Happy When Curious
Happy When Curious
Dr. William House: Conversation as a Medical Practice
Dr William House is physician and owner of Eventide Health in Friday Harbor Washington . He is also one of the more thoughtful people I've had the privilege of speaking to and is working hard to help move healthcare forward in patient centric ways.
Join us as we discuss how he navigates his patients embarrassment and fear, how he has transformed his primary care practice away from the insurance model, the traumatic event that inspired him to enter medicine, how his work has changed the way he carries on conversations and much more!
Hello and welcome to another episode of Happy when Curious. I'm your host, brady Ryan. Today I'm joined by Dr William House. Dr William House is a physician and owner of Eventide Health in Friday Harbor, washington. So let's start off with a simple one how would you like to be referred, dr House, or Will, or how do you want to go?
Speaker 2:Just Will, will's fine.
Speaker 1:Will perfect Will. So here's an out of left field question, something I've been thinking about a lot in relation to healthcare and medicine. What do you see as the role of client shame, or maybe patient, not client? Patient shame and embarrassment in primary care medicine Ooh the role of it.
Speaker 1:Yeah, because I've noticed in myself I've delayed going to seek advice about things, or there's a lot of shame in that I haven't been taking care of myself well enough, and embarrassment and shame seem to be a potent force in my interactions with doctors. And so how have you seen that play out?
Speaker 2:I would say a don't have it. A good clinician should not invite that and should not interact with that, should acknowledge it. Yeah, we've all been in a situation with a trainer or a clinician or a teacher where we think, oh gosh, I didn't really do my best or I didn't hit the mark that I wanted to, or I haven't hit any mark, I haven't tried at all. Right, but a good clinician, a good teacher, I don't think should ever interact with that. Acknowledging is good. Say, yeah, I get how you feel, I can understand how you feel, maybe even empathize. Say, yeah, I've been there too. But let's not let that be a data point for our conversation. If you want to use it as a personal motivation, yeah, that's good. Turn it into something positive.
Speaker 2:But I don't ever want to interact in a way that highlights that or that brings that to the forefront. In fact, I usually tell people look, when you're with me in clinic, you can be all kinds of things you can be angry, you can be upset, you can be emotional, you can be stoic. But be honest. Be honest with me because that's the way I can help you best, but be honest with yourself because that's the way you're going to help yourself best. So that's a really interesting question. I've never thought about it from this vantage point, but I'm not naive to the fact that certainly people do come in and sometimes sheepishly report oh yeah, I haven't really worked on the goals that we talked about last time and I just tell them that's okay, let's figure out how to help you do that best.
Speaker 1:So yeah, and I would guess it happens the shame and embarrassment on the patient side. It's actually a sorting mechanism. A lot of people don't ever come in because it's like a dentist. If you haven't been a dentist for a while, I don't know about you, but I get real fucking nervous. I'm like same. I'm like flossing, I'm doing lots of stuff I don't normally do because there's like some embarrassment to my dentist to admit I didn't. I have not been taking care of my teeth and I I would guess that is there's financial barriers to going to see a doctor, but I think there's also emotional.
Speaker 2:I mean I certainly been in that boat myself where I'm thinking, oh gosh, I haven't been flossing as much as I should and I haven't been doing this, and we all have that 72 hour come to Jesus moment of with the tooth floss, dental floss. So yeah, I've been there. I hope that listeners and people that are reflecting on this don't let that be a barrier, because having a clinician in your life, I think is an important thing, whether you see us a lot and interacted with us a lot or once a year. Don't let anything be a barrier in as much as shame or embarrassment or feeling awkward. Those shouldn't enter into the equation. I know they do. From our standpoint, I think we're a lot like priests we're never shocked. There's nothing you can tell your priest or your doctor that should make them aghast. Now there are times where we do go wow, I haven't heard that one before. That's interesting, but I never contextualize what somebody's going through in their plan for their health and the goals that we make together.
Speaker 1:so yeah, that's well said, well said. I think it's something a lesson for all of us that they got. Y'all are like priests. You've heard it all, don't need to be scared. It's like nobody flosses. That's just a given. Dentists assume that, okay. So next question what have you learned about the art of listening and conversation from your time in primary care practice?
Speaker 2:Part of my answer immediately wants to go to the cliche, things like being an active listener and stuff like that. But I think the most striking thing that I recall from medical school was when they talked initially about being a good listener and they said the statistic was that when they did peer review and recording of student doctors with people and residents and seasoned physicians as well, I think the average time to interruption in other words, when the patient or the client would sit down and begin talking, the average time that they would get interrupted with the first question or the first point from the clinician was somewhere around 15 to 20 seconds, which I always found striking. And I've tried to make a good habit of letting people get everything out and it's in the old style of practice that we used to do in the more traditional care which was based on payments from insurance and Medicare and things like that. We were bound by those dreadful 15 minute visits and people sometimes come in with a list of a dozen things they want to talk about and that's OK and that's appropriate. But in those rushed visit it is hard to hear that list right and to sort of not interrupt. So that's a big problem in medicine that I think every clinician goes through, and what I've learned is more about our current model, which allows us to have the time.
Speaker 2:So I try to let people come in and sit down and say the same phrase every time what's on your mind today? And because I know maybe it's a wellness visit or maybe they're there for labs, or maybe the one-liner says right knee pain, and that's okay, but I think the leading phrase of what's on your mind today because maybe it's not the right knee pain yeah, that's a problem, but maybe it's anxiety, maybe it's depression, maybe it's wow, I had a really bad week and or I'm having side effects from this med. So more of an open-ended what's on your mind. And then the other bookend that I try to utilize is what else? Any other questions or concerns, comments, things you wanna talk about, things you wanna know, and, again, leading more with a just more of an open-minded aspect than this sort of very structured way that we're trained to do.
Speaker 1:Do you find yourself in a fight? The impulse of somebody starts talking and then your clinician brain's going oh, diagnosis, or like I know what. This is going on. A diagnosis is a prescription. It's already, I already got locked in. Do you find yourself having to fight that impulse, or have you gotten better at kind of staying with the person as they're talking?
Speaker 2:So it's both. And the way a clinician's brain works, or should work, or is trained to work, is that we immediately do start thinking in what we call a differential diagnosis and we're building based on the history, like what do you tell me? Where does the pain happen, how long? What does it feel like? What's correlated with it, what makes it better, what makes it worse All these questions that we start asking or sometimes just start hearing, sometimes we won't have to ask people, just start saying the quote, unquote, right stuff for us to diagnose with. So I think that all at once that's an automated process, or at least it becomes that way at some point. So it gives us the ability to sort of listen to what's happening in the moment, but also in parallel to that, being our diagnostic mind. And then there are times often where I'll do callbacks and say tell me more about this that you said early on, and I'm a big proponent of.
