Mushrooms, Mindsets, and Medical Niches

Because, you know, you heard of microdosing. Yeah, yeah, you said that like, you're like. Oh, yeah, I know.

Microdosing.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie, and I'm joined.

Here by my colleague, Dr. Sarah Davis.

Who'S also my mother. Hello. Happy Friday.

Happy Friday the 13th.

Oh, God.

Yeah. It's almost the end of the day.

I just realized that. Yeah, well, it's okay. My day hasn't gone too disastrous. Knock on wood.

Good, good.

Speaking of disastrous, though, sorry to get right into a Debbie Downer note at the beginning of the podcast, but I did not realize that.

Yeah, we were just talking about the Air India plane crash that crashed into medical school in India.

So terrible.

Yeah.

So awful.

Yeah. So, you know, all the people on the plane died, and then some of those people on the ground died. I think that. I think they were, like, having lunch or something.

I just. That is literally so awful. And. Well, we're. Because for our listeners who don't know, I'm going to India in a couple of weeks to do some, like, healthcare stuff over there with a medical school in India. Actually, I don't really know the name of it. Yeah.

But I don't know. I did. I looked up. This one is. It's kind of far away from where you're gonna be, but.

Yeah. Good Lord.

I certainly hope none of your people were affected.

I know, and it does just make me nervous because I am taking an Air India flight.

Wait, what?

Yes. From Delhi to where? To the Himalayan region.

Yeah. A nice little tiny plane. I mean, all things considered, you know, there's plenty of other dangerous things just living daily life, but I don't know, it's. That is a little scary.

You know, that's the thing that. So as I've been doing this preceptorship, and I was with Dad a little bit when he's seeing patients, and he has this one line when he's talking about. He's like, talking to these patients who are. He's clearing them for surgery, so they're coming in, making sure that everything is good for surgery. And he has this line that he always says. He's like, okay, well, yeah, I. I mean, you know, know, obviously, there's never. No one's ever cleared for surgery. There's always going to be a risk. Like, there's a risk when you're going to drive home today and you could crash. He said his thing every single time, and I'm like, no, like, every single time I'm like, why are you saying that? You would say so many other things.

That is not what people want. You want to hear.

No one wants to hear about getting in a car crash when they're, like, nervous about, you know, coming in to see a doctor and want to get surgery and.

Yeah, okay, we gotta maybe tell him to correct that. I don't know.

I didn't say anything about it because I'm. I don't know.

But that's like. I mean, while true and I understand that Dad's like, well, you know, that's true. You could get in a car crash. I'm like, but you don't really want to plant that seed.

Yes, exactly.

When the anxiety is already pretty high.

And still it's like, yeah, it just. He's trying to make the point that there's, you know, a risk in everything you do, and there's a risk when you have surgery, but, like, the point needs to be made in a different way.

Well, especially because you are actually driving home. Like, if you. If it was something a little more theoretical.

Yeah, yeah, yeah.

Then that would be okay. But you're going to be you. You survive your surgery and then you get in your car and then you're like, well, I don't know. He said we could crash on the way home.

Yeah, exactly. And especially. Yeah, yeah.

He needs a new line.

It is funny as I've been, like, shadowing different doctors and stuff, I'm like, learning everyone's little bits that they do, and it's just. It's fun. I'm trying to, like, pick up on some little bits. Like when you're, you know, the patient's getting discharged, then they're like, bye, hope to not see you again. You know, it's good ones little things. Everyone has different. Different little things that they say.

Yeah, that's. I remember you had some bits when you worked for me.

Oh, for sure. It's easy. Just revert back to things and. Yeah, well, I started saying. I started saying every time. Well, when I left, well, we'll be around. Holler if you need anything.

Nice. Holler. Holler.

Kept saying that.

Yeah. Yeah. That's a good one. Well, wait, so this is what you.

Were saying when I was seeing patients? Yeah.

Out in East Texas.

Yes, yes, yes.

That's good. When I talk to patients that, you know, have a little bit more of an accent, as, you know, I develop an accent.

No, dad does, too.

He does.

No. Oh, my God. It was like. Yeah.

No.

