Why you've tried everything and still don't feel right

0:00 103.5 The Light, streaming online at wmuz.com Detroit made Bible strong For 15 years you've trusted Your Weekly Checkup to challenge the status quo in health care But the conversation has grown bigger the stakes are higher and the truth matters more than ever That's why Your Weekly Checkup is now the Dr. Lazar Show where dr. Lazar exposes what's broken challenges the system and gives you real answers you won't hear anywhere else. Same mission, same fight, bigger platform. And now here's Dr. Lazar. There's a question if you ask out loud in a doctor's office will change the room.

1:01 It's not a rude question or a combative question. It's actually the most reasonable question a patient could ask. That question is what's actually causing this. Not what do we do about it or what medication will help or what's the code for this. Just what is actually causing this. And if you've ever asked that question in that way in a seven minute appointment, you already know exactly what happens. The room gets a little quieter, the pace changes, someone looks at the screen and said of at you and then you get an answer that sounds like an answer but isn't.

1:42 Today I want to talk about why that happens because I don't think it's because your doctor doesn't care. I don't think it's because anyone on the front lines of medicine is a bad person. I know too many of them to believe that. I think it's because the system they work inside of was never designed to answer that question. And until you understand that, really understand it, nothing about your health is gonna fully make sense. Let's get into it. Before we get started, I want to be clear about something. Most people aren't failing at their health.

2:24 They're not lazy, they don't lack discipline or willpower. In fact, most people are unknowingly making their health problems harder to solve, not because they're doing anything wrong, but because they're following advice that was never designed to get them well. On this show we don't focus on helping people feel better for a moment. We focus on helping them get better. We don't talk about getting well and stopping there. We talk about staying well. And we're not interested in you simply staying alive. We actually want you to feel alive again. This is The Dr. Lazar Show.

3:04 Alright, welcome in. The title of today's show is The Truth About the Healthcare System They Don't Want You to Question. And I want to do something careful right at the start because the word they in that title is going to mean something different to every person listening. Some of you will interpret they as pharma. To some of you they means insurance companies. To some of you they means the federal government or medical schools or hospital systems. And to some of you they means nobody in particular, it just means kind of the way things are. I don't want to tell you who they is, that's actually not the most useful conversation here.

3:48 Because the minute we pick a villain, the rest of the conversation collapses into politics and everyone's shoulders go up and then we stop thinking, we stop having a real conversation. So let me reframe the title for you. In the language I actually use in my practice every day. The truth about the healthcare system you've been taught not to question because that's the actual situation. It isn't that somebody is actively stopping you from asking questions or it's that the way we were raised, we were raised inside a model of care where certain questions just don't get asked.

4:29 Not because they're forbidden really but because they're just not on the menu. And the question that isn't on the menu is the one I open with. And that question is what is actually causing this? Now here's what I want to say to you before I go any further. If you're listening to this show and you're someone who has done everything you were told to do, you know who you are. You went to your doctor, you got the blood work, you took the prescriptions, you followed the diet, you did the physical therapy, you tried the injections, you had the surgery, you did the thing and you still don't feel right.

5:11 This episode is for you. And if you're listening and you're thinking that's literally me, I've done everything and I still don't feel right, it's not your You didn't fail. You're not lazy. You're not making it up or being dramatic. You're not the patient who just doesn't want to try. That's not you at all. Most people I work with and I've been in practice a long time, most people I see in my office are people who have been trying their hardest for years and some of them for multiple decades. They're not short on effort or motivation or knowledge, what they're short on is a real clear explanation.

5:59 And that's what this show is about, not villains, not conspiracy theories, not burn it all down. I'm not interested in any of that. I'm interested in the structural reason the system keeps producing people who have tried everything and still don't feel right. Because if we can see the structure clearly, we can actually do something about it. Clarity is the thing that changes this, not anger or drama or fear. Clarity. So over the next hour I want to walk you through four things. Number one, the thing the healthcare system is actually designed to do, not the thing we tell ourselves it's designed to do, the thing it's actually built for.

6:42 Mechanically, structurally, economically. And why when you understand that, a whole lot of things stop being so mysterious. Number two, how the seven-minute visit and I'm going to explain exactly what that means changed medicine in a way most patients have never had explained to them and why your doctor even if they're brilliant and I'm sure they are and they care deeply about you I'm sure they do is usually just as stuck inside that structure as you are. Number three. The question that medical training at some level teaches doctors not to ask or I guess more accurately the question there isn't time to ask. There's not a billing code for it.