Speaker 2:I don't use electronics in the room with patients very much. I have an iPad mini with a stylus and I'll take a note or two if I feel like oh, that's something I know I'm going to forget that later. So, yeah, obvious reasons, but I don't interact with a keyboard or a computer or anything while I'm in the room. So I really want that focus eye contact and observing the patient, because looking at the body and seeing the little telltale signs that might add to the picture of the diagnosis or maybe start thinking as making us think about another area that might be a concern that maybe the patient's not talking about yet. So I think a lot of it happens in parallel and again it takes time because when you're a new clinician you're going through all those mnemonics in your head and trying to remember all the right questions to ask. But over time it's more organic and again in our setting we don't feel rushed, so we have the ability to kind of go back and tease out the details.
Speaker 1:It's cool. I like that opening question of what's on your mind. It seems like it could be useful in a husband-wife relationship, in employer-employee relationship. It just gives that space. So I would assume I'm going to ask anyway have you gotten better at conversation with friends and family, as your practice has continued over the years? Do you think that muscle is built in your personal life as well?
Speaker 2:I think so, years. Do you think that muscle is built in your personal life as well? I think so. I think it's. I think being a clinician has taught me to be a better listener, but also to be a and I'm going to use a poor word here but to be a better understander. And that's a hard thing in medicine. It's hard thing in anything relationships and marriage, best friends, worst enemies, whoever you're dealing with to understand what somebody is saying. Because, again, the reason I ask what's on your mind is sometimes it says right knee pain for the visit, but that's not really why they are there. Sometimes.
Speaker 2:To go back to your shame and embarrassment question, sometimes people are there for medically embarrassing reasons oh, it has to do with this or that, and I didn't want to say to the receptionist why this, what this visit was about. And that's okay. We totally understand that. But it allows us to, I think, have a better leeway into what is the patient really saying and coming back to again, trying to understand better what they're saying versus I guess it's sort of connotation versus denotation. In other words, we obviously understand english, but what are you saying behind that? Is there something that, as a clinician, I'm missing, that you're trying to, in some cases, hit me over the head with clinically like here, doc, I'm trying to give you a hint that I really want to talk about this. So, yeah, I think there's improvements in conversational understanding with people. I hope so.
Speaker 1:Yeah, it reminds me a bit of like if I argue with my wife about who fed the cats and it repeats and repeats. It's not really about the cats, it's about something else. And so, understanding text versus subtext, I think obviously that's what we're talking about there. Have you heard of the term psychic income? No, so I just heard this recently. It's really grabbed hold of my attention, the idea being we have financial sources of income our work and maybe they're overlapping, but maybe not with where we're getting our psychic pleasure from, like what's really lighting us up spiritually, mentally, whatever. And so in your work, what part, what time period, what interactions, type of interaction are forming your psychic income? What's the magic part of your job? Because in every job there's drudgery components, there's repetitions of components, and there's some parts that are really magical. And so I'm curious in your job, what part of that is kind?
Speaker 2:of feels like is getting you psychic income. I think, interestingly, it has to do with your previous questions of people getting being heard again in in the previous modality of medicine that I've worked in there's just not time to hear everything sometimes and when that rush environment. But now we have this sort of luxury to really be able to listen and I've had people who are just emotional, tearful, like this is the first time I've ever gotten through my entire list with a doctor and that means a lot to people sometimes to know, yeah, somebody has actually heard me and taken time and didn't interrupt me in 15 seconds. Right, and not to say that we do everything perfectly. We don't.
Speaker 2:There's still mistakes in learning, but I love going to clinic and knowing that I'm going to have time to really give somebody a moment with a professional and with just another human. Because people have these lofty ideas of doctors sometimes and the only lofty idea is the training. The training is lofty, it's hard and it's long years and long hours. So I think when I get to sit down and impart what I've learned in a hopefully healing way, in a human way, that's psychic money to me. I like that term.
Speaker 1:That's cool. I appreciate that. Could you think back, if possible, to the moment that you had clarity that you wanted to be a doctor?
Speaker 2:Yeah, that happened in 1983. I grew up in Louisiana. We were at a water theme park. It was called Critter's Creek Great name, right. They had excavated this massive earthworks. At that time they were not building water slides and stuff with metal and scaffolding, they actually did earthworks. They built these big earthen mounds and they built concrete water slides into it and you had to ride it down on a foam mat, otherwise it would just chew you up. It was really rough and horrible and we were there waiting in line to get in me and my friends and some of my cousins. They're waiting in line to get in, me and my friends and some of my cousins.
Speaker 2:And again, louisiana, middle of the summer 1983, we heard a commotion and over to the side there was this big excavation pit where they had dug all this earthworks out of to build the water slides and it was a very loud, noisy place, bumper boats and music and arcade and kids yelling and screaming and playing and summertime noises. But we hear this noise in the background that didn't sound like summertime noise and we look over and people were yelling and calling for people at the side of this excavation pond. Long story short, three young boys had gone in and they drowned. And another young man who was, interestingly, for this weekend for the Kansas City Chiefs. He was a running back for the Kansas City Chiefs and he dove in to save these young boys and he drowned.
Speaker 2:And this event unfolded again in rural Louisiana in 1983 before we had a 911 system. So ambulances finally showed up but by that time these boys and this young man were, they were all dead. And that had such an impact on my 12-year-old brain at the time that I just thought why didn't anybody do anything? And again, this was a different culture, different era. People weren't trained in CPR like they do anything. And again, this was a different culture, different era. People weren't trained in CPR like they do now.
Speaker 2:I mean, here on our rural island, if you have an event in the grocery store, somebody will be there and I know that for a fact. I mean, we've had events here on the island that people did amazing heroic measures. But at the time where I live that kind of training just didn't exist. So these four young men died and I remember at that moment thinking I want to be somebody who could help. So that was the, burned into my memory, quintessential moment for wanting to be a doctor. It would be many years later before I would get there, but that was the moment. Jim Delaney he was the gentleman who went in after them.
Speaker 1:Wow, my goodness, it seems like there's people I have no idea if there's a personality type, but just moments of people's lives when they feel like they weren't capable of entering the fray of the suffering of the world, of the chaos of the world and entering that might be as a soldier or a firefighter or a doctor and they feel drawn to developing the skills that allow them to enter the fray of chaos, the chaos that the world is always presenting, chaos to us. Wow, it's the clarity of that, my goodness. Yes, that stopped me in my tracks for a second there. So, moving forward a little bit, you didn't go right into it. You were in tech. You were in technology, software engineering, and so you could have been just staying along on that. What then caused you to switch gears?
