Vetting Endometriosis Surgeons Like The CIA: Don't Get Bamboozled by a Medical Madoff: With Dr. Melissa McHale

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Finding the right endometriosis surgeon can feel like searching for a needle in a haystack—especially when you’re already dealing with chronic pelvic pain and the emotional toll of the disease. The wrong choice can cost you years of suffering, but the right surgeon can change your life. In this episode, Dr. Melissa McHale, a gynecologic surgeon specializing in minimally invasive endometriosis excision surgery, shares a proven step-by-step framework to help you confidently choose the right surgeon and reclaim your quality of life.

You’ll discover:

• Why traditional ways patients pick surgeons often fail—and how to avoid being misled by those who simply tell you what you want to hear
• How to research a surgeon’s qualifications, training, mentors, and real-world excision surgery experience
• Where to check public medical board records, license status, and malpractice history for surgeons and their practice partners
• How financial structures in a gynecology practice can influence care quality and surgical flexibility
• What a thorough preoperative workup should include, from advanced imaging to detailed preparation
• How to critically read patient reviews and spot patterns across multiple platforms
• Why transparency matters—surgical documentation, photos, and post-op explanations are key to trust
• How to evaluate a surgeon’s communication style and whether they give detailed, thoughtful answers
• The importance of a multidisciplinary care team in successful endometriosis treatment
• How to combine instinct and objective evidence when making your final decision

Whether you’re just beginning your search for an excision specialist or are feeling stuck after disappointing care, this episode will give you the tools and confidence to find the right endometriosis surgeon for your needs.

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Episode Transcript

Speaker 1 (00:03):
People used to ask me how do I pick a surgeon?
And I really, I thinkhistorically, have fumbled the
answer to that and I don't knowthat there's really a great
framework out there for how topick a surgeon.
There are a lot of lists outthere that are like ask your
surgeon if they do excision, askthem this, ask them that.
But often your surgeon knowswhat you want to hear and so
what are the things you shouldbe looking at?

(00:25):
And that book was like totalclarity for me.
I was like, oh, like now I knowhow to think about this, and
what's ironic is the book I wasreading at the end of Summit is
actually like the inspirationfor the conversation we're about
to have, because I was readingMalcolm Gladwell's book Talking
to Strangers, strangers and thewhole time I was reading it I
was like, oh, this, this is likeI'm having having a clarity

(00:53):
moment here about how weunderstand other people.
And there's this one case of aspy that they talk about a lot,
who was a CIA agent, who wasalso a spy working, you know,
for the Cuban government.
And why is it that no onepicked up on these people being
up to no good?
And the truth is, some peopledid pick up on it, the people
who hadn't met them, right, thepeople who were just looking at,
like what have they written?
What have they done?

(01:14):
And people would repeatedly saylike hey, I'm pretty sure this
is a Ponzi scheme.
And then people would gointerview Bernie Madoff and
they'd be like he's such a niceguy, it can't possibly right,
like he said he wasn't going toinvade Poland, I'm sure he's not
going to invade Poland.
And, like you know, we all knowhow these stories ended.
And so Malcolm Gladwell reallybreaks down like okay, what are

(01:38):
the traps that we fall into?
And then I tried to you know,sort of use those traps to think
about like, okay, what are theways that you can talk to a
surgeon and really think aboutwhether they're the right fit
for you?
Yeah, I think transparency isessential and, and it's funny,
there's transparency in sort oftwo different senses.
One is the obvious.
Like I'm transparent about whathappened inside your body while

(01:59):
you were sleeping.
I'm going to give you completedocumentation, not the op note.
You get the pictures and youget my explanation of the
pictures and why I did what Idid.
It's the.
Here's my mental math onwhether or not, you need an
ostomy and it doesn't matterwhat the question is.
Right, you could ask me any ofthe questions on those lists of
questions to ask your doctor,and I mean some of them have

(02:22):
like a very black and whiteanswer, right?

Speaker 2 (02:40):
Welcome to EndoBattery, where I share my
journey with endometriosis andchronic illness, while learning
and growing along the way.
This podcast is not asubstitute for medical advice,
but a supportive space toprovide community and valuable
information so you never have toface this journey alone.
We embrace a range ofperspectives that may not always
align with our own, believingthat open dialogue helps us grow
and gain new tools.
Join me as I share stories ofstrength, resilience and hope,

(03:02):
from personal experiences toexpert insights.
Strength, resilience and hope,from personal experiences to
expert insights.
I'm your host, Alana, and thisis Endobattery charging our
lives when endometriosis drainsus.
Welcome back to Endobattery,Grab your cup of coffee or your
cup of tea and join me at thetable Today.

(03:22):
I'm excited to welcome DrMelissa McHale, a gynecologic
surgeon specializing inminimally invasive endometriosis
surgery.
Known for her compassion,patient-centered care, Dr McHale
combines advanced surgicalskills with dedication to truly
listening, educating andcreating individualized
treatment plans.
A graduate at Boston UniversitySchool of Medicine, she
completed her residency at theJohn Hopkins University Hospital

(03:45):
before training for two yearswith internationally recognized
endometriosis specialist, DrAndrea Vidali.
She's also highly skilled indynamic ultrasound to map and
diagnose endometriosis.
Dr Miguel takes amultidisciplinary approach,
often collaborating withspecialists from other fields,
and has a special interest inpatients with conditions like

(04:06):
hypermobility, POTS and MCAS.
Her mission is to improve earlydiagnosis, reduce delays in
care and help patientseverywhere reclaim their quality
of life.
I'm thrilled for you to hearfrom her today, so please help
me in welcoming Dr MelissaMcHale to the table.
Thank you, Melissa, so much forjoining me today and sitting

(04:27):
down at the table.
I think I'm excited for thisconversation, for various
reasons.

Speaker 1 (04:31):
Thanks.
Thanks for having me.
I love your podcast so I'm veryexcited to be here.
That's very kind of you.
No, I do, I do.
I mean it's great that I get tosort of hear what other people
think and how other people dostuff you know.
So you know, when you're in theendo world, you want to see the
other parts of the world.

Speaker 2 (04:49):
It's true, I'm excited to welcome you because,
first of all, I saw you onsocial media first time I'd ever
seen you, and the thing I lovedabout you is that you are so
funny and personable and yetrelatable, and you allow people
who have endometriosis to seeendometriosis in a different

(05:09):
light, that it's not all serious, but there's lessons to be
learned in it.
How did you get intoendometriosis?
How did this become a thing foryou?

Speaker 1 (05:20):
Well, actually I first got interested in it in
medical school, which I know islike a very uncommon answer
because most people are like youknow, I had 20 minutes of
endometriosis education inmedical school.
But I got very lucky.
I went to BU and I did arotation with Kip McKenzie who
is, you know, like old school hejust retired endometriosis

(05:40):
surgeon and he basically talkedme out of general surgery and
into gynecology and like therest is history.
So you know I did that.
Then I did my residency atHopkins and afterwards I trained
with Andrea Vidali because Iwas like I want all endo all the
time and you know this is thebest way for me to get the
skills I need.
And you know it's just sort ofsnowballed.

(06:01):
And now here I am, all endo allthe time.

Speaker 2 (06:04):
What keeps you going, though, because this is not an
easy field to get into.
What keeps you striving forbetter?
What keeps you striving formore?

Speaker 1 (06:19):
I would say there's two things.
One is the patience right.
There's nothing more rewardingthan hearing back from your
patients and I will say a lot ofpeople in my life make fun of
me for the texts I get.
Like, you know, I'm the onlyperson I know where someone will
text me like I I pooped thismorning and I thought of you
because it didn't hurt, and I'llbe like, yes, and my husband
will be like what?

(06:39):
And then you know the otherthing is is honestly.
And then you know the otherthing is is honestly.

