It’s no surprise that mental and emotional health are directly related to physical disease. Here’s what we can do about it, starting with primary care.
– [Zubin] Dr. Lucy McBride, welcome to the show. You’re an internist in practice in D.C. area?
– [Lucy] I’m right in the heart of Washington, D.C..
– [Zubin] And what I love about you, you’ve been a big voice during the pandemic fighting back against the things that really I think the mainstream isn’t talking about enough, like the mental health effects of our response to the pandemic, the effects on both adults and children and the bigger picture stuff. And you’ve written a series of op-eds. You’ve worked with my colleague, Dr. Monica Gandhi a few times. You are one of rare voices of reason on Twitter that isn’t just shooting out doom bait everywhere. So welcome to the show, Lucy. It’s a real pleasure.
– Oh my gosh, I’m thrilled to be here and to talk about the non-cocktail party small talk kind of conversation because again it’s overrated. And I think if the pandemic has taught us nothing else its that we really need to step back and think about what it is that gives us meaning and purpose and what does it mean to be healthy? And that’s why I’ve been talking publicly about health and wellbeing because for 20 years I’ve been seeing patients one at a time and I’ve realized kind of by accident, but partly because it’s my interest that we define health very narrowly. Currently, we define it as seeing your doctor once a year, checking the boxes, getting your cholesterol checked and getting on the scale. And health is for a lot of people being told lose weight, exercise more, see you next year. What health is really about, our everyday lived experience, it’s about our past, it’s about the social determinants of health. It’s about our thoughts, our feelings, our behaviors. It’s about our relationships. It’s about our relationship to each other. It’s our relationship to work, our relationship to the external world. So for me to talk about health in a pandemic, when it’s been laid bare that health is not just about your cholesterol and a Fitbit has really been awesome because people want to hear like a broader definition of health.
– [Zubin] The pandemic has awakened us I think in a way to what actually matters to us. For many people, their health didn’t matter. It was like a side note. It was all about achievement and accomplishment and this and that and the other thing. So the pre-pandemic norm was isolation, diseases of despair, misery. And yet we are now looking back and going, oh, we need to get back to normal, right? But some of the beauty of the pandemic, and I don’t mean the pandemic that’s killed so many and has caused so much suffering. I’m talking about the aspects of the pandemic where we stopped. We took a defibrillator to society and went stop, hold on, take a pause for a second. And I’m talking about the early pandemic. I’m not talking about the prolonged closure of schools and all the terrible things we’ve done that we’re gonna look back and go this was terrible. I’m talking about that initial defibrillation. It was like, oh, wow, wait, there’s a thing called the present moment. There’s a thing called my family. There’s a thing called a sense of connection and purpose that when society is torn a little bit and the fabric has changed, it comes into an immediate clarity. And then the resuction back into the fear and the social contagion and the despair happened relatively quickly. And I’m sure you’re seeing this with your patients, yeah?
– [Lucy] Yeah I mean as you just said diseases of despair were having a heyday well before the pandemic, right? I mean depression, anxiety, the opiate epidemic, which by the way is on fire right now. Suicide has gone up. It was going up well before the pandemic. So you then put lighter fluid on the gas grill of despair, AKA COVID-19 and not just the virus, right, but the social isolation, the loss of life, the loss of jobs, the loss of a sense of normalcy and security and safety. And you’re off to the races with more diseases of despair. So pre-pandemic, I thought about health like I just described as more than just about your cholesterol and your blood pressure and the weight on the scale, but rather this sort of parallel this parallel between mental and physical health. So for example, when I’m addressing someone’s high blood pressure in my office, it’s not appropriate just to ratchet up someone’s medication. It’s appropriate to ask them what’s going on. If you’re stressed, if you’re working too much, if you’re managing kids on Zoom school, taking care of elderly, vulnerable parents and managing a stressful job and you’re drinking too much and you’re not sleeping well enough, that is arguably more important than the blood pressure medicine dose, right? So I take a very broad view of health and you really have to know the person who you’re talking to, right? I mean it’s kind of like common sense, do you know what I mean? A lot of what I do is really, really, really simple. It’s just unfortunately in the current healthcare system we live in, we’ve lost sight of what it means to be healthy and what is, when you drill down into the human experience, what is going on under there?
– [Zubin] Yeah, I think that’s exactly right. I connected with a primary care physician for the first time in a few years since I closed my clinic in Las Vegas just yesterday and went, and it was really interesting because, I’m 48, I need to get screening labs, I need to start talking about colonoscopy and these other things that are very uncomfortable. And I’ve got tennis elbow from using the mouse too much. I’ve got chronic neck pain from staring at my devices, all the diseases stupidity that I could possibly have, I have them. And what was interesting is when I went there, you know it’s quite common, I’m generally pretty chill, do a lot of meditation and stuff. The minute I stepped into that office and the MA came check my blood pressure, I could feel the epinephrin start to surge and feel that little bit of heaviness that you know okay, my pulse just went up, how interesting. And when she checks my blood pressure, it’s like 134 systolic. Now you know that’s kind of borderline. When I’m at home checking blood pressure at any time, it’s like 110, 120, my pulse is in the 50’s. My pulse was 70. So the mind body connection, that unconscious anxiety, it manifests physically. Why is it that we don’t appreciate, honor-
– [Lucy] Why is it we don’t talk about that? It’s just bizarre. I mean mental health is health. We all have mental health. As I said to a group last week, part of being human is to have mental health. It’s not a feature you can opt out of like a feature for your like alarm system or your phone. Right, you can’t be like, oh, I’ll take the human model without the mental health part. I’ll just take the neck down. So it’s only appropriate and normal, and in my opinion, it should be a mandate to talk about mental health like we do any other organ system because after all, I mean this is really basic, right? But thoughts and feelings, right, they are chemical reactions that happen up here. They inform our behaviors. Our behaviors inform our health outcomes, our medical outcomes. They also inform our decisions. So when we have been marinating in stress, in fear, for 15 plus months, it makes sense that you would see what I see in my office every day, which is the emotional, physical, and medical outcomes of stacked trauma. So you can call trauma, trauma is defined as many things you could. You could feel traumatized from having lost your goldfish when you’re seven years old, right? You can feel trauma from having witnessed your loved one die on a ventilator during COVID-19 and you have to be on FaceTime. And I’ve lost patients to COVID-19 during the pandemic. That is trauma, right? But trauma is really any major life disruption or minor left disruption that affects you emotionally and physically. So my argument to my patients one at a time and then more publicly is that it’s time to name these things. It’s time to call these things what they are. It’s time to call it anxiety. It’s time to call it depression. It’s time to call it trauma. Let’s stop nibbling around the edges of health and treating all the symptoms, like your high blood pressure and your gravitational pull towards alcohol and your flare of diabetes, we need to treat those as well, of course, that’s my job, but let’s also get at the root causes. Let’s talk about stress. Let’s talk about trauma. Let’s face these uncomfortable truths about ourselves. Because guess what? It doesn’t make you crazy, it makes you human. So normalizing these things is what I do. And you know, a lot of people are talking about mental health, wonderfully so, who are psychiatrists and psychologists, you know, wellness experts and that’s fantastic. Like any dialogue about mental health to me is welcome. What I don’t see a lot of is people, and I welcome more people talking about mental health in the primary care space, where to me, it should be a hub for problem solving where we look at mental health and physical health in tandem like two train tracks, that’s how the trains run on time. But as you know it goes back to the systemic change in our healthcare system. We just don’t make room for that. The relationship is not the priority. The relationship is really kind of a sidebar issue. I don’t think you have enough time on this podcast, Zubin, to go on, but these are the things that keep me up at night in addition to having been on Twitter and not giving myself a screen time break like I tell my patients to do. But yeah it’s time, on the eve of re-entry, it’s time for us to acknowledge the universality of mental health, to acknowledge we’ve all suffered trauma in some way or another, and to connect the dots between our mental and physical health and to kind of grow a garden of coping tools to manage everyday life and the next pandemic which will happen.
– [Zubin] There’s about 13 hours of discussion and all of it needs to be discussed because what you said first, okay, let’s call these things what they are, okay?
– [Lucy] Name it.
– [Zubin] Name it, I had a guy on my show recently, we were talking about this awakening, enlightenment and meditation and this kind of thing and he said something interesting. He said everything in the universe just wants to be experienced for what it is. It wants to be seen for authentically what it is. That includes a human organism. It includes an emotion. It includes a trauma. It wants to be witnessed for what it is and experienced for what it is without resistance. And if you can do that, that in itself is healing if you’re gonna define it. You let it pass through and you understand it and you acknowledge it and you manage it. But you don’t necessarily resist and repress and ignore because that’s just gonna make it worse. How does it manifest? In depression, anxiety, guilt, alcohol, opiates, everything that you talked about. And then those, we talk about somatization and, oh, well, they’re somaticizing and now they’re manifesting these symptoms of, whether it’s fibromyalgia or whether it’s this fake back pain or whatever it is. Okay, that’s nonsense. The mind and the body are one thing. They’re not even a thing. They’re just an energy field together. So why don’t we acknowledge, experience that and treat it? And like you said, it means a relationship. It doesn’t mean a transaction. Healthcare’s not a transaction. And then again, just putting it back to my experience yesterday, the doctor that saw me, fantastic guy, we went to medical school back in the day, we were a couple years off. He spent time, he looked me in the eye. He had a little iPhone that had a scribe that was taking notes remotely so that he could look at me. He asked me about, like, “Well what’s going on in your life? What’s it like being ZDoggMD? Is that driving you crazy? Do you get anxiety?” I’m like, “Yeah all of the above, of course, yeah. Thanks for acknowledging it. I feel better already. I bet if you check my blood pressure now, it’s gonna be 120.” And then there the labs and the screening, okay like all that’s great. When we ran our clinic Turntable, which is again, it’s the model you’re talking about that you do, this idea of re-personalized, re-humanized, relationship driven medicine that incorporates mind, body and spirit into one thing, ’cause they’re not separate.