So I'm like, shadowing him as he's Seeing patients out there in East Texas who, you know, people have a little twang and. Oh, yeah. Like, the way that he was talking to people, I was like. And then we walk out of. You know, he does the whole thing. And I had a nurse practitioner in the room, too, and we walk out, and she was like, you kind of sound like Matthew McConaughey. Dad does not sound like Matthew McConaughey at all. He kept doing this thing where he was like, all right, all right.

Yeah.

No. And he kept going, fair enough. Fair enough.

Oh, my God.

The patients liked it.

Yeah.

And like, the way. And he was explaining stuff like. Like very slow and just like, yeah, but. And the patients liked it.

I liked it. You know, you do have to alter your style a little bit depending on the patient, and I think that that's. I think that's good. But that's funny because I get roasted in our family for picking up accents when I talk to people. Like, if I start talking to somebody with a British accent, within five minutes, I've got a British accent.

What do you think that is?

I think it's deep empathy.

I was looking up into yawning because I was like, that's such a weird way. What's the deal with yawning? Why do people yawn? And I remember reading something about how if you are more likely to yawn when somebody else's yawns, then you are a really empathetic person.

I kind of feel like yawning right now. No, just even talking about it.

When you see someone yawn, then you. Then you have that reaction. It's just like. Like, why do we yawn? Like, that's a weird, weird thing.

Yeah. Yeah. Well, you could start yawning or you could develop a British accent.

Yes. Either way, you are empathetic.

Well, okay, so that leads me into this article that I was just reading. And it's topical because it's talking about Gen Z doctors versus other generations of doctors. And there's some good. There's some good quotes in here. Let's see. This article is written by Lisa Marie Baselli, and it was in, I don't know, Maryland, but there's a couple of quotes here. So it starts off, there's a beautiful opportunity right now for intergenerational collaboration.

There we go.

Older physicians bring depth, pattern recognition, and wisdom. Younger ones bring innovation, adaptability, and a refreshed sense of purpose. I do think that's true.

Yeah.

I like being around your med school friends. They're just so. They've just got so much energy. But there's some great quotes in here. Like most of the patient experiences included in the recent article suggest that Gen Z physicians adopt a more casual bedside manner, including a hearty dose of humor. In one example, a patient was quoted as telling their doctor that had a tubal ligation. To which the doctor said yes, Queen, no more kits.

Yeah, yeah.

And that they're more culturally competent, empathetic and they're going to make great changes as healthcare workers. And so then they're just kind of talking about that there's really a cultural shift in medicine that historically the field was marked by strongly paternalistic approach. Physicians said like they could just make the decision for you, I know what's best for you, just do this. And then over the past decade there's been a notable move towards more patient centered care, emphasizing shared physician patient decision making where patients are actively involved in choosing their treatments based on information and guidance from their physicians.

Well, I think that just to talk about like the bedside manner and people being more casual, I you see that in the professional world too. Like people Gen Zs in the workforce are just more casual in like emails and in sort of things like that.

The way they dress.

Okay, well yeah, yeah, it's just more casual. Yeah, it's more casual. And but something that I think is interesting is, and that I think about is the idea of like you have professional to professional relationships and then you have like professional to personal relationships. You know what I'm saying? So, so like when you are a professional working in, I don't know, working in sales and you are talking to another, to a company owner, that's like a professional, professional relationship versus like when you're a doctor and you're treating a patient, you're not treating their professional self, you're treating them. So it's like it's just a different dynamic. And I mean there's other things like that too, I don't know, therapist, um, even like say like general sales or something like that. Like you're, you're professional but you're talking to this person who's just trying to buy a microphone for from you. So I just think that those sort of, I think inter professional relationships are also kind of changing with Gen Z. Like you look at work emails now and everyone's just a lot more casual. But I think, I think it's even more casual because it's like I'm like I'm talking to a person even though I'm, I'm still a professional in this setting. I'm not, I'm not talking to this professional person. I'm talking to just a person.

