Will: [00:00:00] Knock, knock. Hi. Welcome everybody to Knock-knock High with the Glock Flecking. I am Dr. Glock Flecking. I’m Lady Glock Flecking. We’re so glad you’re here. Uh, we have, uh, a fun show, uh, today talking with a gastroenterologist. Yes, our first GI doctor on the podcast and not a specialty that overlaps with me very often.
Wouldn’t think so. No. You know, it is just not a lot of digestion and the eyeballs. No, there’s really not, uh, you don’t have to feed the eyeballs. So it’s, it’s a very, uh, uh, it was a new, so I had a lot of questions, uh, just about his field and, um, and so we’ll get to, to our interview here in a second. But one thing that has come up recently, uh, that, uh, I honestly can’t stop [00:01:00] thinking about is this article that came out from, uh, ProPublica about the inner workings of UnitedHealthcare.
And this was, they put out a call for stories, I wanna say like almost a year ago. And is UnitedHealthcare like a hospital? United Healthcare Health insurance company. Okay. Yeah. And. They actually reached out to me to see if I could help, you know, sh you know, share this, basically a call for stories. So,
Kristin: no, we got some health insurance stories.
Will: Yeah. So, so, you know, I I, I helped kind of, you know, spread the word that they were looking for this, because I was like, this is a great idea. Mm-hmm. . So ProPublica is a, um, a, i, I believe they’re nonprofit, um, company or, or media organization. And they, they put out a lot of investigative reporting and stuff like that, so I was like, maybe we should mention
Kristin: we have no
Will: ties to prop.
Yeah, no, I have no ties to ProPublica. I just, I just like what they put out a lot of, [00:02:00] a lot of their work and so, uh, I, I helped amplify their call for stories and, uh, they, I guess they got a whole lot, which is not surprising because there are so many people out there that have horror stories around health insurance, and so they.
Just recently, uh, they came out with a story about this, uh, young man who was a student, um, at, uh, it’s blanking on me, where he was a student at, but basically detailing he college. Yeah. He was in, he was in college, college student, and he was detailing his struggle with getting his treatment for inflammatory bowel disease covered.
And it is just so hard to, to read just the, the, the pain and the, all the, the challenges and the denials and the letters and, and ended up having a lawsuit about it and [00:03:00] what we get through reading that story. Is some, a little bit of insight Into the tactics. Into the tactics, exactly. Yeah. That UnitedHealthcare and pro, honestly, probably other health insurance companies, I’m sure are doing the same thing, but United in particular and, and, um, the types of, of physicians that they have reviewing claims and denying claims, these are doctors that haven’t been in practice for 30 years and are not up to date with anything.
And, and, and so it just, the inner workings of United Healthcare as, as far as, you know, their treatment of claims, it was really eye-opening to me. And, uh, the only reason we have all those details is because they were from depositions, uh, as part of this lawsuit. Otherwise, there’s no way any of this information would be privy to the general public.
Kristin: Yeah. And see it was like the basic [00:04:00] philosophy is deny everything. until, you know, something happens where we just can’t deny
Will: it, essentially. Yeah. Or, or you’re legally required to pay for it. Right. Or, you know, that that’s kind of what it takes. And uh, it’s, um, it’s a harrowing story and it makes, it made me so angry.
But also I’m so glad that they did that. And what it really drove home for me is the importance of sharing stories. Because we need examples of these health insurance companies and what they’re doing to people. We need like actual anecdotal stories, which can lead to truth through subpoenas or deposition or whatever it takes.
It all starts with the story, right? And, and social media is such a powerful way to do that. And so I’m always encouraging people, Kate, even if who cares how many followers you have, it doesn’t matter if you have. [00:05:00] A story to tell about health insurance, about the terrible things these health insurance companies do.
Share it because that matters. And that is the one area of society that health insurance companies can’t control. They can’t control social media. They can’t control what people post, what people talk about. And so we need a lot more of that. So good on ProPublica for putting that out there. And I hope they do more.
And I, I believe that they are. And so
Kristin: do you wanna share your story of, of one of the, I mean, a story I should say? We have many, yeah.
Will: I guess, I guess my, you know, as a physician, I. For a long time didn’t really think too much about health insurance because, well, I mean, I, I should have, but I wasn’t because I wasn’t actually had to like use my health insurance very often.
Uh, but, uh, that did change when I had a cardiac arrest and had all these bills that were out of network bills, even though I was unconscious and didn’t get to [00:06:00] choose which hospital I was taking to.
Kristin: Well, and your hospital was in network? My
Will: hospital was in network, but some of the doctors were out
Kristin: of network.
The doctor that treated you in the ICU was out of
Will: network? Yeah, so it ended up with thousands and thousands of dollars in, in bills that insurance refused to pay. And it was a long, arduous six to nine month process. Um, eventually ending in the health insurance company, putting pressure on the hospital to drop the charges, which is not what I wanted to happen.
So they, they got it out of it anyway, and it was a very unsatisfying ending and, And so that really got me on this path of putting out all this content that I do with, with health insurance companies. And they
Kristin: use tactics like that all the time. You know, there’s no way to know as a patient, certainly not while you’re unconscious
But even if you’re not, there’s no obvious way to tell that that provider or this hospital or what have you is out of network. I mean, it’s kind of an arduous process to even figure out [00:07:00] which hospitals and which doctors are in network. And then there’s. You know, price tag on healthcare. And I think that a lot of people assume that doctors are walking away with a lot of money cuz the procedures cost so much or what have you.
And I don’t think there’s a lot of recognition that actually the health insurance companies have a lot to say about how much things cost. And, and so, I mean, it just goes super, super deep. There’s a million avenues of horror stories, so
Will: well done by ProPublica putting that story out and, um, it’s, I I encourage you all to go out and read it.
It, it’s, it’s really great. It’s not behind a paywall or anything, so you should be able to, to access it. And, um, yeah, I guess the, the bottom line is, you know, tell your stories, you know, get out there and, uh, get on social media and talk about these things. And, uh, because the. . The more that’s put out there for the public to read, the more people will realize, Hey, a lot of us are in the same boat.
A lot of people are experiencing the same hardships and [00:08:00] challenges with health insurance. Um, yeah. So check that out with ProPublica. Um, let’s get to our guests. Should we? Yeah. All right. I could, we could talk about health insurance companies all day. Mm-hmm. , so, we’ll, we’ll save it. We’ll, we’re not gonna, we don’t wanna start off too angry with this podcast because it just doesn’t deserve that.
Yeah. It, it kinda, it, it gets me fired up thinking about these, these insurance companies. All right. So, yeah, today we have Dr. Cave Hoda. Um, a friend of ours, we’ve, we’ve, uh, been back and forth with podcasting for a while now. Um, he is a gastroenterologist and also the host of the house of. , do you know what that’s from, by the way?
Kristin: It’s a play on words. Um, for the House of God. The House
Will: of God, which is, uh, an old novel that, um, you know, everybody who’s kind of gone through medical training is probably aware of that, of that book. So, uh, it’s a play on the house of which is a great, great name for a podcast. Mm-hmm. , the House of Pod.
Uh, [00:09:00] and I’ve been on his podcast. You’ve co-hosted it? I’ve been on it and co-hosting. Yeah. So very familiar with him and had a great conversation. So let’s get to it. Here is Dr. Cave Hoda.
Welcome cave. Thanks for coming on. We’re, uh, so excited. I, I always love getting to talk with you. You know, you were the first, your podcast was the, I think the first podcast that I was ever a guest on. Wow. That can’t be right. I think. No, I think it was because Cuz how long have you been doing the house of pod?
Dr. Kaveh Hoda: wanted to say like a year, but it’s been like five .
Will: It’s been longer than that for sure.
