Transcript

Will: [00:00:00] Knock, knock. Hi. Hello and welcome to Knock-Knock High with the Glock Flecking. I am Dr. Glock Flecking. I am Lady Glock Flecking and we’re so excited for you to be with us today. We have a wonderful guest who’s an artist and a physician, and uh, his name is Dr. Mike Natter. Super cool stuff that he does following him on social media for quite a while.

And, uh, so we’ll talk about, talk to him here in a bit. But before we do that, we are is May. Mm-hmm. And this is the post-match, uh, pre-graduation time period for med students. Yes. So they have matched, which means they all know where they’re going next year to start residency. Mm-hmm. But they have not graduated yet.

This is the prime time for ophthalmology rotations. Some of them 

Kristin: may be graduating. Like [00:01:00] imminently. Yeah. 

Will: It’s like happening this month. Yeah. It’s, it’s, uh, but they, that that the like two months, that two and a half months. Yeah. That’s a real sweet spot. Oh, it’s great. Yeah, because you can, uh, you just check out.

Yeah. You can do a, do a research elective. That’s, I think that’s what a, one of the things 

Kristin: I do, researcher 

Will: moving costs and you just, yeah. You just try not to think about the fact that you’re still paying thousands of dollars in tuition for these like two months that really, you know, don’t offer much in the way of education, nor should they, because everybody should be taking 

Kristin: a break.

What were we doing in those two months? I mean, I was still working. I, what were you doing? 

Don’t 

Kristin: you don’t even remember. We were probably planning our move. I 

Will: think there were some parties involved. Oh, probably. Yeah. I do remember one specific med school party where everybody burned their notes. Cuz we all had paper notes still.

This was how Yeah. Old I am. Oh, 

Kristin: that’s right. I wasn’t working. We, I was, we had a little tiny baby. That’s 

Will: right. We did doing that. [00:02:00] And so there was the note burning party. Right. I remember that. Big bonfire. Big bonfire. Mm-hmm. And a lot of people burn their white, their short white coats as well. Oh, I am glad I did because it became an integral part of my That’s right.

My costume. Yeah. Uh, wardrobe 10 years later. So I saw that coming. I probably worn that coat in more videos than anything else in, uh, my closet. Yeah, that, thank you for devoting the closet to my, it was painful. I have a whole closet for my apartment props. That’s great. I love it. It’s good. I mean, considering our, our actual clothes closet you’ve taken over like more.

That is, 

Kristin: that is half and half, eh, half and half 50. 

Will: It’s up for debate 50. I don’t know about that. We’re gonna have 

Kristin: to post a picture, let the people decide. 

Will: All right. Well, let’s talk to Dr. Mike Natter and stop talking about, uh, our, our, our closet, our closet arguments. Uh, so Dr. Uh, Dr. Natter is a [00:03:00] clinical assistant professor of medicine and a clinical endocrinologist.

He is a doctor and artist, a humanist overall, just wonderful patient advocate and physician. Uh, and, um, uh, on, uh, Instagram and, and Twitter. He’ll tell you where he is, where, where to 

Kristin: find him. But yeah, he’s a good model for kind of a, a non-traditional path. To medical school Exactly. And through medical school, he’s done some really cool thing and really 

Will: fascinating, uh, you know, educator in terms of learning through art.

And, uh, he talks a little bit about that. So, really fun conversation. Let’s get to it. Here is Dr. Mike Natter.

All right. We have Dr. Mike Natter. Mike, thank you so much for joining us. It’s, it’s thank’s. Really. Thank you. It’s really a pleasure to see you. 

Dr. Mike Natter: Thank you for having me. It’s an honor and a privilege to be with you guys. So, 

Will: you know, the, I I’ve been following you on Twitter, uh, for, for actually quite a while now.

Like, went back, I don’t [00:04:00] know, probably pretty soon after I first started on Twitter and yeah. And I just remember seeing your, um, your drawings and your art and being like, oh, that’s, that’s different. That’s, that’s pretty cool. And, um, and that’s something you’ve been doing. When did you, like first start that part of your kind of, I don’t know what you Yeah.

Call it as, as a hobby. It’s, it’s really a, a big part of your career now, it seems like. 

Dr. Mike Natter: Yeah. Yeah. So, well, so first off, um, the fact that you follow me at, at any point is, uh, quite an honor, um, massive fan, um, as of, as are millions of people, I’m sure. Um, so I, I actually have been drawing my whole life, um, as I imagine you’ve always been funny your whole life or telling jokes your whole life.

Mm-hmm. Just kind of like, kind of something natural for us. I, I would imagine. Um, and then, you know, I, I believe that all of us are, are born with some kind of creative or artistic tendencies. Um, you know, we all finger paint and draw and, and do all these fun things, and then [00:05:00] something really sad happens and we stop.

And I have a lot of reasons for why I think that is, but they’re all terrible. Um, I think we grow up, 

Will: we grow up, we’ve become adults. Yeah. We have like day jobs we have to do. Is that what, is that what it is? 

Dr. Mike Natter: Totally. And like, there’s no RVs apparently when, when you draw and, you know, it’s like the, the what’s valued in the world.

Um, but, um, you know, Reasons that I never really understood. I never stopped, I always continued to draw. So that kind of was with me my whole life and, um, it, it, it, it sparked a lot of my imposter syndrome when I wanted to go into medicine cuz I thought, you know, how, how could I like an art kid make it in medicine?

Will: So how did you make that decision to go to Medicine Med, uh, to go to med school? What was that process like? Yeah, 

Dr. Mike Natter: so I, um, I, I have type one diabetes. I was diagnosed when I was age nine. Um, and I know you also have had, um, your share of, of, of health concerns too. Um, I, I, I dunno what you’re talking about, right.

Um, I mean, the way [00:06:00] that, I mean, not to take it too much off of me, but the way that you both. Have spun, you know, what I imagine is extremely traumatic experiences into such a really beautiful educational platform, but also, you know, find the humor in it, I think is really amazing. Um, and inspiring to me, myself and, and I’m sure millions of others.

Um, 

Will: well, a big part of that’s just like a self-preservation. Which I’m sure you can probably relate to, just I, I feel like I have to tell jokes and, and have that creative outlet just to mm-hmm. Process 

Kristin: and I feel like I have to advocate and make the world a better place for other people. So you decide which one’s better?

Dr. Mike Natter: Well, I, it’s a, right, it’s a bit of a power, power couple. I mean, those are both such, but there’s such like healthy ways of, of kind of coping. I tend to kind of rock in a ball and cry a lot is usually how, oh, okay. 

Will: Yeah, let’s step one. You gotta shed that. Once you, you get out of training, eventually you’ll grow out of that.

But not completely. It’s, it’s, there’s still times in medicine where you [00:07:00] will be crying in a ball, but, um, you know, 

Dr. Mike Natter: it’s, yes, it’s true. I, I started my attending career this past September and I have not shed that cocoon of, of shaking and crying so much. But yeah, you’re, 

Will: you’re right in it. You’re right at the beginning here.

This is right at the beginning. This is great. So, so you are, well, I, I want to actually, uh, continue on and, and hear a little bit more about, uh, about the combining the art with the, the medicine. Because I, you know, as someone who has this for a long time, I had this other hobby I was doing, I did some standup comedy and it was separate from medicine.

And then, uh, you know, at some point medicine gets your life as a doctor. Just gets Yeah. Too busy. 

Kristin: Well, and even, you know, outside of medicine, I feel like there’s this, this. Push and pull of like, you’re either an artist type or you are a scientist type. And at some point along the way it feels like you have to choose one if you have talents in both of those areas.

Um, but I think [00:08:00] that, you know, I was a victim of that. I didn’t figure it out as well as you did. Um, you know, I went the science route because I do have that side. Um, and I didn’t even think of myself as a creative. Person until I left the science field, because I can’t draw, I cannot draw to save my life.

Stick figures are all I can do. Um, but I better than me. I do have other areas of creativity and, um, you know, artistry that I just didn’t recognize as that. Um, because there’s this like push and pull, right? So how did you, did you feel that Yeah. How did you, uh, combine the two? How did you know to do 

Dr. Mike Natter: that?

Yeah, yeah. So I should go back a little bit. So, so I was diagnosed with Type one diabetes, um, at age nine, and that was the kind of initial introduction to medicine for me. And I was like, wow, this is really, really cool. You, you basically become your own pancreas. So something that was otherwise autonomous and that you kind of took for granted, you’re, you’re doing it yourself.

So it, it sucks. Don’t get me wrong, it still sucks, but it allowed me this kind of insight into, [00:09:00] into pathophysiology and I gained that appreciation for it. But I was an art kid and I sucked at math and science, and I had no medicine in my family. I never thought that I could be a doctor. I just, I thought I was not particularly bright, honestly.

So it wasn’t until I was in undergrad, I was studying art and undergrad and I had this kind of epiphany. I said, you know, I really wanna try. And that way if I try and fail, at least I won’t have that regret if I didn’t give it a shot. So I, and I al I always felt like there was a lot of creativity in art, in medicine, and I thought that what I could bring to the table was actually something a little bit, you know, novel and potentially, you know, unique to, to helping folks.

