March 10, 2025 • 44 mins
The delicate balance between mental health medications and addiction treatment remains one of healthcare's most challenging terrains. Lisa Wheeler, PA-C, brings her 30+ years of experience to this conversation, sharing how her journey into addiction medicine revealed both her passion for helping marginalized populations and the systemic problems preventing truly integrated care.
Wheeler's refreshingly authentic approach stands in stark contrast to traditional healthcare environments. "The person you see here in the room is the exact same person I am on the street," she explains, describing how dropping the clinical facade helps patients lower their guard and engage more honestly in treatment. This authenticity becomes particularly crucial when navigating the complicated territory where substance use disorders and mental health conditions intersect.
Our conversation talks about how truly effective treatment requires both specialized expertise and meaningful collaboration between providers—something our current healthcare system, with its territorial silos and corporate-driven patient volumes, makes increasingly difficult. For anyone navigating these waters themselves or supporting someone who is, this frank discussion offers valuable insight into finding providers who can genuinely help rather than simply perpetuate problematic patterns of care.
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Episode Transcript
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Speaker 1 (00:00):
Hello folks, thanks once again for joining us on
Head Inside Mental Health,featuring conversations about
mental health and substance usetreatment, with experts from
across the country sharing theirthoughts, insights and practice
perspectives on the world ofbehavioral health care.
Broadcasting on WPBM 1037, thevoice of Asheville independent
(00:21):
commercial-free radio, I'm ToddWeatherly, your host,
therapeutic consultant andbehavioral health expert.
Today I have the privilege ofbeing joined by my friend and
co-conspirator, lisa Wheeler.
Lisa has a private practice,legacy Recovery and Wellness in
Hendersonville.
She's been a physicianassistant for over 30 years,
specializing in addictionmedicine and chronic pain for
(00:42):
over 10 years, specializing inaddiction medicine and chronic
pain for over 10 years.
Lisa has her master's ineducation and athletic training
from Old Dominion University andtrained at Wake Forest School
of Medicine.
Lisa Wheeler, friend andcolleague and person I've known
now for probably, I think, 15years, welcome to the show.
I'm so happy to have you.
Speaker 2 (00:59):
Thanks.
Speaker 1 (01:01):
Western North Carolina.
Strong though you know, I thinkthe thing that I want to talk
with you about today and thething that probably hits
everybody somewhere, somewhereat home, because of the, because
of just the wide scopingpresence of, of behavioral
health medications, you know,medications to help people who
(01:24):
are suffering from mental healthconditions and those suffering
from addiction, suffering fromsubstance misuse, possibly even
prescribed medication misuse,and the delicate and weird and
often poorly managed territorythat exists between those two
(01:46):
things.
And finding a prescriber,finding a person like a PA or a
nurse practitioner or apsychiatrist that really knows
their way around both ends ofthat spectrum, is difficult,
honestly, it's just really hardto find somebody who knows what
the pitfalls are and what tolook out for and everything else
(02:07):
.
And this is something that Ihave.
I have come, in our years ofknowing one another, to entrust
your opinion, your professional,uh, expression, your
professional acumen and mostly,like we can talk about all your,
all the accolades of things,places that you come to school.
I personally find pas and psoften much easier to work with,
(02:29):
but I also find that they, they,they, they live on the ground,
they see where it's allhappening, like what got you to
the place.
I mean, after 30 years ofpractice, what got you to the
place?
That really caused you to feellike this is an important place
for me to focus.
My practice is to help thesepeople who are, you know,
somewhere in this divide, don'tknow what's going on, need a
(02:49):
prescriber who knows how todirect them well and give them
the tools they need to besuccessful in recovery.
Like how did you get here?
Speaker 2 (02:56):
Tell me the story.
Yeah, it's a little circuitousbut I'll try and keep it pretty
fairly brief.
So you know, historically, youknow I had a consulting company.
You, pretty fairly brief.
So, um, you know, historically,you know I had a consulting
company.
You and I um collaborated on acouple of things back when I had
my consulting company and umthat was over 10 years ago.
Um and I got a phone call froman opioid treatment program.
They were looking for um.
(03:27):
They actually called me for aheadhunter.
But um, as a headhunter personto go find a you knowlevel for
like 10 hours a week and um, soI, you know, we chatted about
that and I thought I can do that.
That's, how hard is that?
So I entered this place andwith my job was just histories
and physicals, and then um, justbasically it the nature of my
personality and curiosity.
It just became more and moreand more to the um point where,
(03:48):
um, I was there a lot andspending a lot of time um and
fell in love with um, thismarginalized community that
doesn't have a socioeconomicfactor to it, you know, and in
(04:10):
some respects it reminds.
Well, let me back up.
So there's that.
But the other thing is that itwas an area in which I could be
authentically me, and there'snot.
Speaker 1 (04:23):
Well, there's not like you could be anything else
right well, I know.
Speaker 2 (04:27):
Well, let me tell you I've done some things and it's
like.
You know, you got to wear thewhite coat, you got to be nice
and you can't cuss, and you got.
You know, you've got a, you'vegot a placate blah, blah and I'm
like no, um, and you know, theother place that you really
don't have to do, that you canbe your authentic self, is
emergency medicine, whichi've've done, and so I I fell in
love with this sort of platformand addiction medicine, that,
(04:52):
um, I could be authentic, and Ithink the most important aspect
of that authenticity is thatallows me to meet the patient
where they're at and, moreimportantly, when the patient
sees or the client, because itdepends on what, it depends on
what aspect within medicine youare, whether you're a client or
(05:14):
a patient.
Obviously, in medicine you're apatient.
So for me, patients but it letsthem drop their guard because
they see my authenticity andthey see me kick back and laid
back and my feet might be up onthe desk or just chilling, and
there's no white coat, there'sno stuffiness.
(05:38):
We've known each other for along time and, like I tell my
patients, the person you seehere in the room with you right
now is the exact same personthat I am on the street.
There is no difference.
Um, you know, I will hug youand squeeze you and hold you and
love you If that's what youneed, I will drop, kick a boot
up your tail if that's what youneed, but this is a journey that
we walk together.
I will not work harder than you, um and um, and I think what
(06:04):
that does with being able to betruly authentic.
I fell in love even further withwhat I do for a living, and
then I fell in love with thispopulation and then, coinciding
with that was running intochronic pain as an issue in my
background, also withorthopedics, and my supervising
(06:25):
doc at the time was aphysiatrist who did chronic pain
and also addiction medicine,and so it just dovetailed
perfectly and the majority ofall folks with opioid use
disorder have chronic pain.
So it just dovetailed reallywell.
And then I mean that just sortof you know and away I went, and
(06:47):
so my practice specificallyfocuses, you know, half the
practice is chronic pain andfolks that don't have a
substance use disorder, and thenthe other half is substance use
disorder and of that, probablytwo thirds of those folks have
substance use disorder andchronic pain, and so with that,
(07:11):
obviously, then we start gettinginto what are underlying
factors that are going tothreaten your sobriety, increase
your pain and so that what areyou doing to your body while
we're doing all this?
Exactly.
And then that kind of that getsinto the mental health aspect
(07:33):
of stuff.
And so you know, and you knowthis from doing what you do, I
take folks in on an intake andparticularly coming out of um
some facilities or transferringsome some places, there aren't a
lot of meds and I'm like, well,you know what came first, the
chicken or the egg, um, and howdo we figure that out?
(07:55):
And so my, my theory on thatone is I want to, I want to.
You know, you're on medication,assisted treatment, typically,
assisted treatment typically, um, and I want to try and wean off
what we can wean off, um, findan optimal dose on things that
we can't Correct.
(08:15):
Correct, that's exactly it.
And then, because then I want tosee what, I want the brain to
marinate in sobriety for a bitand then we can kind of tease
out really what's going on.
We're not going to get you offyour meds necessarily if you, if
you don't need to come off ofthem, but I think we need to
kind of let the brain marinatein sobriety for a while, um, and
tease out, um, what is going on.
(08:36):
And I, and I think that um, alot of folks will be out there
looking for maybe the quick fixof medication assisted treatment
, um, and then mental healthwise people are going to look,
maybe the quick fix ofmedication-assisted treatment.
And then mental health-wisepeople are going to look for the
quick fix for their anxiety andtheir depression, which is a
pill and get the primary care,et cetera, et cetera, when in
fact, what we need to talk abouttoo is the significant
(08:57):
importance of getting therapistsin there.
Therapists in there, um and um,in some cases, peer support
specialists, and you know kindof.
I always tell folks, I willtake care of the, the biology,
the physiology, the biochemistryof the brain aspect of it, but
(09:19):
your frontal lobe is going to bea process of doing some um,
therapy.
And that's just the reality.
We, you know some therapy.
That's just the reality.
I mean, that's just the realityis that we've got to do this.
Speaker 1 (09:31):
I think you're addressing something here that's
super important in my practiceand in the clients that we work
with in general First of all,the medical industry and even
the insurance industry, and Iknow where it came from.
I've discussed this with othersbefore, but it's kind of the.
(09:53):
It's an emergency, it's areactive emergency model.
You came in, you break your legyes, at the leg.
We put a cast on you, walk out,give you some meds come see us
in a few weeks, uh, and you'vegot the, you've got you.
You overlay that practice modelover mental health and
addictions.
(10:13):
Uh, first of all and I justdiscussed this with an attorney
with an, incredible uh, jordanlitis has this incredible
recovery story and has turned itinto advocacy for his practice.
Speaker 2 (10:24):
But I know who the guy is, yeah.
Speaker 1 (10:26):
Yeah, good, yeah, cool guy, and his story is just
like it's got.
It's heart wrenching and andit's true that the medical that
you walk into a person withaddictions issues walks into a
hospital, walks into a provider,walks into a pharmacy and and
experiences experiences beingdiscriminated against.
Speaker 2 (10:51):
Oh, you know, it's a daily, daily conversation with
the majority of all my patients,because and because of the
medications I write, whether itis, you know, an opiate, a
partial opiate, vivitrol ornaltrexone, it's like all of a
(11:12):
sudden.
