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What happens when a physician who spent decades treating patients suddenly finds himself on the other side of the exam table, unable to get a simple answer about his own aneurysm? Jeffrey Junig, a psychiatrist and addiction medicine specialist, shares how a life-saving surgery and a casually dropped diagnosis exposed the growing disconnect between clinical excellence and patient experience. Based on his KevinMD article, “Why quality of life in health care is often overlooked,” this conversation digs into what gets lost in 15-minute visits, why patients turn to the internet when doctors won’t engage, and how even a physician with full access to medical literature struggled to advocate for his own care. You’ll hear practical advice for patients who feel rushed or dismissed, honest reflection on polypharmacy and the limits of app-based communication, and a powerful case for why the doctor-patient relationship remains the most undervalued tool in medicine. If you’ve ever left a clinic feeling unheard, this episode will remind you that your questions deserve real answers.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Jeffrey Junig, psychiatrist and addiction medicine specialist. Today’s KevinMD article is “Why quality of life in health care is often overlooked.” Jeffrey, thank you so much for joining me today.

Jeffrey Junig: Thank you so much for having me. I’m really happy to be here. Thanks, Kevin.

Kevin Pho: All right, so just briefly introduce yourself and let us know why you decided to write and share this particular article on KevinMD.

Jeffrey Junig: So just to first explain where I came from. I started with the MD-PhD program in the mid 1980s and eventually went to Penn for anesthesia, did anesthesia for 10 years. Left the field in 2001, about 25 years ago. Took a couple years to do other things. I did evaluations on the first TSA employees when they were hired, things like that. Then I went back to residency and psychiatry. Got out with the opioid problem happening, and really made a name for myself with Suboxone, one of the early prescribers back in 2006. And continued that with psychiatry patients.

And I’ve always, besides my private practice, I’ve had many things on the side. Prison work for men and women, university work, methadone clinic. I think for someone in private practice you really want to do something else or you really kind of get isolated. So that’s how I approached it, and I just retired a few months ago.

So as far as the story, I started noticing with my psychiatry patients, we’d talk about psychiatry, but they always had questions about their personal health problems. And I end up explaining what Arnold-Chiari meant or what an abducens nerve palsy was, or pictures of the lumbar spine and showing them what discs do to nerve roots. That was always a big part of the day with some people. But I didn’t really pay much attention in kind of an angry way until I got sick in 2022. I developed CTEPH, which is a fascinating condition, and had PTE, 12-hour surgery. Saved my life out in California, definitely I was going to die. The surgery was very quick, but if someone saves your life, you want to spend more than 15 minutes with the surgeon. But you really don’t.

But it became more of an issue. Then after that, just last summer, I saw my cardiologist, a new cardiologist this time, and he kind of said in passing, initial visit 20 minutes, and he said, “Oh, your aneurysm looks stable.” And I said, “Aneurysm? What aneurysm?” And he said, “Oh, your thoracic, your ascending aortic aneurysm.” I said, “No one ever told me I have an aneurysm.” And that was the end of the visit pretty much. But I went home, and as a doctor I put all the echo data together, and I looked, and yes, I got an aneurysm right above the sinus of Valsalva. And I project it, it gets bigger every six months, but I’ve never done anything about it. Probably need surgery in five years.

And I sent a message on the app to my cardiologist, nurse, because in my area, nobody talks to doctors. And I said, “I really want a beta blocker.” And the nurse wrote back a couple days later, “He’s not comfortable.” And I said, “Well, could you ask him why he isn’t comfortable?” And she got back a week later and said, “He just said he isn’t comfortable.” And for someone like me, that just isn’t good enough. I love physiology. So I pushed, sent article copies on the app. Eventually I got metoprolol at the lowest dose. But my fingers were freezing all the time. And again, I have access to an electronic library because I teach. And I started reading about nebivolol and nitric oxide. So I asked for that, and it took about a month of pushing, and I got nebivolol at 1.25 milligrams. And I just wanted, I’m laying in bed feeling my heart pound and I can’t really talk to anybody about this. They told me we can talk about it more at my next visit in six months, but I didn’t want to wait six months.

So I went on an online pharmacy, and they sold nebivolol, five milligrams, any dose. So I ordered five milligrams, not as a doctor, as a patient. And they said it’ll need doctor approval. And I paid the $20 to have a doctor approve it, and 10 minutes later it was OKed, and a few days later came in the mail. No one ever asked about my health. My heart, I don’t know how a doctor approves it in that situation.

So that’s what led to it. And I sometimes feel like Rip Van Winkle, because I’ve been in my own practice for 20 years. And I just didn’t realize how different things were these days. So I think that with the decreased time that all of us in health care have with patients, there’s a gap between clinical outcomes of lived experience. And there’s no doubt medicine has become fabulous at helping with disease. My surgery, treatments for so many things we didn’t have 30 years ago. But at the same time, I think it really misses something. And I think doctors underestimate how much patients want to have some type of relationship. They don’t want the doctor walking in and standing while they sit and then walking out. They want to talk to someone.

Kevin Pho: Now you connect this experience in your story to seeing long medication lists in your years of psychiatry. So how did becoming a patient yourself change the way you understood polypharmacy?

Jeffrey Junig: So polypharmacy is a big problem in psychiatry, as you know. And just working with people, I’d often see all sorts of things that didn’t make sense. Someone on an SNRI and an SSRI, or somebody on two antipsychotic mood stabilizers, things like that. So that certainly made me aware of it.

