May 16, 2024 • 34 mins
Embark on an emotional voyage with us as we explore the intricate world of bariatric surgery and the heartfelt journeys of those who traverse it. Tammie who is both a bariatric coordinator and a patient herself, provides an insider's look at the tangled web of feelings and fears that patients face, emphasizing the critical need for a compassionate healthcare environment. We delve into the significance of empathy and the essential role of post-operative support in shaping a patient's experience—because the road to wellness extends far beyond the operating room.
Dr. Iliakova and Tammie share their insights on the transformative power of respect and understanding, discussing the profound impact these gestures have on building trust and ensuring patients stay engaged with their post op journey long after they leave the hospital.
Tailoring the treatment to the tapestry of each patient's life, we discuss how personal circumstances and individual needs are the threads that, when woven together, produce the most successful outcomes in bariatric care. We invite listeners to weigh in with their experiences and perspectives on clinical environments, as we strive to create a supportive community attuned to the nuances of bariatric healthcare. Join us in this heartfelt conversation that's not just about shedding pounds, but also about shedding light on the path to a healthier, more understanding world.
This is a podcast about setting an intentional rhythm, savoring life’s blessings and ...
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to Core Bariatrics Podcast hosted by
bariatric surgeon Dr MariaIliakova and Tami LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatrics Podcastdoes not offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Speaker 2 (00:26):
Tammy, how are you today?
Speaker 1 (00:28):
How are you doing, Maria?
Speaker 2 (00:29):
I'm pretty good.
So I wanted to ask you aboutsomething that you told me now,
a few months ago, and it's whenyou told me that worst five
minutes of your life were thefive minutes before you met me.
That's so offensive.
Five minutes of your life werethe five minutes before you met
me.
Speaker 1 (00:44):
That's so offensive, Don't take it personally.
It was just anxiety.
There was a lot of what am Idoing here?
Not necessarily what am I doinghere, but what am I about to
experience Definitely.
And what are people in thisclinic thinking about me?
Because I am obese in thisclinic waiting to get a consult
(01:09):
for bariatric surgery.
Speaker 2 (01:13):
Part of the reason is I'm not a scary person usually
and but you know, what we dodefinitely has a lot of stigma
and fear and misunderstandingattached to it.
So what you actually saidresonated with me a lot.
Speaker 1 (01:37):
I'm glad you said it, yes, and I think that a lot of
people probably have that samefeeling when they're sitting in
that bariatric surgery waitingroom waiting for their initial
evaluation.
Speaker 2 (01:48):
Exactly.
You know, and it even made methink of, are we making the
process harder than it needs tobe?
It's already pretty tough forsomeone to even get to the point
where they know what bariatricsurgery is or ever consider it.
Even other doctors have adifficult time necessarily
knowing what it is or when totalk to their patients about it.
And so and certainly you know,it was brought to my attention
(02:09):
not too long ago by a goodfriend of mine, who's been a
friend of mine for years now.
But even she was like okay, sowhat is bariatric surgery?
Speaker 1 (02:18):
So I think that is definitely a big thing that
people don't understand Right,look at it Okay, it's a weight
loss surgery, but yeah, how areyou losing the weight?
Are you sucking the fat out?
Speaker 2 (02:29):
Right or what.
Right, and so a lot of people,I think, come into that setting
for their very first appointmentbefore seeing anyone in a
bariatric program and really areskeptical or scared or unsure
or really don't know.
And I know that anytime I'm inthat kind of situation I find it
(02:49):
hard even to ask questions orknow what to ask.
Speaker 1 (02:53):
Absolutely, because you're scared.
You're still getting thefeeling of who this provider is,
how this provider is nurse orMA is medical assistant.
Speaker 2 (03:06):
Exactly, exactly.
Speaker 1 (03:08):
How they're perceiving you.
Speaker 2 (03:09):
Exactly, Even the receptionist, even like who's
checking you in.
I think it can be really scary.
So what it made me think isyou're a very strong woman.
You are the mom of three boysand a professional and just a
very inspiring and caring andstrong person.
Speaker 1 (03:24):
And when you told me oh, I appreciate that.
Well, it's true.
Speaker 2 (03:27):
It's true, but when you told me those are the five
worst minutes of your life, Ijust thought that ain't right
and we can do better.
Speaker 1 (03:37):
And that's why I told you that.
That's why I've also told youthat post-op care and follow-up
and support was crap.
Yes, and that's why I ended upcoming into the clinic
professionally as a bariatriccoordinator, because I wanted
and still want all of this tonot I agree with you entirely.
(03:59):
I want people to be ascomfortable going into their
bariatric surgery appointment ascomfortable as they are just
going in and talking to a friend.
Speaker 2 (04:07):
Well, right, exactly, and it made me really think
about this worst five minutesexperience and what we could do
to make it better.
But first I want to talk aboutwhat makes it scary and what
makes it that worst experience,and some of the things that
really came up in thinking aboutthis were stigma and fear, the
process being prettyintimidating to even get to that
(04:28):
spot in the first place andthen not really knowing what to
expect out of it or how much itwould cost, or being afraid that
people would be judgmental orunfriendly.
Does that sound like a prettydecent recap, or what else do
you think is part of that?
Speaker 1 (04:42):
Absolutely All of it, a hundred percent yeah.
Speaker 2 (04:49):
You and I have talked about this a lot since then, so
I'm glad that you're sharingsome of those things too, and
then it's made me think what dowe want to do instead?
If it were me in that chair, ifit were you in that chair again
?
What are the things that wewould want to accomplish for
people and want other programsto accomplish?
Speaker 1 (05:07):
Yeah, and so you know .
You said the process or unclearpatient is.
Speaker 2 (05:13):
Yes.
Speaker 1 (05:14):
It's an intimidating process to get there.
So for me, I worked in theclinic space that the surgeon
was in and I knew the medicalassistant that the surgeon was
in and I knew the medicalassistant she's actually the one
that was like yeah, calm down,just have a chat with the
surgeon and see if this issomething you want to do so that
, even though some of my anxietywas still really intimidating,
(05:39):
and so I could not imagine howsomeone who has never been in a
clinic in that sphere or doesnot know anybody in the clinic,
how intimidating and justfeeling is yeah, and if you
think about it like a lot of themedical settings in general are
just intimidating and scary.
Speaker 2 (05:59):
There's a lot of everything is pure, sterile,
technical, very formal.
Sometimes there's very littleability to laugh or feel
inviting comfortable.
A lot of times you're waiting.
It just seems like we could betreating people in a more
welcoming and respectful mannerin general and providing more
(06:24):
transparency, because I thinkthat when people are coming in
and they really don't know whatto expect in terms of time or
cost or what they're going tohave to do, that really creates
a lot of anxiety.
Like you mentioned about notknowing and that's something
that oftentimes you know thisprocess of going through
bariatric surgery, getting readyfor it and even the care
(06:44):
afterwards a lot of that isfairly predictable.
It does not have to be this youknow, mystical process that
people don't know what to expectin the beginning.
We can be more transparentabout what it will entail.
Speaker 1 (06:58):
Absolutely.
And so yesterday I hadorientation at a new job yeah,
and one of their trainings wasAIDIT.
Have you ever heard of that?
What's AIDIT?
So it is A-I-D-E-T, and whatthis is is when you are first
(07:28):
introducing yourself to apatient or coming in contact
with a patient, acknowledge them, you introduce yourself and not
only just say my name is Tammy,but my name is Tammy, I'm a
respiratory therapist.