Speaker 1 (11:13):
Oh, you're this person, right you?
Speaker 2 (11:14):
know, now we've got a profile.
Yeah, yeah, I um, yeah, we'regoing to profile and it
essentially I have one, onemotto that drives me in the
practice of my uh and care formy patients, and that is don't
mess with my patients.
Not the mess is the usual wordthat I use, it's a cuss word and
(11:36):
everybody else can figure itout.
But do not mess with Wheeler'spatience, because I will come
after you, I will come after youand you know, I mean it's funny
because you know I have a very,very small staff, but they know
they can watch me on the phonewith the insurance companies or
with the pharmacies.
And they're uh-oh and I'm like,oh, you bet, yeah, you know we
(11:57):
are gonna go to town and I, Ihave, truly I have sat there and
called a, um, um, pharmacist.
I called one pharmacist, a bigat one time, and one one
discriminates, and that catchesthem in their path.
They're like, well, no, no.
I said well, yeah, yeah, I mean, let's just call it what it is,
you know if I were writing thisperson different than you treat
(12:18):
everybody else, that is correct.
If I wrote for um because I dochronic pain management right.
So I'm writing for traditionalopiates for that population that
doesn't have a substance usedisorder.
If I write for morphine oroxycodone, you hand that out to
them two days in advance of whentheir start date is.
You don't think twice about it.
But I write for buprenorphineor Suboxone and you won't let
(12:41):
the patient get it until the daythat their start date is based
on when you last filled it forthem.
Because you know and here's thegreat story If we give them two
days early, then they'll havean addition.
They have the potential to havean additional.
If we keep giving them two daysearly, then they'll end up with
an additional 24 pills or filmsat the end of the year.
And I'm like where do you,where do you even get that?
(13:04):
Well, you know they can abuseit.
Speaker 1 (13:05):
I'm like like no, they can't, that's not, that
doesn't cost that amount ofextra, doesn't constitute abuse
for one.
Speaker 2 (13:11):
Yeah, and I and I have yet to hear of anybody
overdosing on it.
So, um, but then, but, but,todd, I come back to, which is
why I love doing what I do,where both sides of the coin and
I come back and go.
So you're also doing the samething with the guys that are
getting morphine and oxycodoneYou're giving them 24 extra
pills.
Um, no, no problems there,right, like, seriously, like you
(13:35):
do.
You even hear yourself.
And one of the other ways that Ilove to deal with the pharmacy
and insurance industries is Ilike to ask questions, and I
learned this as a consultant andyou know, when people are stuck
in their way, the way you getthem unstuck is not to
necessarily directly push atthem, but basically start asking
(13:55):
questions and you can askyesuck is not to necessarily
directly push at them, butbasically start asking questions
and you can ask yes and noquestions, to a point where they
get themselves turned around towhere they're answering your
question in the affirmativeultimate, like what you were
saying from the get-go right,like, why are you doing this?
And they're like well, becauseblah, blah, blah, blah, and you
go through a series of questionsand you come back and go all
right, so then why do we go back?
(14:17):
So let's go back to theoriginal question.
And they're stuck.
There's no way around it.
I had that situation happenwith Medicaid up in Virginia and
this gal was holding her line.
She was like the director ofMedicaid in Virginia this is
years ago and she was holdingher line.
Speaker 1 (14:32):
She had already decided what the right answer
was right.
Speaker 2 (14:38):
You betcha, and you know me well enough to know that
I was, like you know, for thatyou know, when I was accepted,
that challenge accepted, and I'mand you know, I'm like, oh well
, this is cool, this is sportand you know we've talked about
it.
Sometimes doing this it's a, itis it's time consuming, it's a
pain in the tail, but, depending, depending on the daytime and
situation, sometimes it's sportand challenges, and this is
sport and this gal was reallystuck in her in her way and and
(15:02):
and I was like, okay, so I, we,basically I did a series of
questions and this, at thispoint, this one was mental
health and it was surroundingthe coverage of equine assisted
psychotherapy, and you know whyyou couldn't do it and, um, it's
actually you and I have spenttime together yeah, yeah, but it
was a really funny story and itreally comes down to.
It really relates to this when,if for anybody listening, when
(15:25):
you start asking these questions, you kind of change the
scenario as you go with well, wewon't, you know, we're not
going to let people do anythingwith a horse.
Okay, why?
Well, because it's not in anoffice.
I'm like, well, you know what'sthe size of an office?
What do you mean?
Speaker 1 (15:40):
what is?
Speaker 2 (15:40):
it?
What is an office?
Yeah well, you know it's, it's,you know, got four walls and
I'm like, well, barn has fourwalls, so keep going, help me
out here.
Well, sheetrock walls andeverything else.
And I'm like, oh, you want themin a, you want them in like a
nine by 10 office?
Yeah, okay, well, do you have?
Do you have that in pop inwriting somewhere?
Speaker 1 (16:01):
No, Is there evidence-based practices that
say a nine by 10 office is theoptimal treatment environment
for your client?
Speaker 2 (16:07):
Exactly, exactly.
Speaker 1 (16:09):
You don't do you.
Speaker 2 (16:10):
No, you don't, no-transcript a true story.
(16:36):
And and the lady came aroundand she was like, oh, I get it
now.
And I'm like, yeah, you got it.
But that you know that thewhole point of that is we have
to.
We end up pushing againstresistance, and so we have to
figure out sometimes how to kindof go around, and sometimes
going around is not, is isliterally just asking questions,
until you this is the wrongverbiage, um, but I think you'll
(17:01):
know what I mean and you mayget have better verbiage, but
you know, until you trip them up, um, because you'll hit the
point in dialogue of questionsand you can ask questions in a
way that are non-challenging,non-threatening, and they just
(17:21):
answer them just kind of like ohyeah, you know like what's for
breakfast?
Okay, Um, and then, as you'veasked your questions, you come
around and they're like oh, sothat's.
Speaker 1 (17:24):
That's a lot.
There's this.
There's a dawning revelationthat happens in these and you
know part of it.
I, I love to sit around aclinical team inside of a
hospital with a bunch ofpsychiatrists and social workers
and make them feeluncomfortable.
Yeah, I do a very similar thing.
Well, guys, you know.
So what you're telling me isthat you know, you end up in a
line of questioning and theyrealize that what they're doing
(17:47):
is referring an individual toinappropriate levels of care.
Yes, that's the conclusion Ineed them to reach here.
I'm an advocate and they allget on their toes anyway, but
you know.
Speaker 2 (17:58):
I met them directly.
Right, you couldn't have said,hey, we need to refer them to X,
y and Z because they're goingto go.
Well, I'm the doctor, you arenot, and I know what's best for
the patient.
Speaker 1 (18:08):
Well, there's this, you know.
The thing is, you know there's,we thought we started little
trip.
We're starting with talkingabout stigma and how a person
you know they find stigma whenthey go to these environments.
And then you've got mentalhealth environments where you've
got these standards, which iswhat you're addressing when
you're talking about whetherit's the use of equine therapy
(18:30):
or standard doses of aparticular mental health
medication.
This is the standard dose, yeah, but this person doesn't need
that much.
Speaker 2 (18:41):
Exactly.
Speaker 1 (18:43):
So there's all these protocols that are written, and
then you've got these doctorsand practitioners that live in
these silos.
They don't really live out inthe real world.
They live in a hospital, orthey live in a practice that
does a certain thing, or theylive in this policy world where,
oh, you don't go live out inthe real world.
They live in a hospital, orthey live in a practice that
does a certain thing, or theylive in this policy world where,
oh, you don't go outside ofthis policy.
(19:03):
I've decided how to interpretthis policy and this is how it
gets interpreted.
I pass that interpretation onto all the people that I
supervise, train or teach.
And all of a sudden, you've gota whole field that's operating
with inconsistent philosophies,ideologies, interpretations,
policy about how to treat theseindividuals, none of which
actually lives on the ground,and we end up with the
(19:23):
complexities that we have in thetreatment environment and in
the population that we'reserving and suddenly we've got
real problems.
I think that this is the reasonwhy we end up with such
complexities and conditions andpeople on things like 300
milligrams of methadone, likehow in the world is prescribing
a person more methadone afteryou get up over about 80
(19:46):
milligrams?
Speaker 2 (19:47):
Yeah, the average person is somewhere between 80
and, and that, and one of thethings I want to add on to the,
to tag onto that is that we alsoare in a climate in which we
change tunes so quickly that wecreate whiplash in our in our
industry, and in ourselves asproviders.
You know, one day benzos are um,are great, they serve a purpose
(20:11):
, there's a place for them, andthe next day it's like, oh my
God, it's the worst thing.
You know, we can't ever do thatagain, and so we can't.
We are not a society or systemand I can't speak for the rest
of the world.
I can only speak for the UnitedStates of America.
We are not a society or system.
Who can find the middle of theroad?
Um, I had a.
Either do do it or you don't doit.
(20:49):
This is bad or it's good, yeah,and so it is that balance.
And it is that balance and itis it is.
You know, I had a um, acolleague of mine who had
someone with um, opioid usedisorder and chronic pain, and
we were talking about it and I'mlike I can help you with the
chronic pain, part of this, ifyou want, because, um, you know,
(21:10):
um, buprenorphine is a partialagonist, it's um.
Butrans and belbuca are usedfor pain management etc.
And let feel free to justholler at me and I'll help you
with this, with take care ofthis person well and I haven't
heard a thing, because the wholedeal is well, that's not their
problem.
The problem isn't their chronicpain, the problem is their
(21:31):
opioid, and this is true they'vegot more than one problem.
No, no, no, no, but that's whatyou run into and so, yeah, and
so you know, getting back tomore than one problem, it's like
, well, all right, so you haveopioid use disorder, or you have
stimulant use disorder, alcoholuse disorder, and then I have
(21:52):
to go there and I have to go,all right, well, you have
bipolar and disorder and youhave schizoaffective, or you
know, you've got all these otherthings, and then it's like and
then personality disorder, whichis, you know, we'll run you all
, we'll run you ragged onmedications.
