Functional Medicine Reality Podcast

04. Humanity in Healthcare: A Candid Talk with Dr. George Papanicolao

• Dr. Mark Su MD, Functional Medicine Practitioner for Health and Longevity • Season 1 • Episode 4

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In this episode, I sit down with Dr. George Papanicolao, long-time mentor, colleague, and friend, for one of the most honest conversations we’ve ever had publicly about medicine, humanity, and what it really means to care for people.

George was my first boss early in my career and has spent more than three decades practicing medicine across vastly different settings, from the Navajo Nation to primary care to the UltraWellness Center. This conversation is not about protocols or supplements. It is about the inner work of being a doctor and the shared humanity between practitioner and patient.

What We Explore

  • Why medicine is never just about symptoms or lab values
  • The complexity of patient stories and evolving health narratives
  • How bias quietly shapes clinical decision making on both sides of the exam room
  • Why self-awareness is essential for good medicine
  • The gift and burden of empathy in patient care
  • Emotional depletion and burnout in clinicians who care deeply
  • Why hypervigilance around health can slow healing
  • The limits of medicine and the role of acceptance
  • How contentment and gratitude can coexist with illness
  • What it means to partner with patients rather than try to fix them

A Rare Look Behind the Curtain

This episode offers a rare and honest look at what happens on the other side of the exam room. We talk openly about the pressures clinicians carry, the responsibility of working with complex chronic illness, and the ongoing effort required to stay present, objective, and human.

We also explore why healing is rarely linear and why progress often depends as much on mindset, relationships, and expectations as it does on treatments.

Key Takeaway

Good medicine requires more than knowledge.
It requires humility, self-awareness, and humanity.

Patients are not puzzles to be solved.
Doctors are not machines without limits.
Healing happens best when both are seen clearly and honestly.

This conversation is a reminder that clarity begins with truth, and truth begins with being human.

Dr. Mark Su:

I'm Dr. Mark Su and welcome to the Functional Medicine Reality Podcast. Join me and our community weekly as we bring you unfiltered health from inflammation to longevity. Real stories, real people, real solutions. Experience real life health changes from both patients and practitioners and learn how to turn cutting-edge information into real results in your own life so you can feel better, live longer, live healthier, and be confident and clear in your healthcare choices. Let's get real and get results. Hey friends, welcome again to the Functional Medicine Reality Podcast. I'm Dr. Mark Sue. I am here today with a really special guest and friend and mentor, not just professionally, life mentor, Dr. George Papaniccolo. Let's get started, right? We're here as usual for to help create clarity in your life so you can lead a better life. We're about truth telling and vulnerability and just the reality of not just medicine, but even life, humanity. Just the life as experienced as humans in this in this world as we know it. George, that was a we've been connected for a lot of years, but let me let me just go ahead and if it's all right, I'll just introduce you briefly and then shift it over to you. George Papaniclo is a he's at this point a full-time functional medicine practitioner. He's at the Ultra Wellness Center in Western Mass. He's been practicing for over 25 years. He has a really deep passion for treating root cause of illness. He was invited by the well-known Dr. Mark Hyman to join the Ultra Wellness Center team in 2017, I think. Is that right, George? Correct. Yes. Okay. All right. He's so there he's helped thousands of people over the years at this point worldwide. And he has a particular focus these days in the realms of ADHD and autism in particular. He's known for his relentless approach. And he's described often as being an FBI agent to uncover clues and asking questions, examining data, and looking for the sort of story that emerges in patient journeys and patient profiles and their health experiences. And he helps partner with patients, helping them to reclaim their health over time in a persistent way, a lasting health in body, mind, and spirit. That's what he does professionally. I'll say here also that as context, so George and I know each other because he was my first boss. So he's been practiced for I think over 25 years. For me, it's been 22 years because I you were more than that. I think it's been more than is it over 30 now? That I've been practicing medicine? Yeah. Oh, yeah. Yeah, yeah. Okay. All right. Yeah, yeah. So yeah, you were my my first boss from 2003 to 2006. And I was straight out of residency, green as can be behind the ears. We got connected from my perspective and story and recall because we sensed who we were. We sensed we sensed who we were as people through even just on paper, on resume, that we had a similarity and in particular about our worldview and our faiths, our faith, who we were in faith worldview. And I was really excited and looking forward to being able to be under your wings in that early part of professional life and but also in personal life. And so, George, you continue, obviously, you continue to be instrumental in my life in in countless ways, have been, continue to be. So yeah, thanks for being here, being the first expertise interview among our rotating type categories and types of sessions. But anyway, enough said, thanks for joining. Thanks for joining us and getting started here.

Dr. George Papanicolao:

Mark, it's a it's a real pleasure and privilege to be on your podcast with you. I know what you're endeavoring to do. You're trying to bring humanity into medicine. You want us as doctors to be seen as humans, as co-journeymen with all of our patients. We bring our own lives in. And I think it's really exciting what you're doing. I'm really glad to be here. And just a couple comments. Uh, I consider you to be one of the most influential people in my life in regards to medicine and growth. And I really have enjoyed our professional relationship and certainly our personal relationship and the things that we've been able to do in our lives together. It's great. It's you're right. From the very beginning, there's been a quantum connection. We've experienced a lot of life outside of medicine together. And I think that speaks to the connection that we've had. I remember when we sat down and you signed your contract, I said, Mark, I said, There's a good chance that this will not be the last practice you're in. And I remember you said to me, No, I'll be here a really long time. And I said, if you're here, I said, if you're here, because I'd been in the community, I remember saying, if you're here in three to five years, we've done it really well. And even though after three years you saw another opportunity, I just I always look back to that and I see there's lots of times that relationship, when that ends, those two people never talk again. And you and I have maintained that relationship, and it's been one of the real treasures of my life that we have. And I'm really glad. I'm really glad to be here. And I'm really glad to be able to share what I've learned over the years, and hopefully it will be helpful to your listeners.