I'm going to do your breathingtest today.
I've done hundreds of thesebreathing tests and I'm going to
coach you along the way, thewhole way, that way you know
what you're doing.
You coach you along the way,the whole way, that way you know
what you're doing that rightthere, doesn't that already I'm
(07:52):
breathing.
Speaker 2 (07:52):
I'm breathing a fresh , fresh air breath right now,
because that makes me feel sorelaxed, it makes me understand
you're going to be there for me,you know what you're doing and
you care.
Speaker 1 (07:58):
Yes, and then it's so AI, and then D is duration.
Look, this breathing test isprobably going to take an hour.
It could take up to an hour anda half, and then we'll let you
out.
Nice Explanation.
Speaker 2 (08:10):
Yes, of what you're doing.
Yes.
Speaker 1 (08:12):
Doing this breathing test because we want to see how
well your lungs are working.
This is not a pass or fail test.
This is just to see whereyou're at.
Speaker 2 (08:20):
Love it.
Speaker 1 (08:21):
Love it.
Thanking them, love it, andthen thanking them, thanking
them for their patience, seeingif they have any questions, all
of that.
So that's something I learnedyesterday that I'm like oh my
gosh, every single clinicprovider, health care provider,
needs to.
Speaker 2 (08:38):
That's a great method and, honestly, if you think
about it, there's a lot of thatin customer service and I'm not
saying all customer service isgreat or anything like that but
I think in health care a lot oftimes we don't see our patients
as also our customers or ourclients, and I think that's a
mistake actually, because peoplehave choice in where they go.
Speaker 1 (08:58):
They have the choice to be there or not be there and
we don't necessarily treatpeople like they have a choice
and like it's a privilege totake care of them, especially
when it comes to bariatricsurgery, elective surgery yeah,
so they do not have to have thesurgery like they would need to
get their gallbladder come out,or something Exactly.
Exactly Though it will helptheir quality of life.
(09:21):
It's not going to make or breaktheir life.
Speaker 2 (09:23):
Right and also exactly.
It's not like your gallbladderis coming out one way or another
or else you're dying of sepsis,right, like that's not what's
happening here.
This isn't a cancer surgery.
But what we don't realize ispeople have the right to, yeah,
make a choice of whether or notto be there, and I think a lot
of the problems sometimesthere's a lot of worry that like
, oh you know, people won't cometo a bariatric surgery clinic
(09:45):
or they won't get care for theirweight because of all these
stigma and all these otherbarriers but I think one of the
biggest barriers is actually howwe as providers and we as
programs treat our patients andour customers.
Because we don't, yeah, right.
Speaker 1 (10:00):
We've had so many patients who said it wasn't
going to come in today.
But, tammy, that email that yousent me of this is what to
expect.
This is how things are going togo.
This is what you guys are goingto talk about Questions or
concerns let me know, here'ssome resources.
And so I eased that anxiety alittle bit.
And then, even when they werechecking out for their first
(10:24):
appointment, they did a lot ofinformation, so much information
.
Nobody can take that muchinformation.
So I was always there to belike, look, I got a lot of
information.
So make sure you reach out tome if you do have any questions
or forgot something.
Just have a friendly checkoutprocess.
Speaker 2 (10:45):
Exactly.
Speaker 1 (10:45):
A lot of patients said that's the reason why they
came back.
They knew it was such afriendly place.
Speaker 2 (10:52):
Exactly, and that's probably the compliment that
carried the most weight, becausewhen people felt they were
taken seriously, with respect,but also made to feel
comfortable and like they reallycould reach out for help or
support and like they would betreated like a person that meant
they were going to stay andthat meant they were going to
(11:13):
then help their friends andfamily get in the door and they
were going to trust us not onlyto take care of themselves but
also of their loved ones, and Idon't think there is a bigger
compliment to be had inhealthcare.
Right, people trust you withtheir ones, so it really, I
think, matters a lot, and Idon't think making that five
(11:34):
minutes before that firstappointment better I don't think
that's very highly valued, butI honestly think thinking about
the process of how you makepeople feel welcome and how you
make people feel included andsupported as patients is maybe
the most important aspect ofshepherding people through the
process overall.
Speaker 1 (11:56):
Absolutely, especially when it comes to
bariatric patients.
Yes, when a bariatric patienteven goes into their primary
care doctor Right a bariatricpatient even goes into their
primary care doctor.
Look, most of the time, even ifthey're there to talk about.
Okay, let's just say for awoman that my menstrual cycles
are super heavy.
What's the first thing thatthey're going to say?
Well, your BMI is super high,Take care of that.
(12:19):
I understand that.
That's what I loved about youis that it wasn't all about
weight.
It's not always about weight.
You're like you've lost 10pounds this month after surgery.
That's great, but how's yourenergy Right?
How do you feel?
How's your just all of?
Speaker 2 (12:51):
remember, even way before I was a bariatric surgeon
, having friends and family andothers tell me basically about
their health care experiencesand going in for like an earache
or a headache or a broken boneor whatever, and weight would
come up as the primary reasonfor the visit, even if it really
had nothing to do with what wasgoing on and that being just
really offensive to people andreally once that trust is broken
(13:13):
, where a person doesn't feelheard and doesn't feel like
their reason for coming in thedoor is getting taken care of,
that is someone that may losetrust for the overall health
care system.
Speaker 1 (13:24):
After you just said that there's smoke coming out of
my ears Right.
Speaker 2 (13:29):
And I think it's also like where's the justice in
that?
Where's the health care in that?
Where's the like good?
Even if you don't treat peoplewith and think of them as
customers or clients or whatever, how are you doing your duty as
a health care provider ifyou're ignoring the person's
primary reason for being there?
That doesn't make any sense tome, right.
So I feel on your behalf anddefinitely I think this is an
(13:53):
issue that affects sometimeswomen more than men, because
there are some studies that showwomen coming in with health
care concerns, oftentimes theirprimary concern is overlooked
more than than for men.
So it does.
In our population, which isprimarily women that come to get
this kind of care, it's evenmore pronounced.
Speaker 1 (14:14):
I think a lot of that has to do with things I feel.
You know, men obviously havingspeech, but as women I feel like
more so because we care aboutwhat people think more and yeah
so yeah, I think that's anotherthing where men is.
A lot of men are just trying togo with the flow right right
but you know what I think?
Speaker 2 (14:35):
obviously we are not doing a good job with men either
, and here's how I think.
Why I think that?
Speaker 1 (14:40):
because we don't see very many there's none of them
coming, exactly because there'snone of them coming in, because
men that we see coming in arethe ones that their doctor has
told them.
You either go see this doctoror you're going to die next year
.
Speaker 2 (14:53):
Right, right.
I hate that.
Right or right.
Or they've been scared into itor they're dragged by
potentially a spouse.
There that happens a lot, butthe guy that comes in on his own
is actually kind of a rarebreed in our field, right they?
Speaker 1 (15:07):
do so good.
They do so good For the mostpart.
They do what they're told andthey yes they do.
Speaker 2 (15:14):
Yeah, they do very well.
That's true and I think thatthey're, yes, the soul.
It's.
It is interesting to me becausewe're clearly not getting it
right with either men or withwomen and it it really affects
people's ability to get the carethey need and it's also like a
bad business.
So, even if you're thinkingabout this as a big hospital
system or you know some chiefexecutive or a business person
(15:38):
that's looking at the numbershere, when we treat people well,
when we care, when we show themin these sometimes little ways
that add up to a big picture andpeople feel supported and
respected, they stay, they comeback, they get care through us
and they are loyal.
