EP 184 WTH?!?: Empowering Women in Healthcare with Susan Salenger

FOREIGN welcome back, everybody. Dr. Greg Eckel. And this is what the health and our topic today is Navigating a Broken Health Care System. I have my guest, Susan Salinger is the author and researcher behind Sidelined How Women Can Navigate a Broken Health Care System. Sidelined examines the many ways in which some women manage and sometimes mismanage their health care. Susan explores how women typically navigate the medical system as the gatekeepers for their families. And they tend to be extremely conscientious about taking care of themselves, yet at the same time inadvertently undermine their own care. Born and raised in Los Angeles, Susan attended UCLA to study English. And after graduation, she worked alongside her husband Fred for 25 years at their production company, Salinger Films, which produced corporate training and development films distributed worldwide. Today, at age 80, Susan lives in Northern California to be near her incredible family, which includes her two daughters, four grandchildren, a cat named Max, and a dog named J.D. when she is not speaking about her book or spending time with family and friends, you'll find Susan powerlifting to stay in shape. Welcome aboard.

Well, thank you so much. And actually 81, not 81, I'm not.

Noticing that you had a birthday. Excellent. Well, I would love to know, you know, how you, how did you come down this path? Right. What inspired you to write this book.

Was it was a long journey and sort of a weird one. But about, gosh, when I was in my 20s or 30s, I agreed to have some surgery that I knew I didn't need. I mean, the details are irrelev, but I knew I didn't need the surgery and yet I agreed to it. So I had this. They did some exploratory surgery. They found nothing. I had been on new medication. I went back on the old medication and everything was fine. So, you know, I was upset with myself, but, oh, well. And life goes on and I was working and I had two kids, etc. So then after 25 or 30 years, my husband and I sold our business and I thought, this is great. I'm going to retire. And that lasted 2, 3 seconds. Something like that. Bad idea for me. So I went back to school because my kids said if I didn't do something, they were going to kill me. I was driving everybody crazy.

Sure.

So I took some anthropology classes, which I had never taken as an undergraduate. And so for one of the classes, I did a project on women who had undergone hysterectomies. How I landed there, I don't know. But nevertheless, some of them had also agreed to that surgery, which was irrevocable Even though they weren't sure that they needed it. And, of course, that triggered my memory. So I just. I. I was very curious how women make medical decisions. I mean, why do we do this to ourselves? And do we. Maybe it was just me and. And these few other people. So I interviewed about 60 women, all with different diseases, and wanted to find out, you know, what they. What behaviors they had in common. And many had agreed to. To procedure surgeries, take medications that they weren't sure they needed. And it just became really interesting to me, and I. I'm still fascinated by it, frankly.

That truly is. And, you know, women in our practice are about 70% of our patients. And, you know, in medicine, you realize, you know, women do take care of themselves a lot more than men.

Yes.

But then here you're finding that there's a. What. So what's going on with that? What is going on?

I think. I actually think a couple of things. I mean, we do, as women, we do take care of ourselves. Yeah. Very proactive.

And the family, for crying out loud.

Oh, yeah. No, we're literally. Did you. I mean, this fascinated me. Women do 80% of all the caretaking in the world. I mean, not just here. It transcends cultures. But I think what's happening is women. Well, we listen to the doctor and we hesitate to ask questions. I was interested to see that in the literature says that women hesitate to ask for second opinions more than men do. And I think that's a lot of it, because we don't want to be rude, we don't ask questions. We don't want to hurt the doctor's feelings. So we sort of take what's said and we run with it. Plus, we're busy because we're taking care of the family and the kids and parents, and we have jobs. So it's a pain in the neck to go pursue whatever it is we feel we really should pursue but don't have time for. I think it's mostly cultural reasons that really interfere with our ability to say, hey, wait a minute, that doesn't hit me quite right.

And were all of the women from North America that you interviewed, or was it a global assessment?

They were north from North America. They were pretty much. Well, I established a couple of focus groups I put together because I needed some geographical diversity. So basically, they were some from the east, some mostly from the west, some from the east, and some from the, you know, Kansas, Nebraska, whatever you call that area, Midwest.

What were some of the commonalities? I think you had asked and mentioned like what the top three things you found that were common for the women.

I think the first thing I found which did not surprise me was that women put themselves last. In fact, there was a research study done, I loved this, where women were given a list of five things to prioritize. What would they take care of first? And everybody said they take care of their children first. And then I loved this. Number two was their pet and number three was their elderly parents, which at 80 or 81, whenever I did this, I was not thrilled about that.

Right.

Number four, they took care of their significant others and then last is where they put themselves. And I think that's part of the problem because we have all of these other responsibilities and duties. But so that was the first thing I found.

Yeah.