Speaker 2:So been just staying along on that. What then caused you to switch gears? So my wife and I got married in 1991. We were high school sweethearts. We'd known each other since we were kids. The idea was that she would go to school and I would work and when she graduated we would switch. In that time I was working with kids, doing youth counseling and trying to help, and I felt like that kind of answered part of my need to help people. And then I was working another job and she was going and working on becoming a math educator and she spent over 25 years as a high school math teacher and in that time I sort of burned out working with people and I thought, maybe this isn't what I want and I was still kind of a kid myself early twenties and so I thought, well, I'm gonna do something completely different. So I had a little bit of a penchant for it and doing networking and learned to write some code Didn't have any degree at that point, hadn't been to college at all and we moved to Boulder.
Speaker 2:We left Louisiana, we lived about a year and a half in Albuquerque, which was interesting times, and then we moved up to Boulder and I found my way into this little small startup, compatible Systems, who would later go on to invent one of the first VPN technologies. And then Cisco Systems bought our company in. I think it was 2001. But when I first started with the company, there was a policy that you could go to any department in the company I think it was every Thursday and you could just learn hardware, software, marketing didn't matter, just learn. And they were very gracious in allowing us to advance.
Speaker 2:And again, I didn't have any degree at the time, but every year on my birthday, every year April 3rd, wake up, spend about 10 minutes just secretly, silently hating myself because I thought I still wanna be a doctor, I still wanna to be a doctor, I still want to do this and I haven't done anything about it. But I thought I missed my window. I didn't know at the time, I'd never heard the term non-traditional student or things like that, so I just kind of put it off. Oh well, I missed it and I'm going to, I'm having a good life and that's okay, and so, yeah, and we're living in Boulder, we had actually done a trip out here to the San Juan Islands and we were going to move to Orcas Island and my late father had a stroke and so this news comes out of the blue and so we fly home to Louisiana.
Speaker 2:Actually, we drove home and saw him there and I remember coming out of the ICU probably two in the morning, and I sat down next to my wife and I said hear me out, I still want to be a doctor. And I remember vividly she just looked at me and said, I know, and then she said we've just got to figure out how to make that happen. So we went home and it was a long path of moving away from the tech industry, getting a job at the local hospital. I worked in MRI department starting IVs and just doing medical assistant work, enrolling at CU, getting degrees in neuroscience and psychology, and then migrating back home to New Orleans to Tulane University to get a degree in master's degree in pharmacology and then enrolled there for my medical degree.
Speaker 2:So it was a long, circuitous sort of path, but it was really that moment at the water theme park that set things in motion, and then it was my father's change in health to really be the catalyst to remind me I still want to do this and what I found out, interestingly and thankfully, was that there are tons of people out there. You know now more than ever, but at the time changing careers and wildly changing careers. I mean, this is not our great grandfather's era where they just have the same career all their life and that's fine if you do. But you know now people. I think what's the average like two or three career changes throughout a lifetime and I wouldn't change anything at this point.
Speaker 1:Wow, it's an incredible story Speaks to the power of mortality, or near mortality, to, I don't know. Just cut through the noise, there's lots of ideas we have in our mind about what we want to do with our lives, and then confrontations with mortality seemed to clear all that out. You had clarity there. So, yeah, I'm trying to think how I want to. I think we'll stick on this track a little bit longer than when I talk about DPC.
Speaker 1:So we talked about shame and embarrassment as potent things operating in a patient's mind, and the other biggest elf in the room is fear, of course, because besides just being embarrassed that I haven't brushed my teeth, I'm also afraid because there's some kind of lump on my jaw. I don't know what that lump is, and the mortality is kind of hovering up here as a vague cloud, right. And so what have you learned in your practice in your time about navigating around people's fear? Because, at the end of the day, all the fear is maybe fear of death, fear of pain, but anyway, just what have you learned about fear in your time time as a practitioner?
Speaker 2:Normalize it, Don't minimize it or push back on it. And normalize it, meaning let people know that we're all in the same boat. Everybody's afraid of death, Everybody's afraid of disease, Everybody's afraid. I mean if we saw anything in vivid color throughout the pandemic, it was that everybody's afraid of dying. We know that's intrinsic, but some people never even want to say that phrase because it's so sort of verboten or deep or dark, painful fear for them.
Speaker 2:I have patients of all ages that are okay with death. They say, when my time comes, I'm okay with that, I'm living the life that I believe I'm meant to live and I'm ready to move on to what's next. So some people seemingly have very easy time sort of accepting that, but for the vast majority of us it is frightening. And so one when I work with a patient who we're talking about something that affects their mortality and in essence we're always talking about that, whether it's hypertension, high blood pressure or a brain tumor or something striking we're always sort of talking about that. And so I try to normalize it and let people know it's okay to feel afraid about that. It's okay to feel, whether it's mild fear or just terrifying fear of it, and then not to minimize it, because the old walk a mile in somebody's shoes. I don't know what it's like to live in their skin and how great their fear is and what that fear connects to. What's their past? What was their family like? What was their upbringing? What sort of experiences have they had? That flavors and colors that? And then, I think, trying to work together, as we do with all health issues, work together and build a plan that we're both happy with. I don't like the old patriarchal thinking of medicine. That here's the plan. The doctor says that you should do it and if you don't, then move on. I want to make a plan with somebody and say here's as my training tells us and informs us. Here's what I think the options are and here's, maybe what I think the best option is how do you feel about it? What do you want to do about it? Do you want to hear further opinion? Do you want to talk to others? Because we can make that happen. So when it comes to death issues which we deal with, I mean I've had to put people in hospice and that's a hard thing, but at the same time it is the great equalizer we are all going to face that and that sobering thought.
Speaker 2:I think if anything could be gained out of it, out of this conversation, is planning, because anything that we want to be successful in requires planning. I mean, you've toured me around your amazing industry here of your business with salt and it's amazing and it's clearly has a lot of planning that went into it, and a marriage has a lot of planning that goes into it. Having kids anything that's a big event should require planning and does require planning. Doesn't always get that, but to successfully navigate it takes planning. I think that's a point that maybe doesn't get talked about enough with patients.
Speaker 2:What do you want your exit to look like? And I don't mean in certain context, but having a voice when you don't have a voice, things like pulsed forms, which is a way to designate. Do you want to be resuscitated if an event happens? So things like that I try to talk with patients more about, because it's one of the checkboxes, so to speak, in medicine, and I don't like it as the checkboxes, so to speak, in medicine, and I don't like it as a checkbox. I like it as something that we have some real discussion about.
