How to Get What You Need From a 15-Minute Doctor's Appointment with Dr. Lucy McBride

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Lucy McBride, a Harvard and Johns Hopkins trained primary care physician and author of the new book Beyond the Prescription: A Doctor's Guide to Taking Charge of Your Health. Dr. McBride has spent twenty five years watching patients bounce between a rushed medical system and a wellness industry. The conversation opens with a hard truth about modern healthcare: doctors interrupt patients within eleven seconds of them speaking, and fifteen minute appointments leave almost no room to understand the whole person behind the diagnosis codes. Dr. McBride explains why this happened, how insurance incentives reward volume over conversation, and why trust and rapport, not just lab values, are the real birthplace of health. She and Dr. Haver share stories from their own practices, including patients who were given thousands of dollars in tests but never asked a single question about their actual lives. Guest links: Dr. Lucy McBride https://www.lucymcbride.com/ Dr. Lucy McBride https://www.instagram.com/drlucymcbride/?hl=en (Instagram) Dr. Lucy McBride https://www.linkedin.com/in/drlucymcbride/ (LinkedIn) Dr. Lucy McBride https://x.com/drlucymcbride (X) Dr. Lucy McBride https://www.youtube.com/channel/UCpvPY2sxQ-ahv4UQ5GPvedQ (YouTube) Dr. Lucy McBride https://www.ackerlymcbride.com/drmcbride (Ackerly McBride Group) Beyond the Prescription https://podcasts.apple.com/us/podcast/beyond-the-prescription/id1620896047 (Apple Podcasts) Are You Okay? By Dr. Lucy McBride https://lucymcbride.substack.com/ (Substack) Books “The New Perimenopause,” https://thepauselife.com/pages/the-new-perimenopause-book?srsltid=AfmBOoqkbc2_wmfEQSfuf1fMT3s-ImuwNhUak8wC4KsEiYhHyNtQgSy5 by Dr. Mary Claire Haver “The New Menopause,"⁠ https://www.amazon.com/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z/ref=sr_1_3?crid=10GNBSGVPDFJZ&dib=eyJ2IjoiMSJ9.djG88jtefTqLpTg36Li8QIefDxRPHA-WKVyCC9DQ7X71Ad734j96bPWX-yewnsv9Pqm7WCali5P5-h2eixUH_yHkbz1DHy2rQFoQSh7O92HNwttIL_ZBgXVor81D-Z3sbsfBh7JOJXDQwUuhWNnA5LHbsuI1CyhIyjtRm6_DXYJFaWrkYTjJeqJyFBnBZfgTprhlgJe_RZoWH9pOY6S9XzRapnMjnZgOq7PBA7Wy2KM. ZfI9WXwN58225D-i3qDhw4ZlXZO4pt8rPX1nAKiBNHM&dib_tag=se&keywords=perimenopause+book+mary+claire&qid=1775810714&sprefix=perimenopause+book+mary+claire%2Caps%2C511&sr=8-3 by Dr. Mary Claire Haver “Beyond the Prescription: A Doctor's Guide to Taking Charge of Your Health,” https://www.amazon.com/dp/1668024381?lv=shuf&channelId=500&plpRedirect=mhFallback by Dr. Lucy McBride For full show notes, please click here https://thepauselife.com/blogs/the-unpaused-podcast/how-to-get-what-you-need-from-a-15-minute-doctors-appointment-with-dr-lucy-mcbride.

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

• 0:00Speaker 00

  I think the problem is that when you don't have context around it, and when you have access to unfiltered information, ChatGPT, Google, you can make yourself crazy. You can diagnose yourself with pretty much anything you want to. It's interesting, if you look at studies of how ChatGPT compares to actual doctors, there's studies to show that ChatGPT actually does better than doctors. But remember that in the studies, the questions were being asked by doctors. So the framing was already there. When you're a patient, you don't know what question to ask. And so in real life, people are being misled by ChatGPT more often than they're being misled by doctors.

• 0:55Dr. 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. My guest today is someone I've been wanting to sit down with for a long time. Dr. Lucy McBride is a Harvard and Johns Hopkins-trained primary care physician, practicing clinician, and one of the clearest voices I know when it comes to what is actually broken about the way we take care of patients. She writes the Substack newsletter, Are You Okay?, with nearly 39,000 subscribers, hosts the podcast Beyond the Prescription, and her first book,

• 1:38Dr. Mary Claire Haver?

  also called Beyond the Prescription: A Doctor's Guide to Taking Charge of Your Health, is out this month, and I had the honor of writing the foreword for this book. The book is Lucy's attempt to solve a problem she sees every day in her practice: patients caught between a healthcare system that treats them like a checklist and a wellness industry that sells them false promises. Neither one actually gives people what they need, which is agency over their own health. So Lucy has a five-step roadmap for becoming the CEO of your own health, not by rejecting medicine, not by becoming your own doctor, but by learning to ask better questions, advocate for the care you deserve, and make decisions that are actually aligned with your own values.

• 2:23Dr. Mary Claire Haver?

  She brings 25 years of clinical experience to this conversation, and what she's really talking about is a shift from passive patient to empowered partner: awareness, acceptance, and agency. It sounds simple, but it changes everything. And if you've ever walked out of a doctor's appointment feeling dismissed, confused, or like you were handed a prescription instead of an answer, this conversation is for you. 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, the podcast where we cut through the silence

• 3:07Dr. Mary Claire Haver?

  and talk about what it really takes for women to thrive in the second half of life.

• 3:20Dr. Mary Claire Haver?

  All right, Dr. Lucy McBride, welcome to UnPaused.

• 3:23Speaker 00

  Mary Claire, I am so excited to be here. I am just thrilled. I woke up elated.

• 3:28Dr. Mary Claire Haver?

  I want to talk about the book. Great. Are you down for that? Why on earth would you write a book? Why this book?

• 3:34Speaker 00

  I wrote this book because I've been caring for patients for 25 years, and I was seeing the same problem again and again. Patients being churned out by the medical system, frustrated by 15-minute appointments, and then naturally turning to the wellness industry and wellness influencers for advice on how to be well, but feeling just as confused as when they left their doctor's office. So this book is a guide to getting what you actually need for your life, for your health. And it's not a recommendation to ditch your doctor. We all want to be well.

• 4:17Speaker 00

  It's a roadmap to make sense of your health and then ask the right questions and get what you need.

• 4:22Dr. Mary Claire Haver?

  You are still in traditional practice, correct?

• 4:24Speaker 00

  Yes. I started my own practice in 2024. I was in a practice for 19 years with, in a big group. And I wanted to run my own place. I wanted to really drill down into the relational aspects of care, to be able to have time with patients, to understand the whole person. Because there's so many aspects of health that aren't measured in a blood test or on a scan. It's about a conversation. It's about trust between patient and doctor.

• 4:50Dr. Mary Claire Haver?

  Yeah.

• 4:51Speaker 00

  And our system isn't designed to care for the whole person.

• 4:54Dr. Mary Claire Haver?

  Right.

• 4:54Speaker 00

  It's not designed to understand that your diabetes is informed in part by your lack of childcare that makes it impossible to chop broccoli in meal prep. So you have to have time with the doctor. You have to have a partnership for there to be trust and rapport. Patients tell me things that they wouldn't say out loud to anybody else. And if I don't have that trust and rapport with them first, I can't really help them in a really meaningful way.

• 5:23Dr. Mary Claire Haver?

  I feel the same. I, you know, was trying to crank out as much empathy as I could in these 10-minute visits, where half of that was her uncomfortable insurups and me coaching her through how to get through this pain, you know, with as little pain as possible, and then trying in three minutes to cram in everything else about her health. And it just, it's impossible.

• 5:48Speaker 00

  It's impossible. So take my 80-year-old patient I saw last week. He's on six medications. He just lost his wife, and he's got hip pain. If I had only five minutes with him, I could barely scratch the surface of what's actually going on in his life. What's most interesting to me, and what's most relevant to his health, is his grief and his loss, and how that informs his compliance with his medicines. So again, it's really difficult to take care of patients in hurried 15-minute appointments. It's nearly impossible to understand the whole person.