Dr. Kaveh Hoda: Yeah. It’s been like, yeah. Five, four or five years. Yeah. Wow. And
Will: I just, I, because it was before we had. It was pretty fairly early on in the kind of Glock fleck and stuff. And so, um, I I, we didn’t have a studio and remember like the first like five or six podcast episodes that I recorded, I was sitting in my closet.[00:10:00]
Surrounded by clothing, like with this janky setup. It was, it was really, uh, very low
Dr. Kaveh Hoda: budget. That was early in the Guam verse. And now look at you guys. This is like
Will: Right, legit, like actual,
Dr. Kaveh Hoda: yeah. I feel like I won a contest or something being on this show. This is exciting. No, this
Will: is great. No, you were, you were high on the list.
Uh, it is always, uh, fun to talk with you. So you’re a gastroenterologist. Yes. Uh, I, I know you from this podcast though. I don’t know you for your, um, your GI skills and knowledge.
Dr. Kaveh Hoda: Not yet. At some point. At some point let’s gonna
Will: change. We’re gonna learn more today. That’s good. Change today. Um, and so what I wanted to start with is just why.
Just in general, like why? Like I, I, there’s some specialties there. It’s just kind of like, yeah. Why?
Dr. Kaveh Hoda: Yeah. No, this is a very loaded question that I get. Not infrequently, like patients will come in for the [00:11:00] procedure, they’ll be wheeled in and they’ll be like, uh, you know, sir, do you have any questions for me?
And they’ll be like, Why do you do this? . Which, which I get, I mean, it’s a weird gig when you look at the, some of the stuff I do. But uh, you know, it depends. My answer will really range on like how much energy and how like nice the person seems. Cuz sometimes they’re just like angry and they’re just like, wrong.
Oh, I’m sorry. Can I cuss?
Will: You, you, you can we’ll figure it out. We’ll figure it out. Okay. So sorry.
Dr. Kaveh Hoda: That’s fine. In their, in their mind they’re like, what is wrong with you? There’s something deeply disturbed about you. And sometimes they’re actually really curious. And then I’m like, okay, well, you know, it’s a really fun part of medicine where you get to both be procedural and do things procedurally, but you also get to think about fun things like the liver and there’s a cerebral component to it and you put it together and they just still just look at me like I’m a jerk.
And they’re just like, you,
Will: some people are just mad that you made them drink all this, this prep. [00:12:00] And I understand, understand? Yeah. It’s gross. I get it. Just live on the toilet for a while and so, you know, you can understand why people would be a little bit upset about it. Do you have a go-to Quip
Kristin: for when it’s the angry
Yeah. What do you say? What do you say? Uh, I have
Dr. Kaveh Hoda: a couple. Uh, you know, the fun ones are the ones where they come in and they’re like, um, how many of these have you done? And if, if I get a sense that they have a good like, sense of humor, I’ll be like, this will be my first. But I watch it on YouTube. I feel really good about it.
And then they usually like laugh, um, when, when they’re like really angry. I I, or they, they don’t seem like they’re gonna have a good sense of humor. I, I, I say something along the lines of, you know, this is to help prevent colon cancer. And this is, yeah, we’re doing a lot of good with this. So, you know, I, I try to keep it pretty simple.
Um, cuz I get it. People, well some people come in and they want a doctor to help relax them. And you know this probably better than anyone. They want a doctor to joke with them. And then there’s some people who don’t, they just want to come in. They want to get their, their thing done and they want to go and they don’t wanna watch chit [00:13:00] chat.
And I understand that too. I mean, some people don’t want to go into a plane and have like their pilot telling jokes. I get that
Will: right. It’s, I mean, for, for me, all my surgeries are the patients are awake. So there’s a wide range of, of how people react in those situations. Some, some people are like, tell me like step by step as you go, like, I want to know what’s happening.
Mm-hmm. . And then some people I’ll like start doing that and they’ll be like, please don’t talk to me. , ,
Kristin: that would be me. I don’t wanna know anything like, please about what’s going on. Please don’t,
Will: don’t say anything. Yeah. Get it. Just do, just do the work, which I’m happy to do. Like, trust me, I would much rather just, just like, just all be silent, listen to the music, whatever’s playing.
But I, but I don’t think any of your patients are awake during a colonoscopy. Right. Or sometimes, sometimes
Dr. Kaveh Hoda: they are. You know, we, we oftentimes use conscious sedation, which means you get like a little benzo, a little opiate, and you’re like, calm. And most of ’em will sleep through it or be in a twilight.
Sometimes people are [00:14:00] more awake than others and then they’re like, wait, what is that? Is that then this is great. This is a, and sometimes you really enjoy it. They’re like, Enjoy the experience. They’re comfortable and they’re seeing what’s going on in their body. It’s like an underwater like jato exploration, but it’s them as the star and they’re really into it.
So it’s like some people are like, and that’s great. Those are, I, I love it when people ask questions, you know? Yeah. That, that
Will: could be fun. And it’s because they’re, you have the monitor for them. They can see it while you’re doing the thing, right? Yeah, that’s exactly, you’re, you’re behind them, obviously.
Correct. So they have a nice unobstructed view of their own colon .
Dr. Kaveh Hoda: They do. Some people don’t wanna, you’re right. Some people are like, I Yeah, they close their eyes and fall asleep. And
Will: you’re, you’re, I assume, like patients that are awake and talk and then can kind of, you know, follow this, you’re, I’m sure you’re probably trying to put on a show too, right?
You’re doing the thing where you turn the camera back around on itself, , and you can kind of see Retro. Retro, yeah. I’ve seen all your tricks. I’ve seen a few colonoscopies in my day.
Dr. Kaveh Hoda: Yeah. Yeah. You sure have. No, you know, you got us down, buddy. We, oh, [00:15:00] showman. If nothing else, .
Will: Uh, it was always, I remember cause I did a, um, a gi rotation in med school and one of the most exciting moments was always whether or not you could get through into the, the small intestine from the colon.
Right. You, you hit that, that,
Dr. Kaveh Hoda: uh, that two point conversion. That’s valve.
Will: That’s right. Yeah. The ileocecal valve. There you go see. Are are you impressed? I’m impressed. I’m very far away from the
Dr. Kaveh Hoda: eyeball. Listen, I, I mean basically rods and cones and my limit of the eye stops there. So the fact that, you know, any of the anatomy of the, the guts pretty impressive.
I’m getting there.
Will: Yeah. How so? How, what’s the farthest you’ve ever gone into the small intestine? How far into the ileum can you get?
Dr. Kaveh Hoda: You know, you’re usually only gonna get about like 15 centimeters. You’re not getting that far. And that’s pretty good. I mean, generally, I’m not even sure if every gastroenterologist has it as a goal to do that.
Um, I usually try to go into the IC whenever possible just because I’m a little O C D. [00:16:00] Um,
Will: what, I guess, I guess that’s a good question. What is it exactly that you’re. Looking for when you do that part of the
Dr. Kaveh Hoda: procedure. So if you’re doing just colon cancer screening and you’re looking for colon cancer, you usually don’t need to go in there.
You’re looking at the colon for colon cancer. You don’t need to look into the small intestine. Um, I oftentimes will anyways, just because if I find some inflammation there, then I’ll, I’ll be interested to figure out what that’s all about. Or if they have maybe a stool test that was positive for blood and I didn’t see anything remarkable on the way in, I will poke my head into the TI terminal illum as well to sort of get a sense.
Is this, this is fascinating stuff, isn’t it? For you just
Kristin: poking your head, the image of poking it. That was, uh, We
Will: some good imagery there on this podcast. We love making Kristen as the, this, this is why it’s so good to have her here on this podcast is because we need a non-medical voice. Yeah. And reaction to, to the things that we just are, are, it’s normal for us.
Well, normal for you. I, I don’t routinely talk about colons. I’m fully aware
Dr. Kaveh Hoda: that [00:17:00] my job is weird. , I mean,
Kristin: all of your jobs are weird, like, medicine is
Will: weird. Was there, was there a moment for you, uh, that it like, clicked as like, oh, this is what I want to do.
Dr. Kaveh Hoda: You know, there, for me it was something I kind of had interest in early, cuz there were some, uh, I had family members who had some GI illness and that sort of got me down that path.