7:26 There's not a specialist for it. It doesn't fit inside the 15-minute time slot and then it gets missed as a result. Number four, what changes for you, for the person listening and your family, when you start seeing your own health through a different frame, when the confusion finally lifts and things start to make sense to you again. That's the show. Now before we get into the first segment, I want to say something because I know some of you are already tensing up. I'm not Dr. Bashing, I'm not a medicine basher.

8:09 I have deep, deep respect for the people who work in emergency rooms and trauma surgery and oncology and the ICU and obstetrics. These people save lives every day. If you're in a car wreck, you don't want to be thinking about this conversation. You want a trauma surgeon and you want one fast. If you're septic, you want antibiotics, not contemplation. So that's not what we're talking about today. What we're talking about today is what happens when a system that was designed for acute emergencies or crisis, infectious disease, which it handles extraordinarily well by the way, is then asked to handle chronic ongoing everyday suffering.

8:56 You know, the headache that won't stop, the dizziness, the fatigue, the digestive stuff, the brain fog, the anxiety that has physical components nobody can even name, the neck pain, the migraines, the reflux, the sleep that is never restorative, the autonomic conditions nobody can get to the root of or even identify. When a system designed for acute crisis tries to manage chronic suffering, which is what most of modern life is, something goes wrong. Not because anybody's evil or because anybody is stupid or because the tool doesn't match the problem. It's not any of that.

9:37 And when the tool doesn't match the problem and you keep swinging the tool at the problem and the problem doesn't go away, what does the system do? Well, it tells you that you are the problem. It tells you need to try harder, eat better, sleep more, exercise more, stress less, meditate, lose weight, take the medication, take a different medication, take a third medication, take a medication to help with the side effects from the other medication, goes to another specialist, here's a referral, come back in three months, and when it still doesn't work, the word that starts showing up in your charts is compliant or worse something like somaticizing or functional or psychosomatic or stress related, age related.

10:25 These are all code for we can't exactly explain this so we're going to gently suggest the problem is you and that's really not fair. The phrase, the term that's used to describe something they don't know why it's happening is called an idiopathic diagnosis. It's actually a thing but instead they'll just suggest that you're the problem and that's the quiet shaming or not so quiet I guess sometimes that millions of Americans are living inside of right now. People who are working, raising kids, running businesses, leading companies, serving in church, showing up every day even when you don't feel like it and then also carry around this private feeling like you're the problem, that your body is the problem or you could just be a little bit more disciplined or have a little bit more self-control or have it life a little bit more together if you'd be just a little better than you'd be fine.

11:32 But I'm here to tell you plainly and flatly that is not at all what's happening. You are not the problem. Your effort is not the problem. Your willpower is not the problem. Your discipline is not the problem. Not if you're at this phase. Bad information is the problem. Let me say that one more time because if you take nothing else from this show take this. Most people are unknowingly making their health problems harder to solve not because they're doing anything wrong or lack discipline or willpower but because they're following advice that was never designed to get them well.

12:14 That's not a catchphrase for me this is the single most important idea in my entire practice and I want to unpack that with you today, specifically through the lens of how this massive sprawling health care system or sick care system actually ended up in a place where the most obvious question, what's actually causing this, became the hardest one to get answered. We'll be right back. When we come back, the single biggest misunderstanding most people have about modern medicine. It's not that the system is broken, it's that it's working exactly how it was designed to work.

12:58 And once you see what it was designed for, everything else starts to make sense. Be right back. Welcome back to the Dr. Lazar Show. I want to start this segment with a sentence that's gonna sound like a throwaway, but I promise you it isn't. The healthcare system in this country is not broken. That sentence makes people bristle because everybody who spent any time inside the system, any real time at least, has a story or a dozen stories where they felt like the whole system was broken. Where a loved one got lost in the paperwork or appointments got mixed up. You were sent to the wrong location or they didn't know why you were there.

13:43 They misunderstood. They x-rayed the wrong part where an obvious thing got mixed, missed. Where they spent six hours in an emergency room to get told we don't really know or where a test got ordered and then another test got ordered and another one and nobody actually said what was even going on. I'm not saying those experiences aren't real, I'm saying the word broken is actually the wrong word because broken implies that the system is failing at what it was designed to do. And I would submit to you, and I've spent almost 20 years thinking about this, that the system is actually succeeding extraordinarily well at what it was designed to do.

