DR. MIRIAM ZYLBERGLAIT LISIGURSKI: The 3G's for well-being: Goal, Grit and Growth & The Truth About Doctor Burnout

Episode Transcript
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Don Priess (00:00):
When the world has gotcha down, and Alzheimer's

(00:04):
sucks. It's an equal opportunitydisease that chips away at
everything we hold dear. And todate, there's no cure. So until
there is we continue to fightwith the most powerful tool in
our arsenal. Love. This is LoveConquers Alz is a real and
really positive podcast thattakes a deep dive into

(00:24):
everything. Alzheimer's, TheGood, the Bad, and everything in
between. And now, here are yourhosts Susie Singer, Carter, and
me, Don Priess.

Susie Singer Carter (00:35):
Hello, everybody. I'm Susie Singer
Carter.

Don Priess (00:38):
And I'm Don Priess.
And this is Love Conquers Alz.
Hello, Susan.

Hi, Donald.
How you doing?

Don Priess (00:44):
I'm tired. How are you?

God, that's so coincidental. I'm exhausted.

Don Priess (00:52):
I know. Oh, my God.
I know. I mean, why are we drawnis this is Austin, because
there's so many reasons. But oneof the main reasons is we are
just in full, full force goingtowards this documentary. You
know, that's, I mean, I knowthat you're living it. 24/7 I'm
living it. 12 Seven, because theother 12 I'm working on my other

(01:14):
job.

I know. I know. You might hear a speaker
in my house, but it's not reallya cougar. It's a five pound dog.
That sounds like a cougar. Letme know out there. Yeah, let me
know. We're working on

Don Priess (01:29):
Gidget?

Yes.
Gidget. Is it the diva Cougar.
Yeah, so we working on NoCountry for Old People. So if we
don't remind you enough, butwe're gonna remind you again,
because we are doing somethingthat we hope will create a lot
of change. It's a it's a, it's ait's an expose a more or less

(01:51):
about our broken healthcaresystem, which I personally
experienced last year for sixmonths straight and without, I
had no idea how broken oursystem is and how it is
affecting every aspect of it.
And and it's not just thepatients or residents living in
assisted living or long termcare or nursing homes. It's the

(02:14):
doctors, it's the nurses, it'sthe provider, it's everybody
that's involved in the industryof and it really is an industry
because it's, it's, it's run bycorporations now. And it's run
by people that who have profitover, you know, their goal is
profit over people, which isincredibly tragic, and the

(02:35):
opposite of humane. And so weneed to make this change. And so
if I keep talking about it alot, it's because it's very
important. And it's because Ididn't know. So you know, and I
don't think a lot unless you'rein this business, or unless you
get pushed into somebody thatneeds care. And you fought

(02:55):
that's when you find out andthat at that point, it's a
little bit too late. So that'swhy I'm hoping to take what I
went through and share it withall of you and, and let's
prevent other people fromsuffering, like my mom did last
year. So that's what we'redoing. And through this project,
like everything, everythingevery every tough road brings

(03:16):
you more experience and andcloser to the path that you
should be on. And that's why Ireally believe that and that's
why I'm meeting suchextraordinary people. Every
single path, you know, like mymom and the girl remember, Don,
we know

Don Priess (03:33):
it takes you a nominee. It's kind of like the
Wizard of Oz. You're kinda likeDorothy, and just meeting all
these magical people along theway better. I mean, you know,
maybe a little better thanscarecrows, and tin men, but
it's really it's a greatjourney, the Scarecrow you know,
and he had a brain in the longrun. So we

all have it, we have heart, we have brain
we have courage, and we haveread. But we do we do we really
are, we can be really strongwhen we have to be. And we and
you know, and that's a greatmetaphor, Don, I liked that you
brought up the Wizard of Oz.
Because you can use that walkthrough life. We don't realize
that we have the brains, we havethe heart and we have the

(04:18):
courage to make change and dothe right thing that

Don Priess (04:24):
will lead us and that will lead us home,which is
you know where the heart is.

There's no place like home?

Don Priess (04:30):
Well, let's go with a few more of these.

Anyway, let's let I want to tell you
Yeah, so So jumping off of my myrant my ramble, really about
meeting wonderful people. I meta wonderful, a wonderful soul of
soulmate, really. This womanwho's a doctor, how am I meeting
all these amazing people andthen doctors and who are so a

(04:55):
step that amazing careers wouldtriple licenses and Like I like
talk about talk about motivationand and resilience and and
fortitude and all that stuff.
Wow. I'm just I'm just humbledto meet all these people. So
will you introduce our guest?

(05:15):
I'm excited.

Don Priess (05:16):
I will Dr. Miriam Zylberglait Lisigurski or Dr. Z
was born in Peru where sheattended medical school and
practice medicine for almost 10years. In 2011. She left her
parents, her friends and her jobas an academic physician to come
to the US to be with the love ofher life. Now, she's a triple
board certified physician ingeriatrics, internal medicine

(05:36):
and obesity medicine withextensive clinical and academic
experience. In 2021, she wasselected by the American College
of Physicians to be part of theNational Wellness and
professional fulfillmentcommittee, and in 2022, she
joined the creators Institute atGeorgetown University to write
her first book about well beingand growth. The 3d cycle of life
the secrets of achieving joy,meaning and well being is an

(05:59):
introspective journey that gaveher the opportunity to heal,
create new friendships, find herpurpose, help others and create
a meaningful impact. It includesmore than 30 experts personal
and professional experiences,evidence based data and Dr. Z's
insights and stories. She hastwo awesome sons, a caring
husband, a supportive family andalthough she is caregiving long

(06:22):
distance for her mother, who wasrecently diagnosed with
dementia, her dream is to helpothers achieve lives full of
joy, meaning and well being. Soplease welcome the very
irrepressible Dr. MiriamZylberglait Lisigurski, MD.
Hello,

hi, hello, Dr. Z.

Dr. Miriam Zylberglait Li (06:44):
Thank you so much for having me. It's
such a pleasure to be here.

Thank you so fun to have you and I'm just
I love everything you do. I'mjust so impressed with you. And
you have a body of work that'sjust so such a such a role model
for so many people. And I thinkfor I've always, you know, my
company is Go girl media andyou're such a go girl. You

(07:08):
really are. Look, I mean, Idon't need to repeat it, right?

Well, for me, I am very impressed by
you. And I love the things thatyou are doing. And I am so
grateful of having theopportunity to be part of your
life and part of your project.
So I feel like this isworthwhile. So

wonderful.
Me too. It's, it's reallyextraordinary. You know, when
people have to, we don't realizeit's difficult enough to go
through med med school, rightand get a B license, it's
difficult, you know, to as awoman, let's face it, I don't
know if it's the same in Peru,but you know, here, right? And

(07:50):
all until you have all theseachievements, and then you fall
in love. Right? And then you andthen you decide to pick up
yourself and, and leave thisthis country that you know
everything about it, includingyour degrees and whatever you
you know, you, you pick up andcome and start your whole life
over again, more or less, in anew country without the

(08:13):
language, you had to learn it onthe trot. So, you know, and, and
I know this is love conquersall, but I just think that the
way that Marian has, hasnavigated her life is the way
that we should with any kind ofchallenge, which is what I did
with my mom is leaning into itand then you find the joy, which

(08:34):
is, you know, so I mean, tell usit can't be that easy. So tell
us a little bit how you how yougot here like how did you pick
yourself up again? And how'd youlearn the language so quickly?

