This is what a successful health care system looks like [PODCAST]

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“If we are serious about supporting the optimal health and well being of our nations’ patients and physicians, we need to start believing and implementing the science across the public and private sectors. We need to recognize that at its core, the practice of medicine is a human science. We need to allocate and deploy resources to the people and programs in health care doing the work of healing our nation. We need to provide a ‘self-care as health care’ optimal health system, which is educative, accessible, preventative, and patient-centered.

This is what a successful health care system looks like.”

Lillie Rosenthal is a physiatrist.

She shares her story and discusses her KevinMD article, “This is what a successful health care system looks like.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Lillie Rosenthal. She is a physiatrist and osteopathic physician, and she wrote the KevinMD article “This is what a successful health care system looks like.” Lillie, welcome to the show.

Lillie Rosenthal: Thank you so much. It’s such a pleasure to be here. Thank you for all your good work and for giving a voice to all of us physicians who really care about bettering the lives of our patients and, hopefully, the health care system. I look forward to the next 15 minutes of chatting about that.

Kevin Pho: Well, thank you so much for those kind words. We’ll get into your KevinMD article in a little bit, but first off, can you just share your story and your journey to where you are today?

Lillie Rosenthal: Sure, I’d be happy to. In addition to being a very proud mother of a 20-year-old daughter, who hopefully is on the road to becoming a physician herself, and the grateful daughter of two wonderful parents who have supported me along this journey, along with my patients and friends, I have come to the place where I’ve been practicing as a clinical physician for 30-plus years. So it’s been decades of having the privilege and honor to keep my patients healthy and make them healthier, which is a basic thing that we may be losing in this conversation around health care.

I’m mostly a pain management physician. As a physiatrist, I have a robust, successful outpatient practice in the middle of New York City. But what I really do is get into very basic things about what healthy means. We’ve come a little bit away from that in the past couple of decades, which I’ve noticed. I’d say I’ve stayed true to my mission as a tried-and-true osteopathic physician, and that’s what attracted me to go into the osteopathic field to begin with, because I really cared about the human science of medicine and the humans that would be sitting in front of me. I realized that a lot of what I do is really about very simple, but not easy, behavioral change.

So this may come as a surprise to most of my colleagues listening, but as a pain management physician, I rarely, if ever, prescribe a medication or recommend a medication, even an over-the-counter medication, and I rarely recommend procedures. Why that is so unusual, and I hear this all the time in our climate, is because I really stand out, I think, from where the health care system is going. My mission, and I do consider myself a bit of a medical activist, is to change the status quo by really getting back to basics. We are physicians, but we are also teachers, because, as I say to my patients, the doctor, including myself, is not going to make you healthy. We as physicians are really educators, to help you and incent you to create healthy behaviors. We know this. This is science, guys, right? Epigenetics: Our environment changes our health path.

So I am fierce about wanting to remind us about the very basics. I know tech is sexy. I know the new biotech and procedures, and I know they’re lucrative, and that’s part of the problem. I get it. But I am passionate about reminding my patients and this audience of the basic things: 80 percent of chronic disease, and I’m a pain management specialist, but chronic disease is reversible and preventable. We’re in a public health crisis right now. There needs to be more of a shift of focus, a rethinking of who we are as doctors and who we are as a health care system. For anybody that’s listening that wants me to jump on board, I am ready, willing, and able to contribute to this mission. And that’s putting it mildly.

Kevin Pho: So tell me about the patients that you see in your pain management clinic, and in a little more detail, how you approach pain specifically.

Lillie Rosenthal: Yeah, great question. I’d be happy to. I see patients from all walks of life. I have a particular interest in seeing artists. It’s not exclusive; I don’t see exclusively artists. But I see people who have a pain problem, as I remind my patients. How I look at it is: I see pain, and I try to figure out the root cause of why. As I say all the time, pain is not a diagnosis. We have an opioid crisis, guys. Pain is not a symptom to be suppressed. It is a puzzle. I’ve written an article about this, not for KevinMD, but I will. It’s not about suppressing symptoms. I actually see pain, Kevin, as a portal to optimizing people’s health.

