An ER Doctor's Warning On Grill Brushes, Trampolines, & Unvaxxed Kids | Dr. Beachgem

I fell in love with pediatrics

because um kids get better.

>> You just don't always see that with

>> She's on the front lines non-stop in the

>> What drove you to specifically

the emergency portion of it? >> I have ADHD.

>> So, you quick moving? >> Quick moving.

>> I never even dreamed of making content.

This entire thing was just a complete

>> What makes you good at this? >> I don't know.

One of the most interesting cases that I have had to >> What's the scariest

thing that can happen in a barbecue?

Do not use grill brushes with metal wires.

I have another related story. This is rough.

I don't know if we can handle this.

>> This is a medical podcast, so this is

>> There's a kid that's eating a sandwich from a local joint.

He suddenly starts to like cry and complain that his throat hurts like something

is sticking in his throat.

So, they took him to the O and they did a scope.

Are you ready for this? >> Okay.

Is it a toothpick?

>> Welcome back to the Checkup Podcast where on this episode I'm interviewing Dr. Dr.

Beach Gem, the pediatric

ER physician who has blown up online for her authentic self

and informative videos about health and hurricanes. That's right, Dr.

Beach Gem has not only had to treat patients in the ER

during natural disasters in Florida, but done so after paddle boarding out of her own flooded house.

She's truly one of the most genuine voices in healthcare online.

and I was thrilled to dive in deep with her on the reality of

treating unvaxed kids, which toys actually send kids to the ER, and the horrifying

things her patients have found in their sandwiches.

Let's get to it.

And huge thanks to Microsoft Dragon Copilot

for sponsoring this video.

Practicing pediatric medicine is really hard.

It's true or >> Um, true.

I But I think medicine in general is hard.

I personally prefer pediatrics

to adult medicine, honestly. >> Interesting. Why?

Uh uh the kids are just better.

Sorry, no offense, but >> yeah, you don't ever feel that when you have a

pediatric patient, you also have multiple patients with the parents.

>> Oh yeah, you do.

You definitely have like multiple multiple.

>> But I think that the the

thing that's different is that everyone's goal it's the same.

>> Everyone's goal is to get the kid feeling better,

>> And so like I don't really to me it doesn't feel like multiple patients

because like the goal for everyone there is to do the same thing.

It's like let's get you better.

you never have the struggle because something that I've experienced

is I'm treating the child

maybe not in the ER maybe as an outpatient

and the parents have different expectations

of what they believe should be done

>> based on something they've read online

sometimes based on misinformation.

How do you handle that?

I think it is really important, especially in the emergency department,

to set expectations early in the visit.

And sometimes you can tell when there's they have they come in with certain

expectations, whether they're verbal about it or whether you can kind of tell by

the way that they're asking questions or talking.

Um, in the emergency center, like we don't

order a lot of like, you know, send out genetic tests and we don't

do certain we don't do routine MRIs, right, for example.

And um I've had patients come in that say, you know, I need an

MRI of my knee.

I think I have a, you know, a miniscus tear or something like that.

And that's just not something that we do in the ER.

We don't have access to

an MRI table that's being used for all of those outpatient

studies that are maybe sedated.

And so, I think it's really important to walk in the room,

you know, have the conversation,

listen to what the patient's saying, and sometimes we have to set expectations.

I'm not going to be able to do an MRI for you today.

Let's talk about I can get you outpatient ortho setup.

I can get you some pain control, some crutches.

What else can I do for you?

that, you know, an MRI is not something that we're going to be able to manage.

So, setting expectations early in the visit is so important before we get down

the down the road or, you know, whatever.

Um, just talking about what I'm able to do and what I'm not able to do.

>> Yeah, that requires a very high level communication skill set.

Is that what having that drove you to falling in love with pediatrics?

>> I fell in love with pediatrics

because um kids get better

>> and that's something that I noticed usually quickly too. >> Quickly, right?

so resilient like you know we see like kids in really bad accidents and

they have a full recovery and

um you just don't always see that with adults

I think a lot of the conditions are more chronic and when they are

injured a lot of times they carry those

um limitations with them for the rest of their life so kids get better

it's so fun to watch them get better too and they're fun I color

I blow bubbles on shift

like we have we have a blast

um and so I think like I can play

we have a facility dog

um and uh the kids are going to get better most of the time.

Kids get better and so I think that there's

that aspect of it that we don't see in adult medicine all the time. >> Mhm.

And what drove you to specifically the emergency portion of it? >> I have ADHD.

>> So you quick moving. >> Quick moving. Okay. >> All right.

So I had a couple

qualifications for a job.

I wanted to wear scrubs.

I was like I will not be dressing up the rest of my life.

>> Um I didn't want a round.

>> I was so bored on rounds in residency. I struggled.

Um, and then I just needed something procedure-based

and quick moving and ER hit all those buckets.

>> In moving quickly, do you feel like

you're able to process

your emotions, your attention,

hyperactivity symptoms a bit easier?

Is that part of the treatment that you uh have found that works well for you?

>> Yeah, I think so.

I, you know, the emotions most

there's not many times that I have emotions that I need to process.

A lot of times it's the, you know, the bigger cases, the stronger ones,

a bad diagnosis, but

so much of pediatrics

is not that, you know, pediatric ER.

Um, we do a lot of like the breadandbut

type of pediatric stuff, mostly Genpede stuff.

Um, so but the quick moving,

it just it fits with the ADHD

and I I don't even I don't even have to medicate most of the

time just because there's so much adrenaline in the ER.

>> And what is your shift schedule look like?

Are you working every day,

three shifts a week?

What's the general >> flip a coin?

I might be working that day.

Like there is no consistency to my schedule. It's completely inconsistent.

Um I work on average

uh 12 or 13 shifts a month.

>> Um and then I work anywhere from early shifts to late shifts to overnights

to the urgent care section.

Um and it I could work 13 days in a row or I could

work every other day. It's completely >> Yeah.

Do you work for a hospital system or are you subcontracted

by an employee group?

Like >> I work I basically work for the hospital. Okay.

It's like a separate hospital employee.

No, hospital-owned separate physician group. Got it. Okay.

So, but it's the hospital.

>> How do you feel the world that exists in our health care system

that staffs ER physicians?

Do you think overall it's moving in the right direction, wrong direction, or are

you pretty neutral about it?

Um, you know, I

since I do pediatric emergency medicine and I'm in my cute little bubble,

um, I feel comfortable, but I know that a lot of the,

um, emergency care in

the US that's owned by these groups,

um, I'm concerned about the level of care that they're able to provide, the

people providing the care.

Um, and that it's really for profit.

like instead of, you know, focusing on doing the best care for the patient,

we're focusing on making the most profit.

Um, and we're focusing on some of the check boxes as well.

But again, I think like we really just need to get back to

focusing on the care, which is luckily what I'm able to do in my

hospital, which is academic based.

I'm able to take the time I need for my patients.

I'm not worried about productivity.

Um, I'm able to do what I need to do.

But, uh, from a lot of my ER colleagues,

you know, they're struggling with some of the ownership of these >> Sure.

Do you have residents? >> We do.

We have residents and fellows and >> Yeah. What's that like?

Uh how do you feel uh in the ER with residents about >> Yeah.

I really enjoy working night shifts with the residents

because I feel like the night shifts actually give me more time to like

teach, sit down, like go over some some stuff,

go in with them, you know, examine the patient together.

on like a day shift.

I feel like sometimes we're so busy and we have like all these learners

around and it's harder to like sit down and like teach about something, right?

Just because I know I've got 12 more patients left to see.

But for some reason, you know, the nights seem the flow goes a little bit better.

