This Doctor Gets It: Burnout, Bureaucracy, & Better Diabetes Care, Dr. Gregory Dodell

[00:00:00] Rob Howe: Hello podcast listeners, we are continuing the journey to learning what it takes to live well with diabetes. We're continuing on the physical track here, but it's a little bit of mental as well because we are interviewing on today's episode Dr. Gregory Dodell, who is an endocrinologist from New York City. You might know him from social media as Everything Endocrine, and he is part of Central Park Endocrinology. You can visit their practices website at centralparkendocrinology.com. And he's one of the practitioners, HCPs, endocrinologists who are content creators. And I think it's really cool to see, and we talk about this a little bit in the episode, there are people like me who don't have any credentials and we're sharing our lived experience with diabetes online. And then there are people who are sharing misinformation and sometimes stigma and not rooted in science information. And a lot of times that goes really viral. And now there are people who are sharing with credentials, who are sharing the science and are also getting a lot of views and sort of combating that false information. And so we talk a little bit about that on this episode. But Dr. Dodell is a really awesome advocate for patients with diabetes. And he also talks a lot about type 2 diabetes and about some of the mindset around fighting some of that stigma. He's also a New York Knicks fan. So at the time of publishing, congrats to Dr. Dodell. The Knicks are back in the conference finals. So please enjoy this episode with Dr. Gregory Dodell, everything in a grin. Guys, who was MVP of the chat? Rob Howell! Rob Howell! What were you on? We need more of that. Dr. Gregory Dodell, welcome to the show, man. Thank you so much for taking the time.

[00:01:45] Dr. Gregory Dodell: Thank you. I'm excited to finally connect with you. We've been following each other for a while here.

[00:01:48] Rob Howe: Yeah, man. And I think one of the reasons I wanted to have you on the show is because you and there's a few others that I could think of who come to mind and probably many listeners will recognize like you guys are leading the way on whether it's diabetes care or it's endocrinology discussions from HCPs as content creators. And I think this is a trend that I'm really glad to see for two reasons. Number one, obviously combating misinformation and like giving patients a really easy way, a natural way for them to get clinically viable and like accurate information. But also just communicating with patients in the way that they're comfortable with and like seeing videos, like short videos and entertaining things about learning about diabetes or other endocrine disorders and how to think about things. And one of the things I really like about your content is you address some of the challenges that maybe people have had with their endocrinologist or with conversations with their endocrinologist. So I know for me, my life with diabetes changed for the better dramatically when I found an endo that I could really get along with and we had a good rapport. So I'd love to talk about that journey as well. But like, tell me what made you decide to start creating content, you know, on Instagram and social media?

[00:03:00] Dr. Gregory Dodell: Yeah, I mean, a lot of it was just wanting to expand the things I talk about every day in the office. I felt like there was certainly a place for that. And part of it started by what you're mentioning, which is just the stigma out there and hearing patients come into me with maybe like more of the old school medicine who had just not had good experience with doctors. So I was kind of like, this is a nice way to get out there and collaborate, as you're saying, with patients and hopefully drop some good education, but more of just talk about, you know, the patient experience and like how we can all work together. Because that's where the art of medicine and that's hopefully the goal of clinicians is not just about the numbers, but it's about how do we take care of the whole person. So I felt like that was a cool thing to get out there and do. when I was interviewing for med school, you know, the guy was like, well, what do you think your career is going to be like? And this and that. I said, yes, I want to be a doctor, but I also want to be a teacher. I also want to get into research. I want to be out there doing more things than just seeing my patients in the office. And I felt like this was a good opportunity to get out there and

[00:04:05] Rob Howe: do it. I mean, it's amazing how many people you can reach. That's been part of my journey as well is like connecting with other people with diabetes and seeing how much we all view the world in a similar way or like all of the things that we're going through is super relatable. And I'm sure it's been the same for you, not only on the patient side, but probably also on the clinician side.

