Episode 6: Trust with Dr. Puja Aggarwal

Show Notes

Contact Dr. Aggarwal: contratto2012@gmail.com

Youtube video about Amy Purdy: https://youtu.be/iUYc5CVNWow

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Dr. Weisman: Hey. You are listening to Doctor Me First, with me, Errin Weisman, DO, episode number six. This is a podcast where female physicians come together to have authentic conversations, get encouragement, and leave absolutely refreshed to take on our world. Feeling alone in medicine? Well, not anymore, because you are in the right place now. I'm your colleague in medicine and coach in life, Dr. Errin Weisman, and I am all about support, encouragement, and hope for you.

Dr. Weisman: In each episode, I talk to an amazing female colleague, and today, I will be talking with Dr. Puja Aggarwal. She is an amazing telemedicine neurologist who is kicking ass, taking names, doing all sorts of brain stuff, and the word that she chose today was trust. I hope you enjoy our conversation, and as a side note, I flubbed up during this conversation and called her Dr. Puja when I should have called her Dr. Aggarwal, so I apologize for that, and I love you, and I appreciate your gratitude in all of this, Dr. Aggarwal. So here we go. Here's the conversation, and make sure you stay tuned afterwards for that kick of encouragement.

Dr. Weisman: Hey, everybody. It's Dr. Errin Weisman. I am here with a very special guest today. Her name is Dr. Puja Aggarwal. Did I say that right?

Dr. Aggarwal: Yeah, it's almost there. It's Puja Aggarwal.

Dr. Weisman: Okay, there you go. That's the correct pronunciation, and I'm going to let her give a little bit about herself, and we'll talk about our word today.

Dr. Aggarwal: Okay. So, my name is Puja Aggarwal. I'm a neurologist. I'm a little bit different. I don't actually practice in a hospital. I do telemedicine, so I do teleneurology. I do that pretty much ... I don't do any actually in-person visits right now, so I work as an independent contractor with the company, and I work about 10 ... you know, eight to 10 shifts varying, depending upon the month.

Dr. Aggarwal: I enjoy doing teleneurology, and I've been doing it for the last couple of years, so I do acute stroke, migraines, seizures, epilepsy, and treating MS, so I see patients on an inpatient basis at various hospitals, and across many different states. I, two years ago, when I first started, was kind of ... You know, I didn't know ... It was unknown territory, didn't know what I was getting myself into. I thought it'd be different. I used to practice in a hospital setting, and I mean, I did like that, but I wanted a change. And this was a nice change, something, again, I didn't really know how it would go, and it turned out to be really good, and I liked it, and still like it.

Dr. Weisman: That is so amazing. Yeah, I love you guys, because I am in rural Indiana, and we use telemed for all of our strokes or neuro-emergencies, and I think it is amazing that we are embracing technology instead of being scared of it, because I remember too, just like you said, two years ago, people, our colleagues, were like, "Oh, you've got to be able to touch the patient. You've got to be able to do this," and now, just, it's so widely ... Like, almost every hospital I know in my region is doing some sort of telehealth, from you satelliting in into our small little community, and I just applaud you. You are a trailblazer, girl.

Dr. Aggarwal: Thanks. Yeah, I mean, you know, honestly, when I first started, like I said, I wasn't that ... I was good with technology, but I wasn't so great. And then once I got into it, I mean, you get the rhythm, and it works well, and as far as the physician-patient relationship, I think it can be established well with telemedicine or teleneurology. I mean, you are seeing the patient. You are physically visible to them. Somebody there usually is helping you with the neurological exam, so that does help, and they're usually trained in the neuro exam. So, you get to have access to their medical records. You get to look at their imaging for-

Dr. Weisman: Their scans, yeah.

Dr. Aggarwal: Yeah, look at all their scans, and lab work, and all that, so I function as like the inpatient neurology consultant for these patients who are on the inpatient at various hospitals, and I mean, I sometimes do feel like I'm actually there, even though I'm not physically present, because I feel like, you know, I'm looking at somebody doing the exam, and I'm speaking to them. I get the whole history, and you know, meds, and all of that, so I mean, I think that that relationship can still be established well with teleneurology. Dr. Weisman: Absolutely, and just think about like your impact. It's so much bigger than if you were just like an attending in one hospital system, or a couple hospitals. I mean, you are, across the US, doing your art of medicine. That is amazing. I just-

Dr. Aggarwal: Yeah. I mean-

Dr. Weisman: I think it's great.