• 6:22Dr. Mary Claire Haver?

  Right. Let's talk about the system for just a second. It didn't start out like this. We weren't, you know, this whole 10, 15-minute visit thing is really new in the last 10, 20 years. Like, how did this happen?

• 6:36Speaker 00

  It happened because of the insurance industrial complex. Insurance rewards doctors for volume, for transactions, for prescriptions and referrals over

• 6:47Dr. Mary Claire Haver?

  And procedures.

• 6:48Speaker 00

  And procedures. You're more likely to see a doctor and get a prescription and a referral than you are to have a conversation. But dialogue, rapport, trust is the birthplace of health. It's not just trusting me. It's about me understanding you. So it's not just about the patient has to trust me and do what I say. It's equally important for me to understand who you are. What are your goals? What are your needs? What is your tolerance for risk? Because I think what has happened in medicine because of the system, through no fault of doctors, is that we end up assuming that our tolerance for risk is the same as our patients' tolerance for risk.

• 7:31Dr. Mary Claire Haver?

  Right.

• 7:31Speaker 00

  That my goals are your goals. But take a patient who is facing the decision to pursue further chemotherapy for her cancer, or prioritize quality of life. That decision is so personal, so individualized. But the oncology space, for example, would say, treat the cancer at all costs.

• 7:55Dr. Mary Claire Haver?

  That's it? No, we're living this in our family right now.

• 7:58Speaker 00

  Whereas my job is to center the cancer, of course, but really to center the patient. She may decide, I would rather go to my grandson's baseball games and feel alert and aware than suffer the brain fog from more chemotherapy. It's not my decision to make. It's hers.

• 8:16Dr. Mary Claire Haver?

  Right.

• 8:16Speaker 00

  But if I don't understand why she's alive in the first place, or what her goals are, it's very hard to guide people in making decisions.

• 8:25Dr. Mary Claire Haver?

  So you open the book with two patients.

• 8:27Speaker 00

  Yes.

• 8:28Dr. Mary Claire Haver?

  One who got dismissed by traditional medicine and fell into the dark hole of wellness culture. And then another one who got $12,000 worth of tests, and no one even talked to her about what was going on in her life. So, you know, which version of this brokenness do you see most often, or is it equal?

• 8:45Speaker 00

  So I see both. Obviously, I see all different comers. But I see a lot of people who have been disillusioned by the medical system. They've been treated like a set of body parts, a bag of organs, and they have gone other places for advice, specifically to the wellness world, which I'm very much part of. I mean, I want my patients to be well. If I don't want you to be well, there's something wrong with me. It's a doctor. I also see people who have been given a lot of tests and a lot of scans, but never been asked, what's going on in your life? So the patient I opened the book with is someone who had abdominal pain, didn't have a primary care doctor, went to the ER, got $12,000 worth of tests, and no one has ever asked her, what's going on?

• 9:30Speaker 00

  Turns out she was stressed over having a home situation that was stressful, that she was drinking more coffee, taking Advil. And she didn't need a liver biopsy or more tests. She needed someone to say, hey, I wonder if your stress and your default to alcohol and Advil are affecting your liver and your belly. And they were.

• 9:56Dr. Mary Claire Haver?

  And they were. So when you have someone who comes in and says, I've given up on traditional medicine, what do you say?

• 10:03Speaker 00

  I start with empathy. I say, I get it. I've been a patient. I have been treated like

• 10:12Speaker 00

  A set of organs, a set of diagnosis codes. In fact, I went to medical school to become the doctor that I never had. I also get curious, what happened? Tell me the story.

• 10:23Dr. Mary Claire Haver?

  Yeah.

• 10:23Speaker 00

  The amount of dismissal and over-medicalization is really astonishing. And again, it's not doctor's fault. If you're a doctor and you have five minutes, it's very difficult to understand the nuances of a patient's life and how their stress affects their relationship with food. It's very difficult. So again, first thing is, I understand. Let me understand why you feel disillusioned. And let's meet you where you are. And let me tell you how I work and tell me how you feel about being cared for.

• 11:03Dr. Mary Claire Haver?

  You wrote that knowing your numbers, which I think is important, is not the same as understanding your health. I say something similar about, you know, hormone therapy. You could have a normal estradiol level and still feel terrible, like not everything is menopause. But what are we both kind of pointing at here?

• 11:19Speaker 00

  What I'm talking about is that you can have two patients with the same high cholesterol level. And one of them got there because she's going through a divorce and is binge eating. And so she doesn't need Lipitor, she needs a divorce lawyer. You could have the same person with the same cholesterol levels who's exercising every day and eating a high protein, low cholesterol diet, and just has a genetic predisposition to high cholesterol. That person may need cholesterol medication. So the numbers don't tell the whole story. The numbers are the starting point, not the end point.

• 11:54Dr. Mary Claire Haver?

  Right. This is going to sound very familiar to patients who are listening. In the book, you mentioned that doctors interrupt patients within 11 seconds of them starting to speak. 11 seconds, you get interrupted. Is this fixable? Is this a fixable behavior problem? Or is it a system design problem?

• 12:16Speaker 00

  I think it's a systems design problem. Most of us in medicine, I'm assuming you're the same way, Mary Claire, went into medicine to care for human beings.

• 12:24Dr. Mary Claire Haver?

  Totally.

• 12:25Speaker 00

  So I don't think that a doctor who's interrupting a patient wants to be interrupting. They just know they have three other people in the waiting room, a whole inbox full of messages, and they're just trying to get through the day. So we can talk about this later in the show, but we need a whole-scale reinvention of the healthcare system to allow patients to be heard.

• 12:50Dr. Mary Claire Haver?

  11 seconds, amazing. One of the good and bad things about modern medical care is, you know, our patients are having access through, you know, MyChart and these companies to their portals that give them access to their labs and results, often with no context. So sometimes getting cancer diagnoses or, you know, incidentalomas found on imaging. You wrote about a patient whose brain MRI results popped up showing nonspecific white matter changes. She Googles it, as any human would do at this point, or now go to Claude or AI, and was convinced herself she had multiple sclerosis. And then her headaches got worse from the anxiety.

• 13:31Dr. Mary Claire Haver?

  And the actual cause in this patient was workplace harassment. Should we be giving patients access to this data? I mean, how dangerous could that be? Are you a fan of it?

• 13:41Speaker 00

  But just to be clear, her headaches were from the workplace harassment. The answer to your question, Mary Claire, is that, of course, I believe that patients have a right to their own healthcare information. I think the problem is that when you don't have context around it, and when you have access to unfiltered information, ChatGPT, Google, you can make yourself crazy. You can diagnose yourself with pretty much anything you want to. It's interesting, if you look at studies of how ChatGPT compares to actual doctors, there's studies to show that ChatGPT actually does better than doctors. But remember that in the studies, the questions were being asked by doctors. So the framing was already there.

• 14:26Speaker 00

  When you're a patient, you don't know what question to ask. And so in real life, people are being misled by ChatGPT more often than they're being misled by doctors, if that makes sense. I love ChatGPT. I love Claude. They're wonderful. And I do think that they sometimes have more empathy than physicians do, right? They say, oh, I'm so sorry about that toe pain. That sounds horrible. I mean, that's much more empathetic.

• 14:53Dr. Mary Claire Haver?

  That's how they lead, yeah.

• 14:54Speaker 00

  They are much more empathetic than I might be about someone's toe pain. But there's really no context being provided. And so you can convince yourself that you have the flesh-eating bacteria or a brain tumor if you don't have access to someone to help you make sense of your data.

• 15:09Dr. Mary Claire Haver?

  Patients often see multiple specialists, and we've both seen this, who are not talking to each other.

• 15:14Speaker 00

  Right.

• 15:15Dr. Mary Claire Haver?

  So you describe a shared plan that travels with the patient to every appointment. We used to have this in OB.

• 15:22Speaker 00

  Yeah.

• 15:23Dr. Mary Claire Haver?

  A patient had a, we called it a passport. And we would fill in whatever information from whatever visit, because she was going from clinic to clinic, and we were the high-risk kind of end of the road. She had her passport in her pocket, she'd pull it out, and I could look back and see all of the visits that she'd had and kind of have an idea of what was going on with her care before then. But, you know, why don't you think, you know, most patients have access to something like this?