14:29 The problem is that what it was designed to do is not what most to view are asking it to do. Let me explain. The modern American medical system, the one that most of us grew up inside, was largely assembled, at least in its current form, between roughly 1910 and the late 1960s. It was shaped by a handful of very specific historical forces. Infectious disease, two world wars, the rise of pharmaceutical companies, the Flexner report with the Rockefeller's which reshaped medical education entirely. We've done shows on that. Medicare, Medicaid, employer-based insurance, the growth and incorporation or business-ification, if that's even a word, of the hospital systems, the creation of specialists, the industrialization of the doctor's office.

15:28 that's what shaped our current system and every single one of those forces was pushing the system in one single direction and that direction was toward acute care toward crisis response or intervention when something has gone dramatically or catastrophically wrong and when you need to stop a person essentially from dying right now that's what the system was built for and if If you've ever been in a trauma bay when a person is actively bleeding out or in cardiac ICU and somebody's being brought back to life after cardiac arrest or in a labor and delivery room when a baby's heart rate is dropping, then you've seen what this system can do and it's nothing short of miraculous.

16:17 I mean that sincerely. The ability of a modern hospital to take somebody who in 1890 would have been dead within hours and send them home walking, that's one of the greatest achievements of the last hundred years. I would not trade that for anything. And I want you to have access to it if you ever need it, your family too. But, and this is a very big but, that system, the system of acute intervention, crisis response, keep them alive and stabilize them, that system was never designed to answer the question open the show with. What is actually causing this? Because in acute care you don't need to know it's causing it.

17:04 Not in that moment at least. In that moment the person is dying and they need to be stabilized. Somebody needs to stop the bleeding or restart the heart or intubate or transfuse. You get the blood pressure back up. You get them breathing again. You get them to surgery. That's the job, that's heroic work, that's hard work, that's irreplaceable work. And the question of why did this person get here in the first place? Well that's somebody else's problem. That's the primary care doctor's problem or the patient's problem or the specialist problem if there is one. That's the next appointments problem.

17:44 Fine, there's a reasonable way to set up acute care. that's reasonable. But look at what happened because we built such a magnificent machine for acute care, for crisis care, for emergency care. We started applying it to things it was never designed for and that's a really big point. A person shows up with chronic migraines for 10 years, three a week, nothing helps. And what does the system do? The system takes this chronic ongoing problem and it treats it like an acute event every time. The person shows up, the system intervenes in the moment, a medication, a scan, a referral, and then the person goes home.

18:34 And the underlying thing that's producing those migraines has not been addressed. So three days later they're back, and then three days after that they're back, and then over the course of the next 10 years they've accumulated a chart that's two inches thick and they're no closer to getting better than they were when they started. It's really frustrating. Is that a broken system? No, that's a system that was designed to respond to acute events and it's responding to every migraine as if it was an acute event because that's what that system was built to do. So actually it's working exactly as designed. And a tragic thing, I guess the thing that most people don't ever have explained to them, is that the system does not have a mechanism inside it to step out of that acute event mode and ask, hey wait, what is going on here?

19:28 Why is this person producing a migraine every 48 hours for 10 years? That question lives in a place that the system is not built to reach. Same thing with the person who has chronic dizziness or chronic reflux, chronic fatigue, chronic anxiety with a physical component, chronic neck pain, chronic autoimmune flares, chronic sleep problems, chronic anything. The system keeps pulling out the acute care tool because the acute care tool is what it has and the acute care tool is beautiful. It's brilliantly engineered. It's one of the great human achievements in all of history.

20:09 It just isn't the right tool for this problem and that's what you're experiencing. If you've been in the system with a chronic issue and you keep feeling like nobody is really seeing the whole picture, you're not imagining it. You're noticing something that's real. The tool is not matched to the problem. Let me give you a metaphor. I use this with patients a lot. Imagine you have a beautiful precision engineered fire department. The gold standard. Fastest response time in the country. The trucks are state-of-the-art. The firefighters are the best trained in the whole world.

20:52 If your house is actively on fire there's no better team on the planet to put that fire out. They'll save your life, they'll save your family, they'll save whatever they can of your home. Now imagine that in your town for some reason houses are developing a slow smoldering problem. If they're not raging fires they're smoldering, electrical issues in the walls maybe or slow chemical reactions in the basement, little wisps of smoke from the attic every other night or so. Nobody's in immediate danger right now, but you know something is clearly going on inside the structure of these houses.

