SYPHILIS TSUNAMI

Chlamydia, Gonorrhea.

Hiv. Syphilis. Syphilis.

Hi, everybody, and welcome to Generations MD Podcast. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis, who is also my mother. Welcome back, everybody. We are happy that you guys are listening. Happy you're here. What are we doing today?

You know, we're just kind of. We've got some stuff to just go over from previous episodes and just, you know, just some things on my mind. I'm not sure what's on your mind.

Try not to move. So, like, every time you move and this stuff clicks, and that's gonna cause an issue.

I am using my core to say, stay stable.

Maybe you need to do some Pilates. Get that core going.

Did Yuba three times. This way. Okay.

Flex. Goodness gracious.

Yes. Well, so how are you? What's new with you?

Just got back from a trip.

Yeah.

Got to visit my friend. I'm really doing my swan song here. I'm going around visiting all my friends in various places before I start medical.

School, before she goes to prison.

Yeah. I'm just like, I just want to get it all in right now, and thus far, it's been great. I have no regrets, and I'm just trying to take advantage of all the time that I have.

Yeah, living your life, man. That's what you should be doing.

Yeah, it's good.

Yeah.

I realized I really like visiting my friends because in college, I was the person that planned all the trips and did everything. And now when I visit my friend, I'm just like, oh, I can just show up and not plan anything, and.

They just take you around and show you the spots.

Exactly.

It's a nice way to travel.

No, it's great. Yeah.

Yeah. So, you know, some of the things on my mind, I was just thinking about our four previous guests. Just some of the patterns that I've seen. Now I realize this is just an and of four, so it's hard to draw tons of conclusions. But, you know, we interviewed two doctors that are more my age, a little later career, and then two doctors that are younger, more early career. And I thought there were some distinct differences between those two groups. And I don't know if those things are explained by somebody just doing something for a long time, or if there truly is a generational difference. Difference.

Ah, generational.

Yeah. You know, we have the. We had Dr. Flag and Dr. Geyser, who I would call, like, Gen X my generation. I don't know, maybe even bordering on boomer generation. And then we had Dr. McPherson and Dr. Donnelly, who I would call millennials. And I felt like the, you know, my generation, people were a little bit more of that, like, not totally getting the whole work life balance thing or really having to learn that a little bit later in their careers, and that they were really more like, okay, just power through all in, do it all. And that even though, I mean, Dr. McPherson and Dr. Donnelly are very, very successful, but, I don't know, they just seem to be a little bit more in, you know, a little bit more in balance with, like, being home for dinner with their families and that being a real priority. I don't know. What did you relate to any of that?

Yeah, and I think that. That I was actually just listening to something about millennials. And, you know, every generation says that the younger generation is more lazy and, like, all this stuff. But, like, it is just. It is a generational thing that millennials have been able to prioritize, like, work, life balance more than generations before. But, I mean, at the same time, they grew up in the Internet age. So you're working, you know, 24 7. You can always be doing something. A vacation isn't, like, truly a vacation and all of those sort of things. But at the same time, just like that kind of discussion with work, life balance. And I feel like your generation was more like, oh, when I get a job, you know, I'm gonna stick with it. I'm gonna stick with my company. I'm gonna work so hard for them. And then in 2008, when a bunch of people got laid off to. Then I feel like the rhetoric kind of switched to be like, well, why would I work so hard for this company when they're not doing anything for me? And I think that's like kind of the period where millennials were growing up and getting jobs and finding careers and really emphasize that work life balance more. And I think that kind of transitioned into kind of conversations around medicine more.

And, you know, my generation and the previous generation had a lot of criticisms for millennials with that, you know, that, you know, that they weren't lazy and that they didn't want to work hard and that they weren't willing to give everything to their job or their, you know, for their career or that type of thing. And then the millennials are just exactly what you're saying. They're like, well, wait, my career or my company isn't doing everything for me, so why am I supposed to do that? And I think that is that with the Internet and because you can work 24, 7. You have to have some of these boundaries, otherwise, you know, you can just get eaten alive by. By any job.

I guess your generation feels like they are more, okay, hustle, hustle, hustle. But then we've seen the effects of that. When we talk to the people who were totally burnt out in medicine and burnt out and all these things and not even to blame them, but if that was the culture that was surrounding them at the time, then obviously they fell into that.

