April 1, 2025 • 40 mins
As a hospitalist at Maimonides Medical Center, Brooklyn’s largest and busies safety-net hospital, Dr. Maryam Baqir, treated some of sickest patients imaginable at the worst of times imaginable—during the COVID-19 pandemic. Seeing such pain and suffering every day left her with the profound realization that so much can be prevented; we don’t have to wait to be sick,” she says. In this episode, Dr. Comite interviews Dr. Baqir about her recent move from conventional medicine’s reactive approach to a proactive, preventive method of care, a shift Dr. Comite made more than 20 years ago when began practicing precision medicine.
You’ll learn…
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Most conventional medicine is excellent at saving lives and treating disease but does a poor to fair job of preventing illness from emerging.
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As a front-line physician during COVID, Dr. Baqir became very skilled at taking care of very sick
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Reactive healthcare to prevent and reverse diseases of aging is the future of medicine.
(00:04):
For me, it's my past and future because I've been doing this for over two decades.
But if we hope to win the battle against chronic disease like diabetes, heart disease,obesity, dementia, cancer, we have to really shift from reactive medicine that treats
disease once it presents and emerges to really being proactive beyond prevention so thatwe can keep our health despite the aging process.
(00:27):
Hello, and thank you all for tuning in to the Healthy Longevity podcast.
I'm Dr.
Florence Comete, founder of the Comete Center for Precision Medicine and Healthy Longevityin New York City, Palo Alto, and Miami Beach.
As an endocrinologist and clinical researcher, I've been practicing a specialty ofproactive healthcare called precision medicine for more than 20 years.
(00:48):
And when I began, I thought every physician worked this way, critically analyzing eachindividual patient for signs of early
potential disease and stopping it and reversing it before it would actually causeproblems.
But I was a little naive.
Even today, there are only about two preventative medicine specialists to every 100,000people, according to analysis by the AMA.
(01:10):
That's really starting to change as more physicians question the logic of conventionalmedicine's reactive approach and what they were taught in medical school, which is
standard of care.
Today's guest is one of those physicians.
name is Dr.
Maryam Bakker, and she's delightful and lovely and sort of made this change quiterecently.
So we'll get to hear what happens in medicine practice conventionally and where we'reheaded for the future.
(01:35):
She practices internal medicine for Northwell Health in Brooklyn.
Welcome, and thank you for joining the podcast.
Thank you for having me here.
I'm honored to be in your space.
just delighted you here as I told you I thought it was going to be a video.
Brooklyn isn't too far away from New York City, right?
And as I told you earlier, I was...
Yeah, no, it's a lovely place.
(01:56):
I think we could start by telling our listeners a bit about your background as a physicianand what inspired you to actually pursue medicine.
Sure.
In some ways, it came in easy for me.
Both my parents are physicians, so it was a lot of initial exposure.
My dad is an emergency medicine physician in Pakistan.
My mom is in family medicine.
So I was obviously exposed to medicine from a very young age.
(02:19):
But even in terms of aligning my own interests, I did have the love for science.
I remember I didn't like physics as much, but biology, chemistry were subjects that Ireally liked.
So that sort of tuned in.
then I think at that time, even though I didn't really ask big questions about lifeexistence or things like that, I still had this inner knowing that service is part of
(02:43):
purpose in life, right?
And then you can serve people in so many different ways.
But the fact that I was exposed to what medicine is about, the fact that I loved biology,chemistry, the fact that
I wanted to serve and help people and see if, you know, it's corny, but we all feel thatway, right?
That you want to make a difference in life, which can be done in so many ways.
(03:04):
But for me, I felt like becoming a doctor was just a choice.
Like there was not a lot of argument or comparison there for me.
It sounds like you're a natural healer and most of your family are physicians.
Yeah, yeah, it came in naturally to me and I still stand by it.
Like, know, so many years later, I still feel that I am in it for life.
(03:25):
So it's not it's not something that thankfully that I feel like I'm want to switch to someother field now.
I don't have that at all.
So I love medicine.
I love speaking to people.
I love getting to know their stories.
And I love making that a part of their healing journey.
And through them, heal, I heal too, like we're heal each other.
So yeah, I think that's where the initial start happened.
(03:48):
I can completely understand that as an intern.
I remember when I was first on the wards on the floor at Yale, I had patients tell methings that their significant others didn't know.
And the trust they put in you and the way you can help people is just kind of, I don'tthink there's anything that compares to it.
It truly is such a precious space that I am in awe of and very thankful for everybody whoputs their trust in me.
(04:14):
They truly share the deepest, darkest secrets with you that you're right, their own lovedones may not know, and I don't take that lightly.
And through that, like, it's just beautiful.
Yeah, have a lot of I'm for the changes that people can see and make.
So yeah, great.
You did go to medical school in Packard.
Correct.
I grew up there as well.
(04:35):
Yes, I grew up there.
I went to medical school and then after medical school, I was briefly in Sweden.
I got married and that's where my husband was at that time.
My husband is also from Pakistan, but he was working in Sweden at the time.
So briefly after medical school, I moved to Sweden and then we moved here for myresidency.
And then I've been in New York since then.
So in Sweden you didn't have any medical experiences or?
(04:56):
did electives there, but everything is in Swedish there.
They don't practice in English.
Everything.
was shocking to me in a very good way that it was the first time because back in Pakistan,part of it was Urdu, but most of it was English.
But in Sweden, everything was in Swedish.
This is even worse in America in some ways.
We're so isolated.
I was always jealous when I went to other countries like Switzerland where the kids growup, trilingual.
(05:20):
I know my parents were European and so they spoke many languages and I felt that it wasvery hard to even
I wasn't off how they practice their like every single thing, like not a word of Englishin their hospitals.
worked in their hospitals.
I did electives there.
They took care of that.
They were very like, yeah, they, really honored that I don't understand Swedish.
(05:40):
took care of that.
Hopefully with all these AI models, we'll be able to translate into
is the hope.
That is the hope.
I agree.
I agree.
So you were a hospitalist.
It sounds like you had very deep training in medicine and also advanced critical careprobably before you transitioned.
And you bring a unique perspective as to why our healthcare system needs to shift fromreactive to proactive.
(06:04):
And I'd love to understand what led you to recognize that shift since you're young andyou're in, you just started your work in medicine the last couple of few years.
It was an inner knowing, but it took me some time to figure out that I now have thecourage and the confidence to make that step in the right direction.
But I do think that even right from the start, there was always an inner knowing.
(06:26):
And the inner knowing was really that I saw, I worked in the heart of Brooklyn atMaimonides Medical Center.
It's the largest hospital in Brooklyn, one of the busiest in New York City, one can argue.
I saw such sick people.
And like I, was, it was just shocking to me.
It shocking how sick people were.
It was, and granted, and I was getting a lot of exposure to inpatient medicine.
(06:49):
I was getting good at taking care of sick people.
I could see that my confidence in hospital medicine was increasing.
I could see that I was making a difference.
I could see that we were saving lives and we were doing incredible things.
But
there was always a part of me that always questioned that, my goodness, this decay couldhave been prevented.
And it's not even, I'm not even talking about anything like out of ordinary right now,even like basic, simple things like the kind of things I saw both in my residency and then
(07:18):
as my, as I spent four years as a hospitalist, things that I saw, the agony, the pain, thesuffering, unending nature of it.
It was like, even right now, I think if I talk about it, it would make me cry because andall to only realize that nobody's saying everything can be prevented.
And of course, there's a time and place to be in hospital.
(07:38):
And I'm in awe of the work we do in these hospitals.
But so much can be prevented.
And we don't have to be this sick.
We don't have to wait till we get this sick.
And I also sort of in terms of like the conventional background, I always.
Felt that.
I was probably the only one thinking like that.
I could be wrong, maybe it was something in my mind, but I felt like most people didn'tquestion that.
(07:59):
Like a lot of people did want to be in patient medicine and they would talk about it.
But when I would question things like that, I felt alone questioning that.
And then I was like, okay, I guess maybe it's probably very difficult to prevent this, sowe are doing the best that we can do.
And I continued to nurture my skills as a hospitalist.
(08:20):
But then slowly and gradually, and in my own personal life at the same time, right?
I was going through burnout.
I was the frontline worker in the COVID pandemic.
So residency in New York is already so hard on you.
And then boom, in your last year, the pandemic hits.
I was already going through my own burnout.
I was losing weight.
was under-slept the way residency is, right?
(08:42):
and then so much trauma at the hospital.
So I was also in the process of figuring out how to take care of my own self, with basicknowledge of nutrition and exercise, nothing deep, but I still had that inner knowing that
these are things that I do kind of want to reflect on and take care of my own self.
But then I'm like, why am I not doing this with my patients?
(09:02):
Right.
And for how long is this going to go on?
Because it's always that voice that hits you when you're
going to bed at night, right?
That do I feel like I would love to do this all my life?
And I felt that resistance.
So I think it's very important to like have that connection with your own self.
And sometimes when they say, listen to yourself as well.