Dr. Mark Su:

That's yeah, that's really heartfelt. I'll be honest with you. I remember a lot of different conversations we've had even way back then. That one I that one I don't remember so much, but might have had I was probably deering the headlights on multiple levels. Yeah, yeah. Naivity is like my middle name. That sounds like me right there. Yeah, yeah. Yeah. Yeah. So we'll see, we'll see if some of that comes back up in our conversation here. But I love where you start from. So just a quick, just further, it makes me think about your so we have maybe as a rough sketch here, right? Because the whole goal is to not over-rehearse and fabricate and script these things out. So we have in mind here possibly up to three questions for today, right? Three questions slash topics. And the first one kind of stems, extends out from just you've had a really diverse professional career over 30 some ish odd years. And in that context, I didn't mention earlier, you've worked on the Navajo revs reservations for how many years was that? Was that more than three? Four, four, four years. You worked in the Navajo reservations with a completely different, not just demographic, but cultural and everything kind of life. All right. That's just a whole nother world, obviously. You worked in the suburbia North Shore, Massachusetts, where you know I still am, where we met, where you reside half the time. Now you've been working for eight years at the famed ultra wellness center, working with a whole nother world of kinds of patients, clients, not only in terms of their backgrounds and who they are, where they come from in life, but the kinds of complexities and illness. You've worked in primary care, which is where you and I started in the mainstream world, like insurance and all that craziness that continues to be, maybe even more crazy now. Who knows? You've worked in that arena in the last eight years, obviously at the Ultra Wellness Center. It's a wholly different story, functional medicine, largely not insurance covered. It's just a whole nother beast. The diversity is just immense, right? Yeah. On so many levels. The question is at this point in this extensive and illustrious career, what kinds of patients do you find to be the most difficult for you in this day and age for you? Yeah, for you personally. Is it in terms of clinical topics? Is it in terms of personality and behavior profiles? Do you find there's themes and patterns to that? And if wherever your response might be, any thoughts behind what's evolved in those regards, whether for you or from the patients? Yeah. Yeah. How's that for loaded? First question.

Dr. George Papanicolao:

It's loaded. There's just so much to talk about in that question. When I think about difficult patients, it's not the difficulty of the patient. It's the complexity of what we're doing when we meet with a patient. Because it's a communication that has to happen. It's a very complex communication. And it's never just about the physical symptom that the patient comes in with. It's intertwined in a complexity of emotion, social, relational, cultural, personal aspects of a person's life. And you have to work through that, that, that grid, that network in order to figure out what's going on. And you have to do it in such a way that the patient feels comfortable. And you have to understand the layers and help them understand the layers. And it's really the art of navigating that complexity. So I don't, and that's the art of medicine. That's what really excites me. So when I have a patient, particularly at the Ultra Wellness Center, I have a 25-page intake form they fill out. Then my PA goes through that intake form, meets with the patient for an hour, does their own assessment, writes out their own summary for me to review before the visit. I have all the labs that the patient presents. So before I even walk into the room, I've done a deep dive into this person. And I often tell them, you don't really need to tell me too much today because I pretty much know more about you than you do. And I bring to it 30 years of experience. And so I tell people when they're coming in, I'm like reading their story. And I'm reading this story, and it's their narrative. And my job when they come in is to interrogate that narrative and find out what's real, what isn't, what's been missed, and what might be missing entirely, like whole chapters of a narrative. Like I'll be reading a book, and then all of a sudden I've gone from chapter seven to chapter 12. And I'm like, wait, we're missing something here. And then helping people to fill in the blanks for themselves, I help them understand things about their narrative that they may not have understood. And so there's it's it's complexity, it's navigating that. And that that's exciting. And I and it's working through that, and it becomes where's the challenge lie? I think you're where does the challenge lie in all of that? I think from my perspective, on my end of it, is and I think I may we may have talked about this years and years ago, and you maybe even have asked me, like, when do you start to feel like a doctor? Like, when do you feel like you arrive finally arrived? And it takes a while to really begin to understand yourself and your ability to walk into that room and be a doctor in the complete sense of understanding not just the physiology, the biochemistry, the pathophysiology, but really understanding what I just spoke about, the multiple layers and being able to engage in the with the patient in a really comfortable way to get them to be part of the process, feel like they're part of the process, know they're part of the process, they're feeding into the process and do that. So there are two things that I had to learn about myself. I had to learn about my biases. I had to learn about what triggered me regarding a patient.

Dr. Mark Su:

Yeah.

Dr. George Papanicolao:

And that can be hard. You need to develop a certain level of emotional intelligence to be able to engage in a healthy way with your patients. And if you go in with bias, whether it's a cultural, relational bias, whether it's a personality bias, whether it's a class bias, you need to be aware of them. And it took me a long time to become aware of. I always thought that, yeah, I love everybody, right? Oh, I have people just like you that are my best friends. And I realized that I had biases. And I and they're pretty, it's pretty humbling when you begin to see them and you're like, wow, I never thought I was that person, but I am. So bias was one thing that took years and years to uncover one at a time. Because if you're biased, then you can't see the whole picture.

Dr. Mark Su:

Yeah. And you can't communicate authentically. Do you want to uncover the second one? Or I've just jotted notes to myself for three sub-questions now. All right. Yeah. So do you want to shoot for your what's the other topic?