– [Lucy] It’s so easy. So it’s easy and it’s hard because I think it’s hard for people to name hard emotions. I think it’s hard for people to take ownership of behaviors that we’re not proud of. But that’s why my job also involves providing a safe, nonjudgmental space where people can trust me. So I had a patient this morning, for example, who’s very, very obese. We have worked together for a decade and she gets on the scale and I’m like, “You know this is not anything I really, I mean I’m interested in the number, but we both know this number is just a symptom of everything else, right? So like there’s no judgment here, right?” And she’s like, “Oh I know, we’ve worked together for a long enough.” It’s a symptom of her emotional challenges that stem from childhood. It’s dysregulated eating. It’s self sabotage. And look I’m not trying to be her psychiatrist and her therapist and her mother and her doctor. I have a team of people helping her. But what would be terrible to say it to someone like her is, “Tsk, tsk, tsk, you’ve gained weight, do better, exercise more, get another gadget. Oh by the way, get a gadget to monitor your gadgets, track your steps, track your sleep.” Because at the end of the day, that’s what people are doing right? Is they have so much data, but not enough care.
– [Zubin] Absolutely, we’ve turned them into quanta of information. Well, that which is not measured cannot be intervened upon.
– [Lucy] Well that’s it. That’s exactly it. You said it.
– [Zubin] So how ’bout we measure your emotional state? Can we measure that? Can we measure your trauma? Can we measure the conditioning that went into the behavior that you’re now seeing? You know, I interviewed Jud Brewer who’s a psychiatrist who specializes in this sort of thing. And it’s this loop of stimulus, behavior, reward and we’re stuck in it but we don’t talk about that. We reduce it to a receptor or a number to treat or a surrogate marker like lipids. Oh your lipids are up so here’s a statin. Well, what else is going on, right?
– [Lucy] What else is going on?
– [Zubin] And we don’t get paid to do that in a standard fee-for-service model.
– [Lucy] And here’s how this segues into the COVID-19 pandemic, right? And the decisions we’re making about reopening. And I mean I could talk about COVID-19 all day long if you want to, but what’s more interesting to me is how it has laid bare these fundamental principles of the human existence and the human condition and what has helped. But when you think about, for example, kids going back to school, we’re looking at metrics that are by definition measurable. But what about the mental health toll, which is harder to measure? You can look at the suicide rates and the ER visits, which by the way have been increasing in adolescents. But what about all the kids who are not being counted? What about all the kids who are behind closed doors and suffering from isolation, loneliness, depression, from listening to their parents fighting, who are living in poverty since the pandemic? I mean those metrics should be woven into the fabric of our decisions about school reopening, for example. Just like in a non-pandemic era, we need to think about the mental health components of people’s health as we make any health decision.
– [Zubin] I think that what we’ve done in our response to the pandemic is we have worsened these aspects of human condition in a way that was not predictable, wasn’t done with ill intent, but it’s real. So for example, you know, we can talk about kids, but I think this idea right now fear generationed by-
– [Lucy] Let’s talk about it.
– [Zubin] Yeah, so let’s talk about the public health messaging and how it generates more trouble and problems and distrust than it does actual the behavior they’re trying to promote. And they do it because they try to speak in a monolithic voice without any deviation, any nuance, they just say, “We do this.” And they try to generate fear to the extent that they want people to comply with behaviors, but it ends up backfiring. So now there’s the Delta variant. Oh my gosh, do I need to vaccinate my nine-year-old when the EUA of the vaccine for the nine-year-old because the Delta variants infecting children? I mean, how do you think about this?
– [Lucy] I think about it this way. So in practice, when you see patients one at a time, as I do and as you do, fear is not motivating. Shame is not motivating. If I tell someone, “Look, if you don’t take this Lipitor, you’re gonna have a heart attack before you’re 50”, that just makes them afraid. If I say to someone, “Look, you gained weight over the pandemic. What’s going on? That’s kind of disgusting.”, and I shame them, that just makes them feel ashamed. But if I arm them with the tools to help them manage their cardiovascular health, like let’s talk about a reasonable, sustainable way to get more movement that isn’t gonna bust the knee injury that you had back in college or that’s gonna be unrealistic because you have a full-time job and have a lot of kids, or in the case of the weight gain, let’s talk about the underlying stressors that are driving emotional eating and arm people with tools and structure and support, that is the way you move the needle. Similarly in public health, we’re seeing this sort of blunt instrument of fear being deployed as a mechanism to get people to do things. And here’s the thing, as you know, people are smart, most people are smart and they see through that. You know, most people, people are, maybe they don’t have an MD, but that doesn’t by definition make you that smart, to be honest.
– [Zubin] Yeah.
– [Lucy] Yeah, right? But most people are pretty smart and informed about health. And most people I believe are well-intentioned and altruistic. Of course, there are people who are not. But I think what we need to do is like what we do with patients one at a time is trust the patient, trust the general public with nuanced guidance so they are then armed with the tools they need to make the decision that suits them with their doctor at their side, which most people don’t have by the way. 80 million Americans don’t have primary care doctors.
– [Zubin] Yeah, that’s one of the biggest problems is we’re such a specialty and urgent care and ER-driven kind of society that we get it all backwards. And I think this idea of like trusting the public is a key thing. Like if you just looked at social media, you wouldn’t trust the public, you’d think they were all insane. You’d think they were polarized.
– You would think they’re all insane. I would think I was insane.
– [Zubin] Me too.
– [Lucy] I mean I kind of am in a way.
– [Zubin] Yeah I mean this is actually a fact.
– [Lucy] Separate story, separate story.
– [Zubin] Exactly. But when you look at like patients, you go, oh, well look, but their behavior on posts on social media implies that they’re clueless, they don’t understand science, they’re easily misled by conspiracy theories and misinformation and so on. No, no, no, no, no, no. What’s happened is the public health apparatus, the government, physicians, everybody, have been messaging in a way that assumes that the public are idiots. And so what happens is the public goes, “These people think I’m stupid. My intuition says this. This guy who speaks in absolutes, this other guy, opposite of what the government’s saying sounds pretty convincing to me. And he’s got some letters after his name, even though he’s from some quacky quack McQuack, it doesn’t matter, he sounds like he’s speaking to my intuition. I’m gonna listen to him or her.” Right, the Sherri Tenpenny who talks about vaccines causing nanobots and magnetism, that sounds pretty compelling to someone who feels like the vaccine’s been shoved down their throat without any choice, without any explanation and they don’t feel like they’re heard, when their concerns come up, they’re called an anti-vaxxer, right?
– [Lucy] That’s right, that’s right. And at the end of the day, most people who are hesitant about the vaccine are not anti-vaxxers. I have plenty of patients who are hesitant. They just need the information, they need to be heard and they need me to be humble about what I don’t know. Do you know what I mean? They need me to admit, and I fully, I mean ask my kids, I don’t know everything. Like they will tell me that every single day, I’ve got three teenagers. I don’t know everything. I’m learning. I have a little bit more knowledge about medicine than my patients do. I look at myself as kind of like The Cheesecake Factory menu. Like here are the potential outcomes of this disease you have, whether it’s depression or dementia or diabetes. Here are the ways that in my experience and based on my understanding of the medical knowledge, it could go. Here’s the way your unique situation is happening. And let them figure out a way for you to take ownership of your health with the understanding that I don’t have a crystal ball, there are no guarantees and that you could get hit by a bus on the way out of my office today. So we have to have humility when we message. We have to have a posture of information delivery and not preaching. And we have to understand that people are generally smart and get it, and they can also trust their intuition, but we don’t do that in public health that well. At the same time, look being Rochelle Walensky right now would be brutal. It’s hard to message to people. If you don’t have a primary care doctor and you’re only using the CDC and the internet, like I don’t blame you if you’re pissed off, suspicious and exhausted, right?
– [Zubin] Yeah. It makes her job very difficult. And the thing is, you know I don’t agree with a lot of the stuff that CDC has done, but then I agree with some of it. And the thing is it’s a very tough job because you do have to be this public health monolithic voice and it’s not easy to do. And you know, CDC sometimes disagrees with WHO, and we’re talking about kids and kid’s vaccines and all of this other stuff. And what I love about what you do publicly is you’ll write up a piece or you’ll talk on Twitter and you’ll say, “Okay, here’s the risk so that you know of your child dying of COVID.” And what was it, something like one in two million or something?
– So if you talk to Allison Krug and Tracy Beth Hoeg, who I was talking to today, who are awesome, who are by the way putting out the myocarditis data in the next week or so, that’s real, it’s a real signal. And for anybody who thinks I’m reckless and into child genocide by recommending schools reopen, please understand I’m a mother, I take risk very seriously, and we need to pay attention to risks on both sides of the vaccine and COVID-19. And my job as a doctor is not to tell people what to do. It’s to help them frame risk. It’s to help people understand what the harms of action and the harms of inaction are. And so yes, on Twitter, I’m not saying do this or else because I have an MD. I’m saying think about the pros and the cons. Think about it because you’re smart and because you have access to data. Although you might not have access to data so let me give you a little bit of it. Yes, the risk of dying from COVID-19 in kids is about two in a million as of last week. It’s low. The risk of myocarditis, we’re just learning, but it’s not zero and it’s real. It’s a signal that needs to be paid attention.
– [Zubin] And for reference, the chance of getting struck by lightning is one in 500,000. So two in a million is the same as getting struck by, the risk of being struck by lightning. Now that doesn’t mean, that may be, and you’ve said this, that may be an intolerable risk for some parents.
– [Lucy] That may be. Actually, one of my best friends got struck by lightning in high school.
– [Zubin] Oh man.
– [Lucy] I know. She emailed me and she’s like, “Does that mean I’m good to go for the rest of my life?” She’s like a living metaphor. But she’s like, “But I survived.”
– [Zubin] So yeah you’re charmed, you have a charmed life. I mean and some people and they parse risk very personally through their own value system, what their own moral palate tells them is important for them and their children. So we should allow that. And I think, I agree, I did a piece on the myocarditis thing, I think the signal is real. And so this question of, I think there are a lot of physicians who take a very absolutist stance, particularly on Twitter and on the TV news shows and things like that. And the reason I tend to gravitate to physicians like yourself and Monica and others, is that they take a more nuanced stance and they say, it’s not just being anti-establishment or oppositional defined, although I have all those characteristics.
