For the love of health & wellness: Episode 01

Healthy Connections for a Healthy Life:
Dr. Danielle Ofri

With the second episode of our For the Love of Health & Wellness series, we’re taking a deep dive into physical health—but this is not a “go get your annual physical” guilt trip. We’re talking with a doctor who’s taking a refreshing “body and mind” approach to looking at health, a physician who started a literary journal and decided to learn how to play the cello because she wanted a little more beauty and learning in her life. Dr. Danielle Ofri is a general physician at Bellevue Hospital in New York City, the oldest public hospital in America, and today she brings us into life inside the white coat as she and Jen discuss some of the HUGE changes the medical world has seen over the last few decades, what we really need to do to stay healthy (hint: make friends, get a hobby, and drink lots of water), and some of the exciting medical breakthroughs we might see in our lifetime. Equal parts art and science, Dr. Ofri emphasizes that better and more frequent communication and connection is at the heart of what will keep us healthy in the long run, which she talks about in her latest book What Patients Say, What Doctors Hear.

Transcript from the show

Narrator:  Hi everybody, my name is Remy. Welcome to the For the Love Podcast, with your host Jen Hatmaker, my mom. She writes books and speaks to crowds. But she mostly loves talking to amazing people every week on this podcast. Thanks for listening! We hope you enjoy the show.
Jen:   Jen: Hey everybody. This is Jen Hatmaker, your host of the For the Love Podcast. Welcome to the show today.

We are in a really cool series right now, and it is stretching me, and challenging me, and actually encouraging me.

I don't know if you remember when we talked with Hillary McBride earlier this year. If not, absolutely go back and listen to that podcast episode. One of our best ever. But when we talked to Hillary, we talked about embodiment and making sure that we remember to care for these physical bodies that have carried us thus far in our lives. And so we wanted to think about caring for ourselves in every way: through nutrition, through mental health, spiritual care, even career health. We've got a really great episode coming up on that. And there's just nothing more key to each of these than caring for our physical health.

You're going to enjoy today's episode, you guys. My guest is just this really scary smart person walking around on this planet with us. She's one of those, well, in my experience, very rare gems who has both this analytical, scientific mind, obviously, but then she also writes beautifully and produces poetry and plays the cello. She's right-brain/left-brain in all the best possible ways.

And so I'm really, really pleased to have Dr. Danielle Ofri on today. And so Dr. Ofri, she's a physician at Bellevue Hospital in New York City. The very famous Bellevue Hospital, hello. Oldest public hospital in the United States, so really cool credentials.

She's a faculty member of the NYU School of Medicine, so fancy. She writes about medicine, specifically about the doctor-patient connection, which we're going to talk about in a really cool way today. I love her approach to this. I loved everything she had to say. And she writes for a lot of publications, like these little small, off-brand publications you've probably never heard of like New York Times and Slate Magazine, just these little struggling things.

And let's see. In 2000, Dr. Ofri co-founded the Bellevue Literary Review, which is the very first literary magazine to arise out of a hospital. I asked her about that because, of course, she's now in my world. Now I understand something she's doing: writing. That's the one thing that she and I both, apparently, know about.

And her latest book is called What Patients Say, What Doctors Hear. And so she's this wonderful bridge to help us communicate better with one another to prioritize healthy results in our healthcare. She's just really, really cool.

So this is an enlightening discussion, you guys. I wanted to talk to her because she's this perfect person to tell us what really goes on in a doctor's world. She's been watching healthcare change since she began practicing a couple decades ago. And then she’s spent her career taking a step back to remember that the path to physical health isn't just about forms, and needles, and tests, and insurance payments, and surgeries. But that physical health, and mental health, and soul health, and healthcare in general is about people healing people. I loved her holistic approach. You are too. Hang in because this is a great interview.

So today, Dr. Ofri and I talk about relationships between doctors and patients, and how that's changed, and what we can do to ensure that we are making the most of our time together. And then she just had some really good ideas about what actually makes us healthy. And so tune in for that. We kind of go all over the medical map on this one. You're not going to want to miss a single minute. It's very, very fascinating.

So I'm very pleased to share my conversation with the brilliant and creative Dr. Danielle Ofri.
Jen:   Dr. Ofri, welcome to the For the Love Podcast. I know that you are so busy and so slammed and so jammed. So, having you here on the show today in the middle of a work day, I'm just very grateful. Thank you for making the time for me and my listeners.

Dr. Ofri: Oh, I'm thrilled to be here. Thank you.

