Emerald Coast Medical Mastery
Get to know the physician members of the Emerald Coast Medical Association. Empowering Physicians to Promote the Highest Quality Patient Care.
Emerald Coast Medical Mastery
Episode 17: Samuel B. Wolf DO, FACOG
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He calls himself the "unhinged gynecologist." His father was Panama City's pioneering solo OB-GYN. His practice built the first outpatient robotic surgery program in the United States. Fair warning: this episode contains moments you will not see coming. Dr. Sam Wolf, DO, joins Emerald Coast Medical Mastery for the most entertaining and genuinely surprising conversation in the show's history.
Well, hello and welcome again to Medical Mastery, the podcast of the Emerald Coast Medical Association. I'm your Amaranthane host, Don Davis MD, and I am more than happy to have a friend, a colleague, an obstetrician, a gynecologist, an athlete, a father, a YouTube star. I mean, you're virtually everything, Sam.
SPEAKER_00Just summer it down to unhinged gynecologists.
SPEAKER_01Unhinged gynecologists is actually what we have as the title here. We'll put that on the episode notes. Okay. So Sam, I'm just going to let you in on a little insight here. Whenever we came up with this brainchild of doing this podcast, I said to Michelle, the absolute first guess that we have to get is Sam Wolf, because that would be perfect. Now our schedules haven't aligned because, you know, you're a busy guy who does all kinds of things.
SPEAKER_00Well, I'm really glad to be here. And I never get to see you hardly anymore. And I can just say this. You know, they say you are what you eat, but Don, I don't remember telling me you ate a legend. Whoa, look at you don't know. I just missed you. I never get to see you. We're both getting so caught up in our lives. Uh I and I get to see you at medical association meetings every once in a while, but that's not enough. I sometimes don't want we have certain, you know, I'm a little older than you. How much older am I? I'm 54.
SPEAKER_01You're 46. So if I can carry the two. Chris, can you help me out there? It sounds like eight years.
SPEAKER_00On dog years, I'm doing okay. That is. That's true.
SPEAKER_01That's true. All right. But you look great. Now, um, so uh this is gonna be a wide-ranging uh conversation here where we're gonna cover all kinds of things. I have just an inkling in my mind that you might be a repeat guest at some point, so we may leave some things just for the guests later. But you are certainly kind of uh I'm probably the modern-day version of a Renaissance man with all the things that you do. But we're gonna start off by getting an idea of tell me where you're from.
SPEAKER_00So my story is it basically started, I guess, on a warm Miami evening in 1970 when my parents had a little too much to drink. And then I nine months later, here I am. I'm in October. Exactly. It's a good party gone bad. I was born in Miami when my dad was in medical school at the University of Miami. Okay. And my dad was Air Force, and that's what actually he went kind of a circuitous route and ended up here at Tyndall, stationed here. He was actually, believe it or not, people know this, but Tyndall used to have a little hospital. It's still a building there. Yeah. It's a clinic now, but it used to be a hospital. And they used to actually did deliveries there, they did surgeries there. And my dad was actually the head of the department with John Mayslook and John Pappas was out there as well. And those guys basically, I think they drove the base commander insane, but maybe that's why they got rid of it. I don't know. But after a while, I think it was more of just like you know, pushing things to the private sector because now that that's just kind of a clinic out there, isn't it?
SPEAKER_01I've heard OB and the military services is an interesting uh place to do things.
SPEAKER_00It is, and well, my dad is is is is got a great, he's got a I you could do a whole podcast on just his story. And we might. But uh he he came here and he loved and then he got transferred to Carswell Air Force Base, which was the third and fourth grade for me, and we got into horses out there, okay? So we we are there for two years, and then my dad's kind of getting into the reserves now. I'm gonna get out of the military. Loved Panama City, came back to Panama City, um, and since I was in the fifth grade, and we had these horses, and my dad bought 20 acres on Airport Road, okay, which is now all housing in the I used to ride my horse to my friend's house in Briarwood in Kings Point. That's what it was like back then. Okay. And when I when I was a kid, that was kind of a neat thing until my horse pooped in Dr. Stringer's lawn, and that was a not a good thing. I mean, you know who of our horses haven't done that. I know. I mean, at least I cleaned the top. So the we my dad came back here, started private practice, and he did it solo for I think 10 years. Oh man. You can imagine being solo be solo OB. My dad was, we never got to movies. My dad would have a beeper and he would have to get called out of the movie and we would have to leave the movie sometimes. So did you go on to the issue at all? I mean, we did, and they would sign out to other private docs and they would cover each other. But it wasn't like today where we're, you know, you're saying you have bigger practices where you can cover each other. And that's changed the lifestyle for OBs because I have a pretty good lifestyle, I think. When we're on, when we're on call, we're staying now in the hospital. We're just there. We're so busy because the practice is big. Back then it was like you had to be available all the time, but you weren't going in that much.
SPEAKER_01Man, it harkens back to an older school physician that was kind of um would cover a lot of different territories. I mean, I would imagine you did a lot of internal medicine primary care, and you've kind of done the same kind of thing.
SPEAKER_00We end up being primary care for, you know, and I kind of there's a probably a a range of which which OBGYans will do. There's some that were like, I'm not doing any of it. Sure. My kind of thing is like if you have one problem, a little hypertension, okay, I'll help you with that. You get hypertension, a little diabetes, and then touch of something else. No, no, but you go to Don, you go to Don. Go to a mediocre cardiologist that can take care of that kind of thing. Top notch.
SPEAKER_01Well, so so this is it. So you actually kind of have, you know, uh no spoiler alert about you end up going into OB, but you kind of have that model of what the idea is like.
SPEAKER_00I knew what I was getting into.
SPEAKER_01Yeah, which is strange because you see the kind of things that your dad had to go through and you still said, you know what, maybe I'll sign into that.
SPEAKER_00Yeah, but I I also kind of knew that I wasn't gonna do it by myself. Yeah. I knew I knew that I'm not doing that. Yeah, it's crazy. And I've seen other practices where they cover that's the that's that's the model. Um and so but what what really drove me to it was I got to do, I got to see a lot. Back then, there it's so different because you could expose yourself to a level you cannot do now.
SPEAKER_01That's true.
SPEAKER_00So if you want to go watch, like, hey, Dr. Wolf, I really I'm in high school or I'm in the you know, first year of college and I want to see you do a surgery. Now you would have to go to administration, take a drug test, put in a thing. Yeah, you you would have to do that. You have to get a T you have to get a little how annoying. And then you get 72 hours where you can do that. Exactly. And then if you want to do it again, you gotta repeat it or something like that. I don't even remember. I don't remember the policy that well, but it's it's it's it's a little onerous and it's onerous. Whereas I used to be able to sneak in and my dad would sneak me and we would I would be able to watch the surgeries. I actually was a phlebotomist for a short time period at Gulf Coast Hospital. Oh wow. Um I think I was 18 or 17 or 18. Anyway, and my dad, when my dad would have a surgery, I would just run in there with my. I was already wearing a shrub. I don't get to watch it. So anyway, I had a good exposure to my my dad, you know, be people don't know this, but the GYNs are the ones that uh brought uh laparoscopy to the table. It wasn't the general surgeons, they they started it out well after the GYNs were doing it. And my dad was one of the first ones to do laparoscopy. I think he he he and Masek, I think, did the very first uh LAVH in this in this town way back in the 80s. And so I I I was fascinated with that. I said, this is really awesome. You can do you can do major surgery through these tiny little holes, and and then fast forward to now where we're doing robotics, it's pretty much very rarely, very rarely do we open a patient. It does not happen very often. Um now, and I've been doing robotics. We were huge early adopters of robotic technology. I'm kind of jumping into that, but I want to talk about it because we're gonna get into it. This is something hardly anybody knows, and it's really to me fascinating. We were very early adopters in this community of robotic technology, and I'll give definitely credit to Makeda. Makeda was one of the very first ones to do it here. One of your partners, Dr. One of my partners, yes, shout out Dr. Makada. Extremely experienced, one of the best robotic surgeons in the southeastern Unit States, United States. He's probably done more than just about anybody in the uh in the southern southeastern United States. But we were early adopters of that. In fact, when we got a robot at HCA, Gulf Coast Hospital there, we were the busiest single robot hospital in the country. Okay. So now then fast forward a few years, we're like, hey, why can't we do this in the outpatient setting? Sure. Panama City Surgery Center. We talked to the CEO. Can you get us a robot? We've got an older version of a robot, and we get this robot.
SPEAKER_02Yes.
SPEAKER_00And we started doing our cases there. We said we can do this. We we were the first outpatient center, outpatient surgery center, surgery center robotic program in the country. That is, by the way, per intuitive, which is the only robot manufacturer, they're the ones that let us know that. We corroborated that. Well, how about that? So that is something crazy. Here in Panama City, like all these guys. Panama City, Florida, the first ones to do it. And we're still doing it. We have it going. Our robot broke, by the way. I think my wife broke it. Makato broke it on my wife, actually. I won't go into the details. Interesting details. Anyway, just the the case after that was when that broke. Anyway. But so we went for a year with no robot. It's because it's they're extremely and they're they're not dumb. These guys, intuitive, they they had they know where the money is. The money's in you know, you you you have the robot, but you're gonna get a new parts. So the the parts will work for 10 times, 10 clicks, and they're gonna give you a new part, and now you have to use that. That's so that's revenue coming in. Yes, yeah. And intuitive is so far ahead in technology than everybody else that I don't really see competition for them. They don't really have a lot of competition, and they make a really good product, but it's extended, so they can keep the price pretty high. And so even to get the robot in the outpatient setting, now it is very, very the pri the margins are very small. We're not making a huge amount of money on that. Because, you know, but where you're it costs a lot to fund that program. Yeah, there's a certain amount of cases you have to do or it or it doesn't work, okay?
SPEAKER_01And so and there there has to be an efficiency in doing that kind of thing for to be able to keep the margins capable of doing that. Now, look, we're gonna come back to some robotic surgery because I've got a ton of questions about that kind of thing in and of itself. But I do want to take a step back because we were kind of alluding to you being 18, doing phlebotomy, seeing how your dad was working his life. Yes. Where'd you go to undergrad?
SPEAKER_00So I did my undergrad at Florida State. I actually went to Gulf Coast. I went to Gulf Coast two years, transferred over to FSU. Did I did, I kind of was on the three-year plan at FSU after that. Okay. Five-year total plan. I started playing rugby and I really loved it. That that that year after the fifth year of college is wonderful. That was wonderful. I agree with that. Yes, exactly. It's I crammed four years in a five year tell. I tell kids that want to go into medicine. I said, look, man, don't take your time. Take your time. And if you don't, I didn't even get in med school the first year I applied. I didn't get in any of the schools I applied for. I was like, it was very competitive. I think one of the schools I applied for had 5,700 applicants that you're gonna do. For a hundred spots. So it's like, and I'm uh I I did okay, but I wasn't like cream of the crop, okay. It was for academics. But but um I tell kids, look, go into uh when I I was very upset when I didn't get in, and what did I do? I I ended up going to South Africa, Cape Town, South Africa, and I played rugby for a full season with one of the oldest rugby clubs in the world, False Bay rugby and uh Cape Town. And man, that was one of the best times of my life. I had so much fun, yeah, and I learned a lot about the world, and this was before there was even really cell phones or anything like this. You traveling was it was like hard to organize this trip. I ended up staying with a rugby friend of mine that I played with in Tallahassee, who were still lifelong friends. Um, and and I say, Look, once you go to med school, you're gonna get locked in. You get locked into this sort of silent 13 years, and then you're gonna meet Miss Miss Perfect, and you're gonna get married, and you probably have a kid or two, and then it's over. No, I'm just kidding, it's not over. But it's like it's like there's certain things you just aren't going to be able to do. And it's that's right. A four-month trip to South Africa is probably not on that list. It's not gonna be on that list, yes. So I like take just don't don't take your time on that, and you know what, you're gonna you you can get it all done. I I say this in the same way as take a Shakespeare course.