As an osteopathic physician, again, my most valuable tools are my eyes, my ears, and my hands, to listen to the stories, to decode and demystify where the pain is coming from. With all the pain syndromes I see, and I’ll say it again, I rarely prescribe a medication, because the answers to these are simple, simple things: food, exercise, sleep, prevention, and managing stress. We know that these are the tools. I know they’re not sexy. I know they’re not lucrative, I’m going to say that again. But these are the things that flip people to better health and healthy habits. And, oh, by the way, chronic disease and pain problems are bankrupting our country, not countries, but bankrupting lives and families, and the human toll. We can do so much better.

So the message really is back to basics: recognizing that medicine is a human science, and that we have the tools, with the emphasis of being physicians, to remind people of these very basic things. Patients are not only consumers just wanting the latest drug. Some do, but we need to talk them out of that.

Kevin Pho: Excellent. So let’s transition now into your KevinMD article, “This is what a successful health care system looks like.” You talked a little bit about your vision of the health care system earlier, but for those who haven’t read the article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Lillie Rosenthal: Sure, I’d be happy to. Actually, full disclosure: I wrote this abstract to present at the Aspen Ideas Festival, under the topic of everything was changed, or big changes, and it never happened because of COVID. And I’m like, “I need to get this out there.” So thank you for accepting it and giving this a voice.

If, and I’m going to really highlight the “if,” if the mission of our country is to really have the healthiest population possible, which is why I went to medical school, and that’s why I think most of us went to medical school. But unfortunately, I think a lot of this has been derailed for many people. We talk about the moral injury in physicians. We have the unhealthiest population: chronic disease through the roof, obesity through the roof. We only have 15 minutes, I get it. I can talk for days on this.

But if we really got serious about the singular focus of keeping people healthy, the financial burden, the physical burden, the death tolls. And now we have COVID, right? This is shining a light on the unsexy public health, back to basics: food, exercise. People need to know that medicine is really a verb, and living our medicine is the best we can do, not the most boring we can do. But it’s an imperative. People are dying. And we know, pre-existing with COVID, right? This is a lane. This is an opportunity to change the focus to doing what we know. There are enough studies. We don’t need more studies; we need stories. We need stories of how people are pivoting to living healthier lives.

I walk my walk. I found this. I didn’t learn all this in medical school, by the way. I’ve been experimenting with myself and my family and my patients for the last 30 years and getting more into the research of a plant-based diet reversing diabetes. Once again, I’m a pain management person, and it’s all the same. We are across the board. If we got very serious about literally prescribing lifestyle, social determinants of health. This is not fancy. People in communities of color, right, are unbelievably being affected in this situation. I live in New York. People associate that with money and fancy and all that. Seven bananas for a dollar: You can buy that on the streets of New York. This is not an elite system. It should be available for every human on the planet. And, oh, by the way, following these behaviors will also save our planetary health. So I always say: same prescription for the patient and the planet.

Specifically, I’m talking about a whole-food, plant-based diet, which we know decreases pain and prevents and reverses diabetes, and all of that. So simple. I say simple, but not easy, because, as we know, we’ve all been asked for so much behavior change recently, right? I’m hoping that maybe we can extrapolate. Well, we’ve all been doing social distancing, being at home, masks, hand washing. Everybody’s become a surgeon, right? So if we can actually take the moment to really digest what we know and pull back from this race towards poor health, which is what we’ve been on, I think there’s a huge possibility. I do this in my practice, and I want to have a voice on a grander scale, reminding us doctors of what we really already know but are not really implementing.

Kevin Pho: So I’m a primary care physician, and a lot of the people who listen to podcasts are clinicians themselves. What actionable steps can you suggest that we do in the exam room? Because a lot of times, like you said, we only have 15 to 20 minutes with a patient, and they have a laundry list of problems. So if you could distill your vision into a few actionable steps, what can you suggest that we do in the exam room?

Lillie Rosenthal: I love that question, Kevin, because I’m super, super practical. So what I do, literally, is I have one of those, and you know that I’m telling the truth, because I have no e-prescribing rights, because I don’t prescribe anything. So I actually have New York State prescription pads. If you don’t have them, print something up, go to Staples, and literally write down a few things.