Speaker 1:Yeah, it's fear in its most primal sense is unknown. It relates to the unknown. There's known and unknown, and fear is like the wall that separates the known from the unknown. And what you're doing is bringing this big big thing that we're calling mortality in small ways into the known, via planning and like. Let's talk about this as planned out. It doesn't erase the fundamental facts, but it brings it a little bit more into the realm of the known, and it seems like that very act could just lessen the fear a little bit. Yeah, drop it down a bit. Okay, so we're going to go a little bit easier here. Just tell us a little bit about DPC. What problems is trying to solve, what initiated your switch to this model? And we have to define it for our listeners, of course, as well.
Speaker 2:So DPC is direct primary care and there's a lot of terminology that gets used in place of it.
Speaker 2:Some practices use the word concierge medicine, direct care. There's a variety of ways, but DPC has kind of been what a lot of this new-ish industry has been settled on for a few years now, and it's not really new, it's the old model come full circle. I mean, before insurance got involved with primary care, you just went to a doctor and you paid some reasonable fee to them and they took care of whatever the need was and they knew you. There wasn't a 15-minute visit imposed and there wasn't a payer that was between you and that clinician. And I tell people sometimes the way insurance is used in primary care and I'm separating primary care from specialty care like specialty care, meaning if you need an operation, if you have a heart attack, if you get hospitalized or put in an ICU, insurance and payers should pay for those because that's big cost. Primary care shouldn't be big cost, and so it would be a little bit like using your car insurance to pay for wiper blades or gas. None of us would consider that and in fact when people hear that sometimes they just laugh like, oh, that's silly. Well, of course it is. We wouldn't do that. But that's what we do with primary care and insurance or Medicare or whoever the payer is. It doesn't really make a lot of sense because what we do should not be expensive and isn't expensive. We do a lot of preventative care, we get labs which don't have to be expensive and again, we're not incurring bills in the tens or hundreds of thousands of dollars. So your car insurance doesn't buy wiper blades or gas. It pays for your engine when it blows up or when you total the car. That makes sense. So because of the payers and the problems that creates meaning payers get in between clinicians and the patients and say what can or can't be done they try to dictate based on the payment model.
Speaker 2:That's part of why visits, 15-minute visits, exist, because in the traditional model clinics and hospitals are based on volume. They have to see X amount of patients. You'd see 20, 25 patients a day to basically sort of keep the lights on, to pay the staff right and hospitals and the ones that I worked for in multiple locations and very big systems, very high volume. But again, we all sort of know that healthcare as it is in the traditional sense is really broken. 15-minute visits. That's not medicine. I have a friend who says would you want a seven-minute visit with your barber? Because the 15-minute visit, when it all comes down to it, it's about seven minutes. By the time the nurse or MA or whoever sees you get your vitals and you get seated and the clinician comes in, you get an average of seven or eight minutes. So if seven minutes with your barber sounds scary and it does to a lot of people, why would you settle for that with a doctor or nurse, practitioner or PA or whomever you see?
Speaker 2:So direct primary care takes the insurance and Medicare and Medicaid completely out of the equation and we don't receive or seek payment from any of those payers anymore. We make a contract with individuals and in some cases businesses to say, look, you pay us a reasonable monthly or yearly fee and then you get unlimited usage out of that and unlimited usage in clinic visits, email messaging, phone, zoom or FaceTime, whatever works for you, sort of all-you-can-eat healthcare plan, and it's not insurance. So we do encourage people look, you should still carry major medical because if you do need that hospitalization, if they need some care, that happens at a hospital or another clinician's office, their insurance or their Medicare or Medicaid will still pay for that. We just won't seek reimbursement from any of those payers and what it's done is free us up to spend more time with patients, to ostensibly do better care. We still make mistakes and we still have things that we can improve on. That's just the nature of being human. But I think effectively we do deliver better care and statistically, when you look at direct primary care models versus traditional models, the outcomes are typically not even comparable, meaning less hospitalizations, less ER visits, overall just better outcomes and being healthier and having less bad events. And that's nationwide. I mean.
Speaker 2:This movement's been going on for a while. We decided because of the practice that I bought. It just simply wasn't sustainable anymore. There were changes that happened because of quote a new doctor owning the practice. Medicare decided to downgrade the payments to us through no fault of anyone. It just happened and other payment agreements that had been in place were not sort of honored and it quickly put us into a situation of get bought which we didn't want to get bought. I don't want to work for big medicine again, I would frankly rather just do something else. So we didn't want to get bought. We could have closed permanently, which we thought long and hard about or we could try a different model and we started looking into this.
Speaker 2:I hadn't known about DPC since, really med school, so for years I've known about it and really at one point really wanted to do it. I thought this would be a great thing to do. I think it was helpful and good to go out of residency and to sort of quote the real world and do traditional medicine. First, because it allows me to interface with other clinicians in a way that is more traditional and if I hadn't done that beforehand, it's such a confusing world you can't begin to describe it to people who haven't worked in it, just like many industries. So it became really our only option in our minds and all of the people that had changed their practice.
Speaker 2:We got great advice from throughout the state of Washington and across the country and everything that they said would happen happened. They said you'll keep this percentage of your panel of patients, you'll have this happen, you'll have this happen and just like clockwork, it all happened and it was scariest moment of our life and we did get pushed back and some negativity because people didn't understand why are you doing this? And it's like well, because we have to. We don't really have another option. And I really don't want to close because, as I mentioned earlier, we came out here in 2001, I think, and we were going to move here then. We would have been Islanders for 20 years now if it hadn't been for the career change. So we've long wanted to settle here and be here forever and we're happy that's finally taken place.
Speaker 2:But closing the clinic was just not something that we wanted to do and, yes, we don't see nearly as many people as we used to. If you can say that there's any downside to direct primary care or concierge medicine is that our panel size is much smaller thousands versus hundreds and that is detrimental and that's not something that we like. But when you look at what we can do for patients per capita and just by and large, it's much better outcomes and we're happier with that. And I guess I had to really come to grips with the fact that even though the national average for a clinician of any type whether they're MD or nurse practitioner, pa, whomever is somewhere between like 1,200 or 1,500 patients, that's kind of an average At the end of the day, I had to come to grips with the fact that, yeah, I can't see that many people because if I do, then the model loses what it promises. Then you start going back to the old sort of challenges of volume-based medicine. I don't want to do a volume-based practice, I want to do higher quality work. And I don't mean to imply that physicians and traditional models can't do quality work. They can, but it's so challenging and I think it's just increasingly difficult to do the right thing for patients all the time in traditional medicine. And I think more clinicians would change if hospital contracts were different.
