Music, Medicine and Dr. Malini Sur: The Heartbeat of a Surgeon’s World

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In this episode of Soma Says, we delve into the world of surgical oncology with Dr. Malini Sur, an expert in tumors of the liver, pancreas, and gastrointestinal system. Dr. Sur shares her inspiring journey—from experiencing a benign tumor as a young teenager to becoming a leader in minimally invasive and robotic surgery.

We explore the complexities and ethical considerations of treating advanced cancer patients, the importance of patient advocacy, and how communication shapes clinical care. Dr. Sur also opens up about her background in music and dance, highlighting the significance of creative outlets in maintaining balance as a physician.

Tune in for a compelling and informative discussion on bridging medical expertise with compassionate care.

🔹 Episode Breakdown: 00:00 – Introduction to Soma Says 00:08 – Meet Dr. Malini Sur 02:54 – Dr. Sur’s Journey into Surgical Oncology 05:44 – Challenges and Rewards in Surgical Oncology 07:21 – Current Practice and Patient Care 10:16 – Screening and Risk Factors for Pancreatic Cancer 13:49 – Advocacy and Genetic Testing 22:40 – Women’s Health and Medical Bias 33:55 – Ethics and Palliative Care in Surgery 41:44 – Balancing Medicine and Personal Passions 47:49 – Conclusion and Final Thoughts

🔗 Connect with Us: 📩 Have questions or thoughts? Reach out at [e-mail] 🌿 Follow Soma Says for more episodes blending Western medicine with Eastern wisdom!

Episode Transcript

(00:00):
Welcome back to Soma Says, the podcast where we bridge Eastern wisdom with the best of Western medicine, all related to women's health.

(00:08):
Today, we have the honor of introducing a true leader in the field of surgical oncology, Dr.
Maal leeni Soor.
Dr.
Soor is a board-certified surgical oncologist specializing in tumors of the liver, pancreas, and gastrointestinal system.
With expertise in minimally invasive and robotic surgery, she is dedicated to delivering compassionate, evidence-based care to her patients. 7 00:00:31,987.5 --> 00:00:37,987.5 A Harvard graduate with medical training from Mount Sinai and a fellowship at the University of Chicago, Dr. 8 00:00:37,987.5 --> 00:00:44,397.5 Soor has held prestigious leadership roles, including serving as Chief of Surgical Oncology at Mount Sinai Queens. 9 00:00:44,797.5 --> 00:00:52,847.5 She’s not just a gifted surgeon—she’s also a dedicated educator, a researcher, and even a musician! Dr. 10 00:00:52,847.5 --> 00:01:01,327.5 Soor believes in treating every patient with the same care she would want for her own family, guiding them through some of the toughest moments of their lives. 11 00:01:02,187.5 --> 00:01:05,137.5 We can’t wait to dive into this conversation with her today. 12 00:01:05,717.5 --> 00:01:06,7.5 Dr. 13 00:01:06,7.5 --> 00:01:15,125 Soor, welcome to Soma Says! Hi, this is Dr.

(01:15):
Soma.
Just a disclaimer, this podcast is for informational purposes only and isn't intended as medical advice.
Always consult with your doctor before making any changes to your diet, exercise, or health regimen.
Let's go to the show.

(01:56):
We are here until the work is done.
We're on call for our patients were there.
.0005If there's a problem for the most part, unless we're rare times that we take vacation. 21 00:02:07,120.1695 --> 00:02:21,150.1695 So It's a lot of connection to the patients, even though we're surgeons, which people don't necessarily think of as being a job where you're, have a long term relationship, but we do because we'll see them if I do a Whipple for pancreas cancer, I'll see them. 22 00:02:21,705.1695 --> 00:02:22,155.1695 Forever. 23 00:02:23,930.3395 --> 00:02:31,0.3395 I do lots of complicated surgery, which is challenging and fun and all that stuff, energizing. 24 00:02:31,0.3395 --> 00:02:35,960.3395 But sometimes I obviously have cases where I can't offer any kind of procedure. 25 00:02:36,510.3395 --> 00:02:48,950.3405 But I have found sometimes that the discussion, like having a successful discussion about serious illness when you can't have surgery, sometimes it's, first of all, sometimes it's harder than the surgery. 26 00:02:50,735.5105 --> 00:02:52,575.511 Welcome to my podcast. 27 00:02:52,575.511 --> 00:02:53,915.511 It's great having you here. 28 00:02:54,485.51 --> 00:03:05,435.51 Wanted to know and learn about your practice and what led you to the world of surgical oncology specifically in the field that you are. 29 00:03:06,595.51 --> 00:03:08,305.51 That's a great question. 30 00:03:08,435.51 --> 00:03:13,435.51 I think early on, we come from the same kind of backgrounds. 31 00:03:13,435.51 --> 00:03:20,845.509 Of course, we have hardworking immigrant parents that pushed us and were themselves very decorated with degrees. 32 00:03:20,845.509 --> 00:03:24,295.5105 And I, when I was a teenager, I had a. 33 00:03:24,970.5105 --> 00:03:27,220.5105 benign salivary gland tumor. 34 00:03:27,660.5105 --> 00:03:31,60.5105 I just, I was in eighth grade and I felt a lump kind of thing. 35 00:03:31,60.5105 --> 00:03:37,460.5075 And I remember that experience very well because, I venerated my parents as being the smartest people that I knew. 36 00:03:37,870.5085 --> 00:03:41,20.5075 But that was a time that I saw them completely vulnerable. 37 00:03:41,430.5085 --> 00:03:48,900.5075 And, I just thought, wow, there's this other person, this surgeon that knows more about me and my body. 38 00:03:49,530.5075 --> 00:04:07,640.5095 And my parents or me and I thought that whole process was interesting and watching my parents be very frightened about it and just, having the surgeon allay their fears and explain that, with diagrams I thought looking at my MRI, looking at my brain and my I had a neck MRI was really cool. 39 00:04:07,640.5095 --> 00:04:09,430.5095 I brought it into my biology class. 40 00:04:09,430.5095 --> 00:04:12,190.5105 And that was my, my, my mark going through surgery. 41 00:04:12,190.5105 --> 00:04:13,190.5105 That was all fine. 42 00:04:13,620.5105 --> 00:04:14,920.5105 As I got older. 43 00:04:15,325.5105 --> 00:04:27,305.5095 And in undergrad, I was a student at Harvard and I was lucky enough that kind of through they had a career office and they have a long list of people that you could contact if you wanted to shadow them. 44 00:04:27,305.5095 --> 00:04:28,905.511 And I tried to shadow. 45 00:04:29,225.511 --> 00:04:59,25.511 A surgeon, and I ended up not working with him directly, but one of his colleagues, but basically I worked with Myron Shorts, who's a liver transplant surgeon in New York City very well respected man internationally, and that was the summer between freshman and sophomore year, and that was like a life changing summer because I just followed the surgical team around and transplant, and as you can imagine, liver transplant especially is just a very Intense thing to watch to see the patients and the approach to care. 46 00:04:59,305.511 --> 00:05:02,875.51 For me, that was just a summer where I was like, oh, I just this is I have to do this. 47 00:05:02,875.51 --> 00:05:04,755.51 This has to be a part of my life. 48 00:05:05,225.51 --> 00:05:13,145.509 And then, of course, I went on, finishing undergrad and ended up at back at Mount Sinai which is actually a few blocks away from where I went to high school. 49 00:05:13,145.509 --> 00:05:14,845.508 That's how I ended up at Sinai. 50 00:05:14,855.509 --> 00:05:16,865.508 I volunteered there when I was an eighth grader. 51 00:05:17,255.509 --> 00:05:22,45.5085 And then I, I really, I did general surgery, which is broad training and surgical care. 52 00:05:22,370.5095 --> 00:05:32,290.509 I had a little diversion where I was interested in pediatric surgery for a couple of years, but then the neonatal ICU I thought was very scary and I didn't like that. 53 00:05:32,290.509 --> 00:05:33,300.5085 I wanted to deal with adults. 54 00:05:33,310.5095 --> 00:05:37,200.4095 Went back to the world of liver and big abdominal surgery. 