SPEAKER_01Yeah, take something that's out there. Like, I mean, you're gonna have plenty of time to get into the science and the minutiae and into the hubbub. You're gonna have to do that. You're gonna figure out how to practice. That's that's gonna happen. But but take the things that are gonna make you more well-rounded.
SPEAKER_00And then the other thing is it gives you something kind of puts you a little bit apart of everybody at the interview process. Absolutely. Like, what did you do when you when you didn't get off? Well, I went and volunteered in a home, a shelter. Okay, that's important. You I'm not demeaning that. Sure, sure, sure. But it's also I went to South Africa and played rugby, and I went and stayed in Kruger Park for a week with hyenas. Okay, let that's I remember that guy, that's hyena guy.
SPEAKER_01Yeah, of course. No, no, it it it it picks the it's a good thing. It gives you a little something to set the fact that it's important. Now, I almost asked to Michelle's chagrin that you do this entire interview in a South African accent. And I I would have been really happy to hear that because I think the South African accent is extraordinarily difficult, and you do a fantastic job.
SPEAKER_00So well, I know I remember a very tiny minute a bit of Afrikaans, which is Yidifro ist the moist of Vata Collam a lava chasnet. Okay. Which is which is which me it basically means here this woman is the most beautiful woman I've ever seen. Why why I just only remember that who knows? I mean it could have been anything. I don't know why I have it. It's the only thing I can remember from my time there. You know, and I still remember how to make a poiki. A poiki pot. You know what a poiki is? I make a poiki pot, I still do this. Like every three months I make a poiki. A poiki is and it's it's spelled P-O-T-J-I-E. But it's Afrikaans. You pronounce it poiki, poiki, which is a pot, a stew, like a witch's pot. And it's this awesome thing, and I have one, and it's a I've got the classic one that my buddy Garth gave me. And so you it's nice because it takes about three hours to make it, and by the time it's made it's made, it kind of doesn't even matter how good it is. Everybody's gonna love it because they're starving, okay? Plus you're drinking a little beer or whatever.
SPEAKER_01I mean, that happens, yes.
SPEAKER_00And then uh, but I remember the first time I was the first time I learned how to do it, I'm in I'm in a place called Belleville, which is north of Cape Town, and and my friend's brother, he's like, Sam, we're going to make you a poiky pot. We're gonna make you an ostrich, ostrich poiky. Have you ever had ostrich, Sam? And I'm like, no, I've never had ostrich. That sounds awesome. He goes, Well, let me tell you something about ostrich. It's the healthiest meat you can eat. There's no better meat than ostrich. And I'm like, Wow, it's awesome. So, what does the guy do? The first thing he does is he takes a huge chunk of lard and puts that as in the pot. And I'm like, this is the base. I'm like, wait a minute, wait a minute. You just said you just leave me. You said it was the healthiest. Oh, you have to put this in there to make it taste good though.
SPEAKER_01Okay, got it. Perfect. There's a lot of wisdom there. Uh yeah, there's a lot of wisdom. So I I think South African accents are kind of like uh Burt Reynolds impersonations. I'm going to laugh no matter what. Even if you're talking seriously, like I'm gonna be just gonna hook line and sinker. So but I mean, what an interesting kind of place to go for four months. I mean, also, I mean, playing South African rugby is not just uh weeks, but like you're I mean, that's that's really that's where I learned to play the sport, you know.
SPEAKER_00I thought I knew it. I was fast, I was really fast. I was kind of you know in in in rugby, you have like the the forwards. Yes. They're the big, you know, tall, big, they're when you see like scrum. Almost the light buttons or anything like that. Yeah, you're huge. They're big guys and they're tough. And they're I was a back, the guys that kind of hang out back. We have nicer hair. We we are way better looking. Yes, way better looking. Exemplified. We actually have our ears attached to our head, and we don't have to wear things to keep them there. And so yeah, though we I was a fast back, and and but man, I thought I knew how to play it, but man, I get there, that was completely different. It's a religion over there. They start very, very well.
SPEAKER_01Well, it it is, but there's also something incredibly formative about team sports and playing it at a really high level. And you know, you being part of a team that I think could really manifest itself later on in your career, but but this learning that people are going to be depending on you and you have to do your job, and you don't ever want to leave your teammates alone. You don't ever you want to play through the entirety of the game, you don't ever want to let down at the end of the year.
SPEAKER_00There's a lot of camaraderie. In fact, rugby in America is really still has that camaraderie because it's still at the club level. There's no pro-rugby industry. We have a the American Eagles team that can barely qualify for the World Cup, and we have 350 million people in this country, these little countries like Scotland and Wales that have less of a population than one of our states, it can can no problem get in. But it has to do with where is the populace going? Where's the the real athletes of that population? Where are they going? They're going into professional football, they're going to be able to get it. It gets delayed. Yeah, it's because that's a more it's an American sport. So really rugby has just been it's kind of a niche sport that certain people are really drawn to it, I like I was, and we we love it. And the teams always go and have a party after the after every game, and you'll be partying with the guy that was trying to kill you five years three hours ago. Yes, I mean so that that that's unique to rugby and lacrosse. And really tough, yeah. Yeah, I mean, oh, and it's a very tough sport. Yeah, you're not wearing any pads, there's no helmet. Okay, that's right. You know, we have two t-shirts, bigger balls, no pads, okay? That was that's rugby, okay. Um, and and but actually, you want to know something. One of the rules in rugby is you see this all the time in American football, where they just run at each other and they'll just battering ram them with their helmet and they're just literally lay the guy out. That's illegal in rugby. You can't you can't tackle like that. You have to wrap the person around. And so you actually have less major injuries in rugby, but a lot more superficial injuries.
SPEAKER_01Right, right. And it's odd because it's it's almost like the padding and everything is like, oh, I'm safe. I can hit harder, I can be with a little bit more reckless abandon. Whereas when you see rugby players, uh you know, there is some sportsmanship there too, where you're not really trying to injure the other guy. You are gonna try and stop them.
SPEAKER_00But no, you you're trying to you're trying to win. You're trying to win, for sure. There's injuries that occur, but there are times when, for example, if you are in rugby, you have to release the ball immediately. Yes. And when you do that, when you do that, you want to do it in a very specific way where you're releasing the ball towards your team. Two guys are gonna meet over the top of you, and they're all these teams. If you end up on the bot the bottom side of their scrum, you will you will get raked. You will they will cleat you in the head and the face and they will do it very forcefully and very uh it's kind of part of the game. It's part of the game. It's called raking. Okay. If it's on your side that your team, you they'll gently kind of nuzzle you out with their back of their heel as you're trying to crawl out of that. But no. But you you you'll you'll learn pretty quickly. You don't want to be at the bottom of that screen. It's it, yeah, and it's a tricky. I remember this. This is a funny story, then we'll move on from rugby. But this is a funny story. We might stay here all day. I'll just tell it. I remember this was my first year playing. And like I said, uh the only talent I had at this point in rugby was speed. I was very, very fast. Hard to coach that. And um, I got a ball and I had a beautiful breakaway. The only thing between me and the tri-zone was this one, and we were playing an Ecuadorian touring team. Okay, these guys, and they were amazing. But the only thing between me and that tri-zone was this one dude, this fullback, and he looked like he was 45. This guy looked old. I'm like, Take offense to that. I'm like, okay. Yeah, but I was like young. I was like, 20 years old, 21 years old. I was like, okay, I got this. And I go ahead and just beeline it. This guy gets the angle on me. He just gets the angle. He's crouching, crouching, and then he kind of sprints at me like some sort of puma, and literally grabs one hand, grabs my jersey with his right hand, his other hand goes up between my legs, grab my testicles, squeezes, pulls, and grinds them. And I screamed like a little baby girl and went down immediately and released the ball. I learned a lot about rugby that day.
unknownOkay.
SPEAKER_00Totally legal, by the way. Anyway, I could still come and pick that guy out of a lineup right now.
SPEAKER_01Uh yes. I'm gonna get him one day. You hear me? Yes. Uh well, that might be the tagline for this entire podcast episode. So, um, well, now getting back to your undergrad, what did you do? What was your major? Biology. Biology. Okay, did you have some burning desire in biology, or was this kind of a means to an end to get through medical training?
SPEAKER_00I remember just being all over the place with what I wanted to do. I think my first thing, and a lot of it was culture influenced. I remember after seeing Pretty Woman, I wanted to be a corporate attorney after Top Gun. I wanted to be a jet pilot. I mean, it kind of moved around a little bit. Lord of the Ring movie wanted to be able to put me outside, you know. Um so, so, but I I I went sci once I switched, I said I went to sciences. I said, I want to go science. And then I I thought medicine was sort of that was about the time I was had that exposure. I said, I think I may want to do this.
SPEAKER_02Yeah.
SPEAKER_00And so I started, I went to the medical track. Plus, I had a lot of friends that I grew up with that were very tight friends that they were all going medical to. And so we were kind of studying the same things. One of which is, you know very well, Lloyd Logue, who's still to this day one of my best best friends in the world, my neighbor, and we've been friends since the same. One of my wife's brothers in uh Bay Radiology is a very good thing. We've known each other since Sunday school in the sixth grade. I mean, it's like a first Methodist church, okay? That's how long we we go back. And so, you know, you're influenced by your friends too, and we decided to go that route. And and um, and then once I got over there and started doing biology, I got into a little bit of aquatic pollution biology, which I really was fascinated with. I took a lot of great classes at FSU that just really are like you said, make you a Renaissance Renaissance man. I'm a bird nerd, I've always been a bird nerd, it's deep in my soul. It's probably one of the most like ask me what I did. The first thing I did this morning, I got up and went out my backyard and checked on my purple martens. I have two, I have two uh two beautiful colonies there. And um, and so I took an ornithology class at Florida, and I got into bird watching, okay? So that's there's things that shape you as a human being besides medicine. I think it's so important, like you said, to not just take medical classes, but take your time if you can do it, yeah. And take some classes to broaden your your one of my absolute, if you ask me, there are my two favorite courses I ever took in all of college, including medical school, by the way. Two two favorite courses. One and I saw this teacher actually not too long ago in Publix. Religion in America, where you learn about all the different religions. Yes. I found that to be fascinating. Yes. Okay, I don't remember where I got this quote, but I heard it recently, and it was like Religion and science are not in competition, they're not enemies, they're just two languages trying to sell the same story. That's right. Okay. That's right. Anyway, so I think that's a good idea. Stephen Jay Gould would say non-overlapping magisterial. Okay, and then my my second favorite was a class I took with a uh a professor named Ellington over at FSU. And the the class was comparative animal physiology. Yes. Where you didn't go through you, you it went through it was a systems-based approach. So respiratory system. That's right. Okay, cardiovascular systems, yes, mammals, and went down the list. And how do these guys respire? Circulatory system, boom, boom, boom, boom. That blew my mind. It was one of the most amazing and the guy was so organized. He was a phenomenal teacher. Um, and that that absolutely was my favorite. Now, here's my child, okay. I have two girls, two children, okay. One is doing neuroscience in Japanese at Florida State. The other one, my older one, is at UF and she's doing zoology. And the weirdest thing is, I've never pushed the kids into anything. I kind of want to just see what they want to be. Okay. The younger one's artsy, and she's going to do something. Sophie, my oldest one, she guess what she's into? She's into birds. I went to see her Sunday. Dad, let's go to this park. There's an awesome bird park. We're going to see like nine 19 species of birds in this one park. I didn't push her to this. I maybe have introduced her a little bit as a child, but she's totally into it. She's absolutely into animal physiology and all this stuff, and it's kind of just neat to see that. Yeah. That's wild. I don't know what churn's going to do for a living.
SPEAKER_01Well, of course.
SPEAKER_00But that doesn't matter as much. She'll figure it out. She'll teach or something like that.
SPEAKER_01It's the same churn in your own brain that piqued your own interest to see that writ large and your genetic lineage is I mean, that's fascinating and really, I mean, it's kind of oddly humbling to see those kind of things.
