr. Mary Claire Haver?

  So who's making money in healthcare right now?

• 34:06Speaker 00

  The insurance companies, the insurance, I mean, the hospitals are losing money hand over fist, too, by the way.

• 34:12Dr. Mary Claire Haver?

  There's a lot of misconception about that.

• 34:13Speaker 00

  Yeah, I mean, people are getting these crazy, crazy bills and like their Tylenols, eighty dollars, whatever. But that's because they're, the hospital cannot bear it under the weight of the insurance system either. So the pharmacy benefit managers, which are essentially owned by the insurance companies, which are setting the rates and telling you whether or not this medication will be covered. This is like a freaking cartel, man. It's a cartel. And I think the other thing is when people call it a health care, it's not health care, it's health insurance. I mean, it's there for, God forbid, you end up with a heart attack or cancer diagnosis or a car accident. You need to be insured. I believe people need to be insured.

• 34:50Dr. Mary Claire Haver?

  My husband and I are fully aware that our health insurance is to keep us from going bankrupt.

• 34:57Speaker 00

  Yeah.

• 34:57Dr. Mary Claire Haver?

  If something catastrophic happens.

• 34:59Speaker 00

  Right.

• 34:59Dr. Mary Claire Haver?

  But I don't know if our listeners understand.

• 35:00Speaker 00

  I do not think they do.

• 35:02Dr. Mary Claire Haver?

  The number one cause of bankruptcy in the United States.

• 35:06Speaker 00

  Is medical.

• 35:07Dr. Mary Claire Haver?

  Is medical bills.

• 35:08Speaker 00

  Yeah.

• 35:09Dr. Mary Claire Haver?

  The number one cause of, this does not exist in Europe.

• 35:11Speaker 00

  It's just, it's just.

• 35:12Dr. Mary Claire Haver?

  This does not exist in Canada.

• 35:13Speaker 00

  Talk about moral injury and then we're involved in this.

• 35:17Dr. Mary Claire Haver?

  Then.

• 35:17Speaker 00

  It's wrong.

• 35:27Speaker 00

  Okay, so I have a 25 year old who is on my insurance for another, I know, not that we're not counting, because we are. And I mean, I'm spending almost $2,000 a month on the premium. That doesn't mean that it's paying for anything that I need or she needs. I had a fabulous experience this year where I ended up having to get, whatever, I had to get a biopsy on my other breast and everything's okay, but it was, I was $3,000 out of pocket and I'm paying my premiums. And this was a recommend, I wasn't doing some experimental procedure. It was like, hey, we saw something abnormal, we need a biopsy. No, I gotta pay for that. You got your deductible, you got all these things. It's insane. So how do I think it needs to be fixed? I think that needs to go away. I think there needs to be a level playing field. I think there needs to be national health care for people.

• 36:12Speaker 00

  Will it all be fabulous? Maybe not, but it'll be something. Better than people not being able to afford, not qualifying for state or federal insurance. So then they're not taking care of their chronic diseases. They're developing chronic diseases. They don't have any access and now they're showing up to the emergency room for their chronic disease management and it's costing them their lives. It's costing them their finances and it's costing us a lot of money because someone walks in having that stroke, we're going to treat them. So now it's costing a ton more money than if we just would have treated them. And there are going to be people like in other countries where there's national healthcare, who have the means to invest in their health. And is it fair?

• 36:57Speaker 00

  It's the way it is and they will seek doctors like you and I and have a different experience. And I think there's a trickle down. One of the things that I say to my patients, you know, because I called you a lot about this. It was a very, very hard decision for me to make ethically and morally to leave the system behind as well, for the exact same reasons.

• 37:17Dr. Mary Claire Haver?

  And so when we talk about alternatives to insurance, there's a lot of pushback from people who believe in socialized medicine or that healthcare should be a right and not something. How do you respond to that?

• 37:33Speaker 00

  I think they're right. I think it is a right and I think it shouldn't be a privilege. I think people who have the privilege to afford the care that they want to access should have that right as well. And these are people often that are influential and that can also have big impacts out in the world in the ways that they are, including in policy. But the reality is, why are we either oaring everything? Why is everything so binary? It's very important that we have more than one way to do this. And I do think that it is a right. But the other thing is that people don't understand how you and I got here, right? I self-funded my medical education.