Jen: I've filled everybody in, a little bit, about what it is you do. But I would love to hear a little more first, if you don't mind, about who you are. If you could tell us a little bit like why did you go into medicine? And are you doing, today, what you thought you would be doing when you stepped into med school, however many years ago?

Dr. Ofri: I always thought I'd be a veterinarian 'cause I love animals. When I got to my high school, public school, everyone who liked science was going into medicine. Not that I knew anything about what doctors did. I come from a family of teachers. But I ended up following the crowd.

And then, I ended up going to college by serendipity at McGill University in Montreal. I only attended because it had a late application deadline. So, I ended up there not knowing I'd be in for a 100% science program. As it turns out, if you like science, you're gonna be a scientist. Medicine, that's for technicians. So, then I'm thinking, "Now what do I do?"

Then, I learned about an MD/PhD program. I decided to do that and I'd figure it out. I ended up doing PhD and an MD, thinking I'd go into science. But, you know what? I got to my internship, and I completely fell in love with talking to patients, hearing their stories. So, I stayed in clinical medicine. So that’s how I became a doctor.

Jen: I'm so very happy for you science people, that you would grab ahold of that tail and just hang on and let it take you where it's gonna go. I am words and big ideas, and so thank goodness for you and your colleagues.

What does a typical day look like for you, right now, if there really is one? How much are you seeing patients versus doing admin versus helping students versus writing. How does your day, typically, shake out?

Dr. Ofri: I'm a general internist, so a general doctor. I work at Bellevue Hospital, which is the oldest public hospital in the country. Big, public hospital. And I work in a clinic. So, for example, this morning, I saw patients all day with their diabetes and hypertension, heart disease, depression, obesity, all the usual, run-of-the-mill stuff. I see patients about half my time.

Then, about a third, it’s an academic center. So, I'm teaching, I'm supervising residents and medical students who are learning to become doctors.

Then, the other quarter/third of the time, is my time that I use for writing. I edit the Bellevue Literary Review. I work on my books and articles. The rest of the time, I just run around like a chicken without a head.

Jen: How long have you been at Bellevue?

Dr. Ofri: All my life. After medical school, I trained there. I'm a Bellevue lifer. They'll probably take me out on a gurney.

Jen: I also feel like Bellevue is the quintessential location for all our New York City hospital dramas. That's just what I think of. I feel like you're in the center of the famous hospital, New York. I'm sure everybody is incredibly beautiful and fancy like all of the shows show us. These very realistic, yes, of course.

Dr. Ofri: I can't imagine a more wonderful place to work. Not so much because of the drama, but because it attracts people from all over the world, all walks of life, literally. And I learn so much every day. I meet people I would never meet before. I learn things I wouldn't have known about. And it's a wonderful place of colleagues. The patients are the most amazing people, salt-of-the-earth folks I could ever imagine having the fortune to work with.

Jen: What a nice thing to say.

When did you graduate from med school?

Dr. Ofri: I finished in '96. I finished '93, medical school, '96, residency. I've been practicing at Bellevue as a faculty member for, now, 20 years.

Jen: That's great.

This is something that I find really interesting about you. Along with your MD and your PhD, in pharmacology, you have, actually also, clocked in a lot of time in the arts and humanities—which is, of course, now you're in my world. And I'm loving it. So, not only have you written extensively—and we're gonna get to this in a minute—about the way doctors and patients should, or possibly could, communicate, but you also started the first literary review by a hospital and you study the cello. You are incredibly well rounded. I find your areas of focus really, really fascinating.

Can you talk for a minute about both the cello and the literary review? Why are the humanities so important to you? Why do you also pursue art as passionately as you pursue medicine? And I'm curious, if in your opinion, you feel like the pursuit of creativity and artistic expression contributes to our overall health.

Dr. Ofri: That's a huge question.

Jen: I, actually, gave you five. So, you can, literally, just start wherever you want.

Dr. Ofri: I'm actually gonna go back to two questions ago when you asked about if you're doing what you thought you would be doing.

Jen: Okay, great.

Dr. Ofri: When I got to McGill, a school I chose because of the late application deadline, a graduating student said to me, on his way out the door, "If you don't take a class with Professor Ruth Wisse, you will have wasted your education at McGill."

I though, Well, that's a pretty strong recommendation. What does Dr. Ruth Wisse teach? She teaches Yiddish literature which I had never, actually, heard of, other than schlep and schlemiel. But I thought, Okay, I'll take it.

