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Dr. Aaron Carroll answers Hank's questions about what you should do at a doctor's appointment, what "catastrophic coverage" means, and how necessary it is to even have a doctor.

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[Upbeat music]

Hank: Hello, it's How to Adult, today we're talking with healthcare policy expert and doctor of doctoring, medicine, Aaron Carroll. Is that what it is?

Aaron: Pediatrics.
H: Oh.
A: I'm a pediatrician.
H: You take care of the kids. How are they?
A: Yes, in fact, they're doing well. They're doing great.
H: Your kids or kids in general?

A: I meant kids in general, in fact. That's an ongoing theme we talk about on our show all the time, by almost metric you can measure kids are doing fantastic. 

H: My kid is about to get his 12-month vaccines, and this will be the first time I give him a vaccine where he's gonna kinda know what's going on. 

A: He still won't remember them. 

H: No, I'm not worried about him remembering, I'm worried about him looking at me with the eyes of like, "Why have you allowed this to happen to me, dad?"

A: That's possible, although I still say until you're laying down permanent memories everything you do is excusable. You still got a few years. 

H: That doesn't sound like what a pediatrician should be telling me. 
A: That's also what a parent will tell you. You're good for a few more years. You got a few more years of do-overs. 

H: Aw man. Well, good. Well, now there's much less pressure. 
A: Good.
H: But vaccines are good.

A: Unequivocal good. Probably one of the best things we've ever done for public health. 

H: What do you think are the hardest things, especially in America, when you're coming out from under your parents' wings in terms of healthcare.

A: I think the biggest thing is first establishing yourself and seeing a doctor that's not your pediatrician, not the person your parents picked out for you. 

H: I only very recently as a 37-year-old got a primary care physician. Because I have my GI doctor, who I was like, "I see this guy once a year and he's handling the major problems of my health." But I went ahead and did it. If I don't have a primary care physician and I want to go see a doctor, is it okay to see whoever's at the walk-in clinic that day?

A: Yeah, as a matter of fact, you can often strike it rich and find a really great doctor that way. But I would say, still, your best bet is you take a doctor like you pick anything else, talk to your friends, talk to people who have a doctor they like. You're looking for things that are different for you, you're trying to screen.

H: But, is it, maybe I don't feel like I need a doctor. Do I?

A: I think that everyone should have one in their back pocket. 

H: Somebody that I have a relationship with? Instead of just going to the walk-in clinic and being like, "Hello, person who is here right now."

A: Correct, because I think it's just easier when you have an established rapport with, you can talk to, that might know something about your history and your preferences.

H: I often, by the time I go to the doctor I'm like, "Okay, I've brought you this list that's like 8 things long. My hip hurts every once in a while, I don't know what that's about, is that normal?" And they're like, "Well, uhh."

A: I don't think, I don't want to say you're not normal, but I don't think most people do that at this age. 

H: How do I make the most out of a doctor's visit?

A: So I think what you do is not actually a bad idea if you go in with a plan. To know, "These are the things I want to talk about."

H: Instead, if it's a yearly checkup, you're like do what you do to me and tell me if I'm sick." 

A: Exactly, that's how I go to the doctor. I just sit there and answer questions. I offer nothing, almost like I'm at the stand and they're cross-examining me. Going back to your question of how you make the most of it, I think it's having a list, knowing what you want to talk about, not letting your doctor drive the conversation. Making sure you get to the things you think are important. Doctors are overwhelmed, there's a list of things they're supposed to do at every visit that is enormous and impossible. There have been studies that show in adult medicine if they adhered to every guideline that exists, visits would take like 16 hours long. It's just not possible to actually get to everything they're supposed to, so they have to prioritize and often doctors are creatures of habit, they'll hit the things that are important to them, but maybe not the things that are important to you. Making sure that those things happen is important. 

H: So when I go and there's sort of a, which I guess I know this when I go to a checkup, which I do now, but didn't for a long time, there's sort of a "these are the things that we do." That's not based on me, it's based on guidelines and recommendations. 

A: Well, you hope. Sometimes it's not. Let's be honest, some doctors are great and some doctors are not. Some doctors are just doing what they think is right, even if it's not based on guidelines or evidence. I'd say your best doctors are trying to stick to at least the evidence-based and what we know we should be tackling. 

H: What do I want my doctor to do to me when I go to a checkup?

A: I think a lot of it depends on the age and what risk factors you have. A lot of it is what we call in the pediatric world anticipatory guidance, of you know, "As your child ages, we know, now he's mobile, we have to worry about things that he could get into. Now he might get into water or turn on the faucet and get burned." A lot of it is trying to anticipate where the high-risk things are coming from. A lot of that is dependant on do you have certain diseases, do you engage in certain risky activities? It's sex, it's alcohol, it's drugs, it's things like that. Those might shift your doctor into talking about some things. Otherwise, a lot of it is going to be diet, it's going to be nutrition, it's going to be exercise, things we all know we should do. It's going to be a physical exam, where they're trying to see if anything if wrong, but most-

H: Like check and see if you have this hernia thing that people sometimes have, you wouldn't notice. Tap on your back.

A: Most- most of the evidence says the physical exam is really not useful. The number of things that you picked up that you otherwise would is incredibly small, which has led some people to believe we don't need as much primary care as we used to, or as people thought that we did. But a lot of the still risk-based screening and trying to do things for you, making sure certain things happen especially as you age, and you start to need certain tests every year, that's what's important.

H: Yeah, I mean I feel like, has anybody ever like diagnosed pneumonia? Said they didn't know they had pneumonia and they're listening to my lungs now and I'm like "oh what a surprise!"