• 15:50Speaker 00

  Because medicine in the US is so fragmented. And you have a digital avatar of your health in every place you've ever been for medical care. So your pharmacy has a digital avatar of you as someone who's received these three vaccines and got these prescriptions. The ER has a digital avatar of you as someone who had an appendectomy and had a baby. And then your primary care doctor maybe has an avatar of you as someone who has hypertension and high cholesterol. But they're not connected.

• 16:22Dr. Mary Claire Haver?

  Right.

• 16:22Speaker 00

  And one of the hardest parts of being a patient in the US is the lack of integration of all of those pieces of information.

• 16:31Dr. Mary Claire Haver?

  Is anybody doing this well? Any country? It's not us.

• 16:35Speaker 00

  The VA hospital actually does a fantastic, fantastic job. So the VA hospitals in the US have a wonderfully integrated tech platform.

• 16:44Dr. Mary Claire Haver?

  But what if you step outside of the VA?

• 16:46Speaker 00

  If you step outside the VA, it's the Wild West, right? You are a different person in different electronic medical records, and no one is keeping it together in-house. I mean, that's what I do as a primary care doctor, is I spend an enormous amount of time myself and asking my staff to help me pull information from different electronic medical records to house it at home. The medical home is the primary care's office job. But that's not accessible. A hundred million Americans in the US do not have access to a primary care doctor. Primary care is meant to be a hub for problem solving, a home for the whole person, where mental health, physical health, nutrition, body mechanics meet.

• 17:29Speaker 00

  And referrals are meant to be there for when the primary care doctor needs help. But we can solve a lot of problems in-house when we have time with a patient, when we have time to understand someone's grief and loss and vulnerabilities and connect the dots with their labs. And then hand that information to the patient so they can be well in the 364 days a year they're not in my office, right? Health is not about me or the moment you see me, it's about you in your regular life.

• 17:59Dr. Mary Claire Haver?

  How is that going for you in your new practice?

• 18:02Speaker 00

  It's great. I mean, I am the luckiest person alive to be able to care for patients in the way that I wanted to when I was in high school. That I can care for patients, I understand that their blood pressure is informed just as much by their insomnia and work stress as it is by their medications or their genetics. So my job as a primary care doctor is really not to lecture people, it's to help them understand what choices they have, to help them understand where they have agency and where they have to let go. So you can't change your genetics. You can't change, for example, that you have a predisposition to breast cancer or heart disease.

• 18:41Speaker 00

  But what you can do is understand how to mitigate those risks and how to make choices, lifestyle, behavior-wise, medication-wise, to be able to let go of the anxiety you have about these predispositions. So my goal as a doctor is really to hand power from guidelines and the medical establishment back to the patient for them to operationalize whatever plan they need to feel well.

• 19:11Dr. Mary Claire Haver?

  Do you think the magic is time? What is the biggest difference from the traditional way you practiced, you know, in the big practice where you were under time constraints, to the way you're practicing now?

• 19:20Speaker 00

  I think it's time with the patient to be understood. You know, when I was in medical school, at Harvard Medical School in the 90s, we had one class called Patient Doctor, where we learned how to talk to patients, and I loved it. So I had this patient, we had, we had these actors that would come off the key.

• 19:36Dr. Mary Claire Haver?

  Yeah, yeah, yeah.

• 19:37Speaker 00

  And they, I remember this guy, he was, I write about him in the book. He was wearing pink leg warmers. He kind of shook off his day, wherever, whatever his day was, came in, and I had to deliver bad news to him. I had to, I had to deliver to this actor patient that he had prostate cancer. And I thought this was the coolest thing ever, that I had five minutes to establish rapport and to help him trust me.

• 20:03Speaker 00

  And then deliver hard news. So I think that we don't get enough education in medicine, at least I didn't, on how to relate to other people. We talk about body parts. We talk about diagnosis codes. We talk about prescriptions, but we don't necessarily get an education on the whole person. So I think the difference I see in my practice as it is now is that I have time to talk to patients. Time is a requirement for developing rapport and trust. And then I also, because of the time I spend with patients, I have a deep understanding of the relationship between people's mental health, their biography, their story, and

• 20:45Speaker 00

  the choices they make and the barriers they face to execute on the things that doctors recommend to them all the time.

• 20:52Dr. Mary Claire Haver?

  Mm hmm.

• 20:53Speaker 00

  Eat more protein, eat less sugar, exercise every day. Those are wonderful recommendations. I recommend those all the time. You do too. Those are essential. Everybody knows, most people know that exercise is good for you and that strength work matters and that protein is

• 21:10Dr. Mary Claire Haver?

  Underutilized, yeah.

• 21:12Speaker 00

  The challenge I see isn't so much that people don't know that, although there's plenty of people who don't know that, it's that they don't know how to operationalize a plan around it. They have a barrier to entry on the recommendations. So they are feeling ashamed and less than because they can't get protein with every meal. They can't wear the weighted vest. I love the weighted vest. It's wonderful. But if I have a patient who has chronic shoulder pain and depression, my job is to help her fix those things first before we can actually get her in that weighted vest and on the treadmill.

• 21:55Dr. Mary Claire Haver?

  You write that when the healers are sicker than the patients they are supposed to treat, the system is not just broken, it's actively harmful to everyone it touches. You know, we see a lot about, there's a difference between burnout and moral injury. Can you talk about the differences?

• 22:09Speaker 00

  So I have been burned out in my life. I'm guessing you have too.

• 22:13Dr. Mary Claire Haver?

  Totally.

• 22:14Speaker 00

  I had my first child when I was an intern at Johns Hopkins Hospital, and I didn't know what burnout was until later, and that was it.

• 22:20Dr. Mary Claire Haver?

  Yeah.

• 22:21Speaker 00

  Where I was burning the candle at both ends, and I wasn't as good of a doctor because if I'm not caring for myself, it's very hard to take care of other people.

• 22:30Dr. Mary Claire Haver?

  Mm hmm.

• 22:31Speaker 00

  So burnout is, you know, part of the problem in medicine.

• 22:34Dr. Mary Claire Haver?

  Exhaust.

• 22:35Speaker 00

  It's imperative that physicians apply the same level of self-awareness and self-care that we recommend to our patients. We are not good at that as a general rule. Doctors are not generally very good at taking their own advice. At least I have not been historically. Moral injury, I think of as the inability, because of a systems problem, to take care of patients in the way that you want to, that you need to, for your core values. So take the pandemic, for example. We saw a lot of moral injury during the pandemic where people were not able to care for patients, say, a patient who is at the end of their life in the ICU, and not able to see their loved ones at the end of their life. That's

• 23:19Speaker 00

  moral injury to a doctor who's empathetic. It's moral injury to the patient and their families as well. But take a more practical example of moral injury. A more practical example of moral injury is simply not having time to talk to patients. So if you don't have time, and you have a patient who's crying in your office because of

• 23:38Dr. Mary Claire Haver?

  Anything.

• 23:39Speaker 00

  pain with intercourse, or depression, or they've been confused and been given conflicting advice about some medical problem. It is hard on the caregiver, like it is the patient, to not have the time to understand what's actually going on with that person.

• 23:57Dr. Mary Claire Haver?

  Yeah. I, you know, trained under what was a charity system at the time, and, you know, anyone who walked through the doors, we took care of.

• 24:04Speaker 00

  Yeah.

• 24:05Dr. Mary Claire Haver?

  And the state would pay the check, you know? And then I went into private practice, then came back on as faculty, and the whole system had become more corporate, and they got rid of the charity system. And then now it was insurance-based, and a few counties would feed into our hospital that had kind of plans, but not all. And so we would get these patients who we could cure their cancer with a simple surgery or something very basic, but we had to turn them away because they couldn't pay. And I'll never get over that, having to sit down and tell a patient, you need a simple hysterectomy, or you need a, you know, whatever, and this would 100% cure your cancer, like a stage one in a metral,

• 24:48Dr. Mary Claire Haver?

  right? But we can't do it because you can't pay. And that was really, really hard because I didn't, that wasn't how it was in medical school. That wasn't how it was in my training. And then to turn around as like the boss in charge and have to look someone in the eye and say, you're too poor for me to save your life, was one of the hardest things I've ever had to do.