Yeah, Yeah. I think there's. There is kind of this line there that is interesting because, like, when I'm talking to a patient, so I'm my professional self, they're their regular self. Right. And we're chatting about something in, you know, I. I know my patients well, known them for a long time. We get chatting about lots of personal issues, but, you know, there's sort of this rule that you're not really supposed to, like, self disclose lots of stuff. But I do find myself. I mean, we're having a personal conversation, and again, we're like, we have a professional relationship, but we're also kind of friends. We've known each other forever. And so I do find myself telling them lots of things about my personal life or my travel or my children. And sometimes I think to myself, ooh, I went too far. I got too personal with that. I don't know. I'm not really sure. Sometimes I'm like, I'm not really sure what the, what the rules are. Are the rules changing?

What's the, like, the downside of. Of giving too much personal information just because they're going to have judgments about you? Is that the problem?

I just. I'm just afraid that it just doesn't feel quite professional enough.

Or the why, though? Like, what's the down. Like, what's the downside of that?

I don't. I don't know. You're just not supposed to. It's against the rules. Yes.

See, that's where it's like, okay, well.

The one thing that I notice that I do sometimes and I don't like it if I do it too much, is that if I start talking too much about my personal life, I'm like, oh, yeah, the patient's here to talk about.

Yes, yes, for sure. For sure.

Does that ever happen to you? Like, sometimes you go to the hairdresser and the hairdresser is like, talking about their life, and I'm like, no, I'm the client. I get to talk. I could just say whatever I want. You're supposed to listen to me for an hour and a half.

I mean, I guess I can't think of a situation where I definitely been in social situations where I walk away and I'm like, I thought I talked way too much. So.

Yeah, yeah, but. And I don't think I do that too much with the patients, but once in a while I'm like, okay, I don't want the patient to dread coming in, being like, okay, I don't really want to hear that much about her life.

No. Yeah, well, there's obviously that, but I think, like, just, you know, casually mentioning something or whatever. I think. I feel like if it's just facts about your kids or travel or that sort of stuff, I think it's different if you're talking about, like, opinions and that sort of thing, and that can, like, base judgment or can have a patient have judgment of you. And like, I think that there. There's a line there, I guess, in that aspect. But I think just the broad idea of being like, well, that's not professional to say anything about your life, and you need to have this boundary. It's like, okay, well, the. As. As a patient, I would like to know that my doctor is a person.

Yeah. So, yeah, I don't think it's too bad, but I can't imagine dad, like, giving a lot of personal information.

Definitely not.

Well, my patients all ask about you, and so I always have to give them the update about you. Well, you know, but they know you. Plus they've been seeing Christmas cards with you on it for years and years and years.

So I do think it's interesting that just the Gen Z, the difference. I. I think it's really interesting, too, because as I was growing up in the Internet and I feel like I'm very prime Gen Z. Like, I like him in the, like, I guess a little bit older, but still the middle of it, growing up just with the Internet and like, all of the meme culture and just very unserious, I guess, in a lot of things. And I was just in the way that people talk and then just text, you know, texting now we all text and, like, it shortens everything and it just changes our. Our language. I think that I didn't know how I thought, you know, seeing y' all and seeing older people and parents and professionals, it's like, okay, well, then you're gonna get more serious and then you're not gonna. Your language is gonna change. And yes, of course it does a little bit from when you're a kid to an adult. But I still think that now, as we are seeing Gen Z enter the workforce and enter the medical field and all of this stuff, we are still taking that kind of. That language with us. And that more relatable, quote idea of talking to somebody, you know?

Yeah, yeah. And. And I don't think that now. I think that some older generations would say it's a negative thing. Not for Any real reason other than that. It's just different, you know, it's like, well, that's not the way. That's not the way I do it. So. And I think if patients respond then, you know, then there can't be anything wrong with it.

Yeah, I think it's definitely understanding your audience and understanding the patient that you're talking to is important. That's a skill you have to have.

Yeah, I can see that. You know, if it's an older patient, they might not, you know, that might not work for them so much. You know, they want, kind of want their doctor to be a particular, you know, act in a certain way, talk to a certain way. But those people a lot of times are going to gravitate towards an older doctor.

Yeah, exactly.

When they have a choice, which you don't always have a choice. Choice.

