Dr. Shelia Bee on Lifestyle Medicine

I was getting more and more dissatisfied with medicine because when patients are coming in and they're on 10, 12 medicines for their, you know, 8, 10 diseases, nobody comes in saying, gosh, I love all these drugs. Can you please give me another? They're saying, how can I get off of these?

Well, hi, everybody. Welcome to the podcast. This is Generations Maryland. I am Dr. Sarah Davis, and I'm joined here by my colleague Stanley Stephanie. And we have a very exciting guest today. She is my good friend and she was one of my colleagues at the University of Kansas Medical Center. She has a. She did her residency in internal medicine and currently practices what's called lifestyle medicine, and she's going to tell us more about that. So please welcome to the podcast. Dr. Sheila, baby.

Yay. So, yeah, we're so happy that you're here with us and chatting with us again. As I was kind of talking about before, if you want to kind of just give us a background about how, like, you got to where you are today, where you studied at, kind of your trajectory, you can take it away.

Well, I. In undergrad, I really didn't know what I wanted to do. I knew that I loved biology, I loved psychology. I. But I was also interested in everything. So at one point in time, I think I was a, you know, thought I was going to be a humanities major, art history, things like that. So then I think it was my sophomore year of college. I took a human physiology class and absolutely loved it. And I have to say that professor probably had the biggest impact on me because I went into his office hours one time and he asked what I was doing and I said I really didn't know. So then he said, well, if you thought about medical school. And I think he was the one who really made me feel like, oh, you can do this. Because there's so many people in undergraduate who I think doubt themselves. And I think just to hear it from somebody who believes in you and says, oh, yeah, you've got this. You could definitely do this. So then I still wasn't 100% sure, and I was afraid of debt. And so I remember my senior year in college when I was accepted to ku, I actually went back to the. To the career counseling office and talked with them about what would I need to do to be a teacher, to be a high school biology teacher. And at that point in time, I was going to need to go back and get two more years in undergraduate to get a teaching degree. And at the time, because I was on scholarship in undergrad. And so at the time I said, I thought, well, shoot, if I'm going to end up being in debt, I may as well go to medical school.

As a good financial decision.

Exactly. So. So I felt. I felt like getting a medical degree was going to give me so many more opportunities and so many more avenues to move up. And my goal was that I was always going to be able to do something that I enjoyed, that I had a real interest in, but be able to support myself and my family. I didn't want to be dependent on anyone else. So went to KU and I had a great time at ku. I have to say, I think medical school, the four of the toughest years of my life, but far and away for the best years of my life. And kind of the same thing with residency. So I. We went from University of Kansas. We couples match. So my. My husband was in our medical school class as well. Jim B. He's the one who is just that little. It's just a building on the corner.

He was closing on last week's podcast, if anybody.

So. So in residency we were in Michigan. And so I was at the University of Michigan in Ann Arbor, was downtown Detroit. And so we lived in the middle. And so I would drive anywhere 45 minutes to 60 minutes to get to work. He would have 30 to 45 minutes to get to work. And we saw each other, you know, once or twice a week during the first three years of our marriage when we were both residents. So it was really tough. But again, I think those were some of the best days of my life because I think that when you are truly engaged in something that you find so fascinating and you're learning every day, I think being in an academic environment is so stimulating and fun and I don't know, I loved it. It was really tough. But I have to say, I it truly the best. Some of the best days of my. My life. And you meet some of the. Your. Your closest friends, I think, because you've gone through that experience together.

Yeah. 100.

That's good. That's kind of. That's a nice positive span.

Yeah.

People don't usually do that.

Yeah. I want to kind of touch on a couple things you said just about going back and wanting to be a teacher, and then you're talking about just like being in an academic environment. It sounds like your career path might have kind of shifted more towards like academia. Was that something that you explored or something that you were interested in? And like, why did you choose not to go down that path?

Honestly, I think it has more to do with where you are at the time and what you're doing with your life. I think if we would have stayed in Ann Arbor, the Detroit area, I would have stayed in academia. So after residency, I continued on and I was a. It was called a clinical instructor at that time. Clinical instructor for University of Michigan. And so I had an outpatient clinic, but I had medical students and residents rotating through, and I truly enjoyed that. I loved going to Grand Rounds and Morning Report. They didn't have Morning Report when you're attending, but you still go to Grand Rounds and. And you just have the opportunity to always be learning. And I did really enjoy that. And I think if we would have stayed in Michigan, I would have stayed in that area. But we moved and I. You do what you need to do with your life at that time. And right after residency, I had my first child, and then we moved for my husband's fellowship and. And so you get the job that you need at the time.