Dr. George Papanicolao:

Or I pause because I just I know your mind's twisting and turning and doing acrobatic stunts.

Dr. Mark Su:

I've had yeah, I've had to write down a couple notes before I forget them.

Dr. George Papanicolao:

Yeah, I wanted to give you a chance. And I when I do podcasts, I just hate to go on and on. But are you gonna remember the second one? There are certain podcasters, I don't have to worry about it because they tend to interrupt me all the time.

Dr. Mark Su:

Are you gonna remember your second topic or do you I know exactly what it is?

Dr. George Papanicolao:

Okay, you're gonna remember it? Yeah, I got it.

Dr. Mark Su:

Okay, all right. So let me I'm gonna okay, let's just go back a second here. Let's just take a look at where we're at with the bias topic. Okay. Yeah, I'm totally with you. I we've if we haven't talked about this in dinners or whatever it is over the years, I don't remember a definitive conversation around it, but I think we know each other well enough. That's uh and it comes out in other conversations, whether podcasts or with patients or whatever. For me, that's just a huge thing for me. And a lot of that's just, as you say, it starts with just self-awareness, and which is in my book, maybe one of the top things therapists are working with all of us about when we're working with therapists. So here's a question not to be like throwing shade or being judgy or critic critical or whatever, but how from your experience working with a lot of different colleagues on the practitioner level, they could be prescribing practitioners, they could be nutritionists, they could be health coaches, whoever, it doesn't matter who they are. The person who's in the support caregiver role for a patient, any thoughts on like how often other practitioners are aware of or think about their own biases?

Dr. George Papanicolao:

Okay so it's not a conversation that I frequently have with my colleagues. However, I talk to a lot of yeah, so interact with a lot of my colleagues, see a lot of my colleagues, interact with patients. And when I say colleagues, I don't mean just at the Ultra Wellness Center. Through the breadth of my experience, I would say that humans in general tend to be blind to their biases. It's obvious, right? We have and and doctors are no less susceptible to bias. Yeah. We're probably it's probably most important for us not to be biased. And it's probably most important for us to really be always learning how what we're blind to. And I would say if you want me to give you an answer and you want me to be controversial, I'd say that most of the doctors that I deal with have no clue, don't even think about it.

Dr. Mark Su:

Yeah, I'm not trying to be intentionally provocative or whatnot, but I am. Oh, you are okay, fair enough then. I think I'll join you.

Dr. George Papanicolao:

It's mind-boggling.

Dr. Mark Su:

Yeah, I'll join you. You know, you you you know me well. Like I shy from conflict, all right. But and so I'm not trying to be provocative per se, but it's based out of my own experience of how and I think I'm hearing the same from you, right? Because we've never we haven't had this kind of conversation before. Okay. That's kind of like the cool thing that I'm I thought might happen with us here. If I heard you right, you were saying, hey, one of the two biggest developments or evolutions in my own life and in how my professional and personal for that matter, life has changed is becoming more aware of my own biases as a doctor. And I'm right with you. And I feel that same way. And when that I, when that crack screen, wide open experience happens, it then makes me wonder, okay, before and after. And then who else has had this experience or hasn't? And then if I'm and then I start wondering when other practitioners are helping patients, especially the mutually, the patients were mutually helping, then how am I going to try to account for that to help the patient? Because some of the suggestions or directive thoughts that the other practitioners might be having, whether for a mutual patient or for my friend or my family member, whatever. And it's not, it's again, it's not to be critical. It's just to say, for your best interest as a patient, are you there might be some biases there that they may not be aware of? And I'm not trying to presume and be assumpted, be judgy about, but for your best interest as a patient, like it matters.

Dr. George Papanicolao:

Yeah.

Dr. Mark Su:

Fair?

Dr. George Papanicolao:

Absolutely. Absolutely. As it's absolutely true. You have to be aware of your own. Then you have to be aware of the ones that have influenced that person. So that patient, particularly at the Ultra Wellness Center, we call ourselves the practice of we call ourselves the resort practice. And it's not because Canyon Ranch is down the road.

Dr. Mark Su:

It's because we're the Because you give everybody Mai Th when they walk in.

Dr. George Papanicolao:

Yeah, no. I think by the time people leave, they're so overwhelmed they want a Mai tie. Yeah, there you go. But no, we're the practice of last resort. So I get patients that come in and I call it the tear gauge. And it's or the or the yeah, I'll just call it a tear gauge. How many steps it takes into the room, into my room, before the patient starts to cry? Because they with so much baggage and they've been so many places, and so many of my patients come and they've said it to me. You're my last hope. And why do I say all that? Because they come and they take their bag of puzzle pieces and they dump it on my desk and say, here's where I've been for the last two years, five years, ten years. Nobody can make sense of it. I've got primary care, five specialists. I've been to the mayo, I've been to, I've been to Hopkins, I've been here. And they and then they start. There's that narrative I'm talking about. And so now they want me to put the puzzle pieces together. So we have to work to put them together. And not to mix my metaphors. So we'll put the puzzle piece aside. But before I put it aside, I've got to put those puzzle pieces together. And some of them fit, some of them don't. Some of them were pieces really were should be part of another puzzle, right? Yeah. So then I look at it and sometimes I can see, you know what, we're only missing a couple pieces. I can tell what this is. This is an elephant. You're just missing two critical pieces. Okay. That's a pretty easy one. If we put that metaphor aside and we go to the narrative piece, people have been speaking into their narrative, right? Doctors have been speaking into their narrative. They've had relatives speaking.