Speaker 2:I had the luxury of moving across the country. We lived Louisiana, albuquerque, boulder, hudson Valley, coast of Maine and then here and so, because we moved all the way across the country, my contract with my previous hospital was null and void. And all of those contracts that doctors and nurses and everyone sign has what's called a non-compete contract or a clause, and that is usually about a 90 mile radius Meaning. If you're a doctor in a hospital and you decide I don't want to work here anymore, I'm going to go across the street, hang out my shingle and have my patients see me there. Legally you can't do it. You can go 91 miles away, but they know that your patients are probably not going to follow you that distance, so, best of luck, 91 miles or greater. So we were fortunate in that when I moved literally from one ocean to the other, we didn't have to abide by that.
Speaker 2:So if non-competes weren't in place, I think we would see the largest mass exodus out of traditional clinics and hospitals that we've ever seen, because as a clinician who used to work in that model, it was incredibly stifling and I have the utmost respect and gratitude for the people doing that.
Speaker 2:Whatever their background is, whatever their practice is, whatever model they're working in, it's always hard, it's always challenging, it's always rewarding and a huge privilege and honor to help patients and to be invited into their lives and to work with them on things that matter. But I do think that we really need a lot of change and I don't think that change is coming from Capitol Hill, I don't think it's coming from politicians. I think it has to come as sort of a grassroots re-imagining of healthcare and outside of the current payer models, because they're part of the problem. I don't point fingers at hospitals or clinics or politicians or the good people that surround us, but I do point fingers at the payers as the organizations and the companies. They don't have our best interests in mind, they just don't. And that's what's breaking, or has broken, the model.
Speaker 1:To play the cynic here, does DPC subscription-based DCs like you're talking about? Is it a niche thing that only works in relatively affluent communities? Or I guess the question is, is it scalable? And then, congruent with that, your thoughts on Amazon, what Amazon has been trying to do and how it relates to what you've been trying to do.
Speaker 2:Yeah, I think it's. I think it's. There's not a one size fits all, and one of the concerns that people have is, yeah, this is only for the wealthy, it's really not. I mean, what we're essentially asking in remuneration is not much more than people spend for their Starbucks or their Netflix or their well, not Netflix, but their internet payment per month. I mean essentially, and people are going to invest in what is important to them. Some people want to invest in their health and they like having a physician they can talk to anytime. That's important to them and they can decide if they want to pay for it. And some people will decide that eating out at restaurants is important to them, and I don't mean that in a bad way, but I mean we're going to invest in what is important to them and I don't mean that in a bad way, but I mean we're going to invest in what is important to us.
Speaker 2:And so the models when you look at them, our prices are sort of right in the middle. There are people that far exceed the prices. Some of the local prices are nearly three times what we charge. Now there are other people that charge less than what we charge. We're right at a price point that we feel comfortable with, and even with a recent price change, we've had no real change in the practice size. So I think what we and most other DPC clinics are asking is not outside the realm of possibility for most people. And then what we do is we have a plan that some very wonderful people in the community give scholarships, and so we scholarship some families in and they don't have costs incurred, and so we try to make ways that we can see more people, and there are DPC clinics that do free clinics on the weekends sometimes.
Speaker 2:So there's a lot of ways, when you get freed up with this model, to be creative. So when it's the Amazons and the One Medical and all these different things that are popping up, I think that's a good idea too. Is it more commercialized? Yeah, but it's still kind of the same model, and some people like to go to Starbucks and some people like to go to a local coffee shop. They're doing the same thing and it depends on what you feel comfortable with, what you like and what you wanna spend. And so I think that all of these getting us away from insurance model in primary care is the key. Insurance has to stay around, medicare has to stay around for the big costs, but for primary care, yeah, bring them on all comers. Let's have more clinics spring up, whether they're the Amazon medical or whether it's small ventures like us.
Speaker 1:Nice, that's cool. It's not really. It's just something I noticed. I'm young and healthy. I'm part of your program. Don't use it that much and so effectively. Because it's a flat rate model, I am subsidizing already your patients that use it more, and so there's kind of a risk pooling effect happening by having a flat rate versus an a la carte model. Am I right on that?
Speaker 2:Yeah, and what I tell people initially and throughout using the model is get the value out of it. And what I mean by that is we get these patients that come in apologetic sometimes and they say, hey, sorry, doc, I've been on Google and I've been on WebMD and I think I know what the problem is. And I always tell them A, don't feel ashamed of that. I applaud that. That means that you care about your health and you've researched and you're helping me to do my job better for you. So I think that's great. But I also tell them that's part of how you get better value out of this model. I'm available to you 24, seven, all the time, and so when you get that weird rash, take a picture of it, send it to me. When you get that new headache, when you get that feel more anxious about this, contact me email message, call, come in and utilize it more, rather than going to WebMD and then sometimes going down that algorithm that ends up at some horrible, terrible diagnosis that A not correct and B very stressful to read about.
Speaker 2:We've all kind of been there.
Speaker 2:Allow us to guide you down that path and just simply utilize it more, and we've had a lot of people sort of take off on that idea, and I think what the barrier is for some people is thinking oh, I know you're busy, I don't want to bother you too much, I don't want to be a pest, and we tell people banish that thought.
Speaker 2:You can have whatever thought you want, but not that one. You get to utilize this as much as you want, and we have some people that do that great. And we have some people that show up once a year and that's okay too. That's the value they get out of it, and they like knowing that when they call up we'll see them that day or the next day or that week or whatever, and that the email will get answered, the phone will get answered. There's no phone tree. You just get someone right then. So the value is either there in being the retainer for somebody at all times, or the value is there doing the preventative care, or the value is there by just encouraging people utilize us more. It's okay, we're not going to be bothered by it and in fact we like that because that ends up with you being healthier and with you hopefully being happier.
Speaker 1:Yeah, it just seems like just what you're saying. There is a real comforting thought, because previous to this model, the idea of getting an appointment with a doctor might be three weeks out. But this little thing, I know it's not that big a deal. So you just tend to ignore a bunch of stuff, or you web MD it and you're either. You just do go down that rabbit hole. So, lowering the bar for when we get to have surface contact with a physician, it seems like it's just a wonderful thought, because so many people wait until it's just really gone off the rails before they interact with the physician.
Speaker 2:Yeah, there's definitely been times where I get a call or somebody comes in and they say I've had this problem. When did it start? Maybe eight or nine months ago? And my first thought that I don't verbalize is gosh, I wish you had told me eight or nine months ago, because now this is something that's complicated, it's something that's gonna be harder to get a good outcome with, or, in rare cases, it's like, yeah, this is really bad and again, that's not the patient's fault. I don't mean to sound blame shifting, and certainly not, but that's part of the reason why we do have better outcomes, because we are more easily accessible. And again, there's clinicians and other models that are accessible, but, by and large, when you have thousands of patients that you're responsible for, it's just. It becomes the numbers just don't match. So, yeah, accessibility is the, I think, the key to good healthcare.