But I really enjoy teaching

>> Um, you know, bringing up the next

>> next group of our, you know, colleagues. >> Sure.

Uh, has anything surprised you about this generation of residents physicians?

You know, I it's that,

you know, I walked uphill

both ways to get to residency

and I worked 36-hour

calls, you know, all three years, and I had four days off a month.

It wasn't even four entire days.

It was four 24-hour periods.

I could get off a 36-hour

shift at 6 a.m.

and have to be back the next day at 6 a.m.

That's not a day off.

>> Um but at the same time,

um I got really sick

when I was in residency. I got septic.

I got RSV and I was working night shift

>> and I had a a 10 or 11 monthth old baby at home and

I kept telling them I was like I just don't feel good.

I feel like I need to go home and like rest and they're like you're fine.

You're still here and for like your motivating

really for three or four days I just was like I just feel really

really bad and then the next day when I was supposed to go into

work I could not like I physically could not.

I went to the ER my blood pressure was in the tank.

I got started on um pressers.

I got a central line. Wow. >> Yeah.

I got some Norepy

uh pumping through my veins and

you know got my blood pressure up enough. It was good.

And but my chief resident was like I just want you to know that

we have to call in backup

coverage for you now.

>> Like there was like a total guilt trip about it.

And so >> part of me like I walked up both hill both ways to

get to work and but at the same time when a resident's like I'm

just not feeling good.

I'm like go home. >> Yeah. Yeah.

>> Like let's not like if you're running to the bathroom every five minutes go home.

>> We can handle it.

you know, I it's really important for you to take care of yourself and

not end up in an ER bed like I did.

So, you know, there's that like,

you know, I want

I see what I did and I'm,

you know, frustrated that they're not suffering like I had to suffer, but I

also don't want them to suffer.

I want them to be able to learn in a safe environment.

So, >> it's like one of those uh typical pendulum swinging

potentially too far the other way where

maybe during your time of training they were like, "We don't care if you're dying literally, >> right?"

But now it's, oh, you know, today I feel like I need a a

a tired day and I'm not going to come in.

So maybe there's something in between. Yeah.

Where we can be reasonable and rational.

>> I remember when they switched some of the duty hour requirements

and we were so worried about handoffs

and all these errors and stuff that were going to happen with handoffs.

And I'll be honest, like we just didn't end up seeing it and it

ended up, you know, I think the interns had had to work like six

days in a row and no overnights or something when they were doing some sort of shift.

But it ended up being okay and we were able to make it happen.

So I I know that there is like good things are happening and we're

keeping our residents safer, but

at the same time like

need to make sure that they're trained well enough. >> Yeah.

And you were in Buffalo at the

>> I did my fellowship in Buffalo. >> Okay.

So where was this uh training program where you had your

>> It was in Florida. >> Okay.

So it was in Florida. >> Was in Florida.

>> Um and how does the difference in training between the two states feel to you?

Is there any specific

geographic differences or not really?

>> Um, you know, geographically

like we saw definitely different pathology. Oh, really? In Buffalo.

Um, we saw we had a very large Amish population that we pulled from. >> Oh.

Uh, President Trump told me that they're really healthy. So, >> yeah.

Um, you know, when it's the same thing, you know, for adult docs when

a farmer comes into the ER, it's the same thing when >> organo phosphate poison.

>> Well, it's like when a farmer comes in willingly to the ER, like they're

really sick or like a rancher.

um when an a kiddo that's an Amish kid comes into the department

a you know we get really concerned about underlying genetic stuff

metabolic um just because of the the genetics there but also like this kid

is really sick >> regardless of how they look right now this kid is really

sick if the family is willing to get them here

>> we need to we need to be on our best because

this kid is not well

>> um they're self-pay they don't have insurance

and so the community has to get together and make sure that they can

fund the trip um and they the group that we worked with didn't fly

in helicopters um for some religious reasons.

And so um we would have to transport them long distances

um from outside hospitals.

>> Don't say by horse and carriage.

>> Um no, we we would trans we would they would usually go to an

outside ER and then we would

um go and get them as a a transport team.

And I got to ride with the transport team a lot which was cool.

>> Um kind of getting some experience in inner facility transports. Mhm.

And were those patients having

higher risk for vaccinereventable illnesses?

>> Um we definitely saw we definitely saw

>> protis, whooping cough, bacteria, mostly like numacco. >> Oh yeah.

>> mostly that uh there were also just a lot of like environmental

type injuries like uh

a car runs into a horse and carriage.

Uh we saw that unfortunately quite a bit.

And then farming uh equipment related injuries as well, orthopedic type stuff.

>> What about when it snows like a hundred inches in Buffalo? What happens then?

>> Oh, you still go to work.

>> You still go to work.

>> You don't have a snowmobile.

I know you got four-wheel drive cars. >> We did.

We did have to buy new cars.

So, when we went to Buffalo cuz my Honda Civic was not a four-wheel drive.

Um, but it was uh there were some days that it was really we

had some lake effect snow happening and it was,

you know, I got to the hospital and I just

>> Uh, it wasn't safe to go home. Were there spikes?

I mean, perhaps in the pediatric ER, you wouldn't have seen it, but were

you seeing from your colleagues on the adult side heart attacks when it did

when it did snow?

That typical shoveling snow exerting yourself? >> We did.

And I was on So, we have to as a pediatric ER, we have

to do some adult medicine.

And so, I was working at the kind of cardiology

hospital um when we had a big snowstorm

in like November of 2014.

And uh they're like I made some joke about like, oh, at least nobody's going

to be coming in because of all the snow.

And they're like, "No,

everyone with the heart attacks, like they're going to be really sick people that come in."

I was like, "Oh, okay. I didn't know. I'm sorry."

>> They were really serious about it.

And uh we did.

We saw a ton of um angina, chest pain, heart attacks,

um some really not great stuff that shift.

>> When does uh I know it's different group to group, practitioner to practitioner.

What is the cuto off for when you should no longer be seeing a

pediatric >> That's a great question.

Um, in general, most pediatric

facilities are either 18 or 21.

>> So, our hospital goes up to we see patients until they turn 21.

Um, there are some exceptions

for certain patients on, you know,

if they have congenital heart disease or if they have, you know, a certain

type of cancer that's already been managed, but for the most part under 21

years of age, happy to see anybody.

Um, that being said, if you have an adult problem

and you're 20, you I mean, you know, 18 and up, you can go

to an adult facility as well.

that there's some crossover and care >> Makes sense.

>> Um, in uh working in Buffalo,

did you become a huge NFL fan?

>> I was already I'm a big football fan in general.

I started uh fantasy football when I was in medical school. Okay.

And I win a lot,

but um I didn't win this year, but I was

>> Um I I did become a big-time Buffalo fan.

Like the Bucks have struggled

for many years uh you know, up until that point.

And then we got to be Bills fans and also enjoyed the struggle.

>> Um and >> now it's uh it's feeling better these

>> It is like the Bucks, you know, they had some Super Bowls there and

then the Bills have had some great seasons.

You know, I'm still waiting.

>> Maybe you're the good luck charm.

>> I'm still waiting for

a Super Bowl win as a Buffalo fan, but

um they're Josh Allen's just a rock star.

Their whole team I just I love. >> Yeah, for sure.

Um, when you're working in the pediatric

ER, uh, are there certain cases that you get excited

about treating and teaching about,

uh, what gets you like really amped up?

>> I, you know, it's, it sounds silly, but I think everyone loves a good nursemaid's elbow.

>> Um, so nursemaid's elbow is the

radius, uh, gets pulled out of the little cartilage ring, and we just do

this little maneuver to help get it back in.

But the kids look like they have a broken arm.