• 38:06Dr. Mary Claire Haver?

  Same.

• 38:07Speaker 00

  I, my debt was probably half a million in premium, in like, you know, just in my loans. So you can't ask doctors to sacrifice a decade or more of their life, plus their financial future, and then come out and not be cared for. It's not a human system. I don't think any of us are saying like, I didn't go into medicine to get rich. Okay. Hello. My friends of mine who wanted to get rich already did that, like a long time ago.

• 38:37Dr. Mary Claire Haver?

  Yeah.

• 38:38Speaker 00

  That's not why I'm here. I didn't, I didn't work 80 hours a week while I was pregnant because all I care about is money. And I, I feel like if people understood what it took for us to become physicians and then to stay physicians, they would, they would understand that we're on the same side. And, and this is also, this polarization is coming from forces that want us to stay divided because if we all united, then we would all recognize where the problem really is. And it's, it's not who's delivering healthcare and who's receiving it. It's how the healthcare is getting delivered and who's controlling that. It's, it's a complex, it's a complex situation. I do think it's solvable. And I think right now we're in an interesting time because people are thinking more creatively.

• 39:23Speaker 00

  People are thinking in a more positively disruptive way. And I do think that social media has brought patients and clinicians together in a very powerful way.

• 39:31Dr. Mary Claire Haver?

  Yeah. I am a member of several physician groups online and it just seems to me that a lot are leaving traditional medicine, wanting to leave traditional medicine or can't leave because they're tied down by loans or contracts and, and whatever. What do you say to them?

• 39:48Speaker 00

  Well, I mean, we are looking at, I think, a deficit of something like 86,000 physicians in the United States in the next like 10 years. That's a huge problem. Who's delivering care? Right? And, and we're, we've been talking endlessly about how the system is really injuring the patients and the clinicians. So of course they're leaving. They can't take it anymore. And there's this sort of conversation that you brought up actually about burnout versus moral injury.

• 40:15Dr. Mary Claire Haver?

  Yeah.

• 40:15Speaker 00

  And they are different. Burnout is, you know, physical and emotional exhaustion. And it sort of centers the problem on the person experiencing it. People will kind of depersonalize, get kind of like, You often see like a lot of negativity, skepticism, cynicism. Moral injury is the choices you're being asked to make are in conflict with your own ethical and moral guidelines.

• 40:37Dr. Mary Claire Haver?

  Yeah.

• 40:38Speaker 00

  And that is really injurious. That's PTSD.

• 40:41Dr. Mary Claire Haver?

  We were kind of taught and we knew to expect the exhaustion.

• 40:45Speaker 00

  Yeah.

• 40:46Dr. Mary Claire Haver?

  That is what you signed up for.

• 40:48Speaker 00

  Yeah.

• 40:48Dr. Mary Claire Haver?

  You know, and at some point in your career, you start pivoting and shifting and whatever. But like, people are leaving the system.

• 40:54Speaker 00

  They're leaving. They're leaving because they can't take it anymore.

• 40:56Dr. Mary Claire Haver?

  Because of moral injury.

• 40:57Speaker 00

  Yes, that's exactly right.

• 40:58Dr. Mary Claire Haver?

  They cannot resolve a conflict in their head and it's killing them.

• 41:01Speaker 00

  Yeah, and we don't, and it is killing them because physicians have actually the highest suicide rate of any profession. We're sensitive people.

• 41:11Dr. Mary Claire Haver?

  And females live longer than males.

• 41:13Speaker 00

  Unless you're a female physician.

• 41:14Dr. Mary Claire Haver?

  Unless you're a female physician.

• 41:16Speaker 00

  It's no joke.

• 41:17Dr. Mary Claire Haver?

  You lose.

• 41:17Speaker 00

  This is some serious stuff.

• 41:18Dr. Mary Claire Haver?

  That advantage.

• 41:19Speaker 00

  So, and we're not here whining and complaining.

• 41:21Dr. Mary Claire Haver?

  I'm not laughing.