Dr. Aggarwal: You can just logon, one second be in one state, and then, you know, a few minutes later see another patient somewhere else, if you're doing acute stroke, or whatever it is, but I mean, you can see people in multiple different states, and have access to them, and it allows access to, like you were saying, rural areas, where they don't have physicians, as many or enough to see all the patients. So, you can just call somebody, have them logon to a screen, and have access to a physician, so it improves access, rural, suburban, and even some urban areas.

Dr. Weisman: Well, I know too, I really enjoy it from the emergency medicine time, is like when I'm not quite sure as far as management, I appreciate that doc-to-doc interaction to be like, "Are we going to give TPA? Are we going to hold it? Do we need to go ahead and do perfusion?" Like, I greatly appreciate you guys's services, because whenever I get on the phone, I know I'm talking to a colleague, you know? I'm not talking to a stroke nurse inpatient. I am talking to a wonderful expert, who is right there on my computer screen, so I love that. I didn't even know about that about you until we started getting going.

Dr. Weisman: But anyway, guys, today our word topic that we are talking about is trust, and I think it is such an amazing and huge topic, that we're just going to see what rabbit hole it runs us down, but before we jumped on the recording, we were talking about the difference between the staff, nursing, just general healthcare's trust in a male physician versus a female physician. Give me more on that. Are you there? I lost you.

Dr. Aggarwal: I'd say that-

Dr. Weisman: There you are.

Dr. Aggarwal: [crosstalk 00:06:27] I felt, and I think other female physicians feel, most likely, is that patients, nurses, healthcare staff tend to trust male physicians more. It's this stereotype. Okay, so I would say that trust is important, you know? For a doctor-patient relationship, in addition to doctors and nurses, in addition to doctors and just other healthcare staff in general. And I would say when I was in residency, in addition to when I became an attending, that you know, trust is placed more so right away in the male physicians versus female physicians. Female physicians have their knowledge second-guessed, have their medical decisions second-guessed, not just by nurses, by patients, and just healthcare staff in general.

Dr. Aggarwal: I mean, I think it's just generalized. It's a stereotype, that I mean, may be not true with everybody, but I think it is pretty prevalent and pretty prominent, and I think that that leads to a lot of, then, doubt, or self-doubt for female physicians, in addition to them feeling like if they don't have the trust of their patients, then I think that can affect the relationship.

Dr. Weisman: Absolutely. I know in my own experience, that is 100% true, that when you do not have the trust of your team working around you, you don't have the trust of your ... Your full trust. They may trust you a little bit, but like that full, unconditional, buy-in trust from your patients, it does ... A lot of self-doubt definitely does creep in. Specific examples that you can think of in your own practice?

Dr. Aggarwal: I would say maybe a few years ago, when I was practicing, just as an outpatient basis, I mean, I've had patients who have come to me, and seen me, and I've given them my medical diagnoses, what I felt was wrong, and then they've gone and seen a male physician neurologist, and basically had the same thing told to them, because I was being ... You know, that lack of trust.

Dr. Weisman: Right.

Dr. Aggarwal: So, I mean, I think it's common. I mean, I think it's [inaudible 00:08:32] talked about as much, and I also think that, you know, staff tend to go with male physicians, giving them more trust, like your own staff, versus sometimes female physicians. Again, that's not always true. I think there are cases where certain staff may not, or certain patients may not, so I think even like on the inpatient setting, I think that that can happen, you know, where-

Dr. Weisman: They're doubting your call, and then they go to your partner, and you're like, "What the hell?"

Dr. Aggarwal: Not only that, but I would say even when ... Like, let's say you walk into a room with a resident, and you're an attending, or a medical student who's a male, they would ... You know, patients will tend to look to them, as if they're the attending, versus like when you're the one who's completed residency [crosstalk 00:09:18]

Dr. Weisman: Yes.

Dr. Aggarwal: ... training, and they're in training, so-

Dr. Weisman: Oh my gosh. So, I had a student a couple months back ... Okay, he was taller than me. He was like 6'5", so yeah. He definitely had a baby face, though, and the ... The three patients he saw with me during this short shift, all of them were like, "Oh, Doctor," looking at him, and I had to redirect them every freaking time. And it's so frustrating. I know that they don't always mean it. I know that it's ... That patient perception is not that they're trying to be degrading. That pissed me off for like weeks. It still pisses me off. Can you hear it in my voice?

