Complex Benign Gynecology: Mandy and Lara
Show Notes
Episode 1 of No Referral Required starts strong with the voices behind the podcast: Courtney, Mandy, and Lara. In this candid kickoff conversation, listeners get an inside look at the world of medicine through the lens of two complex benign gynecologic surgeons and one patient advocate. Mandy and Laura share their journeys from medical school through residency and fellowship, explaining the training, specialties, and career decisions that shaped their paths. Along the way, they demystify medical jargon, discuss the realities of surgical practice, and offer a behind-the-scenes perspective on what it truly means to care for patients in today’s healthcare system.
The episode also explores the human side of medicine - how doctors make difficult decisions, balance risk and quality of life, navigate patient relationships, and adapt to a rapidly changing landscape shaped by technology, social media, and AI. Through thoughtful discussion and plenty of humor, the hosts tackle common gynecologic conditions, explain when patients should seek specialty care, and encourage listeners to become informed advocates for their own health. Whether you’re a healthcare professional, a patient, or simply curious about what happens beyond the exam room door, this episode sets the stage for honest conversations that make medicine more accessible, understandable, and personal.
Transcript
Courtney [00:00:08] Hey, everybody, and welcome to episode one of No Referral Required. We’re so glad that you’re here joining us. Episode one. Yay! Technically, we have episode point five, which if you have not listened to that, please go back and listen to that. We just kind of gave you some behind the scenes, introduced ourselves, told us kind of the why as to what we’re doing. So just for a refresher, I’m Courtney. Mandy. And I’m Laura. Yeah, and so we are two doctors and one non-doctor that are discussing all things behind the scenes of medicine. Specifically with specialties that you maybe have always wondered, what is that? What do you do? What are you? What do you know? What are you gonna do to me? Why would I go see you? Things like that. So that’s kind of the goal of this podcast. So our first episode, we actually had somebody else plan, but then they had to reschedule. Yes, right. I mean, especially with doctors, we are finding out. I am finding out. They know. It does make the most sense for our first episode to be interviewing you guys, Mandy and Laura.
Mandy [00:01:14] Once you said it, I was like, ding ding, of course.
Courtney [00:01:18] Because you are doctors in a specialty situation, like specialty, and it would just be really good for us to hear from you guys exactly why you’re doing what you’re doing, what you do, and how you got there, and things that maybe only a patient would know to ask. So that’s part of why I’m here. Well, that’s pretty much the only reason why I’m here is that I can be the patient side because I do not, just as a refresher, do not have a degree in any kind of medicine. my degree’s in child development, but it is, I’ve been through some medical things, and so I feel like as I was going through that, I kept getting, like, learning a little bit of what I needed to ask, and I hope that that is what I’m able to bring to the table, is things that either a listener who is also not medical would want to ask a doctor that is in that specialty, or something that they don’t think they’re, they haven’t thought yet to ask when they go in that situation. Because definitely when my first appointments, I’m like, yes, whatever you say, whatever. Yeah. Yes. Which I do still say that, but I also am like, but let me ask this one question, you know, like I kind of have learned a little bit when you go around the block a couple of times, you know what to ask a doctor. So you’ve got a crash course. Yes, yes, yes I did. Somebody said, I’m basically an oncologist now. That’s right, that’s exactly right. You’re probably more up-to-date than many. Well, maybe, maybe, just because I was with very up-to-date oncologists, yeah. So for all of us listening, remind us of your area of expertise, your job title, however you want to talk about it, your specialty.
Mandy [00:02:57] All right, so this is Mandy talking, just so you can get used to hearing what I sound like. So Laura and I are both minimally invasive gynecologic surgeons. That’s a mouthful. We have forever been known as MIGS because it’s just so many syllables. And just recently the acronym changed because every now and then a specialty likes to throw a curveball at the general public and all the referring physicians and change their name. So you might also see it as complex benign gynecology or CBG, which I am forever trying not to say the acronym for marijuana. Whenever.
Courtney [00:03:32] But MIGS is a Russian missile. Yeah, that’s true. My daughter’s initials are MG, and some of her friends call her MIG. Call her MIG all the time.
Mandy [00:03:40] So I’m like, oh, that’s funny. OK, all right. Yeah, so the designation is just like, we take care of gynecologic problems, surgically and medically. But when we do surgery, we try to do it in a minimally invasive fashion. So that means like laparoscopy, robotics, vaginal surgery.
Lara [00:04:00] Hysteroscopy, it’s a fun thing. We get to put a camera in the uterus. It’s very unique to our specialty. Nobody else does that. You do the oophectomy? Oophorectomy, that’s what it is. I always love that word. That’s a new one I learned. We do have a lot of O’s in our words.
Courtney [00:04:15] It’s a lot of funny names.
Mandy [00:04:17] It’s a minor in Latin.
Courtney [00:04:18] So what training goes into doing what you do? guys do?
Lara [00:04:25] Yeah, so you go to medical school, that’s four years. You do a residency in obstetrics and gynecology.
Courtney [00:04:32] Do you have to major in anything in particular in med school or in undergrad? What does that start at? How do you get to med school?
Lara [00:04:43] Not, there’s not any, not specialty wise, but as an undergraduate, you need to do physics and chemistry and biology. Those are requirements for application. And you have to take the MCAT, which is big, long standardized test, and then submit your application. And that’s just for medicine, generally, for everybody. And then four years of medical school, or DO school.
Mandy [00:05:05] Yes, that’s true.
Lara [00:05:06] Another path. DO. Oh, yes. Yeah. Say that. What does that mean? Oh, different kinds. Oh, yeah. That’s a great segue. We should get into that.
Mandy [00:05:12] Yeah. So in the US, there are two medical degrees that come from two different types of school. The MD is what people are most familiar with. Which stands for? Medical doctor. Allopathic. Which is an allopathic path. Oh, jeez. Yes, right. You need to write these down. More Latin. And then the osteopathic path, which is you get a DO when you graduate. That’s your degree, your doctorate degree, which stands for doctor of Osteopathy, or as we used to say, a doctor begins with D-O. So are y’all D-Os?
Courtney [00:05:46] No, Laura’s an M-D. I’m an M-D. She’s a D-O. And I’m a D-O. Oh, so you took two different paths to get to the same thing. Yeah, pretty much.
Mandy [00:05:52] And they are so very similar. The D-O schools, philosophically, have a more holistic focus. And they offer some things that are similar to what chiropractor type medicine is with manipulation of bones and joints and muscle tension. Right, yes, which is funny that I became a surgeon. But at least I became a minimally invasive one. So you can go either path. DOs are the minority by far. And they’re sort of geographically situated where there are D.O. schools. So there are areas of the country where you hardly will see a D.O. They’re actually more in the military, actually. There’s quite a few in the military. But from there, M.D. ‘s and D.O. ‘s can go to residency at allopathic institutions, or DOs can go to osteopathic residencies, which are actually few and far between and getting much less. But they both end up kind of at the same finish line, where you’re board certified, even though they have separate certified tests.
Lara [00:06:59] Yeah, it’s sort of a different flavor, even though they’re equivalent degrees. Right. Okay.
Courtney [00:07:05] Okay. So residency is how many years for, well, it varies for obstetrics and gynecology. It’s four years. Okay. So what are you doing while you’re a resident?