• 41:21Speaker 00

  We're just stating the fact. Well, because it's gallows humor, that's how you get through it. But I mean, we're just stating the fact. So it's like, if we want to have excellent healthcare, excellent provision of medical care, which is what all of us deserve, then we need to start supporting our clinicians in a real way and offering opportunities for them to practice the best medicine. If people want to get great medicine, they have to expect it and they have to expect that the people who are delivering it are being treated well.

• 41:49Dr. Mary Claire Haver?

  Mm-hmm.

• 41:49Speaker 00

  I mean, this is a whole podcast in itself, unionization and all these other things. My response was to pull out of the system and say, you know what? I can't do this anymore, but I don't want to leave medicine. And with the help of a startup that I was a part of, you know, I was advising and consulting for years in industry.

• 42:09Dr. Mary Claire Haver?

  So this is Monarch?

• 42:10Speaker 00

  Yeah, so this is Monarch, yeah.

• 42:11Dr. Mary Claire Haver?

  And let me get this right, you are the chief clinical officer?

• 42:14Speaker 00

  I am.

• 42:14Dr. Mary Claire Haver?

  What does that mean?

• 42:14Speaker 00

  It means that I'm in charge of the clinicians, right? Basically, I help to shape. Who we want to bring into the company and I'll explain what we do. I also help support these doctors in practicing in the way that they want to practice. The company itself is operational support. So we support independent practitioners. The physicians own their own practice. We come in as operational support. All the things that doctors are not good at, running a business, like you said. We don't know how to start a business, the legal, the insurance things, the back office, the marketing, the billing, all that stuff. So we come in and we do that. And you get to practice medicine the way you want. It's a membership model.

• 42:56Speaker 00

  So that also actually takes a lot of pressure off because people pay for the year and they're getting their care. And now every visit isn't being billed. You're not like, do I call her because I'm going to have to pay? And I'm not thinking like, do I fill my day with 25 patients or I'm not going to be able to pay my rent and my staff? It just removes all of those barriers and what you get is time and you get bandwidth and you get creativity. So as Chief Clinical Officer, I'm helping to shape who's joining us. And I'm also helping shape the clinical protocols. We don't have like a monarch way, but we are really excited to be like, we're working on a sleep module. We're working on a cardiovascular health module.

• 43:39Speaker 00

  So if you are practicing in an environment where you have great clinicians and referrals and people that you're, you know, working with already, terrific. But if you don't, here's what we have to offer you. It's really powerful medicine. We're allowing people to do great medicine because we're doing that structure and that foundation. So for me, it's been super exciting. And also, listen, Mary Claire, I've been all over the country this year, talking to doctors like me, hearing their stories. And it's been hard. It's been gratifying because I think that I'm, whether or not they decide they want to do this kind of medicine, they see that there is some hope, there is a way forward for them. But it was rough to be all over, I mean, the East Coast, the South, the Midwest, it's

• 44:23Speaker 00

  everywhere where doctors are like, I'm done, I'm piecing out, or I can't afford, I have to keep doing this, I have all these bills to pay, I'm stuck and I'm miserable. I mean, that is terrible. And that is not a person who's going to be able to provide great care to anybody. So having an option for them has been very, very, it's been fun, actually. And reignited my passion for us.

• 44:50Dr. Mary Claire Haver?

  Now it's time for the Midi Pause. I'm Dr. Mary Claire Haver, host of the podcast UnPaused, bringing you a word from Midi Health. Today, we're going to take a pause and discuss heart disease. Did you know that heart disease is the number one killer of women, responsible for one in three deaths? And here's what many women don't know. Up to 80% of your cardiovascular risk is shaped by your lifestyle. When estrogen declines during menopause, its protective effect on your cardiovascular system go with it. Cholesterol rises, blood pressure climbs, and visceral fat increases. Your heart needs more support now, not less. Heart health can have a significant impact on women, especially during menopause. The same hormonal shifts

• 45:35Dr. Mary Claire Haver?

  that trigger hot flashes and brain fog can hurt your cardiovascular health. But treatment could make you feel better. That's why Midi Health is dedicated to changing the way menopause is treated with a personalized approach to each woman's specific needs. Women come to Midi Health to address the symptoms of menopause they see and feel every day. They partner with you to find a treatment, whether that's HRT or a non-hormonal solution that will relieve your symptoms and make heart healthier habits easier to put in place. I personally have found that these five habits can make a real difference. Number one, don't ignore your hot flashes. They're not just uncomfortable. Frequent untreated vasomotor