(07:02):
You know, in in my practice, Ihave this great community of
other people who are just aspassionate about, about endo as
as I am.
And and it's like you know,vicky, vicky Vargas, my, my
partners, people hate hangingout with us because all we talk
about is endometriosis, like ourhusband, you know.
But but you know, anytime andand you know, vince, my
colorectal colleague, vinceObvious, anytime he and I are
like, oh, what if we do it thisway, we could try this.
I'm like we get so into it andit's, it's energizing.
And and then you know when,when we have patients who
continue with Jen, our nursepractitioner, and she's like
she's doing great and this andthis with Jen, our nurse

(07:24):
practitioner, and she's likeshe's doing great and this and
this, and we're like.
You know, this is like thiscommunity.
It's like we feed off of eachother on coming up with the best
ways to take care of ourpatients, and so I would say,
like those two sort of differentgroups of people really keep me
going.

Speaker 2 (07:39):
Yeah, what's funny about that is this ties into how
we met, because we met at theendometriosis summit and we met
in the elevator and you weregoing up to go to bed.
I was for sure not going up togo to bed, because I don't sleep
at the summit, because thepeople there are my friends and
they fuel me and I leave thesummit just ready to go.

(08:09):
You know like I get ideas and Iwant to serve people.
I want to help people more andI'm re-inspired to continue with
advocacy, which is not alwaysan easy thing to do when it's so
tiring a lot of times.
And so you and I were in theelevator.
You were going to sleep.
I was not.
How.
How did you do that?
Because I am not someone who,you know, values sleep very well

(08:29):
.
Sometimes I'm not great at it.
I would like to get better atit, but you clearly have
mastered this, because I wouldhave not done what you did.

Speaker 1 (08:38):
Well, I'm, you know, I I've been trying to prioritize
certain aspects of my self-carethat may have been neglected,
particularly through trainingand things like that, and one of
them is sleep right.
So, and especially at theendosummit, you're like mind is
going a mile a minute thinkingabout all these different things
.
And so one thing one of my,like you know, recent past year

(09:01):
or so resolutions is working onmy sleep hygiene.
So I always read before I go tobed and and what's ironic is
the book I was reading at theend of summit is actually like
the inspiration for theconversation we're about to have
, cause I was reading MalcolmGladwell's book talking to
strangers, and the whole time Iwas reading it I was like oh,
this, this is like I'm havinghaving a clarity moment here

(09:25):
about how we understand otherpeople, and so what we're
talking about today, which ishow to, how to, you know, choose
the right surgeon for yourself.
People used to ask me how do Ipick a surgeon?
And I I really, I thinkhistorically have fumbled the
answer to that, fumbled theanswer to that, and I don't know

(09:47):
that there's really a greatframework out there for how to
pick a surgeon right.
There are a lot of lists outthere that are like ask your
surgeon if they do excision, askthem this, ask them that.
But often your surgeon knowswhat you want to hear and so
what are the things you shouldbe looking at.
And that book was like totalclarity for me.
I was like, oh, like now I knowhow to think about this.

Speaker 2 (10:06):
Yeah, if you want to talk about deception in the eye
of the beholder, like thatrelational deception, like you
get to know someone and then youknow the Bernie Madoffs or the
what was it, amanda Knotts?
Everyone thought she was, orthey thought she was guilty, and
so it's about perception, right, like it's about how they're

(10:27):
being perceived when you meetthem, when you look at them, and
if you look at them from adistance or you look at them
from a personal lens, how youmake your decision making.
That's kind of the title of thebook, right?

Speaker 1 (10:39):
Yeah, so the whole point of the book is basically
why is it that we are so bad atinterpreting the behavior of
people we don't know and we cannever sort of do a good job of
assessing whether someone istrustworthy, whether someone is
capable, and so you know, withthe examples you've talked about
, those, those all come up inthe book, right, and there's

(11:00):
people you know like people whoare up to no good, like the
Bernie Madoffs or the Hitlers orwhoever of the world, right,
there's this one case of a spythat they talk about a lot, who
was a CIA agent, who was also aspy working for the Cuban
government, and why is it thatno one picked up on these people
being up to no good?
And the truth is, some peopledid pick up on it, the people

(11:23):
who hadn't met themno-transcript.

Speaker 2 (12:16):
Find a surgeon.

Speaker 1 (12:18):
So the first step really is establish whether or
not this person is qualified,right, and so you know some of
the things.
It's like do the backgroundresearch on this person right?
Like, did they go to medicalschool?
Right?
Like, yes, I'm sure they did ifthey're a surgeon.
But like, where did they go?
Where did they do residency?
Did they do a fellowship?
And then, who taught them to doendometriosis surgery?

(12:39):
Right, Is this something thatthey learned in fellowship Did?
Is this something that theylearned in fellowship?
Did they have a specific mentor?
Did they learn it afterfellowship?
Like, really try to figure out.
Like, okay, if even mostfellowship trained gynecologists
in the US don't know how to doa complete excision of endometri

(13:05):
, find anyone at the Universityof whatever who you would trust
to do your surgery, OK, wellthen, if this is where that
person trained and they taughtthem everything they know, is
this person really qualified ornot really Right?
And sometimes someone got extratraining after fellowship, they
were mentored by somebody,these kinds of things.
Sometimes someone got extratraining after fellowship, they

(13:26):
were mentored by somebody, thesekinds of things.
You know, everyone has adifferent journey and it's not
always necessarily about wherethey did fellowship.
But figure it out.
Don't be afraid to ask likewhen did this become your focus?
Is this something you learnedon your own?
Did somebody teach you?
Did somebody mentor you Right?

Speaker 2 (13:55):
If you wouldn't let their mentor operate on you,
consider whether or not theyshould operate on you.
Right, like you know, and someof who's not.
How do we decipher that as apatient if we don't really you
know, like you and I, we're kindof in this endo community,
pretty thick into it, you know.
So we know who's really good,we know who's credible.

(14:17):
But for people who don't knowand they're just starting this
journey how would you go aboutfiguring out if someone is
credible or not?

Speaker 1 (14:26):
starting this journey .
How would you go about figuringout if someone is credible or
not?
So there's a few different, youknow a few different things you
can look at.
Right, there's all thesedifferent lists, right, people
talk about lists on social mediaand those kinds of things of
who is qualified, who believesin excision, all those kinds of
things.
Right, you can look at the sortof reputation both from
patients and we'll get into thatmore later in our discussion

(14:46):
like what are their reviews,that kind of stuff.
But also what do other doctorssay about them?
Right, because often you knowyou can sort of tell what
doctors associate with otherpeople whose whole world is
endometriosis.
Right, if somebody is spendingall of their time with other
people who totally focus onendometriosis, it's because
they're like you and me.

(15:08):
They feed off of constantlythinking about how to get better
at providing endometriosis care.
Right, if they're totally ontheir own nobody refers to them,
they're not doing all of thesethings to forward their
knowledge then you know thatshould give you pause.

Speaker 2 (15:28):
Yeah, Is there.
I mean we talk about red flagswith surgeons.
We've talked a little bit about, like you know, if, if you
don't trust them or you're not,you wouldn't have the other
surgeons, what are some otherred flags when people are
researching these surgeons thatwe should be aware of?

Speaker 1 (15:48):
Yeah, that gets into the next element that I think
you should be discerning online,which is whether or not
somebody is trustworthy.
Right, is the surgeontrustworthy?
And so you obviously like lookup, you know, okay, you're
vetting a surgeon.
You have their name, you haveevery name they've ever had.
Right, like, I changed my namewhen I got married, so like my

(16:10):
medical degree is not under mycurrent name.
Right, like, come up with everyname for this person and their
partners.
Right, who else is in thepractice?
Because birds of a featherflock together.
Right, and if one of theirpartners is sketchy and they're
they're endorsing their partner,their partner might cover them
when they're on vacation.
Right, you might be rounded onby the other people in the
practice.
So you look at everybody whothey associate with and then

(16:34):
you're looking that person up.
Right, every medical boardcomplaint is a part of the
public record.
Right, and every medicallicense is a part of the public
record.
So, for example, I'm licensedin five states New York, new
Jersey, maryland, the Districtof Columbia and Virginia.
So you can pull my license fromevery single one of those
places and you can GoogleMelissa McHale Medical Board,

(16:56):
Virginia.
Melissa McHale Medical Board,maryland.
See what comes up, right, if mylicense has been suspended in
Maryland and I'm, you know, andthat's why I operate in Virginia
, that's something you shouldknow about.
My license has not beensuspended anywhere.
I don't have it.
Go, please, you won't findanything, but this happens,

(17:18):
right, like I see patients whohave seen physicians who have
lost their licenses in somestates and the patient has no
idea until after the surgerydidn't go very well, right.
So look it up, right.
How do they have any medicalboard complaints?
It's something you want to know.
And does anyone in theirpractice have any medical board

(17:39):
complaints?
And then also, part of thepublic record are court cases,
so you can google their name andmalpractice, google their name
and lawsuit, google their nameand the major newspapers of
where they live, right, right,all of these things like it's.
It's going to come up ifthey're getting into trouble or

(18:00):
they're getting sued.
A lot, right, like this kind,this kind of thing.
It's, it's not a secret, and soif you go looking for it and
and they have, you know, a trackrecord of this, you'll find it,
yeah, and I think that's andyou have to look at that.

