The Food Allergy Brain Episode 14: Dr. Robyn Liu, MD

This week on The Food Allergy Brain, Mia sits down with Dr. Robyn Liu, a family medicine physician in Portland, Oregon, a member of the board of directors of the American Academy of Family Physicians, and, as Mia learns during their conversation, a food allergy mom herself.

Dr. Liu sees the family doctor as the "quarterback" of a patient's whole health team: someone who knows not just your labs but your story. In this conversation she walks Mia through what it looks like to support a food allergy family from the very first appointment, starting not with a prescription but with a question: What do you already know about this, and how did it feel to get this diagnosis?

The two also go deep on the parts of allergy life that rarely make it into medical training. Dr. Liu opens up about her own years as an allergy parent, including the moment her grown daughter told her that what stuck with her most wasn't the vigilance, but being unable to share in the fish dishes at family meals and feeling separated from her Chinese American heritage. They talk about the misinformation patients bring in from social media, and why Dr. Liu meets every patient with curiosity instead of correction. Mia shares her own lifelong food allergy anxiety along the way.

This is a warm, grounding conversation about treating the whole person and building real community around food allergy families, including the one piece of the support system most of us overlook: a debrief plan for after a reaction, so fear and isolation don't get to take root. If you've ever felt alone in managing allergies, this episode is a reminder that good care and real community can meet you wherever you live.

Find Dr. Robyn Liu: Dr. Liu doesn't keep a large public social media presence, but you can explore her work through the American Academy of Family Physicians and the patient resources at familydoctor.org.

Find Mia Silverman (Allergies with Mia): 

Instagram & TikTok: @allergieswithmia 

Website: allergieswithmia.com

Transcript

SPEAKER_00 0:01

Welcome to the Food Allergy Brain. I'm your host, Mia Silverman, Food Allergy Advocate, Cent Creator, and Master's student in clinical psychology. This podcast explores the mental and emotional side of living with food allergies through conversations with experts and people doing important work in this space. Before we begin, please remember that everything discussed on this podcast is for informational and educational purposes only. It is not medical advice. For questions about your own health, food allergies, or treatment, always consult with a qualified doctor or medical professional. For today's episode, I'm so excited to welcome Dr. Robin Liu, a family medicine physician based in Portland, Oregon, board member of the American Academy of Family Physicians, and as I learned during our conversation, an allergy mom herself. In this episode, Dr. Liu shares what it's like to support food allergy patients from both a medical and personal perspective, how she navigates misinformation when patients come in with stories from social media, and why she believes the ideal support system for food allergy families includes something most of us never think about: a debrief plan for after an allergic reaction. Without further ado, let's get into today's conversation. Welcome, Dr. Robin Liu to the podcast. It's such an honor to have you on here today. Thank you for taking the time out of your busy schedule to be here to talk about food allergies and mental health.

SPEAKER_01 1:22

Well, thank you. It's an honor to be asked, and I'm looking forward to chatting with you.

SPEAKER_00 1:27

Yay, amazing. So before we begin, I'd love for you to share a bit about yourself for those that are learning about you for the first time. Yeah, just share about who you are and what you do.

SPEAKER_01 1:36

Yeah. So my name's Robin Liu. I live in Portland, Oregon, and I practice family medicine full-time at an urban multi-specialty clinic. Um, family medicine is a specialty that covers all ages, all conditions. I'm generally the first line of health care for um most people's concerns when they are trying to figure out what's going on or managing a chronic illness, or, you know, I see kids, well baby checks, well adult checks, all your preventive care, vaccines, labs, disease prevention, all that kind of thing, paps mirrors. So I kind of do a little bit of everything. And um I'm on the board of directors of the American Academy of Family Physicians.

SPEAKER_00 2:20

That's awesome. Yeah, I mean, family physicians, you guys do, as you said, like a little bit of everything. It's super duper cool, but obviously I'd love to learn a bit about why you chose that specific specialty. There's all kinds of medical specialties out there. You chose family medicine. So I'd love to learn kind of why you chose that track.

SPEAKER_01 2:35

Yeah, well, I grew up in a really, really small town, and family medicine was the doctor that I was aware of, you know, for most of my life. The doctors that I knew that were in my town were all family physicians. When I decided to go to medical school or or, you know, pursue the pre-med track when I was a student in college. The deciding factor that really drove me to medicine was the opportunity to interact with people, to learn their stories, to really make a difference in someone's life. And so that was the mindset I was going into medical school with. Once I got there, and you start learning all the pathology and you start learning all of the like really cool organ systems and just how fascinating the body is, you kind of want to do everything. Like you're learning about the heart and you want to do the heart stuff, and you're learning about the kidneys and you want to do the kidney stuff. I was going to be a pediatric endocrinologist for a while because it was just so cool. Um, and then when I got into my clinical years and started working in clinics with doctors, with patients, what I realized was that my family medicine mentors really kind of did all of those things. They took care of little kids with type 1 diabetes, they took care of people with, you know, eczema and allergies. They took care of people who had orthopedic injuries, they did minor surgeries in the clinic, joint injections, lumps and bumps, things like that. And it really satisfies both the medical curiosity aspect and also my just natural tendency to relationships and stories. So it was the perfect fit in the end.