Yeah, yeah. Well, just. I think people didn't really realize that there was a choice that they didn't have to. You could still be very successful in any career without just doing it for 20 hours a day or whatever. But I just. I thought that was interesting, kind of, you know, seeing those differences and as we continue to talk to more people, we'll see. But I thought it was interesting, too, that both of those younger doctors that we talked to seemed very, very happy. Didn't you think? I thought they seemed very happy with their choices, their life choices, their choice of specialty, the way that it is in practice for them now. I just thought it was. It was. It was just very nice and refreshing, especially because so many other doctors to you, every time you say you're going to med school, they say, oh, don't do it. It's always like, I saw this thing.

I was, like, listening to this doctor rant about how he regrets going into medicine while I'm standing there for him to finish asking for my letter of rec for medical school. Like, it is just exhausting hearing about it, like, how terrible it is so many times over again.

Yeah. Yeah, it's. I don't know. And. But I'm just like, okay, show me some job where somebody's like, this is fantastic. I love it. I mean, everything has good days and bad days.

But, yeah, again, like, it could be. They just. They've been in practice for, like, three years. So, I mean, you got to factor that into it when the other people have been practicing for years and years.

Yeah. Yeah. So, right. It's. I think it's a little. Our sample size is a little low to draw too many big, big conclusions, but I do. One of the themes, though, I think that has. Has come out with all the people we've talked to so far have been in private practice. And I think even though there are some difficulties with private practice, especially starting your own practice and building it up, that. That's everybody. All of these people have been very happy about being in private practice. So I think that that's Interesting. At some point we will talk to some other people that are in academics or, you know, some, you know, something else and see what, what they have to say and how they kind of could compare that to other types of practices that they could be in. But I think that's. But again, that was part of why I wanted to do this as well, is to be able to talk about private practice, because that's not something you get a lot of exposure to when you're in med school or residency. I saw this thing posted in one of my. One of the Facebook groups that I'm in now. I don't know for sure that this is actual fact, but I can tell you for sure that the spirit of what is in this is most definitely true if you are an employee, especially in primary care of a large hospital system or a large corporation. So people don't normally put this in writing.

So this was a letter that was sent out to all the physicians in this large hospital system of a bunch of do's and don'ts.

Okay. So it starts off with, this is effective 12924. All providers are required to work 8 hours per day, 5 days per week. If you take a 1/2 hour lunch, you will need to work 8 1/2 hours. If you take an hour lunch, you will need to work nine hours. I mean, I understand that like when you are working at your very first job and you have to punch in, those things are true. But when you're a professional and you've gone to school, as long as we have to put something like that is just. It's just so important, so demeaning.

Yeah.

Especially because when you have a sick patient, you end up staying hours late to do this and that and transfer them to the hospital or all kinds of other things. And of course, we don't get paid overtime or anything like that. So to be like. If you take a half hour lunch, I mean, that's just super annoying. Okay. Please use your downtime during your daily schedule for paperwork notes. Yeah. Because we never would have thought of that.

Yeah.

