You're listening to the fertility docs, uncensored podcast, featuring insight on all things, fertility from some of the top rated doctors around America, whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.
Speaker 2Welcome to fertility docs, uncensored. This is Dr. Carrie BDN from the fertility center of Las Vegas. I am here with Dr. Susan Hudson of Texas fertility center and Dr. Abby Ablin of the natural fertility center. And we are joined today by our guests, Dr. Leah Kay , who is one of my partners at Las Vegas. Um , and we are very happy to
Speaker 3Have her today. Thanks for having me. Yay.
Speaker 2So before, before we hit the record button, we were talking about, oh, just where each of us did school came from. And , uh, it sounds like Leah , you went to college in a zoo.
Speaker 3Well, beside a zoo , technically speaking. Um, but it was, it had, it had its own wildlife, I guess it was its own little bubble . We went to Rhodes college and the college
Speaker 4Had its own wild
Speaker 3Loss. Oh, well, they kind of spilled into each other, I would say at least on more crazy weekends for sure. But I went to school in Memphis, a little liberal arts school and then , uh , Rhodes college. And so we were just talking about it because we have mutual friends with similar experiences and the college happens to be located directly across the street from the Memphis zoo. Um, and so it was, I was talking to some of the legends of, of people late night, early morning , sneaking across the road and , um, not paying their zoo admission fees to see some of the wildlife never me though, never me
Speaker 2A likely story. So would they just , uh, you said that the walls were pretty tall and trying to get in where you, part of the, the wall scaling crew and
Speaker 3The numbers, or never that either though I had plenty of friends who are more physically active and inclined than me, but the walls of this campus, like it's a beautiful campus. It looks very Ivy league, even though it's a liberal arts school. And we kind of, as a result, we have a beef against sort of the true Ivy league schools, but it's beautiful campus. And all the walls are like the sandstone that are perfect for climbing again in the middle of the night when , when nobody else has any attention. So he didn't want to scale the brick wall across the street to get into the zoo. You could at least scale like the bell tower , um , and get pretty far up before security was notified. And back down ,
Speaker 4We were talking a minute ago later about what am I anatomy lab partners who went to Rhodes college also. And he, when he moved into the college, he heard all these wild animals sounds. And he found out about two weeks later that he was actually really close to the monkey. And that's what he was hearing. Rumor has it, it may be urban legend, but rumor had it that actually some of the monkeys got out one time and got onto roads campus. Is that right? Or
Speaker 3I heard that as well. Who knows if it's an urban legend? I never happened in my time. Luckily. Um, but we've, we've all heard those stories.
Speaker 2The question is where the monkeys helped out or did they just kind of quote unquote get out on their own because they were so clever or did some brilliant junior and senior class liberate them to take a field trip.
Speaker 3I truly think that some of these monkeys might've been a little bit smarter than some of the junior and senior classmates of mine. It was a really great school, a really, really like the smartest people that I've ever met, smartest people that I will ever work with, but we had a lot of fun in addition to doing a lot of hard work, work hard and play hard.
Speaker 4And I'll say one more animal story. The only thing is we were talking about this that's funnier than the monkey story, I think is when I got to residency at the university of Florida, they were talking about this lake called lake Alice. And it was right on fraternity and sorority row and it was full of alligators. And I'm like, are you kidding me really? And that, I mean, that is the honest truth. I've seen the alligators. You just don't want small dogs around like Dallas in the middle of it's already a sorority row. So I think I'd rather have monkeys and alligators
Speaker 3That makes me very nervous for rush week
Speaker 2And people who don't make it and get fed to the alligators. I mean that , that's an extra penalty just for sorority and fraternity rushing. So talking about students , um, Leah is very active in, in all the educational programs that we have at the fertility center of Las Vegas, because there are multiple residency programs throughout town here, as well as , uh, medical schools. And so we, we hold appointments at university of Nevada, Las Vegas, as well as with , um , the mountain view residency program. And I think between the three docs here, all of us have either lectured taught, had students, rotate residents, rotate with us fellows from the minimally invasive program. So we've got a fair number of learners coming here and in the patient response to that is always, is always kind of interesting and a little bit unique when they're like, who is this other person? Like, I understand I came here to see you, Dr. K and who is this other person who's sitting in the corner of the room. So today we thought we'd talk a little bit about what, what learners are in this environment and , and really what that means for our patients.
