- I'm no stranger to being critiqued
and confronted, even trolled online.
But when it comes from a fellow medical colleague,
I tend to take it a little bit more to heart
because I want medical colleagues to be able to criticize me
and for us to create better information.
I think this is a group effort
when it comes to educating people online,
but when it comes from a place of toxicity,
that's when it becomes problematic.
Let's first watch the clip that caused the controversy.
Different traumas can actually show up
as physical ailments later in life.
- What?
How do you work through that then?
- Well, first, you have to be honest
and do a proper workup and make sure it's not anatomical.
You have to do proper history.
You have to do a physical exam.
We have to get imaging to make sure
there's nothing going on anatomically,
again, there's no tear,
there's no broken bones, all that.
And then you see if the patient is open to it.
You have to say, "Hey, I think that I've ruled out
"everything anatomically that could be wrong,
"and I'm thinking that this is real.
"You are feeling this.
"I'm not saying this is in your head.
"The root cause is coming
"from something mental health related.
"Do you wanna try and talk about that?"
And if they're open to it, we do it,
and it works a lot. - Wow.
- And what controls the volume
of the pain is our mental health.
The initial feedback was very positive.
People started talking about how their experiences
were shaped by their mental health,
how their pain was impacted by things going on
inside their minds or within their lives.
And I thought, great, we accomplished two goals here.
We had a short-form piece of content perform very well,
and then we were also able to educate a million people plus.
Then started coming the controversy,
as with any piece of content that gets wide distribution.
Now, the negativity was about people saying
that I'm a doctor who's now gaslighting his patients
and saying that there is nothing wrong with them.
This is all made up in their minds,
which goes exactly the opposite
as to what I was saying in this clip.
This is real.
You are feeling this.
I'm not saying this is in your head.
I saw a comment up here from a verified
physician colleague of mine, an orthopedic surgeon,
a DO, and I was curious about their take on this matter
because I always love learning from other doctors,
especially subspecialists who are experts in this field.
But I was sad to see
that the comment that was left by this physician states,
"Why do so many people take medical advice
"from a pediatrician when the topics
"have nothing to do with pediatrics?
"#clickbait."
I honestly haven't been as confused in reading a comment.
I'm not a pediatrician.
This really has nothing to do with pediatrics.
This person came in again and said,
"In general, there's a lot of medical information
"about topics he and others aren't experts about.
"It would be like me as an orthopedic surgeon
"giving info on a cardiology subject.
"I'm not the person for that info."
They rightfully go and correct themselves and say,
"Ah, right, family doctor.
"Again, each specialty should stay in their lane."
"Orthopedics is not his lane.
"That's an orthopedic surgeon's lane."
"He is assuming the musculoskeletal pain
"is a mental health issue when he isn't an expert
"in musculoskeletal conditions."
Now, obviously, I get upset reading this.
I work with orthopedic surgeons.
I've trained under orthopedic surgeons.
I had a focus on sports medicine
preparing to become a sports medicine fellow
after family medicine,
but all the social media stuff got in the way.
So I have a lot of experience
treating musculoskeletal conditions.
And to see a fellow ortho say that no one else
is an expert on musculoskeletal conditions except them
made me feel upset because it's inaccurate.
I went on and clicked on this person's name
and wanted to see if they've ever messaged me before.
Lo and behold, they messaged me before,
and the message, from a few years ago, states,
"Love what you are doing, brother.
"I'm a fellow DO and an orthopedic surgeon.
"If there's anything I can do for you,
"ever answer an orthopedic question for you
"for any of the projects you're working on, etc.,
"please let me know."
Oh man, what happened in the few short years
that this person loved what I was doing,
all of these things, and now is so critical?
For another doctor to publicly call out
a fellow colleague and then generalize
against all the other colleagues as well,
they must see something malicious
in the intent of the content that they're posting on.
And I didn't feel like what I was posting was malicious,
let alone even controversial.
Pain medicine organizations, ortho organizations,
physical medicine and rehabilitation organizations
stand by these principles,
that mental health plays a role in physical health,
and that we need to be more cognizant of it.
In fact, what we do wrong as physicians
is oftentimes write off mental health.
So I respectfully said, "Hey Doc,
"I saw your comment on my latest video.
"Curious what part you felt was inaccurate?"
This doctor writes back, "Well, I'm an orthopedic surgeon,
"so I look at it with a different perspective.
"I specialize in lower extremities, but I take care
"of a lot of professional athletes in general.
"But say I see someone with a shoulder issue
"that I can't quite put my finger on despite my exam,
"and imaging doesn't always give you a clear answer either.
"All day I see athletes with normal MRIs
"but have a musculoskeletal issue.
"I don't, at that point, assume it's a psychiatric issue.
"I assume that I'm missing the diagnosis,
"at which point I will send to my colleague,
"who is an expert in shoulder issues
"in professional athletes.
"If he can't figure it out, which I would say
"between us both would be exceedingly uncommon,
"then maybe we consider psychosocial issues, etc.
"But again, of all the thousands of patients we see,
"it's less than 0.5%.
"Now, maybe psychiatric issues like depression, etc.,
"can complicate the issue in regards to pain tolerance.
"It's not that the actual musculoskeletal
"pathology is not real."