Dr. Miriam Zylberglait Lisig (08:49):
So So I used to read in English all
the materials that are used toreview in federal were in
English. So I had this basic,you know, hello by how are you
doing and stuff like that, butnothing more than that. So I
really, I learned with myhusband a little and then I was

(09:14):
hired to do research. And in myoffice, I was only interacting
with two medical students fromIndia that were not able to
speak Spanish and this is inMiami. So in Miami it was very
difficult to only speak Englishexcept that you saved me with
someone from India they not onlybecame very good friends of

(09:40):
mine, but really they helped meto you know, improve my English
and I feel like my patients mypatients are very, very kind
also and my colleagues and myyou know, my mentors is so
little to you know, jump intothe pool knowing the people will

(10:00):
not be judging you but will behelping you um suddenly you're
speaking English of course Ican't even recognize when I make
a mistake. And I'm like, inretrospect if like I said
something wrong, right. Toolate, and grammar Lee's
wonderful. I'm doing some otherwith Grammarly but let's say

(10:27):
that makes me look moreprofessional now when I write
English probably with the lessless difficult part, the
emotional, the most emotionalpart, the most difficult part
was to leave my parents, I wasvery close to them. They didn't
want to join me in this trip sothey stay there even I really

(10:49):
try. And it was scary also tostart from zero my career not
knowing that I will be able tomake it because the percentage
of people that applies to theseresidency programs and is able
to go again and recover theircareers. It's not super high,

(11:11):
especially when you are olderthan the average was my case
after 10 years of being aphysician in my country. But I
guess a little of luck a littleoff pushing hard and a lot a lot
of support. I had the support ofmy family and I believe that
that that's the reason why I amwhere I am right now.

I agree.
That's amazing. So what So theother thing that interests me is
that you have three differentfocuses right? So you have you
have your your an internalmedicine, medicine, right. And
then you are you have ageriatric focus and then you
have an obesity focus. Let'slet's cut let's, let's ask you
why why obesity? Because, yeah,well, how do you fall into that?

Dr. Miriam Zylberglait (12:00):
Because they are not disconnected. They
are absolutely connected,internalizing is just knowing
how your body works. In general,geriatrics takes you to the next
level where you see or learn howto apply this general knowledge
in a more specific population, apopulation that is more frail.

(12:23):
And I adds to the combination,their holistic approach where
you don't only focus in liversand kidneys, bonds, but where
you see the cognition and theemotional aspect and the social
aspect. That's the part that Itotally adore about geriatrics,
and we see patients as humanbeings. And obesity, really,

(12:45):
obesity, for me is a pandemic.
It's affecting young and oldpopulation. And it's something
that not only is preventable,but it's also treated, if you do
it correctly. And I shall not bedoing this for the elderly,
probably when when we try tocorrect obesity in their lives,

(13:05):
elderly, we are doing thisstuff, you know, too late. It's
something that is reallyprevention. And it's it's part
of educating in appropriatelifestyles, which will prevent
all of us to get to the elderlytimes. Right. And until, to be

quality sick. Yeah, right. Yeah. quality
to have. So it's end of life. Sohow do you so there is there's a
big sort of stigma about talkingabout obesity, and you know,
these days, because I remember,you know, just anecdotally, I
had a friend who was, you know,gorgeous, but always, always a
larger gal. And, you know, andshe was, she had a, you know,

(13:50):
she got to the point where shewas like very, very militant
about the fact that, you know,it was okay to be the way that
she was, and it is, it's okay,you can choose what you want to
do. But there was, you know,what we had, I remember having a
discussion with her because Ihad mentioned that I had seen a
family member who I hadn't seenfor years, who was quite large
when I saw them, and I wasworried about them. And she was

(14:11):
very offended, because she said,that's such a bias and a
stereotype that just becausethey're big, that they're not
healthy, but so I mean, how doyou respond to that? Because I
feel like you're it isn'thealthy, to be overweight. So I
mean, and how do you deal withthat in this in this sort of
climate of politically correct.

So I feel like we crossed the line.
When we are trying to be diverseand inclusive, which I consider
myself that I am I mean, being awoman and it may grant for sure
I am part of minority. So I willget there number one who's
saying like we need to bediverse and inclusive, if not, I

(14:54):
am affecting myself. But onething is to be diverse.
inclusive and respected,respected with others. And the
other is to cross a line when weare compromising our own health.
Because we want to, you know,set a precedent or we want to
establish something like, youknow, I have the right to Yes,

(15:17):
you you have the rights toeverything, and we have the
right to or the obligation ofrespecting others, when we don't
cross certain lines, right whenwe don't cross certain
boundaries. And when someonethat has a medical condition,
because obesity is a medicalcondition and and that's the
wrong perception. We transformobesity in the way that you

(15:42):
look. Right? In how sexy youare. Right? How How nice you
look for others that are yoursize, but but obviously is is
not how you look, obesity is amedical condition that reflects
that your metabolism is notworking well for some reason.

(16:04):
And that will carry medicalconditions as a consequence that
will affect your quality oflife, because you will live with
back pain, the pain that willincrease your risk of having
diabetes of having cardiacproblems or having cancer and
strokes and even dementia. Soyes, I have the right to be

(16:27):
green, I understand you want tobe green, you want to be yellow,
you want to be purple, Iunderstand. But when you are
trying to fight for your rightof being green, or yellow, or
whatever, are you compromisingyour own well being?

Right? Are we putting out the wrong
message? Are we putting out thewrong message, the message is
Yes to accept yourself and youcan make the choice if you want
to live, compromise your health,because that's what you want to
do. That's okay. But it also itis a fact, like you said there's
a line that when it becomesdetrimental to your health. And

(17:02):
so it's it's right to worryabout someone that you love, if
they if they've crossed thatline.

Dr. Miriam Zylberglait Lis (17:08):
Yes, however, society created this
monster, society created thismonster when we started to
really a stigma, stigmatizeobesity, right, and we started
to okay, that person will not beinvited to the, to the party,
and that person will not find anice dress in the store. So we

(17:32):
create that in society andenvironment that is toxic. And
what we are seeing right now isour reaction. Individuals that
suffer from obesity are reactingand trying to defend themselves
against the aggression, right ofthem by him. And and I
understand I understand that,my, I guess that my point for

(17:56):
them is to not put yourself in asituation that it's dangerous,
just to make sure that you arerespected, there are other ways
where you can, you know, reclaimtheir rights and you have to be
treated with respect be your howyou look by gun, the color of
your skin, this is not, this isdifferent than when we talk

(18:17):
about someone having an accent,like in my case, or being from
one religion or another home onecolor of a skin or the other we
are talking about, this is aboutyour life, this is about your
health. And I feel like we needto reassess what we are doing
with obesity and the messagesthat we are sending, because the
consequences are really tragic.
And we will keep seeing them westarted now to see them but But

(18:40):
what then that then 20 yearsfrom now, we will have a very
high level of patients withdisabilities. Because obviously
they will not kill you will turnyou into a disabled person, a
person that is suffering aperson that is not able to work.
And at that point, we as acommunity as a society, we will

(19:04):
suffer too.

Right.
Thank you.

Don Priess (19:10):
Yeah. I mean, we don't we have to define it. We
have to define what obesity isor what you know, because there
is the the physical what we lookand we see. And then there's
some people who probably don'teven look and are probably
health compromised, and we don'tknow it. So how do we define
that?