• 46:18Dr. Mary Claire Haver?

  symptoms are a signal that your cardiovascular system is under stress. Take them seriously. Talk to your clinician. Number two, move your body. A sedentary lifestyle is a major risk factor for heart disease. Aim for 150 minutes of cardio per week, plus two to three strength training sessions. Even daily walks add up fast. Number three, eat for your heart. Colorful whole foods, enough protein and fiber, healthy fats like omega-3s, and cut the ultra-processed foods. Studies link them directly to higher cardiovascular risk. Number four, if you smoke, please stop. Smoking is the single most modifiable risk factor

• 47:01Dr. Mary Claire Haver?

  for heart attack and stroke. Number five, have the HRT conversation.

• 47:07Dr. Mary Claire Haver?

  Women who start hormone therapy within the first 10 years of menopause, or before the age of 60, show lower cardiovascular risk and lower risk of death from any cause. The science is clear. You deserve to know your options. It may not be right for everyone, but every woman deserves the conversation. And Midi Health is setting a new standard for healthcare. As the nation's fastest growing women's telehealth company, Midi provides accessible, insurance-covered services. Building on its leadership in perimenopause and menopause, Midi fills the critical health gaps women face at every age and life stage. If you want a clinician in your corner who understands what your body and your brain need right now, that's exactly what Midi is built for.

• 47:52Dr. Mary Claire Haver?

  Go to joinmidi.com, join M-I-D-I dot com, and connect with one of their clinicians today.

• 48:01Speaker 00

  Integrative medicine. Yeah, what is that? Because so many people don't know what that is. I mean, integrative medicine is really integrating more traditional holistic indigenous systems. You have special training. Yeah, I'm trained in Ayurvedic medicine, which is the medicine of India. The ancient medicine, I mean, it's probably one of the oldest medicines recorded on the planet. There are textbooks on surgery and on anatomy from, you know, depending on how you date them, 2,000 to 5,000 years ago. So it's pretty interesting. It came out of spiritual practice, like most indigenous medicine, right? It's rooted in the land, in the plants, in the seasons, in what was available there, in something bigger than ourselves, came out of Hinduism. Chinese medicine developed around the same time.

• 48:46Speaker 00

  And so I, just out of my own curiosity, started studying that after I finished residency. And I think it's because there was something missing. I was like, all this technical stuff is magical. You know, I can do surgery and people can be in the ICU and all these things. And I can, you know, do a C-section if I have to. But something was not quite there and I was seeking, I think, some deeper meaning. And I found that the more holistic, traditional medicines.

• 49:15Speaker 00

  Used everything. They talked about community and spiritual and plants, which are medicine and procedures, if you need to do it. It was fascinating to me. So I did it initially out of my own curiosity and to sort of fill some sort of gap that I thought I had. But then people started hearing like, oh, you know, she's open minded. She'll use herb. I wasn't practicing Ayurveda. I was more open to things. So integrative medicine takes the best of science and modern medicine and convention and evidence and combines it with ancient. Because this idea that conventional medicine like booped onto the scene magically, like, that's ridiculous. It's, it's, you know, the great, great, great, great, great grandchild of all these traditional medicines. Yeah. And it's been really satisfying for me and interesting to me.

• 49:58Speaker 00

  Do you feel like this model, your new model allows you to like integrate integrative practices more? Yeah, definitely. How are the patients responding? They love it. Do they think you're too woo woo? No, I mean, I don't, I'm not, you know, listen, you meet people where they are. Yeah. So I'm not like throwing herbs and meditation at everybody. I like saw you speak multiple times before I knew you did any of this other stuff. Because I'm like a regular, degular doctor with like this other interest. I weave it in. It helps me understand where that person's coming from. For a long time, especially when it came to perimenopause and menopause, people came to me because they didn't feel like I was going to force a prescription on them. And so I do have specifically around that, I have a lot of interesting herbs that I use that have decent evidence to support their use.