Yeah, 100. That makes sense. So then you. You're still a practicing internal doctor.

Correct.

And then kind of walk us down the path of what led you to be interested in lifestyle medicine and kind of like what that is.

So lifestyle medicine didn't exist when I finished my residency. So I did a very traditional internal medicine training, and I practiced for years in the outpatient arena with the University of Michigan. I loved my practice. It was great. I was very fulfilled and satisfied. And then we moved to Colorado. I. During Jim's fellowship, we were only going to be in Denver for a year, and so it's pretty hard to establish yourself as a primary care physician when you're someplace for a year. So I knew that that really wasn't going to work. And so I worked for a year as a hospitalist. And so you know, you know what the life of a hospitalist is like. I did not enjoy being a hospitalist, and so I. It was great because then I always feel like every experience has something to offer. And some experiences, you know, that. Okay, well, that's not what I want to do, so I can cross that off my list. And along those lines, too. I remember in. In medical school and residency, even when you have the attendings who are really not nice at all, you learn from them because you learn what you don't want to.

So.

Yeah, so you learn what an A hole looks like? Is that what you're saying?

I learned what I didn't want to do. And so then when we moved to Colorado Springs, I. At that time, then I had a A three year old? No, I'm sorry. I had a four year old and a two year old and so I had a four year old and a two year old and I thought I want to have another baby. And so I didn't even look for a job when we moved to Colorado Springs and I stayed at home full time for maybe six weeks. I got an IUD and started looking for a job. Not ready to have a third child and I was not good at staying home. So much better mother when I have more things going on.

Yeah.

And so I realized that I definitely wanted to work part time because I wanted to be able to be home with my kids as much as possible. But I still needed that external stimulation and, and building self esteem, you know, I mean you're, when you're at home with kids, you're doing the same thing literally a hundred times a day and no one says thank you, no one has a conversation with you. They're just always wanting something from you. And it's a little bit different at work. They're always wanting something from you, but at least you get paid for it and somebody says thank you occasionally. So, so I did, I worked part time. I think the challenging thing for me was childcare. So I had a lot of childcare issues. My childcare was not reliable. So I finally ended up having, you know, getting pregnant, having that with the third child. And when I was pregnant with her, a few things happened that really made me reevaluate my life. Number one, my mom died. So then I really realized that you get one chance, that's it, you get one chance, you don't get a do over. So figure out what you want to do and how you want to live your life. So that was important. And then I got put on bed rest. So when I got put on bed rest and I also then was reevaluating my child care situation and I was like, I don't know how I'm going to do this because you can't. When you have a, at that time, a seven year old, a five year old and a newborn and the five year old and the seven year old. If I had, didn't have good child care, I could just call friends and say, hey, can I drop them off before school or can you help me pick up or whatever. But you can't just drop a newborn at somebody's doorstep and say here she is.

So I think that would be against the law.

Yeah, exactly. I would, she would be taken away from me permanently. So at that point in time I just kind of stepped back and I just thought, you know what, I'm just going to stay home for a couple years because I feel like this is what I need to do with, for myself and my family. So I stayed home for a couple years and then I was ready to go back. And so then when I went back, I went back full time because I felt like I really wanted to establish my practice. And it is kind of hard to really establish a good practice when you're part time. Various reasons I think, you know, your, your colleagues in your group don't know if you're really serious about it. Your patients, you know, well, are you going to be there? Are you not going to be you? So I went back full time and so I think I worked full time for a couple of years, had a full time nanny, and then went back again to various, I don't know, ways of being part time. So whether it was four days a week, three days a week, and then I ended up similar. Took some inspiration from Sarah and we started our own private pay direct care practice. Direct pay practice. Because at that time, so this was circa 2010, when EHR was coming in, insurance companies were coming in saying, you need to do blah, blah, blah, blah, blah, blah, blah. And, and all of this. And I just stood back with my partner and I said, listen, I'm quitting or I'm changing, but I'm not doing this because all of these things that are being required of us now are taking time away from patient care. So you know, these forms that I need to fill out and this checklist for all of this, none of this is benefiting my patient and it's, it's taking away because now I have to do all this and I don't have time to, to actually take care of what the patient needs. And, and then they were also doing things like, oh, well, when somebody comes in for their physical, you just need to only address their preventative care issues. Do not deal with any acute issues. They need to make an appointment to follow up for that. And that's, yeah, it's not good practice, it's not good care. And, and if people are in there, you need to capitalize on the fact that they're in there. And if they're willing to talk about a problem that they haven't been willing to talk about, then you need to address that problem, not tell them they need to come back.