[00:04:23] Dr. Gregory Dodell: Totally, yeah. I mean, people ask and colleagues too, did you start doing this as a way to market your practice? And that really wasn't high on my list of things. It was more of what I was telling you, which is just a way to be out there and be a face of one of my colleagues as an endocrinologist and have these important discussions because that's, as you're alluding to, that's where people are going to more often than not for information. Like they may see their endo between two and four times a year, but they're on social many days a week.

[00:04:53] Rob Howe: Yeah, many, many hours of many days a week.

[00:04:55] Dr. Gregory Dodell: Right, right, right.

[00:04:58] Rob Howe: Well, and it probably gives you a chance to like, I feel like one of the things that I hear a lot from patients is like how we only see our endo a couple of times a year. And sometimes it's for a very short time. And we know there's a shortage of endocrinologists in the United States. And some people have to drive considerable distances to see their endo. And preparing for that can be anxiety-inducing. We're looking at numbers, and maybe some of us have had bad experiences. It was as simple as one party's having a bad day, and they just didn't have as much time. There's a lot of different factors going into that. But one of the things I wanted to talk with you about is how to prepare for that. But I imagine that your patients are spending more time with you via your videos and your content, and that allows them to maybe build more of a rapport with you when they're with you in person.

[00:05:43] Dr. Gregory Dodell: Yeah, I mean, the way to prepare, I think, is hopefully, I mean, obviously, if it's a follow-up patient, it's a little easier. But just having an endo that you trust and you have a collaborative approach with so you're not going to feel judged and that it's really, you know, how do we collectively do better? if you have an off quarter or six months or a year or years, like how are we going to move forward and not focus on what should have been done, but what we can do going forward. If you're a new patient, it's a little challenging because you're going to meet someone new and you're going to talk about all their personal history and all these things. And hopefully that just means the doctor, the clinician, whoever you're seeing is going to be receptive and not judgmental and work to form hopefully a relationship going forward.

[00:06:29] Rob Howe: You mentioned like, yeah, it can be, you know, building that relationship is going to be the most important thing, just like anything. Right. And, you know, trying to do things or fit everybody into one box or one modality that applies to everyone, I think was maybe an approach that many endocrinologists took for a long time. And do you find yourself, because I noticed in your content that you're creating is maybe addressing that along the way, you might have tried something that didn't work. Or maybe there was language that was used that's now outdated. Or, for example, like restricting carbs is something that I think is always in and around diabetes management conversations. conversations so how do you address those things and how does that inform your practice or how do you approach those types of discussions with somebody who may have had a bad experience

[00:07:17] Dr. Gregory Dodell: somewhere else i think the most important thing we could do is listen to the patient because everyone's had different experience you know whether it's nutrition or exercise or stress or how long they've been living with diabetes so all those factors play a role and that's what people come in the door with and just listening to who's in the exam room is the most important thing you could do. And you can kind of get a sense if someone's like coming in, they're really hard on themselves, like, oh, my A1C is whatever, a little bit over seven. And it was I'm so upset and this and that. To me, that tells me to say, look, we all have a tough time. And so what? Then, you know, you're not putting yourself at risk. It's one time and let's work on getting it better, or if there's someone who's persistently not well managed, what can we do to improve this? So it's just like reading the room, you know, that's the most important thing. And me learning

[00:08:07] Rob Howe: from my patients. What do you think the biggest thing that you maybe, this might be too big of a question, but let's think about like some of the things that you've learned from your patients, right, that maybe surprised you. Or like you maybe came in with looking at a chart or looking at some data, came in with one idea, but left with another one after you talked to the person.

[00:08:25] Dr. Gregory Dodell: Yeah, I mean, I think that over and over again, and now I don't think it's me learning anything new, but I think I've learned it, is the impact on stress on people's blood sugars. Because, you know, early on, we're taught to really look at nutrition and how much insulin they're getting and things like that, and you kind of miss the big picture. So over and over again, I kind of hear how much stress can affect people's numbers. And I mean, I think I don't have data on this, but I would assume like, you know, we're more connected than ever. We are aware of things happening both in our communities and around the world all the time. Even things like checking our own glucose can be stress inducing or work or family stress. And like all of those things are factoring into our daily diabetes management. And a lot of times they're kind of like silent killers, so to speak.