They want to bring their familyand friends and they, you know,
(16:01):
even in the situation where wewere in, where the overall
hospital system was having somefinancial and other struggles,
people wanted to stay with usand they didn't care that there
were overall bigger strugglesand battles.
They wanted to stay with us.
Speaker 1 (16:14):
Which was such an eye-opener.
We didn't know if an OR wouldbe open and whatnot.
People are still self-referringthemselves.
Speaker 2 (16:25):
And.
I was just like.
This says something about usand that made me proud not to
(16:46):
blindside people with what thecosts were, what the realities
were of getting medications forweight management.
And as that practice grew, oursurgery practice grew too,
Because we were so, I think,honest, transparent and
supportive and didn't tellpeople, oh, you just have to
have surgery and that's the onlyway to go, but we were honest
(17:07):
about, well, there's actually alot of options and we can
support you in all of them andyou can take your time to decide
what's right for you and we'llbe there to support you along
that path.
It really resonated, I think,with people.
Speaker 1 (17:20):
Yeah, there's so much as we've said in the past.
There's so much like oneducation or not, about this
topic.
Right Words are hard yeah.
I know words are hard, thatwhen people came in, sometimes
on their appointment it says medweight loss only does not want
bariatric surgery and by the endof the appointment, after the
(17:42):
provider educated, let them knowall of their options, the pros
and cons of all the option andeverything, a lot of them did
come out wanting surgery or atleast wanting to explore that
option more.
Speaker 2 (17:55):
Definitely, definitely, and that's something
that it definitely takes moretime than just going through one
option or the other, butultimately it's also more
accurate to do that.
As a healthcare provider myself, I take a lot of pride in being
able to do more than one thingand being able to give people a
full spectrum of options eventhough it can take a little bit
(18:18):
more time and actually helppeople get to the goals they set
for themselves a lot better.
And it's also maybe a goal thatchanges over time where people
want to be in six months may bedifferent than where they want
to be in five or 10 years fromnow.
So being able to support peopleas their mind changes, as their
goals change, that's prettycool.
(18:40):
I think that's amazing that wedon't just have a one size fits
all approach to weightmanagement anymore and we're
starting to really learn that ittakes a lifetime right.
Speaker 1 (18:51):
Absolutely, and we've even had patients that come in.
They only want bariatricsurgery.
And you know they're like, okay, we're going to go towards the
steps of bariatric surgery, buthey, why don't we just add a
medical weight loss on there?
While we're doing things thatinsurance and the program
require.
Exactly doing all the thingsthat insurance and the program
require.
She actually had a patient thatwas doing so well on medical
(19:12):
weight loss and actuallytapering herself off of it,
decided not to go through withbariatric surgery because weight
loss gave her the head startshe needed.
Speaker 2 (19:25):
Exactly, and I think that's the right answer for some
people.
Certainly that's not the answerfor everyone, but that's kind
of.
The point is that this is not aone size fits all approach.
You don't like.
You know, you said agallbladder surgery is done when
you have a gallbladder problembecause you only have one
gallbladder and that's.
There's no other real goodtreatment for gallbladder
problems.
Right?
(19:50):
It's not a?
You're pregnant, you have tohave the baby and deliver them
and then you're done.
No, this is very different.
This is weight and all thecomplexities that go with it,
and also figuring out what'sright for that person at that
time.
In order to go through surgery,you have to have financial
resources.
You have to have socialresources.
You have to have people aroundyou who will support you.
You have to really know whatyou're getting into to be
successful and not everyone isat that point right, there's
(20:13):
people.
Speaker 1 (20:15):
Absolutely.
Speaker 2 (20:15):
Right, because there's people changing jobs,
for instance, that aren't ableto take time off to recover from
surgery, or people goingthrough financial or family
transitions, and actually we'vehad quite a few people who
needed a little bit of extratime to get through some of
those transitions or to gettheir life to a point where they
were more ready.
And guess what, those folkstypically do a lot better than
(20:37):
anyone who gets rushed throughthe process.
Speaker 1 (20:38):
Absolutely.
I 100% agree with you.
That's why we had so much.
I feel like we had a lot ofpushback when we're like no, I
think instead of just threeappointments, we need to have
maybe four or five, and we doneed to look at everybody's
situation separately.
Everybody is going to taketheir own time.
We got a lot of pushback fromthat, but I think some are
(21:00):
co-workers and stuff.
I think, then, from patients,even though it's the initial
frustration of oh, I thought Iwas going to have surgery in
three months.
Speaker 2 (21:09):
Today, yeah.
Speaker 1 (21:10):
At the end of the day they were like oh, I'm glad I
took extra time to get my lifestable my mental health a little
bit better.
Speaker 2 (21:24):
Yeah, exactly.
And the other thing that reallystruck me was that there are
some people and I know we've hadthese conversations and we've
definitely had them with ourdieticians and things too that
you're like this person would beready for surgery today, like
they walk in the door, they'vedone their research ahead of
time, they really know whatthey're getting into, they have
fantastic support, they've gotinsurance coverage and you're
like you know what, if therewere a way to fast track this
(21:45):
person and get them to surgeryin a month or two, maybe that
would be the right approach forsome people.
Speaker 1 (21:50):
That's how our dietician felt about me.
She's like.
I think you could almost teachme some things, not literally,
but just like the little thingsI taught you of like how to be
helpful, just like a clothingcloset of people bringing in
clothes that don't fit themanymore so that another patient
can wear them while they gothrough that stage.
(22:11):
So I sometimes talk to thedietician just little tips and
tricks.
But she's like, wow, done a lotof research and yeah, but then
she personalized my nutritionplan and stuff.
Speaker 2 (22:25):
Exactly.
But, tammy, I think that yoursort of bigger community picture
of this and the biggerinfluence that this has is what
makes you stand apart, and Ithink it's honestly what makes
you such a great advocate forpeople who are going through
bariatric care and for peoplewho need to access it or want to
access it, because you're notall the good, the bad yeah.
(22:49):
Yeah.
Speaker 1 (22:51):
What can happen?
We need to look at picture case.
You could have surgery and notknow.
Oh, it's sleeve cause acidreflux.
Speaker 2 (23:00):
Exactly.
Speaker 1 (23:01):
People don't know that.
Speaker 2 (23:02):
They're a little upset.
Speaker 1 (23:04):
So I think, just like before the first appointment,
being transparent about all thethings gains trust, yes, gains
that community, yes.
Speaker 2 (23:15):
And encouraging people to know what they're
getting into ahead of time, andthat's something that I think
you did really really well inour program and that's something
that we continue to evolve.
But even educating andsupporting other health care
providers, because we started tosee a lot more referrals when
we engaged other healthcareproviders more, so, like we went
out into the community and didteaching, we invited people to
(23:39):
come and see what we were doing,we invited partnerships, we
created the feedback loopsbasically of like hey, thanks so
much for sending us this personand here's how they're doing
and here's what's going on.
And I think people reallyappreciated that.
Because we're kind of siloedotherwise from each other, it's
tough to have a lot ofcoordination, naturally between,
(24:00):
like, the cardiology office andthe bariatric surgery office
and respiratory and their sleepclinic.
But if you actually create someof those relationships and
partnerships, that makeseverything so much easier and it
also, I think, reallyencourages people to work
together and then notice whensomething's off track.
So that was.