Um, when you first start doing colonoscopies, I, I don’t golf, but I assume it’s a lot like golf where it’s just super duper frustrating until you get it, until you start kind of figuring out what to do. And then, uh, once you do that, it, it can be very satisfying. So, and, and I wasted so much of my youth playing video games.
I felt like I had to sort of adapt that into a career. I feel like GI was, was, was a good way to do that, you know, so it was early for me. I don’t know if there was one particular
Will: moment. I was trying to think of a, uh, of a comp for video games. Like what video games is like. Do you control
Kristin: the camera with the joy
Maybe [00:18:00] I don’t. ,
Dr. Kaveh Hoda: you know, our, our systems have to be updated. I mean, we, we use like basically the same scopes with slight improvements in digital quality and, and, and slight improvements overall. But we’re using kind of the same technology that we’ve been using for years. Like, it would be nice at some point to hold like a PlayStation controller that’s ergonomically sound in your hands, basically driving it through.
We’re not there yet, but maybe one day.
Kristin: Somebody needs to innovate and come up with that. I would love to be a tester, a business idea of
Will: the day. . Yeah. Um, and I remem and you can do it pretty quickly too, like these colonoscopies, they don’t, uh, I guess, I mean the, I remember the preceptor that I. Worked with on my rotation, worked with the, the room.
I stood in the corner while watching a colonoscopy. I remember that. It was like a, like someone shooting a laser through the colon. It was like, yeah, like 15, 20 minutes it seems. I don’t know if they go that fast, but,
Dr. Kaveh Hoda: you know, the, the, the trick is to not, [00:19:00] I’m trying to spend too much time on the way in.
You don’t wanna spend too much time there. That’s when it’s uncomfortable for the patient. Um, but to take more time on the way out, that’s when you’re really looking at stuff. So, you know, studies have looked at this and, and if you’re not taking at least six minutes to on your withdrawal, like what I tell like people in training is I’m like, don’t pull it out like you’re starting a lawnmower.
You have to like, take some time on the way out. Like that’s where you see the things, that’s where you find the stuff. So. Oh, interesting. Yeah. So there is some studies done on that, like
Will: to, to look and see. It’s,
Kristin: uh, too late for me to call in sick today. ,
Will: you’re, you’re in it. You’re in it. We’re talking about you are.
We haven’t even gotten to the prep.
Dr. Kaveh Hoda: You’re gonna experience this at some point, you know? That’s
Kristin: right. I’ve been total denial about
Will: that. . No, what, what is the age now? Is it still, is it 50? Is it,
Dr. Kaveh Hoda: so it’s actually, this is a bitten flux. Now we are saying 45, but, you know, this is sort of a, this is a bit of a, a moving target right now.
And, and I don’t know if it’s gonna be the same thing five to 10 years from now. Um, you [00:20:00] know, uh, there there’s not that much in terms of like real controversy in GI topics, you know, but there’s a lot of discussion about some of them. And one of them is when to start screening. Who to start screening, um, how to start screening.
So that’s an ongoing discussion and those guidelines are gonna continue to change, uh, for quite a bit. I think right now, 45 is when we say you start colon cancer screening. Gotcha. Unless you have a family history or there’s something else that makes you want to do it
Will: earlier. . What if you just like it, you just, you just want to have a
Dr. Kaveh Hoda: colonoscopy.
I’m a charming fellow. Some people I’m sure want to come and get colonoscopies with me. I get it. Um, actually, you wouldn’t be surprised There would be, there are two camps. There are people who are very eager to get it. I don’t know if anyone Yeah. You know, likes the experience. I don’t think that’s true.
But there are people who are like, probably like you guys who are like, I gotta do this. And then there’s some people who are like, I want to know what’s going on. I want to make sure it’s [00:21:00] okay. I have a family member who had colon cancer. I want to get this squared away. I want to
Will: know. I’m actually in the camp of, I, I I won’t, I don’t mind.
Like I, yeah, yeah. I’ll, I’ll do it. I mean, my, my body tends to grow things. I’ve, you know, I’ve had cancer a couple times now. I don’t have an increased risk of, of colon cancer, I don’t think. But, uh, but you know, you gimme a little propofol. Just knock me out. I don’t wanna watch my own colon. You say that now, but you can record it and show it to me later.
In fact, we could do maybe, how about my first colonoscopy? We could have a, uh, a live, we could
Kristin: have a, like a, a
Will: little rewatch, a little, uh, watch party. Watch party. . Listen, I can invite you on. We can look at my colonoscopy.
Dr. Kaveh Hoda: Listen, if Katie Corick could do it, you could do it. That’s right. 10 times better. Oh, that’s right.
She did that. I would love to livestream your colonoscopy. .
Will: Oh, that’s a, that’s another idea. I was thinking we record it and show it later, but we could just livestream the thing. That’s, that’s great. Yeah. All right. Um, so we’ve talked a lot about lower, but what about the upper? What, what do you [00:22:00] perf? What’s, what’s from your perspective, do you have like, A procedure.
Do you enjoy doing upper endoscopies more than a colonoscopy, or are they all kind of the same to you? You know,
Dr. Kaveh Hoda: they are. You do. I mean, they’re all, they’re all fun to some degree, but you do them enough. Um, you know, they, they stop becoming super duper special and that’s probably good. You don’t wanna be a patient with an interesting procedure, but the procedure’s True.
That’s true. The, the one I do that is really fun that I enjoy is the, is a really challenging procedure called an E R C P, endoscopic Retrograde Ang Pancreat in Oof. Yeah. Yeah. There we go. It’s pretty good. A lot of training to get that out in,
Will: it’s not, say it five times, it’s not just ophthalmology with the crazy words.
Dr. Kaveh Hoda: Yeah. No, that’s a, that’s our biggest one. I’m pretty sure that’s our biggest one. And, um, That’s a procedure that’s a little bit more challenging, it’s a little bit more interesting. You go in from above. But the hard part is to get into these series of tubes and ducts that [00:23:00] connect your gallbladder, your liver, your small intestine, your pancreas, and do work in there.
Uh, so that’s really difficult. It takes a long time to get good at. Um, you have to keep doing a lot of them to stay good at it. It’s a really, um, challenging procedure. Has higher risk, it is more invasive, but, uh, from a technical standpoint, it’s it that, that’s kind of en enjoyable. Those are fun. The most fun.
Will: Yeah. It’s a satisfying type of procedure. Yeah. I re I remember seeing a couple of those. You have to wear lead, right? Yeah, yeah, yeah, yeah. I, I, as a med student, I hated it. Oh yeah. It’s, it’s the worst thing when you have to, you know, cuz usually, you know, for procedures, you’re there to watch and learn a little bit, but you.
Really usually doing anything. You don’t, I don’t think you routinely have med students hold the Go Ono scope or the, the whatever the upper one is called. Um, but uh, uh, it’s just, you’re like, you’re wearing that lead and it gets so heavy when you’re just standing there doing nothing. Uh, so that was my big take away.
You are watching
Dr. Kaveh Hoda: some RCPs. It’s, it’s hot. I’m a large mammal. Will, [00:24:00] I’m, you know, imagine if you were wearing like an 80 pound flesh jacket, that’s like me, and then you have to, on top of that, put on lead and then a gown on top of that to protect you. Yeah. It’s really hot in there. Yeah. No, that’s a, that’s a
Yeah, that’s a rough one, I swear. Are there any, are there any like, Any misconceptions about your feel? Like things that people like me make fun of all the time that are, are not, uh, actually that accurate?
Dr. Kaveh Hoda: Well, yeah. There was like this one dude who made like, he was like a TikTok guy and he made like this TikTok video about GI doctors, like looking in the toilet at poop.
I forget who that guy was. It was you. That’s right. It was you. Um, it was me. I did that for, for sure. I think the biggest, for sure, , I think one of the biggest misconceptions is how much people think our lives and our work revolve around poop. Like we’re ologists or something. Like I’ve been on, I’ve been on like shows and podcasts [00:25:00] where like there’s just.
