Hello and welcome back everyone to the vocal pelvic floor. I have a unique guest with me today and I am super excited to welcome Dr. Efrat LaMandre Did I mess up your name? To the vocal pelvic floor, welcome Dr. E.

Dr. E, The NP With A PhD (00:12)

Almost perfect.

Hey,

I’m so excited to be here. Thank you.

Dr. Ginger Garner PT, DPT (00:19)

I’m stoked that you’re here. So y’all, she has a unique background and I just want to like celebrate that for a second because in our healthcare world where it’s hard to get an appointment, it’s hard to find a PCP that listens, it’s hard to find someone that you can even get in with in a timely manner, ⁓ she brings that background of being a nurse practitioner. And I think that I just love nurse practitioners. You guys listen.

so well, you’re looking at the kind of the 40,000 foot view big picture, you’re thinking about the whole person, you’re more inclined to take that holistic approach and less likely to fall in the trap of, well, there’s drugs and surgery, drugs and surgery, you know, there are so many different ways to handle people’s issues. so, yeah, let me read a little bit. Let me brag on you just a little bit before we jump.

Dr. E, The NP With A PhD (01:06)

Thank you for that.

But like the short

version like no like no one cares

Dr. Ginger Garner PT, DPT (01:15)

All right. All right. Dr. is a nationally recognized nurse practitioner, educator, and I love this, healthcare disruptor. She founded one of the largest NP-led practices in the US and leads EG Prep, a nonprofit education company that trains nurse practitioners nationwide. Through her podcast, The Medical Disruptor, and frequent national media appearances, Dr. E challenges medical assumptions and equips

patients to think more critically about their care without abandoning science or going to war with their doctors. It is.

Dr. E, The NP With A PhD (01:51)

important.

We don’t need another battle in life. There’s plenty already.

Dr. Ginger Garner PT, DPT (01:55)

No, there’s

enough of that. There’s enough stress already. I like that because as healthcare providers that think from more of a functional medicine background, ⁓ it can often be pitted like that, right? That one is against the other and that is not the case. We’re all here to work together for ⁓ the listener’s benefit. So let’s get a clear definition because you, I told you before we hit record, I mentioned to you that one of my favorite things to talk about like,

Dr. E, The NP With A PhD (02:05)

Mm-hmm.

Absolutely.

Dr. Ginger Garner PT, DPT (02:23)

really is medical gaslighting because I feel like our role in healthcare is to empower the patient, like send them away with hope, send them away with options, send them away with power ⁓ back in their side, their court, so to speak. But a lot of you may have not really dwelled much on the topic of medical gaslighting, but you might’ve felt this, you go into your practitioner and you didn’t feel quite heard.

And if you felt like you weren’t heard, then you probably are right. So let’s just define medical gaslighting. Just tell us what that’s about and how you kind of landed on focusing on that, because it’s a brilliant thing to be focusing on in today’s healthcare system.

Dr. E, The NP With A PhD (03:04)

⁓ I think you’re right. It’s really important to start with a definition because I think people, even if you’ve heard of medical gaslighting or you haven’t, there’s a vague sense of what it is. And so I think let’s get down to it. For gaslighting, the term itself is very particular about a malicious intent to completely ⁓ change someone’s perception of reality, like purposely rearranging the furniture and then telling them, I didn’t rearrange anything where you’re talking about. Right. So there’s malice.

behind gaslighting. Medical gaslighting, as my contention, is not done with malice. ⁓ There is, let’s just say, 5 % of providers who are just not nice humans. Let’s remove them from the equations, because they’re just gaslighting everyone in their lives. So let’s just remove them, right? Generally speaking, people do not go to med school, MP school, PA school, dedicate at least a decade of their lives just to come out to maliciously gaslight someone. That’s really important.

Dr. Ginger Garner PT, DPT (03:50)

Mm-hmm.

Dr. E, The NP With A PhD (04:04)

So medical gaslighting is more about a feeling of being dismissed and being not heard, but it does not have malice. It still happens, and we can talk about why it happens in a moment. has to do with indoctrination of the medical world, but it’s not malicious. And that’s important because that feeling that we get as patients is compounded if we think someone’s doing it purposefully or maliciously. So that’s the definition.

I can go on to explain a little bit about why it happens, if that’s all right with you. So why it happens, though, so you’re like, I don’t care, malice, not malice, still ⁓ not nice feeling in the exam room, like, I don’t care if they meant to do it or not, right? That’s not my problem. And you’re right, it’s not your problem. But an understanding of why it happens will empower the patient to not. ⁓

Dr. Ginger Garner PT, DPT (04:36)

Yeah, definitely.

Dr. E, The NP With A PhD (04:55)

to not take it as personally and to know what to do about it. So the reason this happens is because when you go to med school, PA school, MP school, DO school, you are taught to listen a certain way. You are taught to look for a diagnosis. I’m a recovering medical gas lighter. I was just like this. When someone tells you the story, we don’t care.

about what that happened on Tuesday and that you can go to your daughter’s recital or to your dad. We don’t care. We just need to know the things that we need to know to get to a diagnosis. So part one is that we listen a certain way. Part two is that the providers then only are looking for a diagnosis to find an answer because that is how we are taught to listen. It’s a very different listening, right? Like it’s just a very different listening. And then we are taught to, once we have a theory,

of what could be going on to then prove it with labs or imaging or another diagnostic. If the story doesn’t add up, add up meaning it doesn’t lead us to a diagnosis or the labs and the images don’t lead us to a diagnosis, then your lived experience does not matter by default of the curriculum. I get it, you’re tired, but there’s nothing wrong with you, right? If I can rule out anemia and thyroid,

And anything else like mono and anything else that could be with fatigue, you’re tired, but it’s no longer something that I can control medically by curriculum, by design. And so therefore, by definition, the provider has to say, you’re fine. There’s nothing wrong with you because it cannot be found. That’s very different than, I don’t believe you. I purposely don’t want to listen to you. Right. And so.

So there’s a we have it allows us to remove a little bit of the emotion like, my God, this guy just doesn’t care. No, this guy is indoctrinated girl. The guy is indoctrinated into thinking a certain way. And the other piece of the indoctrination and I know because it took me a really, really long time to undo it and to be a guest on my show, you have to be a clinician first and all clinicians will tell you the same thing. We are also taught in school.

that anything outside of the curriculum is dangerous. So when you come in and say, took ashwagandha for X, Y, or Z, that’s dangerous. We don’t want to talk about it. Well, not only are we taught that like everything we learn is the gold standard, we’re taught that everything else is dangerous. And so when you come in with your list of supplements and your list of like research that is not medical curriculum, not double blind study by design,

Dr. Ginger Garner PT, DPT (07:26)

Mm-hmm. Mm-hmm.

Dr. E, The NP With A PhD (07:37)

The provider has to not listen to you. And so you, you start looking at the provider and saying, okay, if I go to my plumber and I say, I really want to talk to you about electricity, the plumbers and be like, I can’t help you, but you won’t be mad. You won’t get personally insulted. You’re to say, ⁓ my bad. You’re the plumber. I need to talk to you about plumbing stuff. And that is how you should go to your primary care or conventional. I can only talk to you.

about the things that are in your world. As soon as I’m asking you to talk outside of that, I actually can’t get mad at you for not listening because you never learned it. And that’s when you turn and you go somewhere else without the emotion, without the hurt. So hopefully that already begins kind of like the understanding of where it all comes from.