[00:09:18] Rob Howe: Like I had a recent conversation with another diabetes creator. Sometimes putting down the phone and just like going outside and taking a walk, a little nature bath, touching some grass is a great way to relieve, at least temporarily, some of that diabetes distress.

[00:09:32] Dr. Gregory Dodell: Yeah, no, absolutely. I mean, obviously, you know, there's more and more data coming out about how detrimental being on your phone or device or just screen time can be. So I think that's a great point is if you're feeling that or you're scrolling through or even if you're just someone's overly tuned into their blood sugar in a day and it's just continuing to snowball and it's making them more stressed, put it down for a little bit. As you said, go outside, take a break, and revisit it.

[00:09:59] Rob Howe: I spoke at an event this last weekend with some caregivers and parents of kids with diabetes. And I could see and I could tell how challenging it was for them to come to this event. They organize like a sitter for their kids or they're with another caregiver and they're not watching them on the phone and they're plugged in and they're learning and they have a lot of passion, but I could tell how much they are obsessing over every blood sugar.

[00:10:23] Dr. Gregory Dodell: Yeah.

[00:10:24] Rob Howe: I know not all patients are the same. How would you approach a patient who is overly stressed out or maybe experiencing diabetes burnout, diabetes distress from over fixation on every blood sugar?

[00:10:35] Dr. Gregory Dodell: Yeah, I mean, don't let perfection be the enemy of the good, right? I mean, it's actually becomes detrimental and vicious cycle if you're so hypervigilant you know on and you're not living your life even if you have perfect blood sugar control what kind of quality of life is that i you know i i would say that patient look i'd rather your sugar run a little bit high and you go out and you have some fun you play ball like you go outside and be in nature and your sugar is high for a little bit but you're doing something that's enjoyable and worth i mean this is a big statement but like worth living for than to be like so tuned in on

[00:11:10] Rob Howe: that number that you're not living. We had a guest on the podcast recently who talked about, like, I don't want diabetes to force me into a small life. Yeah. You know, that landed for me.

[00:11:20] Dr. Gregory Dodell: You know, I think the idea that, you know, this is a bigger discussion, right? But we're all going to die at some point. You know, there's going to be a day where we can no longer do what we can do today. And none of us make it out of here alive, so to speak. So like what, you know, at the end, what's the life in your years or whatever that saying is that I just, but that's, that's a huge

[00:11:38] Rob Howe: part of it. There's so much more than just having an in-range blood sugar. Totally. I mean, really, the whole point of being focused on this and having follow-ups and living day-to-day with the technology is to avoid complications so you can live your best life and the most meaningful and quality life that hopefully we're all striving for. And if you're so tuned in that you're missing that, you're missing the objective of having well-controlled or well-managed diabetes. Totally. And I think like that perspective, that's one of the things that I think being connected to people with diabetes and even folks like yourself, HCPs, who are talking about these things is really important because otherwise it can be really isolating. and you think you're the only person having these thoughts or the only person who's going through this and then you realize it's a lot more normal than you may think. I wanna ask you a question here because you mentioned complications and I've lived with diabetes now for 21 years and I'm very grateful I don't have any complications and some of that I can certainly credit to my good diabetes management, but I also I think just physically have, am predisposed to not having as many complications or my diabetes management is a little bit more stable And I know that's not true for everyone. And also there are people who have great numbers forever and they they just are more predisposed to having retinopathy and things of this nature. So I've tried to, you know, being in this community and trying to put out a more positive spin on things many times is that leaving room for complications like that there really isn't a life that's without complication. And obviously, we want to do what we can to avoid them, but we can still find space for ourselves if we were to encounter them. And so I'd love to hear your perspective on managing complications as they come up and also not beating ourselves up too bad if we experience them, even if we've been really active in our management.