55 00:05:37,420.5095 --> 00:05:44,390.5095 And then got exposed to cancer surgery, which is has some overlap with transplant a little bit different approach. 56 00:05:44,390.5095 --> 00:05:57,800.5105 I liked the holistic work of looking at things from a medical side, not just a technical decision making about whether or not I can do an operation, but also whether I should and so that's how I got into surgical oncology. 57 00:05:58,120.5105 --> 00:06:23,850.5105 GI surgical oncology, which broadly includes, at least in my practice liver tumors, pancreatic cancer stomach cancer, and then I say the miscellaneous other kinds of rare tumors, neuroendocrine tumors, appendiceal cancer lots of kind of unnamed things that are sarcomas of the abdomen, which are rare but also it's hard to find a person that only does one of those really rare tumors. 58 00:06:23,860.5105 --> 00:06:29,470.51 So many of us bring together a bunch of rare things and then become the expert on that. 59 00:06:29,870.51 --> 00:06:31,870.51 But yeah, my practice is. 60 00:06:32,240.51 --> 00:06:33,170.51 Completely clinical. 61 00:06:33,170.51 --> 00:06:37,340.51 I know, one of our topics we had discussed was research, which I've done a lot in the past. 62 00:06:37,340.51 --> 00:06:40,930.51 Currently, I'm a very high volume kind of clinical surgeon. 63 00:06:41,280.509 --> 00:06:47,940.509 I do about 50 percent pancreas, liver, and then 50, 50 percent kind of other abdominal surgical oncology. 64 00:06:48,280.508 --> 00:06:50,230.508 And yeah, I love what I do. 65 00:06:50,520.508 --> 00:06:51,20.508 It's. 66 00:06:51,440.509 --> 00:06:52,50.509 It's hard. 67 00:06:52,480.509 --> 00:06:54,220.509 I have a old school job. 68 00:06:54,230.509 --> 00:06:55,770.509 We're not shift workers. 69 00:06:55,810.509 --> 00:06:58,70.509 We are here until the work is done. 70 00:06:58,930.509 --> 00:07:00,920.509 We're on call for our patients were there. 71 00:07:00,920.509 --> 00:07:05,170.5095 If there's a problem for the most part, unless we're rare times that we take vacation. 72 00:07:05,590.5085 --> 00:07:19,620.5085 So It's a lot of connection to the patients, even though we're surgeons, which people don't necessarily think of as being a job where you're, have a long term relationship, but we do because we'll see them if I do a Whipple for pancreas cancer, I'll see them. 73 00:07:20,175.5085 --> 00:07:20,625.5085 Forever. 74 00:07:21,175.5085 --> 00:07:23,395.5085 And where do you practice right now? Yeah. 75 00:07:23,395.5085 --> 00:07:29,35.5085 So I practice in Atlanta in a system called Northside Hospital Cancer Institute or Northside Hospital System. 76 00:07:29,35.5085 --> 00:07:33,685.5065 It's a five hospital very large community practice. 77 00:07:33,685.5065 --> 00:07:34,995.5075 So very busy. 78 00:07:34,995.5075 --> 00:07:36,315.5075 It's an interesting environment. 79 00:07:36,655.5075 --> 00:07:45,775.5075 Not academic in that we don't have a lot of trainees, but we I would say practice with the academic mindset. 80 00:07:45,795.5075 --> 00:07:52,245.5075 We have tumor boards, multidisciplinary conference every week and all the different specialties. 81 00:07:52,255.5075 --> 00:07:56,335.507 So it's not just one GI conference or one cancer conference. 82 00:07:56,335.507 --> 00:08:02,25.5065 It's liver and pancreas conference and colorectal conference and melanoma sarcoma conference. 83 00:08:02,55.5075 --> 00:08:05,295.5075 And, every subset has its own plan. 84 00:08:05,295.6075 --> 00:08:05,310.4075 Yeah. 85 00:08:06,60.5075 --> 00:08:13,280.5075 weekly hour long meeting with 20 plus doctors looking at what's the best pathway forward for this patient. 86 00:08:13,780.5075 --> 00:08:20,180.5075 And we do have some clinical trials that we can encourage patients to join in. 87 00:08:20,190.5065 --> 00:08:23,820.4095 But I attend all the academic conferences that are related to my field. 88 00:08:24,960.5095 --> 00:08:27,70.5095 So it's a great environment. 89 00:08:27,80.5095 --> 00:08:29,150.5095 I think one of the things that's different. 90 00:08:29,150.5095 --> 00:08:38,900.5075 I probably have without, we have a lot of extended providers, advanced care practice providers, like PAs and MPs, rather than residents and fellows and students. 91 00:08:39,400.5085 --> 00:08:40,930.5075 I definitely miss that. 92 00:08:41,15.6085 --> 00:08:44,505.6085 Teaching a someone who's going to be a surgeon is a different experience. 93 00:08:44,505.6085 --> 00:08:45,385.6085 And I miss that. 94 00:08:45,695.6085 --> 00:08:49,605.6085 There's a lot of teaching that goes on with a PPS advanced practice providers. 95 00:08:49,985.6085 --> 00:08:55,625.6095 But I think that, we, in a community practice we reduce the layers between the patient and the doctor. 96 00:08:56,125.6095 --> 00:09:02,945.6085 If somebody is coming to see me, they will see my PA briefly but then I sit down with them I'm doing most of the discussion. 97 00:09:03,475.6085 --> 00:09:04,375.6085 Rather than. 98 00:09:04,855.6085 --> 00:09:17,685.6085 In an academic center, sometimes it's layers of you're seeing the student, you're seeing the resident, and similarly, if there's any issues in the perioperative period I'm finding out about things related to patient care much sooner. 99 00:09:17,705.6095 --> 00:09:20,345.6085 There's not layers of communication. 100 00:09:20,395.6085 --> 00:09:21,185.6085 Another thing is. 101 00:09:21,845.6095 --> 00:09:25,475.6095 It's very easy for me to pick up the phone and call the other doctors. 102 00:09:25,475.6095 --> 00:09:30,515.6095 So if I had a patient with chest pain and I'm not relaying it to someone. 103 00:09:30,565.6105 --> 00:09:35,515.6105 I'm not asking someone else to make the phone call to another resident to get it, to get the attending. 104 00:09:35,515.6105 --> 00:09:40,710.6095 I pick up the phone and I call, the chief of cardio oncology to say, Hey, I have this issue. 105 00:09:40,760.6095 --> 00:09:41,340.6095 I have this patient. 106 00:09:41,340.6095 --> 00:09:44,210.6095 What do you want to do? And so that, that's really nice. 107 00:09:44,250.6095 --> 00:09:51,10.6095 I think in some ways that is a model of care that is a little old school, but I think we miss that in a lot of environments today. 108 00:09:52,60.6085 --> 00:09:52,340.6085 Yeah. 109 00:09:52,670.6095 --> 00:09:58,660.6105 I think that's changing because of how medicine has evolved. 110 00:09:59,260.6105 --> 00:10:13,480.6105 As an internist, I have patients and they're all very eager to stay healthy, so obviously, we go over preventative care and all the things, the screenings, everything that they can do. 111 00:10:14,240.6095 --> 00:10:15,970.6095 But the one question that comes up. 112 00:10:16,560.6105 --> 00:10:17,760.6105 pancreatic cancer. 113 00:10:18,450.6105 --> 00:10:22,690.6105 How do I screen for it? Or I have ovarian cancer. 114 00:10:22,690.6105 --> 00:10:41,510.6105 What are my chances of having pancreatic cancer? I'm not necessarily asking you the answers for both, but the screenings for pancreatic cancer, unlike colorectal cancer, unlike breast cancer, there's nothing that I can really advise patients. 115 00:10:42,170.6105 --> 00:10:49,720.6105 So what approach do you take or advise patients when it comes to that? I think it's a great question. 116 00:10:49,720.6105 --> 00:10:57,170.61 I think people are very scared of pancreas cancer just from, what they hear in the news and the media probably from their friends and family too. 117 00:10:57,550.611 --> 00:11:05,690.611 Yes, there are no national guidelines advocating for the general public to undergo screening for pancreas cancer. 118 00:11:06,150.611 --> 00:11:15,860.61 So I think, then it goes to for the general public, which is no genetic mutation, no family history, what are the risk factors? And we can, we can talk about that. 119 00:11:15,860.611 --> 00:11:20,640.61 Obviously, I think any kind of, and this is not just pancreas, but any kind of, G. 120 00:11:20,640.61 --> 00:11:20,810.61 I. 121 00:11:20,820.61 --> 00:11:22,850.61 Symptom that to me is not getting better. 