• 25:09Speaker 00

  It's excruciating. If you think about all the unmet needs out there in the community, and all the people who do not have access to a medical guide who's evidence-based and centered on the patient's needs, it's, it's, it's really soul-crushing.

• 25:25Dr. Mary Claire Haver?

  Mm hmm.

• 25:26Speaker 00

  This book is one attempt to help people make sense of this dizzying landscape where most people go to the ER for their primary care.

• 25:36Dr. Mary Claire Haver?

  Now, yeah.

• 25:37Speaker 00

  And then look on the internet for wellness advice. Now, again, we need doctors. We all want to be well. The solution is not to become your own doctor, is to be a more empowered patient.

• 25:48Dr. Mary Claire Haver?

  Okay, we'll get into it. You describe patients as being stuck between two extremes, a healthcare system that reduces them to checklists, and a wellness industry that can be full of false promises. You know, what does that look like in your exam room, really for women in midlife? Because that's our audience.

• 26:04Speaker 00

  Yeah.

• 26:05Dr. Mary Claire Haver?

  Right?

• 26:06Speaker 00

  Well, you see this too. I see patients who come in who are like 30 years old, and they're like, I have brain fog. I think I'm perimenopausal. And they may be, but they may also have brain fog because they're raising children, they're working full-time, they don't have a supportive spouse, and they're not sleeping enough. Sometimes things are much more simple than

• 26:25Dr. Mary Claire Haver?

  Right. Not everything is hormones, guys.

• 26:27Speaker 00

  That's it. But a lot of it is. I mean, I don't need to tell you, Mary Claire Haver, that women have been deprived for generations about basic information about their hormonal health, and their brains, and their hearts, and their bones. But what I'm seeing out there is that people are being misled by voices that are very certain. So if you hear someone talking on the internet, and by the way, I'm on the internet, you're on the internet, like, and I'm trying to spread truth and facts. But if you hear someone on the internet who's preaching certainty, who's convinced that you will be better if you just do X, Y, or Z, and do as I say, that's a red flag.

• 27:09Dr. Mary Claire Haver?

  Mm hmm.

• 27:10Speaker 00

  I would say the same thing about a doctor. If you see a doctor who says, don't do this, do this, do as I say, that's also a red flag. So, you know, doctors don't speak in absolutes. We speak in ways like this. I wonder if you've thought about how this medication might affect you in this way versus this other alternative treatment. What do you want? That's how we speak. We speak in nuance. We speak in

• 27:36Dr. Mary Claire Haver?

  We should be.

• 27:37Speaker 00

  relative risk. But that, but that's how we should be speaking. Yes.

• 27:41Dr. Mary Claire Haver?

  Okay. What, right now, you know, for women, what are you seeing as, as really dangerous wellness advice? So what is trending out there that you're like, whoa?

• 27:50Speaker 00

  So I think the biggest problem with some of the voices in the wellness space is suggesting that yoga and mindfulness and quinoa are necessary and sufficient for health.

• 28:02Dr. Mary Claire Haver?

  I think it, it's placing blame and shame on the patient.

• 28:05Speaker 00

  Absolutely.

• 28:06Dr. Mary Claire Haver?

  That she walks away from that message feeling like she did something fucking wrong.

• 28:10Speaker 00

  Yes.

• 28:11Dr. Mary Claire Haver?

  You know, that somehow she wasn't yogying enough, or, you know, she wasn't wellnessing her way out of whatever situation she's in. We preach the same lifestyle, right?

• 28:20Speaker 00

  Yes.

• 28:21Dr. Mary Claire Haver?

  Both sides of the fence, but not in absolutes, right? Like, and I, I just hate when I see these, you know, messages, and somehow the woman, especially the female patient, she's always doing something wrong.

• 28:36Speaker 00

  It's not enough. The problem I have with the wellness space, again, is similar to what you said. It's that it's, it's implied that it's necessary and sufficient to, you know, lifestyle your way to health. Two, that it's not enough, that you're not doing enough, and that you can't always be doing better. And it plays a shame on the individual. And then third, I think it often leads people away from doctors. Now, doctors do a very good job of shaming patients as well. I mean, we are the chief shaming officers in many ways. Take my patients who have suffered from obesity their whole lives. I mean, they will tell you

• 29:09Dr. Mary Claire Haver?

  Yeah.

• 29:10Speaker 00

  how shamed they have been by the medical establishment. It is a crying, crying shame. But I think what I'm trying to message in this book is the both and. You can try to be healthy with exercise and lifestyle and behaviors. You also need a doctor to partner with you, to shepherd you through sickness and in health.

• 29:32Dr. Mary Claire Haver?

  Let's talk about supplements.

• 29:33Speaker 00

  Yeah.

• 29:34Dr. Mary Claire Haver?

  We, of course, in the medical history, ask about all supplements that patients are taking

• 29:39Speaker 00

  Yes.

• 29:40Dr. Mary Claire Haver?

  in our clinic, and I'm sure you do. Are you, what are you seeing in the supplement world? Like, that scares you?

• 29:44Speaker 00

  I think the reason the supplement industry scares me is because I think people often think of it as a substitute for medical care. So it drives people away from medicine. Now, again, as I just said, I'm a both and person. There's a role for supplements. There's also a limitation that supplements have. Same thing with pharmaceuticals. There's a role for Lipitor, but there's a limitation of Lipitor, right? Lipitor can lower your cholesterol, but it's not going to change your stress that's making you overeat. I think the problem I have with supplements is that

• 30:21Speaker 00

  There's this notion that there's a one size fits all program for people. I love supplements. I take supplements myself, certain supplements. I prescribe and recommend supplements. But there are limitations to supplements. There are also limitations to pharmaceuticals. So the question isn't, do you maybe need a supplement? Or do you need a prescription medication? It's what is your goal? And what are the limitations of these things you're taking for the health issues that you have? So let me give you an example. I have patients come in all the time and they say that I'm taking ashwagandha for my sleep. I'm taking magnesium for my constipation. I'm taking fish oil for my heart.

• 31:02Speaker 00

  And they have a number of complaints that haven't actually been addressed. And they don't really know that their constipation is because they're not getting enough fiber, that their brain fog is actually menopausal, and their sleep is disrupted because they're drinking too much caffeine. So instead of supplements, I want them on the thing that would actually help them. Hormone replacement therapy, fiber diet.

• 31:28Dr. Mary Claire Haver?

  Higher fiber diet.

• 31:29Speaker 00

  And, you know, understanding that alcohol plus menopause means you're gonna sleep.

• 31:34Dr. Mary Claire Haver?

  You're not gonna sleep.

• 31:35Speaker 00

  Terribly. So the supplement industry, I think, meets an unmet need, but we want, we want to make sure we're solving the right problem.

• 31:42Dr. Mary Claire Haver?

  Right.

• 31:42Speaker 00

  Right.

• 31:43Dr. Mary Claire Haver?

  Let's talk about the bad boyfriend in the book.

• 31:45Speaker 00

  Oh, the bad boyfriend? Yeah.

• 31:46Dr. Mary Claire Haver?

  Trackers, wearables, shareables, nearables. Are you a fan?

• 31:50Speaker 00

  So I think an empowered patient is a better patient, right? I understand why people want to track their sleep, track their steps. I think these trackers are wonderful. It's sort of democratized, you know, medical data. But as we talked about earlier, Mary Claire, data without context isn't particularly helpful. So here's what I tell patients about data. When you want to bring that data to your doctor, bring the patterns, not just a single data point. It's more useful to me to know that your sleep was disrupted when you were laid off from your job than it is to know that you had a bad night's sleep just one off. It's helpful for me to know that your headaches and your migraines got worse

• 32:32Speaker 00

  when you slept less than six hours than just handing me a spreadsheet. I think what's most interesting about the explosion of the wearables is that it shows us just how disconnected people often are from their own bodily cues.

• 32:46Dr. Mary Claire Haver?

  Right.

