Today on the show we are very glad to welcome Dr. Nina Shapiro, ENT specialist and author of Hype!  In our conversation we chat about her book and what inspired a general and popular publication of its kind before getting into some of our guest’s experiences and opinions on the medical field at present. We discuss confirmation bias, common health concerns and the attitudes of parents towards health in the modern climate. Dr. Shapiro opens up about e-cigarettes, vaccines, online information and gender bias in medicine too. She shares some of the challenges that come with writing a book, and particularly a medically focused one, why mentorships are so important to young doctors and the troubling advice she offers encounters in her work. We finish off the episode with a few fun questions about wishes, her mission and a question that Dr. Shapiro wants to ask Shree! For all this and more, tune in today!

Key Points From This Episode:

  • Confirmation bias, the influence of Google and the inspiration behind the book.
  • Surprising beliefs that are widely held to be true.
  • Reformulating the pyramid of health concerns.
  • E-cigarettes, JUUL products and the effects that Dr. Shapiro has noted.
  • The evolving attitude of parents about their children’s wellbeing.
  • The unrealistic debate around vaccines and legal and ethical concerns.
  • Close-knit communities, the speed of outbreak and the importance of education.
  • Lay press, battling fake information and Dr. Shapiro’s attitude towards these.
  • The most challenging elements of writing the book.
  • Medical education and mentorships within any program.
  • Shapiro’s experience of gender bias in the medical profession.
  • The professional advice Dr. Shapiro disagrees with the most.
  • Shapiro’s mission and what gets her out of bed in the morning.
  • The three things Dr. Shapiro would wish from a genie!
  • And much more!


“I work in healthcare, I work with patients, I work with families, we’re exposed to a lot of information, all of us, not just doctors, all of us on a daily basis.” — @drninashapiro [0:01:04]

“I really felt that there was a dire need to write a book that was as evidence based and as non-biased as possible.” — @drninashapiro [0:01:29]

“I take care of very elective problems and I take care of severely emergency, life and death problems and everything in between. And no two days are the same.” — @drninashapiro [0:34:56]

Links Mentioned in Today’s Episode:

Common Sense Medicine —

Hype —

Dr. Nina Shapiro —

Dr. Nina Shapiro on Twitter —

Dr. Peter Attia —

When Breath Becomes Air —

The Spirit Catches You and You Fall Down —

How Millennials Became The Burnout Generation —

Digital Minimalism —


[0:00:10.7] SN: With that, welcome to the show Dr. Shapiro, thanks for being here.

[0:00:13.6] NS: Thanks for having me, great to be here.

[0:00:15.4] SN: I guess we could get started with one of the things that I loved about your book which is that of confirmation bias. Routinely, we see people gravitate to the evidence that they like and with Google, it’s far to easy to search something that you think is true and then buying the safety evidence that you like. Do you want to explain a little bit about why you wrote the book and why you had an inspiration to set the record straight on some of the things that we routinely see? Like [inaudible]?

[0:00:46.8] NS: Sure, I wrote the book really inspired by everything as you said, everything around us, people talking about Google searches, people really wanting this confirmation bias, meaning that if they think something is true, they want confirmation that that is true and I work in healthcare, I work with patients, I work with families, we’re exposed to a lot of information, all of us, not just doctors, all of us on a daily basis, minute to minute basis.

The more I was hearing and the more sort of unusual questions I was getting and unusual thought processes that I was hearing from patients and families, I really felt that there was a dire need to write a book that was as evidence based and as non-biased as possible and really addressing the issues that people have as far as concerns and fears and terror that we all experience.

But also, providing a real balanced piece of work where people can say okay, well, if this is something that I’m worried about, how am I really going to better understand my concerns? The book was written and published in 2018, we are now in 2019, we’ll soon be in 2020. We’ll have new information. But a lot of what I like to provide in the book is not just, “Here’s the answer and here’s the right thing to do.”

How do you – what are the tools that you need when a new piece of information comes up? When there’s a new fear, a new scare about a new infection or a virus or you know, some sort of health catastrophe, how do we as a society address these new issues on a daily basis?