122 00:11:23,150.61 --> 00:11:34,280.61 So abdominal pain, nausea, vomiting, unexplained weight loss for pancreas, back pain things that have no explanation, I think need further work up. 123 00:11:34,280.61 --> 00:11:39,540.61 And this is where my best friend from college, my Harvard roommate from freshman year Elizabeth Quinn. 124 00:11:39,540.61 --> 00:11:43,800.61 She's the chief of family medicine and Salem Hospital in Massachusetts. 125 00:11:43,800.71 --> 00:11:50,200.61 And she said, I think it's such a hard job that you guys have, right? We think that Oh, like cancer surgery, that's a hard job. 126 00:11:50,210.61 --> 00:11:56,230.61 But when I talk to her, I'm like, Oh my God, you have a hundred people a week with abdominal pain. 127 00:11:56,720.61 --> 00:12:00,760.61 It's easy for me to sit at my office and say, everybody should get a CAT scan. 128 00:12:01,860.61 --> 00:12:04,190.61 But she can't do that, right? You can't do that. 129 00:12:04,190.61 --> 00:12:11,90.6095 And that's the struggle is what's the, just the indigestion and what's, something that's more serious. 130 00:12:11,120.6105 --> 00:12:22,640.6105 I, that I wouldn't be interested in your commentary, but from my end, I think, something that's refractory that's new and unusual and not getting better with the, with the general first line medical treatment. 131 00:12:22,970.6105 --> 00:12:27,765.5105 I think in my opinion, endoscopy, colonoscopy, endoscopy. 132 00:12:29,95.6105 --> 00:12:33,875.6105 Axial imaging, which is a CAT scan or an MRI with contrast. 133 00:12:34,415.6105 --> 00:12:39,535.6095 That to me is if you've done all those things, you probably, and they're done with good quality. 134 00:12:39,535.6095 --> 00:12:42,955.6095 Then the chance of you having something I think is low. 135 00:12:43,815.6095 --> 00:12:53,45.6095 I see a ton of patients that have gone through a six to 12 months to sometimes longer process where they've had. 136 00:12:53,615.6095 --> 00:13:08,745.6095 These first early symptoms, then going back and, maybe not getting better where maybe they got some blood work, then maybe they got an EGD, but they didn't get a colonoscopy, maybe they got an ultrasound, but they didn't get a CAT scan or they got a CAT scan, but it wasn't with contrast. 137 00:13:08,755.6085 --> 00:13:11,15.6085 So I see this a lot. 138 00:13:11,45.6095 --> 00:13:18,455.5105 We're little snippets are done of the whole workup, but the whole workup is not done until the very late, stage. 139 00:13:18,455.5105 --> 00:13:25,475.5095 And this is where, we're going to get into advocacy, right? Where, of course, we have a whole range of patients. 140 00:13:25,475.5105 --> 00:13:34,85.5105 We have patients that are very well informed, that are on chat GPT, that read everything, know everything and are right on top of their symptoms. 141 00:13:34,575.5105 --> 00:13:38,155.5105 Maybe a little bit too much sometimes, but they're more likely to. 142 00:13:38,580.5105 --> 00:13:44,60.5105 Go back to the doctor, go seek, I want to see a specialist, get the referral, get extra stuff done. 143 00:13:44,510.5105 --> 00:13:48,800.51 And I know that there's a downside to also over screening and, that may be outside the scope of today. 144 00:13:49,210.509 --> 00:14:00,310.51 But we also have the other side where we have patients that, first of all may not have insurance, or if they have insurance it's still difficult for them to make time to get to see a doctor. 145 00:14:01,255.51 --> 00:14:12,595.509 Many times, in some ways, going to the first doctor, whether it's the emergency room or their PCP, some people I think feel like I went to the primary care, I went to the ER, and they said it was this. 146 00:14:13,135.51 --> 00:14:25,825.5105 So then, two or three months later, when their symptoms are worse, they're still saying the doctor said it was fine, so I'm just going to keep going, and they're not necessarily getting that message of they saw you once on that day. 147 00:14:26,300.5105 --> 00:14:32,540.5105 And if it's three or six months later, and you're still having these symptoms we need to think about escalating, so we have that range. 148 00:14:32,550.5105 --> 00:14:34,510.5105 And that's where I think advocacy is very important. 149 00:14:35,210.5105 --> 00:14:44,50.5095 But then going to your other question of, surveillance, if you have a family history of pancreas cancer, technically that doesn't meet criteria for genetic testing. 150 00:14:44,550.5105 --> 00:14:50,580.4105 However, genetic testing these days out of pocket testing is about 250 and 300. 151 00:14:50,580.5105 --> 00:14:53,620.51 So if it's something where, you think the peace of mind will come. 152 00:14:54,50.51 --> 00:14:59,550.51 I would say consider getting it done just for peace of mind, especially because a lot of people don't really know their family history. 153 00:14:59,740.51 --> 00:15:13,255.51 They had an aunt, they had a cousin who died of stomach cancer, but we don't really know when we say stomach, what was it? If they say liver cancer, was it liver cancer? Did it spread from somewhere? So we have a lot of mysterious family members with mysterious illnesses. 154 00:15:13,255.51 --> 00:15:15,285.51 It's hard to really pinpoint family history. 155 00:15:15,785.51 --> 00:15:25,415.5085 Definitely if you have ovarian cancer, I don't want to speak for gynogs, but my understanding is ovarian cancer gets genetic testing or should get genetic testing no matter what. 156 00:15:25,415.5085 --> 00:15:33,425.509 So those patients should know whether or not they have a mutation that also predisposes them to pancreas cancer like the BRCA genes. 157 00:15:33,875.509 --> 00:15:37,375.409 We see the BRCA gene, the ATM mutation. 158 00:15:38,835.509 --> 00:16:01,365.509 There are a couple that we see that we have a pancreatic cancer screening program, roughly speaking, that's using a combination of a lab test that are called tumor markers that look for GI and pancreas cancers an MRI of their pancreas, and then something called an endoscopic ultrasound, which is a procedure that a GI doctor does to look up close at the pancreas and do any biopsies if needed. 159 00:16:02,265.509 --> 00:16:14,15.509 The general public should not be getting all that work up because we're going to lead to a few people finding things that shouldn't need anything done, a few people getting pancreatitis from a unnecessary biopsy. 160 00:16:14,575.509 --> 00:16:20,845.508 So that's not the approach for all patients, but for all patients, it's to be attuned to your body and to your family history. 161 00:16:21,335.509 --> 00:16:24,105.509 and see a medical doctor when you have a problem. 162 00:16:25,485.509 --> 00:16:27,545.509 You had asked me my approach. 163 00:16:27,545.509 --> 00:16:35,345.5085 I think it's similar to my colleagues where it depends on the symptoms as well as the severity. 164 00:16:35,345.5085 --> 00:16:40,615.508 So I don't necessarily always throw the kitchen sink at every single patient. 165 00:16:40,615.608 --> 00:16:43,508.875 But let's say they come in with mild discomfort. 166 00:16:43,508.875 --> 00:16:48,652.4607778 I'm like, okay, we're not necessarily looking, as the expression in medicine, looking for the zebras. 167 00:16:49,402.5607778 --> 00:17:03,782.5607778 But I tell them we're going to do X, Y, and Z, and that might involve getting an ultrasound, trying some proton pump inhibitor to see if it relieves the discomfort and possibly seeing a gastroenterologist. 168 00:17:04,522.5607778 --> 00:17:14,212.5617778 But even then I'm like, we, you should not, you should continue to stay in touch with me because even if it stays mild, we don't necessarily want to ignore that. 169 00:17:15,182.5617778 --> 00:17:19,672.5617778 And we should do some further type of CT imaging, as you mentioned. 170 00:17:20,242.5617778 --> 00:17:25,302.5617778 We should mention the other thing is that, the new onset diabetes in the older patient. 