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Amanda: Hey guys. Welcome back to the podcast. We are excited because today we have another podcaster with us. Dr. Bradley Block is joining us today to talk about, in his own words, everything we should have been learning when we were memorizing Krebs Cycle. He's a board certified otolaryngologist who practices general adult and pediatric otolaryngology in Garden City, New York He's the host of the Physician's Guide to Doctoring podcast. And disclaimer, we are doctors, but we are not your doctor. This is just for educational purposes only because we get just slightly a little bit into medicine at the very end of this. You need to talk to your doctor before starting any treatment.
Laura: Welcome to the podcast. We're so excited to have you with us.
Bradley: Thank you so much for having me. I'm, I've been looking forward to this.
Laura: Awesome. Well, can you tell our audience just a little bit about who you are, your background, training, family, whatever you'd like to share with us about you?
Bradley: Yeah, so I'm a private practice otolaryngologist on Long Island, which is where I'm from. You know, I, I left for college and medical school and residency, but ended up making my way back home to New York and eventually moved out to Long Island, but that's where I've been in practice for the last 12 years.
I'm at practice is called ENT and Allergy Associates. We're the biggest ENT practice in the country. We have both ENTs and allergists. And there are, as of now, like 250 of us between New York and New Jersey. So we're a big monster practice, and , I'm a partner there and I love it.
I love the practice. I wasn't so great at it. I wasn't so great at like, seeing lots of patients and hour. I just didn't know how my partners were able to do it and have it be fulfilling for the doctor and the patient. That's where the podcast was born out of. You know, like, social engineering is sometimes the term that's used.
I think now it's more used to talk to people and find out their passwords from talking to them. I think that's when you Google social engineering. Yeah. But it could also be like engineering a social interaction. And so I initially looked into that and who's talking about that. And it was like dating coaches and sales coaches and there was a lot out there that could help doctors engage better with their patients.
And so I looked at it. And I started back in 2018. I'm like an old podcaster at this point, and you know, decided that I was gonna get those experts in front of me to help me be a better doctor. And as it turns out, it helped me be a better human.
Laura: So, what are some of the key things that you learned from, say, a social engineering perspective that helped you in your practice of otolaryngology?
Bradley: So it's a lot of just that, the doctor-patient interaction. Right? And so that's what, that's not all that I cover on the podcast. I cover, you know, my tagline is everything we should have been learning while we were memorizing Krebs cycle. So I get into like health policy and personal finance , and med mal, and all this other stuff. But, but the stuff that I'm, you know, the most passionate about is really that doctor-patient interaction. And so a lot of times, you know, some of the, some of the things that I've gotten better at are figuring out what the patient's really here for. Right?
And I'm sure that happens to you in the, in the emergency department all the time where like the patient says they have a sore throat, but really what they're worried about is they have throat cancer, right? Maybe they don't go to the emergency department. Maybe they're worried that like they're having an anaphylactic reaction.
They're like, my throat's itchy. And you're like, really? You came to the ER cuz your throat's itchy. But really they're like, I think I might be dying of an anaphylactic reaction. And then you can be like, you're not. And they'll stay there forever, perseverating on their itchy throat. And you're like, they're like, you're not paying attention to me.
You're not listening to me. And you're like, I did, you said your throat was itchy. But really what's in their mind is like, I need this doctor to reassure me that I'm not having an anaphylactic reaction. Right. Maybe they're having like oral allergy syndrome where it's just like when you bite into an apple and your, your brain thinks that you just bit into like pollen, and so your mouth is getting all itchy.
You're never gonna die from that. But they don't know that. And so like, you know, I call it the question behind the question, getting at the question behind the question, like, why? What worries you about this? And that helps the patient find the visit more fulfilling, and it also helps you be more efficient and move through more patients to be able to help more patients more efficiently. So that's one example.
Another, another thing that I've learned from my podcast is just how to be, how to use humor? And I think we all kind of have our shtick, right? We have their, our things that we say to patients over and over. And I think we're kinda like standup comedians in that regard, right?