SPEAKER_00 4:15

That's so awesome. And so, given the fact that you do deal with, you know, all kinds of patients, you definitely have seen patients that have, you know, severe or multiple food allergies. Um, based on that experience, you know, what do you typically notice with these patients that do have these food allergies in terms of their mental health? And how do you best support them with that?

SPEAKER_01 4:34

Yeah, so I think that in thinking about the patients that I've seen and known over the years, and patients currently under my care who have severe allergies, I think that they are some of the most medically savvy and well-informed patients that I know. Um, they really um do their research. They really come in prepared to their appointments in general. Um, they also do tend to have a good support system and people who are participants in their care who might join them for their appointments or um, you know, stay involved with questions and things like that. Um, and so I really um, you know, I'm not their allergist. I'm not the one managing their, you know, allergy therapies um, you know, intensively, but I am kind of aware of that history when I'm seeing them and um knowing kind of what their what their stories are and and their background, um, that definitely informs kind of how they approach all of their care.

SPEAKER_00 5:35

Yeah, absolutely. I mean, I think it's so important for food allergy patients and their families to have that support system. So I'm glad that, you know, you've definitely been seeing that. Um, but obviously, you know, there are patients that probably do experience a lot of anxiety. Um, do you notice that too when when you do encounter patients that maybe don't have a strong support system?

SPEAKER_01 5:54

Oh, for sure. I think that it's a huge mental burden for those patients to manage, you know, having um a plan for prevention, having a plan for avoiding exposures, having a plan for response, you know, where are they gonna carry their EpiPen, their emergency plan, who's gonna administer it if they need it, you know, having, and that's just kind of a background, right? Just sort of always um in their minds about how they are gonna deal with this potential emergency. So yeah, I definitely have seen the the toll that it can take on mental health.

SPEAKER_00 6:28

Yeah, I mean, something that I wonder, especially with just general all kinds of physicians, and I'm very curious to hear your thoughts on this, is that at least with allergists, they were never really informed of the mental health implications of food allergies during their training. And because you see all kinds of patients, not just people that have food allergies, but probably other chronic health conditions or just in general, when you were in your training, you know, were you informed about just the mental health implications of not only allergies, but just other health conditions, or is it something you kind of had to kind of learn along the way throughout your time as a physician?

SPEAKER_01 7:02

Yeah, well, my medical education never ends, right? So I'm still in my medical education. Um, but you're correct that when you're when you're in training, when you're kind of learning the basic science and your first clinical experiences, I think that the really the focus is on is on the medical aspect of things. You know, what medical, what medications do you use? What's the difference between an IgE mediated allergy and a non-IgE mediated allergy? And how do you how do those show up differently in your patients and what's your differential diagnosis? You know, you're really thinking about the medical and pharmacological aspects of that care. And then as you work in patient care and you meet patients and you learn about them and their experiences, that's when you really start to understand more of the mental health aspects of what living with food allergies is like.

SPEAKER_00 7:51

Right. Yeah, it makes I mean that makes complete sense is obviously the primary concern is the patient's overall health and getting those needs met. But obviously, I think not only is it secondary, I think it's I think it's primary too, is the mental health side. I think, as you kind of mentioned, you're always continuing your education. And I think that's what makes a great doctor, a great doctor, someone that's always willing to learn and be open. And so in situations where, you know, because as you mentioned, family physicians are the ones that kind of are the first point of contact, I would say, um, when it comes to any sort of general probably medical questions or concerns, I I can assume that probably the first thing that it would do is probably come to you, because that's like you're a physician in that regard. So when that does happen, say if there's a patient, like a new patient of yours that comes in that has um a severe fruit allergy diagnosis, you know, what's the first thing you want them to know or kind of tell them to best support them and the caregivers too? Because obviously if a caregiver's child gets diagnosed with severe food allergies, that also weighs on them heavily and impacts their quality of life. So kind of typically, how do you approach that situation?

SPEAKER_01 8:51

Well, I I wanted to share with you too that in addition to being a family physician, I'm also a food allergy parent. Um, my oldest daughter was um, you know, started showing signs of food allergies at a year old and was later diagnosed with allergies to several different things. And so I've also had some personal experience with that, you know, that kind of vigilance, that preparedness, that little extra step that you that you have to take when you're going out in the world with a child who could potentially have an emergency situation. And so um, so I really have a lot of empathy for for my patients, like I feel um for what's going on with them. And I think, you know, always my first approach to any patient with any new condition is what do you know about this? What do you feel about how did it feel to get this diagnosis? What do you not know about it? What are your questions? And really start there with asking them, you know, how do they um, how do they want to approach the conversation with me? What can I do to be helpful to them? And then I think having just the ability to say, both from professional and personal experience, you know, you can have a really grateful life. You aren't going to be, you know, shackled or, you know, you're gonna have to learn to work within some constraints, but that's not uncommon. Actually, most people have something going on with them that they can't just do everything. So um, you know, your life really can be can be full and good. And um, I'm here, you know, for again as the first stop for questions or anything that you want to um want to have my help in dealing with.