They're acting like they have a broken arm and I don't even need to do an X-ray.

I can just They cry for a second.

I come back in five minutes with a popsicle and they're waving it all

around and you know the parents think I'm a magician.

Um so it's this really cool feeling like I'm fixing them. Everyone's happy.

I didn't have to do any radiation or hurt the kid.

You know, no IVs.

And so I think everyone

loves a good nursemaid's elbow in our department.

And I love teaching them too because there's different ways to do it.

And I usually have to grab someone.

I I don't want to hog them all.

So I usually grab like a resident or a student.

have you done one before?

Let me show you.

And kind of demonstrate it on them and then let them do it on the kiddo. And it's cool. >> Yeah.

What about uh I know you're passionate about disaster medicine.

Tell me about your passion for that. How'd that happen? >> Yeah.

I don't really know how it happened.

I just I think I fell into the drama of,

you know, getting ready for a disaster and

um obviously we have a lot of hurricanes in Florida and that kind of

falls into it as well.

Um, but I I think it is so important

um that we're prepared to take care of kids in disasters because a lot

of hospitals have disaster plans that just don't include kids. Wow.

>> Kids are what a fifth of the population

>> an afterthought in these things.

>> An afterthought in a lot of these things and a lot of hospitals may

or may not have the equipment ready.

Um so there's like initiatives of like pediatric readiness.

Um we've got our centers for excellence like

um the Gulf 7 and RAPOM

um and region five that are just groups that are focused on pediatric readiness.

And so um I've kind of started working with some of the different groups

and um just trying to push readiness in our communities and then making sure

that you know our our hospital specifically is ready.

Um there was a couple years ago it was actually right after UVA day.

It was like two days after UVA day.

We got a call that said there was a

active shooter in one of the middle schools

and I had two kids in middle school at that time and I

you know >> It was and I you know I

immediately messaged them which is probably not the right thing to do and then

just started setting everything up just in case and they ended up it was

a prank and there wasn't really anything.

Um, but just making sure

that we have everything we need, the people, the staff, the stuff,

um, the equipment, the space,

um, to do to take care of all the kids that we need to

because there's going to be problems in disaster.

You're not going to have all the resources that you need.

That's just the way it works. >> Yeah.

And speaking of weather related

>> you've had one of your own.

Uh, care to share that story? >> Uh, yeah.

Uh, it's I've actually had several of my own, unfortunately.

Um, so we live in a pretty floodprone

area when we bought our house.

We bought it without seeing it

>> um because we were living in Buffalo and and moving down and uh turns

out it's um pretty lowlying.

So we had a small flood in 2020 with tropical storm Ada.

Uh we got decent flooded with Adalia

in 2023 and then

um with Helen this um

2024 we had about four feet of storm surge flood our whole house and

it just you know three floods in 5 years it was like we have

to we got to figure something out. >> Yeah.

So what's the solution?

What what does one do when you just repeatedly get >> Yeah.

So the first two times we kind of just put it back together and

we were trying to find ways to fix it but we ended up raising

it up 12 feet in the air.

Um there's a rule in our area because our flood insurance is backed by

FEMA because no one wants to give us flood insurance, which makes sense.

>> Um that if you sustain more than 49%

of the damage of the value of your home, you can't rebuild.

>> So it we weren't able to get permits to rebuild.

So you either have to tear it down or raise it up to be

compliant with the flood code,

>> the most recent flood code.

So we tore uh we raised it up 12 feet.

Um obviously the whole inside has to be >> How does one lift a home?

>> That's a great question.

Uh it's really cool.

It takes time, but you know, they kind of like dig out underneath these

like trenches and then they put these big metal beams,

you know, going, you know, side to side and then back and forth.

And then they literally just put jacks underneath

>> and they just slowly >> Yeah.

like in a foot at a time

>> And they use these um like called railroad ties, but there's another name for them.

And you just kind of stick them underneath the house as you're going up

and then you move the jacks and it's just it's crazy just to watch it.

They do it all in one day.

>> So is your house sitting on four beams basically?

Um, there's more beams underneath.

There's like, I don't know, 12 or 16 of them

>> because I I saw

I forgot what it was on National Geographic or Discovery where they show how

skyscrapers here in New York City.

They're just basically dug

poles really deep into the ground.

And the building itself is not super deep.

It's just these poles

that are super deep.

And I'm like, "Oh my god, this is super scary."

If you think about it when you're in one of these buildings, I mean,

like we are right now. >> it's crazy.

They do have to do soil testing ahead of time because they do put

these big posts or beams in the ground to like

keep the house up and not >> do they have to like drain the water

>> cuz there's wells I'm sure that are like

pockets of water and stuff.

>> So the problem in in Florida we you know you basically live at sea

level if you dig six inches like the water the water table's right there

and so um you kind of have to like

pump the water out of the trenches when you're digging down.

Um, but there's most of us don't have wells,

especially on the coast. Got it.

>> Just because you're >> It's ocean water.

>> And that's actually part of how you got your social media

stardom, sharing these intimate stories of what it's like going >> repeated flooded episodes.

How did the audience connect with that?

What did Why did you actually even make the choice to share that?

Because I know when doctors get on social media, they're like, I'm going to

share information, but not what I'm going through personally.

So that there's a layer of separation there.

>> What's that decision like?

>> I started social media with

co >> um and talking about like the science and the misinformation

and I the comments that I was getting was I trust you.

You feel very authentic.

>> Um and I continued to make content and just you know I was at

home and my kids were just running around and I did include my kids

in some of the initial content just because like they were there and every

you know where are we going?

We're sitting on our butts at home.

Um, and so I just kind of shared,

you know, a little bit of that.

And I think when people get to know you a little bit as a

person, they trust you more rather than I'm a doctor, I'm a talking head,

I'm just talking about this.

They know me a little bit more.

They feel like they can trust me a little bit more.

>> Um, and then I've gotten little bumps here and there from different things.

Like there was a grill brush video I made a couple years ago that

went that went pretty big viral.

I think I doubled my following like almost overnight.

What's the scariest thing that can happen in a barbecue?

>> Metal wire grill brushes.

>> Um, if you use those to clean the grill, there's these little

pieces of the brush that can break off and get into the burger or

the food, whatever you're cooking.

And if you swallow it, it can end up kind of anywhere from

your lips, your tongue, all the way down.

And uh, we've had some get lodged in tonsils

and in the intestines.

And um, it can cause some pretty bad bad problems.

And that's probably not top of mind when people are coming in with an

obscure non-specific symptom like belly ache. Yeah.

Oh, I vomited, etc.

So, how do you get there?

Or is it you did some imaging and luckily you found it?

>> Yeah, the patient that we had

um it was kind of

we ended up doing some imaging, but it was the kid had to present

a couple different times.

His complaint was ear pain.

M >> he was and and the family had thought he had gotten stung by

a bee and so they said he got stung by which makes it even

more complicated right and so we kind of maybe a little bit of anchoring

initially on this like idea of he got stung by a bee in his

ear you know we looked

looks fine gave him followup and then he presented back we did a cat

scan of the mastoids

cuz he's complaining of ear pain

no mouth or throat symptoms and the CT of the mastoids was negative

uh and then came back again and then he had started having fevers and

throat pain and so we were able to kind of localize it at that point.

We did a CT with contrast of his neck.

The contrast obviously wouldn't have mattered either way, but we were able to see

it on the neck image.

It was just lodged kind of down in the tonsil a little bit and

referring the pain to the ear, which it's wild.

Um, and in the comments, everyone's like, "You should have cted him the first time."

And I was like, "If you CT every kid with an ear pain

that comes in, but >> that's too easy to say after the fact."