For myself, I don’t think I faced polypharmacy as much as kind of a lack of pharmacy. It is just hard to, in 10 or 15 minutes, it’s hard to talk about all of the things that might favor, especially a broad class like beta blockers where there’s so many of them. And they’re all a little different. And my guess is most doctors kind of have their favorite beta blocker more than looking at the patient, really understanding, is this someone more prone to fatigue? Is this someone who complains about cold hands? Because that was kind of the point in my article. It’s all those little things. You get your life saved, but the little things, not so much.

Kevin Pho: Yeah. So sometimes I know as physicians we get focus on the clinical outcomes, the mortality benefits, but sometimes these quality of life changes, they often become secondary, right? So in the context of a limited time visit, like a lot of people like me in primary care have, how do you balance sharing some of the potential clinical outcomes with some of the potential side effects or changes in quality of life?

Jeffrey Junig: And I don’t know, because I’ve never worked for a system. I’ve worked in one as an anesthesiologist. But I’m sure doctors, when I go to the doctor, my doctor doesn’t look happy. He looks rushed, he looks hurried. And I wish there was more pushback from the medical, the physician and nurse practitioner side of things on that type of issue. Because when people don’t get the answers met by their doctor, they go online, they go to Quora or Google. And I think it reduces medicine in a way, and it creates risk, because people are doing things that might not be appropriate for them.

Kevin Pho: So when you were initially prescribed that beta blocker, the metoprolol, if you were to replay that scenario again, what would you have liked to see happen?

Jeffrey Junig: I really miss, and I don’t know if it’s just my area, but I really miss the days. I think my mother, when I was growing up in the sixties, and her yelling, “Stay away from the phone, the doctor’s going to call,” and she’d wait all day for a 10-minute call. And in my area they no longer called with test results. It’s all on the app. So that’s been my biggest, it just would be nice even if it was three minutes. And I get it, doctors are too busy. So I don’t know. And it’s not like we have a lot of extra doctors either, because here you wait four or five months for an appointment. So I don’t know. I just wish that an answer like “I’m not comfortable” doesn’t say enough for someone like me.

Kevin Pho: Yeah. So what kind of advice do you have for patients who may be listening to you now? Because I think what you’re describing in your story would resonate with a lot of patients. Do you have any advice for patients on how they can ask these questions and get some of these concerns addressed during a visit? How can they approach their physician?

Jeffrey Junig: I probably had some patients make their doctors angry, because I generally tell them, “You paid $400 for this visit, or somebody paid $400 for you, and it’s a service industry, and you have a right to know. If there’s something significant in your head that hasn’t been answered, push.” And people, I know they feel like they’ll ask a dumb question, or the doctor might get mad at them, which does happen. But I try to encourage them, and sometimes I’ll even coach them. They’ll say, “How can I ask about this?” And we’ll run through it. And just be very nice, be very respectful. Just keep kind of gently pushing until you get an answer. And that’s what I would tell any patient really, because you are paying a lot of money, and it should be more than just picking up your script and walking out the door. There should be some transfer of information. And I don’t think sometimes patients get that information in a forum that they understand.

Kevin Pho: In your article you write that there is very little space for a sentence like, “This is a dangerous, but it’s making my life smaller.” What would it take for health care to make that sentence matter again?

Jeffrey Junig: That’s funny. I think it’s going to take a cultural shift. I don’t think, I think we have enough metrics and regulations and things. I really think that at some point maybe organized medicine will see, we’re losing patients to the internet, to online practices, to things like that. And maybe they’ll start teaching. I mean, you went to medical school some time ago. They used to teach, you sit at the same level as your patient’s eyes.

I took my mother, who had a broken arm, to, she’s 92, to an orthopedist recently, and as he was talking, he reached out and put his fingers on her kneecap, she’s in a wheelchair, and said, “I’ll do what I can to help you.” That was probably the most important thing about that entire visit. It’s just those little things that really make a difference to people.

Kevin Pho: I think there was a saying, one of the marketing books, you probably know, like, people don’t remember what the doctor says, but they remember how they made them feel, right?

Jeffrey Junig: Absolutely, absolutely. And by the time, a lot of times by the time you get out of the clinic, you’re not feeling good, because you’ve passed through a few different people, and some receptionists aren’t having a great day. So, but yeah, I think that’s exactly right.

Kevin Pho: We’re talking to Jeffrey Junig, psychiatrist and addiction medicine specialist. Today’s KevinMD article is “Why quality of life in health care is often overlooked.” Jeffrey, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Jeffrey Junig: Take-home, again, I just remind doctors out there, I know everyone is busy and I know it’s such a tough job, and I just say, if you’re running your own practice, you know this already, because people won’t come back if you don’t really provide a connection and a service. But if you do provide that connection, if you can find a way to get the time to do it, at least with people who are really struggling, you’ll love your career more.

One of the benefits of my type of practice was getting to know patients, some for 20 years. And that was so rewarding. You have to have a boundary, but they feel like family in a way. And it made my job truly wonderful, and I’ll carry those memories with me. And I can imagine if I was working as a throughput type of physician where it was just bang, bang, bang, I don’t think I could do it. Certainly not as long as I have. And I just think the reward is there, but the connection is the reward. And that’s, I think, why people went to medical school in the first place, and then they kind of lose that because of the way practices are organized these days.

Kevin Pho: Jeffrey, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Jeffrey Junig: I really appreciate it, Kevin. Thanks for having me.