Speaker 2:And also, I don't like buzzwords, but there's this phrase that came along, I don't know, several years back therapeutic alliance. And again, I'm not big on buzzwords, but I do like that and that's. There's a lot of truth in that. When you find a clinician to work with, make sure you have a therapeutic alliance, meaning make sure you feel like you're on the same page. You don't have to like them and be their best friend, but you need to be able to come together and agree on things and not in a patriarchal way like do as I say because I'm the clinician sort of thing.
Speaker 2:Again, I don't like that ideal, but you need to be able to feel comfortable with them and to trust them and to be able to be open and honest with them. And if you don't feel like you can do those things for any reason, find somebody else. And I encourage people all the time that are my patients. If you don't feel comfortable with me at some point for any reason, find somebody else, because your health is so far vastly more important than you seeing me for something. It's not about me, it's about your health, and I want you to find somebody who is going to do the job that you need done, and if it's not me, that's okay. So, yeah, I think there's something to that therapeutic alliance.
Speaker 1:Nice, I like it. So shifting gears a little bit. What do you see as the role maybe more forward-looking of technology in primary care, Because we can all imagine technology in more specialized care, from mRNA vaccines to robotic surgeries in a primary care setting. What do you see as where technology should be going?
Speaker 2:I think a lot of it is. Monitoring is getting easier. If you had mentioned the word pulse oximeter in just general society five years ago people would have looked at you like what are you talking about? But now most people know that during the pandemic they went on Amazon and for 12 or 15 or $20, whatever they got they got this little clip to go on your finger and tell you what your oxygenation percentage is in your blood and your heart rate and so forth, and we've used those in the hospital for a while, a long time. But now a lot of people have them and it's a good tool to have. And now we've got these Apple watches and Fitbits and devices that can tell you if you're in atrial fibrillation very serious kind of cardiac issue.
Speaker 2:We have blood pressure cuffs that are finally starting to be really accurate and digital so that it can feed right into an app on your phone and that app can feed me directly information. So it's always challenging to get a quote unquote good blood pressure at the doctor. White coat hypertension is a thing that sort of flavors the number itself, meaning our pressure is always higher. Like you mentioned dentistry earlier, my pressure is always high when I go to the dentist, right, and it's just normal. But when we're able to monitor people from home, where they really live, you get more accurate numbers.
Speaker 2:So I think the digital technology world, that's so easy for us as a society now, and people of all ages I mean I've got octogenarians that know so much more about technology sometimes than I do they're showing me these. Hey look, I got this new device and it's like oh, wow, I've never seen that before and it's so amazing and reassuring that, wow, we can actually get really good data outside the clinic and we've had devices before, but they're much less cumbersome, they're far more accurate and they're just more widely accepted. So I think that's a big part of where we're going is just getting better data on people, and a lot of that's for preventative care and monitoring.
Speaker 1:Yeah, have you heard of Peter Attia? And a lot of that's for preventative care and monitoring. Yeah, have you heard of Peter Attia? Yes, yeah, so I read his book Outlive and he's trying to describe a big transition in medicine from medicine 1.0. I can't remember how he did it. Maybe that was basically germ theory, something like it, understanding what causes us to have diseases. Medicine 2.0, basically where we are now really good at addressing acute diseases as they arrive in very late stage, and medicine 3.0, where we're trying to shift to is seeing things that are 10, 20, 30 years in the future and addressing them. So how do you see yourself in that context, in that framework, or if you think it's a valid framework at all?
Speaker 2:I think that the shift that's going to happen in medicine and also just overall health and when I say health I mean not necessarily medical treatment, in other words, not me prescribing a pill to somebody or doing a medical procedure, but health overall, non-allopathic, non-western medicine sort of attention is going to be directed by more genetics and more AI. And AI is the hot term right now and has been for a little while, and we've seen some really incredible things over the past even two years with generative technology, and we're actually getting ready to launch something called NovoDawn. And this is something I've worked on for almost eight years now and from my technology days to now. I started feeling overwhelmed in med school looking at the amount of variables that go into health. What food did you eat last night, what is the cloth of your socks made of, and where do you live, and what are you breathing, and all of these chemicals and all of these just variables in our lives, and not just the material things but our stress levels and our background and our genetics, our epigenetics, all of these variables. It's so overwhelmingly just exponential from person to person and it's surprising to me sometimes that we can even practice medicine in a sort of consistent way, because the variables are so far reaching and variegated. And so I started looking at artificial intelligence as a way to analyze data better than we can. Because you can get the best team of a thousand doctors in the world and they're all going to think like the best doctors in the world right, and that's good. But how much data can they all crunch, even all thousand of them? Well, they can crunch some. I don't know what that number is, but it's some. It's a lot, and it would undoubtedly give you some good therapeutic data and some good plans.
Speaker 2:But AI can do so much more, and so what we've essentially done is take a cheek swab to get a genetic sample and we feed that via a device from Oxford technology. It's called the Nanopore. It's a DNA sequencing device, and we get data from there and feed it into our AI, which is named LAURI L-A-U-R-I-E, which is linked analysis using real-time informatics everywhere Mouthful right To analyze that and then to curate in a very precise way a longevity plan for an individual based on their own genetics, and then we apply it to something called the series. The series is an eight-step approach that is based on the latest data for longevity. So what we're looking to provide is a better lifespan, but also a better health span, because we all want to live, to be a centenarian 100 or greater but at what cost?
Speaker 2:Do you want to be that miserable sort of 103-year-old? No, of course not. We want to be a centenarian, 100 or greater, but at what cost Do you want to be that miserable sort of 103-year-old? No, of course not. We want to be healthy and still vibrant. How do we get to that point? Well, I think that it's going to be driven by AI and evaluation of genetics. I don't think there's another way. I don't think that modern medicine has the answer. We're still stumbling in the dark in a lot of ways with medicine. We've got a lot of great technology and pharmaceuticals and treatments, and we've made huge strides over the past several decades in making people healthier and fixing acute problems and getting better at chronic disease, but we haven't figured out how do we really live longer? And I know that's the big conversation right now, like with Peter and so many people out there that are working on that, and I do think that AI driven longevity is the next thing.
Speaker 1:Cool, it's exciting. Do you think it's near term for you, or is it still years away before this becomes a product that you release?