I I've even run into this with, let's say, appendicitis.

Someone comes into an outpatient uh setting. I see them.

They have mild abdominal pain. They're not vomiting. They're non-febrile.

Uh their appetite is starting to improve.

You press on their right lower quadrant. No pain.

They said, "Oh, but my loved one's worried about appendicitis."

I'm like, "Look, I'm not worried about appendicitis

based on these symptoms,

but if XYZ happens, follow up."

And then they develop appendicitis,

it ruptures, and now they're really mad. >> Yeah.

What is the what are you supposed Monday morning quarterback, you know, oh, you

had belly pain, but

you know, we're we're

going with the information and the exam we have at the time. >> Yeah.

I actually have a friend uh who's been on the channel before

uh share a story with me similar to the metal grill brush,

but it was a fishbone.

And you're not going to believe this.

The fishbone was stuck in so long

inside the esophagus, it migrated

out and came out protruding

out of the skin. >> Oh my.

>> So a fish should have formed. >> How?

And I have a picture of it.

I'll show you later. Isn't that wild? >> That's wild.

>> He sent me this picture.

I'm like, "No, you're making this story up." Nope. Absolutely true.

>> I have I have another related story.

So, right after the grill brush happened, this is this is rough.

I don't know if we can handle this.

I haven't talked about it on social media. medical podcast.

So, this is safe.

>> So, um I have to make the video real quick before you post the

>> So, we had this kid come in and it was like 6 months after

the grill brush thing that had happened.

So, there's a kid that's eating

a burger from a local joint or eating something, let's say a sandwich, eating

a sandwich from a local

>> Um and as he's eating the sandwich, he suddenly starts to like cry and

complain that his throat hurts like something is sticking in his throat.

>> And they um they they looked, they couldn't really see anything. They came in.

We looked, we really couldn't see anything, but like we're gonna start with an X-ray.

If it is a metal wire, grill brush.

It wasn't anything that would make sense that it was like >> epidemic of grill brushes.

>> We're like, everyone's like, get the X-ray.

Look for the grill brush wire.

Um, and it and it wasn't there, but we could like you could kind

of see a little something kind of in the paratonsor tissue.

So, we ended up calling ENT

and they're like, we're going to have to scope him cuz he's like kind

of gagging and irritated.

Um, so they took him to the O and they did a scope.

Are you ready for this? >> Okay. Wait, hold on.

Let me get Can we Do we know what sandwich it is?

>> I think it was like

It wasn't something that was >> Okay.

Is it a toothpick?

>> That's So that was what we were thinking. Toothpick.

Um it was like a deli meat sandwich

with some vegetables on it. >> Deli meat sandwich. Sharp object.

>> You're not going to sleep well tonight.

I can >> Oh no.

Is it like a a pig tooth or

>> The leg of a cockroach.

It's got these like little like spikes on the outside.

It's like it's like

>> This whole time I was eating them thinking I was safe. >> Yeah.

>> And it just like the the leg was like just lodged right in the tonsil tissue. >> I know. Like >> cockroach leg.

>> The leg of a cockroach was just embedded in the

>> See, that's that's the first one that I feel is appropriate to call foreign body.

>> When we say metal grill brush, that doesn't that doesn't seem very foreign.

>> This is this >> this is foreign.

>> This is foreign and it was a body part.

those foreign body part.

>> That's like uh Have you seen the book?

It's called like weird ICD10 codes.

>> I I've Googled some. >> Oh, you have?

There's one called Bit by >> Oh god.

>> And I think that's the title of the book.

And I'm like, hold on a second.

Where in what part

of the WH ICD10

classification are orcas biting people that we need to code for? >> Yeah. Yeah.

Like trying to code for like a kid getting hit by a car like

you >> Oh my god. Even those.

And it's like in

>> four-wheel drive sport utility vehicle

>> train like pedestrian struck by a non-tra accident.

Like what are we can we just >> I don't know.

I don't know what the benefit

of getting that I guess for record

keeping but then read the note. I don't know.

>> Yeah, I don't know.

>> Yeah, those are really rough. Wow.

I can't believe you had a foreign body

>> Yeah, it was rough.

It was I again I still don't sleep well at night thinking about it.

Zooming back to residency,

what was because it seems like you bring on unique cases.

Anything unique that happened to you during residency or fellowship that sticks out in your mind?

>> Oh, I had a lot of crazy cases.

Um, I think the probably the best one was a kiddo that presented with

like stroke like symptoms,

>> abnormal speech and weird movements and we were trying to figure everything out.

Um, and we had this really, really smart infectious disease doctor.

And so we did all the imaging and then the kid, I don't remember,

they spiked a fever,

had a rash or something.

Um, they're like, "We need to we need to strip the kid down."

So, you know, we're looking in all the clothes and they start to look

in the hair and there's a tick.

>> There's a tick that was adhered.

So, the kid had like a tick paralysis.

Um, and we took the tick off and the kid had a recovery

like within a couple days

>> I don't even know what tick paralysis is.

Yeah, it you can get bit by a tick and then as long as

the tick is on you, you can continue to have persistent symptoms.

And then you know, obviously kids are weird and they do weird things.

They don't read the book and know what they're supposed to do.

But >> um you know, once you take the tick off, the symptoms can improve.

And so it was just knowing that we had to look for it and

it was >> But he's just he knew like just

>> talking on the talking on the phone.

He was like, "I had an idea."

And he came and he was just like, >> "Oh, was he looking for the

tick or he was just looking?"

>> He was looking for the tick. >> Yeah.

He He didn't tell us he was looking for the tick and you know

and then when he found it he was like there it is. >> Told you. Wow.

>> That's like some house level.

>> Yeah, it was really it was cool. >> Yeah.

Well, speaking of house,

uh are you a fan of any medical dramas?

Obviously besides the pit.

We're going to say that. Yeah, the pit. Yes.

But anything pre- pit? >> Um pit. >> Scrubs.

Scrubs is was incredible.

It was an incredible show.

>> Um I love Grace Anatomy, but more for the drama. >> Right.

Um, >> and now that we're in pit season,

>> obviously we get to hang out at the pit premiere, which was awesome.

That was really cool.

How nice is everyone first of all?

>> Yeah, that was I, you know, you're expecting like I don't know.

I think I was expecting like snoody celebrities,

but everyone was like so cool.

Like Patrick Ball was like, "Oh, hey, hey, I like how are you?"

And I was like, "You don't even know me."

And he's like, "I'm so happy you're here." >> Yeah.

I I have yet

in doing the social media thing for like a decade now,

you're going to some of these things sometimes.

No one has ever been as nice as the crew of the people on the pit. I >> so cool. >> Unbelievable.

Uh actually, >> um when you first watched it, did you watch it already knowing

that this was going to be an accurate show or did you start watching

and go, "Whoa, this is good."

I I don't think

I think I I watched it very early like the first I think only

like one or two episodes had come out so the hype hadn't really started

yet and so I

one person had said I think it's a pretty accurate show like let me

know what you think and so I was like oh go watch it and

then I was like oh this is like

>> you know this is this is

literally what I do every day and there's a couple things you know obviously

for show >> yeah well hit me with the criticism I love to see it

>> because my biggest criticism they don't have a pediatric ER doctor.

That's >> But most places don't. >> Oh, okay. Interesting.

Maybe the pit doesn't have the actual pit. >> Actual pit. Yeah.

>> but still I would love to see the >> Call me. >> Um, yeah.

Uh, so I think,

you know, one of the most obvious is the charting.

I spend quite a bit of my times, you know, sitting at the computer

putting the orders in.

>> But how do you show that on a show without putting the audience to sleep? >> Right.