Um, it it, it dawned on me in the application process that that wasn’t readily apparent to most, uh, unfortunately. But I got very fortunate and to get in, uh, to one of the 30 medical schools I applied to. So I was very fortunate for that. And it was in medical school when I was doodling my notes and I started to doodle on the, kinda like the margins initially of these like typed up summaries, as I’m sure you [00:10:00] know will, I’m sure you remember like people basically memorize these like volumes of texts and then regurgitate them on tests.

Right. And I, it’s just ridiculous in the funny mnemonics and stuff. But I found. When I would doodle and make these little comics or cartoons, they became stickier and I re recalled them for the test. And that’s when I made that big leap when I said, you know what? Let me try and switch out my notebooks for sketchbooks, see if I can retain this information in a better way that’s more, you know, specific to me.

And it, it worked and, and it worked for me for that didactic purpose. And it’s been working for me to teach my patients and to teach, you know, my colleagues and my med students. And, 

Kristin: and yeah. Did you have like a little side hustle of like, drawing on flashcards and selling them to your, to your other students?

It’s 

Will: funny you say that because there are a lot of resources that med students use now Yeah. That are picture related sounds to do that even I remember, uh, I think it’s like some of the books that I had, and now we’re talking, you know, this is back like [00:11:00] 22,000, 2009 or something and there were, uh, a couple, I don’t even remember what long, longer ago.

So, Made ridiculously easy or something like that. Right? Yeah. It was like microbiology or something. Yes. And it, it had all these pictures in it and it was helpful and so it makes, it makes perfect sense, you know, that, that it, it helped you, you know, retain some of this nonsense. We have to, we have to learn mm-hmm.

Throughout med 

Kristin: school. Yeah. But did your, I really am curious, did your classmates come to you and, and want to hear or want to see what you had come up with to help them 

Dr. Mike Natter: study? It was a journey actually. It was really funny. So I was very embarrassed and kind of ashamed that I was drawing because I was like, what if people see me as not taking this seriously?

And you know, I’m in the library kind of doodling away. And I remember it was, I was a first year medical student. I was making this huge illustration and that went to the bathroom and that’s the only time you would socialize cuz you were busy studying. And then you’d go in the bathroom and there’d be someone next to you in the u.

And I ran to my buddy and [00:12:00] he goes, uh, naar, what, what are you, what are you doing? You’re, you’re drawing. Like, aren’t you worried you’re gonna fail? And that’s when I had this like sheer panic. I was like, oh my God. Like what am I doing? And like they look at me, all these people and then I did well on that test and I said, oh no, something’s here.

And then I started to post them to social media honestly, because I wanted to wait like a repository to save them for myself to study for step one and everything else. And my classmates would come up to me after tests and be like, Natalie, you got me a couple points with that comic you drew. Oh nice. And I was like, oh, so people are actually having some benefit from this.

It was really nice. Yeah. 

Will: Well, I remember seeing, you know, periodically I’ll see a little video that you’ll take, um, of you teaching students teaching. You know about the one I saw, I think it’s your pinned tweet right now. Uh, is you teaching the renin Angiotensin aldosterone? Yeah. I, I remembered what a, a s.

Because you saw his drawing because of that, because of you. I’d like to, I know what those words, 

Dr. Mike Natter: [00:13:00] but you’re a very intelligent, intelligent 

Will: ophthalmologist. Come on. Don’t give us too much credit as ophthalmologists. But anyway, I I, there was a wonderful video of you, uh, you were drawing the system out and I, I, cuz like that’s the type of education I think is, is really helpful.

You know, whenever you’re on these rotations. And do you still, do you still do that with your, now that you’re the, the boss man, you’re, you’re running rounds for what, how long? Three or four hours is that typically? 

Dr. Mike Natter: So I imagine compression take seconds. 

Will: Yes. Your compressions time. Take some time through those drawing.

You have to draw your way through rounds. Uh, so it’s gonna take a few extra hours, I’m sure. No, but it can, it can. 

Dr. Mike Natter: Um, so as an endocrinologist these days, most of my practice is outpatient. Um, I get to attend on the, on the, on the service, uh, two weeks of the year, which I really enjoy. And I do try to draw a lot for the, the fellows and the residents then.

But what I found is, um, and I believe this firmly, and this comes partially from being a patient, I really believe that every patient has the right to understand the pathophysiology of their disease. I, I really mean [00:14:00] that. And, and I think especially when you’re dealing with chronic conditions like diabetes and others, a lot of how the outcomes are, are dependent on the patient’s, uh, you know, kind of agency and if they’re gonna take care of themselves.

And I think if they understand what’s wrong at that level, they’re, they’re more likely to take care of it. And when you draw to explain, you’ve broken down the educational barriers, language barriers. I trained at a, at, at NYU and Bellevue. And Bellevue is like a very special place. It’s like the city hospital of New York.

And we, we treat people from all different walks of life who don’t have, you know, ascent to their name or don’t speak the language or don’t have citizenship, which is a really beautiful thing to be able to help anyone. And when there’s that language barrier or an educational barrier or a cultural barrier, you’ve flattened all that.

When you draw something and you create that rapport and even if the drawing is not great, that process you took really connects you to that patient. And oftentimes I’ll draw what looked like scribbles and they’ll want to take that home at the end of the visit, which is really magical. 

Kristin: Yeah. Do you [00:15:00] have an education background?

Because I’ve seen you, you know, in some of these videos you’re drawing and you’re teaching at the same time and you seem like kind of a natural educator. So is that something that’s in your family or that you’ve seen or been trained in somewhere? 

Dr. Mike Natter: Thank you for that. That’s a big compliment. Um, my mom’s an elementary school teacher.

She’s retired. Okay. There it is. So I think that might be part of it. Yeah. But I also think growing up and not being very smart, like I didn’t excel academically and so I like to break things down to a child’s understanding. And if you can do that, then anyone can understand it. Exactly. 

Will: Very cool. Yeah, I wish I, I mean, it makes me wish I was a better artist.

Kristin: I know, I really, 

Will: I need you to draw some eyeballs for me. How’s your, I got you. How’s your eyeball these days? You got a good eyeball going. I can make some, you know, actually have, it’s complicated anatomy. It’s, it’s, it’s sometimes it’s, it’s hard to, you know, we have plenty of models in the, so I use those, which is, you know, 

Dr. Mike Natter: that’s probably better.

Three-dimensional. I actually, I was a, i a, um, a bad [00:16:00] Jonathan. I was a, uh, like the evil Jonathan. That was me, uh, in my, okay, in my, I did a postback. I think we might actually be very similar in age, to be honest with you. I don’t wanna ask, but I think we’re there. I’m a lot older than I’m, I’m 37. You can ask.

I’m 37. I’m 37 as well. Yeah. Oh, okay. All right. Nice. So I, I took a weird roundabout. So I did my art school and then I did a post-back pre-med program. And then it took me some time to get in and in that interim, I worked as a medical assistant to a corneal transplant surgeon, and I was his scribe and, you know, assistant.

And I was horrible, just terrible. It was embarrassing how bad I was, but I could still remember most of the layers of the cornea. So I got that. So you, well 

Will: you were, so were you going to the operating room? Were you doing, were you there like for everything just in clinic? You were. Describing we, we, you know, you’re probably weren’t as bad as you think you 

Dr. Mike Natter: were.

Uh, it was pretty bad. 

Will: Well, the problem, the hard thing about my field is that it, the, our language is, is so different. Ridiculous. Yeah, it’s absolutely [00:17:00] ridiculous. I mean, the fact that Glock flein is an actual thing and ophthalmology, right. Uh, you know, it’s, which is the reason I chose it in the first place.

So I always, uh, anytime I’m working with like a new scribe or we have new scribes in our clinic, it’s, uh, It’s always a learning curve. Uh, you know, but, so yeah, I think, you know, maybe if you had just drawn everything instead of tried to spell out these terrible words, you know, it would’ve been a little bit easier 

Dr. Mike Natter: for you.

O os and od still plagued me to this day, but I’ll get there one day. 

Will: Od it’s, it’s, it’s simple. OD is right eye, the other one is the other one that’s, 

Dr. Mike Natter: but then you gotta throw an OU in there, and then you got GTS and all these, I mean, it’s too much. 

Kristin: They just like to feel important. They make it overly 

Will: complicated.

So I didn’t go to back to, you know, endocrinology and your job now. I didn’t realize that it was, I guess it makes sense that it’s so outpatient heavy. Uh, but I guess I was surprised that you’re, that you don’t have to spend as much time on the inpatient side of things. Um, and so is [00:18:00] there like a, a service, uh, uh, I’m assuming there’s a consult service and, and you have, you know, fellows and, and residents kind of rotate through there.

Mm-hmm. Do you like that balance of outpatient and inpatient that you have? 

Dr. Mike Natter: It’s funny. So like my residency was so intense, um, and I was just so burnt out that I thought coming into the outpatient world, I’d be like, oh, what a relief. But you just trade one for the other, you know, it’s, you know, the MyChart messaging and Yeah.

And the results that come in and, and, uh, all that stuff. It’s, it’s exhausting. But I found I do miss a lot of the inpatient medicine. Um, there’s something really nice about seeing a problem in front of you, having that cognitive space to figure it out and then solve it right then and there, and you, you kind of feel the benefit of that.