171 00:17:25,512.5617778 --> 00:17:54,762.5627778 That's another, red flag for, again, we don't have any guidelines that say new onset diabetes should get a scan, but it's something I think about depending on how new and how radical signs of, again, nutritional deficiencies, steatorrhea, which is, floating stools or abdominal bloating related to pancreatic enzymes, especially that if there's GI stuff with new onset diabetes, I think we'd want most. 172 00:17:55,627.5627778 --> 00:17:58,97.5627778 clinicians to be thinking about the pancreas. 173 00:17:58,727.5627778 --> 00:18:08,747.5617778 And then just as, because I have my foot in both doors, I don't take care of primary colon cancer for the most part, but I do a lot of surgery for liver metastases from colorectal cancer. 174 00:18:08,747.5617778 --> 00:18:17,257.5627778 So I'm also an advocate for early, screening, just wanted to shout out that, now the new age for screening colonoscopy is age 45. 175 00:18:17,982.5627778 --> 00:18:25,812.4627778 But also again, if you're younger than, if you're seeing blood in the stool, you're anemic, you don't know why, that's something that needs a workup. 176 00:18:26,292.5627778 --> 00:18:37,922.4627778 It's, our job is just, it's such a weird perspective because you mentioned this word zebra, right? And we are, my office is literally, my schedule is zebra, zebras. 177 00:18:37,972.5627778 --> 00:19:02,222.5627778 So we're messed up because, we're always seeing the rare and unusual, and so it seems like it's like a, all the time, but we're definitely seeing, I don't want to be alarming, I know it's a podcast we're definitely seeing younger patients with colon cancer, pancreas cancer, gastric cancer, and it was when I was in medical school, and I'm sure for you too, it was unheard of. 178 00:19:03,267.5627778 --> 00:19:06,877.5627778 To have people in their 30s with some of these types of cancers or 20s. 179 00:19:07,407.5627778 --> 00:19:12,867.5627778 I have a series of patients in their 20s, not with pancreas, but with colon and gastric. 180 00:19:14,447.5627778 --> 00:19:22,397.5617778 And so the thing about they're young, and so it can't be X, Y, and Z, like that's to me is out the door. 181 00:19:22,397.5617778 --> 00:19:26,157.5617778 I think it's a function of our environment, our diet. 182 00:19:26,657.5617778 --> 00:19:27,967.5617778 Probably other things. 183 00:19:28,57.5617778 --> 00:19:31,967.5617778 But yeah, no, there's definitely an increase. 184 00:19:32,447.5617778 --> 00:19:34,377.5617778 I trained at NYU Bellevue. 185 00:19:34,387.5617778 --> 00:19:36,777.5622778 So I'll do a comparison. 186 00:19:37,167.5622778 --> 00:19:46,137.5622778 So at that time, and I think still now we had a large Bangladeshi Bengali population that came to the hospital. 187 00:19:46,137.5622778 --> 00:19:50,287.5622778 And as South Asians tend to have a higher risk of heart disease. 188 00:19:50,747.5622778 --> 00:20:00,347.5612778 And so we would be seeing patients who are in their thirties or forties having heart attacks or unstable angina. 189 00:20:01,912.5612778 --> 00:20:04,722.5612778 And so that kind of got drilled into my head. 190 00:20:05,212.5612778 --> 00:20:11,602.5602778 And so even now, and if, even if it's not a patient that's South Asian let's think about heart disease. 191 00:20:11,642.5602778 --> 00:20:12,882.5602778 Let's screen for it. 192 00:20:12,912.5592778 --> 00:20:15,432.5602778 Let's make sure that's not what's going on. 193 00:20:15,452.5592778 --> 00:20:19,562.5602778 Even if they're, if their discomfort is coming from their acid reflux. 194 00:20:19,932.5602778 --> 00:20:22,752.5602778 So I think as you were mentioning the zebras. 195 00:20:23,357.5602778 --> 00:20:35,317.5602778 And for those who don't know what we're referring to, it's basically all the unusual conditions or findings that you don't necessarily think about. 196 00:20:36,137.5592778 --> 00:20:37,697.5602778 For the listeners, it's the whole phrase. 197 00:20:38,247.5602778 --> 00:20:51,217.5592778 What is it? If you hear not hoofbeats, is that the word? Footsteps, it's the footsteps of the horses, what's it called? I'm not going to say it correctly, I'll google it. 198 00:20:51,217.5592778 --> 00:21:01,897.5592778 So I said, okay, but basically you're supposed to think about horses and not zebras, right? And that's that is my job as an as the primary care physician and I'm comfortable doing that. 199 00:21:02,287.5592778 --> 00:21:18,187.5592778 But yes, every once in a while, and I would say it does it happens more often than I'd like but there are times when I have to deal with the zebras and know who to connect with And obviously how to refer, the patient as quickly as possible. 200 00:21:18,387.5592778 --> 00:21:20,987.5592778 So I'm grateful for doctors like you. 201 00:21:21,17.5592778 --> 00:21:22,77.5592778 I'm in New Jersey. 202 00:21:22,77.5592778 --> 00:21:30,337.5592778 So I have a whole network of colleagues where when these issues come up, I know who to refer to. 203 00:21:30,827.5582778 --> 00:21:36,677.4592778 I usually just, I tell every now and then I tell the patients, because they're there. 204 00:21:37,92.4592778 --> 00:21:41,2.4592778 Obviously very humbly grateful for what I'm doing. 205 00:21:41,72.4592778 --> 00:21:47,632.4592778 And but I often tell them like you need to call your primary care doctor and say thank you. 206 00:21:47,682.4592778 --> 00:21:51,452.4582778 Because not I know that not everybody will get that workup. 207 00:21:51,522.4592778 --> 00:21:54,612.4592778 And so I often just tell them the person who saves your life. 208 00:21:55,377.4592778 --> 00:22:01,507.4592778 is this person who took you seriously and started this work up that, led you to this day. 209 00:22:02,167.4592778 --> 00:22:05,67.4582778 And I tell them, I said, you pick up your phone, you call the primary care doctor. 210 00:22:05,437.4592778 --> 00:22:40,867.4577778 Oh, I think I, I don't need the kudos all the time, but, and I have, honestly, I've been blessed, and I hope my patients are listening to this, but I have been blessed with some really Good people who are my patients and the gratitude that I have received at times I don't I feel so humbled, when they do reach out or send me a card, thanking them, thanking me for, find whatever I found and however, which way I've helped them, but I could not obviously do it without highly specialized surgeons and other colleagues. 211 00:22:40,932.5587778 --> 00:23:05,542.5577778 As you probably know, I focus a lot on women's health it's, I've been doing this now for, gosh, I can't even remember, but the large majority of my practice is focusing on women's health and that, not just from a GYN perspective, because I'm not a gynecologist, not to say it's not important, but it's a very comprehensive approach that I take. 212 00:23:06,277.5587778 --> 00:23:20,537.5587778 So in your practice, obviously you're seeing more of the unusual things than I am, but what do you find women are coming in with more often? That's a good question. 213 00:23:20,537.5587778 --> 00:23:21,807.5587778 I don't know that I know this. 214 00:23:22,37.5587778 --> 00:23:25,997.5587778 It's hard for me to say that I have a real percentage difference. 215 00:23:26,437.5587778 --> 00:23:50,487.5602778 I guess my Thoughts on, women and certainly what I see number one, I want to say it's a rare, but now again, I've seen it many times is this issue of, I think women first of all, they're busy and they're, just whatever level of education, whatever slice of society they come from, they're working hard, whether it's at work or with kids or at work and with kids. 216 00:23:51,17.5602778 --> 00:23:53,527.5592778 And so we tend to ignore our bodies. 217 00:23:54,227.5592778 --> 00:23:58,177.5592778 And not take time for, looking at, what's going on with us. 218 00:23:58,677.5592778 --> 00:24:02,947.5592778 I think that's a big problem and can lead to delays in presentation. 