Speaker 3Sure. So I think it's , it makes sense. First of all, to kind of define what different types of learners there are in a given medical practice, especially like ours. And it's tricky because we use this term learners, but I know if you, if you Google a picture of me, I don't look like I've been in school for the last 25 years, but I truly have, like, there are so many steps to get to being an attending and medicine. And so when you think of a learner, they're not all at the same stage of their learning. Um, so there are medical students, all of us went to medical school and it's important to know that that's at four years after your bachelor's degree. Um, and so medical students are not yet doctors, but that's your first kind of exposure to being in a clinical setting every day , all day. So you're not getting paid yet at that point. In fact, you're still paying hundreds of thousand dollars to be in that setting, but that's your kind of first exposure to patients on an everyday, all day basis. You show up like, it's your job. You're there at four 30 in the morning. You're there until 7:00 PM at night, many times. And so that's kind of the very, the , the earliest step that patients might run into learners. After we graduated from medical school, we enter residency. And so that's where we've chosen a certain specialty track. And for each of us, we've gone through an OB GYN residency, which means that we spent our first four years learning how to deliver babies, do gynecologic surgery, run clinics for many women are seeing us for their annual exams. Um, and in residency limit truly is a job. We are all doctors. When you , when somebody introduces themselves as a resident, they are Dr. So-and-so, you're getting paid to be there, not nearly as much as we would need to survive comfortably, but we are getting paid to be there. And so that's residency. And for us, that was a four year period of time. After that, there are a number of residents who will go into fellowship . So that's yet another level of learning where you're not yet an attending doctor. Um, but it's still a paid job that you're learning on the job. You're doing your training on the job. And so we all go through a fellowship specifically for fertility and reproductive endocrinology, and that for us as another three years after residency, before we finally become attendings. And so in an office where you're seeing a doctor for fertility, you could be seeing a learner at any of those stages. Um, and they've all come with various perspectives and various interests a lot of time at , at , at F CLV . The learners you're going to see are primarily residents. So they are younger than me, men and women who are interested in OB GYN at the very least, because that's what they're specializing in. Some of them that are interested in sub specializing in infertility, others might be interested in sub specializing in other parts of gynecology or high risk OB. And so they are practitioners and physicians who are training to help you out at some point, whether it's at this beginning stage where you're trying to get pregnant or at an, a later stage when you're in your pregnancy, or is as a generalist seeing you throughout your reproductive years and through menopause. So you'll see a whole bunch of learners from all different places, with all different kinds of interests. So I think it's important, first of all, to just clarify kind of what , what those possibilities are when asked kind of the general question, like, is it a good thing, have learners in your office, hands down? The answer is yes. And I'll tell you why. I think that's the case for a number of reasons. Um , the first reason I think the it's the reason I think is most important and closest to my heart as well, is that you could kind of teach anybody to read textbooks and to take tests and to pass tests. You could teach anybody that the testing, the diagnosis, like how do you recognize this? How do you treat that? And we can all go to UpToDate online and read like the content of what we're supposed to learn in medical school and in residency. But the part that you can't get from textbooks is watching your colleagues do what they do best, which is to work with people. That's , that's the , the job that we went into, that's the business we're in, is not, how do I read this textbook chapter to my patients, but how do I teach you, how do I explain this treatment to you? How do I provide a shoulder for you to cry on when I have to give you bad news? Um , and those are the things that we as learners, all of us learn from our models, from the other people that we're around. And so for me, I think it's really important that the people in Las Vegas are getting to learn from some of the best teachers that are available, not the people who can give them the most reliable textbook, but rather the people that are going to show them, this is what it looks like to have good bedside manner. This is what it looks like to work with a woman who is at the lowest point in her life and who was for the first time failing. It's something that she felt like she should've been able to do easily. And so for me, that's the most important reason to have learners in the office because they need to be able to see and practice , um, that humanistic part of medicine that they can't get in the classroom. So
Speaker 4I have a question for you. What would you say to patients who are on the other side of the bedrail? Because we have learners in our office as well. And, you know, we always want to make sure our patients are comfortable when learners are present. And so we always ask them ahead of time, is it okay if this person comes in? And I think some patients are hesitant to say, no, they don't want to hurt our feelings are hurt, the person, learners , feelings. Um, what would you say to the patients that are on the other side in terms of, you know, why it's good for them to have that person there? And , um, I guess to kind of assure them that we're not there to kind of treat them as a laboratory specimen. What's the, what's the benefit to the patient?