– [Lucy] I have oppositional defiance. I have opinions. Get me talking to my teenagers and I have plenty of absolutist views. But when it come to doctoring and messaging to a broad public who look, I don’t live in your shoes, I don’t live in your life. I don’t claim to know what it’s like to be you, nor should I judge you for being you. So I am here to tell you what my experience and knowledge and understanding of the facts is. And then you take what you want and understand that that’s okay. The beauty of medicine as you know is that I’ve learned so much about the human condition. I mean my patients are my teachers more than my med school professors or residency instructors, right? It’s like you learn, I learn all the time. Trauma to me is one of the most fascinating phenomena. And I’ve learned so much about post-traumatic stress and how we define traumas so narrowly in the medical world and in general, in the sort of public narrative about trauma. And then also about post traumatic growth. And so my patients inspire me when, you know, you see someone who was sexually abused as a child who then went on to develop an eating disorder that in college was just called bulimia nervosa, which it was, but it was basically post traumatic behavior. Then go on to self-awareness, self-actualization, facing the uncomfortable truths of their lives, confronting their trauma, naming it, working through therapy, regaining control of their relationship with food, and then becoming this bad-ass whatever they are, whether it’s a grocery store checker or a lawyer or whoever, I mean that to me is, those are the people I admire in the world. Those are the people I’m like hats off, you know? I live in Washington, D.C.. I do not have, I don’t get starstruck by, I mean maybe I’m starstruck by you, right, because you’re like ZDoggMD.
– [Zubin] What can I say?
– [Lucy] But I don’t get starstruck by, like I see people, like I see a lot of like VIPs, but I’m starstruck by people who are, and this sounds really hokey, but it’s true, by people who’ve like done the really shitty hard grunt work of being a human and they’ve owned it and they’ve made it something good. And then they’ve maybe helped other people with it too, which is a bonus.
– [Zubin] I think another way to phrase that, because I’m with you a thousand percent, it’s like it’s almost the hero’s journey that they’ve been under is they have found the capacity within themselves to bear a completely human life. And many of us feel that we can’t bear a completely human existence. It’s beyond us. I can’t bear that. I can’t bear that trauma. I can’t bear that emotion. I’m gonna keep reliving it. Or it’s post-traumatic stress instead of post-traumatic growth. They have figured out through help, through sweat equity and through introspection and through acceptance that they can bear it, they will bear it, they do bear it and they’ve grown from it. And those are the people, and there often are patients, that you just admire. Nothing ultimately is gonna break this person.
– [Lucy] I have the luxury of being in touch with this blind college student in Southern California, who reached out to me randomly during the pandemic because she, so she reached out to me and to Monica, because Monica is like my new best buddy, I love her and I have so much respect for her and she just needs to sleep a little bit more because she’s working too much, as do I, as do probably you. Talk about nuanced approach and humility. But so this blind college student reaches out to both of us. Monica’s too busy so I’m like let me call her. We become kind of pen pals. She in the pandemic isolated in a dorm room that’s basically a college campus that’s shut down, develops depression, suicidal ideation, she told me today, she’s like, “If you go on ZDoggMD, don’t talk about me I’m gonna be really pissed off.” And she said that reading my newsletters, listening to Monica talk on TV and the podcast is what’s given her hope and what has brought her back to life, like a hydrangea, I’m making up this analogy, I’m a big analogy person, but like the shriveled up hydrangea in your backyard in July that has been given water. And so now she’s pinging me all the time, which is adorable. But my point is that we really need to understand that mental health is health and that hope is healing and that I’m an optimist to begin with, I have to deliver a lot of bad news, but when hope is actually in the air and you’re allowed to dispense it, it’s really gratifying. My job is not to deliver false hope. That would be unethical, immoral, inappropriate, and like not good for me or my patient. But when you can actually dispense hope and say, “Hey look, we have got three marvelously effective vaccines, more on the way that basically take death and severe disease off the table, that reduce your risk of COVID-19 at all to a tiny number, that protect you from transmitting it to other people and that are powerful weapons against all of the circulating variants, including Delta, by the way, get your second mRNA shot. And if you had J&J maybe get a booster, especially as we come across the winter, we should be hopeful and we should message that with humility and an understanding that I don’t have a crystal ball and that Delta is real. There’s no denial of Delta, it is absolutely there. But with population immunity and natural immunity and vaccination rates going up, I think we’re gonna be okay. But we also need to define what that means. It means something different for different people.
– [Zubin] For every person, exactly. I get a lot of those messages too from people that are like oh, you’re the voice of sanity during the pandemic, which I’m a little uncomfortable with, because again, there’s always that fine line between is this false hope, is this real hope? Well no, it’s the best information we have at the time and then you make the decision. There’s so many people with high levels of anxiety who’ve been just housebound during the whole pandemic because they watch the news or they read the wrong social media, meaning they’re falling into one echo chamber or another. And what ends up happening is they’ll look to this and go, “Okay now what’s going on?” Now the truth is like you and I both agree on this fact, these vaccines are ridiculously effective against pretty much every variant right now that we have that’s described. Now we can vaccinate adults almost exclusively and we’ll protect children by that mere fact that we’re gonna reduce the circulating case rate in the community. That doesn’t mean that you can’t vaccinate your kids if you’ve done the risk benefit analysis and you want to do it. My 13 year old is vaccinated. It doesn’t mean I’m saying don’t vaccinate your kids. I’m saying here’s the information and there’s hope no matter what, as long as a bunch of adults get vaccinated. Do you need to be vaccinated for us to solve this pandemic? The answer is no, probably not, but I’m gonna argue that if it were me in your shoes, again with all your life experience, I would have a decision that’s based on that and it wouldn’t be my decision. But I can give you all the information and my own bias. It’s okay, right? Do you tell patients this is what I would do for my loved one? Do you ever say that?
– [Lucy] Oh my gosh. And sometimes I reveal things about myself. I mean I’m a big believer in boundaries, right? Like I don’t air my dirty laundry to everybody. But sometimes it helps to just say, “Look, I’m not here to tell you what to do, here are the choices. But here’s what I would do if you were my sister and my brother.” I also sometimes say my daughter to my older patients. I love flattering them that they’re that young. Or, “Here’s what I would do.” Because yeah people, one of the ways that we help people is by modeling behavior. It’s one of the reasons why I wrote that piece for CNN that some people had strong negative reactions to about unmasking in my exam room with my vaccinated patients once I was vaccinated to my model vaccine confidence. Because if I can’t take my mask off with a vaccinated patient who’s willing right-
– [Zubin] Yeah you don’t force ’em, yeah.
– [Lucy] I’m not like wrestling people to the ground and take that mask off.
– [Zubin] “Listen Esther, get that mask off your face or you’re out of here, okay? I’m gonna get my MA to drag you out.”
– [Lucy] Yeah that’s just not my vibes, like coercion if you can’t tell. But the point is, so modeling, I’m not a role model in every way. I was up last night too late on Twitter. I drank too much alcohol with my friends sometimes and I regret it later, not because I have an alcohol addiction, but because I just like my friends. We could go on. I’m just saying in medicine it can be helpful to model behavior. And what I’m trying to also do in my newsletter and my public facing stuff is just talk very honestly about myself. Like I haven’t experienced trauma like other people have, but I have a life experience that I’m happy to talk about to the extent it’s appropriate or helpful for other people. In other words, I’m human too. I have biases absolutely. I have blind spots. And I know there are things that I do not know. I’m absolutely aware of that, but I’m also trying to learn more about what I don’t know and I’m trying to learn more about what I don’t know. There’s just not enough hours in the day.
– [Zubin] Yeah. I mean there’s a humanness to being vulnerable with our patients that I think many patients really deeply connect with. And part of the intuition of being a physician is knowing when and where that’s appropriate and setting those boundaries with each patient. And each patient’s very, very different. I’ve had patients where I tell them my life story and that helps and I’ve had patients where it’s very formal and professional and you’ve got the tie and that’s what they expect from that interaction. But in all cases, you honor who they are, but you don’t ignore who you are too because I think that’s part of the problem with our own sense of moral injury and unsustainability of the job is if we can’t be authentically ourselves on at least some level, it becomes an unsustainable job and we’re not good at it and then we feel like cogs in a machine. We call that burnout. That’s really the end stage of kind of chronic moral injury where we’re torn in all these different directions. I want to be who I am, but I have to be this person or this person or this person. To some degree, that’s a part of life. We have to play different roles. We play the role of mother or father. We play the role of son or daughter. We play the role of coach or coached. And that’s okay too, because as humans, we’re infinitely flexible and resilient when given the capacity and support to do so and the space to do so and the vulnerability. Being able to show vulnerability in the face of when we feel like we can’t, it actually allows us to expand into a space where we might actually be able to do it.