Speaker 2:Interesting. We didn't plan this, but I actually ran our very first sample today, our first live sample. And we've run samples raw DNA samples quite a lot of those previously and by that I mean if you go to 23andMe or Ancestrycom or some other company, you can get your genomics done and they send you your raw data. So up to this point, lori has analyzed only raw data in that format. Today we've had our first usage of a live client who happened to be my oldest daughter. She volunteered and was very excited about it and hello Jackie. And so we're hoping to go live with it next month. And again, it's been years in the making and it's really forefront of our minds right now and still nothing's happening. With Eventide, we're still going strong with with this. This is akin to health coaching right, we can. Our reach will be farther than simply the state of Washington, because my license to practice medicine is in the state of Washington, but this is essentially not medicine itself. Again, we hope to go live with that in March.
Speaker 1:Very exciting. So give me an example of an insight that this thing might pop out at you. It's an actionable insight, just like what is it going to look like for a patient that does go through this process and what is it going to tell them that's going to change their life?
Speaker 2:So the series again is based on eight succinct areas of health. They have to do with diet, has to do with oral health, has to do with breathing, has to do with activity and movement and several other areas. So the areas themselves are not groundbreaking. Nothing groundbreaking about those, but the way we apply the data to give a person a curated plan. In other words, what's your biggest return on investment? What things should you concentrate on that will cause you to live longer? And that those keys are found in your genetics, but also in the variables that affect your genetics, the epigenetics, and so that's the analysis that gets done. And so, for instance, one thing that a person might walk away and this will sound very simplistic, but this is part of a very, very complex plan once it's delivered to the client but one of the things that they might find out is how important their oral and dental health is to their longevity.
Speaker 2:We've long known that a healthy mouth is a healthy person. Right? Dentists pre-treat people with antibiotics if they have maybe a history of heart problems, so we've long known that there's big correlation there. But with the data that we look at, we can find out should you have a yearly cleaning, should you have the six month or maybe every three months, which some dentists will recommend that, but how do you know? How do you know that's gonna contribute to your longevity? Now you can.
Speaker 2:So the analysis that Lori will do will tease out those details and a person will leave the session knowing that they have a blueprint. That's going to matter and not in a way that I've served as a health coach for thousands of people. I've sat in a clinic and said, yeah, I think you should do an anti-inflammatory diet and low carbohydrates and intermittent fasting and build more muscle. All clinicians serve as a health coach, but all that is based on the best data and my assessment of that person in front of me and what I know of them, based on their labs and based on what I see and based on what they tell me. It's not based on their genetics and it's also not evaluated by a tool AI that can evaluate far better than I or any human can or ever will.
Speaker 1:It's cool. So what I keep coming back to and it's like the naysayer is like, even with perfect knowledge of the different variables that will lead to greater health span and lifespan, even with perfect knowledge of that, we still have to enact it. There's still the person that actually has to do the shit, and we know that there's good data on. People don't take most of the prescribed medicine they get from pharmacies. They just don't take it, they forget to take it, and that's just like that's the norm. And so it seems like the linchpin between technology telling us more and more about what's going to get us to live longer and healthier is still human behavior. And so how are you navigating that in your mind?
Speaker 2:So I think, hopefully, the carrot that this dangles in front of people is the promise of an actual curated blueprint, because, again, between simply being a health coach and saying, yeah, here's some great data and some really good advice and we know it'll benefit you to some degree, versus, no, this is actually from your own genetics, from your own cheek swab that you just did and customized to you, and so, again, the return on investment, hopefully, is what people will see out of that and know that this is not just generally good advice.
Speaker 2:This is advice based on my genetics, not somebody else, not my own demographic, but mine right now, today, and I think that'll spurn people on to hopefully have I hate the word compliance because it implies the patriarchal kind of mindset, but, for lack of a better term, yeah, compliance, that this is what I think is going to actually help you live longer and have a better life in that duration. So, yeah, please do it. I really believe in this data and I'm going to apply it to myself, my wife's going to do it, our family's going to do it and I hope to get this into the hands of lots of people and I hope that at some point maybe this becomes some kind of standard. We're still in AI and longevity technology. We're still with that stumbling around in the dark too. There's a lot we don't know, but we're getting better all the time and we've made so many strides in genetics. But yeah, it's exciting.
Speaker 1:So technology has improved a ton. Here's an odd question Do you think the average person, say 40 year old person living today, feels better in their body than the average person 40 years ago did Like? Are we actually more vital? The average person would be more vital than, or more less pain whatever metric you want to look at than we used to be.
Speaker 2:Yeah, 40 years ago. I think that's hard because I immediately think about the. We lived for many years in Boulder. Boulder's usually voted as the healthiest or one of the healthiest towns in America. People jog everywhere. They're very fit Bike paths through the whole city. I mean it's health-wise, it's almost unparalleled. And you look at those people and you go, yeah, these people have to be healthier than people were 40 years ago or maybe even longer. So there's that. But then when you look at just your typical Westerner, I think the obesity rates are far worse than they were decades back. And then you have to start wondering. I mean, you're saying 40 years. I'm going to think even farther back to maybe our great grandparents or somebody. Those people.
Speaker 2:I don't think that the obesity rate was not what it is today. You see these old ads for circuses and they would have this very obese person and they would have made a spectacle of them. Come see this person and how large they are. And it was made a spectacle of. And it's very sad that you look at those pictures and you think that doesn't look very abnormal.
Speaker 2:That doesn't look very unusual to me and that's a really strong statement of where we are as a society and with the average weight of people and the person growing up in America thinking about getting fast food when I was a kid and the sizes and the portions and I mean we all know this the portions of everything these days is just gargantuan. I mean we will sit at one meal and eat the amount of food that the whole family would have eaten in the 60s or 70s. Right, like seriously. So it's a hard question. I think that there's pockets of the country that, yeah, they're healthier than they were 40 years ago. But I think maybe, by and large, you don't think of just the pockets of the bowlers. I think, by and large, they're probably better off that many decades back.
Speaker 1:Yeah, so technology is going this way and actual lived experience how people feel in their bodies going the other way. So last few questions. I kind of have this theory that it's just this whatever cockamamie theory. Just take a step back.
Speaker 1:One of the things I didn't like about Peter Tia's book called Outlive and he magnificent book about all the science of longevity was I don't know if he ever said the word feel once it was all about. It's like how do you maintain your strength through? How do you deal with cancer? How do you maintain strength through your eighties? Great stuff. But it never was about feeling better today, feeling better tomorrow.
Speaker 1:And, for instance, I love exercising. When I exercise, I don't exercise so that I'm going to live marginally longer. I don't exercise so that decreases my risk of cardiovascular disease by X percent. I exercise because it makes me feel better today, and so that was a missing link in that book for me. And so that got me thinking how well could you design a life program based on just tracking your vitality on like 24 hour cycles? So I'm like I don't know anything about medicine, I just pay attention to my body. What makes me feel better in my body on 24 hour cycles. You can't do like a one minute cycle, because slamming a milkshake is going to make me feel great right now. It's going to be a little longer than that, but knowing shit about medicine, you know I'm like. It seems like there's some kind of alignment between 24-hour cycles of vitality or whatever, roughly speaking, and longevity and all the things that he's talking about in that book. So anyway, what do you think of that theory?