It doesn’t happen all the time in internal medicine, but you know, like in the, in the unit or here and there, you’re able to kind of, you know, see the result of, of, of your, of your work. Outpatient endocrine, it’s a little bit of a slow, I get very excited when I see the A1C drop, don’t get me wrong, like very excited.

We have a little party in the room, but, uh, it could take time. 

Kristin: Do [00:19:00] you find that being, um, a patient and specifically a patient of, you know, in within your own field, do you find that helps you be a 

Dr. Mike Natter: better doctor? I do, I do. I don’t think you have to have, you don’t have to share the affliction with the patient to be empathetic.

I, I believe that firmly. Sure. Yeah. But it definitely helps with a chronic condition cuz like I said, the patient needs to take ownership and take care of themselves. And so, you know, I won’t always upfront share that with the patient, but then when the patient comes in and I say, oh, what were your, you know, fingerstick glucose checks, you know, and like, well doc, I didn’t do it.

Well why not? Like, what’s the barrier? Because you don’t understand. It hurts, it hurts to prick my finger. And I said, I do, I do. And I’ve been doing it for, you know, 20 whatever years now. Um, and that, that palpably shifts the dynamic in the room when they understand that you really do get it cuz you do it too.

Right. And I always make that clear that just because you know, I’m telling you to do something doesn’t mean it’s not difficult or annoying, but it’s for your benefit. And I can tell you that I do it as well. And that makes [00:20:00] me, I think, a little bit more of an understanding physician. 

Kristin: I think that’s so powerful, you know, across the board of just under just recognizing what they’re going through and letting them know that you see that and you understand that whether you experience it yourself or not, just to be, to feel like you’ve been seen and heard as a patient or as a, you know, a copatient copatient.

Um, I think that is sometimes that’s all it takes. It’s so powerful and it can really change the, the course of action that they take afterward. 

Dr. Mike Natter: Absolutely. 

Will: Within the next few years, I’m gonna be in reading glasses and then I’ll, I’ll 

Kristin: be able to, then you’ll be able to empathize I’ll your patient, empathize with the vast majority of, she’s had like my patients perfect vision his whole life, like eagle eyes.

So, 

Will: yeah. I’m the, so, you know, you have your experience as a type one, you know, diabetic and, and I, I have never worn glasses. I actually have never had like a dedicated eye exam. Isn’t that, isn’t that weird? Isn’t that Yeah. You should feel sad. You’ve never, it’s 

Dr. Mike Natter: not great. Like I, you’ve never been dilated.

Will: Uh, [00:21:00] I, I had one of my eyes dilated. I just In med school. In med school? Mm-hmm. Yeah. No, in residency. It was in residency. Um, so, which is a little bit embarra. I can’t, 

Kristin: everyone feel free to publicly shame it. I can’t believe I’m 

Will: saying this on. I know. Podcast. You’re admitting it. Uh, but yeah, it’s, it’s, um, you know, so I’ve, I’ve never.

Had to wear glasses. Let’s 

Dr. Mike Natter: dilate your eyes. See? You like it. I was gonna say, I feel like, I feel like this is a great opportunity for Kristen to dilate you in your clinic. Have it filmed. This could be a great educational episode. Yes. Oh, that’s a great idea. 

Kristin: Oh, that’s, that’s, that’s a good point. Take my revenge because I hate having my eyes messed.

Oh, it’s worse. The dilating. Yeah. It hurts. Like I have very light eyes or sensitive to light as it is. And then when you dilate them, it’s even worse. And it stays that way for like way longer than it’s supposed to. But he’s always complaining at me to go get my eye exam, go get my eye exam. 

Will: Mm-hmm. You gotta do it.

You’re no stranger to eye exams, you know? Right. You’re, you’re good for your 

Dr. Mike Natter: yearly. Get my yearly dilated exam. Thankfully. No cotton wool spots. No, 

Will: that’s great. That’s good. That’s [00:22:00] good actually. Uh, you, you sent us like a few stories and one of them involves, um, an a. An eyeball and, and an exam of the eyeball.

So I’d love for you to tell everyone about 

Dr. Mike Natter: that. Ooh. Yeah. This was, um, so, so part of, I think what makes me a little bit of a non-traditional medical person is I, I tend to wear my shortcomings on my sleeve. Um, I think we in medicine are take this idea of perfection a little far and people don’t kind of speak about things that they don’t feel comfortable with.

Mm-hmm. I was the opposite in med school. I would kind of poke fun at the ridiculousness of things. I did love it. Um, so I, um, I was, I think, I think third year medical school was like some of the most dehumanizing, like most awkward experience, um, of my life. You basically are six to eight weeks in a rotation where by the end of it you’re just starting to understand the lingo and then you switch into it all over again and you just feel like a total idiot the whole time.

Um, so this was not, this was, uh, [00:23:00] the case on my neurology exam, on my, uh, rotation. Rather. I was rotating in Philly where I did my med school and I was in a clinic setting and I was convinced that this patient had pseudotumor, cerebri eye. I was sure of it. And one of the things I recall from, actually one of my comics that I drew from step one was that they get this papi edema like, uh, situation in the back of the eye, uh, from, from I, I guess from the high icp.

Mm-hmm. So I told the attending as I was presenting, you know, I believe this is on the differential. And he says, well, did you look at her eyes? I said, no, I haven’t. He goes, go take a look. So meanwhile, while I’m trying to examine her eyes, he’s got his back to us typing up his note and she’s on the exam table, and I went to the wall and I didn’t have my own ophthalmoscope because.

Why would I, it’s too expensive. And I was like, I’m not smart enough to get into OP though, so we’ll, we’ll fix that. Um, and I grab what I believe is the ophthalmoscope and I’m, you know, I’m doing what I recall doing, but I was trained where I have my right hand and I’m on the, I’m on their right side and all this stuff, and I can’t seem to see [00:24:00] anything like, nothing.

And I turn around, I said, you know, attending, I, I can’t seem to visualize the, uh, the fundus there. I’m having a difficult time. And he goes, yeah, because maybe you’re using the otoscope to look at her eyeball and I the wrong scope. That one’s for ears. Yeah, you got it. I now know that, unfortunately 

Will: a little late, but, so that was, well, you know, it’s, uh, it’s funny because that, that’s a big area of, um, uh, anxiety for a lot of non ophthalmologists is just being able to look back there.

And so, you know, chances are your neurology attending probably wasn’t much better at it than you were. Just to be honest. So it’s uh, it’s 

Dr. Mike Natter: probably true. Yeah. That’s probably why he had you do it. 

Will: I, I it’s, that’s right. No, it’s, I love that. Uh, I think I actually made a video, like it’s very similar to that because I have seen that happen before.

Oh. I mean, they’re both, that makes feel a little better. They, they, they look kind of the same, you know, it’s, it’s, you can’t really see much [00:25:00] of anything with either of ’em whenever you’re a med student, you know, in particular. So I can, uh, you know, yeah. Easy mistake to make. I, I bet that neurology attending is also still talking about that to this day.

Remember that idiot? I, it’s funny cuz I. You know, whenever I talk to non ophthalmology audiences in medicine, sometimes I, occasionally I’ll talk about eyeball things and I always tell them like, we have no expectations for anybody outside of ophthalmology. Being able to see into the back of the eye, like it’s, you know, for the same reason, you know, I wouldn’t, no, no med student should ever buy an ophthalmoscope.

Like that’s because it’s just, it’s a difficult exam. It’s, it’s really hard to like, to learn to master and, and, uh, I think the future is probably a, a camera that will actually take a picture of the fundus, like in every mm-hmm. In every office. 

Kristin: That would be so much better for the patient too. I feel like, well, I don’t know, maybe you still have to have the bright lights and stuff.

They’ll 

Will: have them now, but, but more for the [00:26:00] benefit of the, like, physicians outside of ophthalmology right now, all those cameras are in ophthalmology clinics and, well, that’s what ultrasound is for. Come on. You know, that’s, 

Dr. Mike Natter: uh Oh, that’s a hot topic on Twitter. 

Kristin: That was a cheap shot. 

Dr. Mike Natter: Yeah. 

Kristin: Well, I, well, attendings can be really intimidating sometimes, and especially when you’re like a little baby and three, right?

Cuz that’s the first time that you are in a clinical setting. Where you’re expected to kind of know things and they’re, they’re asking you things. I think you have a story about that too. 

Will: Oh boy. Your surgery 

Dr. Mike Natter: rotation. Oh my God. Yeah. The only time I think my entire, uh, medical journey where I thought, you know what?

I’m just quitting. I’m done. This is not for me. Oh boy. I, this was my very first clinical rotation. Um, Yeah, this was a rough go. So I, I was scared outta my mind. I was waking up at like three, four in the morning to go into my surgery rotations. Um, and I get there and, uh, there is a [00:27:00] notorious, uh, attending at this particular, uh, location that apparently, I didn’t know this going into it, but apparently loves to kind of pick one of the medical students and just make their life hell for those six weeks and Oh, nice.