Dr. Ginger Garner PT, DPT (08:23)

Yeah, yeah. And then I think there’s another layer, you know, that as we dig in, and I focus a lot ⁓ on this in the podcast, because we know that there is, you know, women’s health, ⁓ minority health, et cetera, is underfunded, under attended, under researched, et cetera. So the next question, you probably know where I’m going with this is why then, you know, women and minorities feel dismissed more often when they go to their

Dr. E, The NP With A PhD (08:54)

Yeah, so that’s layered. That’s layered. First of all, women and minorities are just dismissed more often everywhere, right? Not just in medical communities. So what we’re seeing in the exam room is definitely a reflection of what’s happening in society. I mean, I’m in business all the time. Women’s expressions of emotions is very like a man can completely fly off the handle and that’s fine. But if a woman, God forbid, sheds a tear, she’s emotional, right? So like in general society, and we all know that minorities have to work twice as hard to be considered half as good. like

Dr. Ginger Garner PT, DPT (08:54)

provider.

Period. Yeah.

Dr. E, The NP With A PhD (09:24)

the listening embedded in for all of us, which is by the way, why we need providers who look and sound like us. So we need providers in the LGBT community. We need providers from the black and brown community. need that. That is the only way to really make that change. So there’s that part. The other part of that is since we just said that the indoctrination

Dr. Ginger Garner PT, DPT (09:32)

Yes.

Dr. E, The NP With A PhD (09:48)

comes from the medical curriculum and the medical curriculum, and this is not a conspiracy theory. I still practice medicine. I have a primary care practice. I deliver evidence-based medicine all the time. So I’m not a conspiracy theorist in any way, but this is the reality of the curriculum. The curriculum is based on amazing grounded research, double blind studies, all the things that you need in order to get this population level decision-making. It’s good stuff to a certain degree, but it is primarily based on white men.

Dr. Ginger Garner PT, DPT (10:18)

Mm-hmm.

Dr. E, The NP With A PhD (10:18)

So let’s just talk about the classic example of chest pain, of heart attack. We all know we’ve seen enough movies that a heart attack means left-sided chest pain, clutch the heart, maybe down the arm. And that is a heart attack. That’s what a heart attack looks like. That’s how it’s described everywhere. There’s not like that for women and they are 50 % of the population. So 50 % of population can have neck pain. They can have fatigue. They can have right-sided pain. They can have.

Dr. Ginger Garner PT, DPT (10:38)

Mm-hmm.

Dr. E, The NP With A PhD (10:48)

like back of the head, they could have a completely different constellation of symptoms and it is called atypical. So 50 % of the population presents a certain way and the medical curriculum will call that atypical. So now when you go to school, you’re studying only the typical, typical, typical, typical, anything that comes out, like even in the language is dismissible, it’s atypical. So like, if you miss it, what are you going to do? It’s like an atypical presentation.

Dr. Ginger Garner PT, DPT (11:05)

Mm.

Dr. E, The NP With A PhD (11:16)

So the dismissal is embedded in the learning. And one of the things I’m sure you know is that every single human body is different. I I’ll have people who have reactions to medications that no one else have. They’ll tell me I took a Tylenol and it put me to sleep. I’m like, I’ve never heard that as a side effect, but I believe you that’s what happened, right? so.

Dr. Ginger Garner PT, DPT (11:27)

Mm-hmm.

Yeah.

Dr. E, The NP With A PhD (11:40)

So to answer your question, women and minorities are dismissed more, one, because it’s a reflection of the problem of society, and two, because they were never considered in any of the studies.

Dr. Ginger Garner PT, DPT (11:51)

Yeah, yes, exactly. So when we talk about this from a sexual health perspective, it is very easy to see then if we know our research was basically done based on a typical whatever that means, white ⁓ male, then.

when we talk about sexual health, my goodness, know, like the, all right, the gloves are off now. Now we’re really in uncharted territory where not only is that not studied ⁓ for this population, but they also feel like they can’t talk about it to anyone. And that, and I was telling you this before we hit record two that as a pelvic floor PT, even people know I, that’s what I do, orthopedics and pelvic floor.

and they still think talking about sexual health is maybe unrelated to pelvic health. So there’s this, this is embedded into patients, you know, cultural experience too, where they’re not able to talk about these things. So it’s not just, you know, us as providers in the education, medical education system, that it’s also patients internalizing this medical gaslighting and gaslighting themselves.

Dr. E, The NP With A PhD (13:11)

⁓ Well, I think you said a few things in there.

Dr. Ginger Garner PT, DPT (13:14)

Yeah,

yeah. One is they end up gaslighting themselves because of the cultural experience they’ve had and what they’ve come to anticipate, like a typical, like just a female going in with an issue, for example, is already thinking about how they’re going to be dismissed. So they bring in more information, right? ⁓ So if they are feeling like they’re going to be dismissed, how do they end up?

internalizing that and gaslighting themselves. Well, maybe it’s not that bad. Maybe I don’t need to, maybe I’m not that tired, right? And then that extends into the whole sexual health realm too.

Dr. E, The NP With A PhD (13:43)

Hmm.

Well sure.

Well, let’s let me back into the gaslighting question and just touch on the sexual. I’m not a sexual health expert as you know, however, sexual health is no different than any other body part. Let me, I know what you’re about to say, but in the sense that everything is separated in conventional medicine, right? So like you have ENT health, your nose, throat, and then you have your neurological, then you have your GI, then you have sexual health, which of course is even more closeted, but

Dr. Ginger Garner PT, DPT (14:13)

Yeah. Yeah.

Dr. E, The NP With A PhD (14:22)

this idea of sectioning off body parts is already problematic. Then in your particular world, we’ve sectioned off body part that in general society doesn’t want to talk about. it’s just sex, it’s just taboo and vaginas. Oh my God, like how do you even say that at the dinner table? it’s like, it’s like layers of difficulty in that. And then I want to say that

Dr. Ginger Garner PT, DPT (14:27)

Mm-hmm.

Dr. E, The NP With A PhD (14:50)

I’ve had many OB-GYNs on my podcast who have gone to school for years and years and years and are double, triple board certified. Women’s health is about fertility, babies, and postmenopause. Women’s health is not to discuss sex. It’s not to discuss pleasure. It’s not to discuss until very recently even perimenopause and menopause. Women’s health is really around bringing babies into the world. God bless. I have three kids. It’s very important time.

Dr. Ginger Garner PT, DPT (15:06)

Mm-hmm.

Dr. E, The NP With A PhD (15:20)

OB-GYN, unless the OB-GYN went back for additional certification, their knowledge base ends after the baby’s born. ⁓ not only the section, not only the taboo conversation, but then even to the specialist that you’re finally going to go to, they are not taught at all about anything that has to do with that. Very different than for men who have urologists talk about erectile dysfunction.