I have a five-point plan, which I tell my patients after I diagnose their pain problem. A whole-food, plant-based diet. I know people are rolling their eyes: “Oh my god, vegan.” Terrible word; that’s a flash point. “I can’t do it,” right? Take steps. Meet patients where they’re at. Just throw in more vegetables, throw in more fruits, things that grow, right? That’s the food part. Exercise: Get out for an hour a day. The gym’s not a safe place to be at the moment. Super simple, no cost: Get outside and walk an hour a day. Sleep: Turn off your screens before bedtime. I know it’s been very hard with the election cycle and all the pandemic news, and we’re all totally addicted, which is another whole problem. Turn off your screens, less on the alcohol, which has gone through the roof lately because of the stress situation. Interrupted sleep: Sleep is one of those major pillars of cultivating good health and rebooting our systems. Stress management: I know it’s a challenge in these days, but something. Commune with nature, get outside.

And by the way, all these things that I’m recommending feed on each other. They reverse the loop of unhealthy, not feeling well, to “Oh, this is possible.” And remember, the body wants to go towards health. It’s us humans who often get in the way of that. So just even reminding ourselves and our patients: I often say, power to the patient. As a physician, you have a giant highlighter around what you say. You have the authority. We have the science behind us.

And for those of you who are on the front lines working in emergency rooms, who don’t have time to read the research on this, or think that it’s not important: We’re in a major crisis, a public health crisis and a health crisis. The science is there. This is not just, “Oh, a good idea.” This is epigenetics. Our environment actually can change the course of our genetic makeup. We are living human beings, and we can trend towards health instead of accepting all the commercials for food and pharma, which are really blocking that, and it’s all for money and power. I mean, we have 15 minutes, so I’m going to be super direct on that. So we need to have the fortitude.

And I’ll also say, for my physician friends, who I super care about as well: We have to start with ourselves. I think there’s so much more credibility if you take those actionable steps yourself and experience it. So experiment with yourself. I’ll present this two-week challenge to the physician group who’s listening: Try to go for a walk every day. Try more vegetables, more vegetables and fruits. A recent Lancet article: Our biggest all-cause mortality is food issues. Food. So if that was one thing that people are going to do, if they’re just not going to go for a walk, let them change their food, because we’re really in trouble with that situation.

Kevin Pho: We’re talking to Lillie Rosenthal. She’s a physiatrist and osteopathic physician, and she wrote the KevinMD article “This is what a successful health care system looks like.” Lillie, when you take this approach with patients, especially in your pain management clinic, in general, what are their responses? Are they receptive to your approach?

Lillie Rosenthal: People come to me because they know what I’m about, so there’s an opening, although behavior change is not an easy thing. Like I said, I’m recommending and prescribing very simple things. But I’d say the most, because we’re so very close to our food, people are like, “Oh my god, can I do that?” So people do take steps towards better, and that’s what I would recommend.

And I’m not quiet about this anymore. I used to be very reserved about it: “Oh, people are not going to do it.” And my 20-year-old daughter, who I mentioned, is like, “Oh, Mom, don’t say vegan.” So plant-based is a little softer. I think our language matters, right? So I tell stories. I mentioned my dad. He’s 86 years old, he runs four miles a day, he takes no medication, and he is mostly on a plant-based diet. And you say genetics? Well, both of his parents unfortunately died very young. So I believe, and this is one story, and that’s an anecdote, but I believe that people need to be committed to making changes and not outsource their health to physicians, even pills, procedures. There’s a very, very deep way of thinking here in this country: “I don’t have to do anything, and I want instant gratification, and I can eat this because there’s a medication for it.” Really, really bad idea.

So I don’t really have that challenge, Kevin, because people come to me because they know what I’m about, and they’re aligned. But I am willing, ready, and able to help change the conversation for people who may not be oriented towards that.

Kevin Pho: And my final question, Lillie: What’s your take-home message that you want to leave with the KevinMD audience?

Lillie Rosenthal: Please remember that medicine is a human science and that there’s a person sitting in front of you. So patient-centered, holistic care. Not alternative, not weird, not crazy stuff, not fringe, but just: We are humans. There’s all this talk about AI taking over and what’s the newest whatever, but we all need each other. So recognize that, meet people where they’re at, and let them know the possibilities of getting better, helping themselves, and helping themselves feel and function better. But we need to be the ones prescribing those tools, those actionable items, which we talked about earlier.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Lillie Rosenthal: Oh, it’s a pleasure. Thank you so much for having me, Kevin. Stay healthy. Take care.

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