Yeah, we had a. Some sort of. We have like, you know, problem based learning stuff or whatever. And one of the topics that was brought up was like, because something. The patient went in and they saw this older doctor that told them their blood pressure was fine, and then they ended up having an MI and whatever. So that mom had escalated to them being in the hospital. And the point was, was it was a question like, are older doctors better or are older or are younger doctors, like, better in regards to like primary care physicians and their patients ending up in the hospital? Something like that. I don't know the exact thing, but essentially they were saying, and everyone was saying, well, I think older doctors are better. They have better experience, better, all of that. And then they're like, well, no, this study shows that actually like, younger doctors are better. I don't have any scientific. I don't have the study or whatever exactly what it was.

And there was, there was a study that Dr. Jenna did that was like looking at, looking at those exact things, like looking at like mortality rates of patients. And they, in that study, they did find that the younger doctors had lower mortality rates than the older doctors in a group of like hospitalists or something. But I still had questions for the study because I was like, well, if you're just using mortality rates.

Yeah, yeah, yeah, we gotta control for age.

Yeah. And sometimes having the patient live longer is not always the ultimate goal. Sometimes I say, let's consult hospice because I know what's gonna happen here and I want them to die with dignity and all that. So I was like, I don't think that can be your only end point. But they're, you know, knowing him, there was probably a lot more to the study.

Yeah, no, but I don't know, it's just interesting and we'll see how it continues to develop as more. Yeah, I saw a tick tock of someone say, they're like, yeah, my, my sister got surgery and it was a Gen Z doctor, Gen Z surgeon. And she was just like, I know that that is what, how things are now, but it's just, just, it's just weird.

Yeah. Oh, I just wanted to recap a little bit about our talk with Dr. Gamboa where we're talking about the business side of medicine just because there were some real highlights. It's, it's, it's two part podcast. If you haven't listened to it and you're interested at all in the business side of medicine, you could, you should go back and listen. But if you just want a brief recap, I thought he, you know, in a nutshell, he basically builds up his. Starts with a little practice and builds it up into a really big practice and ends up selling it and doing very well financially. But one of the keys about what he did and the reason he was able to do it was he did work that other people don't want to do. He started off, I mean, he was a hospitalist and then he started working in these nursing homes. And you know, people think of nursing home doctors as, you know, it's just one of those things that just seems so not glamorous, you know, like, okay, go and work in a nursing home. And you know, it's, I mean, those places can be kind of depressing and for so long, a lot of times those patients really didn't get great care. And probably in a lot of places they don't get great care. Like you said, the doctor comes in, sees them like once a month, blah, blah, and takes off. And then if they get at all sick, they just have to go to the hospital. And he really tried to, you know, make a big difference, provide better care. But the, but the key thing was that he was doing work that other people didn't want to do. And because of that, he was really able to build it into a really successful business. And I think that that's just, it just struck me as an important thing to think about as you're going along through the path. There's certain things that seem glamorous and seem really interesting and a lot of people want to do them, like don't dermatology, you know, just seems like so fun and cool, but you know, those spaces are competitive and crowded and you know, sometimes that doesn't end up being the greatest place to be an entrepreneur. And so sometimes when you sort of look for those little things, well, what are people not doing or what do people not want to do? And how could I make that?

Find the gap in the market.

Find the gap in the market.

Well, like you did.

Like I did.

Yeah. I mean, you were family medicine doctor, and then, you know, found this niche and found this. This gap in the market that people want better care and they want better.

Access to their physician, and they are willing to pay for it. And people didn't think that they would be willing to pay for it. And that was kind of the big gamble that I took, that I said, I think that people really do want good care, and they don't want to sit there and wait in the waiting room, and they want access to their physician, and they're willing to pay for that. And so I took that gamble and kind of won.

Well, I think this speaks to, like, I. This is kind of a theme that we've been talking over the past couple weeks with different guests and stuff, is just this idea that a lot of people who do go down this medicine path, it's like you just, okay, you get into med school, and then it's one foot in front of the other, and then you see you graduate from a resident or finish residency, and then you're like, okay, now I'm just going to take a job and then work like a doctor. Like, I've seen through my training. I just. All I see is the attending who is, you know, in whatever specialty it is. That's all you see. And it's hard to see those other gaps. And it's also hard to imagine taking a risk and taking a gamble on yourself when you're not exposed to it at all.