[00:13:32] Dr. Gregory Dodell: Totally. I mean, thankfully, science medicine continues to advance. So if someone develops retinopathy, for example, which for your listeners, you most probably know, but is a dysfunction of the vessels of the eyes. There's great treatments out there now that if people are going for the preventive screenings, hopefully it's caught early, they can do things like laser injections, things like that to help. Same thing with cardiovascular things, being on top of preventive screening for heart conditions, being on top of cholesterol, all these things, We have the benefit of living in a time where medicines continue to advance and there's treatment options. So if someone gets a complication, just having a team in place and hopefully getting the access to take care of yourself. And as you said, not beating yourself up because these things unfortunately happen even for people that are giving it their best effort.

[00:14:20] Rob Howe: Yeah. And like you said, if we have the awareness that we're going to our screenings and we catch them, we can hopefully catch them early and there are good treatments available. And every year we get more and more advancements there as well. You talk a lot about on your platform, and you mentioned it here as well, these results, A1Cs, time and range complications are not a morality test. They're not a judgment on your character or an indictment that you're not a good person. Do you find that the stigma around diabetes management or around like how big of that, how big of a role does that play in your patients that you see on a regular basis?

[00:14:59] Dr. Gregory Dodell: it's all tied together because it's not just about the number, whether it's the blood sugar number or the A1C, any of these things. You deal with it the best you can, but I think being a compassionate doctor yields itself to hopefully patients that are going to be receptive and be open with you and hopefully troubleshoot things more effectively versus unilateral-type discussion or whatever. The patient's not going to mention things that are going on that could be the culprit for high numbers or complications or whatever it could be. So I think the best thing you could do as a clinician, whether it's diabetes or thyroid or any of the other things that we're seeing is being open, receptive, nonjudgmental, listening to the patients and learning from them.

[00:15:47] Rob Howe: What do you think, I guess early in your content creation journey, what's something that maybe surprised you like hearing from either from patients or from some of your peers on the HCP side? As you were sharing that, like, what are some of the maybe surprising conversations

[00:16:01] Dr. Gregory Dodell: or like light bulb moments for you? Really how traumatized some patients have been from being in healthcare settings. I just, because I know and I hope that doctors are in this to help people and we're unfortunately a challenging system to do that. You know, you can be the best doctor ever, But if you're in a system that doesn't yield itself to that, you're hopefully good or maybe just okay. And just hearing that not only from patients who unfortunately have been traumatized, you know, everything from, I recall a patient who was diagnosed with type 1, young, like, I recall it like age 10. Like the doctor held up like a regular Coke and a Diet Coke or something like that. And threw the regular Coke in the trash and was like, you can never drink this again your whole life. So just hearing that kind of stuff and then clinicians just sharing in the challenges of being a doctor these days and taking care of patients, whether it's the financial stuff, whether it's not having the time to sit with the patient or their family or whatever. You know, that's also something that's discussed a lot. And it's just unfortunate from both sides.

[00:17:11] Rob Howe: I'd love to touch more on that, too, like the peer discussions. There's a shortage of endocrinologists in the United States. I think there's 8,000 or 9,000. And when you think of the number of people with diabetes, clearly there's not enough hours in the day, right? And some of that is the incentives in medical school. There are fewer incentives maybe to being an endocrinologist than there are for other areas to practice medicine.

[00:17:39] Dr. Gregory Dodell: Financial, some of them.

[00:17:40] Rob Howe: And then I think a lot of people that I've met have some sort of tie that pulls them to endocrinology, whether it's a family member or themselves living with diabetes or other endocrine disorders. Like what are, you mentioned like time. I think that's probably one that sort of even has negative downstream effects for the patients where unless a clinician can see 20 patients a day, you know, they're not able to, you know, operate their practice. And that leaves them very little time, not only to spend with the patient, but to prepare for the patient. That's just like such a difficult place to be. It's like one of those sort of unsolvable problems. What do we do about that? So I guess, you know, for a patient who maybe feels like, hey, my doctor doesn't have any time for me. I feel like I'm getting moved back and forth and maybe add a little bit of knowledge or perspective on why that may be.

