Just Women Talking Shit
Just Women Talking Shit is your go-to self-help podcast for real talk on personal & spiritual growth. Hosted by Jacquelynn Cotten, personal evolution mentor & founder of Spiritual Support System, this podcast features juicy interviews with badass, one-of-a-kind women. We dive deep into the good 💩, bad 💩, weird 💩, & life 💩, offering insights & inspiration to help you live a more authentic, fulfilled life. Join us for relatable stories, expert advice, & practical tips on overcoming challenges, building resilience, & embracing your true self. Tune in & start your journey towards personal evolution today!
Just Women Talking Shit
Ep 89: Navigating the Hospital with Dr. Monique Nugent: Improving Patient Care & Communication
In this episode, we sit down with Dr. Monique S. Nugent, MD, MPH, a seasoned hospitalist and physician leader in the Boston metro area, to explore the complexities of patient care and communication in hospital settings. With a career dedicated to improving safety, quality, equity, and patient experience, Dr. Nugent shares her expertise on how patients can better prepare for hospital stays and advocate for themselves during their time in care.
We delve into her book, Prescription for Admission: A Doctor’s Guide to Navigating the Hospital, Advocating for Yourself, and Having a Better Hospitalization, which provides an inside look at hospital care. Dr. Nugent explains how her book serves as a practical guide for both patients and their families, offering tips on improving communication with healthcare providers and addressing mental health concerns that may arise during hospitalization.
www.drmoniquenugent.com
Key topics include:
- Effective communication between doctors and patients
- How to advocate for yourself during a hospital stay
- Understanding the role of family support in patient care
- Navigating the complexities of the healthcare system
- Mental health challenges in hospital settings
- Preparing for hospital stays and feeling empowered as a patient
Dr. Nugent’s wealth of experience—from medical school at Loma Linda University to her time as a Commonwealth Fund Fellow at Harvard—offers invaluable insights for anyone looking to better understand hospital care. Whether you're planning for an upcoming hospital stay or want to be more informed about your healthcare, this episode provides actionable advice to improve your hospital experience.
You can buy her book here: https://amzn.to/47S1m7B
Follow Dr. Nugent on Instagram here: @the_happiest_hospitalist
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Ladies and gentlemen, you're listening to Just Women Talking Shit with your host, Jacqueline Cotton.
Speaker 2:Hi, monique, hello, I'm so excited to have you here. Like I was saying, before I hit record, I was reading the notes so I could get to know a little bit more about you and what we're going to discuss today. And the inner nerd in me is so excited because whenever I was a little girl, whenever I was a little girl, I I thought for sure I was going to be a physician and that I wasn't the smartest whenever it came to science and whatnot. And I just remember, whenever it came time to like applying for college and stuff, my guidance counselor swayed me towards art and he was like yeah, but you're that girl who won the poetry contest, right and anyway.
Speaker 2:so I like all, all, uh, any reassurance I had that I could be a physician, and so I'm really excited to hear from you someone who's actually out there doing it. Yeah, what, what you have to to talk about today, because I'm fascinated. I'm absolutely fascinated, can I?
Speaker 1:first go back to your guidance counselor. That was horrible, because there's no reason why you can't be both. And there's a long history of physician artists. One of the most famous, I think, that, like any physician you talk to, is gonna know if you say netter, they're gonna know exactly who that is. And he was a physician who painted the human body. He painted all of our like anatomy books and they were like kind of like real standard of what you learn out of as a netters, right, and these are like beautiful, amazing paintings. We have physicians who are great authors, poets. So to tell a child like you have to pick one, like you're the, you're the kid who does this. And I just feel like and I'm a parent to three little girls, people tell kids that all the time. So I'm going to apologize on his behalf to your inner you, your inner child, I mean, because there's no reason you couldn't have done both.
Speaker 2:Well, yeah, I know, I know now how fucked up that was was, and it made me.
Speaker 1:It made me feel about this yeah, we do that to kids a lot.
Speaker 2:I know, that's what this conversation is about, but we do that.
Speaker 1:We'll have to talk about that another day, um try to go away.
Speaker 2:Oh no, my dog came up to the window.
Speaker 2:Oh okay, no, we're, I think we're good, uh, but yeah it was, it kind of messed me up.
Speaker 2:So like, thank you for for that, for like, I guess making me feel a little bit my inner child, feeling a little bit better about that, but it really does spark up like you coming on and apologizing on behalf of somebody else already shows me like what kind of person you are.
Speaker 2:Your bedside manner, manner and I guess, with some insight into how you probably are in the workplace and in the industry, because from my experience now I just haven't had the best experiences whenever it comes to physicians, like being listened to, being heard, and I know, for instance, like my mom now I'm just going to say this with lots of love but the women in my family tend to embellish and I think a lot of us are just so anxious that we have so many things that we think are wrong with us. So I can see how a physician would get annoyed with people. But, on the same token, I've seen so many people in the in hospitals and like, especially with chronic illnesses and visible illnesses, like it's really hard to even go to the doctor because people feel like they're not listened to. You know what I mean.
Speaker 1:And that's where I am now trying to bridge that gap for both the physicians and the patients. Right, like nobody's particularly happy with what's going on right now, and the stressors on the healthcare system and the interactions, the way that they are right. So one of the things I hear a lot and I see on the social media is that idea that you know, physicians are not listening to me. I go in, I go for my regular appointment and they spend 15 minutes with me and I have something to say and they're walking out the door. And that's a hundred percent true because they have 15 minutes to spend with you, right, they are booked in their clinic for 15 minute slots and so, like, if you book a regular appointment, I'm here for my physical, that's not a problem appointment. So they may say to you, like, if you book a regular appointment, I'm here for my physical, that's not a problem appointment. So they may say to you, like, come back and people say, like, the doctor is trying to get rid of me, they don't want to talk to me. No, like I can't a hundred percent attest to each physician, right, but they have 15 minute slots in their appointments and a problem appointment is given a different amount of time than a physical which is given, you know, maybe a shorter amount of time or longer amount of time depending on the specialty. And so if you book something as a physical, but now I'm going to tag on a bunch of problems, the physician literally doesn't have the time and resources to say, okay, I'm going to sit down and do this 45 minutes with you, because the next person in their clinic, who you have gotten your 45 minutes, that's their 15 minutes times three patients and now three people are behind schedule and everybody's mad and the physician's mad. And it's really unfortunate because right now the whole system is stressed and everybody is hurting from it.