I fell in love with all these writers from Eastern Europe who'd I'd never really known much about. I began taking another class with her. And another. And then Russian literature and Russian history. She gave me this whole entre into deep literary side that I hadn't really had, at all, in my science training. She gave me this love of literature.

Then, when I was, finished my residency training, I ended up taking off a year and a half, just to kinda get away. I trained during the height of the AIDS epidemic. Very tough.

I ended up taking off a year and a half. I traveled, mainly, to Latin America to study Spanish. A lot of my patients speak Spanish. I did some temp doctoring work to pay the bills.

Along the way, I started writing down the stories of my patients because they were so singular, especially the AIDS epidemic—not to write a book, just to write them down.

When I got back to Bellevue and I was an attending, as a faculty member, I wanted to incorporate the writing, of course. I had my students write the stories of their patients. Anyway, I ended up getting together with our new chair of medicine. We each had a collection of wonderful stories. We thought about making a student photocopy journal. We ended up with the Bellevue Literary Review, recognizing there was such a, I think, an intense need to discuss the vulnerabilities of our bodies.
We made this literary journal of poetry, fiction, and non-fiction about health and healing.

Jen: That's great.

Dr. Ofri: Now, did I expect to be doing poetry between patients? Not at all.

Jen: Right.

Dr. Ofri: I spend up to 20% of my time editing the journal, reading. We get 4,000 submissions a year from all over.

Jen: Oh, gosh.

Dr. Ofri: I think there’s a deep need to address health, illness, healing from [not only] a nontechnical perspective, but [also] from a real human perspective.

That may be the lead into the question of why do I think it's so important. I believe that all of our great science ties in and healthcare that we have addresses a part.

Jen: That's right.

Dr. Ofri: But not all. It doesn't address fear. It doesn't address shame. It doesn't address worry. All of these things, I believe that poetry and literature and music are a part of that.

Jen: I love that. To me, that feels really fresh and it feels rare to hear from a doctor.
It seems like—and I'm painting with too wide a brush, obviously—but it kinda feels like, just as an average person who's not in the medical field, that our choices are either to reach for our medical, scientific doctors and healers, or we reach for our soul care, mental health, creative, nurturing healers. Rarely do we see those overlap. It almost seems like we have to carve out two separate paths and hope that we can figure out how to walk on both of them. I commend you, really commend you for pioneering, really, something that didn't exist before.

I wonder if you've seen any either colleagues or anybody, has somebody picked up on this and done this in their own hospital or in their own medical community? I can't imagine this has not inspired other doctors or technicians to take the baton and run with it in their lane.

Dr. Ofri: Absolutely. I've gotten the baton from many other people, as well. There's, thankfully, I think, a groundswell of interest in addressing the entire issues because, listen, we're all patients, right?

Jen: Mm-hmm.

Dr. Ofri: Even your doctors. They're caring for their elderly parents or their sick children or their own medical issues. So you may get through life and not need a plumber or an accountant or a roofer, but you'll never get through life and avoid the medical world. Even if you're the healthiest person, you have your family.

It's so universal that we're all there. And I think, for much of us, if we had the ability to get to those aspects of it, we would. We're so jam packed in the medical visit, we often don't have time or mental energy or bandwidth or ability. I think that we really do all want to be there. And, increasingly, we're recognizing how critically important it is.

There's an interesting study that looked at doctors, and they rated the doctors job and life satisfaction. That's it. Then they measured the blood pressure, sugar, and cholesterol level of their patients. Nothing they did, what medications—just how they felt in their lives. When the doctors were more satisfied in their lives and jobs, their patients had better control of their sugar, their blood pressure, and their cholesterol.

So, tending to the doctors' emotions and fears about life and about their work, is important, too. It really resounds, as well. Of course, attending to their patients' needs, as well.

Jen: That's so interesting.
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Okay, back to our show.
Jen:  I want to explore, basically, something you just said a second ago. Over, maybe, I don't know, the last 50 years or so, it seems like the doctor-patient relationship has changed. It feels like it's more limited. Most people don't have the same family doctor, for example, for years and years and years, even decades in the same family, like we used to. Then, sometimes, when we step into a clinic, we maybe get 10 minutes with our doctor. I'm curious about your perspective on this. What has changed and why?

Dr. Ofri: Many, many things have changed. Part of it is the increased pressure on being “productive.” Again, the way that hospitals and practices keep the lights on is by billing for things they do. The more you do, the more procedures you do, the more patients you see, more revenue you have. Part of it is we have a healthcare system that's treated like a commodity, like cars or other things you buy, which already distorts the field quite a bit.

