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have-i-gotten-it-wrong

Have I Gotten It Wrong?

I'm no stranger to being critiqued and confronted even trolled online but when it comes from a fellow medical colleague I tend to take it a little bit more to heart because I want medical colleagues to be able to criticize me and for us to create better information I think this is a group effort when it comes to educating people online but when it comes from a place of toxicity that's when it becomes problematic let's first watch the clip that caused the controversy different traumas can actually show up as physical ailments later in life what how do you work through that then well first you have to be honest and do a proper work up and make sure it's not anatomical your proper history have to do a physical exam we have to get an Imaging to make sure there's nothing going on anatomically again there's no tear there's no and then you see if the patient is open to it you have to say hey I think that I've ruled out everything anatomically that could be wrong and I'm thinking that this is real you are feeling this I'm not saying this is in your head the root cause is is coming from something mental health related do you want to try and talk about that and if they're open to it we do it and it works wow and what controls the volume of the pain is our mental health the initial feedback was very positive people started talking about how their experiences were shaped by their mental health how their pain was impacted by things going on inside their minds or within their lives and I thought great we accomplished two goals here we had a short form piece of content performed very well and then we were also able to educate a million people plus then started coming to controversy as with any piece of content that gets wide distribution now the negativity was about people saying that I'm a Doctor Who's now gaslighting his patients and saying that there is nothing wrong with them this is all made up in their minds which goes exactly the opposite as to what I was saying in this clip this is real you are feeling this I'm not saying this is in your head I saw a comment appear from a verified physician colleague of mine an orthopedic surgeon a do and I was curious about their take on this matter because I always loved learning from other doctors especially sub-specialists who are experts in this field but I was sad to see that the comment that was left by this physician States why do so many people take medical advice from a pediatrician when the topics have nothing to do with Pediatrics hashtag clickbait I honestly haven't been as confused in reading a comment I'm not a pediatrician this really has nothing to do with Pediatrics this person came in again and said in general there's a lot of medical information about topics he and others aren't experts about it would be like me as an orthopedic surgeon giving info on a Cardiology subject I'm not the person for that info they rightfully go and correct themselves and say ah right family doctor again each specialty should stay in their Lane Orthopedics is not his Lane that's an orthopedic surgeon's Lane he is assuming the musculoskeletal pain is a mental health issue when he isn't an expert in musculoskeletal conditions now obviously I get upset reading this I work with orthopedic surgeons I've trained on orthopedic surgeons I had a focus on Sports Medicine preparing to become a sports medicine fellow after Family Medicine but all the Social Media stuff got in the way so I have a lot of experience treating musculoskeletal conditions and to see a fellow Ortho say that no one else is an expert on musculoskeletal conditions except them made me feel upset because it's inaccurate I went on and clicked on this person's name and wanted to see if they've ever messaged me before lo and behold they messaged me before and the message from a few years ago States love what you are doing brother I'm a fellow do and an orthopedic surgeon if there's anything I can do for you ever answer an orthopedic question for you for any of the projects you're working on Etc please let me know oh man what happened in the few short years that this person loved what I was doing all of these things and now is so critical for another doctor to publicly call out a fellow colleague and then generalize against all the other colleagues as well they must see something malicious in the intent of the content that they're posting on and I didn't feel like what I was posting was malicious let alone even controversial pain medicine organizations Ortho organizations physical medicine and rehabilitation organizations stand by these principles that mental health plays a role in physical health and that we need to be more cognizant of it in fact what we do wrong as Physicians is oftentimes times write off mental health so I respectfully said hey Doc I saw your comment on my latest video Curious what part you felt was inaccurate this doctor writes back while I'm an orthopedic surgeon so I look at it with a different perspective I specialize in lower extremities but I take care of a lot of professional athletes in general but say I see someone with a shoulder issue that I can't quite put my finger on despite my exam and imaging doesn't always give you a clear answer either all day I see athletes with normal MRIs but have a musculoskeletal issue I don't at that point assume it's a psychiatric issue I assume that I'm missing the diagnosis at which point I will send to my colleague who is an expert in shoulder issues and professional athletes if he can't figure it out which I would say between us both would be exceedingly uncommon then maybe we consider psychosocial issues ETC but again of all the thousands of patients we see it's less than 0.5 percent now maybe psychiatric issues like depression Etc can complicate the issue in regards to pain tolerance it's not that the actual musculoskeletal pathology G is not real I think uh my fellow colleagues respond