The second thing I found that really did surprise me, and frankly it still does, is that women feel a lot of shame about being ill. We're supposed to be the caretakers, not the cared for. And I think that it's really, women are embarrassed when they get sick. And one of the reasons or the main reason that I found for that, and I'd be interested in your opinion on this, is a lot of the women that I met, regardless of their illness, I don't know if I said that all of the women I interviewed pretty much had different illnesses. I did that on purpose. One of the things I found is that most of them blamed their illness on their stress. They felt that they were overstretched and they couldn't manage their lives. So that, that, to take that a little further, that means that their illness was almost a public acknowledgment of look at me, I can't manage my life, I made myself sick. So they were very ashamed and embarrassed. So much so that in the focus group, many of the women had never talked to anybody else about their illness other than their doctor because they were, they were embarrassed. Some of them were too embarrassed to even call the doctor. So I wondered if you found that at all. Have you found that in your practice?

Well, you know, ours is a bit different. You know, being an integrative functional medicine clinic, we're able to actually spend time with our patients.

Yes, and I saw that in your.

And really, and really get to know them. And so we become part of the family and really a trusted confidant in that. I, I, I haven't found that over 25 years of practice, but again, my practice is very different where we're able to, we have that ability to take the time. So it's not rushing, it's not a transaction. You know, we're really bringing the heart back into health care. And so it might be that caring component or open heartedness of the practice where it's kind of welcomed or we're creating an environment. You know, I, I often say I'm, I'm humbled by, you know, we, we're told things that no one else on the planet has heard from the individual. And so I guess in that case perhaps it's, you know, we're able to create that environment. But I know in the, in the medical kind of complex, it's really hard to have any intimacy because of just the structure of the demands on the clinician, on the practice of you got to see somebody every five to seven minutes. There's just really no way it's about a drug delivery method. And so that, that component, you know, one of the things that we're up to creating here is that new system where the old one becomes irrelevant and bringing the heart back into health care. So I might not be the best one to ask.

Yeah, yeah. That's fascinating. I think maybe concierge medicine now is probably trying to do on a more traditional model what you're doing. I would suspect.

Yeah, yeah. Bringing that relationship.

Yes.

Into healthcare. Well, what else? I mean, where do you feel like, where did this go off? Has it all? I mean, you can't really go back in time. So this is the assay of today. How do you recommend women advocate for themselves in that relationship? And this is in light of, and I think a component of our listeners and viewers really are tuning into what the health. Because they are looking for a different way of being. They understand our agencies have been captured. The health care system is fractionated and may not have our best interests in mind in the interaction. So this is really timely to bring this to the table for, for folks listening and viewing.

Well, I think what I would say in terms of advocating for ourselves, and I guess this would apply to your patient group as well as the more traditional patient groups. I think the first thing I would do when I would prepare for the doctor visit, particularly in the traditional model, because they only have, as you said, seven minutes or 15 minutes or whatever the hell it is, but it's not.

Long, too little of time.

Right, right. It's irrelevant because it's such a short time, but I've always told people that I think they, and I now do this myself, is that you should make a list, write out a list of your symptoms and your medications. And when I say Write it out. I mean, write it out. I don't mean have it in your head. Because if you're like me, you get anxious when you go to the doctor and you forget half of what you want to say, and then you walk out of the room thinking of everything you should have said, you know, and if you have a list, I think it helps focus the visit for both you and the doctor. So I think that that's really important. And I also think it's important if you get a diagnosis and to get the clinical name of your disease. I'm a strong advocate of doing my own research, and I think it's really important to know what you have and to spell it correctly so that if you do have access to a computer, you can go home and look it up and see what the prognosis is, what the treatment is, where the right number of tests done. I mean, does this make sense to you? I think that's really important. The third thing that I always suggest patients do is repeat in their own words what they heard the doctor say. And that's because one of the things that really surprised me that I found in the literature is that 85% of women do not understand some or all of what the doctor said. 85%. Only 15% will question the doctor. And even if that needs updating, because I did research this maybe three, four, five years ago, so it's still not going to be Whether it's 85% or 75%, it doesn't matter. A heck of a lot of us just don't question the doctor. So it's really important to, you know, when you repeat it back, it gives you a chance to be sure you heard correctly, but it gives the doctor a chance to be sure that they said what they meant to say. I mean, we all misspeak. So I think those are really important things you can do to guide the visit and to advocate for yourself. And of course, to take somebody with you if you can. Because again, if you're like me, I get anxious. I don't hear, you know.

Well, I like that idea a lot because sometimes even, you know, when a diagnosis comes out or some discussion, a lot of times people will just completely shut down and you're not able to hear it. So bringing a friend or a family member, a couple sets of ears with you can be very helpful. You know what's interesting, we are doing a lot of more telemedicine these days post Covid and, and recording sessions for our patients. So they have the recording to go Back to.

That's great.