[0:02:31.7] SN: Something that I really liked about the book is the chapter that talked about what you should really be worried about. Because a lot of people don’t talk about yeah, you might get killed by vaccines that trigger an autoimmune reaction but that’s like one in a million, you should be worried about cardiovascular health because heart disease is the leading cause of death and so is preventing dementia.

So is sleep deprivation, those are the boring things that no one really talks about but are the bigger causes of death. I was recently on a binge for longevity information and I found there was a lot of information about nutrition and what you should eat, what you shouldn’t but there wasn’t a lot of information on how you should choose what to eat and I think that physicians have a duty to kind of tell people about this.

In your research, what was the most surprising thing that you found out that people were following but had no basis and evidence?

[0:03:37.6] NS: Yeah, actually, that was the chapter you’re mentioning is called ‘Risky Business’ which were those of us who remember that movie, it was one of my favorite chapters to work on because it’s so different from what we think, you know, for instance, when there was the Ebola scare and Ebola is still present and still terrifying.

People were worried more about Ebola but they weren’t worried about basic ways to live longer and live safe and healthier. You know, I think it’s really interesting to see how people think. You know, one of the things I think when we talk about nutrition and health, you know, we talk about gluten and you know, or dairy, all of these parts of foods that are supposedly the root of all evil.

What are they really and what’s the basis of that? Is there really truth to worrying about these components of foods without really understanding what they’re doing, why they’re doing that and if it’s really that good or that bad for us. I think it’s just, if you hear something and it sounds bad and it sounds bad in the press or by some advice or some extreme diet, then you will equate that to either being unhealthy or being healthy regardless of really understanding what it’s doing to your body.

[0:04:57.8] SN: Something else that I wanted to stress is that, a lot of people – I know you had mentioned this in the book as well but a lot of people talk about, I think you had written it in the form of a lot of people worry about what can cause like death like they’re so afraid of eating something that’s a GMO or something like that but they’re not afraid of kids riding around on their bikes without a helmet.

I thought that was really interesting because a lot of people talk about focusing too much on the micro and not enough on the macro. What do you think that patient should be focused on primarily. What should be the base of the pyramid of health and then what should we build up to?

[0:05:40.3] NS: That’s a great question when you think of it as a pyramid. I think that you know, something that people – they do understand but really, they do pick and choose, it’s something that is so important at any age in that safety. We just talked about the example of wearing a bike helmet or wearing a seatbelt or you know, not driving when you’re sleep deprived or after you’ve had a few drinks.

Those are just very basic safety things that people do know and people do understand the importance of it but we don’t necessarily think of it as a health practice. We think of it as something in some ways, well, we don’t want to break the law, the law is to wear seatbelts, the law is to wear a bike helmet, the law is not to drink and drive. Those are really I think the basis of our health and accidents are one of the highest causes of death at many stages of life, primarily under age 45 or so.

You know, oftentimes, we take that for granted and there’s a certain age group primarily, people under 25 who have a sense of invincibility and their safety is not really considered an important health practice. I think that’s a really important basis. Another important part is of course, diet and I think we do get carried away with these extreme diets, keto is a perfect example or paleo and I think there’s good to many of these diets.

But to do one of them at the expense of or negating anything else, I think is oftentimes short lived and not necessarily healthier in the long run. I think that a lot of times, I’ve said and people get a little bit disappointed when I say I think a balanced diet is really important. There’s no perfect balance but there is a reasonable balance depending on your physiology and I think that is an important basis.

Exercise within reason is very important and then another thing that I think we sort of push to the wayside is emotional support or spiritual support. Whether it’s friends or family or your spiritual relationship, whatever that means to each individual is critical for health at all ages, you know? Young people and certainly in older people.

The other things that are sort of minor are you know, things like vitamins and supplements, I think there’s minimal evidence that any of those help. Oftentimes if they make people feel better, that’s fine but as long as you understand that primarily, that’s from the placebo effect. Getting sleep is critical for health. There’s so many parts that we don’t really think of necessarily as health practices, we think of things as we just have to do but they’re so important for our health.

There’s a lot that’s there. I think safety is one of the big ones that we don’t really think of as a health practice.