Yeah, when you're not exposed to it and by the time you're finishing residency and everything, you're not in it a lot of times financially, in a place where you can take a big risk. Risk. So, yeah, the odds really are stacked against you in a lot of those things. And, gosh, a lot of times you're kind of so beaten down by that time that doing something really different is not on the agenda. But, like, for Dr. Gamboa, I mean, he started off doing something a little bit more traditional and then just sort of saw this opportunity and thought about it. And I think he really started off as just, hey, I just kind of want to improve this care. But anyway, I just. There are. There. There are opportunities out there, but you have to be open minded and willing to explore.

Yeah, that's really, that's a great point though. What do you know about psilocybin?

I don't, I don't know anybody named psilocybin.

Do you know what psilocybin is?

It's mushrooms.

Mushrooms. Yes. So actually this is big news that I don't know if you heard about this, but the Texas legislator just passed, passed this big bill to allow like psilocybin research in Texas and then they had a grant of $50 million that they are going to push towards doing wow. Research and it's not. So it's ibogani is the main thing that they do. So it's not exactly psilocybin or the main like thing that they're trying to push.

Okay.

So, but, so iani I didn't really know what this was.

I don't know what that is.

But it's a psychedelic, so. And it's a plant derived psychedelic used in west central African rituals, but now has recently been investigated for its effects on substance use disorder, depression, anxiety and then PTSD is the big thing. So I think this is also kind of why the Texas state legislator got involved is like essentially what happened was there's these veterans who had terrible PTSD and you know, were kind of at a loss of what to do about it, tried all the treatment and everything. And then they went and to like Mexico and did this ibogani ritual stuff and then came back and then felt better.

Better.

So now it's like. And people there was this whole program of sending these veterans to this place in Mexico to do it. To my understanding. Yeah. It's not like it's. The only thing that I can think to compare it to is like ketamine therapy.

Okay.

Where it's not like you just, it's not like other medications where you're just taking it consistently.

Okay.

It's like you go and take a certain amount of doses or whatever and then like the idea is that like some sort of neural rewiring and then like you don't have to do it again.

Oh, okay. I have, I listened to a podcast talking about, I think they were maybe talking about lsd but, but using things in. In some similar way. And the, and yeah. And it's not like you just hand them the drug and say goodbye. Like it' all done through, you know, whole guided experience. And I do have to say I'm naturally a bit skeptical.

Of course. Yeah. That's what the thing is. Like. Yeah, of course. Like you're skeptical or, you know, we all are of just like, you know, the. This one study shows that it was with a group of veteran veterans with mild traumatic brain injury and comorbid psychiatric symptoms, including ptsd. That's okay. Including PTSD have shown large effect sizes for symptom reduction at one month post treatment with the Abagondi. I don't know if I'm saying that.

Right.

With reports of remission rates exceeding 80% for PTSD, depression and anxiety. However, these studies are limited by small sample size and lack of control groups. You know, all the things.

Yeah.

Um, but. And you know, there's no large scale studies and all of that. But now. Yeah, it was. Let's see, on May 25th, I think the. They launches the largest publicly funded psychedelic research initiative with $50 million in investment, and they're still trying to find the place to send that to. Exactly. The grant money.

Oh, wow.

But, yeah, because, like, my school has a big psilocybin lab. Yes.

Oh, wow.

So. And I. I've, you know, working with. In substance use and stuff. When I was at Musc, like, there's a. Other people in my, like the lab right next to us, they were doing psilocybin research. Like it's been a thing.

Okay.

But. Yeah, and I think Dell Medical School also has a big psychedelic research program as well. So I. I don't know exactly where if they're gonna put all this money in one or split it up, but it's just. Yeah. Interesting.

That is interesting. That's. I mean, it's always good to explore other options. Yeah. I think, I think there was a Radiolab podcast that was talking about that. And. And it was. It was some. This whole protocol. And then. Yes, it was. They got rewired and then you were done. Like, you didn't have to stay on these medicines forever. Which, you know, there's definitely some appeal to that. That's when they're talking about that, you know, one month out, I'm like, okay, that's fine. I want to know how they are five years out.

Yeah. But I mean, for these veterans, you know, they're terrible depression, ptsd, not engaged with the family, and they're these stories of them going and doing the thing and then they come back, you know, they have nothing to lose. It's like, well, right? It's like someone said that they went to Mexico and then they felt better and it's like, why not? Why not? You know, I'm on the brink of.