Speaker 1 (24:23):
Absolutely agree and I think patients that are
choosing their provider whetherit be a bariatric surgeon, their
primary care doctor, theirspecialty you know sleep
cardiology doctor seeing howthey communicate with your other
providers, that's huge Like,and if you have a provider that
isn't doing that, don't beafraid of finding another
(24:44):
provider.
Right your health overall andthe ones that are willing to
take the extra five minutes tocommunicate with your other
provider, that's having a goodteam on your side.
Speaker 2 (24:55):
Exactly, and it does mean that there's more than one
set of eyes on whatever's goingon, because we can't all I mean
everyone knows our healthcaresystem is not perfect and things
slip through the cracks morethan we want them to because
everyone is working on differentsystems, everyone has different
schedules and communicationcould definitely be better.
So when you have a team thatworks together, even if they're
(25:17):
not in the physically samelocation, it's just such an
easier process for everyone andI think everyone, even in a bad
situation, for instance, canjust really work together a lot
better to help each other, helpthe patient, help everyone just
overall, do better.
Speaker 1 (25:34):
Yeah, and I think if everybody's on the same page,
and how you've met with primarycare doctors and let them know
what you offer medical weightloss surgery, all of that when
the primary care doctor iseducated before sending that
referral, they educate thepatient, which then results in
less anxiety.
Speaker 2 (25:55):
Exactly, they know what's coming they?
know what to do Exactly.
So it's sort of like if you'regoing into an interview process
for a new job and you have noidea about anything about that
company.
You don't know anything abouttheir culture.
Yeah, it's scary, right.
That's never a situation inwhich you're set up for success.
Instead, if someone's referredto you there because they
(26:15):
personally know someone and theyreally like that person, they
can speak really highly aboutthem and they know exactly what
you're going to go through inthat job interview or that
process.
You're going to really lookforward to that and really know
what to expect.
Speaker 1 (26:28):
Setting people up for success.
Speaker 2 (26:30):
Exactly, and I think that's really a key in changing
that five-minute experience thatyou had from one that was the
worst into one that is great andone that is not necessarily the
best five minutes of your life.
Speaker 1 (26:46):
But the five minutes that people could recommend to
others it wasn't the worst, LikeI don't know if I would have
recommended people to come intoour clinic after I felt what I
felt now different.
Now it's obviously differentwhen I've worked down here and
changed a few things.
Speaker 2 (27:04):
But that's why because I think that is
technically the first impressionpeople get right the first
impression that people get of aprogram or a provider is sitting
in the waiting room oftentimesand if that experience is awful,
if that experience sucks, thenyou're not setting yourself up
as a provider for a goodinteraction and you're
(27:25):
definitely not set up well asthe person receiving the care to
be open to it, to beopen-minded and to know that
that person's really going tocare and give you a lot of
respect through the appointmentthat that person's really going
to care and give you a lot ofrespect through the appointment.
Speaker 1 (27:43):
Yeah, part of that aid training was managing up.
Speaker 2 (27:45):
So I managed you up.
Speaker 1 (27:46):
A lot like saying if I roomed your patient, just
letting them know like she isamazing.
She listens to all of yourproblems.
She honestly doesn't care somuch about your weight.
She wants to know how you'refeeling, what goals you have,
all of that.
Speaker 2 (27:59):
I love that, tammy, that's so kind and I think
honestly we did have a clinicatmosphere of very much talking
each other up, and that was realbecause I think we all really
respected and liked each other.
But it was also helpful to youknow.
At some point we transitionedto actually going to reception
and grabbing patients andinitially I was like, oh my gosh
, this is kind of difficult todo where it sort of disrupts
(28:20):
your workflow.
Speaker 1 (28:21):
But then it really you yelled at me through
Microsoft Teams I can't do this,I cannot get my own patient.
Speaker 2 (28:27):
But it really grew on me.
I was totally wrong because,like completely, because I think
you're trained as a provider,like as a surgeon, that you need
to stay put and people need tocome to you, and I think that
was really short-sighted on mypart because in that you know,
30-second interaction that I wasgetting to have, walking to
reception helped me clear mymind a little bit.
(28:48):
Now I was transitioning to thenext person and I needed to
focus on them.
And then it also helped me walkpeople back to reception or to
the next place they needed to go, which was typically a
dietician, and it helped mecreate an introduction for them.
It helped me, like you said,like talk up the next managing
or leveling up basically Right.
(29:09):
It helped me establish that kindof positive expectation of the
next step.
Speaker 1 (29:14):
Eased anxiety 100%.
So when you, the provider, arecoming out to grab the patient,
that walk to your office is notwith another person.
Speaker 2 (29:25):
Right.
Speaker 1 (29:25):
The anxiety of who this provider is going to be,
and then you actually walkingthem to the next person.
Speaker 2 (29:32):
Right.
Speaker 1 (29:32):
Again eased that anxiety of oh my gosh, what's
next?
Right?
Speaker 2 (29:37):
Exactly Because it was such a nice way also to get
introduced to people, becauseinstead of people getting walked
into my office and it feelingsort of like you're going to the
principal's office or somethingwhich is I know how it can feel
sometimes for people andinstead, you know, my first
interaction was like hi, how areyou?
And tell me about yourself alittle bit.
And we were walking down ahallway, not talking about wait,
(29:57):
not talking about health care,literally learning whether, like
how many dogs this person has,about their kids, about their
trip down.
Well, I mean, I love my dog themost, but Sasha forever, but no
, but it just created such adifferent dynamic right off the
(30:17):
bat with people and it reallygrew on me and I would not go
back at this point, I think, tohow we did things before, but it
took, honestly, also me beingwrong, me changing what I had
been trained to do to what mademore sense for the people I was
taking care of.
Speaker 1 (30:39):
And not bash on surgeons or anything, but
surgeons have a hard time ofbeing wrong.
Speaker 2 (30:45):
Yes, Tammy, I don't know what you're talking about.
No, I'm kidding.
So that's where this community?
Speaker 1 (30:52):
our core bariatrics.
Not only do I want to reach outto, and touch and be supportive
of patients, we also are goingto be building community for
even providers of how they canmake their practice better.
Speaker 2 (31:08):
Exactly.
So that anybody listening herethat still hasn't had bariatric
surgery hopefully theirprovider's office has the same
(31:31):
very welcoming, respectful andtransparent office and arts and
culture groups and reallyrealizing that our reach is
powerful within our clinics andour hospitals and our ORs.
But really bariatrics lives inthe real world, not in our
healthcare facilities.
Speaker 1 (31:49):
Absolutely.
Speaker 2 (31:49):
Right and like kind of care that we're providing and
the kind of results people areseeing, the kind of lives people
are living.
99% of that happens out in theworld, outside of medicine.
Speaker 1 (31:59):
Absolutely, and I feel like if all programs are
like how we were or how we werebuilding to be, people long-term
are going to be more successfulas well.
They're going to haveencouragement to stay
accountable and stay on trackand they're going to want to
come to their one-year follow-upExactly that's what I'm hoping
for to come to their one yearfollow up.
Speaker 2 (32:18):
Exactly that's what I'm hoping for.
Speaker 1 (32:21):
That's what we're here for.
Speaker 2 (32:21):
Exactly I think, yeah , we're here to make the whole
process better, and the processis better for people going
through it as patients, peoplegoing through the process as
providers or others withinprograms, because ultimately,
the goal is for all of us to dobetter, not either or and not
against each other by any means,but absolutely the tide that
(32:42):
raises all boats.