And, and, and understanding. I understand, like, hey, you may not have questions today, but like, here's how you contact us going forward. You know, if it's an immediate need, you call us. It can wait a couple days. You put it in the portal. That way we can track and keep consistent responses for you.

Right.

But it is 85% is. That's a massive component and huge. It's some. At some point, we, we in general, men and women, it has been.

You.

Know, we're looking for those solutions outside of us. And one of the things that we're really bringing back here is deep presence and listening. And actually the answer lies within. You know, I, I've kind of for 25 years been a deep listener. And what I train my clinicians on is that presence to listen because in front of us will tell us exactly what's going on. If we take a thorough. Of a case, thorough enough of a case and order the correct laboratory and imaging, we can really get at what is going on for somebody. But in the rush and, you know, the rush and the hustle and the bustle, it's. I've seen misdiagnosis. You know, people come to me on a list of medications they can't pronounce, they don't know what it's for. I just got off an office visit right before this, and woman is nebulizing something. She has no idea what it's for. I was like, well, what's that for? I don't know. I'm like, okay. Well, you know, as I train and have taught my children, you really don't put anything in your body unless you know what it is.

I agree.

And know your source.

Yeah.

And so that component of giving the power back to basically your consumer in the health care. Right. Model and, and taking that power back because the power, it's your body, it's your choice. You know, we've just gone through, I think, one of the greatest crimes against humanity of force.

Which one?

Yeah, there's been multiple. But on, on forcing people to take an untested and, and very unsafe medication called a quote unquote vaccine, which was not a vaccine. So I mean, that is criminal in my book and it's against all ethics of medicine right now. I could not publicly say that during that pandemic. Covid time.

Right.

Or fear of losing my license. Right. There was. There is and continues to be such censorship. So that component where you have advocated folks to go online and research, I would just put a little asterisk on there to know. Depending on your search engine, you may not be getting all of the options or solutions and you may not be getting correct information from trusted sources.

No, that is so true. And just to put in a plug for my book, and it's the only one I'll do, I promise.

But it'll put the links on too, for the rest.

But no, the most important part of the book. Don't read the damn thing, I don't care. But at the end of the book, there's a resource list. I've done your research for you and I've given all of the reliable websites, websites that I think are reliable anyway that I used in my research and that I'm pretty sure they were reliable at the time I did the research. I mean, I. If you go to Mayo Clinic, you can't go wrong. Or Harvard or Stanford. I mean, you know, I didn't, I don't.

It depends on the topic, to be honest with you.

You know what? It does?

It does.

Yes, yes. And you know, one of the things I learned that people should really know is that it's really important to research your doctor and your hospital. I mean, some hospitals are good based, are great for neurological issues. Some are better for cardiac issues. So if you're having heart surgery, you want to go to the right hospital. If you're in a location where you have a choice, I mean, I do. I'm near San Francisco.

So let's get, let's get into that a little bit for folks because I don't think everybody understands that.

I didn't until I did the research, actually.

Right. Yeah. So what did you find with that?

I found that it's. That hospitals. I found a couple of things that I didn't really understand fully. Number one, hospitals are graded and a hospital can have an ABC or D rating. Part of that. And you'll help me with this because it's not really part of my book, but part of that I think is based on cleanliness and also, of course, safety. So you can have, for example, an A in your cardiology department and I think a C in your OB GYN department. So you really want to re. It's all in the back of the book. But you really need to research that. And I believe strongly in researching where my doctors have trained. If I don't know them and if they, if I don't have a personal recommendation, I want to make sure that they, that they just didn't go to a correspondence school or something.

Yeah. You know, the. One of the kind of silly but true jokes is, you know what they call.

I know just where you're somebody that.

Went to medical school and got Ds, right? Yeah. They call them a doctor. And so I think that is really important. So in the book, there's resources that you've given to help do some of that research if you need.

Absolutely. Have it organized under if you want to research.

That's a massive service for folks.

Yeah, it is. I really worked hard on that because I could see how important it was for me. There was stuff I didn't know.

Now, Susan, this is a question I hesitate to ask because I'm not sure that I want to know the answer, but do women get better care from a male doctor or a female doctor?

That's a huge question, and I'll tell you why. When I started researching the book, which was about 10, 15 years ago at this point, the book is newer than that, but it took me a long time. The jury was still out. Now it looks as if women are better. And this is all the newest research is that women patients are probably better off with a woman doctor. Women in particular, women doctors seem to spend more time with their patients than men doctors. They also seem to. They listen more. It's more of a relationship. Particularly if a woman is having surgery, she's better off with a woman doctor. I want to add a caveat to that, because although it's mostly true, I think two things. Number one, women doctors, the appointments longer. So if you're rushing in and rushing out because you're on your lunch hour, you're probably better off with a male doctor. I mean, I think that's important. Not everybody has the time to spend 15, 20 minutes, or in your case, an hour or two. That's the first thing. And the second thing is it depends on the doctor. I mean, my cardiologist is a male. He spends an hour with me. I mean, it's amazing. My endocrinologist is a female, and she says, hi, how are you? I go, fine. And then we move on, and I'm out in 10 minutes. So it just depends. Yeah, I think the most important thing is not the gender of the doctor, but truly how comfortable you feel. If you're not comfortable, you'll find that you won't talk as much, you won't get as much from the. From the visit. So I think that that's. It's more a comfort feeling. And if you're more comfortable with women, that's great. But not everybody is sure, you know.