And I don't want to, and it'sreally important for me to
really respect and honor myinpatient colleagues, and
(22:17):
they're seeing them in the worstof the worst conditions, and so
I get how some of theprescriptions are set up and
handed out at inpatient.
Speaker 1 (22:25):
You go into a hospital, they're giving you the
velvet hammer, right, andyou're coming out on the velvet
hammer.
But the velvet hammer, you'renot supposed to stay on that.
Speaker 2 (22:34):
No, I like that term the velvet hammer.
I I'm going to have to stealthat from you, whether I did not
create it.
You're welcome to it, the velvethammer.
I'm like good God, almighty,yeah.
And then, exactly, Todd, youcome out and you're like, and
you know, then you end up in theoutpatient providers and we're
all like I get it.
So, first of all, I get it, Iunderstand what we have going on
(22:56):
here.
But, holy cow, and you know,I've I've had the privilege of
doing some um, um, medicalmanagement for sober living
houses and catching these guysright when they come out of
inpatient.
And you know these are folksthat were never on meds before.
Um, it doesn't mean that theyshouldn't have been on some sort
of medication for somethingtypically a depression or
(23:18):
anxiety type deal.
Um, and now they're on likeseven meds.
Speaker 1 (23:24):
Yeah, what do we do with this?
Speaker 2 (23:26):
Where do we find the middle road here?
And you know.
Then you're like, well, youknow, well, I got to start
peeling, it's peeling an onion,I got to start peeling this crap
off.
And T you know and for, andpeople need to understand.
You know, well, I got to startpeeling, it's peeling an onion,
I got to start peeling this crapoff.
And you know and and peopleneed to understand.
You know, for your audiencemembers, that may not be
providers.
Um, there may be providers outthere that are going to take
multiple, that will makemultiple changes to medications
(23:47):
all at once.
I'm not that person, becausethen I don't know when we have a
result of that, I don't knowwhat caused the result.
So I'm someone who, basically,you know we're going to adjust
your meds, but we're going toadjust one at a time.
Speaker 1 (24:00):
A little bit at a time.
Speaker 2 (24:01):
And figure out, you know.
Okay, well, that was it or itwasn't it.
Speaker 1 (24:05):
You might want to consider a residential
environment if you're going tobaseline off of all meds because
you don't know what's going tohappen.
Speaker 2 (24:10):
That's it.
So, yeah, no, no, no, that'stotally it.
Yeah, it's a challengingenvironment, but I'll tell you
what.
(24:31):
I think it's important forpeople to know the lanes that
they're in.
Um.
I, you know, just like umspecialists, you know.
Let's take orthopedics.
You know, orthopedics, there'susually the guy that, like he
really likes knees, he's theknee guy right, or she's the
upper extremity, or she's the,she's the hip person, hip gal
(24:52):
and and this is you know, theycan be a general surgeon.
That's fine.
Um.
And with mental health andsubstance use disorder, when you
combine those two um, I tend tofind that you have a um within
that.
Whoever that provider is, tendsto be um more more proficient.
(25:13):
I'm yeah, I'm going to go theremore proficient and has a
tighter leaning towards mentalhealth or towards substance use
disorder, but not necessarily50-50 as good on both sides of
that page.
Speaker 1 (25:30):
Yeah, they've got a leaning and they walk into the
other side going hey, I need toknow enough about this to be
able to do this other job.
Well, that's correct, Right.
Speaker 2 (25:39):
So my deal is I always like to tell people that
you know I am substance usedisordered.
Um, strong, like, like.
I take it to the bank every day.
I've got that inside outbackwards and forwards, um, and.
Speaker 1 (25:53):
I'm not going to leave you hanging on your mental
health or, frankly, yourmedical health Cause I know what
I'm looking at Right.
Speaker 2 (25:59):
But I also know and I tell them I'm like so here's
the deal, I'm going to take careof your mental health up to the
point where I feel like I'm notthe person for you and then I'm
going to refer you to someonewho you know, where I'm so super
strong with substance usedisorder.
They're that strong in mentalhealth and we'll get you over
there and we'll work tandem.
Speaker 1 (26:18):
I am very, very fortunate to have Well, I'm
going to stop you there, likelike, right there, you just said
it.
You just said the exact thingthat I think a lot of the
medical world, psychiatric world, addictions treatment world is
missing.
I'm going to, first of all, youknow where your line is.
You're like, hey, we'restarting to get into territory
(26:38):
that I don't feel as comfortablein, where you've got a lot of
docs that are just makingdecisions, sending their
patients on to wherever they gohome, the farm, whatever, and
calling it a day.
The second thing that you said,which is something that I kind
of have to just make happen forlots of different siloed
(26:59):
providers that are working withone person and everything else.
You're going to reach out,you're going to communicate with
that person, you're going towork in collaboration with them.
Hey, I'm doing this, what areyou doing?
Let's make sure that we're notat odds, that you're not doing
something that'scounter-indicated, or I'm not,
that you're actually having acommunication with the other
(27:19):
professional and have a workingrelationship so that this
person's getting that, gettingthat really high quality like
where does the middle live?
So that this person can get thebest care, like that's the
trick, right there.
Speaker 2 (27:35):
It is, and but let me tell you some of the underbelly
of that is is that you know Iwant to reach out to somebody
who you know, let's say they dosubstance use and mental health.
They tend to do a lot moremental health than do substance
use disorders, and so you know Isend them up there for the
higher level game of psychiatricstuff.
And I am not and so, talkingabout me, I am not the only one
(27:59):
who experiences this.
But you end up getting poached.
You know they go into a facilityand then they poach your
patient.
And I've made more than onephone call in our area going do
not poach my patient.
Like what are you doing?
You know?
I mean, I referred them upthere for the purpose of X and
you basically kind of said youknow, instead of seeing two
(28:19):
people, you could actually justcome to us and get you know, get
the, you can get the everythinghere right, like we are we are
the Walmart.
Speaker 1 (28:28):
We can prescribe all that buprenorphine or Suboxone
or whatever you need.
We can do it all right here,right Right.
Speaker 2 (28:34):
We are your Amazon, we are your Walmart, no, you
know.
And so that's so, I think,where people sometimes get stuck
in.
So first of all, they get a,they get in their own way, first
and foremost, we, they get intheir own way, we, they get in
(29:04):
their own way.
And then, two, I think that youknow there is a concern when
you develop and establish arelationship and then you're
going to transition them out fora medical problem, in this case
, a mental health, medicalproblem that you have.
But for me, I feel like I'vedone as much as I can do, um,
and they're going to poach them.
So I can, I can very, verystrongly and passionately say if
I got a referral for someonefor substance use disorder from
um, a behavioral health um,nurse practitioner, pa or
(29:25):
physician, and they are workingon that corner of the world, I
am in no way, shape or formstepping into that territory.
Um, I will take care of theirsubstance use disorder.
I'm happy.
Thank you very much for thereferral.
You will never have to worryabout me poaching.
But I think that that's areality, that when first, well,
first of all, when I, when Ifirst say so, let's start with
(29:46):
the ego when I first say well,you know I don't have the chops
for this.
Well, you know there are lotsof people with lots of egos out
there and you and I both knowhow that goes.
So when you first acknowledgethe ego issue and you're able to
get beyond your own ego andthen ask for help, you need to
feel comfortable in the sense ofyour community that your
patient isn't going to getshitty bad care.
(30:07):
Sorry, you have to edit thatout.
Speaker 1 (30:13):
Get bad care or they're going to get poached,
and so well, and, and, and youknow, part of the issue in being
poached is is that you, youlose that person's done it lives
, doesn't live on your side, youknow, and and just because
you've established a regimenthat you think is probably
workable, by the time thisperson who's on the mental
health side, let's say, isputting in other medications.
(30:33):
Well, that equation's changednow, isn't it?
Are they reaching back out toyou to collaborate?
Are they reaching back out toyou to understand the side that
they need to understand?
No, they're not doing that.
You know it's like there's thisterritorialism that goes on.
That's how silos get created,and you know that's how the
field and I don't, you know,honestly, in many ways I don't
(30:54):
really understand it, becauseit's not like every psychiatrist
, it's not like every area thatI know of is not woefully,
woefully low on the number ofpsychiatrists with open, open,
open area.
You know, the ability to takeanother patient in there to
their practice.
They're all full or they'realmost next to full.
You have to be on a waitinglist to get in with them.
(31:15):
They're all full or they'realmost next to full.
You have to be on a waitinglist to get in with them.
You know, there's there's allthese very these kind of subtle
uh problems and and issues thatarise out of this kind of what I
would call personality drivenuh issues that happen with high
level professionals, right yeahyou know, I mean, nobody likes
(31:35):
to get their toes stepped on,but, being collaborative, they
don't get trained in in medicalschool.
It's something that eitherpeople do and they're good at
and they and it makes thembetter docs, honestly or they
don't and they're just kind ofthese people who this is my
practice, this is what I do.
I'm the authority I say what'sgoing on.
You know that's the way.
That way I can have controlover everything.
(31:56):
The truth is is that they don't, because they don't have the
expertise.
I mean, this is a bunch ofstuff that was like Robert
Robert Whitaker, you know theanatomy of an epidemic.
He talks about a lot of thisstuff in his book.
Just the medications and thehigh doses and the.
What are we doing?
And we're not collaboratingwith one another doing?
And we're not collaboratingwith one another and we don't
know what the mix of thesemedications is doing, because we
(32:16):
don't cross?
We don't cross channels withothers because we're too busy in
this silo, right, right and andall the while, you know the the
pharmaceutical industry islaughing to the bank and they
are and here's another deal andand, and this is um.
Speaker 2 (32:32):
It's two points.
One real quick on the.
You know, I'm the provider andI know what you know, I know
what's best for you.
I literally just had thatconversation with a patient
yesterday where I said you know,you've had this, you know very.
It's kind of a zebra in thesense that it's not a common
disease, congenital issue.