– [Lucy] Yeah, I think you’re so right. I think the pandemic has, again, to say it again, laid bare how very vulnerable we are as human beings, as individuals, and how very vulnerable we are as a population. And how imperfect science and medicine are and how, I’m just sort of processing as the pandemic comes to a close, with of course an asterisk on that, how we might reenvision what it means to be healthy as we enter this next chapter. I think back in 2020 when it was those hair on fire days of what should I do if I’m coughing? Should I stay inside? Can I go to the grocery store to pick up food? Do I need to wipe down the doorknobs of my house? That’s actually where my newsletter was born was out of necessity to try to dispense information to my friends, family, patients, as quickly as I can, ’cause the was ringing off the hook and I couldn’t answer all the calls, But since 2020 at that moment, we’ve watched in real time, the general public and doctors and scientists all around the world, the airplane being built in the air and we’ve witnessed how messy and imperfect and flawed and how controversial it is. And I think what’s been disconcerting for a lot of people who are generally healthy and maybe thought that wearing a Fitbit and having a sleep tracker and using the Peloton and getting their cholesterol checked once a year was health have realized like, oh shit, like I’m really vulnerable, like I’m anxious. I drink too much. I have a relationship with my spouse that is really toxic. I don’t feel safe in my house. My kids are suffering. I don’t know what to do. And so that’s what I’ve been seeing in my office. And people have really been sort of stripped to the studs if you will. And that’s the conversation I like. That’s why I started this conversation with you saying screw the small talk because I’d rather go right to the hard stuff. I’d rather talk about death and rectal bleeding, than how the weather is, although the weather is fine to talk about. My point is that if the rubber meets the road when you’re in a global pandemic and you have to take a hard look at your life because you’re forced to, and I think people have realized how vulnerable they are as people, as individuals, how vulnerable we all are together and what would be cool, and this is like a fantasy of mine is that we, number one, we realize what it means to be healthy, that it’s mental and physical health in tandem, that it’s not enough to check the boxes at your doctor’s office once a year. It’s about your everyday thoughts, feelings, behaviors. We need to acknowledge that we have fears and anxieties that inform our decisions, that we can’t help, that fear when it’s in the driver’s seat makes us do crazy stuff and make decisions that we wouldn’t otherwise make. It makes us intolerant of even tiny risks. It makes us lose perspective of risk at all. We’ve been hyper-focused on this one virus when it’s time to sort of head up and look around and realize, whoa, there’s risk everywhere. There’s a risk of, I mean there’s risk everywhere. There’s wonderful opportunities everywhere to be sick and distressed. And then secondly, that we realize in healthcare that we must give people access to primary care medicine where behavioral health is woven into the fabric of healthcare. It’s not enough to have people come in and get the boxes checked once a year. We need to address people and see them for who they are. We need people to be fully seen and heard. And we need telehealth to keep going as an adjunct, not a substitute for healthcare. And we need every American to have healthcare as a right, not a privilege with behavioral health woven into it, with unfettered access to mental health services. Now I will probably be dead before that happens and the federal government pays for it, but that’s what I hope for and that’s what I would love for my kids to have. Right when they’re older that they say, look, I had the flu and I went to my doctor. I also had my depression, you know, my brain flu and I got that dealt with my therapist. And it’s just a matter of fact and it’s part of health.
– [Zubin] You know, this is a fundamental transformative stage of the evolution of healthcare where we go from this caterpillar that’s nothing but a consumptive creature that’s destroying the ecosystem around it, that’s just eating, eating, eating, and acquiring, acquiring, acquiring to the cocoon and the chrysalis and the metamorphosis into the butterfly that actually gives back to the very trees that it was eating by pollinating. And that kind of looking at inclusive holistic medicine, that means behavioral health, physical health, spiritual health, all these other aspects of it. And we always talk about how we’re gonna pay for it. Is it single payer? Is it government? Is it what? We ought to be talking about what it is and then-
– [Lucy] What is care?
– [Zubin] What is care? What is care? Because I’ll tell you the biggest purse strings in the country apart from the government are self-funded employers. And they could actually spend their healthcare dollars wisely on care like you provide, on what these very innovative pioneers in healthcare, like Iora’s and ChenMed’s.
– [Lucy] Iora’s, I love Rushika.
– [Zubin] Rushika was our partner at Turntable Health, at the clinic that we ran for three years.
– [Lucy] Oh my God, he’s amazing. So he was a couple of years ahead of me at Harvard Medical School and is really an inspiration.
– [Zubin] Yeah you were a Princeton, Harvard, Hopkins gal, right?
– [Lucy] That’s my jam, yeah.
– [Zubin] What a gunner, oh my gosh, I love it.
– [Lucy] I am like one of those weird people, I was really nerdy, but really social too, extroverted. When I got with my husband I met in college, he was the like soccer player with hair out to here and kinda this wild child and I was the pre-med buttoned up student, but always social. People thought we would last about five seconds together and here we are 21 years later, three kids and he’s the wind beneath my wings and sometimes the wings and the engine and all of it together.
– [Zubin] I think you and I share the same spouse, just mine happens to be female and introverted.
– [Lucy] Really?
– [Zubin] Yeah, same thing, same dynamic, right? And you know I always tell people, I’m like the most important sort of business decision you ever make in your life is who you marry because you will never find success and happiness if you marry for the wrong reasons or there’s, I don’t know that there’s the wrong person, there’s the wrong reasons that you marry sometimes. You’re not really being authentic to who each of you are. And for us, it was the same thing. People were like, they would look at us like we were insane. Like, “You’re a couple, how is that? You’re diametric opposite.”
– [Lucy] Because is she, what is her vibe? I gotta get to know this gal. What is her situation?
– [Zubin] So I’m the extroverted but nerdy class clown type who’s always wants to be the center of attention. She’s the introverted Asian quiet type who has a very advanced sense of humor, but will only deploy it on people she’s very close to. And so everyone’s like, “This makes no sense. Like what do you talk about?” And it’s like, that’s the great thing. We talk about anything we want to talk about without any preconceived notions about what that’s gotta be. And that kind of connection is so stable, like I mean it’s been almost, I don’t know, we started dating in 1999. And unless I’m missing something, I don’t see a divorce in our future. And of course I’m always the blind one. So she’s probably at home like already writing up the papers.
– [Lucy] She’s like writing the papers right now?
– [Zubin] Exactly.
– [Lucy] Yeah I mean no. You know what the other essential ingredient in a marriage is to me, or any relationship really, including with my patients is humor. I mean obviously humor can be inappropriate, right? Like I’m not a big-
– [Zubin] Guilty.
– [Lucy] Put a Whoppee cushion under someone’s chair when they come in as you’re delivering like an end of life conversation.
– [Zubin] You don’t do that? Shit, that’s my jam.
– [Lucy] I got to start doing that.
– [Zubin] Just have a seat. Okay so here’s the thing, we can do stuff for you or do stuff to you, your choice.
– [Lucy] Right, right, right. No but I mean humor, life is so hard, it’s so hard to be a human, no matter who you are, whether you’re rich, poor, black, white, gay, straight, like it’s hard to be human. If you can’t laugh about things every now and then, so some of the people I respect the most in addition to my patients who are like trauma victims and trauma survivors are people who are really funny, including my husband. He is freaking hilarious. He’s like the pied piper of our friend group.
– Humor is like being able to see the paradox in the universe, which is the universe is made of paradox. And laughter is that tension between things that seem paradoxical. When you’re saying yes and no at the same time, that’s funny, that’s funny. And that’s why I love like we talk so much about how race is tearing us apart and we have all these social and class distinctions and all of that. And yet a comedian can go up, a really good comedian can go up and make you laugh at this stuff in a way that it’s cathartic. You know, Dave Chappelle’s a great example.
– [Lucy] Oh my God, I love Dave Chappelle.
– [Zubin] I mean the way he, I mean his original stuff, like the Clayton Bigsby, the black white supremacist routine that he did in his original Chappelle Show was genius. And everybody across any sort of racial spectrum or class spectrum could laugh at that in a way that actually brought people together because it, yeah this is true and this is true. He’s like, “Connell”, I can’t, I’m not gonna do it because it’ll make our thing PG-X. But the point being is I think there’s a role for that. And I think what we’ve done is we’ve kind of come a ways towards silencing some of those voices for fear. Right again fear driving so much, like fear of being ostracized by the prevailing wisdom that we have to all speak in one voice about race. That’s not true. The whole point is we’re a diverse species that’s beautifully flawed. And we do get on each other’s nerves and let’s laugh and find the common humanity instead of-
– [Lucy] Well that’s it. And I think you just said it. I think humor can be disarming and it can be a relief because I think we all have, we all have vulnerabilities, we all have shame. We all think we’re the only one who has like bad breath or farts or like has body odor or like has like hemorrhoids. And so when those things are made to be funny, not just body parts, but like humor in general, it’s giving people permission to kind of release some of the kind of emotional energy that they have that makes them feel ashamed when actually we’re all thinking the same thing, right, we’re all thinking the same thing. We all have fears and vulnerabilities and major flaws. It’s just whether you name it or not. And so that’s what I try to do with my patients is, and what I’m trying to help people do in the pandemic is like, just be honest with yourself. Like no shame, no blame. You can shame yourself. People do all the time. Plenty of people walking around with tons of shame. But if you can turn the shame into a conversation with yourself about what is it that makes me vulnerable and then how do I dig out from that and how do I face those fears, that’s really the birthplace of health. So yeah, I think that, I don’t know if you know, Brene Brown. I mean she’s kind of become this like popular figure.
– [Zubin] Vulnerability Barbie, yeah.
– [Lucy] She’s the vulnerability Barbie. She talks about shame for a living. And who knew you could talk about shame and make such an incredible career out of it, but she’s done it because she’s relatable and she’s funny and she tries to appeal to a wide audience, which I think is mostly like middle-aged women and you.
– [Zubin] And me. Yeah I saw her live in Las Vegas. It was one of the best talks I’ve ever seen because she came off as authentically her. She wasn’t playing a role. She was being her. And that’s so appealing. It’s so magnetic because I think we look at ourselves and go, what part of me is not authentically allowed to show itself? She’s doing her thing. Like she’s talking about very taboo subjects, very painful subjects, and just puts it out there in a knack, now it helps that she’s an incredible communicator and clearly she prepares and puts in her sweat equity. But man, the total thing is an experience of joy. You just go, this is great and I feel better for it.
– [Lucy] She’s giving people permission and naming these things that are universal truths of the human condition, right? Like she’s giving us permission. I think you’re right, in the world we live in, and the world that came well before you and I were even alive, it’s hard to be human and it’s hard to acknowledge uncomfortable parts of ourselves. And she does that beautifully. And I think we need to bring the kind of work that she does, for example, into medicine. So like she’s a social worker, she’s got a PhD, she’s a brilliant mind. Why though is shame and vulnerability being talked about not in the doctor’s office? Like that’s what I’m trying to do is bring it into the doctor’s, it’s medical. So like it’s not just for Gwyenth Paltrow or, I mean don’t even get me started on Gwyneth Paltrow. I think she’s a wonderful actress, she looks great in pink at The Oscars.
