October 22, 2025 • 45 mins
Dr. Jill Grimes joins Dr. Erich Schramm to discuss young adult health, covering topics from teens and college students to those just starting life on their own. They discuss her book, The Ultimate College Student Health Handbook, and the evidence-based advice Dr. Grimes shares to help students navigate the healthcare system confidently.
From practical tips like keeping a photo of your insurance card on your phone to knowing what to tell your doctor at the start of a visit and what to ask before you leave, this episode covers real-world lessons every young adult should know. The doctors also dive into important privacy questions, including who can access your medical information when you’re still on your parents’ insurance.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Announcer (00:00):
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts, hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Erich Schramm (00:11):
Hello and welcome back to another episode
of the MedEvidence Podcast.
I'm your host, Dr.
Erich Schramm, sitting in forDr.
Michael Koren today.
I am a board-certified familyphysician and longtime clinical
research investigator with morethan 10 years experience with
the ENCORE Clinical ResearchGroup.
And I'm really excited to betalking to Dr.
Jill Grimes today.
(00:32):
For those who don't know Dr.
Grimes, she is aboard-certified family
physician.
So shout out to board-certifiedfamily physicians, of course.
She specializes in teen,adolescent, and young adult
health.
And so she is also widely knownas the TikTok college doc.
So she's on multiple uh socialmedia platforms.
(00:57):
She goes on TV.
She's an educator.
And uh most importantly, forour purposes today, she is the
author of the ultimate collegestudent health handbook.
I'm holding the third editionin my hand right now, so I'm
really eager and excited to diveinto that discussion.
So welcome to the Med Evidence!Podcast.
Dr. Jill Grimes (01:19):
Thank you so much.
I'm really excited to be here.
Dr. Erich Schramm (01:22):
So, Jill, um, you've got such a fascinating
background.
Um, maybe you could tell us alittle bit about where you grew
up, what got you interested indoing uh medicine and how you
ended up pivoting intoadolescent and teen health.
What did that look like foryou?
Dr. Jill Grimes (01:40):
So I grew up a lot of places.
My father was a professor andas an administrator, and as he
moved up the academic ladderevery couple of years, we moved.
So I was born in California,but lived a lot of different
places.
But I went to middle school andhigh school in San Antonio,
Texas.
And uh, so that's how I endedup in Texas.
(02:00):
And my dad, again, being aprofessor, I have a brother and
sister.
My sister is a doctor, mybrother is an engineer, but also
has an MBA and teaches.
So we we were all very muchindoctrinated into the more
education is better.
And uh the doctor part part ofit is a funny story.
(02:21):
Literally, when I was in fifthgrade, I had all A's and a C in
handwriting.
True story.
Teacher pulled me aside and shesaid, That's okay, Jill, you
can be a doctor.
And my handwriting has notimproved.
This is actually a plus ofelectronic medical records.
Dr. Erich Schramm (02:35):
Uh, but I was just gonna say that.
That's great.
Dr. Jill Grimes (02:39):
And I was not the only doctor with bad
handwriting.
I am not.
But the the reality is that Ihad teachers and educators along
the way who were constantlysaying, you know, be everything,
do everything.
And I loved science and I lovedhelping people, and I loved
animals.
I thought about being aveterinarian briefly, but mainly
(03:00):
I just was focused on being adoctor.
And to me, family medicine willlove this, but to me, being a
doctor meant being a familyphysician.
And sure enough, in medicalschool, I loved every single
rotation except anesthesia andmy husband's an
anesthesiologist.
Um, I have an issue about spit,but anyway, I really loved
(03:21):
every rotation.
And the cool thing about familymedicine is we get to do a
little bit of everything.
And so I did private practicefor 20 years.
And during that time, I endedup doing some writing.
And I'm always I'm a problemsolver, um, or I want to be a
problem solver at any rate.
(03:41):
And so I saw a problem in myvery wealthy, educated private
practice community about lack ofeducation about sexually
transmittable infections.
And that is not a cool or funtopic, but it was something that
the education that I was doingin the exam room and that
(04:02):
classrooms were doing with sexed, clearly it wasn't hitting
home.
And that's because nobodythinks it's their group of
people, right?
We always think it's them overthere.
And so, what started as acouple pamphlets for my office,
which were stories, becausestories are more powerful than
statistics.
My patients could tell me everystory from Gray's Anatomy or
ER.
(04:22):
So I'm like, hey, let me trythis method.
But anyway, that ended upcoming together and becoming a
book.
And that is how I startedpublicly speaking in general
about health advocacy andteaching about how STDs are
really passed around and howgreat, smart, beautiful,
wonderful people catch them.
Dr. Erich Schramm (04:40):
Wow.
So I love that.
So inherent in your course iscuriosity, obviously that drew
you into family medicine, asmost of us do, um, but also uh
uh uh wanting to write andcommunicate.
And had that was that alwaysnatural for you, or was that
something uh a skill you reallyhad to develop?
Dr. Jill Grimes (05:01):
Uh I would say it was rather natural to me.
It's getting me to shut up,that's the problem.
So I I am the person who alwaysuh spoke up when I saw that
something I at least perceivedto be an injustice.
And sometimes I was right andsometimes I was wrong.
But I was gonna be, if I'mgonna be wrong, I'm gonna be all
(05:22):
out there wrong.
So uh the speaking up partwasn't hard.
The awkward topic was hard,partly because I was a parent
and I was a parent of two younggirls, and it's a little awkward
when your mom's on the radiotalking about STDs.
So uh there was some balance,there's some give and take
there.
Dr. Erich Schramm (05:41):
Well, but but that's a that's an important
point.
And and by talking about it andand you know being open and and
educational, right?
Then you can help to todestigmatize a lot of that for
patients.
And so in the course of your umthe the many years in your in
your primary care practice, wereyou really focusing on doing
(06:01):
you know adolescent and teenhealth and pediatrics, or were
you kind of full service um youknow, uh kids to to to the
elderly, doing all kinds of allaspects of the of the practice?
Dr. Jill Grimes (06:15):
I I absolutely did all aspects of it and loved
it.
And you know, started offwanting to still go in the ORs,
but that ended up just not beingpractical with having your own
private practice and um thewhole business part of medicine,
not my favorite, uh, wasn'tparticularly good at it and
didn't like it, but I definitelyloved seeing all ages.
(06:37):
And I had patients from Istayed, I did my residency in
Austin and I stayed there forprivate practice, and so I had
patients who I delivered theirbabies and then I delivered
their babies, babies in youknow, in residency and early
private practice.
And um, so I had the full, thefull range and I loved, I loved
(06:58):
all ages, but I have always hada special passion for teens and
adolescents, and I think a lotof it was because, again, as
being an outspoken person,sometimes I felt that adults
were perhaps talking down to meor not not appreciating the
depth of the intensity of thingsthat I felt.
(07:19):
And so I've always tried not todo that.
I really genuinely, I think, Ithink my special gift with
patients is has always been thatI can hear them.
And even if I disagree withsomething where it wouldn't be a
choice I would make, I'm not afinger pointer.
Um, because you know point backat you, right?
(07:42):
So I I I think that's that'show I especially connected with
teens and I love the potentialthat teens have.
And then circling back to theSTD thing, that when a young
person who is just kind ofgetting started in the world and
(08:02):
and they're in high school orcollege and they're trying to
figure out what they want to doand what pathway and who they
want to do that with, and theyend up with a sexually
transmittable infection, theyare often just destroyed, far,
far more so than you know,medically.
It might be something we cancompletely cure.
It might be chlamydia, it's abacterial infection.
(08:23):
Boom, we're done.
But they're not done.
They are, oh my gosh, I'm, youknow, their image of themselves
has completely changed.
And so I am all aboutprevention.
And that that's that's alwaysmy push is let's get ahead of
things, let's educate so thatyoung people can make different
choices and informed choices,because it's it's nobody's fault
(08:46):
if they make a choice about abehavior or a medication or a
drug, if they literally have noidea of the negative potential
side effects.
Dr. Erich Schramm (08:56):
Well, I tell you, you know, and I think the
credit to your book, because youspend a great deal of time
talking about uh preventionthere, treatment, prevention,
very holistic uh approach to umall the different aspects and
into what you're treating.
I think, again, I love thefamily practice holistic
element.
I I think as as I read throughthe book, I'm like, well, you
(09:19):
know, this is this is great forcollege kids, but you know,
adults would get a whole lot outof this, right?
Because it's it's a it's a veryholistic approach.
Dr. Jill Grimes (09:26):
Um I've been asked to just change the cover
and make it one-on-one.
Dr. Erich Schramm (09:32):
Your uh daughter did a great job on the
uh on getting doing uh theillustrations for the cover.
So some it's a lot of talentthere.
So the that's
Dr. Jill Grimes (09:42):
she has a degree in animation.
Dr. Erich Schramm (09:43):
Oh, wow.
Okay.
Still pictures are quick and easy for her, ButI was the that was such a
surprise.
I had when I submitted my brookproposal, and they you've of
course include sample chapters,and I just included her
illustrations because I'vealways had her illustrate for me
when I give talks like at theAFP or whatever.
And it never crossed my mindthat they would let her or not
(10:07):
let would ask her to be theillustrator for the book.
So that was that was awonderful surprise.
Yeah, it's it's quite good.
So that's that's great.
Thank you.
Um, so you spent uh a number ofyears as doing student health
at the University of Texas, isthat right?
Dr. Jill Grimes (10:24):
Yes.
Dr. Erich Schramm (10:25):
So you're an Aggie, but you're in on the
campus at the University ofTexas.
How did that work out for you?
Dr. Jill Grimes (10:31):
Uh it was quite humorous, actually.
And yes, this is an Aggie ringwhile I'm holding up my hand for
the people who are watching.
Uh, it's actually prettyhilarious that a good chunk of
the doctors that work in theUniversity of Texas health
services are actually Aggies.
So the truth is that, you know,it's all just good fun.
The students, you know, love toraz me if they saw my Aggie
(10:54):
ring and I'd tease them rightback because they're, you know,
their Texas ring looks kind oflike a copy of the Aggie ring.
So now that I've just offendeda huge group of people, but um,
but no, it was it was reallygreat.
And uh I do need to have adisclaimer that I I am no longer
currently working at theUniversity of Texas and um love
(11:17):
them, had a great experiencethere.