[0:08:36.7] SN: You know, it’s so interesting that you had mentioned those five things that you did. Because I’ve been listening to a podcast about longevity, Dr. Peter Attia has a podcast dedicated to squaring the health curve, basically extending the health span until you die and he hits on five of those pillars of health. So diet, exercise, sleep, mental – I think he deems it mental distress so like emotional health and I don’t know if I mentioned sleep but he said four of them.

I think that you hit on all of them and it’s very interesting that all of the doctors that I’ve talked to just mentioned those as the base of health. Based on that, everything else follows, you don’t need to follow a specific diet as long as you have a well-balanced diet and I think that’s keeping in perspective because it allows you to live your life without being obsessed about the small things, talking about the micro versus some macro.

[0:09:36.2] NS: Right. Some people enjoy focusing on a small thing and it gives you a sense of control. Again, I think that’s fine within reason. I think when it gets a little bit carried away and that’s the be all end all and I feel so much better. Overall in life because of this diet change.  I think that’s where people sort of go down a little bit of a slippery slope.

[0:09:59.1] SN: Right, another thing that you mentioned was below the age of 25, people kind of feel like they’re invincible and coming out of college, I can definitely see a lot of people think that way. Another thing that you didn’t mention in the book but I was curious about since you have experience as an ENT and a pediatric ENT so you’re very specialized in that specific aspect.

Have you seen a lot of kids who have used the JUUL and in recent years, it’s really taken off as a consumption of e-cigarettes but JUUL has controlled the market basically? I see everyone in class in college doing it and I was wondering if you had seen any patients with complications after the JUUL and whether you can speak to its effects, at least in the population that you’ve seen. I know there’s selection bias but still.

[0:10:46.8] NS: Sure, that’s a great question and I have written a little bit about the concern of the explosion, literally and figuratively of JUUL cigarettes and other e-cigarettes. I haven’t seen yet any major illnesses or complications or even acute injuries from e-cigarettes but I know that they’re out there.

It is widely used as you knew in college but it’s used as young as middle school, we’re talking about 11, 12 year old’s now. It’s not uncommon for them to be using them. In school, out of school, as you know, a lot of them look like USB ports so people can easily put them in their backpacks and use them even in class and get away with it.

I personally think that it’s a terrible market because – well, it’s a brilliant market from a financial standpoint for the company but it is capitalizing on young people just by the flavors and the packaging of them. The false notion that they’re safe and there have been several large studies looking at kids who use e-cigarettes and their higher likelihood to go on to smoke tobacco cigarettes and marijuana and use other drugs and other risky behaviors, it is somewhat linked already.

I think it’s great for people who are trying to stop smoking tobacco cigarettes. I think that there is a place for it, e-cigarettes in general have really helped people come off of tobacco cigarettes but they are nicotine, they’re very high nicotine. You know, we are certainly seeing young teens use them. I haven’t seen any specific ENT problems yet.

But I think again, it’s very early because we’re going to start seeing them probably in about a decade or so. Some of the longer term effects of – certainly about the kids who start really early, the kids who start late elementary or middle school.

[0:12:56.2] SN: Yeah, even today, kids have a different environment growing up. Parents are – I think parents have become more helicopter-y, if I can say that, I don’t know if that’s a word.

[0:13:09.5] NS: Yes, you can.

[0:13:11.7] SN: They’re more in tune or maybe not obsessed about their kid’s health and wellbeing. I didn’t see this one, I was growing up, even when I was growing up and I’m part of generation Z. My parents were mostly hands off. I played outside and I was able to do that but now, if I go to the playground, I don’t see any kids there, if it’s just after school.

I’m just wondering, as a pediatrician or as a person who is dealing with kids and more specifically, their parents when a kid gets an ENT condition, how have you seen their attitudes change or maybe have you seen parents more concerned about their kids and how do you deal with that?

[0:13:52.5] NS: I think it is a definite change over the last generation or so, as far as they’re concerned for their children. I think that in some ways, it’s for the good in that parents are much more skeptical and questioning in a good way when it comes to any sort of intervention for their children. For instance, if a child needs an X ray, if a child needs a procedure, if a child needs a medication, parents are rightly questioning the safety and necessity and efficacy of all of these interventions, whether it’s for a diagnosis or for a treatment.