Yeah.

And then, you know, limiting time with patients, I mean, 15, 20 minutes is, is never enough for an internal medicine patient. Most Internal medicine patients, they're elderly, they've got multiple medical problems. You can't, you can't even ask them to walk back to the room, get a urine sample and go over their problem is in 15 minutes, much less actually what's going on. So we made a change and it was great and we had a fabulous internal medicine practice. So I applaud Sarah for leading the way on that and helping us figure out how we were going to get a practice going. And I was really, really happy with the promise I had with my partner. We, we split it. We had the same values in terms of how we wanted to treat our patients and also how we wanted to respect our own time. So when we were away from the office, we were 100% away from the office. I covered 100% of the office when she was gone. She covered 100% of the office when I was gone. It was a really. Yeah, it was a wonderful work environment and partnership.

So when you were working part time prior to opening your own practice and you said you weren't a hospitalist, were you in an outpatient setting or where exactly, how exactly were you practicing medicine?

So initially I was in an outpatient practice, but we still took care of some patients in the hospital. And so I would go in and have to be on call, okay, once every four to six weeks on the weekends. And you know what I mean. There are certain aspects of inpatient care that I think I really enjoyed. But if you're not doing it all the time, you, you need a hospitalist there. It truly is. It's its own specialty.

So people who don't know, like, lifestyle of a hospitalist versus like lifestyle of like an outpatient internal medicine doctor. You talked about how you didn't like the lifestyle of a hospitalist. Can you kind of explain like why you didn't like that? Because I know people do do part time hospitalists a lot. So can you kind of touch on that a little bit?

Well, and I think it wasn't just the lifestyle. I think just being a hospitalist is really not in tune with somebody who likes to watch people over time. But I'll let Sheila answer that.

Both. Absolutely both. So number one, at the time, I had a three year old and a one year old and my husband was in a orthopedic spine fellowship, so he was absent. Yeah. So with my three year old, my one year old, here was my schedule. I would get up at whatever, 4:45, 5:00am So I could try to get a workout in before I would then Wake up my children, put them in the car in their pajamas, usually at 6:15, 6:20 in the morning, you know, have the bags ready to go. I would drop them off at the, at my daycare, which was an in home daycare. So I dropped them off at the in home daycare, 6:45, 7am and then I would go to the hospital and I had a 12 hour shift. So generally I wasn't home until 7pm or 7:30. And so I would brought my kids off in their pajamas. Somebody else was giving them breakfast, they were giving them lunch. The in home daycare closed at 4pm and so I had to hire a nanny to pick them up at 4pm to bring them home, give them dinner, give them a bath, put them in their pajamas and I would come home then and hopefully see them before they were asleep. And yeah, so it was awful. I mean, talk about feeling like a terrible mom. I mean I wasn't doing, I wasn't doing anything with my children. And so the nice thing was, is that I, I worked three days on and then I had four days off. And so that was nice that I, that I had four days in a row then where I could at least be with my children. But you know, during that time then, I mean, I was by myself. I was in a city that I didn't, I would just moved there. I, it's not like I had a social outlet where I was meeting other moms because it was just, it was a pretty isolating time, honestly.

It sounds terrible. Yeah, that sounds like a recipe for depression and all kinds of stuff.

Yeah, so. And then the other thing is, is that being a hospitalist, you don't get to develop relationships with your patients. And that's the thing that I loved about internal medicine was that, you know, when I actually had a practice then where I knew patients for a long period of time, you would they how their, you know, their kids grow up, their grandkids. You, you know, you come in like I had some patients where they would come in and I have to say, okay, we need to get down to what you need to talk about. Because they were busy telling me about their lives and their kids and showing me pictures and all of this. And so it's those relationships that I would love about internal medicine, especially when we had our practice with, we had so much time to spend with our patients. You know, they're giving you a hug and saying I love you when they leave the office. And so those are the relationships that you really, you just, I don't Know, you just savor that. And that's what's important being a doctor is being there for them day in and day out, not just taking care of them in three or four days at a time and then sending them back.