SPEAKER_00Um and to see this world that we're living in that's changing, not back in when we were young, it was changing at a much slower pace. Yeah. It's a good thing. And now I feel like we're wondering another quote I heard that I loved. We're on a Ferris wheel and somebody's randomly pulling out boat bolts. I feel like sometimes when of this AI and when you're getting into this, it's just like what's going to happen. I've always had kind of confidence that I knew what was going to happen. And this is the first time in my life. I don't know. I can't process what's going to happen.
SPEAKER_01Well, you know, uh we'll we'll come back on to those things, but but I, you know, it's one of the things that's been really sitting with me a lot. Part of the conversations that I want to have here are to kind of delineate these ideas because you know, I'll sit at home and talk with Lindsay about how my purpose is kind of well defined. I I have an idea of the things that I want to do. Um, my meaning is is there, and I think I have the things that drive me and my priorities pretty straight. I don't know about the kids. How do you find purpose in this world where all of a sudden you might deal with abundance? Where all the things that we had to work for, you will not have to work for anymore. Um, a career you may not have to have. That may not be existent as far as we know.
SPEAKER_00Because, like, yeah, I think about this as well in a society where you have like a universal incomes and things like that. Where now what do you what's the purpose of it? I think that allows us as a society to pursue things that we love. Of course, arts and seeing things, experiencing other cultures and things like that. So I think well, you know, one of my dri drives for wealth is is one, I want to retire at a relatively young age. I would like to do that before 60, but who knows? Um, and the other is I've always thought I don't my kids can't be losers, okay? You're not allowed to be a loser. That's right. Okay, but if you're trying your hardest and you are you want to be uh, you know, uh a teacher who I don't think teachers make enough money. Okay, I think they're not gonna be a good thing. Comic book writers, whatever. I mean, whatever whatever, but I don't want you to have to worry about is your power bill gonna be are you gonna have food to food, enough money for food. That's right. I don't want you to worry about that. You're gonna have enough for that. I'll provide for the basic, basic stuff. And you know, you still can't be a loser, you can't be a drug addict, all that. But you you you know, I think that's one of my drives to be successful. I want you to contribute more than you received.
SPEAKER_01Yes, I want you to give more in this equation than you had gotten taken out. Um, well, we'll talk about parenting here in a little bit. But however, um, so you did eventually matriculate on to medical school. Now, um, you know, as as we understand, and part of the podcast audience here is gonna be lay folk who are not exactly familiar with medical training. And so so the first two years of medical school is much more of a didactic lecturing experience. Yeah. And I'm assuming that that was your experience. Yeah. Where did you go, by the way?
SPEAKER_00And so very interestingly, I went to Nova Southeastern University in Fort in Fort Lauderdale, it's in Davy. Yeah. And it was a really amazing program. Um, it had some federal funding. This is a neat story from my very first year they started this, and I think this was one of the most valuable things. And I I tell even still tell deans of schools that you know, this is this was so valuable to me. Now I got lucky. There's some luck in this, but they had a program where every Friday afternoon you were spun off to a local private doc and you would hang out as a first-year medical student in his office and see patients with him or her. Well, who do I get? I get this guy named Eugene Mascarenis, this Indian doctor who was at Columbia in New York forever, or someone may not be in Columbia. It was a huge, well-known uh New York, and he just basically moved to Florida. I want to retire, and then got here and was like, I miss medicine. Went ahead and joined a group and started seeing patients, and he wanted a student. And I and and this guy was his his claim to fame was uh he had this little thing on his doorknob, and it said the great one, or what was Jackie Gleason, his nickname, the great one or something like that. Well, I wouldn't know. I don't know. What the fuck? Anyway, so put that in editing. So I saw that, yeah. And and it's like this guy was Jackie Gleason's uh cardiologist to the dying day. No, Seattle. And he was just he was so awesome, this doc. And I just loved the way he talked to patients and the way he treated his patients, and it was such a good exposure. But what I'm getting at is I think didactics are important, but I think we should be putting in a be putting in medical students in a clinical situation from day one, the week one, I should say. It's so important because we're learning these things, but you need to see it in principle. Plus, the way my brain learns pathology is by it's I remember uh what is it, um, inferior vena cava syndrome. Okay. Guess what? I saw a patient with that guy, with that doctor. I saw this patient. I can still tell you what that guy looked like. I know what he looked like. I remember everything about that pathologic process because of that one situation where I saw that patient. Whereas if I saw it in a book, I just wouldn't remember it. Okay? So I think that that's so important.
SPEAKER_01Sam, 100%. You know, we as humans, we learn by stories. Yes. Stories really resonate with us. Patients that come to us, that's not in a book, that's not abstract, that's actually a person that's suffering, that becomes the story, and that's where it really lands on us. Yes. My very first patient ever in pediatric uh rotation, third-year medical school, had Job syndrome, hyper-IgE. I would have never remembered what Job syndrome is at any point in time reading about it. I can still read it to this day, it wouldn't be the first thing, but I saw a patient. And so now I know exactly, I was like, oh man, I can hearken back to that. So I totally agree with you. When you see the patients that have this, that's how it really lands with me. That's how it really resonates. Yeah, yeah.
SPEAKER_00Yeah, and so I I feel like I got very good medical school training. I did my I did my third and fourth year through the Broward Health System, and I remember we did, for example, I would did a lot at Broward General. And it was Broward General's interesting because they had a family practice residency, but that's it. And so you you could be as aggressive as I mean and my friend Shoddy Foss, who's a general surgeon still up in uh Michigan, he knew he wanted to do surgery. And I I knew I wanted to go surgery. We we would give the ER docs our pager number and we would say, Call us. If you have a big laceration, you and you got you don't have time to let us call us, we'll come in. We would and they did. The first one was this guy, HIV positive, probably in stage if stuff huge head flap where you're getting hit by a car, and we're on we're in there like that looks right, put this to this, yeah, that looks good. And so uh yeah, that's uh it you so you have to have that sort of drive if you want to really be successful. And and and I see a lot of students, there's some that are very good, but there's others that are like, I'm just gonna do what I need to do, you know.
SPEAKER_01This is not a timid thing. Yeah, you have to get into it and you have to jump into it. And you kind of kind of have to volunteer into it. Like you gotta be like, you know what, I'm in, in for a penny, in for a pound, and just do it. So so good on you now. So you were thinking some sort of surgical practice was there. You know, in in general, you kind of cordon off into am I gonna do internal medicine, am I gonna do surgery? Of course, there's some other nuance there that you could do. Um, you were thinking a little bit more surgery?
SPEAKER_00I uh well, I just knew OBGYN, which is a surgical field. And so I knew I knew that's what I really wanted to do. And so that kind of just had it that way. Any any time I had an opportunity to to sew or to do to get in and do a procedure, I was doing it. And and and we we just that's how it was. And then um, and then when I finished, so uh you know, DOs, one of the differences with DOs, and it's gotten less strict with this, but it's one of the few things with the whole DO thing that I I have some pr problems with the DO leadership and it has to do with more CME hours and things like that. I I'm not gonna get into that because they'll come after me probably. But um but one of the DO things that I think that persisted that didn't persist in the MD world, except in a couple of specialties, like radiology, by the way, where uh we were were required if you're going to specialize, you're going to do what's called a traditional osteopathic rotating internship. And you would do two months of PEADs, two months of OB, two months of uh family practice, and then they give you electives as well, because I did a pathology elective, I did an NSE. I did mine up in Michigan. And man, I grumbled about it. I was mad. And one of my friends, one of my really good friends in med school, he because he was military, he had an out, okay? So there was exclusions to it, but for the most part, and you could chant it. I have friends that said, I'm gonna chant it and I'll fight it. I think I can because if you if you were in uh, for example, a medically needy area, you could write a letter and can I get an exemption, but that wasn't guaranteed. So you really had you really needed to do it. And so I did it. I went up to Michigan and grumbled, but man, I had one of the best years of my life up there. And I learned so much. Uh I did, I think, 40-something MICU call nights, okay? I was putting in lines, I was doing all these things. Yeah, that they were teaching incredibly sick patients. Very sick patients. And in and when I got to residency, when I started day one, and I trained, I trained at an MD residency, okay. All these kids, all my compadres were straight out of medical school. They had I was slight years ahead of them. My biggest problem was pulling my reins back. I didn't want to be an a-hole and like, sure, look at me, I can do this. And and and I even remember one time uh I put a central line in a patient, and and I get called by the attending, and she's like, I was dead blind. She's she's like, Look, you can't you can't do that. And uh, she's like, I said, No, but I I did lot lots of them in training. She goes, No, you can't do it. I'm your attending and I can't do that. So you can't do that. Understood? Fair enough. Okay. Yes. But so that that experience and that I think that's important for specialists because there's so much that I learned during that. And I did an anesthesia elective, which every OBGYN should absolutely have to take an anesthesia elective. Yes. Well, you don't have time for that in residency. I did pathology elective, which was incredibly valuable. I mean, just it made me have appreciation also for all of these other specialties and my compadres that I work with.
SPEAKER_01Your colleagues that you're gonna be interacting with on a day-to-day basis.
SPEAKER_00So um I anyway, and so after that, I knew I wanted to go OB, and I ended up getting into the the the UF program at in Jacksonville. And uh which was just an incredible place to train, just an enormous amount of pathology.
SPEAKER_01So so let's talk about UF Jacks, because um, so UF Jacksonville, great program. Um, going to hit a lot of underserved people. Yeah. You're going to get which which typically translates into deep pathology. Yes. And for obstetrics, especially, you're going to get no prenatal care whatsoever that's just going to show up. It's going to have a lot of concomitant illnesses, and you're going to have to learn on the fly. Is that right?
SPEAKER_00A lot of that happens. Well, here's the thing: it's volume. You're seeing a lot of volume. Yeah. And that's where when it comes to programs, especially, the thing that there's a lot of programs like that, okay? And one of the things that the OBGY and programs really struggle with is they they mostly you'll get the OB volume. It's the GYN volume. And are you coming out surgically qualified? Surgery is not, it's like, and I was very, very lucky, okay. When I came out, even though I had a really good program, and I got, and one of the things, for example, that our program did, you had six months of elective, uh, not elective, but they were called out rotations. And you would operate with all these other community docs who would let you basically do the surgery. Okay. Well, they made a rule change and they had to, they said, okay, well, if he's gonna do the surgery, you got to put his name on the thing. And a lot of these uh with the liability, the docs were like, no, now you're just gonna assist. That happened right after me. So I got to benefit and I got to do so much surgery. And and when I came here, you know, we we didn't really have a robot. Now, when we do the robot, we don't really need an assistant, right? We do it's all you don't have to book an assistant for that. The nurses essentially assist us. And so, but when I came out, we weren't doing that, and you kind of needed an assist for a lot of these cases. And I had Mike Ingram, and I had my dad who was who was assisting, he wasn't working working full-time in the office, but he was assisting. And man, I got this wonderful time period where I got to just operate with my dad for like five years, five or six years coming out. He would help me. And I would call my dad, and he, you know, for when I knew it was like a 400-pound c-section and two in the morning or whatever. And I'm gonna wait. My partner's like, uh I'm gonna random. Uh, I gotta go. My dad would come, and my dad's I'll be there. And my dad would come up there and we would knock the C-section out. And it was just uh it was a really awesome experience. And my dad, he's still doing pretty, pretty well. He stopped operating completely, but but uh it was just something I don't take it for granted. It's something I got to have that not many people get to experience that kind of thing with your dad. Makes my brother very jealous, which I'm happy about. I've got brothers, I know how this game goes.
SPEAKER_01Um, but it's also, I mean, you you just get the sense whenever you kind of work with some of the older school physicians like that, that they've forgotten more than you'll ever know. Like, I mean, just it's their love wisdom, they know exactly when to operate, when not to, they know their hands just kind of go in the right places, and kind of achieving that level of legendary status is something that I've always aspired to do.
SPEAKER_00There's there's I think there's there's a soul factor there, and like doctors like my dad, and there's some even some ones that's still up there that I see in the lab, they were they're just doctors to their core. Yes, it's their existence. Yes, okay. They raison d'être. It's their existence. Yes, raison d'être. No, actually, don't even start this, okay?