Lara [00:07:15] You’re doing it all. So you rotate, you work on labor and delivery, you deliver all the babies. A lot of residencies also have an emergency department rotation where you kind of learn how to treat things. You also will rotate through gynecology and surgery and issues.
Courtney [00:07:31] When you’re doing emergency, are you a general physician in the emergency room, or are you the person that they call when they’re like, hey, there’s a woman here that is having a baby, and you need to come and save her life? That kind of thing. Great question.
Lara [00:07:44] Yeah. As a resident, if you’re rotating through, you sort of act like the ED resident. The goal is for you to learn.
Mandy [00:07:50] So you’re Dr. Carter. Yes. But do they call you for all the women things? Yes. Absolutely. Because they know you’re interested in that? You’ve already declared it? Well, you’re there, and most people who are there are not interested.
Lara [00:08:02] It’s just your rotation. I picked up a chart once when I was on mine. It was like testicular torsion.
Courtney [00:08:07] I was like, , I should go back. Someone else knows more about this.
Mandy [00:08:11] But a lot of other specialties do have vagina amnesia. They just choose to forget. Selective vaginal amnesia.
Lara [00:08:24] Tag, you’re it. Many times. Our favorite chief complaint presents to ED with vagina, so therefore OBGYN. Yeah, whatever.
Mandy [00:08:31] You have one, call OBGYN. Right. Half the population, but that’s fine.
Courtney [00:08:35] Sure, sure, just forget about us. Okay, so four years of residency and then after that?
Lara [00:08:41] After that you can either be done and practice and be a general OBGYN, do obstetrics and GYN surgery. A lot of people do both, but there are some additional pathways you can take if you’re interested. There’s actually many and growing different things that you can consider.
Mandy [00:08:57] Remember, we talked about that doubling time last time, which actually got my facts wrong. And for medicine, it’s 73 days. For the general knowledge, it’s less than a week. But the current medical knowledge doubling time is 73 days. That’s still pretty quick. That makes me feel a little better. I know it’s quick, but like… General world knowledge, less than a week. Medicine, 73 days. It’s still a lot. But yeah, that’s how we get subspecialization.
Courtney [00:09:18] So you guys took the route to go specialize in this particular area. That’s when you made the choice?
Lara [00:09:24] Yes, during residency. So you do a similar process to applying to residency. You fill out an application, you do an interview. When we did it, you did it in person. These days it’s kind of on Zoom. And you are matched again. So this is a match day. Yes, it’s a match day 2.0. So we do this weird thing in medicine where you put your list of programs where you would be willing to go, and then the programs put in a list of applicants they would be willing to have. It’s like a sorority. That’s exactly it. It’s very much like that. It goes into a black box. An external company has a proprietary algorithm that nobody knows. You’re not joking. OK, I thought you were bringing this joke home. The computer decides where you will live and work.
Mandy [00:10:04] The computer decides.
Lara [00:10:05] And that’s it. You move, you go. So it’s not like you get offers and you decide. Choose. You just get one.
Courtney [00:10:12] And you already said, yes, I’m going to do it. Yes, by entering the match. You only list places where you’re really OK with. So where did you each end up going at that point?
Mandy [00:10:24] For fellowship.
Courtney [00:10:25] Oh, so this is to get a fellowship.
Mandy [00:10:28] Yes, you do it for residency as well. So we did it twice. Yes, thank goodness we didn’t have to do it.
Lara [00:10:34] So I matched my first choice, which is at the Academic Medical Center, where I work, with Dr. Yonkers. That’s how we met. She trained me. Taught me everything I know.
Mandy [00:10:47] I think I knew that, but that’s funny. That’s fun. I, , matched at UNC for my fellowship in Chapel Hill, which was my first choice for fellowship. And how many years do you do the fellowship? It was two years, but they do offer it three in some places right now. Okay. Yes. Most of them are two year fellowship. Why would you want to do a three as opposed to two? Oh, they’ll add something like research year or a simulation training year where you can get a master’s in education or something along those lines. So some sort of, Add more letters. Extra feather in your cap, yes.
Lara [00:11:18] Especially if you’re thinking of an academic career, maybe a path someone would choose.
Courtney [00:11:23] You need a credential like that. Okay, so after fellowship, then you get a job?
Mandy [00:11:27] Yeah, so this time you actually have to interview like a real person in the world, which you are not prepared for. So like, you know, look at a contract and weigh those things. But yeah. And you have made a lot of contacts, you know, in your training. And you use those to sort of like, hey, will you talk to so-and-so at WashU or at UT Southwestern or whatever.
Courtney [00:11:50] You know, I’m interested in moving there. appeal of going into continuing education in person is that you get to make lots of contacts and then you still have those contacts forever.
Mandy [00:12:05] But you learn also to not burn bridges. You’re always auditioning.
Courtney [00:12:14] How many times do you graduate? How many times do you do some kind of ceremony where it’s like, This is the end.
Mandy [00:12:20] Do you just do like… Well, enough that my parents are like, we’re not coming to anymore. And my sisters are like, really? Another one? Right. What does this mean? Let’s see. Do we count high school? Well, okay.
Courtney [00:12:32] You can start with your whole like professional, well not professional, but yeah, like higher education.
Lara [00:12:36] Yeah. College, med school, fellowship, residency, fellowship. Okay. Yeah.
Courtney [00:12:42] But you graduate and you do the whole pomp and circumstance and all that stuff.
Lara [00:12:45] It gets a little less high key each time. A little more personalized. Med school is the white coat.
Courtney [00:12:51] You get your white coat pretty early in med school, right?
Lara [00:12:53] Yes, the short white coat. It identifies you as a learner.
Courtney [00:12:57] A short white coat. That’s funny. And then a longer one. Oh, he’s got a short coat. I don’t want him. Hierarchy is alive and well. So if a short coat walks into my room in the emergency room, I need to be like, , where’s your long coat, friend? Can you bring them along?
Mandy [00:13:16] Please, friend. And then at some point, you’re so far down the path, you quit wearing a coat. Oh, sure. You’re just like, this is my, I’m in my clothes.
Lara [00:13:24] This is who it is. You come in from rounding in street clothes. Although there was one rather famous attending. at our institution who continued to wear the short coat his entire career. Was he hiding? He said he was always, he was a lifelong learner. Oh, look at that.
Courtney [00:13:42] He probably won teaching awards every year for that. Yeah. That’s funny. That’s funny. So why did each of you do, why did each of you choose to do what you did? Because you were obviously in your residency, you saw all like lots of facets of things. I’m sure you delivered lots of babies. Yeah. So many babies.
Mandy [00:13:59] You know, 600 ish, I think. I think, yeah.
Lara [00:14:02] Yeah, around in there. If you add C-section and vaginal deliveries. Why did you not want to do that?
Courtney [00:14:12] You can say it. Well, I just wasn’t sure which one. Why was that not appealing to you and then what made what you’re doing now interesting to you?
Mandy [00:14:24] Obstetrics is a whole Bolo wax. It’s a ball of something. Lots of fluids. I would say, you know, obstetrics is the reason for most people to go into OB-GYN. Because it’s amazing, it’s new life, it’s fascinating. It’s the happy side, usually. Very happy. When it’s not, it’s very, very sad. But usually it’s very happy. It’s exciting. People who like adrenaline and energy.
Courtney [00:14:57] All of that. A 2 a.m. phone call? Yeah. Come to the hospital.