Nothing I say though reflectsthem um legally.
Dr. Erich Schramm (11:22):
Okay, duly noted.
Um so during this time, soobviously that's solidifying
your experiences in studenthealth, adolescent, teen health,
and is that kind of solidifyingyour commitment to really
putting that together intosomething more tangible?
Is this kind of where the ideafor the book's coming out at the
(11:43):
same time?
You know, your you said yourdaughters are heading off to
college.
But was this kind of a thoughtin the back of your mind at that
time?
Dr. Jill Grimes (11:53):
Actually, it was more than a thought.
So when our girls were fairlyyoung, their babysitter, who's
our next door neighbor, who'sabout eight years older than
them.
So eight years before theygraduated high school, she
graduated high school.
And their mom, who's a dearfriend of mine, asked me if I
would put together a first aidkit for Elise when she went off
to college.
So I did that.
And I took it over and I was soproud of this first aid kit,
(12:16):
had everything in it.
And I'm real crafty.
I was a Girl Scout leader, youknow, love to do all the artsy
stuff.
And my friend looked kind ofdisappointed as she opens it up
and she's like, Well, Jill, thisis great, but it doesn't have
you in there.
How is she gonna know when totake Tylenol versus Advil?
What cream to use?
What does she do?
She gets food poisoning.
(12:36):
So she runs to her kitchen andshe gets index cards out and she
starts rapid fire asking mequestions, and I'm rapid fire
answering.
So the next kit that I made forthe next babysitter that
graduated, I had a littlelaminated booklet that I put
together, which grew to be a26-page laminated booklet.
And that by that point, I thinkour girls were in, you know,
like late middle school.
(12:56):
And I was like, oh, I have waymore I need to include.
This needs to be a book.
And I had already written acouple other books.
So it's like, this is what Ineed to do.
So the book came first.
And then um actually, uh when Iwas taking a leave of absence
from my clinical practice tofinish up a book, um, my my I
didn't, this was this I had myown practice for about 10 years,
(13:20):
and then I worked for anotherpractice for about 10 years.
And while I was out on leave,that practice was sold to the
hospital, and I didn't want togo back into that different
setting.
And so I was kind of lookingaround and I had always
volunteered a couple, I mean,sometimes it was like one day a
semester.
It's not like it was a ton, butI had worked over at the
University of Texas here andthere for the whole 20 years,
(13:42):
just really sporadically.
And so I called them up andthey were, oh my gosh, yes, come
over, join us.
So it just worked out, thetiming was perfect.
And then it was so great for meas my girls did, our girls did
go off to college that I wasliterally around kids their
exact age and you know, kidsthat needed mom hugs too.
(14:04):
And uh, you know, so it it itwas really a win-win.
Dr. Erich Schramm (14:09):
Wow.
So terrific.
So what what are your uh whatdoes your practice look like
now?
Are you uh are you seeingpatients or what's what's what's
what's-
so right now I I do not havetime to see patients right now,
actually.
This this um I I do I wear alot of different hats.
Um I'm a clinical instructorfor UMass Medical School, but
(14:29):
basically that's sort of gradingpapers and interacting that
way.
Obviously, that's not a hugecommitment, but I do that.
I work with Thread Health,which is a digital health for
teens startup, and reallyfocused on teen access to
accurate, evidence-based, youknow, med medical information.
And so I'm doing creatingcontent for them and writing and
(14:52):
speaking.
And this has just sort of takenover my current practice.
Well, that's great.
You're you multitasking and itlooks like you're doing on great
on every front for that.
So congratulations.
Thank you.
So maybe maybe we could talk alittle bit more about the book
that I'm holding up.
So um so this is so, like yousaid, it's organized from head
(15:16):
to toe.
That's right.
So and um things that I thoughtwere very impressive is um uh
the preface at the beginning andthe introduction, which is gee,
uh, how to prepare your kids tointeract with the health
system, what to do, you know, towalk into a doctor's office
appointment.
Uh maybe you could say just alittle bit about uh about that.
Dr. Jill Grimes (15:37):
Yes, and I'll tell you that is was one of the
major additions, uh major thingsthat we added to the newest
edition.
So I, you know, I've beengetting feedback, and that was a
big thing of my kid doesn'tknow how to go to the doctor on
their own.
And so the it starts off withsomething really simple.
What is the first thing whenyou walk up to any health care,
(15:59):
anything?
So emergency room, urgent care,private practice, the first
interaction you have is with thereceptionist and they're gonna
ask you for your healthinsurance card.
So you need a picture of thaton your phone, front and back.
They actually need both sides.
And as long as it's at least onyour phone, you know, you can
email it to them standing rightthere and you have it always.
So that's just a really simplebut really important thing
(16:21):
because when it's three in themorning and you're at an
emergency room and you're pukingyour guts out or whatever the
issue is, and you don't haveyour health insurance card with
you, it it just itunderstandably makes kids just
kind of decompensate.
You know, they're they'reholding it together until a
certain point and then they'relike, I can't even get in.
Dr. Erich Schramm (16:38):
There's not a lot of processing going on when
that's happening.
So you're that's that's right.
Dr. Jill Grimes (16:44):
So that's one.
The second thing is that Ithink it's really important to
teach our kids two things.
And that is number one, leadwith your most important
concern.
In an emergency room with abroken arm, it's obvious in our
family medicine practices, lessso.
If your real concern is thatyou're having terrible test
anxiety, but you're tooembarrassed to say that.
(17:05):
So you got an appointment forstomach pain because it's giving
you stomach pain that you havetest anxiety, just jump right in
there with what you're therefor because unfortunately, time
slots are so limited.
And then the next thing is Ithe biggest source of
dissatisfaction withdoctor-patient interactions is
(17:26):
that the patient uh doesn't knowwhat's next.
So literally teach them justjust remember those two words,
what's next?
So at the end, they get toldthey get their prescription,
they get uh a prescription forphysical therapy, they get sent
to the x-ray.
Um they need to ask what'snext.
If it's normal, what do we donext?
(17:47):
If it's, you know, if I don'tget better from the antibiotic,
what do we do next?
When should I get be gettingbetter?
How do I contact you?
Is it's gonna be usuallythrough a patient portal
nowadays.
But you have to ask.
So lead with the most importantthing and ask what's next when
you're done.
Dr. Erich Schramm (18:03):
Right.
And I'm I'm hoping all theadults out there are taking heed
and do exactly that at yournext doctor's visit because
that'll you'll be well prepared.
And it's like you said, what'snext?
That's always always thebiggest uh question, and you
want to make sure you're clearabout that.
So that's that's excellent.
Um can we dive into chapterone?
(18:24):
So chapter one is hangovers.
And I was like, wow, that'sreally cool because put it right
up front, right out there.
Um, and I tell you, it's quitea it's quite a really good
chapter because it talks aboutum how to treat a hangover and
how to prevent hangovers, andyou know, uh, you know, and it's
a it's a really holisticapproach to that.
(18:45):
But uh, but yeah, so um, youknow, and you make some
recommendations about, okay, uh,you know, clear versus uh
colored alcohols.
And so uh so how did how didyou come about uh coming to all
that, uh knowing all that andthat determination?
Dr. Jill Grimes (19:05):
Well, quite honestly, I wanted the the title
of the book that I submitted tothe publisher was hangovers to
hangnails.
I wanted it just, you know,just head-to-toe, boom.
But publishers are smart aboutmarketing, and the reality is
that while many people mighthave typed in hangovers,
probably they wouldn't havetyped in hangnails, and it
(19:25):
doesn't fully convey that thiswas a head-to-toe, you know,
guide.
So hangovers was always at theforefront, partly because as our
babysitters and their friendsand our, you know, our kids were
in dance, so they always hadfriends three years older than
them.
As and I was giving these theselaminated booklets and then
(19:46):
first aid kits, uh, which theyall still have.
It warms my heart.
I get texts probably, I don'tknow, once every few weeks with
one of these.
I mean, I've I've given outmany, many, many of these.
And I'll get texts saying, Dr.
Jill, I just want you to knowthat I went through all my
medicines were expired and Iredid them and I re I re-upped
it, or they had a baby, andthey're like, Oh, I've I've
(20:06):
added new things for my for mybaby.
Dr. Erich Schramm (20:09):
Wow.
That's that's great.
Dr. Jill Grimes (20:10):
Which is kind of wild.
But anyway, so there's always alot of questions about
hangovers and about specificallyall the things surrounded, so
alcohol toxicity and hangovers,which are different animals.
But when do you need to gethelp?
You know, what were the signsof that?
I wanted to be sure tocommunicate that.
Some of the mistakes we see ofpeople that are hungover is
(20:34):
number one, they'll take theirADHD medication.
They're they're hung over.
They have been throwing up,they have a headache, they're
dehydrated, and their heart isracing.
And they take their ADHmedicine, which I will admit may
actually help with theirhangover, not recommended, 100%
not recommended.
But then they go into kind ofpanic attack because their heart
(20:57):
rate that was already fast isgoing a whole bunch faster.
And that is a, you know, so Iwanted to warn against that.
I wanted to make sure ifthey're rehydrating as they
should be, that they're ideallyusing an official oral
rehydration solution likePedialyte.
And because that's gonna bemore effective than just water
(21:17):
and don't drink coffee.
People try to wake up.
It's the same thing with theADHD medicine concept.
You know, I'm gonna wake you upbecause you have this brain
fog.
No, the brain fog is frominflammation and anything that
just is a stimulant is not gonnafix that.
So that's really important toaddress some of those things
that they can do that areactually harmful.
And by the way, pro tip don'tuse a straw when you are
(21:41):
rehydrating after vomiting ifyou're still nauseous for any
reason, because it can actuallyyou get more air into your
stomach, and that can actuallymake you more nauseous.
Dr. Erich Schramm (21:51):
Wow.
See, these these are gonna begreat pointers.
So I'm uh I'm gonna have tohave all my kids and their
friends all take a listen tothis when this comes out.
So um, but also too, and that Ithink you make mention that um,
you know, sometimes sensitivetopics there did if the if the
patients have concerns like,well, gee, could you uh put
(22:11):
yourself in a compromisingposition and getting back to
testing and talking about STDsbecause you know people get
blackout drunk, they may sothat's it's vulnerable people.
So they have to be you have toconsider that too.
So um yeah, and it's cool.