I was the lucky, the lucky one. Oh, nice. I was in, in a, uh, long some, some abdominal surgery and, um, as you know, that, that my job primarily was just the retracting, so I was just retracting, um, and I was exhausted. Uh, you know, you’ve been there since four or five in the morning and the surgery’s going on forever and you’re not being included in any of the surgery.

You’re just being there as a, as, basically like a, a doorstep. You’re holding the door open. 

Will: So, yeah, I’m holding it open and it’s, it’s several hours in one position and, ugh. You’re scrubbed in, your forearms are aching. You’re trying to like dissociate mentally to, to, to keep yourself, uh, you know, from just collapsing.

And so I’m, I’m with you. I, I, I think we’ve all had those experiences in med school. 

Dr. Mike Natter: Exactly. And this, this surgeon, um, who had a, a slight accent and spoke very [00:28:00] softly, was looking down in the surgical field and mumbled under his breath between his mask, um, what space am I in? And I had no, I, I didn’t hear him at all as I was dissociating, as he so aptly noted.

And, um, I didn’t say anything. And then he stops, he looks at me and he goes, I said medical student, because that was my name, medical student at the time. Mm-hmm. What space am I in? And I said, oh, Jesus. And I had to like, Ooh, so let me backtrack and think, okay, you’re through like the fascists and the carpet, there’s like fascia.

I’m like, Ooh. And I was like, and then I, I was kind of, I didn’t wanna sit there in silence. So I went through my thought process out loud thinking, you know, at least till know that I’m not just That’s a good strategy. Yeah, that’s a good strategy. That’s, yeah. And I said, okay, well you’re through this part of the fascia, right?

And he goes, did you just ask a question in my, or. I was, Ooh, yes. I’m the only one that asks questions in this. Or, I remember this like it was yesterday. Like, it’s amazing how this is. Oh yeah. Seared into my hippocampus here. Don’t be this person everyone. Please never leave you. Yes. Never leave you. And it got to the point where I was like, I think you’re in the, [00:29:00] um, what did I say?

I think you’re in the, um, uh, oh my gosh. Now I’m blanking on it. It was the, what did I say? Peritoneum. It was, yes. I was like, I think you’re in the peritoneum. Oh, I love that. You knew that. And he 

Will: goes, that’s the only space, the only space inside the abdomen. I know there are other, apparently there are other types of spaces.

I have no idea. 

Dr. Mike Natter: Neither did I, nor do I now. And I said, uh, yeah, par, I said, peritoneal space. And he said, wrong. What space am I in? I said, oh, God. So he, he like puts his tools down. He’s kind of like coming closer to me at this point. I’m feeling kind of threatened. And he says, you know, My chief resident said that he thinks that I intimidate you.

And I was like, oh my God. And he’s like, so what is it? Do I intimidate you? And he like, leans in closer. I’m like, what he with this guy? Yeah. Yeah. Really crazy. So I, at this point, I have totally just like made a mess of my scrubs. I’m like totally like peeing myself out of fear. And I, I was like, I just don’t, I don’t know what to say.

And he goes, I’m in the pre-prepared toal space. I was like, oh gosh, pre-pa. And that was that. [00:30:00] Yeah. Mm-hmm. So that was a, that was a miserable six weeks of 

Will: my life. Fun. So you decided not to go into surgery? 

Dr. Mike Natter: Yeah. That was, it was a big off my list. I, I will say, I thought for a moment I might like a procedural field because of my artistic background, I, I don’t think I could live that lifestyle.

It’s a crazy lifestyle. It really is. 

Will: They’re, um, you know, and it’s, it’s far different than like, I knew I didn’t want it either cuz I did seven weeks of vascular surgery for my surgery rotation. So very similar experience. But my attendings were not nearly as as toxic as, as yours were. I just had to like suffer through wearing like 20 pounds of lead, you know, in the OR for like five or six hours behind a couple trash cans.

That was, it worked out though. It’s 

Kristin: the reason he chose ophthalmology. 

Will: Yeah, that’s true. Because, you know, I immediately went to ophthalmology. I did a two week elective in ophthalmology right after my core surgery rotation. And the first day they offered me a, a, a stool 

Dr. Mike Natter: to sit on. That was, and that was it.

That was it. That [00:31:00] was it. That, 

Will: that was, that my decision was made. I was like, oh, why couldn’t, because I liked, I liked the operating room. I liked being there. I liked surgeries, but, um, I, I, I love sitting down too 

Dr. Mike Natter: much. That’s funny. So, so you didn’t come in, you didn’t come into med school, you weren’t like, oh, opto all the way you came in, you were like, I like procedures, I like surgery.

Yeah, I, 

Will: I, well, I, you weren’t pretty undecided. I was totally, yeah. I was an undifferentiated bed student. Mm-hmm. I was completely, and so, you know, just trying to feel my way through it, see what, what I, I really clicked with. And most things I was pretty sick of by the time the rotation ended, uh, and was ready to move on to something else.

And then, you know, but in 

Kristin: ophthalmology it was only two weeks, so you didn’t have time to get sick of it. 

Dr. Mike Natter: Yeah. And you’re 

Will: sitting, so it’s great. But opt I will say ophthalmology is not the most comedy, heavy specialty, so, you know, I, I think, uh, you know, gastroenterology or urology would’ve, would’ve probably been a little bit better on the comedy front.

But, uh, you know, you made 

Dr. Mike Natter: those. Yeah, 

Will: make it work. Um, [00:32:00] and so you did all your, your, your education and training in New York, is that 

Dr. Mike Natter: right? No, I did my med school in Philly. Oh, you said you were in Philly. That’s right. Yeah. I had, I had a really wonderful medical school experience, uh, outside of that one, that one time.

But, uh, very, very grateful. I, I went to Jefferson Medical College, very, very grateful for that opportunity. Um, and then I’m from New York City, so I went home and did my residency and fellowship at NYU in Bellevue for the last five years. 

Will: And tell me about your intern year. Do you, because, because it’s obviously notoriously the most challenging year of, of, uh, residency with the hospital you were in, was was community hospital.

It was a community hospital, right. 

Dr. Mike Natter: And, and City Hospital, New 

Will: York. Yeah. So like, kind of a safety net type hospital. Yes. Um, and so I imagine the, the breadth and volume of, of patients you were, you were seeing was pretty. Wild. Is that 

Dr. Mike Natter: right? I saw, I saw the spectrum. Yeah. I’m very grateful for it. And, and like I said before, really, really an honor to work there, but there would always be a couple [00:33:00] of interesting kind of things that would crop up.

Yeah. Working in those environments for sure. Um, I, I think you might be alluding to one of my other 

Will: stories. Yeah. I’m, I’m, I’m looking at it right now and it’s just, I’ve never heard of anybody being asked to do something like this in, in any level of, of medical training or education. Um, and so I, I have to have to have you tell this story.

Dr. Mike Natter: Sure. Yeah. I, I, it takes scut work to like the next level. Um, One, one of my hesitations of coming back to New York to do my training was there’s a lot of horror stories about what is expected of the interns. Um, and I had to kind of get over that fear, but I went ahead and I said, you know what? I really want to get the best training I can and I want to be back home in New York.

So I went for it and I have no regrets, but, um, some of the things were intense. So I remember very vividly as, uh, beginning of my intern year, Um, my first rotation actually was in the icu, which was horrifying, but also very good experience. And then that was my first intern year [00:34:00] rotation. That’s right. I was actually just listening to your other episode with, uh, Dr.

Silverman. I remember you talking about that. Terrifying. It’s brutal. Terrify, terrifying. It’s a, it’s a tough way to start for sure. You were under the, under the desk having a little snooze, right. 

Will: Uh, under the desk rocking and ball. Where else you gonna be? Cause if you go anywhere further away, then people will start dying and it’ll be all your fault.

That’s, mm-hmm. That’s the, uh, the nonsense mentality of an intern 

Dr. Mike Natter: starting, so, oh, no, I had the same, I still have that mentality, but yeah, that’s, uh, so I, I was on night float, which, um, is, is for those that aren’t as familiar with, uh, with the system, basically you are expected to cover upwards of like 60 to 70 patients.

You just get these huge lists of patients with a couple lines written about them, and you carry like 18 pagers and just don’t sleep. And, you know, most of it’s a lot of like, Tylenol and blood sugar stuff like, you know, very, very manageable. Uh, every once in a while there’s a rapid response or a code, but then every once in a while there is a task that needs to be done.

Mm-hmm. And, um, I was getting my sign out, which, uh, the day teams were giving me, [00:35:00] and I remember, I forgot my buddy’s name at the time, but he said, NA, I’m really sorry. Um, but there’s something you’ll have to do for this patient. The patient is currently under, uh, N Y P D or, or, uh, the police department custody.

Uh, they’re chained to the bed down in the emergency room. They’re admitted to medicine, but, uh, they may have swallowed a few baggies or many baggies of drugs, um, the refusing imaging, but you need to, um, basically, um, sift through their stool, uh, if they have a bowel movement to ensure that the baggies are still encased and not had, you know, burst open, which would be a bit of an emergency.

Um, and he handed me, I don’t know if he was serious or not, but he handed me a set of chopsticks. Oh my gosh. Um, I think it was a joke, but I think he was like, you know, this, you know, this could be helpful, 

but 

Will: maybe not a joke. I mean, maybe that’s all they had. 