SPEAKER_00 10:28

You know, obviously because you are an allergy mom and you know the experience firsthand, and you know, doctors have different levels of comfort when it comes to self-disclosure, but do you ever self-disclose to, you know, new allergy parents that you are an allergy parent yourself to kind of provide that comfort, or how do you kind of manage that because you, you know, understand this experience if it hits very close to home.

SPEAKER_01 10:49

Yeah, I mean, for sure. I I I will in the right situation with the right family, you know, where we have that trusted relationship and and where it's helpful, right? Because again, you kind of really need to figure out where they're coming from, what their sort of emotional state is about it, and you don't want to make it about yourself, but you do want sometimes to let them know um that you have um have lived this too, and sometimes that can really help to deepen the connection and also the trust.

SPEAKER_00 11:20

Absolutely. And so given the fact that you know you are an allergy parent, um, has that that definitely has probably informed or has really probably shifted your perspective and uh as when you do have patients that come in that have allergies, like has that also come into play with other patients that have other chronic illnesses in terms of maybe having more not like empathy for them, but I mean that too, but just being more understanding of how impactful having a health condition can be on someone's quality, like not only for your child, but also for yourself too, because it does change not only like the dynamic of the child, but the family dynamic. Yeah, you know.

SPEAKER_01 11:56

Yeah. So I think that, you know, in sort of contrast to a lot of the chronic um conditions that I help my patients to manage, living with food allergies is much more sort of externally experienced, right? It's a very, it's a very sort of social condition, even though it's something that's personally happening to you. But how you interact with people in the world, you know, with if you have hypertension, you don't have to tell your flight attendant, right? You don't have to sort of bring it up to people that maybe you just met or on a first date or something. And so I think, you know, there is a lot of commonality, like I said, with sort of just helping people understand that, you know, just because you're living within some limitations doesn't mean that you can't enjoy your life. Um, but also understanding that, you know, this is its own thing too, and it has some really important differences from other conditions that um that we might be dealing with. Um, I will say one thing that um my daughter, you know, and and the other thing I think is again, as doctors, just to stay curious and to ask people questions, um, because you don't know you you can make some assumptions like about whatever kind of anxiety they might have. But when I asked my daughter recently um about this experience growing up, because from my side of things, when she was very small, it was like, where's her bag? Where's her, you know, we have this little pouch that had her epi pen and her anihistamines and her, you know, and um and little written plan and everything, and we carried that, and if we left a house without it, we'd go back. You know, that was to me, that was the most salient part of the experience. Um to my daughter, she said that actually that wasn't as um, she wasn't as alert to that kind of vigilance that that we kept when she was little. Um, but what she remembers the most powerfully is, you know, my kids are Chinese American. And when we would have a meal with my husband's side of the family, she couldn't eat the fish. And there were so many dishes that she just couldn't enjoy. And, you know, everybody's it's a very, you know, it's very sharing. It's very like, here, try this, try this, everybody's got a little bit of everything. And she would have to, you know, not participate in that. And it really helped her or it it made her feel separated and and isolated from part of her heritage. And to her, that was the most salient part of this when she was growing up. And so, you know, things like conversations like that, you just really can't assume how people are feeling, right? You really just have to ask.

SPEAKER_00 14:26

Absolutely. I mean, as someone that's allergies myself, I can totally resonate with that because food is a big part of just different cultures. Um, and so obviously, when you are of a certain culture where food is one of the big pieces of it, you know, like it probably makes you feel a bit disconnected to it or you feel left out from it. And so I think that it is so important to acknowledge like the mental health side of allergies because there is so much like food is like allergies are not, as you said, not just like a health condition, but it also impacts your social life, family, dynamics, schooling, just everything. And so, you know, given that you're, you know, an allergy mom, like how has that been? And obviously, whatever you're comfortable answering, like I don't want to pressure you anything, but you know, first of all, I guess I'd like to kind of backtrack a bit. When you found out your child had these food allergies, how did that make you feel? Did you experience any sort of mother's guilt? You know that there is a there is an occurrence that's some I mean, I I just spoke with a with a physician yesterday on an episode and he mentioned that lots of mothers experience mother's guilt. It doesn't happen to all allergy moms. Like my mom didn't seem to experience it, but other moms that I know did. So I'd love to kind of hear your your thoughts on on your personal experience, whatever again, whatever you're comfortable sharing.