Speaker 2 (18:14):
And then you have to look at what the complaint is,
because I do know like there'scertain providers that say, do
excision and others that don'tbelieve in excision and they're
like they're taking too muchtissue, do excision, and others
that don't believe in excisionand they're like they're taking
too much tissue, like there isthat element of it.
So you have to kind of like isthis valuable information to me?
Is this going to break my trustor is this going to?
Is this, you know, skill set oris this you know?

(18:37):
So I think that you have tolook at all of that.
It's not just like, oh, theyhave a complaint, I'm not going
to use them.
You have to look through that.

Speaker 1 (18:48):
Yeah, of that.
It's not just like, oh, theyhave a complaint, I'm not going
to use them.
You have to look through that.
Yeah, absolutely, there's adifference between you know,
they lost their license forgross negligence and, like
someone sued them over somethingthat wasn't malpractice and,
like you know, it didn't goanywhere.
Obviously, like, every surgeonhas complications Every single
surgeon if you're doing highvolume of surgery, you're going
to have complications, and themore complex the cases you're
taking on, the more likely youare to have complications, right

(19:10):
.
If you're doing ablation ofendometriosis for people who
don't have complex disease,you're going to have a really
low complication rate, right,but that's not what you want,
and so I think it's veryimportant to like read these
things and take them with agrain of salt.
If someone got sued oversomething that isn't a known

(19:31):
potential complication ofsomething and it wasn't
malpractice, obviously that'snot a reason to not see a
surgeon.

Speaker 2 (19:36):
Right, and that's, I mean, malpractice is one thing,
and so you just have to kind ofweed through that, and that's
what's tricky about this diseaseis like if you aren't familiar
enough, it can be challenging,and that's one thing that I
always tell people like get acommunity, talk to those people
in the community.
You know, I think understandingthe surgeons and how they

(19:58):
operate is is key.
The other thing that I think isimportant is not everyone has
access to pay out of pocket, orthey don't have access to be
able to, you know, see aspecific surgeon.
What would your take be on thefinancial aspect of that too,
because that does play a role inhow we choose our surgeon.

Speaker 1 (20:23):
And I think it's really important, as a patient,
to both think about yourfinancial limitations and also
think about the financialpressures that a surgeon might
be under right and it's not.
You know, this is not somethingwhere I would say to you like,
do or don't have surgery withsomeone based on the financial
setup of their practice, basedon the financial setup of their

(20:44):
practice, but it is something tobe aware of, right.
Do they own their own practiceor are they owned by private
equity?
Do they work for a for-profithospital?
These are all things that it'sjust important to know, because
someone both faces differentpressures of how long they get
to spend with you and how manycases they have to do a week,

(21:08):
and all those things based onwho they work for.
And similarly, like you know,if they work for in a practice
where the people making most ofthe decisions are either people
in finance or hospitaladministrators, those people are
going to say you can't cut thisperson a discount for surgery,

(21:28):
no matter how bad their case is,no matter how much they're
suffering, no matter theirfinancial limitations.
It costs what it costs andthat's not up to you, right?
Surgeons who own their ownpractice do have more wiggle
room.
And so, as you're thinkingabout what your financial
barriers are, also ask them whenyou make an appointment.
You can ask what it costs to seethe doctor.

(21:48):
You can ask what theout-of-pocket cost for surgery
is and you can say do you guysever offer discounts for people
with financial hardships?
Do you offer payment plans?
These are all reasonablequestions to ask.
It's not insulting to ask howmuch it costs, right, just like
if you were, you know.
If you're buying or paying forany other service, it's

(22:11):
reasonable to ask what it costs.
You can ask your doctor what itcosts and if they can't tell
you or no one you know oftenit's not the doctor who knows
who who has that conversationbut if whoever the administrator
is or the coordinator orwhoever can't tell you how much
it costs, then you know that'ssort of oh like.
They often can't tell youspecifically, right?

(22:32):
Often it's going to be likewell, your deductible is this
and your out-of-pocket maximumis this, right, they can't
always tell you exactly what thecost is going to be, but they
should be able to set reasonableexpectations.
And if you're paying, if you'reself-pay because you don't you
know it's an out-of-networkpractice and they don't, you
don't have out-of-networkbenefits, then yes, it should be
a specific dollar amount.

(22:53):
This is what it's going to costyou.

Speaker 2 (22:55):
Right, Well, and I think too, is it worth when
we're talking about thetrustworthiness, is it worth?
Looking into what doctors arebeing paid from pharmaceutical
companies or surgical companies.
Things like that Are thosethings that we should be looking
for as well when we're lookingat the financial aspect of
finding a surgeon.

Speaker 1 (23:16):
I think looking at whether or not someone is paid
by a pharmaceutical company isalways valuable.
I don't think it disqualifies asurgeon, right.
But if you know, if yoursurgeon got fit you know $15,000
last year from the makers ofLupron then like you should ask
them like how does this impactyour practice?

(23:36):
What do you do with this?
You know and, again, you shouldfeel at liberty to ask your
doctor about those kinds ofthings.

Speaker 2 (23:43):
Yeah, I think one of the things that you know we kind
of alluded to this a little bit, but the surprise billing
aspect of endometriosis.
So asking what your price isgoing to be for this surgery
also means that you probablyneed a preoperative workup to
know exactly what you're goingto be charged for.

(24:03):
How do you recommend goingabout that Is this, you know,
figuring out how your providerthe one that you're considering
is practices.
Do they do imaging first?
Do they do the price checkfirst?
Like, what is yourrecommendation for that aspect
of surgery and pricing?

Speaker 1 (24:23):
I mean, I think it's very reasonable to ask like what
does the appointment ahead oftime cost, right?
And then what is?
You know what the workup isoften is determined by the visit
you have with the doctor, right?
Some doctors are doing likedynamic transvaginal ultrasound
and really like mappingendometriosis in the office and
those kinds of things.

(24:43):
Some doctors aren't doing that,right, and people obviously
charge differently sometimesdepending on whether or not they
do the ultrasound, butsometimes they don't right,
sometimes it's included in thevisit, but certainly I wouldn't
choose a surgeon because they doless workup and therefore the
workup is cheaper.

(25:03):
Right, because you know and Ithink we'll get into this more
later but preparation isessential for surgery and I
think that I'm a big believerthat all of the preoperative
workup is critical.
And so you know, depending onwho you are and what your case
may need, the workup may bedifferent the workup may be

(25:24):
different.

Speaker 2 (25:25):
Yeah, it's interesting that we are like
talking about the workup,because it's not something that
I had really considered prior tomy excision surgery and I wish
I would have, because I think itsets patients up better,
knowing what they're going tohave done in the operating room,
and I think that if you're onthe same page with your surgeon
you have a better outcome.
You know, I think that justplanning is huge and so, looking

(25:47):
at, okay, how do they, how dothey do the billing for this and
do they include thepreoperative imaging or
consultation or whatever I thinkthat's, I think that should be
part of the consideration inchoosing a surgeon.
Um, because I think it speaksvolumes about their approach to
your care.
It's individualized at thatpoint.
Just that's my personal take onthat.