The world may be saying whatever.
(09:23):
And like I had no training in prevention or proactivity in medical school, almost nothingin residency.
Is there any time?
No, there was none at Yale when I was...
student.
was no, no, I I don't, don't think so.
It was primary care, but even primary care was a lot of, sure in primary care, do dopreventive care, but it was most, it was still not the kind of care I want.
(09:45):
Here we do is maybe some diagnostic tests if they believe in it, whether it's a mammogramor issues with a prostate.
And really teaching people how to investigate and they don't even give the students or thetrainees the tools to understand nutrition, exercise, sleep.
And that's where the world has changed.
So you can imagine.
(10:05):
So you can imagine, because I went to school more than 20, 30 years ago, what I faced.
There was no one.
And in fact, people would laugh about it when I would say, listen, there's a better way totake care of people.
We need to know more.
Excellent.
Do you have any real examples of patients you saw as a hospitalist to illustrate thatimpact?
Or even in your own family, when you compare notes, is it the same situation in Pakistanand Sweden, where I know you started your career?
(10:30):
Have you heard stories?
And what does your family feel about it?
mean, yeah, my dad is very my both my mom and dad.
They so my dad and mom, they have their own kitchen garden over there.
Right.
So they grow a lot of vegetables on their own.
So this this also sort of instilled it's not like we are a plan based family only.
We're not vegan, but we are an omnivorous family.
(10:52):
there was always a very big emphasis on making sure that you're eating not just yourvegetables, but a variety of vegetables.
Plant diversity was ingrained in me right from a very young age.
And my dad grew broccoli in his kitchen garden when broccoli was not available in themainstream market in Karachi.
Like you wouldn't find broccoli anywhere.
You wouldn't find parsley anywhere.
(11:13):
He would grow, cause he would come here and get the seeds.
He would come to the U S and get the seeds here.
And then he would go back and grow there.
And my mom and dad take care of the garden together.
I guess.
my case, it was just my mother.
My father did other things.
He did the sports and the exercise.
Yeah, so because of this, my dad being an emergency medicine physician, sees emergencycases over there, right?
(11:38):
So of course there is like, it's so common for people over there.
Like the thing that really bothers me, it's so common for people there to die in their 50sactually, 50s and 60s.
Like the average age in my country is probably in its 60s.
know, people say, well, they died of old age and I'll say how old and they'll say, well,60, 65.
And I'm like, way.
What are you talking about?
(11:58):
yeah, it's aging.
I'm like...
No.
Even when they're 90 or 100, it's not old age.
Yeah, it's the shift in how you think about life and living.
It's so common for people there to die in the middle of the night.
What is a sudden cardiac arrest representing?
What's going on?
Of course, there's no way for me to tell
I see a lot of folks from Asia and from Pakistan and India.
(12:21):
And in general, even when they're sick, they actually look and seem healthier.
And I always wondered if like turmeric and curcumin and all are playing a role.
I think it is.
I think it reduces inflammation.
But it sounds like it's not a great system over there either.
It's worse than the States maybe.
We get all chronic diseases and we stay alive a long time, but very sick.
(12:42):
And there are, mean, if there are good genes, people will live longer there, but theaverage lifespan is in its 60s.
So that's just the truth right now.
And then in terms of what I saw, I would, I'm not sure, there are demographics aresimilar.
So I would probably think that maybe, yeah, maybe the average, my guess would be maybeIndia is, would be a little bit better.
(13:05):
I would argue maybe, but it's also a much bigger country.
so I'm actually not sure about the statistics, but in terms of like, if they're goodgenes, have my, my grandparents lived up to their eighties.
So there's good genetics, you know, they, but even in their eighties, it's not likethey're living their best lives in their 80, right?
It's, it's the at 60, they start preparing to die.
Right.
(13:25):
Like that's how the mindset changes people over there.
just get sick and they cope with it.
You see them and even people who have the wherewithal to get the help.
I'm always shocked when I get their labs and I hear their story because no one's doinganything proactive.
I had a patient call me from Atlanta, a really smart guy who's a CEO and chair of acompany.
(13:46):
And he was telling me how he has a concierge doctor.
And then he went on to tell me all the things that were diagnosed.
And he said, but nobody's doing anything about it.
They're like keeping an eye.
on it.
So I'm always shocked about that.
Yeah, I feel like I'm living in an isolated world, so it's great to hear you.
In your new practice, what's your typical patient like?
You're seeing patients through Northwell.
(14:08):
You have a primary care setting now, which is different than hospitalist.
Hospitalists can absorb it, but I guess it's gotten more complex at the hospital level,more critical care.
People are living longer and they're probably sicker when they get admitted.
They're sicker.
actually just going back to what I saw in my practice as a hospitalist, not only are theygetting sicker, I also saw a lot of people who are like tracheostomy, ventilator, like
(14:36):
people who are living lives in nursing homes on ventilators.
Like that's it.
That's it.
And that was the kind of...
It's both.
used to be both.
was maybe when people, family members didn't want to let them go.
And at the same time, there were some cases where there was just nobody to speak for themand it was a whole thing.
(14:56):
but then, and guess why they were on the ventilator to begin with, they had a stroke andguess what?
80 % strokes are preventable.
So like those kinds of things, right?
Like they would come back with a ventilator associated pneumonia and now they have a PEQtube and there's some complication of the PEQ tube.
Now they have a sacroiliac uberous ulcer.
So there's a company, there's a complication of that.
Just going down and we're trying to keep, you know, keep figuring out how to just keepthem alive, keep them alive, stabilize and send them back to the nursing home.
(15:24):
And of course, sure, there's value in that.
But my question always was like, what am I achieving here?
Right.
this person is not coming back and those are, and it was a mix, but there were many, butthere was none.
There was none.
Maybe they would blink the eye.
Maybe they would lift a little.
That's what I, yeah.
And that's what my frustration was.
(15:45):
was like, you know, there's, there's, you know, I, I see we're trying to help this person,but to what end and for what I don't understand.
what are we trying to achieve here?
And, and then if you, if I go back into how this happened, it was a fateful stroke.
And then when you talk about, okay, what did we do for strokes?
Once you get the stroke, there's not a lot you can do other than maybe physical therapy.
(16:06):
mean, there is some acute management of stroke now, which of course is very helpful.
But that's another thing.
If you make it on time, if you make it on time, exactly.
Now what's a patient like?
Because I imagine it's still like, I remember transitioning to New York, because I didn'tknow anyone in New York and I had a practice of primary care with excellent doctors.
And I was ending up staying until midnight because I saw so much that could be treated,reversed, prevented in a pretty, you know, like smart population of people.
(16:36):
These were people that could afford to do what they wanted.
They wanted help.
It was insurance based too, but it was fee for service.
And this was one of those doctors I work with.
He was fabulous.
And he, you know, he really gave excellent care.
And I kind of went back into primary care routes to understand it.
But there was so much to do that I felt like I had to organize an approach.
And that's where why I ended up doing what I did.
(16:58):
And I that's what I'm in the process of figuring out as well.
I became a primary care physician just a year ago after only doing internal medicine.
how do you convince patients that prevention is worth it and it matters or proactiveprevention?
So one of my biggest things that I really focus on is family history.
And I've heard you saying also that family history is a poor man's genomic study, right?
That was the beginning because I wanted the genome to be here.
(17:22):
And then as years went on, I realized that it was richer than genomics, at least intoday's world still to some degree, because it's emergence of diseases.
Because a lot of us are programmed to get diseases we never get, or we live a life acertain way, so the epigenetic factors protect us.
And so now to me, family history actually trumps genetics for the time being.
(17:42):
That's going to change.
I'm glad to hear that.
I'm sure it may change exactly as we advance in the field.
But for now, that's my tool.
So one of the ways in which I do two ways.
One is I really dig into family history.
When it comes to family history, I dig deep, including if I feel like I was not able todig deep into family history in this one visit, I will ask them to follow up just to tell
me their family history.
(18:02):
And when it comes to family history, I'm talking about
age of diagnosis, at what age should your father get a stent, at what age was this breastcancer diagnosed, when did this person die?
Tell me about your maternal aunts and uncles as well, what's happening in the wholefamily?
a little fly on the wall when I had a leads call earlier today because that's exactly theway to go about it.
(18:23):
Congratulations.
that's where the light bulbs open because they're like, oh, just, then she's, and thenthey're messaging their moms about answers, right?
Oh, I just found out my paternal aunt was actually diagnosed with breast cancer at 40 andyou're 35.
I'm like, there you go.
That's why I'm asking this question because if you're
fire under them in a way that they realize that they may be at risk too because it runsin.
(18:48):
said if you because oftentimes I feel that if you don't ask them, it's often not on theirradar.
Many of them maybe are not even living with their parents.
So you you tend to forget I'm not sure maybe this that but when you dig and you and thenthey go back and they go talk to them and they bring back the answers, then it lights up
more problems.
So then what I what I tell them is that hey, this stent that your dad got at like 65.