219 00:24:03,237.5592778 --> 00:24:05,737.5592778 And I think, anecdotally, I think that I see that more. 220 00:24:06,357.5592778 --> 00:24:16,227.5592778 With women, and I always wonder, always, hard to quantify, but whether their symptoms are taken seriously, especially in the urgent care setting. 221 00:24:16,737.5582778 --> 00:24:23,597.5582778 I have a series of patients, I almost wrote a case series about it, which is the patient who's pregnant. 222 00:24:24,477.5592778 --> 00:24:34,447.5582778 With symptoms of an advanced cancer that just go through the pregnancy with everyone around them saying, Oh, it's because you're pregnant. 223 00:24:34,457.5592778 --> 00:24:36,397.5592778 You're you have rectal bleeding. 224 00:24:36,517.5592778 --> 00:24:37,447.5587778 It's because it's hemorrhoids. 225 00:24:37,447.5587778 --> 00:24:38,17.5587778 You're pregnant. 226 00:24:38,297.5577778 --> 00:24:39,87.5587778 You're vomiting. 227 00:24:39,97.5587778 --> 00:24:40,67.5587778 It's because you're pregnant. 228 00:24:40,497.5577778 --> 00:24:41,197.5577778 It's not getting better. 229 00:24:41,197.5577778 --> 00:24:44,277.5577778 It's because you just have a bad case of being pregnant. 230 00:24:44,357.5587778 --> 00:24:47,327.5587778 I now have a whole series of pregnant patients. 231 00:24:47,922.5587778 --> 00:25:14,547.5577778 That have had symptoms, and I don't, again, I don't, I know that it's not common, so it's easy for me to say why isn't this escalated, but I just worry that might be the reason that it's being not taken seriously because we think it's, a woman patient who is Hormonal or whatever, whatever the phrase is, you know that they're anxious and they're they're more worried about it than they should be. 232 00:25:14,547.6577778 --> 00:25:15,947.5577778 I think that's an issue. 233 00:25:16,447.5577778 --> 00:25:25,17.5577778 Some of it's whatever you want to call it bias or our way that we see the lens in us as providers evaluating patients. 234 00:25:25,517.5577778 --> 00:25:26,917.5577778 But I think it's two sided. 235 00:25:27,7.5577778 --> 00:25:28,597.5577778 I think women also tend to. 236 00:25:29,122.5577778 --> 00:25:29,922.5577778 overwork. 237 00:25:30,512.5577778 --> 00:25:32,552.5577778 I'm the prime example, oh yes, oh my. 238 00:25:34,902.5577778 --> 00:25:36,132.5577778 I totally hear you. 239 00:25:36,152.5577778 --> 00:25:43,132.5577778 I think, I focused on this a lot in other podcasts as well as in my everyday practice. 240 00:25:44,222.5577778 --> 00:25:47,962.5567778 I think that it is a thing. 241 00:25:48,512.5577778 --> 00:25:56,682.5577778 And unfortunately, I have also experienced the discrepancies that can occur. 242 00:25:57,192.5577778 --> 00:26:04,462.5577778 One of the ways I've leveraged and, you and I come from a very similar background, same background. 243 00:26:04,872.5587778 --> 00:26:10,22.5587778 And we have immigrant parents who have always taught us to be humble. 244 00:26:10,42.5587778 --> 00:26:12,482.5587778 Don't brag, don't say you're going to do this. 245 00:26:12,947.5587778 --> 00:26:18,317.5587778 Don't, tell them that you're important and so you continue with that mindset. 246 00:26:18,797.5587778 --> 00:26:24,877.5587778 But as I've gotten older, I've realized that I definitely need to use my MD title. 247 00:26:24,877.5587778 --> 00:26:35,477.5587778 I definitely need to, when I go into any kind of special doctor's appointment, I need to basically let them know that I'm a physician to leverage the care. 248 00:26:35,687.5577778 --> 00:26:46,667.4587778 And as I've said to other people, you really shouldn't have to, but It's important because when I have not some weird things have happened. 249 00:26:47,167.4587778 --> 00:26:49,767.4587778 And not a long time ago, fairly recently. 250 00:26:49,767.4587778 --> 00:27:03,87.4587778 And so it made me realize that this is a thing, but it also humbles me in a way to realize that obviously not everybody has the ability to do that. 251 00:27:04,147.4587778 --> 00:27:06,307.4587778 Not every woman can say, Oh, I'm a doctor. 252 00:27:06,307.4587778 --> 00:27:13,317.4577778 I work here and this is my background and they don't necessarily have the understanding because, they're not medical doctors. 253 00:27:14,487.4577778 --> 00:27:18,807.4577778 I think that we think of questioning as maybe being challenging. 254 00:27:19,367.4577778 --> 00:27:27,27.4577778 And so we're, we think of I don't want to be perceived as someone who's challenging the authority figure, the doctor. 255 00:27:27,47.4577778 --> 00:27:43,562.4577778 But, I find some of the best clinic encounters are the patients that are Asking a lot of questions and they're not doing it in a with any kind of aggressive tone or that they're upset, but they're just truly going down the list. 256 00:27:43,562.4577778 --> 00:27:52,682.4567778 And I love it because I'm like, this is a fun visit where I'm being forced to figure out how to explain something or why this and why not that. 257 00:27:52,682.4567778 --> 00:27:57,552.4577778 And, I love it when people ask me questions that most people don't ask, and I don't see that as. 258 00:27:57,552.4577778 --> 00:27:57,602.4577778 Yeah. 259 00:27:58,62.4577778 --> 00:28:11,2.4577778 A negative thing at all, so there's nothing about asking questions or, expressing your thoughts that, that from our end is necessarily in and of itself seen as a challenge or I don't know what the word is. 260 00:28:11,72.5587778 --> 00:28:34,802.4582778 I mentioned, some of the negative things that I've experienced, but I've also experienced, and it just so happened that these were male doctors where, they were excellent in handling questions and they were highly specialized, but they answered all my questions and I left feeling like, okay. 261 00:28:35,47.4582778 --> 00:28:47,737.4582778 I know that this is going to work out, so I always advocate for my patients to come in with a list of questions because number one, I have only X amount of time. 262 00:28:47,817.4582778 --> 00:28:50,787.4572778 I'm seeing patients just like you back to back. 263 00:28:50,827.4572778 --> 00:28:52,507.4572778 My schedule is completely full. 264 00:28:53,37.4582778 --> 00:29:12,157.4572778 So if you come organized and prepared, then that appointment will be much more structured and we will get much more done and likely you will not have to come back or call me again because you forgot to ask me certain questions. 265 00:29:12,882.4582778 --> 00:29:23,182.4582778 So I think that's really important for women to really advocate for themselves and obviously do it in a, in an honest and respectful manner. 266 00:29:23,732.4582778 --> 00:29:34,222.4582778 I don't want that to be confused with I think there's a fine line between being thought of as aggressive versus advocating for yourself. 267 00:29:35,232.4582778 --> 00:29:41,512.4587778 And if you feel like you're not being heard, sometimes you just have to end that conversation and move elsewhere. 268 00:29:41,872.4577778 --> 00:29:43,732.4567778 It's a two way street. 269 00:29:43,732.4567778 --> 00:29:49,192.4577778 I don't think, I'm sure I, both of us have worked with patients for a long time, but. 270 00:29:49,777.4577778 --> 00:30:09,597.4572778 I still am like, why did that encounter not go as well as I wanted to? What could I do better? I think on our end, we tend to, when we hear questions, we tend to as doctors hear the question as a knowledge question and not as a cognitive question instead of a emotional question. 271 00:30:10,327.4572778 --> 00:30:14,377.4572778 And especially in my line, when people have cancer or they might have cancer. 272 00:30:15,27.4572778 --> 00:30:27,557.4572778 Sometimes the tone or whatever, obviously is that you're feeling with that question as a provider, as a clinician is not it's really just coming from the emotion and they need the emotion to be acknowledged. 273 00:30:27,617.4572778 --> 00:30:29,687.4572778 I dunno if you know about Vital Talk. 274 00:30:29,757.4572778 --> 00:30:36,687.4572778 So I did a version of that when I was at Mount Sinai, which has a very strong geriatrics and palliative care program. 