• 50:43Speaker 00

  Okay, tell us, because everyone's curious. Of course I will. I love chaste berry, which is also called Vitex. That's the Latin name. And one of the ways that it works is probably in helping to increase the amount of progesterone that is secreted from your own body in the second half of the cycle. So in perimenopause, it works really well because we see a loss of progesterone secretion in the agus, it's aging. And that's where we see a lot of the physical symptoms, a lot of the mood symptoms. Sleep disruptions. Yeah, exactly. So that's a big one. And it can help, especially with mood, sometimes some of the physical symptoms like breast tenderness, sometimes sleep. That's a great one. And that's safe for everybody. Things like Russian rhubarb, Siberian rhubarb,

• 51:27Speaker 00

  acts possibly like a selective estrogen receptor modulator and can be quite helpful for hot flashes. I think we know black cohosh, which got a bad name. It is not hormonal, but there were a couple of case reports of liver toxicity. And so now all of a sudden, black cohosh caught, no. If you don't have high quality medicine, whether it's pharma or plants.

• 51:50Dr. Mary Claire Haver?

  Number one liver toxin is acetaminophen.

• 51:52Speaker 00

  Exactly.

• 51:53Dr. Mary Claire Haver?

  Tylenol.

• 51:54Speaker 00

  That's exactly right. But there is a long history in this country of marginalizing anything that is not standard of care. And who is setting the standards.

• 52:04Dr. Mary Claire Haver?

  You just did.

• 52:05Speaker 00

  Yeah.

• 52:05Dr. Mary Claire Haver?

  This is so fascinating, a Substack. So Dr. Suzanne has a Substack.

• 52:09Speaker 00

  I have a Substack.

• 52:10Dr. Mary Claire Haver?

  Which I'm obsessed with. Talking about.

• 52:13Speaker 00

  The Flexner Report.

• 52:14Dr. Mary Claire Haver?

  Oh, my God.

• 52:15Speaker 00

  Yeah.

• 52:16Dr. Mary Claire Haver?

  I think it's worth it for our listeners. I think they'd be fascinated.

• 52:19Speaker 00

  It hurts my heart so much to talk about it because it's so, I knew about it. And I think I even had mentioned it in my first book. I'm working on another book on, on plant medicine.

• 52:28Dr. Mary Claire Haver?

  Yes.

• 52:29Speaker 00

  But when I looked into it even more deeply, I was like, whoa. So in 1910, the very early formation of the American Medical Association was supported by Rockefeller and Carnegie Foundations, for better or worse, to look at like, hey, can we clean up medicine? Cause it's a little bit of the Wild West out there.

• 52:48Dr. Mary Claire Haver?

  Yeah.

• 52:48Speaker 00

  So I think that there were.

• 52:50Dr. Mary Claire Haver?

  Intentions were good.

• 52:51Speaker 00

  Intentions were good, but you know, now in retrospect, it's like, but were they? Because there was also a big push from the early, you know, developing pharmaceutical industry to sort of standardize things. Not necessarily bad, but you know, what's going on? And I want to make sure, no one thinks I'm like a crazy anti-pharma because I'm not.

• 53:11Dr. Mary Claire Haver?

  No, no, of course not.

• 53:12Speaker 00

  Okay. So at that time.

• 53:13Dr. Mary Claire Haver?

  You prescribe more.

• 53:14Speaker 00

  Yeah, I do. I prescribe. I just sent a Z-Pak to our friend last night. Anyways, I, so they hired Abraham Flexner, who was an educator. And he went all across the country, looking at all the medical schools.

• 53:25Dr. Mary Claire Haver?

  What did medical schools look like back then?

• 53:27Speaker 00

  Well, they looked like everything. So a lot of them actually integrated. A lot of them taught homeopathy. A lot of them taught natural. Medicine, a lot of them taught women. It turned out there were all these part-time medical schools that women went to. It's not true that women weren't going into medicine, but they were doing things. They were having babies. They were taking care of families. They couldn't just up and, you know, if you weren't rich, you couldn't just go to Harvard. And also, if you weren't a white Anglo-Saxon male, you were definitely not going to Harvard. So anybody who is ethnic of any sort was not going, getting into these schools. And there were seven black medical colleges at the time. They shut down all but two of the black medical colleges. They shut down like 80 or 90% of the part-time for-profit colleges,