21:37 And your town's only response is the fire department. The fire department shows up every time there's a wisp of smoke. They kick down the door, they spray everything down, they save the day, they leave. And the next night another wisp of smoke, different house, same response and then the next night another one same response. After a year of this you'd look at the situation and you'd say we don't have a fire department problem. Our fire department is incredible. We have an inspection and infrastructure problem. We have no system for looking inside the walls or figuring out what's slowly going wrong.

22:21 We don't have a system for preventing the smolder from starting in the first place. And until we build that, we're gonna be using a fire department for something it was never built for, and we're gonna burn that department out. And then we're gonna lose houses, and we're gonna watch families get hurt while our magnificent fire department does exactly what it was designed to do brilliantly night after night after night. That is modern American health care or as I refer to it as sick care. We have a magnificent fire department and we're using it every day to respond to the smolder and the person listening if you have a chronic condition that nobody's been able to get rid of or get to the root of, you're the house that keeps producing smoke.

23:14 And every time you go in, the fire department in this metaphor shows up. It does its job. The immediate flare gets knocked down and you go home and the thing in the walls that keeps producing the smoke, well that's still there. And then one day somebody in that system, because they don't have another way to talk about it, looks at your chart and says, this patient is non-compliant or this person is somaticizing or this person is anxious, this must be anxiety or this must be in their head or this person is just one of those patients, you know.

23:56 Well you are not the problem. You're not one of those patients. You're a human being created in the image of God standing inside a system that was not built to answer your question. That's what's happening. And that reframe, just that reframe, has I've seen set so many people free. Because once you understand that the system isn't broken, it's doing exactly what it was built to do, and that it was simply never designed to ask what's actually causing your problem, you stop feeling like you're failing. You stop feeling like if you just tried a little harder or a little more or a little differently or you'd crack the code because the code isn't on that map.

24:51 The code is somewhere else entirely and we have to go look somewhere else and that's what the rest of this show is all about. But before we get into that I want to stop and take a short break. And when we come back, I'm gonna explain the single most important number in American medicine. And it's a number almost nobody talks about on the air. That number is seven. We'll be right back. When we return, what the seven minute visit actually is, why it exists, and why it means that even the best doctor in America can't answer the question you came in with.

25:35 Not because they don't want to, because the clock literally won't let them. Call and speak with Dr. Lazar at 866-521-WELL. That's 866-521-WELL. Welcome back. All right, seven minutes. Here's what most patients don't know about the doctor they see. The average primary care office visit in the United States is somewhere between 7 and 15 minutes of actual face-to-face time with the physician. The number moves depending on the study you cite or the state you're in or the practice model and whether you're including check-in, waiting, the nurse, the medical assistant, the student. But when you strip it down to the minutes the doctor is actually in the room with you, you're often in single digits.

26:29 Seven minutes on average. And that seven minutes is not seven minutes of open-ended curiosity. It's seven minutes in which the physician who by the way has spent four years of college, four years of medical school, three to seven years of residency, sometimes additional fellowship, has to accomplish a very specific checklist of things. They have to greet you and review your chart since the last visit. They have to ask why you're here. They have to take a history. They have to do a physical exam. They have to order any test. They have to interpret any test that might have already come in. They have to give you a diagnosis if they can.

27:11 They have to make it into a plan you can follow. They have to write prescription. They have to document all of this in your electronic health record. Usually while you're still in the room, they have to assign the correct billing code. So they have to do it all in a way that will not get the practice flagged or down coded or audited. And they have to do it well enough that you leave feeling heard in seven minutes. Now let me ask you something. If you were the one in the doctor's chair and you had seven minutes and you had to do all of that for 25 patients a day, five days a week, how much room would you have inside that seven minutes for the question, hey what's actually causing this?

28:00 The answer is zero. That's how much time you'd have. There's no room for that question. It's not that the doctor's uninterested, it's that the question does not fit inside the container. And this is where I want to be really careful with you who are listening. I'm not mad at primary care doctors or internists or family medicine. I know those people. Some of them are my close friends. The vast majority of them went into medicine because they genuinely want to help people. Many of them are heartbroken about the situation they're in. They're seeing patients they know they can't help in the time they have.

28:45 They're writing notes at 11 p.m. from home because they didn't have time during the day and they didn't want to make patients wait and they're experiencing rails of burnout and depression and all too many cases of suicide that are higher than most any other profession in the country. So I'm not firing shots there and your doctor is not the problem. Your doctor is a human being trapped inside a container that was built for an entirely different purpose. Let me explain how that container got built that might help. In 1965, Medicare was created. Suddenly the federal government was paying for a huge slice of American sick care and the federal government needed a way to decide how much to pay for what.