Mandy [00:15:01] Sure. You get to build relationships with patients. So that’s nice. But I would say it is difficult to maintain an excellency in an obstetrics career and operate to the same level because it wins. It is like a magnet. And I feel that more and more over time as we watch the interplay between obstetrics and gynecology. I still love that they’re together as a specialty, but it is on the horizon that they may not be at some point.
Courtney [00:15:33] So you will either go to your OB or gynecologist. That’s definitely in talks.
Mandy [00:15:38] I don’t know if it’ll ever change, but that’s been a big conversation for a long time.
Courtney [00:15:44] would prefer not to do surgery, and there’s probably others that are like, I don’t ever not want to do surgery. I want to take care of the whole patient.
Mandy [00:15:52] In the future, some podcast guests coming up who will be able to speak to that, who have chosen that side of things, and one who’s done both still. So it’ll be good to compare what we say to them. But I really wanted to be a good surgeon. So you felt drawn to the surgery side? Yes, totally. And I loved the gynecology. It’s very much problem solving. And there’s a lot of variety in gynecology, and it spans a much larger lifespan than the obstetrics time frame. So you get to see different disease pathologies over time. And I really liked that. So the combination of the gynecology and the surgery is what did it for me. Yeah.
Lara [00:16:29] What about you? Yeah, very similar. I still joke that there’s, there’s nothing nicer than a nice, normal vaginal delivery. It’s an honor to be in that space. It’s a lovely thing. But obstetrics is definitely the highest of the high and the lowest of the low. And I think what I slowly learned about myself over residency was it kind of depends on your personality too. There are some personalities that like settings, like labor and delivery, like the emergency department, like the intensive care unit, where there are many, many things happening at once. And they like going from thing to thing. triaging and hitting the most acute or serious issue and then doing a quick flip and doing the next one. I think some people really thrive on that. And what I learned about myself over time is that I really love the flow state. I like to get into the OR where I have one problem, And it may be a big, bad problem. A lot of times they are big, bad problems. It’s not simple, but it’s definitely one. Yes, but I love kind of getting that extreme focus. It’s like a deep versus wide situation.
Courtney [00:17:35] Yes, and really tunneling in. wide and hit a lot of things. And some people like to go deeper in one thing issue at a time.
Lara [00:17:44] And I felt like that was just kind of my jam. It worked with my personality. It’s where I became really drawn in and was fascinated and would think about, you know, after my work day. , and so over time I just started to think, I think, you know, this is where I need to go. Okay. That’s great. That’s, I’m glad for people, especially surgeons who like to go deep.
Courtney [00:18:06] So as a surgeon, what is your day-to-day life like? Like, what does that look like? Week, maybe, I mean, well, and yeah. That’s the nice thing about it. Yes, from knowing you guys, like, daily, but then also, like, a week at a glance. Like, you’re in clinic, you’re in, like, how does that usually get organized for you? Do you do the arranging? Does someone else do the arranging? How does that look? What does that look like?
Mandy [00:18:33] So we’re gonna speak from an academic standpoint, which is gonna be a little bit different than maybe a private practice standpoint. Okay, because that’s where you practiced together. So yes, and I will say that I’m no longer in academia. I moved actually to the VA and I’ll say right now that all of my thoughts and opinions have no reflection on the VA or the federal government and are solely my own. And we can talk about that later, why I did that move in the height of my career from a fairly high leadership position at a somewhat prestigious academic medical center And I have been totally fine with my decision. But because I think burnout’s important to talk about. But we won’t talk about that right now. But in academics, you are sort of allotted time for the things that you need to do based on what this institution needs from you. And you have to fit into their puzzle of all the other specialties that are there. So, you know, all the other surgical specialties that you share the OR with, and then, you know, clinic and things like that. So it’s, you have less control, but you still have a good amount of variety. Okay. So Laura, you want to talk about what your week looks like?
Lara [00:19:47] So my week, personally, I have three half days of clinic a week. So that’s when you. drive to the office, see your patients. A lot of them are consults that are coming in with a problem that someone thinks you can help solve. There are post-ops, so someone I’ve operated on that I’m checking in, or pre-op appointments where we’ve made a plan for surgery and this is kind of the last time we’re going to go through our list, talk about the consent form, talk about any questions they have. And then I have usually, we get cases sprinkled around, but usually at least one full day of OR. So that starts at 7.30, usually get there 6.30, 7-ish. You know, you meet your patient, you do the consent form, you answer any final questions, and the operating rolls on.
Courtney [00:20:33] Those are usually… How many surgeries do you typically do in a day?
Lara [00:20:36] That’s a great question. So it depends on the size. So what we call majors, generally a hysterectomy we book for around three hours. And then we might have smaller things like hystereoscopy. Our block time is 12 hours. So we could fill that with 12 hours. 12 hours is a lot for me. It’s a lot. It’s a long surgery day. I get pretty wiped. Yeah. So your brain and your body. Yeah. But yeah, definitely. It’s physical and mental. I think a lot of people don’t realize that about surgeries, how physical it is because you’re standing in one place, you’re holding your arms in one place, you’re moving patients. Yeah. Doing a lot of pulling, especially with fibroids. Yeah. So it’s, , it’s pretty draining by the end. And then, , I have a day where I get to attend to my, academic duties, so teaching, running our fellowship program, so there are things that, just a lot of paperwork and grant things, I work on some grant projects at our university, so there’s a lot of maintenance.
Courtney [00:21:35] Emails, forms, documents, things you have to attend to, meetings. So you said fellowships, so just making sure we keep the thread going. So are you now in charge of choosing students to get to come and do fellowships with you all?
Lara [00:21:52] And I took that role over for Mandy.
Courtney [00:21:54] Oh, so you look at a long list of people and you say. When a group does it. OK. And you all decide these 10 or whatever the number is would be a great fit with us. Yes. OK. And then you put them in the black box. Now you’re on the other side. You’re putting them in the black box and then knowing the weight of what you’re deciding, right? That’s a lot.
Mandy [00:22:16] And we all say, once we review them, if I were interviewing right now, there’s no way I would have matched. It’s just the caliber goes up and up, and I’m always like, thank goodness I trained when I trained.
Courtney [00:22:28] And they’ll probably say that same thing when they’re in your shoes, when they go through all the things. It’s changed a lot, I think. Yeah. OK. So a day is usually from 7 AM till when you’re done. Yeah.
Lara [00:22:41] Whenever you’re done. I mean, clinic’s more predictable. Yeah, clinic’s more of a normal person’s day. Like 8 to 5.30, yeah. OK. If you have a call night, that can be busy. Right now, we take home call on weeknights. So that’s usually once every one to two weeks. And I’ll take phone calls, talk to other physicians that want to transfer patients to our center, or come in if there’s an emergency that needs surgery, needs some other kind of attention. And then some weekend call occasionally.
Courtney [00:23:15] So how do patients get to you? or do you wanna talk about your situation? Okay, is it pretty similar? No, my situation’s not similar. Yeah, very different now.
Mandy [00:23:26] So you talk about, okay, let’s go back, go back. You talk about that, what that looks like. Sure, what my day-to-day is like.
Courtney [00:23:30] Yeah, and weekly.