Do you have an erection in the morning? Is it better at night? Like there’s a whole conversation about erections that are very much normalized in urology. But who talks about orgasms at the gynecologist? Not at all. Not at all. And if you talk about sexual desire, it’s like, maybe you’re busy or stressed. Right? so there’s definitely, there’s definitely layers to that. But you asked me about gaslighting and this is true, the internal gaslighting. So a few things happen. We are as patients, as a society,

Dr. Ginger Garner PT, DPT (15:59)

Right. None.

Dr. E, The NP With A PhD (16:18)

have come to worship data. And don’t get me wrong, I love data. ⁓ But we’ve come to worship it so much that the data is more important than our lived experience. So I’ll feel unwell, I’ll write it down, I’ll put it on my iPhone, I’ll come on my list, I’ll go to the medical exam room, I say all the things I’m listened to, I’m heard. My doctor’s amazing, I love my doctor, he’s great, she’s great. And…

Dr. Ginger Garner PT, DPT (16:31)

True.

Dr. E, The NP With A PhD (16:45)

You’re ready for the lab results and the images and they do everything you ask them to do. And then it comes back and it says, all your labs are normal. And in that moment, because we have all, are all, know, the women that we’re speaking to are like science-based science is important to them. They want to research. when the science that they’ve learned to trust says you’re normal, well, then who are you to like go against that? Like, so then you’re going like, ⁓

Dr. Ginger Garner PT, DPT (17:11)

Right.

Dr. E, The NP With A PhD (17:14)

Well, maybe I’m just being dramatic. Maybe I just need to push through it. And so that’s the internalization is because we handed over the power to the data. Um, and God forbid you go home and somebody’s questioning you at home already. Like, why are tired all the time? Like, why don’t you want to have sex all the time? So now they go to the doctor, let them figure. And now the doctor says nothing wrong. How do you even go back home and advocate for yourself? You got nothing because lived experience is meaningless.

Dr. Ginger Garner PT, DPT (17:18)

There it comes.

Mm-hmm.

Yeah.

Dr. E, The NP With A PhD (17:44)

in the world of medicine. It means nothing. So that is how it happens.

Dr. Ginger Garner PT, DPT (17:50)

that’s so powerful. It’s like take a moment to ⁓ deep breathe everybody because you’re listening to this, you have felt this on some level or you felt this on all the levels ⁓ of going back and then, and that happens so often in your experience as a patient. And you know, and we, we, you and I are also patients, you know. no, that’s good.

Dr. E, The NP With A PhD (18:02)

all the levels.

Yeah, I just want to say, I’m so sorry to cut you off. I just want to say that to your audience

is like, if you’re feeling this, I need you to know that some of my case studies in my book that I’m writing are powerhouse women. mean, one of my case studies is about a woman lawyer who’s presented to the Supreme court. I mean, this is a woman who knows how to present a case and still was completely gaslit when something happens in the exam room, you lose your voice.

So if any woman out there is listening, it happens to me, I should get it. Like it’s happening. It doesn’t matter your education level. It doesn’t matter what you do for a living. It just, doesn’t matter. Something just happens and you become a patient where you just strip yourself away of all your skillsets.

Dr. Ginger Garner PT, DPT (18:50)

Yes.

That encapsulates so perfectly a shared experience. ⁓ So I almost feel like we need like a warning label, like, listen with care, because this is going to bring up some heavy stuff, right? And it’s okay to feel all the feelings that come up with that, ⁓ whatever that is. So if you need a box of tissues or you need to go step away and shout for a minute, ⁓ or whatever you need to do.

Please do that because this is, we’re talking about, this is not a small thing that we’re talking about. It is something that impacts everyone. ⁓ If you’re not a woman or minority and you’re not in that bigger category that gets dismissed, well then you probably love someone like that. So it’s going to impact you at some point in your life. And to be aware of that is incredibly important. So thank you for ⁓ putting that into such a…

Dr. E, The NP With A PhD (19:46)

Yes.

Dr. Ginger Garner PT, DPT (19:58)

an amazing container. That’s a lot. no, no, no, that’s exactly where we need to be. It’s exactly where need to be because, and I know that’s part of your mission too, is that every person that hears this goes out and then feels empowered. They’re not going to hand over that power. when they come back, and this is pretty much every patient that sits down in my practice too, because so much of it is about pelvic health, sexual health. They have been told,

Dr. E, The NP With A PhD (20:03)

Sorry.

Dr. Ginger Garner PT, DPT (20:27)

Your labs are normal. Now what? Now what do we do? Especially when we start talking about, you know, they’re told they’re fine, they don’t feel fine, they know they’re not fine. ⁓

Especially when we’re talking about women’s health, I think, in sexual health. So this could be any gender, hormones, thyroid issues. I see that largely just blown over. And to your point, yes, unless someone’s had advanced training in perimenopause, menopause, for example, just to talk about women’s health for a second, ⁓ they have no training in it unless they have gone and got additional education on that. So I think for the listener, it’s really important to realize that…

Just because you go to a specialist does not mean they actually are a specialist in the problem that you’re having when it comes to thyroid and hormones, that kind of thing, because it so can impact energy levels, fatigue, sexual health, et cetera. So what do they do when they come to you and they’ve been told their labs are normal? What do you look at in terms of thyroid and hormones, just for example?

Dr. E, The NP With A PhD (21:29)

Well, I don’t want to get into specifics of what to look at, but I think something in ⁓ the way you presented it was like, it’s blown off or it’s blown through. I don’t think that’s an accurate description of what’s happening, if I may. And I think this is important because that feeling of blown off or blown through, you told normal, it brings us back to this idea of malice. And I don’t think there’s malice. to this point, and then if…

You don’t agree, let’s talk about it. But to this point, I think what we need to understand is the concept of pre-disease. So labs in your conventional medicine ⁓ world are designed to find disease, right? Let’s just go with something that everyone’s familiar with, diabetes. We have a test that’s called the A1C. It tells us if someone has diabetes, it’s different than a blood sugar. It’s a three-month average of your sugar.

just to orient our listeners, 6.4 and over, more or less diabetic. 5.6 and under, more or less not diabetic. And then this world of 5.7 till 6.4 is this world of pre-diabetes. So we have this inherent understanding when it comes to diabetes that there is a stage of pre-disease. It is a stage where if I could tell you that your A1C is like 5.8, 5.9, I’d be like, hey, Susie, hey, Tommy.

Dr. Ginger Garner PT, DPT (22:40)

Mm-hmm.

Dr. E, The NP With A PhD (22:56)

Can you please watch your carbs so that we can avoid disease? And it’s like, we know it, like we get it, we all get it. We’ve heard this term pre-diabetes, we understand that you don’t get diabetic overnight. We know we have to eat sugar over years. And if we make the change in that space between, we could reverse things. And so this idea that disease lives on the spectrum from completely normal to not so normal to disease is something that exists, it’s something that we could see with diabetes.

But this idea is true for every single chronic illness. Every single chronic illness has a stage of pre. So like, let’s talk about our autoimmune patients. Let’s talk about our thyroid patients. Our thyroid patients will go in day after day after day after day, being told the thyroid is normal. And we can argue if it’s this range or that range, which I think where your question is going, like, is it between two and three? Is it between three and four? Doesn’t matter. Like that’s still a state of, this is where I think your disease is starting.