Dr. Mike Natter: So I went, I did a, I did a set of rounds that night and I, I remember going to the bedside of the gentleman.

I said, [00:36:00] sir, For the love of God. Oh, no, please. At 7:00 AM and after you have all the bell movements you want. Oh, man. So that was an evening. 

Will: Did did you ever have to use those chopsticks? 

Dr. Mike Natter: You know, surprisingly, um, he, he did, he did pass stool, but it was, um, diarrhea and, uh, there was nothing in it. And I was, uh, spared.

Oh my goodness. The experience. 

Will: Yes. Wow. Oh man. Okay. Well, I don’t know who came on after you at 7:00 AM but they probably have a very different story. That’s 

Dr. Mike Natter: right. 

Will: All right, let’s take a quick break and then we’ll be right back with Mike Netter.

Hey, Kristin, do you know why a stethoscope is so difficult to use? Because there’s no heartbeat in an eyeball. That’s actually a really good point, but also the heart is quiet. The sounds can be distant and you’re in a noisy environment trying to listen to all the beeps and beeps. [00:37:00] Uh, but with Echo Health’s 3M Litman Core Digital Stethoscope, it’s easier than ever.

You get 40 times sound amplification, active background, noise cancellation. Even an ophthalmologist could hear the heart. Yeah, 

Kristin: you know, I really could have used that before I had to do 10 minutes of cpr. And it leads to earlier detection, better outcomes, definitely something that’s personally meaningful for us.

Will: We have a special offer for our US listeners. Visit echo health.com/kk h in use code knock 50 to experience echo’s digital stethoscope technology. That’s E K O Health slash kk h, and use knock 50 to get $50 off, plus a free case, plus free engraving with this exclusive offer, which ends April 30th. We have a new podcast in the Human Content Podcast family.

That’s right. It’s called Hidden Stories with host Andy Jang. It’s, it’s fantastic. So Andy is a storyteller. Uh, he’s all over social media. He is got like [00:38:00] over 3 million TikTok followers, over a million YouTube subscribers. Uh, a ton of, uh, views on YouTube. It’s just really interesting stuff, uh, uh, addicting viral stories.

It’s just like you can’t stop watching his content. It’s, it’s 

Kristin: fantastic. They’re stories. So, 

Will: and he’s going long for him because like all the other stuff is kind more short for him. Uh, and so he is going long for on a podcast. Uh, and so, uh, we’re excited for this. It’s, it’s launched recently and so you can go check it out and subscribe on any podcast app or on his YouTube channel.

Uh, and, um, you can hear the world’s most incredible tales through these captivating depictions and investigative research. 

Kristin: Fantastic. You guys, stick around to the end of the episode and we’ll show you 

Will: the trailer. Yeah. So welcome to the family, Andy.

All right, we are back with Dr. Mike Netter, uh, endocrinologist, uh, extraordinaire. 

Kristin: You just had a little Freudian slip there. You said netter nat. 

Will: I thought I said netter. You know, you said netter. How many times have you gotten [00:39:00] that, by the way? Like, I’m sure people get the vowel wrong. 

Dr. Mike Natter: I, I like to, I mean, it’s, it’s the highest of compliments because I mean, that guy was the master of, of illustration.

So I, I would love to be. Um, but no, it happens every now and again. Yeah. I get, people usually mis pronounce it with Ds. They usually call me Nader. Um, oh really? I get, I get Netter every once in a while. That’s one I don’t Correct. I’ll let that slide. Yeah. Yeah. 

Will: So it fits those. Are you unaware? Uh, Netter was his name.

Mike. Why are you looking at e I don’t know. Frank. Frank. Frank Netter. That’s right. Frank Netter, uh, has, he’s like historically one of the most famous, um, medical artists out there, just because I don’t think he’s alive anymore, is 

Dr. Mike Natter: he? No, he passed, uh, I think like five, six years ago. Yeah. 

Will: Mm-hmm. But he, he illustrated this entire atlas that pretty much every doctor on Earth, uh, knows about at this 

Kristin: point.

See, that’s so crazy to me. You said you, you know, you didn’t feel like you were smart enough or that art, you know, in medicine that people wouldn’t take you seriously, but then like, [00:40:00] Medicine 1 0 1 basically is this book full of illustrations, so that’s that’s 

Dr. Mike Natter: true. Yeah. Kind of ironic. Yeah, it’s very visual.

Yeah. Yeah. So, um, 

Will: tell us, uh, just give, give us a, a one or two liner on like what endocrinology is. We’ll start there. 

Dr. Mike Natter: It’s a, yeah, it’s, it’s interesting, like when people ask what I do, I say, I’m a doctor, and they ask what field? And if they’re not in medicine, I say endocrinology. Most people have no idea what it is.

And you know, if you say gastroenterology or ophthalmology, people know what that is. So it’s always interesting. So I tend to ask them like, what do you think it is? And they always come up with these funny, funny things. But I, I say it’s, uh, it’s metabolism, um, and hormones, but that often gets missed as, you know, misunderstood.

So I usually say I deal with things like diabetes, pituitary issues, thyroid issues, um, you know, osteoporosis, somehow found its way into our bag. Hmm. Um, you know, different, different types of things. You know, sometimes we have a little bit of a turf war with, um, you know, the, the, the nephrologist sometimes, [00:41:00] you know, we mm-hmm.

We talk about certain things with like, diabetes, insipidous, or, um, different things kind of get overlapped, but the most of what I do, bread and butter is gonna be diabetes and thyroid is kind of the bulk of it. A little bit of adrenal, a little bit of, um, pituitary, a lot of P C o S. Um, but it kind of spans a lot of different things.

I 

Will: mean, turf four, I, I don’t think I’ve ever like seen an, an angry or irritated endocrinologist in my life. So I feel like you guys are, uh, 

Dr. Mike Natter: on the nicer, we’re very, very nerdy. Very nice bunch. Yeah. So 

Will: what I thought we could do is, you know, I usually like to play a little game, uh, and I did prep you briefly, like, like la late last night.

You were probably already asleep. So I, I love not giving my guests enough time to, to actually prepare for something like this, but, uh, I call it six degrees of endocrinology. So, mm-hmm. You know, everybody know, like, there’s the six degrees of Kevin Bacon, so like, like everybody is within six degrees of Kevin Bacon in [00:42:00] terms of some kind of connection.

Right? So we’re gonna do six degrees of endocrinology because I, I don’t have a lot of understanding of endocrinology, but it does, uh, seem like almost everything in the human body is connected in some way to endocrinology. So I’m gonna give you an anatomic structure in the body. I had to do a significant amount of research because, uh, there’s a lot of things I don’t know about anatomic structures in the body.

So I came up with a handful of things and I’m gonna just give you something and I want you to relate it to endocrinology in some way. Okay? Fair enough. We gotta count how many degrees it take. That’s right. We’ll see how quickly you can get these. Okay. There’ll be some, so, yeah. So we’ll start, uh, with like a very obvious one.

All right. Just to give an example. So retina. So the retina. 

Dr. Mike Natter: So, so the retina, I mean, there’s a number of things, but for me personally and professionally, I’d say diabetic retinopathy or, you know, diabetes would be related, I would assume. Perfect. 

Will: Right. So there you go. That’s one degree, yes, one 

Kristin: degree. Very closely 

Will: [00:43:00] related.

Let’s, uh, let’s go with tibia. 

Dr. Mike Natter: Tibia, well, we could do one degree again and say osteoporosis theoretically. So there’s something there. How does that, 

Kristin: how are those related? You said osteoporosis is part of your field, 

Dr. Mike Natter: but how so? Yes, so the tibia is a bone. I, I hope, I think, I believe, uh, I think you’re right.

I think you’re right. Yes. Rather important one. Um, yeah, it does, it does things downstairs there and, um, osteoporosis. So the bone exists in a state of building up and breaking down. Um, that’s like a normal state. There’s a buildup part and a breakdown part. And, um, when that’s disrupted and it’s spending more time in that resorptive phase where it’s breaking down, then the bone mineral density is such that it’s very fragile and it could break.

And so that’s osteoporosis. Um, and so if someone had osteoporosis, perhaps they had it in that area, or I could also think of maybe like a rickets, which would be like a vitamin D deficiency, which can cause that weakening of the bone. And it’s usually in the lower limbs. So maybe [00:44:00] that would be part of that.

That all. Did I pass? Did I get, I want all the, I wanna, I wanna honor this rotation here. No, that’s, yeah. You got extra credits. 

Will: Is there, is there a hormone that’s involved in osteoporosis? 

Dr. Mike Natter: So, yeah, there’s a bunch of hormones. So, um, the main ones that I think about, there’s a hormone called PT H. It was actually a very cleverly named hormone.

Very few are cleverly named cuz it stands for parathyroid hormone, where it comes out of the parathyroid gland. Thank God for that. Right. Um, and so that, that’s, that’s gonna regulate your blood. Calcium. Calcium comes from the bone. If you have too high p t H for reasons that we don’t have to get into, it might lech that calcium from the bones weaken in them.