Mandy [00:23:30] Well, our OR block ends at 3 p.m. Oh, man. Such is one of the reasons I went there. There’s no 12 hour exhaustion for me. Sorry, no. So what’s that? 7.30 to three, whatever that is. Seven and a half hours, that’s our block. And I routinely, now I’ve done this several times, finished around 2.15. So I know I love it. It’s amazing. which I also love. Here goes Laura’s and my friendship, it’s over. Ladies and gentlemen, this is the end. Or it is a funeral. So, I take post-op call, you know, I had to be available for my post-ops, but that’s pretty much it. Don’t take ER call anymore. And my clinic day also ends around 3 p.m. I’m sorry. I love it. I love it for you. And I work four days a week. Yes. So I love it so, so much. But I still get to do what I love. Yeah. And so it was a trade. I understand. I knew it would be different working under the federal government. And that I was leaving, really, all my friends and my colleagues that I’d worked with for 15 years. And that was the hardest part. I missed them. So it was a choice, you know, for quality of life. But that’s what my day-to-day is like. So it can be different. It just depends on where you work. But I also have no more upward mobility. Like I’m stagnant. Or as I told the fellows the other day, I have petrified. Like a piece of wood. They last the longest. It’s all right. Good point. There it is. Good point. Stability. Get that pension. Yeah. So that’s what I gave up. And that’s OK with me. OK. All right. So what was your question? How do patients get to you? Why would I be referred to your office? Well, mine’s obviously all within the VA system, so I’m taking care of the veterans. But in other instances, they get referred multiple different ways. It kind of depends on how you set your practice up. If you want to be a consultant based on a referral only, then you have to have a primary care doctor or a general OBGYN who doesn’t do these types of procedures. or take care of these complex medical problems, send to you. And then other practices, the patient can just self-refer. They can often look you up online. There’s a lot more of that, I feel like, recently. They’re Googling their problem. They’re finding a list of doctors or some mom groups on Facebook or something similar.
Courtney [00:26:08] And they might get a referral from a friend or somebody online, not necessarily from their primary care or OB.
Mandy [00:26:16] So some will have a gatekeeper, which might be the primary care, and some may not.
Courtney [00:26:21] Okay. What’s the most common thing that you treat?
Lara [00:26:25] Abnormal uterine bleeding, probably. That’s probably the number one diagnosis.
Mandy [00:26:29] Before I left it was endometriosis and pelvic pain. And those are the top three of the specialty. Abnormal uterine bleeding, which would include fibroids. Pelvic pain and endometriosis would be the most common reason to see a minimally invasive gynecologic surgeon.
Courtney [00:26:42] Okay, and that’s something that probably an OB-GYN wouldn’t, that’s out of their typical- I think it’s more of a matter of degree.
Lara [00:26:49] A lot of times a person may have seen their routine OB-GYN and tried kind of a frontline therapy. Sure. And if that’s not effective, that’s when they get referred. Okay. Or if they have a small and easily treatable anatomic problem that their primary OB-GYN feels comfortable with, They may handle that, but they send somebody with a 20-centimeter uterus to us. So we ended up getting kind of a selection of the more acute and severe and complicated cases of these things.
Courtney [00:27:22] What’s the scariest thing that you treat?
Lara [00:27:26] That’s such a good question.
Courtney [00:27:28] It made me reflect a lot.
Lara [00:27:29] I mean it could be the most common scariest thing you treat or could it could be like a particular
Courtney [00:27:44] I don’t think you said that. No, like a particular case that you remember that like stayed with you.
Lara [00:27:49] Well, I, you know, I think a lot about endometrial cancer because we were trying to rule that out a lot in our population with abnormal bleeding because it can present as abnormal bleeding. And I ended up thinking about a lot because the incidence is going up pretty, pretty significantly both in the U S and around the world. So we’re anticipating seeing a lot more of these patients.
Courtney [00:28:11] Endometrial cancer. Tell me, Tell me, because I know ovarian cancer, uterine cancer, what is the other one?
Lara [00:28:20] Cervical cancer, yes. The lining of the uterus. The lining is the glandular layer that grows with your menstrual cycle and kind of sheds when you have your period. Those glandular cells can change and become cancerous. And it’s actually the most common GYN malignancy. It’s more common than cervical cancer. Really? It’s a lot more common than ovarian cancer. And there’s no test for it? There are some good tests for it. You can screen for it pretty well. With a biopsy in the office, that’s a very common way people do it. And if you catch it early, it’s one of the more treatable.
Courtney [00:29:05] Is the treatment just to take it all out, like hysterectomy, or are we doing chemo, radiation, and all that stuff? Depends on the staging grade.
Lara [00:29:13] So more severe cases will need chemo, possibly radiation, too. But very, very, very early cancer can be treated with just hysterectomy, which is nice.
Courtney [00:29:23] But, I mean, with a grain of salt, it’s really hard to have a strict, it’s not hard to have it, it’s hard to live after.
Lara [00:29:31] That’s the hard part, really. Fair point. But it’s very, I think a lot of people haven’t heard as much about endometrial cancer as some other types. No, you said it, that is a great job. Educating the public on it, and it’s the most common GYN one.
Mandy [00:29:48] But we think about it because abnormal uterine bleeding is in that umbrella of things that often get referred to our specialty, and that’s the one symptom that’s going to show up. And so we’re always sort of thinking about it and needing to rule it out.
Courtney [00:29:59] Yes. So would you be paired with an oncologist at that point that specializes in that?
Mandy [00:30:04] If we find it, we just refer to the oncologist. Okay.
Courtney [00:30:06] And then they will say, yes, they need a hysterectomy or we’re going to do the other bigger things.
Mandy [00:30:12] Okay. I would say the scariest thing for me isn’t necessarily the procedure, but the medical complications that patients have, their comorbidities, and then they need a surgery that you really need to do. And they’re very sick. Primary pulmonary hypertension. Someone who is anemic but doesn’t want blood products. Yeah. I mean, you know, you feel very stuck. Someone with severe cardiac disease. We’ve operated on patients who had congenital anomalies, had very crazy cardiac surgeries as kids. And now they’re on blood thinners. And then you have to do surgery and put them under and all those risks that come with that. So you’re working very closely with anesthesia to make them safe. So those would be the more scary situations. Okay. So it’s the actual while you’re doing the procedure that you’re like, well, in post-operative.
Courtney [00:31:05] Okay. Yeah. I’m thinking of all the 50 things that could go wrong and trying to think ahead.
Mandy [00:31:09] And you want to be quick and you want to be bloodless if you can. As much as you can. So you just want to be mindful of all the other systems that are affected when someone is under general anesthesia and you’re doing surgery on them in their abdomen. it’s not a black box. You know, surgery isn’t, you don’t go into a black box and then come out fixed on the other side. Gotcha. There’s just so many factors.
Courtney [00:31:31] You consult with all of those people before you do it. Do you often send the patient off? Hey, I need you to go see a cardiologist and make sure that you’re up to speed.
Mandy [00:31:42] That’s when clearance comes in. You know, here I say, are you cleared? Did you get clearance for surgery? That’s what that means. Okay. That they have a chronic comorbidity or diagnosis that could put them at increased risk, and so we have to make sure that the doctor that manages that particular diagnosis is comfortable enough, or has at least done everything they can to lower the risk. Optimize.
Courtney [00:32:06] Go off your blood thinner for a week, or whatever that looks like. Sometimes if you can, yeah.