Maybe 40 minutes of questions about poop. And I’m like, guys, yeah. This is, you know, part of what I do, I deal with, I have to ask questions about, but I, I guarantee you that your average er doctor deals with poop way more frequently than I do. . I mean, there’s, it’s only part of what I do. There’s so much more.
Um, that’s probably the biggest one actually. Yeah. You know, we, we actually don’t see that much cause people do this whole intense cleanse right before they come and see us. You want it clean, right? Yeah. You can see things.
Will: That’s right. Poop. Poop just gets in the way. It’s an annoyance.
Dr. Kaveh Hoda: Well, I mean, look, don’t get me wrong, having a nice poop is important.
I think that’s a, a big part of someone’s happiness.
Kristin: Did you know that when we had little babies, uh, will hear composed a
Will: poop song? Oh yeah. I did. I would love, I had a to hear it. Yeah. Do you wanna hear it? Should I, should I sing
Kristin: song? Yeah. He would sing this while changing
Will: the diapers. Just keep in mind like we were, we were delirious
Yeah. Like with our first.
Dr. Kaveh Hoda: I [00:26:00] grab one of my guitars and we could make this a whole, like f feel. You know what, maybe let’s lemme just hear,
Will: hear the melody, and then we can add I’m, I’m better at my poop song being acapella. Gotcha. I gotcha. You know. Okay. So, so anyway, yeah, we were just very delirious and just, you know, I had all kinds of issues like mentally during that time period.
So, you know, I, I made up a song because my kid was pooping, you know, however many times a day constantly. Um, so it goes, um, um, poop in the morning, poop at night, poop in the evening, poop. D, light poop when you’re hungry, poop with all your. Poop in the evening. Poop delight. So I would sing this at 2:00 AM by myself, uh, with only my screaming baby.
Mm-hmm. , I didn’t, induction
Kristin: became a toddler and he was still singing it so much that she learned the [00:27:00] words and sang
Dr. Kaveh Hoda: along. Oh my God, that’s so cute. That’s so
Will: cute. I guess the point is kave, feel free to use that. Yeah. Whenever your, you’re a
Kristin: musician. Take that into yours. I’m
Will: gonna remix
Dr. Kaveh Hoda: that. Yeah. . It’s great.
Autotune you. It’s gonna be wonderful. .
Will: I, I do remember though, on rounds, so let’s talk about rounds. Yeah. Because, um, some of my most vivid memories of my GI rotation. Endless rounds like it, it, I almost felt like it was worse. Maybe it was just the team I was with, but you guys are so busy. You get, GI gets a lot of consults and I do remember for a lot of those PA having to go into the bathroom and look in the toilet.
Like, it’s like, it, like we did that. I don’t know if it was just that fellow I was with. He, he was a little bit of a strange individual, to be honest. , that may have just been his style. I don’t know. Uh, but it was some, maybe, um,
Kristin: he was hazing
Will: you, uh, there, but there was a, he’d be like, he’d go over there, he’d, he’d look in the toilet.
If [00:28:00] he’d see something, he’d be like, Hey, hey, will come over here. Come look at this and I, and as a med student, you know, you gotta like, pretend to be interested in everything. Yeah. Yeah. And so that, that was probably the hardest part of my, of my life, you
Dr. Kaveh Hoda: know, during that rotation that, that, I don’t know how necessary that is.
Like if someone tells me there’s blood in their stool, I’ll be like, was it a lot or little? And I, they can usually give me the words, but I, but you know, I’m not gonna. Sometimes we look just because people expect us to, like, I’ll be like, yeah, that’s blood. Yep, that’s blood in the stool. Just like you mentioned
So sometimes, sometimes it, it is, there’s like some, I’ll be like, oh, this is a little darker than you guys made it out to be, or, you know, vice versa. Um, but yeah, generally I, I don’t need people to send me pictures of their bowel movements, uh, generally. I bet you get a lot of that, don’t you? I get a lot of that and usually I don’t need it.
I mean, every now and then I will ask for some pictures of something, but that’s pretty rare because usually I’m able to elicit the stuff I need [00:29:00] from like, you know, words. Uh, and that, that usually does the trick.
Will: Did you see the picture I sent you? By the way, , I, you didn’t, you
Dr. Kaveh Hoda: never got that. This very impressive how it coiled.
I have to tell you.
Will: are you, how often are you, uh, so you have, you have a group of people, right? Yeah. You have. So are you part of a, a group of gastroenterologists? Mm-hmm. . And so how often are you in the hospital kind of doing rounds? And I assume you take turns.
Dr. Kaveh Hoda: Yeah. Yeah. It, it totally varies on the groups and some groups do it in very different ways.
My group does a week at a time, so I actually just finished a week of call. Um, and that’s, that, that can be pretty grueling. That is like a week of you’re in every day working pretty hard. We, I, I have a particularly busy hospital, and then when you go home, you could get called in at any point, which is, which is a difficult part of the, the gig.
Um, it’s part of the gig, but you know that, that part of it can be very challenging. And if you’re doing that for a [00:30:00] week, yeah, that can be tough.
Will: I think I, I know how to take GI call. Can I please? Yeah. Yeah, I think so. Yeah. You get a call from, uh, the emergency room because a patient is, um, has a lot of blood.
Mm-hmm. per rectum. Mm-hmm. , uh, you just, you get on the phone and you, and you say, all right, um, you know, let’s stabilize the patient. We’ll do a colonoscopy in the morning. That’s pretty good. That’s
Dr. Kaveh Hoda: pretty accurate. Good. I think you’re about ready,
Will: What’s an ophthalmology call? Let’s see. The thing is, when I, when I was, uh, doing some research for one of my, the GI videos that I did, I’ve only done like a couple, but, um, uh, that was what I’d like to do is look at all these social media platforms. I see what people are complaining about. Yeah. Reddit’s a great source for this.
Uh, uh, and, and so, um, looking at like, what are the pet peeves for all these, you know, specialties. Yeah. And that was something that I saw with, uh, GI is like, well, the patient has a bleed. They need a treatment. , but they’re not stable enough for [00:31:00] treatment. And so how do you stabilize them if you gotta control the bleed to, in order for them to be stable?
it’s like going around in a circle. Yeah. Uh, and so, uh, I would like to hear your thoughts about
Dr. Kaveh Hoda: that. You No, I understand why people are frustrated about that. Um, the truth of it is most GI procedures are better served and they’ve shown this are better served by waiting until you have your full staff there, which is usually in the morning.
You have everyone, all the equipment’s there. The patient has gotten enough blood product to bring their blood up, their own pressors and all that stuff is done. And importantly, you know, sometimes really you’re, you’re not doing the patient any favors by rushing in to do the procedure. There are some times when you’re, you’re actually gonna de you’re, all you’re gonna do is end up having to do two procedures.
Like, for example, there are times when people will want me to come in. I’ll be like, okay, well we gotta get this stabilized. Cause if I go in right now, all I’m gonna see is blood. If there’s a really bad bleed. Yeah. And, and then I just can’t do anything. And then like literally it’s like, okay, I can’t see anything.
You [00:32:00] know, we, we didn’t have time to clear out the stomach. We didn’t have time to stabilize them, so I can’t get them into better sedation for whatever reason. So, you know, sometimes we’re not just being obstructionist, . I mean, sometimes I’m sure there are people who just don’t wanna do it. But for, for the most part, like, you know, if, if the, if I’m saying we should hold off on doing this right now, I mean, I’m trying to think of the patient’s best interest, you know, and that’s sometimes hard cuz we like our reflex is to like, okay, I gotta go do something.
I gotta go put scope with somebody. This is what I do. I, you know, I have to scope somebody right now and sometimes it’s better to, to wait
Will: a little bit. Well hey ophthalmologists get, get where you get the obstructionist talk more than probably anybody else. Um, but it’s, uh, I, I agree with you in terms of.
Having the staff Right. Uh, emergent eye. I just, you know, obviously that’s all the only thing I really know about. And so, um, like open globe injuries, you know, the, kinda, the more serious eye conditions, it’s always a lot more difficult when you don’t have like the, [00:33:00] your typical staff and setup, especially for specialized things.