But you can go for years and have a normal TSH, whatever normal looks like for you, but still be in a state of pre-disease, pre-thyroid. In the state of pre-disease, your labs will look normal. But no one’s blowing it off. Your labs look normal. And this goes back to you’re going to the plumber and the plumber is there for so they are the ones who are like, can only, their tool sets.

like primary carrier, endocrinologist, their tool set, they can only open up their toolbox once that lab is abnormal. When the lab is abnormal and you’re in a state of pre-disease, there’s nothing in the toolbox in them. They can’t talk to you about pre-thyroid. They can’t talk to you about pre-dementia. They can’t talk to you about… There’s nothing in the toolbox. So if you are told your labs are normal, the first thing I want you to do is be so grateful.

Cause the last thing you want is an abnormal. Like abnormal means that now you need the toolboxes of conventional medicine. means medication, surgeries, protocols, hospitals, all the things that we don’t want. So you’re like, yes, I don’t have a pathology. Yes. I don’t have a sickness. This is such an important mindset shift to celebrate the normal lab and say, yes, I need nothing from you, sir, ma’am. Amazing. Now I still believe my lived experience.

I still know I feel horrible. And then I go and I find providers like you and providers are on functional medicine. And I go to it. I go to the electrician and I go to people who specialize in pre-disease. And once you create that shift, so you’re not being blown off, you’re just being told exactly what’s here. they’re like, amazing, great. Thank you so much. Awesome. And then you’re like, I still believe myself. I don’t need you to validate me. still believe myself, but now I need different team members to help me with the solution.

I think that’s a really different way of looking at labs. I don’t know how that lands for you.

Dr. Ginger Garner PT, DPT (25:56)

Yeah, I think that the categorization of, because categories aren’t always great and labels aren’t always great, right? So if we kind of do a little meta view of that and go, okay, without the categorization of ⁓ pre-disease versus disease states, because that’s also a layered topic as well. So when we get into the discussion of, why won’t they talk about it?

Well, then the answer is, because that’s not how our medical education system works. That’s not what we’re taught to do. We’re taught to only look at the disease states, only identify disease states, and out of that is one big shrug emoji. know, like, well, can’t do anything for you because it’s not a full-blown disease state. I think that one thing that we could, like, focus in on for the patient that you said that was very important is that, and you focused on A1C for that, know, hemoglobin A1C.

Dr. E, The NP With A PhD (26:41)

Correct.

Dr. Ginger Garner PT, DPT (26:57)

They get their A1C and it is not diabetes, which is wonderful, right? Nobody wants that diagnosis. But I know that you’ve seen this a lot too. And our healthcare system is not aligned with values of pre-disease identification or treatment. Meaning a healthcare provider in a big system is not going to get paid to do lifestyle medicine with you. They are only gonna get paid to treat you for diabetes, right?

Dr. E, The NP With A PhD (27:15)

Correct.

Dr. Ginger Garner PT, DPT (27:26)

if you’re pre-diabetic in that, you know, 5.7, you know, range, I know you’ve seen this a lot where a patient comes in, they bring their labs and you’re like, okay, wait a second, did no one tell you that you were pre-diabetic? Did no one discuss that with you? And they were actually told even in that range, it’s normal, right? Which then, you know, it’s a point of empowerment of a patient to look.

at a number like A1C and go, well, I’m actually pretty close to pre-diabetic or I am pre-diabetic, then it’s about finding that team member and building a team that can help you deal with that, because no one wants to wait until you hit that mark for diabetes. So I think that it’s helpful to think about it that way. I know that if patients could

And again, I say patients, but you and I, we’re patients in a system too. So all of us could do well by ourselves to remember that sometimes, yeah, something could be overlooked. Like I have seen patients overlooked for being pre-diabetic before and received no counseling and just said, things are fine, go home and eat what you want ⁓ versus when someone different needs to be pulled into the team.

Dr. E, The NP With A PhD (28:25)

Earth.

Dr. Ginger Garner PT, DPT (28:49)

It’s increasing that level of awareness and also ⁓ shifting that mindset away from, know, someone did something on purpose or by malice, or we’re also stuck in a healthcare system that does not value prevention, is not going to pay for prevention in an insurance-based system, especially in the United States. And that’s largely problematic because our values aren’t lining up with, ⁓ you know, with prevention and wellness overall.

Dr. E, The NP With A PhD (29:19)

That is true. I think the difference here and the ultimate mindset shift for me is like, I’m not going to change healthcare. No one’s going to change healthcare. This is the healthcare that we have. But it’s pretty good compared to some countries. It could be better compared to others, but there’s certainly countries that have none of this. And so if you learn to use it, there is a state of like, my God, it’s not good.

Dr. Ginger Garner PT, DPT (29:32)

That’s what we got.

Dr. E, The NP With A PhD (29:47)

It’s not aligned and they don’t do it for wellness. I’m like, oh, that is true. But like, what are we doing with that angst? Nothing. We are not changing anything. And in fact, we’re just depleting ourselves and reducing our HRV and like adding one more thing to ourselves. like I’m asking patients to flip the script, let go of the angst. is an understand that anything in medicine only gets activated when you’re sick sick.

Dr. Ginger Garner PT, DPT (30:14)

Yes.

Dr. E, The NP With A PhD (30:15)

So you are going there to rule out, not to get validated. You’re and, you’re not going to get wellness and you’re not going to get coaching and you’re not going to get nutrition. best you’ll get a handout or PDF, but don’t be angry about it in the same way that you will not be angry at your plumber. Let it go. They, they’re, they’re not there. Like you could, this is the other, the scripture I can give like, even if you’re happily married,

You still have a best friend that you talk shit to. Like you don’t tell your husband some of the weird stuff you would tell your best friend or maybe some of the stuff you bought that you didn’t want your husband to know or whatever. Like we all have three, four friends. You have your best friend, then you have your sister relationship or your brother’s relationship or your mom. And everyone gets a different part of you and everyone gets a different, not everyone. There’s no one person that is your everything. It’s the same thing here. We go into our PCP and we want our PCP to everything. Why didn’t you tell me about nutrition? Why aren’t you talking about antibodies for thyroid?

because that’s not my jam. And the minute we accept that, we sever that emotional pain that I’m coming in and constantly expecting them to do something that they were never designed to do. And I think it’s really, I think that’s so empowering once we like break that, break that expectation.

Dr. Ginger Garner PT, DPT (31:33)

Yeah. Well, because one thing to go back to what you said, one thing about not being able to change it is… ⁓

maybe in the future decades, things will change and things will improve. But for now, this is what we have. This is what we have. if you look at, so let’s look at medical education for just a second. The reason that it’s so hard to change, and this is really for, you know, ⁓ the listener’s understanding, if you’ve not been to any kind of school of education, whatever it may be,

Dr. E, The NP With A PhD (31:49)

No, they won’t. They won’t change. Yeah, they won’t change. No, they won’t change. They will only get worse.