Speaker 1 (32:44):
Absolutely, absolutely Well, maria, let's
wrap this up here For those thatare listening.
Please don't hesitate tocomment, let us know what you
think about this, let us knowwhat your experience was in your
clinic and if it was differentthan what we're explaining and
if you would want an environmentlike we're explaining.
(33:05):
So don't forget to comment,follow our podcast and we will
see you next time.
Speaker 2 (33:12):
Absolutely.
Thanks, guys, great to talkwith you.
Bye-bye, bye.
Welcome to Core Bariatrics Podcast hosted by
bariatric surgeon Dr MariaIliakova and Tami LaCose,
bariatric coordinator and apatient herself.
Our goal is building andelevating our community.
The Core Bariatrics Podcastdoes not offer medical advice,
diagnosis or treatment.
On this podcast, we aim toshare stories, support and
(00:22):
insight into the world beyondthe clinic.
Let's get into it.
Speaker 2 (00:26):
Tammy, how are you today?
Speaker 1 (00:28):
How are you doing, Maria?
Speaker 2 (00:29):
I'm pretty good.
So I wanted to ask you aboutsomething that you told me now,
a few months ago, and it's whenyou told me that worst five
minutes of your life were thefive minutes before you met me.
That's so offensive.
Five minutes of your life werethe five minutes before you met
me.
Speaker 1 (00:44):
That's so offensive, Don't take it personally.
It was just anxiety.
There was a lot of what am Idoing here?
Not necessarily what am I doinghere, but what am I about to
experience Definitely.
And what are people in thisclinic thinking about me?
Because I am obese in thisclinic waiting to get a consult
(01:09):
for bariatric surgery.
Speaker 2 (01:13):
Part of the reason is I'm not a scary person usually
and but you know, what we dodefinitely has a lot of stigma
and fear and misunderstandingattached to it.
So what you actually saidresonated with me a lot.
Speaker 1 (01:37):
I'm glad you said it, yes, and I think that a lot of
people probably have that samefeeling when they're sitting in
that bariatric surgery waitingroom waiting for their initial
evaluation.
Speaker 2 (01:48):
Exactly.
You know, and it even made methink of, are we making the
process harder than it needs tobe?
It's already pretty tough forsomeone to even get to the point
where they know what bariatricsurgery is or ever consider it.
Even other doctors have adifficult time necessarily
knowing what it is or when totalk to their patients about it.
And so and certainly you know,it was brought to my attention
(02:09):
not too long ago by a goodfriend of mine, who's been a
friend of mine for years now.
But even she was like okay, sowhat is bariatric surgery?
Speaker 1 (02:18):
So I think that is definitely a big thing that
people don't understand Right,look at it Okay, it's a weight
loss surgery, but yeah, how areyou losing the weight?
Are you sucking the fat out?
Speaker 2 (02:29):
Right or what.
Right, and so a lot of people,I think, come into that setting
for their very first appointmentbefore seeing anyone in a
bariatric program and really areskeptical or scared or unsure
or really don't know.
And I know that anytime I'm inthat kind of situation I find it
(02:49):
hard even to ask questions orknow what to ask.
Speaker 1 (02:53):
Absolutely, because you're scared.
You're still getting thefeeling of who this provider is,
how this provider is nurse orMA is medical assistant.
Speaker 2 (03:06):
Exactly, exactly.
Speaker 1 (03:08):
How they're perceiving you.
Speaker 2 (03:09):
Exactly, Even the receptionist, even like who's
checking you in.
I think it can be really scary.
So what it made me think isyou're a very strong woman.
You are the mom of three boysand a professional and just a
very inspiring and caring andstrong person.
Speaker 1 (03:24):
And when you told me oh, I appreciate that.
Well, it's true.
Speaker 2 (03:27):
It's true, but when you told me those are the five
worst minutes of your life, Ijust thought that ain't right
and we can do better.
Speaker 1 (03:37):
And that's why I told you that.
That's why I've also told youthat post-op care and follow-up
and support was crap.
Yes, and that's why I ended upcoming into the clinic
professionally as a bariatriccoordinator, because I wanted
and still want all of this tonot I agree with you entirely.
(03:59):
I want people to be ascomfortable going into their
bariatric surgery appointment ascomfortable as they are just
going in and talking to a friend.
Speaker 2 (04:07):
Well, right, exactly, and it made me really think
about this worst five minutesexperience and what we could do
to make it better.
But first I want to talk aboutwhat makes it scary and what
makes it that worst experience,and some of the things that
really came up in thinking aboutthis were stigma and fear, the
process being prettyintimidating to even get to that
(04:28):
spot in the first place andthen not really knowing what to
expect out of it or how much itwould cost, or being afraid that
people would be judgmental orunfriendly.
Does that sound like a prettydecent recap, or what else do
you think is part of that?
Speaker 1 (04:42):
Absolutely All of it, a hundred percent yeah.
Speaker 2 (04:49):
You and I have talked about this a lot since then, so
I'm glad that you're sharingsome of those things too, and
then it's made me think what dowe want to do instead?
If it were me in that chair, ifit were you in that chair again
?
What are the things that wewould want to accomplish for
people and want other programsto accomplish?
Speaker 1 (05:07):
Yeah, and so you know .
You said the process or unclearpatient is.
Speaker 2 (05:13):
Yes.
Speaker 1 (05:14):
It's an intimidating process to get there.
So for me, I worked in theclinic space that the surgeon
was in and I knew the medicalassistant that the surgeon was
in and I knew the medicalassistant she's actually the one
that was like yeah, calm down,just have a chat with the
surgeon and see if this issomething you want to do so that
, even though some of my anxietywas still really intimidating,
(05:39):
and so I could not imagine howsomeone who has never been in a
clinic in that sphere or doesnot know anybody in the clinic,
how intimidating and justfeeling is yeah, and if you
think about it like a lot of themedical settings in general are
just intimidating and scary.
Speaker 2 (05:59):
There's a lot of everything is pure, sterile,
technical, very formal.
Sometimes there's very littleability to laugh or feel
inviting comfortable.
A lot of times you're waiting.
It just seems like we could betreating people in a more
welcoming and respectful mannerin general and providing more
(06:24):
transparency, because I thinkthat when people are coming in
and they really don't know whatto expect in terms of time or
cost or what they're going tohave to do, that really creates
a lot of anxiety.
Like you mentioned about notknowing and that's something
that oftentimes you know thisprocess of going through
bariatric surgery, getting readyfor it and even the care
(06:44):
afterwards a lot of that isfairly predictable.
It does not have to be this youknow, mystical process that
people don't know what to expectin the beginning.
We can be more transparentabout what it will entail.
Speaker 1 (06:58):
Absolutely.
And so yesterday I hadorientation at a new job yeah,
and one of their trainings wasAIDIT.
Have you ever heard of that?
What's AIDIT?
So it is A-I-D-E-T, and whatthis is is when you are first
(07:28):
introducing yourself to apatient or coming in contact
with a patient, acknowledge them, you introduce yourself and not
only just say my name is Tammy,but my name is Tammy, I'm a
respiratory therapist.
I'm going to do your breathingtest today.
I've done hundreds of thesebreathing tests and I'm going to
coach you along the way, thewhole way, that way you know
what you're doing.
You coach you along the way,the whole way, that way you know
what you're doing that rightthere, doesn't that already I'm
(07:52):
breathing.
Speaker 2 (07:52):
I'm breathing a fresh , fresh air breath right now,
because that makes me feel sorelaxed, it makes me understand
you're going to be there for me,you know what you're doing and
you care.