– [Zubin] We could just stop it right there, yeah.
– [Lucy] I’m just gonna stop right there. I’m just gonna stop right there because I don’t want to sound mean and I’m not catty person, although maybe I am, but I’m just trying to say like let’s bring all that knowledge and awareness and put it into the doctor’s office. And then let’s help understand how vulnerability and the behaviors that are born out of it, like drinking too much, binge eating, being in an unhealthy relationship, making choices that are self-sabotaging, how those inform your blood pressure, your cholesterol, your weight, the way you sleep, your nutrition, all those different things. Because again, I think I’m preaching to the choir here that health is not just about a single virus. Health is more than the absence of disease, right? It’s our lived experiences. It’s our everyday existence.
– [Zubin] It’s almost like you can call disease the physical correlates of emotion and thought and consciousness. They’re almost like what those things look like from a human mind. They look like a-
– [Lucy] My kids tease me. I have this as a poster, the periodic table of emotions.
– [Zubin] You weren’t kidding about being a nerd. That’s amazing.
– [Lucy] I’m so nerdy. So I’m a huge alliteration nerd, I’m a grammar nerd. I’m a nerd in so many ways.
– Can you read off some of those emotional elements?
– [Lucy] Oh my God. My kids and I were laughing about it. So they think I’m such a nerd, they tease me about it which is really fun. I love my kids teasing me because it’s love, you know what I mean?
– [Zubin] Mine do it too.
– [Lucy] At least that’s what I call it.
– [Zubin] Mine do it out of pure spite but yeah, it’s equally loving.
– [Lucy] It’s so fun ’cause they’re old enough now that, my kids have wickedly keen senses of humor and they like make me spit my drink out laughing. They’re also the moral police, like they just, anyway, they crush me. So like the periodic table of emotions, the goal of this table and the reason I have it and show it to patients is because it’s supposed to help, let’s define these different feelings you have, let’s name them. Instead of calling, like I think a lot of people think that emotions are like, like the primary colors, like blue, red, and yellow, like we have anger, happiness, sadness. But there’s actually a whole lot more nuance, to use my favorite word. So frustration, hostility, confusion, suspicion, insecurity, disgust, melancholia, weariness, dread, fear. And then on the fun side, love, gratitude, trustfulness, sympathy. What we were laughing about at dinner the other night is clearly they were looking for like one more because they had one spot that was empty and the intern couldn’t think of another emotion. So one is called BM, bad mood, which is like they just were like, you know what, it’s Friday at five, we gotta think of one more emotion, just knock that, BM it.
– [Zubin] What I love about BM is it’s sensitive but not specific. It’s perfect, you know? It’s a nice screening test. BM? Pretty high, pretty high. Can’t tell you why but-
– [Lucy] Right, the other ones are like CO, compassion, GR, gratitude. But the point of the periodic table of emotions is that we’re more than one trick ponies, right? We can be glad, we can be sad. Like I’m delighted I’m vaccinated against COVID-19. I’m heartbroken to see what’s happening in India and Latin America. I can hold two emotions. It’s the holding paradox concept, right? I can be like at my mother, she’s not gonna listen to this, I love my mother, but I can be pissed off with her and love her so hard at the same time, like in the same moment. And so the point is in the emotional range, we need to acknowledge these feelings, own them, and then connect them to our physical health and our everyday habits because we’re creatures of habits and we do stuff that is on the one hand good for us, like brushing our teeth, flossing before bedtime, which I should do more of, going to the gym, sitting up straight, taking our medicines and then we do things that are bad for us, like that we know are bad for us and then we do things that are bad for us we don’t know are bad for us. So all of those behaviors are driven by these emotions and we all have them.
– [Zubin] I’ve never heard a primary care physician talking about emotion the way you do. It’s so important. It’s exactly what you’re saying is taking the Brene Brown ethos and bringing it into the doctor’s office, which is where it’s always belonged, but we’ve never, and I think some of that, this is me editorializing, some of that is that medicine has historically been a male profession for the majority of its history. And therefore guys are really good at denying they have emotions other than anger. And I think part of it too is we misunderstand even what emotion is. I think we feel like there’s a lot of stigma around emotion, there’s a lot of reason to resist emotion. If you really look microscopically at what emotion is, you have thought, which is this kind of amorphous thing in the thought space and you have sensations which are physical in the body. It seems to me an emotion is like a waystation between the two, between these physical sensations and thought. And that’s why they’re so deeply all connected. You can get butterflies in your stomach related to the emotion of fear or anxiety or anticipation, those complex emotions and then you can then start to trigger thoughts, which tell you stories and beliefs about the emotion, including the belief which I think is the core belief, this emotion is good or bad, welcome or unwelcome. And I think once we start to bifurcate it like that, that’s when the trouble begins because when you categorize it good, bad, you’re no longer allowing yourself to feel the pure emotion and it makes it more difficult. But that’s what we do as humans. That’s kind of our piece. But nobody talks about that stuff, especially not doctors. They’re just like, well, so you like a PSA? Here are the pros and cons of the PSA.
– [Lucy] Right, it’s funny though, when you invite the conversation as I’m sure you do with your patients and you do on your podcast, people are so happy to talk about this stuff. When you give them permission, so I will have the most uptight guy let’s say, and I’ll ask them about like so how’s it going, how are you doing with the stress of the pandemic? Sort of give them some of the vocabulary if they don’t want to talk about it themselves. Like, how are you managing the fact that your job is really busy and you’ve got three kids and your mother has cancer? I mean is that stressful or do you feel like you’ve got it kind of buttoned up? If you give people permission to talk about it, they really do want to talk about it. And part of the problem in medicine is we don’t have time to talk about it. But if I can help the person talk about those feelings and then say, “Well maybe that relates to why I’m drinking too much or why I’m staying up too late or why I have insomnia. And then that’s why I drink coffee all day long and that’s why I have a stomach ulcer and that’s why I have to take Prilosec all day long, which gives me a headache.” I mean that’s how we unlock health. But you know it’s interesting, it’s really cheap to to talk, right? Like it’s really inexpensive. So if we could just make it so that, I would love for graduating medical students who are going into primary care, which by the way when I was graduating from Harvard Medical School it was almost a dirty word that I wanted to go into primary care. And certainly when I left Hopkins, I mean I loved Hopkins, it was wonderful, but it was a little bit strange that I wanted to go into primary care medicine. But if we could help people understand what is possible in primary care, what you can do, that you’re the hub for problem-solving, and not just a gatekeeper, in an ideal world and when healthcare is reformed in a better way, and then help people understand what is it under the hood of human beings, then we can make primary care sort of the jewel and the crown. I mean again this is all hypothetical theoretical, but I will die thinking about it or dreaming about it.
– [Zubin] No, I think is what we talk about is Health 3.0. This is what Rushika and I used to talk about. It is the future of healthcare. It has to be. There’s no other way to do it because we’ll bankrupt ourselves before if we don’t. So this is inevitable. It’s just a question of do we do it sooner or later and in what cataclysm results in it I think?
– [Lucy] Yeah and is it gonna be the federal government or is it gonna to be the private sector? That’s interesting.
– [Zubin] It’s a very interesting question. And my bias, I’ll put my bias on the table, my bias is that having worked as an entrepreneur in this space with Rushika and others is that the private sector when incentivized correctly by government can actually do this in a public private partnership that doesn’t require a frank single payer socialization. It would require a hybrid where the poor are covered and everybody else is covered by employers in an affordable way with a primary care centric health system that’s a hub and spokes with the specialists that focuses on all the things you talked about where we’re paid well to do good for patients. That’s it.
– [Lucy] It’s very simple. I could not agree with you more. I could not agree with you more.
– [Zubin] I think that’s it. You’re already doing it. That’s the thing, you’re on the ground doing it in D.C.. You have a website, right, lucymcbride.com?
– [Lucy] That’s my website. And so what I’ve been doing since the pandemic as I said, is trying to, so I’ve actually cut my practice in half just as of like a month ago, because I’m trying to help reach a wider audience to the extent anyone wants to listen about what does it mean to be healthy, to empower people with some tools and guidance and a little bit of dorky humor so that they can think a little more broadly about what it means to be healthy, to bring with them to their own doctor if they have one or to be inspired to see a doctor or a therapist or a nutritionist or whoever they need, a trusted guide to help them go from point A to point B. Because hopefully on the eve of the pandemic’s end people will start to think wow, that sucked. I think I need to be better prepared not just for the next pandemic, but for being a human.
– [Zubin] Yeah, yeah, man I love it. I love that you’re doing that. That’s authentically you. That’s where your journey has taken you. I’ve seen your website. The writing on there is beautiful. Your op-eds are beautiful.
– Oh you’re nice. It’s funny though. I mean we should talk about this either now or another time, but like I can’t be anybody but myself, but you do get smeared publicly for talking about stuff. The more people you reach, the more you get smeared. And it’s a very, very bizarre phenomenon. And I don’t know how you put a fence around that, but-
– [Zubin] Let’s talk about that. Yeah no because this is one place, I’m not a mentor for people. So in other words, I love to teach, I love to teach.
– [Lucy] You’re mentoring me right now so.
– [Zubin] So that’s what’s interesting. I’m not a mentor for people typically except in this instance, because there are so few physicians and healthcare professionals who are putting themselves out and inevitably there’s patterns of stress that come up and one of them is exactly what you just said. I am authentically me and I’m rewarded with all this hate. And what I would say is having been through all this and continue to go through it is that the hate that you get is inevitable because what you’re saying is you’re also taking a stance. And by being authentically you, you’re saying this is also what I’m not, and that’ll trigger people. It’s always, always about them. It’s never about you. It’s always about what you’ve triggered. And once you start to recognize, okay by being authentically me, that’s the only way I can be in the world, some people are not gonna like that. That’s okay. And then starting to recognize our own negativity bias. So when we see one negative comment in a stream of a 100, oh you can’t sleep at night, but you could get the most beautiful, amazing, inspiring email about how you’ve changed someone’s life, like the blind student you were talking about, it would make you cry, but it’s forgotten instantly the minute you get, “Hey, you’re a dangerous clown who’s like in pharma’s pocket.” And it’s like, oh.