SPEAKER_01 15:32

Yeah, I don't I don't think I felt a lot of guilt about the allergy. I mean, I certainly felt mother's guilt about plenty of things over her lifespan. Um uh, but I don't I don't remember that what you know, but it really just like sticks out in my mind. Um when she was born, you know, there were some complications with the delivery, and then she had some jaundice and issues. We ended up staying in the hospital for about four days. Um and when we were in the hospital, um, my husband and I kept, you know, a little like little supply of groceries in the room just for ourselves to, you know, be able to fix simple meals. We had a big jar of peanut butter in the room when we were in the hospital when she was a newborn. And that just has always sort of like planted itself in the back of my mind, like, did that have anything to do with, you know, it just it it you because she did end up so you know, so her allergies are to to fish and nuts mostly. Okay. Um and um yeah, it's it's not I wouldn't call it guilt necessarily, but it's certainly like, you know, that that idea. And of course the the science around um peanut allergies and how you um introduce foods and all of those things, the guidance has completely flipped in the last 22 years since she was born, right? And so you just kind of look back and you question, like, well, did I do enough? Did I do the you know, it I didn't know, honestly. And it and that's I think why I don't feel a lot of guilt about it is that I just didn't know. Um, and I still don't know, you know, how if anything would have been different.

SPEAKER_00 17:04

Yeah, I mean, I think it's obviously not your fault that your daughter was born with these allergies. And also you just mentioned a really important point that at the time, like 20 years ago, there was way different information than there is now about allergy and treatment options, and just it's a it's a always a for like a new not like a new evolving field, but it's always evolving, and there's always new research and data coming out for things. And so I definitely think it's important to note that that's true. Like times have changed, and so how are you supposed to know that nowadays maybe it is important to do early introduction? But back in the day it was heavily discouraged to do that. Like I know my mom felt the same way where it was like she was too nervous to introduce these foods to my diet because she thought it would increase chances of me having food allergies, but obviously now the data says the opposite.

SPEAKER_01 17:47

So it's just the opposite, exactly.

SPEAKER_00 17:49

It's the opposite. But you know, as since you are a physician and you have a child with food allergies, I mean, did you experience like just did having a child with food allergies just like how did that impact you as like as an as a parent and as a physician, if it if it did at all?

SPEAKER_01 18:07

So when she was so she was born when I was um in my residency, which was here in Portland, and then after graduation I went out to a very small community to practice rural medicine for um several years while she was growing up. And so a lot of the time that, you know, I was really, you know, where I was the one managing her, right? She wasn't old enough yet to sort of have the alertness and the awareness to kind of manage herself. That was happening in a very, very small town. So it's a really tight-knit community. I was the doctor there, so I was really well known, and all my kids were really well known. And so, you know, kind of everybody in town knew that my kid had a peanut allergy. Um, and there was like, you know, there was like the the the the Christmas on the square, right? The downtown all lights up and everything on the day after Thanksgiving for, you know, and all the stores stay open late and the hardware store, and you go in, you just kind of visit everybody's got like, you know, guessing games in the window, things like that, a little, you know, little small town parties like that. And the hardware store has a big barrel of peanuts in the back and everybody eats peanuts and crushes the shells on the ground. And so my daughter and I had to leave the party early. Um makes sense. Yeah, you know, makes sense. She just uh just just being in the store. She had to, you know, we didn't have to take her to the hospital or anything, but but certainly it was, you know, it was just part of things. And then when she started kindergarten, it was talking to the lunch lady at the school and figuring out, you know, how her meals at school would be provided, you know, so that she wasn't too set apart and, you know, talking to her each of her teachers like when other families bring snacks, here's what you eat. And and so again, it was just kind of an extra thing, right? It was just one more thing that as a parent, you're navigating so many, you know, different challenges and and things. And so I think for us, this was just one more, you know, this was just part of the deal with her, with with this kid who um, you know, she had a lot of other parenting that she needed, and this was one of them. Right, right.

SPEAKER_00 20:01

And so, you know, when for allergy parents that are listening to this or that that have a child that's newly diagnosed with a food allergy, you know, based on your lived experience, like what would you what would you tell them that maybe are that are feeling, you know, maybe discouraged or just really unsure of the future of their child and and having concerns about that they may not have a good quality of life?

SPEAKER_01 20:24

Yeah. Um, I think what I would what I would want other parents to hear is is that you know, it really is possible to be prepared. Um I I think that, you know, if you if you're if you're educated, you educate your family, you have, you know, things written down when your child is with other people, you know, you have kind of your go kit. Um that there there really is some some safety and comfort in that, and that you can allow your child to have sleepover or go to sleepovers, pool parties, you know. Um obviously, again, if they're too small to kind of make their own um food choices, you want to be with them and make sure, you know, you're checking the cake and everything like that. But once they get a little older, you know, you can really um uh give your child the knowledge that they need and the the you know the preparation and the equipment that they need. And and it's okay. They're just they're just a normal kid. You you're ready. Like things will happen in life, you know, there are emergencies all the time. Um and and you could this is one that you can be prepared for, um, and that your kid can feel empowered and safe to go out in the world. I really don't think it has to be something that um that limits you, you know, too much.

SPEAKER_00 21:46

I love that, Dr. Lou, because that's absolutely the truth. And I think that it's always so important to remind not only allergy parents, but allergy folks themselves to know that. Like I think you can live a fulfilling life, but you obviously have to be prepared and think. In life, happen like things happen in life, like emergencies do happen. But as long as you are prepared and you're informed, educated, you know, thing, I mean, knock on wood, like everything will be okay. But I think that that's such a such a beautiful answer. So thank you for sharing that.