I think sometimes, certainly, it’s too extreme where they will be more concerned about the intervention in absence of wanting to get the intervention, thinking that if we don’t do anything, it’s safer for my child and that’s certainly not always the case. There’s a little bit of a shift of not wanting to do anything, whether it’s medication or surgery or even a diagnostic test because they’re worried about the risks of the intervention. I think that’s definitely gotten much more.

[0:14:59.0] SN: What in this world of medical hype and medical myths, most excites you about this disproving or maybe even challenging because people have held this notion for a long time and it’s like very widely assumed to be true?

[0:15:16.5] NS: I think a big – I hate to even call it a debate but you know, a big concern is vaccines. I think that it’s completely blown out of proportion as far as the risks of vaccines and certainly, they’re not without risks. I think that that is a huge myth that people feel that either that was something they call natural immunity is better, meaning, it’s better to actually have the illnesses and that builds up a stronger future for our children as opposed to being protective with immunizations.

You know, I think that’s gotten to extreme that people are so terrified of vaccines and they’re not terrified of the illnesses which is really a fallacy and I think you know, we’re seeing yearly, outbreaks of these horrible vaccine-preventable illnesses and deaths from these illnesses all over the world and you know, certainly in pockets in this country and pockets in other countries and it spreads very quickly.

You know, it’s fascinating to see people’s understanding of how a vaccine works and who is – who should be getting vaccinated, the notion that our children are getting too many vaccines, too soon. Well, we’re lucky to have access to so many vaccines so soon as supposed to thinking of it as a negative. It’s kind of an interesting cultural shift, we have access to so much and we are pushing all of that access away.

[0:16:48.9] SN: Yeah, equally as fascinating in an article that I think that you wrote about the grey zone when a teenager is able to say yes or no to a vaccine and their parents do not want them to get that vaccine. Where is the ethical boundary of consent for care? Am I getting that right?

[0:17:09.6] NS: You are. I mean, certainly when it comes to teens and we talk about the 12 year old’s to 18 year old’s because they are old enough to really have some understanding of their health and interventions but too young to make decisions from a legal standpoint. It’s the ethics of it and it’s the legal issue of it because in many states, it’s an issue of what the law is and it’s a state by state for a lot of medical interventions as including vaccines which vaccines, when they can be given, which teen can decide.

Some of those, even the laws are a bit arbitrary based on whether the physician feels that the teen really understands the implications. It’s a very interesting, from a medical standpoint, from a doctor’s standpoint, from a patient standpoint, from a parent standpoint — that age group is very interesting because in many ways, have no rights but they certainly do have a big stake and a big understanding in any sort of health intervention including vaccines.

[0:18:10.0] SN: Right. Another point in the same string of arguments, in terms of for vaccines and making sure that people have the herd immunity. A lot of communities that are close knit for example, the Slavic community in Washington. I know they deny treatment for vaccines and other pharmaceutical treatments because they’re distrustful of “big pharma” and the doctors, they’re distrustful of their doctors.

Because of that, there’s a lot of measles outbreaks in that same orthodox, Slavic community and how do you reach those communities that really need it? Because the measles outbreaks at least in recent years are a lot of them are in these close knit communities rather than the population in the United States, broadly.

It’s mostly concentrated in these isolated communities in New York, in Washington and other states. I was just wondering, how do you get to those people who really need the vaccines and have a huge propensity for benefit from these vaccines as well.

[0:19:21.0] NS: You know, it’s really tough and most recently, there was a measles outbreak in Rockland County in an orthodox Jewish community. They were trying to the, you know the public health was trying to say, public health officials were trying to say well, if a child is not vaccinated, they cannot go out in public. And you know, how can you start to do that to – you know, we’re not talking about just going to public school, we’re just saying being out in public. That gets very tricky when you’re taking people’s rights away to be out on the street.

It’s not easy because it really is a matter of education and these communities as you said are very tight knit but a lot of these communities, especially some of the ones that we mentioned do travel. A lot of these illnesses which are highly contagious, will get to airports and get to other countries within a matter of a day or two, once there’s an outbreak or, you know, something like measles which is so contagious and can live on surfaces for many hours, can travel within an elevator and not necessarily within one family.