• 32:47Speaker 00

  We live in a hustle culture. We live in a culture where we can have access to the internet 24/7. And I think it's interesting that some people need a Oura ring to understand that they're tired. Or they need a device to tell them that they're hungry. And I think it says a lot about society and modern hustle culture that the devices are so popular. I also think they're wonderful in many ways.

• 33:13Dr. Mary Claire Haver?

  What about, I'm seeing a lot of, you know, contention around the continuous glucose monitors. I've tried them.

• 33:20Speaker 00

  Yeah.

• 33:21Dr. Mary Claire Haver?

  And out of curiosity, I have, I had insulin resistance. I've gotten it managed. And I was curious.

• 33:27Speaker 00

  Yeah.

• 33:27Dr. Mary Claire Haver?

  Right? And they offered me a free one. So I'm like, sure. I had more anxiety.

• 33:32Speaker 00

  Yeah.

• 33:32Dr. Mary Claire Haver?

  From, you know, I do wear an Oura ring and I've made peace with it. And I use it, I think, in a healthy way.

• 33:37Speaker 00

  Yeah.

• 33:37Dr. Mary Claire Haver?

  But that glucose monitor made me crazy.

• 33:40Speaker 00

  Well, that's the bad boyfriend I was talking about. So I recommended to one of my patients to take off her Oura ring because it was making her feel bad about herself. It was demanding more and more from her. It was like a bad boyfriend. And she took it off and she finally slept. She was having insomnia because she was so stressed about the lack of sleep she was getting. So the CGMs, the continuous glucose monitors, can be really useful. I recommend them all the time for patients who have, you know, diabetes, of course. That's the standard recommendation.

• 34:10Dr. Mary Claire Haver?

  But someone who's otherwise metabolically healthy.

• 34:13Speaker 00

  For someone who's metabolically healthy or who has an elevated hemoglobin A1C that's, you know, pre-diabetes, it can be really informative because everyone's metabolism is a little bit different. And it can be useful to get a microscopic view of what in your daily life affects your blood sugar and, and why. So in the spirit of empowering patients with information, they can be very empowering, but they can also be an albatross and cause people to restrict and overthink eating. And then it's a net negative.

• 34:45Dr. Mary Claire Haver?

  You write in the book, and I see this all the time on social, you know, some of the darker side of wellness culture is you are ill because you didn't try hard enough. You got sick because you failed at wellness. Talk about that.

• 34:59Speaker 00

  The ease with which the medical establishment and the wellness culture we live in shames patients is pretty astonishing. I think people know that exercise is good for them. Like, I don't know if we need more studies to show that exercise helps with brain health, with heart health, with metabolic health.

• 35:15Dr. Mary Claire Haver?

  We all agree. Everybody agrees. All sides of health and wellness agree. Yeah.

• 35:19Speaker 00

  We all know that broccoli is good for you and like eating sheet cake is not as good for you. Right? I would argue that sheet cake is good for you every now and then, right? It's like part of joy. So what I want to tell patients, and this is part of what is in my book, is that health is very personal. It's not about a specific protocol. It's not about a specific diet. It's not about someone else's version of health. And we can reduce shame and feel like we're enough when we understand what our actual needs are first. So in the book, I talk about five elements for being healthy and being an empowered patient.

• 35:57Dr. Mary Claire Haver?

  Okay, what are those?

• 35:58Speaker 00

  One of them is understanding what health is to you. Not everyone wants to be exercising seven days a week and optimizing their macros. And that's okay. Not everyone who has an extra 10 pounds on them or 50 pounds wants to lose that weight. That's okay. I mean, of course, being obese, having extra weight on you carries risk. But my first question to my patients isn't, what do I want? It's what do you want? It's also to help them understand, okay, if you were to lose this 10 pounds, this sort of menopause weight gain, here's what that would require.

• 36:42Speaker 00

  And here's the risk of keeping it on you. And then helping them make decisions that work for their life.

• 36:48Dr. Mary Claire Haver?

  But all of society is telling them those 10 pounds are bad. Every magazine article, every picture of a celebrity who's over 50 now on the red carpet. And so when all of the messages are coming from, you know, we need to look like 14-year-olds.

• 37:04Speaker 00

  Right.

• 37:05Dr. Mary Claire Haver?

  You know, how, how do, how do you counsel your patients about that?

• 37:08Speaker 00

  I really want patients to give themselves permission to understand what health looks like for them. For some people, that's feeling comfortable in their own body. So for other people, it's not living in pain. For some people, it's not being depressed. For some people, it's being a certain body size, and that's okay too. But the biggest question you can ask yourself as a human being, in my opinion, is what does health look like to me? What is that defined by? Is it a certain cholesterol level? Is it a certain body mass index? Is it a certain, is it an appearance?

• 37:51Speaker 00

  Or is it a sense of agency, a sense of purpose, a sense of having access to guides when I run into problems? The healthiest people in my practice, who are in their 80s and 90s, are patients who don't necessarily have the perfect labs, but they're patients who have understood where they need to relinquish control and where they have agency. They've made peace with the parts of their health and their life they cannot change. So it's a little bit like the serenity prayer of health is what I'm talking about. I think, you know, in our 20s and 30s and 40s and 50s, women in particular are told that health is about a certain number of steps per day, a certain weight.

• 38:35Dr. Mary Claire Haver?

  A certain amount of protein.

• 38:36Speaker 00

  A certain amount of protein.

• 38:37Dr. Mary Claire Haver?

  A certain supplement stack.

• 38:38Speaker 00

  A certain supplement stack. And that's not wrong. But there's more to health than a set of protocols or someone else's version of health. So if I had one message to patients at the end of reading this book that I've written, it's stop and ask yourself, what does health actually look like to you? You know, if you talk to enough people at the end of their life, you want patients who are not at the end of their life to have that kind of wisdom and self-reflection and ability to pull down the sort of defenses and the, the shoulds. And you want to apply that knowledge to you right now. That's what I try to do in my life now. I've had to define health. It's, it's not just about a set of labs or a certain BMI.

• 39:23Speaker 00

  It's about a sense of agency and purpose and meaning. It's about relationships with other people, with food, with alcohol. It's also about knowing where you need help. So I don't think health is a one-person job. I think it takes a team. And you may need to assemble a team to help you be healthy that includes a yoga instructor, that includes a cardiologist, that includes a walking partner on the weekends. So one of the things I talk about in the book is how to build your team. It doesn't have to be expensive. It doesn't have to be fancy. But you want to make sure that you are solving the right problems and not solving someone else's problem for you.

• 40:14Dr. Mary Claire Haver?

  Okay, let's talk about self compassion. So you wrote, "Sometimes our bodies need fresh chemistry, new behaviors, and deeper self-awareness all at once."

• 40:23Speaker 00

  Yes.

• 40:24Dr. Mary Claire Haver?

  "Two or more things can be true at the same time, but no prescription will work efficiently without a dose of self compassion."

• 40:32Speaker 00

  I think you know this, but we all have an internal narrative in our minds, right? We have the critic, we have the governor. You have that voice in your head that says, "Oof, you shouldn't have done that," or "Ooh, you really blew that," or "Wow, if only you were XYZ, then you'd be better." That narrative, if it occupies too much brain space, too much real estate up there, it can inform your health more than a prescription will. So one of the things I talk to my patients about, and one of the things people need to ask themselves about, is what are the stories you're telling yourself? What are the voices in your mind, the shoulds, the what ifs,

• 41:17Speaker 00

  the oh my God, the catastrophization? What are those voices telling you? And how do those affect your everyday habits? So if you have a narrative that says, "You're not thin enough, you're not fit enough," and then you skip lunch, and then you overeat at night because you're hungry, because you're human, and then you feel ashamed the next morning, and then the voice tells you, "You ate too much last night," and you keep doing the same pattern, then you have a problem with your relationship with food. And maybe your weight's going up. You don't need Ozempic, you just need lunch. Maybe your negative inner critic is born from someone in your life who, you know, you need distance from.

• 42:01Speaker 00

  The point is, self-awareness is a superpower. And if you can understand what you're telling yourself, that can help you immensely show up as a more informed consumer of healthcare and a more powerful agent of change in your own life.