Speaker 1:Physician burnout is a thing and empathy burnout that's something that we talk about in our profession of. I have to give so much of me all the time and a lot of the things that come back on healthcare providers are negative, are toxic, right, People don. The things that come back on healthcare providers are negative, are toxic, right, people don't talk about it. But healthcare providers are assaulted at work, all right, yeah, yeah, like nurses and physicians are assaulted. There have been providers killed at work, nurses, you know, severely injured. There's security and those are the worst of it. But like being verbally abused. Ask any nurse, and those are the worst of it. Right, but like being verbally abused. Ask any nurse who works in the hospital how often they're verbally abused. Right, those, those things eat at you as well, and so everybody is unhappy.
Speaker 1:The system right now is so stressed and we're coming at each other in this really like toxic, negative way, and not just in medicine, right, like educators say the same thing. Right, anyone who interacts with the public for their job is saying the same thing. And so I'm really trying to work in that space where I'm trying to give both sets of people the public and physicians skills to say how can we communicate better? Right, because a lot of the times it's really kind of a one-sided set of education. In medical school, there's not a lot of education around how to communicate with patients, but there is Right, they like have didactics. You sit down, you talk about it. You may get some feedback on your bedside manner. There is this teaching. We don't teach people how to interact and speak with healthcare providers. Right, you have a couple of books like how to train your doctor, but we don't actually say things like did you really know that a physical appointment is different from a problem appointment.
Speaker 2:I did not. It makes complete sense now.
Speaker 1:Right, yeah, but those are like we don't teach people that, we don't teach the general public that and I'm a hospitalist, I work in hospitals only and people come into the hospital, they're sick, they're uncomfortable, they're confused, right, and they're expected to interact with the system that moves really quickly. They're meeting a ton of different people who are saying a ton more different things. Plan ahead for this. Oh, and there's also financial blowback that people are not like thinking about or aware of, that may be coming down the pipeline All while, again, you are uncomfortable, right, like, even if you want to go to the hospital, right, there's one group of people who are looking forward to going to the hospital and that are pregnant women. Right, even those who want to go to the hospital, and that's like a number that's trailing off too right, they take a tour, they meet their doctor, they pack a bag, they want to be there.
Speaker 1:It is a stressful situation. It is scary. We have women in this country dying in birth and people talk about traumatic births. You know PTSD after birth and this is something you like signed up for and got an outfit to do Right Now. Imagine that you are sick, like you fell down some stairs, you got a virus, you have pneumonia. You were not prepared. You don't have a bag. You certainly didn't go online and be like I would like to see Dr Nugent today. No, your name popped up on my list and I was told to go see you. And now we're in this interaction and I'm trying to give people the skills and a little bit of resilience to get through that experience a little bit better.
Speaker 2:Well, I love that. So when you say you're bridging that gap, how are you doing that? Is it obviously in the form of podcasts and just raising awareness, but I read that you have a book as well.
Speaker 1:I did. I wrote a book called Prescription for Admission. It's a physician's guide to. It's one of those books with like a colon right, a physician's guide to navigating the hospital, advocating for yourself and having a better hospitalization. It started for me. The idea started to write this book during the COVID pandemic.
Speaker 1:Because here I am, I'm a hospital based physician, and suddenly, like no one thinks about hospitals and no one's excited about hospitals. We're kind of like in this corner right and suddenly in healthcare it's like hospital, everybody is talking about the hospital. At the same time, the thing that is most important for communication, which is friends and family support system for patients, suddenly gets locked out of the hospital. Right, you can't come in. And now I am a physician who sees a lot of people who are confused and in pain, and so it helps me to have someone's husband there and I'm like is this how your wife usually is? Or someone's daughter? Is your dad not telling me he's in pain? You know, oh yeah, dad's ultrasonic. He's having a lot of pain right now. You know things like that. He's having a lot of pain right now. You know things like that. Those things help.
Speaker 1:Suddenly, that resource is gone and people in the public were crying out saying like, oh, we don't know what's happening. No one's communicating with us. But inside the walls of the hospital it was kind of the same you know stress Like how can I call 14, 15 different families every 30 minutes that I'm getting paged and how can I manage this amount of communication? Because we have to make big decisions. I've got to tell people what's going on, things like that.
Speaker 1:And so I had this idea. I was like I'm going to write a book that's going to teach people how to get through this pandemic. And when I sat down to write the book it was like, wait a minute, none of this is new. I have practiced in hospitals on the East Coast, the West Coast VAs, tertiary care, academic centers, community hospitals. I'm currently at a regional medical center that is an independent community hospital network, and none of this was new. It was just amplified. People were just experiencing it in this like way you know. And so I sat down and I wrote the book and prescription for admission came out of me without the word COVID in it, because these are skills for the hospital and for getting through any hospital stay, no matter what the pathology.
Speaker 2:I love how you said without the word COVID in it, but that makes sense. I mean, these issues have been there probably since hospitals have existed. Something else that got me was when you said nobody looks forward to going to the hospital with us pregnant women, and it just immediately took me back to both my pregnancies. Whenever I'm just ready, I'm like okay.