SPEAKER_01 22:14

Yeah.

SPEAKER_00 22:15

So, you know, with your dog, you kind of mentioned a little bit about just like the cultural side of having allergies in terms of the food situation and how hard that can be to navigate. But aside from that, like, how was it for her growing up, especially in a rural town? You know, there's probably a lack of resources available compared to a more urban environment. At least I grew up in a pretty urban environment. I grew outside of Boston, and Boston obviously is like a medical healthcare hospital center. Yeah. And all the best hospitals, like, I mean, I feel very fortunate, but obviously that's not the reality for a lot of Americans. And so what was that like, I guess, for her growing up in a rural environment and also you as an allergy parent as well? It's kind of a broad question, but I'm curious to hear your thoughts on that.

SPEAKER_01 23:00

Sure. Yeah, I mean, I can share a little bit of the of the story. So, like I said, we started to notice when she was 12 months old. Actually, we were overseas. We were in Taiwan. Um, the first time we noticed her like having sort of like hives around her mouth and vomiting and, you know, after a meal. And we were like, huh, that's weird. I wonder what's going on. And then um a while later, we had a like a Mother's Day brunch at the Oregon Zoo, and similar kind of thing happened. She sort of had this reaction, and um uh and it, you know, it was never an anaphylaxis. Like I I will say up front, I don't have the experience of having seen my child um go into anaphylactic shock. And I um so my experience does not include that um severe of a stressor. But she definitely, you know, so so she started having these reactions as a toddler, and so we're still living in Oregon, in Portland, um, for my residency, and there was only one pediatric allergist in the city. Like there or there was only one we could see, right? And he wasn't even with the university, like the like the university itself like still sent all of their pediatric allergy um specialty appointments out to this community doctor. Um, and so God bless Dr. Osborne. Uh he was the one who did her first kind of testing and um and diagnosed for the allergies and told us about things like, you know, um, like her her reaction to the peanuts was so strong that, you know, he said, just probably don't even keep peanut butter in the house. Um and you know, her other reactions were a little less severe. Um and so, you know, he he was the one to kind of like talk us through all of this. And then when we moved to um, we were actually in a really small town on the western edge of Kansas, and so um our closest allergist was in Denver. And so we would go about three and a half hours to, and of course, telemedic telemedicine wasn't such an option then either. So we would go, you know, three and a half hours away to to Denver to see the specialist. But you know, I think at that point um we'd been doing this for a year or two, so we kind of had a little bit more comfort with what was going on. Um, and you know, her again, yeah, her her family doctor, my partners, you know, kind of knew what the situation was. Um and luckily we didn't have to take her to the emergency room for any um allergy or asthma related issues. Well, no, I take that back. We had we did have to take her in for some asthma episodes um a few times when she was when she was small. So you know, but I I just I feel like there again, there were just she's our first kid. There were so many things we're learning as a new parent. I think when it's your first time doing this, everything is just kind of, you know, just kind of kind of baked in, like this is part of the experience of raising this particular child. Um, and so you have to be familiar with anhistamines, you have to be familiar with when to use the epi pen, you have to know, you know, when the um what are the signs of of uh an asthma attack that needs emergency care versus, you know, watching and waiting. Um so we kind of learned that as we went along with her. Um and luckily, you know, as she grew up, she's you know, she's a really bright kid. She figured a lot a lot of things really quickly and um became able to advocate for and manage herself pretty well. So I also feel, you know, pretty fortunate about that that she was not a child who was afraid to, you know, go up to the host of a kid's birthday party and ask them about the ingredients in the foods or whatever. Um, she was pretty confident in that kind of management. So um, you know, so it was, yeah, I don't have any other experiences to um to judge it against other than just to say, you know, this is this is what we did because we needed to.

SPEAKER_00 26:50

Yeah, I mean, first of all, props to you. I mean, I think any child that is able to navigate food allergies with with confidence and grace is a reflection of the parents' work. And so I I think that's definitely a reflection of you and, you know, your partner or your spouse. Um, because, you know, a lot of times the way the parents deal with food allergies for their child kind of translates onto the child. Um, so I think that that's really awesome that your daughter is now able to, or throughout her life, you've been able to be really confident with navigating allergies, especially in a in an environment that maybe is is rural or there's not a lot of resources available super close by. So that's really, really important. And just so props to you for that as an allergy mom. Um, and then secondly, you know, that brings up another important question just that I've kind of discussed with other guests on my podcast, is just access to health care and resources. And so when you do have, you know, patients that come in that have food allergies and it's in a rural area, do they oftentimes have concern about access to different treatment options that are now readily available or um seeing an allergist that obviously, because you mentioned that the one that you were seeing was about a three-hour drive. If that's yeah, three and three and a half hour drive, yeah. That's wow. Wow, yeah. So how do you kind of support your patients with that? Obviously, not to get political or anything, but that's just unfortunate, that's the reality in rural America is that there's just a lack of funding, lack of resources, and that's a serious problem in this country. Um, is everyone deserves to have access to good high quality health care that's accessible for all. So I'd love to kind of get your input and thoughts on that.