29:37 It needed a language, a system, a code. Over the next couple of decades, that system became what is now known as the CPT code system or current procedural terminology and alongside it the ICD diagnostic code system. Everything that happens in a medical encounter has to be translated into one of these codes or it doesn't get paid for. Think about that for a second. If what you did in the visit cannot be assigned a code then it financially does not exist. That's frustrating. There's no code for spent 45 minutes listening to the patient and building a root cause hypothesis.

30:24 There's a code for office visit established patient moderate complexity and that code pays a certain preset amount. And if you do that code in seven minutes, the practice makes money. And if you do that code in 45 minutes, the practice loses money because the overhead, the rent, staff, malpractice, insurance, electronic health records subscription, the billing service, the overhead is calibrated to a certain volume per day, RBU, relative value unit. And the volume per day is determined by those codes.

31:10 So now, here's what you have. You have a massive elaborate medical education system that trains doctors for decades to be diagnosticians and healers. And then you put those doctors into a practice model where the economics mathematically require them to see a patient every seven minutes. And in that seven minutes, they can only do work that maps to a billable code. There's no code for figure out the actual cause, but there are codes for managing the symptom. So, what are doctors supposed to do? Well, they're kind of forced to manage the symptom, at least in a model where insurance is paying, because that's what the system will pay them for.

31:58 That's what the system will reward them for. That is what will keep the practice open. That's what will feed their family. That's what will pay off the $300,000 in medical school student loan debt. not a moral failure on the part of the physician. This is a structural incentive and when you tell me some of these doctors are still despite all of this finding a way to slow down and listen and dig I consider those people to be absolute heroes because they're doing it at the cost of their own sleep, their own families, their own mental health, often their own finances. Now there are different models that have emerged that allow for more of that and it has nothing to do with insurance.

32:40 But the model doesn't want them to do that. The model rewards throughput like widgets. Now, stack on top of that, the model the prescription drug ecosystem operates in. Here's something almost nobody has ever explained to the average patient. The United States is one of only two countries in the entire world that allows direct to consumer advertising of prescription drugs. The only other country is New Zealand. Every other developed country on earth has decided this is not a good idea because when you advertise prescription drugs directly to the public, the public walks into the doctor's office asking for actually now demanding the drug by name.

33:35 I think it was John Abramson he used to teach at Harvard Med School and he wrote a book called Overdose to America. I read that back in 2006 or 2007. It's not a new crop, it's not a new problem. And the doctor inside that seven minute visit under the weight of throughput demands, the office manager writing them up, no time to reframe with a patient who's seen the commercial and decided what they want, you know, ask your doctor if this is right for you. Well no, they're saying, hey I saw this and I want it. And the reality is if you don't give it to them, they're just gonna go somewhere else.

34:11 They'll often entirely, understandably, just write their prescription. Now, I'm not telling you prescription drugs are bad. I'm not an anti-medication person either. There are medications that save lives every day. I have family members who are alive because of those. I have some that are dead because of those as you've heard. But what I'm telling you is this, the system has been quietly retrained over 40 years or so to respond to the question, what's wrong with me? The answer is here's the drug. And the drug in the vast majority of these chronic cases is managing or covering up the symptoms.

34:56 It's not even answering the question. You go in with migraines, you get a migraine medication, you go in with reflux, you get a proton pump inhibitor, you go in with high blood pressure, you get an antihypertensive or a beta blocker, you go in with anxiety, you get an SSRI or selective serotonin reuptake inhibitor, you go in with high cholesterol, you get a statin that eats away at your muscle cells and then you have pain all over your body since you started taking the statin. But you're just doing what you were told. You go into chronic pain and we're lucky that the guidelines finally pulled back from the opioid era but you still get a muscle relaxant, an anti inflammatory, a nerve pain medication, a topical referral for injections, some combination of those cocktails.

35:48 And what's almost never happening, not because the doctor is bad, but because the structure doesn't allow it, is a conversation that goes, let's stop and think about why your body is producing the signal in the first place. What is the underlying reason your nervous system or your vascular system or digestive system or endocrine system? What is the underlying reason it's producing this output? Because the output is a symptom and in the body it's cause and effect. For every effect there's a cause, it's a downstream event. But what's the upstream driver? And until we find the upstream driver we're gonna be standing at the bottom of the waterfall with a bucket trying to empty it.