(19:12):
The process of that, like I explained it to them in as simple a manner as it can be forthem to understand the process of this catastrophe started at your age or maybe even
younger.
So younger, right?
Not even thirties.
We're talking about primordial prevention now of cardiovascular disease.
already answered the next couple of questions, which I like people to think about.
What is the promise?
(19:33):
Because in order to have people take it seriously and make lifestyle changes, they haveto, or make any change, they have to see themselves.
And there's also the other end of the spectrum where sometimes people feel it's inevitableand you have to tell them, it's not.
Diabetes is inevitable.
That I tell them the same thing, that it may be there.
(19:53):
Maybe even with the best of efforts, you may still get it, but can we at least try and seeif we can push the age?
Yes, make it a hundred instead of...
Can we push the age at which you get diabetes?
Or who knows, if we do it properly, we'll be able to escape the genetic predispositionaltogether, the trigger of the genetic lies in what we do on a regular basis.
(20:13):
And then also, I get a lot of women in their 20s, 30s, for example, even 40s, right?
So I remind them, just like how I remind myself, that we feel okay right now, but this isalso our time to...
I describe it as our 401k for health.
This is our time to invest in our health, to bear the fruit not just today, but also fordecades to come.
(20:33):
I like seeing an image of, I remember when I first started this work in women's health in1992 at Yale, I would tell people that you should think of your health portfolio in
addition to the, you work on your financial portfolio, but what's all the money gonna doif you're sick?
So that's a similar approach.
perspective shift in terms of looking at your health, giving you importance, includingsome financial investment.
(20:56):
For example, I give my own example.
I decided to invest in a fitness trainer.
said, I would buy less bags, less clothes, but I'm going to pay for a fitness trainerbecause when she comes in, she trains me.
It's a completely different level.
Yeah.
Yeah.
Like I, and I shared my own example with them because
I don't say that I'm imposing this, for example, if we can, like I give them my examplethat I decided to budget a bit differently.
(21:23):
And I told myself, I am willing to buy less bags and less clothes.
But I would pay for a fitness trainer every month because for me, my health is a priority.
And I see the difference that the trainer brings to my training routine when she comes andshe trains me, it's a completely different ball game altogether, both in terms of the
efficiency and the safety that is there when she teaches me.
(21:44):
So I give them different kinds of examples.
I tell them you can do this even at home.
It can be zero cost as well.
But depending on wherever you are, I would like to meet you where you are.
If you can't afford a fitness trainer, no problem.
If you can't afford a gym membership, no problem.
We can even start from home.
Then I give them home exercises.
You could do this with body weight.
You can get some resistant bands from Amazon.
You can get some dumbbells, some bell.
(22:07):
What are they called?
Free weights.
Free weights.
You can get some free weights.
can get started at home as well.
You can use apps.
The point is to get started.
The point is to not shoot for the stars immediately.
Let's get moving.
But the point is to think of this as a lifestyle.
How do you find the time in such short visits?
Because most of insurance model care is 20, 30 minutes at best, and people have a lot ofthings they want to share or say.
(22:33):
How do you fit in the extras, the extras about talking about exercise?
I used to give people a prescription pad.
This is your prescription for exercise.
This is your prescription for eating.
How do you manage to fit that in realistically in today's world as a primary care doctor?
Yeah, so that is true.
And it is a challenge that I have every single day.
(22:53):
And it's just about me brainstorming within the capacity that I have.
How best can I make it?
That's something that I do every single day.
allowed to bring patients back as often as you want?
Is that part of like your...
Exactly, exactly, exactly.
So that's what I do.
That's exactly what I do.
And I'm glad you're bringing that up.
I tell them that, we discuss these things because I want to make sure that I'm addressingeverything that's on your mind, that whatever you expected from today's visit, we try to
(23:20):
make sure that we address those things.
But then there's some things I want to address and we may not be able to talk about thosethings.
But I briefly tell them and I said, how about we follow up in two weeks, three weeks, onemonth?
And this could totally be a virtual visit.
So for this, you don't have to come in with me, come into the office, as long as you'rebased in New York, I can see you from home.
But I do kind of want to talk a little bit more about your diet.
(23:41):
I do kind of want to dig a little bit deeper into your sleep.
I do kind of want to look into your family, you do a little bit more.
If your exercise is being an issue, let's talk about a little bit of you, depending onwhatever is, it's all personalized, right?
Depending on whatever point I feel someone needs to focus on.
I tell them it's not done yet.
These are supposed to be annual preventive visits, but I'm not asking you to see me nextyear.
(24:03):
I actually think we should see each other more often.
And they're super happy with that.
And then they follow up, they go back.
And in the meantime, I give them some homework.
For example, on the portal, I send them podcasts to listen to.
I send them different videos.
I send them some books to read.
I'll send them this podcast, for example.
Exactly.
So anything that if it's religious, so I have also designed like specific things for likefor sleep, what I want my patients to know.
(24:30):
So I've had like a shortlist at some podcasts, some books, some things for exercise I'vedone similarly for high cholesterol I've done similarly for heart disease.
Like I've built those things and I keep improving them as time goes.
So what I do here within, so this is me hacking the limited system I have.
Let's get you these resources so you go home, you read up on this, and then let's do avirtual visit and we can talk about what you learned and then I want to talk to you about
(24:55):
more.
So this means several visits in a year, but I think that works like.
you don't have to worry.
I know you see 16 to 20 patients a day.
So that you must be tired at the end.
I'm very tired of telling you.
Ask my husband.
So we already crossed the bridge of you weren't taught much about preventative medicine inmed school.
How are you educating yourself now to be able to provide the best proactive insights toyour
(25:19):
through people like you.
And this time, think what I've also, since my training, I've also dealt really deep in, Ireally understood.
Now I follow nutritionists.
follow, I read the work of exercise physiologists.
I read the work of sleep psychologists, because these were aspects that were not taught tome in my training, right?
So, but I guess what my training did teach me was how to read papers and how to be able todiscern.
(25:43):
you know, what works and what doesn't work.
And so a lot of my focus now is to really dive deep into alongside the conventional stufflike that's happening, right?
We all know the guidelines and we keep ourselves updated on those things.
But some of the things that I really dig deep now into are nutrition, exercise, sleep,even psychology.
(26:04):
I try to understand a lot about the mind.
I follow a lot of different psychologists.
I read their work.
I read the books because I don't think psychology is disconnected from any of this.
If anything, maybe the starting point, maybe that.
So and that's what I try to bring in my practice that in simple words, I tell my patients,right, if you need this particular blood pressure medication today, I'm going to give you
(26:24):
this because I know that this is what's supposed to be for you right now.
But in future, we are also going to talk about all that.
I don't just say, go diet and go eat healthy and exercise.
Like, like we know that doesn't work.
and, then for me, for two, for me to be able to guide them, I need to know what shouldthey eat and how should they move?
(26:46):
And if they're having difficulty moving, how should I help them do that?
I see that as part of my, my, my work with them as well.
It's not just prescribing medications.
So I keep myself up to date on those things in terms of what's, what are the latestguidelines, what works, what doesn't works.
What are the myths?
Then I debunk a lot of those things as well for me to be able to, and I learned frompatients too, because they're coming to me hearing a lot on social media.
(27:09):
But then I need to know, okay, what's right, what's wrong, what works, what doesn't work.
So those are by following the right people and figuring out the yeah, the material.
It's something that I've been able to upscale.
It's all really wonderful.
mean, I'm fascinated and I think it's a work in progress.
sounds new but...
Yeah, but you're making progress.
(27:30):
So if you could wave a magic wand and change anything about conventional medicine, wouldthere be one thing that you would start with?
I think...
I think connecting all the health records, I think the silos have to go.
I don't know.
I'm not sure if there is value in these silos, but I don't see this.
It makes my work and it makes things for my patients so much harder than it needs to be.
(27:55):
Like if only I could, like when they're coming to me, if only I could.
see whoever they've already been to, the impression, everybody.
Like right now we're literally talking in terms of faxes, right?
Like I get faxes from different offices.
Like the most advanced GI practice is faxing like 50 pages.
I think if the doctors can start talking to each other, if the records can start talkingto each other, like that would be my one.
(28:23):
problem that I've solved by asking for release of records of all the doctors and gettingthem, whether they're faxes or, because a lot of doctors don't even use email yet or scan.
And then the other factor for doctors I find is time.
Like they're seeing so many patients a day, they don't want to get on, you get them on aphone for a couple minutes, you're lucky.
In my case, having done work so early in this field, doctors used to get angry at me forwhat I was doing until they saw the outcomes and then they became my patients.
(28:51):
So that was always rewarding, but it is hard because the medical system isn't set up.
It's not set up.
It's not set up for success in there.
Let's shift a little bit.
don't know if you have experience, but I would love to hear if you've had experience withGLP-1s.
Have you seen patients coming and asking, given it's become a celebrity thing?
And how do you approach those conversations, and what has been your experience just outbeing in primary care?