But can travel amazingly quickly and break through and break out of that community. Then it really puts other populations at risk. I think it’s a matter of education, its’ a very tough area to battle because it’s really based on that community’s rituals and beliefs, it’s not something that is as easy as it seems to just mandate because people have their own rights to their own bodies and you know, the other side as well then you can restrict them from being out in public.

That only goes so far when you can’t really restrict people’s rights to be out in the world. You can’t necessarily quarantine them if they don’t have an actual illness. It’s a tough area. I think that’s going to be several generations before we can really get through that.

[0:21:20.2] SN: Yeah, it’s a really complex topic for sure and the relationship between taking away people’s rights and making sure that everyone is safe and healthy is a very – in terms of security versus the change that we want like it’s hard to implement that.

One thing that I wanted to ask about which is not related to the book or vaccines is about your journey as a physician and coming into this world of lay press and communicating the science and evidence based medicine to people who aren’t necessarily familiar with all of it.

Especially with the advent of the internet and with the advent of, if I can say fake news across the medical sphere with WebMD and all these other sites. How did you get involved with the lay press and how did you stay interested in it as people were trying to attack evidence with mere anecdotes and stuff like that? How did you stay a happy warrior in all of that?

[0:22:31.0] NS: Wow, that’s a great question. I think it did come along gradually. When I was first in – I’ve been in UCLA for my entire career after training. As many of us do when we are specialists, we give presentations to other people in our specialty. For instance, we’ll give talks to pediatric EENT doctors or other EENT doctors and then I started being asked to give talks to pediatricians.

You speak differently to people who are in different fields, even if it’s within medicine, it’s a different type of communication and I really enjoyed that. Then I started giving talks as my kids were getting school age, I started giving talks to parents at school, parents of kids and so that’s yet another way of communicating. Then, you know, sort of relatively early in my career, I do live in Los Angeles, we are you know down the block from Hollywood.

I did get asked to participate in a few television shows which were talking about health – a particular health problem, primarily at that time it was kids and snoring and how that was not normal and what do we need to do and what do we need to address and what could that mean if a child has a breathing problem or a sleep problem.

I started doing that. Now it’s been about 16 or 18 years and again, it was another way of communicating and I really enjoyed being able to provide good information to different types of audiences, whether it was another type of profession, another type of medical profession or non-medical audience.

In a way that is appropriate and not demeaning and I hope I don’t come across as talking down to people the way I have come on some times, that I have. Really, that’s not my intention. It’s really just to provide information to people who are educated in a different way but they can understand in a way that I think is important and meaningful without necessarily having to go to medical school and doing a six year surgical residency.

But to understand the same information that I’m understanding. It’s a lot of fun, it’s a lot of – it’s challenging because you have to really find that sweet spot, talking to all different kinds of audiences, I’ve talked to school kids and adults and again, it’s a really fun way of communicating, whether it’s writing or speaking or you know, being on television it’s every different audience is a different way of speaking. So I really, really enjoy it.

[0:25:09.0] SN: Another question about the lay press is it takes a lot of effort to write and research a book and what was the most challenging part of writing this new book that you have made for the popular press?

[0:25:24.3] NS: You know I think it was a lot of challenge. It was a challenge along the way really just deciding first of all what the message of the book was going to be. Was it going to be focused or was it going to be a little bit more broad and, you know, I chose broad because there were so many areas that I really felt needed to be covered. You know from the book there is a lot of research that went into it. I really wanted to make sure that the information was accurate.

And I think one of the challenges is that health information is dynamic and what was looked at and thought of as not necessarily absolutely true but was thought of as the main thing regarding any particular health issue back then may change and so I had to write it in a way where it would still be valuable years after it was written.

[0:26:17.6] SN: The next act of the podcast is mainly about recommendations that you may give as a physician who has been practicing for some time and you have seen a lot of people at multiple stages of the journey from university to medical school to residency and going through that yourself, what rare and valuable skills should a medical student cultivate to be successful in your specialty or what you are doing currently as a physician?