Speaker 1:Yeah, right, I remember like, where can I I'm here now, give me a room, whereas usually I call the hospital like the DMV of healthcare, like everybody is going to be there at some point in life. Nobody's excited and everybody wants to get out, including the people who work there. They're all like when can I, you know, get going? When can my shift? Because it's it's a stressful environment. Like, when can I, you know, get going? When can my shift? Because it's it's a stressful environment. It's, you know.
Speaker 1:I liken it to if you had an appointment with your accountant and you had a fever and started vomiting and then tripped in the driveway and the accountant calls you and is like, by the way, the IRS is here, so they're going to ask you some really intense questions. Would you still go? Would you resched? Would you still go? Would you reschedule? You would most likely reschedule, right, but in the hospital it's like, uh, now you have to be here and I'm going to ask you some really intense questions. Yeah, right, and wait a minute, let's make some really intense decisions. Yeah, but you're still vomiting. So it it is. It's, unfortunately, an unpleasant experience. It's a place I love. Like I clearly built my career in hospitals. I love the hospital for a lot of professional reasons, but all the reasons that I love it, I know, are the reasons that people are having a hard time.
Speaker 2:Yeah, I don't know anybody that likes going to the hospital. I'll tell you what I like about hospitals. For whatever reason, I like the food, but it's mostly the mashed potatoes, don't know what. I don't know why mashed potatoes at the hospital tastes better, but they do. Outside that, yeah, I don't. I don't know anybody that really likes going to the hospital, because it is, it's super scary. So what is? I guess what is?
Speaker 2:My mom has spent a lot of time in hospitals and so she's. She has very strong opinions, uh, and she's one of those people that feels like people don't listen to her, but it is very much so. One of those situations where my mom talks a lot. I think it's a defense mechanism, it's like kept her safe for a long time, but every, everything comes out at once.
Speaker 2:And as someone who, like I literally I'm I call myself a personal evolution mentor.
Speaker 2:I help people evolve, like their nervous systems and all these things, and so I see how is someone who protects her energy and helps people like with their boundaries and live a better life how that be a lot, you know, you don't? I feel like it's when my kid comes in and he's like hey, mom, I want to play, but he didn't specify what he wanted to play. And then he brings a big bucket of legos and just dumps them out and is like here's all this shit. Build something he didn't want to play. He wanted me to to build everything. You know what I mean, and so I can see how it could be. Like I try to put myself in that position, showing up every single day, listening to people's problems, and some of these problems are like self-inflicted problems and it's got to just be like. Sometimes you want to shake the person and so, as someone the daughter of someone who is chronically ill she doesn't take great care of herself either, but I want to say that's, that's such a generational thing.
Speaker 2:Sometimes you don't know what you don't know, Right, and me I've, I've, I don't know, you notice it kind of work out. But I haven't always been this way. Like it's been such a an evolution and I realized how important health is and how a lot of it is genetic and whatnot. And so I don't want to be and I say this with love, but I don't want to, I guess, carry on those habits and some of the conditions that are health related. So, set all that to say and to ask what for that person who is chronically ill or spends a lot of time at the doctor and does not feel heard Like you were saying there's a difference in appointments and all these things what, like, what's your advice to the person who because a lot of people feel like they're not heard, they're, they're scared to use their voice?
Speaker 2:Some things I've heard is like I go in there and want to talk about my issues and as soon as I mentioned like, some research I've done, the doctor just shuts off and it's like, oh you self-diagnosed, or something like that.
Speaker 2:So I've like heard all these horror stories and I've experienced some of them myself, but usually it's because, like, I'm not even clear on what I need to ask the doctor. So I'm like I got this this, this, this and make them like again with the toddler throwing Legos at me, make something of this, like, give me all the answers, heal me right now, but like, what can you tell them? Because I feel like it's like if they, if you can commit to the mindset of this is like it's figureoutable, but it's going to take numerous exposures, and then, like you and your doctor have to have a relationship, no, and like you have to be willing to like, be in it for the long haul and make some adjustments. And so what advice can you give? I guess I'm going to shut up now to that person who just feels like they don't listen to me. I'm not getting better, they're just pumping me full of pharmaceuticals, Like I don't know what mindset they're in right now. But yeah.
Speaker 1:So I would say I have three pieces of advice. One there is a physician to fit your temperament, your personality and your expectations. Finding that physician is the difficult part, right, because it it may be that you need something ultra specialized, right? So like if you're going for an ultra specialized surgery and there's one guy who does that surgery, like that's the person who's there and, just like they've taken some classes on how to communicate, they're still also bringing their personality, their expectations of you, expectations of themselves, their expectations of you, expectations of themselves, time constraints and what they have to plan ahead. They're bringing their humanity as well. And so when we're talking about primary care physicians, there's somebody out there who will fit your personality and your niche and whatever, and finding them is going to be the difficult part. If you're talking about specialists, it's more, I think, going into the experience and the appointment with what am I trying to accomplish?
Speaker 1:All right, I just finished listening to a really great book called being Mortal by Atul Gawande. He's a physician and I think right now he's something in like the president's cabinet or whatever, but he talks about his mother-in-law and he said we brought the doctor an unfixable problem, right, so she had all these things. She's aging and she's getting and he at least acknowledged that like we're bringing the doctor something that can't really be fixed, like she's not going to go back to being 38 years old if she's 88 years old. And he went and talked about geriatricians, like those were more her speed, what she was needing Someone who was going to meet her, where she was not trying to fix everything. Understand that some things were not fixable, right. So there's the specialty, there's the personality, there's the everything. There's somebody out there who's been a vibe with you Unfortunately, in American healthcare we've got constraints of insurance and who accepts and where.