Yeah, 100%.

The I wanted to ask one thing about when with your third child, but you stayed home and then I think went back to work. Like I think you said you stayed home for like two years and how hard was that to go, go back to medicine with that two year hiatus, did you feel like you didn't have, like you'd lost some of your skills or how did that go?

So I volunteered. So first of all, you, you can't take that much time off or you're not going to be able to maintain your license. So you have to do something where you're maintaining your license. And so I volunteered at a local low income health clinic. So that was one thing I did. The second thing I did is I made sure I was still going to continuing medical education conferences and, and doing things online. And then I also, I recertified for boards a year early. So that way before I went back, I made sure that I was absolutely 100% up to snuff when it came to what's going on in medicine right now. So I, I, I needed to feel good myself, that I was going to be able to go back and, and, and feel confident in my, in my medical acumen and, and skills.

Do you think if you, if, if that had been longer, like four or five years, do you think you still would have been able to do those same things and come back or do you think that just gets harder and harder?

I think it gets harder and harder. Especially medicine changes so much. So even just in the time that I've, not that I've been doing lifestyle medicine as opposed to writing prescriptions, I, you know, there are drugs that I have to look up and so I look them up all the time now and so I have to reread. Okay, what's the mechanism, action, what's, what's going on here? And refamiliarize myself or just familiarize myself with them because they weren't, those medications weren't available four years ago.

Yeah, well, let's talk about that switch. So you're practicing general internal medicine and what this lifestyle medicine thing pops up. How did you learn about this and like what piqued your interest about it?

So I was getting more and more dissatisfied with medicine because especially in internal medicine, everybody was so excited about all these new drugs. And these procedures, these interventions. And I just felt like, okay, we are taking really expensive measures to mitigate end organ damage here. We're not fixing anything. I'm not making anybody better. So when patients are coming in and they're on 10, 12 medicines for their, you know, 8, 10 diseases, nobody comes in saying, gosh, I love all these drugs. Can you please give me another? They're saying, how can I get off of these? And so I felt like, I feel like good health is like a really good solid roof over your head. And when you have a really good house, it's solidly built, there's a good roof over your head, you are healthy, it's a good foundation. And I felt like in medicine we had this really leaky roof. And what we were doing is we weren't ever fixing the roof. We were just going around with buckets, collecting the water that's leaking from the roof. And I felt like, like the buckets started with little wooden buckets because it was simple, simple drugs. You know, the simple things that we grew up with back in the, back in the 80s and 90s. And so then we have these buckets. And so you just place these buckets around for every single little leak that's in the roof. But then over time, it just gets leakier and leakier. And so then you've got all these leaks coming through and the water's pouring in. And now we've got gold buckets and silver buckets and bronze. And then I got to the point where it was like diamond line, ruby lined, golden buckets that we've got around. And it's amazing drugs, amazing science, wonderful. I mean, really can be life saving for some people. But we're not fixing the roof. And I feel like we are spending a lot of money mitigating end organ damage. We're not fixing anything. This is unsustainable. If you look at the lifestyle of Americans and the trillions of dollars that we spend on pharmaceuticals and interventions, we can't keep that up. I mean, look at, look at what's happened, Sarah. When we first started practicing, the number of patients that we had who had obesity and type 2 diabetes and all of the diseases that go along with that, it was not the majority. And now the majority of Americans are overweight to obese. Diabetes is rising exponentially. Maybe that's an exaggeration, but diabetes is, is to me at alarming rates. When you think at, think about it, never travels alone, right? So if you're diabetic, you diabetes, typically you've Got metabolic syndrome. And so you've got high blood pressure, you've got cholesterol, lipid issues along with your diabetes. Typically, then expect some sleep apnea, expect some reflux. You're going to have some sort of hormonal things that are going to go along with that. Probably some depression and anxiety because of all the medicines you're on, all the things you can't do anymore. Typically, then you've also got some arthritis. Now we're on so many drugs. You've got some reduced renal function. And then. And then we just start piling on more and more drugs.

Yeah.