Speaker 1 (26:11):
Right, and I totally agree with you.
I think you know you can figureout that financial piece before
you decide to meet with them.
But once you have made thedecision to meet with a surgeon,
that's when you should belooking really hard at what is
their preparation like for yoursurgery, right?
How are they building thatmental map that they have of

(26:32):
what they're going to expect andhow are they talking to you
about it?
Right?
I don't think it's ever fairfor a surgeon to ask you for a
blank check, to do whatever withno preparation ahead of time,
right?
You know, I have a colorectalsurgeon in my practice, which
means that, like, if you need abowel resection, you're going to
get a bowel resection, but youshould be prepared for how

(26:54):
likely it is that that's goingto happen, right, and so that's
what I find is essential.
Is that expectation management?
So when I'm doing the dynamicultrasound in the office, I'm
actually looking at your rectalwall, right, like I can look at
the muscular wall of your rectumand I can trace it from you
know where it leaves your body,all the way up to your pelvic

(27:15):
brim.
And so there are patients whereI can say, like, look here,
like see this line, we'refollowing it up and right here
it's fused to the back of yourcervix and see this bump here
like this is something thatlooks like an endometriosis
nodule, and based on that, Istratify you as higher risk for
needing some type of bowelsurgery.

(27:35):
Right, and then we get into thedifferent types of bowel surgery
.
What do I think you need, right?
Most likely the most commontype that we do in our practice
is a discoid bowel resection.
And so here you know, here'swhat that looks like.
And if your disease is moreextensive, then you would get a
segmental.
If it's less extensive, thenyou would get a shaving.
But I stratify you as highestrisk for needing this type of

(27:58):
bowel surgery rather than justsaying I don't know, we'll see
when we get in there, but we'reprepared for anything.
You could wake up with anegative you know negative
pathology.
Or you could wake up with anostomy and you know who knows.
Right, that's not fair.
That is not fair because atthis point we have the tools to

(28:19):
be able to give you appropriateexpectations about your surgery.
Imaging is not perfect.
Doctors are not perfect.
Surprises happen.
But we should be able tostratify you as high risk or low
risk for bowel surgery, forexample.
Right so that you can go intoit knowing what you're going to
expect.

Speaker 2 (28:38):
And there's usually indications of deeper disease in
imaging and if you know whatyou're looking for, you can tell
pretty instantly, like thatthere's going to be more
significant disease thansuperficial.
And that's where, like I thinkthat conversation always comes
up a lot of times is, likeimaging is it useful, is it not?

(29:00):
Well, it probably is if youhave deep infiltrating
endometriosis, like, I thinkit's a good map to be able to
see and if you have an expertlooking at it, they'll know.

Speaker 1 (29:09):
Mm-hmm, a hundred percent.
And this is something I getinto.
Anytime I talk to someone whosays, like you know, I had prior
surgery, I had a myomectomy orsomething and then we discovered
, surprise, stage four endo,like it's.
It's not usually a surprise,you know, like it's.
This is one of those thingswhere it's like if you close

(29:29):
your eyes and cross the streetand you get hit by a truck, like
surprise you were hit by atruck, right.

Speaker 2 (29:37):
Right, that was the surprise.

Speaker 1 (29:40):
Right Like it shouldn't be a surprise.
Right Like good.
If, if we hold ourselves to thehigher standard of like needing
and, like I said, likesurprises do happen.
I don't mean to say that I'venever gone into a surgery and
been like man.
This is worse than I expect.
No, that definitely happens.
We all know endo is a tricky,tricky disease and our imaging

(30:03):
for endometriosis is notoriouslybad but it is getting better.
And there's a differencebetween saying our imaging isn't
perfect and so I'm not evengoing to try to look, I'm not
even going to try to stratifyyour risk, and saying, based on
all of the information we have,here's my expectation of what

(30:23):
your surgery is going to looklike.
If it's more, we're preparedfor it.
If it's less, great.
But here's what I think, basedon my hundreds of cases of
experience, what I think youknow, this is my expectation of
what your surgery is going to belike.

Speaker 2 (30:36):
Yeah, I also think that it's imperative, before we
even get to that step, to reallyread what other patients are
saying.
Like we talked about this alittle bit, because I feel like
you're going to get a good senseof how a practice runs and how
a doctor practices by listeningto the other patients.
Now, take it with a grain ofsalt sometimes, because there
are going to be those patientsthat nothing is going to be

(31:00):
right and maybe it wasn't a goodfit.
Maybe they didn't.
They weren't a good fit forthis provider, but what do you
suggest for people when they areseeking out advice from other
patients?
How, how would you go aboutthat and what are some things to
listen for that would make ared flag or a green flag for
people?

Speaker 1 (31:20):
For sure.
I mean, first of all, look forthe consensus, right, and the
consensus means go to more thanone source, right?
Somebody may be like loved onFacebook and they're hated on
Reddit, right?
Or their Google reviews aregreat, but you know, again, a
lot of these things.
People find ways to curatereviews and that kind of stuff.
So, like, look for lots ofdifferent sources, right, and

(31:41):
then don't, you know, read thewhole review.
Don't stop at like I had surgeryand it was great, right,
because sometimes it's like Ihad surgery yesterday and it was
great and you're like, okay,you may still be under the
influence of anesthesia if youhad, if you like, just woke up

(32:01):
from surgery and you're writingthis review, right, and it
doesn't really speak to, likethe long-term experience of how
you feel, and that's okay, it's,it's perfectly fine to write a
review that just says, like theywere a compassionate doctor,
they got me in for surgery, thehospital took good care of me,
like these are all importantfactors, like what was your
experience at the hospital?
What was your experiencegetting ready for surgery?

(32:22):
But it's not a global review of, like, the ultimate result and,
similarly, sometimes peoplewill write a horrible review and
it's mostly about the hospitalrather than surgeon, or it's
mostly about the billing officeor the coordination of the
surgery, right, Like things thatare often outside of the
surgeon's control, especially ifthey work for a big

(32:44):
organization.
If your surgeon works for ahospital, they're not in control
of who's scheduling thesurgeries or what time your
surgery was, or the billing orany of those things.
If they work for such and suchhospital, all of those things
are out of their hands.
So, especially if they have badreviews working for that
hospital and they don't evenwork there anymore, definitely I

(33:06):
would write like don't, don'tbring that review into your
thought process.
Yep, and sometimes, you know.
Another thing to keep in mind issometimes there will be.
They'll say like this doctor iswonderful, and then when they
describe the course of treatment, it gives you pause, Like we
were just talking about you knowsurprises If they're like the

(33:26):
doctor was wonderful, theybelieved my pain, they got me in
for surgery, and then they weresurprised that I needed a bowel
resection so I have to comeback for surgery in a month or
two, but they were reallyfantastic, right, like that's
something that should give youpause.
And again, I'm not saying thatshould disqualify them as a
surgeon, because surpriseshappen.

(33:48):
And so if your surgeon wassurprised and the general
surgeon on call is someone theydon't trust to operate on you,
you would rather come back foranother surgery than a bad
surgery, right?
And so in that case, ask thedoctor about it.
You can say, like, how often doyou get surprised?
What happens if you getsurprised?

(34:09):
Who do you call if you needhelp?
And again, look at reviews forthe whole team.
Look at you know, are theyusing the same colorectal
surgeon over and over again?
Does that person have goodreviews, right?
These are really reallyimportant things because you
know, endometriosis is a teamsport.

Speaker 2 (34:27):
Right?
Well, I think not.
Every person is going to meshwell with every surgeon.
Do you think it's reasonablefor people to get multiple
consultations with differentsurgeons?
Is that a reasonable thing forpatients to do in seeking their
care?

Speaker 1 (34:44):
Totally.
I mean I think, listen, you needto have peace in your heart
about your surgical plan.
It's okay to be nervous forsurgery.
It's normal to be nervous forsurgery.
But if you meet with a surgeonand something doesn't seem right
, or they said something thatgives you pause or you're just
not sure, if you trust them, byall means get another opinion.
I think sometimes people sayyou have to have multiple

(35:07):
opinions.
I don't think you have to havemultiple opinions.
If you feel confident, right,the doctor has gone through your
case, they've reviewed yoursymptoms, they've reviewed your
imaging.
You feel at peace with the plan.
You've connected with thatsurgeon.
I don't, you know, if you'resuffering and you want to have
surgery soon, I don't think youhave to wait two months to get a
second opinion from someoneelse, just so that you know

(35:28):
another doctor can rubber stampthat plan Like no, that's not
necessary if you feel peace inyour heart.
But if you don't get anotheropinion, you don't owe the
doctor anything.
And you know, I tell people allthe time if you're sitting in
the doctor's office and you'rehaving a visit and they say
something where you're like thisis not like, this is not for me

(35:50):
, I'm good it's.
This is not algebra class.
Like you don't have to staytill the bell rings, you don't
have to stay till the end of theappointment.
You can say to somebody like,thank you so much for your time.
I appreciate you know, Iappreciate everything that we've
talked about, but I'm I'm allset, I'm good and you can excuse

(36:11):
yourself Like you don't.
You don't owe your doctoranything.
At the end of the day,especially with surgeons, you're
interviewing them for a job.
Right, the job is to be yoursurgeon.
And so like yes, do abackground check, check their
references, interview them.
Are they qualified for the job?
It's the same thing.
You're hiring someone for a job.