I think with the rise of the EMR, the electronic medical record, there's more and more focus on data entry. I'll tell you, we just switched to a new EMR two weeks ago. Today, it's taking an hour per patient because I have to go through it all.

Jen: Gosh.

Dr. Ofri: On the one hand, it was a nightmare. On the other hand, for each patient, we spent an hour going . . .  I pulled the chair next to me and [said,] “We'll do this together.” So, we went through things in detail but there was so much time, I hardly had time to talk about their medical issues because we're feeding the beast.

So, the digitization, although it has many advantages, it really makes it hard to be in the focus of about, "How's your family? How's your daughter doing these days?" All those things that matter to the patient.

Jen: To your point, you wrote an entire book about the importance of what, on its face, maybe seems like a low-tech, undervalued diagnostic tool, which is simply conversation between a doctor and patient. I think that's a really insightful observation, especially in a world where we have, what appears to be, more diagnostic tests than ever. We're all drowning in insurance forms. On your end of things, paperwork and all this input that you just mentioned.

I think as patients, it's so valuable, it's so meaningful when a doctor engages us like you just mentioned and asks us questions and kind of sees us and hears us.

I wonder if you, because you’ve spent a lot of time on this idea, are you seeing doctors return to this relational approach? I would love to hear you answer, also, on what you wish that us patients knew when we were talking with our doctors.

Dr. Ofri: To start with your first question, I think that when I give the talks on doctor-patient communication, I'm often asked, “What's the response from your colleagues?”

All my colleagues, they want to spend time talking to their patients. That's the most important part. It's the best part of medicine. But that is so taken away by the digitization of our doctor, patient encounter that every doctor I talk to will say, "I would love to have an hour just to talk."

So there's no reluctance to get there. Most want to be there and try to be there to the best of their ability.
The question is pushing back against the insurance system, the hospital system, it’s very hard as individual doctors. I think we're trying to make the point and part of the reason I wrote the book, What Patients Say, What Doctors Hear, is to make the point that, in fact, conversation can be incredibly efficient. You can actually save quite a bit of money by making the correct diagnosis and not overorder unnecessary tests.

Jen: Right. Totally.

Dr. Ofri: Most doctors over order tests because there isn't time to probe the whole history.
Jen:  Yeah. That makes sense.

I'm curious, too, how you feel about this. Obviously, human beings have always wanted a quick fix for our problems. That's not new. In the last 10 years, for sure, 15 even, now that we can order pizza by texting a single emoji, we've taken instant gratification to new heights. This has to have an effect on medicine. And the expectations that patients are now putting on their doctors to find a very immediate cure. Something they, maybe, saw on TV or they saw on a Facebook ad or who knows what.

I wonder how this affects your practice. I know that we've come a long way, medically, but do you sense an unreasonable expectation that your patients are now putting upon their medical professionals, in terms of quick and immediate and spot-on diagnosis and then treatment?

Dr. Ofri: Just this morning—I have a patient with diabetes on massive doses of insulin and three other pills, as well. I always ask about diet. He's eating white rice every day, red meat two to three times a day, every day. Not exercising. And then he asks if there's some kind of surgery he can get to cure the diabetes.

Jen: Right.

Dr. Ofri: We just have to say, "No, there is not. We have to talk about what you eat and what you do."

I think we have a big disconnect from our lifestyle, which is a word that I think underestimates, it's just your life, really.

Jen: Sure.

Dr. Ofri: About what you eat and what you do, your physical activity has an enormous impact on our health. We have to start there. I know it's not a quick fix. It never will be.

On the other hand, there are many things that do give fairly quick response. When patients make small changes in their diet or small changes in exercise, very often, you can feel a little bit better fairly quickly.

Jen: That's true.

Dr. Ofri: It's not instantaneous. And not that you should want to diet or find a way of living that's comfortable. You should enjoy life, too. If you need to have brownies once or twice a week, that's fine, as long as you are also having your salad and brown rice and finding ways that you can live.

Most of these problems, they didn't occur overnight, so they won't be cured overnight.

Jen: That's right.

Dr. Ofri: Patients, I think, do have an expectation, partly, from the advertising.

Jen: Totally.

Dr. Ofri: Since drug companies are advertising directly to consumers, it's really changed the tenor. “Ask your doctor about X,Y, and Z.” They offer as though, overnight, with this medication, you will be jogging on the beach with a golden retriever at your side, and a sexy partner next to you.

Jen: That's right.

Dr. Ofri: So, yeah, we present this.