Dr. Jill Grimes (22:29):
If we could talk about that for just a
second, I want to emphasizebecause because now blackout
drunk is not just so first ofall, blackout is not passed out.
So for for the parents in theroom, blackout means that you
have a memory gap the next day,whereas passed out is
unconscious, and that's that'ssuper serious.
(22:50):
And you know, you need to callfor help if someone is
unconscious, they're unconsciousif you cannot wake them up.
Um, but a blackout means thatyou have a memory gap.
And there has been in the partyculture, unfortunately
emphasized in the party sectionof TikTok, which is why I'm
there, by the way, um, the theparty call of blackout or
(23:12):
backout.
You know, if you don't getdrunk enough that you forget
part of the night, you haveapparently not had a good time.
And obviously, not everybody isdoing this.
It is, you know, less than athird of college students, but
it's a significant number.
And it's concerning becausethere is this misperception of
if you can't remember, itdoesn't matter.
(23:34):
Uh family medicine, we canimmediately think of a couple
outcomes where it matters,right?
Any kind of accident, uh,whether it's just stepping off a
curb and getting a concussion,or whether it is sexual assault,
pregnancy, STDs, all of thesethings.
So it does matter even if youdon't remember.
And it's these are the kind ofthings that I think it's really
(23:55):
important to have realconversations with teens and
young adults, because otherpeople are not having those
conversations.
They're saying don't drink oryou can't drink till you're 21.
Well, that would be great.
That would be ideal.
I would have no problem if noone drank until they're 21.
But that is not the reality ofour culture in the United States
today.
Dr. Erich Schramm (24:14):
Right.
And as a physician, you'realways daily having to face with
reality, so and doing the rightthing for your patients.
So um, so yeah, that's that'sreal that's a really good point
to make.
Um another chapter that uhstruck a um a chord with me was
the talk on the chapter onanxiety, um, depression, and
(24:35):
homesickness.
And so um, and and again, yougive some really good uh, you
know, some some pointers there,and maybe you could elaborate on
that a little bit.
Dr. Jill Grimes (24:47):
Sure.
Well, this time of year, thebiggest thing is homesickness.
We've got kids who who justmoved in or are about to move
in, and we've got kids who maybemoved in early and went through
the Greek system recruitment,used to be called Rush, and
maybe they didn't get thatsorority or fraternity that they
really wanted.
(25:08):
And these are tough ways tostart the year.
Um, so the biggest thing abouthomesickness is looking forward
rather than back.
The more that you are lookingon social media at your friends
who are all at different schoolsand obviously posting their
highlight reels, as are you, uh,it just makes you feel more
(25:30):
lonely and you're missing thepast.
The best thing you can do, Ihave this rule of three.
Pick three organizations tojoin.
And I'm talking join, not tryout for, not audition for, just
straight up join.
And I encourage people to pickthree completely different
organizations.
So maybe a serviceorganization, maybe something
just super fun if you likeintramural sports, something
(25:54):
like that, or if you lovemovies, joining a movie club.
There's there's trust me,there's something for
everything, but something,something service, something
I'll say frivolous, like foodieor movie or whatever, and
something maybe in your major.
And that way you'll meet threedifferent groups of people.
They all share one thing thatyou like, and you'll start being
(26:16):
able to see who you reallytruly jive with, because at
first there's all this pressureto be friends with your roommate
or your suite mates, and thatmay be great.
Or you may, you know, they maybe somebody who sort of is a
ship passing in the night.
So you gotta dive in.
Dr. Erich Schramm (26:35):
And you know, I think another important uh
point I recall reading is likeum, you know, the kids that
might want to come home on theweekends, you know, and try to
try to reconnect there, right?
Dr. Jill Grimes (26:46):
Yeah.
So honestly, I see this just asfrequently, if not more
frequently, from the parentperspective of if your kid goes
to college within say an hour,hour and a half radius, there is
a big drive to, especially ifit's the oldest, oh, come home
for your sister's volleyballgame.
Come home for Sunday dinner.
Oh, come home, I'll do yourlaundry for you.
(27:08):
And and and none of it is, it'snot trying to control them, but
what's happening is they'rebeing pulled backwards and they
are not having the sittingaround in the laundry room where
you meet some other randomperson who's also sitting around
in the laundry room.
You know, you that's when thosefriendships are formed.
And I found like Austin, Texas,obviously you have the huge
(27:30):
University of Texas right there.
But some of the people who arethe most homesick literally live
in the same city.
So it's it's not correlatedwith how far away you are.
Sometimes I think the peoplewho are far away, and both of
our girls actually went over athousand miles away, different
directions.
But you know, you're kind offorced to jump in and do things
because it's not an option to gohome.
(27:51):
So I think sometimes thatthat's helpful.
Dr. Erich Schramm (27:53):
Wow.
Um, so uh talk, I want to goback and uh you would have been
seeing a patients during COVID.
Uh, is that recall that timeframe and and how COVID what
that how that affected um thosekids growing up and then going
off to college?
And did that you knowcontribute to some of the issues
that kids are seeing now?
Dr. Jill Grimes (28:15):
Well, I don't think there's any question that
COVID disrupted all of ourlives.
And certainly there's a goodargument that students in
general all ages got disruptedthe most.
But it's very uh I I actuallyonly saw students during the
first year of of COVID, reallyfirst six months or so of COVID.
(28:37):
Um but the the hard thing isthat you know each each
challenge is unique to eachgrade that they were in when
they were completely on virtualschool, right?
And now we have a whole groupof college students who were
(28:58):
affected all to some degree oranother during all of their high
school.
And I certainly I think we'reseeing a lot more difficulty
interacting with other people inperson.
Um, seeing a uh a reliance onvirtual classes and more and
(29:19):
more colleges, it's quite asurprise to parents paying
tuition that there are a lot ofreally outstanding schools who
still have a lot of classes thatare also offered on online or
maybe only offered online.
And it it's a big transition togo from what they had as a
COVID high school class onlineto now a class in university
(29:44):
online.
And I I just, you know, thatthink it's really important for
students to recognize that it isa different situation.
They need to jump in, they needto be responsible for
connecting with that professor.
Again, my dad was a professor.
We when My brother and sisterand I went to school.
The rule in our household wasif you're in college, the first
(30:05):
two weeks of every semester, yougo around to office hours and
you meet every one of yourprofessors.
It doesn't have to be a longconversation, but go to their
office hours.
So you're going when theyexpect students and just
introduce yourself and you know,use context clues.
Look around the room if they'vegot pictures of something that
you like.
There's maybe they're skiers orthey, I don't know, whatever
they do.
(30:25):
But comment on that and talk tothem as a person.
And it's going to just set youup for so much more success.
And I think it's important toeven do that with your virtual
classes.
And all the professors I knowfeel very strongly that those
the kids who do that are theones that succeed the most.
(30:47):
I always feel strongly that we're so much better in person, andhopefully one day uh we can do
a podcast in person.
And, you know, uh, but yeah,and I'm I'm glad to see it, you
know, with my kids that they'vereally embraced um doing a lot
of that, showing up and andbeing there and knowing their
professors and their TAs.
And so I I totally agree withone other thing, um, so one of
(31:09):
the things that's reallyimpressive about uh your book is
it's evidence-based.
So um say let's take, forinstance, the chapter on sinus
infections and runny nose andsore throat.
So um, and you again kind ofreiterating the point, look, you
know, this really isn't uh theplace for antibiotics.
And you know, and you can andyou know, for those all of your
(31:31):
recommendations um can go backand you can go back and
reference and say, look, youknow, this is this is really
evidence-based practice.
So it it is that time of theyear when everybody's catching
the things that are goingaround.
And so um maybe just to kind ofreiterate a little bit about
um, you know, an approach towhen you get that cold, when
(31:52):
you're getting that sinusinfection, um, you know, kind of
the best approach for that.
Right.
And it is I I want listeners toknow that from the doctor's
standpoint, it is way easier togive an antibiotic unnecessarily
than to have a five-minutediscussion about why you're not
giving an antibiotic.
(32:12):
So we're not doing that, and wedon't make money from the sale
of antibiotics.
There's there's no conspiracythere.
But trying to convince peoplethat they don't need antibiotics
for a viral, you know, greensnot does not equal antibiotics.
That's that's the take-homemessage.
So we what we want is forstudents to treat symptoms.
(32:32):
And one, have a thermometer sothat you can check your
temperature.
If you have 103.7 fever, weprobably want to see you, you
know.
Uh, if if you've got 99 tempand a stuffy nose and sore
throat and you know, you'refunctioning fine, probably
that's a time forover-the-counter medicines.
(32:55):
And, you know, obviously Ican't give individual
personalized medical advice, butby and large, most respiratory
viruses and sinus infections aregoing to be viral.
And we want you to, we don'twant you to come in at the first
sniffle, but we also don't wantyou to wait until you're in
crisis.
And that's true whether it's awhether it's a horrible, you
(33:15):
know, sinus pain or whetheryou're in crisis from test
anxiety or anything.
Don't, don't, we're we're thereto help.
And if you have questions, andparticularly young college
students, this is the first timethey're managing these symptoms
on their own.
But that's why we have mostplaces have 24-hour nurse
(33:38):
hotlines, and you can call andyou can get recommendations.
And if you just keep in mind,if you take other medications,
like if you're on prescriptionADHD medications or
antidepressants, anti-anxietymedications, some of those
interact significantly withcough and cold medications.
And so that there needs to be adiscussion with a medical
(33:59):
professional, including apharmacist.
If you're gettingover-the-counter medicine, the
pharmacists are well versed inwhat is going to interact and
what is not.
Dr. Erich Schramm (34:06):
Right.
And I think a great point aboutyour book is making it clear,
you know, at what point you needto engage a doctor.
You know, it's one thing tonurse symptoms at at home, but
you know, when in doubt, here'swhere you need to go and and how
to how to contact thoseresources.
So that's very, very helpful.
Um, I'm also now looking attowards the bonus section of the
(34:28):
book called Do It YourselfFirst Aid Kit.
And I'm like, holy cow, this isfantastic.
Um, you've got any.
Yeah, I mean there's literallya checkbox.
I love that.
First aid kit.
So um to that point.
So the the if you're uh at homewith a sniffle, sore throat, or
cough, or whether you've got arash, or whether you've got
(34:50):
whatever you have, uh upsetstomach, um diarrhea,
dehydration, I mean, there's allkinds of things here.