Dr. Ginger Garner PT, DPT (32:14)

of medical education, you may not realize how full the curriculum is and how just wedging one more thing, you one more postcard size thing into an already packed curriculum, whether it’s nurse practitioner or PT or PA or whatever it is, feels nearly impossible. That, for example, my last book that I co-edited was on integrative and lifestyle medicine. Now, wouldn’t it be nice if everyone just included the

big evidence-based on integrative and lifestyle medicine in their practice. But the reality is you don’t always have time for that. And so that’s where then the team comes in, that no one can do absolutely everything. But the cool thing is, the great thing is, I’m dating myself, Gen X-ing myself, by saying cool. No, I’m not cool. Is that, I don’t think so. Yeah, my Gen Z.

Dr. E, The NP With A PhD (32:53)

Exactly right.

Are we not allowed to say cool anymore? I didn’t know that. Well, I say it all the time. Yeah,

Dr. Ginger Garner PT, DPT (33:10)

I got two Gen Zs and one alpha and I,

Dr. E, The NP With A PhD (33:12)

I’m going to ask my Gen Z kids also.

Dr. Ginger Garner PT, DPT (33:13)

yeah, I can’t, I can’t say that anymore. ⁓ They say that’s very mid. ⁓ Is that there is a huge evidence base to support looking at the pillars of lifestyle medicine, of nutrition and stress management and physical activity and addressing that HRV, the heart rate variability that, you know, building that team. I think the issue then becomes for people.

Dr. E, The NP With A PhD (33:19)

Hahaha

Dr. Ginger Garner PT, DPT (33:38)

Gosh, how do I access that? Now they know, right? You’re not gonna be able to get everything that you need from PCP. You’re gonna need to talk about ⁓ subclinical issues, pre-disease states with practitioners in functional medicine, which then brings us back around to like the thyroid and hormones, you know, type of issue, ⁓ is how they begin to access that. ⁓ But I’m gonna save that for just a second, is the access point. But.

Dr. E, The NP With A PhD (33:49)

Yes, yes.

Okay.

Dr. Ginger Garner PT, DPT (34:05)

Let’s go back to, because I know I’ve seen some of your fantastic Instagram posts on thyroid, for example, because I think that’s a really common one ⁓ where it’ll be kind of normal, normal, normal, less than looking ideal and normal, or they’re not getting maybe all the measures, all the labs done that need to be done.

Dr. E, The NP With A PhD (34:11)

Thank you.

Dr. Ginger Garner PT, DPT (34:28)

So, you know, as much as you want to, or as little as you want to, can you give the listener just a little bit of an in-depth perspective? Because I think a lot of people don’t realize ⁓ how important it is to monitor that and to track that and how that can relate to their overall, you know, health. And what that means particularly for women going into perimenopause, menopause, because you see that a lot as women start to enter that phase of their life, is that is the thing that starts to change for them.

before they may even notice any other symptoms like loss of libido or vaginal dryness or any of that other stuff.

Dr. E, The NP With A PhD (35:03)

So do you want me to like explain the labs a little bit or do you want me to?

Dr. Ginger Garner PT, DPT (35:06)

Yeah,

think for the listener, it’s really easy to get confused because they’ll go, well, know, TSH was normal. What else is there? Right?

Dr. E, The NP With A PhD (35:13)

Yeah,

there really is nothing else if you’re in conventional medicine. your thyroid, here’s like a quick, and usually I draw this and it’s like all over my papers and like my staff makes fun of me because I do this like 50 times a day. Your thyroid produces a hormone called T4. That’s its job. It has some other minor jobs, but nobody cares right now. So that’s his job. His job is to produce T4 and then it becomes T3 in your body. ⁓ So if your T4 is low,

Dr. Ginger Garner PT, DPT (35:18)

Right.

Dr. E, The NP With A PhD (35:43)

Your brain will freak out and will try to wake up the thyroid. And it does that with a hormone called thyroid stimulating hormone, TSH. So this is one of those labs that really confuse people because if your brain is really panicking and trying to wake up your thyroid, you will have a very high TSH. Your brain’s like, TSH wake up, stimulate, stimulate, stimulate. And so if you see a high TSH, that means that your thyroid is under active, does not.

functioning probably is not producing enough T4 and the brain’s trying to wake it up. So high TSH means hypothyroid. It’s confusing because it’s the opposite. If you have a very low TSH, that means the brain’s like, ooh, I don’t want to talk to you. You’re producing too much. That’s a hyperthyroid. But let’s just stay with hypo. So there’s kind of two pathways. You talked about the age-related one, which is a little bit different. But

So when you’re hypothyroid, when the thyroid is not producing, there’s not enough T4 on board, you could have, well, before I tell the reasons. So basically when you go for your annual, they check your TSH. If your TSH is normal, there’s an assumption that your thyroid is producing the right amount of T4 and all is good with the world and you can go on. Now there’s different variations of normal, know, ⁓ conventional medicine is kind of like up till four.

⁓ Functional medicine, like the little tighter window between two and three. There’s debates, there’s studies on both sides. Okay. So that’s your TSH. And then your T4 is a level that you can measure just to see like, how’s my T4 doing? Is my T4 trending down? Will I soon see that I’ll have a TSH problem? But that is the entire conversation of thyroid in ⁓ your conventional medicine. And that’s all you’re going to get. And there’s nothing wrong with it because they’re looking for disease.

Dr. Ginger Garner PT, DPT (37:27)

Mm-hmm.

Dr. E, The NP With A PhD (37:30)

If you want to know if a thyroid disease is cooking, specifically Hashimoto’s, kind of the only one that you can see, then you want to check for thyroid antibodies. Antibodies means your body is attacking the thyroid. We’re not supposed to be attacking the thyroid, supposed to be attacking measles, we’re supposed to be having antibodies for COVID. We’re not supposed to have antibodies for own thyroid. So if they are present, then we can safely assume that your body is mounting an attack to thyroid.

Now, if your thyroid is strong, your TSH will be normal. Your T4 will be normal because it’s like, yeah, it’s fighting, but I got this. And it’ll just fight. And you could be in that state for decades and be 100 % fine. Now you can get mad at your PCP and say, well, why aren’t you testing my antibodies? Why didn’t you tell me my antibodies are high? And your primary will be like, because there’s nothing I can do about it. So like why, the idea there is like, why would I do a test that there’s nothing I do for it? Because if you’re going to have a conversation,

with like 10 people a day and say, listen, if our antibodies are high, it means you’re cooking a thyroid disease. There’s nothing I could do about it. See you next year. Not everybody wants that conversation. We tend to have a confirmation bias for the type of patient that comes to us, these are the patients that are looking for it. But most people in primary care, believe it or not, don’t. They’re like, OK, well, why are you calling me? If there’s nothing to do about it, leave me alone. So there are different kinds of patients also. So if your antibodies are on board, ⁓ it just means that something

is cooking and you keep an eye on it and you keep checking and you keep checking your T4 because eventually your thyroid will not be able to keep up. And eventually your thyroid or your T4 production will go down. TSH will go up and then they will give you medication. The medication is basically hormone replacement therapy. They’re just going to give you the T4 back into the system. It’s not without its own risks, but that is necessary. ⁓ so that is what we have to kind of look out for.

If you think you’re going to have Hashimoto’s, there’s a family predisposition, not every single one has to look out for this, but like if there’s a family predisposition, if you have other autoimmune issues, then you’re more likely to get this autoimmune issue. ⁓ But it’s really just a conversation of being on top of it for the sake of starting medication. For the sake of, did I, I hope I answered your question.