Speaker 1:So finding that person is going to be difficult. But think of unique ways of accessing healthcare. There are lots of physicians who are doing what we call direct care now, which is kind of like another word for concierge medicine, but a little lower priced. Is that something that maybe you may be able to swing or you're interested in and talk to them about what they offer? Or do you need somebody who's like a geriatrician, who's not going to try and fix you, who has longer schedules booked, like appointments booked, and is going to sit down and be able to have these more like relaxed and timely conversations. Or are you looking for, like, really aggressive management and you want that really aggressive neurosurgeon who's like we're going to cut it out, then we're going to blast it and we're going to do this and then like, where are you, where are you in your journey? There's someone out there who's going to figure it out, right?
Speaker 2:The second thing- I'm sorry, I just had to jump in with the blast.
Speaker 1:Like this is going to do something, we're going to fix this thing. There's somebody out there who's going to say, like I can do that right. The next thing is really be clear about what you're trying to accomplish and understand the venue where you are. So something that happens to me a lot is that people will come in for an acute problem, like an injury, an illness has brought them into the hospital, particularly older people, and their daughter usually, who's a person helping take care of them, says oh, mom has this appointment for, you know, an orthopedic surgery eval for her knee replacement. Can she just get the MRI? While she's here and I'm actively treating the mother for, like, a heart attack and pneumonia, this is not the venue for that. And it's not because I don't want you to get it, it's not because I am too busy and I hate you. It's because, like, your insurance likely is not going to pay for an MRI of the knee if I'm treating you for an infection in your lung. The hospital also has different ways of running MRIs and acuities, so it's likely someone's going to look at this and say like, is this 100% necessary in this hospital stay versus this trauma that's coming in? You know what are you trying to accomplish and is this the venue for that? And sometimes that requires a little bit of preparation beforehand, like sit down and write it out and say, like, what am I going to the doctors for? Am I going to the doctor, you know, for my physical and to get one refill, versus we're taking mom to the hospital because we feel like she's getting a little slower, she's not remembering, we don't know what the next steps are. Those are two different questions, two different appointments. You're in the hospital for pneumonia. Let's focus on that thing, right, and say like, okay, now we'll plan for the next.
Speaker 1:And my third piece of advice is what you already said. This is a journey. Your health and every illness, injury, condition, everything changes over time. Everything is a journey. We will all pop in and out of different health populations, right, we're all going to pop in and out of having some anxiety or depression or, you know, mental health. Illness will touch essentially all of us at some point in our lives. You may pop in and out of it. You may stay in that condition a little bit longer, you know.
Speaker 1:Disability that's another thing that people don't think about. Like I once fell down hiking and was on crutches and in a boot for months, right? Never once considered disability as something in my life, but suddenly I'm like going to the DMV to get placards, you know, to make sure I can park in places. You know I'm looking for the little carts in the supermarket because suddenly I'm not mobile. There are people for whom disability is a more permanent part of who they are and their health journey, but a lot of us are going to pop in and out of that as well.
Speaker 1:As aging, as we get older, disability comes with age. Loss of function and independence comes with age in this country. And so, where you are in your journey, a lot of people want an answer. Right, what I encourage people to do is get a plan, an answer. People just want, like a diagnosis, and I get it.
Speaker 1:There's something soothing to say like I have this thing and I can do research on this thing and say like, oh, I should be getting this medicine and the next step is this, this and that.
Speaker 1:Right, but for me, as I have thought about my own health journey and my patient's journey, I find that my job is to get them a plan, because it doesn't particularly matter what the diagnosis is.
Speaker 1:You've got to live in this thing, all right, and I can give you medicines that's in a textbook. But if it doesn't help you live, if it doesn't fit your need, you're not going to take it. You're going to come back and you're going to be like I didn't like this medicine. Or you might do worse and lie to me and tell me you're taking it and I'll just keep refilling it and I'll keep patting myself on the back. Or I'll be like why is this medicine not working Right? Like you need a plan, because the plan will change over time as you get more information, as you get more coping mechanisms, as you get better, as you get worse. Whatever it is, you need a plan. And so, instead of just seeking an answer, I encourage people to say like well, I'm going to see the doctor or in the hospital. We need a plan. What is the next step, so I can plan for the next and the next and the next thing.
Speaker 2:Well, man, there were a few moments I know you saw me over here like, oh yeah, that's so, that's so good, but so it's, it's an x? Um, instant gratifier, like I needed everything and like, and quick too. Now, for some of us based on, you know, my experience, personal experience, but also professional experience with my clients who have a lot of childhood trauma, ptsd, cptsd, anxiety, depression just are controlled by their nervous systems. Right, it's. It's been so interesting seeing them grow, because and seeing myself grow because whenever you have like prior conditions or you are, it's just human nature you're in pain, you want to be out of pain immediately, like they're right. So that's, your nervous system is supposed to let you know when you're in pain.
Speaker 2:And but some of us are so wired and so that instant gratification, it's, it's so, I know, it's so appealing and it's like give it to me now. But the more I get on this journey and this is where I'm trying to string my thoughts together real quick, that's the ADHD brain, but I, it's just so I think what I want people, what I'm trying to tell people, is it's so much more worth the plan than getting quick results, and I think that goes with most things like love, relationships, health, success, like I also encourage people. Like if you have a plan, you're always like you're going in a direction right, like you're moving movement. There we go, you're moving the people forward.
Speaker 1:Yeah.
Speaker 2:Versus. Like searching for the quick results in the instant gratification. I don't know about you. But like searching for the quick results in the instant graphication I don't know about you. But like anytime I get quick results, they also leave me pretty quickly because I don't, I'm not dedicated and committed to the plan in the first place. Um, but whenever you said, I encourage that you don't seek answers, you seek a plan.
Speaker 2:That landed hard for me because, like I was never a planner and with the CPS, cptsd and just my, my, my childhood, which was pretty fucked up, it makes sense. It makes sense people and for anybody listening why you want the quick results. Because nobody wants to lean into more pain and what I've found is like on my chronic illness journey and my health journey is it's a lot of like rehashing stuff, rehashing memories, stories. It's such a discovery period and sometimes the quick fix is just I get why people chase it. But you're hearing what you're saying about bridging the gap and just the communication portion of it.