I know, I know.

Yeah.

Very high Suicide risk and all that. Yeah.

So it's like, what. Like, why not? So that's what they've been doing. So now it's like. And I think it people. It sounds like these people came and told their stories and stuff and it really just, like, stuck with the legislators and. Yeah. Now they're moving forward with this stuff.

It does seem very surprising in Texas.

Yeah. I mean. Yeah.

Well.

And, you know, like, a little bit. Do you know anything about. A little bit about the history of, like, studying drugs and how that really. I mean, I. I can't speak on behalf of this greatly, so I don't know. Do your own research on this. But I mean, just the criminalization of drugs came with that. And like, the Nixon administration also came in and then took away a lot of the ability for, like, for funding for studying illicit drugs, but then also the legality of studying illicit drugs. I don't know. All the ins and outs of everything, but essentially just war on drugs, all that sort of stuff. But that. There was a bunch of stuff that was passed that you. We can't, like, move forward with any of these sort of, like, illicit things. I think the idea with this is it's like. It's some, like, random psychedelic plant that we don't know much about. It's not like cocaine, you know.

Yeah.

So there's a little bit more ambiguity there, but it's still. Still kind of classified under, like, an illegal psychedelic. So I. First they had to pass a thing that, like, d. Criminalized it and in.

Certain settings, I assume.

Yeah, yeah. And then. So they passed that bill earlier in May. Then they did the thing where they did the grant money to push towards studying these psychedelics.

Well, I mean. Yeah, And I know there's. Yeah, there are some. There's. There's one guy who's been trying to get LSD legal to use, like, in therapy, and he's been working on it for, like, 30 years and, you know, has never has not been successful so far. But. Yeah, I mean, that's. That's exciting. That's interesting.

I feel like this is a generational thing because I feel like it's like.

Well, you know, we should. We should have Grandma on here because she'd probably be all for it, you know.

Shout out Grandma.

Shout out to Grandma. But, you know, I mean, there's the generation who was, like, coming of age in the 60s and there was lots of experimentation with. With all of those drugs. And, you know, I mean, obviously some people go on to have problems with drugs, but a Lot of those things, people experimented a little, went on, lived their lives. They're not still doing. I don't think grandma's doing LSD at this point. But then, you know, I mean, I really grew up with the kind of war on drugs. And this is your brain. This is your brain on drugs, you know, all of that stuff. And so I just.

I think my point was more like. Yeah, I mean, obviously, like, just drugs in general are a complicated issue, but I think opening your mind up a little bit and just being like, okay, well, you know, we don't have anything to lose. Let's study this. Let's try it. Let's see.

Yeah. And, yeah, I mean, you don't need to invent new things if you already have things that exist.

Exactly.

That can work. But. Yeah, I mean, but that's what you need to know. You need to know, does it really work? And then who. If it does work, who does it work for? And how do you choose those exact patients that it's going to help? And, you know, I'm much more in favor of doing that in a scientific way rather than patients just doing that on their own.

Yeah, for sure.

Well, that's what. When you're first talking about, like, okay, people with PTSD and then trying psychedelics on them, I'm like, you would have to really do that in a very careful setting because you think about somebody who's already had triggers of lots of painful things. I mean, that, to me, seems like somebody who could really have a bad trip.

Yeah, I think it's like, not. Because, you know. You heard of microdosing.

Yeah, yeah, you said that.

Like, you're like. Oh, yeah, I know.

You're like, micro dosing. I've listened to podcasts about it. I've seen things on tv, but I. The.

You don't, like, trip on something like that? I think it's.

Oh, really?

It's something to do with serotonin. Female. I don't know.

I'd be afraid I'd be tripping.

Well, all right. No tripping. No tripping today, no tripping tomorrow. But we will be tripping. Tripping to Japan. Tripping to Japan and then to India. Tripping. We're gonna go on a little summer break. We're gonna take a couple weeks off, but when we come back, I will tell you guys all about my trip to India and.

And you know where to find us.

@Generations MD on TikTok and Instagram. And if you have any questions or interested in being a guest on the podcast, you can email us ataskgenerations MD gmail.com and we will talk to you next week. Bye, guys.

Bye.