And then this person happens tobe dual substance use disorder
(32:56):
and chronic pain and mentalhealth.
So not dual, but trifecta, it'sa lot.
And so they're new to the area.
And I said you have to rememberthat you are the expert in your
health and your disease.
You've had it for as long asyou've had it and you have to be
able to have thoseconversations.
And this is where you know forsome patients that you know you,
(33:19):
the doctor, knows best.
I'm like, eh, not always Um.
And then it the, the wholeaspect of um being in the silo
and trying and staying kind ofin the middle of.
Well, this is what thediagnosis is.
And so this is our, this is ourmenu.
(33:42):
So you know, we've got our, ourthis is the boxes, and then
you've got.
But then you but, todd, youhave people out there that like
really interesting cases.
You have what we call.
I call them zebra hunters.
And you know, for your audience, we all, we always think about
Dr.
Speaker 1 (33:59):
Strange.
Speaker 2 (34:00):
Yeah, well, yeah, and when we think about in
healthcare, you know, when youhear hoofbeats, think horses,
not zebras.
So when you're looking atsomething, and in medicine, if
you hear hoofbeats, what's the?
If I look out my office window,am I more likely to see a horse
going down the street or am Imore likely to see a zebra?
Well, you're more likely to seea horse, right?
(34:21):
So everybody's trained forhorses, everybody anticipates
horses, everybody likes treatinghorses.
It's simple.
We've got a map, we've got thebuffet menu.
It's pretty straight up.
We don't have a lot of peoplewho are good zebra identifiers
and like to chase zebras.
Now, I love to chase zebras.
(34:43):
I was actually talking to aphysician colleague yesterday
and I went.
I'll tell you what I'll chase azebra all day long.
So if it's a complicated healthsituation mental health or
substance use disorder or acombination physical disorder
I'm on it.
Man it's.
It's fascinating to me.
But part of what we're lackingin these siloed worlds are
(35:04):
curious providers who arewilling to chase stuff.
And that goes back, todd, intoinsurance and pharma and big
pharma, because they don't.
First of all, you do havepeople who don't want to chase
zebras.
You know.
They just want to go to work.
They want to take care of thenormal easy stuff that they can
take care of.
Um, the, the really thoughtchallenging things.
(35:27):
Um, there are some people whoare great at it and they, they
find pure, like me, pure joy andpleasure and in the mystery.
But the majority of healthproviders are not like that.
They're going to go in and theyare going to not challenge big
pharma.
(35:47):
They're not going to challengethe industry, the insurance
industry.
They're not going to work to.
They're not going to work tothe to, you know, to seven
o'clock or eight o'clock atnight for that one patient on
that one thing.
They're not, that's a zebra,they don't advance.
Speaker 1 (36:05):
I mean, it means basically that whatever training
they got in school, they'reobserving the rules and
regulations that they've beengiven.
They're doing just enough.
Just enough continuing ed tomake sure that they stay true to
their license, whatever theirboard is telling them they got
to do.
Speaker 2 (36:20):
Yeah.
Speaker 1 (36:20):
And then, but none of that drives a person to become
better in the place where youcan, in the only place you can
really get better, after thatlevel of training, which is in
the real world, facingchallenges that you don't know
how to face withoutcollaborating with others.
That's what causes people toget a lot better at what they do
(36:42):
.
They're not reaching out anddoing it, and maybe it's because
their caseload is too high.
Maybe they're sitting in ahospital.
They got no time for that.
Speaker 2 (36:49):
That's a lot of it, particularly in mental health.
I think that's a lot of it.
It was really interesting to.
I sit on.
You know a couple of or I don'tsit, but I follow on social
media some psychiatric andsubstance use groups and it's
fascinating to watch.
(37:09):
You know people go.
Well, you know I see 35 peoplea day.
Well, I, you know I see 35people a day.
My max load a day is 14.
Now I'm sunsetting in my careerand I own my own practice and
I'm not chasing the dollar.
Um and so I've hit a pointwhere I want to do um.
I want to talk about yeah,exactly so, um, but it's you,
(37:32):
you 30, I mean, think about that.
You come in at eight, 30 oreight o'clock and you're your
last patients at 430 or five,and somehow you've seen 35
patients.
And this is mental health, thisis primary care, this is pain
management, this is specialties.
You're just.
(38:08):
How do you provide good serviceand good care and take care of
that complex patient that needsmore than 10 minutes or 15
minutes?
When you got, they're going togive you a ridiculous caseload.
And they're giving you theridiculous caseload because
corporate medicine moreimportantly, pharmaceutical or
not pharmaceutical,insurancement rates and chasing
the God Almighty dollar, and sothat breeds poor medicine and it
breeds laziness and it's not apurposeful laziness.
(38:29):
There's no such thing as a lazyprovider who chooses to be lazy.
They are tired and they aretaking the easier way out and,
quite frankly, a lot of placesare running into corporate
medicine and they're justbasically, you know, they're
just kind of like all right,what do I do?
So here's your checkbox go.
Here's the parameter, here'syour menu go.
And so I mean wheelers inprivate practice and owns their
(38:52):
own business, because lots ofcircumstances.
But I'm done, I have played,I've been on the hamster wheel.
I've followed the checkboxes.
You know, I've followed thebouncing ball.
Speaker 1 (39:12):
And you know, particularly in the area that we
work in, right, mental healthand for me, Concierge mental
health, private pay mentalhealth, a lot of that category
where people who afford to payto slow down.
Speaker 2 (39:18):
They need time and listen to them.
I always laugh becauseeverybody gets 30 minutes with
me and they, you know, I'm likeyou got to go get a therapist.
And they're like well, you'remy therapist, I'm like I am not
a therapist and, of course, todd, you've known me for a long
time.
I'm like, I am a lot of things.
A therapist is not one.
My spouse right my spouse is isa licensed um mental health
(39:40):
therapist and like that, youknow that's the person you need
to see, I'm going to tell youlike.
Speaker 1 (39:44):
I'm going to tell you like it is pretty much and then
you, then you might have somefeelings about that.
You should process it with that, with somebody else, because I
don't have the time it's notthat I don't have the time, but
I'm like I don't have.
Speaker 2 (39:58):
That's not my.
So um, I, I am.
Um, I will toot my own.
I'm very good at motivationalinterviewing.
Um, I am trained in tfcbt.
Speaker 1 (40:09):
Um you lack the skills but, but it's not you're
staying in your lane and in mylane.
Speaker 2 (40:16):
Well, in addition to that, you know like here's,
here's.
Speaker 1 (40:19):
The thing is that you know you're not chasing the
dollar.
You know I because I've seen,I've seen the analyst slash
therapist, slash psychiatrist.
I'm not a huge fan like the.
The 90 minute, 90 minute andthis is not just the first
meeting, this is the everymeeting, the 90 minute meeting
where there's a lot ofprocessing around feelings and
(40:41):
everything else.
In truth it's a conflict ofinterest.
In truth it becomes it's likeyou know you got feelings about
these things and you want to,you want to compel me with your
feelings, but I need to look atyou objectively because what
we're talking about is thescience of your chemistry and
(41:01):
the biology of what it is thatyour care needs to look like.
Now you're going to havefeelings about that.
You're going to go through aprocess as you engage in changes
with medications and otherkinds of things like that.
I need you to take that to atherapist, because that's the
mill for them, that's theterritory they live in.
They want to do that with you,me.
(41:22):
I've got to.
I've got to make sure I'mpaying attention to the
chemistry and I can't getdistracted by all the, all the
nuance of how you, of how yourprocess unfolds in your feeling
environment, like I don't thinkthat people understand that I
really don't, and it's notmeaning to be disrespectful
either.
Speaker 2 (41:39):
It's like.
You know I'm not in fact.
You know, in fact, if anything,I'm championing the therapist
here because I'm like this islook man, these people are
wonderful at what they do,they're great at what they're
trained at.
They have the time.
They have the time they havethe skills um and they want to
do it.
And it's not to say I don't wantto sit in and, you know, spend
an additional.
(41:59):
You know time's up with mebecause really, and and and
therapists also have a time up,like you know.
Hey, we're in it too and I haveanother patient or another
client, but the that is not soyou hit.
You hit it perfectly.
Um, my job is the physiologyand biochemistry of what's going
on with you.
That is not to put in secondplace by any means, cognitive
(42:25):
processing, behavioralprocessing and all those things.
But I'm not your gal, but I canget you to the guy or gal who
is that person for you.
And I always said at the opioidtreatment facility I'm like I
will take care, and I said thisearlier, I'll take care of the
biology and physiology, but wehave to have you see a counselor
(42:48):
, a therapist, because we havethe entire frontal lobe that we
have to work through.
Speaker 1 (42:53):
This is a multi-pronged approach.
Oh my God, you can't just.
I mean sure there are peopleout there who have gone through
processes, or maybe they're whatthey, you know, kind of gets
referred to as the worried.
Well, they can come in, theyknow what their issues are, they
can see somebody like you ortheir doc, get the basics, go
home, feel better.
(43:13):
Maybe they've got a therapistthey see infrequently but
frequently enough, like there'sa, there's a group of
individuals that can live inthat world and that's sufficient
.
The world that you and I aretalking about, it's not even
it's.
It's inadequate to it's aninadequate to the need that
we're serving.
Speaker 2 (43:31):
You know, and we can go down the line too, of whether
you know.
So here we get into, and thisis I think this is a
conversation for another day,and it'd be a great topic.
Why are you here, are you?
Here, because, or are you herebecause the court system said
you need to be here and you'rewent to impatient because you've
got a dui or a possession or orwhatever, and so you're
(43:54):
following groups, right.
So, um, you know, I so I think.
Certainly, Todd, this is aconversation I'd love to have
with you?
Speaker 1 (44:02):
Why are you here?
Because if you follow up onthis topic, let's talk about
golly yeah.
It's going to be well, you know,I, I you've dealt with the
courts.
You've dealt with people insober homes that are, you know,
faced the courts.
You've dealt with people insober homes that are, you know,
faced with consequences.
You've dealt with people thatare just coming to you on the
street.