Dr. Miriam Zylberglait Lisigu (19:27):
I love the question. And I was
actually planning to answer tothat when you ask. Yes. I feel
like there's a big problem inhow we define this. And yes,
there are methods of course,this very well known BMI that is
the relationship between yourheight and you're on your way,

(19:48):
which is kind of the standardnot necessarily appropriate for
all the groups for elderly isnot appropriate for people from
China, for example is notappropriate. See Most of the
characteristics of their body,right? So we cannot, we cannot
necessarily we have to adapt thenumbers that we use is not the
same that we use in this in theUnited States. And then you have

(20:10):
these body builders, forexample, where they have a very
high BMI that if you see thenumber, you will call them
obese, and then you'll noticethat fat percentage is very low.
So we need to incorporateforeign fat percentage and the
circumference of your, yourbody, your abdomen to
incorporate extra data andreally qualify someone as

(20:33):
overweight or obese or morbidlyobese. So that's, that's number
one, it's a little more fancythat what we do, or what we
know. But the second thing thatI believe is even more important
is that we need to understandthat obesity is not the result
of over eating or notnecessarily in the in the, in
all the cases that we theadvantage, or have more

(20:57):
technology and geneticassessments and the ability to
see receptors in the brain, wehave any identifying that there
are some conditions that becauseof genetic reasons, or because
of, you know, malfunction ofareas of our brain conditioned
individuals to or eat morebecause they cannot feel full.

(21:22):
And they need to keep going orto have problems with the
metabolism. So even if they maynot eat a lot, they will gain
this weight. So we weren'tjudging people because they eat
too much. They are too lazy.
They do not exercise. But thetruth is that we may, we were
being very unfair, we were justignorant that there was a real

(21:45):
medical condition, right?
causing this condition. Okay.
Yeah, conditions, actually.
Yeah, yeah, it's plural. And weneed to go back to the community
and to and to add, okay, them.
So we'll reduce the bias. No,just saying like, all everybody

(22:06):
has the right to look the waythey want, because that's a very
wrong message is, yes, we needto be kind with people because
it's the right thing. Butbecause it specifically is this
group is not like I say is noteating a lot. They have a
medical condition equal thanhypertension, or diabetes, or
cancer or anything else, right?

(22:29):
We will go in front of someonewith cancer and tell them like,
Oh, you look awful. Or you ifthis is your fault,

that's your fault, right? Yeah.

Dr. Miriam Zylberglait Lisi (22:38):
You wish you would not go to someone
that is obese and tell them thisis your fault. You look like
this? Because you want no, theydon't want.

It's like alcoholism, too. It's fine. You
know, it was before it wasalways thought of as like, oh,
well, you're indulgent. Youcan't. Why don't you just quit?
And some, you know, and it'slike, I don't I don't I don't
have that, that predilection tobe an alcoholic? I just wouldn't
be that's just it's not in mygenes where someone else can
pick up and they can't. And likeDon has, you have the Jethro

(23:09):
syndrome? You never get full?

Don Priess (23:11):
I couldn't I well, I don't and you don't. And that's
I've gotten older. That doesn'tbenefit me much. But it is it's
it's it's it's a condition. It'snot, you know, you know, look,
there's always exceptions to therules or some people who you
know, but in general, it's notit. You know, we think of

(23:32):
obesity. We've been trained tothink of oh, it's because you
overeat and you have no selfcontrol. gladness, you're

being a glutton negative. Yeah, right.
Yeah,

Don Priess (23:41):
therefore, you're bad. And it's not that

I love that. I love that to change the
perception because I thinkyou're right, the pendulum had
to swing very, you know, as itdoes when we're trying to make
change, you have to swing it allthe way. big and wide. So people
will take it, you will payattention. And that's what
you've done, right? We've got soeveryone is paying attention.
That's why we see differentbodies and ads. Now we see that

(24:05):
and we are accepting of it. AndI think now is I love what
you're saying because now it isa good time to come back now.
Because we did we did make achange in perception.

Yeah, we were to the we went to the
extreme right. To the completeopposite. We need to go to this
middle healthy place. Yeah.
Where we will treat people withrespect because that's what is
correct. But we will also allowthem to get to a condition or a
situation where they are happyand healthy, healthy and right.
And I say happy and healthy forone reason because obesity not

(24:40):
only causes problems in yourbody is not something that will
only give you diabetes or canceror strokes, but also it's also
related to depression, anxiety,isolation, high risk of suicide
and etc. If you are a victim ofabuse continuously on bowling
and rejection, you're reallyhurting the soul of someone

(25:06):
because of something thatprobably they have not enough
control. And we need as humanbeings to be a little more kind.
We we don't know when it willhappen to us and I'm saying
obesity but COVID Whatever,anything is a question of luck.

I think it's a good, that's a great time
to pivot into, you know,geriatrics because there's an I
think, you know, which brings,which will tie this into No
Country for Old people and yourmom who has dementia and, and
that area of medicine that is,is really underserved in my

(25:50):
opinion. And, and even geriatricdoctors, many of them don't know
about a lot about the, you know,a certain amount of what they've
been taught. And then, you know,unlike what you said in the
beginning, that you you take inthe whole person, I don't think
that that that is incorporatedin every doctor that I met

(26:10):
during my mother's journey. So Ilove I love to, to pivot into
that and to say, how do you, youknow, we need to apply the same,
the same idea, the same paradigmthat you're talking about for
obesity, for people that areolder for people who have
dementia, you know, and then youknow, and the combination
thereof, because that is thehorse that is the worst

(26:33):
combination in terms of livingin society.

Unknown (26:37):
I feel like we need to be kind in general, we need to
be kind of an elevator, youknow, where the person that is
asking you to push number three,that will be the way that we
manage ourselves in life andright now when everybody's
suffering in some way, not onlybecause of COVID but because of

(26:57):
the economy or whatever ishappening in their own lives.
Being kind is just the littlething that we can do for others
and for ourselves. That is free.
You know, it's just a smile onlike a tiny, nice word due to
Agra, how are you doing, I wishyou a good day the end and you
may we change the complete datefor that person free. In

(27:19):
geriatrics. And, and I want tobe careful on this. I don't
think that you react is the onlya specialty that she will have
or that has this concept of aholistic or comprehensive
approach. I believe that in amajority of the cases, that's
what we will like everyspecialty to have sure right.

(27:41):
Every doctor should practicelike that. I receive extra
training or extra, I will sayencouragement to do so during my
geriatric training in Peru, andalso here in the US for some
reason that is part of thephilosophy that is included and

(28:02):
you will see it also inpalliative care, hospice. In
many cases, we are seeing thattransition also in the ICU in
intensive care unit, but is notyet practiced all over, I will
love internist to do it, andprimary cares in general to do
it. But I don't blame them. AndI don't I don't judge them and

(28:25):
the reason is that the system isnot allowing us to practice the
way that we want the thing, thefact that you are going to a
physician office and you are notseeing this, when they are
treating, you know, notnecessarily reflect that they
don't know or they don't want todo it is reflect that they have

(28:45):
a manager in that clinic thatscheduled 30 patients for the
day, and that they have 30, no15 minutes to see each of them.
And then they have to documentand click a lot of things in the
computer to fulfill metrics andthen call patients to give them
results and refill things in thepharmacy. And this happened in a

(29:08):
period of time that you willlike to be able to you know, I
extend that I mean there are nomore hours in the day. So, I
have my I have my doubts on howwe will fix this because even
you may have motivatedhealthcare workers. If the other

(29:31):
side of the system right theadministration doesn't get the
point that we are not producing,you know bottles or whatever,
that we are really rigid humanbeings. Yes and that not every
appointment will last 15minutes. Some of them may last

(29:52):
10 minutes because it's ahealthy person that comes to say
hello and have that checkup andthe end but Add when you have
complex patients, and they don'tnecessarily need to be elderly,
I don't want to be biased. Theymay be a 30 -40 year old lady
with cancer or with diabetesthat already had a stroke or

(30:13):
going through a divorce, rightand very depressed or with
suicidal ideas. So, especiallyin primary care, internal
medicine, we see these varietyof patients, and we don't know,
just checking on the age of thatpatient, you will not know what
is coming. And and trying to puteverybody in this, you know,

(30:38):
range of 15 minutes is enough, Ibelieve that we are getting very
short, sadly. And what happensis that you are not building
this good relationship, thisappropriate relationship with
your patients where you canlearn more about the social
aspects and emotional aspects oftheir lives. Someone will not
come to them for first time andtell you oh, I went through a

(31:02):
divorce or my dog is sick, and Iam living in a place that is not
safe. And I cannot go and buygood food because I don't have
the money and working in threeplaces. They will try to give
you the I have been here I'mpaying there. And I have this
black spot here. Right. So thistakes time. And we don't have it

(31:23):
sadly, and for me, personally,is heartbreaking. Very
disappointed. And the reason thereason number one for me,
personally, and for many doctorsand other professionals to
develop burnout, because thereis a very big gap between what
we want to do what we thoughtmedicine should be, and what we

(31:48):
aren't doing every day.