– [Lucy] You’re like. And the other thing is as Steph Loral said to me on Twitter, he said, “Just mute the shit out of Twitter until you’re having fun.”
– [Zubin] Oh yeah, it works great.
– [Lucy] That’s a great tip because I only got on Twitter actively in February this year.
– [Zubin] Oh wow. And you’ve already got like a whole bunch of followers.
– [Lucy] Yeah I mean my newsletter is what’s growing the fastest because that’s my home base.
– [Zubin] And that’s at your website, people can sign up there, yeah, yeah.
– [Lucy] Yeah but it is fascinating and it’s an exercise in practicing what I preach to patients, not that I’m saying, hey, go out there and get your ass kicked by people on Twitter to my patients. But thankfully I’ve done enough therapy in my life to know when to hold ’em and know when to fold ’em and not to react. You know I kind of feel like before you’re allowed to have a Twitter account, you should have to go through DBT, dialectical behavioral therapy, which is like the mantra is don’t just do something, sit there. Because there are lots of times where my finger is like twitching and then I’m like, you know what? I’m not even gonna reply because that just enables that person’s narrative and they think that I’m interested in that trash talk. That’s not to say I’m not interested in criticism. I’m very interested in criticism and feedback and constructive ’cause again I don’t know everything and I need to know more and I want to learn more and I need to know what I don’t know. But it is interesting the more you put yourself out there, and especially when it’s authentic, like if I was trying to be somebody who wasn’t me and I was getting attacked, it’d almost be easier because I’d be like, “Oh, well they’re attacking that persona.” But I’m actually putting me out there. I talked about my own child and the decision whether or not to get vaccine dose number two, which I did what you did which is she got it. And not because I think everybody in the world should do that but because that was our decision.
– [Zubin] Exactly.
– [Lucy] But then someone started doing this riff on Twitter about how I’m this awful child killing-
– [Zubin] I got that.
– [Lucy] So I actually wrote them privately on Twitter. I said, “Hey, this is my child. Can you just not?” And you know what he did? He said, “You know what? I was being really impulsive and reactive and I just liked the reaction I got and I’m gonna delete that and I’m so sorry.”
– [Zubin] Dude okay, stop-
– [Lucy] It was amazing. It was amazing.
– [Zubin] Listen, we forget that human beings are on the other end of these things and people who attack us forget that as well. And so what happens-
– [Lucy] He admitted it though, it was amazing.
– [Zubin] And they will almost always when you do what you did, which is private message and say, “Hey, I saw your tweet. Just so you understand, this is how that sits with me and how it makes me feel and this and that and the other thing.” And every time that’s happened to me and every time I’ve done that, I’ve had an incredibly satisfying and beautiful interaction. In fact, I had someone send me a death threat, like, “I will kill you and your family and this and that. You’re a horrible murderer of children” for promoting vaccines, you know, for measles say. And I emailed them back and I said, “You understand that you’re threatening another human’s life and that that human has an email and has your email and I take it very seriously because I love my family very deeply, which is why I vaccinate them” and so on and so forth. And they wrote back and said, “Uh, I’m actually, this is why you upset me and I didn’t mean to threaten your life. It’s just it came out that way, I have impulse control problems, but this is what you do that really upset.” And we had a dialogue.
– [Lucy] So great.
– [Zubin] This is the thing. These are human beings. You can do that. And the more you do it, Lucy, the more you’ll start to come into those, you’re already way ahead of the game, because you’ve gone through all this stuff. For me, it was like a trial by fire, like I was Mr. Impulse. Like someone would say shit and I would go off and it felt good for a minute and then I couldn’t sleep ’cause I’m like why’d I go off on this poor person? And the best emails you get are the criticisms that are actually constructively framed. “Hey, I like your show, but here’s what’s really upsetting me.” And then can dive in and go, am I wrong about something or is my approach wrong? It’s great.
– [Lucy] Right, right. No, this guy who kind of apologized, he actually apologized, we ended up, it was like the emojis, like heart, heart, heart, heart, it was like, you would’ve thought he was my new boyfriend all of a sudden. It was great, it was great. But it is a metaphor for kind of human interaction in general that we assume, we’re quick to judge, when actually we’re all just kind of twitchy and trying to get through the day and do stupid shit and like tweet things that we don’t mean to. And if you call people out on it, but in a nice way and say, “Hey, that hurt me”, it doesn’t always work like that, right? And by the way, the positive feedback I’ve gotten and hopefully the same way for you, the positive, like your show is extraordinary, it’s enlightening, it’s helping people, it’s moving the needle, it is a breath of fresh air. And I hope you hear that more than you hear the haters saying that you want to kill baby seals or whatever. But like the positive stuff, I do soak it in. Like that’s what I tell my patients to do. It’s like this whole practicing gratitude thing, which sounds very corny and like-
– [Zubin] No, it’s real.
– [Lucy] Of a journal at T.J. Maxx or whatever. But practicing gratitude is actually a way of discharging adrenaline and calming our bodies and minds. So I do soak it in. So when I get a nice email or a note or some, I got a handwritten letter from a guy who wrote me, this was like back in the summer of 2020. He said, it’s gonna make me cry but I’ll try not to cry. He wrote, “I’m a black man in South Carolina. I’m a tough nut to crack. If you can reach me, you can reach anyone.” I just cried, I cried. It’s gonna make me cry right now. And I’m not trying to sound like I’m God or something. I’m just a girl who’s trying to like tell people a few things that I know, but that, like that stuck with me. And so I don’t take the negative stuff and let that consume me because I realize it’s people are just, we’re all so desperate for attention and desperate to like get stuff off our chest. And so I don’t disparage people. I just am like, wow, this is new and weird and very, very fun.
– [Zubin] Look, all true. This is one thing that I’ve realized only recently. I think I have a lot of resistance to taking compliments and kind things because it feels egoic. It feels like, oh now I’m gonna revel in my greatness. You know what a wonderful thing Zubin is that he’s able to get these emails. And that feels wrong, it feels inauthentic. It actually feels like it’s coming from the wrong place. And so instead the reaction formation is to discount it and say, forget it. But recently what started happening is when I get an email like the one you got, which is so beautiful, this is what happens. I realized what the emotion is that I feel. It’s a warm open expansion that is gratitude on every level. It’s gratitude to the person for taking the time out of their day to say a nice thing to a stranger. Who does that? It’s pure gratitude. And then the gratitude that you’ve been given some way to help people that you never thought you’d do and you’re just like uh, and it’ll make you cry.
– [Lucy] Oh my God, it makes me cry thinking about it right now.
– [Zubin] Just thinking about it. It’s what Jonathan Haidt calls moral elevation. You just feel like ah. It’s a sense of open expansion. Even your body language changes. You open your arms instead of contracting. If we can even name that, now people will start to recognize, oh I feel that sometimes. Maybe a nurse who never gets enough thank yous, but that one patient who gives you the thank you and you just feel this sense of expansion. It’s not about you anymore. It’s about transcending you. It really is.
– [Lucy] And it’s really important to breathe those things in because there is so much negativity and there’s so much hardship in life. I mean we all face hardships. And so if you can take those, and that’s one thing that pandemic, if you can talk about opportunity in a pandemic for a second, if you can breathe in those little moments like where you’re sitting on the couch on a Saturday night with your teenage kid, who would much rather be at a party with their friends, but if you’re in lockdown and then you look at them out of the side of your eyes smiling at the show you’re watching and you see how happy they are and then you feel like this joy go over you, like that is awesome. It’s not to say I don’t also love buying a fancy pair of shoes and doing superficial things as well. But I think the pandemic has, if you’ve had the luxury of taking the time to think about it, no matter who you are, to drill down into what it is that gives you meaning. And for me, it’s those relationships with my patients, with my family, with other people. I mean the relationships I’ve gained in the pandemic with like you right now, with Monica, with Tracy Beth Hoeg, with Allison Krug who is like, oh my God, Allie Krug, epidemiologist, her brain like blows me away, same with Tracy. I’m on this group text with these women physicians, from Lillian Brown at UCSF and Jean, oh my gosh, what’s her last name, at UCF who’s the ER doctor who just wrote that opinion piece for the Wall Street Journal.
– [Zubin] I can’t remember. Ah, I’m drawing a blank.
– [Lucy] Yeah anyway, and it’s so much fun because we’re all trying to help in a hopefully authentic way to share knowledge with humility and to help people understand that there’s no black or white. There’s lots of nuance and there’s lots of complexities in medical decision-making. And again, my little tagline #mentalhealthmatters. It’s not just a hashtag, it actually does matter. And oh Dan Griffin. Oh my God, you get TWIV?
– [Zubin] Yeah.
– [Lucy] This Week in Virology? It’s Vincent Racaniello and Dan Griffin, he’s become a new buddy. Anyway, those relationships have become so fun. I mean it like reminds me of residency all over again.
– [Zubin] It really has created a kind of collegiality, like I’ve got my crew too, you’re in it as well, Monica Gandhi, Vinay Presad, sometimes Jay Bhattacharya will pop in, Marty Makary. And again, these guys get a lot of hate. They get a lot of hate. But to a one, and I will say this, I’ll say this right to the camera, to a one, these are the most authentic, caring, passionate people, they have no ulterior motive in any of the things that they’re doing that I can detect and I sit with them off camera and spend time and my BS meter’s quite attuned.
– [Lucy] You have a good BS meter, I can tell.