Mandy [00:32:11] But yeah, what’s their echo? Can they breathe okay?
Courtney [00:32:16] Are they smokers? Do they have sleep apnea? Yes, I was asked that question lots of times.
Mandy [00:32:21] Those, I think, are the scary ones. situations for me.
Lara [00:32:24] Those are hard conversations that what is the risk of surgery here and is it worth the risk that we’re taking?
Courtney [00:32:30] Right because everything I think that’s something that most people do not understand truly and at least from you know now that I’ve again gone around the block I know but I think I thought either that like doctors slash hospitals were this almost like a factory situation where it’s like, Oh, I go in for a tune-up and it comes out all fine. You know what I mean? It was like a, and that was naivete and age, you know, I was younger and things like that, but like, I just never, there is a risk with every single thing we do, with every vaccine you take, with every procedure you do medically, with every vitamin you take, with every, you know, medicine or whatever, over the counter or not. You know, I had like crazy stuff happening to me because I was taking Tylenol and I was like, who knew that that was the thing that my liver did not like at all. And that’s just me personally. Like most people, you know, pregnant women take Tylenol. But I think that’s something that, , most people, unless they are at least in the medical field or have had a lot of medical procedures, understand that that is a step that doctors are there to guide you through. Like, okay, my risk of something really bad happening, what’s the higher risk? Not doing something or doing it, right? And that’s like the world you live in all the time. And I think I just thought there was like, that you’d be like, okay, for this you do this, for this you do this, and this is exactly like a recipe. I need that recipe book or whatever. Can I get it on Amazon?
Lara [00:33:59] Can I take less than 16 years of education? But sometimes we have help. We have an ethics service, so I’ve consulted them when I’ve had patients that either strongly desired a surgical procedure, but I had serious concerns about whether we should take that risk given you know, their medical problems or their beliefs around blood transfusion. It can be really hard. It’s hard on you personally because you really struggle. It’s your call. I don’t, you know, I want to give this person the service that they came to me for. Right. But at the end of the day, the risk is on your shoulders.
Mandy [00:34:37] Yes. And it’s not just them, it’s their family. You know, something, you know, yeah, it’ll change their whole life. Right. Right.
Lara [00:34:42] And I think you make a good point. I think it’s hard to really feel sure sometimes that people understand the risks that they’re taking. So services like our ethics team will talk with you, talk with the patient, kind of help provide a more neutral perspective and help give a framework to think about these decisions. But it can get really sticky.
Courtney [00:35:04] Yeah.
Lara [00:35:04] Yeah. What’s the weight of that emotionally?
Mandy [00:35:08] , you know, in our specialty there, if you look at the OBGYN as like a whole, there’s, there’s a baby and part of this specialty obstetrics. And so they kind of have to do things related to pregnancy. Right. You know, so it’s easier. And then there’s people who treat gynecologic cancers and they kind of have to treat. Right. So in those groups, It’s a little more cut and dry. You don’t have another option. You have to deliver the baby. You have to treat the cancer. For us, because it’s elective and benign, you’re weighing quality of life and risk. And you don’t know the quality of life. You’re not walking in the person’s shoes. So you’re really trying to guess at that a little bit. on, based on open-ended questions and sometimes things like lab values and like how many days of missed work, things like that, that are very subjective. And that’s harder because you don’t want to withhold a treatment, but you also inherently know more than the patient about what can happen.
Courtney [00:36:11] Yes. I think there were several times where I was told by a surgeon that this would be the end result. And sometimes to the positive and sometimes to the negative, it didn’t work that way. And it wasn’t because they were not educated. It wasn’t because they didn’t do something properly or they didn’t present me with all the facts. It was more just like they literally have not had the surgery. So they don’t know. And every individual’s response to a surgery is very different, like, you know, rate of recovery. They were always like, you’re going to be down for like six weeks, like you don’t need to do anything. And I’m like, at a week, I’m like, I am so bored. I have to get up. I feel fine. I am fine. And so we discovered that is kind of a superpower that I particularly have, but like, I know that’s not the same for most patients or for many patients. And there’s, it’s just really hard. Cause you guys are looking at averages and you try to get to know the patient, but you have what 15 minutes with them, you know, to really know like, what do they do? Yes. What’s comfortable to them.
Mandy [00:37:14] What do they understand? What is their level of understanding?
Courtney [00:37:17] Right. Right. So it’s a, it’s a, I can see where it would be a bit of a, I don’t want to say guessing game, that sounds really dangerous in a medical podcast, but just a judgment call. There’s a big judgment call that you all have to make. It’s not if A, then B. That’s not the thing. How do people stay out of your office? It sounds like you handle a lot of problems. Bare men. That’s the only way. You were waiting on that. That’s funny. You were waiting on that question. That is kind of me. The only way. But I’m done. That’s it. Call it a night. Tip your waitress. All right. Any other? You’re not going to expound.
Lara [00:38:02] This was a great question because it made me reflect how many things we treat that aren’t lifestyle lifestyle is not as big a driver right like you have no control things you have no control over yeah yeah even endo endo fibroids yeah there’s no control yeah so there’s no yeah
Mandy [00:38:22] Good genes?
Courtney [00:38:23] Yeah, I mean, your parents making good choices when they met each other? Yeah.
Mandy [00:38:27] I would say that, so probably not for us is staying out of the office, but maybe coming sooner would be really the thing that people need to think about. Okay, as a good thing. Yes. Like to get ahead of something, would you say?
Lara [00:38:43] Yeah. I think so. To be kind of preventative maybe. Yeah. Because some of these problems, if untreated, can really result in some pretty severe health impacts down the road. Bigger changes in your lifestyle and things the longer you wait.
Mandy [00:38:56] So the patient who’s like, oh, I’ve just always bled like this my whole life. I thought it was normal. My mother bled like this. And they’re like, well, you’re running at a hemoglobin of seven every day, which is not good. No. No. Not good for a lot of things. So assuming that things are normal when really they’re very detrimental to your health.
Courtney [00:39:15] OK. So us being educated as patients and not being afraid to ask questions. Does it make you nervous? when a patient starts asking you, what makes you nervous when patients start asking you questions? Is there any point in time? I love the questions.
Lara [00:39:30] It’s when the patient just sits and gives nothing back. And I’m like, where are we? Do you understand? Am I reaching you? Is there a need I’m not meeting? That’s when I feel most flustered.
Courtney [00:39:46] So you’d rather somebody being like, I googled it, and it said, blah, blah, blah. I said, bring me your list. Let’s go through it.
Lara [00:39:53] Because then I know where they are. I know what they’re worried about based on their questions.
Courtney [00:39:57] I know what their fears are based on their questions. That’s a good point. So don’t be embarrassed if you have Dr. Googled yourself. Don’t be like, oh. that’s going to be awkward. Cause I’m going to go in and you know, say that I think it’s this and they’re going to say, no, it’s not or whatever.
Mandy [00:40:12] As long as they’re coming open-minded. Yeah. I don’t want to be told what to do. You know what I mean? I do like to know what someone prefers, you know, and off the bat, you know, like I’m here to talk about hysterectomy. All right. Why? You know, also be open if I’m like, I don’t think that’s going to fix your problem. Talk about why.
Courtney [00:40:29] Right. Okay. How off, how long a time do you think you spend on average with a patient with each, new consult kind of thing.