36:37 That conversation, the upstream conversation does not fit inside the model. It doesn't fit inside seven minutes and there's no billing code for it. So it doesn't happen and you the person who came in with the thing that won't go away you leave with the prescription and the prescription hopefully reduces the symptom maybe or it doesn't or it does for a while and then stops or it produces a side effect that requires a second prescription and then a third and then pretty soon you're on five medications and you're not exactly sure what any of them are doing and nobody's ever actually answered the question you came in with.

37:22 What is actually causing this? And the tragic thing and this is the part that really matters is that you will start to blame yourself because the system will imply gently I hope that if you had just eaten better or slept better or moved more or stressed less or lost the weight sooner or gotten up earlier or pushed harder, you'd be fine. That's the move. Throughput that doesn't resolve the problem, a prescription that manages the symptom.

38:02 If the symptom persists, a subtle reframe that places the failure on the compliance of the patient. It's not an evil system, that's a system doing exactly what the incentives tell it to do and it's not going to change. So I'm going to say that part plainly too. The system is not going to change on its own. It's been moving in this direction for 50 years and the force is pushing it in this direction. Reimbursement structures, insurance models, hospital consolidation, private equity, electronic health records designed around billing pharmaceutical companies, lobbyists, those forces are not going away. In fact, most of them are actually getting stronger.

38:46 So if you're waiting for the system to start answering your question, you're gonna be waiting for a really long time and you're gonna keep being frustrated. What has to happen instead is that you have to start asking yourself this question somewhere else. That's it. that's the whole move. You don't have to be angry at your doctor, you don't have to burn the system down, you don't have to quit conventional medicine, you just have to understand clearly and honestly what it can and cannot do for you. And if the thing you need is not on the menu, you have to go to the kitchen that serves that dish.

39:30 You're trying to force something to meet a need it wasn't designed to meet. In the next segment I want to talk about what that actually looks like because this is the place where most people get stuck. They figure out the system isn't serving them and they don't know where to go and so a lot of them end up wandering through a wilderness of influencers and supplements and internet advice and fads and tik-tok trends and that's its own kind of misinformation sometimes. So when we come back I want to talk about the question that changes everything.

40:13 The question your doctor was never trained to ask, not because they're bad but because there just was never time. And I want to tell you exactly what that question has been missing in the bodies of the people I see in my practice every day. We'll be right back. Coming up, the question I ask new patients that almost no one has ever been asked before and the reason it changes the entire conversation about why their body hasn't responded to anything else. Welcome back to the Dr. Lazar Show. I want to do something a little different in this segment. I want to walk you through the way I actually think when a new patient sits down in my office because in the last two segments I've been diagnosing the system.

41:03 I've been explaining why the system can't answer your question and why that isn't anybody's personal fault. And if the show ended there I would have left you with a diagnosis with no clarity and that's not the show I run. The show I run is once you understand the diagnosis what is the move? So let me tell you what happens when somebody walks into my practice because I think it will make the abstract thing we've been talking about very concrete. A person comes in let's say it's a 42 year old woman she's had chronic migraines for 12 years she's seen and I'm making this up but it's pretty realistic composite here.

41:48 She's seen her primary care doctor, two neurologists, a headache specialist at a major academic medical center, an ENT, a physical therapist, a massage therapist, an acupuncturist, functional medicine doctor, a psychiatrist, she's tried triptans, she's tried preventatives, she's tried Botox, she's tried an elimination diet, she's tried daily magnesium protocols, and she's tried mindfulness-based stress reduction. She's had her hormones evaluated and has had an MRI.

42:31 She's had a CT scan and she's tried acupuncture and even dry needling and she's still having four to six migraines a week. This is a real person. I've seen her, somebody very much like her many times. Now what is the question I ask her look like. The question is why is the nervous system that produces these migraines dysregulated in the first place? Not what medication will help, what's the trigger food, what's your stress level, is it sound, light, noise, smell. The question is what is the upstream driver of the nervous system dysregulation that's producing the downstream migraine out migraine output?

43:19 That's the question. In my specific specialty, I want to be careful here because I don't want to make it sound like mine is the only answer to everybody's problem, it's not, but in my specific specialty what I'm looking at is whether there's a mechanical problem in the upper neck, the upper cervical spine, that's producing pressure at the brainstem, which is disrupting the very structure that regulates the nervous system output that produces that migraine. And in a pretty sizable percentage of the cases, I see the answer is yes, there is. And no one has ever looked at it, not because anybody's negligent, because the question in this woman's nervous system, is this woman's nervous system dysregulated because of a mechanical problem at the top of her neck, that's not a question any of the previous eight providers had a reason to ask.