Nobody's gonna go on their Netflix special using material they've never used before. They go to like comedy clubs, and they try, and they see what hits, and they see what fails. And, and that happens with us too. Like you try and make a joke, and it's just, it's just not funny. If you make another joke and like they think it's hilarious, so you use it again and again and again.
It, it becomes part of your shtick. And so like using humor, but there are some rules for humor. I actually, I don't know how I managed to do it, but I got Scott Dickers. He founded The Onion, like The Onion.
Laura: Wow.
Bradley: And he
Laura: That's awesome.
Bradley: He was on my podcast talking about how to be funny cuz he had written a book called How to Be Funny, which then had a sequel, How to Be Funnier, and threequel, how to Be Funniest, A Trilogy. So his, his rule, and, you know, I'm sure everybody who listens, knows William Flanary, Dr. Glaucomflecken. He's like amazing at this, that you never punch down, right?
You never punch down. And the way that Scott Dickers put it was: the, the goal, the purpose of comedy should be comfort the afflicted and afflict the comfortable. So you can poke fun at people in positions of power. You can poke fun at the power structures. Anyone who's in, who's comfortable, you can poke fun at them. But those who are afflicted, the patients, right, they can never be the punchline. You can never make fun of them. Like, Hey Doc, is this gonna hurt? Well, it's not gonna hurt me. No. You're making fun of the fact that they're, they're nervous about being uncomfortable. Mm-hmm. That's not okay. So, you know, when, when you guys had me on your podcast, and you've talked about on your show a lot is boundaries.
Like, where do you draw this line? That is the line. You don't cross that line. And so anything that's not. You can, you can try it. And if it's not funny, you know, there's an easy save. Oh. I'll stick to my day job. I guess I won't take up comedy, you know? And then you move on.
Amanda: Yeah. So nice transition is, you've had some amazing guests on your show, a wide variety of guests. Who were, what were some of your favorite episodes? Who were some of your favorite guests?
Bradley: So one of my favorite guests, actually, you guys mentioned on your show. You talked about the book Tiny Habits. So I had BJ Fogg on my show, and I couldn't believe that he replied to my email and he was like, interested. And we did like, like this really long episode that we had to split into two where we talked about habits.
Cuz that's something that we, you know, we talk to patients about patients about that all the time. Like, oh, you should eat better, you should move more. Yeah, we. They know, they just don't know how. Right? So if you're giving patients advice, and we hear this all the time, like it gets under my skin, like, oh, doctors are just like pushing pills on people.
They're not trying to help them get at the underlying, yes we are. We're telling patients all the time that they should eat better and move more. We just don't know how to get them to execute on it. And like nobody knows. Except for those who research habits. And so it was a great episode. And you know, there are a few big takeaways there that you're, you know, one of them being like, you're only gonna do things you want to do.
You're only gonna eat things you want to eat. You're not gonna become a runner if you hate running. So find something else. And then the hard part is like getting it into your schedule. And he's got this whole formula for it, like B equals PV equals NRT. Okay. Not that, but something like that, that like getting people over the action line to actually do the things that they want to do.
And so that was one of my favorite episodes because it, it gave me the tools to actually be better at helping my patients. When they came in with, you know, their weight was a problem, contributing to their asthma, their weight was a problem contributing to their sleep apnea. You know, like they're not taking their medications regularly.
What are the things that, that I can do to help them? And then another episode was when, when I was early on in podcasting, I realized the power of podcasting. Cause at the beginning it was really like people that were in my social circle, or like friends of friends that I had. Because you know, you all went to medical school, you all did residencies.
You have lots of friends who are like experts in their fields. And so you just call up one of your friends and be like, I wanna talk about this. So I did it at the very beginning and one of the first times I reached out to a stranger. There was a Huffington Post article about how bad physicians are about talking to patients about their weight.
And so I pushed back. I, I emailed one of the psychologists that was, that was quoted and I said, Hey, I've got this podcast. Teach us how. You, you know, this whole article saying, we're bad at it. How can we be better at it? What can we do? So we did, and then like we did an episode, and then a couple years later we did a, a follow-up episode, and now I'm, I'm better at that.