Just telling you how to work right now. Primary care physicians. And this is what gets really dicey. And I'm curious if this really was put in writing or not. We would like you to refer your patients to this hospital's specialist whenever possible. That is true. If you are in a big hospital system, part of the reason that they hire primary care physicians is to feed business to that hospital system and to the specialists there. That's okay. I mean, that's. I worked for a hospital system here in Dallas. And I mean, we were told right off the bat that's part of, part of the reason we're here. They put satellite clinics all around Dallas to try to feed business to that hospital system. There's nothing wrong with that. And they did it by taking us around and meeting all of the specialists within the hospital system. So that's who we knew, so that's who we would refer to. But they can't tell you. You have to send your patients to one of the specialists in that hospital system if there's somebody else in your same town that is a fantastic doctor in whatever specialty to tell you that you are, you know, basically going to get in trouble if you send it to somebody within your hospital system, even if you feel like those people are not as well qualified as this other person. That's just terrible. I mean, if I were a patient, I would just be like, wait a second, you know, I didn't, I came to see you. I didn't realize I was committing to only see the people in your little circle. Next one, we would like you to see 32 patients score scheduled per day. What? Let's just break this down. 32 patients per day in your eight hour shift. Okay, so that's four patients per hour. That's 15 minutes per patient. The doctor needs to spend almost twice as much time with the chart as they do with the patient. By the time they have to click through and do all these different stuff that they have to do in order to do their notes and they're billing properly and all that kind of stuff. Okay, so now you're down to free. Five minutes with the patient, ten minutes with the chart. And that's just, I mean, imagine being told you've got five minutes to see a patient. I mean, a lot of my patients have diabetes, hypertension, heart disease. Like, how in the world can I look at all of those things as well as whatever problem that they're having that day in five minutes and realize that you still have all that other stuff that you have to do to, that you're supposed to be doing during your downtime. I'm not sure how you have any downtime because there's other things. Like I ordered blood tests on somebody today, they come back tomorrow. Well, now I've gotta review those tomorrow, but I've still gotta see those 32 patients tomorrow and review the blood tests from today and review the X rays that I ordered today and everything else that's coming in, as well as questions from patients that are Coming in through the portal. Somebody else is calling in that they're sick. What should they do? I mean, it's just.

Yeah, no, that's ridiculous. Preposterous. Yeah. I remember when a doctor saw me for five minutes one time, and it was at a dermatologist clinic. And they came in. They're like, acne. Okay, great. You're gonna be on Accutane. All right, bye. And then they hand me the paperwork for Accutane, and it's like this long thing. Like, suicidal thoughts, like, you might get depressed. Like, this. Do not take this. This is the last resort. And I'm looking at all this paperwork, and I'm like, wait, what? And then I just. And then I'm like, wait, do I have an option? Like, whatever. And. But the doctor was gone. That.

And once they're gone, they're gone.

Yeah, yeah. And I was just like. I was so.

Like, well, because some other patient took your extra time, and so he was like, okay, now I gotta make up time on some of these other people. Right. She's young and healthy. It's gonna be fast. Okay, now just need to, like, blow through this.

I understand. Like, there's only so much that the medical education can do. And, like, this is really, like insurance companies and large companies, like, putting this pressure on. But, like, I don't know, they just emphasize this communication and taking time with your patients and how important it is to listen to your patients. But then, like, you can't even do that when you have these rules.

Well, right.

They.

I remember learning that, you know, a doctor interrupts a patient, like, seven times or something. Or on average, every X number of seconds, whatever it is. I'm like, of course. Because you're like, you got to get to the point. I've got to get through this. We got to, you know, figure out what your problem is. I gotta get on to the next thing. You can't sit there and have time for the patient to say, well, let's see. So it started after dinner. Was it after lunch? I think I had a bologna sandwich. And you're like, listen, don't care what you had for lunch. Not important. We need to move on.

Which is sad because, I mean, like.

It could, like, it could be important.

Like, I don't. Like, you know, or whatever it is. And it's just. I don't know. And then that patient feels terrible and.

Yeah, like, they weren't listened to. And then that. Then they don't want to comply with the plan because they don't feel like they were listened to in order to do that. And yeah, and the other thing is that what you learn after you've seen lots and lots of patients and patients kind of rehearse what they're going to say to their doctor. And so when they, when they get there, they have this story that they want to tell. And if you have the time, it's much better if you can just let them tell their story and then you can ask the questions. Because if you interrupt them, then they just kind of start their story back again from the beginning.

I mean, I even do that. It's scary going to the doctor. I'm not criticizing. Yeah, you're just like, okay, this is what I want to talk about. I'm like, okay, this is what I'm gonna say. And yeah, you definitely rehearse it. That makes sense.