(29:15):
and actually this is one of the most common things I manage in my clinic because it'sobesity, weight gain has been, I see 70 to 80 % women.
It's not exclusive to women, but it's a lot of women come to me with issues such as bothweight gain, obesity, obesity associated complications, and many of them are coming with
(29:37):
the intention to explore GLP-1s.
And in my practice, I found them to be revolutionary.
I am like, I'm very pro.
I'm very pro salmoglutide, very pro trisepidide.
What is the usual decade age-wise that you're seeing patients asking because they haveobesity or what?
I think my, I would say my majority is 30s to 50s or maybe 30s to 60s.
(30:02):
starts changing in their 30s and right.
Exactly, they...
Exactly, exactly.
That is the time.
as convinced as you and very optimistic because I think these are breakthrough medicationslike antibiotics that will change the trajectory.
making things so much easier for so many people.
Even when they, and if anything, I feel like when they start taking it, all the thingsthat, you know, they always kind of knew they were supposed to do in terms of managing
(30:28):
their diet, it sort of becomes so much easier for them.
I noticed that as soon as the medication starts, now they start going to the gym.
Now they start focusing on their protein.
Now they start eating the right way.
For once you start it, I think people realize food noise disappears and it's the foodnoise that keeps them thinking they're eating breakfast, what are they gonna have for
lunch?
And then they're eating lunch and when am I gonna have a snack?
(30:50):
And I think we're driven by that because of the way modern society works.
We have access everywhere, but I think you're right and I agree that these arebreakthrough drug.
Yeah, so I think I'm as optimistic as you are and I've seen it over 20 years, I'm excitedabout it.
Okay, we're kind of running out of time a little bit, but I thought I'd turn the tablesand give you an opportunity to ask me anything about the way I practice and how I approach
(31:13):
things since you're beginning your new venture into primary care.
I actually really appreciate this question because I had that in mind myself.
My question would be.
tell me how you do things differently.
For example, in terms of as a comparison of what I'm doing, and now if you add theadditional layer of epigenetics and genomics, are there something else that you're also
(31:33):
incorporating in proactive medicine?
What difference would that make?
That's a great question and it's massive, but let me tell you that in growing what I did,I realized I needed more time with patients and I needed to make it efficient.
So starting back 20, 25 years, I started doing telemedicine and nobody, everyone in myfamily is a doctor, most of them, they're scattering other things.
(31:55):
My twin sister, my brother, my son, my niece.
So we're a family of doctors and my family would laugh at me.
They think I was getting out of washing the dishes in Thanksgiving because I was in thegarage talking
on the phone.
Yes, I would be getting out of washing the dishes, but I also had to talk to my patient.
Right.
So I designed a way to engage with patients from a distance and creating spreadsheets andinformation that would allow me to share real data, not just conversations, but actually.
(32:22):
go through what the patient has eyes on it.
I had eyes on it.
It wasn't through Zoom, because Zoom came later, but through the phone.
And equally, I was able to teach other people who would be shadowing me or working with mehow to think differently.
And then collecting as much as I could.
So going back 20 years when computers were like three gigabytes, I would.
constantly crash my computer because people would be sending back their data and thecomputer was too overloaded.
(32:49):
And so I created questionnaires and ways to dig into areas that I knew were pertinentbefore I even saw a patient collecting their information and then digging into all of this
because there's no way to do it in a 20 to 30 or 40 minutes.
And so I was very fortunate to carve that time for myself and to know that I was doing itin a way that was be valuable for
(33:12):
both me and the end result for my patient.
So that's where I started a long time ago.
And now it's developed into having a way of course, the care we give here is bespoke andyou know, it's very in depth along the same lines that you're speaking, but advanced to
include.
all things genomic, all things epigenetic.
We even talk to trainers.
(33:32):
We have exercise physiologists.
I have, you know, other clinicians who work with me, so I'm able to train them and extendand leverage the time because I train them in rounds.
In fact, I run it like it's it's academics, like it's Yale.
So we are privileged not to have to see 20 people a day and give them a little bit ofeverything and then more time.
(33:53):
So it's time that is really, I think, a big, great limiting step in primary care.
Because I did primary care for a few years as I was transitioning, helping a doctor in NewYork.
And I knew what it took.
I think I mentioned before that I would stay till midnight to make sure I could workthrough all the issues for any one person.
There's a doctor I work with who is lovely.
His approach to high cholesterol
(34:16):
high blood pressure or weight was to starve and I'm like that doesn't work.
certainly for some people.
So he learned as well along with the patients and it was very rewarding.
I think you also need to be in a system that isn't insurance-based to begin with.
It's wonderful if you can help a little bit, but I think the frustration that you mighthave in the future will outweigh your ability to continue on this level because there's a
(34:40):
lot to learn.
Yeah, agree.
Like I said, I am aware that time is the challenge, but we try to make the most of wehave.
That's what we're all trying to do here within the limited constraints.
How can I still provide what you write?
Time is where because these things like one hour, two hours.
It might help you, one practical step would be to share like a questionnaire of things youthink are important before you even meet a new patient.
(35:07):
Or if that's hard, once you meet them, send them home with that homework that involvesanswering all these questions.
I love So you can get the detail and the information you need.
And that will take you a long way because it's...
the questions that you need for, I'll give you a real example.
We have a patient, long-standing patient who called last week with back pain, severe backpain.
(35:27):
And she was a little upset because she was babysitting her seven-month-old granddaughterand she had to bring someone in to help because she couldn't carry the baby.
And so in exploring what she was doing, it turned out that she was doing a new exerciseher farmers carry was...
holding weights that was half her body weight, because that's what her trainer told her todo, which was insanity.
(35:48):
And so that put her back out.
And by simply probing and asking the right questions through a phone call, you can figureout what you need to do to help.
And so that's how I've learned over the years to make a difference.
That's where the extra 10 minutes help, right?
Because you can go deeper than exactly just what they've come with.
Sure, I can put a bandaid here and fix this problem, but I want to ask you how thishappened and dig like two, three layers deeper so then I can make sure that we talk about
(36:18):
that too and then hopefully in future this doesn't happen.
It's like I think a bit as being a detective and learning all the bits and bytes aboutthat particular human being because all of us are unique.
Even my identical twin and I are not the same.
And so by learning that you can really help course correct the future health trajectory ofany person.
And that's what we've been lucky enough to do here.
(36:38):
So I'm thrilled about it.
I always like to ask any of my physicians and other participants on the podcast, ifthere's one burning question, you meet a person on a plane or a party.
and they ask you, what's the most important thing I could do to improve my health?
What would you say?
Gosh, in terms of choosing one.
I think, like I said, I think it's understanding our own psychology.
(37:02):
think, and sleep is not disconnected from that.
So I would say mind and sleep, because everything else, including like working onself-esteem, because those are some of the things I notice in patients, right?
Like, why would I think I deserve to do all this for my future health if my, yourself-esteem has to be high for that, right?
You want to feel like,
(37:24):
there's something special to preserve.
Like I see that people are, like a lot of people are really struggling with their mind alot.
Like I see a lot of mental health concerns and even young women, for example, and theywant to do things, but in terms of like stress resilience or emotional resilience or
mental resilience.
And I like to say that with a caveat because sometimes that me feel like I'm implying thatthe problem is just in them.
(37:48):
That's not what we're saying at all.
Our systems are broken.
There's a lot of corruption.
There's a lot of awful things going on.
But I think what we can still have some control over is just having a little bit betterunderstanding of our own mind, our own self-esteem, our own ways of coping up with things.
Gratitude comes there.
(38:08):
Social networks come there.
interacting with the right kind of people who uplift your energy, who motivate you, don'tpush you down.
And I think that's tied in with sleep as well, because if you're not sleeping properly,none of this is going to happen.
exercise, diet, everything else is extremely important.
But I think mind and sleep, I think that trumps.
So as much as we can, we should try to see if we can optimize our mind.
(38:33):
I think that's beautifully said and I couldn't agree more, but actually you were ahead ofme, you're ahead of me with that.
Cause when I first started, I was in internal medicine before I did endocrine and I feltit was all mind and psychology.
And I was raised in a family where you got to be tough.
No, there's no weakness.
If you're, if you're depressed or you're anxious, then you're weak.
And so I had to get over that.
(38:53):
And I will tell you that the biggest thing we do here, it's all about the mind andpsychology for every single person.
And they have to feel deserving and you see a
lot of women and a lot of times women are the caretakers.
They and they put themselves last.
Their kids come first, their parents come first, their husbands come first, or partnerscome first.
So I'm going to thank you now and then we can you can do you have a way to tell people howto reach out to you or thank you for joining me Dr.
(39:20):
Marion Bacher.
It's really been a pleasure.
I feel echoes in resonating with you and I'm very excited for you because I think yourfuture is really bright.
If listeners want to learn more and tune into you, where would you suggest they go?
Are you on social media?
I'm on Instagram.
That's my primary mode of presence.
They can follow me there.
My handle is Dr.