You know, let me know how triggering it was for patients, how we can bring it up, how we can talk about it, how we definitely shouldn't be talking about it. And even as an otolaryngologist, like, these are conversations that are really important. And these conversations are very triggering for patients, and you can really alienate them from the healthcare system.
So I know you're trying to help them, but like it's really hard to navigate that and do it well. So, you know, some of these episodes have really given me and hopefully my listeners, some great tools for, for navigating some of these things.
Amanda: Okay. I'm teeing those up next. I saw those on the, on the list. I'm gonna listen to those next. What are some of, you've had a lot of coaches on, you've had a lot of people discussing physician wellbeing, health, you know, how we take care of ourselves, finishing, charting all of the things that matter to our lives. You've interviewed so many, so what are some of the more important lessons on physician wellbeing that you've learned from your years of podcasting that you think we should all know?
Bradley: One was, one was pretty recently and it was, actually it's a theme that's coming up a couple of times. And it's just sitting down and establishing what's important to you and what your values are . What are, what is important to you, and then making sure that your decisions are consistent with those values, right?
Because we're making decisions all the time. And you guys talk about that on your show a lot. Where you know, should I take on this extra responsibility? Should I quit this other responsibility? What direction should I be taking my career in? Should I be spending more time, less time at work and more time with my kids?
I mean, the obvious answer to that is always gonna be yes. But at the same time, like you're also modeling for your children. And so do you want them to see that, like, you know, once you're done with work at like whatever hour, you're home and you're only home and you don't have this other stuff going on, right?
So what are your values and then how do you...guess that was another one that, it hasn't come out yet, but I have a couple episodes on parenting, parenting for physicians. And, and a big theme that came up over and over again was, was that modeling. And so that's just, just at the very basic level, knowing what's important to you and making sure you're living your life consistent with that.
I mean, you brought up charting, I had two episodes on charting, and they're two of my most downloaded ones. And it's freaking charting. I mean, how boring to talk about charting, and yet everyone wants to hear about charting. So I think it bears mentioning that. I can, I can summarize it. Those two episodes pretty quickly. So it is when you're done with your patient, finish that chart. And granted, it's much easier said than done. And now, even now, I don't do it. But this whole idea of that, like, I've got all these patients waiting, so I stop, charting so I can move on to the next patient and then I'll save it to the end of the day.
We shouldn't be doing it, for a bunch of reasons. You should be doing it as soon as, as soon as you're done with the patient. One, it closes out them mentally. So they're closed out mentally, so now you have more cognitive bandwidth to deal with the patient that's in front of you. Two, you're not gonna remember things as well.
And three, and this is the biggest one. This work, it's like a gas. It's gonna fill the space it's given. And so if you finish your day, and now you've got seemingly limitless time to finish your charts, it's gonna take you limitless time. So a chart that would've taken you one, two, maybe three minutes because it's fresh in your mind. And you've got these other patients breathing down your neck, so you know you're gonna blow through it, right?
And finish it quickly. That pressure evaporates. And so now it's gonna take you five or 10 minutes to finish that chart, cuz at least me, I'm gonna screw around on social media. Like, I'm not gonna, I'm not gonna get it done. And so those couple of principles, you know, if you can, you can apply them. Fine. It's not gonna help you every single chart, every single time, but it's helped me get home on time so much more often. So much more often. Those patients that you assume are gonna be angry cuz they had to wait another two minutes, like it's another two minutes. Finish the stinking chart.
Amanda: Love it.
Laura: That's awesome. Yes. Such good information.
Bradley: Do you want me to say anything else about physician wellbeing?
Amanda: Yeah!
Bradley: Okay. So two of my favorite guests who have actually come back on my show as, as guest hosts. Each of them has written a book. One of them, she's still a resident. Jordyn Feingold is a, is a psychiatry resident. I think she's at Mount Sinai. And then Sanj Katyal's a radiologist. And both of them have masters in positive psychology. So, you know, in all their training and all their free time, they got masters in positive psychology.
And so they have all these different practices. And one of the things that I've used in my life, is negative visualization. And it seems like in theory it would be awful. Like imagine yourself living without. So I'll be with my kids, and I'll have trouble with bedtime. Cuz I, you know, my kids are still little, and so bedtime still takes forever. And so sometimes that negative visualization when I'm like, oh, just get to bed. Like, I've got so much stuff I need to do. Like, okay, you know what, in a couple of years, they're not gonna need me. They're not gonna want schmoozes anymore.
