#86: A Word on Malpractice w/ Dr. Philip Ovadia

In this episode, Dr. Ovadia (a cardiologist), Larry Hicks (a malpractice lawyer), and Larson Hicks discuss the benefits of being an independent physician and the cons of having to work in a system with malpractice agencies enforcing a restrictive definition of “normal medicine.”

Join them today to hear how malpractice agencies have missed the mark while independent physicians are working out the causes of heart disease!

Catch us on your favorite podcast streaming service!

Transcript

SPEAKER_01 0:05

Welcome to Branch Out with Sycamore, the Calar Text. I'm the CEO of Sycamore, and we've got a very special guest this morning. I'm excited to have with us uh Dr. Ovedia, who is a certified cardiac surgeon. Um also has his own practice, does virtual telehealth, metabolic health, and uh and has a pretty interesting take on heart disease, and I'm really excited to have him on the show and hear uh his story. So thanks, thanks for joining us, Dr. Vedia.

SPEAKER_02 0:39

Oh, thank you for having me, Larson. I'm really excited to connect with uh the sycamore audience here, and I think this is going to be a great discussion.

SPEAKER_01 0:48

In my simplistic understanding of of what the purpose of a physician is, it's it's to help f you know patients, one you know, individual by individual, uh ascertain you know what their medical challenges, problems are, and uh arrive at a uh a treatment plan, you know, that that helps them uh get healthy. And all of this has been um complicated uh by the fact that A, we've got uh insurance companies now who are paying the bill. So so patients aren't paying a physician anymore, they're paying an insurance company. Insurance companies are deciding what treatments they think is worth are worth paying for and aren't. And then uh and then on the on the uh medicine side, you know, on the drug side, you've got these large pharmaceutical companies who are paying for, you know, most of the sort of uh research and science and and sort of options that the interventions that that uh physicians have. Um and so it just seems like this whole uh this whole thing has gotten pretty um pretty complicated uh to to a to an extent that uh that um that that there's a bias now it seems towards intervention, whether it's a whether it's a uh pharmaceutical intervention or surgical intervention.

SPEAKER_02 2:09

Yeah, certainly. Um, you know, so uh when you go back to you know what a physician should be, you know, the the Latin root of uh you know doctor is uh you know a teacher, an educator. And uh ultimately, you know, physicians should be here, like you said, to educate their patients about you know health and about you know the diseases that might uh afflict them and the options you know on how to treat that. Uh and it's you know key to understand that you know we're not here to tell for tell patients what to do. Um, you know, people are are surprised to hear me say, you know, even as a heart surgeon, I don't tell patients you need to have heart surgery, you know, talk with them about their conditions and where you know heart surgery might fit in as an option for that. Uh, but if for whatever reason, you know, even if I think that heart surgery is truly the best option for a certain situation, if the patient decides they don't want to have heart surgery, for whatever reason, you know, it's not my role to dictate that to them. And I will still work with them on you know whatever other options they choose. And as you said, you know, the the options that are presented to patients these days are often you know colored by not what is best for the patient, um, but what is best for the healthcare system. And uh, you know, that can take the form of insurance companies denying you know care because it it's judged not to be cost effective. Um it can be guidelines that you know kind of force doctors' hands as to how certain you know conditions need to be treated. Um, again, without any real um, you know, without taking into account that every patient is unique. And uh, you know, guidelines play a role, uh, you know, they they can help. Obviously, you know, every doctor can't know everything about every condition, uh, even the ones they commonly treat. And so guidelines can help to you know bring together some of the information and sort of show what might be best. Um, but we got to realize that those guidelines are incomplete, they can't be you know tailored to each individual. And also, unfortunately, these guidelines are oftentimes heavily influenced by other forces such as the pharmaceutical industry. And so, you know, we've gotten into a situation now, and this has become you know very obvious uh in you know our current environment, uh, that you know, any anything that questions things like guidelines, uh, anything that goes against what is felt to be you know the mainstream by the healthcare system uh gets looked upon negatively, gets questioned, and you know, and and those physicians are often put under undue scrutiny when, you know, in the end, a lot of us are just trying to do what we feel is best for the patient, help the patient decide what is best for them, and that's looked upon negatively by the healthcare system.

SPEAKER_01 5:31

There's something really there's something really uh paternalistic about I think the way that medicine has become. Um and and you bring up a really good point about sort of the you you mention at the top of the call the fact that there have been uh physicians who have had their medical licenses revoked because of because of recommending metabolic um strategies to to address heart disease. And and I didn't even mention when I was talking about some of the big players in medicine being insurance companies uh uh and and uh you know health I was thinking health insurance and then also um uh pharmaceutical, but you bring up the the other elephant in the room, which is which is medical malpractice, right? And and the threat that doctors are under uh to provide quote unquote standard of care. And that's a that's always a concern that I don't want to do anything outside, I don't want to paint outside the you know, lines or I might get slapped.