Dr. Aggarwal: Yeah.

Dr. Weisman: That this 28-year-old kid, you know, who I'm like, "No," but you know what the biggest thing pissed me off with? Is that medical student embraced that, and there was ... Like, then there became some resistance, just between us during that shift, where I was like, "Whoa, whoa, whoa, whoa, whoa," and I even called him on it. I was like, "Okay, I've been doing this for ... You know, I've been practicing family medicine for four years, and I'm in the ER now, and yes, I understand that I am a new attending here in the emergency room. However, you are a fourth-year medical student," and I had to back him down from that, because for instance, like the circumstances I had, we had a guy that came in.

Dr. Weisman: Had a pretty bad extremity laceration, and like before staffing it with me, he was like already starting to do stuff, you know? And I mean, he was embracing that doctor role, but I had to stop him, because I'm like, "You didn't follow what you needed ... You didn't get an x-ray," you know? We do that with this kind of thing, with this mechanism of injury, potential foreign bodies, you know? And he requested not to come back with me.

Dr. Aggarwal: Oh, wow. Okay.

Dr. Weisman: Yeah. And I was like, "Okay. That's fine." But, exactly what you're saying, like that trust level-

Dr. Aggarwal: [crosstalk 00:11:19]

Dr. Weisman: That trust.

Dr. Aggarwal: Yeah. It's more inherent in men, that people just more inherently trust men versus female. It's unspoken. It's there. I mean ...

Dr. Weisman: Yeah.

Dr. Aggarwal: So I think it needs to be talked about more.

Dr. Weisman: Absolutely. So we're talking about it, and we're not man-haters, by any means.

Dr. Aggarwal: No, no, no.

Dr. Weisman: I love one very special man in my life, but like you said, it just needs to be verbalized. It needs to be like, "Hey, that's not right. Don't know how we're going to make it better in this situation, but you need to have my back." That's one thing that when like I talk to my staff, and I'm like, "I don't care if you don't agree with me 100% of the time, but you have my back, and at least call me Dr. Weisman. Don't call me Errin in the patient room."

Dr. Aggarwal: Yeah, by your first name, yeah. I mean, it's very common, even just, I would say in general, when I go somewhere, or just recruiters contacting, or just in general. I think people just do that sometimes. They're like, "Oh, you're Puja," and not Dr. Aggarwal, call you by your first name. I mean, it's just more respect also, not just trust, more respect inherently for men, male physicians.

Dr. Weisman: Well, there's definitely some studies too, that show they went back and watched a bunch of recordings from when there were male physician presenters and female physician presenters, and how many times the person who was introducing the speaker, they used the formal title for men and formal title for women, and I can't remember the exact odds or exact numbers from where it was, but it was astronomically different. Like, men were, a majority of the time, introduced as Dr. Such-and-such, and females, a majority of the time, their title of Dr. was left off.

Dr. Aggarwal: Yeah.

Dr. Weisman: It's just being, like, conscious of that. I think that's what we're asking for.

Dr. Aggarwal: Yeah, and I think it's just so easy for people not to be. I mean, I can imagine how many times I've had patients just say, "Oh, hi, Puja," even though I introduced myself as Dr. Aggarwal, and they just think it's all right, versus like with male physicians, they're like, "Dr. Whatever, so-and-so." So, I mean-

Dr. Weisman: Absolutely. Well, what are some ways in your life, that you've kind of counteracted that?

Dr. Aggarwal: I would say, "Oh, it's Dr. Aggarwal," and reinforce it, say it multiple times, for it to hopefully get through to the person, depending upon who it was, you know? And even with the patient, I might be, "Oh, well, it's actually Dr. Aggarwal. That is my first name, Puja, but, I mean, in order to have a doctor-patient relationship, it needs to be Dr. Aggarwal, please," and I'll address them as they want, Miss, Mrs., you know, whatever, Mr. So-and-so.

Dr. Weisman: Yeah, I've found that same way. I'll say, you know, "I prefer to be addressed as Dr. Weisman. What would you like to be called?" And I feel like that sometimes defuses the situation too.

Dr. Aggarwal: Yeah. Yeah, that definitely does.

Dr. Weisman: Do you have any tips or tricks as far as, like, establishing more trust with our staff that we work with?