[0:26:46.6] NS: You know I think for medical students, it is a great time and I really hope that and I think that when you look at medical education it has changed dramatically for the good and I think that as a medical student you really do need to keep your options open, ask a lot of questions and really, it is the one time in your medical career that you have the opportunity to be exposed to just about everything and to really use that opportunity.

To connect with people that you feel are good mentors. I think mentorship is key at all stages including once you are out of training and out of medical school, you know even as a young professional, an older professional, mentorship is so important and you know I think finding a mentor in medical school is really a key to success and that mentor doesn’t necessarily have to be in the specialty where you land.

So I have been a mentor to people who have gone into specialties completely unrelated to my specialty. Maybe they thought they’d be interested in it but maybe not but just to sort of help guide somebody through their decision process and what is the best adoption and sort of somebody that is a little bit ahead just step back and see how to guide a younger person I think is really important and you know there’s no – people think, “Oh well I have to do the best in this test or I have to do the best in this exam,” and yes that is important.

Believe me, I understand how important that is. But what is more important in the long run is to really make sure that when you are making decisions because so much of medical school will become making decisions as far as you future, is to make sure you are making those decisions for the right reasons. I don’t like it when medical students say, “I don’t want to do this because I am not going to be good at it.” Or, “I don’t want to do this because I think I am going to have a balanced life if I choose this specialty.”

And I really feel that if you are passionate about anything in medicine, whether it is a research or surgical or medical or a combination, do that and the rest of it will work itself out because if you pick something as a default, you are always going to question yourself and you are not really going to be satisfied.

[0:29:14.4] SN: Yeah, I think that’s something that a lot of people have told me that work-life balance is a misnomer because if you love your work then you’ll find a way to balance the other things that you want to do with that work in terms of being passionate about what you do. You are always going to be excited to go to work. You are not going to have to balance anything because you are going to be occupied a lot of the time.

And going back to your journey, I know you had mentioned this in the book but not many women who are going into surgery when you were going into training and I was just wondering, what was your experience with dealing with challenges that came from biases against your gender?

[0:29:58.4] NS: Yeah, so it was interesting because in my medical school class there were really a handful of us out of a 160 people and probably a little less than half female, so I would say 70 women in my class and maybe three or four of us went into surgical fields. I didn’t really think of it at that time. I don’t know why, I just didn’t strike me as odd. It did strike me a bit odd when I was going on the interview circuit for residency.

And many of the residency programs, because ENT is a very small field. So some programs will have one resident per year, the biggest will have five. So many of the residency programs had never had a woman in their entire history. So I was a bit of an anomaly and the residency directors didn’t hesitate to tell me. “We’ve never had a woman here and we don’t plan on starting.” So it was pretty harsh at the beginning but once I ended up where I did for my residency — and I was the only woman in my class of five.

So you know and within the whole program of 20 people they were maybe two or three females so it was very, very small, it didn’t feel wrong and I didn’t feel that I was discriminated against at all. People especially in my generation of training, which was in the early 1990s I had no negative experiences with male colleagues. I never felt that I was treated differently. I didn’t feel like I was treated less or abused, there was really nothing.

I think it was more of just during the interview experience that the people who have never met a woman going into surgery were a little bit surprised, didn’t know what to make of it. But once I ended up where I did, it really didn’t come up as an issue which is nice and you know just gradually it does take time. There are more and more women in surgical fields. It certainly not half but it is probably 30 or 40% now. So it really doesn’t feel like an anomaly anymore at all.

[0:32:09.4] SN: Going on with that strain about your experiences, are there any bad recommendations that you hear on the hospital or on rounds or anywhere in your life really and why do you think that people keep making these recommendations?

[0:32:25.7] NS: Bad health recommendations like from doctors or bad professional recommendations?

[0:32:32.2] SN: I think we have covered the health recommendations, the bad ones. I was wondering more of the life where the professional ones.

[0:32:40.0] NS: Yeah, I mean I think that I don’t like when people will say it’s okay to settle. You know there are plenty of fields that are easier than others but maybe they are easier just because the schedule is easier. That doesn’t necessarily make it an easier life or an easier choice because. I think choice is, your choice is easy if it is one that you’re happy with. So you know if somebody says, “Oh I don’t want to such and such, you know this very challenging surgical specialty because I don’t think I am going to be good at it or it is going to be too hard.”