You've dealt with 20-somethingsand you've dealt with
50-somethings Like there's awhole spectrum of who are we
(44:24):
providing services for.
That's a great conversation forus to hit next time.
Lisa, god, I love having you onthe show.
I love talking to you.
I love having you on the show.
I love talking to you.
I love having you as a friendand colleague there on the world
doing the good work.
I appreciate you coming on.
We're going to do it again verysoon.
This has been Head InsideMental Health with Todd
Weatherly on WPBM 1037, thevoice of Asheville.
(44:46):
No-transcript.
Hello folks, thanks once again for joining us on
Head Inside Mental Health,featuring conversations about
mental health and substance usetreatment, with experts from
across the country sharing theirthoughts, insights and practice
perspectives on the world ofbehavioral health care.
Broadcasting on WPBM 1037, thevoice of Asheville independent
(00:21):
commercial-free radio, I'm ToddWeatherly, your host,
therapeutic consultant andbehavioral health expert.
Today I have the privilege ofbeing joined by my friend and
co-conspirator, lisa Wheeler.
Lisa has a private practice,legacy Recovery and Wellness in
Hendersonville.
She's been a physicianassistant for over 30 years,
specializing in addictionmedicine and chronic pain for
(00:42):
over 10 years, specializing inaddiction medicine and chronic
pain for over 10 years.
Lisa has her master's ineducation and athletic training
from Old Dominion University andtrained at Wake Forest School
of Medicine.
Lisa Wheeler, friend andcolleague and person I've known
now for probably, I think, 15years, welcome to the show.
I'm so happy to have you.
Speaker 2 (00:59):
Thanks.
Speaker 1 (01:01):
Western North Carolina.
Strong though you know, I thinkthe thing that I want to talk
with you about today and thething that probably hits
everybody somewhere, somewhereat home, because of the, because
of just the wide scopingpresence of, of behavioral
health medications, you know,medications to help people who
(01:24):
are suffering from mental healthconditions and those suffering
from addiction, suffering fromsubstance misuse, possibly even
prescribed medication misuse,and the delicate and weird and
often poorly managed territorythat exists between those two
(01:46):
things.
And finding a prescriber,finding a person like a PA or a
nurse practitioner or apsychiatrist that really knows
their way around both ends ofthat spectrum, is difficult,
honestly, it's just really hardto find somebody who knows what
the pitfalls are and what tolook out for and everything else
(02:07):
.
And this is something that Ihave.
I have come, in our years ofknowing one another, to entrust
your opinion, your professional,uh, expression, your
professional acumen and mostly,like we can talk about all your,
all the accolades of things,places that you come to school.
I personally find pas and psoften much easier to work with,
(02:29):
but I also find that they, they,they, they live on the ground,
they see where it's allhappening, like what got you to
the place.
I mean, after 30 years ofpractice, what got you to the
place?
That really caused you to feellike this is an important place
for me to focus.
My practice is to help thesepeople who are, you know,
somewhere in this divide, don'tknow what's going on, need a
(02:49):
prescriber who knows how todirect them well and give them
the tools they need to besuccessful in recovery.
Like how did you get here?
Speaker 2 (02:56):
Tell me the story.
Yeah, it's a little circuitousbut I'll try and keep it pretty
fairly brief.
So you know, historically, youknow I had a consulting company.
You, pretty fairly brief.
So, um, you know, historically,you know I had a consulting
company.
You and I um collaborated on acouple of things back when I had
my consulting company and umthat was over 10 years ago.
Um and I got a phone call froman opioid treatment program.
They were looking for um.
(03:27):
They actually called me for aheadhunter.
But um, as a headhunter personto go find a you knowlevel for
like 10 hours a week and um, soI, you know, we chatted about
that and I thought I can do that.
That's, how hard is that?
So I entered this place andwith my job was just histories
and physicals, and then um, justbasically it the nature of my
personality and curiosity.
It just became more and moreand more to the um point where,
(03:48):
um, I was there a lot andspending a lot of time um and
fell in love with um, thismarginalized community that
doesn't have a socioeconomicfactor to it, you know, and in
(04:10):
some respects it reminds.
Well, let me back up.
So there's that.
But the other thing is that itwas an area in which I could be
authentically me, and there'snot.
Speaker 1 (04:23):
Well, there's not like you could be anything else
right well, I know.
Speaker 2 (04:27):
Well, let me tell you I've done some things and it's
like.
You know, you got to wear thewhite coat, you got to be nice
and you can't cuss, and you got.
You know, you've got a, you'vegot a placate blah, blah and I'm
like no, um, and you know, theother place that you really
don't have to do, that you canbe your authentic self, is
emergency medicine, whichi've've done, and so I I fell in
love with this sort of platformand addiction medicine, that,
(04:52):
um, I could be authentic, and Ithink the most important aspect
of that authenticity is thatallows me to meet the patient
where they're at and, moreimportantly, when the patient
sees or the client, because itdepends on what, it depends on
what aspect within medicine youare, whether you're a client or
(05:14):
a patient.
Obviously, in medicine you're apatient.
So for me, patients but it letsthem drop their guard because
they see my authenticity andthey see me kick back and laid
back and my feet might be up onthe desk or just chilling, and
there's no white coat, there'sno stuffiness.
(05:38):
We've known each other for along time and, like I tell my
patients, the person you seehere in the room with you right
now is the exact same personthat I am on the street.
There is no difference.
Um, you know, I will hug youand squeeze you and hold you and
love you If that's what youneed, I will drop, kick a boot
up your tail if that's what youneed, but this is a journey that
we walk together.
I will not work harder than you, um and um, and I think what
(06:04):
that does with being able to betruly authentic.
I fell in love even further withwhat I do for a living, and
then I fell in love with thispopulation and then, coinciding
with that was running intochronic pain as an issue in my
background, also withorthopedics, and my supervising
(06:25):
doc at the time was aphysiatrist who did chronic pain
and also addiction medicine,and so it just dovetailed
perfectly and the majority ofall folks with opioid use
disorder have chronic pain.
So it just dovetailed reallywell.
And then I mean that just sortof you know and away I went, and
(06:47):
so my practice specificallyfocuses, you know, half the
practice is chronic pain andfolks that don't have a
substance use disorder, and thenthe other half is substance use
disorder and of that, probablytwo thirds of those folks have
substance use disorder andchronic pain, and so with that,
(07:11):
obviously, then we start gettinginto what are underlying
factors that are going tothreaten your sobriety, increase
your pain and so that what areyou doing to your body while
we're doing all this?
Exactly.
And then that kind of that getsinto the mental health aspect
(07:33):
of stuff.
And so you know, and you knowthis from doing what you do, I
take folks in on an intake andparticularly coming out of um
some facilities or transferringsome some places, there aren't a
lot of meds and I'm like, well,you know what came first, the
chicken or the egg, um, and howdo we figure that out?
(07:55):
And so my, my theory on thatone is I want to, I want to.
You know, you're on medication,assisted treatment, typically,
assisted treatment typically, um, and I want to try and wean off
what we can wean off, um, findan optimal dose on things that
we can't Correct.
(08:15):
Correct, that's exactly it.
And then, because then I want tosee what, I want the brain to
marinate in sobriety for a bitand then we can kind of tease
out really what's going on.
We're not going to get you offyour meds necessarily if you, if
you don't need to come off ofthem, but I think we need to
kind of let the brain marinatein sobriety for a while, um, and
tease out, um, what is going on.
(08:36):
And I, and I think that um, alot of folks will be out there
looking for maybe the quick fixof medication assisted treatment
, um, and then mental healthwise people are going to look,
maybe the quick fix ofmedication-assisted treatment.
And then mental health-wisepeople are going to look for the
quick fix for their anxiety andtheir depression, which is a
pill and get the primary care,et cetera, et cetera, when in
fact, what we need to talk abouttoo is the significant
(08:57):
importance of getting therapistsin there.
Therapists in there, um and um,in some cases, peer support
specialists, and you know kindof.
I always tell folks, I willtake care of the, the biology,
the physiology, the biochemistryof the brain aspect of it, but
(09:19):
your frontal lobe is going to bea process of doing some um,
therapy.
And that's just the reality.
We, you know some therapy.
That's just the reality.
I mean, that's just the realityis that we've got to do this.
Speaker 1 (09:31):
I think you're addressing something here that's
super important in my practiceand in the clients that we work
with in general First of all,the medical industry and even
the insurance industry, and Iknow where it came from.
I've discussed this with othersbefore, but it's kind of the.
(09:53):
It's an emergency, it's areactive emergency model.
You came in, you break your legyes, at the leg.
We put a cast on you, walk out,give you some meds come see us
in a few weeks, uh, and you'vegot the, you've got you.
You overlay that practice modelover mental health and
addictions.
(10:13):
Uh, first of all and I justdiscussed this with an attorney
with an, incredible uh, jordanlitis has this incredible
recovery story and has turned itinto advocacy for his practice.
Speaker 2 (10:24):
But I know who the guy is, yeah.
Speaker 1 (10:26):
Yeah, good, yeah, cool guy, and his story is just
like it's got.
It's heart wrenching and andit's true that the medical that
you walk into a person withaddictions issues walks into a
hospital, walks into a provider,walks into a pharmacy and and
experiences experiences beingdiscriminated against.
Speaker 2 (10:51):
Oh, you know, it's a daily, daily conversation with
the majority of all my patients,because and because of the
medications I write, whether itis, you know, an opiate, a
partial opiate, vivitrol ornaltrexone, it's like all of a
(11:12):
sudden.
Speaker 1 (11:13):
Oh, you're this person, right you?
Speaker 2 (11:14):
know, now we've got a profile.
Yeah, yeah, I um, yeah, we'regoing to profile and it
essentially I have one, onemotto that drives me in the
practice of my uh and care formy patients, and that is don't
mess with my patients.
Not the mess is the usual wordthat I use, it's a cuss word and
(11:36):
everybody else can figure itout.