And that's 100% the reason why they don't

show them sitting and charting.

And they do a little bit here and there, but

you know, makes sense.

>> and I love that they in the first season the administrator

came down and was like, "Oh, you need to improve satis."

I'm like, "So real, so real."

All day >> We have this whole committee that works on it. Yes.

>> Um, I I think that there's there are a couple little things like representation

wise of like the respiratory therapists.

Like we work very closely handinhand with our RTS.

They're helping managing um nibs and

vents and that kind of thing, helping, you know, if I'm intubating, like they're handing me supplies.

So, I think there's a couple like things like respiratory therapy.

Obviously, they had great representation of social work, which I thought was

>> Um child life, it's not a pediatric ER, but I would love to see

like some childlife uh representation

because what they do is so important

and the fact that parents don't know about them, I think, is a criminal. Yeah.

to walk into an ER and be like, "Hey, is there a childlife person

who could help me with, you know, an IV placement in my kiddo?"

So, I showing that I think would

>> would help my heart feel better.

But really, it's it

>> what they do is just so accurate to

what I do on a daily basis. >> Yeah.

The core of it is so realistic and valuable.

Um, do you feel like

because PIT is so

omnipresent in culture, it would actually

have a bigger impact than perhaps

some of our educational

stuff on the general public because it is so

>> of how people relate to doctors or expect to be treated in an ER.

I think it shows like I can tell you all day what what a

day of my life is like and I can do I can do like

a get ready with me but I can't take you along on my day

in the ER where the pit is showing you you know HIPPA compliantly

>> uh what life is like and you're seeing their feelings and you're seeing

you know the different pressures and stressors that they're dealing with.

Um and I think they do it in an entertaining

way that's really fun and and just holds your attention.

Uh I think they and I think they do a really great job at it. >> Yeah.

I'd love to make a call officially on this podcast with you

to get either HBO

or SNL or whoever it is

to put some money behind

shooting one episode or half an episode

with only medical influencers as pit characters.

>> That would be really entertaining.

>> How fun would that be?

>> That would be really fun.

Even if it's just on SNL.

>> Yeah, that's what I'm saying.

Like or if they want to just put it on YouTube to promote the show. Yeah.

That would be >> We all collab post it.

>> Maybe I need just a fun >> I'll throw in. I'll throw in.

>> We got to hit up uh one of the execs, Scott or someone, and

say like, "Hey, can we borrow the set?"

And I know it's ridiculous,

but can we borrow the set?

I know you have Screen Actors Guild rules and all that, but can we

borrow the set >> just after in between seasons? >> Yeah. Yeah, exactly. >> In between seasons.

Since there's going to be a four, I'm assuming.

>> That would be so fun.

>> After season 3, we'll write it. >> Yeah.

after season three is finished filming because I know they haven't even started yet. Then we'll go.

>> God, which which character would you

>> Oh, this is tough.

>> Who would you play on the pit?

>> Uh maybe Trinity Santos. >> Yeah.

What drives you to that?

>> Um I think she's just like

uh she's got that adrenaline

seeking like let's go like

I'm gonna go do this like let's and just like that I want to do it.

I want to get the procedure.

I want to do this stuff.

That's I I think I have some of the male characteristics

probably of like the uh what you know a little spectrumy

got a hint of the tism.

>> She's uh she's my favorite character on the show.

>> I love her >> and I also feel bad

uh I'm not fully caught up on second season cuz when I watch them

on YouTube is my first time seeing them

>> and with the exception of the premiere

that that we got to see.

So, uh, so far I've seen her get really hurt and

>> which makes me sad and knowing that she has to go to this deposition

when she's like the nicest character and I feel so bad

like we need to save her.

>> I don't want to I want to hold her hand and just be like,

we're going to be

>> I want to go to the Renaissance fair with her.

Like, that would be good times. >> Be good. >> Um, okay.

So, the pit is there.

The pit's doing a good job trying to educate the world about the struggles

that we face in healthcare.

But do you see that the world

has changed in the last few years with increasing

distrust of not just perhaps providers

but also specific treatments, vaccinations?

What's been your experience with that? >> Yeah, I 100%.

Um, and I'd say it's

probably been growing even before like the pandemic.

I think the big shift was obvious during that time.

Um, and I think

there's two parts of it.

I think people are

looking things up themselves and asking questions and I love that.

I want our patients to be educated and informed and like I want to

be a resource to like have that conversation.

Um I think the trouble comes when people

already have kind of made up their decision based on information that's not necessarily

correct or sometimes accurately interpreted.

Um and especially when it comes to kids like it gets

it gets a little challenging sometimes

because um you know obviously we have vaccines and we have things like

um if you have a newborn with a fever

and you know you and I know how

serious that is and the risk for serious bacterial infections, bacteria in the bloodstream,

urinary tract infections, menitis

and so we follow these standard treatment protocols

you know and families

a lot of times now are refusing the workup.

they're refusing blood work or a lumbar puncture,

things that we have data and evidence and

um you know kind of risk ratios

to show that like

you know the risk of

having bacteria in your bloodstream is really high and you know these are the

things that we should do.

Um, so I think we're seeing a lot of the kind of distrust

and making up their mind about things, you know, without maybe having all the

nuance or the um

information and it's it's

made our job >> Yeah.

Uh, not just challenging,

I'm curious if you have a specific example of a child who potentially was

hurt by the decisions

made based on misinformation.

Yeah, we see we see more and more vaccine preventable

illnesses um and we're starting to see

um some numacco bacteria.

So obviously numacco is

bacteria is a really serious

uh we vaccinate against it.

You can have you know strep numo in the bloodstream.

You can also have like ear infections and pneumonia and

um when we started vaccinating

against it the numbers started to plummet but we're starting to see them grow again.

again, mostly unvaccinated kids.

Um, and some of these kids, unfortunately, are really sick.

>> Um, and uh, it can be very challenging.

We also, um, and I made a video about it uh, a while back.

I had a kiddo that came in that had

a cough, really, really, really bad cough.

And the mom was really worried about the kiddo.

Um, and I heard the cough and I knew immediately it was ptosis.

And I talked to the mom about, you know, I think he's got whooping cough.

And, um, you know, right now he's okay.

I don't think we need to admit he's, you know, keeping fluids down.

and he's not in any distress.

And um and she's like, "Well, how do I sleep at night?

You're probably not going to for a while cuz this is going to be

a couple months potentially even that he's going to be doing this." >> Almost constantly.

Uh and and she made a joke about, you know,

I guess I did this to myself.

>> That's why uh I think it's valuable.

Perhaps you could tell the audience

if a child comes in

uh with let's say a fever, not feeling well and fever.

>> How does your workup

as an ER physician change

when you know the child has not gotten vaccines?

>> Yeah, especially in kiddos under three, the risk of

serious bacterial infection like menitis

or bacteria in the bloodstream.

Um mostly the bacteria in the bloodstream is higher.

And so if a kid comes in that hasn't received vaccines

or is significantly delayed, hasn't received like the first couple

uh especially if like numaccoal

or himmophilus influenza B hib

um you know I want a blood culture.

I want a blood culture and a CBC.

If the white count's elevated

you know we get concerned of you know potentially that we do need to

give a dose of something like a septraxone

potentially admit to the hospital we have to be more worried about sepsis.

If that kiddo has a headache and neck pain, then we also have to

be concerned about menitis.

And if a kid has a simple febal

seizure and they're not vaccinated,

like we also have to have a higher

threshold to think about menitis.

So, um, the workup absolutely

changes when it comes to vaccines.

And so, it's one of my questions, you know, do you have any medical problems?

You take any meds?

You have any allergies?

You had any surgeries?

Are your vaccines up to date?