• 54:10Speaker 00

  which is where women went. And, you know, they got rid, any homeopathy, natural medicine, all was marginalized. This is bad. This is dangerous. It became doctor as technician, patient as pathology. Look, there were things about that that were very modern and progressive for the time, but it was exclusionary to the point of really damaging, I think, damaging the way we delivered healthcare and the way we looked at humans. We, we started isolating parts and pieces of bodies instead of looking at the whole, the whole person. And the cool thing that I have found, and I knew this from my, my study of Ayurvedic medicine, was that it

• 54:50Speaker 00

  turns out all indigenous medicines were communal. So there are these ideas, for instance, that if you're sick, your family is sick, your community is sick. So we need to work together to help you heal. You have to take responsibility and you have to do certain things different, but we are a whole. Doesn't that sound like something we might want to look at again? One of the biggest problems I'm seeing now is isolation. We know the Surgeon General has told us that isolation and loneliness are more dangerous to your health than smoking cigarettes. I think we got a bad taste of it during the shutdown and the pandemic, but it's deeper than that. We can't even talk to each other if we don't have the exact same opinion. What is that? This isn't

• 55:34Speaker 00

  humans. We're tribal. So I'm a little Pollyanna-ish, I guess, but I don't think we have to all like throw out our scripts and, you know, roll around in the dirt. Okay, I'm not telling you to do any of those things. If you want to, go for it. It might, might be fun. But I think we need to be a little more expansive. And a lot more curious and humble. That, to me, is what medicine is. Is my toolkit big and wide? Yes.

• 56:03Dr. Mary Claire Haver?

  So your new book is plant medicine?

• 56:05Speaker 00

  And it's a little bit of a play on things because I know that for people who are in the know, plant medicine sounds like psychedelics, and that's very interesting for people right now. But plant medicine is really where medicine comes from.

• 56:16Dr. Mary Claire Haver?

  Yeah.

• 56:16Speaker 00

  Plants.

• 56:17Dr. Mary Claire Haver?

  Plants.

• 56:17Speaker 00

  Over 30% of our pharmaceuticals today are plant derived. And they did not, again, some genius in a lab.

• 56:23Dr. Mary Claire Haver?

  And they used to be 100% derived.

• 56:24Speaker 00

  Exactly. And we borrowed them from whatever people were living in that area. Okay, this is not new. So the book is about both the use of botanical medicine and how we can use it today, and what the actual evidence to support that use is. But also the history of medicine and the history of humans with medicine, and how we interact with nature in order to heal ourselves. And that is an inclination that we've always had. It's super fascinating. I'm having the best time working on it, and I'm so excited to share it with the world.

• 56:55Dr. Mary Claire Haver?

  Who should read it?

• 56:56Speaker 00

  Everybody should read it. I mean, anybody who's interested in healing themselves. This is not just for women. This is for everybody. I mean, there'll be some recipes in there for things. I brought you some things today that I made. But also people who are interested in the history of medicine or the history of like how humans interact with each other. It's the book that I've always wanted to write.

• 57:15Dr. Mary Claire Haver?

  Well, what does it look like when science and ancient, you know, practices coexist? I mean, are they? I don't think they're exclusive, right?

• 57:22Speaker 00

  Of course not. But people make assumptions. And I think if you understand that Flexner thing, you understand where some of our biases come from. Like, we didn't get trained learning about Flexner at all.

• 57:32Dr. Mary Claire Haver?

  Nope, never heard of him. Till I read your subtitle.

• 57:34Speaker 00

  Right. So there's a lot of biases that are built into the way we as clinicians are trained. And I think that's a big opportunity to widen the lens here and look at like, wait, what is medicine? What is the art and the practice of medicine? And this idea that there's no science to support the use of herbs is untrue. There's a ton of ethnobotanical research. There's a ton of bench research, you know, so not necessarily in humans, but we know how rosemary works, right? We know that rosemary, most of your cooking herbs are medicinal because they have very specific chemical components that, for instance, are immune boosting or are literally anti-infective. They work against microbes. They're antimicrobial. So, you know, we know that honey does that, too.

• 58:19Speaker 00

  There's science to this. I'm not making this up.