Lara [00:40:37] Pretty exactly. You’re very intimately acquainted with that data. You know exactly? Yeah. Well, I mean. They only give you so much time. They only give you.
Mandy [00:40:45] So I would say I get now an hour for a new and 30 minutes for a return. But that is not standard in academic practice. It’s 30 minutes for a new and 15 for a return.
Courtney [00:40:56] OK.
Mandy [00:40:57] So I get to spend a lot more time now.
Courtney [00:40:58] Do you often have a fellow with you when you do that?
Lara [00:41:02] Are they coming with you? I would say maybe 25% of the time I have a fellow with me. And so a lot of times the fellow will meet the patient first and take their history and understand why are you here. what other medical journeys have you been on that are pertinent to this, that we need to know, because surgeons do not like to be surprised. So when you have a pre-op visit and the patient’s like, oh, and I had been on this anticoagulant, and you’re like, what? Yeah, right? What exact medicines did you take? Yes, for sure. So you get that important history and then we’ll make a plan together and go in and talk to the patient. We have 30 minutes to kind of get to know someone and make an initial plan. Plus do an exam.
Mandy [00:41:50] One of the things about OB-GYN that no one really talks about and really wasn’t factored in when they were like, oh, everybody, every specialty gets this amount of time, is that we have you get undressed. Yeah, right. And then redressed. Yes. And I’m not going to talk to somebody with their clothes off.
Courtney [00:42:04] OK. That’s nice. I appreciate that.
Mandy [00:42:05] Because I’ve been in that situation where you’re like, OK. I just think that’s disrespectful. Sorry if people are listening and do that. But they’re probably doing it out of efficiency, you know, because they don’t have a lot of time. But, you know, giving people a chance to talk, change, do their exam, change back, and then talk again takes time.
Courtney [00:42:23] Yeah, right. Are you ever allowed, this is a question that I have, are you ever allowed to ask to not have a fellow. Yeah. I personally felt several times like, okay, well I’ve never met you before, but here you’re going to see all the things. All right, let’s do that. That sounds fun. You know what I mean? And it’s often, I know sometimes women, especially with OBGYN or, you know, gynecological things, they will pick a woman. as a doctor, and then there may be a male fellow in there, and you’re like, well, okay, I went to do a dermatology, you know, the full body thing that you have to do once a year or whatever, and it was a female, because that’s who I had chosen, and her male fellow that also came in the room, and I was like, well, okay, you’re 12, you’re 12, this is what a 42-year-old woman looks like, so sorry to disappoint you, but here it is. It just can make it, especially if you’re not, I know that doctors can do a little bit of a, out-of-body situation when it comes to bodies like that’s your yeah that you make it clinical bread and butter and so you don’t think about it as being anything private or you know yes nothing so kids are ever a time when you can say I I’m not. You can always say that. You can always ask. But how could you say that? That wouldn’t be so good to that other fellow. Because I’m like, I want you to be a good doctor, but maybe just not mine. On somebody else’s. Yes. You’ll be so great. You will be so great with everybody else.
Lara [00:43:53] But I just don’t really care to let you see. You can always ask. And what we try to do is have our MAs, when they’re rooming the patient, say, oh, Dr. Harvey has this fellow, this resident, this student. Because we have a lot of learners. Yes. Yes. has what we call our tripartite mission, which is clinical care, research, and teaching. So they hold the clinical care, and they’re equally important, because they’re always, we’re contributing to society. We’re making new doctors.
Courtney [00:44:21] No, again, on a dream level, I’m like, this is exactly what I want. But then when it’s personal, I’m like, hello, David. I’m not coming to get you. But good luck in your rounds or whatever.
Lara [00:44:35] I don’t know. In your rounds. So you definitely can. So that’s a great opportunity when you’re talking with the MA, just to say, you know, I’d prefer not. And it’s not weird. They’re not going to be like. It helps a lot if you’re also flexible, because what that means on my end is a change to my flow.
Mandy [00:44:51] Yeah. Yes. You know, right. So now I’m slower. Because I don’t have someone helping. Right.
Lara [00:44:56] So we try to accommodate those things. But it is helpful if you have flexibility or patience, you know, willing to kind of work back with us on how.
Courtney [00:45:05] Would it be better if I called ahead and said that? Nah, it won’t. They won’t put it in my chart? Like does not like? No. Male fellows. Okay, no.
Lara [00:45:14] And it’s very, it’s also harder to adhere to those things in an emergent setting or in the OR.
Courtney [00:45:19] Well, I feel like emergency things go out the room. Like whatever, save my life, I don’t care. And that’s a very healthy view, but not everyone does that. I’m sorry, I’m probably going to talk about the pit just because that is a most recent medical thing. But there was this whole discussion because these this EMT would not insert of like a, I don’t even know, something, some medical something to keep someone alive because it meant she had to remove her bra and she had a larger chest and he was uncomfortable doing it. And like they make a whole big deal about women in the room. Would you rather have life or modesty? And all the women were like life. And the EMT was like, noted. OK. Like, he got it because I think sometimes, you know, it does make people uncomfortable. But anyway, so in emergency settings, I don’t care. Whatever. But yeah, there were just a few times that I was like, this is a very sensitive area of my body. And now there’s a man doing it. You know, right. I had a what’s it called? Oh, gosh, you just said the word. I’m going to forget it. A procedure. that what I was totally not expecting. It was not, I didn’t know there was going to be men doing it because everybody in that whole building I’d ever seen were women. And I was like, oh, this is like the women’s area. And then it was two men. And I was like, all right, nice to meet you. Okay, let’s just do this. So I mean, whatever, it’s fine. I was just curious if you ever can do that. Okay. Yeah, you can. , let’s talk real quickly about social media, the internet, AI, all of these things. How do those things how have they affected the practice in your span of working because you all have been working while everybody has been changing with social media like we all grew up with none and now it’s every day you know all the time and just the internet in general that did not exist right when you were in med school i’m sure right or very Very small. Especially for me, I’m a little bit older than Laura. Right. So how has that changed the practice of, in your particular practice of medicine? Let’s talk about the positives first.
Lara [00:47:22] I was just about to say it is truly a double-edged sword. Like so many things.
Mandy [00:47:26] So as far as access to current information, Chef’s kiss. Right. Yes. I mean, the things that I can look up on my phone. Yes. Because you cannot. From reputable, all the good journals. Reputable sources, right. Because I cannot keep all of that in my brain, and I cannot read that number of journals to keep up. Right. So to be able to provide current care with good evidence, it’s much easier. Things like UpToDate, which is a resource that most physicians use. which is topic driven based on something that gives you the most current guidelines. Okay, very accessible. I would say that it, as far as patient information, they’re definitely more informed, but are they well informed or poorly informed? Is the key. And it’s hard to decipher, even for me, and I have a master’s in clinical research, which means I took 30-something hours on how to critically evaluate the literature and design a well-designed study and complete that in order to answer a clinical question. That is not the general population. And there are lots of studies that are not done that way. And let’s put that in quotes. Studies. Research. And so while that’s out there, the skills to evaluate that and separate the wheat from the chaff, if you will, is not common. And so that gets tricky.
Courtney [00:49:01] And it’s not like a born-with-it skill. You have to be taught how to find source material, original source material, all the things, yes.
Lara [00:49:13] Okay. Yeah, I think, I tell my patients all the time, there’s good things out there and there’s bad things out here.