So, you know, I get that. Yeah. Yeah. It could wait, it’s okay. Let’s do it in the morning. Better for patient outcomes,
Kristin: I think, I think it’s just important to say that though, of like, right, this is okay to wait on, nothing is gonna happen between now and in the morning, and we’ll be better equipped for it in the morning.
Yeah. I think that’s the, like, education and people’s aspect. Nervous, nervous. Sure, but there’s like internal bleeding and you’re saying, Alice, just do this in the morning. Get a good night’s sleep. Right? They’re gonna spend that whole night just worrying. So I think for sure you say that upfront is,
Dr. Kaveh Hoda: is helpful.
Yeah, no, I mean, I did internal medicine residency in the chief year of residency, so I, you know, I took care of a lot of sick patients in ICUs before I, you know, went out to GI Fellowship. So, you know, I remember calling, you know, GI and other consultants in the middle of the night if I had to. That was sort of, you know, where I trained a big part of, you know, our training was to feel a sense of pride about doing as much as you could on your own, um, and figuring out as much as you could on [00:34:00] your own.
But, you know, um, it, it, I know what it’s like to, to be dismissed. So, uh, you know, I hope I, I don’t come across that way to when, when people call, I don’t know what, yeah, I was gonna, my nicest, I gonna ask you my
Will: nicest definitely. Where does GI stand on the kind of angry, angry consultant getting called in the middle of the night scale?
Dr. Kaveh Hoda: Ah, you know, I’m, I’m. I only get a little bit annoyed when one of a couple things happens. One, sometimes people call like just ready for a fight and maybe they’ve had a phone call with an angry neurosurgeon just a minute ago, but they’re just like, they’re in, they’re like, yeah, there’s like angry giving you the information.
I’m like, whoa, dude. This is like one in the morning. Gimme a moment to like, you know, warm me up to this conversation. And then some, sometimes it’s um, when I get the sense that, you know, they’re having me do the chart biopsy for them, look into, well, I’m like, you know, this is not that challenging. Is the patient on blood thinners?
You know, [00:35:00] that’s something you can tell me. I don’t have to look that up. But, but generally, I mean, I don’t find most, most people don’t call those consults without having some thought go into it. I try and remember that, and I try to remember that, you know, they, they need help at one, one form or another.
They need help sometimes, you know, they’ll be like, I just wanna give you a heads up. Oh, like, like last week I got a call like two and the, and uh, the guy answered the phones and he is like, okay, uh, you want the mrn? I’m like, dude, it’s two in the morning. I’m not in front of a computer. , just tell me the story.
Will: logged into Epic. Yeah.
Dr. Kaveh Hoda: Go. And, and he was like, it was just a, it was just a heads up for the next day. And I’m like, you know, there’s nothing I’m gonna tell you right now that’s gonna change a thing. I don’t, you don’t need to let me know that. But thankfully that’s pre, that’s not common. That’s not very typical.
Will: Yeah. Yeah. It’s, uh, you know, the, the heads up. I, I get some of those as well with, uh, with I prob, you know,
Kristin: conditions. Is there not a better way to give each other a [00:36:00] heads up? Can you send a text or
Will: an new email or something? It’s, it’s hard because, you know, you got, I mean, most of these, I think most of this comes down to, it’s just hard to communicate at two o’clock in the morning.
Yeah. Like for, I think for everyone involved. Right. And so, uh, in a perfect world, like we’d all, you know, understand each other’s personalities perfectly and how awake somebody is and how asleep somebody else is. Yeah. And you would, you know, have just the, the perfect intonation and everything, but it just, you know, so people are gonna be a little bit on edge in the middle of the night.
Uh, and, uh, but yeah, I. For a lot, some, a lot of non-urgent things, you know, waiting until, you know, five or six in the morning, you know, is, is I, and, and with, uh, when I’m on call, like we have, I, I cover a lot of community hospitals and, uh, there’s, uh, that’s what a lot of the emergency physicians will do.
They’ll be like, okay, well this patient came in, is having double vision. I know they need to be seen the next day or two. [00:37:00] Even if they came in at two o’clock in the morning, a lot of times they’ll just gimme a call like five or six in the morning. So like, you know, at least you give the person some uninterrupted sleep.
And so I understand that’s not always possible, but, you know, I think that’s a good way to go about it.
Dr. Kaveh Hoda: Yeah. I mean, we have to, as consultants always remember what it was like, and people who are calling us have to also understand they’re not getting the best from us at two in the morning, . You’re just not gonna get like the best, most thoughtful, like, Hmm, this patient’s really sick.
I need to figure it all out. You’re not gonna get that. All right, then you gotta give them some time. Yeah. Where does, where does Opso, because I’ve never called, I don’t know if I’ve ever called an OP though. Consult .
Will: Yeah, that’s right. We’re probably not a lot of like the black box of medicine. No one really, uh, knows what happens over here.
So smart. So smart . Um, you know, I, I take, I think I. I don’t say a lot of words, but I, I don’t think I am. I’m ne I don’t get upset, I don’t think. I’ve never, I can’t think of a time when I’ve, [00:38:00] you know, been angry on the phone. Um, it’s, it’s more just, you know, there’s times I can
Kristin: tell you’re irritated.
Yeah. Yeah. Yeah, yeah. You can tell.
Kristin: But it’s hard. I mean, maybe that’s just because I know. Yeah. You so well enjoy your irritation. Sounds like,
Dr. Kaveh Hoda: do you feel like after all these years you could answer some of the questions for him? Do you feel like, oh yeah.
Kristin: Yeah. Like, like for sure. A lot of it is just, is there vision loss?
Um, has it changed? Right. Has the vision changed
Will: at all? Artificial tears, hot compresses.
Kristin: Yes. That was what I was about to say next. And so you do that and then send them to the clinic in the morning. We’ve got some scheduled, you know, slots for, for call patients. We’ll slip ’em right in. Yeah, that’s pretty good.
Come right in. I’ll, I’ll see them in the morning. I really
Will: want you to take call from me. See? Yeah. I can do it. , I think, I think, I think we’re gonna explore this all let’s,
Dr. Kaveh Hoda: you should check out the legality.
Will: Yeah, [00:39:00] that might be a problem. Well, I think, uh, medical also, I’d like to sleep a lot. I think medical licenses can be transferred to the spouse, right?
Or is that just something
Dr. Kaveh Hoda: I made? No, I think that’s the reason to get married. It’s like taxes and that, yeah. .
Will: All right. Let’s take a quick break and then we’ll be back with Cave to, uh, do something a little fun. A big thank you to all our listeners. Spread the Love. Share this podcast with everyone you know, every single person, everybody.
as like every person you know. Leave a rating and review. Be honest. You can tell us what you think. We wanna improve this thing as we go. Uh, later today we’re gonna share some of your own medical stories. You can share yours at knock-knock high human content.com. We also have a Patreon. Come hang out with other members of this community, uh, early episode, access check out bonus episodes where we react to medical shows and movies.
And it’s just a lot of fun. So come hang out with us. All right. Now let’s get back to Dr. Kave Hoda.[00:40:00]
All right, we were back with Dr. Kave Hoda, and we are going to play a little game Kave. We’re gonna do battle of the specialties. Okay? All right. Okay. I think I’ve done this once before, uh, but not, never with a gastroenterologist. All right. So the way this works is, okay, we are going to make arguments for who has the better specialty.
Hmm. Kristen, here is the med student. We are trying to convince her that they should choose our specialty. The twist is that you have to convince her that you, she should be an ophthalmologist, easy. And I have to convince her that she should be a gastroenterologist. Do you know what I do for a living?
Okay. I know. And I, it’s, I’ve, I’ve had to put a lot of thought into this to figure out you exactly how I can, uh, compete here. Okay? Because I think I have the advantage. Uh, yeah. Yeah. We’ll see. We’ll see. Let’s, uh, okay, let’s, let’s give this a shot here all. Do you wanna go first or me? [00:41:00] Uh, yeah, let me go first.