[00:18:30] Dr. Gregory Dodell: Yeah, I mean, it's just a numbers game. I mean, I see 20 to 30 people a day, which is a lot, you know, for anyone to kind of be all in and listen and be attuned to all the different things that are going on in people's life. because as I'm alluding to, I'm not just like, oh, your blood sugar is this, your cholesterol is this, see you in three months or six months. I'm, you know, what's going on with the fam? How's work? Blah, blah, blah. You know, to do that for 25 people a day and then get back to patient portal messages and, you know, all these things, it's a lot. So I think thankfully there's physician extenders now, whether it's physician assistants or very educated nurse practitioners or diabetes educators. if someone has resources to do that, a bigger practice. Like I have a physician assistant in my office who's great. So sometimes like if someone needs a little bit more help, they can see her kind of in between visits or even just she can just take over and she has the ability to see them much more frequently than I do. So just reaching out for help and putting yourself in a system that allows support for you and your.

[00:19:37] Rob Howe: Definitely. Having to figure out ways to solve around that capacity issue is really challenging. And you mentioned financial sort of coming up when you're talking with your peers. You know, we didn't even talk about time to write prior authorizations or to fight for insurance coverage. Do you find with any sort of regularity challenges when you're, even if you have a patient who's engaged, they need something, you guys work on a plan, and then you have to go fight a whole other battle over days, weeks, months to try to get it covered?

[00:20:04] Dr. Gregory Dodell: brutal. And then, and being a business owner, as much as I'm a doctor, I'm also in customer service. You know, I've seen patients who have a great rapport and then they may get frustrated with the office because their prior authorization is not getting done as quickly or the pharmacy claims, oh, we're calling your office and telling the patient, we can't get ahold of your doctor. All this kind of stuff just takes a toll on the practice, on the relationship, stress for both the patient and the doctor's office. So yeah, it's all. I mean, if I go through my messages now, probably half of them are either refills or need a prior authorization

[00:20:39] Rob Howe: or not a lot of medicine going on in that patient portal. Right. Yeah. I mean, and we were talking about the distress aspect of it, like just the continuous management of supplies and prescriptions. And well, now I've maybe didn't go back to my six month appointment. So my prescriptions are expired and I'm almost out of insulin and it's the weekend and I got to figure out a way to get my prescriptions refilled. And like you said, it's just sort of a never ending. It's not a problem with one solution, right? It's just sort of an ongoing, a good metaphor for life in that

[00:21:09] Dr. Gregory Dodell: way that there's always going to be some other problem to solve. Yeah, no, it's really challenging. Friday afternoon, we close up shop and someone's like traveling and they don't have their insulin or they forgot something. It's a lot. It's a lot for everyone. Yeah. It's interesting though,

[00:21:26] Rob Howe: when you're able to really make progress and keep track of those wins and you have a patient that breaks through or you're able to do, you know, something that they had wanted to do for a long time or whether it's, think of things like having a family or even small things like taking a trip that they were maybe not able to do and things of that nature. In those limited moments where you're able to connect with your patients, how much of that do you think of when, you know, you're working

[00:21:50] Dr. Gregory Dodell: with a patient from one stage to another? I mean, that's everything. You could be having a terrible day and a patient just says, thank you, or how are you doing? Like just those little moments or a patient that hasn't historically been well managed on their blood sugar and they come in and they have a great lab test. I mean, it's hard in the moments where you're struggling to hold

[00:22:12] Rob Howe: on to those, but that's the win. Yeah. No, I mean, I think as many people as I talk to, Many have had a negative experience maybe early in their life. You're talking about a clinician with the Diet Coke and the regular Coke. They weren't trying to be mean or damaging. They probably didn't know what that was. And it may have worked for somebody in the past and they kept doing it. But somebody's had a difficult experience. And it's really amazing the correlation between having an endocrinologist or a nurse practitioner or someone able to meet them where they are. and the launch pad, the foundation that that gives them to do whatever it is that they're looking to do. And, you know, that works just really important. And I don't know, we're probably a little bit hard on you guys. So sorry for what we said about endos when our prior authorization gets denied or prescriptions are running out.