Courtney [00:49:18] I was going to say, do you ever correct them? Like, and teach them how to look for… I do give them cites. Okay, I see. Oh, good. Oh, good. Good. That’s good to know.
Mandy [00:49:27] It’s better to give them cites than to say, that’s wrong, that’s wrong. That’s not well received. I could be their cousin, you know, so I don’t want to…
Courtney [00:49:38] But you could say, this is how I always make sure that what I’m reading is.
Lara [00:49:43] These are some trusted resources that are going to give you good information that’s going to help you make a good decision.
Courtney [00:49:48] And you want us to know good information, yes?
Lara [00:49:51] Yeah. I love that people are more informed, and I think that’s been a real positive. People learn how to identify warning signs, like there’s been a puzzle bleeding, needs to be evaluated. Those are ways that people can learn more about their own body.
Mandy [00:50:05] And they’ve advocated for themselves. Menopause is a really great example of that. I feel like the tide is turning with that. Totally. Yeah, so much out there.
Courtney [00:50:13] We’re talking about it now. Yeah, which is a good thing. I don’t ever remember my mom talking about it, ever. That’s wonderful.
Mandy [00:50:18] So they’re definitely better advocates for themselves.
Lara [00:50:21] And people are finding communities of support in ways they couldn’t do in a physical community in the past, which also can be a double-edged sword. Because great information can spread, but also misinformation can spread through those groups, too. And then there’s sort of a spectrum of a well-informed, supportive group to an echo chamber that starts really dictating the way people think and feel, and there’s been some great literature that’s come out about how sometimes these groups can really send somebody down a rabbit hole. So it does run the gamut of good and bad. Sure, sure. Is AI a threat to this profession?
Mandy [00:51:06] No.
Lara [00:51:07] AI can use a speculum. AI is helpful with the literature and you know pulling things out on a theme search basis and you know
Mandy [00:51:28] digging through good sources. So there’s AI apps that are very helpful that I use. But as far as doing our job, I’m not really worried about that.
Courtney [00:51:37] That’s good. That’s good to know. What has changed? You talked about patients being more informed. I’ve heard you saying that. I’ve heard you saying that information is more accessible. What else has changed in your area of expertise in the last 20 years? What’s expected? Is there more or less expected of you? Is there, I don’t know, more people doing what you’re doing or less people doing what you’re doing? How has that changed?
Mandy [00:52:05] I would say the biggest change has been the differentiation, or that’s a fancy medical term. It costs $10 to say that. Essentially, what I mean by that is the creation or the evolution of more subspecialties out of the general OBGYN. So that you could pick ultrasound medicine, you could pick genetics, you can pick family planning, you can pick pediatric adolescent gynecology. So the evolution of more of those subspecialties where you can really get into a niche and that be the only thing that you take care of. That’s definitely changed. But it’s created experts. How do you feel about that? It’s good and bad. It’s great for someone who needs that expert. It’s not great for places like rural communities. That’s what I was going to ask. need general OBGYNs who can kind of do everything. Because otherwise, those people are usually in cities, those big experts.
Lara [00:53:01] And people get tired of being told you need to see 12 different doctors. Oh yeah, I don’t treat this, go to this person. I don’t treat that. I think that’s one of the downsides of being in an academic center. That does tend to happen. You have so many specialties. And you’re like, who’s running this ship?
Mandy [00:53:15] Who’s in charge of all of this? When I go to my gynecologist, can I not get my birth control, my pap, and talk about my bleeding? Yes. Right. You need to go to two other people.
Courtney [00:53:24] Yeah. Does it feel like you all have to be on your toes in terms of who you like? Some of the things you’ve just said, I didn’t know there were doctors for that. How do you keep track of, oh, there is a specialist that does blah, blah, blah, you know, certain issue. I know of that person. Do you, is that a Google, like a search situation, internet situation, or do you feel like you have like a Rolodex in your head? Word of mouth. Yeah.
Lara [00:53:50] Like the further you go, also the smaller the world gets, you know. Okay.
Mandy [00:53:55] So most academic centers, large ones, will try to have someone in those areas of specialty. And they’re not all, I should say, they’re not all board certified. So board certified means you take a separate boarding process. So while they all have some extra degree of training, fellowship, they don’t all have to take another exam for that. They’re just sort of noted to be specialists based on their training. but they’re still obviously quite skilled in that. So most academic centers will know of these, and they sort of populate their departments with them because that’s how they draw in patients and become high-level tertiary referral care centers. But you could also go online to the board, the orthopedics board or the OB-GYN board or whatever, and they often list what subspecialties.
Courtney [00:54:47] are under the umbrella of their bigger specialty. And then you could look for that kind of situation.
Mandy [00:54:53] So if you’re like, I wonder if anybody does, so ortho’s definitely sub-specialized. Hand, knee, I only do hips. And so that’s one that’s kind of very special.
Courtney [00:55:05] How far down do we go in this list of things?
Mandy [00:55:08] So you could go online and see what’s available.
Courtney [00:55:10] Okay. Okay.
Mandy [00:55:12] So that’s Google, but you have, yes.
Courtney [00:55:14] Right. What’s available. What’s in my, what’s in my area. , okay. If you could give patients one piece of advice as a new patient coming into your office, maybe they’re a little nervous. Cause I mean, I think you’re a little nervous because usually you have some kind of issue going on and it’s a. unknown area as much as we are more enlightened. It’s also very dark. It’s also a very dark area. You know, there’s not as much attention given on the lower half of a woman’s body as there is the upper half. I mean, that’s just the truth. So medically speaking, what would the piece of advice be to a patient from a doctor’s perspective?
Lara [00:55:53] That’s such a good question. I tell my patients a lot, don’t be afraid to get a second opinion. It doesn’t hurt our feelings. I get a lot of people who are seeking second opinions, especially for something that tends to be more of a quality of life issue. There’s probably a lot of options available to you. it’s okay to seek a couple different opinions and thoughts on what your options could be. Okay. And none of us care. No.
Mandy [00:56:22] And if you did care, then you need to get over yourself. Right.
Lara [00:56:26] So just, you know, I think a lot of people feel really hesitant to do that.
Courtney [00:56:30] Sure. , but I don’t, yes, there’s, I think it’s a generational thing, honestly. I think the older the generation you are, the less likely you are to disagree with your doctor. And I don’t mean that in a disrespectful way, just ask questions, say, you know, who else could I talk to about this or whatever? So that’s, that’s good.
Lara [00:56:51] But I think in this era of the multiple subspecialties and there’s, there’s just a lot more out there, you know, it used to be hysterectomy was pretty much the answer to everything. There’s a lot of stuff now that you can do besides instruct me for a lot of problems. And if you don’t feel like you’re gelling well with somebody or you have further questions or you just want to know if somebody else has a different thought process on it, that’s totally fine to do.
Mandy [00:57:14] I would say that all those esoteric details you think aren’t important might actually be. So feel free to tell me everything. Okay. Yeah. Okay. Because I can filter it. You know what you’re saying? Right.
Courtney [00:57:26] That doesn’t apply.
Mandy [00:57:27] This definitely applies. And you might not think it’s important, but it might be.
Courtney [00:57:31] Right.
Mandy [00:57:32] And so feel free to just share it all.