Um, and you know, you reallyit's it's it's very clear, very
concise.
So uh again, um, you know, usadults need to have something
like this at home because uh,you know, again, these are gonna
(35:11):
be so helpful.
Dr. Jill Grimes (35:12):
Right.
And when you need it, you needit.
You know, when you're whenyou're throwing up all night at
3 a.m., you don't want to haveto make a run to the store to
get an oral rehydrationsolution.
So I keep those single servinguh powders in there.
So you've always got it onhand.
That's really important.
And even if it's just that youneed an ace wrap, again, if
(35:34):
you're hobbling around, it'd benice to have it at your
fingertips.
If your roommate's coughing allnight and keeping you from
sleeping, it's really nice tohave some over-the-counter cough
syrup if it's appropriate forthem to take that.
Uh, and also I'm gonna put in aplug for Narcan.
This is something new thatwe've added to the first aid
kit.
Narcan, everyone knows aboutthe fentanyl crisis, the opioid
(35:58):
crisis in our country.
And I think what a lot ofparents miss is that they expect
that these fentanyl overdosesare only going on in like party,
you know, raging parties,right?
And there are kids that willtake all kinds of substances to
(36:18):
party, but they know thatthey're taking a risk.
And I certainly hope that theyhave Narcan on hand as well.
Something that a lot of parentsdon't think about, however, is
that kid who is so anxious thatthey just they can't sleep.
They've got a chemistry test,you know, Gen Chem test coming
up and they can't sleep.
They've been studying for threenights, and their roommate
(36:40):
says, Oh my gosh, just take thisXanax and so you can get a good
night of sleep, right?
Well, if that's a prescriptionXanax that was prescribed for
that roommate, one, you stillshouldn't be taking it.
But two, that might be safe.
But if it's a Xanax that theygot from somebody else because
they were having troublesleeping, now if it's a street
drug Xanax, there is a verystrong chance that there's
(37:01):
fentanyl in there.
And that's why it's one pillcan kill.
It is college students, youngadults who are looking for a
simple fix to a problem.
They think they're gettingsomething that is not risky, and
yet it can stop them frombreathing.
So Narcan is a spray that canreverse that.
So I think that's an importantthing to have.
Dr. Erich Schramm (37:22):
Yeah, that's a great point.
I mean, Narcan saves lives, youknow, and that's the reality we
are we're living in right nowwith uh with the opioid
epidemic.
So absolutely.
Um, I know we talked a bitabout uh sexually transmitted
disease STDs, and I'm referringback now to look at chapter 45,
uh, very well written, but ummaybe touch a little bit about
(37:44):
how um, because a lot of people,a lot of you know, young people
think, well, if I've got anSTD, I'm gonna have symptoms,
right?
Something's gonna show up, andso I must be okay, right?
Hey, if I must be all right,right?
I mean, what could possibly gowrong?
Dr. Jill Grimes (37:59):
Or or I had symptoms.
Oh, thank God those symptomswent away.
I had some burning there when Iwas peeing at first, but that
was it's been two days and ithasn't happened anymore.
So I must be fine.
So, yes, we have to get themessage across that sexually
transmittable infections arehonestly most often silent, and
yet they can do damage,particularly in young women.
(38:21):
The you know, biggies that weworry about missing are
chlamydia and gonorrhea.
And those can go on to createproblems, scarring, chronic
pelvic pain, and eveninfertility in women.
They're easily treated.
They're bacterial illnesses.
Actually, gonorrhea, let mestep back.
It is a bacterial illness thatis not easily treated because
(38:42):
it's got so much antibioticsresistance.
I shouldn't be laughing atthat.
Dr. Erich Schramm (38:46):
The super bugs.
Dr. Jill Grimes (38:48):
Yeah, it's it's actually gotten a little
scarier.
But chlamydia is very easilytreated, but we have to know
it's there.
So if you are sexually active,meaning that you are being
sexually intimate with otherpeople, then you need to be
checked once a year at least.
Dr. Erich Schramm (39:04):
Yeah.
Do you think in terms of thetreatment then as far as as a as
a clinician, are you justgonna, you know, go ahead and
just presumptively treat, youknow, somebody comes in and
says, I think I might havesomething.
Um, are you gonna just say,Okay, well, look, we're gonna
presumptively treat you forgonorrhea and chlamydia or are
you gonna wait for the test tocome back?
Dr. Jill Grimes (39:24):
It depends on the setting.
Nowadays, I you know, in a in acollege health setting, uh
students are highly, highlymotivated and likely to come
back.
So typically we would testfirst.
There are certainly uh publichealth clinics where there may
not be as consistent a follow-upwhere there is presumptive
treating.
Dr. Erich Schramm (39:44):
Yeah.
And and that that makes sense.
I mean it's your patientpopulation at the end of the
day, and then you know them andwhat's best for them.
And but you also make a point,an important point about
follow-up.
So if you're gonna get treated,go back and make sure you're
you you're clear.
Is that right?
Dr. Jill Grimes (40:00):
Absolutely.
And the other thing is I'vealways said that STDs travel
in packs.
You know, people are are alwaysshocked, almost always, 98% of
the time, pulling that numberout of my head.
But from my experience, thevast, vast majority of people
are just shocked when they'rediagnosed with a sexually
transmittable infection.
Like, how could this happen tome?
(40:20):
How could that person havegiven that to me?
But they're even more shockedwhen they have more than one STI
and see that all the time.
A lot of times it's genitalherpes and chlamydia, or you
know, pick, pick, pick yourmatch.
But the reality is that they'reall transmitted the same way.
So of course we see a lot ofthem together.
And gonorrhea and chlamydiahave been together so much that
(40:43):
a a lot of times we empiricallydo treat for both when you're
positive for one.
So it the but the the the majormessage I want to get across
though is just get tested and beunderstand that if we are
offering testing for say HIV, somany times people will say, Oh,
they're not that kind ofperson.
(41:03):
Like there is no that kind ofperson.
Exactly.
We're all that, we are all thatkind of person, right?
It's these bugs don't care whatyou look like or how much money
you have or where you live orany of that stuff.
And yes, they are moreprevalent in certain
populations, but the reality isanyone can get any of them.
And if you're positive for one,you should be checked for all
(41:24):
of them.
Dr. Erich Schramm (41:24):
That's right.
And I think the advice you'dgive in there was don't don't
ever hook up with an X, right?
Dr. Jill Grimes (41:32):
Oh, if there's one, don't do the X.
Dr. Erich Schramm (41:35):
Don't do the X, right?
Dr. Jill Grimes (41:37):
Every every primary care physician.
So then uh yeah, yeah, we brokeup, but then I ran into him or
her at this bar, and we all knowwhat's coming next.
Dr. Erich Schramm (41:46):
And and adults too.
Let's be clear that it's notjust college kids, but maybe
adults should be heeding thisadvice, yes.
Dr. Jill Grimes (41:54):
So even more so if it's an ex-spouse.
Guaranteed you're gonna get itfrom exactly okay.
Dr. Erich Schramm (41:59):
So that's an important take home message for
everybody.
So, Jill, thank you so much.
You've been very generous withyour time.
Um, and like I said, the thethe book is uh tremendous.
Um, I can't wait to to spreadthe word because I know it's
this is is gonna really uh sinkhome for a lot of people.
Um anything, uh any questionthat I should have asked that I
(42:22):
didn't ask you or a point thatuh you'd like to make.
Dr. Jill Grimes (42:26):
I just want to reiterate the biggest thing,
biggest mistake that I see inyoung adults and and actually
really everybody is waitinguntil you're in crisis to seek
help.
And part of that's because ofall the barriers we have with
access to care.
And I understand that.
And but whenever possible, I'mnot don't go in at your you
(42:47):
know, second flake of dandruffor your first sniffle, but also
don't wait until you're somiserable that you cannot cope
with it because then it's evenharder to get in.
And and we can intervene withthings, especially with anxiety
and depression, and you know,mental health is equal to
everything else.
It is a valid reason to see adoctor if you have insomnia.
(43:10):
That is a valid reason
Dr. Erich Schramm (43:11):
And and this ties into what you're doing
through your um in your virtualhealth uh project that you're
doing, right?
That's that that's that kind ofaccess.
Um, and that's and there'sconfidential uh confidentiality
in that uh for uh for thosepatients.
Dr. Jill Grimes (43:26):
Oh absolutely.
Dr. Erich Schramm (43:28):
Because I think a lot of times, you know,
kids are like, well, are my aremy parents gonna find out about
this stuff?
And you know, they're they'rehesitant.
Dr. Jill Grimes (43:35):
We should add one thing since you said that,
especially this time of year.
College students are mostlystill on their parents'
insurance.
And what they need to know isthat while there is complete
confidentiality between thedoctor and the patient, there is
something called an EOB that isan explanation of benefits.
(43:56):
And it is just it's not gonnasay your diagnosis, but it will
certainly say pregnancy test orchlamydia test.
We can't change the names onthose things.
And so students need tounderstand that if their parents
are paying the bills, theirparents are going to get this
explanation of benefits thatdoes have names of tests on
(44:21):
there that would stronglysuggest with context clues
what's going on.
So I think it's reallyimportant to have open
communication about that.
Dr. Erich Schramm (44:28):
Can those patients go to, say, like a
public health office, publichealth department, and avoid
the-
if those patients pay cash, ifthey go to a uh public health
office, uh if you're not, it'spurely if you're using your
parents' insurance.
If you're using your owninsurance, you will be the one
getting it.
Uh, if you're paying for theinsurance, it's whoever's
(44:48):
paying, the guarantor, who isgoing to get it.
So the what the workaround isthere are many free clinics um
and there are many places youcan pay cash.
And almost all college campusesnow have free SDI testing in
particular.
That's that's that's a great point to make.
So well, great.
Well, thank you so much.
Um, I hope we'll have a chanceto talk again soon.
(45:10):
Um, is there another book inthe in the works?
Dr. Jill Grimes (45:14):
There may be another edition in the works,
but not not right now.
Honestly, we I've got my platefull for the next year.
Dr. Erich Schramm (45:23):
That sounds that sounds good.
All right.
Well, thank you so much.
And you have a great rest ofthe day here, and uh we'll
hopefully talk again soon.