That kind of brings up a great, great discussion around that. You know, feeling comfortable. Right. You're going into the medical system because you have a need. Right. You know, usually it's odd for me to say, hey, great to see you. That means you're at the doctor's office and something's wrong.

Right.

And so you're already on edge. And so listening to those intuitive components of yourself, like, do you feel safe or do you feel seen? Do you feel heard? And if not, what. How does somebody navigate that?

Well, personally, if I didn't feel seen and heard and I have options, I'd change doctors. I'm in a large city, you know, I'm in a northern Cal. I have plenty of options. So I would just get the hell out of Dodge, I believe was the expression. But if I didn't have those options, it's much more difficult. But I think I would say something like, I really feel that I need you to hear me. I'm feeling unheard at the moment. Let me. Let's try again and in a different way. And I'd rephrase it. I'm not sure how I'd handle that because, I mean, me personally, I just get pissed and I leave the. I'd never go back.

Yeah.

Which isn't necessarily the best way.

Sure.

I think the other thing I would do, and I really wanted to talk about this for a second, is go back to second opinions. Because, you know, sometimes you may feel unheard, but the doctor may be able to zero in pretty quickly on what they think you have. But I think what people don't realize, and I didn't until I did the research, is there's. Correct me on this, 40, 50,000 diseases out there, many of which have similar symptoms. So getting an accurate diagnosis can be really tricky. And it doesn't mean the doctor's incompetent. It doesn't mean that you feel unsafe. It just means that there's a hell of a lot of diseases out there. And it can be, you know, if you break your leg and you have pain in your leg and the X ray shows a fracture, that's. No, I mean, you know, that's not brain surgery.

Yeah. A little more straightforward.

Yeah, exactly Right. But I think if you. Particularly if you have an autoimmune disease or something like that and you're recommended a serious medication or a serious. A serious surgery, it's so important to get another opinion. I read somewhere, I mean, we all see what we expect to see, and the same. The same sort of vague symptoms can feel Like a stomach issue to a gastroenterologist or a stress issue to a psychologist, you know, we see out of a certain parallel lens and that's important to know.

Sure, yeah. I'm wondering, in the, in the researcher interviews, did you talk to many women that had experience with integrative care or alternative medicine? Did that come up at all?

Very little, but that was because of who I picked. That wasn't. It has nothing to do with, with alternative medicine. The way I got the women I interviewed as I went to support groups and most of the women in support groups had gone to doctors, traditional doctors. That's why they were in the support group, because they've been recommended. So I didn't have a random population at all.

Yeah. You know, one word on, on your short lived retirement. You know the statistics on retirement are horrendous. Right. The universe recalls the pieces and parts when there's no purpose. So really glad that you found a purp office. Your, your community and family said get back to work.

Oh, it was. I mean, it's funny now, but looking back on it, I was depressed. I mean I was fortunate that I had, I was, you know, I had enough financial resources. I was going to do lunch and play golf and go that whole route. I mean, I just, I couldn't do it. And I just started my second book. I'm doing a book now on gaslighting for women.

Oh, wow, that's important. Well, Susan, is there any last parting information message that you like to give? We're going to all of your contact information in the show notes. You know, side. I was going to say sideswipe. No, it is called the same thing Sideline How Women can Navigate a Broken Health Care System is name of the book and you have a great resource section there. Any, any last message you'd like to share?

Well, the only thing I really want to say and which is what the whole book is about, and you sort of said it earlier, it's your body and your choice about what to put into it, how to deal with it and how to take care of it, it's not only your choice but your job. And looking at it now from a perspective of being 81, it's really important because if you want to have a quality old age and if you've taken good care of yourself, if you've exercised and if you've eaten properly and all of the stuff that we all know it will pay off. I mean, so does good luck and good genetics. I know, but the part you can control is taking good care of yourself and that includes advocating for yourself. So that's. That's it?

Yeah. That's awesome. Thank you so much. And everybody, this is why we do this show. We're bringing you information you don't hear anywhere else. If you like today's show, please give us a thumbs up, a like a comment and also give us a five star review and let us know what you're going to put into action as a result of today's show. Thanks for tuning in.

Thank you.