So, 

Will: interesting. So, tibia, osteoporosis, pt, h we’ll say, we’ll do two. I think it’s two, two degrees of separation to, I don’t know, to a hormone. I haven’t, I haven’t. The rules for this are very, you know, are very vague. All right. All right, let’s keep going here. All right. How about, um, the skin? 

Dr. Mike Natter: The skin. Oh, this is good.

Um, okay. I’m gonna say pre tibial mix [00:45:00] edema. Bless you. Gz tight. Those are words. I’ve, I recognize those. You know those? Yeah, yeah, yeah. Pre tibial. What now? Mixed edema. Mix. Edema. Mixed edema. Yeah. 

Will: M yx. Oh, edema. 

Dr. Mike Natter: That’s a fun word, actually. Mixed edema. Something 

Kristin: about fluid. 

Dr. Mike Natter: That’s all I know. Edema. Yeah. Very good.

Yeah, so it’s, it’s kind of like a gnarly skin rash, um, usually in the lower limbs, um, associated with thyroid conditions. Um, so it’s, it’s an autoimmune, uh, thyroid condition that can cause a skin manifestation. 

Kristin: Okay. So how many degrees with, that’s just still one degree. That’s still, everything is very closely related.

Dr. Mike Natter: The endocrine system is all around. Yeah. 

Will: I’m, I’m, I’m, I’ve really tried to. Okay. I got some harder ones coming up here. All right. Let’s do, um, also, you’re getting these 

Kristin: questions from an 

Will: ophthalmologist. 

Dr. Mike Natter: Yeah. You know, I do my best here. The eye is the window to the entire body, isn’t it? 

Will: Yeah. Not quite. Uh, nor do I want it to be.

All right. So how about [00:46:00] the diaphragm? Ooh, 

Dr. Mike Natter: the diaphragm? Hmm. Let’s think, let’s think, let’s think. Okay. I’m gonna say kuzma breathing from diabetic ketoacidosis is rapid, shallow breathing, which the diaphragm would be a part of. Does that count? Yeah. 

Will: Yeah. And then about that. Is that two or one degree? So Kuzma breathing and you said diabetic ketoacidosis.

So 

Dr. Mike Natter: kuzma breathing would be a symptom of diabetic ketoacidosis. Cause you’re trying to breathe off all of that acid. 

Will: Oh, okay. All right. There you go. All right, man. I thought I thought that was gonna Yeah, really get him. Okay. 

Dr. Mike Natter: The inner ear. Ooh, the inner ear. Oh, man. 

Will: Cochlea, semicircular canals. Those are 

Kristin: things you have read about.

Let’s cochlear nerve. 

Dr. Mike Natter: Good job. That’s, oh man, that’s, I gotta think about this. Oh, good. 

Will: Got one. There you go. Think I, I think I, I 

Dr. Mike Natter: may have stumped her in [00:47:00] her ear. Well, I mean, there’s meier’s disease, but Meier’s disease is not really endocrine related. Mm-hmm. 

Kristin: Is it related to something that is related to, 

Dr. Mike Natter: oh, yeah.

So, okay. We go 

Kristin: all the way down to six 

Dr. Mike Natter: degrees. Did 

Will: you get, you got six degrees 

Dr. Mike Natter: to play with here? Yeah. Oh, I see, I see, I see. Okay. So it doesn’t have to be one to one, so I’m gonna keep going here. Mm-hmm. Okay. So I misunderstood the rules here. So I’ll say, okay, that’s my fault. I’ll say Muni’s disease, which is characterized typically by vertigo and tinnitus or tinnitus, depending on you ask.

Um, and I’m gonna say that vertigo is a dizziness that you would see if you’re disoriented in dizziness. And you had, I don’t know, a theo Chromo cytoma. Oh, you might get a little bit lightheaded. Well, you could get, mm, you don’t really get dizzy from that, do you? Okay, I’m gonna go, I’m gonna take it back a step.

I’m gonna say, I’m gonna say thyroid storm causes tachycardia, which [00:48:00] could cause a lightheadedness, which could cause a dizziness, which could cause an inner, which could be related, I suppose, to an inner ear. That’s a really, mm, that’s a soft 

Will: one’s. That’s, I think we’ll accept it. Three. You did much degrees than I’d be able.

Three or four. That’s pretty good. Yeah, 

Dr. Mike Natter: he got there all debatable. 

Will: All right. How about, um, how about 

Dr. Mike Natter: hair? Oh, that’s hair actually more straightforward than, than you would assume. Hypothyroidism. One of the major complaints I get, chief complaints I get, um, is, uh, people coming in with, uh, either brittle or loss of hair.

And that could be from severe hypothyroidism, um, or it could be from like an androgen driven, you know, like male pattern baldness kind of situation. Both of us. What about 

Kristin: when you are pregnant and your hair texture just totally changes? 

Dr. Mike Natter: Yeah. Pregnancy’s wild. The It is, it is wild. It’s wild. The placenta makes all these crazy hormones and everything kind of goes outta whack, but [00:49:00] it’s kind of meant to go outta whack in a way.

Right. It’s very interesting. Yeah. Yeah. But I, I, um, I’m sensing that you might have had, is there some, are you having some hair? Did you have some hair issues with pregnancy? It changed 

Kristin: a little bit. Yeah. Like it was, I, well, I don’t know. Part of it was just learning how to deal with curly hair other than just straightening the heck out of it.

But it, yeah, it made the, the curl pattern a little bit looser than it had been. Interesting before. Yeah. Huh. 

Dr. Mike Natter: That’s fascinating. My hair also changed too. 

Will: Yeah, his guy, gray. I just got gray, 

Dr. Mike Natter: but can I tell you that’s most gray is good. Losing the hair is is not good. But going gray I think is a good look.

Will: Yeah. Well, let’s see. People are, I, I’ve, I’ve, that was reminded, uh, I posted a. A video like sometime in the last couple weeks. And occasionally, like, I always read some of the comments and, and somebody was like, I’m, it’s sad. We’re gonna watch this guy grow old, hopefully. 

Kristin: Oh my God. Because like, have you heard about his health history?

Will: It’s like, damn, that’s, that’s, [00:50:00] that’s very sad. Like I, I’m, I’m going to age through my videos assuming I keep doing it. Yeah. 

Dr. Mike Natter: And, but that’s a beautiful thing. That’s a 

Will: wonderful thing. I guess. I mean, I’d be beats the alternative. I 

Dr. Mike Natter: That’s right. I, I, I hope I age, uh, I, I can only imagine the comments. I mean, you have such a huge following.

I mean, I have a, a fraction of the following that you have, but you could put out the most benign, like well intended post or skit or joke or comic. Yeah. And 99% of the people will love it. And there’s just that one person. And that’s all I think about is that one person. It’s really terrible. There’s 

Will: always, there’s always somebody and, uh, you know, maybe they had a bad day.

Maybe they’re. I don’t know. I, I, you know, it’s, I try to like rationalize it in some way. Like, you know, that’s, I don’t know what this person’s going through, but the fact that yeah, the fact that it’s 99% positive, right. You know, that’s, that’s what, 

Kristin: that’s what we have to pay attention to. That’s hard. Like it’s the overwhelming opinion one thing, and then there’s just this one person, and if so, that says more about that one person than it does actually about [00:51:00] whatever they’re saying about 

Will: you.

But it’s, it, it, it can be hard. It’s really easy. I think our nature is to like, you know, focus in on the negativity and, uh, the, the angry upset people versus the mm-hmm. People that are really supporting you. But I don’t know, feel like it’s kind of a learned skill to like, be able to block that stuff out.

Yeah. You probably don’t get much of that. I mean, 

Dr. Mike Natter: come on. How could possibly get any I got, yeah, I got a lot. I mean, I, I feel like when you have a platform you like, I, I am so honored to have it. I kind of backed into it through, like by chance. Mm-hmm. But I feel like there’s a responsibility and so I do, I mean, like for instance, the, the platform you take against the, the evil corporations that run America, which is like the insurance companies and the PBMs and everything.

It’s like, yeah, we need to stick it to them. We need to kind of highlight that and. You know, you’ve personally experienced that, but there’s also millions of people that also don’t have the platform that are experiencing that. So I, I feel, you know, I, I have views. I know people disagree with some of them, and sometimes I use my platform for [00:52:00] that and Oh, I caught some, I caught some hate from that.

Yeah. And 

Will: then in, in the, the, the nature of social media today is that within 24 hours, it’s. People 

Dr. Mike Natter: move on. People forgotten about. 

Kristin: Yeah. That’s the other thing, right? There might be one negative comment, but then, you know, just come back tomorrow. It’ll all be all different. That’s true. 

Dr. Mike Natter: Very true. All 

Will: right.

I have, um, just like a couple more here and, okay. And before I, I haven’t decided if I never do this type of game again or not, but, um, sometimes I come up with good ideas, sometimes not so good. But, uh, maybe I need to tweak it a little bit. I don’t know. Or explain the rules better, or have some rules that, that’d be good.

Dr. Mike Natter: That might be a good, or have a guest who’s a little bit smarter than me. That might be 

Will: No, no, you’re doing, you’re doing great. Um, I mean, the, the fact that you have to know so many, all these different organ systems, all these, the really, 

Dr. Mike Natter: these pathways so complicated. 