SPEAKER_02 6:32

Yeah, and I'm uh I'm sure your dad will have uh much to say about this, but you know, again, medical malpractice has evolved to a point of uh you know what it was originally intended to, which was you know, to be able to compensate patients if they truly receive negligent care. Uh to now it's a uh system you know that's utilized uh for any, you know, anyone that strays outside of what is felt to be, you know, the mainstream, I guess we can call it. Um, you know, malpractice is a is a constant threat there. And again, you know, that's not what was it was originally intended to be. And again, I would say that that's not the you know what it should be. Um, you know, there are unfortunately truly, you know, patients that are harmed by care that is substandard, um, but uh the the net has been cast much more broadly uh by the uh malpractice system that you know recently.

SPEAKER_00 7:39

Yeah, the sad thing about it is that uh um malpractice uh seems to start with a poor outcome. So if you have a less than desirable outcome, then uh the default position that a lot of a lot of uh plaintiff malpractice lawyers take is okay, we have a bad outcome, let's see if we can figure out how to make this negligence. And uh and that that that that's difficult, and and for the most part, the system will sort that out, but in the process the doctor has been has gone through the ringer uh having to having to defend himself in a situ him or herself in a situation that that he knows or she knows that he did nothing wrong. And and it and it makes doctors, particularly subspecialists like surgeons, and makes them nervous because they see every they begin to see every patient as a potential plaintiff.

SPEAKER_01 8:38

Right, right.

SPEAKER_02 8:41

Yeah, and then you know, again, out to you know, kind of a little bit separate from malpractice, but uh the the you know the sort of licensing environment, you know, any uh you know, pretty much it's gotten to a point where licensing boards can come after physicians for anything that they perceive to be uh you know uh uh not within the standard of care. Um and uh, you know, when we again look at the current issues going on in the healthcare system and trying to question some of the narratives that are out there, uh, you know, just raising those questions uh you know can get you can get you on the uh radar of the licensing boards, and that that becomes very problematic. You know, I I would I would say that you know the patients uh you know do not want physicians uh who are not able to question you know uh things. Um you know medicine was not uh has not made advances uh because people were afraid to question things. You know, you look at all the great medical advances that have been made, uh surgical, you know, new surgical procedures, medications, um, you know, all the treatments that we have available to us, um, you know, those did not come about but because people were afraid to you know question the norm. And quite frankly, heart surgery is a great example of that. You know, heart surgery as a specialty is pretty young, it's only about 60 years old. And the the you know, the original heart surgeons um were called crazy, and and you know, the concept that you could operate on someone's heart, you know, was felt to be, you know, you know, I mean, quite frankly, crazy, you know, 70, 80, 100 years ago, um, you know, that concept would have been uh you know labeled as uh you know outside the standard of care, heretic, uh, you know, all of that stuff. And uh, but there were some brave uh you know physicians who were willing to question that and um you know get us get us to advance. And I think we're in an environment now where thinking like that is is not tolerated, and I think that's gonna have devastated consequences for the future of healthcare.

SPEAKER_01 11:09

Well, one of the one of the things that I mean as you talk about that, and and and I'm always cognizant of the fact that I probably sound like a conspiracy theorist at times, and I really don't want to, and I don't I don't like that that orientation. Um but but there there are there are it it's hard what you said about just skepticism. Just skepticism being a skepticism it seems like it should be part of the uh one of the core uh um virtues of a a man or woman of science, right? And and and anymore science is quote unquote science is the bludgeon uh which is used to compel uh uh compliance to the the status quo, whatever that might be. And so you know we we see this in all other all manner of other areas where science is science is telling us to do X, and if you're if you're uh conscientiously you and your physician armed with a lot of information are skeptical, you're anti-science, which uh which uh uh which somehow has become uh the the the cut down for anybody who uh disagrees with uh the uh the prevailing um uh mainstream uh um theory.