Speaker 2:I think that's really great and that makes me start thinking about our attack with Novodon. I do think that the series, this eight-part set of components, will make people feel better right now. I think it will have some sort of instant vitality and maybe not instant within 48 hours, but within weeks, within months and then making that part of a person's who they are. I mean, these things can't just be programs, it can't just be well, I did ketogenic diet for a while, or I did this, or I did that program, I used to do Pilates. It can't be those things that we did. It has to be the things that we are and I think that's how we get to vitality, because a whole lot of this and something we haven't touched on yet has to do with peace.
Speaker 2:I tell patients sometimes you're more than your body, You're more than your symptoms. You're not your symptoms, You're not your depression, You're not your anxiety, You're not your knee pain. Those are things that you have and that sometimes feels like they have you maybe, but that's not you. But the important point out of this, I think, is make these and again, hopefully through Novodon and whatever program people are doing make these things part of you, make them intrinsic to you and not extrinsic, not things that you attach yourself to, but things that are part of you and yeah, so I like the aspect of looking for the vitality now and, yeah, you're right, I mean exercise makes us feel good in the moment. The endorphins, which it's not that different from the milkshake that you mentioned, I mean the dopamine and serotonin, all these reward chemicals that we have, yeah, those are real. But the vitality we get from treating ourself well in an investment way for our health, I think is better now and certainly in the future.
Speaker 1:Yeah, that last question how does your spirituality play into your practice?
Speaker 2:Because you start talking that way my bells are going off, I'm just.
Speaker 1:I'm hearing something Buddhist, something Christian. Something's happening in my brain, so I'm curious what's happening in your brain?
Speaker 2:Yeah. So my faith informs pretty much everything I do. I don't impose my faith on other people. I was raised in a Christian family, christian background. I mean, I grew up in the South. You can't, as they say, you can't, swing a dead cat without hitting a Christian in the South, right? I mean we're everywhere there, and I think faith is an interesting aspect because it is as a scientist, as a physician, I like tangible, I like data, but faith is not that, it's the substance of things not seen, right, as St Paul said. So we don't get to touch these things, we only get to believe in them.
Speaker 2:And for some people that's crazy and gosh. How could you believe that? How can you believe in things or people or events that you've never seen or can't see? How do you know that? Well, that's what faith is. People can say prove to me that you love your wife. Okay, well, I could show you me giving her flowers, I could show me giving her a kiss, I could show you a lot of things. But does that prove that I love her? No, it's maybe some evidence, maybe I don't know, but I know that I love her, I know that she loves me, and that's an intangible.
Speaker 2:We practice it in tangible ways. The church calls some of these things sacraments, things that are tangible evidence of an intangible thing the sacrament of marriage. You can't see marriage. You can see a ring on a finger, but can you see marriage? Nope. You can see people that cohabitate, that have kids. You can see a marriage license, but can you see marriage? No, it's a sacrament, and so it's a very interesting conversation, and I love to have that with people, but it's also obviously one that's fraught with landmines and trips and experience, flavored by all sorts of things. And the world is full of humans, and some humans are not good people and what the church has done and what people have done is sometimes very bad choices. And people want to point fingers at different organizations and things, and I always step back and say those organizations are made of people. It's not the organization that's bad, it's individuals within those organizations that are bad. And I know that's not the question you asked.
Speaker 2:But, coming back, my faith, yes, informs everything I do, but at the same time, I don't impose it and I don't allow it to make decisions for people. There are certain things within practice that I can't or won't do for people, but I won't get in the way of them with their goals. In other words, if people come to me and say, will you be a therapeutic alliance with me for this? And I might say no, but you know what, I can give you a referral to somebody who can. So my job is not to ever pass judgment or to tell people what they can or shouldn't do. That's not my job. My job is to do medicine, but I am first and foremost a person of faith, and then I'm a husband, and then I'm a father, and then I'm a doctor and so yeah. So I think faith is important. It's important to me. Yeah, some people it's not. That's okay.
Speaker 1:Well, I appreciate it. I appreciate you sharing a little bit. It's just the way you described. Those simple words of you are not your pain, you are not your symptoms. I've never heard a doctor talk like that, so I like that. I remember when I first came to you and I was having some pretty bad anxiety bouts and the first thing you mentioned was meditation download a meditation app, which I thought was like I don't know, it's so easy, like here's a pill. But no, it wasn't a pill. Download a meditation app and I just I love that. So I love what you're putting out into the world. Final question We've talked about a little bit at the beginning, so, circling back to it do you think your practice, your career, will make you approaching your own mortality easier?
Speaker 2:I hope so. I think about mortality more and more, as we all do, as we age. In your teens and twenties it's a concept you don't even think about or understand In your thirties. It zooms by at some point In your forties you go. Okay, yeah, I get it. And now I think the interesting thing to me is you know, as a child growing up in the eighties, so many of the pop stars are gone. You know Prince and Michael Jackson.
Speaker 2:I just watched the new documentary on Netflix the other night about the making of we Are the World Really fascinating and think about the people that are in that room that are no longer with us and that's a real sobering thought, like these legends that we grew up with that are just not here anymore.
Speaker 2:And we've always known that celebrities check out, they die and that happens, but when it's from your generation, it starts getting really real. So, yeah, I do think about it more and yeah, I hope that I'll put it this way I hope that I exit with the grace that I've been privileged to witness in others, because I've seen some people go out and I think that was so brave and that was so amazing in the way that they treated their family, in the things that they gestured and the things that they said and the things that they were, the legacy that they gave to their kids and to their friends, and the way they made people feel. I never know if attributed quotes are right, but I've always heard that Maya Angelou said people won't remember what you said or what you did, but they'll remember how you made them feel. Or I can't paraphrase it or quote it exactly, but yeah, I hope that when I check out, I hope that there's more people than not that look back and say I liked how he made me feel.
Speaker 1:Beautiful. Thank you. I appreciate you sharing your life experience and some real intense moments you've been through and the cool new stuff you're doing with your business. I appreciate all of it. Any last words you want to share with our audience before we check out Be good to people.
Speaker 2:Call your mom, call your dad. Some of us don't have those people in our lives anymore. Call them up, tell them you love them right now. Whatever you're doing, just stop Call. Tell them you love them right now. Whatever you're doing, just stop Call your parents.
Speaker 1:Tell them you love them. It's beautiful, I love it. It's a great closing message. Thank you, and thanks to the listeners for sticking with us and we'll see you next time on Happy when Curious.