Speaker 1 (07:58):
Yes, and then it's so AI, and then D is duration.
Look, this breathing test isprobably going to take an hour.
It could take up to an hour anda half, and then we'll let you
out.
Nice Explanation.
Speaker 2 (08:10):
Yes, of what you're doing.
Yes.
Speaker 1 (08:12):
Doing this breathing test because we want to see how
well your lungs are working.
This is not a pass or fail test.
This is just to see whereyou're at.
Speaker 2 (08:20):
Love it.
Speaker 1 (08:21):
Love it.
Thanking them, love it, andthen thanking them, thanking
them for their patience, seeingif they have any questions, all
of that.
So that's something I learnedyesterday that I'm like oh my
gosh, every single clinicprovider, health care provider,
needs to.
Speaker 2 (08:38):
That's a great method and, honestly, if you think
about it, there's a lot of thatin customer service and I'm not
saying all customer service isgreat or anything like that but
I think in health care a lot oftimes we don't see our patients
as also our customers or ourclients, and I think that's a
mistake actually, because peoplehave choice in where they go.
Speaker 1 (08:58):
They have the choice to be there or not be there and
we don't necessarily treatpeople like they have a choice
and like it's a privilege totake care of them, especially
when it comes to bariatricsurgery, elective surgery yeah,
so they do not have to have thesurgery like they would need to
get their gallbladder come out,or something Exactly.
Exactly Though it will helptheir quality of life.
(09:21):
It's not going to make or breaktheir life.
Speaker 2 (09:23):
Right and also exactly.
It's not like your gallbladderis coming out one way or another
or else you're dying of sepsis,right, like that's not what's
happening here.
This isn't a cancer surgery.
But what we don't realize ispeople have the right to, yeah,
make a choice of whether or notto be there, and I think a lot
of the problems sometimesthere's a lot of worry that like
, oh you know, people won't cometo a bariatric surgery clinic
(09:45):
or they won't get care for theirweight because of all these
stigma and all these otherbarriers but I think one of the
biggest barriers is actually howwe as providers and we as
programs treat our patients andour customers.
Because we don't, yeah, right.
Speaker 1 (10:00):
We've had so many patients who said it wasn't
going to come in today.
But, tammy, that email that yousent me of this is what to
expect.
This is how things are going togo.
This is what you guys are goingto talk about Questions or
concerns let me know, here'ssome resources.
And so I eased that anxiety alittle bit.
And then, even when they werechecking out for their first
(10:24):
appointment, they did a lot ofinformation, so much information
.
Nobody can take that muchinformation.
So I was always there to belike, look, I got a lot of
information.
So make sure you reach out tome if you do have any questions
or forgot something.
Just have a friendly checkoutprocess.
Speaker 2 (10:45):
Exactly.
Speaker 1 (10:45):
A lot of patients said that's the reason why they
came back.
They knew it was such afriendly place.
Speaker 2 (10:52):
Exactly, and that's probably the compliment that
carried the most weight, becausewhen people felt they were
taken seriously, with respect,but also made to feel
comfortable and like they reallycould reach out for help or
support and like they would betreated like a person that meant
they were going to stay andthat meant they were going to
(11:13):
then help their friends andfamily get in the door and they
were going to trust us not onlyto take care of themselves but
also of their loved ones, and Idon't think there is a bigger
compliment to be had inhealthcare.
Right, people trust you withtheir ones, so it really, I
think, matters a lot, and Idon't think making that five
(11:34):
minutes before that firstappointment better I don't think
that's very highly valued, butI honestly think thinking about
the process of how you makepeople feel welcome and how you
make people feel included andsupported as patients is maybe
the most important aspect ofshepherding people through the
process overall.
Speaker 1 (11:56):
Absolutely, especially when it comes to
bariatric patients.
Yes, when a bariatric patienteven goes into their primary
care doctor Right a bariatricpatient even goes into their
primary care doctor.
Look, most of the time, even ifthey're there to talk about.
Okay, let's just say for awoman that my menstrual cycles
are super heavy.
What's the first thing thatthey're going to say?
Well, your BMI is super high,Take care of that.
(12:19):
I understand that.
That's what I loved about youis that it wasn't all about
weight.
It's not always about weight.
You're like you've lost 10pounds this month after surgery.
That's great, but how's yourenergy Right?
How do you feel?
How's your just all of?
Speaker 2 (12:51):
remember, even way before I was a bariatric surgeon
, having friends and family andothers tell me basically about
their health care experiencesand going in for like an earache
or a headache or a broken boneor whatever, and weight would
come up as the primary reasonfor the visit, even if it really
had nothing to do with what wasgoing on and that being just
really offensive to people andreally once that trust is broken
(13:13):
, where a person doesn't feelheard and doesn't feel like
their reason for coming in thedoor is getting taken care of,
that is someone that may losetrust for the overall health
care system.
Speaker 1 (13:24):
After you just said that there's smoke coming out of
my ears Right.
Speaker 2 (13:29):
And I think it's also like where's the justice in
that?
Where's the health care in that?
Where's the like good?
Even if you don't treat peoplewith and think of them as
customers or clients or whatever, how are you doing your duty as
a health care provider ifyou're ignoring the person's
primary reason for being there?
That doesn't make any sense tome, right.
So I feel on your behalf anddefinitely I think this is an
(13:53):
issue that affects sometimeswomen more than men, because
there are some studies that showwomen coming in with health
care concerns, oftentimes theirprimary concern is overlooked
more than than for men.
So it does.
In our population, which isprimarily women that come to get
this kind of care, it's evenmore pronounced.
Speaker 1 (14:14):
I think a lot of that has to do with things I feel.
You know, men obviously havingspeech, but as women I feel like
more so because we care aboutwhat people think more and yeah
so yeah, I think that's anotherthing where men is.
A lot of men are just trying togo with the flow right right
but you know what I think?
Speaker 2 (14:35):
obviously we are not doing a good job with men either
, and here's how I think.
Why I think that?
Speaker 1 (14:40):
because we don't see very many there's none of them
coming, exactly because there'snone of them coming in, because
men that we see coming in arethe ones that their doctor has
told them.
You either go see this doctoror you're going to die next year
.
Speaker 2 (14:53):
Right, right.
I hate that.
Right or right.
Or they've been scared into itor they're dragged by
potentially a spouse.
There that happens a lot, butthe guy that comes in on his own
is actually kind of a rarebreed in our field, right they?
Speaker 1 (15:07):
do so good.
They do so good For the mostpart.
They do what they're told andthey yes they do.
Speaker 2 (15:14):
Yeah, they do very well.
That's true and I think thatthey're, yes, the soul.
It's.
It is interesting to me becausewe're clearly not getting it
right with either men or withwomen and it it really affects
people's ability to get the carethey need and it's also like a
bad business.
So, even if you're thinkingabout this as a big hospital
system or you know some chiefexecutive or a business person
(15:38):
that's looking at the numbershere, when we treat people well,
when we care, when we show themin these sometimes little ways
that add up to a big picture andpeople feel supported and
respected, they stay, they comeback, they get care through us
and they are loyal.
They want to bring their familyand friends and they, you know,
(16:01):
even in the situation where wewere in, where the overall
hospital system was having somefinancial and other struggles,
people wanted to stay with usand they didn't care that there
were overall bigger strugglesand battles.
They wanted to stay with us.
Speaker 1 (16:14):
Which was such an eye-opener.
We didn't know if an OR wouldbe open and whatnot.