Dr. Mark Su:

Are you talking about the patient the patient's narrative?

Dr. George Papanicolao:

Yeah. Okay. So the patient, so it's almost like it's like it's like an evolving book narrative, right?

Dr. Mark Su:

You don't mean like the patient's own created narrative. You mean collectively evolving narrative.

Dr. George Papanicolao:

Yep, yep.

Dr. Mark Su:

Right, okay, sure.

Dr. George Papanicolao:

It's their narrative, it's and it's being spoken into, and they're they begin to believe their narrative. They begin to understand it. There's and there's all these characters in their narrative. They'll tell me about this doctor here and that doctor there, and their grandparent or their husband, and how they're speaking into their lives, and how this is becoming their story. And and that story is now combined with the fact that they're in chronic pain, they're bloated, they're they have brain fog, and they're not getting better. Right. Okay. I need to help them understand some of the things that they're believing are based on some of their own biases, some of the biases that the doctor spoke into their lives. And these are those things I was talking about earlier in the narrative. I'm interrogating the narrative for their benefit and mine to get to the truth, get to what's really what's the true story.

Dr. Mark Su:

Right. So I love that because that's this is a more much more fine niche manifestation or road of what we're talking about. But this all aligns with your and my value in about truth telling or detecting being a detective for truth. And just bringing it back to the bias question. Do you have observations of common themes or patterns of bias from other clinicians? Again, just we're all humans, so it's not a judgy thing. It's just as other for other clinicians, maybe it's based on prescribers versus non-prescribers, maybe it's mainstream versus functional, maybe whatever it is, or it's just individuals or whatever. Do you have observations of what are common biases from other clinicians that you observe as brought to you from the patients that you uncover as in working through their sort of story and narrative? That's a good question. And we if it's too much, we can move on.

Dr. George Papanicolao:

No, because it's a good question to ask because it just it uncovers some real important issues, I think, that we all have to be thinking about. I would say that I'm not sure it's a bias the thing I'm puzzling over is I'm trying to, I know so many, I have so many examples, but I have to sift through what's a true bias and what's not.

Dr. Mark Su:

And how about if I would it help would it be helpful if I threw out a couple of my thoughts and see how they how you relate with them or not? Yeah. So I don't want this to come across the wrong way, but one one that strikes me of my top three is you and I both know a lot of practitioners in the functional medicine world come to this place as a functional medicine practitioner because they've gone through their own crap. They've gone through some experience that you commonly themselves, if it's not themselves, then the family members or somebody, close friend, family members, et cetera, where functional, where mainstream medicine did not suffice, right? On whatever level they didn't get better or they had bad experiences by just as a human or whatever the case may be. And commonly it's the clinical thing, they just don't get better. It doesn't, they don't fit a specific diagnosis in the mainstream world, and then they discover this functional medicine world. And then when the practitioners like they they explore that, they know enough to explore it, they get better, and then that all of a sudden the screen's cracked, and I want to help other people, I want to pay it forward. The one concern I have out of that is if I'm a person who's gone through that as a practitioner and I found myself in the healing space after treating Lyme disease, let's call it, let's say that, just chronic. Lyme disease. It's easy for me to be on the lookout for chronic Lyme disease for everybody. And the thing is, yeah, a lot of people who have chronic inflammatory illnesses or autoimmune illnesses, whatever, they're going to test positive for Lyme disease a lot. But for me, I'm not, I can't say what percentage of those people actually is Lyme disease the biggest root issue as you talk about complexity, right? There's speaking of complexity, we're gonna have to try to find a way to keep this simple today. But I mean, those people, is Lyme disease actually the big dog issue? And I'm and if I'm overly focusing on that, because each topic, as you already said, is complex in and of itself. So if I get narrowed into Lyme disease for the next 10 people, but I'm missing the boat for eight to nine out of those 10 people because they got a bigger deal. I don't want to waste their time. I I feel badly for the patient who it's not that they were intentionally, right, or malignantly or maleficently, whatever the word is, right? They're not they weren't intentionally being led astray, but it's a bias that I I just wonder how many practitioners are aware that and try to not even just aware, but actually then secondly, try to compensate for it.

Dr. George Papanicolao:

What do you mean by compensate?

Dr. Mark Su:

I think you and I see this all the time.

Dr. George Papanicolao:

What do you mean by compensate for it?

Dr. Mark Su:

So compensate would be like, and I do this for myself too much, but okay, so if I know that I'm looking for I'm thinking about LEMSE's too for everybody, right? Okay, I'm gonna can I purposely say, okay, let's put that for a side. I know I already think about that. What else should I be thinking about? What else should I look for also? Or hey, if I don't, if I don't, if we don't see progress soon enough, let's not keep going down deeper in that rabbit hole too long. Maybe I need to look sideways and and diversify my thinking.