(36:32):
I'm not saying you should berude.
Don't say to them like you seemlike you don't know what you're
doing, goodbye, it's notnecessary.
We're all doing our best.

Speaker 2 (36:42):
I promise it's not necessary, right Like we're all
doing our best.
I promise there there are thosetoo that you're like are you?

Speaker 1 (36:51):
are you in this for the right reasons?
But you're typically, if youget to this point, that's not
most people.
That's not, you know, and and Ithat is something I think it's
important to talk about Mostdoctors.
We didn't go to medical schoolso that we could have a sneaky
cover to hurt people, right Like.
No, we wanted to like.
Doctors want to do the rightthing, they want to help, and I

(37:13):
do feel that the vast majorityof bad endo care because, at the
end of the day, there's a lotof bad endo care out there and
it doesn't come from a place ofmalice.
It comes from a place of lackof education, lack of skill,
lack of training, lack of timeon the part of the doctor.
Is the doctor accountable fornot getting more skills and

(37:34):
training and all those things?
Yes, the doctor is, but youknow, we're all.
We're all humans, you know, andwe're all trying to do our best
and we all have a lot ofdifferent pressures on us.
And so, at the end of the day,if a doctor doesn't seem like
the right fit for you, itdoesn't mean that they're a bad
person or a bad doctor.
It just means that you shouldpolitely say thank you so much

(37:54):
for your time.
I'm going to go now.

Speaker 2 (37:57):
Yep, well, and that's like.
I mean, this is like afteryou've had surgery and we talk
about even, like if you've hadone surgery and it didn't go
well, and then you go see a newsurgeon and they found all this
endometriosis.

(38:17):
Do you take that paperwork backand say, look, they found this.
Is that part of education?
Because we hear this all thetime.
Right, like we should be partof that change.
We should be the ones pointingout the flaws, if you will, and
I don't think it's a flaw, Ithink it's, it's an educational
moment.
Not everyone is, you know, tookeen on learning from patients,
but I do think that that is, ifa, if a provider is willing to
learn from you, I think that's agood thing too, in my opinion.

Speaker 1 (38:40):
I, I totally agree, and I think this is one of those
things where, like, somedoctors are open minded and some
doctors are closed minded andeveryone's going to respond
differently to that kind offeedback.
And you know it has to doprobably with their ego and
their training and their beliefsystem and what they had for

(39:01):
breakfast and how their day isgoing right, how they're going
to respond to that.
But it doesn't hurt them foryou to tell them those kinds of
things.
I think the thing that'schallenging is you don't know
why it is that the doctor didn'thelp right or didn't do a good
job right.
Is it because they don't havethe skill to remove all of your

(39:22):
endo?
Is it because they didn't havethe skill to remove all of your
endo?
Is it because they didn't evensee it?
Or, like, I know a lot ofdoctors who I actually think do
have the skill to remove endobut they firmly believe it
doesn't help.
The only thing that helps isremoving the cysts and removing
any of the other disease.
It doesn't help the patientfeel better and so we're not
going to subject them to thesurgical risk of doing it, and

(39:45):
so in those cases the thing thatmakes the big difference is to
say to them, like I went, I hadsurgery, they removed all of the
other endometriosis and now Ihave my life back.
And you can always frame it tosomebody as like it seems like
maybe this isn't your area,because I went and I had
complete excision surgery withanother surgeon and now I can do

(40:05):
this and I can do that and Ican take a poop without pain and
my life is great.
And so you should refer to DrSo-and-so next time, because I
think your patients will have avery different experience.
And I will tell you, as adoctor, I also do this.
So I had a, you know, andthere's a classic example.
There's a, there's an OB, ageneral OBGYN in this area.

(40:26):
She's a great doctor.
I I would happily like have herbe my, my general OBGYN.
And I saw a patient of hers andshe had had, you know, surgery
for endometriosis.
It was minimal, they did mostlyablation.
Patient didn't feel better andthen she ended up, you know, ivf
cycles.

(40:46):
Later she comes to me and Icould see on her MRI was red as
normal.
I looked at her MRI.
I was like right there, youhave a nodule, it's on your
rectum, it needs to come outLike you have invasive disease
right here.
We went, we took, you know, Idid the surgery.
She got a disc bowel resection.
She felt like a new person andI took the video and I went to
that OBGYN's office and I waslike, hey, you know your patient

(41:09):
, so-and-so, I just want to showyou.
I brought lunch, right, sheknew I was coming, I brought
lunch.
Let me just show you thepictures from her surgery.
This is what I found, this iswhat I did, and she's coming
back to you now for her wellwoman care.
Of course, the patient wentback for her well woman care and
felt like a different person,and now I get referrals from

(41:31):
that doctor all the time.
I operated on one of her familymembers, right, and so, like
there is a change, it ispossible for that kind of
education, both from doctors andfrom patients, to make a really
big difference.
But you know it takes work.

Speaker 2 (41:48):
Would it be worthwhile and I just thought of
this Would it be worthwhile toask your surgeon hey, would you
be willing to have like ameeting with this other surgeon
so that we can go over my careor this other provider to go
over the care that you providedfor me, to give them a better
picture?
Is that reasonable or is thatkind of like?
Yeah, probably not.

Speaker 1 (42:09):
So it depends.
So I do this anyway most of thetime, whether the patient asks
me to or not.
If I know the doctor or I havelike a contact thing, I will
reach out to them and say hey, Isaw your patient, I want you to
know X, y, z.
And I do this the most, I willtell you with the fertility docs
.
The fertility docs in my areaare some of them.

(42:30):
It's like funny, some of them,I'm friends with them and so the
patient will be in my officeand they'll be like well, what
do you think that my IVF docwould say about this?
And I'll be like, well, let'sask her.
I love that doc would say aboutthis, and I'd be like well,
let's ask her.
And then we make a plantogether, right.
And I think that that'sactually like those are the
people who get the best care.
When me, the patient and theREI are all on the same page.

(42:54):
We make a plan together.
It's like, okay, we're going todo this, we're going to do this
, and then, like, you're goingto feel better and you're going
to have a baby and ride off intothe sunset, right.
Whereas there's other fertilitydocs where I'm constantly like
you know, I have their emailaddress and if you look at our
correspondences, it's justunanswered emails from me being
like I wanted to update youabout your patient.
So you do that though.

(43:17):
Oh, I'm, I'm such a pest, um,but a polite pest, I really.
I tried, I tried to, you know,I tried to channel my sort of
inner puppy.
When I'm such a pest, but apolite pest, I really I try to.
You know, I try to channel mysort of inner puppy when I'm
like, hey, I just some doctorsare really receptive to it, some
doctors are not.
And there are some doctorswhere I will tell you I don't, I
do not try, I do not even tryanymore.
I know they don't want to hearit, and that's fine, you know,

(43:39):
and and that's that's tough If apatient asks me to, then even
if it's someone who's on my youknow my do not engage list, I'll
do it Right.
I also, you know, anytime Ioperate on someone, I also I
have like a very set like.
This is how we do it I walk outof the OR with a really big
stack of pictures and I sit downwith the family member and I

(43:59):
make them take their phone outand they take a video of me
going through the pictures.
This is what it looked likebefore, right?
And I have a very set, like Itake a picture of this and then
I take a picture of this andright.
So I go through all thepictures, saying these are all
the before pictures, and then Igo through the after pictures.
These are all the same thingsphotographed after the surgery
and that's yours, right?
And so I'm like take this videowherever you want, show it to

(44:21):
any doctor.
You see, I'm proud of what I do, and so every patient of mine
has a video of me likechit-chatting with their family
going through pictures in office, Like when we are talking about

(44:46):
our care, like do you takesurgical images?