Okay. You go first. Let me go. I need, I need the, I need the opening. I need to, to try to, you know, grab the attention. You’re right. You’re, I have the advantages thinking about gi before we introduce ophthalmology, I’m scared. Here we go. Kristen, you should do Optim. You sh , Kristen. You should be a gastroenterologist.
Why is that? All right. Well, the first thing, obviously it’s, I think it’s an easier word to spell than ophthalmology and you’re gonna be spelling it a lot. Right? Okay. But I am a good speller. You are a good speller. But, uh, here’s the thing. When there is something wrong with your poop and the way you poop mm-hmm.
it’s incredibly distress. Sure. Right? Mm-hmm. like, it, it’s, it’s like, it’s never, it’s such a, a, a challenge and you’re, you’re constantly thinking about it. Like, oh man, my poop is, I’m either pooping too much or not enough, or it’s too difficult, or it’s way too easy, and you [00:42:00] gotta, and, and so from the patient standpoint, you’re like, man, I just, I want someone to fix this for me.
Mm-hmm. figure help me, help me, help me poop better. And that’s, that’s a part of the job of a gastroenterologist, is to help figure out why your poop isn’t normal. And it can be a very big, um, uh, quality of life issue. Mm-hmm. . Mm-hmm. . Okay. That’s, that’s my first point. .
Dr. Kaveh Hoda: Wow. You’re, you’re not even trying, you’re not at this point.
You’re not. All right. Here’s my, what do you got my rebuttal? Uh, and this is, this is to you, will, uh, have you ever had to get up in the middle of the night to go pull a hotdog out of somebody’s throat? Do you know the things I’ve pulled out of people, I’ve done unspeakable things
Will: give us, give us a couple examples.
Dr. Kaveh Hoda: I actually, I’ll tell you what, I don’t, we used to have this bit on the show on, on our, [00:43:00] my podcast, and we would have on a GI doctor or an ER doctor and we’d bring them on and, and we talk about that and I, I, there’s no doubt it, it. Some of the stuff is amazing and, and mind blowing, but at some point I started to just be like, you know what, it is hilarious.
But this was someone’s like worst day having to go in with like this thing I had to pull out of them. So, and, and I always have this, this fear that one day they’ll listen. I’d be like, yeah, that was me. That was my butt. And so that’s true. You don’t have to tell us. I don’t say, I don’t say it anymore.
That’s, yeah. Yeah. You can go back through the old episodes if you want,
Will: but you’re approving my point for me. Uh, because, because how wonderful is it to have someone who cares and who shows compassion for you as a person? I don’t know. Something
Kristin: stuck in your butt. Wonderful. I think they feel mortified.
but they get it that they had to show someone whatever their situation
Dr. Kaveh Hoda: was. It’s
Will: true. Sometimes they can laugh about it. What do you got? Tell us what, what about ophthalmology you think should, okay.
Dr. Kaveh Hoda: Uh, I think this is, this is a [00:44:00] no-brainer. I mean, you’re helping people. See there is some grandmother out there who is now watching her grandson’s Peter Pan performance in elementary school because you fixed their vision and they went from no vision to vision or some, you know, impaired vision to vision.
And that’s a real tangible thing that you did. I, that’s pretty awesome. That’s like, you know, sometimes what I do as a gastroenterologist, you go in there, you make people go through this whole process and then you’re like, Hey, good news. I took out a two millimeter polyp for you. And it’s important that you do that.
Very important. But they don’t walk away being like, oh, I feel so much better. I have that polyp. It’s not that immediate
Will: relief counterpoint. It’s true counterpoint. You can give the patient the polyp, , , like a little, like a little jar
Dr. Kaveh Hoda: necklace
Will: out of it. Yeah, little. You know, when you’re doing cataract surgery, you know the cataract’s gone.
You break it up into a thousand little pieces, you emulsify it and suck it out a vacuum and [00:45:00] it’s gone. You don’t get to keep the cataract, but I actually, I’m, I probably shouldn’t say, I shouldn’t assume you can keep your polyps. No you can’t. You gotta send it to
Dr. Kaveh Hoda: the lab and have it looked at and see what kind of polyp it is.
Will: At my gastroenterology shop, you get to keep the polyps .
Dr. Kaveh Hoda: They’re like, we don’t care what kind of polyp it was. We’ll assume it was a really bad one. Here
Kristin: All right. Um, do you ever just like, take a picture of it for them and then like draw a face with like a mustache and just make it like a little happy polyp?
Dr. Kaveh Hoda: yet
Will: that. That would be a good poster to put on the wall of, of your clinic. You know, you know Peter, the
Dr. Kaveh Hoda: polyp, we
Will: polyps have feelings too. That’s right. Coffee.
Dr. Kaveh Hoda: Uh, we all, here we go. Aab, all polyps are bastards. You need to all them out.
Will: That’s true. That’s right. They polyps. There’s never a good polyp.
Right. It’s all bad.
Dr. Kaveh Hoda: All bad. Yeah. I mean, there’s variations of it. There’s hyperplastic ones, which are not to worry about at all, but in general, yeah. You wanna get rid of polyps. If they’re
Will: there, get rid [00:46:00] of ’em. You want a nice clean colon. That’s right. Just the RGA in there. Mm.
Dr. Kaveh Hoda: Oh look, the Hals.
Will: Oh, is that No Ru stomach.
Stomach, right? Yeah. Okay. All how Stra Stra, right? Those are the like little things. The rings. The folds. Yeah. The rings.
Dr. Kaveh Hoda: Folds. The rings. Yep. Whatever you call it. Pretty good. I mean, you’re, yeah. You got, you mean you got, you’re in the ballpark.
Will: I haven’t even gotten to sphincter yet. Mm-hmm. Sphincter dog.
That’s something that the two of us have in common. You know, ophthalmology and GI Ice SPKs, huh? Yep. The iris has sphincters in it. All right. Mm-hmm. . And they do an important job. I, the sphincters that you are, um, in charge of also have a very important job. .
Dr. Kaveh Hoda: Yeah, yeah, yeah. No, they’re very important. You should have them functioning.
Um, but you,
Will: I don’t have any control over the sphincters in the eye though. You, you know, you have sphincters that you can actually control, which is
Dr. Kaveh Hoda: Yeah, sometimes a little bit, sometimes it’s quite challenging. Of course, that’s a real problem if it’s a [00:47:00] sphincter problem, but there are things we can do.
Yeah. But I mean, you’re also, you’re also touching on something that’s very good about ophthalmology, which is that there is like really interesting. Like biology and anatomy. There you have this one tiny little organ and all this stuff is crammed into it, and it’s sort of at the nexus of like medicine and neuro neurology and, and surgery.
And there’s all this exciting, I assume research going on. I’m assuming there is. I don’t, I don’t keep up on the opto research, but there’s all this, like, it’s at the, it’s a, it’s really like, you know, uh, where all these things meet. That’s pretty. That’s
Will: a good point. All right. But, uh, you get to focus all your energy on a tube.
Yeah. On a long mm-hmm. tube. Yep. And, uh, and so it’s internal medicine, but kind of not really. I don’t know. It, it’s, it’s, uh, actually that’s not true. You do like, do liver stuff, right? [00:48:00] Yeah. And yeah.
Dr. Kaveh Hoda: Yeah, yeah. No, but that’s part of the tube. It’s part of the digestive process. It’s a digestive
Will: organ. Yeah. I think it’s cool to just have, be able to focus on, you know, the health of the tube.
Yeah. That’s what I do. Do you call it a tube? I keep saying I
Dr. Kaveh Hoda: tube. I say when I, when I have a patient, I say, look, I’m gonna put this tube into your tube, and if I see anything funny in your tube, I’m, and they love it, gonna drops on it. Patients, patients just love it. They,
Will: I bet they do. Um, okay, here’s, here’s, here’s a a, a reason to love.
Okay. Being a gastroenterologist. Okay. Um, The jokes. Mm, mm-hmm. that you can’t, the it’s, that’s a good point. It’s joke heaven. Yeah. Like you, there’s no, when you’re, when you are in a situation that is a bit embarrassing, uh, for everyone involved, just, you got the jokes right there. They, they, they, they write themselves in gastroenterology.