Dr. Aggarwal: I think in general, that female physicians being more confident, projecting that confidence, showing it, and that can help. I think that depending, I mean, on certain staff, if they're ... if you have a personal relationship with them too, I think that can help establish more trust or confidence, and as far as patients, I think, you know, coming off being confident, being able to explain everything well and thoroughly, all of that can help.

Dr. Weisman: I definitely feel like my journey through medicine, that that was not anything that was ever emphasized to me, like how to gain that confidence, and then like beam that energy out into the world. How, through your practice, have you gained more confidence?

Dr. Aggarwal: I think as I've practiced more, I mean, I'm about six years out from finishing residency, that as time goes on, you get more experienced, you become more confident. As you see more things, you expand your knowledge, and see more patients, I think that that builds confidence. And also, I think it's just inherently ... You know, some people do come out of medical school confident, even if they're female, or male, or I think a lot of it's also just personality-wise, that can change over time. So, I mean, I think you know, believe in yourself, knowing that you have the knowledge, knowing you have the skills to take care of patients, that can help too. Being confident in yourself and having that knowledge that you can do it, and do it right is also [crosstalk 00:15:55]

Dr. Weisman: Absolutely. I'm a big one about mantras. Like, I feel like that has really helped my inner game, so then that it elevates my outer game of medicine, and that's one thing that I use a lot, just exactly what you're saying. Like, having that mantra of like, "I am a capable attending," or you know, like for me, I'm getting ready to go into maybe a difficult situation in a patient room, just reminding myself, like, "I have done this before. I will do it now." You know, just like those little things that kind of beef you up a little bit before you step into something like that, I find is a big confidence builder, and something that kind of keeps that energy beaming out.

Dr. Aggarwal: Yeah. I would say, I mean, I've heard, just from female physicians coming out of residency, or medical school, there's like sometimes this occurrence of this imposter syndrome, where they don't feel like they can do it, or they feel like there's ... You know, they shouldn't be there, they shouldn't be taking care of the patients, even though they have the knowledge and the skills. Yeah, I think that's just more inherently in females as opposed to males. I think that also, just in medical school, maybe there could be something to help female medical students, physicians, do something more where their confidence is built more, and not only that, but like it's ... Somehow, I wish you could change society, that'd make it so much more ... you know, that everybody were to give equal trust and respect, but that's not going to happen. There's someway something like that could happen, but-

Dr. Weisman: Absolutely. You know, just brainstorming as I've worked with medical students and residents, one thing that I try to do, and I hope to see that it turns the tide more, is like that more positive reinforcement. You know, psychology tells us to negate one negative, you need like seven positives, and I think that's something that we don't do well with learners, is when they do do something well, reinforcing that. Be like, "You just did a really good ..." Like, if someone does a good history and physical exam, I'm like, "That was an excellent ..." You know, trying to like beef them up a little bit, because I feel, like you said, so much in our medical culture, it's about we don't do that, you know? You're beat down. You're tired. It's rough.

Dr. Weisman: And not that we need to coddle people. I'm not saying that at all, but I think we just need to have a more positive, encouraging environment for when things are really done well, that we acknowledge that in other people. So then, like you said, then they come out and they're like, "Okay, I got this," because I can think of some of probably the most minor experiences, as like a fourth-year medical student or intern, but because an attending was like, "That was a really great job," you know, that's what sticks with me now, because I respected that person, and you know, they gave me praise on that. And maybe that's potentially a way that we need to help reinforce our younger female colleagues, is making sure to praise them. Because I know also, too, when there's been research studies done on female residents, most often the time, they cite the hardest judge of them or the hardest grader are their female attendings, so that's one of those that I'm like, "Oh, don't eat your young. We want these people."

Dr. Aggarwal: Yeah. Yeah. I mean, I would say not just trust from other people, like patients, healthcare staff. I mean, as female physicians, trust in ourselves. Like, we don't ... I mean, that sometimes isn't always there.

Dr. Weisman: No it's not, and you know, it should be. I mean, think about how much we have used to prepare for the career that we're in, how many hours spent over the last several years. Why are we not trusting ourselves? Because there's hundreds of patients who do trust us, and they do acknowledge everything that we've done. We've got to, like you said, get more of that trust within ourselves. That is a great, great thing.