Speaker 2:My listeners, my beautiful listeners, but some of y'all are stubborn. I just encourage you to listen to Dr Monique Nugent because I'm what I'm hearing from all. This is everyone I think could benefit from some emotional intelligence. It sounds like from a consumer's perspective, like we take things very like personally and what I'm hearing is is a lot of I mean, it makes sense. You go into a physician and you I guess some people think like this is my time, give me all of your energy, and like I'm your prime focus, not thinking about the schedule and whatnot. But if, if messages like this get out, then what you're saying is is that way it boils down to communication really?
Speaker 1:Communication and expectations right, like if you are going into something expecting the unfixable to be fixed in an appointment. I hate to be this person. You're going to be disappointed.
Speaker 2:Yeah.
Speaker 1:Right. You should expect your physician's full attention for the time that you have them. You really should, right. You've booked that time, right? That's a social contract that I'm showing up because you said I could right, and so you should definitely expect that you should also expect to be listened to. What I encourage people is that it may take some time if you're going to stick with that position and there'll be lots of reasons why you just like I'm done with this person, I'm gone, right. But if you're going to stick with that position, like I want you to be invested in that communication as well, like I want you to be invested in that communication as well, right, I want you to be invested in that relationship as well.
Speaker 1:And so it's not. It should not just be one-sided that the physician is going to come in and they're going to like build this relationship with you and they're going to get it right. That's totally impossible. Right, like I pride myself on my bedside manner. Right, I have people who hate my guts. I do, I do. I have. I have patients and families that if they saw me walking inside the street it would like swerve. Right, and I, I try my best. I teach people how to talk to each other. I know I've gotten it wrong at lots of times. I know that even me trying to get it right, I've gotten feedback that I get it wrong. Like my bright and cheery personality in the hospital. Somebody may think this is really inappropriate. For this doctor to walk in and have a smile on her face when she's helping my mother pass away.
Speaker 2:Yeah.
Speaker 1:Right, versus somebody who says, like that was a breath of fresh air, that we were in this heavy space as my mother dies and is passing away, and this doctor came in with a smile on her face and was able to light the mood a little bit.
Speaker 1:So it's impossible for one physician to get every single interaction right, yeah, right. So if you're going to, if you're in this relationship with this physician, for whatever reason, I'm trying to ask people to also participate, right? Not expect that this is just a push system. I'm going to push everything out and every, every ball will be caught and it will be perfect. It's not right. Years and years ago I want to say that it was Cleveland clinic, but I could be wrong. They made this really great commercial where someone's walking through the hospital and there you could see people's thought bubbles over their head, right. And so they're walking through the lobby and you see like, oh, I hope that this person is okay. Why is this surgery taking so long, you know? But as they're walking through the hospital, they get into an elevator and a physician gets on and the physician's thought bubble was about their sick child and that hit me.
Speaker 1:I saw it when I was in medical school. That hit me because I always in medicine, early in my career, thought I was coming into every interaction as a blank slate, right. Um, I started as a psychiatry resident and then I switched my specialty into internal medicine and I was talking to one of my psychiatry attendings and I said that I said that a patient had triggered me and I was really disappointed in myself. It was unprofessional. And he said why? Why is that disappointing that you are human, that, like you, are bringing your own humanity into this. You're not a robot, right, you learn to be professional, but you are still bringing your humanity into this, right. And so the days that I was seeing patients for 12 hours when I was nine months pregnant, like I can guarantee you, the first patient of the day got a different version of me than the 12th patient of the day, and it's not because I wasn't trying to be professional, it's because I was like 40 weeks pregnant and I'm tired and that's the humanity that I'm in right now.
Speaker 1:Right, and so, if you're going to continue to be in this relationship, if you're going to continue this relationship in this relationship, if you're going to continue this relationship and there are lots of reasons why you have to. You choose to and you don't have to choose to try and foster that as well, because the other thing that we don't talk about is that there are a lot of people in medicine who are a little bit on the spectrum, a little neuro-spicy, a little bit on the spectrum right, a little neuro-spicy and the things that make them great physicians may be the things that make them not the best communicators. Yeah Right, attention to detail this like small details. You want somebody who is looking at every lab and doing this, but they may not be able to like get out of that part of them when they're speaking to you and interacting with you yeah, like the social aspect, yeah, yeah yeah, and that's that's okay.
Speaker 1:Uh, for you to be like this person's kind of difficult for me to, but, but, like, can you read them a little bit and see that like, oh, this this person's a little okay? Okay, I have to interact with them maybe a little bit differently, right? They may be really trying, of course someone's technically, they may be really trying and try and meet them there too.
Speaker 2:Yeah, in the middle, yeah, so I'm hearing like we could all benefit from compassion. I think it's really. I think people would you agree with this? Just we get so caught up in our own shit that it's often just like we don't even stop and think about the other person, especially in that situation where you're coming into a clinic or a hospital and you're the one with the needs, like it's. It's so easy to forget, like the person on the other side who is trying to help you, which you guys could be perfect strangers, um, but I don't. I always try to. I always try to put myself in other people's situations.
Speaker 2:I was recently told by a client while we were on our retreat. I have an annual retreat and she was telling the other people there. She was like Jacqueline is just, she's just different. I was like, well, that's what's gonna mean, it was a good thing. But she goes. She said you're almost too nice. And then again, um, what's wrong with that? And she was like no, just like.