Speaker 3Just the learner? Absolutely. Well, I think one of the most important things in the , the, the thing that I also tell my residents in my learners when they are , when they are first on our rotations, or when they're doing any kind of rotation, that's a little bit more intimate like this. Um, the benefits to the patient I think is you've got a very active listener who is probably infinitely more available than I am to them to do those other things that I can't necessarily do. So, Dr. BDN and I have full schedules in the office all the time, and it's very easy in fertility for offices to , to start to feel like they're turning out patients like numbers. And it's very common for patients to feel like a number when they come into our office and the visits are quick and they go fast and you just get to the front of the line, get in, get out. One of the things that I think is great about having residents in our office is that they have nowhere else to be. They have nothing else they're supposed to be doing except to be there with you. And they're getting something from it. They're learning from that interaction. But at the same time, this is a chance for them to, to work on their bedside manner. And what I experienced when I was in training was that I was so much more available than my attendings, that I started to develop really close bonds and relationships with some of those patients who needed a little bit more. Um, they didn't want to just come in, you take your pants off with Probio , you put your pants back on, you run, like they, they have questions, they have concerns. They want to talk. They want to be able to spend a little bit more time with us. And, and we all wish that we could be that for everybody. But the reality in healthcare is that we just can't the best thing I think about the learners as a resource to us is that they are there when we can't be, and they can be your first line of contact. And you just need somebody to vent to you have a question that you feel like it might be too silly to ask your doctor. Um, there's no question. That's too silly. That's the honest truth. But sometimes having that, that learner in the room with you can kind of be like somebody else who can stay back a second or who can read your, read your expressions and say, I don't know if that exam went as well as, as the doctor might've thought it did. Let me just hang back and make sure she's okay. Um, I felt like that was one of the best ways I could be useful when I was a learner. And so I try to tell my learners that that's one of the most important roles they can play as well. Yes .
Speaker 4And sometimes what I've noticed too is because the learner spend more time with the patients and they take a history. Um, you know, I feel like I've done this for awhile and I know how to take a , a fairly good fertility history, but it's really interesting how coming from a different perspective, sometimes they'll ask questions that I don't think to ask. I don't ask really specific things that , um, that, you know, I probably wouldn't have not thought to ask. So I think you , you get more information when you have somebody in the room, that's, that's doing an H and P that are physical, that you wouldn't be doing, basically. What do you think says ,
Speaker 5I think it's great to have that, that other perspective, the other set of eyes and ears , um, you know, I think there's, there's things that people who are, you know, closer in their formative, you know , learning stages that there , there are things that they may see that we may not see. And , and it's always great to have that additional perspective.
Speaker 2One thing that I've found is that a lot of our residents ask really good questions, and sometimes it's stuff that I know and can answer and give, give the textbook answer, because it's such a frequent thing that we deal with. But sometimes it's something where I have to go back and say, okay, let's look that up. And in the process of looking it up, whether it's me looking it up them, or both of us, we pick up some random new tidbit because there's so much overlap. I mean, the human body is really elegant in how much overlap it has. So that six different cells that do six, very different things, all have the same structures. And, and you may realize, Hey, that, that structure that we thought didn't have anything to do with what our favorite cells do, you know, that may be really useful. And, and so sometimes even though the patients don't really see it, just the presence of the residents or the students around makes us think harder, look deeper, make connections that we otherwise wouldn't have a reason to make
Speaker 3Where they keep us on our toes and they hold us accountable to having them like most accurate and most recent. And evidence-based medicine is really easy to kind of like, get really settled into what you, what you learned. But even for me, what I learned was 3, 4, 5, 6, 7 years ago, and fertility is such a rapidly changing technology. The treatments that we have changed just from when I first started, I'm not that far out. And so having learners around requires that we all stay on top of our game.