But do not mess with Wheeler'spatience, because I will come
after you, I will come after youand you know, I mean it's funny
because you know I have a very,very small staff, but they know
they can watch me on the phonewith the insurance companies or
with the pharmacies.
And they're uh-oh and I'm like,oh, you bet, yeah, you know we
(11:57):
are gonna go to town and I, Ihave, truly I have sat there and
called a, um, um, pharmacist.
I called one pharmacist, a bigat one time, and one one
discriminates, and that catchesthem in their path.
They're like, well, no, no.
I said well, yeah, yeah, I mean, let's just call it what it is,
you know if I were writing thisperson different than you treat
(12:18):
everybody else, that is correct.
If I wrote for um because I dochronic pain management right.
So I'm writing for traditionalopiates for that population that
doesn't have a substance usedisorder.
If I write for morphine oroxycodone, you hand that out to
them two days in advance of whentheir start date is.
You don't think twice about it.
But I write for buprenorphineor Suboxone and you won't let
(12:41):
the patient get it until the daythat their start date is based
on when you last filled it forthem.
Because you know and here's thegreat story If we give them two
days early, then they'll havean addition.
They have the potential to havean additional.
If we keep giving them two daysearly, then they'll end up with
an additional 24 pills or filmsat the end of the year.
And I'm like where do you,where do you even get that?
(13:04):
Well, you know they can abuseit.
Speaker 1 (13:05):
I'm like like no, they can't, that's not, that
doesn't cost that amount ofextra, doesn't constitute abuse
for one.
Speaker 2 (13:11):
Yeah, and I and I have yet to hear of anybody
overdosing on it.
So, um, but then, but, but,todd, I come back to, which is
why I love doing what I do,where both sides of the coin and
I come back and go.
So you're also doing the samething with the guys that are
getting morphine and oxycodoneYou're giving them 24 extra
pills.
Um, no, no problems there,right, like, seriously, like you
(13:35):
do.
You even hear yourself.
And one of the other ways that Ilove to deal with the pharmacy
and insurance industries is Ilike to ask questions, and I
learned this as a consultant andyou know, when people are stuck
in their way, the way you getthem unstuck is not to
necessarily directly push atthem, but basically start asking
(13:55):
questions and you can askyesuck is not to necessarily
directly push at them, butbasically start asking questions
and you can ask yes and noquestions, to a point where they
get themselves turned around towhere they're answering your
question in the affirmativeultimate, like what you were
saying from the get-go right,like, why are you doing this?
And they're like well, becauseblah, blah, blah, blah, and you
go through a series of questionsand you come back and go all
right, so then why do we go back?
(14:17):
So let's go back to theoriginal question.
And they're stuck.
There's no way around it.
I had that situation happenwith Medicaid up in Virginia and
this gal was holding her line.
She was like the director ofMedicaid in Virginia this is
years ago and she was holdingher line.
Speaker 1 (14:32):
She had already decided what the right answer
was right.
Speaker 2 (14:38):
You betcha, and you know me well enough to know that
I was, like you know, for thatyou know, when I was accepted,
that challenge accepted, and I'mand you know, I'm like, oh well
, this is cool, this is sportand you know we've talked about
it.
Sometimes doing this it's a, itis it's time consuming, it's a
pain in the tail, but, depending, depending on the daytime and
situation, sometimes it's sportand challenges, and this is
sport and this gal was reallystuck in her in her way and and
(15:02):
and I was like, okay, so I, we,basically I did a series of
questions and this, at thispoint, this one was mental
health and it was surroundingthe coverage of equine assisted
psychotherapy, and you know whyyou couldn't do it and, um, it's
actually you and I have spenttime together yeah, yeah, but it
was a really funny story and itreally comes down to.
It really relates to this when,if for anybody listening, when
(15:25):
you start asking these questions, you kind of change the
scenario as you go with well, wewon't, you know, we're not
going to let people do anythingwith a horse.
Okay, why?
Well, because it's not in anoffice.
I'm like, well, you know what'sthe size of an office?
What do you mean?
Speaker 1 (15:40):
what is?
Speaker 2 (15:40):
it?
What is an office?
Yeah well, you know it's, it's,you know, got four walls and
I'm like, well, barn has fourwalls, so keep going, help me
out here.
Well, sheetrock walls andeverything else.
And I'm like, oh, you want themin a, you want them in like a
nine by 10 office?
Yeah, okay, well, do you have?
Do you have that in pop inwriting somewhere?
Speaker 1 (16:01):
No, Is there evidence-based practices that
say a nine by 10 office is theoptimal treatment environment
for your client?
Speaker 2 (16:07):
Exactly, exactly.
Speaker 1 (16:09):
You don't do you.
Speaker 2 (16:10):
No, you don't, no-transcript a true story.
(16:36):
And and the lady came aroundand she was like, oh, I get it
now.
And I'm like, yeah, you got it.
But that you know that thewhole point of that is we have
to.
We end up pushing againstresistance, and so we have to
figure out sometimes how to kindof go around, and sometimes
going around is not, is isliterally just asking questions,
until you this is the wrongverbiage, um, but I think you'll
(17:01):
know what I mean and you mayget have better verbiage, but
you know, until you trip them up, um, because you'll hit the
point in dialogue of questionsand you can ask questions in a
way that are non-challenging,non-threatening, and they just
(17:21):
answer them just kind of like ohyeah, you know like what's for
breakfast?
Okay, Um, and then, as you'veasked your questions, you come
around and they're like oh, sothat's.
Speaker 1 (17:24):
That's a lot.
There's this.
There's a dawning revelationthat happens in these and you
know part of it.
I, I love to sit around aclinical team inside of a
hospital with a bunch ofpsychiatrists and social workers
and make them feeluncomfortable.
Yeah, I do a very similar thing.
Well, guys, you know.
So what you're telling me isthat you know, you end up in a
line of questioning and theyrealize that what they're doing
(17:47):
is referring an individual toinappropriate levels of care.
Yes, that's the conclusion Ineed them to reach here.
I'm an advocate and they allget on their toes anyway, but
you know.
Speaker 2 (17:58):
I met them directly.
Right, you couldn't have said,hey, we need to refer them to X,
y and Z because they're goingto go.
Well, I'm the doctor, you arenot, and I know what's best for
the patient.
Speaker 1 (18:08):
Well, there's this, you know.
The thing is, you know there's,we thought we started little
trip.
We're starting with talkingabout stigma and how a person
you know they find stigma whenthey go to these environments.
And then you've got mentalhealth environments where you've
got these standards, which iswhat you're addressing when
you're talking about whetherit's the use of equine therapy
(18:30):
or standard doses of aparticular mental health
medication.
This is the standard dose, yeah, but this person doesn't need
that much.
Speaker 2 (18:41):
Exactly.
Speaker 1 (18:43):
So there's all these protocols that are written, and
then you've got these doctorsand practitioners that live in
these silos.
They don't really live out inthe real world.
They live in a hospital, orthey live in a practice that
does a certain thing, or theylive in this policy world where,
oh, you don't go live out inthe real world.
They live in a hospital, orthey live in a practice that
does a certain thing, or theylive in this policy world where,
oh, you don't go outside ofthis policy.
(19:03):
I've decided how to interpretthis policy and this is how it
gets interpreted.
I pass that interpretation onto all the people that I
supervise, train or teach.
And all of a sudden, you've gota whole field that's operating
with inconsistent philosophies,ideologies, interpretations,
policy about how to treat theseindividuals, none of which
actually lives on the ground,and we end up with the
(19:23):
complexities that we have in thetreatment environment and in
the population that we'reserving and suddenly we've got
real problems.
I think that this is the reasonwhy we end up with such
complexities and conditions andpeople on things like 300
milligrams of methadone, likehow in the world is prescribing
a person more methadone afteryou get up over about 80
(19:46):
milligrams?
Speaker 2 (19:47):
Yeah, the average person is somewhere between 80
and, and that, and one of thethings I want to add on to the,
to tag onto that is that we alsoare in a climate in which we
change tunes so quickly that wecreate whiplash in our in our
industry, and in ourselves asproviders.
You know, one day benzos are um,are great, they serve a purpose
(20:11):
, there's a place for them, andthe next day it's like, oh my
God, it's the worst thing.
You know, we can't ever do thatagain, and so we can't.
We are not a society or systemand I can't speak for the rest
of the world.
I can only speak for the UnitedStates of America.
We are not a society or system.
Who can find the middle of theroad?
Um, I had a.
Either do do it or you don't doit.
(20:49):
This is bad or it's good, yeah,and so it is that balance.
And it is that balance and itis it is.
You know, I had a um, acolleague of mine who had
someone with um, opioid usedisorder and chronic pain, and
we were talking about it and I'mlike I can help you with the
chronic pain, part of this, ifyou want, because, um, you know,
(21:10):
um, buprenorphine is a partialagonist, it's um.
Butrans and belbuca are usedfor pain management etc.
And let feel free to justholler at me and I'll help you
with this, with take care ofthis person well and I haven't
heard a thing, because the wholedeal is well, that's not their
problem.
The problem isn't their chronicpain, the problem is their
(21:31):
opioid, and this is true they'vegot more than one problem.
No, no, no, no, but that's whatyou run into and so, yeah, and
so you know, getting back tomore than one problem, it's like
, well, all right, so you haveopioid use disorder, or you have
stimulant use disorder, alcoholuse disorder, and then I have
(21:52):
to go there and I have to go,all right, well, you have
bipolar and disorder and youhave schizoaffective, or you
know, you've got all these otherthings, and then it's like and
then personality disorder, whichis, you know, we'll run you all
, we'll run you ragged onmedications.
And I don't want to, and it'sreally important for me to
really respect and honor myinpatient colleagues, and
(22:17):
they're seeing them in the worstof the worst conditions, and so
I get how some of theprescriptions are set up and
handed out at inpatient.
Speaker 1 (22:25):
You go into a hospital, they're giving you the
velvet hammer, right, andyou're coming out on the velvet
hammer.
But the velvet hammer, you'renot supposed to stay on that.
Speaker 2 (22:34):
No, I like that term the velvet hammer.