People are still self-referringthemselves.
Speaker 2 (16:25):
And.
I was just like.
This says something about usand that made me proud not to
(16:46):
blindside people with what thecosts were, what the realities
were of getting medications forweight management.
And as that practice grew, oursurgery practice grew too,
Because we were so, I think,honest, transparent and
supportive and didn't tellpeople, oh, you just have to
have surgery and that's the onlyway to go, but we were honest
(17:07):
about, well, there's actually alot of options and we can
support you in all of them andyou can take your time to decide
what's right for you and we'llbe there to support you along
that path.
It really resonated, I think,with people.
Speaker 1 (17:20):
Yeah, there's so much as we've said in the past.
There's so much like oneducation or not, about this
topic.
Right Words are hard yeah.
I know words are hard, thatwhen people came in, sometimes
on their appointment it says medweight loss only does not want
bariatric surgery and by the endof the appointment, after the
(17:42):
provider educated, let them knowall of their options, the pros
and cons of all the option andeverything, a lot of them did
come out wanting surgery or atleast wanting to explore that
option more.
Speaker 2 (17:55):
Definitely, definitely, and that's something
that it definitely takes moretime than just going through one
option or the other, butultimately it's also more
accurate to do that.
As a healthcare provider myself, I take a lot of pride in being
able to do more than one thingand being able to give people a
full spectrum of options eventhough it can take a little bit
(18:18):
more time and actually helppeople get to the goals they set
for themselves a lot better.
And it's also maybe a goal thatchanges over time where people
want to be in six months may bedifferent than where they want
to be in five or 10 years fromnow.
So being able to support peopleas their mind changes, as their
goals change, that's prettycool.
(18:40):
I think that's amazing that wedon't just have a one size fits
all approach to weightmanagement anymore and we're
starting to really learn that ittakes a lifetime right.
Speaker 1 (18:51):
Absolutely, and we've even had patients that come in.
They only want bariatricsurgery.
And you know they're like, okay, we're going to go towards the
steps of bariatric surgery, buthey, why don't we just add a
medical weight loss on there?
While we're doing things thatinsurance and the program
require.
Exactly doing all the thingsthat insurance and the program
require.
She actually had a patient thatwas doing so well on medical
(19:12):
weight loss and actuallytapering herself off of it,
decided not to go through withbariatric surgery because weight
loss gave her the head startshe needed.
Speaker 2 (19:25):
Exactly, and I think that's the right answer for some
people.
Certainly that's not the answerfor everyone, but that's kind
of.
The point is that this is not aone size fits all approach.
You don't like.
You know, you said agallbladder surgery is done when
you have a gallbladder problembecause you only have one
gallbladder and that's.
There's no other real goodtreatment for gallbladder
problems.
Right?
(19:50):
It's not a?
You're pregnant, you have tohave the baby and deliver them
and then you're done.
No, this is very different.
This is weight and all thecomplexities that go with it,
and also figuring out what'sright for that person at that
time.
In order to go through surgery,you have to have financial
resources.
You have to have socialresources.
You have to have people aroundyou who will support you.
You have to really know whatyou're getting into to be
successful and not everyone isat that point right, there's
(20:13):
people.
Speaker 1 (20:15):
Absolutely.
Speaker 2 (20:15):
Right, because there's people changing jobs,
for instance, that aren't ableto take time off to recover from
surgery, or people goingthrough financial or family
transitions, and actually we'vehad quite a few people who
needed a little bit of extratime to get through some of
those transitions or to gettheir life to a point where they
were more ready.
And guess what, those folkstypically do a lot better than
(20:37):
anyone who gets rushed throughthe process.
Speaker 1 (20:38):
Absolutely.
I 100% agree with you.
That's why we had so much.
I feel like we had a lot ofpushback when we're like no, I
think instead of just threeappointments, we need to have
maybe four or five, and we doneed to look at everybody's
situation separately.
Everybody is going to taketheir own time.
We got a lot of pushback fromthat, but I think some are
(21:00):
co-workers and stuff.
I think, then, from patients,even though it's the initial
frustration of oh, I thought Iwas going to have surgery in
three months.
Speaker 2 (21:09):
Today, yeah.
Speaker 1 (21:10):
At the end of the day they were like oh, I'm glad I
took extra time to get my lifestable my mental health a little
bit better.
Speaker 2 (21:24):
Yeah, exactly.
And the other thing that reallystruck me was that there are
some people and I know we've hadthese conversations and we've
definitely had them with ourdieticians and things too that
you're like this person would beready for surgery today, like
they walk in the door, they'vedone their research ahead of
time, they really know whatthey're getting into, they have
fantastic support, they've gotinsurance coverage and you're
like you know what, if therewere a way to fast track this
(21:45):
person and get them to surgeryin a month or two, maybe that
would be the right approach forsome people.
Speaker 1 (21:50):
That's how our dietician felt about me.
She's like.
I think you could almost teachme some things, not literally,
but just like the little thingsI taught you of like how to be
helpful, just like a clothingcloset of people bringing in
clothes that don't fit themanymore so that another patient
can wear them while they gothrough that stage.
(22:11):
So I sometimes talk to thedietician just little tips and
tricks.
But she's like, wow, done a lotof research and yeah, but then
she personalized my nutritionplan and stuff.
Speaker 2 (22:25):
Exactly.
But, tammy, I think that yoursort of bigger community picture
of this and the biggerinfluence that this has is what
makes you stand apart, and Ithink it's honestly what makes
you such a great advocate forpeople who are going through
bariatric care and for peoplewho need to access it or want to
access it, because you're notall the good, the bad yeah.
(22:49):
Yeah.
Speaker 1 (22:51):
What can happen?
We need to look at picture case.
You could have surgery and notknow.
Oh, it's sleeve cause acidreflux.
Speaker 2 (23:00):
Exactly.
Speaker 1 (23:01):
People don't know that.
Speaker 2 (23:02):
They're a little upset.
Speaker 1 (23:04):
So I think, just like before the first appointment,
being transparent about all thethings gains trust, yes, gains
that community, yes.
Speaker 2 (23:15):
And encouraging people to know what they're
getting into ahead of time, andthat's something that I think
you did really really well inour program and that's something
that we continue to evolve.
But even educating andsupporting other health care
providers, because we started tosee a lot more referrals when
we engaged other healthcareproviders more, so, like we went
out into the community and didteaching, we invited people to
(23:39):
come and see what we were doing,we invited partnerships, we
created the feedback loopsbasically of like hey, thanks so
much for sending us this personand here's how they're doing
and here's what's going on.
And I think people reallyappreciated that.
Because we're kind of siloedotherwise from each other, it's
tough to have a lot ofcoordination, naturally between,
(24:00):
like, the cardiology office andthe bariatric surgery office
and respiratory and their sleepclinic.
But if you actually create someof those relationships and
partnerships, that makeseverything so much easier and it
also, I think, reallyencourages people to work
together and then notice whensomething's off track.
So that was.
Speaker 1 (24:23):
Absolutely agree and I think patients that are
choosing their provider whetherit be a bariatric surgeon, their
primary care doctor, theirspecialty you know sleep
cardiology doctor seeing howthey communicate with your other
providers, that's huge Like,and if you have a provider that
isn't doing that, don't beafraid of finding another
(24:44):
provider.
Right your health overall andthe ones that are willing to
take the extra five minutes tocommunicate with your other
provider, that's having a goodteam on your side.