here brings up a few points one our patient population is very different this person treats pro athletes I treat real people the rate at which legendary running back Adrian Peterson heals won't be the same rate that I heal or one of my patients who has heart disease or diabetes the way that they experience symptoms is going to be different they need to be able to deliver a fastball a hundred miles an hour with millimeter accuracy my patient needs to be able to type at a desk without experiencing high levels of pain and while my Orthopedic colleague here thinks that I'm diagnosing this as a psychiatric issue what I'm saying is psychosomatic issues which is the medical term for this can raise the volume of symptoms it's not saying there's no pathology and if our mental health State isn't clear if we're dealing with something if we have traumas that have been unaddressed these are not necessarily psychiatric diagnosis but these mental health conditions lead us to experience pain worse than what the anatomical condition or pathology is there's actually a book on this called the body keeps the score that talks about how adverse childhood events that Trauma from our childhood can actually leave physical symptoms in our bodies into adulthood I didn't say that I don't involve Specialists I didn't say that I don't get a second opinion in fact if a patient still thinks that there's something anatomically going on or we're not just getting a clear diagnosis that I'm comfortable with we absolutely continue finding what the cause is I even pointed out in my response message that we can disagree on how often mental health is a leading or contributing factor to the symptom of pain but is it necessary to put down a fellow do and say inflammatory lines like stay in your lane he did offer to remove his comment if he was offending me and that was nice I had a genuine question for this physician should only cardiologists talk about high blood pressure because they are the experts of the heart who is the expert who is allowed to talk on it he States it's a good question because even in some Specialties like Ortho there are docs who don't have enough knowledge to speak on certain subjects and this includes me so I don't give advice on it I would guess it's an individual decision and you would hope it would be based on what the doctor feels comfortable with problem is these days social media people just want to talk about stuff just for the hell of it to get clicks not saying that this is what you do no my friend that's exactly what you said I do you wrote hashtag clickbait on my post and we couldn't really find a moment to agree on except when he said that he actually liked what I was saying and he would eventually use the same approach with patients in the future it really ended up getting confusing and all of that is to say one thing we need to do better as Physicians as medical professionals communicating online what I'd like to see happen is how Dr Rena Malik critiqued me and communicated with me after seeing a clip of mine from the very same interview about testosterone now Dr Arena Malik didn't just leave a random negative potentially even toxic comment under the video she messaged me privately saying hey Mike letting you know recent data shows that there is no evidence of increased cardiovascular risk with trt and the original study data that was popularized was actually Incorrect and later corrected but still got propagated through the medical community blood clots yes not heart attacks I was so happy that she sent this I love to get critiqued challenged by my colleagues I want to get better as a doctor I want to do the right thing and put out accurate info in fact I've made mistakes before I've even shared that in a whole video so here I understood where Dr Rita Malik was coming right away testosterone replacement therapy is used for patients who have low testosterone for whatever reason there's multiple reasons when I asked Harry this he said that he is on trt and my doctor was like Hey like your test levels are fine you could be better let's juice me up this is steroid use this is not trt it's using testosterone to create what we call Supra physiological levels of testosterone mean higher than normal so the risks are not going to be the same as trt this is why I began to explain to Harry jowsy the risks of using testosterone when you don't need it like heart disease like infertility and pointed out those issues and I needed to confirm that I was thinking correctly so I asked Dr Malik who is a urologist and I said but what about testosterone use above normal because what he's doing is not trt it's more like steroid use and I pointed out an article from the National Institute of Health that shows using steroids to get higher levels of testosterone will create heart disease she goes yes in Supra physiologic levels but she is worried that people who are truly low testosterone which she calls calls hypogonadal and they're trying to be you gonadal meaning they're restoring their normal level of testosterone would see this video and be worried and I said that could be a problem and I probably should leave a note in the video to make sure that I'm clear in what I'm communicating and she agreed that it is nuanced thank you Dr Malik for correcting me where I could have done better but for not resorting to toxicity online because that wouldn't help anyone so I updated my caption on Instagram based on Dr Malik's advice and we came together and ultimately made a better piece of content to educate others about unnecessary steroid use and that's the goal of communicating online as Physicians do not seek to destroy and always look for nuance because Nuance is a superpower just like Jonathan Heights said on this channel very engaging work worthwhile conversation author of the coddling of the American mind definitely check this out as always stay happy and healthy and don't leave toxic comments [Music]

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