I think my fellow colleague's response here
brings up a few points.
One, our patient population is very different.
This person treats pro athletes.
I treat real people.
The rate at which legendary running back
Adrian Peterson heals won't be the same rate that I heal
or one of my patients who has heart disease or diabetes.
The way that they experience symptoms is gonna be different.
They need to be able to deliver a fastball
100 miles an hour with millimeter accuracy.
My patient needs to be able to type at a desk
without experiencing high levels of pain.
And while my orthopedic colleague here
thinks that I'm diagnosing this as a psychiatric issue,
what I'm saying is psychosomatic issues,
which is the medical term for this,
can raise the volume of symptoms.
It's not saying there's no pathology,
and if our mental health state isn't clear,
if we're dealing with something,
if we have traumas that have been unaddressed,
these are not necessarily psychiatric diagnoses,
but these mental health conditions
lead us to experience pain worse
than what the anatomical condition or pathology is.
There's actually a book on this
called "The Body Keeps the Score"
that talks about how adverse childhood events,
that trauma from our childhood
can actually leave physical symptoms
in our bodies into adulthood.
I didn't say that I don't involve specialists.
I didn't say that I don't get a second opinion.
In fact, if a patient still thinks
that there's something anatomically going on
or we're not just getting a clear diagnosis
that I'm comfortable with,
we absolutely continue finding what the cause is.
I even pointed out in my response message
that we can disagree on how often mental health is a leading
or contributing factor to the symptom of pain.
But is it necessary to put down a fellow DO
and say inflammatory lines like, stay in your lane?
He did offer to remove his comment
if he was offending me, and that was nice.
I had a genuine question for this physician.
"Should only cardiologists talk about high blood pressure
"because they are the experts of the heart?"
Who is the expert, who is allowed to talk on it?
He states, "It's a good question,
"because even in some specialties like ortho,
"there are docs who don't have enough knowledge
"to speak on certain subjects, and this includes me,
"so I don't give advice on it.
"I would guess it's an individual decision,
"and you would hope it would be based on
"what the doctor feels comfortable with.
"Problem is these days, social media,
"people just wanna talk about stuff
"just for the hell of it to get clicks.
"Not saying that this is what you do."
No, my friend, that's exactly what you said I do.
You wrote #clickbait on my post,
and we couldn't really find a moment to agree on
except when he said that he actually liked what I was saying
and he would eventually use the same approach
with patients in the future.
It really ended up getting confusing.
And all of that is to say one thing,
we need to do better as physicians,
as medical professionals communicating online.
What I'd like to see happen
is how Dr. Rena Malik critiqued me
and communicated with me after seeing a clip of mine
from the very same interview about testosterone.
Now, Dr. Rena Malik didn't just leave a random negative,
potentially even toxic comment under the video.
She messaged me privately saying,
"Hey, Mike, letting you know recent data
"shows that there is no evidence
"of increased cardiovascular risk with TRT,
"and the original study data that was popularized
"was actually incorrect and later corrected
"but still got propagated through the medical community.
"Blood clots, yes, not heart attacks."
I was so happy that she sent this.
I love to get critiqued, challenged by my colleagues.
I wanna get better as a doctor.
I wanna do the right thing and put out accurate info.
In fact, I've made mistakes before.
I've even shared that in a whole video.
So here, I understood
where Dr. Rena Malik was coming right away.
Testosterone replacement therapy is used for patients
who have low testosterone for whatever reason.
There's multiple reasons.
When I asked Harry this, he said that he is on TRT.
- And my doctor was like, hey,
like, your test levels are fine.
You could be better.
Let's juice me up.
- This is steroid use.
This is not TRT.
It's using testosterone to create
what we call supraphysiological levels of testosterone,
meaning higher than normal.
So the risks are not gonna be the same as TRT.
This is why I began to explain to Harry Jowsey
the risks of using testosterone when you don't need it,
like heart disease, like infertility,
and pointed out those issues.
And I needed to confirm that I was thinking correctly.
So I asked Dr. Malik, who's a urologist, and I said,
"But what about testosterone use above normal?
"Because what he's doing is not TRT,
"it's more like steroid use."
And I pointed out an article
from the National Institute of Health
that shows using steroids to get higher levels
of testosterone will create heart disease.
She goes, "Yes, in supraphysiologic levels,"
but she's worried that people
who are truly low testosterone,
which she calls hypogonadal,
and they're trying to be eugonadal,
meaning they're restoring
their normal level of testosterone,
would see this video and be worried.
And I said, "That could be a problem,
"and I probably should leave a note in the video
"to make sure that I'm clear in what I'm communicating."
And she agreed that it is nuanced.
Thank you, Dr. Malik, for correcting me
where I could have done better,
but for not resorting to toxicity online
because that wouldn't help anyone.
So I updated my caption on Instagram
based on Dr. Malik's advice, and we came together
and ultimately made a better piece of content
to educate others about unnecessary steroid use.
And that's the goal of communicating online as physicians.
Do not seek to destroy and always look for nuance
because nuance is a superpower,
just like Jonathan Haidt said on this channel.
Very engaging, worthwhile conversation,
author of "The Coddling of the American Mind."
Definitely check this out.
As always, stay happy and healthy,
and don't leave toxic comments.
(upbeat music)