I I'm going to have to stealthat from you, whether I did not
create it.
You're welcome to it, the velvethammer.
I'm like good God, almighty,yeah.
And then, exactly, Todd, youcome out and you're like, and
you know, then you end up in theoutpatient providers and we're
all like I get it.
So, first of all, I get it, Iunderstand what we have going on
(22:56):
here.
But, holy cow, and you know,I've I've had the privilege of
doing some um, um, medicalmanagement for sober living
houses and catching these guysright when they come out of
inpatient.
And you know these are folksthat were never on meds before.
Um, it doesn't mean that theyshouldn't have been on some sort
of medication for somethingtypically a depression or
(23:18):
anxiety type deal.
Um, and now they're on likeseven meds.
Speaker 1 (23:24):
Yeah, what do we do with this?
Speaker 2 (23:26):
Where do we find the middle road here?
And you know.
Then you're like, well, youknow, well, I got to start
peeling, it's peeling an onion,I got to start peeling this crap
off.
And T you know and for, andpeople need to understand.
You know, well, I got to startpeeling, it's peeling an onion,
I got to start peeling this crapoff.
And you know and and peopleneed to understand.
You know, for your audiencemembers, that may not be
providers.
Um, there may be providers outthere that are going to take
multiple, that will makemultiple changes to medications
(23:47):
all at once.
I'm not that person, becausethen I don't know when we have a
result of that, I don't knowwhat caused the result.
So I'm someone who, basically,you know we're going to adjust
your meds, but we're going toadjust one at a time.
Speaker 1 (24:00):
A little bit at a time.
Speaker 2 (24:01):
And figure out, you know.
Okay, well, that was it or itwasn't it.
Speaker 1 (24:05):
You might want to consider a residential
environment if you're going tobaseline off of all meds because
you don't know what's going tohappen.
Speaker 2 (24:10):
That's it.
So, yeah, no, no, no, that'stotally it.
Yeah, it's a challengingenvironment, but I'll tell you
what.
(24:31):
I think it's important forpeople to know the lanes that
they're in.
Um.
I, you know, just like umspecialists, you know.
Let's take orthopedics.
You know, orthopedics, there'susually the guy that, like he
really likes knees, he's theknee guy right, or she's the
upper extremity, or she's the,she's the hip person, hip gal
(24:52):
and and this is you know, theycan be a general surgeon.
That's fine.
Um.
And with mental health andsubstance use disorder, when you
combine those two um, I tend tofind that you have a um within
that.
Whoever that provider is, tendsto be um more more proficient.
(25:13):
I'm yeah, I'm going to go theremore proficient and has a
tighter leaning towards mentalhealth or towards substance use
disorder, but not necessarily50-50 as good on both sides of
that page.
Speaker 1 (25:30):
Yeah, they've got a leaning and they walk into the
other side going hey, I need toknow enough about this to be
able to do this other job.
Well, that's correct, Right.
Speaker 2 (25:39):
So my deal is I always like to tell people that
you know I am substance usedisordered.
Um, strong, like, like.
I take it to the bank every day.
I've got that inside outbackwards and forwards, um, and.
Speaker 1 (25:53):
I'm not going to leave you hanging on your mental
health or, frankly, yourmedical health Cause I know what
I'm looking at Right.
Speaker 2 (25:59):
But I also know and I tell them I'm like so here's
the deal, I'm going to take careof your mental health up to the
point where I feel like I'm notthe person for you and then I'm
going to refer you to someonewho you know, where I'm so super
strong with substance usedisorder.
They're that strong in mentalhealth and we'll get you over
there and we'll work tandem.
Speaker 1 (26:18):
I am very, very fortunate to have Well, I'm
going to stop you there, likelike, right there, you just said
it.
You just said the exact thingthat I think a lot of the
medical world, psychiatric world, addictions treatment world is
missing.
I'm going to, first of all, youknow where your line is.
You're like, hey, we'restarting to get into territory
(26:38):
that I don't feel as comfortablein, where you've got a lot of
docs that are just makingdecisions, sending their
patients on to wherever they gohome, the farm, whatever, and
calling it a day.
The second thing that you said,which is something that I kind
of have to just make happen forlots of different siloed
(26:59):
providers that are working withone person and everything else.
You're going to reach out,you're going to communicate with
that person, you're going towork in collaboration with them.
Hey, I'm doing this, what areyou doing?
Let's make sure that we're notat odds, that you're not doing
something that'scounter-indicated, or I'm not,
that you're actually having acommunication with the other
(27:19):
professional and have a workingrelationship so that this
person's getting that, gettingthat really high quality like
where does the middle live?
So that this person can get thebest care, like that's the
trick, right there.
Speaker 2 (27:35):
It is, and but let me tell you some of the underbelly
of that is is that you know Iwant to reach out to somebody
who you know, let's say they dosubstance use and mental health.
They tend to do a lot moremental health than do substance
use disorders, and so you know Isend them up there for the
higher level game of psychiatricstuff.
And I am not and so, talkingabout me, I am not the only one
(27:59):
who experiences this.
But you end up getting poached.
You know they go into a facilityand then they poach your
patient.
And I've made more than onephone call in our area going do
not poach my patient.
Like what are you doing?
You know?
I mean, I referred them upthere for the purpose of X and
you basically kind of said youknow, instead of seeing two
(28:19):
people, you could actually justcome to us and get you know, get
the, you can get the everythinghere right, like we are we are
the Walmart.
Speaker 1 (28:28):
We can prescribe all that buprenorphine or Suboxone
or whatever you need.
We can do it all right here,right Right.
Speaker 2 (28:34):
We are your Amazon, we are your Walmart, no, you
know.
And so that's so, I think,where people sometimes get stuck
in.
So first of all, they get a,they get in their own way, first
and foremost, we, they get intheir own way, we, they get in
(29:04):
their own way.
And then, two, I think that youknow there is a concern when
you develop and establish arelationship and then you're
going to transition them out fora medical problem, in this case
, a mental health, medicalproblem that you have.
But for me, I feel like I'vedone as much as I can do, um,
and they're going to poach them.
So I can, I can very, verystrongly and passionately say if
I got a referral for someonefor substance use disorder from
um, a behavioral health um,nurse practitioner, pa or
(29:25):
physician, and they are workingon that corner of the world, I
am in no way, shape or formstepping into that territory.
Um, I will take care of theirsubstance use disorder.
I'm happy.
Thank you very much for thereferral.
You will never have to worryabout me poaching.
But I think that that's areality, that when first, well,
first of all, when I, when Ifirst say so, let's start with
(29:46):
the ego when I first say well,you know I don't have the chops
for this.
Well, you know there are lotsof people with lots of egos out
there and you and I both knowhow that goes.
So when you first acknowledgethe ego issue and you're able to
get beyond your own ego andthen ask for help, you need to
feel comfortable in the sense ofyour community that your
patient isn't going to getshitty bad care.
(30:07):
Sorry, you have to edit thatout.
Speaker 1 (30:13):
Get bad care or they're going to get poached,
and so well, and, and, and youknow, part of the issue in being
poached is is that you, youlose that person's done it lives
, doesn't live on your side, youknow, and and just because
you've established a regimenthat you think is probably
workable, by the time thisperson who's on the mental
health side, let's say, isputting in other medications.
(30:33):
Well, that equation's changednow, isn't it?
Are they reaching back out toyou to collaborate?
Are they reaching back out toyou to understand the side that
they need to understand?
No, they're not doing that.
You know it's like there's thisterritorialism that goes on.
That's how silos get created,and you know that's how the
field and I don't, you know,honestly, in many ways I don't
(30:54):
really understand it, becauseit's not like every psychiatrist
, it's not like every area thatI know of is not woefully,
woefully low on the number ofpsychiatrists with open, open,
open area.
You know, the ability to takeanother patient in there to
their practice.
They're all full or they'realmost next to full.
You have to be on a waitinglist to get in with them.
(31:15):
They're all full or they'realmost next to full.
You have to be on a waitinglist to get in with them.
You know, there's there's allthese very these kind of subtle
uh problems and and issues thatarise out of this kind of what I
would call personality drivenuh issues that happen with high
level professionals, right yeahyou know, I mean, nobody likes
(31:35):
to get their toes stepped on,but, being collaborative, they
don't get trained in in medicalschool.
It's something that eitherpeople do and they're good at
and they and it makes thembetter docs, honestly or they
don't and they're just kind ofthese people who this is my
practice, this is what I do.
I'm the authority I say what'sgoing on.
You know that's the way.
That way I can have controlover everything.
(31:56):
The truth is is that they don't, because they don't have the
expertise.
I mean, this is a bunch ofstuff that was like Robert
Robert Whitaker, you know theanatomy of an epidemic.
He talks about a lot of thisstuff in his book.
Just the medications and thehigh doses and the.
What are we doing?
And we're not collaboratingwith one another doing?
And we're not collaboratingwith one another and we don't
know what the mix of thesemedications is doing, because we
(32:16):
don't cross?
We don't cross channels withothers because we're too busy in
this silo, right, right and andall the while, you know the the
pharmaceutical industry islaughing to the bank and they
are and here's another deal andand, and this is um.
Speaker 2 (32:32):
It's two points.
One real quick on the.
You know, I'm the provider andI know what you know, I know
what's best for you.
I literally just had thatconversation with a patient
yesterday where I said you know,you've had this, you know very.
It's kind of a zebra in thesense that it's not a common
disease, congenital issue.
And then this person happens tobe dual substance use disorder
(32:56):
and chronic pain and mentalhealth.
So not dual, but trifecta, it'sa lot.
And so they're new to the area.
And I said you have to rememberthat you are the expert in your
health and your disease.
You've had it for as long asyou've had it and you have to be
able to have thoseconversations.
And this is where you know forsome patients that you know you,
(33:19):
the doctor, knows best.
I'm like, eh, not always Um.
And then it the, the wholeaspect of um being in the silo
and trying and staying kind ofin the middle of.
Well, this is what thediagnosis is.
And so this is our, this is ourmenu.