Will: Very complicated. All right. How about the lens?

This is a little harder one. The lens. Ooh, the lens. 

Dr. Mike Natter: That’s good. The lens of the eye. Yes. Yes. I like this. Um, when I think of [00:53:00] the lens, I think of cataracts. Um, They’re scaled on up to four plus system, is that correct? They are. And several, I’m just trying 

Will: to get it. Yeah, there’s, there’s nuclear sclerosis that’s kind of an age related.

There’s cortical cataracts and they all have varying severity. Yeah. 

Dr. Mike Natter: Oh, um, okay. So, so we got the lens and so we’re thinking, uh, cataracts and so we’re thinking, what are we thinking? So, I mean, not, I mean, I do unfortunately don’t wanna keep going back to the bds, but the bds I do, I do think. Can accelerate the beatties, the sugars like that.

I think it can accelerate. Oh, I just 

Kristin: got that. I say diabetes. There’s so many medical words that I just don’t know. I assumed that was 

Dr. Mike Natter: one of the Oh, no. The beats that, you know. Got it. I think, I wanna say, I think that can accelerate the nuclear sclerotic sclerotic process possibly. Absolutely. 

Will: Nicely done.

Yes. Diabetes is, um, [00:54:00] some nuclear sclerosis, but also those other types of cataracts as well. Cortical cataracts. Uh, posterior subcapsular cataracts. Uh, that’s a fun one. Yeah. Yeah. And, and they, they affect different parts of the lens, but yes. High blood sugar for an extended period of time, no point on could cause the, the proteins in the lens to cloud over.

Huh. And cause a cataract. So the, the youngest people I’ve done cataract surgery on. Because I don’t do pediatric cataracts, but for adult cataracts, you know, people in their late twenties or thirties, almost universally, they’re type one diabetics who, you know, have just had high blood sugar for quite a while, they start developing a cataract.

Hmm. So 

Dr. Mike Natter: is there not to get too academic, is there, do you see in the, in that population with, with diabetes, with the cataracts, do they have a higher prevalence of retinopathy as well, or does it necessarily go together? No, it’s, 

Will: it, it typically does go together. Yeah. So, um, a lot of times they, they will have some [00:55:00] retinopathy, varying degrees of it.

But, you know, I’ve seen some very severe diabetic retinopathy, but cataracts have not formed. So they do go hand in hand. But sometimes the cataract’s a little bit worse. Sometimes the retinopathy is a little bit worse, so. Got it. Yeah. Well, I have 

Kristin: to say before we, we switch gears here that I’m, I’m sensing in you something that I think might.

Be relatable to others also in medicine. So, um, I feel like you, well, I don’t, you’ve just said it many times you, that you don’t think you’re smart. You don’t think you’re, you’re smart enough. And I would like to disabuse you of that notion publicly here. Um, first of all, I feel like you don’t need any, any justification of why, like it’s just obvious to anyone other than you.

But here we are. So you’ve made it all the way through medical school, all the way through residency, all the way through whatever other training you’ve had, fellowship, and now you are in one of the most complicated, I mean, who even [00:56:00] knows about hormones? They do everything in there. Everywhere. 

Will: Did you hear ’em say, that’s too hard, Theo Chromo.

Cytoma. 

Kristin: Yeah. I don’t even know what that is and I probably couldn’t even repeat it. And I think that maybe what’s happening is, you know, there’s been a very stereotypical pathway through how you become a doctor historically. Um, And I think that that is starting to change and that needs to change, right?

That, that there are many ways that people are intelligent, first of all. And um, you may not fit some mold that you had in your head of what being intelligent looks like. But you are very intelligent and, and I can see in your videos, right? Like I said, you’re a natural educator. You can’t be a natural educator if you don’t understand things.

You can’t be a natural, 

Will: you don’t have to be to, you can’t be an educator and, and be a dumb dumb. 

Kristin: Right. Exactly. And then your artistic ability is obviously very great. And then your insights, you know, [00:57:00] some of your, like you said, sometimes you have a view and your insights are, are, you know, also show science of intelligence.

So, you know, I come from the field of gifted education, so I have a little bit of authority to say. So you are, you are an intelligent individual. And if there’s others out there who maybe came to medicine through, you know, non-traditional paths, they might feel the same way. You guys are smart. You’re 

Dr. Mike Natter: smart.

Thank you, Kristen. That, that means a lot. And I, I feel like I owe you money for this session. I’d like to see you once a week. Okay. We can do that. Um, no, but you’re, you’re right. And you know, it took me a long time. I mean, I think imposter syndrome is very prevalent in our field. Yeah. Um, and it took me a long time to, you know, I feel more comfortable in my shoes these days, but I do like to use my platform and my story and my experience to do exactly what you just, exactly what you just said and inform and kind of bolster the people in the beginning of this process because it’s such a long, dehumanizing, exhausting process to say that you [00:58:00] are and what makes you different.

Is that gonna make you actually a little bit stronger and, and a better position? Yes, I 

Kristin: think it does. Yeah. And I, thankfully, I think the tides are changing a bit in that direction of, you know, you don’t wanna be just this one dimensional person. Like you wanna keep some hobbies. We say that all the time, you know, keep some things that.

That you’re passionate about, that make you feel human. Uh, don’t let medicine just like suck you dry of all of that stuff. And like you said, what makes you different? That’s what’s gonna make you stand out. That’s, what’s that in a good way? You know, being different right now in particular I think is starting to be valued.

Will: So, We need more artists in medicine. Yes. I we need also, we need more comedians in ophthalmology too. I, I could, I would appreciate a buddy some company here. 

Dr. Mike Natter: You have that covered though, don’t you? Alright, let’s, you gotta come out to New York and, and get on the stage. Oh God 

Will: would be fun. No way. That’s, see the thing I call myself now here.

Here’s his imposter syndrome. Oh yeah. I do have an imposter syndrome when it comes to like calling myself a comedian. For a long time I [00:59:00] didn’t, but I do get paid to tell jokes. So like, I guess technically I am a comedian, uh, but. To a very narrow audience. Like, you know, some, a lot of the stuff that I do comedy wise, if I went on a stage in like some, a random New York comedy club, I don’t know if it would go well.

I don’t know. 

Dr. Mike Natter: I’m gonna push back on that and I’m gonna say, that’s your imposter syndrome speaking. And I, I think that I like you, when I’m with my art friends, I identify as a doctor, and then when I’m with my doctor friends, I identify as an artist. It’s that, it’s that feeling that you don’t really, but you clearly have a talent.

You clearly have a passion. And I don’t know, I think you’d crush it. And I also secretly want you guys to come hang out with me and my girlfriend in New York, so Okay, 

Will: fine. Fine. I’ll go to New York. I’ll go to New York. I’ll quit my job as a ophthalmologist. Nope. Nope. And, uh, 

Kristin: we’ll just go, 

Will: we’ll take a trip.

All right, let’s take a quick break and then we’ll be right back.

All right. We are back with Dr. Mike [01:00:00] Natter. I said it. Correctly. You did this time, Kristen. Mm-hmm. Uh, so what we’re gonna, uh, take a look at a, a couple of our favorite medical stories or jokes that were sent in by the listeners. Uh, so we have, uh, story number one comes from Steve. So Steve says, as I was being released from the hospital, after a month following a heart attack, the hospital insurance ninja came to me, an admitted defeat in getting my inpatient rehab covered, even though the doctor restated the need for it.

My wife told her, hand me the phone. Well, like this lady, Over the next 15 minutes, she turned into the greatest actress I had ever seen. She went through all stages of grief. She expressed denial, uh, that patient’s, an anger confusion even went full on Mega Karen. It was stunning to behold the insurance company caved and paid for the two weeks.

An hour later, the hospital administrator came [01:01:00] in and offered her a job and a corner office. 

Kristin: I don’t know if he’s serious about that or not, but I would believe 

Will: it. I dunno that Absolutely. Uh, I’m sure, um, insurance is a big part of your life as an endocrinologist dealing with all these different medications, especially with diabetes.

Well, 

Kristin: and in your own medications. 

Dr. Mike Natter: Yeah. Yeah. Yes, absolutely. It is. It is. It is very, very frustrating. There has been some movement and some news, I’m sure you guys are aware that insulin has been dropped in terms of, of cost and capped, uh, $35 a month, which is, it’s, it’s a, it’s a move in the right direction, but it’s still, you know, I, I believe that, and especially in type one diabetes, like no one did anything to get type one diabetes and they need a hormone to live.

And when it was first, you know, kind of discovered by Banting in, in Canada back in 1923 or whatever it was, he sold the patent for a single dollar and said, insulin does not belong to me. He belongs to the people who need it. So the fact that people are making millions of dollars or billions of dollars and, [01:02:00] and people are dying and rationing their insulin, that there’s still ways to go.

Yeah, that’s a big problem. Ugh, that’s disgusting. 

Will: It’s also one of the coolest medical stories is that he sold that patent for $1. Yeah, that’s, and I’m sure he’d, uh, be, um, Distraught at what it’s turned into. So, which is pretty sad. Well keep up the, uh, the good work advocating for your patients. And that’s, is that, is that for all insurance, like everybody $35?