[00:23:03] Dr. Gregory Dodell: No, I look, I get it. I mean, to be blunt, I mean, it's a life or death situation. Some of these cases, I mean, someone's out of insulin or, you know, They're trying to get an authorization for their pump, and they're having to go back to injections. I mean, I get it. I totally get it. And there's got to be a better way, but I don't know what that is. I don't think anyone knows what it is.

[00:23:24] Rob Howe: Yeah, I feel like a lot of people smarter than me are trying to figure it out, and they haven't quite done it yet. So we'll just keep on trusting that they'll do it.

[00:23:31] Dr. Gregory Dodell: look, the amount of staff that we need to really just handle these PAs, it's just not feasible given the cost of overhead in general. And I was speaking to a colleague who has, I mean, a huge practice, but like five staff full-time just doing PAs. I mean, that's like a million dollars. I mean, it's crazy by the time you pay health insurance and salary, you know, You got to see a lot of people talking about why are you seeing 20, 30 patients? You got to see more than that to have a huge practice. I mean, I would love for AI to be able to handle these PAs and we're close to doing it. But that's really what it is. I mean, it should be so automated that literally just AI could submit the node and that's it. And also, I prescribe someone insulin, let's say Novolog, bounces back, oh, this is not covered. but they don't tell me what is covered then i gotta send humalog sorry that's not covered then i gotta send Fiasp oh that's not you know it's like a guessing game it just takes so much time

[00:24:37] Rob Howe: it's not what do you think the right like so if money were no object which is obviously for the sake of this example like what what would a endocrine clinic like need to properly staff and you know give let's say 45 minutes to every patient that came in and have their prior authorizations and all of their, you know, back office paperwork, prescriptions covered, even, you know, throwing mental health, whatever you need to that equation. That seems to be an extremely large team and you'd need so much capacity to handle for one person. I don't know. What do you think the right, if money were no object, what is the dream scenario for, you know, what you'd be

[00:25:18] Dr. Gregory Dodell: able to give a patient? I think the dream scenario is not having all the like need for the authorizations and the paperwork and all these things where you get X amount of dollars to take care of this patient. They've been on Humalog or Novalog their whole life. They're grandfathered in. You don't need an authorization. You're not going to change it every year because of your formulary. You're not going to have to spend the time to do the authorization. You're going to be able to take care of the patient without needing to drive up your overhead and have more and more staff to detract from the clinical benefits of having a patient, the bureaucracy that goes into it, and dealing with, you know, submitting claims and insurance, you know, all this stuff,

[00:25:56] Rob Howe: submitting records. I mean, it's a lot. So I think. And almost none of that is, it's like not, it's like all non-billable, right? That's how we would say it in the agency world. It's like, you're not, it's not directly affecting the patient's outcomes. It's all paperwork and

[00:26:09] Dr. Gregory Dodell: bureaucracy, like you said. Non-billable. And that's why you're seeing, you know, a lot of us are going into concierge medicine, you know, or just going out of network completely because the cost of or the reimbursement to take insurance just doesn't allow you to to do these things so unfortunately that just means there's going to be even less endos that are available for you know i myself which i haven't really announced on social media so here it goes but i'm starting to do primary care concierge medicine because so many patients ask me can you be my primary care doctor and i've historically said no because i want to really just focus on the endocrine but Then it was like they see a primary once a year for 10 minutes and they don't know anything about them. And it's like a waste of everyone's time. And or they see someone else who's like changing up to other medication and things like that. And it's hard to track. So I just said, you know what, let me just do this because I can be a one stop shop and take care of the person the way I want to. And I have to worry about other people, you know, that I have to keep in touch with or interfering. or if they need to see a specialist, I'll have the time to get on the phone and say, hey, you saw my patient or can you please squeeze my patient in, whatever. That's the way it's going to go, unfortunately.