Speaker 2:If I see a dude checking me out, I'm gonna be like what the fuck are you looking at? I'm gonna do you need me to rearrange your face? And and then I'm just like, well, maybe he was just like he saw two beautiful women and and what I was getting at was, like I, I think it's so important and I do this especially, like with cash cashiers, anybody in the service industry especially I will worship the ground you walk on and medical and everything. Cause, like I, it's gotta be hard fucking work, and I know service industry was, and everything. Because, like I, it's gotta be hard fucking work and I know service industry was. I mean, it's it sucks, it's really hard work. So I can imagine like hospital, like being in a hospital and all that, but I think it's what I was trying to explain to her is it's so important, like to just take yourself out of the equation for a minute and like the same things that we want to receive the compassion and the like empathy. They probably want that too. Um, I want to.
Speaker 2:Before we hop off, I want to ask you because I'm thinking about some situations. I had a client who, um, I want to say that her physician broke up with her and it was based on some boundaries, uh, like calling after hours and stuff, and so can we chat about boundaries real quick? I would love to. Okay, cool.
Speaker 2:And then I would also like to know, since we're talking about effective communication like with these boundaries comes like I mean respect and communicating in a way that, like I think people take communicating way too personally, like if I tell you something, it's my opinion, how I feel they take it personally, like they did something wrong and it's like no, I'm just stating like these are my non-negotiables. Or I like these are my boundaries, but which? What do you have for me? Whenever it comes to like boundaries with these kinds of relationships I know it's expectation related, but like what is appropriate, what's not appropriate. And then, when you find yourself in a situation cause I think that finding a doctor is a lot like dating, like a therapist, anything like that Um, so I I see the importance of going to people and figuring out who works for you, but whenever it comes to like shopping around for someone because that's what it feels like, is there a right way to do it? Are our doctors making notes? Are we like, are we being dinged for the?
Speaker 1:record? Is it on the record Are?
Speaker 2:they like you know, like does it look? Like I've got a record of just hopping, or like I need to know all that too.
Speaker 1:Yeah, so I've heard this question about the record and it more. This is the first time I've heard it as, like, am I personally being tracked? Usually it's like how come they don't know what's in my record? Like, so there is no national medical record in this country record in this country. Each hospital system, each clinic system, practice, whatever, has the ability to choose how they keep their records and sometimes the records speak to each other. Sometimes the records don't right. So I am outside of Boston, I work in one of the suburb hospitals and I can sometimes link into, like Mass General or Boston Medical Center and see some of those records. The VA system, it's the same thing. The VAs across the country can communicate with each other, but there are sometimes there's like this one guy who has a clinic by himself, you know in Nantucket, and like no, I can't get to his records, right, so there isn't a record.
Speaker 1:But you are right, like how you treat people and how people feel about you is in the record, be it in a professional manner, where they write something like you know, the patient was belligerent with me this morning, you know or in a non-professional manner, where they write something mean or dismiss you from clinic for whatever reason, right? So there's no like high school record in that way when it comes to choosing a physician. But moving around physicians, particularly primary care doctors, I think people understand because of the fact that healthcare is tied to employment in this country, and so if somebody's employment changes for whatever reason, particularly around health like if somebody has a chronic condition and that you know they were working and now they're not working, or you know they were married and now they're, you know, on different insurance, like that type of stuff, clinics everybody understands that and no one looks. It's not like when you're applying for a job and they're like, oh, you've got 18 jobs in 18 months. What's happening? You know so.
Speaker 1:But when you talk about boundaries with physicians, I actually speak more about like patient boundaries and like making sure that you feel safe in a space with a physician, and safety is like the big thing for me, right. If you're feeling unsafe for whatever reason, that's like a big key to say, hey, this is not the person I need to continue seeing. And so all of the respectful things should happen, like asking if they can't examine you instead of just like grabbing at you, right, making sure that you are appropriately draped and clothed in a hospital? Right, because I, again, I work in a hospital, people walking by. If I'm just like, ripping the blanket off of you, that's disrespectful to your body, your autonomy, and I should be able to give you the space to feel safe, right and so. But as far as boundaries for physicians, I actually had to learn in my career being hospital-based, to set boundaries and that there will be some people who want me to come back to the bedside, like every 15, 20 minutes for a question or like something that I talk about a lot with family members. Nobody should go through a hospital, stay alone, right, you should have some support system, and a lot of the times, particularly with older people, they have lots of children who will say oh, I'm one of five. Can you call like three of my brothers today, tomorrow? No, I can't do that. And it's not because, again, I hate you or I don't want to talk to your three brothers, who sound very lovely. It's because I'm going to give you three different versions of the thing that's happened, because three different people are going to ask me three different versions of the thing that's happened. Cause I'm going to three different people are going to ask me three different sets of things and they're going to come away with their own conclusion and they're going to say that's not what the doctor said. So, so, like I try to keep communication really streamlined one person or at one time, sure, I'm happy to have a family meeting and we can all sit down and have this conversation together. So we're getting that information. But I have had to set boundaries. Since this conversation is about compassion with healthcare providers, I've had to set boundaries with how people treat me and my staff and speak to me.
Speaker 1:I once had a conversation with somebody who hated me for, you know, the thought that I was really not doing a good job and I was. You know there was a whole lot of strife, but they had like someone in the background as like a hype man type situation. So I would say something and the person in the background would be like if that doctor like just like screaming of sadness in the background and the person on the phone with me wasn't screaming of sadness, but I'm not going to be verbally abused like that, you know. So I was like okay, can you have your friend step out, or this conversation will have to resume when you're alone. You know it's the same thing when I, if I'm with you at the bedside and you know people are inappropriate, I do set that boundary pretty quickly, you know, and so it's a skillset.
Speaker 1:I don't want people to think that every physician, every female physician, is going to have that skillset easily, because I've been doing this like close to 15 years. Like I said, I've been in hospitals on the East Coast, the West Coast, no-transcript, and I have not gotten it right and I have lots of times I've had to grow into it, and so I'm pretty firm with my boundaries. But there's a difference between being firm and being you know. But you know it's a skill, yeah.