Dr. Jill Grimes (45:31):
All right, thanks so much for having me.
Sure.
Dr. Erich Schramm (45:33):
Bye bye.
Thanks for joining theMedEvidence Podcast.
To learn more, head over toMedEvidence.com or subscribe to
our podcast on your favoritepodcast platform.
Welcome to MedEvidence, where we help you
navigate the truth behindmedical research with unbiased,
evidence-proven facts, hosted bycardiologist and top medical
researcher, Dr.
Michael Koren.
Dr. Erich Schramm (00:11):
Hello and welcome back to another episode
of the MedEvidence Podcast.
I'm your host, Dr.
Erich Schramm, sitting in forDr.
Michael Koren today.
I am a board-certified familyphysician and longtime clinical
research investigator with morethan 10 years experience with
the ENCORE Clinical ResearchGroup.
And I'm really excited to betalking to Dr.
Jill Grimes today.
(00:32):
For those who don't know Dr.
Grimes, she is aboard-certified family
physician.
So shout out to board-certifiedfamily physicians, of course.
She specializes in teen,adolescent, and young adult
health.
And so she is also widely knownas the TikTok college doc.
So she's on multiple uh socialmedia platforms.
(00:57):
She goes on TV.
She's an educator.
And uh most importantly, forour purposes today, she is the
author of the ultimate collegestudent health handbook.
I'm holding the third editionin my hand right now, so I'm
really eager and excited to diveinto that discussion.
So welcome to the Med Evidence!Podcast.
Dr. Jill Grimes (01:19):
Thank you so much.
I'm really excited to be here.
Dr. Erich Schramm (01:22):
So, Jill, um, you've got such a fascinating
background.
Um, maybe you could tell us alittle bit about where you grew
up, what got you interested indoing uh medicine and how you
ended up pivoting intoadolescent and teen health.
What did that look like foryou?
Dr. Jill Grimes (01:40):
So I grew up a lot of places.
My father was a professor andas an administrator, and as he
moved up the academic ladderevery couple of years, we moved.
So I was born in California,but lived a lot of different
places.
But I went to middle school andhigh school in San Antonio,
Texas.
And uh, so that's how I endedup in Texas.
(02:00):
And my dad, again, being aprofessor, I have a brother and
sister.
My sister is a doctor, mybrother is an engineer, but also
has an MBA and teaches.
So we we were all very muchindoctrinated into the more
education is better.
And uh the doctor part part ofit is a funny story.
(02:21):
Literally, when I was in fifthgrade, I had all A's and a C in
handwriting.
True story.
Teacher pulled me aside and shesaid, That's okay, Jill, you
can be a doctor.
And my handwriting has notimproved.
This is actually a plus ofelectronic medical records.
Dr. Erich Schramm (02:35):
Uh, but I was just gonna say that.
That's great.
Dr. Jill Grimes (02:39):
And I was not the only doctor with bad
handwriting.
I am not.
But the the reality is that Ihad teachers and educators along
the way who were constantlysaying, you know, be everything,
do everything.
And I loved science and I lovedhelping people, and I loved
animals.
I thought about being aveterinarian briefly, but mainly
(03:00):
I just was focused on being adoctor.
And to me, family medicine willlove this, but to me, being a
doctor meant being a familyphysician.
And sure enough, in medicalschool, I loved every single
rotation except anesthesia andmy husband's an
anesthesiologist.
Um, I have an issue about spit,but anyway, I really loved
(03:21):
every rotation.
And the cool thing about familymedicine is we get to do a
little bit of everything.
And so I did private practicefor 20 years.
And during that time, I endedup doing some writing.
And I'm always I'm a problemsolver, um, or I want to be a
problem solver at any rate.
(03:41):
And so I saw a problem in myvery wealthy, educated private
practice community about lack ofeducation about sexually
transmittable infections.
And that is not a cool or funtopic, but it was something that
the education that I was doingin the exam room and that
(04:02):
classrooms were doing with sexed, clearly it wasn't hitting
home.
And that's because nobodythinks it's their group of
people, right?
We always think it's them overthere.
And so, what started as acouple pamphlets for my office,
which were stories, becausestories are more powerful than
statistics.
My patients could tell me everystory from Gray's Anatomy or
ER.
(04:22):
So I'm like, hey, let me trythis method.
But anyway, that ended upcoming together and becoming a
book.
And that is how I startedpublicly speaking in general
about health advocacy andteaching about how STDs are
really passed around and howgreat, smart, beautiful,
wonderful people catch them.
Dr. Erich Schramm (04:40):
Wow.
So I love that.
So inherent in your course iscuriosity, obviously that drew
you into family medicine, asmost of us do, um, but also uh
uh uh wanting to write andcommunicate.
And had that was that alwaysnatural for you, or was that
something uh a skill you reallyhad to develop?
Dr. Jill Grimes (05:01):
Uh I would say it was rather natural to me.
It's getting me to shut up,that's the problem.
So I I am the person who alwaysuh spoke up when I saw that
something I at least perceivedto be an injustice.
And sometimes I was right andsometimes I was wrong.
But I was gonna be, if I'mgonna be wrong, I'm gonna be all
(05:22):
out there wrong.
So uh the speaking up partwasn't hard.
The awkward topic was hard,partly because I was a parent
and I was a parent of two younggirls, and it's a little awkward
when your mom's on the radiotalking about STDs.
So uh there was some balance,there's some give and take
there.
Dr. Erich Schramm (05:41):
Well, but but that's a that's an important
point.
And and by talking about it andand you know being open and and
educational, right?
Then you can help to todestigmatize a lot of that for
patients.
And so in the course of your umthe the many years in your in
your primary care practice, wereyou really focusing on doing
(06:01):
you know adolescent and teenhealth and pediatrics, or were
you kind of full service um youknow, uh kids to to to the
elderly, doing all kinds of allaspects of the of the practice?
Dr. Jill Grimes (06:15):
I I absolutely did all aspects of it and loved
it.
And you know, started offwanting to still go in the ORs,
but that ended up just not beingpractical with having your own
private practice and um thewhole business part of medicine,
not my favorite, uh, wasn'tparticularly good at it and
didn't like it, but I definitelyloved seeing all ages.
(06:37):
And I had patients from Istayed, I did my residency in
Austin and I stayed there forprivate practice, and so I had
patients who I delivered theirbabies and then I delivered
their babies, babies in youknow, in residency and early
private practice.
And um, so I had the full, thefull range and I loved, I loved
(06:58):
all ages, but I have always hada special passion for teens and
adolescents, and I think a lotof it was because, again, as
being an outspoken person,sometimes I felt that adults
were perhaps talking down to meor not not appreciating the
depth of the intensity of thingsthat I felt.
(07:19):
And so I've always tried not todo that.
I really genuinely, I think, Ithink my special gift with
patients is has always been thatI can hear them.
And even if I disagree withsomething where it wouldn't be a
choice I would make, I'm not afinger pointer.
Um, because you know point backat you, right?
(07:42):
So I I I think that's that'show I especially connected with
teens and I love the potentialthat teens have.
And then circling back to theSTD thing, that when a young
person who is just kind ofgetting started in the world and
(08:02):
and they're in high school orcollege and they're trying to
figure out what they want to doand what pathway and who they
want to do that with, and theyend up with a sexually
transmittable infection, theyare often just destroyed, far,
far more so than you know,medically.
It might be something we cancompletely cure.
It might be chlamydia, it's abacterial infection.
(08:23):
Boom, we're done.
But they're not done.
They are, oh my gosh, I'm, youknow, their image of themselves
has completely changed.
And so I am all aboutprevention.
And that that's that's alwaysmy push is let's get ahead of
things, let's educate so thatyoung people can make different
choices and informed choices,because it's it's nobody's fault
(08:46):
if they make a choice about abehavior or a medication or a
drug, if they literally have noidea of the negative potential
side effects.
Dr. Erich Schramm (08:56):
Well, I tell you, you know, and I think the
credit to your book, because youspend a great deal of time
talking about uh preventionthere, treatment, prevention,
very holistic uh approach to umall the different aspects and
into what you're treating.
I think, again, I love thefamily practice holistic
element.
I I think as as I read throughthe book, I'm like, well, you
(09:19):
know, this is this is great forcollege kids, but you know,
adults would get a whole lot outof this, right?
Because it's it's a it's a veryholistic approach.
Dr. Jill Grimes (09:26):
Um I've been asked to just change the cover
and make it one-on-one.
Dr. Erich Schramm (09:32):
Your uh daughter did a great job on the
uh on getting doing uh theillustrations for the cover.
So some it's a lot of talentthere.
So the that's
Dr. Jill Grimes (09:42):
she has a degree in animation.
Dr. Erich Schramm (09:43):
Oh, wow.
Okay.
Still pictures are quick and easy for her, ButI was the that was such a
surprise.
I had when I submitted my brookproposal, and they you've of
course include sample chapters,and I just included her
illustrations because I'vealways had her illustrate for me
when I give talks like at theAFP or whatever.
And it never crossed my mindthat they would let her or not
(10:07):
let would ask her to be theillustrator for the book.
So that was that was awonderful surprise.
Yeah, it's it's quite good.
So that's that's great.
Thank you.
Um, so you spent uh a number ofyears as doing student health
at the University of Texas, isthat right?
Dr. Jill Grimes (10:24):
Yes.
Dr. Erich Schramm (10:25):
So you're an Aggie, but you're in on the
campus at the University ofTexas.
How did that work out for you?
Dr. Jill Grimes (10:31):
Uh it was quite humorous, actually.
And yes, this is an Aggie ringwhile I'm holding up my hand for
the people who are watching.
Uh, it's actually prettyhilarious that a good chunk of
the doctors that work in theUniversity of Texas health
services are actually Aggies.
So the truth is that, you know,it's all just good fun.
The students, you know, love toraz me if they saw my Aggie
(10:54):
ring and I'd tease them rightback because they're, you know,
their Texas ring looks kind oflike a copy of the Aggie ring.
So now that I've just offendeda huge group of people, but um,
but no, it was it was reallygreat.
And uh I do need to have adisclaimer that I I am no longer
currently working at theUniversity of Texas and um love
(11:17):
them, had a great experiencethere.
Nothing I say though reflectsthem um legally.
Dr. Erich Schramm (11:22):
Okay, duly noted.