[00:27:20] Rob Howe: It's interesting, too, because that's kind of how, I don't know if 100 years ago, but like 60, 70 years ago, that's kind of how it was, right? You had the one doctor in town and pharmacist, and that's where everybody went. And so you kind of have the one-stop shop returning back to that. But like, unfortunately, right, like it's due to a need. You guys have to be able to make money on the practice and see it and give patients enough time so that, like you said, you're in the customer service business at some point. So they come back. So it's sort of like disincentivizes like you're you're not able to make as much. And so you have to see more people and that just creates more churn and outcomes certainly can't increase with that type of structure. So I get it. It makes sense.

[00:28:02] Dr. Gregory Dodell: I mean, I went into medicine to be that doctor from 60 to 100 years ago because to me, that's what it's all about, which I think hopefully is coming out in this conversation. So if I feel like I'm being mediocre during the day because I just don't have the time to spend and I'm looking at the clock and I'm running five minutes over and I got a full waiting room, that doesn't feel good for me and it probably doesn't feel good for the patient. So unfortunately, like as you're going back to your question of like, if you had 45 minutes and you this and that, the only way to get those 45 minutes, unfortunately, at this point is to like either not take insurance or be a concierge doctor or someone pays you an annual fee and it helps cover the overhead and allow for that time.

[00:28:43] Rob Howe: You mentioned research earlier and like that being an important part of why you wanted to become an endo. What are you seeing? What's exciting in the research space? In the type 1 space, we've seen some clinical trials that are coming up with really exciting cure research still early on, but really promising results. There's GLP-1 research, not only for type 2 and weight loss and heart and kidney, but also type 1 diabetes and a lot of momentum there. What's exciting to you?

[00:29:10] Dr. Gregory Dodell: Yeah, I mean, those are two huge things that I was going to say. Like the stem cell stuff's obviously been going on decades, and it seems like maybe some headway happening with that. I think the GLP-1 stuff for managing type 1 is certainly very interesting, and potentially SGLT2 inhibitors like Jardiance and Farxiga as well. And then the Tzield stuff, you know, So for people that may not be familiar, screening people that have first-degree relatives or a strong family history for autoantibodies, if they have these autoantibodies and they have any element of like slightly elevated blood sugar, whether it's an A1C or fasting blood sugar, anything like that, there's this Tzield two-week infusion every day for two weeks where it's been showing to delay the progression to developing full type 1 diabetes, need insulin. Obviously, you have antibodies, you have type 1, but more of preventing the onset of needing to be on full insulin therapy. It's really changed my perception around screening because, you know, maybe three or four years ago before Tzield was more widely known or widely available, I just saw screening as a chance to identify whether somebody in your family was going to get type 1 or not. And not that there was really nothing you could do except know that and be on the lookout for the signs, which you would probably be doing anyway. But now learning about the different phases of type 1 and how even people who have had the diagnosis for many years could still technically be in a type or a stage two where they could get treated with Tzield and dramatically need less insulin or come off insulin completely. And I have a friend who's a pilot who received Tzield and now is able to continue to be a pilot because he doesn't have to take insulin yet. He's able to continue to fly planes without having to go through all of the extra documentation while he's on insulin. It's allowing him to stay employed more stably. So I don't know. It's a really interesting time. I think, like you said, there's a lot of things to be excited about. And we're learning more and more about all of the things surrounding what causes diabetes and what we can do about it. I mean, the whole autoimmune field in general, whether it's rheumatoid arthritis or, you know, obviously type 1, even though looking at things for thyroid and autoimmune things, I think in the next like five years, we're going to see a lot of breakthroughs for autoimmune, which encompasses so many of the chronic conditions that we handle.

[00:31:41] Rob Howe: Yeah. And I mean, like the, do you find, I guess, like, obviously you would like, cause you're not just focusing on diabetes. Like, so there's thyroid. I also have hypothyroidism. When one part of the system messes up, like usually it kind of interrupts the rest of it and it's all connected. In your practice, what other types of disease states are you treating?

[00:32:00] Dr. Gregory Dodell: So type 2 diabetes, pretty prevalent. Hypothyroidism, hyperthyroidism. PCOS, which is polycystic ovarian syndrome, which is really insulin resistance in a lot of ways. But that's for women who have irregular periods. It could be fertility issues, different metabolic effects, pituitary disorders. There's another big one. So like low testosterone is like that. pituitary tumors, osteoporosis, which is like thinning of the bones, all of it really, all the endocrine stuff.