Yeah, yeah. No, people do. And so if you have to interrupt them because you only have five minutes to get through this thing, I just don't see how you're ever going to buy in with compliance and form any kind of relationship with that patient. But then, so this is interesting too. Then they say, and this, I mean, I'm sure this is again, this is definitely in the spirit of what you're told at these things. Please try to schedule follow up visits as frequently as possible. If the patient needs to come back, they need to come back. And of course they're going to need to come back because you only had five minutes to spend with them. But I feel like this is, this is something that patients feel all the time. They're like, well, I was there and I was trying to tell the doctor A, B and C, but they weren't listening to me and now they want me to come back to talk about those things. And I was just right there. Why couldn't I just told them then? Well, because these things are done. You get paid per visit. You can, if it's, if it's a really complex visit, you can maybe get paid a little bit higher rate, but for the most part it pays better for the patient to come back to do the rest of that stuff at a later visit. Well, that's real nice for the health system, but for the, you know, for the patient. I mean, a lot of patients don't have reliable transportation. They have to take time off work. I mean, it's a big deal to get all the way down there to the doctor's office for this very short period of time. And then to be told you have to come back again is just, again, you're not really. You're not forming great relationships with those patients with all that.

Yeah, that's frustrating. I mean, like, okay, so what are the solutions to that don't work in like a big system. Well, people need to go to these big systems because they can't afford going to somewhere like a private practice.

Yep. I don't know the answers. I'm typical doctor. I just point out the problems. No solutions.

I thought doctors are supposed to be.

Problem solvers, you know, for the most part. No, not with big problems. With smaller problems. Yeah, but bigger system wide problems. No. Walk into any doctor's lounge and you'll hear the same conversation over and over. Been happening since I was in training. Oh, man. Medicine's going down the tubes. Blah, blah. There's nothing we can do. The insurance company's got us over a barrel.

But you guys are problem solvers in, like your career.

Are we? Yeah. The patient comes in and they're sick.

And you figure out what's wrong and then you provide a solution. Is that the whole thing?

Yeah, right to that person's. Just micro problem. I mean, just this health problem, but not like a macro problem, system wide problem. Anyway, sorry, we were getting. We were all being all positive earlier in the pod. Now I've kind of brought us down with this.

You have brought us down.

Anyway, I don't know the answers.

Well, you know the problem, but I know the problem.

That's step one. That's right. That's right. That is step one. Okay, well, onto other things that. We'll circle back to this and come up with some solutions.

Do you like that term, circle back?

Isn't that what they say, like in corporations, corporate meetings? Circle back, we'll work on solutions. We welcome any solutions from our listeners as well. If you have solved the problem, if.

You'Ve solved the insurance doctor problem, then let us know in the comments.

Let us know. We'll take your solutions and take it to the highest level. Okay, shifting gears. I've got a question for you. Do you know what sexually transmitted disease has increased by 80% since 2018?

Chlamydia, gonorrhea.

HIV. Syphilis. Syphilis.

You know, I know that because on the highway at one point there was a big billboard that said syphilis Tsunami.

Okay.

They were trying to, you know, say it's back.

Yeah, I was gonna give you the hint that it is. It's. The cases are as high now as they were in 1950. So that was gonna be a hint that it wasn't HIV because we didn't know about HIV in 1950.

Ah, that's good trivia.

I don't think I would have put that all together. That's true. You were born after. I mean, I was alive when we found out about hiv, so anyway. But syphilis, it's back and it's worse than ever. Oh, well, okay, I'm trying to use some scare tactics. It's the same as ever, which is actually really, really bad, you know, because syphilis is treatable.

Oh, really?

Yeah, it's treatable with.

I thought it was, like, really bad.

It is really bad. If it's not treated, you just give shots of penicillin. Boom. Cheap. Done.

Wait, they don't normally just test for that in your standard STD test, do they? Wait, is it a blood test or a.

Yes, there's. There's blood tests you can do. Here's the thing about syphilis is that the symptoms start with, like, okay, this big sore that you get on your penis or vagina.

My foot.

I know. I don't think you have syphilis on your foot, but it's good to always be in the differential diagnosis.

Wait, so it's always symptomatic? All the other ones are like, it's asymptomatic?

Yes, it is symptomatic, but it has these three distinct phases. And so the very first phase is just. Is getting this sore, and it's. It's apparently a painless sore. I mean, I'm telling all this because I've read about it and stuff. I've actually never seen a case of syphilis as far as I know.

My foot.

So you get. Now this is gonna be a little awkward, but you get syphilis in the place where you've had sexual activity. So I don't really want to go into detail if there's something I need to know about your feet. Oh, no, no. Oh, my God. Okay.

There's not sympholism on my foot.