Um so during this time, soobviously that's solidifying
your experiences in studenthealth, adolescent, teen health,
and is that kind of solidifyingyour commitment to really
putting that together intosomething more tangible?
Is this kind of where the ideafor the book's coming out at the
(11:43):
same time?
You know, your you said yourdaughters are heading off to
college.
But was this kind of a thoughtin the back of your mind at that
time?
Dr. Jill Grimes (11:53):
Actually, it was more than a thought.
So when our girls were fairlyyoung, their babysitter, who's
our next door neighbor, who'sabout eight years older than
them.
So eight years before theygraduated high school, she
graduated high school.
And their mom, who's a dearfriend of mine, asked me if I
would put together a first aidkit for Elise when she went off
to college.
So I did that.
And I took it over and I was soproud of this first aid kit,
(12:16):
had everything in it.
And I'm real crafty.
I was a Girl Scout leader, youknow, love to do all the artsy
stuff.
And my friend looked kind ofdisappointed as she opens it up
and she's like, Well, Jill, thisis great, but it doesn't have
you in there.
How is she gonna know when totake Tylenol versus Advil?
What cream to use?
What does she do?
She gets food poisoning.
(12:36):
So she runs to her kitchen andshe gets index cards out and she
starts rapid fire asking mequestions, and I'm rapid fire
answering.
So the next kit that I made forthe next babysitter that
graduated, I had a littlelaminated booklet that I put
together, which grew to be a26-page laminated booklet.
And that by that point, I thinkour girls were in, you know,
like late middle school.
(12:56):
And I was like, oh, I have waymore I need to include.
This needs to be a book.
And I had already written acouple other books.
So it's like, this is what Ineed to do.
So the book came first.
And then um actually, uh when Iwas taking a leave of absence
from my clinical practice tofinish up a book, um, my my I
didn't, this was this I had myown practice for about 10 years,
(13:20):
and then I worked for anotherpractice for about 10 years.
And while I was out on leave,that practice was sold to the
hospital, and I didn't want togo back into that different
setting.
And so I was kind of lookingaround and I had always
volunteered a couple, I mean,sometimes it was like one day a
semester.
It's not like it was a ton, butI had worked over at the
University of Texas here andthere for the whole 20 years,
(13:42):
just really sporadically.
And so I called them up andthey were, oh my gosh, yes, come
over, join us.
So it just worked out, thetiming was perfect.
And then it was so great for meas my girls did, our girls did
go off to college that I wasliterally around kids their
exact age and you know, kidsthat needed mom hugs too.
(14:04):
And uh, you know, so it it itwas really a win-win.
Dr. Erich Schramm (14:09):
Wow.
So terrific.
So what what are your uh whatdoes your practice look like
now?
Are you uh are you seeingpatients or what's what's what's
what's-
so right now I I do not havetime to see patients right now,
actually.
This this um I I do I wear alot of different hats.
Um I'm a clinical instructorfor UMass Medical School, but
(14:29):
basically that's sort of gradingpapers and interacting that
way.
Obviously, that's not a hugecommitment, but I do that.
I work with Thread Health,which is a digital health for
teens startup, and reallyfocused on teen access to
accurate, evidence-based, youknow, med medical information.
And so I'm doing creatingcontent for them and writing and
(14:52):
speaking.
And this has just sort of takenover my current practice.
Well, that's great.
You're you multitasking and itlooks like you're doing on great
on every front for that.
So congratulations.
Thank you.
So maybe maybe we could talk alittle bit more about the book
that I'm holding up.
So um so this is so, like yousaid, it's organized from head
(15:16):
to toe.
That's right.
So and um things that I thoughtwere very impressive is um uh
the preface at the beginning andthe introduction, which is gee,
uh, how to prepare your kids tointeract with the health
system, what to do, you know, towalk into a doctor's office
appointment.
Uh maybe you could say just alittle bit about uh about that.
Dr. Jill Grimes (15:37):
Yes, and I'll tell you that is was one of the
major additions, uh major thingsthat we added to the newest
edition.
So I, you know, I've beengetting feedback, and that was a
big thing of my kid doesn'tknow how to go to the doctor on
their own.
And so the it starts off withsomething really simple.
What is the first thing whenyou walk up to any health care,
(15:59):
anything?
So emergency room, urgent care,private practice, the first
interaction you have is with thereceptionist and they're gonna
ask you for your healthinsurance card.
So you need a picture of thaton your phone, front and back.
They actually need both sides.
And as long as it's at least onyour phone, you know, you can
email it to them standing rightthere and you have it always.
So that's just a really simplebut really important thing
(16:21):
because when it's three in themorning and you're at an
emergency room and you're pukingyour guts out or whatever the
issue is, and you don't haveyour health insurance card with
you, it it just itunderstandably makes kids just
kind of decompensate.
You know, they're they'reholding it together until a
certain point and then they'relike, I can't even get in.
Dr. Erich Schramm (16:38):
There's not a lot of processing going on when
that's happening.
So you're that's that's right.
Dr. Jill Grimes (16:44):
So that's one.
The second thing is that Ithink it's really important to
teach our kids two things.
And that is number one, leadwith your most important
concern.
In an emergency room with abroken arm, it's obvious in our
family medicine practices, lessso.
If your real concern is thatyou're having terrible test
anxiety, but you're tooembarrassed to say that.
(17:05):
So you got an appointment forstomach pain because it's giving
you stomach pain that you havetest anxiety, just jump right in
there with what you're therefor because unfortunately, time
slots are so limited.
And then the next thing is Ithe biggest source of
dissatisfaction withdoctor-patient interactions is
(17:26):
that the patient uh doesn't knowwhat's next.
So literally teach them justjust remember those two words,
what's next?
So at the end, they get toldthey get their prescription,
they get uh a prescription forphysical therapy, they get sent
to the x-ray.
Um they need to ask what'snext.
If it's normal, what do we donext?
(17:47):
If it's, you know, if I don'tget better from the antibiotic,
what do we do next?
When should I get be gettingbetter?
How do I contact you?
Is it's gonna be usuallythrough a patient portal
nowadays.
But you have to ask.
So lead with the most importantthing and ask what's next when
you're done.
Dr. Erich Schramm (18:03):
Right.
And I'm I'm hoping all theadults out there are taking heed
and do exactly that at yournext doctor's visit because
that'll you'll be well prepared.
And it's like you said, what'snext?
That's always always thebiggest uh question, and you
want to make sure you're clearabout that.
So that's that's excellent.
Um can we dive into chapterone?
(18:24):
So chapter one is hangovers.
And I was like, wow, that'sreally cool because put it right
up front, right out there.
Um, and I tell you, it's quitea it's quite a really good
chapter because it talks aboutum how to treat a hangover and
how to prevent hangovers, andyou know, uh, you know, and it's
a it's a really holisticapproach to that.
(18:45):
But uh, but yeah, so um, youknow, and you make some
recommendations about, okay, uh,you know, clear versus uh
colored alcohols.
And so uh so how did how didyou come about uh coming to all
that, uh knowing all that andthat determination?
Dr. Jill Grimes (19:05):
Well, quite honestly, I wanted the the title
of the book that I submitted tothe publisher was hangovers to
hangnails.
I wanted it just, you know,just head-to-toe, boom.
But publishers are smart aboutmarketing, and the reality is
that while many people mighthave typed in hangovers,
probably they wouldn't havetyped in hangnails, and it
(19:25):
doesn't fully convey that thiswas a head-to-toe, you know,
guide.
So hangovers was always at theforefront, partly because as our
babysitters and their friendsand our, you know, our kids were
in dance, so they always hadfriends three years older than
them.
As and I was giving these theselaminated booklets and then
(19:46):
first aid kits, uh, which theyall still have.
It warms my heart.
I get texts probably, I don'tknow, once every few weeks with
one of these.
I mean, I've I've given outmany, many, many of these.
And I'll get texts saying, Dr.
Jill, I just want you to knowthat I went through all my
medicines were expired and Iredid them and I re I re-upped
it, or they had a baby, andthey're like, Oh, I've I've
(20:06):
added new things for my for mybaby.
Dr. Erich Schramm (20:09):
Wow.
That's that's great.
Dr. Jill Grimes (20:10):
Which is kind of wild.
But anyway, so there's always alot of questions about
hangovers and about specificallyall the things surrounded, so
alcohol toxicity and hangovers,which are different animals.
But when do you need to gethelp?
You know, what were the signsof that?
I wanted to be sure tocommunicate that.
Some of the mistakes we see ofpeople that are hungover is
(20:34):
number one, they'll take theirADHD medication.
They're they're hung over.
They have been throwing up,they have a headache, they're
dehydrated, and their heart isracing.
And they take their ADHmedicine, which I will admit may
actually help with theirhangover, not recommended, 100%
not recommended.
But then they go into kind ofpanic attack because their heart
(20:57):
rate that was already fast isgoing a whole bunch faster.
And that is a, you know, so Iwanted to warn against that.
I wanted to make sure ifthey're rehydrating as they
should be, that they're ideallyusing an official oral
rehydration solution likePedialyte.
And because that's gonna bemore effective than just water
(21:17):
and don't drink coffee.
People try to wake up.
It's the same thing with theADHD medicine concept.
You know, I'm gonna wake you upbecause you have this brain
fog.
No, the brain fog is frominflammation and anything that
just is a stimulant is not gonnafix that.
So that's really important toaddress some of those things
that they can do that areactually harmful.
And by the way, pro tip don'tuse a straw when you are
(21:41):
rehydrating after vomiting ifyou're still nauseous for any
reason, because it can actuallyyou get more air into your
stomach, and that can actuallymake you more nauseous.
Dr. Erich Schramm (21:51):
Wow.
See, these these are gonna begreat pointers.
So I'm uh I'm gonna have tohave all my kids and their
friends all take a listen tothis when this comes out.
So um, but also too, and that Ithink you make mention that um,
you know, sometimes sensitivetopics there did if the if the
patients have concerns like,well, gee, could you uh put
(22:11):
yourself in a compromisingposition and getting back to
testing and talking about STDsbecause you know people get
blackout drunk, they may sothat's it's vulnerable people.
So they have to be you have toconsider that too.
So um yeah, and it's cool.
Dr. Jill Grimes (22:29):
If we could talk about that for just a
second, I want to emphasizebecause because now blackout
drunk is not just so first ofall, blackout is not passed out.