• 42:18Dr. Mary Claire Haver?

  You wrote about a patient in her 60s who came in asking for Ozempic, a stronger pain medication, and a sleep aid. Okay? And you realized, after talking to her and getting to know her, what she actually needed was a dose of self compassion. Walk me through what you saw in the room with this woman.

• 42:35Speaker 00

  So you see this patient, I see this all the time. People come in, they've looked up online what their complaints are. They come in with a list of things they want, pain medication, Ozempic, and something else. And those are things I prescribe. I think Ozempic is a wonderful medication in the right context. But before we start solutioning problems, I want to understand what we're actually solving. So this patient had been bullied and shamed by her dad since she was a kid. She was told she was fat and lazy since she was 10 years old. Those narratives die hard, right? When you are an adolescent and young adult, our brains are extremely plastic.

• 43:19Speaker 00

  And the narratives that we literally hear from our parents, the narratives we hear from society, those thought patterns can get laid down like concrete highways. And it takes a lot of self-awareness and sometimes therapy to help reroute those thought patterns. So when I took a minute to understand what was going on, that she was having pain because she had a hip problem, and the hip problem resulted from her weight problem, and her weight problem resulted from a shame problem, she didn't need Ozempic and pain meds. She needed a dose of self compassion to understand that the narrative that she was telling herself,

• 44:01Speaker 00

  the story that she was telling herself of unworthiness was coming from her childhood.

• 44:06Dr. Mary Claire Haver?

  Did it work?

• 44:07Speaker 00

  Absolutely.

• 44:08Dr. Mary Claire Haver?

  How did you do that? Are you a therapist?

• 44:10Speaker 00

  Well, I kind of am. No, but I said, "Look," I asked the question. I said, "You're getting emotional when you're talking about how frustrating it is that you can't lose weight, and why you skip lunch, and you do it all over again." And she started crying. And that's the moment where you say, "Pen down, laptop closed, what's going on?" Well, she said, "My dad shamed me for being lazy and fat since I was 10 years old." Okay, let's talk about that. First of all, I'm so sorry. And second of all, let's address that, because that is probably informing a lot of your everyday choices in ways that you may not even be aware of. And I'm not going to do therapy with her, but I'm going to have her see someone who helps,

• 44:55Speaker 00

  will help her untangle their relationship with food and their relationship with her dad.

• 44:59Dr. Mary Claire Haver?

  Right.

• 44:59Speaker 00

  So let me just say this too. It's a lot easier to prescribe Ozempic and pain pills than it is to have that conversation. And that's where medicine is falling down, not being able to understand the whole person.

• 45:09Dr. Mary Claire Haver?

  Right, I mean, I have patients coming in on polypharmacy, meaning multiple different prescriptions. When everyone's like siloing

• 45:16Speaker 00

  Right.

• 45:17Dr. Mary Claire Haver?

  each symptom, "Okay, we're going to give you a sleeping," "So we're going to give you a benzodiazepine for your sleeping habits." "We're going to give you a beta blocker for your palpitations." And we're going to get, you know, and so they end up on multiple meds, each individually treating problems where there's a common thread.

• 45:33Speaker 00

  There's a common thread.

• 45:33Dr. Mary Claire Haver?

  And no one's trying to untangle, because we don't have time, we're not trying to do it, you know, and women are very complicated. And then we throw hormones on top of it, you know, and the whole system goes cattywampus. So let's go to the woman who's pushing through perimenopause symptoms.

• 45:48Speaker 00

  Yeah.

• 45:49Dr. Mary Claire Haver?

  My patients, and I'm sure yours, are busy women. They have built these busy, busy, complicated lives. I mean, they could be CEOs, moms, stay at home, whatever. It runs the gamut, but they are busy, you know? But they had it, they managed it. They had it, they had it under control. The ebbs and flows, the ups and downs, they could manage and still be okay, right? And now they're not okay. They're running on fumes, cortisol's going crazy, hormonal chaos in the background. How do you counsel them?

• 46:22Speaker 00

  So first, I want people to understand that they are more normal than they think. That it's God's cruel joke that we put people through perimenopause. When you're raising children, you're caring for elderly patients, and you're at that career moment where you're, you know, maybe not the top, but you're almost there and you're hustling. So I want people to understand that they're not crazy, that they're human. And then secondly, I want people to understand that there is help for menopausal symptoms. You know, 10 years ago, we would prescribe antidepressants for the depression.

• 46:57Dr. Mary Claire Haver?

  I was 100% guilty of polypharmacy. I just wanted to help the patients, and here are the tools I have. And so I'll give you six different things to treat each, and no one had taught me, and I didn't understand the common thread of menopause.

• 47:12Speaker 00

  The root cause, right? There's almost nothing more satisfying than having the phone call I did last week with a patient who, I put on an estrogen patch about a month ago. She's 45, she has an IUD for the progesterone element of hormone replacement therapy. I put her on an estrogen patch for all the symptoms of perimenopause that other doctors had told her was just stress. You know, her boss, who's a woman, said, "You're just working too much. You need to, you know, take a day off." And she calls me, and she's like, "I can't believe how much better I feel." And I said, "Describe." And she said, "The best way I can describe it is I feel like myself." And I said, "That is what we want. We want you to be you." She was sleeping better, she was not having hot flashes,

• 47:55Speaker 00

  she wasn't having that irritability that comes from your hormones being yanked around. And in the old days, even 10 years ago, and I did this too, you would have prescribed, you know, an antidepressant, a sleep aid, and sort of patted people on the back and said, you know, "Use a fan at night and put your foot out of the cover so you don't get so hot."

• 48:15Dr. Mary Claire Haver?

  One leg.

• 48:15Speaker 00

  One leg. But we now know so much more. And so it's great to be able to empower people with the basic information. So to the woman who says, "I feel crazy during perimenopause," I would say, "Welcome to the club, and you're more normal than you think."

• 48:29Dr. Mary Claire Haver?

  Yeah, you feeling crazy is a predictable biological consequence of being in perimenopause.

• 48:34Speaker 00

  Yes.

• 48:35Dr. Mary Claire Haver?

  But we can help you. The funniest story, you know, I was early in my menopause clinic, which, you know, I built like Field of Dreams. I don't know if anybody will come see me, and I'm just going to try this and see what happens. And I had a patient, young, very much perimenopausal. She came in, we started her on hormone therapy. She comes back for her follow-up, and she's stomping down the hall furious. And I'm like, "Oh, God," you know? Throws herself in the chair, sits down, and is like, "I feel great." And I'm like, "Okay, you know, like, good, right? Why are you so upset?" She says, "Because I was allowed to suffer for so long. No one should feel this way."

• 49:14Speaker 00

  Right.

• 49:15Dr. Mary Claire Haver?

  I'm like, "What are we doing?"

• 49:17Speaker 00

  Right.

• 49:17Dr. Mary Claire Haver?

  And it took social media for me to learn so much about this.

• 49:21Speaker 00

  Oh, yeah.

• 49:21Dr. Mary Claire Haver?

  You know, we weren't talking about this in clinic, in traditional practice. We were just hustling to get from one patient to the other, and run to the OR, and do all the other, and then get to soccer practice and pick up my kid, and make sure the nanny's got food going and whatever. And it was social media and listening to thousands and thousands of voices to realize, one, how much women are being gaslit.

• 49:43Speaker 00

  Absolutely.

• 49:44Dr. Mary Claire Haver?

  Bias system.

• 49:45Speaker 00

  Yep.

• 49:46Dr. Mary Claire Haver?

  Why do you think that's happening?

• 49:47Speaker 00

  Because doctors don't have time, and because we weren't trained. I was at Harvard Medical School in the 90s and early 2000s, and I learned very little about menopause. In fact, I don't think I learned anything.

• 49:57Dr. Mary Claire Haver?

  I was at LSU, a very much a state school, super proud of it. We're learning the same thing.

• 50:02Speaker 00

  We didn't learn anything about it. We didn't learn much about nutrition. We didn't learn about mental health. I mean, my mental health education was going to a psych hospital where people were talking to the walls.

• 50:12Dr. Mary Claire Haver?

  Schizophrenia, right.