Dr. Ginger Garner PT, DPT (39:52)

Yeah, I think so. mean, the other piece of that is the age-related stuff because I think that’s when you start to get that intersection of, sexual health is not the same, pelvic health is not the same. I don’t feel as good as I used to. Maybe it’s energy levels, maybe it’s fatigue. So as someone moves into perimenopause, menopause, why do we end up, do you think, seeing so much more issues at that time in life?

Dr. E, The NP With A PhD (40:21)

Well, there’s a natural decline of like anything else of thyroid performance as we age. ⁓ And there’s actually great debate about whether if there’s no Hashimoto’s on board and T4 production is pretty good, there’s great debate about whether or not to give medication for the sake of tightening the TSH. Like functional medicine is very pro about ⁓ tightening the TSH, tightening TSH, but there’s great debate about that.

And also what I would say to someone about this is if you’re not feeling well, make sure everything else is addressed. Listen, if your thyroid is completely off and your T4 is low and TSH is out the window and have antibodies and thousands, no question, right? But if you’re like, trending, ⁓ but nothing’s like truly outside abnormal and you’re not feeling well, I would just first correct for everything else. I would first correct for perimenopausal hormones and testosterone.

Dr. Ginger Garner PT, DPT (41:20)

Mm-hmm.

Dr. E, The NP With A PhD (41:21)

and your nutrition and your sleep and your stress levels, ⁓ before I made the decision to go on a lifelong medication, that just about tweaking for the lab. so, so yeah, so there is a natural decline, but at the same time, so many other things are declining, including our, our sexual hormones that I would, I would, I would correct for everything.

Dr. Ginger Garner PT, DPT (41:36)

Yeah. Yeah.

Yeah.

That’s such an important point, I think, because in, and this is a societal thing too, where it’s like, just give me a pill. I just would fix it with a pill. But longevity is about our lifestyle habits and what we do every single day. It’s the things that you alluded to with sleep and nutrition and getting enough physical activity. And all of that impacts cortisol levels, hormone levels, how we are able to show up.

for ourselves and the people that we love every day. So if you’re not correcting for those things, then a pill is not gonna cut it. ⁓ You’ve got to correct those other things. Yeah.

Dr. E, The NP With A PhD (42:23)

Yeah, I mean, think there’s certain

there’s certain replacements that are kind of non-negotiables like hormones, like your estrogen is declining, get the estrogen on board. Let’s go. are we doing? It’s testosterone, progesterone. Like, let’s go. But with thyroid, unless you have like a real, like an overt issue, there was a time in functionalism was really like pro, like even if it’s not over, like let’s super tweak, let’s get you between two and three. But now there’s new evidence. So, ⁓ I would say correct everything and wait for the thyroid to be really obvious.

Dr. Ginger Garner PT, DPT (42:31)

Mm-hmm. Yeah, definitely.

Dr. E, The NP With A PhD (42:54)

That’s just my take, of course, different approaches.

Dr. Ginger Garner PT, DPT (42:55)

Yeah. Well,

I mean, I think it’s a smart conservative process as well, because you would hope that in the background, they are working on all of those other pillars. So let’s just say you got a menopausal female and she started an estradiol patch in oral micronized progesterone and so hopefully some vaginal estrogen.

Dr. E, The NP With A PhD (43:20)

Yeah.

Dr. Ginger Garner PT, DPT (43:23)

know, perhaps testosterone, depending on, you know, what her profile looks like. If she’s not doing any of the other lifestyle stuff, you’re still gonna end up with a roadblock, you know, in terms of muscle mass, bone mass, sexual health, et cetera. So it’s that whole portrait, you know, that needs to be done, which fortunately, you know, as a listener, I wouldn’t want you to feel overwhelmed, like, my God, that sounds like a lot of stuff that I have to do. It isn’t, it isn’t, it really isn’t. If you have a, ⁓

caring, compassionate provider who’s just, who’s gonna listen, you know, and ask the questions. So I think that would be a green flag, right? ⁓ That practitioner who’s helping you manage hormones and sexual health, whomever that might be on your team, because we all can’t have Dr. E as our nurse practitioner, although we wish we could. ⁓ You want a green flag prac like you to be able to ask about those things. Like, how are you doing in, you know, with…

sexual health, how do you feel like your energy levels are? How are you sleeping? So they can point you towards the practitioners who can deal with those things.

Dr. E, The NP With A PhD (44:30)

You know, I don’t mean to be like argumentative, but I think everyone is compassionate and caring. Cause you’re like, cause you kind of delineate that people ask those questions are compassionate and caring and the people who don’t ask those questions are not compassionate and caring. I disagree. think everyone is compassionate and caring. It’s just, everyone comes to the problem with a different set of skills. And I don’t think it’s reasonable to ask your PCP to ask all those questions in the 15 minute visit.

Dr. Ginger Garner PT, DPT (44:36)

Ha ha ha.

Dr. E, The NP With A PhD (45:00)

And I don’t think it’s reasonable to ask that you’re setting yourself up as a patient to be consistently disappointed. think you need to know what your PCP can do. And then you have to start believing what you’re feeling and you have to build a team. And it doesn’t make your PCP less caring or compassionate. They’re just approaching the issue differently, but not asking about sexual health doesn’t mean I’ve never, I really ask people about their sexual health. I don’t think I’m less caring and compassionate than you.

And I think there’s a lot of people that don’t ask that. And I think there’s things that I ask my LGBT community that I bet you, never ask, but that doesn’t make you less caring, compassionate. I think it’s really important not to equate the two of caring, compassionate with the questions that we ask. And I think it also is important for patients to just start using each provider differently. Cause like, I think you would be amazing for sexual health, but I wouldn’t come to you if I had cancer. I’d go to oncologist.

who may never ask me about my clitoris, but he’s doing great work on my oncology, right? So I think, and he’s caring and compassionate and he only would care about the particular cancer that I have. So I think this rhetoric is really actually enraging patients more because we’re creating like an us and them. No, there’s only you and everyone serves you patient. Everyone there is to serve you in the capacity that they can. And I think that’s really important for.

for us to like hone in on. I think we disagree, but I wanted to start with that.

Dr. Ginger Garner PT, DPT (46:32)

Yeah, yeah,

I just think we come at probably from a, you know, as a ⁓ GP, general practitioner, you PCP, primary care practitioner, ⁓ whether, whatever your credential is, you know, whatever the license are, there’s a lot of different people who will fall into that category, right, of primary care providers. I think where I’m coming from is slightly different because

Dr. E, The NP With A PhD (46:50)

Yeah.

Dr. Ginger Garner PT, DPT (47:02)

I’m already in a specialty of a specialty. So when I say find that compassionate caring provider, what I really mean was, what I really meant to clarify was in that subspecialty of pelvic health, sexual health, you’d want someone to ask you those questions, right? If we’re definitely talking about the sexual health continuum, right? You’d want to know, well, they didn’t ask me about sleep. Well, that kind of matters, growth, repair, blah, blah, blah, all that stuff.

Dr. E, The NP With A PhD (47:21)

Sure.