A: Oh so they do.
H: What are they listening to?

A: So they have, which is with the stories that they will tell, the
problem is there's no counterfactual, there's no like 'if I hadn't done the physical exam likely the next day you would have been sick, you would have come to me and then I would have picked it up'.  And so, it's not that you can't tell a story of 'I picked something up and I found something' it's that people then think 'oh because he picked it up that's how I got cured' as opposed to knowing that in general we could have found the later anyway.

H: Yeah, a week later.

A: Right and it wouldn't make a difference, or it was so sub-clinical it didn't matter.

H: Right.
A: We could have just ignored it. 
H: You diagnose my disease that was gonna go away anyway.
A: Yeah.
H: Does the doctor get antsy if I want to talk?

A: Some doctors will, I would say not all, good doctors wouldn't and I think doctors that would fit your mold would not.

H: Right, that's something you would want to look for.

A: I'll be honest with you, I get antsy like I'm much more of a 'let's do this and let's get out the door'. I'm not the best pediatrician. So it's just- no. There's no news there anyone, that watches this... So I may be a good doctor, I don't feel like I'm- I'm not like the 'let's talk for 45 minutes' kind of guy.

H: Well I mean also, there's other people who have appointments. So I'm always very conscious and sort of worried about this, that 
I don't want to take up too much of your time, but I feel like maybe I'm too much in that vein.

A: Well I go the other way because when I go to the doctor and they're running ten minutes late I'm losing my mind I'm like 'how dare they'. You know, but that's why because they're talking to somebody else and so I just went to my GI doctor a week ago and he was running an hour and a half late but he was talking to somebody who needed his help, so I can't stay angry but I'm in the room conscious of like 'I have to stay on target, I got to get the next patient'.

H: Bring an audio book with you Aaron.
A: I'm not good at that, I should, I should.

H: Just bring your headphones, be like 'ah, this is a nice mystery
novel. Hercule Poirot is gonna solve this in no time.'  I can't, I cannot go to a waiting room without an audiobook. I will murder someone.

A: No see I'm just, I will be on the phone just checking Twitter.
H: And that's that's going to make you feel better.

A: No no, these days that's not helping at all, which is why I was super angry by the time I got in the room, but I diffused quickly.

H: As for getting yourself some health insurance. Do you think that this is easy?

A: So I'll be honest with you, I think your hands-down best bet young adult is if you can stay on your families plan, do that.  Absolutely. If you're up through age 26, if you can do that, there's no way you'll get a better policy at a better rate than doing that.  Now that's not possible for everybody, and then yes I would say
everybody should have health insurance. You just don't know, you're protecting yourself against financial catastrophe, that's
the biggest reason to have health insurance in general. And you can't tell when that's coming so yes, and policies for young adults are for the most part pretty cheap and usually you can even find a catastrophic plan but if you can stay on you're on your family's plan
that's what you should do.

H: We say catastrophic plan, what is that? People say this all the time as if everybody just knows what a catastrophic plan is.

A: So a catastrophic plan in general will have a very high deductible,
so it's like I don't need to use it. 

H: This is this is really only for if I get cancer or a bad accident. 

A: Exactly I mean that's the thing that really a young person is gonna be most worried about, a car accident or something like that or some other, something happens to you. But that that's the big worry and that's what would really bankrupt you. So that's what it's for.

H: And then you're, then you've got a bankruptcy and you're
dealing with bad credit for the rest of your life, and you can't buy a house when you're 45 years old because you got in a car accident when you were 22.

A: And not to mention that it probably is gonna impact your quality of life, you're not gonna get the care that you want, the time you want, you're not gonna feel well, it's a whole bad cascade.

H: It's not good, why can't we just like never get hurt?

A: That would be one solution,  we could also just have a better healthcare system, that would be another one.

H: So to wrap it up, is there anything that you wish you'd known when you were just- now you know everything. When you're just going out getting your first health care.

A: It's ironic you say now I know everything, because the more I learned the more I realize we don't know anything, and I think it's
almost that I wish I'd known how much doctors were guessing and how much leeway there is, and so many of the things that we do to to sort of choose your own adventure, like choose your path. It's not like you must do this and this and this and thi,s and that's how I felt
medicine was.  And a lot of it is, you know, finding a doctor who will
explore the options with you so that you can make the best decision for you. 

H: Aaron thank you for hanging out. This is a book that you wrote.
A: Yes!
H: This isn't what it will eventually look like, this is a galley just for me.
H: It'll be hard back but I think the art will be the same, it'll be hard back.
H: Nice you can check out what Aaron's doing at, really great, one of my favorite channels on YouTube, you do fantastic stuff.

A: Thank you, appreciate that. 

H: Thanks for joining us on How to Adult, we're at, thanks for watching.

[End screen]

A: Oh my god I got the new Millennium Falcon, the Lego Millennium Falcon.
H: Oh the big one? 
A: Yeah.
H: If I had a son who had a manual dexterity...
A: It comes later.
H: Should I just get it and keep it in the basement until...
A: You know you almost need you cuz they're gonna- they run out, no cuz they stop so I have a number of the big sets, but last year we got- or I got I guess, but it's the Disney Castle and that was awesome. That took us a couple months.

A: You look like Nixon when you're doing that.


H: The Bad Food Bible, physician and popular New York Times contributor Aaron Carol-
A: I did not write that.
H: mines the latest evidence to show that many 'bad' ingredients actually aren't unhealthy and in some cases are essential to our well-being. Was it all untrue? Just about you being popular?
A: They-they- there you go, yes.