And I just got to the point where I'm like, this is ridiculous. I am spending so much money mitigating an organ damage. I'm not making people happier or healthier. I just decided I was done with that. And so then I. So the first conference I went to was called Healthy Kitchens, Healthy Lives, and it's all about using nutrition and healthy cooking and healthy eating to start changing lives. And so at Healthy Kitchens, Healthy Lives, I realized, wait a second, I'm not the only doctor who thinks this way. Other people are trying to make these same changes. So then at that conference, I learned about lifestyle medicine, I learned about culinary medicine, and then I just started getting a lot more certification. So I got a certification, and I actually didn't finish the certification in culinary medicine because I didn't want to spend the 500 to take a test.

Yeah.

But I did this culinary medicine training, and then I found out about lifestyle medicine. So I got certified in lifestyle medicine. Then in that I started working with people in lifestyle medicine, and I realized that, wait a second, people are having a really hard time making changes because they can't manage the stress in their life. And if you can't manage the stress in your life, you really can't take on anything else. And so then I did a Mind Body medicine certification. And so now when I meet with patients, the first question I ask them is, what do you value in life? What's important to you? And then once you start talking with. To people and you find out what's important to them, what's their why, then you can start talking with them about, okay, now I know what's important to you, what you want out of your life, where you want to be in 5, 10, 15 years. Now let's talk about what you're doing right now. And does. Does your. Do your current behaviors, do they fall in line with what you want for your future? And then talking about your goals, and then you Start setting goals that align with your values. So, for instance, when somebody comes into my office and let's say that typical American, okay, so they're overweight, their blood pressures either moderately elevated or flat out hyper, you know, like, really hypertensive, some cholesterol issues, maybe some prediabetes, they don't have great sleep. You know, they're drinking a fair amount, exercises here and there. You know, you start talking to them about things. Would they come in and I just start telling them what they need to do? Chances of them making changes are about zero.

Yeah, yeah.

However, if I say, what's important to you? What do you value? And they say, well, I really enjoy spending time with my family. Great. What do you do with your family? Well, we used to go on these trips and we used to do these things, but I really can't do that anymore because I've got knee pain and hip pain, and I can't walk more than about a half mile before I start to get short of breath. Okay, now we're going someplace. So then you say, okay, so if it's important to you to spend time with your family and you'd like to do these things, where do you think is the first place for you to start to start making some changes so that you can start doing the things that you want to do in your life as opposed to, you know, you can't do what you want to do in life because of these problems, but yet you're behaving in these behavior, you're engaging in these behaviors that are contributing to these problems that are leading you to not enjoying your life. And so then you start getting them to think about what they really want in life.

Yeah, no, I have. I have a lot of different questions. I have a lot of pins and a lot of things that you said. No, I'm really interested. I want to talk about. First thing I want to talk about is, like, the difference between what you're doing and, like, holistic medicine. Because I think a lot of times, or at least for me, I'm not super familiar with lifestyle medicine and, like, this whole area of things. So when I hear that, the first thing I think is I'm a little skeptical. Just because so many people, especially around Dallas, like, have these, like, holistic medicine clinics and do kind of all this stuff that's a lot more like foo foo. But it sounds like what you're. You're not like, giving people anything, are you? Or like, you're kind of helping people reach their goals in a different way. Can you kind of just like talk about the difference between those sort of things.

Sure. So lifestyle medicine in, in when you're practicing lifestyle medicine, it doesn't mean that you're never going to use medications.

Okay.