And I actually stopped asking it like that.

I just said, "Tell me about the vaccine status

because so many of them

>> not up to date."

And then, you know, we get into the >> Have you noticed

what percent change have you noticed of folks being

uh not fully vaccinating their children?

>> Yeah, I in the past I could go days or weeks

without having a with

I without a kid with no vaccines.

Almost all their kids that we were seeing were

>> Um and now I would say it's maybe

75% of the kids under two were vaccinated. Wow.

>> Like it's it's not

it's huge >> because you for like measles

you need 95% because it spreads so easily and when you're in the 70s

>> and what we're see you know the data that we have for the MMR

is for kids that are entering kindergarten

in the United States and we've already started to see that number drop but

I think in the next

maybe two or three years we're going to see that really plummet

unfortunately um unless people start kind of taking this information seriously

taking this measles outbreak that we're having right now

in South Carolina seriously because

it's really it's really contagious

>> for patients who are skeptical

of vaccines the medical industry

what's your approach how do you

handle that >> like I love skepticism

like let's talk about it like what questions do you have like

let's have a conversation about it

um I think that

the problem is people have already made up their minds

and when you've already made up your mind you're not open to hearing the

new information, you're not open to having a conversation.

Um, you're not open to asking questions about it.

Um, and so that's where a lot of people are.

They've already made up their decision.

They're not changing their mind.

Um, we're like, you know, we can let's just talk about it.

Like, what kind of questions do you have?

What are your concerns?

Like I ask if if we're >> Have you had successes doing that?

>> Uh, most people are not open to talking about it. >> Wow.

And you know, I have had patients that

um when I've had the conversations

about, you know, your kid doesn't have any vaccines, they have a fever, I'm

concerned about like, you know, these things, bacteria in the bloodstream and

u menitis and things.

Um and they start asking questions, oh, what vaccine prevents that, you know, and

don't always know that like

these vaccines prevent against these certain things.

Um, and so I have had some,

you know, and they said, well, you know, to prevent having to do this

in the future, like what are the vaccines that you would prioritize?

I say, these are the ones that I think, you know, at this age

are the most important, but I think we should have a conversation or talk

to your pediatrician about all of them and what we're preventing and

um what the disease actually looks like. >> Yeah.

What about in terms of just

keeping your ER more busy?

Because I think about how overflowing

so many ERs are across the United States and now you're adding all of

these vaccinereventable illness visits

that require lumbar puncture, extended stays.

>> Do you see that having an impact? >> Uh yeah. Yeah.

We're we're having to do unfortunately more workups.

And one of the things that we have to be really cautious about is

we want to protect all the kids in the department.

And so if we have a kiddo that comes in, we're concerned about measles.

We don't want to be exposing

everyone in the department, everyone that's sitting in the waiting room.

And so we're trying to do screenings.

We're trying to get those kiddos in a room that

um is airborne so that we're not going to be spreading it around that

we can exhaust that air outside and not be exposing other people.

And so we're having to be like really cautious about the rooms we're putting patients into.

Where have they traveled recently?

Do they have their vaccines?

What type of symptoms are they having?

Is it cough, runny nose, conjunctivitis?

Haven't had a rash yet.

So, um, it it makes the flow of the ER a little bit more

challenging and it does create kind of more

a little bit more backups on occasion.

>> Yeah, that's so scary to me.

Have you noticed being so popular as you are across

social media, have you noticed that

be a positive thing in your toolkit

to help convince patients

or parents or do you feel like neutral?

What what's been your experience with that?

I feel like it's neutral.

And I'm actually surprised

at how many people will come see me in the ER and oh my

gosh, I know you from social media. How cool.

It's nice to meet you.

And you know, we go into the thing and then I start asking those

questions and I ask about vaccines and they say their their kid doesn't have

any vaccines, but they love my content.

And I'm like, I talk I talk so much.

>> You're like, what do YOU LIKE ABOUT THE

>> Do you like the hurricane stuff?

Like, what do we what content do you love so much?

Um, and so I try not to be too pushy.

Um, but at the same time, like,

you know, broach that conversation a little bit.

Um, especially if it's pertinent to the visit.

It's a little harder if it's not pertinent to the visit if they're here

for a broken arm or something.

>> Um, but I, you know, I try to

>> ask the questions or inquire a little bit, but

you know, >> it's so hard.

>> Yeah, it's tough >> cuz you're

how on one hand

can you not be pushy, but on the other hand advocate for this child's protection?

How do you balance that?

Well, and I think that,

you know, my job

really is to care for the patient in that moment, and I'm not their

primary care provider, >> Um,

and so, you know, we really need to address I need them to trust

me for what we're doing right now.

>> Um, whether it's getting the labs and the IV or whatever it is.

>> Um, but just trying to drop those little drop the seeds to see if

we can grow something,

see if they ask questions

so that we can open that conversation a little bit.

But I also know that like I need them to trust me for right

now because I have to sedate their kid with ketamine

and I need them to trust me >> Right. Right. Right. >> Yeah.

That's really tough especially with the changes

uh recently coming out from the CDC on the vaccine schedule.

>> The amount of confusion that has caused

>> because if you look at

probably all of our content from the pandemic, we were like trust the CDC,

go on the CDC website and now >> don't. What happened?

like what changed and

to get into that without flaring

political issues and making people feel ostracized is so hard.

How do you do that on social media without getting people upset or are

people upset you don't care?

>> I think people get upset no matter what because you're going to upset if you're

not if you don't take a strong enough stance,

you're going to upset this group and if you take any stance at all,

you're going to upset this group.

But I think what I've tried to focus on is just the evidence.

What does the evidence say?

What does the science say?

Um, you know, the science says that

hepatitis B is an a concern and that we should be vaccinating

patients as soon as they come out and there's potential exposure.

Um, I think it's important and what I've been saying, my kind of tagline

is that the evidence hasn't changed.

The science hasn't changed.

There's no new paper that's come out to say anything new about vaccines.

So, the CDC has changed

their >> good data has come out, >> Great data.

Like, we have data that supports what we're doing.

Um and so the AAP

and so many other you know medical organizations

leading medical organizations have supported this same vaccine schedule and so that's what

I as a pediatrician

stand for as well. >> Yeah.

Um what I find interesting is when uh our administration

changes the vaccine schedule to mirror they say Denmark

but then Denmark has the largest study

of childhood vaccines proving that there is no tie to autism.

they completely ignore that fact but focus on the vaccine part.

So I'm curious how they're cherrypicking

and choosing what they want to learn from Denmark.

>> And I think that the point is that

they're just kind of making things up as they go.

>> They I don't they're not focused on data or science.

They're focused on politics

and and >> do you do you have a theory?

Because I've tried to put myself in people's shoes and I'm like well you

know sometimes people have an ulterior motive.

I don't understand the motive.

Like I don't even know what's happening.

I the person who's leading it is a

>> You know, it's not someone who's going to be focused on looking at the

papers and looking at the data. Sure.

>> You know, digging through the

>> It's an emotional response. >> Yeah.

We're making decisions based on other things. >> Yeah.

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All right, let's get back to the interview.

I've been critical of some of the major medical organizations

about their lack of investment into social media.

And as someone who has invested a lot into social media and has gotten

a lot for it, meaning

a lot of education for so many people, millions of views, probably

what do you feel?

What grade would you give the major medical institutions

on their use of social media?

>> I think it's tough.

I obviously I I think some of them are dabbling now.

I'm, you know, we're starting to see their Instagram,

you know, pages pop up and I'm getting followed by,

you know, some of them and I'm like, >> cool. Welcome.

Nice to meet you.

Yeah, good to see you.