SPEAKER_01 28:24

Yeah, well, I think first of all, you know, even even practicing in a rural area, sure the the resources are not as close by, but I feel like we still gave great care. I feel like we still, you know, we kept up on our knowledge. We were able to, you know, we had a lot of phone a friend, specialists we could talk to when we needed additional information or help. And so we really were able to, um I was with a group of four family medicine physicians in a in a small community. We actually covered like a three county area between the four of us. And I feel like between the four of us, we actually, we actually took really good care of people. Um, and when we phoned a specialist, it was because we really needed them. Like we really needed the specialist knowledge because it was then outside of our scope. But as far as, you know, if we if we needed to manage an emergency, we could we could do that, right? Like, you know, we we had all the all the know-how to help somebody out of a crisis, and then it was just kind of the ongoing management and and prevention that we would um send them out for. And um, but yeah, you're right. Like it was, but then the the specialist is is many hours away. And um, and that was that, you know, posed its own challenges. But in supporting, in supporting my patients, you know, when I worked in that rural area, I think, you know, folks lived there, knew this they they knew the score, right? They knew they they kind of um that that was again that's kind of factored into the decision to live in such a remote and small community, um, that if they, you know, needed they they were sort of accustomed to going further for things, right? Walmart was 90 minutes away. Um, and so um, yeah, it was pretty remote.

SPEAKER_00 30:00

Wow. Wow. Wow. And so a city girl, so it's just a totally you know, again, that's not then it's it's ever there's different, you know, yeah ways of living, but it's just that's that's so shocking because it's like, I mean, there's not really a Walmart near where I live, to be honest either, but I could just walk down the street to C VS, right? You know, so it's just that's and I and see that's the norm, but that's not the norm, really, at all.

SPEAKER_01 30:20

So that's just really it's it's a different situation, but but the the compensation I think is that like I said, it was um it was a town of like 700 people. I was the doctor, everybody, you know, my kids were Chinese American, right? So everybody knew them, everybody knew us, and and they were really um, you know, I think cared for by the whole community, right? So um if somebody, you know, I felt fine letting my kids kind of wander around town and play at the park by themselves and that kind of thing, because I knew somebody was always gonna be around and um and would know to call me if anything happened. So um I think you know that's the that's the flip side of it, is that you really do have a community that that cares, and I think in the city you can be a lot more isolated too.

SPEAKER_00 31:04

Oh my gosh, 110%. I think that honestly, community is so critical and so important. So I think there definitely are pros and cons to the basic, because I I will attest that yeah, like living in a city definitely while there's a lot of resources available, it definitely is isolating and it's harder to find communities. I think that you bring up a really important point of the importance of community, that's how people really thrive best. So you mentioned you kind of touched on telehealth briefly, you kind of mentioned telehealth um and how times have definitely changed. So based on what you've kind of witnessed, you know, the post-COVID era, how are your patients that are in need of an allergist? They're probably more able to easily access an allergist. Obviously, you still have to go to a clinic, but they can also meet with them virtually. Is that have you noticed that or kind of how have you seen telehealth hopefully positively impact you know the at least the patients that you see in in your town? Um yeah.

SPEAKER_01 31:57

Yeah. So so now I work in a multi-specialty group where I have allergists who are colleagues, right? So um it's a lot easier for me to just refer my patients over to them or you know, send them a message through the health record to say, hey, will you take a look at this patient? What do you think? Or um is this a good candidate for such and such? Um, so it's it's a lot easier for me right now. Um but yes, we they they do um they do a lot of consults through just chart review right now that we have electronic health records that are interoperable with most of the systems in the city. Um if a patient's gotten care, you know, at any of the major hospitals in or clinic systems in Portland, um, our team will be able to look at those records and look at their old testing. And so that's really made things a lot more streamlined. Um, like I said, I have the ability to just kind of um access the specialists through the electronic system where they can look directly at the patient's chart. That makes things a lot easier. They do a lot of consultations, you know, virtually through telemedicine, which I think improves access, right? Um, I think patients do still want to see their doctor. That's uh something that we've learned post-COVID. Um, we really didn't know how it was going to shake out in terms of like how much clinic time should we be spending face to face and how much should we be offering these virtual visits that people don't have to leave their homes for. Um, and really um, you know, there there's certainly some convenience to these types of telemedicine visits, especially when it's just sort of a cognitive visit, you know, just thinking through what are we going to try next. Um, but people really do want to see the doctor. Like they really, you know, and they're whether that's their primary care doctor or their specialist. And so I think telemedicine and the electronic interoperability definitely streamlines things, definitely makes things move faster. Um, but I do feel that patients really do still value that in that personal touch and that, you know, being in the same room.