(39:41):
Mariam Barker.
So it's D-R and then my name, M-A-R-Y-A-M-B-A-Q-Y-R.
And I post pretty frequently there.
So I would be happy to have them follow me there.
Fantastic.
And I will too, if I'm not already.
I think we may be following you already.
But thank you for tuning in to all our listeners, to Healthy Longevity.
I'm Dr.
Florence Comete, wishing you a health span to match your lifespan.
Reactive healthcare to prevent and reverse diseases of aging is the future of medicine.
(00:04):
For me, it's my past and future because I've been doing this for over two decades.
But if we hope to win the battle against chronic disease like diabetes, heart disease,obesity, dementia, cancer, we have to really shift from reactive medicine that treats
disease once it presents and emerges to really being proactive beyond prevention so thatwe can keep our health despite the aging process.
(00:27):
Hello, and thank you all for tuning in to the Healthy Longevity podcast.
I'm Dr.
Florence Comete, founder of the Comete Center for Precision Medicine and Healthy Longevityin New York City, Palo Alto, and Miami Beach.
As an endocrinologist and clinical researcher, I've been practicing a specialty ofproactive healthcare called precision medicine for more than 20 years.
(00:48):
And when I began, I thought every physician worked this way, critically analyzing eachindividual patient for signs of early
potential disease and stopping it and reversing it before it would actually causeproblems.
But I was a little naive.
Even today, there are only about two preventative medicine specialists to every 100,000people, according to analysis by the AMA.
(01:10):
That's really starting to change as more physicians question the logic of conventionalmedicine's reactive approach and what they were taught in medical school, which is
standard of care.
Today's guest is one of those physicians.
name is Dr.
Maryam Bakker, and she's delightful and lovely and sort of made this change quiterecently.
So we'll get to hear what happens in medicine practice conventionally and where we'reheaded for the future.
(01:35):
She practices internal medicine for Northwell Health in Brooklyn.
Welcome, and thank you for joining the podcast.
Thank you for having me here.
I'm honored to be in your space.
just delighted you here as I told you I thought it was going to be a video.
Brooklyn isn't too far away from New York City, right?
And as I told you earlier, I was...
Yeah, no, it's a lovely place.
(01:56):
I think we could start by telling our listeners a bit about your background as a physicianand what inspired you to actually pursue medicine.
Sure.
In some ways, it came in easy for me.
Both my parents are physicians, so it was a lot of initial exposure.
My dad is an emergency medicine physician in Pakistan.
My mom is in family medicine.
So I was obviously exposed to medicine from a very young age.
(02:19):
But even in terms of aligning my own interests, I did have the love for science.
I remember I didn't like physics as much, but biology, chemistry were subjects that Ireally liked.
So that sort of tuned in.
then I think at that time, even though I didn't really ask big questions about lifeexistence or things like that, I still had this inner knowing that service is part of
(02:43):
purpose in life, right?
And then you can serve people in so many different ways.
But the fact that I was exposed to what medicine is about, the fact that I loved biology,chemistry, the fact that
I wanted to serve and help people and see if, you know, it's corny, but we all feel thatway, right?
That you want to make a difference in life, which can be done in so many ways.
(03:04):
But for me, I felt like becoming a doctor was just a choice.
Like there was not a lot of argument or comparison there for me.
It sounds like you're a natural healer and most of your family are physicians.
Yeah, yeah, it came in naturally to me and I still stand by it.
Like, know, so many years later, I still feel that I am in it for life.
(03:25):
So it's not it's not something that thankfully that I feel like I'm want to switch to someother field now.
I don't have that at all.
So I love medicine.
I love speaking to people.
I love getting to know their stories.
And I love making that a part of their healing journey.
And through them, heal, I heal too, like we're heal each other.
So yeah, I think that's where the initial start happened.
(03:48):
I can completely understand that as an intern.
I remember when I was first on the wards on the floor at Yale, I had patients tell methings that their significant others didn't know.
And the trust they put in you and the way you can help people is just kind of, I don'tthink there's anything that compares to it.
It truly is such a precious space that I am in awe of and very thankful for everybody whoputs their trust in me.
(04:14):
They truly share the deepest, darkest secrets with you that you're right, their own lovedones may not know, and I don't take that lightly.
And through that, like, it's just beautiful.
Yeah, have a lot of I'm for the changes that people can see and make.
So yeah, great.
You did go to medical school in Packard.
Correct.
I grew up there as well.
(04:35):
Yes, I grew up there.
I went to medical school and then after medical school, I was briefly in Sweden.
I got married and that's where my husband was at that time.
My husband is also from Pakistan, but he was working in Sweden at the time.
So briefly after medical school, I moved to Sweden and then we moved here for myresidency.
And then I've been in New York since then.
So in Sweden you didn't have any medical experiences or?
(04:56):
did electives there, but everything is in Swedish there.
They don't practice in English.
Everything.
was shocking to me in a very good way that it was the first time because back in Pakistan,part of it was Urdu, but most of it was English.
But in Sweden, everything was in Swedish.
This is even worse in America in some ways.
We're so isolated.
I was always jealous when I went to other countries like Switzerland where the kids growup, trilingual.
(05:20):
I know my parents were European and so they spoke many languages and I felt that it wasvery hard to even
I wasn't off how they practice their like every single thing, like not a word of Englishin their hospitals.
worked in their hospitals.
I did electives there.
They took care of that.
They were very like, yeah, they, really honored that I don't understand Swedish.
(05:40):
took care of that.
Hopefully with all these AI models, we'll be able to translate into
is the hope.
That is the hope.
I agree.
I agree.
So you were a hospitalist.
It sounds like you had very deep training in medicine and also advanced critical careprobably before you transitioned.
And you bring a unique perspective as to why our healthcare system needs to shift fromreactive to proactive.
(06:04):
And I'd love to understand what led you to recognize that shift since you're young andyou're in, you just started your work in medicine the last couple of few years.
It was an inner knowing, but it took me some time to figure out that I now have thecourage and the confidence to make that step in the right direction.
But I do think that even right from the start, there was always an inner knowing.
(06:26):
And the inner knowing was really that I saw, I worked in the heart of Brooklyn atMaimonides Medical Center.
It's the largest hospital in Brooklyn, one of the busiest in New York City, one can argue.
I saw such sick people.
And like I, was, it was just shocking to me.
It shocking how sick people were.
It was, and granted, and I was getting a lot of exposure to inpatient medicine.
(06:49):
I was getting good at taking care of sick people.
I could see that my confidence in hospital medicine was increasing.
I could see that I was making a difference.
I could see that we were saving lives and we were doing incredible things.
But
there was always a part of me that always questioned that, my goodness, this decay couldhave been prevented.
And it's not even, I'm not even talking about anything like out of ordinary right now,even like basic, simple things like the kind of things I saw both in my residency and then
(07:18):
as my, as I spent four years as a hospitalist, things that I saw, the agony, the pain, thesuffering, unending nature of it.
It was like, even right now, I think if I talk about it, it would make me cry because andall to only realize that nobody's saying everything can be prevented.
And of course, there's a time and place to be in hospital.
(07:38):
And I'm in awe of the work we do in these hospitals.
But so much can be prevented.
And we don't have to be this sick.
We don't have to wait till we get this sick.
And I also sort of in terms of like the conventional background, I always.
Felt that.
I was probably the only one thinking like that.
I could be wrong, maybe it was something in my mind, but I felt like most people didn'tquestion that.
(07:59):
Like a lot of people did want to be in patient medicine and they would talk about it.
But when I would question things like that, I felt alone questioning that.
And then I was like, okay, I guess maybe it's probably very difficult to prevent this, sowe are doing the best that we can do.
And I continued to nurture my skills as a hospitalist.
(08:20):
But then slowly and gradually, and in my own personal life at the same time, right?
I was going through burnout.
I was the frontline worker in the COVID pandemic.
So residency in New York is already so hard on you.
And then boom, in your last year, the pandemic hits.
I was already going through my own burnout.
I was losing weight.
was under-slept the way residency is, right?
(08:42):
and then so much trauma at the hospital.
So I was also in the process of figuring out how to take care of my own self, with basicknowledge of nutrition and exercise, nothing deep, but I still had that inner knowing that
these are things that I do kind of want to reflect on and take care of my own self.
But then I'm like, why am I not doing this with my patients?
(09:02):
Right.
And for how long is this going to go on?
Because it's always that voice that hits you when you're
going to bed at night, right?
That do I feel like I would love to do this all my life?
And I felt that resistance.
So I think it's very important to like have that connection with your own self.
And sometimes when they say, listen to yourself as well.
The world may be saying whatever.
(09:23):
And like I had no training in prevention or proactivity in medical school, almost nothingin residency.
Is there any time?
No, there was none at Yale when I was...
student.
was no, no, I I don't, don't think so.
It was primary care, but even primary care was a lot of, sure in primary care, do dopreventive care, but it was most, it was still not the kind of care I want.