Dr. Ginger Garner PT, DPT (47:32)

So I think probably where it is not necessarily disagreeing as much because you’re coming at it from the 40,000 foot view, which you have to in your job. And then I’m coming at it, I’m already down on the ground. I’m like, what kind of weed is that? So there’s just a different perspective of where our views are as we come in and land. Because yeah, I would not expect my oncologist to necessarily ask me.

⁓ weed level questions about how my health is if they’re trying to save my life. Right? But they should be aware of… ⁓

Dr. E, The NP With A PhD (48:08)

Yeah, I was just gonna look. Yeah,

I just think we’re all of them are caring and compassionate because like I’ve already I’ve already eliminated the ones that are assholes in my first like those those don’t count. I’m sorry. I don’t know if I’ll have to curse on this pocket, but as well, like we’re just assuming they’re out like they’re just mean people. So the mean people are out.

Dr. Ginger Garner PT, DPT (48:24)

Yes, you can swear.

Right, right,

right, right. And I think that probably from where I have had to live for 30 years in that community of a community that’s always kind of like can’t talk about it, taboo, dismissed, pelvic health, sexual health, is that they run up against too many of those.

Dr. E, The NP With A PhD (48:47)

Yeah, yeah, sexual health is…

Dr. Ginger Garner PT, DPT (48:52)

assholes and then I’m like, God, okay, let me help you. That’s why it’s like all trauma informed and stuff, you know, and we talk about HRV a lot. ⁓ So unfortunately, I have to like still swim in that community where they might be outrageously dismissed and treated poorly. And it was not necessarily a good experience. We can’t say what kind of person they are, obviously, because I think at the end of the day, everybody’s just trying to help and do their best.

But there’s a lot of misinformation out there about sexual health. But yeah, I don’t think necessarily we disagree. think it’s a valued viewpoint and that all, we eliminate those, then yes, mean, everybody is in it because they love what they do and they want to help people. And then there’s varying degrees of what they’re able to do based on what their expertise is. ⁓

Dr. E, The NP With A PhD (49:33)

Eliminate it.

Dr. Ginger Garner PT, DPT (49:51)

I love the work that you’re doing because you are shining such a positive spotlight on how to…

delineate what you can change from what you cannot change, like the healthcare system not changing. So let’s harness the power of what we do have and make it the best that we can because everybody wants longevity at the end of the day. Yeah. So if…

Dr. E, The NP With A PhD (50:16)

Yes. Yes. But if we’re

sick, we’ll be really happy that that institution is there to take care of us.

Dr. Ginger Garner PT, DPT (50:22)

Exists. Exactly.

Exactly. That’s why when I’m talking to patients, always want to tell them it’s, you know, just because your GYN that you saw last week did not know a thing about perimenopause or menopause does not make them a shitty provider. You know, it doesn’t make them a crappy provider. ⁓ They made me the most fantastic, you know, baby catcher and their meticulous work on C-sections are like chef’s kiss. ⁓

Dr. E, The NP With A PhD (50:39)

Yeah.

Exactly right. Exactly right.

Dr. Ginger Garner PT, DPT (50:51)

because I do see that good work all the time, but I also see bad work. But it just means that that might not be the prac for you. Let’s work on building a team that works for this season of your life. And the other thing that I like to point out too is, and tell me what you think about this, is when we’re talking about those dismissed populations, the populations who get put in that experience of medical gaslighting more often,

Dr. E, The NP With A PhD (51:03)

Exactly right.

Dr. Ginger Garner PT, DPT (51:20)

I’m not sure, and we know where this came from, like patriarchy and misogyny and stuff like that, but to saddle one provider with everything that has to do with a woman’s body was never fair to begin with. To think that an OB-GYN is supposed to do everything, it makes my right eye twitch. That’s like never fair, wasn’t fair, still isn’t fair. There needs to be so many subspecialties under OB-GYN, just like there is with…

Dr. E, The NP With A PhD (51:37)

Everything. Yeah.

Yeah.

I mean, I think when I talk to clinicians also, I think what clinicians need to do, because I spoke so much about patients, I don’t expect clinicians to change and I don’t expect them to go back to school. Like anyone who has been on my podcast, we’re all crazy enough that after having finished school, we went back to school to be five years to finish my certification, be another four years to finish my PhD. Like that is not like you don’t get paid for that. It’s just like extra time on top of your practice and your kids and all these things. Right? So,

Dr. Ginger Garner PT, DPT (51:49)

every other provider.

Dr. E, The NP With A PhD (52:16)

I don’t expect every clinician to go and get certified. The only ask I have of clinicians, if I could have one thing, I just…

two sentences at the end of your assessment when you did all your labs and everything and say, I can’t find what’s wrong with you. Sentence number one, but I believe you. That’s a sentence. But I believe you. I don’t have the tools to help you, but I believe you. And the second thing is have a referral list of people that maybe you’ve vetted along the way or that you like, you’ve met at coffee, your neighbor told you about. So here are a list of like four or five providers that I’ve met over the years.

Dr. Ginger Garner PT, DPT (52:39)

Mm.

Dr. E, The NP With A PhD (52:57)

that you can go to. I really don’t know anything about it. You’ll have to do your own thing. I certainly don’t know nephrology. I sent to a nephrologist. don’t, I’m not a cardiologist. I’ll send to cardiologist. I have a list of like 40 people that I sent to, every primary care does. So my ask of my fellow clinicians is add a few more on your referral list. Add Dr. Ginger for sexual health and add, you know, even my GYNs. I have some GYNs that do OB and have some GYNs that are giving my perimenopausal menopausal. So like make your referral list more robust.

Dr. Ginger Garner PT, DPT (53:24)

Yeah.

Dr. E, The NP With A PhD (53:27)

believe your patients and just say the sentence like, I can’t help you. That’s very different than there’s nothing wrong with you. And if I can get clinicians to just do that, it’s no extra work. It’s no extra schooling. It’s like what just no, I mean, it’s hard because we’re dealing with hubris and indoctrination, but that would be a huge win and we would have to fix nothing else. Just that.

Dr. Ginger Garner PT, DPT (53:35)

Mm-hmm.

I can feel

the global heart rate variability improving just with that. Just that. Yeah.

Dr. E, The NP With A PhD (53:55)

Yeah, just with that, that sentence of I believe you is just

like, as I say it, think my HRV is improving.

Dr. Ginger Garner PT, DPT (54:04)

Yeah, I just take a big giant breath, big belly breath, and just you feel validated. And sometimes that’s the best part of their visit, because it’s the first time someone’s ever said that to them.

Dr. E, The NP With A PhD (54:16)

Yeah,

yeah. I believe, and you know, being able to say, don’t know, that doesn’t mean there’s nothing wrong with it. It changes the whole, in fact, your patients will come back to you even more. Yeah, yeah.

Dr. Ginger Garner PT, DPT (54:27)

Yeah, that’s true, true.

So we know the system’s not going to change, you know, overnight or even anytime soon. So tell me about what you feel like listeners can do to, obviously, A, no one wants to feel gaslit. That’s the worst feeling in the world. And also still get the care that they need.

Dr. E, The NP With A PhD (54:42)

Right. It is.