You will not find a GI doctor that [00:49:00] doesn’t have a good sense of humor, and you get to hang out with other people who have a good sense of humor, ophthalmologists. It’s a little rough out there. Mm-hmm. .
Kristin: Yeah. More of a serious punch.
Dr. Kaveh Hoda: I gotta be honest. I know one other ophthalmologist, . . I dunno. Any ophthalmologist.
That’s so funny. Now that I think about it. I can’t argue with you because That’s right. I just don’t know enough of them. And you have fart
Dr. Kaveh Hoda: So we do, we have jokes and, and what patients have jokes when they come in, which I love. I mean, I’ve heard most of them, but it’s always like the old, like, uh, farmer guy comes in, has a joke about like, before you do the colonoscopies.
I always appreciate that. Yeah, I love that. Yeah.
Will: Yeah. They diffuse the tension. Oh yeah, for
Dr. Kaveh Hoda: sure. If you work with anuses as much as we do and you don’t have a sense of humor about it, then you are one . You
Will: know, that’s life lessons from Kave. That’s, you gotta make a shirt outta that. That’s . Exactly. [00:50:00] Sell some merch.
Yeah. Well, Kristen, what do you think? Do you wanna be a, an ophthalmologist or a gastroenterologist?
Kristin: Well, I would very much like to be neither, but if I have to choose based on these arguments alone, I think I would have to choose ophthalmology. Yeah. So I do, I win, what do I win? Chaves the winner.
Will: Yeah. Yeah.
Okay. I’m, I’m, I guess you’re both kind of a winner. Winners. I’m kind a winner, but also not really. Uh, I guess, uh, this last time we did, I, we did this with an ophthalmology and emergency medicine. Oh yeah. Yeah. And you did not choose ophthalmology. . Well, there you go. And so now you are. So, so, um, I, I think, I don’t know what that says about gastroenterology as a specialty.
Dr. Kaveh Hoda: no, I get it. Um, , yeah, it’s not for everyone. I will say this though. Here’s my, here’s my, uh, pitch for, you know, the kids out there listening right now who are thinking about, like I said earlier, there aren’t that many. Uh, I dunno if the grammar’s correct on that, but there isn’t that [00:51:00] many fields of medicine where you get to be so procedural.
But then there is this other component to it where you get to really get to know patients, work with them in acute care settings, and then also chronic care settings. And there’s a little bit of the procedural aspect. And you can do, you know, as, as much of that as you want, you can go deep down that rabbit hole, so to speak, and, and go down that path and learn more and more procedural.
It’s a fun gig in that way. And you can really do some really important stuff in terms of not just colon cancer, but liver cancer, pancreatic cancer, cholangiocarcinoma, you name it. Um, it’s all there is. There’s some real, uh, you know, , you get to play video games basically all day in the human body. That’s true.
Will: I have a
Kristin: very serious question. Yeah. Um, if a patient were to run into their gastroenterologist in the wild Yeah. Say at the grocery. What should that patient
Dr. Kaveh Hoda: say? It, it happens not infrequently. In, in, you know, um, [00:52:00] so it, it, yeah. You, we, we do run into people. I will never go up to someone I recognize and be like, Hey, Mr.
Burns, remember I’m the guy that was in your tube . Remember we talked about your tube? I was in your tube. Um, but I, if they come up to me or if they notice me, I’m, I’m happy to let them direct it. I follow their lead on that.
Kristin: Great. If they just awkwardly avoid eye contact like I would
Dr. Kaveh Hoda: do, oh, it’s me with most people.
Will: Just let it go. Yeah. I think it’s okay to pretend you don’t see each other. Yeah, I think that’s fine. Yeah. Totally. All right. Let’s take a quick break and then, uh, we’ll be back with some of your medical stories. Sorry. I’ll be right back with Ka.
All right, so let’s take a look at some of our favorite medical stories that were sent in by you, the listeners. We still have Dr. Hoda with us to, uh, listen to some of these. I we got, we got a couple good ones today. Uh, you’re gonna appreciate this first one. So this is [00:53:00] from Nate. Nate is a PA student. He.
On one of my directed h and p practicals, my patient was presenting with abdominal pain, which I was rather certain was cholecystitis. Naturally, I went to perform a Murphy’s Sign exam on them. I explained how it would work and did my thing, and proud that I had performed it correctly. After my practical, my faculty member grading me said I did well, but asked, Hey Nate, which side of the body is the gallbladder on
I did the exam on the patient’s left side.
Dr. Kaveh Hoda: So . What if it was sinus inverses? You know what? If
Will: never, no. That is the way to recover from that
Dr. Kaveh Hoda: situation. Check that side first. You know what ? Yeah, I know it’s on that side, but first I want to check the other side just to, cuz you gotta know for sure. Would I look silly if I didn’t get that?
Yes, I would be silly if I didn’t get sinus inverses. This
Will: is coming from a [00:54:00] gastroenter, a board certified, I assume, gastroenterologist, . It’s a
Dr. Kaveh Hoda: good assumption. It’s a tough test.
Will: It’s okay. Just, uh, as you know, check yet. Make sure you do a very thorough bilateral . Here’s my
Kristin: question though, bilateral. Here’s my question.
How long does that exam take?
Will: That’s quick. Yeah. Like,
Kristin: I mean, five seconds or. No, just feeling a
Will: minute. You’re feeling for the, that’s when you breathe and like you feel like the liver go down. Yeah.
Dr. Kaveh Hoda: Right. And you, and you try to feel if there’s tenderness where the gallbladder is and it’s on the right side.
Yeah. It lies underneath the liver, which is this really large organ that’s in your right upper quadrant of your abdomen. And it’s like this little sack that hangs out underneath it and you try to get underneath it or around it to see if there’s a lot of inflammation there. So. So if you’re
Kristin: a student mm-hmm.
I’m gonna guess this is gonna take you a a little while to get in there and do that. So my question is, why did he wait until the student was done before saying, [00:55:00] Hey,
Will: well this was an exam. Oh, okay. So, so this, so it was a practical,
Kristin: it’s not just called an exam. Like I’m doing an exam on the patient. He’s actually taking a, a test.
Will: a test.
Dr. Kaveh Hoda: Gotcha. Right. I wanna know if he passed .
Will: Evidently not. And, and Nate’s, in Nate’s defense, like those practicals, I remember taking those And, you know, you’re nervous, you’re just, I could totally say that happened. I remember I failed, I failed one of my, uh, sks, we call them. Mm-hmm. os I dunno if they’re still called that, or like a standardized patient exam.
Uh, because, uh, it, I forgot to ask to get the information of whether or not the patient was pregnant. Or I, I forgot to say we need to do a pregnancy test. And that was the diagnosis, . I absolutely failed it. Um, and so, um, yeah, I mean, you just kind of like your brain, short circuits and you
Dr. Kaveh Hoda: don’t remember something.
I, I hated those exams and I, I don’t know if you guys had this, but this happened to me on like more than one occasion. They wanted you to learn how to deal with a very difficult patient. And I [00:56:00] remember, like, I had this one patient who’s like, the actor who was being, the patient was instructed to basically not talk to me at all.
Like, and to be really like very standoffish. And so like, I’m doing this whole thing. I’m just like trying for like 10 minutes to get this person to open up to me, then answer my questions. And then they’re like, at the end of it, I’m like, all right, I mean, what am I supposed to do here? They’re not answering my questions.
I mean, they’re like, you were supposed to ask about her son and I. . Okay. But like, it has nothing to do with what she’s here for. I mean, like, I get it, like you have to like know the person, but I’m like, come on, let’s like be realistic. If like, you know, we have like 15 to 20 minutes, I’m trying to like, be sociable with her and friendly and show her I care.
And if I didn’t ask the one particular thing that like, she was instructed to like, open up to me about, like, that’s kind of silly. Like, I, I can, I can win over a patient without knowing that one particular like, key phrase and I hated that.