Dr. George Papanicolao:

So it's interesting you say that because I was thinking about bias stuck because I was thinking more on the conventional side of medicine and not on the functional medicine side. But when you said that, the light bulb went off and it was bing bing. That is, I that's a bias I complain about all the time, particularly with function on the functional medicine side. Functional medicine clinicians can tend to be biased by their own previous experience. And it does impact how they will then see a patient coming to them. And I this might be a little bit off the bias side of things. I call it the functional medicine parade of diagnoses. And it's because people are coming to you from conventional medicine and you're a functional medicine doctor or integrative doctor, then they're looking for you to find that that secret magic thing that the conventional medicine world is missing. With the conventional medicine, it's only looking where the light shines, but we're the guys that who are out in the dark putting on like the miners, the miners' hat with the light shining, so we can start looking in places nobody else looked before. So we're looking for mold, we're looking for lime, we're looking for heavy metals, and we're looking for EMF, and we're looking for all those things. And sometimes we can get too much focused on that that we miss the bigger picture that it's never going to be just one thing. I've had people come to me and they've had mold exposure and and they're concerned about their mold exposure. And they're they even give me enough evidence to say, yeah, you did have a mold exposure. Oh, yeah, and somebody in your environment was affected by that mold exposure. But I'm looking at them and I'm not, you know, their cluster of symptoms are such that I'll once we get all their labs back and we've talked and we've gone through it all together, I'll get to a point and say, you're you have one band positive for Lyme, you've had mold exposure, but look at all this data over here. It really points to all of these things having more weight right now than that one band positive for Lyme in your mold. Let's work on these things. And if we don't get to where we need to be, then we can go to our second-tier items. And so where I find oftentimes patients come to me where they've been getting treated for Lyme disease for three years by a practitioner who's biased by the fact that I believe it's Lyme disease. Lyme can be chronic, and you can you might need to be treated for years and years. And they missed everything else.

Dr. Mark Su:

Yeah. And again, just to for me, I speaking for me, I try to just be objective about it, saying, hey, if that was just a bias of the clinician, like it's hey, it's not faulting it. Hey, you covered that. Let's, hey, they're taking you down a road that you wouldn't have gotten in conventional medicine as it is. We just got to account for that and think about, well, do we need is are the is that was that a correct thinking? Do we need to go deeper or do we need to think more broadly? Or I wanna honor that person for having gotten through that in their own personal life. And hey, they're human just like I'm human. So not only might they have that bias for about Lyme disease, but what other biases am I thinking about for me and that I should be aware of myself so that I'm not leading people astray, also? But it's a hard thing, right? It's a constant talk about complexity. Now you're not just dealing with the person in front of you, like you've got to be talking to yourself all the time, too.

Dr. George Papanicolao:

It's personality bias. Like I'll be reading it, I'll be reading a chart and I'll be reading through it. And I'm like, oftentimes I'll be working on a Saturday or Sunday prepping for the week and or on a Friday, and Michelle's in the house because she works from home, and I'll be reading a chart, and I'll be in the kitchen at lunch and I'll say, geez, I'm gonna have a crazy Monday morning. You know, yeah, and I'll say something about a patient and because I and I know it's a bias when I say it. And I tell her, I'm just gonna have to just I've got to get rid of that. This person is coming in with really high expectations, or this person, they're missing the real issue that's going on. And I'm already building a bias against a hyper-vigilant person. I may be building a bias against a person who it seems like they're hopping from one doctor to the next doctor, never really wanting to get better, just now so engaged in being sick that they've lost sight of where they're at. And I become biased against that. So it's there's so many things I trip over. It's so when I say I'm aware of my biases, I'm aware that I can be biased. I'm still biased and I'm aware that I can be biased. I've got to constantly double check myself. And I often ask my colleagues to go over a case with me to see did I miss something because I had a blind spot.

Dr. Mark Su:

Yeah. No, love the transparency. Again, I we've had maybe we've probably touched on this kind of thing just more of in joking or in jest, but never dug into this kind of thing. But yeah, it's very, I think we're very much in the same fab, same page on this. It's it's a lot of work, but it's it's stimulating and it's challenging. And ultimately, when we see people get better and when we experience personal, per literally personal, your personal growth, my personal growth along the way, like that's fulfilling.

Dr. George Papanicolao:

Yeah, it is. It is. And so are you ready to move on to number two?

Dr. Mark Su:

So yeah, let's do that. And I'll add other yeah, let's do that.

Dr. George Papanicolao:

What's your other number two was, and there's actually a third, but uh it's gonna be like a it's a it's a sub-third, but okay. Number two is empathy. I'm an empath. And and when you're an empath and you feel things and you can feel things in a very deep level, and so a person comes into your room with an enormous amount of emotion over something and you feel it, yeah, it's like a drug. It's it can be like a drug. I have empathy, I feel it. I want to engage with it, I want to help it, I want to smooth it over, I want to connect with that person, I want to carry them, I want to help them, I want to dig deeper. And that can really be a benefit for the patient. And it's really something a doctor should have. You have to have empathy and you have to have compassion.

Dr. Mark Su:

Back me up again. These are the two topics that you said have been really you've become more aware of as far as factors that have really changed how you practice and how you your professional development are. Yeah, yeah.

Dr. George Papanicolao:

Yeah, because I when you talk about the complexity of that doctor-patient relationship, yeah, the biochemistry piece, the physiology piece, the pathophysiology, that's easier for me. Yeah, the detective work, which we're I'm gonna talk about in a second, is number three, but the detective work of trying to piece it all together and go through the matrix of thinking about what are all the possible root causes leading to this person's current condition. That's a those are easier. But the things that impact me and really impact my ability to do those other things well, the things that will bog me down is the bias and the empathy. How can empathy bog you down, George? Here's how it bogs me down it's a weight. It's a weight. And if I have empathy, if I feel everything all my patients feel, if I try to engage on that level with every one of my patients, I am depleted by noon, right? I am definitely depleted by the end of the day. And I have nothing left. And I need more left. I leave at five o'clock and I gotta go put daddy hat on. I gotta go put on husband hat. I gotta go put on board hat, colleague hat. I've got to do all that. And if I'm depleted, I'm not gonna, I'm not gonna have the emotional energy, I'm not gonna have the mental energy to carry on. And over time, it erodes your effectiveness. And so I've it's taken me decades to be able to control that. And I still struggle with it. I hear you.