Is it certain I’m, I’m not as familiar with kind of this 

Dr. Mike Natter: Yeah. So, well, the manufacturer’s very recently put out kind of like lower list prices and then, um, the government has kind of capped, um, like copay insurance and stuff. But it’s still, I mean, there’s still gonna be pockets of the population that, you know, obviously are gonna be overseen and, and not have that opportunity.

Yeah. 

Will: Well, our second, uh, story comes from Jessica. This is, um, a joke that she heard. So she says, my neighbor is an ophthalmologist, and I told her this joke. My friend lost her eye in a tragic accident. She’s having a [01:03:00] hard time putting things into perspective 

Dr. Mike Natter: full time. We need like a, like 

Kristin: a, but yeah, sound effects.

Will: That’s a good one. I’ve, I’ve certainly told a spectacle joke from time to time. What’s your spectacle joke? Oh, I, I, I, oh man. It was, um, There’s something about, uh, a patient being very angry and yelling at people in the lobby and, uh, being told that they’re making a spectacle of themself. It’s, you know, dad joke.

Sorry, I’m not, yeah. See the reaction from Mike here? The little soft, a light laugh. That’s the, that’s, that’s the exact reaction you should have to a joke like that. Yeah. So, 

Dr. Mike Natter: but you don’t want your ophthalmology just be too funny cuz they got, they’re like in your eye while you’re laughing and then you moving around and then it’s a whole mess.

That 

Will: is true. I, that’s a good point. I have accidentally told jokes during surgery and sometimes that’s an issue. So 

Kristin: accidentally told jokes. Is there an ICD 10 code for that accidentally 

Will: accidental joke telling. Well, the thing is you don’t, you don’t want to try to [01:04:00] be, you don’t wanna be too the patient’s awake.

Right. But you don’t wanna be too funny because they’ve also had some sedation. So, uh, lowers lowers the threshold for, um, the only time I’m funnier. Uh, the only time I’m more funny than if like the, the audience has been drinking is when they’ve had sed, like a little bit 

Dr. Mike Natter: of Versace’s. We may have, we may have a business plan here where we have the, the nightclub comedy club just pumping verse into the air a little bit, 

Will: some aerosolized sedation or nitrous.

Nice. There you go. That’ll do it. Yeah. Well, Mike, thank you so much for joining us. Mel, before we finish up, uh, tell us, you know, where people can find you. You got any projects, anything in the 

Dr. Mike Natter: works? Sure. Yeah. So, uh, my social platform handle, so on Instagram, I’m Mike, m i k e, dot natter, and like Nancy, a t t e r on Twitter.

I’m Mike underscore natter, and I’m also on TikTok. I don’t dance though, I just draw a little bit. And that’s, that’s good. I think that’s just Mike Nader in TikTok. Yeah. So that’s, that’s where you can find me. I’m hoping to make a book one [01:05:00] day. It’s gonna happen eventually. Oh, that would be soon. I hope that be cool.

That would be, that’s the point. I mean, that’s the hope of the dream. We’ll see. And you 

Will: also do sell prints of your art too. I think I’ve seen those as well. So if you’re interested in checking out your art, you know, encourage people to do 

Kristin: that. You have to name your book someday. You have to name it after Netters, but it’ll be Netters.

Dr. Mike Natter: Yeah, netters actually a big A 

Will: in there. I think you’d have a pretty good TikTok, uh, presence if you keep, keep posting, keep building that because people love, like, have like nice, you know, soft music playing behind your drawings. Mm-hmm. It’s very relaxing for people. You got a 

Kristin: good voice for like a 

Will: voiceover.

I think watching, watching people, I’ve seen some videos or you know, watching people like write and calligraphy or draw and it’s just like, it’s just fun to like just watch that. So it’s therapeutic. Yeah. It is a bit therapeutic. And, and then, you know, you just, something along the way too. You’re drawing like kidneys and spleens and stuff, so.

Exactly. It’s good. All right, we’ll keep up with the great work and uh, thanks again for coming on. It’s been a [01:06:00] pleasure talking with you. 

Dr. Mike Natter: Thanks so much. Appreciate it.

Will: Have you ever wondered what happens when someone crashes their own funeral? Or heard about the man who stole 1.4 billion with a screwdriver. Have you ever lost sleep? Thinking about those death row inmates who had to play baseball or die? Actually, wait, that’s weird. That’s really weird. But even if you have, that’s okay because it means you’re in the right place.

Hi, my name is Andy Chang. You might know me from the internet and your phone. I tell stories, true stories that are so fascinating, so unbelievably bizarre that I just have to share them. Just have to once a week on hidden stories dive fed first with me as we explore some of the most mind boggling incidents experiences in people on this planet we call our home, hopefully will all come out of this with new perspectives on the world around us, as well as a much better understanding of what unbelievably unreal situations people can get themselves into.

I can promise you this, no matter what books you’ve read or movies you’ve seen, the [01:07:00] truth really is often for stranger than fiction. You just heard the trailer for a new podcast on the, um, human Content Podcast network That’s right. Called Hidden Stories. So definitely check that out. I think it’s, it’s, it’s sounds fun.

Yeah. It’s gonna be awesome. Uh, you can subscribe now on YouTube or wherever you get your podcast. We had such a great time talking with Dr. Natter. Yes, he 

Kristin: is very, did did 

Will: I really call him Natter on You really did. Yeah, Nat, 

Kristin: I mean, it’s, you know, that’s what I heard anyway, 

Will: I guess. Said, listen, it’s, it’s a, it’s a a, a wonderful comparison Yeah.

To have too, uh, one of the greatest artists in medicine, very appropriate. Um, but yeah, it was a, it was, I I just love when people continue to incorporate their hobbies Yes. The things they love to do outside of medicine into their medical, uh, you know, career. Yeah. 

Kristin: I think it’s good for them as people. It’s good for patients, and I think it helps bring [01:08:00] more humanity into the field of medicine, which is something that we 

Will: always.

And I’m serious about getting more comedian, ophthalmologists out there if you, if you’re out there. All right. Let me know. Like, let’s get together, let’s, let’s work. Just start a 

Kristin: mentorship program or 

Will: something. A mentorship program for, for comedian ophthalmologists. Mm-hmm. Okay. Thank you all also for sending in your stories.

Do you have any stories to share? We’d love to hear them and, uh, we’d love to hear your thoughts about what we, uh, talked about today. Uh, thoughts about six degrees of endocrinology, uh, which I, I’m gonna need to tweak it to explain it a little bit better. Yeah, I think, I think I didn’t do a good job with that.

I just came up with it like, you know, 

Kristin: it works. It’s fine like 

Will: eight hours ago, I don’t know. So anyway, uh, I’ll keep tweaking that. You just send us your, uh, I’d love to hear like ideas for games too, if you, cuz like sometimes I rack my brain trying to come up with these things. Uh, there’s lots of ways to hit us up.

Email us, knock-knock high human [01:09:00] content.com. Hang out with us on social media, Instagram, TikTok, uh, Twitter, YouTube. You can, uh, also hang out with our human pod content podcast family on Instagram and TikTok at Human Content Pods. Thanks to all the great listeners leaving wonderful feedback out there and the awesome reviews.

We love seeing those reviews. If you subscribe and comment on your favorite podcasting app, we’re on YouTube. We can give you a shout out. Like Leslie t on YouTube said, thank you for all these informative interviews we try to be in. Try to like make, get people to laugh and enjoy themselves, but also be a little bit informative too.

Yeah, edutainment there. There you go. This is an Ed Entertainment podcast. Uh, also, uh, our full episodes of this podcast are up on YouTube every week at my YouTube channel at d Glock Flecking. We also have a Patreon, lots of cool fun perks, bonus episodes, or react to medical shows and movies. Hang out with other members of the Knock-knock high community.

We are there. [01:10:00] We are posting and commenting and laughing along with you guys. Early ad free episode, access, interactive q and a livestream events, a lot more coming. patreon.com/glock plein or go to glock plein.com. Speaking of Patreon, community Perks, our new member, Jonathan, a, we are, uh, having, I love more, more people named Jonathan need to join the Patreon.

That’s, I’m a big fan of that. Uh, shout out to all the Jonathans on the Jonathan Tier, Patrick Lucia, c Sharon, s Omer, Edward, K Stephen, g Ros Box, Jonathan f Marion, w Mr. Granddaddy, Caitlin, CRE, L Dr. J Chamber W, and Jonathan, a Jonathan’s of Jonathan. Now Patreon Roulette, where we give a shout out to someone in the emergency medicine tier.

Here we go. Shout out to April S for being a patron. Thank you. April S. We are your host, will and Kristen Flannery, also known as the Glock Flecks. Special thanks to our guest, Dr. Mike [01:11:00] Natter. Our executive producers are Will Flannery, Kristin Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke. Editor engineer is Jason Porto, and our music is by Omer Ben-Zvi.

To learn about our Nun Knock Highs program disclaimer, ethics, policy submission verification, licensing terms, and HIPAA release terms. You’re gonna start saying this too. I gotta share the, spread the love a little bit with this. The, you know, speed talking, you’re just getting lazy. You want me to do that?

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Goodbye, goodbye.