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Dear Readers, It’s February, which means that weather is shifting and here in college-town Florida we’re already glimpsing bikini tops at grocery store, but I certainly hope it's not too late to say ‘Happy New Year’! As we move into 2025, I’d like to share the view from where I sit as a doctor looking out from inside the health care system and looking deeply into the lives of women. I see patterns, I see potential, I see problems. I want to raise some questions for you to ponder, connect some dots that have been on my mind, and begin to elevate our conversations about the future of health care. First, women are feeling - in their bodies - the sociopolitical shifts of the world, regardless of their personal political views. Obvious? Maybe. The fact that stress shows up in our bodies is not a surprise to any of us. We’ve all been there. We know from experience that when we’re in the wrong job, wrong relationship, or wrong community our body is capable of giving us direct feedback on those misalignments. But this feels different. Things are heating up lately and our bodies are sending mixed signals. I share this based on direct clinical observation as a physician who sits with her patients for an hour at a time inquiring deeply into their minds and lived experiences. Remember that even under ideal circumstances, the menopause transition is chock full of hormonally mediated symptoms, sensations, and shifts that are hard to interpret and attribute. Add to that an outer world that is shifting, uncertain, or unsupportive, and it gets even harder to peel apart the layers of our experience and our suffering. Very often, I hear my patients engaging in super subtle self-blame which can show up as, ‘I should [insert self care activity] more’, or ‘I should listen more to my intuition’, or ‘I should dig deeper into my role in my own suffering’. Although I strongly support all of those approaches to living wholly, let me offer this advice as we move into a brave new world - please be slow to blame yourself for every perceived lack of personal resilience, whether emotional or physical. External stressors are real and accumulating, and these can destabilize even the strongest amongst us - sometimes without us fully recognizing the source as being clearly outside of ourselves. Second, there’s a HUGE contradiction between how we feel about the health insurance industry and our loyalty to using our own health insurance, literally at any cost. I completely understand why people want to make good use of the insurance coverage they do have, but let me explain... On the one hand, we’re sick and tired of what appears to be a profit-driven, value-extracting industry hellbent on price gouging, surprise bills, and denying access to health care. But on the other hand? We’re paying hand over fist for this product so we’re determined to use it even if the service is bad and the price is high. Might our relationship to health insurance be compared to any other dysfunctional or codependent relationship in our lives? We know it’s not working for us, it might even be unhealthy or toxic, but we have no idea how to leave or make a positive change. So what can you do? What are the baby steps that can move this conversation along? One, acknowledge and confront this paradox in your own thinking. Two, remain measured and humble in your conversations about health reform, a topic which is infinitely complex and that risks stagnation if we reduce it to hashtags and campaign slogans. Three, vote with your dollars (if you are privileged enough to do so) to counter prevailing economic winds that suck the majority of your health spend straight out of your local economy and systematically devalue and degrade the very people (ie: doctors, nurses, therapists) that are trying to take care of you. Third, on a positive note, I am falling in love with telemedicine thanks to my patients! When I set up shop, I was fully hybrid and allowed patients to choose between in-person or video visits. With time, I’ve been amazed to sit back and watch as my patients have essentially converted my practice into a telemedicine business. (Yes, I still have an office and can still see you in person!) I now have patients scattered all over Florida, and as the saying goes - seeing is believing. What made me a believer? It was the first hand experience of quarterbacking complex care in communities where I have never stepped foot, including imaging, labs, specialist referrals, and more. It’s truly magic! My ‘strategy’ has always been to design around gaps in the system as revealed by the women I serve, so I’ll be placing bigger bets on telemedicine moving forward. I know now that when done thoughtfully and responsibly, telemedicine allows women to get high quality care that is convenient, personal, coordinated, and that offers a far superior experience to what they otherwise have to deal with: a half day off work, figuring out childcare, thirty minutes in a car, waiting rooms with poor aesthetics and lots of sick people, and then a 7 minute chat with a lovely but obviously burnt out doctor who is clearly running behind and trying to catch up. On a personal level, these are all ingredients in my own story. I used to be one of those burnt out physicians trying to be kind and present during rushed appointments, then falling behind on paperwork and volume metrics, being reprimanded behind the scenes. And, guess where the stress of the unsupportive health care system showed up? In my body (especially my neck and upper traps!) And why was I burnt out? Because when it comes to low-risk relationship-based care, the current fee for service reimbursement model demanded by health insurance degrades and devalues physician labor to such an extreme that your doctor is almost certainly NOT the healthiest version of herself. I know I wasn’t. And guess who that ultimately impacts? You. Nostalgia for the good old days is not how we design the future. The path forward asks us to tell our stories, reimagine what’s possible, and demand better. If you’ve made it this far, thanks for reading and I hope you’ll join us at Superette or the Lynx for ongoing conversations about the future of health care and women’s health. Sincerely, Lisa Chacko
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