SPEAKER_01Okay, very proud of you. Multilingual uh um podcast here.
SPEAKER_00Yeah. I didn't tell you I learned French.
SPEAKER_01I know you've you're Philip, you've been a long time with this.
SPEAKER_00And I give Adeline credit, Adeline, if you're watching this. Shout out to Okay. She was the one. She was a I started a French club here and I met this couple, and and we made a little arrangement where I basically we met for like a week for I don't even know how long, three or four years. It's like an immersion program. She was awesome because she was just a you know, you no, you can't be lazy. She would push me. And then she ended up when she was a nurse, and she kind of she wanted to take her nursing boards. I helped her with that. I helped her with her medical English, she helped me with the French, and she ended up passing the boards, and I hired her, and then she was one of my best nurses, and then got pregnant with twins and said, I'm going back to France. Thanks, Adeline. Just kidding.
SPEAKER_01I love you. Listen to the podcast, all right? We'll talk.
SPEAKER_00Anyway, back to what what was I talking about?
SPEAKER_01Who even knows at this point? No, so we're talking about time. Working with the uh legendary uh status that we're gonna do.
SPEAKER_00No, you're legendary docs that are just it's in their soul. And whereas I love my job, I love it, and I really love what I do, and but it's like I also love life and I like to do other things, and I want to do that. I value my my leisure time and my family time and my kite surfing and my regular surfing and my foil boarding and my hobbies. I have a lot of hobbies, okay? Um, and so where I think mentalities have changed a little bit on that. They have, and uh and and and you know, there's good and bad with that because I think the burnout maybe that helps with burnout.
SPEAKER_01Yes, but at the same time, so so it was a little bit you were forged by fire, and and and it was you were kind of almost graded out. There was a sieve there of like, you know, if you couldn't handle that kind of thing. I mean, I think uh I'm not trying to date you here, but you may have been a little bit before hours restrictions. Is that fair to say?
SPEAKER_00Oh man, I caught it on that one bad. Uh yeah. So what happened with that? That was exactly I was in residency when the rules changed. Okay. And here's what happened. So I'm a first year, second year. Second year even worse. We had 36-hour shifts as a second year. 36 hours. Almost wrecked my car on the way home. I like I saw I saw the danger in that. You don't know how tired you are until the next day. It is absolutely dangerous. And guess what happens third year? When it's supposed to start laxing up a little bit, that's right when I turned third years when the rule changed. And they said, Well, we're gonna have to change things. Now that these interns in these second years have to have the rules were within the rules, the third and the fourth years are gonna have to, you know, step up to the plate and take up some of that where you would have had some administrative time, now you're gonna be seeing triage patients. Yes. And that was very that rubbed everybody the wrong way. But I understand the big story on that. It's just why did it have to happen exactly at that time? But it did. And you know, we we did it. But I mean, the problem is these patients have to be seen. The attendees aren't gonna do it. Okay, they don't see them. They're not gonna do it. They're just not gonna do it.
SPEAKER_01They're like, well, and this for the lay public here, you know, there was there were some rules, some government-mandated rules about in terms of hours because you were having accents the next day after staying up for 48 hours straight, etc.
SPEAKER_00Falling into an abdomen in the middle of surgery. Yes. You know, and so there were people.
SPEAKER_01So these rules needed to occur. They did need to occur, um, but it started to create this onerous break on kind of the later trainees that were having to facilitate that for the younger trainees. And also, you had the old school physicians that had gone through the the trial by fire, and then they said, How are you supposed to learn? Like there, there's no there's no postcall day all when you're in pro when you're in the pros.
SPEAKER_00It goes back to volume. That's what's gonna determine your training. Did you get the volume that you need to be able to do it? You did you see enough things to be able to handle these very weird situations that are gonna pop up every once in a while? And then you and it creates animosity too, because you still have this well in my day. Yeah, exactly. In my day, you shake your fist at clouds, yeah, kids, millennials, yeah. No, that's right.
SPEAKER_01It's totally it does. And so it's it's a very weird, you're kind of serving two masters there because yes, you understand like you need sleep. Yeah, and and one of the things that I try and inculcate into my medical students is that you know, it's not about the decisions that you make when you have infinite time and infinite resources, it's about being woken up at three in the morning and you have two minutes to make a decision. That's a harder place to be, and it is, and you know, you you you're gonna have to deal with whatever you have to deal with.
SPEAKER_00And well, and the other thing that as I uh go through this very involuntary adventure of senescence that I'm entering, okay. Um involuntary senescence. It's involuntary senescence, by the way. That's senility for you people that don't know the root word. Getting older, yes. Getting older, and so I'm finding it's sleep is more you know, you you you your sleep quality goes down. Yes, and that for therefore you kind of need more of these REM cycles to be able to, and I'm noticing that. I've never I've never been a I've always been able to do fine with no sleep. And now, man, I am grumpy, I'm it's getting worse.
SPEAKER_01So I am not so certain. That's that's part of I think um we got wrapped into the culture of medicine, which was like, no, I want to do more, I'll get up earlier, I'll stay here later, I'll do more and more. I don't know that sleep was never important. I think it probably always was. We just kind of did a mind game, a Jedi mind trick on ourselves and said, like, no, I can do without it. Uh because yeah, it I feel it when I you felt like it could.
SPEAKER_00You and you would there's some adaptive adaptation to that too. But but I remember, like, for example, when I was gunning for residency programs, you know, as a DO in an MD world, okay. I I I literally was when I did my auditions, I was the first person in that hospital, and I was the last person to leave. I you you your work ethic was one of the qualities that could get you in. It's at the highest. And man, and so I said, Well, I'm not the brightest bulb in the suntamp, but I'm a work, I'm a hard freaking worker, and that's I just leaned on what I do. And that and that and that helped. That's probably what you know helped me get out of here.
SPEAKER_01Don't ever be lazy. Don't be lazy. You being lazy is one of the most unforgivable sins. You can make mistakes, you can say the wrong thing, you cannot be smart. Okay. Don't be lazy. Don't be lazy. So you know, you bring up an interesting point there is because um, you know, and I've talked to this about to our DO students, which is that I have seen the most brilliant cardiologists that are DOs, I've seen other practicing physicians, i.e. yourself, that I have an imminent amount of respect for. Lloyd Logan is another one. He's a brilliant radiologist, he's really good. And they're DOs, you're a DO. You can be just as smart as any other ND or anybody else, even Harvard trained, doesn't matter. It's gonna take you a little longer to prove it. That's the difference.
SPEAKER_00And I think that goes down to we lean a little too heavily on things like MCAT scores to pick who's gonna be the good doctors. Yes. I know people that probably ace their MCATs that are just kind of like not the doctor you want to see, okay? And they're probably not that great. They're smart and they can read a book really fast and tell you what's in it. Um, but I don't know that the MCAT is the most important, but you gotta have something to create a bar of intellectual ability. Yes. And so, and I think that's just one of the things is like, and and and I remember this is a funny story. So I told you I didn't get in the first year, right? Okay, well, I I kind of had uh while I had a wonderful year, I also that gave me some self-doubt, and I'm like, I don't know if I'm good enough to do this anyway. Maybe I should do something else. So guess what? I go and I get a job in Orlando, where my aunt and uncle lived with a company that my uncle was working for, actually, it was called Qs, and they were developers and manufacturers of sewer robots. Did you guys know I used to work for a sewer robot company? Yeah, I didn't have that on the big one. So I get a job with this guy, and and and matter of fact, it was the best job interview I ever had because I go to interview with this guy. I think he he's he passed away, so I can tell this story now. My uncle goes, You're gonna interview with the CEO. He only knows a few things. He's a Civil War buff, so know a little something about the Civil War. The only thing he remembers from school is Ohm's Law. Okay, very important as far as I'm talking about. And then he's a hockey junkie. So if you if you like anything, I mean I'm a I love hockey, that's my favorite sport. So that was easy. Yeah, so this is gonna be a good interview. And I kid you not. The hardest part of that interview was me containing myself when I was having to act like I was trying to recall Ohm's Law. Anyway, the interview went well. I get the job. Obviously, you get the sewer robots. I mean, like sewer robots, and so I was he was gonna I was gonna go over the world. He they were sending. People to China and Russia, where the sewers were becoming you know dilapidated, the infrastructure was falling apart. They created a lining that could go in, the robot would diagnose it, and then we'll reline it with this with this petroleum-based product product. I go to call the medical school and say, What you know, what's the status of my application? I just want to kind of know where I am. Well, we don't, here's the deal. We don't have a you're on the alternate list, and that we don't have a priority. There's no ordering of it. So basically, if we and we just had a person notify us today that they're that they're gonna go elsewhere, so there is a spot open. Would you like it? That's I'm sitting here right now because of that one call. That is the wildest thing to me. And I and I'm panicked because I was all excited about this job. Of course. And I called my dad, I said, I'm gonna call you right back. I'm gonna call you back in like five minutes. Yes, yes. In fact, stay in the phone. What's your name? You know, okay, I'll call you right back. And I call and give you, I call my dad. I was flipping out. My heart rate was probably like 150. Well, I mean, yeah, this is the dream. I'm like, I mean, I just called they just said I have a spot. I got into medical school, I don't know what to do. I could really do this job. I'm excited about this job and it's money, and it's like I'm gonna be paid pretty well to do this. And and I just remember my dad saying, Well, do you want to be a doctor?
SPEAKER_02It's like that was what he said.
SPEAKER_00That's the advice you can do. And I was like, Yeah, yeah. I mean, well, there's your answer. So I was like, I hung up and I called, I'll take, I'll take the spot. And that's how it happens.
SPEAKER_01But honestly, honestly, that breakdown, that simplicity, that cutting through is really formative to us. I think because that really is, yeah. What what are my priorities? Is it yeah, is it to make money? Is it to do this thing that interests me? Or is it to ultimately like uh take a larger path, take a bigger goal?
SPEAKER_00Well, I didn't know that I could take the shortcut back then and be called doctor after four years of training. That's kind of a neat thing you can do nowadays.
SPEAKER_01We'll plant a flag there on that one. Um now, uh so I was um second to last, except in into my medical school class, and I was I got real worried real quickly about that, just like, oh my goodness, the the imposter syndrome stuck in pretty quickly there, and that probably served me well because I was I wasn't gonna be outworked. Yeah, I was I was gonna get in there and I was gonna do stuff, and so it worked out at the end of the day. So um so fascinating. All right. Now, you know, in talking about OBGYN, um I think probably for the lay folk, um, you know, it's it's almost like you have two different residencies there. You have the obstetric side, which you have to get your numbers, and as you said, you know, you're gonna people are still getting pregnant, they're still delivering babies. That's that's gonna happen. And getting your numbers, C-sections, etc. But the gynecologic side, this is almost two residencies that you're cramming into one over a four-year period.
SPEAKER_00It's splitting right now. Yeah, I'll tell you right now. Okay, it's splitting. It used to be you come out and you do both, and you could change the ratio of what you do, and then you could do GYN only. I don't want to do OB. You could do G Y N only.
SPEAKER_02Yeah.