SPEAKER_00 33:57

Yeah, I mean, I definitely can agree. I think that telemedicine is, I mean, I think technology definitely has its pros and cons. Like just like it's can be super, super helpful and make, as you said, make things a lot faster and more efficient. But then there are cons. Like, obviously, I'd rather see my doctor in person than through a like a laptop screen like this. Yeah. But um, I think that makes complete sense. So just thank you for providing that insight. You quoted in a, I believe it was like an article on Medscape about um food allergy myths on social media. Um, you know, what do you kind of make of those findings and those myths? Like what are the most common ones you've seen, and how do you combat that misinformation when you have patients that come in, assuming like, because there's a lot there's a lot of fear-mongering content on the internet or things that you're saying, oh, just heal your gut and then allergies are gone. Like type of silly stuff like that. So, yeah, what are your thoughts on that?

SPEAKER_01 34:49

For sure. Um so yeah, so the um the Medscape article is referencing this really wonderful paper that came out in the Journal of Allergy and Clinical Immunology, um, I think April uh of this year, um, which was looking at dominant themes in social media posts about allergies specifically. Um, so they they did, you know, they they looked at all the media platforms, Instagram, X and TikTok and everything. Um I wonder if they've seen mine.

SPEAKER_00 35:17

That's kind of crazy.

SPEAKER_01 35:19

They they did a, I think they searched by, you know, hashtags or however, you know, kind of find categories in um for a uh like a three-month span in 2025. They look like, okay, these parameters and look at posts that have anything tagged with allergies or um and then and then they sort of looked at um first of all the content of those messages that were being posted and and what types of information was being shared, but then also the comments and how favorable or you know challenging the comments were. Um so um what they found was um you know, most commonly um the social media posts are promoting like natural cures, right? Um, like like you mentioned that you change your diet and you take these natural supplements and heal your gut, um, or you use honey to treat your inhalant allergies or um things like um that. And then as well as, you know, capitalism is everywhere, IgG testing at home, right? People can get these kits where they can um be told what they're allergic to through a home test. So those were those were the most common things that were posted about, as well as, you know, as you say, fear-mongering, conspiracy theories, and things like that. Um, but then looking at the commenters, which I think is kind of the more interesting part too, it well, they're it's both interesting, but um less than 40% of people or of the comments on these posts were challenging them in any way. Um, you know, 62% were favorable or neutral toward the content, right? Like, oh yeah, that sounds okay, or yeah, thank you for thank you for speaking the truth. And um, of the ones that were kind of a challenging uh comment, only about a quarter of those cited any kind of science. And so um it really brought to mind the you know, the old saying that the lie can travel around the world while the truth is still tying its shoes, right? Um misinformation is so um so um provocative, so memeable, so you know, that misinformation you can really make it snappy, right? You can make it attention grabbing. Um truth uh is almost always nuanced and complex and context dependent. Um and so anyhow, so that was the that was the paper that was in the allergy journal. And um I think that if if if anything about that surprised me, it was that the challenging comments were as high as they were, I would have probably guessed less than less than 38%, right? Um, because I just don't feel like people on the internet are um you know it's it's very self-selected, it's very self-sorted. And so anybody seeing that content and commenting, making the choice to comment on it probably is going to be pretty favorably inclined towards it. So when my patients come in with these stories, right, these narratives, these um, this information that they've been able to put together from the sources that that they've got. I mean, it's it's it's challenging, but it's it's what I do. It's why I'm a family doctor, right? Because I get to listen to their version of the story. And I can say, okay, well, let me let me back up, let me ask you, like, where did you get this information from? How did you come by this? You know, what is the um and and depending, you know, you kind of have to read the room, you kind of have to know, you know, what's your pre-existing relationship with this patient and how um you you don't just want to tell them, oh, that's stupid, right? You know, that's wrong. You're wrong. Um, because they've they've constructed a story, they have a narrative that makes sense to them about how things go. And to sort of start to untangle that and provide them with a different story, a new narrative. This is actually, you know, um, maybe you don't have to give up every food on the list that the IgG test told you. Like those those things can be um, you know, can can have false positive rates. And let's talk about what kind of testing we might offer and what our allergists might be able to do for you. Um, you know, you you you don't just want to shut them down. Um, you really want to, again, be curious about um, because somebody who's come in with information that they've gotten from whatever, you know, um, somebody who's taken the initiative to buy a kit online to test their allergies, like that person is curious. That person wants to know, that person is seeking information. And you need to honor that, you need to respect that, you need to uh let them tell you what they know and and then to if if you disagree or if it doesn't comport with you know what you know to be scientifically supported, um, again, to to just to present an alternative and say and present it in a way that's also going to make sense to them, right? You can't start getting all medical, you know, um, sort of superiority about it and and just you know making them feel stupid. You have to have to respect their intelligence, you have to respect their desire for information, um, and and their their need to have a narrative and a story that kind of explains what they've been experiencing. Um, so it's it's it's a it's a really satisfying conversation when when you do it right.