Also, I think the rise of social media [says] you are expected to present your best self. You're always having fun, being skinny, and eating a great meal, and traveling here. You can't actually be your normal self with your warts and foibles.

Jen: Yeah. I love hearing that from you because I talk about that exact phenomenon with my community a lot. We talk about it from a lot of different angles, from an emotional health perspective, a cultural health perspective. It's interesting to hear it from the medical perspective, too, that this has an effect on us and on our expectations that we don't just place on ourselves, but we end up placing on our doctors or on our spouses, on our friend groups. It's so unhealthy and weird. It's such a weird time to be a human person and maintain any sense of normalcy.

Let me ask you this. In the medical world, what do you think we're getting right? What are you feeling good about, as you see patients and just the general medical community, in 2019?

Dr. Ofri: I see two big things. One is the idea of a doctor-patient partnership. As today's, I saw my patient and said, "Pull your chair up. Let's do this together." That's a very different model than we had 20 years ago where the doctor said, “Do this and this,” and the patient said, “Okay,” and didn't ask any questions.

Jen: Oh, right.

Dr. Ofri: We're both, obviously, you can go overboard. There are patients that'll send 20 emails a day about their shark tooth cartilage and all the things they wanna know about instantaneously.

But, for most patients, it's been salutary. It's really, "Let's decide if this is best for you or not.” So kind of shared decision making, and that we're a team on this. There are many people on the team besides just us. There are nurses, nutritionists, spouses, and friends, and all these people on the team.

The second thing is really the focus on nutrition. Our clinic, in particular, has been very much focused on the plant-based diet. You don't have to be any fancy diet, just eat basic fresh fruits and vegetables, unprocessed foods, low in the food chain. It's fairly straightforward. We're going back to these real basics.

That is not just a lifestyle. That is your life and your health. And to look at that before we throw on a bunch of medications and referrals to specialists, let's start with that, and I bet we can get a lot of the way there.

Jen: I appreciate you saying that. It's not hard to track our cultural trends here in America—our industrialized diet, our fast-food culture, and then even just working ourselves to death with such a go, go, go pace. It's not hard to see the exact, identical arc with all the same ailments you mentioned earlier. Heart disease, hypertension, and obesity. It's curious that we're unable to line these up, to realize that we actually have a lot of control over our own health, and a lot of control over our own well-being.

I appreciate hearing that you take a holistic approach with your patients when it comes to their treatment and their care. Are they receptive to that? Do you find, in general, that your patients are willing to receive that kind of instruction that doesn't come with a pill attached to it or a procedure attached to it or whatever?

Dr. Ofri: Most patients don't really want pills and things. It's a bit of relief that you can say, “These are things that are actually in your control or at least partially.” We'll often talk about, “It's more expensive to eat healthfully, that chips and soda are cheaper than milk and fruit.”

Jen: That's true.

Dr. Ofri: My patient today, the guy that wanted surgery for his diabetes, complained that brown rice costs more than white rice. I said, "But if you decrease the portion size in half, actually, the net price will be the same."

Jen: Yeah.

Dr. Ofri: "Here are things that you can do that's in your power. Water's cheaper than soda, even though soda's cheap."

Most people, I think, are amenable to that. There's definitely, a segment that really wants a medical answer for everything. “Why am I getting wrinkles? Why am I getting old? Why are my knees hurting when I walk up and down the stairs?” I just wanna say, "Welcome to your 40s and 50s."

Jen: Sure.

Dr. Ofri: But if you exercise, you can minimize that. Not maybe cure it, but help decrease the symptoms.

The other thing I wanna add is that I also talk to patients about what makes them happy in life. Do you have a hobby? Do you have a passion, something you do? You'd be surprised how many people have no hobbies at all. It mainly gets filled in with either TV or random social media sloth that doesn't have any real meaning for them. I think finding meaning in life in something, whether it be literature, religion, study, sports, family is what helps us go forward. Many people have existential pains in their lives. Part of it is loss of real connection.

Jen: You're singing my song. I’ve immersed myself in a lot of research that suggests this exact thing, that loneliness is a real key factor to our health epidemics. And disconnection and lack of belonging, that these have very real, physiological effects on our health. But they're just not necessarily levers that most people think to pull when it comes to improving their health.

So, it thrills me to hear a doctor talk about things like nutrition and connection and hobbies and belonging in their lives because, I think, these are all . . .  Put this all together, this is a great metric for becoming a healthier community.
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All right, back to our show.
Jen:  Dr. Ofri, I wanna ask you this because you're in a field, obviously, that's traditionally been more male-dominated. It's very heartening to watch so many more women becoming doctors with every generation and, frankly, making strides in all the STEM areas.