And then if I hear someone say, “Yes you are probably right. It’s best that you go into something a little bit easier.” You know that really bothers me and I think that that’s not good advice. I think that if somebody is passionate about something and we have seen this from our residency trainees, you know people who are not necessarily coming in as talented superstars but are so passionate and so eager and so hardworking, you know they will end up the superstars.

So I think that the bad advice would be, “Yes, you should do something what you think is easy because you are not going to be good at it or because it’s going to be too hard for you.” I think that’s a really bad precedent to say.

[0:33:59.1] SN: And the last act of the podcast is mainly about your mission and purpose. We have talked a little bit about your experiences and a little bit about what you are currently doing today but what gets you out of bed in the morning?

[0:34:12.1] NS: My alarm and then my alarm. You know I really do feel that I love what I do even though I write books about for the lay press and for the lay public and I do still write for the lay public and the media, I really enjoy that. But my mission as a pediatric ear, nose and throat specialist is to do just that. I really love what I do for work. I take care of children and their families. I take care of some very, very sick children and some very, very healthy children and everything in between.

I take care of very elective problems and I take care of severely emergency, life and death problems and everything in between. And no two days are the same. My patients keep me on my toes and I am talking about the kids, the little children ask great questions and are very inquisitive and really do care about their own health and parents ask great questions and not necessarily in a negative way. They really keep things interesting. New problems evolve, new treatments evolve.

New interventions and diagnosis are coming up that it really is exciting. It is exciting to be in medicine. Yes, there is a lot of bad press that we get and a lot of bad hype that we as physicians get but it is really a privilege and I think that people unfortunately — because there is so much else that goes along with it in the baggage and you know the negative politics of it and the paperwork that we have to deal with and all of that is really bad interference. But we lose sight of what we get to do every day.

We get to take care of people and we get to make them better or make them healthier or relieve pain. It is a gift and very few of us actually get to do that and you know, not to sound sappy but it is really true and you know it is everyone who has been in medicine for however long feels that drudgery of, “Oh, yes another day, another group of clinic, another day in the OR.” And the stress that goes along with it and the pressure but when you really step back and think about what else would I rather be doing something else, the answer is usually no.

It is usually most people who really think about why they chose becoming a doctor and why they chose staying in medicine, you know, it is really the very basic concept of being able to take care of people.

[0:36:54.2] SN: Yeah, well said and I think that something to add on to the fact that you should be very excited about what you are doing and about the empathy that you have with your patients is that I live my life by a mantra, which is do the best that you can even if it doesn’t accomplish the goal that you wanted to see just put your best into it and I think that doctors do embody this day after day and even when they have a patient, when they have to go from the most routine of cases to the most difficult of cases, they still have to bring that same empathy and just doing the best that they can for each patient.

So I think that that’s definitely true and the last bit that I have on the podcast is about priorities and it is a cool question because first of all, it is outlandish but it is also something that I like to ask the guests. So if a genie come up to you and gave you three wishes, what would you wish for?

[0:37:52.5] NS: Wow, three more wishes, I can’t say that. Oh boy, that is a great question. You know I wish for health for my family. I do have a family and hopefully as with most people my family is my priority, so I’d wish for their health, my family’s health and happiness. I wish that I make good decisions and you know that is a broad statement but you know that could really relate to decisions in my own life and also decisions for my patients.

Because often times, I am making decisions for other people whether it is my own family or whether it is children of other people’s family. A third wish is I wish to live a life of a little more balance. I think that is a goal that people are always striving for and I think if you think of it as a goal that you never really can reach because I think there is no such thing as a perfect balance, there is no perfect work-life balance, there is no perfect work-life balance, there is no perfect work-life balance.

I will say that over and over again. But I think it is always a good goal to have, to get there or to feel like you are getting to that point that it is like that — where you are almost not quite there but you feel like you are getting to that point because if you work less, you’ll feel like you are missing something. If you work more, you will feel like you are missing something. So I think to accept that there is no perfection when it comes to that but to always strive for that I think is a good goal.