SPEAKER_00 40:39

I mean, yeah, I think I think you bring up a really important point that people that maybe come into your clinic with this misinformation, they don't really always probably have like malintent. They just are super concerned. And, you know, I mean, uh social media especially is very algorithmic, so it'll kind of feed into what you like. So if you like one post, it'll feed you like 10 more. More very similar, especially with just what's happening with the current. I don't want to get political, but obviously, unfortunately, there's a lot of misinformation being spread online, and a lot of it I think is contributed because of the current administration. And like one example being that vaccines cause allergies, and that's just false. But there's a lot of anti-vaccine, like like conversation and discourse happening online. And so when these patients come in again, I I think it's so important to remember these are real people who just are just as concerned, they're just concerned allergy parents or concerned patients, and they want to seek truth and they want to get better. And so I think the way you approach it is so it's so important to view it that way. I think a lot of people will often get really annoyed or or really turned off like, oh, like you're ignorant. But no, a lot of people just don't know, and they don't also not think people are also really informed about how scientific research works and how how rigorous it is. Um, and that so people, so I think that it's education and the way you kind of approach it, meeting them where they're at is so important. So I think that's such a great answer and the great way to approach it. So it's just thank you for saying all of that. Um you so I love to wrap this up by asking, I asked this question to all my guests, and so I'm gonna ask the same question to you. And I'm very curious to hear your thoughts, especially as a allergy parent and as a physician, a family physician working in a more of a rural environment. So this is definitely going to be interesting. But you know, if you could design the ideal emotional and medical support system for food allergy uh patients and their families, what would that look like to you?

SPEAKER_01 42:27

Yeah, so first of all, everybody deserves a family doctor. Everybody deserves someone who's their first line of care, who knows them, who knows their parents and siblings, who can be a both a physical and a mental health support specialist and be the quarterback of their of their healthcare team. Everybody needs that. Um, I think somebody who's living with a food allergy, you know, they will need to have, and and it's individually dependent, of course, but they should have an allergist, they should have a dietitian who can help make sure they're getting all their nutrients met within the confines of their the limitations that they have. Um, and they should have access to mental health support when needed. Not everybody needs to be in therapy all the time, but you know, that we have um behavioral health uh specialists in our clinic integrated with primary care who provide some of that support around just um navigating the challenges of living with your medical condition. Um I think obviously um, you know, having I've I've mentioned the the kind of go kit and the written plan. Um our website, familydoctor.org, has some um has actually just a bullet list of like here are the things that you should be carrying. You should have one at home, one in the backpack, you know, you should um so having that, and then for mental health support, I think something that can be overlooked is um is is the debrief plan, right? What do we do? You know, we kind of we have the we're prepared for what to do if the emergency happens. What do we do after the emergency? How do we help the the patient, the kid or the adult who's who's had this thing happen to their body um process that and deal with it in a way where they don't, you know, um kind of develop like post-traumatic um stress uh where they're suddenly becoming more fearful or avoidant or isolated. Um and I think that the um the aftercare, you know, the um the ability to sort of process that event with a professional and with your community is really important. So I think having that be part of the plan is something I would really promote.

SPEAKER_00 44:30

That's a I mean, that's a great answer. I think that I think I really hope to see that just nationwide and even around the world. I think that even addressing really important is addressing the aftermath of a reaction. I think that is so key. And I don't think anyone has really mentioned that that I've asked that question to. So I think that's really critical because it obviously impacts how you're gonna move forward and navigate life after having a reaction and how you're gonna, you know, stay vigilant, but also try to live uh try to also live a good life. So I think again, just that's a great answer. So thank you so much, Dr. Lou. Um for those that want to, you know, I guess like follow you or support the work you do. I'm guessing you don't have a social media presence, but do you I can definitely link the article that you wrote or that you responded to because I think that's super interesting. I think my listeners will definitely benefit from that. But is there any other places they can like kind of follow your work or or is that is that yeah, so I I I do not have a huge social media presence.

SPEAKER_01 45:26

I used to be a big part of Med Twitter when that was a thing, you know, 10 or so years ago. It was a really wonderful, gratifying community. Um and now I I I I am on LinkedIn, but I don't really um do very much there, and my Instagram is private. So um, but uh yeah, so uh much of my public work is through the American Academy of Family Physicians. Um I mentioned familydoctor.org. That's our patient-facing website that has a lot of um articles by my colleagues and um you know, health information. Like I said, things like, you know, what's the list of things you should carry when you go out in the world with a food allergy, that kind of information. And so that's definitely a resource I would point people towards. And um we also we provide a lot of advocacy um for family physicians and for our patients around a host of issues, um, mostly ensuring that everybody has access to a family doctor.

SPEAKER_00 46:24

Amazing. Yes, I'll definitely link those websites down below so people can for sure check them out. Um, but thank you so much, Dr. Lu, for spending time with me today and sharing so much insight, especially, you know, as an allergy mom, it's always so beneficial to hear allergy parents' stories and their experience. And so just thank you for taking the time to be here today. And for those that are listening, thank you for listening to today's episode. I hope you all have a great day, night, or afternoon, wherever you're from, and I'll see you next time. Bye.