Speaker 2 (44:47):
How many surgical images do you take?
Do I, am I going to have accessto these images?
Those are all things that youshould have access to.
But to get clarification fromyour surgeon on because I mean,
I'll tell you I've had multiplesurgeons and I don't have as
many pictures as I should.
And, and I think, if you haveto have a follow-up surgery of
any kind or follow-up care, it'sreally helpful to know what

(45:08):
people have done inside yourbody, and that is taking
ownership of your body andknowing what's happened in your
body.
Having those images and havingthose videos or whatever are
very, very helpful.
So asking those questions, Ithink, is key.

Speaker 1 (45:24):
Yeah, I think transparency is essential and
it's funny there's transparencyin sort of two different senses,
right.
One is the obvious.
Like I'm transparent about whathappened inside your body while
you were sleeping.
I'm going to give you completedocumentation, not the op note.
Right, like you get thepictures and you get my
explanation of the pictures andwhy I did what I did, and then

(45:45):
you know.
There's also what MalcolmGladwell talks about in his book
as transparency, which is, canyou actually see through the
person's face to see what isgoing on inside of them?
Right, because there are peoplehe uses the example friends
right, like you can watchfriends with the sound off and
you know exactly how everyone isfeeling and what everyone is

(46:06):
thinking based on.
Like you know the way thatDavid Schwimmer's face looks.
Right, with a doctor, you can'talways do that.
Right, because someone willseem super, super confident even
if they have no idea whatthey're doing, and so he gets
very much into ways to figureout if someone's you know,
outside matches their intentions.

(46:26):
And I think that that's sort ofthe really important thing, and
I think that one of the bestways to assess that actually is
watching how they answerquestions.
You know, and I think this isagain, once you've gotten to the
point where you did all of thatvetting beforehand, right, you
read all the things online, youlooked them up, you've read
their reviews and all that stuff.
If you like what you see, meetwith them.

(46:47):
If you don't like what you see,that's when don't go see them,
right, like, don't say, like,you know, I don't really, they
don't really seem like they knowwhat they're doing online.
But I'm just gonna meet withthem and see you know what, what
it you know.
Maybe maybe I'll feel like Itrust them.
If I meet them they'll convinceme.

(47:11):
Otherwise, you don't want to beconvinced they're not qualified
.
You don't want to convince youthat they're qualified.
That's exactly what you don'twant to do.
And so I think you know I meanit's sort of like the classic,
like the.
He writes a lot about this spywho people would be like she's
doing a lot of things thatreally make it seem like she's a
spy.
And then people would meet withher and be like are you a spy?
And she'd be like no, I'm not aspy, no, I'm not a spy.

(47:34):
And people are like OK, good,most of the people thought
you're a spy.
She was totally a spy, right,and so same thing, right.
If they seem not qualified,don't meet with them.
But then, once you do meet withthem, then you're looking for
transparency in their answers.
And so the classic example Igive I'm going to give you three

(47:57):
answers to a question and Ihope that you'll see which one
of them is obviously the mosttransparent, because I've heard
all of these answers all thetime.
Patients ask am I going to needa colostomy?
One of the answers is I don'tknow.
Our imaging is reallyunreliable, so like, it's not
likely, because most peopledon't, but it's always possible,
right, right, that's one answer.

(48:18):
Another answer is no, you don'tneed a colostomy, right, no way
, yeah, Another Right.
The third answer is there aretwo cases in which I I need to
use a colostomy in my surgeriescentimeters from the anal verge.
In those cases, you will need atemporary protective ostomy for

(48:45):
eight to 12 weeks to allow thatanastomosis to heal and then
your colostomy will beinternalized.
Based on your imaging, based onmy ultrasound of your rectum
and all of these things, right,I stratify you as very low risk
for having invasive disease ofthe rectum within five
centimeters of the anal verge,because I felt like I could see
the muscular wall of the rectumwithin five centimeters of the
anal verge, because I felt likeI could see the muscular wall of
your rectum very well at thatlevel.

(49:06):
The other instance is if youhave bowel surgery and then you
have a complication with ananastomotic leak, where you have
to be readmitted and in orderto allow that leak to heal, you
need a temporary protectivediverting ostomy for 8 to 12
weeks that's internalized later.
In my last 100 cases ananastomotic leak has not

(49:29):
happened.
So it's possible, but the riskof this in your case, even if
you need a bowel resection, isvery low.

Speaker 2 (49:37):
Right.

Speaker 1 (49:38):
Yeah, I mean, I feel like those three answers are
really different and I feel likeif you hadn't heard the third
answer, you may have acceptedthe first or the second answer,
right, right, but the thirdanswer is the most transparent.
It's the like here are the.
Here is here's my mental mathon whether or not you need an

(49:58):
ass and an ostomy.
Right, right, it doesn't, andit doesn't matter what the
question is.
You could ask me any of thequestions on those lists of
questions to ask your doctor,and I mean, some of them have
like a very black and whiteanswer.
Do you do excision or ablation?
You can't really expound likeablation doesn't work, so I
don't do that.
Right, but for a lot of theseother more in-depth things, what

(50:23):
are you going to do if youdon't find endometriosis?
Or you know I have ahypermobility disorder?
How does that impact my care?
Any of these things?
There's a lot of different wayssurgeons can answer those
questions.
Look for the one that istransparent.
How are they thinking aboutthis, as opposed to are they

(50:48):
just trying to answer thequestion as quickly?
as they possibly can to get youto sign up to have surgery or
what have you?

Speaker 2 (50:51):
Do you think it's valuable to look at their social
media accounts?
Because you have social mediawhich, by the way, if you don't
follow Melissa, you need to,because I'm telling you, I laugh
every single time that you postsomething.
It's so funny and so relatableand it's one of my favorite
things when you come up withsomething new, like the home
Depot one, I was dying, that'slike four times.

Speaker 1 (51:13):
It was so I I have so many stories for you about I go
to home Depot a lot.
I'm one of those people like I.
You know I secretly loveplumbing projects, both internal
and external, but I know right.

(51:36):
But I have had seriously atboth in Home Depot and in the
garden center.
I get stopped all the timewearing scrubs and people will
be like do you work here?
And I'll be like no.

Speaker 2 (51:50):
Thank you, but no.

Speaker 1 (51:55):
What is it about me that made you say like, oh that
woman, she works here.

Speaker 2 (52:02):
She works in the plumbing department with scrubs
on.

Speaker 1 (52:06):
Although I will tell you the other funniest thing
that happened to me at HomeDepot.
This is like a total nonsequitur, but I was replacing a
lock on one of my doors and Iasked the man who worked there,
who was like an older man, likewhere do I find this?
And he was like you know, Iwant this one in this finish.
And we went to that aisle andhe was like, oh, it's up there

(52:28):
and you know how it's like thosebig stack things.
It was on like the second stackand and there was not one of
those moving staircases in theaisle.
And he sort of looked around alittle bit helplessly and I and
I was like was like hold this.
And I handed him the otherthing that I was, um, that I was
holding, and I climbed up thethe display, like up the little
shelf.
I climbed up to the second level, I grabbed the lock I needed

(52:51):
and I climbed back down with itand he looked at me and he said
you know, nurses can do anything.
You're like that's.
And I and I said I, I agreewith you, but I happen to be a
physician, and he goes oh no,I'm so sorry.

(53:14):
It was like he knew.
He knew in that moment that,like you saw a young woman in
scrubs and he automaticallyassumed, like she must, she must
be a nurse.
And it was one of those, like Icould tell the whole way home
that night he was going to belike I feel so bad.

Speaker 2 (53:31):
It was very funny, but it also means that you're
going to age so gracefullybecause you look so young that
you didn't it doesn't look likeyou went through medical school,
right.