I'm curious, there's no question about it. There must still be gender nuances in your field, really, no matter what your expertise is. Do you find that patients have preferences about seeing a male or a female doctor? If so, are those preferences based on the fact that the doctor that matches our gender may be able to relate to our health issues more? Or do you think it's a little bit more misogynistic in nature? Maybe not at all. Maybe I'm inventing this. I'm just curious what you see as the gendered dynamic in the medical field right now.

Dr. Ofri: I see it very little with patients. Patients seem to not, they're used to women and men as doctors. I have almost never seen that as a problem.

Jen: Wow.

Dr. Ofri: But what I do see the gendered aspects in medicine is, certainly, women are now are more than 50% of the incoming medical classes. But, as they pick specialties, it very much spreads out. Whereas women dominate in primary care fields, internal medicine, pediatrics, OB. But in things like surgery and cardiology, these are still, predominately, men.

The other aspect where it's gendered is promotion. That's where you see a big skew.

We're certainly, in the academic medical center, in my department, in our primary care clinic, we are a majority of women. But in filling out the greater ranks of leadership, that has not caught up yet. I believe there definitely is bias there.

There's also when women take off-time or go part-time for children. There aren’t the same number of publications or advancements or the fields they choose to do their academic work. Maybe it's education and not bench research. It's not as well recognized.

Jen: That's really interesting. Who can know? It's hard to know the mind of every practitioner. But I wonder if women tend to steer their ship into those fields that you mentioned—OB, general practice—as opposed to some of those surgical fields, I wonder if that is a sense of, “This is where I will have more success. This is where I see women.” Or if there are any systemic or structural factors inside med school, inside residency to separate the women from the men.

Did you ever have a sense, in other words, as a med student that you were being steered in a certain direction?

Dr. Ofri: Not necessarily. But it might be the availability of mentors.

In surgery, there are fewer mentors. Although I will say, NYU's surgery program last year, they have seven separate surgical fields. Plastics and cardiovascular, pediatrics. All seven chief residents were women last year. So, that was super. And it was quite the amazing seven, they called them. But that really stood out because that hasn't happened. It's been a long time.

I think the pipeline is getting there. But the slope of the line is smaller than it should be, but not at the rate, given the women's production and contributions to the field. So, we're getting there. And partly, I think women may choose fields and flexibility for helping families. A lot of surgical subspecialties make it really impossible because the hours just don't make that a possibility, or the training’s longer, or taking time out is not feasible. So, there's some self-selection. And it may also be presence of mentors.

Jen: Just like the rest of the world, as we continue to make discoveries and innovations, even medical standards or ideals change. I wonder if there've been any new wrinkles to the basics that we've been hearing for years about preventative care. Is there new information that we have access to now? Or do the same standard, basic, “These are the, more or less, healthy building blocks or are the building blocks of a healthy life,” are those still the standards or do we have any others to add?

Dr. Ofri: I think those are still the standards. I think we're falling back in some areas, for example, vaccinations. These measles outbreaks are currently, people are not getting vaccinated. Partly is, a lot of people don't remember what polio was like. If you ask your grandparents about what polio was like, they were thrilled to get the vaccination. So, it's scary, as a medical perspective, that some children are not getting protected. So, we have a fallback there.

Future things, the availability of genomics to individualize medicine is still on the horizon, in my feeling. I think there's a lot of things like 23andMe, but they're not quite ready for primetime because we haven't yet developed what to do with the information.

Jen: Right.

Dr. Ofri: People get this and then don't have any validated or well studied plan what to do with that. There's a big disconnect. A lot of fear can come up. A lot of poor decisions can be made in the absence of a good context.

I think we will get there. Maybe 20 years from now, the genome will be in the electronic medical records so when we prescribe medication, it can say, “Here's the dose to adjust for this genome. Or this is the better choice for that.” We're not there yet, but I think we'll get there.

I think our basic things that have been validated and I always refer people to the U.S. Preventative Services Task Force, a very straightforward, no punches pulled, “Here's the information we have on mammograms. Here's why it's considered crucial in this group and why it's not.” It doesn't make any extravagant claims. It's pretty conservative in its claims in that it doesn't do something new until there's really data to support it. So, that's my go-to resource.

Jen: I wanna expand on something you just said. Obviously, not only has our culture dramatically changed in the last 10 years, but the medical world has, as well. We've watched it play out in the halls of Washington and across our news feeds. I mean, healthcare is one of the biggest buzz concepts over all of us right now, especially as we steer into another season of campaigning. This is just something we're all gonna be hearing about in both clear and nebulous ways.