Dr. Aggarwal: Yeah. I mean, I wish it was like every female physician coming out of medical school would have that complete trust out of residency, in themselves, and-

Dr. Weisman: We need to make, like, little pins or little Post-it notes, that say, "I trust myself." Or like those t-shirts that say, "Trust me, I'm a doctor." We need to do that to ourselves. Absolutely. Well, anything else on the topic of trust?

Dr. Aggarwal: Not that I can think about right now. I don't know if you have-

Dr. Weisman: I think this has just been such an awesome topic, talking about outside trust and then how we've directed it back into inside trust. If any of our listeners have any insights to give, I would love to hear your comments on the topic of trust, and I just so appreciate everyone being with us today. Dr. Puja, is there anything else, or if someone wants to get ahold of you and talk with you, what is the best way for them to contact you?

Dr. Aggarwal: They can actually email me. Should I just go ahead and give the email, or-

Dr. Weisman: Yeah, you can give it, and we'll put it in the show notes.

Dr. Aggarwal: Okay. It's C-O-N-T-R-A-T-T-O 2012@gmail.com.

Dr. Weisman: Perfect. All right, well thanks so much for talking with me today, and we are going to work on trust.

Dr. Weisman: Here's your kick of encouragement for today, and I am going to go off of what we just talked about in the interview, which was trust, trusting ourselves, trust within ourselves. And some of this comes from an interview that I heard with Amy Purdy, on YouTube. I did not know her story prior to hearing her on a podcast with Elizabeth Gilbert, but after talking on there and listening to it, I immediately went to YouTube and stayed up until 2:00 AM, hearing about this woman's story. So, she had contracted meningeal meningitis. She went into septic shock within hours. Because of that, she ended up losing both of her legs below the knee. She had renal failure. She was on dialysis. Just a horrific set of medical events, that I know that we all have experienced one time or another as a provider, and what I took away from that was how much she overcame from it.

Dr. Weisman: She started snowboarding again. She earned a bronze metal in the Paralympics, and she went on to compete on Dancing with the Stars with her prosthesis. So, just so many valuable life lessons, but one that I want to share with you today about trusting yourself is when she talks about being hard and being stoic, and just paraphrasing her words, she talks about how we all want to appear powerful, and strong, and successful, but when it really comes down to it, it's maybe not so much those words, but we really want to live life fully. And she encourages anyone who listens to her that to do that, we need to treat ourselves softly, and we need to trust ourselves.

Dr. Weisman: And she talks about how being raw and exposed to others is how we really knit our lives together and have that experience, that instead of hammering away at ourselves, because life is already hard, we should be soft with ourselves, and we should trust our own judgments, not in the fact that we let ourselves cop out, or hide in the shadows, or crumble into a ball of mush on the floor, but instead that we should be gentle with our thoughts and our feelings, and let those guide us at times.

Dr. Weisman: I know as a physician, I was trained and felt that I had to be stoic, and I had to be hard, so that I could perform my job the best. However, when I think back to the most tender moments in my career, it's the ones that I had with patients, and staff, and colleagues that were those soft moments, where I did trust myself, where I'd opened up and showed a piece of my heart under that hard exterior.

Dr. Weisman: So I encourage you today, with this kick of encouragement, is take a little piece of your armor off today. Let a section of yourself maybe be exposed. Do something undefended, that might wound you, but if successful will invigorate you. Trust in yourself. That calling within you, or that something that's going on, trust in it, because if we continue to live our lives behind the armor, behind the hardness, we never really truly experience joy, love, and creativity, because being vulnerable is the exact opposite of what it feels like we should do to protect ourselves, but being vulnerable is absolutely essential to living a life that you love, that nourishes your soul, and that you can live truly trusting yourself. So try that today, and let me know how it works for you. Send me a message. Find me on social media. Come hang out with me on a phone call. But try to embrace that little voice inside of you, and just trust it today.

Dr. Weisman: Well, that's it for today, episode number six in the books. Thanks so much for joining me, and remember, help is available for those who ask. So I keep space open every single week for any colleagues who maybe just need to talk. They need to talk to somebody else outside of their hospital system, outside of their state, outside of where you live your life, and kind of sort through things. And I call these colleague-to-colleague calls. There's links in the show note where you can get set up with those, and it's absolutely just space for you to talk, and there's no selling. There's no buying. There's no sleaze. Again, it's just offering you an opportunity that I think is really special and really unique, and my way of giving back to all of you who are listening. So, check that out if you're interested, and always remember, your life, your calling, your pulse matters.

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