Don Priess (31:53):
Right. And that's part of the I mean, that's
that's part of the diagnosisisn't it isn't like what's
causing this pain? Well, itcould be the fact that they're
working two jobs, and they don'tthey're not sleeping and all
those things, and you don't havetime to talk about that, you
know, you can't you can treatthe symptom but you're not
treating the cause? And doesthat all come down to money in

(32:14):
the long run? Because we don'thave enough time and staff? And
you know, what, is that whereit's stemming from? Because it
seems like everything does? Yes.

It's a very interesting question that
the quick answer could be yes,probably is because
administrators and CEOs ofhealthcare systems has zero
knowledge of medicine, they arenot doctors or nurses or they
never went to medical school. Sothey don't know what happened in
the operation room, they don'tknow what happened in a room

(32:47):
when you see a patient and youhave to tell them that they have
HIV or they have cancer. And youcannot do that in 15 minutes and
think that life continues likenothing because we as as as
human beings we have feelings toand then we have to go to the
next room. Right? If you arepregnant, so I don't think that

(33:09):
they have any idea of whathappened inside and I will
recommend any CEO to please takea few minutes to get the scraps
and go into this rooms, I'mgetting humanize because I feel
like that is missing. That'snumber one. Number two, I have
my doubts. So they understandreally their industry of

(33:29):
medicine, because if they willreally pay attention to what
medicine is about and thebenefits of creating a good
relationship with patients thatnot only increase the
probability of that patient willcome back and again and again to
you because they like you andthey trust you they will
recommend more family members orfriends. So that is good

(33:52):
business. And number one, numbertwo is that if they trust you,
they will follow your advicemeaning that they will recover
easily from the medicalconditions that they have. If
you are talking aboutprevention, they will prevent
right they will be compliant inanything that is related to
commercial. So you will bereducing costs you will be

(34:14):
reducing risk of disability youwill reduce medical or or
admissions visits to the to theemergency. So the cost of the
healthcare system and the costof Medicare Medicaid right will
go down and you will have happyhealthy people that also is
producing better in their jobs.
So I see this like Contraproductive is like how he is

(34:40):
that you are really avoidingphysicians to do their job
correctly so they can bring moremoney to the healthcare system
to the to the country and I justdon't I don't get it. I have
been trying to find Understand,I don't forget about being kind

(35:00):
for better, but about theemotional aspect. I'm not even
trying the humanistic part, I amseparating it. I'm just talking
about money, money, money,

money. Yes.
But I think I think it's, youknow, it really comes from a
corporate mentality. And itbecomes, you know, it's really
down to two Ledger's and, and,you know, how can you when
you've got, you know,stockholders and people that are
having are so far removed fromthe actual business itself, that
it just becomes an accounting?

(35:37):
And how can you get the How canyou get the most and the
fastest, you know, and, and, andfrom, from everything I've heard
read in my research over thelast year, he, what is the most
expensive part of any businessis are your employees, right? So
employees are the mostexpensive, so where are they
going to make their first cutsis with employees, so they're

(36:00):
going to try to get the most outof each employee that they have.
So without, you know, andforgetting that these are human
beings and not widgets, and notmachines, you know, that, and
you know, and if you burn out,well, then they'll hire someone
else, because there's plenty,you know, there's a pool to pick
from.

But again, that's the that's very
poor understanding of theprocess. Because, first of all,
a physician or a nurse, that istire upset, not only will treat
bad patients, so you will haveless satisfaction, which is some
of the wonderful metrics that weare supposed to measure right?

(36:40):
In the hospitals. So you willhave less patients satisfaction
patient will not like to beadmitted again, in that
hospital, they will notrecommend that hospital or that
clinic. So not good for thebusiness, then you have more
more risk of medical errors,this count with Sue's right? Me

(37:02):
too, I'm very bad advertisement.
And last, but not least, if youhave a physician or a nurse that
quit their job, right, or thatcollapse in front of you on USI,
that is not useful. At thatpoint, what you have to do is to
recruit recruitment, andretraining is so expensive, that

(37:22):
is not worth it. So again, I cango back to all these removing
the emotional aspect, just tomoney, money, money, and you try
to get the numbers and doesn'tmake sense. I

mean, you touched on something important,
which is, you know, the, thecost of training and
recruitment, you know, is is isis not, it's not something to to
ignore. And I think because ofthat, this is why, and I'm going
to, you know, turn it back intolong term care and, and, you
know, at nursing homes, thingslike that acute acute centers,

(38:08):
because there's a lot of there'sa lot of people working, that
aren't trained now, becausethey're just putting them
through, you know, the cursorytraining just to have bodies in
there, basically, which is, youknow, and I'm gonna, I'm
speaking not technically so butI'm just saying, This is what
I've seen. And this is why oursystem is is it's it's not a

(38:29):
broken, it's frightening,because your your huge decisions
are made by people that don'tare not qualified.

Dr. Miriam Zylbergl (38:38):
Absolutely.
And not only that, you don'thave enough staff, but the staff
is very low motivated and veryinappropriately terrain. Yes, we
are, we are rushing trainees andwe are we are getting people
that is not prepare. I am veryrespectful with what sadly we

(38:59):
call providers that this pool ofa lot of different professionals
put all together under that sameso you have nurse practitioners
and PAs and etc. But even I amvery respectful and I have very
good friends that are pas andnurse practitioners and I know
the value that they representand their amazing knowledge on

(39:21):
how much they care aboutpatients. But they are excellent
pas are excellent nursepractitioners, right. They are
excellent doctors but you cannotdo the job of others and they
are trying to replace and giveresponsibilities at a level that
does not represent yourtraining. And that's not

(39:43):
appropriate for patients. Andthat's not appropriate for the
same individual that decidedthat wants to be a PA or a nurse
practitioner and feelscomfortable with that role but
is not prepared to theresponsibility than an other
role will, you know, force themto. So that's a big problem. And
of course, it is less expensiveto hire people with less

(40:07):
training, rather than to hire aphysician. But that that's part
of what is happening right now.
And I feel bad for them becauseof the level of stress as is
like dealing with sick patients,long term patients are
counseling and emotionaldistress and, and, and the fear

(40:30):
of doing something wrong whenyou don't have someone there
that you can, because theysuppose we should have someone
available to also discuss thecases and feel that they are
doing things correctly. And Ihave many of these nurse
practitioners and PAs sayingthat it's like, we love what we

(40:51):
do, we want to help but we knowour limitations. And so it's not
me as a physician, judging orunderestimated the value of
others is respecting that theyhave the right to work under
their scope, because that's whatthey say for them. And that's
what they want to do.

Right. And I actually I saw that firsthand,
in my own experience, where somewere a nurse who was not ready
to take on a floor by herselfwas there all by herself and was
an made horrific mistake. And,and it was and she was so
overwhelmed that my heart brokefor her. But it was for but it

(41:31):
was to my mom. So here I amstuck in the middle of like you,
you were put on this situation.
And I feel sorry for you. i Butbut I feel sorry for my mom. I
don't know, you know,everybody's got everybody's is a
victim in this city in this badsituation.