So I like to say that lifestyle medicine, if we think of good health as being, I use all these analogies. So a three legged stool. So if all you're using is medicine and interventions and surgery to keep your stool stable, you're going to always be teetering, you're not going to be stable at all. But if you put lifestyle medicine in there and you work on sleep, substances, social connections, stress management, physical activity and nutrition, and you've got good solid habits in all of those areas, even if you have to use some medicine and you have to have some surgical interventions, your stool is going to be a lot more stable. Right. So lifestyle medicine does not mean that we're not using other avenues. In allopathic medicine, holistic medicine simply means that you're looking at the whole person. So instead of just saying, oh, your blood sugar's high, here's a medicine for your diabetes, oh, your cholesterol is high, here's a medicine for your cholesterol, your blood pressure's high, here's a medicine for your blood pressure. Oh, you're smoking and you have copd, here's an inhaler. Right. And so instead of like piecemeal treating people like that, holistic medicine just means that you treat the whole person. And so instead of treating one disease with one to four medicines, you're treating the whole person. So mind, body, spirit. So then you're taking a look at, okay, what's going on in your life, that's that you're choosing to engage in these behaviors that are causing these medical problems, number one. So looking at, at behaviors, motivations, things like that, psychological issues. So holistic medicine means you're looking at the whole person. Holistic medicine does not mean that you're doing a bunch of tests or you're using a bunch of supplements or other interventions. So you've got holistic medicine. Just that means that you're treating the whole person, mind, body, spirit. Okay. Inter integrative medicine means that you're using things other than traditional allopathic western medicine. So med, Western medicine is the, you know, when you think about, with a traditional, you go in, you get a physical, you get some labs, you're given some medications, you have some interventions. Integrative medicine means that maybe you're looking and you're saying, okay, let's use some acupuncture let's use some medical massage. Let's use some chiropractic. Let's start thinking of some other things. Let's maybe see a naturopath do some other thinking outside of the box. So that's more of an integrative medicine. So I think sometimes people use the term holistic medicine when actually it's just supplement medicine. Yeah. Not holistic medicine. I think there's a big difference.

No, that. That's good. That's a good clarification because, like. Yeah, clearly I was confused about all that natural path. That's maybe the more of the word I was thinking of.

Yeah, yeah.

But I do kind of. I really like what you were talking about in regards to like, asking somebody what their values are and all of that. Because I think just like my honest impression of lifestyle medicine at first was kind of more towards, like, trying to have optimization of health. And I think, like, it can kind of be shifted, especially just kind of like the area that I'm in, like geographically in Dallas, in like this kind of part, we see a lot of patients that come in and just are trying to be like, so healthy, so healthy, so healthy. And like, trying to optimize their. Their health at so much where that it's really goes downhill where it's like, to an unhealthy extent of like, only trying to eat fruits and vegetables and like, all of this sort of stuff. So I like what you say about, like, bringing people in and talk about their values. Do you see that? Do you kind of understand what I'm talking about? And do you have people that come into the office and like, are too focused on optimizing their health and not looking at their whole self?

Yeah. And I think there's a. There's a term now, it's called orthorexia, where people are. It's like an anorexia, but it's orthorexia where people are so focused on I can only eat this. And they have these food rules because of all these things that, well, that's bad for me. I can't have this, I can't have that. I can't have that. And then. And then people get very rigid. And so I have a. My motto is to consistency without rigidity. If I committing to consistency without rigidity, using the pillars of lifestyle medicine, then that means that starting. I always start, number one, with sleep. So number one, I'm trying to get seven to nine hours of sleep at night, trying to keep my bedtime and my wake time consistent and trying to keep good sleep hygiene habits. Now that doesn't mean that when I'm on a girls weekend I'm going to say good night girls, I'm leaving the fun because I have to get my get to bed at my right time. But it is the majority of the time I am trying to be consistent with my regular bedtime and wake time, all of my good sleep hygiene and getting that seven to nine hours of sleep a night. Committing to consistency without rigidity with substances means again that I'm trying to limit alcohol. Limiting alcohol means that I am having like less than five drinks a week. And so but it doesn't mean that when I go on a girls weekend I'm not going to say oh yeah, I'm going to go ahead and have that extra glass of Prosecco tonight or something like that. Right. So committing to consistency without rigidity in all these areas. So with social connections, with stress management, that means that each day I'm trying to start my day where I'm, I'm choosing how I'm starting my day. I'm starting my day with intention, with some exercise, with some meditation, with some things that I'm starting my day on a full battery. So committing to consistency without rigidity with exercise doesn't mean that I have to get an hour five days a week and it has to be this routine, but it means that I'm going to strive for, you know, 300 minutes of exercise a week. And what, however that looks is going to change from week to week but I'm going to do my best to get that in. And then again committing to consistency with nutrition means that I'm going to try to have most plates be, the majority of it is going to be whole plant foods that may look different every day. And every week I'm going to try to minimize my animal products but I'm not going to try, I'm not going to be r, I can't have that. And, and then there's always room for, you know what, this last weekend we celebrated my in laws 60th anniversary. We had a great time. Lots of family celebrations with birthdays and it means having some extras, right? So enjoying life, having the best things in life but committing to consistency on a regular basis without getting rigid, without going to extremes.