So for for the parents in theroom, blackout means that you
have a memory gap the next day,whereas passed out is
unconscious, and that's that'ssuper serious.
(22:50):
And you know, you need to callfor help if someone is
unconscious, they're unconsciousif you cannot wake them up.
Um, but a blackout means thatyou have a memory gap.
And there has been in the partyculture, unfortunately
emphasized in the party sectionof TikTok, which is why I'm
there, by the way, um, the theparty call of blackout or
(23:12):
backout.
You know, if you don't getdrunk enough that you forget
part of the night, you haveapparently not had a good time.
And obviously, not everybody isdoing this.
It is, you know, less than athird of college students, but
it's a significant number.
And it's concerning becausethere is this misperception of
if you can't remember, itdoesn't matter.
(23:34):
Uh family medicine, we canimmediately think of a couple
outcomes where it matters,right?
Any kind of accident, uh,whether it's just stepping off a
curb and getting a concussion,or whether it is sexual assault,
pregnancy, STDs, all of thesethings.
So it does matter even if youdon't remember.
And it's these are the kind ofthings that I think it's really
(23:55):
important to have realconversations with teens and
young adults, because otherpeople are not having those
conversations.
They're saying don't drink oryou can't drink till you're 21.
Well, that would be great.
That would be ideal.
I would have no problem if noone drank until they're 21.
But that is not the reality ofour culture in the United States
today.
Dr. Erich Schramm (24:14):
Right.
And as a physician, you'realways daily having to face with
reality, so and doing the rightthing for your patients.
So um, so yeah, that's that'sreal that's a really good point
to make.
Um another chapter that uhstruck a um a chord with me was
the talk on the chapter onanxiety, um, depression, and
(24:35):
homesickness.
And so um, and and again, yougive some really good uh, you
know, some some pointers there,and maybe you could elaborate on
that a little bit.
Dr. Jill Grimes (24:47):
Sure.
Well, this time of year, thebiggest thing is homesickness.
We've got kids who who justmoved in or are about to move
in, and we've got kids who maybemoved in early and went through
the Greek system recruitment,used to be called Rush, and
maybe they didn't get thatsorority or fraternity that they
really wanted.
(25:08):
And these are tough ways tostart the year.
Um, so the biggest thing abouthomesickness is looking forward
rather than back.
The more that you are lookingon social media at your friends
who are all at different schoolsand obviously posting their
highlight reels, as are you, uh,it just makes you feel more
(25:30):
lonely and you're missing thepast.
The best thing you can do, Ihave this rule of three.
Pick three organizations tojoin.
And I'm talking join, not tryout for, not audition for, just
straight up join.
And I encourage people to pickthree completely different
organizations.
So maybe a serviceorganization, maybe something
just super fun if you likeintramural sports, something
(25:54):
like that, or if you lovemovies, joining a movie club.
There's there's trust me,there's something for
everything, but something,something service, something
I'll say frivolous, like foodieor movie or whatever, and
something maybe in your major.
And that way you'll meet threedifferent groups of people.
They all share one thing thatyou like, and you'll start being
(26:16):
able to see who you reallytruly jive with, because at
first there's all this pressureto be friends with your roommate
or your suite mates, and thatmay be great.
Or you may, you know, they maybe somebody who sort of is a
ship passing in the night.
So you gotta dive in.
Dr. Erich Schramm (26:35):
And you know, I think another important uh
point I recall reading is likeum, you know, the kids that
might want to come home on theweekends, you know, and try to
try to reconnect there, right?
Dr. Jill Grimes (26:46):
Yeah.
So honestly, I see this just asfrequently, if not more
frequently, from the parentperspective of if your kid goes
to college within say an hour,hour and a half radius, there is
a big drive to, especially ifit's the oldest, oh, come home
for your sister's volleyballgame.
Come home for Sunday dinner.
Oh, come home, I'll do yourlaundry for you.
(27:08):
And and and none of it is, it'snot trying to control them, but
what's happening is they'rebeing pulled backwards and they
are not having the sittingaround in the laundry room where
you meet some other randomperson who's also sitting around
in the laundry room.
You know, you that's when thosefriendships are formed.
And I found like Austin, Texas,obviously you have the huge
(27:30):
University of Texas right there.
But some of the people who arethe most homesick literally live
in the same city.
So it's it's not correlatedwith how far away you are.
Sometimes I think the peoplewho are far away, and both of
our girls actually went over athousand miles away, different
directions.
But you know, you're kind offorced to jump in and do things
because it's not an option to gohome.
(27:51):
So I think sometimes thatthat's helpful.
Dr. Erich Schramm (27:53):
Wow.
Um, so uh talk, I want to goback and uh you would have been
seeing a patients during COVID.
Uh, is that recall that timeframe and and how COVID what
that how that affected um thosekids growing up and then going
off to college?
And did that you knowcontribute to some of the issues
that kids are seeing now?
Dr. Jill Grimes (28:15):
Well, I don't think there's any question that
COVID disrupted all of ourlives.
And certainly there's a goodargument that students in
general all ages got disruptedthe most.
But it's very uh I I actuallyonly saw students during the
first year of of COVID, reallyfirst six months or so of COVID.
(28:37):
Um but the the hard thing isthat you know each each
challenge is unique to eachgrade that they were in when
they were completely on virtualschool, right?
And now we have a whole groupof college students who were
(28:58):
affected all to some degree oranother during all of their high
school.
And I certainly I think we'reseeing a lot more difficulty
interacting with other people inperson.
Um, seeing a uh a reliance onvirtual classes and more and
(29:19):
more colleges, it's quite asurprise to parents paying
tuition that there are a lot ofreally outstanding schools who
still have a lot of classes thatare also offered on online or
maybe only offered online.
And it it's a big transition togo from what they had as a
COVID high school class onlineto now a class in university
(29:44):
online.
And I I just, you know, thatthink it's really important for
students to recognize that it isa different situation.
They need to jump in, they needto be responsible for
connecting with that professor.
Again, my dad was a professor.
We when My brother and sisterand I went to school.
The rule in our household wasif you're in college, the first
(30:05):
two weeks of every semester, yougo around to office hours and
you meet every one of yourprofessors.
It doesn't have to be a longconversation, but go to their
office hours.
So you're going when theyexpect students and just
introduce yourself and you know,use context clues.
Look around the room if they'vegot pictures of something that
you like.
There's maybe they're skiers orthey, I don't know, whatever
they do.
(30:25):
But comment on that and talk tothem as a person.
And it's going to just set youup for so much more success.
And I think it's important toeven do that with your virtual
classes.
And all the professors I knowfeel very strongly that those
the kids who do that are theones that succeed the most.
(30:47):
I always feel strongly that we're so much better in person, andhopefully one day uh we can do
a podcast in person.
And, you know, uh, but yeah,and I'm I'm glad to see it, you
know, with my kids that they'vereally embraced um doing a lot
of that, showing up and andbeing there and knowing their
professors and their TAs.
And so I I totally agree withone other thing, um, so one of
(31:09):
the things that's reallyimpressive about uh your book is
it's evidence-based.
So um say let's take, forinstance, the chapter on sinus
infections and runny nose andsore throat.
So um, and you again kind ofreiterating the point, look, you
know, this really isn't uh theplace for antibiotics.
And you know, and you can andyou know, for those all of your
(31:31):
recommendations um can go backand you can go back and
reference and say, look, youknow, this is this is really
evidence-based practice.
So it it is that time of theyear when everybody's catching
the things that are goingaround.
And so um maybe just to kind ofreiterate a little bit about
um, you know, an approach towhen you get that cold, when
(31:52):
you're getting that sinusinfection, um, you know, kind of
the best approach for that.
Right.
And it is I I want listeners toknow that from the doctor's
standpoint, it is way easier togive an antibiotic unnecessarily
than to have a five-minutediscussion about why you're not
giving an antibiotic.
(32:12):
So we're not doing that, and wedon't make money from the sale
of antibiotics.
There's there's no conspiracythere.
But trying to convince peoplethat they don't need antibiotics
for a viral, you know, greensnot does not equal antibiotics.
That's that's the take-homemessage.
So we what we want is forstudents to treat symptoms.
(32:32):
And one, have a thermometer sothat you can check your
temperature.
If you have 103.7 fever, weprobably want to see you, you
know.
Uh, if if you've got 99 tempand a stuffy nose and sore
throat and you know, you'refunctioning fine, probably
that's a time forover-the-counter medicines.
(32:55):
And, you know, obviously Ican't give individual
personalized medical advice, butby and large, most respiratory
viruses and sinus infections aregoing to be viral.
And we want you to, we don'twant you to come in at the first
sniffle, but we also don't wantyou to wait until you're in
crisis.
And that's true whether it's awhether it's a horrible, you
(33:15):
know, sinus pain or whetheryou're in crisis from test
anxiety or anything.
Don't, don't, we're we're thereto help.
And if you have questions, andparticularly young college
students, this is the first timethey're managing these symptoms
on their own.
But that's why we have mostplaces have 24-hour nurse
(33:38):
hotlines, and you can call andyou can get recommendations.
And if you just keep in mind,if you take other medications,
like if you're on prescriptionADHD medications or
antidepressants, anti-anxietymedications, some of those
interact significantly withcough and cold medications.
And so that there needs to be adiscussion with a medical
(33:59):
professional, including apharmacist.
If you're gettingover-the-counter medicine, the
pharmacists are well versed inwhat is going to interact and
what is not.
Dr. Erich Schramm (34:06):
Right.
And I think a great point aboutyour book is making it clear,
you know, at what point you needto engage a doctor.
You know, it's one thing tonurse symptoms at at home, but
you know, when in doubt, here'swhere you need to go and and how
to how to contact thoseresources.
So that's very, very helpful.
Um, I'm also now looking attowards the bonus section of the
(34:28):
book called Do It YourselfFirst Aid Kit.
And I'm like, holy cow, this isfantastic.
Um, you've got any.
Yeah, I mean there's literallya checkbox.
I love that.
First aid kit.
So um to that point.
So the the if you're uh at homewith a sniffle, sore throat, or
cough, or whether you've got arash, or whether you've got
(34:50):
whatever you have, uh upsetstomach, um diarrhea,
dehydration, I mean, there's allkinds of things here.
Um, and you know, you reallyit's it's it's very clear, very
concise.