Speaker 1 (53:41):
You know I, yes, but like it gets it's I get a little
bit weary with.
Like you know I.
I get, you know, called.
I get referred to as themedical student and the resident
and the nurse, and you know thethe janitor will call as the
medical student and the residentand the nurse, and you know the

(54:03):
the janitor will call me baby.
I mean it's like in thehospital, and then people will
be like that's the attending isher case.
That's, oh, that's amazing.

Speaker 2 (54:10):
Anyway, we digress back to choosing a surgeon.

(54:33):
This is what happens at thesummit.
This is why we stay up so lateAnd'm like, okay, is this, can
we verify that this is actualgood information?
And you can do that.
You can look at studies, youcan look at verified resources
and sources of information andsee, kind of, if they're saying

(54:53):
the similar things.
And then sometimes you know I'mmaybe a little bit different in
this, but I do write comments,questioning sometimes some of
these doctors hey, you said thisin this post, what do you mean
by that?
Because that's valuableinformation.

Speaker 1 (55:07):
Yeah, and I think it sparks a great dialogue, right,
I think that that's reallyimportant and also, I think you
know, some doctors incorporatepatients into their social media
.
Some doctors don't, right, andsome doctors sort of present
things in very different ways,and I think that that's really
important.
You should look at it.
You know this is this is howthey conduct themselves and, as

(55:29):
you mentioned, I'm the kind ofperson who, like my sense of
humor, comes through most of thetime, even even when I'm your
doctor, obviously, like whensomething serious is going on,
I'm not like, but I'm but um, atthe end of the day, I do.
You know that that is, it'spart of who I am.
If that rubs you the wrong way,I'm not your girl.
You know, everyone sort of sees, sees different elements of

(55:52):
their doctor, whether they'reincorporating, you know, are
they posting on social mediawhen they're in the, or Are they
put you know, like all thesedifferent things, and then think
about you know what yourexperience is going to be like
as a patient and some peoplewill be drawn to different
things.
Like I said, there's no oneright answer, there's no one
right way to do social media, noone right way to present

(56:13):
yourself, but when you're thepatient and you're looking for a
surgeon again, it tells you alot about who they are Right.

Speaker 2 (56:20):
Yeah, I think it gives you a good picture into
what it would look like for youas a patient in that operating
room and as a patient of theirs.
But I also think you have tofollow that up, if you go to
those providers, in how you talkto your surgeons.
What are some things that youshould be asking the surgeon in
the room to best prepare you foryour surgery?

Speaker 1 (56:42):
Yeah, I think these are things that are really
individualized, right, and Itend, you know, again, I do tend
to struggle a little bit with,like, what are the questions you
should ask your surgeon,because, again, a lot of
surgeons know what you want tohear, and this is another thing
actually.
Again back to MalcolmGladwell's book.

(57:03):
He talks about how peoplebehave when they're interrogated
.
Eventually, when youinterrogate someone, even if
they're like a really stoicperson, most people will crack
and they're just going to tellyou what you want to hear,
Although he does actually getinto this really interesting
thing about male and femaleprisoners of war and how the

(57:24):
female prisoners of war were alot less likely to crack when
they were being tortured.
And if you torture the otherpeople that they're imprisoned
with, the men would like give upnational secrets to have them
not torture the like female POWs.

(57:45):
But the female POWs would belike go ahead, torture them,
you'll be fine, I'm not sayingnothing.
Fine, I'm not saying nothing,anyway, but the point is, you
know, with a lot of these lists,I think sometimes, like your
list should be about you andwhat your concerns are, a lot of
people will go and they'llprint out five different lists
that they found online andthey'll ask every single

(58:06):
question on the list to try togive their doctor, like you got
an A plus.
You knew all the answers.
Your doctor knows the answers,and it's really about how they
answer the question.
How do they talk to you aboutthis, rather than do they
promise to only do excision?
Yes, they should promise toonly do excision, but it's more
than that.
It's really how much does itseem like they know about your

(58:29):
case?
I think it's more important whatyour doctor asks you often than
what you ask them, and youshould be watching them, you
should be paying attention.
Like, did they ask me about mybowel symptoms?
Did they ask me about mybladder symptoms?
Did they ask me about myfertility goals?
Did they ask me about whetheryou know if I don't want
children?
Like, do I want my tubesremoved?
They should really be askingyou about how you feel and what

(58:52):
your goals are, and then thatshould lead to an organic
conversation with your doctorabout, like, oh, how does this
impact this?
What's your approach to that?
And the doctor should be givingyou, like, a thorough, well
thought out answer.
Why do you remove the cervix atthe time of hysterectomy?
Here are all the advantages todoing it.
Here are the disadvantages tonot doing it.
You may have you know, you maybe worried about this, you know

(59:16):
urinary incontinence or prolapseor sexual function or these
different things Like they.
It's almost like they should beanticipating your questions
even before you ask them.
I believe that some of the bestdoctors are the ones where
you're not going to have a lotof questions for them, because
they're going to almostanticipate what your concerns

(59:36):
might be about the procedurethat they're talking about.
And there are times when I'llsay to a patient, like, what
questions do you have for me?
And sometimes they'll be like Idon't know, I'm like really
overwhelmed and I don't have aquestion for you right now.
And I'll be like, okay, a lotof patients at this point in the
visit ask me about surgicalrecovery or they ask me about
this.

(59:56):
And they'll be like, yeah,let's talk about that.
If the visit is incomplete andyour doctor says, do you have
any questions?
And you don't ask them aquestion, they shouldn't be like
, okay, well, call me if you do.
Bye, right, like no, theyshould be making sure that you
understand the whole care plan,and so I think that that's sort
of an important thing to thinkabout.

Speaker 2 (01:00:17):
I never even thought of it that way.
I guess I always.
You know, in my mind I wasalways like you should go
prepared, but I mean you should,but also like you should they
should too.

Speaker 1 (01:00:28):
They should be prepared.
Yeah, you should be.
You should be watching yourdoctor.
It's again.
They're not there to take atest.
They're there to educate youabout what they have to offer
and how they can help you, andso if they're not doing that,
then something's missing here.

Speaker 2 (01:00:45):
Yeah, and I also think it's fair to ask them who
is working with you, who's onyour team?
It sounds like I'm going toneed a Bauer section.
Do you have someone that youtrust that does that, and what's
their name?
I think it's fair to ask who'sgoing to be in that room with
you for surgery.

Speaker 1 (01:01:00):
A hundred percent, a hundred percent.
And and you know they should benaming names right I mean, when
someone asks me, who does abowel resection for you, vince
Obvious, does my bowelresections.
He's.
He's in my practice.
The reason he's in my practiceis because he's really good at
this right.
We did, however, many bowelresections together before we

(01:01:23):
decided to be partners becausenow we were watching each other,
and same thing with Vicky.
We all have watched each otheroperate and we know how good the
other people in the practiceare.
No one should be deciding to bepartners with somebody who
they've never seen operate.
That makes no sense.
You, as a surgeon, you'revetting your partners and so you
never want the surgeon who isgoing to do your surgery to be

(01:01:47):
like I'll call whoever's on callfor a bowel resection.
I don't know who that will beon the day of your surgery, but
like it'll be fine.
And yes, there are times whenthings that will happen
unexpectedly and intraoperativeconsults for whoever's on call
do happen.
That does happen.
It's not like you can have, youknow, a thoracic surgeon and a

(01:02:10):
diaphragm reconstruction personand a general surgeon and a
colorectal surgeon and avascular surgeon and a urologist
and a gynecologist in the roomfor every single surgery.
It doesn't work that way, right, but sort of knowing, like,
okay, who are the other peopleI'm likely to need and who would
that be, and then you know sortof going from there and again,

(01:02:31):
how does your doctor handle thisand part of it's also where
does your doctor operate?
If your doctor's in a hospitalwhere, like, if they call
whoever's on call, that person'sgoing to be good or they know
those people, that's a verydifferent situation than you
know.
They operate in a place where,like, they don't have any
friends right.
Doctors should have friends.
They should have lots offriends in other specialties.