275 00:30:37,107.4572778 --> 00:30:46,917.4572778 And that for your listeners, vital Talk is a course basically for physicians and advanced practice providers that helps with. 276 00:30:48,277.4572778 --> 00:30:52,227.4572778 Communication training with patients about serious illness. 277 00:30:52,237.4572778 --> 00:30:58,257.4562778 It's something that is missing from most medical school curriculums or certainly could be better. 278 00:30:58,787.4572778 --> 00:31:03,467.4572778 And I think part of the problem is when you're a student versus when you're in practice. 279 00:31:04,57.4572778 --> 00:31:12,837.4562778 It's just a completely different amount, the level of communication, the level of doing serious illness, disclosure of illnesses and diagnosis and what to do. 280 00:31:13,77.4572778 --> 00:31:15,217.4572778 It's just so much more and it's day in day out. 281 00:31:15,217.4572778 --> 00:31:26,557.4572778 So you do have to be able to master how am I going to get through this day with all these patients and still, make sure that we're having a connection in each encounter or most of them. 282 00:31:27,237.4572778 --> 00:31:28,567.4572778 And I'm not perfect. 283 00:31:28,567.4572778 --> 00:31:30,647.4572778 So obviously it's not all the time, but. 284 00:31:31,167.4572778 --> 00:31:32,527.4572778 That's a challenge on our end. 285 00:31:32,557.4572778 --> 00:31:34,217.4572778 I think that we can keep working on. 286 00:31:34,967.4572778 --> 00:31:40,497.4572778 I think there's no such thing as perfect when it comes to that conversation. 287 00:31:40,497.4572778 --> 00:31:45,467.4572778 I think you learn from one and you move on to the next. 288 00:31:46,57.4572778 --> 00:31:50,777.4572778 And in the hopes that, you continue to be as close to perfect as possible. 289 00:31:51,417.4572778 --> 00:31:55,7.4572778 But, we're dealing with human lives it's fragile it's emotional. 290 00:31:55,217.4572778 --> 00:31:56,607.4567778 And you're absolutely right. 291 00:31:56,617.4557778 --> 00:32:05,817.4557778 People ask questions especially in your field, right? They're coming in with much more serious things where they're scared. 292 00:32:06,427.4557778 --> 00:32:11,317.4557778 And if that can be seen as something else sometimes. 293 00:32:11,787.4557778 --> 00:32:20,377.4547778 But I think we sometimes need to step back and put ourselves in their shoes and realize that they're feeling scared and intimidated. 294 00:32:20,927.4547778 --> 00:32:22,307.4557778 And so we. 295 00:32:22,857.4557778 --> 00:32:26,957.4557778 are seen as the authoritative figure in that situation. 296 00:32:26,957.4557778 --> 00:32:41,897.4557778 But I think often we need to take off our coats and reassure them and let them know that we're a team here, right? We're making a mutual decision as to whatever approach we're taking. 297 00:32:41,897.4567778 --> 00:32:44,887.4567778 It's not just you or me telling them what to do. 298 00:32:45,127.4567778 --> 00:32:52,197.4567778 I do lots of complicated surgery, which is challenging and fun and all that stuff, energizing. 299 00:32:52,197.4567778 --> 00:32:57,157.4567778 But sometimes I obviously have cases where I can't offer any kind of procedure. 300 00:32:57,707.4567778 --> 00:33:10,147.4577778 But I have found sometimes that the discussion, like having a successful discussion about serious illness when you can't have surgery, sometimes it's, first of all, sometimes it's harder than the surgery. 301 00:33:10,747.4577778 --> 00:33:23,247.4577778 And sometimes it's more rewarding even, because Actually giving that person a moment, to have a good clinical encounter with a doctor and having a satisfying experience at the end of life. 302 00:33:23,287.4577778 --> 00:33:25,477.4577778 Potentially That's more important. 303 00:33:25,487.4577778 --> 00:33:32,697.4577778 That's more lasting, for the wife or for the surviving family member than having an amazing operation. 304 00:33:33,987.4577778 --> 00:33:35,37.4577778 I think in the U. 305 00:33:35,37.4577778 --> 00:33:35,567.4577778 S. 306 00:33:35,617.4577778 --> 00:33:38,787.4567778 and that it's I've studied a little bit abroad. 307 00:33:39,337.4557778 --> 00:33:45,327.4547778 When I've compared the end of life situations, it's a lot different in the U. 308 00:33:45,327.5547778 --> 00:33:45,627.3557778 S. 309 00:33:45,787.4557778 --> 00:33:47,567.4557778 than when you go to other countries. 310 00:33:47,567.4557778 --> 00:33:54,717.4557778 I can say I have an extensive experience which brings me to your surgical ethics fellowship. 311 00:33:55,487.4557778 --> 00:33:59,657.4557778 So tell me how that's influenced you in your practice. 312 00:34:00,347.4537778 --> 00:34:06,977.4537778 Yeah, I had a really amazing opportunity when I was at the University of Chicago for my surgical oncology fellowship. 313 00:34:07,487.4537778 --> 00:34:13,372.4537778 They actually have a Center for Clinical Medical Ethics called the McLean Center. 314 00:34:13,372.4537778 --> 00:34:17,192.4537778 It's been there for I think almost 30 years now, certainly over 20. 315 00:34:17,652.4527778 --> 00:34:24,892.4517778 And they have a fellowship for doctors who want to study medical ethics, clinical ethics, clinical medical ethics. 316 00:34:25,492.4527778 --> 00:34:34,82.4517778 And they allow fellows who are on research to do basically in a synchronous manner, participate in the ethics fellowship. 317 00:34:34,92.4527778 --> 00:34:37,952.4517778 And I also stayed on during another year while I was in my clinical year. 318 00:34:38,362.4527778 --> 00:34:41,502.4532778 And it was just an amazing opportunity to look at. 319 00:34:41,957.4532778 --> 00:34:50,837.4532778 All the different specialties, medical OB and think about those ethical dilemmas, particular to those fields. 320 00:34:50,867.4532778 --> 00:35:04,587.4532778 We had, a course in, jurisprudence and medicine and all going through all the like historical cases of, when that decided our laws currently in our practices on CPR and end of life care. 321 00:35:04,967.4522778 --> 00:35:06,697.4517778 So just very interesting stuff. 322 00:35:07,127.4527778 --> 00:35:16,27.4527778 And my project when I was a fellow I, as a resident was always interested in communication among team members. 323 00:35:16,647.4527778 --> 00:35:20,877.4527778 And the surgical hierarchy, right? We, we're famous for our hierarchy. 324 00:35:21,77.4527778 --> 00:35:45,167.4537778 I thought that, this process by which junior people in a team, and that could be a trainee, it could be an intern, broad, broadly speaking, it could be a nurse, it could be the physical therapist, what influences their ability to speak up when they feel that there's a, at the extreme of medical error, but oftentimes a gray zone of something that's not right, that's going on. 325 00:35:45,167.4537778 --> 00:35:57,527.4532778 And do I have the ability to talk about it? How do I talk about it? How do I decide whether or not I'm going to speak up? So that's something I looked at, as a fellow and, I found that there's many different. 326 00:35:58,42.4532778 --> 00:35:59,412.4532778 Things that influence that decision. 327 00:35:59,412.4532778 --> 00:36:11,12.4532778 It could be the severity of the issue, the environment, the culture of the hospital or the system that you're in, and also the personality of the particular trainee or nurse or, everyone's on a different line. 328 00:36:11,252.4532778 --> 00:36:14,912.4532778 So that was what I looked at as a fellow, but I guess going into practice. 329 00:36:16,127.4532778 --> 00:36:30,427.4542778 I think that it's what's really struck me is that overlap between ethics and palliative care, which, come up with a little bit before, again, as a medical student at Mount Sinai I had a very strong focus, as on palliative care in our training. 330 00:36:30,857.4542778 --> 00:36:35,267.4532778 And I think that's where a lot of what I do has a lot of overlap. 