Courtney [00:57:34] Right. OK. All right. That’s good. OK. Well, we’ve said that at the end, we’re going to do a speed round, or at least you wrote that in your notes. Speed rounds. Speed rounds. Rounds. Yeah. The joke. So I’ll just ask you questions. You can say yes or no, or very short answers. That’s what we’re doing. So we’re going to do that really quick. OK? Ready? Ready. Unless there’s anything you want to say at the last. No, good. Okay. All right. Okay. Speed round. So are you superstitious?
Lara [00:58:01] Yes.
Courtney [00:58:02] Oh, yes.
Lara [00:58:03] I’ve been made so by my medical career.
Mandy [00:58:06] It wasn’t before. And I’m faith based and it’s such a slap in the face. You know, I put my trust in you Lord and you have total control, but I’m not going to say the Q word. Yes. Right. Okay.
Courtney [00:58:18] Is it only when you’re practicing medicine or does it bleed out into other areas of your life? Just medicine. Which other specialty do you have to ask for the most help from? Like who are you talking to?
Mandy [00:58:33] Surgically, usually urology. Urology, okay. Starting to be colorectal surgery a lot. Medically, probably our friends in the pelvis. Medically, probably chronic pain.
Courtney [00:58:50] How many hours per week do you work on average?
Lara [00:58:57] Well, it depends on if you count call, which I would count call. I have to change my life. That’s probably 60, 70.
Courtney [00:59:05] OK. OK. So if you’re thinking about doing this, remember, 16 hours, 16 years of school. You too. Good work. Good work. And I don’t really ask about college debt. I don’t ask about that. I don’t ask about school debt. Is there a word or a phrase that you end up saying multiple times a day as you work? What’s your common thing? Scooch further down.
Mandy [00:59:33] That’s a good one.
Courtney [00:59:33] That’s funny.
Lara [00:59:36] I’d probably say remember you’re the boss every time. To yourself or to the patient? To the patient. Oh, like you’re psyching yourself up in the mirror?
Mandy [00:59:44] Remember, you’re the boss. You’re the boss. You should keep that inside.
Lara [00:59:49] The public exam is such a scary thing for a lot of people, the way I try to, or a procedure. We do a lot of office procedures. Right, like you can say stop if you’re uncomfortable. That’s good. I really can think a lot of pain is fear. Oh, for sure. 100%. And if you can alleviate fear, you go 75% of the way of making a better experience for someone. And I think a lot of people’s fear is that kind of loss of control. Sure. So what I’m trying to say is, I will stop at any time. You are in charge. You can tell me what we can do and can’t do. So I try to give that control back.
Courtney [01:00:26] OK, that’s great. Who in your inner work circle could you not live without?
Lara [01:00:30] I’m Andy.
Courtney [01:00:31] But you are.
Mandy [01:00:33] No. It’s good to see each other some. It is. We’re still trying so hard. Right now, it’s my clinic nurse. She’s amazing. She does so many things. But it’s very tight knit at the VA. Small group. It’s a small group. It’s me and two other people, and then our nurses. So she’s integral in my day to day.
Lara [01:00:53] Yeah, absolutely. Same? Yeah, admins and our MAs get everything prepped for you, lay the groundwork.
Courtney [01:00:59] Right, okay. Would you encourage your children to pursue a degree in medicine?
Mandy [01:01:07] I would. You would? Yeah. And I think because even though it’s been hard. Would you pay for it? Pay for it again. Second level. Second level question. My husband paid for it. There you go. We have separate checking accounts. So even though it’s been hard, and I’ve heard people say, I would never encourage my kids to do this. There’s so much variety now, and you can really mold it. And I’m hoping that with this podcast, we show some of that. Yeah. You know, what different fields and what different jobs are like and how people have modified it to fit their life, then I think you can still have a very fulfilling life but do this. But there is nothing like medicine. There’s nothing like taking care of someone and totally changing their quality of life for the better.
Courtney [01:01:50] That’s the rewarding part. Yeah, totally. That’s why you did it.
Lara [01:01:53] Yeah, that’s a good question. I would never pressure them to go into medicine, but I think if one of them had, like, I think a lot of us feel kind of a calling and I think you see that in people.
Courtney [01:02:03] I think if they truly had that to work 70 hours a week and spend all that time in school and all, I mean, yes, maybe you get a bigger paycheck, which is what everybody focuses on, but like, yes, I think it’s absolutely a calling. Yeah.
Lara [01:02:16] But if they, I wouldn’t want them to do it if it was, just for the paycheck, or if they felt pressure, if they felt familial or societal pressure. Those aren’t reasons that will last in this career.
Courtney [01:02:29] OK, so we have one final question that we’re going to ask everybody, but we asked you guys last week about if you could do anything else. Here’s my question. Oh, good. Outside of medicine, so again, we’re humanizing you, that’s one of our goals. Outside of medicine, what other topic could you discuss at length for like an hour without any prep work?
Lara [01:02:52] Oh my gosh, what a great question. That is a good question. Well, it’s not TV shows. Not up to speed on those. I am not an audiobook person that much, but I’ve started listening to them in my car. Oh, tell me.
Courtney [01:03:11] Because there’s always been a debate. Is audiobooks reading? I think it’s reading. Because people are like, it’s not. It’s not reading. You’re not doing it with your eyeballs. There’s a study that came out that said the amount of things that you actually absorb between reading with your eyeballs and reading with your ears is the same.
Lara [01:03:27] Whoa. So it’s not. Yeah.
Mandy [01:03:31] Oh, I always listen at 1.5. I listen to 1.2. It depends on the author or the reader.
Courtney [01:03:39] It depends on the reader because sometimes readers are real slow and you’re like, okay, we gotta go a lot faster.
Lara [01:03:45] We gotta pick it up.
Courtney [01:03:45] But, , yeah.
Lara [01:03:47] I like detective stories, like mysteries, that’s kind of my thing, so if I find a good audio one, I’ll listen to it.
Courtney [01:03:52] I feel like you would like audiobooks if you like Texas.
Lara [01:03:55] Some of them I like, it depends a lot on the narrator.
Courtney [01:03:57] If they’re not good, then I’m like, forget it. Nope, I’d rather hear my own voice.
Mandy [01:04:00] We’re gonna have to, this is a topic we’re gonna circle back around on later. We’re gonna see if you found an audiobook that you could tolerate. Okay, there you go. Stay tuned. .
Courtney [01:04:09] All right. Well, this has been so fun. Is there anything that we didn’t touch on?
Mandy [01:04:13] You guys are going to be the interviewers, so you know. I’m sure parts of our lives will pop up every now and then.
Courtney [01:04:18] Oh, shall we eat in?
Mandy [01:04:20] Yeah. Yes. But we’re grateful for the opportunity to share.
Courtney [01:04:22] Yeah. I’m glad that we got to listen to you. It was a lot of fun. All the things. So thanks for being here. Absolutely. Thank you. Yeah. Until next time. Yeah. Thank you all for listening. And just make sure you’re following us on Instagram. We’ll be back next time.
Mandy [01:04:36] Thanks. Bye. Bye. This podcast is intended for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The views and opinions expressed by the hosts and guests are their own and do not constitute medical guidance for any individual case. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or health concerns. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast. By listening to this podcast, you acknowledge that the hosts, guests, and producers are not responsible for any decisions or actions you take based on the information discussed.