(33:42):
So you know, we've got our, ourthis is the boxes, and then
you've got.
But then you but, todd, youhave people out there that like
really interesting cases.
You have what we call.
I call them zebra hunters.
And you know, for your audience, we all, we always think about
Dr.
Speaker 1 (33:59):
Strange.
Speaker 2 (34:00):
Yeah, well, yeah, and when we think about in
healthcare, you know, when youhear hoofbeats, think horses,
not zebras.
So when you're looking atsomething, and in medicine, if
you hear hoofbeats, what's the?
If I look out my office window,am I more likely to see a horse
going down the street or am Imore likely to see a zebra?
Well, you're more likely to seea horse, right?
(34:21):
So everybody's trained forhorses, everybody anticipates
horses, everybody likes treatinghorses.
It's simple.
We've got a map, we've got thebuffet menu.
It's pretty straight up.
We don't have a lot of peoplewho are good zebra identifiers
and like to chase zebras.
Now, I love to chase zebras.
(34:43):
I was actually talking to aphysician colleague yesterday
and I went.
I'll tell you what I'll chase azebra all day long.
So if it's a complicated healthsituation mental health or
substance use disorder or acombination physical disorder
I'm on it.
Man it's.
It's fascinating to me.
But part of what we're lackingin these siloed worlds are
(35:04):
curious providers who arewilling to chase stuff.
And that goes back, todd, intoinsurance and pharma and big
pharma, because they don't.
First of all, you do havepeople who don't want to chase
zebras.
You know.
They just want to go to work.
They want to take care of thenormal easy stuff that they can
take care of.
Um, the, the really thoughtchallenging things.
(35:27):
Um, there are some people whoare great at it and they, they
find pure, like me, pure joy andpleasure and in the mystery.
But the majority of healthproviders are not like that.
They're going to go in and theyare going to not challenge big
pharma.
(35:47):
They're not going to challengethe industry, the insurance
industry.
They're not going to work to.
They're not going to work tothe to, you know, to seven
o'clock or eight o'clock atnight for that one patient on
that one thing.
They're not, that's a zebra,they don't advance.
Speaker 1 (36:05):
I mean, it means basically that whatever training
they got in school, they'reobserving the rules and
regulations that they've beengiven.
They're doing just enough.
Just enough continuing ed tomake sure that they stay true to
their license, whatever theirboard is telling them they got
to do.
Speaker 2 (36:20):
Yeah.
Speaker 1 (36:20):
And then, but none of that drives a person to become
better in the place where youcan, in the only place you can
really get better, after thatlevel of training, which is in
the real world, facingchallenges that you don't know
how to face withoutcollaborating with others.
That's what causes people toget a lot better at what they do
(36:42):
.
They're not reaching out anddoing it, and maybe it's because
their caseload is too high.
Maybe they're sitting in ahospital.
They got no time for that.
Speaker 2 (36:49):
That's a lot of it, particularly in mental health.
I think that's a lot of it.
It was really interesting to.
I sit on.
You know a couple of or I don'tsit, but I follow on social
media some psychiatric andsubstance use groups and it's
fascinating to watch.
(37:09):
You know people go.
Well, you know I see 35 peoplea day.
Well, I, you know I see 35people a day.
My max load a day is 14.
Now I'm sunsetting in my careerand I own my own practice and
I'm not chasing the dollar.
Um and so I've hit a pointwhere I want to do um.
I want to talk about yeah,exactly so, um, but it's you,
(37:32):
you 30, I mean, think about that.
You come in at eight, 30 oreight o'clock and you're your
last patients at 430 or five,and somehow you've seen 35
patients.
And this is mental health, thisis primary care, this is pain
management, this is specialties.
You're just.
(38:08):
How do you provide good serviceand good care and take care of
that complex patient that needsmore than 10 minutes or 15
minutes?
When you got, they're going togive you a ridiculous caseload.
And they're giving you theridiculous caseload because
corporate medicine moreimportantly, pharmaceutical or
not pharmaceutical,insurancement rates and chasing
the God Almighty dollar, and sothat breeds poor medicine and it
breeds laziness and it's not apurposeful laziness.
(38:29):
There's no such thing as a lazyprovider who chooses to be lazy.
They are tired and they aretaking the easier way out and,
quite frankly, a lot of placesare running into corporate
medicine and they're justbasically, you know, they're
just kind of like all right,what do I do?
So here's your checkbox go.
Here's the parameter, here'syour menu go.
And so I mean wheelers inprivate practice and owns their
(38:52):
own business, because lots ofcircumstances.
But I'm done, I have played,I've been on the hamster wheel.
I've followed the checkboxes.
You know, I've followed thebouncing ball.
Speaker 1 (39:12):
And you know, particularly in the area that we
work in, right, mental healthand for me, Concierge mental
health, private pay mentalhealth, a lot of that category
where people who afford to payto slow down.
Speaker 2 (39:18):
They need time and listen to them.
I always laugh becauseeverybody gets 30 minutes with
me and they, you know, I'm likeyou got to go get a therapist.
And they're like well, you'remy therapist, I'm like I am not
a therapist and, of course, todd, you've known me for a long
time.
I'm like, I am a lot of things.
A therapist is not one.
My spouse right my spouse is isa licensed um mental health
(39:40):
therapist and like that, youknow that's the person you need
to see, I'm going to tell youlike.
Speaker 1 (39:44):
I'm going to tell you like it is pretty much and then
you, then you might have somefeelings about that.
You should process it with that, with somebody else, because I
don't have the time it's notthat I don't have the time, but
I'm like I don't have.
Speaker 2 (39:58):
That's not my.
So um, I, I am.
Um, I will toot my own.
I'm very good at motivationalinterviewing.
Um, I am trained in tfcbt.
Speaker 1 (40:09):
Um you lack the skills but, but it's not you're
staying in your lane and in mylane.
Speaker 2 (40:16):
Well, in addition to that, you know like here's,
here's.
Speaker 1 (40:19):
The thing is that you know you're not chasing the
dollar.
You know I because I've seen,I've seen the analyst slash
therapist, slash psychiatrist.
I'm not a huge fan like the.
The 90 minute, 90 minute andthis is not just the first
meeting, this is the everymeeting, the 90 minute meeting
where there's a lot ofprocessing around feelings and
(40:41):
everything else.
In truth it's a conflict ofinterest.
In truth it becomes it's likeyou know you got feelings about
these things and you want to,you want to compel me with your
feelings, but I need to look atyou objectively because what
we're talking about is thescience of your chemistry and
(41:01):
the biology of what it is thatyour care needs to look like.
Now you're going to havefeelings about that.
You're going to go through aprocess as you engage in changes
with medications and otherkinds of things like that.
I need you to take that to atherapist, because that's the
mill for them, that's theterritory they live in.
They want to do that with you,me.
(41:22):
I've got to.
I've got to make sure I'mpaying attention to the
chemistry and I can't getdistracted by all the, all the
nuance of how you, of how yourprocess unfolds in your feeling
environment, like I don't thinkthat people understand that I
really don't, and it's notmeaning to be disrespectful
either.
Speaker 2 (41:39):
It's like.
You know I'm not in fact.
You know, in fact, if anything,I'm championing the therapist
here because I'm like this islook man, these people are
wonderful at what they do,they're great at what they're
trained at.
They have the time.
They have the time they havethe skills um and they want to
do it.
And it's not to say I don't wantto sit in and, you know, spend
an additional.
(41:59):
You know time's up with mebecause really, and and and
therapists also have a time up,like you know.
Hey, we're in it too and I haveanother patient or another
client, but the that is not soyou hit.
You hit it perfectly.
Um, my job is the physiologyand biochemistry of what's going
on with you.
That is not to put in secondplace by any means, cognitive
(42:25):
processing, behavioralprocessing and all those things.
But I'm not your gal, but I canget you to the guy or gal who
is that person for you.
And I always said at the opioidtreatment facility I'm like I
will take care, and I said thisearlier, I'll take care of the
biology and physiology, but wehave to have you see a counselor
(42:48):
, a therapist, because we havethe entire frontal lobe that we
have to work through.
Speaker 1 (42:53):
This is a multi-pronged approach.
Oh my God, you can't just.
I mean sure there are peopleout there who have gone through
processes, or maybe they're whatthey, you know, kind of gets
referred to as the worried.
Well, they can come in, theyknow what their issues are, they
can see somebody like you ortheir doc, get the basics, go
home, feel better.
(43:13):
Maybe they've got a therapistthey see infrequently but
frequently enough, like there'sa, there's a group of
individuals that can live inthat world and that's sufficient
.
The world that you and I aretalking about, it's not even
it's.
It's inadequate to it's aninadequate to the need that
we're serving.
Speaker 2 (43:31):
You know, and we can go down the line too, of whether
you know.
So here we get into, and thisis I think this is a
conversation for another day,and it'd be a great topic.
Why are you here, are you?
Here, because, or are you herebecause the court system said
you need to be here and you'rewent to impatient because you've
got a dui or a possession or orwhatever, and so you're
(43:54):
following groups, right.
So, um, you know, I so I think.
Certainly, Todd, this is aconversation I'd love to have
with you?
Speaker 1 (44:02):
Why are you here?
Because if you follow up onthis topic, let's talk about
golly yeah.
It's going to be well, you know,I, I you've dealt with the
courts.
You've dealt with people insober homes that are, you know,
faced the courts.
You've dealt with people insober homes that are, you know,
faced with consequences.
You've dealt with people thatare just coming to you on the
street.
You've dealt with 20-somethingsand you've dealt with
50-somethings Like there's awhole spectrum of who are we
(44:24):
providing services for.
That's a great conversation forus to hit next time.
Lisa, god, I love having you onthe show.
I love talking to you.
I love having you on the show.
I love talking to you.
I love having you as a friendand colleague there on the world
doing the good work.
I appreciate you coming on.
We're going to do it again verysoon.
This has been Head InsideMental Health with Todd
Weatherly on WPBM 1037, thevoice of Asheville.
(44:46):
No-transcript.
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