Dr. Miriam Zylbergl (41:49):
Absolutely.
I believe we are all we are allvictims. Sadly, sadly, this is
something that majority ofindividuals are not aware of,
they see the nurse practitionerdoctor, any of us her
professionals as the monsters onthe, you know, on this picture.
And you don't want to give methis order, you don't want to

(42:12):
submit to the court, or youdon't want to prescribe that you
don't want to be with me Youcare more about your computer.
And, and yeah, that's how itlooks. Really I will not say
that that's not correct. Becausewhen I remove myself from the
white coat, and I am the mom orthe wife or the daughter of
someone, or I have to or thepatient, right, I have to

(42:36):
experiment the healthcaresystem. I am like, oh my gosh,
this is how it looks. And theother day I went to see a
physician as a family member.
And I almost shocked him. It'slike, May I hug you I am
impressed. You were so kind yourstuff is so kind and I was like

(42:58):
looking like a crazy person.
Like, you know, enjoying thefact that I'm feeling normal.

I literally, I have the speech
therapist, I hugged the speechtherapist that came to assess my
mom, the day and I and I thinkshe looked at me like I was
crazy. But it was like finally Ihad somebody that was a human
being right. That I felt like itwas like listening to me and
like and, and and you know,validating what I was trying to

(43:27):
get across but

your perception socio right, you
thought that you were seeingfinally a human being you in
front of human beings all thetime? They were so a stress in
survival mode. Yeah, every fivethe next possibility of you know
having an error. Already IBUsYes, already abused by their

(43:55):
boss says no leaders boss saysand also be used many times by
the patients that are frustratedor scared and that they are
seeing just half of the story.
Right? They don't hear the kindsof things

what you're talking about is moral injury,
because I hear this a lot rightterm. Okay. And I think that
it's really important thatyou're bringing this up because
we we as a patients, and we'renot in the medical, you know,
anybody that's not in themedical field at all? We don't
know. So the only people we areinterfacing with, are those
doctors and nurses and nursepractitioners and PAs. And so we

(44:28):
we really do we because we don'tknow now I know. But before if
you don't know, you really feellike it's coming from them and
that they could do better. Butnow you know, but we need to
tell people that they can't dobetter. And that's why things
have to change. Right?

Don Priess (44:47):
Expectations are when as as the patient or the
family of the patient. You seesomebody in the uniform, and you
immediately think they knowexactly what they're doing. They
are educated They know exactlythey know they can solve a
problem just because you askthem, and it's not the case. And
it's and it's an like Susie saidshe didn't had no idea until she

(45:09):
went through it. And I thinkthat's probably 98.7% of the
people who are going to gothrough this. Just think that,
oh, there's a nurse, there's,they've got that uniform on,
they must know they can solve myproblem. And it's not the case.
And it's

no time, the time that we spend
trying to convince, you know, aperson on the other side of the
phone, that my patient needs anMRI know that x ray, that needs
to be normal, so I can do theCT. So then I can do the MRI,
when I know that everything willhappen, you know, will be

(45:45):
normal, I will take three monthsto get to the MRI, if I am
lucky. I don't need the otherones. I just need to place them
the MRI, don't spend money andtime into tasks that I know will
be normal. I think that comingfrom someone, right? graduated
from medical school, thatconcept shall be so easy, right?

(46:09):
Right. That's an easy task andnormal task is impossible,

right?
Because they're right, becausethe boxes need to be checked
off. And those boxes, you know,equate to money. And they equate
to money, because if they cancharge for another x ray, they
can charge for another, youknow, CT scan, and all you want
is an MRI will know this, thenyou're going to cut you're going
to cut those two steps out. Andthat's money. So I have a

(46:33):
question in that respect. So ifyou as as as providers to throw
of net over, over all, all ofyou very nuanced, nuanced,
skilled positions. What if you,what if you were transparent,
and just said, I want to workwith you more, I would like to

(46:54):
spend, you know, more than 15minutes, but this is the system,
I just want you to know that andif everybody heard that from
their, their provider, so thatthey got a sense of like, it's
not my doctor, it's above thedoctor. I mean, I think that
maybe the doctors can be moretransparent or is that put their
their jobs in jeopardy? Yes,it's definitely

a shoo in for sure. retaliation,
that clear? They fear inside ofthe system is unbelievable. And
and the bystanders, right? It'simpossible to believe you. Yeah,
it's our pricing is verydepressing, actually, to see how

(47:41):
much people is ready totolerate, to keep their jobs.
And I understand why also.
Because if you have kids athome, if you bought recently a
house, or if you have parentsthat are elderly, I need to take
care of them.

I guess they have no choice, you have no
choice.

And you have a non competes. And I
don't know if you are aware ofnon compete non competes are
things that you'll find in yourcontract that, that really limit
your ability to find a secondjob, right, if you quit your
job, you, depending of yourspecialty and the type of non
compete, you might need to movefrom from from not only your

(48:22):
city, but the state to practicefor X amount of years in another
state. So you can be a doctor ornurse on money. And then two
years later, or a year and ahalf later, you can come back
and you know, reunite with yourfamily where you are

that that makes me so angry, because it's
very frustrating to hear thatbecause it it seems like they
they've created a system so thatit does shackle for lack of a
better word of shackles, youknow, everybody's to do their
job in a really profound way.
So, if they can do if they cando that, if they can create that

(49:03):
kind of, of a platform, whycan't we do that in the way that
it works? Because when I talk topeople who are professionals,
they say oh, it's so broken,it's so convoluted. It's such an
a web, you can't you know, wecan't pull it apart. We can't
you know, there's just too manypieces. Well there was there's
always too many pieces. Theyseem you know there there's a

(49:25):
system in place that keepseverybody staying in this
system. So that that you know itso we there is a way to change
it, don't you think?

I well, I want to sing that. Yes.
Because the other option is Ihave to quit medicine and that's
something that I'm not doing. Ilove everything and I refuse to
think that I will be miserabledoing what I love. So yes has to
be a way that the way exactlyway, I don't know if but I can

(50:02):
tell you something is in bigpart of what you are doing with
your documentary could be, youknow, a stone that is building
in that direction, you need tocreate awareness, we need to
remove the core things and allowpatients to be empowered. And to
understand that they are, Iwould like the word victim, but

(50:28):
I will use it in this contextthat they are victims the same
that we are victims of a brokensystem, that we are in the same
site, and that we are supposedto collaborate. So reducing a
little distress that healthcareworkers are receiving from
patients, that mistreatment fromthreat patients, and it's

(50:49):
ridiculous, but when you youwill imagine that a doctor will
get hurt by a patient this isexcept except that these are
psychiatrists. But but thosethings are happening you are you
assaulted, I have been insultedby patients so many times
because I am saying I cannotgive you that referral, or I
will not prescribe yourantibiotic. You know, what

Don Priess (51:12):
insurance won't cover or you know, whatever. And
that's, that's what's socounterintuitive about all of
this is that if the system wasrunning properly, everyone,
including the insurancecompanies would they're paying
out less, they're paying outless claims. Yeah, it's just
it's insane. And it's also alittle frightening. Yeah, go

(51:32):
ahead says

no, I was just gonna say that the people
that it feels, you know, the wayyour your framing that if we
really it is supply and demand,right, that's business at the
end of the day, that's thesimple version supply and
demand. So we are, we are aspatients were in demand, because
without us, they're not going tomake money. Great. Yeah. So so

(51:53):
we we in essence, as apopulation of patients as right,
we have power, because if we wedemand it as a as a population,
and we say, well, if you we'renot going to go here to you,
we're going to go to the placesthat provide us what we need,
instead of just accepting it.
Instead of going oh, this is thesystem, this is what we have to

(52:15):
work within No, we are the wepay there, we pay the checks.