(09:45):
Here we do is maybe some diagnostic tests if they believe in it, whether it's a mammogramor issues with a prostate.
And really teaching people how to investigate and they don't even give the students or thetrainees the tools to understand nutrition, exercise, sleep.
And that's where the world has changed.
So you can imagine.
(10:05):
So you can imagine, because I went to school more than 20, 30 years ago, what I faced.
There was no one.
And in fact, people would laugh about it when I would say, listen, there's a better way totake care of people.
We need to know more.
Excellent.
Do you have any real examples of patients you saw as a hospitalist to illustrate thatimpact?
Or even in your own family, when you compare notes, is it the same situation in Pakistanand Sweden, where I know you started your career?
(10:30):
Have you heard stories?
And what does your family feel about it?
mean, yeah, my dad is very my both my mom and dad.
They so my dad and mom, they have their own kitchen garden over there.
Right.
So they grow a lot of vegetables on their own.
So this this also sort of instilled it's not like we are a plan based family only.
We're not vegan, but we are an omnivorous family.
(10:52):
there was always a very big emphasis on making sure that you're eating not just yourvegetables, but a variety of vegetables.
Plant diversity was ingrained in me right from a very young age.
And my dad grew broccoli in his kitchen garden when broccoli was not available in themainstream market in Karachi.
Like you wouldn't find broccoli anywhere.
You wouldn't find parsley anywhere.
(11:13):
He would grow, cause he would come here and get the seeds.
He would come to the U S and get the seeds here.
And then he would go back and grow there.
And my mom and dad take care of the garden together.
I guess.
my case, it was just my mother.
My father did other things.
He did the sports and the exercise.
Yeah, so because of this, my dad being an emergency medicine physician, sees emergencycases over there, right?
(11:38):
So of course there is like, it's so common for people over there.
Like the thing that really bothers me, it's so common for people there to die in their 50sactually, 50s and 60s.
Like the average age in my country is probably in its 60s.
know, people say, well, they died of old age and I'll say how old and they'll say, well,60, 65.
And I'm like, way.
What are you talking about?
(11:58):
yeah, it's aging.
I'm like...
No.
Even when they're 90 or 100, it's not old age.
Yeah, it's the shift in how you think about life and living.
It's so common for people there to die in the middle of the night.
What is a sudden cardiac arrest representing?
What's going on?
Of course, there's no way for me to tell
I see a lot of folks from Asia and from Pakistan and India.
(12:21):
And in general, even when they're sick, they actually look and seem healthier.
And I always wondered if like turmeric and curcumin and all are playing a role.
I think it is.
I think it reduces inflammation.
But it sounds like it's not a great system over there either.
It's worse than the States maybe.
We get all chronic diseases and we stay alive a long time, but very sick.
(12:42):
And there are, mean, if there are good genes, people will live longer there, but theaverage lifespan is in its 60s.
So that's just the truth right now.
And then in terms of what I saw, I would, I'm not sure, there are demographics aresimilar.
So I would probably think that maybe, yeah, maybe the average, my guess would be maybeIndia is, would be a little bit better.
(13:05):
I would argue maybe, but it's also a much bigger country.
so I'm actually not sure about the statistics, but in terms of like, if they're goodgenes, have my, my grandparents lived up to their eighties.
So there's good genetics, you know, they, but even in their eighties, it's not likethey're living their best lives in their 80, right?
It's, it's the at 60, they start preparing to die.
Right.
(13:25):
Like that's how the mindset changes people over there.
just get sick and they cope with it.
You see them and even people who have the wherewithal to get the help.
I'm always shocked when I get their labs and I hear their story because no one's doinganything proactive.
I had a patient call me from Atlanta, a really smart guy who's a CEO and chair of acompany.
(13:46):
And he was telling me how he has a concierge doctor.
And then he went on to tell me all the things that were diagnosed.
And he said, but nobody's doing anything about it.
They're like keeping an eye.
on it.
So I'm always shocked about that.
Yeah, I feel like I'm living in an isolated world, so it's great to hear you.
In your new practice, what's your typical patient like?
You're seeing patients through Northwell.
(14:08):
You have a primary care setting now, which is different than hospitalist.
Hospitalists can absorb it, but I guess it's gotten more complex at the hospital level,more critical care.
People are living longer and they're probably sicker when they get admitted.
They're sicker.
actually just going back to what I saw in my practice as a hospitalist, not only are theygetting sicker, I also saw a lot of people who are like tracheostomy, ventilator, like
(14:36):
people who are living lives in nursing homes on ventilators.
Like that's it.
That's it.
And that was the kind of...
It's both.
used to be both.
was maybe when people, family members didn't want to let them go.
And at the same time, there were some cases where there was just nobody to speak for themand it was a whole thing.
(14:56):
but then, and guess why they were on the ventilator to begin with, they had a stroke andguess what?
80 % strokes are preventable.
So like those kinds of things, right?
Like they would come back with a ventilator associated pneumonia and now they have a PEQtube and there's some complication of the PEQ tube.
Now they have a sacroiliac uberous ulcer.
So there's a company, there's a complication of that.
Just going down and we're trying to keep, you know, keep figuring out how to just keepthem alive, keep them alive, stabilize and send them back to the nursing home.
(15:24):
And of course, sure, there's value in that.
But my question always was like, what am I achieving here?
Right.
this person is not coming back and those are, and it was a mix, but there were many, butthere was none.
There was none.
Maybe they would blink the eye.
Maybe they would lift a little.
That's what I, yeah.
And that's what my frustration was.
(15:45):
was like, you know, there's, there's, you know, I, I see we're trying to help this person,but to what end and for what I don't understand.
what are we trying to achieve here?
And, and then if you, if I go back into how this happened, it was a fateful stroke.
And then when you talk about, okay, what did we do for strokes?
Once you get the stroke, there's not a lot you can do other than maybe physical therapy.
(16:06):
mean, there is some acute management of stroke now, which of course is very helpful.
But that's another thing.
If you make it on time, if you make it on time, exactly.
Now what's a patient like?
Because I imagine it's still like, I remember transitioning to New York, because I didn'tknow anyone in New York and I had a practice of primary care with excellent doctors.
And I was ending up staying until midnight because I saw so much that could be treated,reversed, prevented in a pretty, you know, like smart population of people.
(16:36):
These were people that could afford to do what they wanted.
They wanted help.
It was insurance based too, but it was fee for service.
And this was one of those doctors I work with.
He was fabulous.
And he, you know, he really gave excellent care.
And I kind of went back into primary care routes to understand it.
But there was so much to do that I felt like I had to organize an approach.
And that's where why I ended up doing what I did.
(16:58):
And I that's what I'm in the process of figuring out as well.
I became a primary care physician just a year ago after only doing internal medicine.
how do you convince patients that prevention is worth it and it matters or proactiveprevention?
So one of my biggest things that I really focus on is family history.
And I've heard you saying also that family history is a poor man's genomic study, right?
That was the beginning because I wanted the genome to be here.
(17:22):
And then as years went on, I realized that it was richer than genomics, at least intoday's world still to some degree, because it's emergence of diseases.
Because a lot of us are programmed to get diseases we never get, or we live a life acertain way, so the epigenetic factors protect us.
And so now to me, family history actually trumps genetics for the time being.
(17:42):
That's going to change.
I'm glad to hear that.
I'm sure it may change exactly as we advance in the field.
But for now, that's my tool.
So one of the ways in which I do two ways.
One is I really dig into family history.
When it comes to family history, I dig deep, including if I feel like I was not able todig deep into family history in this one visit, I will ask them to follow up just to tell
me their family history.
(18:02):
And when it comes to family history, I'm talking about
age of diagnosis, at what age should your father get a stent, at what age was this breastcancer diagnosed, when did this person die?
Tell me about your maternal aunts and uncles as well, what's happening in the wholefamily?
a little fly on the wall when I had a leads call earlier today because that's exactly theway to go about it.
(18:23):
Congratulations.
that's where the light bulbs open because they're like, oh, just, then she's, and thenthey're messaging their moms about answers, right?
Oh, I just found out my paternal aunt was actually diagnosed with breast cancer at 40 andyou're 35.
I'm like, there you go.
That's why I'm asking this question because if you're
fire under them in a way that they realize that they may be at risk too because it runsin.
(18:48):
said if you because oftentimes I feel that if you don't ask them, it's often not on theirradar.
Many of them maybe are not even living with their parents.
So you you tend to forget I'm not sure maybe this that but when you dig and you and thenthey go back and they go talk to them and they bring back the answers, then it lights up
more problems.
So then what I what I tell them is that hey, this stent that your dad got at like 65.
(19:12):
The process of that, like I explained it to them in as simple a manner as it can be forthem to understand the process of this catastrophe started at your age or maybe even
younger.
So younger, right?
Not even thirties.
We're talking about primordial prevention now of cardiovascular disease.
already answered the next couple of questions, which I like people to think about.
What is the promise?
(19:33):
Because in order to have people take it seriously and make lifestyle changes, they haveto, or make any change, they have to see themselves.