Speaker 2 (24:55):
Exactly, and it does mean that there's more than one
set of eyes on whatever's goingon, because we can't all I mean
everyone knows our healthcaresystem is not perfect and things
slip through the cracks morethan we want them to because
everyone is working on differentsystems, everyone has different
schedules and communicationcould definitely be better.
So when you have a team thatworks together, even if they're
(25:17):
not in the physically samelocation, it's just such an
easier process for everyone andI think everyone, even in a bad
situation, for instance, canjust really work together a lot
better to help each other, helpthe patient, help everyone just
overall, do better.
Speaker 1 (25:34):
Yeah, and I think if everybody's on the same page,
and how you've met with primarycare doctors and let them know
what you offer medical weightloss surgery, all of that when
the primary care doctor iseducated before sending that
referral, they educate thepatient, which then results in
less anxiety.
Speaker 2 (25:55):
Exactly, they know what's coming they?
know what to do Exactly.
So it's sort of like if you'regoing into an interview process
for a new job and you have noidea about anything about that
company.
You don't know anything abouttheir culture.
Yeah, it's scary, right.
That's never a situation inwhich you're set up for success.
Instead, if someone's referredto you there because they
(26:15):
personally know someone and theyreally like that person, they
can speak really highly aboutthem and they know exactly what
you're going to go through inthat job interview or that
process.
You're going to really lookforward to that and really know
what to expect.
Speaker 1 (26:28):
Setting people up for success.
Speaker 2 (26:30):
Exactly, and I think that's really a key in changing
that five-minute experience thatyou had from one that was the
worst into one that is great andone that is not necessarily the
best five minutes of your life.
Speaker 1 (26:46):
But the five minutes that people could recommend to
others it wasn't the worst, LikeI don't know if I would have
recommended people to come intoour clinic after I felt what I
felt now different.
Now it's obviously differentwhen I've worked down here and
changed a few things.
Speaker 2 (27:04):
But that's why because I think that is
technically the first impressionpeople get right the first
impression that people get of aprogram or a provider is sitting
in the waiting room oftentimesand if that experience is awful,
if that experience sucks, thenyou're not setting yourself up
as a provider for a goodinteraction and you're
(27:25):
definitely not set up well asthe person receiving the care to
be open to it, to beopen-minded and to know that
that person's really going tocare and give you a lot of
respect through the appointmentthat that person's really going
to care and give you a lot ofrespect through the appointment.
Speaker 1 (27:43):
Yeah, part of that aid training was managing up.
Speaker 2 (27:45):
So I managed you up.
Speaker 1 (27:46):
A lot like saying if I roomed your patient, just
letting them know like she isamazing.
She listens to all of yourproblems.
She honestly doesn't care somuch about your weight.
She wants to know how you'refeeling, what goals you have,
all of that.
Speaker 2 (27:59):
I love that, tammy, that's so kind and I think
honestly we did have a clinicatmosphere of very much talking
each other up, and that was realbecause I think we all really
respected and liked each other.
But it was also helpful to youknow.
At some point we transitionedto actually going to reception
and grabbing patients andinitially I was like, oh my gosh
, this is kind of difficult todo where it sort of disrupts
(28:20):
your workflow.
Speaker 1 (28:21):
But then it really you yelled at me through
Microsoft Teams I can't do this,I cannot get my own patient.
Speaker 2 (28:27):
But it really grew on me.
I was totally wrong because,like completely, because I think
you're trained as a provider,like as a surgeon, that you need
to stay put and people need tocome to you, and I think that
was really short-sighted on mypart because in that you know,
30-second interaction that I wasgetting to have, walking to
reception helped me clear mymind a little bit.
(28:48):
Now I was transitioning to thenext person and I needed to
focus on them.
And then it also helped me walkpeople back to reception or to
the next place they needed to go, which was typically a
dietician, and it helped mecreate an introduction for them.
It helped me, like you said,like talk up the next managing
or leveling up basically Right.
(29:09):
It helped me establish that kindof positive expectation of the
next step.
Speaker 1 (29:14):
Eased anxiety 100%.
So when you, the provider, arecoming out to grab the patient,
that walk to your office is notwith another person.
Speaker 2 (29:25):
Right.
Speaker 1 (29:25):
The anxiety of who this provider is going to be,
and then you actually walkingthem to the next person.
Speaker 2 (29:32):
Right.
Speaker 1 (29:32):
Again eased that anxiety of oh my gosh, what's
next?
Right?
Speaker 2 (29:37):
Exactly Because it was such a nice way also to get
introduced to people, becauseinstead of people getting walked
into my office and it feelingsort of like you're going to the
principal's office or somethingwhich is I know how it can feel
sometimes for people andinstead, you know, my first
interaction was like hi, how areyou?
And tell me about yourself alittle bit.
And we were walking down ahallway, not talking about wait,
(29:57):
not talking about health care,literally learning whether, like
how many dogs this person has,about their kids, about their
trip down.
Well, I mean, I love my dog themost, but Sasha forever, but no
, but it just created such adifferent dynamic right off the
(30:17):
bat with people and it reallygrew on me and I would not go
back at this point, I think, tohow we did things before, but it
took, honestly, also me beingwrong, me changing what I had
been trained to do to what mademore sense for the people I was
taking care of.
Speaker 1 (30:39):
And not bash on surgeons or anything, but
surgeons have a hard time ofbeing wrong.
Speaker 2 (30:45):
Yes, Tammy, I don't know what you're talking about.
No, I'm kidding.
So that's where this community?
Speaker 1 (30:52):
our core bariatrics.
Not only do I want to reach outto, and touch and be supportive
of patients, we also are goingto be building community for
even providers of how they canmake their practice better.
Speaker 2 (31:08):
Exactly.
So that anybody listening herethat still hasn't had bariatric
surgery hopefully theirprovider's office has the same
(31:31):
very welcoming, respectful andtransparent office and arts and
culture groups and reallyrealizing that our reach is
powerful within our clinics andour hospitals and our ORs.
But really bariatrics lives inthe real world, not in our
healthcare facilities.
Speaker 1 (31:49):
Absolutely.
Speaker 2 (31:49):
Right and like kind of care that we're providing and
the kind of results people areseeing, the kind of lives people
are living.
99% of that happens out in theworld, outside of medicine.
Speaker 1 (31:59):
Absolutely, and I feel like if all programs are
like how we were or how we werebuilding to be, people long-term
are going to be more successfulas well.
They're going to haveencouragement to stay
accountable and stay on trackand they're going to want to
come to their one-year follow-upExactly that's what I'm hoping
for to come to their one yearfollow up.
Speaker 2 (32:18):
Exactly that's what I'm hoping for.
Speaker 1 (32:21):
That's what we're here for.
Speaker 2 (32:21):
Exactly I think, yeah , we're here to make the whole
process better, and the processis better for people going
through it as patients, peoplegoing through the process as
providers or others withinprograms, because ultimately,
the goal is for all of us to dobetter, not either or and not
against each other by any means,but absolutely the tide that
(32:42):
raises all boats.
Speaker 1 (32:44):
Absolutely, absolutely Well, maria, let's
wrap this up here For those thatare listening.
Please don't hesitate tocomment, let us know what you
think about this, let us knowwhat your experience was in your
clinic and if it was differentthan what we're explaining and
if you would want an environmentlike we're explaining.
(33:05):
So don't forget to comment,follow our podcast and we will
see you next time.
Speaker 2 (33:12):
Absolutely.
Thanks, guys, great to talkwith you.
Bye-bye, bye.
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