• 50:13Speaker 00

  When, guess what? We all have mental health as part of the human experience. It's ground zero for health. So the point is that we weren't taught these things. And like you, I had to learn about menopause from people like you, from my friends Rachel Rubin and Sharon Malone, and, you know, reading and studying and understanding the nuances, and continuing my education on it, because things change, things evolve. And I think the best thing a doctor can do is to say, I have new information and my opinions and views and guidance have changed over time to have the humility to acknowledge that we have been part of the problem.

• 50:49Dr. Mary Claire Haver?

  How do you guide someone back who was dismissed, was gaslit, turned to alternative sources, was not served there?

• 50:59Speaker 00

  Yep.

• 51:00Dr. Mary Claire Haver?

  You know, how do you bring her back to evidence-based without making her feel bad or shame that she just was looking for help?

• 51:08Speaker 00

  To that person who's been gaslit or dismissed by the medical system, I say, I am so sorry, I understand that. And we have been complicit in shaming and blaming the patient. The system wasn't built for the whole person in mind. So to anyone who feels misunderstood or not heard, that's not a you problem, that's not a us problem.

• 51:30Dr. Mary Claire Haver?

  It wasn't actually built for the female body.

• 51:31Speaker 00

  It wasn't actually built for you. So I think, you know, the first step towards gaining trust is being humble about what we don't know, what we didn't know, and acknowledging people's pain. And then you can try to help someone when they trust you and when you feel like they understand where you're coming from and vice versa.

• 51:52Dr. Mary Claire Haver?

  Okay. Like, why would someone buy this book? What are they going to get out of this book?

• 51:56Speaker 00

  They're going to get a practical roadmap to getting what they need from their doctor's appointments and watching out for the landmines in the wellness industry. The solution, as I said earlier, is not to be your own doctor, it's also to recognize we all want to be well. But it gives you vocabulary to bring to your doctor's office.

• 52:17Dr. Mary Claire Haver?

  Okay.

• 52:18Speaker 00

  It gives you an understanding of a way to frame your whole health ecosystem. It gives you a visual representation of the health ecosystem. Health is not just about your lab tests or a normal mammogram. Health is about your biographics, your story, were you raised by an alcoholic mother? Were you raised in poverty? It's about not just what you eat, but what's your relationship with food?

• 52:44Dr. Mary Claire Haver?

  Mm-hmm.

• 52:45Speaker 00

  Are you a stress eater? Are you a restrictive eater? Are you an emotional eater? It's about understanding where you are mental health-wise. We all have mental health. It's about anxiety and where do you live on the continuum of anxiety? It's a roadmap to help people ask better questions of themselves and then of their doctors.

• 53:04Dr. Mary Claire Haver?

  What are the first steps that a woman can take to reclaim agency in her medical encounter, even when she's only got seven minutes? So what are your top tips?

• 53:13Speaker 00

  My top tip is to stop and ask yourself, what do you actually need? How do you feel? What are the actual pain points in your life? Is it stress? Is it insomnia? Is it your weight? Is it lack of access to a doctor who can answer your question when you're up in the night and on Dr. Google? What are the things you actually want? I think we're given so many messages about what health is out there, when health actually starts in here. So the first step is self-awareness.

• 53:46Dr. Mary Claire Haver?

  Okay. What do you say to the woman who can't afford, you know, she, insurance is her only option?

• 53:52Speaker 00

  Yep.

• 53:53Dr. Mary Claire Haver?

  Will these guidelines work for her as well?

• 53:56Speaker 00

  This book is my attempt to reach people who don't have access to a doctor who has time, which is most people.

• 54:04Dr. Mary Claire Haver?

  Right.

• 54:05Speaker 00

  Again, not through doctor's fault, the system is not designed to take time with people. So it is designed to help you sketch out, map your health ecosystem, your nutrition, your body mechanics, your mental health, your medical data. It's a guide to ask smarter and better questions based on your problems and your needs and your unmet issues. And it's a way to help you prioritize yourself and not someone else's version of health.

• 54:34Dr. Mary Claire Haver?

  You want every patient to become CEO of their own health? I love that. What does that look like practically today for a woman in her 40s or 50 who's managing her symptoms, her family, and a 12-minute appointment once a year?

• 54:47Speaker 00

  Right. Let me first say that not everyone does want to be the CEO of their health. If you look at one of the chapters that I put in the book, it's about the patient personality. So one of the ways to have agency of your health is to identify what kind of patient you are. So in the spirit of self-awareness, understand, are you the person who brings reams and reams of printouts from Google to your doctor's appointment? Or are you someone who just wants a prescription and you don't want to understand the why? That's self-awareness, that's self-empowerment. And not everyone wants to be the CEO of their health. Some people just want, tell me what to do and tell me where to go get it. And other people are skeptical. They've got the one eyebrow raised and they're like, hmm, I know you recommend that medication

• 55:32Speaker 00

  or habit, but why? So not everyone wants to be the CEO of their health. I think like, some people do, but I think the point is to be able to be an empowered advocate for the needs that you have, which sometimes means asking where to get help.

• 55:46Dr. Mary Claire Haver?

  Okay. You've got your appointment, you want to show up at your doctor's office prepared.

• 55:51Speaker 00

  Yes.

• 55:52Dr. Mary Claire Haver?

  What do you recommend?

• 55:53Speaker 00

  First thing is know what questions you want answered. Like, what drop-dead things do you need to know before you leave? And communicate to the doctor that. Say, here are the three things I don't want to leave without having answered. Number two is make sure that you've mapped out your health ecosystem, kind of prepackage yourself before you show up to the-

• 56:14Dr. Mary Claire Haver?

  How do you do that? How do I map that out?

• 56:16Speaker 00

  So that's what the book is about.

• 56:17Dr. Mary Claire Haver?

  Okay.

• 56:18Speaker 00

  The book is basically a guide to map your health ecosystem, to help you understand the different components of your health. It's not just your labs, it's your story, it's your body mechanics, it's about pain, past injuries.

• 56:28Dr. Mary Claire Haver?

  And do you hand this to a doctor?

• 56:29Speaker 00

  No, you do this before you go to the doctor. So this, this book is basically prepping you to be a patient. So if you go on my website, beyondtheprescription.com, you can get the downloadable map of your health ecosystem. And you can write out, based on the instructions in the book, the different elements of your health. What's powerful is the downloading of information that you have inside you already.

• 56:56Dr. Mary Claire Haver?

  Mm-hmm.

• 56:57Speaker 00

  And then seeing how you can connect the dots between your childhood trauma and your relationship with food and your cholesterol. The interesting thing about the health ecosystem isn't just the components, it's about the relationship between your anxiety and your sleep and your protein and your blood pressure. So if you can do the homework and you're a prepackaged patient, by mapping your health ecosystem, you are then going to squeeze more juice out of that 15-minute appointment with your doctor.

• 57:27Dr. Mary Claire Haver?

  What do you think about patients ordering their own labs?

• 57:29Speaker 00

  I think it's a terrible idea. I mean, we're not In-N-Out Burger. It's not that I'm saying I'm better than In-N-Out Burger. I'm not morally superior to In-N-Out Burger. I'm just saying that like, I do have some training, you've had some training, you know a few things about how to apply medical knowledge to the data in front of you and the person in front of you. So I think that if you look at the landscape out there, basically, we're moving to a place where we're asking people to be their own doctor. Download your labs into this chatbot, operationalize a plan, and here's the protocol, print it out, put it on your fridge, and do that. And what that does, it deprives people of agency because it doesn't help them connect the dots between their everyday experience, the limitations in their lives, their fears,

• 58:14Speaker 00

  their vulnerabilities, their problems they're embarrassed to say out loud. It just assumes a certain risk and risk tolerance, it assumes a certain set of goals, and there's no human element there, which is really essential for providing care and for receiving it.

• 58:34Dr. Mary Claire Haver?

  Do you think we'll ever get there, that they'll train the algorithm?

• 58:37Speaker 00

  So this is actually my fantasy. This book is not an ego project. This book is actually my calling card to be part of the health reform movement.

• 58:47Dr. Mary Claire Haver?

  What is the health reform movement?