SPEAKER_00But the reason that it's splitting is because of now what's happening is that hospitals are creating hospitalist programs. Just like in medicine, they're creating laborists, they're called laborists, and they do nothing but manage labors, okay? And then what'll happen is either a group of midwives that'll be usually be managed by an OB uh will will do the outpatient management, and then they'll be they'll when they go to the hospital, you're gonna get who knows on call for that that laborist. But we we have not done that in Panama City, and I I I think part of it is because we've still managed to keep up and we're still doing honestly. I'd not, I'm not there's there's OBs in in town that were very opposed to that, but I I don't I see the value in it. Sure. Um, because also I my ratio of gynecology to obsex is changing. I'm doing a lot more gynecology. I'm doing 80% gynecology now. Matter of fact, the number probably the most common procedure I do is suburrethal slings for stress incontinence. All these patients I delivered their 10-pound baby like 10 years ago, they're coming, they cough, and they sneeze and they pay on themselves, and it's a very easy, fast, safe procedure that works really well. Uh, and and and we're doing a lot of those. But yeah, it's not exactly a seven-hour long surgery either, right? It's 12 minutes. 12 minutes, and they can do jumping jacks on the parking lot afterwards to test it. That's if there's no recovery on that one. When that's when we're only doing the sling. Now, quite often we'll combine a sling with other procedures where you don't do that. But but in general, I tell my patients, like, yeah, go do do a jumping jack before you get in your car and see if see if it leaks. You'll know if it works. Um, but but that that we still most of the OBGYans here, we do both. We truly are the old sort of old school where we do gynecology and obstetrics. And I think that will go for a while. For example, you know, somebody's got to cover the unattached patients that don't have a doctor, they don't have insurance, they don't have anything, they don't have, and plus we're really, really trying to keep up because we've had a 30% growth in this area. And the people that are moving here, I don't really know what they're doing or what they do, but they're not doctors. No. They're not doctors. They're not. Okay. I think they just go to the beach for a living. I don't know. There are a lot of people who are retired early. Or the the the ability to be able to work from home has caused a lot of people. Well, I I can work from home in like Buffalo, New York, and have to see. And be on the beach. Or I could be at my house in Margaritaville, and it's like I'm doing the same thing, and you have much better than it's like. On the beautiful Animal Coast. So I think that's part of the the the what's happening with that. But we are having a surge, and the traffic is telling you that. We put a beach office out there, and it was in within two months, we're our schedules are packed. And it was a brand new practice. We were packed out there already. And so it's better than the alternative, but still, uh, I don't want to work as hard as I'm working. I really don't. I do not want to do it, but I'm doing it, you know. But um, so what we do is we take turns through a call system and we cover that. And well, now we're doing the hospitals cut uh basically paying us to do in-house call now. Yeah, they benefit from that. They're probably insurance goes down, but it's also the patients benefit from that. Because if you look at, I review a lot of cases, legal cases, lawyers, you know, these you know these folks, you know. I've heard of them, folks. You ever talking about these plaintiffs' attorneys? I want to hear my best my best plaintiff impression. My best plaintiff's attorney impression. I'm gonna do this for the podcast. Oh, please. It comes from a little movie that you may or may not have seen called Ace Venture, that detective with Tom Ace. Do you remember Tom? Tom Ace. Nice to meet you. You know, one of the first things we learned back at Stanford Law was the modern proliferation of food poisoning cases against modern wealthy homeowners. In fact, one can make quite a lucrative practice off little else. And how's everybody feeling this evening? My favorite. Spot-on impersonation to add on. Exactly. Okay, back to the old time. Yeah, back to what we're talking about. So so they there's benefits of us being in-house because when I review these cases, quite often it's it's an issue of uh a delay. You're allowed to live you know 15 minutes from the hospital. If you have a patient in labor, you're gonna be there. But sometimes they come in labor and and they're you there's nobody there in the house. You're on the way in. Okay, but so there's we don't really have that. Now we have somebody in-house, 24-7 at that hospital, which I think raises the bar of quality of care for the hospital in general. And I gotta give the hospital props for that because uh they basically kind of came down to the decision they were gonna either create a hospital's program, okay, to do this, which is incredibly expensive, okay, and you know, or resource intentional. Let the community docs let us handle it, and we we do we are handling it. So yeah.
SPEAKER_01Well, look, that's still uh so I love the healthcare aspect of that. I love the ability to be um fluid there, present, available to take care of emergency cases. That's really, really beneficial to us. But I also wear another hat, which is as a physician advocate, and that's hard. I mean, look, you know, your your call in residency is pretty hard. Yeah, you don't necessarily expect it to uh propagate throughout your life.
SPEAKER_00I tech I usually take the next day off, okay, but it's not off. Um that's when I'm doing research. I have a research company, we can talk about that in a minute if you want. Um but here here's something that surprised me. This surprise me. I didn't see this come. So one of the biggest anger moments I have when I'm on call is not the getting called by the to see the patient. It's when I have been to the hospital and then I go home at one in the morning or one thirty, and then 30 minutes later I get a call and I have to go back for an ectopic or something like that. Yes. And it is the most That is a very frustrating experience. I just got back home. The worst thing I want my family upcoming. Okay. And my F-word ratio to regular word ratio, it changes, okay? It goes high. Yeah, by a bunch. So on my way in, anyway. Exactly. It's like, why did I do this? My poor wife has to hear these things. You should hear my wife hates it. You should hear my ringtone. I'll play my ringtone for the ER. Don't let me forget this. This is a matter of fact, but it's the ER ringtone is so perfect. Okay. And every doctor that takes a call from the ER will want this ringtone and I'll send it to you. Okay, it's wonderful. Anyway, but what I didn't realize, okay, that that is the source. So now I'm in-house. Now when I get called and I'm in-house, I'm right there. You're already done. I'm barely asleep because I can't sleep that well there. But I'm like, I don't have, I don't experience that rage of just oh, I've got to go in. Because I'm already there. I go take care of the patient. Can I pull the band-aid off? And then I can go right back to bed. I'm right there too. So I'm not leaving. So it it makes me, it changes your demeanor on how to deal with these emergencies. And I think that that's a good thing. And then so, like I said, I try to take the next day off, try to hit biscuit world on the way home. Yeah, no, I don't make life in my my my tradition. I'll get a biscuit, carb out, which I normally don't ever do in the mornings, but I'll carve out and then I go and I take a nap and then I can Yeah, I like how it's that's a that's a for me day right there.
SPEAKER_01Okay, like no no. I need it, okay?
SPEAKER_00Biscuit world. You know what? Every once in a while, every once in a while. You know the montage. This is Sam Wolf, Cardinal Rule, I think it's number two, is moderation in all things, including moderation. Okay?
SPEAKER_01You don't want to just be moderate all the time.
SPEAKER_00You want to let you just want to do that the most of the time blow every once in a while and you'll get it and have a tutor's biscuit world business.
SPEAKER_01It's wise worlds. I I look forward to your management. They probably keep you in business over this. Oh man, no, no, no look, downstream revenue. Okay. This is why I say whenever we drive past um St. Andrew's Towers and there's six to nine people smoking out there, I'm like, okay. This is upstream revenue, yeah, exactly. Let's just throw out my business card here. So uh don't smoke, kids. Um, anyhow. So um you know, it's also a different mindset between obstetrics and and and gynecologic surgeries. And you know, I think there is um some people may not fully realize that gynecologists are surgeons. You're doing real life surgeons of everything down there, and I couldn't even tell you what is all down there.
SPEAKER_00They they don't. And in fact, when when we would get the the students that would do their first OB rotation, we still kind of nickname these students. We call them Christmas care holders. You know why? Because you know, they come in, they're like they look like Christmas coatings.
SPEAKER_01It's the uh it's the uh SNL sketch of an immigrant uh baby and a guy on mushrooms who like what is going on.
SPEAKER_00There was this much blood. And it's so funny, and even like my plastic surgery friends, you know, they're like bovy every little vessel. I'm like, give me a break. But it's a it's a lot of surgery, and this in the nature of the surgeries are are typically different, you know. Uh almost most OB is gonna be more of an urgent basis, but quite often it's it's it's uh these are planned, these are repeat C-sections, they're scheduled, you know, and and the the dynamics have changed. The C-section rates, everybody's so they're still very focused as a quality metric, using C-section rate as a as a quality metric. Yes. And that's I understand why they're doing it because there are hospitals in South Florida that have well over 50% primary c-section rate. That means the woman's never had a baby, it's her first baby, and she's having a c-section. 50%. That is not a really appropriate. So we should try vaginal birth first out the gate. Well, wait a minute. I think it's a multifactoral decision. It's very important. I have this decision every day with patients. And I say, there's things you need to take into consideration here. And one of the first things I say is how many kids do you want? You know, you you want a big family? Hey, I got a farm. We got we have like six kids. We need a lot of kids. That patient, I will spend an inordinate amount of time and an inordinate trying to push her towards a vaginal delivery. Because six C-sections is rough on your body. Think of a C-section a little bit as a get out of jail free, okay? Right, right. And so each section, there's other surgeries risks, okay? Because more scar tissue. If the placenta goes into that scar tissue, that can cause an accreta, that can cause a placental abnormalities and all kinds of things. So we, in general, if they want a lot of kids, you go, I'm gonna push them to a vaginal. Now, I get patients that other the other side of that is look, I, you know, uh have a sister who had a nine-pound baby, or maybe she had a seven-pound baby, and then it she had a fourth-degree laceration, she had all these problems. I I want to know, is it can I just skip the vaginal delivery and can I have what's called a maternal request or or a primary elective C-section? And 35, 40 years ago, that patient would have gotten a psych consult. Yes. Okay. Yes. That is not the case anymore. Now the case is I need to inform you, I need to explain to you a few things. One is, you know, you increase risk for DVT, the what are the big ones? DVT, hemorrhage, infection. All three of those increase risk with a C-section. Yes. But here's the problem that I that I think society and the bigger organizations don't do this, and they should. A C-section where a woman is coming in for a repeat C-section and she's hopping on the table and getting her spinal in, and we just get the baby out. That is not the same risks at all compared to a woman who's been in labor for 30 hours. The baby's halfway down the vagina, that I have to go now down, and there's but the water's been broken. Yes. All the vaginal bacteria are exposed now to where the baby is. I gotta go down with my hand, get under the baby's head, which is not, force it back up so that I can get it out the abdomen, and then she's been on oxytocin for 20 hours, so her oxytocin receptors on the uterus don't work. So she's gonna have hemorrhage now with atne and all these things. And and so that procedure is different from this procedure. Yes. So you have to you have to give give these dynamics of these risks to the patient in regards to what that procedure is that you're doing. So I approach it very dynamically. I'm not very I think that there's people that are closed-minded and parochial, no, you see what you do. No, it's dynamic, and same thing that comes with vaginal birth after C-sections. Yes. Incredible problem in my field. I I absolutely call ACOG out on this, and ACOG is the American College of Obsession iNcologists. How are we doing on time? Good. I call them out on this, and I call them all, and I know people that are in the higher, and I said, you guys have this wrong, and you should not be doing this. You're misinforming the patient, and I will absolutely spend all of my energy explaining to you why this is. They want for a vaginal birth after C-section, there's this blanket number that they put out that the risk for having a uterine dehiscence where the baby can come through the scar, 0.8%. Garbage. Here's why. Because you there's two groups of women, you have to separate these, you have to partition them. Because if you had a woman that had a vaginal delivery, and then her second one, the baby was breached, and that's the only reason they're doing the C-section. Baby was breached, we don't, it's 3.4% chance of a head entrapment. We're gonna do a C-section. In this country, we do that. In France and Europe, a lot of they'll still do vaginal breaches. Yeah. Anyway, now it's her third time pregnant, and and and she had a repeat. So it's like, okay, well, your risk is 0.8% chance. No, her risk is less than 0.4%. She's had a tested pelvis, she's gonna be in labor less time. It's about it's about time and the amount of time pushing is what really where the force is coming. So her risk is really low, and she should actually be encouraged to consider it, okay? Now, there's another group of women, and it's the lady that had her first C-section, and the baby was like seven pounds, and failure to progress, CPD, cephalopelvic disproportion, because we have to give everything a scary name in medicine. Um, that head is bigger than the pelvis. So it just doesn't fit. And and now she's pregnant again, it's second baby, maybe three years later, which by the way increases her chance of having gestational diabetes and a bigger baby. Of course, because they typically are bigger each one. Yes. And so now she's like, I I read a magazine, uh my risk is less than 1%, and I want to have a vaginal birth. Okay. Okay, well, wait a minute. It's not it's not 0.8% because if you partition out the people that have already had vaginal birth, your your risk is nearly 3.5%. It's somewhere between 3 and 4 percent. Remember what I just said? We don't do vaginal breaches in this country because the risk is is greater than 3.5 percent. What so that they just fell in that yes. I spent a lot of time explaining to the patient it's okay to have this as a dynamic decision. Yes. You because I was trying to do what if I'm if I if not to mansplain, but if I was a woman, okay. If I was a woman, that's how I treat my patients. I'm like, uh, what would I do knowing doing this for 25 years? What would I do? And my answer is to this is I would, if I go into labor on my own up until say maybe 38 weeks, okay, let me try to push that baby out, okay? But if I get past that, mm-mm, I'm not taking the chance. I'm just gonna get another C-section. That's that's kind of what I guide them as I do it.