Speaker 4I think also too , the other perspective from the standpoint of learners is, you know, nobody wants to feel like that they're having something done to them or somebody talking to them that's new, but you know, we all in medicine, like you said, have had many, many years of training and we couldn't be in the position that we're in right now, if the same thing hadn't happened for us many years ago as well. And I think that also is in the nursing profession too. Um, sometimes, you know, we have patients that get a little bit of pushback or give us a little bit of pushback. If we have a new nurse that they're not familiar with. And, you know, the reality of it is we like to keep our employees for a really long time. And we have a really good history of that, but there's always some turnover and, you know, everybody, whether it's a nurse or , uh , a new doctor, I mean, they have to sort of learn our system and learn how we do things. So it's really helpful when patients are willing to let them come in and , and be a part of our, you know, our, our visit.
Speaker 2Have you ever tally the number of tests that we've gone through by the time we get out at the end of all this
Speaker 3Did it , I would have I'd vomit in my mouth. No. Think about it that way. Or you'll never start
Speaker 4Answer.
Speaker 3I don't want to skirt anybody from doing this. This is the best job in the world, but if they knew him, he tests, we had to take, nobody would ever get started.
Speaker 4And I will say it never ends. We continue to take tests. I even took one, I guess, about six years ago, but I had to retake because of my medical, you know, medical credits that I had to get. So it never ends. Yeah .
Speaker 5Uh , hot item everywhere is, you know, the value of standardized testing in schools. And whether, you know, you believe it's valuable or not for your child. You know, one of my one perspective that I come from is that I feel that every major milestone I've had in my professional lot educational and professional life has, you know, fortunately, or unfortunately there's been a standardized test of some sort that has that , that has been a gate that I've had to open up. And, you know , um, like there, there is a value in learning how to take these types of tests when you're younger, because I think if you didn't have that experience as a child, that once you got into college or medical school, or further along in your training , um, you know, we have some unbelievably complex tests that we have to take and, you know, it's, it's harder as you get older to like, make all those like neural connections. And so I definitely think there is some value in that.
Speaker 3Well, I'm hoping that the whole paradigm was shift in that I was signed up to take our sub-specialty oral examinations at the end of April. Um, and , and so what that is, is to become board certified in this subspecialty , you have to sit before a panel for three hours and kind of answer rapid fire questions about what do we do every day about the research that we've completed in the past. Um, it's really big, really nerve wracking, really expensive tests . And it's my center where you take the test because you see where your money goes when you walk in the door. Yeah . It doesn't make me feel good about it at all. But , um, I have a little PTSD from the last time that I was there. Um, and it's a test that we prepare for, for many, many, many, many months in advance and with COVID-19 , my chest has been postponed until who knows when, so I'm on a little bit of limbo and I'm hoping that maybe this COVID-19 is going to be the paradigm shift that changes us from those oral exams to, to something a little bit more reasonable and less nerve wracking, but medicine, oral exams. Now
Speaker 5I would, I would just be happy to get rid of that . And there's safe .
Speaker 2Yeah. By the time you rack up your, your act or SATs than the N M cats , and then step one, step two, step two CS, step three board exams that everybody takes. And then your individual board exams for OBS with both a written and the oral, and then for REI, a specialty exams, a written, an oral, and then the maintenance of certification tests that we do every year. You just kind of get immune to it. Like ,
Speaker 5Well, one thing to keep in mind is we are all obviously lifetime learners.
Speaker 3That's right. Absolutely. Yes. So , yes. Wonderful. I wanted to ask you guys a question that's totally off of the topic of what we talked about before. Um, but I had a question for you guys about, it's a common question that I get, and I want to know what your responses are. You know, I think our patients like to feel connected with us as doctors, they look at us and we look a lot like them. And so it's easy thing to do. And I also have a lot of patients at the end of the visit. That'll say, I'm Dr . K , do you have kids? And I'm always wondering if there's anyone else having to answer this question and if so, how are they answering it? Um, and my answer might be different. I'll kind of save it for after I hear what you guys say, just
Speaker 2The straight up question. Do you have
Speaker 3Kids? Yeah. Like they, they want to know they want to a piece of your life to take home with them. You know, how do you, how do you answer that question?