I wonder, I'm just asking to ask you to pontificate, if you had to predict, how do you think we will receive medical care in the next 20 or 30 years or 40 years? In new ways or in innovative ways? What do you just expect to see?

Dr. Ofri: What I expect to see or what I hope to see?

Jen: Maybe both.

Dr. Ofri: 
One of the trends that I find heartening is I think people are starting to recognize healthcare as a basic human right. I think we're shifting from it's a commodity that if you're rich, you can get it, if you don't have money, you don't get it, the way we buy cars and houses.

That shift, I think, will then change how care is delivered. If we look at healthcare like police protection or fire protection, we pay our taxes and we all call the fire department and the fire truck comes, no matter. I think we're gonna lean toward that. Now, it may not look like Europe but the idea that everyone should, deserves to get their health taken care of will change how we give. It may have to shift in our delivery mechanisms. But I see patients who, "I'm not gonna do that CAT scan because I can't afford it now. Or this medication." And then their health suffers.

I hope and I predict that we will get [to a place[ where that isn't going to be the consideration. That if you need this, our society budgets its resources and time for that, because these are members of society. Plus, if someone gets sick, that's a drag on society, right?

Jen: That's right.

Dr. Ofri: They can't work. They can't take care of their children. I hope, and I think, we will get to that point. I see that happening.

Next is how artificial intelligence might help us. Right now, there are two million scientific papers published every year. I can't read those. And even if I could, I couldn't absorb it all. So when I wanna make a recommendation for a patient, it would be great to survey the literature and make sure I'm doing the right thing. If we had a way that an AI algorithm could help me, for this patient, this medication, that condition, what's the best approach? That would be so helpful.

Jen: Oh, that's interesting.

Dr. Ofri: Yeah, we're getting there with some very simple, somewhat crude systems now. For example, reading a CAT scan, maybe rather than the radiologist just read it themselves, an AI algorithm does the first read of looking for things that are hard to see, then the radiologist reviews it. That can increase the diagnostic efficiency and accuracy. I think the artificial intelligence will begin to help us.

Not miraculous, it's not gonna cure your cancer overnight. But it's going to take things that are hard to do now, for example, if I were to look back at my patient's blood tests from the last 25 years. Well, that'll take me a long time. A good algorithm can pull it all off and, “Oh, here's the trend. Or here's the CAT scan they got when they visited Nevada and had in the ER.” That kind of thing, AI could help that pull together, then maybe make the humans a little better at what they're doing.

Jen: That's pretty fascinating. This is some of the same intel we're hearing out of the technology community. It's gonna be really something to watch roll out in our lifetimes, I think, how this is gonna change medical care for our kids and their kids. It's gonna be really, really fascinating.
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Okay, you guys, now back to our show.
Jen: Let me ask you, as we're wrapping this up, these are just three questions we're asking all of our guests in the health series. You can just answer right off the top of your head.

Okay, what's one small thing you do every day to take care of yourself in some way?

Dr. Ofri: I play the cello.

Jen: 
Oh my goodness! Can you talk about the cello for just a minute? I touched on it earlier, but we didn't really dig into it. How long have you been playing?

Dr. Ofri: My daughter's 13. So, 13 years ago, we lived in Costa Rica for a year, where she was born. Her sister, who was four or five, was going into kindergarten, and I knew they were teaching violin. So, I thought I'd get her started. I asked the teacher, “What's the best way to help a kid practice?” thinking, sticker charts or ice cream. They said, "Seeing a parent practice."

So, I bought a cheap cello and started taking lessons. My daughter long quit, but I stayed with it.

Jen: That's great.

Dr. Ofri: [I have a] wonderful teacher. We meet every other, we met yesterday. It pushes me to learn. In medicine, I learn more every day but in small amounts. It's kind of plateaued. But in music, because I have a teacher who keeps pushing me to take the next step, I'm still on a steep slope, and that is so exciting. With a string instrument, or any instrument, it's so focused. In the hospital, phones are ringing, pagers going off, people knocking. In cello, I just have to get the one note. I gotta find it. I have to make it right. And then I have to make it beautiful. We don't think about beauty much in our regular life. And focus that it sounds right, in tune, that is such a luxury. I don't catch up on all those cables, on those series on Netflix, but I play the cello.

Jen: I love that answer so much.