Dr. Mark Su:

Yeah. And I'll connect that back that from my experience with that empathy part. It's it in some kind of slight overlap way, it's similar to a bias, at least for me. Because for me, if I in that same way, if it I might misinterpret the importance of something or what somebody's telling me because there's an emotional overlay to it, and it's harder to be objective. Yeah. Fair. Like simple, do you have any similar experiences?

Dr. George Papanicolao:

Oh, yeah, absolutely. All the time. I have to tell myself, just stop it. You need to think clearly right now. And your your objectivity is being your objectivity and the advice that you're about to give this person is being driven by your own empathy. And your own empathy is being poisoned by your own personal emotional experiences, and that poisons the bias. It's the bias that I'm bringing to that emotion, that feeling that I have had. And now, because the patient's feeling it, I'm superimposing some of my own emotion on it, which clouds my thinking and my judgment.

Dr. Mark Su:

And again, none of this is none of this is bad per se. It's just being freaking human.

Dr. George Papanicolao:

No, it's not bad per se at all. It's actually a gift that I have that my patients love. Yeah. My patients love the fact that I'm empathetic, but I am aware of the dark side of that empathy and how it impacts me personally, professionally, and relationally. And I also know how it impacts my objectivity in providing the patient the best information. Yeah. No doubt. Those are the two things that have really, as I've grown in those areas, I think that's freed me to use my gifts as a doctor that are really strong more effectively and beneficially. Yeah.

Dr. Mark Su:

So bringing it full circle. When so what I'm hearing from you, interpreting when the question is, what types of patients do you find to be the most difficult? And you start out by saying it's maybe as a yeah, summary response, it's just the overall complexity. And that complexity is on multiple levels, this whole grid, the different aspects of who the person is, the complexity of the narrative of their clinical story that especially, as we know for some people, they might not know, but functional medicine is pretty broad, right? There's a lot of people doing, and it's not to be negative, it's just functional medicine light, right? They're working with less sick people. They're focusing strictly on like gut health issues or adrenal hormone management, or whatever the case may be. Maybe it's just strictly just sleep hygiene. Whereas folks like your my experience is there's a lot of patients we're working with people who are can be really complex. And especially at Ultra Wellness Center, like you're getting people who, as you said, they've they've seen a lot of people already. So it's almost like the subspecialty silos in functional medicine that is parallel to what happens in mainstream medicine, right? We can they can go see patients, can go see a just a functional Lyme practitioner, they can go see a functional mold practitioner, they can go see blah, blah, blah, blah, blah. But when you're a person, like you're doing kind of like Jack of all trades and you're trying to put all the pieces together, as you said, bringing that analogy back, like it's a freaking lot. It's a freaking boat load. And I can I'm envisioning like you prepping it and then, okay, pull the pants and get ready for it's gonna be if you're seeing new patients all the time, as you said. I think Monday through Wednesday, you're seeing new people like all day long, all three days, is that right?

Dr. George Papanicolao:

Yeah.

Dr. Mark Su:

That's just for me, that's just like dumping ground. It's not to be negative to the patients, it's just you're taking in new information with a load of lack of familiarity constantly all day long for three days straight, and all the grids and complexities with each of these people. And in the end, you're saying, I hear you saying what has what I've identified as what is what can be helpful for me or has started to clear things out for me a bit over time is being better aware of and addressing my biases and managing my empathy gift and being able to then navigate those complexities and grids that are being brought to my table every day. Yep.

Dr. George Papanicolao:

Yep, exactly. And the second part of your question was really, or the main part was what types of patients? And I really started with me. I said, to answer that question, I want to start with me first. Sure. It's important. Because if I tell you, okay, what types of patients do I find the most difficult? I find the patients most difficult in the functional medicine world who are who find it very difficult or unable to change. Because I find that fundamentally, if I can't get people to change their lifestyle, and if we think of the pillars I of functional medicine, is the you need to be able to sleep. You you need to be able to, your nutrition has to be spot on, you need to be exercising, you need to be managing your stress, you need to be managing your relationships. If I have people that can't change those habits, won't change those habits, or can't, it's very difficult to move the needle. I can't supplement a person out of a 60-hour work week who's married to a narcissist. The impact that has on their health, right? They can't sleep, they're stressed out, they're eating comfort food, they're coming to me because they're overweight and they're they have brain fog and they're anxious all the time. Those are the symptoms of the bigger problem. You're working 60 hours a week as a partner in a New York City law firm, and you're married to a narcissist, and you have two kids being raised by a nanny, right? When I can't get a person, now that person is in a very difficult position. It's my, I have to help them navigate that. But that's the person I find very, those are the most difficult patients. They go near the top of my list.

Dr. Mark Su:

Maybe yeah, the circumstances and the patients' lives that are you have less control over, and and it's and they find difficult or sometimes unwilling to explore, at least, if not as you say, change, make effort to change. Yep. Not that it needs to change like 180 degrees in the next three days, but just to be willing to explore or acknowledge some of those circumstances and then explore them. Fair.

Dr. George Papanicolao:

I find it particularly with ADHD, my ADHD patients, they need it, their brains need a challenge all the time. There's a large subset of ADHD patients whose brains work the best when they're being challenged. They're doing something difficult. There's this concept that Ned Halliwell and John Rate in their book ADHD 2.0 talk about. And I may misprint, I may not correctly get the term they use, but it's finding your easy hard. And it's basically figuring out what your gifts are, and then using your gifts towards your challenge, finding your gifts. So you may be really good at math, building an AI robot, right, is a great challenge for you, but it's using your gifts. Yeah.