• 58:49Speaker 00

  Well-

• 58:50Dr. Mary Claire Haver?

  Like, what would perfect healthcare look like? I've lived overseas, I've seen the positives and negatives of socialized medicine.

• 59:00Speaker 00

  Yes.

• 59:01Dr. Mary Claire Haver?

  Right? Like, in the UK, clinicians, physicians mostly, practice in a very narrow set of protocols.

• 59:07Speaker 00

  Right.

• 59:08Dr. Mary Claire Haver?

  And if they step outside of the protocol, as that was put together by a very small group of people sitting in government-type agencies, they could lose their license-

• 59:17Speaker 00

  Yeah.

• 59:18Dr. Mary Claire Haver?

  -to practice. So like-

• 59:20Speaker 00

  So I'm not recommending socialized medicine. This is the United States of America, I don't think that's ever happening.

• 59:24Dr. Mary Claire Haver?

  Okay.

• 59:25Speaker 00

  Even if it were a good idea, I don't think it's happening. What I think needs to happen is that we need to scale primary care and dispense it to communities all around the country. Let me say this, if you look at total healthcare spending in this country, 95% of healthcare dollars go to damage control, hospitalizations, ER visits, and damage control medicine, 5% to prevention. There's no shortage of evidence in the medical economics world to show that when you dispense primary care into communities, people live longer and they live better. And we save money.

• 1:00:09Speaker 00

  So that is not up for debate. Like, it's already been decided that deploying-

• 1:00:13Dr. Mary Claire Haver?

  Then why isn't it happening?

• 1:00:15Speaker 00

  Because the insurance companies have a hold on the medical system. They have a hold on doctors.

• 1:00:19Dr. Mary Claire Haver?

  Should we get rid of the insurance companies?

• 1:00:21Speaker 00

  I don't think you want to get rid of insurance companies.

• 1:00:23Dr. Mary Claire Haver?

  Because the number one cause of bankruptcy in the US is medical debt.

• 1:00:26Speaker 00

  Exactly.

• 1:00:27Dr. Mary Claire Haver?

  So-

• 1:00:28Speaker 00

  But there's an easy solution to it.

• 1:00:29Dr. Mary Claire Haver?

  All right.

• 1:00:30Speaker 00

  I'm not saying it's going to be simple to execute.

• 1:00:33Dr. Mary Claire Haver?

  Simple is different than easy.

• 1:00:34Speaker 00

  But easy, I mean, this has been shown again and again. Like, just like we don't need more studies to show that exercise is good for you, we don't need more studies to show that primary care, when deployed nationally and when scaled, saves money, saves lives. When you have a doctor who knows your name and not just your diagnosis codes, who can connect the dots between your sleep, your stress, your grief, your cholesterol, your blood pressure, and then help you make a plan that works for your life, that is medical care. So there's no mystery as to how we solve the healthcare crisis in this country. It's by scaling primary care and deploying it nationally, not just for people who can afford it, but for every American.

• 1:01:17Speaker 00

  Every American needs unfettered access to a primary care medical home. And the primary care medical home needs to be a hub for problem solving, not just a gatekeeping apparatus and a prescription mill. That's what medicine should be. That's what I thought I was doing when I went into primary care as a field. AI has a role in the healthcare transformation space. But if we use AI to replace the patient-doctor relationship, we're no better off. What we need to use AI and technology to do is to elevate the patient-doctor relationship and for AI and technology to do all the crap work that is required to do the backend of, you know, running a primary care practice and all the grunt work that doctors do that could be done better

• 1:02:03Speaker 00

  by AI or some technology. That is going to happen if we have doctors shepherding technology in the appropriate way. But if we let AI and AI alone reinvent the healthcare system, then healthcare is going to be this. It's going to be a chatbot and, you know, physician extender for their license to just prescribe medications.

• 1:02:26Dr. Mary Claire Haver?

  Well, that's the way corporations will make the most money. So what needs to happen?

• 1:02:29Speaker 00

  You need a populist movement. You need a movement of empowered patients, one at a time, to demand what they don't even know is possible. I don't think people know what is possible in healthcare when you have a relationship with a doctor who understands you and not just your medication list. People don't know to ask for it because they don't know that exists. But more and more doctors are leaving the system and voting with their feet and saying, "Look, this is not a healthcare system we have in this country. We have a health insurance system, but we don't actually have a healthcare system."

• 1:03:01Dr. Mary Claire Haver?

  A sick care system.

• 1:03:02Speaker 00

  Right. We need Congress to pass more legislation to allow doctors to practice medicine and build practices that honor the patient, not just their diagnosis codes. We need to incentivize medical students coming out of medical school to go into primary care fields. Why would you decide to choose a primary care field when you're graduating from medical school if you look out there and you're getting paid minimum wage to be a primary care doctor and see, you know-

• 1:03:30Dr. Mary Claire Haver?

  They're terrified AI is going to take their job away.

• 1:03:32Speaker 00

  Well, and they also see the burnout and the moral injury in primary care fields and the low pay. So we need to incentivize financially medical school graduates to go into primary care fields. And we need to empower patients, one at a time, to demand the kind of care that is not just about a pill for every body part and a doctor for every complaint. You need a medical home. You need a primary care provider who knows you. Having a relationship with a patient is why any of us went into medicine. I mean, maybe not if you're a surgeon or an anesthesiologist. You wanted the monastas and, you know, like, under, right? But most of us went into medicine because we want to help people, not just write prescriptions.

• 1:04:17Dr. Mary Claire Haver?

  Right. So you wrote a piece on aging gracefully-

• 1:04:19Speaker 00

  Yes.

• 1:04:20Dr. Mary Claire Haver?

  -that I keep coming back to. So you had a patient in her 80s told you she only needed four things.

• 1:04:27Speaker 00

  Yes.

• 1:04:28Dr. Mary Claire Haver?

  A doctor she could trust, a friends that she could lean on, a sense of humor, and a good hairdresser.

• 1:04:33Speaker 00

  Right.

• 1:04:34Dr. Mary Claire Haver?

  What did that teach you about what actually matters? I'm assuming this, this girl was thriving.

• 1:04:39Speaker 00

  This woman is thriving. And that's what I meant earlier when I said that my healthiest patients aren't the people who are necessarily optimizing in every way they can all the time, or they don't necessarily have the perfect set of labs. They are people who know themselves. They know where to let go and they know where to lean in. So this patient has a sense of humor and a sense of acceptance over the things she can't control. She's not trying to fix every wrinkle. She's not trying to optimize everything in her body. She's, she's understanding that, you know, health is not guaranteed. And she's going to center pleasure and joy and levity. And she's going to take care of herself by getting her hair done.

• 1:05:18Dr. Mary Claire Haver?

  I love it. What are the top three things that you want people to take away from the book?

• 1:05:22Speaker 00

  The three things I want people to come away with from this book are, number one, feeling less alone and feeling less shame from the medical system. It's not a you problem. It's a system's problem, if you've ever felt dismissed or unseen by doctors.

• 1:05:38Speaker 00

  Number two, I want people to have a practical vocabulary to bring to their doctor's appointments, to know what questions to ask and to make sure they're centering their actual problems, not someone else's problem. And then third, I want people to be able to stop and pause and ask themselves what they need to be well. I want people to have permission to stop chasing someone else's version of health. And that would be a job well done if people could come away with those three things.

• 1:06:04Dr. Mary Claire Haver?

  Well, Dr. McBride, so great having you on UnPaused. Thank you so much.

• 1:06:08Speaker 00

  Mary Claire, thank you so much for having me.

• 1:06:12Dr. Mary Claire Haver?

  Dr. McBride's new book, Beyond the Prescription, is out August 11th and is available anywhere books are sold. You can visit drlucymcbride.com to find out more, subscribe to her newsletter, Are You OK?, or listen to her podcast, Beyond the Prescription. And you can follow her on Instagram at DrLucyMcBride. I'd 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 now everywhere and anywhere you buy books and through our website. You can also find full episodes on YouTube at DrMaryClaire.

• 1:06:57Dr. Mary Claire Haver?

  UnPaused is presented by Odyssey in conjunction with Podpeople.