Well, I will tell you something I see
doctors, including myself kindof fast, you know a restaurant
or waitress in a restaurant orthe cooker. You pay well you pay
the owner of the restaurantbecause I don't get the money
with the liner right. You andand I am supposed to give you

(52:42):
these the Legions for that youwill enjoy and you will live
happy you cannot give me a tipis that is illegal in this
country. You will not receiveanything of course but but
that's more or less theirrelationship I physicians, we
are supposed to be servantleaders right in the community

(53:03):
we are so physicians nurses onthe complete team, right? We are
supposed to serve the patients,the patients have the right and
they have their shoe has theright to select who is a doctor
what facility they go to? Whowill see them or not, but that
doesn't happen. Who decides allthat is your insurance. You

(53:24):
cannot pick up and then you goinside of the hospital and you
have to see thesegastroenterologist because
that's the person that theinsurance says and and you're
like, why I hate that person?
Yes, but But if not, you willhave to pay this amount. So
there is no transparency in theprocess. There is not really
democracy in the process ofhealth, if you want to call it

(53:47):
like that where you can selectand therefore your writer They
do that because you don't youdoesn't matter how much you will
have, you know how big is yourtantrum, but if your doctor or
the doctor about you, one cannotsee you or will you know will
build you without insurance.

(54:07):
Your hands are tied. So that'swhat makes complex a situation.

Totally.
And you know what it does? Itbrings us back it just makes me
think about our metaphor fromthe beginning of the Wizard of
Oz because we need to pullbecause behind the curtain is
this ridiculously disgustinghuman being who's back there,
you know, who's just aboutposer, and he's back there being
or, you know, the big the bigbrand that everyone's afraid of
and they think that this is theway it is. And then you know

(54:33):
toto pulls the curtain back andwe see it's just this really
fumbling bumbling man. And nowwe've blown the cover. Well, we
need to blow the cover. And wehave the power to do that. We
just can't be afraid and we haveto do it because that's really
what it is. And they're in suchthey're they've created such an
illusion that we have no powerbut we do. In 30

years you have the power of physicians
and healthcare workers. willhave the power also to practice
medicine in the way that theypromised they will be and that
is patients safety and rightbeneficence and you know, all
the lives of these ethicalconcepts that are a should be
priority. And a big part of, Iwill not say is a solution, but

(55:21):
I feel like is, we need to startwith healing, we need to start
with self awareness, we need tostart being aware, right as what
is happening in the communityneeds to learn physicians,
nurses, etc, we need to learnwhat is happening, we need to
understand what is happeningbehind the scenes. And knowledge
gives you power if youunderstand that this is not the

(55:44):
only way that there are betterways or different ways. So for
that probably medicine only astraining is getting short right
now you need to train physicianleaders, nurses leaders, right
you need to provide educationand emotional intelligence
leadership skills, self care tocreate a strong human beings

(56:10):
leaders that will be using thewhite coat and a stethoscope and
we'll add healthcare workers,but that they have enough
knowledge to be able tounderstand the situation and to
maintain their own well being sothey can keep going and they can
keep helping the community andraising their voices and helping

(56:32):
themselves on under themes.
Because right now, majority ofus I mean, based on the
statistics you have more than60% 65% of physicians were in
burnout right and you can changethe name or a lien theory
whatever anyone but they are notin a situation if they if they
will be if they will be pilotsdriving a plane, they will not

(56:56):
be driving the plane. Right?
Because Bernau means that theyhave error. Yeah, risk of error,
right? They are able toconcentrate or they are tired,
because they focus on or theyare not motivated. You will not

(57:16):
like that pilot to drive yourplane. No, but they are doing
Neurosurgery is

right, right. And there's and the
suicide rate is very high,right?

So three to 400 per year, as per
data. What is very, very fine isthat these numbers are before
COVID. So probably we will getnumbers that are worse now. And
I clarify that because many havein trying to say well, this is

(57:50):
because coffee than they were nono, this is not because coffee,
this is because morally injury,right? And because of this gap
between what we want to do onwhat are we doing. And it's
terrifying because you aretalking about one to two
physicians dying every day inthis country by suicide, and

(58:12):
then you have nurses and otherhealthcare professionals. So
under numbers are notnecessarily better. Um,

this is a disaster. It's no, it's a
disaster. Because if we don'thave we, as it is, we're don't
have we don't we're notproviding, you know, the, the
the environment for doctors andnurses and providers to do what
they do. And then on top of it,so they're either burning out
and leaving the industry becausethey can't stay in it. And I've

(58:44):
talked to a lot of doctors thatare doing that, or they're
taking their own lives which iswhich is so tragic. But then,
you know, as as patients ashuman beings that need doctors,
we now work now we're caughtwe're creating such an such a
horrible crisis. But that's awhole nother Okay, I just feel

(59:05):
like I have to talk about yourbook. And I want to, I want to,
because it's getting so, soincredible. But it is it is
connected, it is connected. ButI want to hear about your the 3g
cycle because I think I want toI don't I don't want to give it
short shrift, but because thisis love conquers all. I want to
ask you one thing about in termsof geriatrics, and that and

(59:29):
that, you know, that focus andhow, you know, we as as
caregivers of someone withdementia or Alzheimer's, and I
know in my community, I hear ita lot that that that there's not
enough. There's not enoughinformation from the doctors
that we go to, and how can wecreate? I mean, again, a big

(59:53):
problem but how can we at themoment, help ourselves help our
loved ones or if we're diagnosedwith You know, early onset or
whatever, we there's not enoughpeople that understand it. And
that's why they're, they aregiven short shrift, because
there's not an understanding ofit, you know,

Dr. Miriam Zylberglait Lis (01:00:12):
well as Slimer is, sees a condition
that, sadly, is very frequent inelderly population more than
what we will like. But at thesame time, even we may be able
to do a correct diagnosis atsome point, clinically, or now
with more sophisticated tests,that treatment is the part that

(01:00:34):
we really don't know. Right nowwe are seeing this controversy
about a new medication that FDAis approving or already approved
from many individuals in thescientific world are questioning
the type of status and I feellike that's the big problem, we

(01:00:54):
are really even we can diagnose,we cannot read and that's very
frustrating for for thepatients, especially for the
family and for for us physiciansto it's very important also for
for those that maybe are not soused to the term Alzheimer and
dementia to understand that theyare. Dementia is a big, big ball

(01:01:17):
that contains Ulzheimer and thatthere are other types of
dementia, right, becausesometimes we think that it's the
same is not the same, theclinical presentation is
different, the progress of thedisease is different. And sadly,
we don't have medication for theother ones either. So So that's
again, a big a big problem.
Right now, the only thing thatwe have really is the support of

(01:01:42):
the family members on thesupport of the the
multidisciplinary team, yes. Tohelp the patient and the family,
it's very hard to find thatagain, in a system that is
broken, where you have apsychologist and a social worker
and a physical therapist andpsychiatrist, geriatrician,

(01:02:03):
working together in order to getyou know, the patient to have
the best quality of life, that'svery complex, when you have a
system that

Susie Singer Carter (01:02:16):
doesn't support that it doesn't support
that. And I think what you saidin the very beginning about
taking into account into, youknow, account the whole person,
so when you have amisunderstanding of Alzheimer's,
and and and so and you and asthe physician not having the
time to be able to take intoaccount that, yes, it it

(01:02:38):
manifests it, it shows up indifferent ways in different
people. Yes, there aresimilarities, but one case is
not every case, that's just theway it goes. So and because
there's no treatment, we as aphysician, as physicians, as the
team, everyone needs to knowthat they understand it better,