Okay, so the first thing is no matter what you feel, never skip the conventional medicine piece. Like, you know, it’s very easy in today’s day and age to put your symptoms in chat or ask a friend or whatever and be like, yeah, yeah, I have a mold issues, but you might, but you didn’t pay attention to the fact that you might have cancer. like never skip the step. Even if you hate it, even if you don’t like medicine and you’re like in a very anti place, just do it. Just use it as a tool, use your insurance.

Get it done. Get the MRIs, the scans, the labs. I mean, if they find something, God forbid, great, they’ll fix it or diagnose it whatever. Or you’ll know what’s going on. If they find nothing. Oh, wait, before I say we find nothing. When you come to your, to any doctor in conventional medicine, there’s one thing I need you to do. Do not use hyperbole when you speak. Do not come in and say, this happens all the time. I’ve had it forever. It’s killing me.

Like do not use dramatic language. It has the opposite effect on clinicians. If you say I’ve had a headache for the past 20 years of my life, it’s a level 10. It’s always this way. We actually don’t think you’re serious anymore. Like you’re not impressing. It colloquially over coffee. It sounds intense in medicine. It sounds like it doesn’t make sense because the first thing is like, ⁓ 20 years every day. Why are you coming today? What’s different today? Nothing. Goodbye.

Like, so it actually, the, the, I’m saying a dramatic without, and not trying to be dismissive, I’m just to use a language, to use a word, but coming in dramatic into the exam room will always bite you in the ass. You want to be really specific when you come in. I have these headaches. Yes, I’ve had a history of headaches, but in the past three months have gotten worse. It’s worse in the morning. It’s worse at night. It’s after I eat, wakes me up from sleep, doesn’t make me up for sleep. Come in like,

Dr. Ginger Garner PT, DPT (56:30)

Mm-hmm.

Dr. E, The NP With A PhD (56:45)

Come in, tell the provider real specifics around it. What makes it better? What makes it worse? And maybe what else happens when I have the headache? I’m also nauseous. That is the language that the medical community needs. So come in with really exact language. Don’t add anything. They don’t care about the extra stuff. And it just ⁓ obfuscates a picture for them. I want you to look at them almost as limited. ⁓

You wouldn’t go to a two-year-old and give him like all your introspective emotion. You’d be like, don’t put your finger in the socket. real, be real simple. Okay. Don’t put your hand in the fire. Yeah. You wouldn’t be like, you know, the other day, and when you put your hand in the socket, I got so nervous. And then my HRV went down. Like you wouldn’t have that conversation with a two-year-old, right? So don’t bring that into the exam room. It will backfire. the toddler is like, okay.

Dr. Ginger Garner PT, DPT (57:30)

Yes. ⁓

Dr. E, The NP With A PhD (57:42)

put my hand, like, am I putting my hand in fire or not? So that’s what you have to do. And don’t, don’t think of it as like, why do I have to change myself for them? You’re not changing yourself for them. You’re utilizing this as a tool, right? If you use a calculator, you have to like know when the multiply sign, when those are in the chat, like that’s how you use a tool. Right? So they are tools for you. So come in, speak to them, get all the labs done. If they tell you that nothing’s fine, do not get irritated. Believe yourself.

Your inner voice is a true voice. Your bloating is the bloating. The headache is the headache. That is all real. Do not gaslight yourself. Say thank you so much. Pay your copay and then go find different providers. Build a team. If your vagina is hurting you, go to Dr. Ginger. If every time you’re home, you have a headache, find a mold specialist. If you’re joints are mess, find a lime literate person. Build a team to help.

get you what you need as long as you didn’t skip that first step. ⁓ That’s what you do. And that’s how you use the system. It’s one tool. It’s a screwdriver. You don’t use it for everything.

Dr. Ginger Garner PT, DPT (58:43)

Yeah.

Good points, really good points and very empowering points. every provider ⁓ loves that when you bring in your patterns and it’s very specific and you get right to the point because then hopefully they’ll have that big referral list and they go, ⁓ well, I have someone for that since your labs currently may look normal. Why don’t you go this direction? ⁓ So I think that’s wonderful advice.

Dr. E, The NP With A PhD (58:58)

Yes.

Thank you. And then look on directories. I’m sure wherever you got certified, you’re on some sort of directory. What is your certification?

Dr. Ginger Garner PT, DPT (59:23)

⁓ it depends. There’s board certification in lifestyle medicine, there’s integrative medicine, there’s menopause society. Every one of those are going to have a list where you can find your therapist, practitioner, whatever it is.

Dr. E, The NP With A PhD (59:30)

Yeah.

exact.

Exactly. Go on Institute of Functional Medicine. There’s Lyme Literate. Go on their directories because those are people who spent the time. Lord knows how much time and rigorous, a lot of time and rigorous certifications. ⁓ These are no joke places. These are not like, you know, like when you get in a ministry to like be able to perform a marriage. It’s not like that. it’s a great resource for people.

Dr. Ginger Garner PT, DPT (59:40)

Mm-hmm.

Mm-hmm.

Lot of money, lot of time.

Yeah, that’s true.

Yeah, so if you’re wanting some of those resources, we will be putting those into the show notes with find a therapist, find a doc list, but also, also, also, where can everyone find you?

Dr. E, The NP With A PhD (1:00:19)

⁓ thanks. So Medical Disruptor is the name of the podcast. It’s also the website, medicaldisruptor.com. And ⁓ I don’t sell anything and I don’t see patients one-on-one for holistic care. have my primary care practice. My goal is to spread the message. My podcast is just about having other clinicians who have various specialties you could find. And my website is set up in a way for you to be able to be like, ⁓ I need somebody who’s on IBS and find the podcast on IBS.

⁓ It’s just there for you to find your path. That’s what we’re on. We’re on a mission-based journey.

Dr. Ginger Garner PT, DPT (1:00:55)

I absolutely love that. It’s exactly what we need, particularly in this country, but everywhere it’s exactly what we need because you want to put that power back in the persons, give them back their sense of agency and their sense of control and to also help them believe that they can. And I so believe that the work you’re doing is doing exactly that. So thank you so much. Yeah.

Dr. E, The NP With A PhD (1:01:17)

Thank you, thank you so much. I really appreciate

it. Thank you for giving me the floor and thank you for letting us, know, agree to disagree on some stuff and then come to an agreement. So thank you for being gracious about that.

Dr. Ginger Garner PT, DPT (1:01:23)

yeah, yeah. No,

I think that’s really valuable perspective to be in because it also illuminates this point that in our education or medical education system, we’ll continue to be educated in our silos. That’s just, how can we be specialists in anything if we’re not? So it has to be that way, but it’s this interdisciplinary interaction that is like the above and beyond that allows us to then see

these different perspectives, which are all valuable because in the end analysis, we’re just trying to like empower the patient. Yeah, so I love it.

Dr. E, The NP With A PhD (1:02:00)

Absolutely. Thank you for being gracious about that. That’s some

serious divine feminine energy right there. Collaboration is all feminine energy and anyone who knows, knows. 100 % correct.

Dr. Ginger Garner PT, DPT (1:02:05)

I really love that. Yeah, that’s where the real change is gonna come from. Yeah. Thank you

so much, Dr. E for joining me today.

Dr. E, The NP With A PhD (1:02:16)

Thank you for having me. It was an honor.