Speaker 2 (01:02:52):
Yes, and they don't.
You don't want to have a doctor.
So, side note on this, I saw,like this, this doctor was doing
a live and I think he was.
I don't know what kind ofdoctor he was, but he was like
cussing out his nurse for asection.
It was like something that shecouldn't control and he live
streamed this and I'm like, ifhe's treating his staff this way
and the people in the OR thisway, Does he have your best

(01:03:15):
interest in mind?
I mean, we don't always haveaccess to that, but it was just
one of those things that I wasthinking to myself.
I would never want someone tooperate on me that treated
someone else like that.

Speaker 1 (01:03:27):
Yeah, I think a hundred percent.
I think a lot of this is aboutthe doctor's mindset and how,
whether they're humble enough tohave friends because they know
they can't do it all themselves.
I, like, loved my medicalschool.
I think BU is the greatestplace on earth, and my advisor,
when I first got there, wecalled you know, hi, Dr
Wittsberg, it's nice to meet you, blah, blah blah.

(01:03:48):
And he was like you got to callme Bob, because I'm a big
believer that if some people ona team are using an honorific
and some are not, that creates apower imbalance and in the
circumstance of a powerimbalance, people are less
likely to speak up in the eventof a patient safety issue.
This has been demonstrated.
This is not a like.
I think there's data to supportthat.

(01:04:09):
If the nurses and the medicalstudents are calling me doctor
because I insist upon it, thenthey're less likely to say hey,
do you see?
Like you know, do you see thatover there?
That's concerning the doctorshould not be yelling, they
should not be intimidatingpeople.
They should.

(01:04:30):
They should behave in acollegial way.
There's a lot of hierarchy inmedicine and some of it's there
for a reason, but not the toxickind.
There's everyone.
Any person who's involved inpatient care can prevent a
medical error.
They can, and medical errorsare a big deal and they happen
all the time to all of us.
Nobody, nobody, is safe frommedical errors, even with the
best surgeon in the world.

(01:04:50):
And so, at the end of the day,like if your doctor is treating
everyone in a collegial way,such that you know, okay, if
someone in the world and so, atthe end of the day, like if your
doctor is treating everyone ina collegial way such that you
know, okay, if someone in theroom is concerned and they bring
it up, the doctor's going totake it seriously.
That's huge.

Speaker 2 (01:05:03):
That's huge.
Well, and I also think thatthat gives you power in the
relationship.
Now, I don't want to say power,but balance in the relationship
between you and your provider,because if you, if they are on a
power struggle, they're notgoing to want to listen and have
you be part of your care, and Ithink that we need to be the
ones driving the train in ourcare a lot of times.

(01:05:24):
I think that makes a hugedifference in how we drive that
train, and if we have thatco-pilot or whatever it is in a
train, I don't know what it is Ateammate, have that co-pilot or
whatever it is in a train Idon't know what it is A teammate
Teammate, I think your successis going to be significantly
better in your care all around.
Is it important for us to talkto our providers about other

(01:05:51):
providers that they work with?
Is that a deciding factor for alot of people, as far as like,
if you're having a hysterectomyand you have to have a
nephrectomy?

Speaker 1 (01:05:56):
You don't have to have a nephrectomy unless you
have cancer or a familial cancersyndrome and someone tells you
you have to have a nephrectomy,I think you should get a second
opinion.
That said, it seems like whatyou're getting at is
postoperative management, right,like if you're having ongoing
symptoms after surgery, how isyour doctor going to handle that

(01:06:19):
and do they have a plan?
And I think that that is.
It's one of those things whereit's tough, right, because some
people do travel for care andit's important if someone's
going to travel for care thatthey ask you about this.
But obviously there's morebarriers there, right.
But, for example, in ourpractice we have someone built
into the practice.
We have a nurse practitionerwho focuses on hormone

(01:06:42):
replacement therapy, hormonalsuppression for people who need
it, a lot of sex medicine, right, sexual pain, that kind of
stuff, and then just a lot ofthe non-surgical elements of
pelvic pain, and we have herthere specifically for this
reason.
Not only is she more availablethan a surgeon to help patients
with this on an ongoing basis,she's actually better at it.

(01:07:02):
Like, at the end of the day,like I'm a big believer in
staying in your lane If aproblem is not surgical, someone
who's not a surgeon is oftenthe best person to deal with it.
And so often when people go tothe surgeon, the patient will
say I'm still having symptoms,and the doctor will be like well
, I guess you failed surgery.
And it's like no, you failedsurgery, like get out of here,
right, and sometimes the answeris like no.

(01:07:23):
Pelvic pain disorders are likebananas.
They often grow in bunches andso the right answer is like okay
, we fixed this element of it,what things might remain that
can be treated to actually getyou feeling better, and who's
the right person to quarterbackthat part of your care?
Because often the answer is thesurgeon's not the best person

(01:07:44):
for that.
And it's OK for your surgeon tonot be everything.
You know everyone andeverything for your care Right,
and I don't think it's wrong.
But your surgeon should have aplan.
They should have somebody where, like this is the person that
we have available to you tomanage this on an ongoing basis
for you.
And sometimes if you travel forcare, then if they have that

(01:08:06):
person in your practice, forexample, with us, you can see
that person in consultation andthen you can do telemedicine
with them going forward, becauseyou've met them and there's so
many murky laws aroundtelemedicine, but at the end of
the day, like often, doctors canhave a plan for this if you ask
them.

Speaker 2 (01:08:38):
Are there any other pieces of advice or tidbits that
we can take away to help usnavigate finding the right
surgeon or provider for us?

Speaker 1 (01:08:43):
I would say you know, this is one of those things.
Again, go through all of thesedifferent things.
Look at the objective things.
If the objective things don'tadd up, then you meet them.
If you meet them and your guttells you something's not right,
listen to it.
You need to feel like you havea therapeutic bond with your
doctor and so, at the end of theday, I'm not the right doctor

(01:09:07):
for everybody and I'm okay withthat.
Look for someone who is theright doctor for you.
We're all you know everyone'slooking for something different
when they're seeking care andit's okay to listen to that
feeling.
Be like you know what they'rereally qualified, but something
about them rubs me the wrong way.
You can find another reallyqualified person to see.
Don't trade the qualifiedperson for an unqualified person

(01:09:31):
who seems really nice Pleasedon't do that.
But you can find a differentreally qualified person who you
vibe with Right and that's whoyou should go with.

Speaker 2 (01:09:41):
Yeah, and these are all things that I think we've
heard like the general answers,but these are also tangible
things that we can do to find areally good provider for us.
But it is going to take alittle bit of work.
If you want quality care, Ithink we have to put the work in
, unfortunately, to find that.
But, that being said, you havecreated a document where people

(01:10:05):
can take this and kind of godown the list and it kind of
explains different pathways tofiguring out if someone is the
right provider for them.
So everything that we've talkedabout today, you have been
amazing to put into a form thatpeople can take and they can
fill it out for themselves sothat they can just map out their
plan and map out their providerto figure out who's best for

(01:10:29):
them.
So thank you for doing that.
I will put that on my website.
I will put that on the bottomof this description of the
episode so you can find it thereas well.
Last, pieces of advice or piecesof wisdom that you would want
to bestow on someone.
What would it be?

Speaker 1 (01:10:49):
I would say if you're not finding what you're looking
for, keep looking.
There are people out there whocan help you.
Don't settle yeah.

Speaker 2 (01:10:59):
And then also go follow Melissa on her Instagram,
which what is your handle?
This is Dr Melissa McHale.
I didn't have, like a creativething.
I couldn't do it.
The creativity is in the posts.
Okay, I try.
They're so fun and and so Ithink that it's good to just

(01:11:21):
laugh in this disease because itcan take a toll.
So I appreciate when,especially, doctors come with
humor.
I don't know why it just bringsso much joy to me.
So thank you for doing that andthank you for taking the time
to do to sit down with me and togo over all of this and to make
a sheet for us to learn more.
This is going to help so manypeople who have felt like maybe

(01:11:42):
some of these answers weren'tanswered before.

Speaker 1 (01:11:44):
There you go, so thank you so much for for doing
yeah, thanks for having me,thanks for having me.
This was, this was great yeah.

Speaker 2 (01:11:51):
You're welcome back anytime.
You're welcome to sit with meat the table.
Oh, be careful I know it couldbe really random.
Honestly, with my ADHD, wecould have a great time.
Until next time, everyonecontinue advocating for you and

(01:12:18):
for others.