(01:02:59):
rather than dismissing it. Imean, I spoke to a professional
who was very respected, youknow, on a high level.
Yesterday, I was interviewinghim and he basically said, Well,
I understand my grandma hadAlzheimer's for 10 years and it
was like she was dead already.
But that isn't true. That issuch a bias and such a
stereotype to like to lumpeverybody you know, just say

(01:03:21):
that they're not worthy orthey're not alive. They're
basically they you know, it's sothat understanding is just i My
heart was pounding yesterday

Dr. Miriam Zylberglait (01:03:34):
because I feel it in different ways
right I feel it like thegranddaughter I'm the daughter
of someone that had the benchand I feel it like the doctor
that decided to study geriatricsin Peru and came to this country
and I'm trying again ingeriatrics and I didn't do this

(01:03:56):
because I think that elderlythey don't deserve a good
treatment or they don't deserveto be respected I did it because
I believe that even until yourlast day you deserve to be
treated as a human being thatyou are how many times we see
this lady ladies or gentlementhat yes they may or may look

(01:04:16):
like they are not there andmaybe they are not it's hard for
us really to say that they canunderstand or not we really we
we don't know each case isdifferent as Susie was saying.
But if you go back on the story,they created something or they
wrote a book or they have us Idon't know a street with their

(01:04:38):
name because they save lives. Wecannot forget the past of these
individuals we cannot forgetthat these individuals are our
future. Tomorrow we will be themtomorrow we will be them. So we
need to train the society okaythe society okay, that word Kids

(01:05:01):
in a way where they are kind andrespectful with those in need
with those that are frail,because tomorrow we will depend
on the kindness of this newgeneration, they will be the one
that are watching for us. And ifthe other way that we want to be
referred as like we are that weare off chair we are, I feel

(01:05:24):
like is a very non humanisticapproach. And what happens is
that, when we remove the humanaspect of individuals, when we
give them the title of providersinstead of Doctor these nurse
doc, right, right, patientnumber 45. Right, we do that we

(01:05:47):
do it to remove, right, theconcept of human. Yeah, that's
right. And that's easier totreat someone that is not a
human.

Exactly, exactly.

Don Priess (01:06:02):
And it starts, it starts with education. And it
starts with educate, we have toeducate from a very young age,
you know, to for the, not onlythe doctors, doctors don't even
know, we need to teach thechildren, our children, we need
to explain it don't avoid it, wehave to explain what's going on.
We have to, we have to demystifyit. And they're still human

(01:06:23):
beings. They're just different.
They're the you know, like Susiealways says, you know, you
don't, you can communicate witha baby, they can't speak, but
they can understand and they youcan do it. And I'm not saying
that they're babies, but youhave to learn a new way.

It's just that they've lost skills.
They've lost a certain level oftheir brain, but there's other
parts of their brain that areworking. And so and they're
very, and they're very, it'smeaningful, because you know, to
the day my mom died even withoutyou should when she started to
lose her, her speech. She wasstill speaking. And we in even,

(01:06:59):
you know, in a different way,you tune into them and you can,
my mom would laugh, She'd cry,she'd swoon, she'd kiss, because
those are all those areemotions, those are feelings,
those are instinctual there.
Those will never go away.
They're there.

Dr. Miriam Zylberglait Li (01:07:17):
Yeah, and again, he's we need to treat
people the same way. I mean, myhusband and I will repeat that
at home all the time to ourkids. We need to treat people
the way that we want to betreated right and we need to
lead by example. I see my momtoday going through this. And

(01:07:37):
the first thing that comes to mymom, to my mind is that she took
her mom to our house when I wasin medical school she moved her
so she was living with us and mymom took care of her mom with
dementia until the last day andmy sister and I we were part of
this process was a family youknow a family commitment that

(01:08:01):
they are you know, My Baba rasawas was my best friend and we
love her until the last day andmy kids are never met her. They
talk about my barbero saw mygrandma Rosa and they know that
you know about hair and and theylove her. And there is nothing

(01:08:23):
wrong about having feelingsthere's nothing wrong about
going through the sad processand the grief especially when
you know that you are doing yourbest that you are trying your
best and being respectfulunkind. The other we can
question or we can you know berespectful and open minded with

(01:08:45):
those that believe that yes,they can care as they cannot
hear as it is sometimes will be,you know, challenges improve
that one thing or the other,except that we don't know
protests or with the images andetc. But But beyond that, that
person is still a person isstill your mom or your dad or
your friend. And now is when youshow how much you love someone

(01:09:10):
in parties and celebrations ingood times. It's very easy to be
there. Or to be surrounded by alot of people. The question is
who is with you when you youknow you are in your most
vulnerable stage.

Amen.
That's and

how do you how do you as a physician because you
have 40 patients and you don'tyou know, how do you with
especially with with somebodywith Alzheimer's? How do you get
to know them enough that youspot things like Suzy sees
things saw things or mom thatthe nurses the doctors would
never know in a million yearswell how she was doing. How do

(01:09:50):
you do that? Because you don'thave the time you don't I mean,
how do you get past Well, I

Unknown (01:09:55):
will refuse to see 40 patients if someone wants to
hire me to see 40 patients Imean Believe me, the answer is
no, I will not do if it goesagainst my ethics and my values.
So no way. But even when youhave a reasonable amount of
patience, right, that allows youto stay one hour with the
patient and allow them for along time, you will not know

(01:10:19):
that person as much as thefamily member. And that's why
one of the most importantmembers of the multidisciplinary
team is a patient on the family.
Yeah, and we cannot ignore that.
And when you see a geriatriciantalking about multidisciplinary
or holistic or comprehensiveapproach, you will see the nurse

(01:10:40):
and the doctor and the physicaltherapists and the, you know,
the clerk and I love and youwill see that in the middle in
the center of this group is theface of the patient and the
family behind them. Why becauseat the end, you need to adapt
your therapy to the patient, thepatient, again, the patient is

(01:11:03):
the one that is asking, I wantfish with the sauce or whatever,
right? You you need to adaptyourself to what the patient
feels.

But it's such a struggle, because Susie, you
know, would tell them no, youdon't understand this is what
she's doing. And they're justlike, you know, they kind of go
by the book, as opposed to bylistening to the family member
when they know. It's that'sthat's a problem. And it's a
struggle is what Susie wentthrough the entire time.

Dr. Miriam Zylberglait Lisi (01:11:31):
And that's and that's a very big
problem. And and I I would liketo tell you that that this is
one case in Emilian. And sadlyis not one case in Emilian. We
are living in compassion,fatigue, and party fatigue, you
have people working just becausethey have to surviving day by

(01:11:54):
day. This doesn't. I want toclarify that I don't think that
these justify mistreatment orlack of respect or medical
errors. Now just explain whythis why it's happening. Yeah,
but but but that's unjustified,right? This never happened. But
but you have and then you haveindividuals that are not well

(01:12:16):
trained remember something.
There are not many geriatriciansin this country. Many of them
they don't want to even go therebecause it's not there are no
jobs for the repetitions becausethere are no geriatric centers.
Because there is like, if youwant to work in a hospital,
there are not even geriatricdoctors to do consultations,
because that goes against themetrics of the hospital, a

(01:12:36):
patient will have to stay longerbecause needs physical therapy,
and needs evolution of this andit's and that mess, metrics. No.
So yeah, geriatricians we work Ihave to admit and Brooks breaks
my heart that I have to work asan internist, a little more
sophisticated internist. Butthat's my role in this country

(01:12:59):
because except that you go tospecific places. You cannot work
as a geriatrician, I apply whatI learned geriatric for young
people to write. But there isnot a way to do geriatrics. And
as a result, as a result, youhave a lot of geriatricians that
are not geriatricians, that theywere trained in places that are

(01:13:21):
not preparing them to begeriatric doctors, because
there's no opportunity.