SPEAKER_01And yeah, well, I think this elucidates a couple things. First of all, your algorithm is more sophisticated than just this number that comes from A colour. That's exactly what it is. It's nuanced and it should be individualized. The risk assessment should be individualized. Make it bespoke for the patients that you're there, and that is a crucial thing to the thing that I compliment highly, which is being a good doctor, which means doing the right thing for the right patient at the right time and not doing the opposite of that. And so, yeah, so being more subtle and more nuanced, and I will say to patients, look, I can tell you the exact numbers on this. I got a bad feeling about this, okay? And I've learned over time to pay attention to that because you're gestalt. There's something that is catching my brain that I can't even fully tell you right now, right? And that has me more concerned about X, Y, or Z. And we should probably approach this a little bit differently. And but ultimately, I'm there to offer you options. You have to walk the path. If you if they say, um, come hell or high water, I'm still gonna go for this vagile delivery. Yeah, you're gonna try and facilitate that as best you can. Absolutely.
SPEAKER_00I mean, and then it's called, you know, they they have it's about informed consent. It's like I I've informed you what can happen about it. If that's the way you want to go, that's okay. And I respect you. I'm always gonna be on your side. I'm never gonna be mad at you for what you chose to do. I'm gonna do help you through it. Now I might try to change your mind, but I'm never gonna judge you or be mad at you. You just don't worry about that. You do what you think's right, but I'm gonna try and help you make the right decision. And that's the way we should approach it. Absolutely, absolutely. Patience king in that whole thing. But you know, there's things that put us in a bind, and let me bring this up because this is a pattern, too. There'll be patients, uh there'll be midwives out there that are basically lay midwives, not sort of registered nurse midwife, not too far. They're lay they're they're midwives, there's different categories of midwives. You can be a midwife without basically very min very minimal. Uh it's more of a just experiencing a few deliveries. I think it's a two-year program. I don't know. To be a lay midwife, you have to do home birth in this Florida, because of Lawton Child's daughter, way, way back, though we have some of the most uh least stringent rules on this in in in the country, and you'd be surprised. So you can totally have even VBACs, okay. These can be done, these can be done, okay. They can at home. They can be attempted at home, okay? So they can't be done in birthing centers, but yeah, yeah, we allow it to okay. So now legally they can do home births. Well, the the problem associated with that is now what if uh what if a patient says, I you know, I want a home birth, I want this experience to be in home. But I also am not an idiot. I want to get the right labs, I want to do all these things. I want to get an ultrasound, I want to get an anatomy scan, I want to do things, but I want so what the patients we we've had lots of patients that that sort of will come to our office and they want to establish care, but then we kind of do their labs and their ultrasound, we never see them again. And they go and they do a home birth. And then what'll happen is is the home birth uh facilitators will say, Well, you know, it's okay because so-and-so is on call for you tonight. Well, what they're referring to is the person that's on call for the ER and unattached patients. They kind of mislead the patients that there's a a collaboration or a collaborative agreement, and there isn't. And that it absolutely should be the law. What you have to have in Florida to be to do this is if you're gonna do a birthing center, even a home birthing center or any kind of thing, you do have to have a collaborative physician to put on the thing, but it doesn't have to it doesn't have to have anything to do with you. In fact, we have one here locally that I had a real issue with and and and this the collaborative physician was in Winter Park, Florida. And I'm like, okay, I remember calling the guy because I actually got his number. And I was like, I said, Are you gonna take care of this patient? That you're you're you're the collaborative physician listed up by the state. Oh, what what what no? No, so I I tried my hardest. I got a resolution through the FMA. Yes to very and everyone that reads the resolution is like, what, this isn't already the rules? Why how could this possibly not be the rules? And the and all I'm saying is that the the collaborative physician for for doing home birth and things like that should have privileges at the hospital that's being designated for emergency services. At the same facility, yes. Would you think that would be the rule? That that's I would think that would be. Intuitively that would make some sense, yes. But that ain't the rule. It is not the rule at all, and it's a little bit silly. Um but anyway, I digress. It hasn't been the same thing.
SPEAKER_01Well, but but but I think this also talks to another thing that that we've spoken about, um, which is that, you know, um my mid-levels that we have in our practice, um, shout out Aaron Colton and Ben. Uh great job, guys. They like to call them mid-levels because I was told that's like, you know, you know, like well, the the point is they are excellent. Yes. They're very insightful, they cover a lot of deep cardiovascular pathology, they're very smart about it. We talk about it a lot. If they ever get in over their heads, they call us immediately and we talk about these things, but they're really good at it. Yeah. And they're very humble about it. They don't want to be independently practicing.
SPEAKER_00I completely we have the same situation. Exactly. We have nurse practitioners that are actually GYN specialists because now they can do a women's health extra certification. And the they're incredible. We have one that's been, and she started as a labor nurse, and she incredible experience, and actually probably are better practitioners than any doctor coming out of rest. Yes. They have developed the experience and and they've done sort of the time. And I and I think they're so valuable to us because we can't deal we can't do it all.
SPEAKER_02They are greaters.
SPEAKER_00That's the issue I have with the whole thing. Okay, I have a couple of issues with it, but this is the biggest one I have. Okay? And this happened to a relative of mine. I'm gonna say. But anyway, this prep this person went to go see uh I can't it was a cardiologist and and said, Okay, did you see Dr. Son? No, I saw the I saw the nurse practitioner or PA, I don't even remember. And she told me the name. I said, No, that that's not right, because that one works, that's with the GI specialist. That's a G that PA works. Oh, no, no. So I go and find out a switcheroo occurred. Now the problem with that is is like that that PA or nurse practitioner had had done GI for more than 10 years and was incredibly good. And technically learned a lot. Of course. But but I as an OBGYN cannot say, you know what, I'm tired of this. I'm sick of the call. I'm gonna do dermatology. Yeah. I'm uh since I'm you're in for it, buddy, because I'm gonna start ticking your business. And so I'm gonna go. Okay, then Jeremy, architect. Okay, Sam wolf coming to you. I'm gonna do dermatology and I'm gonna start up a practice, and that's what I'm gonna do. We we don't allow that in medicine. That's right. Okay, you have to have specialty certification. I think there needs to be, you if you're gonna do primary care, that's fine, you can switch to different levels of primary care, but there should absolutely be some sort of residency, some sort of aftergraduate specialty training for them. It doesn't have to be as extensive as ours or as long as ours. Of course, it needs to kind of be the basics. But I think that that's important because when my when my relative shows up to your office, that person thinks they're getting a very experienced specialist, whether it be a PA or the doctor themselves. And I think not great. And then the other issue is like, come on with the hormone clinics, the bioidentical hormone clinics. Oh my God, you guys, um I've been doing hormone therapy for over 20 years.
SPEAKER_01And it's very easy to learn overnight, right?
SPEAKER_00You can just you can just learn it and it's done. You go to a weekend course, you're not a hormone expert, okay? And then what kills me is this the bioidentical market, and I want to clarify something. I don't, I'm not anti-compounded hormone. I do I write for a lot of compounded hormones. There's there's certain patients that that's the only thing I can get that's gonna help them out, okay? But that's not the preponderance of the patients. Most are fine on a conventional regimen. And the word bioidentical is a word, it's not a medical word, it's a marketing term. The FDA has very clearly said this. It's not a medical word. Levothoroxine is bioidentical, okay? We don't call that oh bioidentic. Uh anyway.
unknownRight.
SPEAKER_00My point is that there's this natural connotation, and and and it's being the patients are being misled, they're being told it's safer. It is absolutely not. If anything, it's less safe because there's less research. They're not doing the research, and any research that's being done on that because it's not under the auspices of the SCP. It's outside the S's level of the conventional. If it's being done, it's being paid for by them, so it's not peer-reviewed. I want to do this analogy. We got time for this. This is one of my favorite analogies, and I I tell I tell patients this a lot, because I get patients that come in and they're everything's jacked up. Their endometrium is you know 15 millimeters because they're banned on estrogen, not really necessarily appropriately opposed, and things like that. And I said, look, let me explain this biodentical thing for you. I'm gonna give you a really good analogy that clarifies it, okay? You can go to Publix and you can buy Landolak's butter, okay? You know how it's gonna cost, you know, four bucks or whatever butter costs these days. And you know it was made in a factory that someone in the government went in that factory and made sure there's not rats running around everywhere. You know very few rats. You know what it's gonna taste like, it's gonna be consistent, it's gonna be like the Landolak's butter that you bought last year, okay? And or you can go to uh the Amish market north of Thomasville and you can buy some farm churned butter, which might all, by the way, be awesome. Yes. And I'm not that's what I'm saying, because there's some compounding pharmacies that do an incredible job, okay? Rx Express, that's who I used. Shout out to them. Shout out to Rx Express. They do, they're very intense on quality. They're there's some really good ones, and they love what they do, and they do a really good job. But that being said, they they're not under the same regulatory stuff that that these the other pharmacies are under. There's there's there's something to be said for that. And when you get when I order a prescription that says, hey, this is for estradiol patch, that's coming from a factory that has been regulated and and for potency and you and consistency. And precision, yeah. So you're you're the dose that you're uh getting is going to be. And the reason that's even available because it's been FDA approved, and there are studies to show that uh safety and and benefit, okay? And so you just don't have that the other way, and and I think that patients get misled. And the other thing is like they're paying gobs of money. Why are you you it it's so you're paying all this money and you're wondering why your insurance doesn't cover it. The reason the insurance isn't covering it is like, we're not gonna cover that. What why would we cover something that had that that hasn't been regulated or the wild west? Yeah, it's the wild west. It's it's a little bit out of control. I think that part of it is our own doing. The WHI trial, which you and I probably may or may not agree on, was one of the worst things that ever happened to women. Yes. There the reason we don't the reason we don't have a testosterone preparation in this country, by the way. I do tons of testosterone therapy in women. I think it's incredibly important in low doses and menopausal and perimenopausal women. Uh, you know why we don't? Because of I think it was 2004, they were they were about to market a testosterone patch for women, women's doses. All the testosterone products now are all men's products. We're doing it at one-tenth the dose. This product was coming out. F uh the uh WHI trial had happened. It's uh all the dust is starting to not even close to settle. An all-male FDA board said, Whoa, triglyceride's elevated, LDL is a little bit elevated in this. We're killing this.
SPEAKER_01Cardiovascular disease is gonna be coming.
SPEAKER_00Yes. They killed it. They said, nope, we're not gonna approve this. This company has spent over $40 million bringing this to market. And so all the other all the other pharmacologic companies are like, we're not doing that. No, we're not gonna invest. We're not gonna take that risk. If they're gonna do that, we're not gonna take that risk. And so I think it was just devastating because I think when I see the difference that test microdose testosterone therapy, it's there's is uh there's extreme genetic variation in the side effects, which that's there's a sweet spot for every patient on that. You can't, it's not a one-dose for all on those. That's right, that's right. And it and it's like it's not about levels, everybody's like, oh, check your testosterone. I gotta check my levels, I gotta check. I check levels when I don't get an anticipated response. Okay, otherwise, you're treating the symptoms. I have patients that come in with a uh estradiol level of you know 18 and like I feel great since you put me on that low dose patch, it's like awesome. And then I'll have patients that have a 60, 70, and they're like, I don't feel anything, my vagina's like the Sahara Desert. What's going on? You know, it's like and you check the box, it's like so. So my thing is levels are can be helpful, but it's not you don't do it just cookbook.