And there's also the other end of the spectrum where sometimes people feel it's inevitableand you have to tell them, it's not.
Diabetes is inevitable.
That I tell them the same thing, that it may be there.
(19:53):
Maybe even with the best of efforts, you may still get it, but can we at least try and seeif we can push the age?
Yes, make it a hundred instead of...
Can we push the age at which you get diabetes?
Or who knows, if we do it properly, we'll be able to escape the genetic predispositionaltogether, the trigger of the genetic lies in what we do on a regular basis.
(20:13):
And then also, I get a lot of women in their 20s, 30s, for example, even 40s, right?
So I remind them, just like how I remind myself, that we feel okay right now, but this isalso our time to...
I describe it as our 401k for health.
This is our time to invest in our health, to bear the fruit not just today, but also fordecades to come.
(20:33):
I like seeing an image of, I remember when I first started this work in women's health in1992 at Yale, I would tell people that you should think of your health portfolio in
addition to the, you work on your financial portfolio, but what's all the money gonna doif you're sick?
So that's a similar approach.
perspective shift in terms of looking at your health, giving you importance, includingsome financial investment.
(20:56):
For example, I give my own example.
I decided to invest in a fitness trainer.
said, I would buy less bags, less clothes, but I'm going to pay for a fitness trainerbecause when she comes in, she trains me.
It's a completely different level.
Yeah.
Yeah.
Like I, and I shared my own example with them because
I don't say that I'm imposing this, for example, if we can, like I give them my examplethat I decided to budget a bit differently.
(21:23):
And I told myself, I am willing to buy less bags and less clothes.
But I would pay for a fitness trainer every month because for me, my health is a priority.
And I see the difference that the trainer brings to my training routine when she comes andshe trains me, it's a completely different ball game altogether, both in terms of the
efficiency and the safety that is there when she teaches me.
(21:44):
So I give them different kinds of examples.
I tell them you can do this even at home.
It can be zero cost as well.
But depending on wherever you are, I would like to meet you where you are.
If you can't afford a fitness trainer, no problem.
If you can't afford a gym membership, no problem.
We can even start from home.
Then I give them home exercises.
You could do this with body weight.
You can get some resistant bands from Amazon.
You can get some dumbbells, some bell.
(22:07):
What are they called?
Free weights.
Free weights.
You can get some free weights.
can get started at home as well.
You can use apps.
The point is to get started.
The point is to not shoot for the stars immediately.
Let's get moving.
But the point is to think of this as a lifestyle.
How do you find the time in such short visits?
Because most of insurance model care is 20, 30 minutes at best, and people have a lot ofthings they want to share or say.
(22:33):
How do you fit in the extras, the extras about talking about exercise?
I used to give people a prescription pad.
This is your prescription for exercise.
This is your prescription for eating.
How do you manage to fit that in realistically in today's world as a primary care doctor?
Yeah, so that is true.
And it is a challenge that I have every single day.
(22:53):
And it's just about me brainstorming within the capacity that I have.
How best can I make it?
That's something that I do every single day.
allowed to bring patients back as often as you want?
Is that part of like your...
Exactly, exactly, exactly.
So that's what I do.
That's exactly what I do.
And I'm glad you're bringing that up.
I tell them that, we discuss these things because I want to make sure that I'm addressingeverything that's on your mind, that whatever you expected from today's visit, we try to
(23:20):
make sure that we address those things.
But then there's some things I want to address and we may not be able to talk about thosethings.
But I briefly tell them and I said, how about we follow up in two weeks, three weeks, onemonth?
And this could totally be a virtual visit.
So for this, you don't have to come in with me, come into the office, as long as you'rebased in New York, I can see you from home.
But I do kind of want to talk a little bit more about your diet.
(23:41):
I do kind of want to dig a little bit deeper into your sleep.
I do kind of want to look into your family, you do a little bit more.
If your exercise is being an issue, let's talk about a little bit of you, depending onwhatever is, it's all personalized, right?
Depending on whatever point I feel someone needs to focus on.
I tell them it's not done yet.
These are supposed to be annual preventive visits, but I'm not asking you to see me nextyear.
(24:03):
I actually think we should see each other more often.
And they're super happy with that.
And then they follow up, they go back.
And in the meantime, I give them some homework.
For example, on the portal, I send them podcasts to listen to.
I send them different videos.
I send them some books to read.
I'll send them this podcast, for example.
Exactly.
So anything that if it's religious, so I have also designed like specific things for likefor sleep, what I want my patients to know.
(24:30):
So I've had like a shortlist at some podcasts, some books, some things for exercise I'vedone similarly for high cholesterol I've done similarly for heart disease.
Like I've built those things and I keep improving them as time goes.
So what I do here within, so this is me hacking the limited system I have.
Let's get you these resources so you go home, you read up on this, and then let's do avirtual visit and we can talk about what you learned and then I want to talk to you about
(24:55):
more.
So this means several visits in a year, but I think that works like.
you don't have to worry.
I know you see 16 to 20 patients a day.
So that you must be tired at the end.
I'm very tired of telling you.
Ask my husband.
So we already crossed the bridge of you weren't taught much about preventative medicine inmed school.
How are you educating yourself now to be able to provide the best proactive insights toyour
(25:19):
through people like you.
And this time, think what I've also, since my training, I've also dealt really deep in, Ireally understood.
Now I follow nutritionists.
follow, I read the work of exercise physiologists.
I read the work of sleep psychologists, because these were aspects that were not taught tome in my training, right?
So, but I guess what my training did teach me was how to read papers and how to be able todiscern.
(25:43):
you know, what works and what doesn't work.
And so a lot of my focus now is to really dive deep into alongside the conventional stufflike that's happening, right?
We all know the guidelines and we keep ourselves updated on those things.
But some of the things that I really dig deep now into are nutrition, exercise, sleep,even psychology.
(26:04):
I try to understand a lot about the mind.
I follow a lot of different psychologists.
I read their work.
I read the books because I don't think psychology is disconnected from any of this.
If anything, maybe the starting point, maybe that.
So and that's what I try to bring in my practice that in simple words, I tell my patients,right, if you need this particular blood pressure medication today, I'm going to give you
(26:24):
this because I know that this is what's supposed to be for you right now.
But in future, we are also going to talk about all that.
I don't just say, go diet and go eat healthy and exercise.
Like, like we know that doesn't work.
and, then for me, for two, for me to be able to guide them, I need to know what shouldthey eat and how should they move?
(26:46):
And if they're having difficulty moving, how should I help them do that?
I see that as part of my, my, my work with them as well.
It's not just prescribing medications.
So I keep myself up to date on those things in terms of what's, what are the latestguidelines, what works, what doesn't works.
What are the myths?
Then I debunk a lot of those things as well for me to be able to, and I learned frompatients too, because they're coming to me hearing a lot on social media.
(27:09):
But then I need to know, okay, what's right, what's wrong, what works, what doesn't work.
So those are by following the right people and figuring out the yeah, the material.
It's something that I've been able to upscale.
It's all really wonderful.
mean, I'm fascinated and I think it's a work in progress.
sounds new but...
Yeah, but you're making progress.
(27:30):
So if you could wave a magic wand and change anything about conventional medicine, wouldthere be one thing that you would start with?
I think...
I think connecting all the health records, I think the silos have to go.
I don't know.
I'm not sure if there is value in these silos, but I don't see this.
It makes my work and it makes things for my patients so much harder than it needs to be.
(27:55):
Like if only I could, like when they're coming to me, if only I could.
see whoever they've already been to, the impression, everybody.
Like right now we're literally talking in terms of faxes, right?
Like I get faxes from different offices.
Like the most advanced GI practice is faxing like 50 pages.
I think if the doctors can start talking to each other, if the records can start talkingto each other, like that would be my one.
(28:23):
problem that I've solved by asking for release of records of all the doctors and gettingthem, whether they're faxes or, because a lot of doctors don't even use email yet or scan.
And then the other factor for doctors I find is time.
Like they're seeing so many patients a day, they don't want to get on, you get them on aphone for a couple minutes, you're lucky.
In my case, having done work so early in this field, doctors used to get angry at me forwhat I was doing until they saw the outcomes and then they became my patients.
(28:51):
So that was always rewarding, but it is hard because the medical system isn't set up.
It's not set up.
It's not set up for success in there.
Let's shift a little bit.
don't know if you have experience, but I would love to hear if you've had experience withGLP-1s.
Have you seen patients coming and asking, given it's become a celebrity thing?
And how do you approach those conversations, and what has been your experience just outbeing in primary care?
(29:15):
and actually this is one of the most common things I manage in my clinic because it'sobesity, weight gain has been, I see 70 to 80 % women.
It's not exclusive to women, but it's a lot of women come to me with issues such as bothweight gain, obesity, obesity associated complications, and many of them are coming with
(29:37):
the intention to explore GLP-1s.
And in my practice, I found them to be revolutionary.
I am like, I'm very pro.