There's no opportunity. That's, that's so
sad. Well, let's let on thatnote, let's talk about the three
G. Let's talk about your book,which isn't sad. It's the three
G psych cycle of life thesecrets of for achieving joy,
meaning and well being. Right,yeah. So tell us in a, you know,
because I want everyone to goout and get your book, which is

(01:13:52):
it is totally charting, as theysay, on the charts on Amazon,
and which so congratulations.
But get give us the gist of thethree G's, what it stands for,
and how you came up with it andwhy everyone should read it.

Dr. Miriam Zylberglait Lisig (01:14:09):
So the three D is a result of me
fighting burnout and trying tofind my purpose again, and you
know, escaping the dark hole ofthe system, plus COVID and I
have been very resilient all mylife and people used to ask me

(01:14:31):
how and I never pay attention tothat I saw that it's so normal
on that stuff, how I am doingCOVID And with everything that
was happening in my life, I wasnot able to leave this to good
luck, right? I was supposed tounderstand what is happening,
how I do it, how I replicatethis and get the help that I
needed to make sure that thosearound me will be okay too. And

(01:14:55):
that's how I came with the 3d Ifunction or identify functions.
Thinking that life is kind of avideo game, I go level after
level, and I don't think that Idie, I see a lot of other, you
know, hearts in the game thatgive me extra life and I learn

(01:15:15):
the new tricks and I adapt. AndI try again and again till I am
able to, you know, get moresavvy and go to pass the level
and go to the next level. Sothat's the concept of the 3d
cycle is life us cycles oneafter the other. And the
components for the cycle are thecomponents that I found that are

(01:15:36):
keeping me alive and I'mdirector. And they're first of
all goal, I start every processthinking about what is my goal?
What do I want to achieve, andwill be something mandatory
finished medical school or getmarried or have kids whether
society force you to do, butcould we write a book or go to
Italy, something that could be adream. And then to be able to

(01:16:00):
continue to recycle, I needenergy, this fuel right that I
call grid, which is a secondyear, goal grid. And some things
come from inside myself. Andsometimes it's people cheering
me up like you can do it, right,which is also very important, I
need it. And you will see thatat the end of that cycle, you
will achieve your goal and youwill close with a second right

(01:16:22):
with that with that G up fromGod. But the truth is a majority
of the times in life we don'tachieve our goals are not the
way that we expected or the waythat we wanted. And many times
what happened is that we changedour mind at that red Ferrari
that was important when we were15 is not so important when you
are 40. And you have to takeyour kids to soccer, right and

(01:16:46):
you need a van. So we we mayadopt even our goals. And that
doesn't mean that we arefailing, it's just that we are
growing, and we are learningsomething new. And we are
developing new skills. Andthat's the last G from the 3g
cycle growth. So go greatgrowth. And I use that

(01:17:06):
perspective to navigatedifferent catalysts in life,
that could accelerate theprocess to achieve our goals for
that pool, you know, make us gochallenge after challenge. And I
was very lucky to interview morethan 30 amazing individuals,
from medical students tolawyers, book, Buddhist monks,

(01:17:29):
Wall Street people, professionalathletes, and four continents
involved. And they were sharingtheir stories of challenges and
their opportunity to grow afteradversity. And they were sharing
also their knowledge explainingdifferent techniques that they
use that after I investigatethem, I back up in the book with

(01:17:54):
some evidence, scientificevidence to explain why they
work and why they call work foryou too. And in between I have
some of my own stories andstories from my family and my
kids and my husband and I addedsome art that my kids created
for me so they feel part of thecombination and this is a family

(01:18:19):
this is theta started us as avery lonely journey and ended
Vienna collective journey whereI have family members and
friends and colleagues andmentors involved.

It's it's I can't I can't think of I was
trying to see if I couldremember it. But I posted this
quote about you know, whenyou're taken off your path and
from a from something, you know,difficult something very
difficult and we think that weare taken off our path and and
we're mourning that loss aswell. And then you that it but

(01:18:56):
then you lean into it like likeanything else. When you lean
into something that's difficult,then you realize that it's
actually the gift because it'sbrought you to a different path
that you that you belong. And soif you can look at the other one
as not being a loss, but as adoor, then then you you are your
you can only win. You can only

Dr. Miriam Zylberglait Lis (01:19:18):
win.
And that comes from talkingabout science, right? What's the
science behind this concept? Ifyou think about positive
psychology, they have a conceptthat is called Post Traumatic
Growth. Normally we talk aboutresilience in resilience to
bounce back. So you go in life,this is your baseline, something
bad happened to you. And thenyou go back to your normal or if

(01:19:42):
that's not the case, you succumband you have you know,
depression post traumatic stresssuicides. Post Traumatic Growth
takes resilience to a differentlevel. You get to your baseline
but then And you learn from theadversity, you use adversity in
your favor. So you don't stayhere. But actually, you

(01:20:06):
progress, you go to a nextlevel. And what is wonderful
about that, and and this isperfect, I could use steel. So
see as a perfect example, rightyou, you went through adversity
with your mom, you saw so manythings happening you were able
to decide to be cranky and upsetand get your tantrum and maybe

(01:20:27):
get depressed or whatever, oryou decided to probably go
through it also, right? Like weare humans, we have to go
through the process. But thenyou went back and you go stay in
your baseline, you could be justresilient, but you decided to
not I will not stay here, I willuse everything that I learned I

(01:20:48):
will use even the pain in myfavor. And now I will grow and I
will do something that is thetypical what happened with
people that grow, I will help mycommunity I will do some
forward.

Yeah, papers.

Dr. Miriam Zylberglait Lisi (01:21:05):
And that's, and those stories are so
inspiring, because you don'tneed superpower for this right.
You don't need to be super girlor whatever. You just need to be
a human being with you know, aclear purpose and in life and to
keep going and to accept alsothe help of those that are

(01:21:27):
surrounding you. Because wedon't grow by ourselves, we we
grow with all they're supportingus. And that's what they want to
inspire with the with the bookthat we are not victims of our
lives, that we cannot live ourlife complaining of what
happened to us, we need to usethe things that happened to us
in our favor, and we need tokeep going and we need to keep

(01:21:50):
growing. Right?

I'm totally totally I mean, I feel like
everything that you've you say,has one big giant theme, which
is the theme of our show, whichis love. It all comes from love,
right, Don? Because we alwayssay that you know

why? Why we do say this, that love is powerful.
Love is contagious. And loveconquers all. This was an
amazing time.

It really does. Look at her. Yeah, it
does.

And, and we we have so much more we didn't cover and
we'll do that again anothertime. But we hope everyone
enjoyed this episode. If youdid, please like, share. And
please, if you can, you know,check out what we're doing with
No Country for Old people. We doneed financial support. We're
not you know, we're not proud.
You're gonna say it, we do. Andit's all tax deductible. 100%.

(01:22:43):
And if you feel you want to bepart of this movement, please,

please, please donate whatever you can.
We'll have it in the show notes.
And we'll have all of Dr. Z'sinformation in the show notes
and how you can reach her andhow you can get her great book.
And, and we love you and we'llsee you next time. Absolutely.
Thank you. Thank you so much.
All you gotta do is sing a song

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}DR. MIRIAM ZYLBERGLAIT LISIGURSKI: The 3G's for well-being: Goal, Grit and Growth & The Truth About Doctor Burnout

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DR. MIRIAM ZYLBERGLAIT LISIGURSKI: The 3G's for well-being: Goal, Grit and Growth & The Truth About Doctor Burnout

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