So uh again, um, you know, usadults need to have something
like this at home because uh,you know, again, these are gonna
(35:11):
be so helpful.
Dr. Jill Grimes (35:12):
Right.
And when you need it, you needit.
You know, when you're whenyou're throwing up all night at
3 a.m., you don't want to haveto make a run to the store to
get an oral rehydrationsolution.
So I keep those single servinguh powders in there.
So you've always got it onhand.
That's really important.
And even if it's just that youneed an ace wrap, again, if
(35:34):
you're hobbling around, it'd benice to have it at your
fingertips.
If your roommate's coughing allnight and keeping you from
sleeping, it's really nice tohave some over-the-counter cough
syrup if it's appropriate forthem to take that.
Uh, and also I'm gonna put in aplug for Narcan.
This is something new thatwe've added to the first aid
kit.
Narcan, everyone knows aboutthe fentanyl crisis, the opioid
(35:58):
crisis in our country.
And I think what a lot ofparents miss is that they expect
that these fentanyl overdosesare only going on in like party,
you know, raging parties,right?
And there are kids that willtake all kinds of substances to
(36:18):
party, but they know thatthey're taking a risk.
And I certainly hope that theyhave Narcan on hand as well.
Something that a lot of parentsdon't think about, however, is
that kid who is so anxious thatthey just they can't sleep.
They've got a chemistry test,you know, Gen Chem test coming
up and they can't sleep.
They've been studying for threenights, and their roommate
(36:40):
says, Oh my gosh, just take thisXanax and so you can get a good
night of sleep, right?
Well, if that's a prescriptionXanax that was prescribed for
that roommate, one, you stillshouldn't be taking it.
But two, that might be safe.
But if it's a Xanax that theygot from somebody else because
they were having troublesleeping, now if it's a street
drug Xanax, there is a verystrong chance that there's
(37:01):
fentanyl in there.
And that's why it's one pillcan kill.
It is college students, youngadults who are looking for a
simple fix to a problem.
They think they're gettingsomething that is not risky, and
yet it can stop them frombreathing.
So Narcan is a spray that canreverse that.
So I think that's an importantthing to have.
Dr. Erich Schramm (37:22):
Yeah, that's a great point.
I mean, Narcan saves lives, youknow, and that's the reality we
are we're living in right nowwith uh with the opioid
epidemic.
So absolutely.
Um, I know we talked a bitabout uh sexually transmitted
disease STDs, and I'm referringback now to look at chapter 45,
uh, very well written, but ummaybe touch a little bit about
(37:44):
how um, because a lot of people,a lot of you know, young people
think, well, if I've got anSTD, I'm gonna have symptoms,
right?
Something's gonna show up, andso I must be okay, right?
Hey, if I must be all right,right?
I mean, what could possibly gowrong?
Dr. Jill Grimes (37:59):
Or or I had symptoms.
Oh, thank God those symptomswent away.
I had some burning there when Iwas peeing at first, but that
was it's been two days and ithasn't happened anymore.
So I must be fine.
So, yes, we have to get themessage across that sexually
transmittable infections arehonestly most often silent, and
yet they can do damage,particularly in young women.
(38:21):
The you know, biggies that weworry about missing are
chlamydia and gonorrhea.
And those can go on to createproblems, scarring, chronic
pelvic pain, and eveninfertility in women.
They're easily treated.
They're bacterial illnesses.
Actually, gonorrhea, let mestep back.
It is a bacterial illness thatis not easily treated because
(38:42):
it's got so much antibioticsresistance.
I shouldn't be laughing atthat.
Dr. Erich Schramm (38:46):
The super bugs.
Dr. Jill Grimes (38:48):
Yeah, it's it's actually gotten a little
scarier.
But chlamydia is very easilytreated, but we have to know
it's there.
So if you are sexually active,meaning that you are being
sexually intimate with otherpeople, then you need to be
checked once a year at least.
Dr. Erich Schramm (39:04):
Yeah.
Do you think in terms of thetreatment then as far as as a as
a clinician, are you justgonna, you know, go ahead and
just presumptively treat, youknow, somebody comes in and
says, I think I might havesomething.
Um, are you gonna just say,Okay, well, look, we're gonna
presumptively treat you forgonorrhea and chlamydia or are
you gonna wait for the test tocome back?
Dr. Jill Grimes (39:24):
It depends on the setting.
Nowadays, I you know, in a in acollege health setting, uh
students are highly, highlymotivated and likely to come
back.
So typically we would testfirst.
There are certainly uh publichealth clinics where there may
not be as consistent a follow-upwhere there is presumptive
treating.
Dr. Erich Schramm (39:44):
Yeah.
And and that that makes sense.
I mean it's your patientpopulation at the end of the
day, and then you know them andwhat's best for them.
And but you also make a point,an important point about
follow-up.
So if you're gonna get treated,go back and make sure you're
you you're clear.
Is that right?
Dr. Jill Grimes (40:00):
Absolutely.
And the other thing is I'vealways said that STDs travel
in packs.
You know, people are are alwaysshocked, almost always, 98% of
the time, pulling that numberout of my head.
But from my experience, thevast, vast majority of people
are just shocked when they'rediagnosed with a sexually
transmittable infection.
Like, how could this happen tome?
(40:20):
How could that person havegiven that to me?
But they're even more shockedwhen they have more than one STI
and see that all the time.
A lot of times it's genitalherpes and chlamydia, or you
know, pick, pick, pick yourmatch.
But the reality is that they'reall transmitted the same way.
So of course we see a lot ofthem together.
And gonorrhea and chlamydiahave been together so much that
(40:43):
a a lot of times we empiricallydo treat for both when you're
positive for one.
So it the but the the the majormessage I want to get across
though is just get tested and beunderstand that if we are
offering testing for say HIV, somany times people will say, Oh,
they're not that kind ofperson.
(41:03):
Like there is no that kind ofperson.
Exactly.
We're all that, we are all thatkind of person, right?
It's these bugs don't care whatyou look like or how much money
you have or where you live orany of that stuff.
And yes, they are moreprevalent in certain
populations, but the reality isanyone can get any of them.
And if you're positive for one,you should be checked for all
(41:24):
of them.
Dr. Erich Schramm (41:24):
That's right.
And I think the advice you'dgive in there was don't don't
ever hook up with an X, right?
Dr. Jill Grimes (41:32):
Oh, if there's one, don't do the X.
Dr. Erich Schramm (41:35):
Don't do the X, right?
Dr. Jill Grimes (41:37):
Every every primary care physician.
So then uh yeah, yeah, we brokeup, but then I ran into him or
her at this bar, and we all knowwhat's coming next.
Dr. Erich Schramm (41:46):
And and adults too.
Let's be clear that it's notjust college kids, but maybe
adults should be heeding thisadvice, yes.
Dr. Jill Grimes (41:54):
So even more so if it's an ex-spouse.
Guaranteed you're gonna get itfrom exactly okay.
Dr. Erich Schramm (41:59):
So that's an important take home message for
everybody.
So, Jill, thank you so much.
You've been very generous withyour time.
Um, and like I said, the thethe book is uh tremendous.
Um, I can't wait to to spreadthe word because I know it's
this is is gonna really uh sinkhome for a lot of people.
Um anything, uh any questionthat I should have asked that I
(42:22):
didn't ask you or a point thatuh you'd like to make.
Dr. Jill Grimes (42:26):
I just want to reiterate the biggest thing,
biggest mistake that I see inyoung adults and and actually
really everybody is waitinguntil you're in crisis to seek
help.
And part of that's because ofall the barriers we have with
access to care.
And I understand that.
And but whenever possible, I'mnot don't go in at your you
(42:47):
know, second flake of dandruffor your first sniffle, but also
don't wait until you're somiserable that you cannot cope
with it because then it's evenharder to get in.
And and we can intervene withthings, especially with anxiety
and depression, and you know,mental health is equal to
everything else.
It is a valid reason to see adoctor if you have insomnia.
(43:10):
That is a valid reason
Dr. Erich Schramm (43:11):
And and this ties into what you're doing
through your um in your virtualhealth uh project that you're
doing, right?
That's that that's that kind ofaccess.
Um, and that's and there'sconfidential uh confidentiality
in that uh for uh for thosepatients.
Dr. Jill Grimes (43:26):
Oh absolutely.
Dr. Erich Schramm (43:28):
Because I think a lot of times, you know,
kids are like, well, are my aremy parents gonna find out about
this stuff?
And you know, they're they'rehesitant.
Dr. Jill Grimes (43:35):
We should add one thing since you said that,
especially this time of year.
College students are mostlystill on their parents'
insurance.
And what they need to know isthat while there is complete
confidentiality between thedoctor and the patient, there is
something called an EOB that isan explanation of benefits.
(43:56):
And it is just it's not gonnasay your diagnosis, but it will
certainly say pregnancy test orchlamydia test.
We can't change the names onthose things.
And so students need tounderstand that if their parents
are paying the bills, theirparents are going to get this
explanation of benefits thatdoes have names of tests on
(44:21):
there that would stronglysuggest with context clues
what's going on.
So I think it's reallyimportant to have open
communication about that.
Dr. Erich Schramm (44:28):
Can those patients go to, say, like a
public health office, publichealth department, and avoid
the-
if those patients pay cash, ifthey go to a uh public health
office, uh if you're not, it'spurely if you're using your
parents' insurance.
If you're using your owninsurance, you will be the one
getting it.
Uh, if you're paying for theinsurance, it's whoever's
(44:48):
paying, the guarantor, who isgoing to get it.
So the what the workaround isthere are many free clinics um
and there are many places youcan pay cash.
And almost all college campusesnow have free SDI testing in
particular.
That's that's that's a great point to make.
So well, great.
Well, thank you so much.
Um, I hope we'll have a chanceto talk again soon.
(45:10):
Um, is there another book inthe in the works?
Dr. Jill Grimes (45:14):
There may be another edition in the works,
but not not right now.
Honestly, we I've got my platefull for the next year.
Dr. Erich Schramm (45:23):
That sounds that sounds good.
All right.
Well, thank you so much.
And you have a great rest ofthe day here, and uh we'll
hopefully talk again soon.
Dr. Jill Grimes (45:31):
All right, thanks so much for having me.
Sure.
Dr. Erich Schramm (45:33):
Bye bye.
Thanks for joining theMedEvidence Podcast.
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