44:14 They're not trained in that, they're not looking for that. It wasn't on their map. We missed 100% of what we're not looking for. It's not on the neurologist map, it's not on the ENT's map, it's not on the primary care's map, it's not on the psychiatrist map. It's on exactly one map, the upper cervical map. And until she found somebody who was reading that map, nobody was going to look in that location. Because why would they? And when you get a mechanical correction at that level, done precisely by a trained specialist and the brainstem pressure releases and the nervous system starts to regulate again, the migraines that four medications couldn't touch because they weren't a chemical problem in the first place start to change.

45:11 in a dramatic height-filled way. I'm not telling you this is a miracle, although I think it is sometimes actually. I'm telling you that it's a mechanism, a structural problem, correctly identified, structurally addressed. And I'm not using that example to sell you on my specialty. I'm using it to show you something that I think is much bigger. There are maps that are not on the map. There are questions that are not asked inside the standard system, not because they're wrong or because they're woo or because they're unscientific or pseudoscientific or misinformation, but because the system doesn't have a reason to ask them inside a seven-minute visit.

45:55 Remember it's not built to ask those questions. It's built to respond to the symptom with a code that will get them paid. And when you start understanding your own health through this lens, what is the upstream driver of the thing my body keeps producing? You know, the symptom it keeps producing. An enormous number of things will start to make sense. The digestive problems that won't go away and aren't explained by a food sensitivity may not be a digestive problem at all. They may be a nervous system problem. They likely are. They may be a vagus nerve problem. They might be a mechanical problem at a level nobody has imaged.

46:40 The dizziness that's been called vestibular then well maybe migraines and then well anxiety or functional may actually just be a structural issue that was never evaluated with the right tools. In fact the more you've heard we don't know the more likely it's this. Because everything else has been ruled out already. The fatigue, the body that nobody can explain, the blood work that's normal, don't get me started on that. May have a nervous system regulation problem producing downstream adrenal, thyroid, metabolic, mitochondrial effects that are the standard things missed because the panels, the standard panels don't catch those.

47:31 the anxiety that feels, it is physical, that nobody can quite locate. That may be the nervous system firing off a danger signal because something structural is in fact not right. Remember it's the check engine light. In every one of those cases, the standard medical response is to manage the output, change the systems, chemically alter it, surgically alter it, alter it with heat or cold, The medication for the reflux, the medication for anxiety, the medication for the migraines, the medication for blood pressure, the medication for the sleep. And I want to be clear, I suppose sometimes that's exactly what's needed. But in the people I see, the people who have done everything right, who've been to every provider who are still suffering, the missing conversation is almost always the same one.

48:24 They never looked upstream. looked at what was actually producing the output. They only looked at the output itself. And the reason nobody looked upstream is because the system we've been talking about for the last half hour is not designed to look upstream. It's designed to manage and alter and block the downstream event in seven minutes with a code that will get them paid. Now, here's where I want to be really careful because I know some of you are listening and you're thinking, all right, so I have to find somebody outside the system and there's a whole honestly industry of people outside the conventional medical system who want to sell you things, their supplements and their devices and their programs and their coaches and their peptides and their light therapy and IV trips and ice baths and cryotherapy and neurofeedback.

49:13 There are a million things and by the way those are all very helpful. You know some of those are legitimate. Some of those are helpful in specific contexts. Some of them are hyped though wrapped in expensive packaging and some of them are just the same manage the symptom model that the medical system uses except with a different color palette and maybe a nicer waiting room. So when you step outside the conventional system you don't automatically get clarity. Sometimes you just get a different kind of confusion and you can spend tens of thousands of dollars on supplements and protocols and not be any closer to understanding the actual driver of what your body is doing.

49:57 Super frustrating. That's why clarity, not alternatives, not hacks, not optimization, but clarity is what matters. The move is not abandon conventional medicine and chase wellness culture. The move is understand what you're actually dealing with. Understand what's producing the signal. Understand what kind of problem it is. Understand what the right tool for that problem is and then make decisions that match that problem. Sometimes the right tool is a medication. Sometimes the right tool is a surgery.

50:39 Sometimes it's physical therapy. Sometimes the right tool is nutritional intervention. Sometimes the right tool is a mechanical correction of something nobody ever looked at and sometimes the right tool is a therapist or a lifestyle change. You've been resisting because nobody explained to you why it mattered for your specific body. But the thing is you can't pick up the right tool until somebody has actually looked at the problem. And that's the conversation that's not happening. At least outside our office. And that's the conversation that doesn't fit in that seven minute visit. That's the conversation. The system has quietly stopped valuing because the system doesn't get paid for it.