Um, but at the same

>> social media when it comes down to it is is generally for education

or not for >> Social media is for entertainment. >> Oh, okay.

>> I thought you were going to say that's how I use it for education.

>> Um, and so I think when people are on social media,

um, you know, they're not like, oh, I'm going to go study medicine.

I'm not, you know, they they want to be entertained.

They want a quick video that makes them feel some feelings or giggle or whatever.

And yeah, people do look up like, you know, what's the best way to treat a cough.

Um, but a lot of it, a lot of the reasons that they're on is for entertainment.

And so, I think a lot of the medical organizations

and um, even like the disaster organizations

are struggling to gain a following.

And if you don't have a following,

what are you doing?

Well, that's why my hope is that they would work with someone like you

to collaborate and bring that fund because clearly they can't and have failed.

And to me, I feel like that's the largest failure out of all of

this because if you look at what makes

people who are spreading misinformation

so effective is that they've literally leveraged the tool

way better than we have leveraged the tool and that is social media.

So when they make a post and they get a million views saying something

inaccurate and one of the major medical organizations

fact checks it and gets 10 likes

not comparable doesn't quite equate in that sense.

So it's great that we have doctors like you fighting back on this cause

and it's something I've been screaming for for a long time.

I think I actually wrote an op-ed on this in for the American Academy

of Family Physicians like 2017

saying that the absence of people like you on social media

is going to be the reason why something bad will happen.

>> And it sort of played out that way.

Um I know you got on to social media during the pandemic.

Did you ever have thoughts of using social media as a tool prior to

that and then social and then pandemic pushed you over the edge or

what was your relationship with social media

>> I I was a consumer.

M >> I never even dreamed of making content.

>> This entire thing was just a complete accident.

Like this was not intentional,

>> but a good accident.

>> It was all happy accident.

I'm I the fact that this has happened, like the fact that I'm sitting

here talking with you, I'm like, "Oh, this is pretty

>> Um I >> I love that

I'm >> I'm accidentally good at this.

>> I love that I'm accidentally good at this.

And and it was never intentional.

And I >> What makes you good at this? >> I don't know.

>> What do you think?

>> I have no I really have no idea, Mike.

I >> it I I would love if someone had I >> What do people tell you?

>> I hear that I'm authentic.

>> And that >> Do you believe you're authentic?

>> It seems like you have a little bit of disbelief about it.

>> I I don't think I have a mask.

>> So, I think what you're seeing is >> that's very authentic.

>> And you come off very authentic.

So, >> I just want you to believe in it because you definitely deserve that

that praise and title.

So, >> um and then I I don't use a lot of the big words. >> Okay.

Um, so I think I speak in a way that people understand.

>> Um, and those are the things that I hear and I Yeah.

I was like, "Oh, yeah, that that fits."

But, um, I'm an introvert, so like talking to people is not my strong

suit, is not my forte,

>> but a camera, a cell phone might be a little different. Right. >> Right.

And so it it's worked out that I can sit in my room and

make a Tik Tok.

I don't let my husband come in if he's out >> if he's watching.

>> You need to be in the living room.

You can't be watching me make a Tik Tok that I'm going to show

to millions of people, you know.

Um, so it's it's an

that I'm good at it and that it's worked out and I'm I'm thrilled

and I love that I can spend time and educate people and connect with

people and make a difference

um and potentially like open people's minds up to you know like let's talk

about the like I don't you don't even need to accept vaccines like let's

just talk about it let's just have a conversation or you know whatever it

might be or just even awareness about like testicular

torsion or you know

uh CROO or respiratory distress like retract actions.

I made a video about that a couple days ago.

Um people go, "Oh my gosh, I saw that and I knew my kid

needed to go to the hospital."

And so I think it's just a really cool opportunity

to provide education for people in a way that like, you know,

15 years ago wasn't an option. >> Yeah.

Being a mom, >> does that improve your ability to communicate with people online? >> Um sometimes.

I think I've got a lot of

>> Uh and yeah, so like I think >> you have four kids, right?

I have four kids and I think, you know, talking to

>> and, you know, communicating

like world issues to my kids has helped me be able to communicate,

you know, to people, not using the big medical words and just in a

way that, um, makes it somewhat

>> What about community feedback

from other moms, parents?

>> Moms are big fans of me.

Uh, but you know who's >> That's a good shirt.

Do you know that's your slogan? >> That's my slogan.

>> Or a book title.

>> Um, grandmas are bigger fans. >> Why grandmas?

I don't I >> grandmas are on social media.

>> Grandmas are on social media

>> and they are big fans. Okay.

>> So many people actually like three people at the pit premiere were like my

mom is going to be so excited I met you.

>> It's everyone's everyone's mom. >> Yeah.

Like 97% of my followers are >> Probably similar.

>> Well, you know what's funny?

Uh when I first started on social media, especially Instagram,

I started under this Buzzfeed

moniker and People magazine stuff.

So, it was very superficial.

At that point, my following was 80% female.

So, uh, in this demographic split on Instagram specifically.

Now, on YouTube, we're 60% >> Oh, that's impressive.

>> And Instagram is now leveling out to like 70, 30, 65, 35. So, it's interesting.

It is >> to see the transition of how these things change

>> because the algorithms have gotten

>> For for good and bad.

So, it's interesting to see that evolution

o of it all.

Um, where do you want to take it

from where it is now?

>> You know, I don't know.

>> I, you know, I think

the the good and the bad of social media is that, you know, I'm

always one video away from being canceled,

>> you know, one bad take from just everyone going, "Nope, she's done."

>> Do you think that could happen, though?

>> I think it's possible,

>> but I, you know, I >> I don't know.

>> That's it's a concern I share all the time as well.

Um, it feels natural in our place

where we exist to experience that.

But >> at the same time, I have to do a little CBT on myself

and be >> how rational is this?

If you say something inaccurately

and you explain your reason for your mistake, if it came with good intentions,

will the world really never want to see your content >> Right?

And uh it's a good exercise

to do that because

sometimes it's it's overwhelming

uh having the responsibility

of making content that

>> even though we say don't make healthcare decisions based on this content, people inevitably do.

>> So how does that land for you knowing

you're putting out content that has such an impact on people's lives? >> Yeah.

I you know I I

think it's hard for me to like internalize

it and I don't know if that comes from like uh

growing up and you know being taught like humility is so important.

Um so I I don't internalize a lot of it and it's just like

okay I'm going to make a video today and post it and there's going

to be comments and I don't internalize a lot of the like

you're making a difference type of thing.

>> What would allow you to internalize it more?

I don't know if I can

>> Yeah, we're just here talking like you

>> when uh a little kid runs up to you and hugs you and says

thank you for all that you've done.

A parent comes up to you and says

I found a metal grill brush inside my child's throat because of you.

>> Doesn't pull at the heartstrings at all.

>> Feels feels good, you know, and I I can have that moment of feeling

good and then I go back to being

>> just myself and not the Dr. Beach Gem, >> okay?

you know who makes the videos and I'm just you know me.

>> So are those two different people?

>> Those are not No, I wouldn't say they're two different people but Dr.

Beach Gem you know talks

on my phone and makes videos and posts and

um and then I go out and I make you know I don't make

dinner my husband does but I go out and we eat dinner and we

spend time together as a family and we play games and that's you know

I feel like that I don't have to be like on I can just

you know being on you have to like

>> sure turn it up a little bit.

>> Turn it up a little bit but it's still me. Yeah.

Do do you get feedback, emails, testimonials?

What's uh some interesting ones you've gotten?

H >> I've uh you know, I've made the there's kind of two

videos that stick out and one of them is I made a video

about diagnosing a friend's kid

with uh new onset type 1 diabetes.