– [Zubin] Well it has to, I developed it through a lot of practice. Like when I moved to Vegas initially and I had to deal with a lot of different people, you start to learn to smell BS and learn to smell inauthenticity, ulterior motives and those kind of things. And then the hardest part, Lucy, is like turning that lens on yourself and going what’s really going on? Like what’s my ulterior motive here? Why do I really want to want or not want to do this? Can I name what that is? And then authentically respond from a place of understanding instead of a place of repressing that or hiding it or whatever it is, inauthenticity. And that’s one thing now, like you’re the same way, you cannot not be you. It becomes painful. And I’ll actually start becoming mean if I’m forced to, it’s like a reaction that I have, if I’m forced to do or be something that I’m not, I start to lash out in these ways. And then I recognize it and I’m like, I can’t do it, this is not me. Whereas in the old days I just would have been an asshole or I would have been passive aggressive or I would have-
– [Lucy] I would have loved to have known you back then. That would’ve been so entertaining.
– [Zubin] Oh complete asshole, yeah, yeah.
– [Lucy] Well I mean look, authenticity is hard to find and I think, that is like if I can be my authentic person and then help someone else, that is like, like I could just die and go to heaven right now. I’d rather not die. I’d rather get my vaccine and not die, but luckily, we have choices here.
– [Zubin] Yeah and we do have choices and we need to tell the public they have choices. It’s not a black or white answer. You said nuance is one of your favorite words. I know that’s true.
– [Lucy] I made a tee shirt that said, “Make nuance great again.” Want one?
– [Zubin] No because we had a tee shirt that we sold that said, “Nuance.”
– [Lucy] No?
– [Zubin] Yeah and it had some tagline. Yeah, I think we’re both kind of alt middle thinkers here.
– [Lucy] I’m an alt middle thinker. I mean I live in Washington, D.C., I could throw a stick and hit the White House. I didn’t grow up in a political family at all. I grew up in just like a family of like musicians and artists and social workers and people with a lot of humor and high emotional intelligence. What’s my point? Was that I grew up in Washington D.C. where politics is in the air, right? It’s like the national news is our local news. Yet there’s really just nothing political about, I mean there’s nothing political about this virus, there’s nothing political about anything I’m trying to message. In fact, one of the cool things about medicine is that it’s stripped of politics, it’s stripped of agenda, or it’s supposed to be. I have biases clearly. I mean not intentionally, but we all have biases. But one of the biggest tragedies of the pandemic is the politicization of it, like the politicization of masks, for example. Masks have become this symbol of on the one side oppression by the federal government, on the other side, this notion of being able to control the uncontrollable. And it just doesn’t have that kind of meaning. It’s basically a little piece of cloth that’s supposed to maybe protect you from a virus when you’re in a global pandemic that by the way is going away so we can stop wearing masks at that point.
– [Zubin] Can we talk about that for a second? So this idea of locus of control, I know we’re going over time here, but do you have a little more time?
– [Lucy] I’ve got time, yeah.
– [Zubin] Okay, perfect. The locus of control for this pandemic has been all over the place. Like, oh we can throw a piece of fabric on our face and we’ll be safe. Even with the vaccine, well if we vaccinate, we’ll be safe. Now that actually locus is more accurate, at least with the data that we have, than almost anything else, right? But that locus of control is a conditioned response it seems of even a community. So here I am in the San Francisco Bay area, we were the first to lockdown, we were the last to open up, masks were happening even before the thing was declared a pandemic, people were wearing masks. I think largely because we have a high population of Asian immigrants and that’s a natural response to any sort of wave of illness that happens. It’s a cultural thing. So now that we’ve, California opened up on June 15th.
– [Lucy] I know you did. Monica cut the ribbon, right?
– [Zubin] Cut the ribbon, I tore my mask off. I don’t even know if I have a mask anywhere. Well, here’s the thing, anywhere I go in the bay area, 95% of people are still wearing masks outdoors and indoors. Even though the signs say, “If you’re vaccinated, you don’t have to wear a mask” and 70% of people in this community are vaccinated. So it makes you go-
– What is that? I mean I think I know what it is.
– [Zubin] Tell me.
– [Lucy] I think it’s because the pandemic has been so politicized. I think people are afraid of-
– [Zubin] Looking like a Trump supporter.
– [Lucy] Chastised or looking like they’re, looking what?
– [Zubin] Looking like a Trump supporter. Here in the Bay, if you didn’t wear a mask before, you were virtue signaling that you were a Trump supporter. If you wore a mask, you were virtue signaling that you weren’t. It’s crazy.
– [Lucy] I think it’s a signal of maybe your politics. I think it’s a signal, it’s become this sort of like moral code, like I care about other people, which when you’re vaccinated, the best thing you did to care about other people is to get yourself vaccinated. That’s the way you protect other people from the virus, not by wearing a mask after you’ve been vaccinated. Unless of course there’s some other circumstance which you would talk about with your primary care doctor and figure out. And I’m not gonna shame people who wear masks. I saw a guy walking by my house as I was driving to work this morning and he was wearing a mask outside and sort of exercising and I’m not gonna make him feel bad but I thought gosh, I wonder what that is? I think it’s probably a little virtue signaling. I think it’s probably fear because even though the CDC guidance changed on May 13th on a dime, a little late, in my opinion, it doesn’t mean our thoughts and feelings and behaviors can change on the dime. So I think it’s that we don’t totally know. like is this real? Like really I can take it off?
– [Zubin] You talked a bit in your piece on fear about this bit of uncertainty. I think people are still very uncertain. They don’t trust the CDC unless it’s something they say that’s concordant with their pre-existing bias of fear. Like the national nurses union came out and said, “We disagree with CDC talking about community masking for unvaccinated and vaccinated people coming off.” And I thought, well this is really remarkable because this is a healthcare organization coming out against CDC based on what evidence exactly? And you’re right, CDC was late and they did it abruptly, which made it worse ’cause suddenly you’re like, is there some political thing here? Like what’s going on?
– [Lucy] I feel like they were trying to overcompensate for the caution and hypercaution.
– [Zubin] Yeah, the impending doom.
– [Lucy] Because that led to more mistrust. And then those charts with like all of the different gradations of what you can and cannot do. It’s like you need to laminate it and put it in your wallet to know like can I?
– [Zubin] It’s like they’re completely unnuanced for most of the pandemic, and then all of a sudden they go into too much nuance.
– [Lucy] Too much nuance. It was too much. It was like choose your own adventure and just so confusing. So I don’t know. I think fear is a major driver right now. I think it’s normal to be afraid after you’ve been bathing in fear for 15 months. It’s normal to be hyperreactive to small risks. I mean how many people call me during the day to say can I do this now that I’ve been vaccinated? Can I do this when I’ve been vaccinated? Can I see my grandkids? Can I get on a plane? And I’ve been writing about this stuff twice a week. I talk to patients one at a time as well. But they still want permission one at a time and validation that the vaccine is as effective as it is. And it is. It’s not to say that the Delta variant isn’t real, that there are breakthrough infections, we should expect that. But the truth is you’re probably not gonna die, you’re probably not gonna get that sick. If you did get the Delta variant, if you were in that unlucky tiny percentage of people, you’d have a mild respiratory illness. It’s hard for people to let go of that fear. I think it sort of has infiltrated our pores. And that’s not to say that fear should be, we should make people feel ashamed of being afraid. It’s part of being human. That’s how we run from danger. It’s how we run from the tiger in the wild is that adrenaline and cortisol, those hormones pumping through our veins. But when the tiger has been put in the cage and it’s now a house cat, we don’t need to behave as if it’s this wild animal. But of course, we’ll see how things go. We’re following the data every single day, you and I both.
– [Zubin] Yeah, and we’re open to changing our mind in the face of new data, but right now my take is, hey Delta variant or not, if you get vaccinated, you’re probably good. In fact, a lot of people who don’t get vaccinated will probably be good too-
– [Lucy] Because of natural immunity.
– [Zubin] Natural immunity and the dropping of case rates in general. Now that doesn’t mean if Delta really is much more contagious than that means there will be this idea of these two Americas, the vaccinated, the previously infected, there’s three Americas, and the unpreviously infected who will now get Delta variant infections and may end up hospitalized and so on just like with regular COVID. So we just accept that and say, okay, we’ll teach as much as we can and people will make decisions. If you’re worried about your family, get vaccinated. If you’re worried about your family, you can still wear a mask if you want, although I would rather get vaccinated. And if you’re not worried and you’re cool and you’re okay with risk, then do what you want I think. I think there’s space for that.
– [Lucy] I think the thing that’s giving people the most fear right now is the kids. And again, I’m not a pediatrician, I don’t claim to be a pediatrician, but I think it’s hard for people to understand that there are other risks to children that are more dangerous than COVID-19 if you look at the statistics. There are kids who are certainly at higher risk for COVID-19 than others, but this is where pediatricians one at a time need to counselor of their patients. But you know, parents I think understandably, and I’m a parent too, and I hyper-focus on certain issues with my kids and then have to kind of zoom out and realize, wow, this kid is more than just his algebra grade. You know, let’s realize that there are other threats to their health and safety and wellbeing than COVID-19. COVID-19 is a threat, it is there, it is real, but in the scheme of things for most kids, for healthy children, it’s only one pathogen and it’s only one threat.
– [Zubin] Yeah, yeah. You know I actually hope that intermittent masking occasionally in the winter when there are things going around happens because I think it’s more effective actually for influenza and RSV, even though the studies haven’t really shown, historically looking at influenza, the studies on masks did not show a lot of benefit, but we see it’s almost gone. I don’t think it’s just masking though, I think it’s physical distancing-
– [Lucy] I think it’s the whole kit and kaboodle.
– [Zubin] Everything, closing schools, international travel, all those other things and some viral interference from the predominant pathogen, which is COVID. So it’s a whole mix of things, but we may be, it’s gonna take five years to figure out, more than that to figure out what really happened here.
– [Lucy] But if we have to mask up, I mean look we are not gonna close schools down again.
– [Zubin] Yeah I hope not, I hope not.
– [Lucy] Those should be the last thing to close, the first thing to open. But if we have a mask in flu season or when whatever the virus de jour is out there, fine, but that’s a relatively benign intervention compared to the blunt instrument of lockdowns.