I'm very pro salmoglutide, very pro trisepidide.
What is the usual decade age-wise that you're seeing patients asking because they haveobesity or what?
I think my, I would say my majority is 30s to 50s or maybe 30s to 60s.
(30:02):
starts changing in their 30s and right.
Exactly, they...
Exactly, exactly.
That is the time.
as convinced as you and very optimistic because I think these are breakthrough medicationslike antibiotics that will change the trajectory.
making things so much easier for so many people.
Even when they, and if anything, I feel like when they start taking it, all the thingsthat, you know, they always kind of knew they were supposed to do in terms of managing
(30:28):
their diet, it sort of becomes so much easier for them.
I noticed that as soon as the medication starts, now they start going to the gym.
Now they start focusing on their protein.
Now they start eating the right way.
For once you start it, I think people realize food noise disappears and it's the foodnoise that keeps them thinking they're eating breakfast, what are they gonna have for
lunch?
And then they're eating lunch and when am I gonna have a snack?
(30:50):
And I think we're driven by that because of the way modern society works.
We have access everywhere, but I think you're right and I agree that these arebreakthrough drug.
Yeah, so I think I'm as optimistic as you are and I've seen it over 20 years, I'm excitedabout it.
Okay, we're kind of running out of time a little bit, but I thought I'd turn the tablesand give you an opportunity to ask me anything about the way I practice and how I approach
(31:13):
things since you're beginning your new venture into primary care.
I actually really appreciate this question because I had that in mind myself.
My question would be.
tell me how you do things differently.
For example, in terms of as a comparison of what I'm doing, and now if you add theadditional layer of epigenetics and genomics, are there something else that you're also
(31:33):
incorporating in proactive medicine?
What difference would that make?
That's a great question and it's massive, but let me tell you that in growing what I did,I realized I needed more time with patients and I needed to make it efficient.
So starting back 20, 25 years, I started doing telemedicine and nobody, everyone in myfamily is a doctor, most of them, they're scattering other things.
(31:55):
My twin sister, my brother, my son, my niece.
So we're a family of doctors and my family would laugh at me.
They think I was getting out of washing the dishes in Thanksgiving because I was in thegarage talking
on the phone.
Yes, I would be getting out of washing the dishes, but I also had to talk to my patient.
Right.
So I designed a way to engage with patients from a distance and creating spreadsheets andinformation that would allow me to share real data, not just conversations, but actually.
(32:22):
go through what the patient has eyes on it.
I had eyes on it.
It wasn't through Zoom, because Zoom came later, but through the phone.
And equally, I was able to teach other people who would be shadowing me or working with mehow to think differently.
And then collecting as much as I could.
So going back 20 years when computers were like three gigabytes, I would.
constantly crash my computer because people would be sending back their data and thecomputer was too overloaded.
(32:49):
And so I created questionnaires and ways to dig into areas that I knew were pertinentbefore I even saw a patient collecting their information and then digging into all of this
because there's no way to do it in a 20 to 30 or 40 minutes.
And so I was very fortunate to carve that time for myself and to know that I was doing itin a way that was be valuable for
(33:12):
both me and the end result for my patient.
So that's where I started a long time ago.
And now it's developed into having a way of course, the care we give here is bespoke andyou know, it's very in depth along the same lines that you're speaking, but advanced to
include.
all things genomic, all things epigenetic.
We even talk to trainers.
(33:32):
We have exercise physiologists.
I have, you know, other clinicians who work with me, so I'm able to train them and extendand leverage the time because I train them in rounds.
In fact, I run it like it's it's academics, like it's Yale.
So we are privileged not to have to see 20 people a day and give them a little bit ofeverything and then more time.
(33:53):
So it's time that is really, I think, a big, great limiting step in primary care.
Because I did primary care for a few years as I was transitioning, helping a doctor in NewYork.
And I knew what it took.
I think I mentioned before that I would stay till midnight to make sure I could workthrough all the issues for any one person.
There's a doctor I work with who is lovely.
His approach to high cholesterol
(34:16):
high blood pressure or weight was to starve and I'm like that doesn't work.
certainly for some people.
So he learned as well along with the patients and it was very rewarding.
I think you also need to be in a system that isn't insurance-based to begin with.
It's wonderful if you can help a little bit, but I think the frustration that you mighthave in the future will outweigh your ability to continue on this level because there's a
(34:40):
lot to learn.
Yeah, agree.
Like I said, I am aware that time is the challenge, but we try to make the most of wehave.
That's what we're all trying to do here within the limited constraints.
How can I still provide what you write?
Time is where because these things like one hour, two hours.
It might help you, one practical step would be to share like a questionnaire of things youthink are important before you even meet a new patient.
(35:07):
Or if that's hard, once you meet them, send them home with that homework that involvesanswering all these questions.
I love So you can get the detail and the information you need.
And that will take you a long way because it's...
the questions that you need for, I'll give you a real example.
We have a patient, long-standing patient who called last week with back pain, severe backpain.
(35:27):
And she was a little upset because she was babysitting her seven-month-old granddaughterand she had to bring someone in to help because she couldn't carry the baby.
And so in exploring what she was doing, it turned out that she was doing a new exerciseher farmers carry was...
holding weights that was half her body weight, because that's what her trainer told her todo, which was insanity.
(35:48):
And so that put her back out.
And by simply probing and asking the right questions through a phone call, you can figureout what you need to do to help.
And so that's how I've learned over the years to make a difference.
That's where the extra 10 minutes help, right?
Because you can go deeper than exactly just what they've come with.
Sure, I can put a bandaid here and fix this problem, but I want to ask you how thishappened and dig like two, three layers deeper so then I can make sure that we talk about
(36:18):
that too and then hopefully in future this doesn't happen.
It's like I think a bit as being a detective and learning all the bits and bytes aboutthat particular human being because all of us are unique.
Even my identical twin and I are not the same.
And so by learning that you can really help course correct the future health trajectory ofany person.
And that's what we've been lucky enough to do here.
(36:38):
So I'm thrilled about it.
I always like to ask any of my physicians and other participants on the podcast, ifthere's one burning question, you meet a person on a plane or a party.
and they ask you, what's the most important thing I could do to improve my health?
What would you say?
Gosh, in terms of choosing one.
I think, like I said, I think it's understanding our own psychology.
(37:02):
think, and sleep is not disconnected from that.
So I would say mind and sleep, because everything else, including like working onself-esteem, because those are some of the things I notice in patients, right?
Like, why would I think I deserve to do all this for my future health if my, yourself-esteem has to be high for that, right?
You want to feel like,
(37:24):
there's something special to preserve.
Like I see that people are, like a lot of people are really struggling with their mind alot.
Like I see a lot of mental health concerns and even young women, for example, and theywant to do things, but in terms of like stress resilience or emotional resilience or
mental resilience.
And I like to say that with a caveat because sometimes that me feel like I'm implying thatthe problem is just in them.
(37:48):
That's not what we're saying at all.
Our systems are broken.
There's a lot of corruption.
There's a lot of awful things going on.
But I think what we can still have some control over is just having a little bit betterunderstanding of our own mind, our own self-esteem, our own ways of coping up with things.
Gratitude comes there.
(38:08):
Social networks come there.
interacting with the right kind of people who uplift your energy, who motivate you, don'tpush you down.
And I think that's tied in with sleep as well, because if you're not sleeping properly,none of this is going to happen.
exercise, diet, everything else is extremely important.
But I think mind and sleep, I think that trumps.
So as much as we can, we should try to see if we can optimize our mind.
(38:33):
I think that's beautifully said and I couldn't agree more, but actually you were ahead ofme, you're ahead of me with that.
Cause when I first started, I was in internal medicine before I did endocrine and I feltit was all mind and psychology.
And I was raised in a family where you got to be tough.
No, there's no weakness.
If you're, if you're depressed or you're anxious, then you're weak.
And so I had to get over that.
(38:53):
And I will tell you that the biggest thing we do here, it's all about the mind andpsychology for every single person.
And they have to feel deserving and you see a
lot of women and a lot of times women are the caretakers.
They and they put themselves last.
Their kids come first, their parents come first, their husbands come first, or partnerscome first.
So I'm going to thank you now and then we can you can do you have a way to tell people howto reach out to you or thank you for joining me Dr.
(39:20):
Marion Bacher.
It's really been a pleasure.
I feel echoes in resonating with you and I'm very excited for you because I think yourfuture is really bright.
If listeners want to learn more and tune into you, where would you suggest they go?
Are you on social media?
I'm on Instagram.
That's my primary mode of presence.
They can follow me there.
My handle is Dr.
(39:41):
Mariam Barker.
So it's D-R and then my name, M-A-R-Y-A-M-B-A-Q-Y-R.
And I post pretty frequently there.
So I would be happy to have them follow me there.
Fantastic.
And I will too, if I'm not already.
I think we may be following you already.
But thank you for tuning in to all our listeners, to Healthy Longevity.
I'm Dr.
Florence Comete, wishing you a health span to match your lifespan.
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