He was in DKA

in car circle >> at the school.

>> Car circle is like pickup. >> Pickup at pickup. Non-parent. >> Yeah.

It's it's we all of us parents would stand under a tree like we

would park and then walk up and pick up the kids and mom was

talking and um she was

just dropping all of the symptoms of type 1 diabetes.

He's been drinking a lot. He's losing weight. He's really tired.

And I was like, I'd like to smell him.

And I smelled him and he smelled he smelled like ketones.

I'm a hyper >> I can smell ketones from a mile away.

And I I said, you know, you need to go to the ER.

And I've talked about that

um pretty much every year in November

um for diabetes awareness month.

Um, so many people have said, "I diagnosed

my niece, my friend, my kid, my

student, you know, because

of the symptoms and I smelled them and

um, you know, I think that

there have been a lot of kids that have probably been picked up earlier

because of the awareness

of those videos and those videos perform, you know, pretty well.

I usually get quite a quite a few views."

Um, and then the other one,

um, I, you know, on social media you make, you know, online mutuals

and, uh, one of the kiddos that I talked about was a kiddo that

was having morning vomiting and headaches and not acting appropriately

and, um, ended up getting diagnosed with a brain tumor.

And so I talked about some of the symptoms

um on a video and then I've gotten a couple emails

of uh you know I saw your video and then I realized you know

my kids been waking up and with headaches in the morning and so they

ended up getting the imaging and had

uh you know a mass or something going on.

So, those two videos I feel like

and and I've made a couple of them those videos a couple times

um have made a difference and help kids get diagnosed sooner and

um I think those are probably things like that are more

impactful than some of the other content that I've made. >> Yeah.

What I find is when you're sitting at a speaking to a camera

uh in some ways it's easier,

in some ways it's harder because it's a little awkward to fill

dead air and essentially act like you're talking to someone.

But what you miss out on are those responses

and when you get them in real life

it kind of pushes you to keep doing what you're doing

because when we're practicing

in our respective uh you know hospital areas

we are >> feeling the improvements

as you noted kids get better quickly

uh because I'm family medicine I have that continuity so I could see the

improvement in their lives that gives me that reassurance to keep going

>> with social media you don't always get that feedback

>> and we use likes and views

in lie of that to some degree,

but it's not the same.

It's not the same as hearing that one story

where you change someone's life and you're like, "Wow,

>> I got to take some time and zoom out and realize that there is

a reason why this is important to do."

Because you are going

far above what you're supposed to do as a pediatric ER physician.

It's hard enough as a job

as it exists today,

but you're doing that

and you're continuing to do the work once you get home

at a scale that's having

huge >> You you have to let yourself at some point feel that. >> Yeah. I Yeah.

It's hard to explain.

I I It's just one of those like okay

and and just keep going kind of thing.

Well, nonetheless, I want to thank you for doing that because

I I I truly want more physicians

to see the the value in this

>> and uh part of them seeing

and hearing the stories that you've been told will hopefully motivate future physicians to

do it better than us

to be like, "Ah, Beach Gem and Dr.

Mike, like they they they uh they did it okay, but I'm going to

do it better than them

>> and they can do something truly special that can have a worldly impact."

So, I'm excited about

future generations making use of social media.

What's your relationship like with the health care system as a patient?

>> Oh, you know, I think

uh I'm not one that's above the challenges of dealing with the health care

system as a patient.

And I think um

it helps uh me understand what our patients are going through. Yeah.

>> You know, having to deal with that >> creates another level of empathy. >> Yeah. Yeah.

>> When they come in and they say, "I've been trying this for so long

and I just can't get anywhere."

like, "All right, well, let's see what we can do to to take those

next steps cuz I know

I know the struggle." >> Yeah.

What's been that struggle?

>> Um, so I recently,

it wasn't even that recently.

I started having some symptoms

uh with my right breast.

Are we allowed to talk about breasts?

>> We don't set the rules.

So, if YouTube bans us, they ban us. >> All right.

So, my right side.

Uh, and I I started a couple years ago and I went through like a partial workup.

Um, my doctor was very concerned initially about the symptoms and she wrote me

a stat mammogram and I went to try to get a stat mammogram and

it turns out that a stat mammogram does not exist.

>> Um, so they they were able to schedule the ultrasound but the mammogram was

going to be in like four to six weeks. >> Diagnostic, not screening.

>> Diagnostic, not screening, >> which I've gotten in trouble for before >> because I was symptomatic.

Um, and it was going to be quite a bit of time.

And I was kind of freaked out.

My doctor was kind of freaked out.

And so, um, I ended up,

you know, tapping into,

uh, a local pediatrician

or physician mom's group and I just said,

"Does anyone who does breast radiology have any openings?"

And somebody had an opening later in the week.

Um, so I had to drive, it's probably hour and a half, almost two

hours away for a 7:30

appointment, >> but you know, I was happy to have the appointment.

It was an opening.

I didn't take anybody else's appointment. Got it done. Pretty reassuring.

And then um kind of uh I had knee surgery,

the floods happened, life happened. >> Oh my god.

>> And then I kind of went back and

um repeated the workup because we didn't have any answers.

The symptoms were >> Um

and I was having

it's a weird symptom.

I was having like black

>> which you know, it's alarming. >> Of course. >> Alarming. Yeah.

And and uh there's a chance there that it could be something that's more

concerning like a malignancy.

And so I went through the ultrasound and the mammogram.

um that we got scheduled reasonably quickly and then

um wanted to do like a something called a ducttogram

where they you know kind of inject dye into that duct just to see

what it is and

um I had this

the doctor wasn't able to express

the discharge and um because it was sterile they wouldn't let me touch the

area and then um kind of came off the table they said you know

we'll just we'll circle back next time you're having the discharge and I was

like I'm I'm active like I can I can show you and I

And they were like, "Well, don't worry about it.

You know, we'll follow up just, you know, next."

And >> this doesn't seem like a common symptom. >> No.

And and they, you know, I'm I'm right here.

I can show you like,

and it was a very frustrating moment.

And I felt like

I almost felt like they didn't believe me.

Maybe like we're on the same team.

Like, you know, I'm one of you

>> You know, I >> And you didn't even need to be one of them.

like that's a added thing that they should >> an added layer, you know, and

I don't expect more because I'm a healthare person, but I'm like I expect

my team to do well and when my team is

letting me down and letting other people, it's just frustrating and

um and so I just in that moment I felt

and I was already

I think I worked till like 4 in the morning and then woke up

at 7 for this and so I was exhausted and hungry and

>> um it was just not a wonderful

day and uh I ended up

finding another um a breast radi

a breast surgeon actually

um who um was wonderful and we went through the data and the recommendations

for people who are having the symptom

and the next test wasn't even a ducttogram

it's actually to excise the duct

>> um which I had done two weeks ago and >> to excise the duct completely

or for biopsy purposes

>> both okay >> so you're taking it you're not going to have that symptom anymore

um and you're making sure that there's no

>> diagnostic and therapeutic all >> diagnostic and therapeutic

okay >> um and so I had that two weeks ago Um,

and the reason I'm able to travel is because I'm on medical leave

>> uh, which is wonderful.

Um, I feel great and the biopsy,

everything came back benign.

Uh, which I feel great about.

And now, you know, we don't have to worry about this situation.

>> Was the diagnosis ever placed.

>> Um, I Yeah, we got pathology back.

It was kind of like a chronic inflammation. >> Oh, got it.

So, nothing specific, non-specific, basically. Inflammatory changes. Great.

>> Which I guess great to hear in one.

We went through this for two years. I had surgery.

I had all these procedur.

>> What I'm sure you look this up.