– Yeah agree, lockdowns, really I would almost say never again unless you have a highly fatal, highly penetrate, kills kids and adults-
– [Lucy] Radioactive-
– [Zubin] Radioactive fallout. ‘Cause look at the damage. And we still don’t even have great evidence that they work. So it’s kind of like wait, and even now we’re not even studying it the right way. How do you do a cluster randomized controlled trial on lockdown versus not that controls for all the confounders of what’s going on? Like usually by the time you lockdown, shit’s gotten so real that it was going to peak and level off anyways. So how do you know what your intervention did? Vinay talked about this a lot, Vinay Prasad.
– [Lucy] Vinay Prasad is so great. He’s so great. He’s so fun to listen to and so fearless.
– [Zubin] He’s another one in this kabal with us that gets really into getting into brawls on Twitter. And it can be counterproductive to our mental sanity. I almost feel like my only advice to you Lucy is to just delete Twitter and just make videos and write pieces and just-
– [Lucy] So I might delete Twitter. I took a Twitter break over the weekend for 24 hours and it was just delightful.
– [Zubin] Awesome, right?
– [Lucy] So do you just take breaks from it entirely?
– [Zubin] Well no the way I do Twitter is I don’t do Twitter. I have the account, I just hate deleting an account with like 74,000 followers because I’m that egotistical. I’m like, oh I’m throwing away this thing, but I’ve come very close. I’ve had my mouse key hovering over the delete button. That’s how close I’ve come to Twitter because I find it to be very counter-productive for my mental health, because people are, they’re anonymous on there, and it’s not the right medium for me. So what I do is I do a dump and run scenario. I dump a video on there with the little pithy saying and then I run away and let it percolate and let people shout about it. Every now and again, I’ll engage on Twitter, but it’s not my platform, whereas YouTube, Facebook, Instagram, those kind of things are my platforms and so I do engage in those much more.
– [Lucy] It’s really, really, really, really good advice. My favorite, I mean aside from seeing my patients and hanging out with my family and my friends, ’cause I’m a social creature, I really love writing. And when you are distracted by Twitter, when it’s on, like tab is open as I’m trying to write, it’s like a mosquito. It’s just very difficult and so addicting. And it really, really harms the creative process or at least it makes it take forever.
– [Zubin] I agree, I agree. I think Vinay would agree too. What I think is what we started doing as a family is a screen-free Sunday where everyone turns their devices off for a Sunday. And it’s so awesome. Man, it’s like rediscover your family much? Like wow. What do we do when we can’t have screens? Oh, we have to talk and play games and like go eat at a nice place and really pay attention to the present moment. What?
– [Lucy] It’s so nice.
– [Zubin] It really is.
– [Lucy] Wait till they’re a little older when they have like girlfriends and boyfriends, although then you just invite them to the brunch.
– [Zubin] Oh gosh, that’s gonna be, imagine me with like one of my daughter’s like suitors, what that would be like. Hey so how many followers do you have on Twitter? I have this many. It would be that kind of thing.
– [Lucy] But it does get better. It’s not that it was ever bad parenting, it’s just hard. But I think it gets more fun as they get older. And my oldest child, for example, is more like my husband and I learn so much from him just about flexibility, authenticity, humor. So I had Henry, my oldest, when I was a intern at Johns Hopkins, right before we got disaccredited for breaking all the rules for abusing residents which I love, now I’m one of those people who can say to current residents at Hopkins, “Back in my day”. And so I was pregnant then. And he really forced my hand on a lot of things. One of them being my decision to go into primary care, to address mental and physical health at once, because I realized, wait a minute, I have mental health too. When you’re dealing with being an intern, being pregnant, when pregnancy wasn’t like a thing back then. So anyway, I learned from them, I learned from the kids. And they have taught me so much because they’re all completely different from me. If you think you have control over the universe, have kids, right? And that’s a good lesson.
– [Zubin] Actually, you kind of nailed the really fundamental truth here, which goes even deeper than all that, and that’s already pretty deep, right? This idea of the kids teaching us how the universe works. If you feel like you have a real sense of agency in the most fundamental way, I can tell you it’s not what you think it is. And when you actually see what it really is, it’s like the universe kind of unfolds and you’re there. There’s a witness there. But when you try to control every aspect of it, you are in for a very unpleasant ride and a lot of suffering and a lot of emotional turmoil. And when you actually surrender to the authenticity of the moment and then act spontaneously from that surrender, you actually will find that things tend to come about in ways that are much more concordant with happiness. And that’s the simplest way to put it, yeah.
– [Lucy] I think that’s right. And I think again, like that’s what the pandemic, if we allow it to, if we have the luxury to let it teach us lessons, ’cause it’s obviously taught us a lot of really awful lessons and it has brought us so much destruction and despair. But if you can let it teach you that we really don’t have that much control over the universe, that even doctors, public health experts, epidemiologists, we don’t always know the right answer, we are fighting on Twitter. Mom and dad are arguing. That look, we only have today, we only have each other. And so let’s make the most of it. That is a, it sounds a little hokey and it sounds conveniently cute, but I really mean that, that I see so many people struggling every day to control the uncontrollable, whether it’s trying to control like a relationship that is unhealthy, they’re trying to kind of make it something that it’s never going to be, or they’re trying to lose weight by chronically dieting and doing the keto diet and then the Mediterranean diet and then they’re doing Atkins diet. What they really need to do is work on the fact that their relationship with food is disrupted and the dysregulated emotions and let go of the attempt to control something that is uncontrollable. And then they actually lose weight when they do that. And so whether it’s emotional or physical, I think realizing with humility that we don’t have that much control is on the one side is healthy, but then also arming yourself with the tools you need to try to exert some control over things you can control. Like the serenity prayer is one of my favorites, right? It’s like, let me know what, I’m not gonna say it, because I’m not a religious person, I’m not gonna say it beautifully, but let me understand what I can’t control and stop trying to control the things I can’t control and let me try to control the things I can control and give me the wisdom to know the difference. That’s really helped, that’s sort of the holy grail. It’s sort of directing your attention away from things you can’t control and towards the thing you can control. And COVID-19, we can lockdown, we can wear masks, we can distance from each other, we can sit behind screens and try to control the uncontrollable and we can do the best we can, but we also need to live.
– [Zubin] I think when we get lost in our own thought stream and our own belief stream and our own anxieties, we forget that something is staring us right in the face right now and that’s the present moment. We do anything we can to project ourselves out of what is happening right this second. And what is happening right this second is not a problem, it’s never an issue, it’s just what is. And when we surrender to that, often we feel those raw emotions, we are more in touch with our authentic selves. And this is not a kind of spiritual bypass where you just do that and you don’t work on all those other things, right? Because that’s not gonna work. You have to do all the things that you said, which I think is absolutely right. But instead we get lost in the sauce as I like, ’cause that was another tee shirt I wanted to make, don’t get lost in the sauce. And you end up on this ride where your thoughts and concerns and anxieties are taking you. And again, then you fail to see what’s really happening, what’s the relationship to the emotion, what’s the relationship to eating, what’s a relationship with you and me, what’s going on here? And that requires a vulnerability, which is where Brene Brown’s teaching comes in and an authenticity, which is where what we’re talking about comes in. And when you tie it all back into health, the pandemic and being, we now have an opportunity that’s unique in our modern history, which is we’ve had a great defibrillation.
– [Lucy] Yes, control alt delete.
– [Zubin] Control alt delete all our old baggage. Now is our chance to decide. Do we click on the file? As Joe Rogan once said, “Do I click on that file that says all my old baggage and open it back up or do I keep it close for a while and see where it leads?” And so I think that’s where we are.
– [Lucy] I think it is where we are. And the other metaphor here just to keep going on the meta is there are these kind of seemingly competing camps, right? The zero COVID camp and the kind of let it rip camp. But just like in individual health, there’s a lot more, I’m not saying when you, when I say let go and realize you don’t have control, it’s not to say like let it rip and just be at the mercy of the universe in terms of your own personal health. But I’m also not saying try to tack down every single risk to zero because that’s not possible. I’m saying know what you can control, know what you can’t. Try to know the difference. Find a trusted guide, whether it’s a doctor, nurse practitioner, a spiritual advisor. Ideally they have a medical degree so that you could then practice evidence-based medicine with your doctor or whoever it is. And then tune out the rest. Because there’s so many messengers, there’s so many megaphones. It can be really hard to think. It can be really hard to know who to trust. Get a diverse portfolio of people you trust when it comes to your own health and do the best you can.
– [Zubin] I think that is beautiful parting advice for everybody, Dr. Lucy. I am really excited, I mean I’m gonna pitch your site to everybody, lucymcbride.com, we’ll put it in the links.
– [Lucy] So nice.
– [Zubin] Your email, all the other stuff, there, the list that you have, follow you on Twitter, I’ll put all those links in. You’re a voice of passion and reason and truth I think in a sea of like where you’re just kind of going what’s going on? I think if people are anxious, if they’re full of fear, if they listen to, again, a trusted physician like yourself, who’s actually nuanced and accepts when we don’t know everything, knows what we don’t know, and isn’t a victim fully of the Dunning-Kruger effect, unless you’re in the valley of imposter syndrome, where I seem to live all the time.
– [Lucy] That’s another podcast we should do together, imposter syndrome, fascinating one.
– [Zubin] I can’t wait. I’ve talked about it quite a bit. I think we could go deep on that. And so we’ll have you back to talk about all the things. Z-Pac, for you guys, share the show, join our tribe, all the usual calls to action. I love you guys. Until next time, thank you, Dr. McBride.
– [Lucy] Zubin, you’re the best. I mean so much fun. I’m gonna come out to San Francisco the next time.
– [Zubin] Oh yeah, in-person’ll be the best.
– [Lucy] In-person.
– [Zubin] Yeah Zoom is a poor facsimile of reality. So we’ll get it to happen.
– [Lucy] Yeah plus you got that background there. I got to see that in person. I mean that is legit.
– [Zubin] It’s burning hair. We just put it in. You guys are seeing it for the first time. I’m sitting in the guest spot ’cause we wanted to mix it up. All right, guys, I love you, we are out, peace.