[00:32:25] Rob Howe: Yeah, it's interesting how like we can talk about complications or comorbidities, like all of those things like are, we have to keep an eye on all of those. Like when we're, you know, that's why it's important to go back to the endocrinologist on a regular basis and do that blood work just because they, you know, run in similar circles, right? Like if you're one part of the system is messed up, you're likely to experience some other.

[00:32:46] Dr. Gregory Dodell: Absolutely.

[00:32:46] Rob Howe: Well, cool, man. Well, what's the one thing I think to the patients in the audience, like want to have prove their relationship with their endo or who maybe aren't comfortable with their current endo and want to get the confidence to find somebody who would work better with them? What would your advice be to a patient out there who's trying to find the right fit?

[00:33:07] Dr. Gregory Dodell: I mean, I think as you said, it's unfortunately a little limited because if you're in a rural, being in New York City, it's a little easier because there's a lot of us-ish. I mean, there's still like a hard wait, long wait to get in, but there's more than if you're in like a rural area. I think, you know, if you're not getting what you're looking for, hopefully you can go find someone else, number one. And number two, when you go into the doctor, maybe have in your mind the things that you want to tackle. And if, uh, if it's not going the right way, I mean, I know it's hard to do this cause it's kind of like a patriarchal hierarchy still, but like speak up and, you know, say, look, these are my goals. I'd like to get my A1C down to this or I want to work on my cholesterol or I want to find ways to incorporate more exercise or I'm really burned out by diabetes. What do you recommend? Maybe like trying to have a couple of things that you want to hit on before you go into the session with an agenda. Sometimes work, sometimes doesn't because like we also have our agenda of like things that we need to check off. So it's challenging, especially when the short visits.

[00:34:09] Rob Howe: I found sometimes if I was I could prepare, but then maybe I'd get distracted or I'd forget. And I, so I, I try to write down, you know, now my, I have a great endo and he and I are usually aligned and he kind of asked me first. Now it's, that was a big milestone for me. If my endo is coming in and it's like, Hey, you're here for your prescriptions, obviously. And your checkup, but like, what do you want? That was always a good sign for me. And like, we're just writing two or three things down and then making sure that I touched on them before the end of the, uh, you know, before the appointment. I think that's something it took a little bit of confidence, even for me, like I'm a pretty confident, like, you know, outgoing guy. Like you said, it's like a patriarchal, like there is a hierarchy. You feel like, you know, your doctor's time is valuable and you want, you know, but you're also, you know what's going on and, you know, they also want to help. So you just have to find, you know, the confidence to get that voice and speak up about, you know, what you're looking for.

[00:34:59] Dr. Gregory Dodell: Absolutely. And, you know, again, to stress that if you're not finding that rapport, then hopefully you can look around and find something else that works for you. Because as you said before, and I agree with, none of us are in this to not do the best we can for our patients. But like we're all human and sometimes you click with people in like business or as being doctors and patients or socially or anything like you're not meant to get along and work well with everyone. And sometimes you just got to move on. Patients leave me and vice versa. Like it's just how it is.

[00:35:32] Rob Howe: Wait, are you suggesting that doctors are people, too?

[00:35:35] Dr. Gregory Dodell: Yeah, exactly.

[00:35:36] Rob Howe: Well, Dr. Dodell, thank you, man, for the time. And, you know, again, for all you're doing to dispel some of that stigma, share real, you know, evidence-backed information and lead the way on the social channels. It's helped me and I know it's helped many others. So keep doing it and tell your friends to keep doing it too. You're at your endo conferences, get them doing their videos because it really does make a difference.

[00:36:00] Dr. Gregory Dodell: Thank you. It's great to hear that because, again, I think that's why we're doing it. And if we can reach people and make a difference on social, in the office, wherever it is, that's why we spent all these years learning and continue to learn.