Speaker 4I actually had two children, but I also have them from IVF. So I kind of welcomed that question cause I can kind of tell them
Speaker 5A little bit of my experience. Yeah. I tell my, I have three children and my last child, I did IVF. I include that, you know, in, in people want to know they , they, they do want to know part of your life. I mean, they have Mo these people have just shared some of their most personal intimate details that, you know, that little bit of, you know, delving into my life. I'm, I'm all for it. You know, we've, we've talked about , um, you know, I practice in a relatively small city and, and I run into my patients and I see them and I see some of them at my kids' events, you know? And so, you know, it's, it's just, we, we all want to form connections. And , um, it's one of those things that I don't have tens of pictures of my family in my office. I have a couple of things kind of to the side and that type of thing. And so if, if people are interested in asking, I I'm more than happy to share it, but it's, it's not something that I'm kind of throwing out there per se,
Speaker 2When people ask that I, you know, I tell people, yeah , I've got two small little human beings at home that , uh , and one for a baby. Um, and I, I have a handful of pictures throughout my office. And in a lot of people I find don't actually notice them because in part they're talked tucked away so that I can see them very clearly, but unless you're looking for them, you don't necessarily take them into the full view. But , um, but they're very much the foundation for why I do what I do. And so there's a part of me that's like, oh, I don't really want to rub into the fact that, you know, you're, you're here trying to have a family. And I have these two little people that I adore, who I think are just cute as buttons , um, most days, but,
Speaker 3And they
Speaker 2Are. But yeah, I mean, that's, that's very much the reason why I do what I do. Like I get a lot of joy for my children and want, want my patients to have that too. So it's, that's part of how it's personal for me to help them get pregnant, because I want them to be up in the middle of the night as well. And I want to not be the only ones suffering every single night by my son and daughter, dog, or all three.
Speaker 4Well , and I'll have to admit, I probably overshare more than the average person. And I just, that's just kinda my personality. I enjoy hearing about them and their lives. And I usually, I mean, it's just amazing. Our patients are so interesting. Um, I've had, I've had patients who are helicopter pilots and patients who work for the CIA and somebody gets a specialist in explosives for the army. And it's just, I think our patients are just so interesting. I like to hear about their lives.
Speaker 3I agree. I just got an email from a patient today who told me that they opening up a new brewery, a microbrew in town. And I was like, that's exactly the kind of patient that I need to keep in close.
Speaker 4Well, I once had a droplet tier , so I'd have to top that with the chocolate here .
Speaker 3Yes . So that doesn't cause one question, well, I, you know, I tell them the truth and the truth is that I'm allergic to children. Not really. I'm not actually, but I have, I tell them, you know, I don't yet. Um, but I have eggs that are frozen. Um, but I always, I always wonder is that like telling them too much, you know, I always wonder, I start to wonder about myself. Like, why are they asking, do I have like a very clear void of a family in my office? Like, should I get pictures of someone else's kids and put them in here? Like, I
Speaker 2Think your answer is perfect. I think your answer is perfect.
Speaker 3It doesn't say does help them. Like when we're talking about, especially when I'm explaining things like needles and giving yourself injections, it helps them to know that we've had to do it. And so we've seen the other side,
Speaker 4I think that's, I think that's great that you share that. I think that makes them feel so much better when you share something like that to share to experience.
Speaker 2I tell a lot of my patients that pretty much every REI physician, female REI physician, that I know by the time she got out of fellowship, she either had babies or had eggs frozen somewhere or embryos frozen somewhere , um, depending on where she was in her life. And, and to the extent that I know those details about the members of my class , um, is very much true. Like we all, we all either went in knowing you definitely wanted kids, or you definitely didn't. And for everyone who did they have figured out a way to try and secure that because so many of us have been on the, have been on the other side of that needle or want to avoid being on the other side of the needle.
Speaker 3So fingers crossed that those eggs will pan out for me one day. But I was just curious to know if other people get that question or if it's just me, because they're trying to sniff out a psychopath.
Speaker 2No , I think it's a pretty common question. I it's one that I always walk on that new fit in with our group because you're the same kind of crazy we are. All right. Well, thank you so much for hanging out with us, Leah . It is wonderful to see your shiny face on the zoom and , and hear your voice on the podcast. I kinda got admit, I, I miss seeing you around the office all the time now that we're all in quarantine and isolation and all of that, so everything's shut down. But , um, this has been fertility docs uncensored, and I'm joined here by Dr. Abby , Evelyn of the , uh , Nashville fertility center, Dr. Susan Hudson of Texas fertility center. And of course my partner, Dr. Leah Kay and myself, Dr. Carrie obedient of fertility center of Las Vegas. So have a wonderful day be safe, take care, and we'll be back soon. Bye everybody.
Speaker 6[inaudible] .