331 00:36:35,307.4532778 --> 00:36:38,907.4532778 I frequently, every week there's a question of. 332 00:36:39,382.4532778 --> 00:36:40,952.4532778 A person with advanced cancer. 333 00:36:40,952.4532778 --> 00:37:07,107.4532778 Should we not necessarily operate on them to take out their tumor? But should we do some kind of other procedure that might help them feel better? In order for them to have a better quality of life or potentially get on to next line of chemotherapy And those are very difficult decisions where there are no clinical guidelines because it's just Not something that anyone's necessarily studied at a high level, and every case is so particular. 334 00:37:07,107.4532778 --> 00:37:19,477.4532778 So it's definitely a challenge and it brings together the patient communication hat and the how do we talk about end of life and prognosis and making sure that everybody's on, on board. 335 00:37:19,517.4532778 --> 00:37:42,742.4532778 So I think those are the dilemmas that I have, which is I can do lots of things, but again, the question is, should I? Open up somebody's abdomen, put their life in danger by virtue of having surgery, which, most abdominal surgery involves some level of risk for something that, is not going to cure their cancer and may not work. 336 00:37:43,882.4532778 --> 00:37:46,82.4522778 It's a very difficult decision. 337 00:37:46,132.4532778 --> 00:37:49,182.4522778 And I would say we're always waxing and waning. 338 00:37:49,182.4522778 --> 00:37:54,172.4522778 I think early in training and early in your career, you're relatively conservative. 339 00:37:54,622.4532778 --> 00:38:05,542.4522778 And then you probably go through a middle course, probably which is where I am now, or maybe I'm a little, I, I feel like what you're taught in your board review course is maybe not, maybe that's not real life. 340 00:38:05,562.4532778 --> 00:38:12,62.4532778 Maybe the boards are too conservative and there's a middle out there where somebody might have this procedure and do really well. 341 00:38:12,62.4532778 --> 00:38:13,832.4532778 And now you've seen them a year later. 342 00:38:14,327.4532778 --> 00:38:16,487.4532778 With weight gain and you're like, oh, I'm glad I did that. 343 00:38:16,567.4532778 --> 00:38:20,467.4532778 And these are very particular situations related to what kind of cancer. 344 00:38:20,707.4532778 --> 00:38:33,157.4532778 Not everybody has the same situation, but once you've done a few and they've gone then you question should you do them more often, so these, I think this changes over one's career, but I think those are the big ethical dilemmas that I have. 345 00:38:34,942.4532778 --> 00:38:35,232.4532778 Yeah. 346 00:38:35,372.4532778 --> 00:38:37,382.4532778 Yeah, I, I've not, I'm not. 347 00:38:38,92.4532778 --> 00:38:51,882.4542778 exposed to that part of medicine because, frankly, when, patients are in that kind of situation, right? I'm far from them at that point, but it's always fascinating to me that. 348 00:38:52,342.4542778 --> 00:39:13,757.4537778 And I think just more generally discussions of just prognosis, maybe the, surgical palliative procedures, that's Out there, but much more common is going to be, what do you do when a patient, you may be someone that has to tell someone they have breast cancer, or that they have pancreas cancer, and then they may immediately say what does that mean? How long do I have to live? Oh, my God. 349 00:39:15,107.4547778 --> 00:39:16,7.4547778 With that question. 350 00:39:16,547.4547778 --> 00:39:21,47.4547778 And of course we're gonna have different views 'cause that's my, maybe my expertise to some extent. 351 00:39:21,467.4547778 --> 00:39:31,367.4547778 But even I struggle with what should be the answer truly to that question because the data, the statistics are not for the patient in front of you. 352 00:39:31,427.4547778 --> 00:39:35,297.4547778 The statistics are for thousands of people lumped together. 353 00:39:36,182.4547778 --> 00:39:43,272.4547778 And I know that if I tell somebody a number, they're going to hold on to that number, and they're going to think that's it. 354 00:39:44,532.4547778 --> 00:39:49,512.4547778 You and I know that's an average, and some people are going to do a lot better, and some people are going to do a lot worse. 355 00:39:49,832.4537778 --> 00:39:57,222.4547778 And that number includes the 85 year old with a whole bunch of other medical problems, as well as the very young person who doesn't. 356 00:39:57,272.4547778 --> 00:40:01,117.4547778 We know that the number is not about that person in front of you. 357 00:40:02,137.4547778 --> 00:40:07,927.4547778 We know that number, may influence the ability of the patient to have hope and stay optimistic and start treatment. 358 00:40:08,677.4547778 --> 00:40:26,947.4557778 So that's always a big one for me, which is I can give you a number, but are you sure you really want to hear it right now? And, are you just scared that this is happening and this is overwhelming and maybe we just need to not go there right this second, but we can bring it back later. 359 00:40:27,497.4557778 --> 00:40:28,827.4567778 So those are things that I. 360 00:40:29,577.4567778 --> 00:40:31,287.4567778 Still struggle with, there's no right answer, I think. 361 00:40:32,367.4567778 --> 00:40:34,967.4567778 Those are the heavier parts of my job. 362 00:40:35,57.4567778 --> 00:40:44,897.4557778 Sometimes it all circles back to me when there's nothing that can be done and obviously we have to then have a different kind of conversation. 363 00:40:45,277.4557778 --> 00:40:47,477.4567778 Probably for you too, the thing is that patients are different. 364 00:40:47,957.4567778 --> 00:40:51,827.4562778 So not every patient is going to want to hear it in the same way. 365 00:40:52,27.4562778 --> 00:40:55,297.4562778 Sometimes we have to adjust what we're saying to divide. 366 00:40:56,917.4562778 --> 00:40:58,900.8239445 We're not always going to get it right, which is important. 367 00:40:58,900.8239445 --> 00:41:02,520.8239445 Part of the problem, maybe AI will do a better job. 368 00:41:02,520.8239445 --> 00:41:06,980.8239445 What do you think I think the doctor patient relationship is more important than ever. 369 00:41:08,270.8239445 --> 00:41:09,40.8239445 Oh totally. 370 00:41:09,40.8239445 --> 00:41:15,650.8239445 Because AI won't be, as far as I can see, I might be completely wrong though, it, I think it's also generational. 371 00:41:15,650.8239445 --> 00:41:30,70.8259445 I think, some generations might want like a quick, but those are the healthier patients where they just want that quick answer to their UTI or their sinus infection, right? AI might serve them well in that case, but not what you do. 372 00:41:30,760.8259445 --> 00:41:44,810.8254445 With all the heavy stuff that we've talked about, right? And I feel like I, as I've advanced in my practice, I realized that it's really important for me to do things outside of medicine. 373 00:41:44,810.8254445 --> 00:41:52,70.8259445 Part of that, even though it's a medical podcast, I focus a lot of, on a lot of things that are not medical on my podcast. 374 00:41:52,340.8259445 --> 00:41:57,370.8259445 So I like to talk to different people, things that are not in my comfort range. 375 00:41:57,740.8249445 --> 00:41:59,200.8249445 I play the piano. 376 00:41:59,480.8249445 --> 00:42:03,130.8249445 I do other things that kind of keep me grounded. 377 00:42:03,410.8249445 --> 00:42:07,130.8249445 What do you like to do? Yeah, that's a great question. 378 00:42:07,140.8249445 --> 00:42:16,770.8259445 So I have a little other side of me that I was lucky that I was again born to a family that gave me lots of opportunities to pursue whatever I wanted. 379 00:42:16,770.8259445 --> 00:42:19,630.8259445 And then I went to schools that supported me as well. 380 00:42:19,630.8259445 --> 00:42:23,540.8269445 I have a prior life as a singer songwriter. 381 00:42:23,540.8269445 --> 00:42:25,750.8269445 I did a lot of music growing up. 382 00:42:25,800.8269445 --> 00:42:31,435.8269445 My claim to fame is that I sang in chorus with Lin Manuel Miranda. 