Dr. Mark Su:

Yeah.

Dr. George Papanicolao:

And you just you're shooting for really high, really cool new innovation nobody's ever thought of, but you're using your gifts versus having ADHD, always being told that you're not a good writer. Then you decide, I'm gonna write a novel. Now you're taking on a challenge outside of your gift set. It's a mismatch. It's a mismatch, but it's meeting the need for you to have a challenge, and now you're mismatched. And now you're now you're you struggle, you're dissatisfied, you're discontent because you just never can get there and you beat yourself up. So in your default mode network, it becomes the demon. All you do is have this negative self-talk versus the other person who, by chance or by guidance, figured out, work out of my strengths. Okay. It's the same thing with our patients that don't have ADHD. They've have a dream that they want their life to look a certain way, but it may be a mismatch for their physiology. It may be a mismatch for their genetics, it may be a mismatch for their underlying condition. If you have airless Danos syndrome, there's a good chance if you're a young, young woman, you're a child and you're a girl and you like dancing, there's a good chance you're gonna go into ballet because you're really flexible. But if you have EDS bad enough, chronic fatigue, POTS, which is posture orthostatic hypotension, you may have those to some degree and they're going to limit you. So you can't this you can't sometimes have a dream to be a uh a marathoner if you have EDS because you just can't manage your blood pressures. You're just chronically fatigued. And so you choose career paths that don't match your genetics, your physiology, if you get unfortunately engaged in a marriage that is disruptive or you experience post-traumatic stress disorder, it's going to impact you and you're going to have to alter your dreams. So you've just that makes sense?

Dr. Mark Su:

Absolutely. And I don't, and I don't mean to make too hard of a pivot here, but I'm realizing like we thought this might happen, and it happened even more than I expect. Again, my naivety in full frontal. The three questions, like pretty much we're gonna stop after this one, right? We're gonna have to, with your willingness and yeah, with your willingness and time, I'll we'll have to consider doing these on follow-up. But more more importantly, I think you just raised yet another question that I think we might have danced around before as a possible topic, and that is so I'm just throwing out here what you've just brought up as the topic of acceptance. That's, I don't know, for me, that's a tough one. And especially in this day and age where, I don't know, feels to me with all the information that is at everybody's fingertips and internet, but now AI, it's even more so. It I suspect it's gonna be able to come to terms with or accepting and deciding when to come to acceptance is becoming gonna become even a bigger challenge over time. But yeah, I'm not I'm just throwing it out there in case we make space to explore that topic some other time.

Dr. George Papanicolao:

Yes, but you can understand in our world now with social media, and I think that the epidemic virus that's worse than COVID is social media. And that it's it's a virus that augments reality.

Dr. Mark Su:

Yeah.

Dr. George Papanicolao:

It's augmented reality, and it's taking life and it's taking things that are good, and it's making them more than they should be, and expectations higher than they should be, and then it's leaving people discontent. And then you bring that discontent and that attitude discontentment into other areas. And so for my patients, it's always a I want them to be at a place where they're content. You can be sick and you can still be content.

Dr. Mark Su:

Yeah.

Dr. George Papanicolao:

And and getting them to understand that I want my patients all to be healthy, and but sometimes we can only get to a certain place. It's a reality.

Dr. Mark Su:

So I love that just to qualify your I'm just because I know you would you would agree with this. It's not to say we're settling because there's always hope, there's always things you can do, but it can't, then functional medicine is not a world of it's gonna, it's a quick fix, it's gonna turn around the next week, especially when you're dealing with really sick people like yourself, like you, you do. And so it's expectations, it's timing, and there's ability to have contentment or like what people often we are always talking about as gratitude, to practice gratitude along the way. And it's not only for the sake of making the journey feel smoother, but we would both agree the practice of gratitude and that attitude, that limbic system, that mind-body thing, only serves to help improve your actual physiology along the way and usher you towards healing, even.

Dr. George Papanicolao:

Which brings me to my second patient, it's very difficult. It's the hyper-vigilant. It's the hyper-vigilant patient that is just perseverating on their health with the desire to be completely free of the disease, or if they're healthy, they want to have optimal health. They've they've in I'm gonna say it, they've bought into the longevity story and they want to live to be 120. And so now they're hyper-vigilant over everything, they're reading everything, they're listening to more podcasts, reading more literature than I have I can. And so it's the hyper-vigilant person. That's the person who particularly is gonna struggle because that vigilance leads to an imbalance in the autonomic nervous system, it leads to limp. Activation and we know the neuroimmune connection. There's a very strong connection between the brain and your immune system. And so when you're under huge amounts of stress, when you're constantly driving cortisol and other hormones, then you're going to be out of balance. It's going to definitely impact your immune system and it's going to put you at high risk for an autoimmune condition or other chronic diseases. So that hypervigilant patient is the other patient that is a more complex patient to get onto that level ground where we can work in a balanced way towards health.

Dr. Mark Su:

Writing a note to myself for another time. So we've, I think we've outdone ourselves here, at least from my perspective, because we can keep going. I think I think you've commit I think you've unknowingly committed yourself to uh at least two, if not more, sessions between us, because this is rich stuff that uh when we get together socially, it's great just to connect on that social level, even though we do connect on professional stuff too. But I don't know. For me, this is magic sauce.

Dr. George Papanicolao:

Yeah, this is liquid gold.

Dr. Mark Su:

For me, this kind of conversation is for me, like you said, I'm similar. I don't know how often I'm I don't know how often I have this kind of conversation with colleagues because uh to be it's too trite to say, but it's just complex. Yeah and breaking it down is tough and being real about it is tough.