Let's move on. You're the one who was bringing it up. Okay, so. But. So here's the thing. A person has sexual encounter, and it can. It's several weeks later when the symptoms develop. So that's kind of tricky for the person to know, too, because this is, you know, enough time has elapsed, and then they get this sore. And the thing is that sore goes away whether or not the syphilis is treated. So it's a painless sore. It's painful. It's a pretty. You know, usually it's a Fairly distinct looking thing. But a lot of times people just ignore stuff. Right. On lots of things. And especially if they're like, oh, gosh, you know, I don't, I don't know what this is. If they don't have access to health care, you can see how, like the.

Sore on my foot.

Yes. No access to health care for you, you know, so they don't do anything about it and the thing goes away and they're like, sweet, gone. I'm not going to worry about it. Well, then that sore doesn't come back. But then they can get the second phase of syphilis. And that can be some things like, you know, fever, malaise, that stuff, and rashes. And the rashes can look kind of similar to other types of rashes. There's also. You can get. The classic thing is to get this rash on your palms and on the side soles of your feet. But the same thing, that stuff goes away as well, even if you don't treat it. So the person's just like, meh, you know, I'm fine. And then there's this latent phase that can last for years and years where the syphilis is there in your body, but you don't really know about it. It's not really causing symptoms. But then if you get to tertiary syphilis, that's the badness. That's where it can cause all kinds of neurologic symptoms. You know, dementia, I mean, problems with your eyes, like, I mean, all kinds of problems with your nerves. I mean, it's like super, super bad. You can still treat it at that point. You can treat it anywhere along this whole thing. And the treatment, it's always penicillin. The dose of the penicillin goes up depending on what phase it is. But you get to. Now, if you've already have really bad dementia from the syphilis, you can treat the dementia. You can treat the syphilis and then it should prevent it from getting worse, but it doesn't mean you can improve the symptoms where the damage is already done to your neurologic system. So I just say that all to say, I mean, the treatment is so simple and cheap, but if you don't know that you have it, then you don't care to treat it. So syphilis, it's back and you gotta know about it and treat it back.

And better than ever.

Mm, worse than ever.

But when you get, when you go to the doctor and get your STD screening, they don't typically screen for syphilis.

I Mean, if they're drawing blood and checking hiv? Well, I guess it depends if they're. Yeah. If you're going somewhere that's, like, doing full STD screening, they should be checking you for that as well. But if you're just doing, like, regular annual blood tests, they might not be. You're right.

Yeah.

They may not be checking for that. I don't routinely check. Yeah, exactly. So, okay, all my patients gonna start getting syphilis tests.

I am stressed. So my Texas matches are due tomorrow. So essentially, what you do is you rank all the schools that you interviewed at, and then in two weeks, I figure out if I matched one of those schools, kind of like Sorority Rush. I am just really nervous that I'm doing something wrong. I'm scared. Like, I press submit, and, like, it's like. I think it's good, but, like.

Yeah, that causes some, I don't know, anxiety.

Yeah. I'm like, I really haven't. I mean, I feel it. I. No one's telling me that I'm doing that I'm doing anything wrong, but no one's telling me I'm doing it right.

There must be, like, every other person in your same situation, like, having those same feelings, you know?

Yeah, I guess I kind of looked at Reddit. There wasn't really anything about it.

I was like, what about Student Doctor Network? Want me to get on there? I've got some friends on there.

No, please don't get back on Student Doctor Network. I caught her on Student Doctor Network. I walk in and I see it on her laptop, and it was so cringey. I was like, mom, what are you doing? She's literally that mom. I'm not.

I just was trying to get a little bit of information and not. I didn't. I didn't want to pester you about it. I was being nice. Really? Oh, my God.

Are you gaslighting me?

Okay, well, drop us a note in the comments.

Drop us a note.

Drop us a comment.

Drop us a note in the comments. What do you want to hear about?

And I want to know if people are enjoying the series, talking to these other doctors, or if there's something else that they would like to hear about. I don't know. What do you think?

Yeah, drop us a note.

Is that not a phrase now? It is. Drop us a no. Generations md.

All right, well, yeah, drop us a. No. You know where to find us. GenerationsMD on TikTok, follow parkcities personalphysicians on Instagram, and we will see you next week.

Bye.