SPEAKER_02 12:37

Um yeah, exactly. You know, the the the scientific method, you know, can not can never prove anything. You know, the scientific method is designed to disprove things. Um we are supposed to, you know, raise hypotheses, uh, you know, and then you're supposed to work to disprove your hypothesis. That should be the goal of a of a true scientist. And um, you know, again, the examples are all around us. You know, if you look at you know what I focus on, metabolic health and nutrition, you know, 40 and 50 years ago in the 1970s, 1980s, we were facing an epidemic of heart disease and a rising obesity. And you know, the uh there there was a hypothesis at that time that you know eating more fat is what was making us fat. And you know, it it seemed to make sense. And so we started down the pathway. We said, okay, the U.S. dietary guidelines were introduced, low-fat, you know, diets um were introduced, and here we are 40 years later, and the results speak for themselves. I mean, you know, we are more unhealthy than we have ever been. 88% of the adults in the United States are not metabolically healthy. You know, uh 60 to 75 percent, depending on you know what kind of sample you look at, are overweight or obese. Um, and you know, the heart disease remains the number one killer in the United States, uh, and that has you know not been you know not been changed in the past 30 years. And so when you look at that empirically, you have to say, okay, you know, our hypothesis must have been wrong. Um, but if you question the narrative that you know, you know, low-fat diets are the only way to keep your heart healthy and to keep you heart, you know, keep you healthy overall, and everyone's cholesterol must be lowered to the absolute, you know, uh lowest level possible with medications. Um you're as you said, you're labeled, you know, uh conspiracy theorist, crazy, uh, you know, all of this. And and I'm just here saying I'm just looking around me and seeing that what we're doing is failing, so we gotta try something different. Uh, but there's there's no room for that.

SPEAKER_01 14:57

So so you touched on cholesterol, which I I figured we'd get into here. So so I I imagine that the the patients you've operated on over the years had high cholesterol, and I also imagine they were on statins. Well what's the problem?

SPEAKER_02 15:13

When you actually look at the statistics around that, you know, uh what you see is that more than half of the patients that end up having, you know, coronary artery bypass surgery, the most common heart surgery I do, um, which is a treatment for atherosporotic heart disease, buildup of blockages in the arteries. More than half of those patients have, you know, low, what are considered normal cholesterol levels. Uh, some of them because they're on medications, they previously had high, you know, and again, when we look at when mainstream medicine talks about cholesterol for heart disease, they're only referring to one type of cholesterol, LDL cholesterol, which is the type of cholesterol that gets modulated by, you know, statins and other medications. Um, but when you look at the statistics, more than half, in some samples, up to 70% of patients undergoing coronary artery bypass have what are considered low, you know, normal to low cholesterol levels. Uh, and like I said, some of them are on medications to cause those low levels, some of them, many of them are not. And yet, you know, we still think that cholesterol is the singular cause of heart disease. And again, just looking at it from a logical and scientific standpoint, you know, there's no way that cholesterol can be the singular cause of heart disease, and yet half of the patients or more than half of the patients who end up with heart disease, you know, don't have high cholesterol levels.

SPEAKER_01 16:44

Right. That seems obvious. Well, why why why then um you know, I I I find it interesting that you you go to a doctor, um I remember going to a doctor once after it's it's just it's kind of funny in retrospect, but I I spent a long weekend uh uh uh at a wedding, you know, where there was, you know, attended a bachelor party, lot a lot of eating, you know, barbecue and drinking a lot of beer. And I came home from that trip with what felt like an ulcer, you know, and went to my doctor and um he put me on a on a proton pump inhibitor, right? Uh drug. And uh and it and it eventually helped, right? But um but as I've grown older and and I'm I'm less inclined to uh to to uh medical intervention in that way. One one day I I had a similar uh situation and I just posited. I wonder if I just fasted for a day what that would do to my uh to this uh gut situation. And lo and behold, it it worked really, really well. I was like, I I wonder how many physicians who have somebody come into their office with those kinds of symptoms uh would reach maybe first for uh something like fasting.

SPEAKER_02 18:06

Yeah, very very few. Um, you know, obviously I uh now you know understand this, and I think that you know, focusing on metabolic health and profit proper diet and lifestyle should be the first line uh in you know the vast majority of conditions we treat, quite honestly. Um but uh but it's not, and you know, the the example you gave is a perfect example, and again, getting back to heart disease, um, you know, when you go to your primary care physician or your cardiologist and they see that your cholesterol is elevated, even if we do think if we accept for a minute that elevated cholesterol is, you know, a problem around heart disease, again, why don't why is the first treatment for that a medication? Why don't we say, okay, let's make some changes in the diet that might lower the cholesterol? Um, you know, now again, um, I even go back a step and I I I no longer accept the narrative that high LDL cholesterol is causative of heart disease. And uh I think more important, um, and again, the data supports this, uh, you know, metabolic disease, metabolic syndrome is a much bigger risk factor for heart disease than an isolated elevation in your LDL cholesterol. The data is very clear on that.

SPEAKER_01 19:33

Yeah, that's huge. Yes, I hope this is the first of a lot of conversations. Thanks again for being on the show. Both of you.

SPEAKER_02 19:40

Sounds good. All right, we'll see ya. Bye.