Dr. George Papanicolao:

Yeah, yeah, it's true.

Dr. Mark Su:

So I appreciate you being vulnerable about it and being I've I think I've said this before to you, but I'll I'll say this as we kind of like condense this down in the end here that one thing I one thing I love best about you, I've said this before, one thing I love best about you is you're very artistic in your descriptions and your words, right? You you paint pictures with your experiences very well. It's very, it's just it's very visual for me with whatever you're talking about. And and uh and then furthermore, as you're breaking down these these different perspectives, experiences, uh ultimately what we've what I think that we've done here today, which is really the goal, is to say, as you started out with, to say, look, yeah, we're doctors, and look, you're George Rappaniccolo, you work at Ultra Wellness Center, like the sickest of the sick. You're like on a whole nother level from a lot of the far far majority of people doing functional medicine, right? On many, in many ways. Yet you're still human. Just like me and we both have a mom. We both came from somewhere, we're both gonna die. Like it's we're both human. We're no different than anybody else. And all the more so the responsibilities that we carry, not as a pity thing, it's just the expectations and the responsibilities then that we carry, much less, especially for you and your colleagues, esteemed colleagues at Ultra Wellness Center, with expectations placed on you, like it's a lot. And to work through all that is a lot. And then to try to help patients become more self-aware, where they can also dissect a bit of their grid so that they can get better and be self-empowered to get better, it's a lot in of itself. And that just takes time. And that's a question I'll have to throw it to you some other time, whether offline or whatever. But I'd love to know how often you get to see people in a consulting practice over a long enough time that they you build a relationship and be able to empower people and then they feel that they've got that guide and they can rely on you, lean on you, and that they're making progress outside of in those sort of less tangible relational limbic ways outside of the physiology I already mentioned. In the end, our goal of saying, hey, we're people too. And for you as patients who might be like tuning in, if you're a chronic complex patient and you have been through different practitioners and you're not making enough progress, that doesn't mean they didn't do their job. It doesn't mean they weren't trying. That's for sure. That's for dang sure. All right. I'll say that for sure with the in the function medicine community. But there's a lot of different complexities to the whole thing and to the everyone's story and trying to dice be reflective of or at least be aware of each of our as patients, our practitioners, being human, giving some grace, and perhaps for our own self-empowerment, thinking reflecting on whether there might be some biases that they may not even be aware of themselves, may not want to confront. And that's okay, that's humans, that's just it is what it is. But you've got to take power for yourself and know that's the case because everyone is a human. And then in you, in any time you step into a relationship with a practitioner, whether it's a new person or someone you've been seeing for a while, how do we bring those to the table to make perhaps better decisions, more effective decisions, so we can get better faster? Yep. And then the other side of the coin that you've really blown out and a great deed awesomely is that what it's like, hey, patients, we're humans too. This is what happens on the backside for those of us, especially who are working with really chronic and difficult patients. It's not a sort of like pity or woe is me or look at me like I deserve value, credit, or whatever. It's just the freaking reality of the more chronic complex functional medicine world. And hey, we're doing our best. You, I know you're doing your best. We're working 24 or 7, our brains are going all the time, like having to learn new things all the time. As you said, like you're between your prepping for patients on weekends and all that stuff, like that's a norm for functional medicine practitioners. Honor and light to you and your colleagues, and certainly Mark Hyman has shined the showing, set set the path for functional medicine for so many years and deserves a lot of credit back laid. So we can all be thankful for the pioneers in whatever aspect of life, but especially here in functional medicine. And then with that, I'll say thank you again for you just on a personal level. I love you. Yeah, I love your family. Your your wife has been has been a real anchor and continues to be, not for our whole for our family, but especially for my wife. Yeah. Thanks for being a mentor and pioneer for me personally, professionally. And yeah, I appreciate you. And uh I trust we'll get to do this again.

Dr. George Papanicolao:

We're yeah, but if you don't invite me back, I'm gonna I'm gonna invite myself back.

Dr. Mark Su:

Okay, yeah, there you go.

Dr. George Papanicolao:

Yeah, done deal. These are those rare conversations that both you and I love to have. And I don't know about you, but there's only very few colleagues I have that I can have these conversations with at this depth, and you're one of them for sure. And I love your way back. And anybody listening has got to know that you are an extraordinarily rich person in thought and character. Oh, in character exponentially, and in your energy to really want to serve. I don't know many people at your level, and you may call me a mentor, but yeah, I call you an oak. And I'll tell you what that means in my life. There, I have a forest in my life of relationships and people. And in that forest, there are oaks. I may not see them all the time, I may not talk to them, but they're the those are the big influencers. Those are the people that if they weren't in my forest, I'd feel lost. And when one of them is missing, if one of them dies, it's an extraordinary loss that can never be replaced. And you are an oak in my life, and it was a privilege to have this conversation with you today. And I just thank you for uh being my friend all these years.

Dr. Mark Su:

Thanks. You helped grow the oak, watered, seeded, seated, watered, nurtured, all the above. Yeah, thanks to you. And I know you got I know you have exponential influence in that same way that you're describing with tons of people, both in the not just in the patient world, but in the practitioner and functional medicine worlds. Yeah, I'm but I'm super proud of what you've just as a friend, I'm proud of what you've done in these last number of years and all along the way. And they it all matters for something.

Dr. George Papanicolao:

And back at you, back at you, brother.

Dr. Mark Su:

Keep doing it. All right, all right, thanks. We'll do it again.

Dr. George Papanicolao:

All right, Mark, my pleasure. Looking forward to it. So fresh, just the way you like to.