I think that's challenging for a lot of people, don't you think?

Yeah, for sure.

Absolutely.

One last thing that I have is just how do you get people to come into your office?

Gosh, you know what, maybe you can help me figure out how I can get more patients in my office. So some, some of my patients are patients that I've had before. And I always say, you know, I give the same advice I gave before. It's just that now I'm not following up with a prescription. So we, some of my patients are patients I've seen before. I do teach a stress management class, and so it's stress management resiliency training. So it's an eight week class. And during that eight week class, we work on setting goals in lifestyle medicine. And so sometimes patients will take the class and then see me afterward to try to work on those goals a little bit more. Sometimes people take the class individually. And so throughout the eight weeks, we spend time each week setting goals for their lifestyle behaviors as well as working on ways to manage their stress, learning some strategies and skills and practicing those. And then, you know, some patients have been virtual where they just have. People are looking for a different way because a lot of patients actually they'll, they'll call and they'll say, my doctor said that I'm pre. Diabetic. Diabetic, and my blood pressure is a little high, my cholesterol is high. And, and, and he or she immediately wanted to put me on medicine, but I'd really like to see if there's another way around. So sometimes it's people just searching on the Internet for other ways to, to treat these common chronic diseases other than just immediately starting a medication. Patients are reluctant to change.

Yeah, it's hard. It's just, it's a lot easier to just take a pill. And that's what, when I kind of talk about some of these concepts with people, they're all for the idea, but the execution is what, is what bogs them down a lot of times. Although I would say so you and I went to the lifestyle medicine conference few years ago, and I did learn a lot there and it was very helpful. I did not go through the certification process that Sheila has, so I only know, I only know a little bit. But I found it helpful to just introduce some of these concepts. And sometimes patients say, well, okay, I'll think about that. I'm not ready to do that now. But then sometimes they have come around even years later and said, okay, I'm ready now to start talking about these things. And so I think that that's been very helpful in my practice.

And you're absolutely right, Sarah, because you have to assess their readiness for change. So the nice thing, Stephanie, about when patients come to see me, they are already at a step where they're ready to change because they're not going to come to see me if their readiness to change is at a zero.

Yeah. But no, I thought that this was really interesting and a unique spin on things. I think it's, again, as we talked about, good to keep an open mind about, about all sorts of different types of medicine because, again, I think that's what science should be and, like, what science is. So, no, I love this. I learned a lot. So, yeah, this was great.

Good.

Yeah. And I think it's also just interesting for our listeners to hear that, you know, you, you think that medicine has to be this particular way or you have to do this particular path. And yet you can, you can pivot, you can change your path, you can do something that works for you for a while. And you know what? Now that you're at a different place in your life now, you can do things differently. And so I think, I think your story is just a great example of that.

Yeah. So if we want to wrap up, if you want to plug anything, your practice, if you have social media or anything that you want to tell our viewers about, then you're welcome to do that plug away.

So, first of all, congratulations, Stephanie, to getting into medical school. I'm so excited for you. It's going to be, it's. I don't know, I think it's a great four years of your life. And, and I just am so happy to see young women going into medicine. Yeah. Yeah. So I'm just really happy and excited for you. But then my, my website is sbmd.com so s b E-E-M d.com and my daughter has started an Instagram for me, which I think has the same handle. I'm available. You can certainly contact me if anybody's interested. I'm happy to talk about, and especially happy to talk about any young people who are in medicine, interested in lifestyle medicine and what that, what that would bring to their practice.

Do you have any other words of wisdom for Stephanie or advice for her?

Yeah. As I start this journey, just stay.

Curious, keep an open mind, and know that as hard as it seems, it truly is the four of the best years of your life. Because the other thing too is, is that you get to go in. When you go in and see in a patient, it's fascinating. You're learning. It's an opportunity for growth and the responsibility is not on you.

Yeah.

So, yeah, you know, once you, once you're, once you got MD behind your name, then you're the one who's responsible for the decision making. But. But in medical school, it's just all learning and I don't know, I think learning is fun.

But again, thank you so much. This was awesome.

Yeah. I really appreciate your time.

Yeah, we really appreciate it.

Good. Yeah.

Again, this was Generations MD. You can follow us on Instagram @Generations MD. Tick tock @GenerationsMD. And we. We will talk to you next week. Bye, guys.

Bye.