Speaker 2:Yeah, no, all that's helpful. It's just so interesting to get insight from, like, the other side. The other side. So whenever it comes to let's say, you're, my, I'm a new patient of yours and I, if the person feels like they're not being heard or maybe they're afraid to speak up, um, what is like? What is a a way to initiate conversations, like, in a respectful way? Um, one thing my, my mom says, and it makes sense, you know, if she's scheduled an appointment and they have 15 minutes makes sense, she's in a hurry, she really does have to be somewhere, she's not leaving you, but how do we kind of, with the time we have as patients, make the most of that but initiate that conversation in a respectful way to get, if we feel like you're too sped up, to slow down and come to our level for a second.
Speaker 1:So there's absolutely nothing wrong with saying just that. Okay, saying like, hey, I'm not understanding what's happening, or that's not the thing that I was hoping to get addressed today. I still have X, y and Z concern, or just that. Can you slow down for a minute? I feel like this interaction is being really rushed and I'm not getting what I need out of it. I've said this a few times about going to the hospital alone, but having another voice, having another person with you who can help advocate for you and can fill in the blanks, because something that happens to me a lot is I say something, the patient says something and I feel like we're speaking the same language and their loved one will say that's not actually what he's trying to get at. Doctor, that is huge. That is hugely helpful, because that person knows you intimately and knows what's going on and can kind of attest that things are going on the right track or not. It can also be another set of eyes of like God, you were right, like that physician was not hearing you, that physician was rude, that physician was disrespectful. We should not come back here. Let's figure out how we can, you know, try again. So it's not asking questions? Is's not disrespectful, and particular older folks, they seem to think that asking questions is not disrespectful, bringing your needs is not disrespectful, and you should be able to bring your needs and your concerns in a reasonable manner and expect to be interacted with back in a reasonable manner. Right, it's the fight that, like, nobody's going to win. I guarantee you nobody is going to win, because you're not going to walk out of there feeling like you got anything solved. You have a plan, you're on your journey, right, and you're definitely not going to walk out of there and be like and I can't wait to come back, right, because that's the truth. This is a journey. There are very few times where, like you see the doctor one time for a thing, right, like you're going back, even if it's like I broke my finger, you're going to go back and like get the little finger thing taken off and get another x-ray and make sure it's okay, right? You're going to go back and like get the little finger thing taken off and get another x-ray and make sure it's okay, right, you're going to go back. And so how? How do we sit in this relationship together?
Speaker 1:I do teach specific like hospital-based communication skills and community events, you know, because it is a very different set of skills to drive a hospital stay and like say, like okay, we have to get from here to here and you can get admitted and discharged and get dragged through the whole thing and then it's time to discharge. You have no idea what happened and where you're going. Or you can participate, you, in support system in every step to get you to where you need to be right, and that's really what my book was about. That's what my teaching sessions are about. My very small blog is about. It's all about like, how do you drive that and get what you need out of it?
Speaker 1:And then, when I talk to med students and I teach about communication skills, for me it's a combination of learning how to build and maintain a therapeutic relationship while using your emotional intelligence to see where that relationship goes Right. And the only way that you can do that is by acknowledging your own humanity and what you're able to bring and what you're not able to bring and what you are bringing into it. Some people are highly emotionally intelligent, right, and some people are not. And if you're somebody who having these interactions with this difficult and you need to sit down and learn, like read a book and learn it, then maybe that's the thing that you need to do, and there's nothing wrong with that.
Speaker 2:Thank you for saying that. Sit down, read a book and learn it, because I'm convinced that humanity is obsessed with distraction right now. Like please bring back the books, y'all pick up a book. I literally dragged my husband to the library, like last week and I was like you're, you're picking a book. And I was like we won't fucking leave until you pick up, like just, and I just sit right next to his bed or our bed, his bed, his side of the bed, and I'm just like at some point maybe he'll, I'll, work some little magic and like maybe do some sage around it. I don't know, but I'm just, I'm on a book kick and I want people to pick up books. So thank you for saying that, because I think that we're so stuck in phones looking for answers and I'd love to see more people get out in nature and just read a book, read a book under a tree and learn about it.
Speaker 1:Thank you, they can grab my book. It's not a. It's not a page page turner, it is a man. It's more like a teaching and a manual. It's not written for physicians, it's written for the general public, for lay people, and you'll learn. You will learn skills to empower you and feel like, okay, I know a little bit more of what's going on. I know I didn't get what I needed out of that interaction. How can we circle back to that? My favorite thing ever is when I get pictures of people with the book. I got this cutest picture of, like, this little older woman holding my book and she was like it helps me to tell them what I needed, and I was like that's what I want. That's it. That's all that I want is that you got a little bit of help, you feel a little bit more confident, because walking into the hospital is not meant to make you feel confident at all.
Speaker 2:Yeah, well, thank you. Thank you for being out in the world, like spreading this information. I want to buy the book. I'm going to buy it for my mom. She and her husband are going through a lot. He just had brain surgery. He had a tumor removed and so there and this is his second like cancer scare, and there are just so many moments where I can. It's just, it's stressful, it's stressful. I think they've been a bit from this. The other thing I wanted to ask do you have like, what are you reading right now?
Speaker 1:So, yeah, I literally, like two days ago, finished that book being Mortal by Tulkuwande, which was very, very moving, very moving. Yeah, um, I have very small children, a two-year-old, a six-year-old, an eight-year-old so, uh, right now we're tucked into the original alice in wonderland and I wouldn't say that I'm reading it. My husband is the one reading it. We're all sitting around listening, um, but I I've never actually read Alice in Wonderland, right, like I know the movie. But, yeah, the book itself is very different from what you would expect and it's not like we picked it thinking it would be a kid's book. It's not particularly like you. You have to have a little bit more like understanding of how people speak and think and there's a lot of dry jokes like dad jokes in there and asides and then flashbacks. Like I'm enjoying it and I think the kids are and I'm being read to, which is great.