They're not gonna want me to sing to them. Like that stuff's all gonna be over, and I'm gonna miss it. So, you know, it helps me, that negative visualization. Just like eventually they're gonna be older and I'm gonna miss this.
So negative visualization is a tool that I've found very useful in order to kind of rewire the way I'm thinking about different situations. I mean, this is, that's kind of like the penultimate example, but it certainly happened also in my practice. You know, when you're busy. Oh. But there was a time when we weren't busy, and we were not making much money and, you know, we were having trouble paying the bills.
So for all those interested in joining my practice, that that doesn't happen. But, you know, like if there's a financial crisis, or there's a pandemic, like this stuff happens. So, you know, negative visualization definitely helps you appreciate that stuff more. Definitely has helped my wellbeing.
Amanda: I love it. That's a good one.
Kendra: Awesome. So, at our institution, the ENTs are always frustrated with inappropriate dizziness referrals. At the end of your podcast called Don't Make Vertigo a Dizzying Diagnostic Dilemma, you give an amazing, quick and dirty summary that would probably benefit us all. Care to share?
Bradley: So yes, as you said in the beginning, the episode, you know, the magic of podcasting makes it sound like I'm talking to you listener, and I'm right in your ear. But no, this is not a doctor-patient relationship. This is for the physicians out there to help them better at Physicianing. But yes, I think that at least the way I was taught about the inner ear and dizziness was not great, right?
We had to memorize otoliths and canaliths and saccules and utricles and blah, blah, blah. But that doesn't help me, and it doesn't help me explain anything to the patients. But ultimately, the inner ear, the semicircular canals are all about rotational information, rotational acceleration, but not anything else. Right?
So the utricle and saccule will give you a little bit of translational information, you know, like back and forth, like moving in a straight line. But the majority of the information coming from the inner ear is rotational. And so if you're trying to figure out if the patient is having an inner ear problem as the cause of their dizziness. Cuz dizziness is so vague.
Dizziness can be lightheadedness or fogginess or tired or memory problems. I have patients that come in with depression, and they're like, I'm dizzy. That's the way that they're describing it. Right? But vertigo is, is often used incorrectly. Vertigo is just a sensation. It's the illusion of room spinning, and it's often from the inner ear, but it's not always from the inner ear.
But that's vertigo. So vertigo's room spinning. And so you know, if the inner ear is overstimulated, it's gonna tell you that the room is spinning. It's gonna give you the sensation of vertigo. And if it lasts for a couple of seconds, it might be benign paroxysmal positional vertigo. If it's a couple of hours, it might be Meniere's disease or vestibular neuritis. If it's days, then it is vestibular neuritis. Unless it's a non otologic cause, right? If it's like a brainstem stroke right, which you don't wanna miss, then that can give you vertigo as well. So, you know, a very simple way to think about inner ear dysfunction is if it's overfunctioning, it'll make the room spin.
If it's underfunctioning, often there's a sentinel event. There's vestibular neuritis where it spins for hours to days, and then the inner ear is weak. And in its weakness it'll give you this more nebulous dizziness. But ultimately what it is, is it's not giving you the rotational information when it should be.
So when you are turning your head to look over your shoulder to check, you know, if you can change lanes, that'll be a disorienting sensation. And so it's either under functioning, and it's giving you this nebulous feeling of disequilibrium, worse when rotating your head. Or it's over functioning, and it's giving you spinning. And it's one of the two, and it's really nothing else.
Now, on rare occasions, we'll have non-vertigo vertigo where the patient has benign proximal positional vertigo, but they're not actually experiencing the vertigo as you would expect them to. Which is really confusing cuz of the name, right? Like well you have vertigo, but you're not experiencing vertigo.
And I just told you vertigo is a sensation and then not a diagnosis, but I'm still telling you it's right, whatever. I don't think we need to get into the weeds with that. But that's a nice, neat way to think about it. And another thing that's often confused is positional vertigo versus postural dizziness.