51:22 And if you're a patient who's been in the system for years going from provider to provider, the single most liberating realization you can have is this. It was never my job to figure this out inside a seven minute visit. it was my job to find a person whose practice is actually built to answer this question and that practice exists. It just has to be found. That realization alone has changed lives and it can change yours. I've seen it happen in my office more times than I can count.

52:03 People walk in and they've been beaten down by a system for a decade. Again, not that they're being targeted, it's just that they're not going to a place that has the tools they need and within the first few minutes of a real conversation, either with somebody on my team like a clarity call or a consultation with one of the doctors in the office, something in them releases. And not because the problem is solved at that point the problem is not solved in just a couple minutes. But because somebody finally asked the question they had been quietly asking themselves for ten years and nobody had ever asked it out loud.

52:43 What is actually causing this? And once that question is finally being asked not as a polite formality but as the actual organizing principle of the conversation then all the other pieces start to find their place. That's really cool. The imaging starts to get used correctly. The history starts to make sense. The timeline starts to click. When did this start? What happened right before it? What was your life like before this? Those questions start to matter because they're clues to the upstream driver.

53:25 And slowly, over appointments, not in seven minutes, a story forms. A real clinical coherent story and that story explains why your body has been doing what it's been doing. And the story finally gives you a way to act on the actual problem instead of chasing those downstream symptoms which are really misleading. That's what this whole hour has been about. Not villains, not conspiracies, not burn it all down, just the question that was never asked and the quiet brutal cost of not asking. When we come back, I want to talk about what actually changes when the question finally gets asked.

54:08 Not in a hyped way or in a promise way, in a real observed 10,000 patients later way. If this resonates with you and you want to look for what we call the silent breakdown, You can text the word truth, t-r-u-t-h, to 734-274-5107, 734-274-5107, and you'll be texted a link to fill out that self-assessment. Coming up, what I've watched happen over and over in people who finally got the explanation even missing.

54:57 Not necessarily a miracle, although it can be, but a mechanism in a very specific moment when people stop feeling stuck. We'll be right back. Welcome back. Here's where I want to end this show and I want to end it carefully because the temptation, what you've spent an hour diagnosing a problem, is to finish with a big promise. But I'm not going to do that. I'm not going to tell you what actually happens or I am going to tell you what actually happens in real life. In real people when the conversation has been having finally starts happening in their life.

55:40 The first thing that happens and this is the thing that surprises people the most is not that they feel better. It's not a physical thing at first at least. The first thing that happens is something settles in them because for years for a decade or two decades for as long as they've been in the system with the thing they've been carrying around a quiet private suspicion that it was their fault that if they had eaten a little better or slept a little better or tried a little harder then a little more disciplined and they wouldn't be here.

56:24 And when somebody finally lays out the picture that we laid out today, the way we did that, when they finally understand that they weren't failing, they were standing inside a system that was never built to answer their question in the first place, something in them releases. Something they didn't know they were holding. isn't my fault is what they start to tell themselves. That's the first thing. The next thing that happens is they stop feeling broken because they spent years being told often implicitly that their body is just unreliable, that it's doing things it shouldn't be doing, that it's producing symptoms that don't make sense and when somebody finally frames it instead is your body is doing exactly what it's supposed to be doing.

57:17 It's incredibly precise. It's a precise signaling system and it's producing exactly what the output it should be producing given the upstream driver that no one has evaluated. When they hear that their view of their own body changes. And the Bible I read says we're fearful and wonderfully made. Your body's not betraying them. Your body's been trying to communicate to them this whole time. Nobody's been reading the message. I'm not broken. That's the second thing. The third thing, and this one takes a little longer, is that they actually start to understand what's happening, not in a vague way, but in a specific way.

58:07 For my patients, it's often a conversation about what's happening mechanically at the upper cervical spine and what that means for brain stem pressure and then what that means for nervous system regulation and then what that means for the symptoms they came in with. It's a real story. It has real diagnostics behind it. It makes sense in a way that lines up with everything they've ever experienced, usually for the first time. For other people's patients working with other specialists, it's a different story, but it's also a real story. A story with a mechanism, a story that accounts for the timeline and explains why the previous approaches weren't effective, why they didn't work, not because the previous providers were incompetent, but because they were solving a...