Will: Yeah. They’re, they’re, they try to trick you [00:57:00] and they is, you know, not exactly like it is in real life, but, all right.
Let’s go to, um, story number two. So this is from McKenzie. I am a loyal Jonathan, aka scribe for a retina surgeon. Here’s a funny story, uh, from a recent interaction. We had a patient the other day that has some dementia or Alzheimer’s. She was finished with her visit. And I stood by her chair to help her up.
She rubbed my stomach and said, that’s a belly . Oh boy. I couldn’t quite tell if she caught herself before asking when the baby was due. in parentheses, I’m not pregnant. . Or if it was just an observation, she decided to verbalize either way. I thought it was cute. .
Kristin: Well, I’m glad she thought it was cute and not horribly offensive.
Will: Well, you know, whenever, you know, I, I, as someone who most of my patients are in their seventies, eighties, and nineties, when you’re, [00:58:00] you’re, when you have patients that have dementia, you know, They get a pass on some things. Sure. Yeah, sure. Yeah. But that was, I like that, that was a good story.
Dr. Kaveh Hoda: I had a patient, all right, so I had a patient before, uh, COVID hit when we were still seeing people were frequently in the office, and it wasn’t that long ago.
And, and I remember walking and she looked at me and she was, she’s not demented. And she just looked at me. She was like, you look awful .
thanks. I was like, oh, alright. Let’s proceed with your colonoscopy, . Okay. Thank you for those stories. Nate and McKenzie, send us yours. Knock-knock firstname.lastname@example.org. Kave, thank you so much for joining us. That was a blast. Always good to talk with you. Yeah, you guys are great.
Dr. Kaveh Hoda: Thank you so much for having me.
Will: Yeah. So before you go, , tell us where to find you.
Dr. Kaveh Hoda: Uh, so, uh, I have a podcast. It’s sort of like the Kirkland version of this podcast. Um, it’s called The House of Pod . If you, if you like this, you probably will en [00:59:00] enjoy, uh, my podcast as well. You can find it pretty much everywhere. Uh, except Spotify. We’re pretty much everywhere else.
And, uh, you can, if you’re on Twitter and you know, you still want to do that, I’m there at the House of Pod. Um, and
Will: uh, yeah, thanks for it’s great podcast. It’s a lot of fun. I’ve been on there twice. I think I’ve enjoyed it three times. I got every day co-host you co-hosted? I did, yeah.
Dr. Kaveh Hoda: Yeah, yeah, yeah. You’ve been on a total of three times.
Cause we just did one with Michael Weber. Oh, that’s right. Yeah. We did the movie one. That’s
Will: right. Yeah. Yeah. That’s right. Yeah. You have, uh, a lot of interesting guests come on. And so it’s definitely, you know, check out the house of pod p o d. Um, alright, well thanks again, Kave. Always a pleasure. Can’t wait to hear
Kristin: the music to that poop song.
Will: Yeah. I’m gonna get
Dr. Kaveh Hoda: to work. Yep, yep, yep. Thank you so much. Recording.
Will: All right. Thank you. Take care. Bye.
Well, our first conversation [01:00:00] with a gastroenterologist went about as well as I could have hoped. Yeah, lots of poop. Talk a
Kristin: lot. And you got to demonstrate your musical prowess.
Will: I did. Uh, yes. I was not coming on this episode today, prepared to display my singing, but thank you for bringing that up. Full of surprises.
Full of surprise. You never know what you’re gonna get on this podcast. Alright, so, but a big thanks to Kave. He’s a great guy. Uh, and hon you know, he was talking about gastroenterology and honestly, it is a really good specialty. I, because of the wide range of things that you can do, like the, you like procedures, but maybe you don’t wanna be a surgeon.
Kristin: maybe you don’t wanna specialize in just
Will: one organ. Yeah, yeah. And, and you get the, the outpatient side of things, but also dabbling in a little hospital that, see, that’s where, that’s where, that’s where you fall off. That’s where I am like, nah, I could, I could handle, I could handle the poop, I [01:01:00] could handle the colonoscopies.
I, I like procedures, but it’s, it’s hospital medicine. I just, for some reason. What is
Kristin: it about hospital medicine that you don’t like? What is, I think it’s, what does hospital medicine refer to? I, I think
Will: it’s, I, I like knowing when my day is gonna end. Sure. like, and that was the, the distinct. Uh, uh, experience of hospital medicine was when is this over
And in many cases it’s never over. I very much take this, doesn’t sleep. Enjoyed having like, okay, this is my last appointment and when I’m done I get to go do something else and it’s just how I am. Sure. So anyway, but I, I think, uh, it’s a good option. Yeah. Lots of variety. Yeah. So thank you also for sending in your stories.
Uh, I was like, wait, what? Wait, what were we talking about? It was totally got sidetracked on the [01:02:00] gastroenterology poop talk. But yes, thank you for sending in your stories and, um, let us know what you think, you know, if we have other specialties or guests that you want us to talk to, you know, let us know.
We’re always open to suggestions. Uh, there’s lots of ways to hit us up. You can email us, knock knock high human content.com. Uh, we’re on social media, TikTok, YouTube, Twitter, and you can also. Hang out with us and our Human Content Podcast family. I said that correctly this time on Instagram. And, uh, don’t, you’re just humoring me now.
I’m I’m being encouraging . Very good. Geez, you said it right. , you said it our human. I’m gonna say it again because I’m so proud of myself. Human Content Podcast, family on Instagram and TikTok at Human Content Pods. Shout out, uh, to all the great listeners leaving wonderful feedback and awesome reviews. If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out.
Curl 619 [01:03:00] on Apple said, the show is fantastic. Lady G’s, uh, female and non-medical perspective really adds depth and relatability to the show. Can’t wait to keep listening. Thank you. I totally agree. I really do. It’s do you? Yeah, absolutely. Oh, that’s, we need. Oh, we need, we need it. It gets, it can get really boring when there’s just doctors talking to each other.
Like, we need, we need that perspective outside of medicine. So yeah, I really appreciate what you bring to the podcast. Well, thank you. Uh, our, uh, full episodes, video episodes full of video episodes are up on my YouTube channel at d Glock Flecking. We have a Patreon with lots of cool perks, bonus episodes, uh, or react to medical shows and movies.
You can hang out with other members of the Knock-knock High community. We are there. We’re posting mm-hmm. making videos, telling jokes. Uh, you can also get early ad free episode access, interactive q and a livestream events. Lot more coming. That’s [01:04:00] patreon.com/glock plein, or go to glock flecking.com for more info.
Speaking of Patreon, community Perks, new members, shout out. We got Laura Lee m, Betsy h, Maggie s Joan. I, I think it’s an I or an L, Joan, I and Corin B, Corin, Corin, Corin. B I’m not good at pronouncing names. I do the best I can. Everyone. Uh, also shout out to the Jonathans, uh, a virtual head nod to all of you.
Patrick, Lucia, C Sharon, s Omer, Edward, k Abby, H Steven, G Robox, Jonathan f Marion, w Mr. Granddaddy Caitlin, C Brianna, l and Becky. Next we have Patreon Roulette. So if you are on the emergency medicine tier of our Patreon, then we will give you a a, we will give a random shoutout to one of you. So, uh, you ready?
All right. I’m gonna, I’m gonna give, I’m gonna throw it to you. You’re gonna name it. I’m gonna give you the drum roll. Okay. Mad [01:05:00] m. Mad m thank you for being a. And thank you all for listening. We are your host Will and Kristen Flannery, also known as the Glock Flecking. Special thanks to our guest today, Dr.
Cave Hoda. Our executive producers are Will Flannery, Kristen Flannery, Aron Korney, Rob Goldman, and Ashanti Brooke. Our editor and engineer is Jason Porto. Music by Omer Ben-Zvi. To learn about our night knock highs program, disclaimer and ethics policy submission verification, and licensing terms and HIPAA release terms, you can go to glock flecking.com or reach out to us, Nan knock email@example.com with any questions, concerns, fun, medical jokes, patient satisfaction surveys, whatever you want.
Nan Knock High is a human content production.[01:06:00]