SPEAKER_01So this is kind of uh an overarching thing that I've always had, which is you're treating the patients. We're not here to treat numbers, we're here to treat patients. And again, if you feel good in general, you are good, okay? I'm not gonna sit there and say, oh, your heart rate's in the 120s, you're dying. That's not how this game works here, okay? So so I I like that kind of bespoke level of where you're really talking with them. And yeah, there's also um we're sometimes enslaved by big data that says, well, we've got this trial of 100,000 patients, and we saw this pseudo-negative response because of data that's 25-ish years old. Right. And so therefore we can't do that. We may be missing out on helping a lot of people. Uh, you know, women that go through menopause, it's it's very quick that they lose a lot of their hormonal balance.
SPEAKER_00And not only that, we've one thing that we did learn with WHI is that when you when they go, you don't want them to be menopausal for five years because that changes the intima of the lining of the vessels. And if you try, so if you I always give this an analogy. If you have two women, they're twin, identical twins, and and and they're both at uh 50 now, okay? And the one lady's like, Man, uh, I got this new husband, okay. I want I want I I want to stay home, I want to be on my hormones, I'm gonna go into the and the other lady's like, nah, you know what, my husband may have died, and I just don't want to, I'm not, uh, I'm not gonna do any hormones. I've I'm gonna get through it, okay? So now let's jump five years ahead, or maybe even for more dramatic purposes, go to 60, okay? Now at 60 years of age, and she's still not hypertensive, not diabetic, she's still a candidate for hormotherapy, okay? But her risk is infinitismally higher than the woman that's been on the hormones the whole time. You're gonna add at 60 years old, you're gonna add a you're gonna add estrogen. That's where we know there's a real risk. And when I see patients on do hormone therapy every day of my life, gajillion times a day, it's like I write on their chart and I tell tell them the right. I'm doing an individualized risk assessment for you, and we're looking at the risks and benefits. Everything has risk. Pulling out of my parking lot has risk. Of course. Not doing anything has risks. Yes. Are the benefits more? I deal with this with breast cancer, vaginal estrogen. The amount of estrogen that's absorbed into your system from vaginal estrogen is from a one-gram dose is seven nanograms per deciliter. Even my wonderful, incredible breast surgeon colleague, Dr. Moody, agrees. Yes, yeah. There the risks have women being miserable.
SPEAKER_01But yeah, so that's the it's a huge bugaboo because I I think we can sometimes be m led astray from these things. I I often say to patients, look, I'm not here to make you miserable. Yeah, I don't get any special bonus points for you being miserable, just as alive as a head in a glass jar. I want to make you alive and active and doing stuff and feeling good.
SPEAKER_00And so and let's not kid ourselves, medicine, just like just about anything else, has fads. Of course it does. There's things that are in vogue and not in vogue. Yes. And so we we like to think that everything we do is is evidence-based, but honestly, if everything we did was evidence-based, we you why why even have a doctor? You just have a computer program, have a have a Cheerios nurses, which is maybe the future.
SPEAKER_01Um, um uh so yeah, look, I I love the way that you're approaching this because I think you're really helping a lot of people. And it also goes to show you that you know, our body's biochemistry is extraordinarily complex. Yes. To have to be able to make predictions. I mean, honestly, we have to try certain things, see how you react to that, see if there's any other changes with it. But ultimately, we're looking at making your life better, God forbid.
SPEAKER_00Well, it's it's still interesting to me because after reading the book, The Language of Life by who wrote that book? Francis Collins. Oh, yes, who I used to be a fan of. Yes. Not so much after COVID, but we'll keep that in. But Francis Collins. He wrote a book called The Language of Life where I discovered the double dealer. I learned about uh pharmacogenomics. Yes. And it's it's still wild to me, 15 years after reading that book, that there's only two specialties that standard use use pharmacogenomics, and that's oncology. Oncology and psych. Just to remind everybody what pharmac pharmacogenomics are, there's thir there's a lots of genetic variation in liver types and liver metabolisms. There's 13 main types, okay? And what they do is they're gonna test how your liver metabolizes that drug genetically, and that can determine significant dose changes. Yes. And it's the biggest in chemotherapy because what is chemotherapy? You're trying to kill as many cancer cells as possible, but minimize toxicity. Yes, exactly. And so there's huge variation, and hey, you should get Haberman or one of those guys on as you to talk about.
SPEAKER_01Oh, of course. I know it's gonna be fantastic. We look forward to having them on. Awesome. Shout out, Chris. So um, well, uh I I've said for some time, you know, we had the Human Genome Project. Our next step is gonna be the Human Pharmacome Project, where all of a sudden we can figure out specifically what is gonna be the right dose for you. Yes, 13.7 milligrams of lysinopril is gonna be the perfect dose for you.
SPEAKER_00That's it. Yes. And then I know we're we're getting wrapped up. I gotta go see patients, but I want to end on this because you just brought up, because it here's in my opinion, here's gonna be the biggest, next big problem we have in mainly in cancer. And I'd love for you to talk to Aberman about this. Well, so Protonomics has been on the horizon. Yes, I mean I remember my first article I read was in residency. That's how long it's been around. Now we haven't had the computing power to do it.
SPEAKER_02Now we do.
SPEAKER_00Okay, so Protonomics is going to be able to diagnose cancers. Well, and I love to use pancreatic because I just lost one of my very, very good friends to uh cholangiocarcinoma, and and it came out of nowhere, and no warning, no nothing. Okay, and so um we're going to be able to diagnose with protonomic studies. I didn't get to talk today about research, but I would love to come back and we're gonna come back and bring it to it. We can go back and do that. But we're gonna be able to diagnose these cancers before we have an imaging modality. Yes. This is what I'd love to talk to Lindsay. Okay, can imagine you're you're the patient, uh, you come in. I've just done this test, by the way. We uh and these are coming. I've done research with the, I know the companies are about to bring these to market. And they're and and and I'm gonna tell you as your patient, okay, look, we did this test, okay? Remember this new awesome test I was telling you how awesome it was? Okay, well, we did it and it came back positive. You you have a stage one, at least, or at most, okay, um, pancreatic cancer. Yes. Here's the deal is it's probably so early. I can do a CAT scan, I can do an MRI. I'm not gonna see anything. I can't just go hacking your pancreas up. I can't remove your pancreas because we don't have an artificial one that I can give you. We're just gonna have to now what do we do? So there's gonna be a step there is gonna be a gap where we're in this zone of what the hell do we do with these cancers? And you don't want to send a picture of the city. You know who's gonna come to the rescue? And this is all conjecture by me, by the way. Sure, sure. My conjecture is the who's gonna come to the rescue is gonna be immunotherapy.
SPEAKER_01Immunotherapist. What's gonna be immunotherapy?
SPEAKER_00We're gonna have targeted viruses that we'll go and get it. We're gonna hit you with a bonus cured before you never even had a symptom. I'll take you one step further.
SPEAKER_01I'll take you one step further. Your watch is going to tell you, hey, this biomarker came up. You need to go to the local. I've already scheduled you for an injection. You're gonna go in there, get your NK cells or whatever that are gonna go in there and take care of it. And I think I honestly think that is my biggest candidate for a cure for cancer as it comes on because you know, cancer's a ton of different diseases. This is how we do it. Once you get that biochemical marker of early stage that a cell has escaped its senescent uh barriers, that's when we give the extra because that's what we're doing all the time, anyway. Our bodies are forming cancers.
SPEAKER_00I don't know if our generation will benefit you and me, but uh I love the fact that my kids might. I know well, of course. I mean, there's there's it'd be cool if we can make it. I think it's coming.
SPEAKER_01I think it's coming. Okay.
SPEAKER_00You gotta start doing the ice bass.
SPEAKER_01Look, um, I'm gonna say there's a ton of things that I still wanted to get through with you. Yeah. Uh day in the life of your practice, what the far future has, AI is gonna be fantastic. Um, some interesting things to do.
SPEAKER_00I'd love to go over that.
SPEAKER_01And we're gonna go through we're gonna go through your research, we're gonna talk about your hobbies. We're gonna do all this, we're gonna have to have you on back. More ace ventura? More ace venture. I actually had about a three-hour long uh segue that I was gonna go into the ace ventura. I have more. Okay. It's a little bumpy here. Sorry. So um, but I do want to do some rapid fire questions for you real quick. Okay, to end up. Okay, you ready? So who's the smartest person in history? Don Davis. Oh man, I totally agree. That's the excellent.
SPEAKER_00The smartest person in history. Okay, uh, I guess I would have to go with somebody like Galileo. I mean, I don't know. Great idea. These guys, Aristotle, Galileo, they they they've survived antiquity. And if you're that if you're smart enough where you are survived antiquity, you're pretty darn smart. Yeah. I am an I am an Elon Musk fan, even though he's controversial. I think he's a pretty bright guy. I would say, the reason I like Elon Musk, if you want to have bright he is, is just listen to one of his longer interviews. And and and like, look, for example, Rogan asked him, like, hey man, why don't we have uh why don't we have uh solar powered planes? Okay, well, Elon breaks that down. Well, because you have a solar panel that weighs this much, and he's lot rather than power. Yes, yes, joules of energy, and this is what it takes to get a plane off the ground. And then now he goes, You you could actually have solar power to fly the plane, you just can't get it off the ground. Yes. And I that that's he's one of the just brightest guys.
SPEAKER_01God, he's he's just he's got a brilliant autistically engineering mind that he can kind of dive into a process. And one of the greatest things I think from a leadership perspective is that you know, he would sit on the Tesla floor and he would figure out we can't get this battery thing to work, we can't get this to work. And then he goes, Wait, why do we have this in the first place? Yeah, and then they they retro cause analysis and find out, oh, we didn't need this in the first place. And so those kind of questions are really formative.
SPEAKER_00Just like intimidating for me. I think you know, we we think we're kind of smart as doctors, but some of these guys, like even like I have my my uncle and my father, these are two of the smartest guys I know. Yes. My uncle used to write math math books, and it's just he's a human computer, his mind is, and he's all he's just an absolute amazing, uh intelligent guy, and my dad's the same thing. My dad can recall organic chemistry still. Yes, yes, I love it. I I cannot. I love it. I don't you you could put a gun to my head and tell me in a uh that you have to do this equation, I would be dead. Well, if you know Ohm's law, it's gonna help out a lot here.
SPEAKER_01So okay. Um now um if we can live to be a thousand, should we do it?
SPEAKER_00I so you no, okay, because I don't care about how long you live. I want to know my health span. That's the new hot word, health span, or your functional life curve. And I think a f I you think your functional life curve should be like this, okay? Yeah, it's going down, a little, down, down, down, down, down, down. Plummet. I want to be dead, okay? Yep. I don't like this. I don't want this. I don't want this. So if you have if you find a way, if the technology is so good that you can allow my functional curve to still, and I can kite surf and I can do these fun things that I want to see and do, or you can, you know. I think that the answer is going to come into honestly, way, way in the in the future, they'll plug us into something. You know, I think that when they figure out how our brain, how our how our nerves work in our brain, you you may they may develop some technology to be able to do something with consciousness. Right now, there's they're not even close. The hard problem of consciousness.
SPEAKER_01Yeah, we just don't even know what it is. We don't, we don't, and I don't know. That may be an insurmountable problem. Yeah, um so um do you like it too cold or too hot at night?
SPEAKER_00Um well that that's changed in since for for my 20 years since you went through medical. 26 years of marriage, okay? It used to be she's all over me, and I'm like, oh my god. Just okay, get over there. And and now it's completely the opposite. I'm like all over her. I'm freezing. And she's like, get off of me. Anyway, so I think I'd rather be uh too warm now. Okay, all right. Look, but I like ice patterns. That's the first time that anybody has said the wrong answer. But I like I think cold is so I think cold water immersion, I don't prescribe it to patients because the evidence is horrible. Okay. Yes, for sure. But here's the deal I'll tell you this. I've been doing it two and a half years now. I absolutely detest it. I don't enjoy it. Oh, it's not fun. Yeah, I don't think it's not fun. So why am I still doing it? There's only one reason. It's how I feel afterwards. Uh I I I run you know six to nine miles a week. I'm swimming a mile, and it's like it when I do this ice bath right after, I'm not sore the next day. And if I don't, I'm miserable. So I think there's something. So I think it's doing something. Yeah.