Speaker 2:That sounds like I'd just be sitting in the bed, all snuggled up.
Speaker 1:What was the last time that you were read to? The last book that I read read for myself was a book called the Sum of Us, which is really interesting, and I'm not a fiction reader, so it goes through and it really talks about how, essentially, all the big, big spheres of American life that you could think of healthcare, education, finance, housing, work, how, how racism has essentially ruined it for all of us Not just for, like, what you think of some people, no, but for the some of us. Like, how we are all victim of a system that's meant to exclude, because once you can exclude one group of people, then you use those tactics to exclude others or to create a subpar system in general, and that like how can we get rid of that for the betterment of the sum of us? Like all of us. It's a very good book.
Speaker 2:S-U-M. Yes, yes, it sounds so good already. Oh my gosh, I got to check that one out, okay. So, last thing, any final words from your beautiful brain that you want to share with listeners, and we'll just just anything that comes to mind. I like to part with just whatever's on your heart, and so, yeah, what you got, whatever.
Speaker 1:So the one thing that I say over and over again is don't do this alone, right, alone, right. We don't do life alone. Well, there's no instance where isolating yourself, you know, has ended with, like all of us, being better, right. And so, when it comes to your health, that journey I live and work in the sphere of chronic and progressive illness. I live and work in the sphere of chronic and progressive illness. You can't go through that alone, right? Bring people in. People want to support you, people want to love on you at different ways different, sorry, in different ways at different times in your life. And don't go through it alone, right.
Speaker 1:I see people who come into the hospital and they don't want people to visit them, and I get why when you're feeling down. But if someone wants to show up, let them. Let them show up. Get, let your community do for you what they can plug into the world. Isolating yourself is not good. Somebody once asked me if you could change the world with a program, what would you do? And I said it'd be something that connected us, because we all just thrive when we are together. So don't do it alone.
Speaker 2:Some powerful shit. Doctor, I try so good, so good, so good. Thank you so much for this. I feel wiser. I feel, yeah, I definitely feel a lot. Yeah, just why? Yeah, wiser? I'm trying to think what are my takeaways? I just feel like I know more now and I'm really excited to read the book. Where can everybody get the book?
Speaker 1:You can get it anywhere you buy books online. You can get it at amazoncom, barnesandnoblecom, anycom place that you buy books. I'm plugged in. You can just stick my name in there Nugent, N-U-G-E-N-T, Monique Nugent, or the title, which is Prescription for Admission, and it'll pop right up. You can also check me out on my website, which is drmoniquenugentcom M-O-N-I-Q-U-E-N-U-G-E-N-Tcom. Like I said, I have a very small blog that I'm fleshing out. I'm paying my little cousin to update all my podcast stuff, so that was the person who's actually texting me while we were talking.
Speaker 2:Oh, so cute.
Speaker 1:So that was the person who's actually texting me while we were talking.
Speaker 2:Oh, so one of the benefits of having little cousins, right? How old is?
Speaker 1:cousin.
Speaker 2:I need an intern.
Speaker 1:I'm updating the website kind of all the time and I'm going to, in the next couple of months, start putting up some education modules and linking with some really exciting projects around caretakers and people who have to interact with healthcare more than they would like to, I think, and so I want to give people the skills to build some resilience and some confidence.
Speaker 2:Beautiful, beautiful. Are you on social media at all?
Speaker 1:beautiful, beautiful. Are you on social media at all? I am, but I'm really bad at it but still follow. I have. I have a like my best friend who teaches social media stuff like on a university level and she's like you need to do this, this, this and that. I'm like I will not, but thank you yeah, just outsource it.
Speaker 2:If you want to keep up with it, just outsource it.
Speaker 1:I'm like that sounds complicated, yeah, um, but I'm, I am on instagram, I am at the underscore happiest underscore hospitalist. Oh my god, yeah, I'm, so I'm the happiest hospitalist and I've got some tidbits there um, some podcasts, some articles. Again, I'm not the best at it, but if you follow me, that would be nice.
Speaker 2:So for when she does get better at it.
Speaker 1:You could be like oh yeah, I remember when this instagram was trash and now it's better well.
Speaker 2:Thank you so freaking much. It looks beautiful wherever you are. I see the trees behind you.
Speaker 1:Looks like a nice day it's a beautiful new england day and I am thoroughly excited about it because it's when it's cold in the morning and then, like, gets nice, and where the sun is still out before the darkness of new england's winter settles on me. Um, so I know you're in the south, right down there I was like how'd you get?
Speaker 1:so yeah, mississippi yeah, I lived in atlanta for for college and I do miss the, the longer days and the warmer yeah, they are like it's whenever the yeah, all the daylight savings time, switching up and whatnot.
Speaker 2:Sometimes it's like 8, 8, 20, 8, 30 before the sun, like before it starts getting dark, and it freaks me out every time when I'm visiting my sister who lives in georgia um, because she's like right there between chattanooga and like the state line, yeah, uh, but it weirds me out to be like past nine o'clock and it's still light out and I'm like what in the hell is going on?
Speaker 1:yeah, no, in new england in the wintertime it's just like it's like 3 pm and god turns off the sun and you're like, oh, I am god turns off.
Speaker 2:She didn't switch y'all, she. For those who can't think so, oh my gosh. Well, enjoy your day. This is this is my like. This was a great way to start my day.
Speaker 1:Thank you so much yeah, thank you, and thank you to your listeners for letting me join in oh, they're gonna love it, they're gonna love it well, I'm gonna hop off here, have a great day.
Speaker 2:Bye, yeah.