How about this? Who's one either, and this can be somebody personal to you or maybe from afar that you've just learned from as a distant mentor. Who's a teacher or a thinker or leader in any way that's impacted your physical or mental or spiritual health that you would recommend to the rest of us?

Dr. Ofri:  Watching the videos of Benjamin Zander. He is this wacky musician who has a great TED talk on appreciating music. He's funny and engaging. Why everyone can find just beauty and thrill in music. I recommend that TED talk. I've watched his other master classes. Benjamin Zander. Just have a good time with him.
Jen: Oh, I'm so happy to learn about him. I will, listeners, I will link over on the transcript page to Benjamin Zander's everything. So you can have a little listen if you'd like to.

And then here's the last question. We, actually, ask every guest in every series this question. It's from one of my favorite teachers. Her name is Barbara Brown Taylor. She posed this question to us, and I love it. You can answer it as sincerely and poignantly or just as silly and small as you want. It can be any sort of answer and we've had them all. The question's this: What is saving your life, right now?

Dr. Ofri: Oy. If I stick with music, I will say Debussy. I'm working on a Debussy cello sonata. The reason Debussy is so lifesaving is he is so out of bounds from normal rules. All the rules set up for hundreds of years, “This is the way you play music, the way you compose it,” and he threw them all out the window. It's like Jackson Pollack with the paint, he just went all over the place. Now, I've gotta try to get into is brain to play his music. I've been a rule follower all my life. I've gone to medical school. So throwing out the rules and trying something wild and wacky is just like a vitamin pill for the brain.

Jen: I love that. I love a good challenge, too, where I feel like my brain is stretched, I'm at capacity, and there's nothing I love more than knocking down an obstacle. That is a fabulous answer.

Before I let you go, can you just let any of my New York listeners know where they could ever find you, where would they go?

Dr. Ofri: I work at Bellevue Hospital. But anyone can find me at danielleofri.com. I have a Contact button and it comes right to me. I also have a monthly-ish newsletter of interesting articles on what I read or medical humanities. You can subscribe. It's non-commercial. You're welcome to reach me through there. I'll write back to anyone.

Jen: Oh, that's fabulous. That's great.

My newsletter is also monthly-ish. That's as good as I can do. I applaud your “get it out whenever you get it out.”

I wanna thank you so much for your time today. I found this conversation so interesting and encouraging, too. I thank you for your approach to healthcare. I love your balanced look at what makes us well, what makes us healthy, and what makes us happy. I just could not agree with you more, in any possible way. So, I am so grateful for your time today. Thank you for lending us an hour to teach us and to stretch us and to encourage us.

Dr. Ofri: My pleasure, Jen. Anytime.

Jen: Love it. Love her. Love her.

Are you ever in this place where everything you're learning seems to be coming at you identically from all the different avenues? That's how it is for me right now. I feel like every expert I'm learning from right now—the books that I'm reading, the studies that I'm reviewing—are all saying the same thing. All pointing towards the same avenues of health. It's just empowering. It's empowering to hear it from all these practitioners and all these professionals.

I wanna make sure that you know that Dr. Ofri has a bunch of stuff that you may be interested in. Over at jenhatmaker.com, underneath the Podcast tab, we're gonna have links to her book. That's a really useful tool for those of us who have an ongoing relationship with doctors, which is all of us, really.

Also, she's gotta couple of really cool TED talks. We'll link to those, also. One was about fear. She's got some great stuff, you guys. We barely scratched the surface with her.
Amanda builds out that page for you every single week, every single podcast episode. All this extra curriculum, extra content, resources, links. Please be using that resource because it is so useful and wonderful. Everything at your fingertips, including the written transcript of every single interview, should you wanna go back and look at it with your eyes, or cut and paste any parts to use. Anyhow.

And, of course, we'd love for you to share any episodes that you love. Thanks for putting them on our social media accounts. Thanks for sending them to your daughters and your sisters and your moms and your friends. That is so meaningful to us.

Also, don't forget to subscribe. We love having you as a subscriber. Then, you never have to look for a single podcast. It just shows up for you week after week. We are thrilled about it.

On behalf of Amanda and I, and my producer, Laura and her crew, we love you. We love For the Love Podcast community.

Okay, you guys. Thanks for being here. And I'll see you next week.
Narrator: That’s it for today’s show. Hope you enjoyed this chat. Be sure to subscribe to my mom’s podcast and give it a “thumbs up” rating if you like it. From the whole Hatmaker family, hope you have a great week and see you next time!

From the show:

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Dr. Ofri's Books

Quotes from this Episode