SPEAKER_01Colchak proteins, heat track proteins. I don't know.
SPEAKER_00I think there's benefit.
SPEAKER_01I want to talk to you about that whenever you come back because I've done some research on heat tracking.
SPEAKER_00It would be a really good podcast. I'll set it up in here. That's what I'm saying. Yeah. We'll actually do an ice bath. You can do it. I'll get you in the ice bath and I'll talk you through it. You need a guide. Get this ready, okay? You need a guide. Yes. Or we can run to my house and we'll do it as a separate video.
SPEAKER_01I think that'd be probably easier. Cold baths. Stay tuned to medical mastery. Um now, um, what's one thing you would tell yourself if you could go right back to when you were starting med school? A piece of advice. Don't hook up with that girl at um at Bullwinkle's.
SPEAKER_00No, I'm just kidding. That's a bad thing. No to Bullwinkle. Cut that out. That's kind of a balance. Anyway, credit that out. Okay. Because I'll do like you know me. You're like me. You do humor to give you time to really come up with the real answer. And so you have to come up with a humor.
SPEAKER_01It's my entire life.
SPEAKER_00Yes. Okay. It's my entire career. You're one of the more funny guys I know. Stop at you. And you just have the gift of gab, and not many of my friends have that. You know what I mean? Yeah. So anyway. So what I would tell myself is don't change a whole lot. I really have had such a good life, and I appreciate every single day of my life and every minute. And then I I really love paying attention and trying to focus my energy on enjoying little things in life that really get because as I get closer to the end, I am terrified of how of how time is being experienced. And let me give you an example. Uh when I I took a week off and did a stay vacation, staycation or whatever. I swear to you, man, it felt like two days. Yes. And it scared me because I want to retire early. And so one of my worries of retiring is that if I retire, is the rest of my life gonna go like that now that I'm not like busy? And I'm that's a genuinely nervous thing. But then again, I'm busy enough that my brain, like I'll find things to do that very much entertain. Oh, but yeah, I didn't get into my event center because one of my my second job, when I retire, I'm not just gonna quit everything. I will be a probably full-time, but at least part-time, um, wedding DJ. And and and by the way, don't knock me until you tried me. That's all I gotta say.
SPEAKER_01I'm not knocking a thing here. Uh, will you be doing it in a um South African accent? Because then I'm in.
SPEAKER_00There might be some involvement in my various accents that I do.
SPEAKER_01Um won't even throw in my Russell accent.
unknownOkay.
SPEAKER_01This is very good, yes? Yes. She's a good woman. She's keeping her. Everything from Blue Game. Um You know, one thing that I've been thinking about lately is about um details that we surround ourselves that we don't notice. So have you ever walked around your house and just noticed pieces? And the way that I think about this is that if I were to take a picture of this piece, could you recognize it as your house? And it's it's kind of been a fascinating study to me to be like, I'm surrounded by things that I'm not paying enough attention to. So anyway, just something that's been a good thing.
SPEAKER_00I think I have mine memorized to the point that I can navigate through it in the dark. Yeah, that's about it. Yeah, it's great.
SPEAKER_01Um, all right. So um what is one current medical treatment or therapy that we do that we're gonna shudder at that we did 15 years from now?
SPEAKER_00Man, I wish I'd known this one ahead of time. I should have looked at these. Because there's so many obstetric ones, maybe. Well, one that I've one that I've had the pleasure of see disappear almost completely that I'm really glad is is amniocentesis. Oh yes. We're doing one thousand fold less amniocentesis than we were ten years ago.
SPEAKER_01Because the complication rate is no, because of NIPT. Yeah.
SPEAKER_00NIPT, non invasive prenatal testing. We now have a blood test that's far more accurate than what we had before. And and the old test we had, nineteen out of twenty positives were false positives. Oh man. And the MFMs loved it. They were five percent. Yeah, they were they loved it. They were putting meals in everybody that came in the door. And and so now that that test is so accurate, very rarely they're getting referred for that. The main MC amnios they're doing now is when they see uh an anomaly with the fetus, but they but the but the testing is still normal. It's like wow there's limitations because you we could have picked up fetal feet uh placental DNA. Yes. The placental may be good and you have a mosaic on the baby.
SPEAKER_01Well, and there's also maybe undiagnosed cardiac abnormalities that are not genetically recognized based on something that we I mean, you can have spontaneous mutations that are going to cause certain things. And amniocentesis uh sticking a needle through the amnion, choreo amnion, and uh high risk procedure, high risk for infection.
SPEAKER_00They're way better at doing that. The original studies were like one in three hundred uh fetal loss with an amnio. This was back in the this was back in the 80s they were doing them when uh not ultrasound guidance, okay? By the way, that's the reason AMA, advanced maternal age, is set to that, but a lot of people don't know that. AMA is set to 35 because back when the initial study showed that the risk of a woman having a baby with Down syndrome at 35 was about one in 300, okay? Well, the risk of the amnio of fetal loss was about one in 300. That's where the risks intersect. That's the code of the case. So now, this is what I tell, so I tell patients isn't the I say, you ready for the bad news? Okay, here's the bad news for you is that uh if you do the modern study, which is one in 800, a one in 800 loss, AMA really should be, if you're using the same algorithm, it should be 32. 32 should be the advanced maternal age. Yes, but I tell them not to worry about it because it doesn't matter because now that we're doing NIPT, it doesn't even matter. Okay, so so so that that's changed. But you know, coming back to that, maybe maybe C-sections, I don't know. Maybe we'll have robotic assisted uh deliveries.
SPEAKER_01I love it. I love it, yes. Or maybe artificial wounds that we're doing.
SPEAKER_00So it's or just to try to query them and just you come in each day. You're like, there he is, look at me. It's uh it's the uh Monty Python of you're not qualified. Well, I could do that ski. I used to make the interns watch that ski. That's one of my favorites.
SPEAKER_01And isolated all times.
SPEAKER_00Um two more questions here. Okay, uh, what books are you reading right now? I'm reading okay, so my nightstand has about four books that I'm kind of halfway through. Yes. Okay, and I do very familiar with it. And and I tend to read them at night and they're putting me through. And then I'm reading the the most recent um Malcolm Gladwell book. Yes. Which is uh um he he did I'm trying to remember the first one that he did was so famous. Um but but I'm read I'm finishing that one. It was the it was the Revenge of the Tipping Point. Revenge the new one. It's called Revenge of the Tipping Point. Yes, and it's really interesting, and if you want, if you I'll give you that if you want when I'm done. Do you want to hear something hilarious? It's a it there's some references to Panama City in there, and I'm not I'll allude to that. Spoiler alert. I'll allude to that.
SPEAKER_01Uh but I am shocked at reading.
SPEAKER_00I know Panama City, yes, and Panama City medicine in a good way, by the way. It wasn't in a good way. He was looking at why does it cost $200,000 to do this procedure here and $100,000? Okay. So anyway, I'm reading that. I have a lot to say about that. And then on Audible, I'm even doing a more a more way better book. And it's called Dungeon Crawler Carl. Oh.
SPEAKER_01So we had uh Future Release coming out, Dr. Jamie O'Neill, who is raving about this book series, and he's a very prolific reader. And he says he's reading all of it because I it's next to my list now.
SPEAKER_00You don't read it. I'll do the Audible. Do the Audible. The the narrator is the best book narrator I've ever heard in my entire life. And he kind of sounds like Kronk, you know, the guy putting the play putty. He's got that deep voice. And that is one of the best narrated books. Okay. Just put it, get it for your next car trip or something. Look, I've had two people that are advocating for Dungeon College. The best book I recently finished, and I highly recommend this book to anybody in here, is also The Mysterious Case of Rudolf Diesel. I think that's two books ago, but though I still can't get over how awesome I love that book.
SPEAKER_02Okay.
SPEAKER_00And that was about Rudolph Diesel who invented the Diesel engine. Yes. This guy was kind of like a my Elon Musk of his day. He was one of the brightest guys of his day. He was just incredible. Nikolai Tesla, kind of and a very interesting human being. And this this book basically went through his life, and nobody knows who killed him, you know, by the way. He got killed. He was killed. Nobody knows how it happened. But it the Rockefellers inspected, okay, or the Nazis, because remember they were using diesels in the subs, and the and Rockefeller won, he's like, I don't want these guys, he didn't like the Nazis. He's like, I don't want these guys being the only ones with the technology. So he was gonna get it to the English, he was gonna get to the English, and he did. He did, and so one of those two groups. Could have saved the war. Yeah. Yeah. Because those those seawolves were something, man. Yeah, that could have turned the tide.
SPEAKER_01Well, fascinating. I love all those uh concepts. All right, now last one here. Um, what is the greatest song of all time?
SPEAKER_00It's a song I wrote called the Chlamydia Song. And it's a song that goes to the tune of I Will Survive by Gloria Gaynor, but it's about a guy that got chlamydia, and it's quite quite realistically the funniest and best song. And in fact, I unfortunately sold the rights to that song to for a ride to the airport when I was stranded in the in the Keys to Michelle Dravis, who's a wonderful musician that's down in the Keys, and she every once in a while will still play it and say, Hey, I'm playing your song. And she wrote another one, actually, that was pretty good. But uh, I remember it was October, I got stranded, and then November uh she texted me and said, I'm about to do your song, but go on to the Sloppy Joe's webcam, uh Sloppy Joe's Stage Cam, and I'm about to do your song, and there she goes. And this song goes out to my favorite gynecologist, Sid Jones, because that's my karaoke name, and I use that when doing this song. Um phenomenal song. I'll do it when I'm closer to retirement. I promise you, and I've told Michelle this because she's heard it, and everybody loves the song. I'm a little bit too in active practice right now. It's a little the the song's a little dicey, a little spicy, it's a little dicey, yeah, but I will do it, and it it's gonna be awesome, and we can do it as a sort of Sam's About to Retire song, you know. I had writer's block in the middle of it, you know, and on a Tuesday night, the kids in school, Tuesday night, I wake my wife up at two in the morning, you gotta get up, I got the rest of the song, and I drag her to the piano room of our house, and I'm I'm playing it. I finish it up, and I'm not wanting to ruin it. But it I came up at the end of the song, and I just remember her looking at me and she's like, That was pretty funny. Can I go to bed now?
SPEAKER_01It's 2 30 in the morning and she's still with it. Um I got a good one, man. So obviously, you guys get a feel for for Dr. Sam Wolf and all the incredible things that he does. I mean, um so so uh a Renaissance man, um hilarious. I knew this would be fantastic. I had an inkling that we would probably have to go to a part two because there's a lot more stuff that I really want to get into here. I know. We've got a lot more than that. I know. Well, uh, you know, we could do it at 1.5. Um, either way, um, Sam Wolf, where can the folks find you right now?
SPEAKER_00Um Emerald Coast WGIN is our practice. I don't really have, you know, everybody kind of knows we're the largest practice. So if if you're trying to get an appointment and it's they're saying it's four months, please um if it's something urgent, send a portal message in. We will try to get you in. We're trying to work patients in. Sure. We opened a beach office, which is less busy than the in town office and definitely quieter. So we can all a lot if you don't mind driving to a pure peer park area, uh, we can get you in uh out there. And just we we we're trying our best. We love our patients, and we're trying to get all the new ones in we can. It's been a struggle, but we have two new doctors coming this year, and I am really really happy about it. And they're both really qualified and very excellent, excellent positions. One's coming out of the military, and so she's got a lot of experience in her belt. And so we we're just stay tuned, and I would love to get them involved in the association.
SPEAKER_01Let's do it. No, let's have them all here. Um, so uh thank you, Sam Wolf, for everything. Thank you for being in our community. Thank you for uh being hilarious, thank you for uh taking care of uh myself and my family and being on call whenever we need to. And um thank you for helping us make medicine better together. That's right. Have a good one.