383 00:42:32,45.8269445 --> 00:42:35,475.8269445 So he was two years ahead of me at Hunter College High School on the Upper East Side. 384 00:42:35,485.8269445 --> 00:42:39,325.8269445 And that was a really great environment that obviously supported music. 385 00:42:39,705.8269445 --> 00:42:44,595.8279445 And then I also for a long time did classical Indian dance called Kathak. 386 00:42:45,585.8269445 --> 00:42:49,335.8279445 And as a high school student or a college student, I did both. 387 00:42:49,335.8279445 --> 00:42:51,595.8279445 I sang acapella at Harvard. 388 00:42:52,100.8279445 --> 00:42:59,900.8269445 And then as I got into medical school and residency, I found dance was just a little harder to coordinate because usually you're with a big group. 389 00:43:00,340.8279445 --> 00:43:03,80.8279445 So I went into the singer and song singer songwriter thing. 390 00:43:03,480.8279445 --> 00:43:10,600.8279445 I have two albums on iTunes on Apple Music for anybody interested, do a little plug. 391 00:43:12,200.8279445 --> 00:43:16,460.8279445 But that was a really important way for me to release, post call. 392 00:43:18,20.8279445 --> 00:43:29,470.8279445 I have a lot of songs about medicine, about my feelings about, dealing with illness and watching that and, worried about, did I do the right thing? These are kind of unique challenges that we have. 393 00:43:30,80.8269445 --> 00:43:34,160.8279445 And I thought that was, for me, it was like necessary to keep going. 394 00:43:34,790.8279445 --> 00:43:41,420.8279445 I took a big hiatus when I had kids, right? Life just stops for a decade. 395 00:43:41,430.8279445 --> 00:43:44,640.9279445 And just recently I've been able to get back into it. 396 00:43:44,985.9279445 --> 00:43:58,915.9269445 A little bit more performed a couple of times and, just can't do everything at the same time, but, something's important because I think being connected to that emotional side is very important in ways that we don't understand. 397 00:43:58,915.9279445 --> 00:44:03,665.9279445 I think a lot of us think that those performing arts hobbies are for kids who are in school. 398 00:44:04,25.9279445 --> 00:44:06,95.9279445 We don't think of it as being something that adults. 399 00:44:06,146.0279445 --> 00:44:23,680.3926111 I don't know if anyone else benefit from, but I think they really do, even though I'm not Lin Manuel Miranda, right? He's a genius and he always has been but even doing it at a low level, I think has value and allows us to be connected to our patients in some way. 400 00:44:24,240.3926111 --> 00:44:33,290.3926111 And certainly when it comes to dance, I think it's physically an activity and I think it's also good for your mind to be forced to be thinking about something else. 401 00:44:34,50.3926111 --> 00:44:40,600.3926111 Because you and I, our patients are in our minds 24 7, I'm psychotic. 402 00:44:40,630.3926111 --> 00:44:44,290.3926111 But sometimes the nurses are like, we saw that you put the order in at 4 a. 403 00:44:44,290.3926111 --> 00:44:44,550.3926111 m. 404 00:44:44,560.3926111 --> 00:44:47,80.3926111 And I was like, yeah, I just, I woke up because my daughter had a dream. 405 00:44:47,80.3926111 --> 00:44:49,820.3926111 And then I said, let me just check the chart and see what's going on. 406 00:44:49,820.3926111 --> 00:44:55,370.3936111 And then I saw that the blood pressure was, so we're always thinking about what's going on, with our patients. 407 00:44:55,920.3936111 --> 00:44:56,910.3936111 And that's a problem. 408 00:44:56,910.3936111 --> 00:44:58,580.3936111 And, generationally, probably. 409 00:44:58,955.3936111 --> 00:45:02,135.3936111 That kind of activity will cease. 410 00:45:02,285.3936111 --> 00:45:05,225.4936111 I'm sorry to say, I think that's it goes hand in hand. 411 00:45:05,225.5936111 --> 00:45:36,220.4956111 We have to have the feeling of wanting to do it, but we can't actually do it 24 7 in order to sustain ourselves so we can be fresh and emotionally, relax so that we can be there for the next patient who's going to be anxious asking a lot of questions, otherwise we're going to be So I think that hobbies are really important, whatever it is, you do you it doesn't have to be a, Grammy award now there was a time though when I used to envision myself as going to the school for, the school of fame. 412 00:45:36,360.4956111 --> 00:45:40,640.4956111 I forget what they call it now, school of visual arts, school of whatever. 413 00:45:40,670.4956111 --> 00:45:45,810.4956111 And so I would be carrying my violin but that all changed once I got to medical school. 414 00:45:46,90.4956111 --> 00:45:51,950.4956111 But I do, I, I am fascinated that I have met so many musicians who are physicians. 415 00:45:52,430.4956111 --> 00:45:54,690.4956111 And I don't think that's a coincidence. 416 00:45:54,690.4956111 --> 00:46:00,570.4956111 I think there's a part of us that it works like the music, math, music, science. 417 00:46:00,940.4956111 --> 00:46:02,790.4956111 There's definitely a connection there. 418 00:46:03,250.4956111 --> 00:46:05,350.3956111 But I also think it serves as an outlet. 419 00:46:05,710.3956111 --> 00:46:11,730.3956111 So that we can release some of the tension and the angst that we go through as physicians. 420 00:46:12,650.3956111 --> 00:46:18,540.3956111 Yeah, I think Mount Sinai has a program, which I was always honored to be associated with. 421 00:46:18,540.3956111 --> 00:46:21,250.3956111 Everybody thought, Oh, are you a human? I'm like, no, I'm not a human. 422 00:46:21,500.3956111 --> 00:46:27,850.3956111 So that's that humanities and medicine, but maybe others now by you too, but encouraging. 423 00:46:28,110.3966111 --> 00:46:43,420.3956111 Premeds to actually not necessarily be premed in college, but go and do something else and explore the humanities and know that they can still go to medical school, and I, there are some of my best friends and, I think that there's a reason for it. 424 00:46:44,575.3956111 --> 00:46:48,755.3956111 And you can't grind the scientific thing for years. 425 00:46:48,765.3956111 --> 00:46:51,795.3956111 Some people can't, but it's hard to only do that. 426 00:46:52,395.3956111 --> 00:47:01,795.3956111 And when it comes to clinical care, actually, the emotional aspect of it is a huge part of how that's done and not being burnt out. 427 00:47:01,905.3956111 --> 00:47:04,995.3956111 If you get burnt out, then you're likely to leave clinical practice, I think. 428 00:47:06,720.3956111 --> 00:47:10,510.3956111 Maybe we can start up an AI model once that happens. 429 00:47:11,120.3956111 --> 00:47:12,700.3956111 But yeah, no, hopefully not. 430 00:47:12,740.3956111 --> 00:47:13,410.3956111 Hopefully not. 431 00:47:13,520.3946111 --> 00:47:16,810.3936111 I think I have a number of years on you in terms of practicing. 432 00:47:17,240.3936111 --> 00:47:24,650.3936111 So I think, but there's a reason why I asked you because I have listened to you sing on YouTube. 433 00:47:25,40.3936111 --> 00:47:25,640.3936111 I forget. 434 00:47:25,640.3936111 --> 00:47:27,250.3936111 I think you posted it on LinkedIn. 435 00:47:27,300.3936111 --> 00:47:27,690.3936111 Yes. 436 00:47:28,20.3936111 --> 00:47:30,980.3936111 You posted it on LinkedIn and I listened to it and you have. 437 00:47:31,330.3936111 --> 00:47:32,760.3936111 My to my listeners. 438 00:47:32,830.3936111 --> 00:47:34,540.3936111 She has an amazing voice. 439 00:47:34,550.3936111 --> 00:47:48,40.3936111 So go on to YouTube and listen to her sing you really do you have a great voice usually pretty hoarse at the end of clinic, but This is a lot of fun, Yeah, this was so much fun. 440 00:47:48,40.3936111 --> 00:47:53,100.3936111 Thank you so much And don't forget to like, share and review my podcast. 441 00:47:53,650.3936111 --> 00:47:57,440.3936111 Remember, it's always ladies first on Soma Says. 442 00:47:57,740.3936111 --> 00:48:01,400.3936111 Let's make a difference one conversation at a time.