• 58:22Dr. Mary Claire Haver?

  How would a woman integrate this into her life responsibly?

• 58:26Speaker 00

  Well, so a couple of things. First of all, because most of you aren't going to go out and make your own medicine, although it's if you grow oregano, for instance, it's very easy to infuse it into oil. I mean, I'll tell you how to do it right now. Clean it off. Make sure there's no pesticides on it. Dry it. Put it into a jar, like, you know, maybe an eight ounce jar of really high quality olive oil or some oil that you like. Let it soak, close it, sit it in the sun in a sunny window for two weeks, strain it. Now you have oregano oil. Okay? You can put that on a burn, on a cut. You can put a couple of drops in your mouth to help fight off a cold. Anybody can go to the market today and do this. Most of you are not going to make all your own medicines. So if you're looking at the supplement world,

• 59:10Speaker 00

  it is regulated. It is not regulated to the same level as the FDA and pharma. There's something called Dushé. Okay? It's not perfect. It's something. You have to be very careful. When you're purchasing online or in a store, you need to make sure that that is third party tested. That what you think is in it is in it.

• 59:26Dr. Mary Claire Haver?

  How would they know it's third party tested?

• 59:28Speaker 00

  There's usually a label on there. And if you go online, you can just usually there'll be a search engine in their own website. Just put in third party. If you can't find it, if you're looking for a long time, forget it. It's not there. Or it shouldn't be that hard.

• 59:40Dr. Mary Claire Haver?

  It should be prominent.

• 59:41Speaker 00

  Right. Because any brand that has integrity wants you to know that somebody else is coming in. Scientists are coming in and testing it and saying, yes, this is the strength. Yes, it's unadulterated. No, there are no, you know, lead or mercury and contaminants. Exactly. A lot of stuff is coming from other countries and it's not so clean. So that is my number one piece of advice. And I think working with somebody who really knows what they're talking about, because I think if you're going to start treating yourself, and now you're going to go to your physician and they're going to be like, what are you doing? Throw all that out. I mean, that's not helpful. I will say, just from the Ayurvedic perspective, we don't treat the same way. Like, oh, you have this problem. Here is the solution. It's much more nuanced than that. So we're going to leave that to the

• 1:00:23Speaker 00

  side for a minute. But there, there are plenty of things that we can reach for that can be helpful to us on a daily basis. And I think the practice of it. Helps us reconnect again to our human history, to ourselves, to some kind of intuition. And I think that's really healthy. Because when we're outsourcing, you know, we started talking about how to advocate for ourselves.

• 1:00:44Dr. Mary Claire Haver?

  Yeah.

• 1:00:45Speaker 00

  When we're outsourcing our entire being and all of our health, that's actually where we get into trouble.

• 1:00:51Dr. Mary Claire Haver?

  I think you're right.

• 1:00:53Speaker 00

  We got to own it a little bit.

• 1:00:54Dr. Mary Claire Haver?

  There's, it's so confusing.

• 1:00:56Speaker 00

  It's very.

• 1:00:57Dr. Mary Claire Haver?

  So much.

• 1:00:57Speaker 00

  It's very confusing.

• 1:00:59Dr. Mary Claire Haver?

  Misinformation, disinformation, you know, people trying to profit.

• 1:01:04Speaker 00

  Yeah, and people also who really think that they know and they don't have the chops. I have been in medicine for, I graduated my residency 26 years ago. I have been practicing medicine for 26 years. I had four years of residency, four years of medical school, four years of life, and four years of college before that, okay? I studied, I have studied Ayurveda for almost 20 years. I'm an authority, okay? I think there are people out there who are super interesting, creative, brilliant thinkers, and they don't have the chops. So I think that they should say they have an opinion, say they're thinking about something, share their ideas, collaborate with people who have works.

• 1:01:47Speaker 00

  I didn't, I studied with people who studied this ancient technology for years and decades and had generational transmission of this, this information, which is what we did in medical school too, right? And I still am learning, I don't know anything. So we have to be a little bit careful about where we're getting our information from. And just because somebody says they're an authority does not mean they're an authority.

• 1:02:11Dr. Mary Claire Haver?