Positional vertigo classically happens when you're horizontal. So the patient will be, they'll be lying down, they roll over in bed, the room spins. They bend over forwards, and the room spins. As opposed to: they lie down in bed, and they get up quickly, and they get dizzy. Or they bend over, and they stand up quickly, and they're dizzy, right? That's postural dizziness, which is rarely from the inner ear. That's more like, you know, cardiovascular, like a transient ischemia where it's a head rush. And so the horizontal versus vertical. And really teasing out from the patient, you know, well, it happens when you lie down.
Yeah, it happens when I lie down, you know, I get up to get outta bed. No, no, no, no, no. That's not lying down. You're getting up, you're vertical. So making that distinction with the patient is important.
And I will, I just wanna put one more, I know you didn't ask me about it, but I just wanna put it out there, that facial pain and facial pressure in the sinuses. Nine times outta 10, and this has been well-studied and well-documented. Patient comes in facial pain and pressure. Nine times outta 10. It's a headache. It's usually a variant of a migraine. It's not a sinus infection. One outta 10, it's a sinus infection. The other nine outta 10, they're migraine.
So when the patient comes in and they're like, there's no like prodromal cold symptom. And just like, I woke up this morning and like my face is pounding. And my face feels a little swollen that's usually, Primary Facial Pain, which is often a migraine, and it's not a sinus infection.
Amanda: I love it. These are the things that somebody should tell me, you know? One of the things that I did not realize was vestibular underfunctioning, and when we are throwing benzos and meclizine at somebody who has vestibular under-functioning, we are making it worse.
Bradley: Yeah, vestibular weakness. So they're having their benign paroxysmal positional vertigo episodes and it's almost like they sprinted and then they're like out of breath. So the vestibular system isn't giving them the information that they need, so the patient's still saying they're dizzy, but it's a different dizziness. Because their vestibular system is under functioning, and if you give them meclizine or a benzo, then it suppresses it even further. So when meclizine is helpful is like in Meniere's disease. They're having like hours of episodes of spinning, cuz then you're suppressing the severity of the spinning.
Or. It's useful in seasickness, right? I feel like the description of seasickness can help you conceptualize the vestibular system. Seasickness happens when your eye, what your eyes are seeing and what your ears are feeling are disconjugate. And so if you're like in a cabin of a ship, you're looking at the motionless inside of the cabin, and yet your vestibular system is feeling you rock back and forth. So those two things don't match, and that's what makes you sick. Same thing if you're in the backseat of a car. You're looking at the motionless inside of a car, and yet the car is accelerating and decelerating and acceleration, decelerating.
And so those two things don't match, so they make you sick. It doesn't happen on an airplane for most people. Because when you're on an airplane, you're at constant velocity. So it's not accelerating and decelerating. Once you hit that 500 miles per hour or whatever it is, you're not accelerating or decelerating anymore. So your inner ear isn't picking up on any motion because there's no change in velocity.
Kendra: So many good pearls. And wait, did I hear you say benzos don't cure something? Wait just a minute. I thought benzos cured everything.
Bradley: Everything!
Kendra: Everything. At least they do in the ER. Okay. So thank you Dr. Block. How do people contact you to learn more about you?
Bradley: So I'm @PhysiciansGuide on Twitter and on Instagram, and I've been told I need to get on TikTok. I don't know. I'm Gen X, like, I don't know. And then I'm at LinkedIn. On LinkedIn. You can look me up. Bradley B Block, my middle initial is B as well. And then my website is physiciansguidetodoctoring.com.
And then you can find Physicians Guide to Doctoring, you know, wherever fine books are sold at like every podcast outlet. I was on YouTube, I'll probably be back putting episodes on YouTube again soon. Just make it convenient for listeners to you know, find it everywhere. And so check me out.
Kendra: Awesome. Thank you so much Dr. Block, for being on our show today and so many good pearls. Actually, our mind has been blown over and over again. But anyways, we're excited to have you on. Also, if you wanna claim CME for listening to this episode, scroll down to the bottom of the show notes and click the link. So until next time, you are whole. You are a gift to medicine, and the work you do matters.