  I know. I always like, if you can't clearly see someone, if they're representing themselves like as a doctor, like I see this all the time on social, and you'll see Dr. X, right?

• 1:02:20Speaker 00

  Right.

• 1:02:20Dr. Mary Claire Haver?

  But there's no credentials after their name. Doctor of what? Doctor, you know, and I always tell people, take that with a grain of salt. Most of us, you will put our credentials out there. So you know where this person is coming from.

• 1:02:36Speaker 00

  That's exactly right. You know, these kinds of conversations bring me hope. I think, you know, working on this book has given me a lot of hope also because I, I see that humans have always struggled and we've always had challenges. But when we come together, we come up with solutions. I got to shout out my dad for being 89 and publishing a book. That gives me a lot of hope. Like, you know, it's interesting because I, early in this. Kind of menopause conversation, I talked a lot about shifting the narrative and reminding people that menopause and beyond is a significant part of your life and it can be the best part of your life, if you have the right resources. To look at my parent who just

• 1:03:15Speaker 00

  keeps going and like decided he should write a book at 89, says everything. Like it's over when you decide it's over. That gives me hope. I'm here now.

• 1:03:27Dr. Mary Claire Haver?

  What do you want women to feel after listening to this conversation? What are your big takeaways for them?

• 1:03:33Speaker 00

  I want them to feel like they have a chance. I do want them to stop adopting that narrative of victimhood, that there's nothing that they can do and that, that it's all like we're being oppressed. I mean, we are. We are actively being oppressed. Okay. But that doesn't mean that we can't exist in some very specific way. We always have. When I look at the history of women and the history of medicine and the history of witches, you know, seriously, like female healers, midwives existed, always. And they always were a little bit under the radar and they were super powerful. I learned that some of the only women that were allowed to travel around the countryside in, you know, like the Middle Ages were midwives and healers. They could go independently. These ladies were, they were very smart. They were going around and they were not just going

• 1:04:17Speaker 00

  around and taking care of health. They were going around and they were talking to people. They were listening to people. They were empowering women in the way that they were capable of doing. So we can do things, but we have to work together and support each other.

• 1:04:31Dr. Mary Claire Haver?

  Yeah.

• 1:04:31Speaker 00

  We have to lift each other up. We don't have to be slapping each other down. That doesn't help.

• 1:04:36Dr. Mary Claire Haver?

  Yeah. That I think is core, at least in our field.

• 1:04:40Speaker 00

  Yes.

• 1:04:41Dr. Mary Claire Haver?

  You know, at this level is, is really collaboration.

• 1:04:46Speaker 00

  Yeah.

• 1:04:47Dr. Mary Claire Haver?

  You know, respecting each other's strengths, really respecting differences.

• 1:04:51Speaker 00

  Yeah.

• 1:04:52Dr. Mary Claire Haver?

  Really, if someone is, is thinking different than you, listen to her and try to understand why, you know, it's usually, you'll learn something from that conversation.

• 1:05:00Speaker 00

  Absolutely. It's an opportunity.

• 1:05:01Dr. Mary Claire Haver?

  Thank you so much for coming on Unpause.

• 1:05:03Speaker 00

  Thanks for having me.

• 1:05:04Dr. Mary Claire Haver?

  We love you so much.

• 1:05:05Speaker 00

  I love you more.

• 1:05:08Dr. Mary Claire Haver?

  You can find Dr. Gilbert Linz on most social platforms at Ask Dr. Suzanne, or through her website at thedrsuzanne.com, or at www.gilberg-monarchmd.com. You can find full episodes of UnPaused on YouTube at Dr. Mary Claire. I would love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at DrMaryClaire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. My new book, The New Perimenopause, is available on Amazon. If you're loving this podcast, I have an important request.

• 1:05:51Dr. Mary Claire Haver?

  Please take a moment to follow UnPaused on your favorite podcast app. Following and listening is what pushes this information to more women who need it. So if this podcast has helped you feel seen, understood, or supported, hit Follow right now so you never miss an episode. Thank you for being here with me. Let's keep going, UnPaused. UnPaused is presented by Odyssey in conjunction with Podpeople. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on UnPaused are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute

• 1:06:35Dr. Mary Claire Haver?

  for professional medical advice, diagnosis, or treatment.