[0:39:36.4] SN: Thanks for all the information and inspiration that you have given me. I just have one more question about where you get your inspiration from. So I know that you wrote a book and it is very successful, multiple books actually and a few of your articles but what are three books that have influenced you about anything? It could be about your world view about medical literature or anything.

[0:40:00.5] NS: Well that’s great. I really love When Breath Becomes Air.

[0:40:03.5] SN: By Paul Kalanithi, right?

[0:40:06.5] NS: Yeah, wonderful beautifully written. I mean the bravery for him to go through that and survive that was incredible. Another great book that I think really all doctors should read is called When the Spirit Catches You and You Fall Down by Anne Fadiman and it is about a little boy. It takes place in Northern California who has a seizure disorder and he is from Laos and the way they describe, the Laotians describe a seizure is the spirit catches you and you fall down.

And it is a beautiful way of thinking of it because it makes a seizure really beautiful. But it is this whole – it is a perfect example of how one community feels about medical intervention and how the doctors feel and how could they not want treatment but this is how this community feels and so I think it is a really good example of tolerance and understanding of when you are going to be taking care of different cultures whatever they may be whether it is orthodox people who are refusing vaccines, really to understand culturally where they are coming from I think is really critical.

A third book, you know I love Song of Achilles. It has nothing to do with medicine. It is a really good book.

[0:41:34.1] SN: It is like all the books that you guys the guest say they come on to my to read list. So I appreciate any recommendations that you have even if it is not about medicine. Just good books are always on my list and I am always on the hunt. So thank you for that and thanks for coming on the podcast.

[0:41:52.4] NS: Thank you.

[0:41:53.6] SN: The last bit I have is I have been interrogating you for the better part of an hour. So I usually do a bit where I am on the hot seat and you get to ask me a question. So is there anything that you wanted to know from a pre-medical student who is going to go to medical school?

[0:42:06.5] NS: So how stressful is it? Are you really – I mean I see this kids who are applying to medical school and is it as competitive and stressful as it seems or has it gotten any better?

[0:42:21.5] SN: So it is interesting. I didn’t go through the normal process of applying to medical school. So I applied to college and medical school at the same time and I am in a program. So I did not have any of the stress because I came into college knowing that I will go to a specific medical school. So I knew that I didn’t want to have any part in the process because college applications are stressful enough. So I looked at these programs and I was like, “This is where I want to go.”

[0:42:50.1] NS: So you are in a place, you are going straight. You’re set but you must have friends who are going through this.

[0:42:55.7] SN: Yeah, it definitely is a very stressful process because it is not just the stress has gone up because I don’t know if you’ve read an article. It was by BuzzFeed and it was about the burnout generation. It was a pretty popular article but the gist of it was that because we are always on all the time, we have an obligation to respond to emails quicker, respond to text quicker, respond to other work commitments but work commitments bleed into the weekend and stuff like that.

And social commitments are also done online. So you have to be always on and the product of that is constant anxiety, constant stress, so because when someone pings you on social media or the text message, it is hard wired into your brain. I think they did a study where there were electrodes hooked up to teens’ brains and the phone was on the other side of the room and they purposefully called the phone and they texted the phone and they could see the anxiety rising in these FMRI scans.

At least the brain parts or the lobes that respond to anxiety and curiosity and this is just pinging your brain constantly. So I think that that builds up the stress and then having to apply to medical school and even in a more competitive environment just boost it in terms of exponentially increasing the anxiety that people feel. So I think it is a combination of the two and that is what I see in my friends. So I always tell people to take time off from social media.

And there is something that I have read recently, Digital Minimalism by Cal Newport, advocates a life of leisure and practiced leisure outside of social media just taking not a detox but at least a framework of life where you can imagine yourself talking to people outside of social media.

So that’s what I have tried to do for the past few months as I am taking off from school for some time before medical school, doing the podcast and stuff like that. But yeah, that is what I have seen in my friends and that is what I counsel them to do before medical school.

[0:45:04.2] NS: That’s great. I mean even just something as simple as getting scores on this exams or getting medical school acceptances, everything is online now that you check to see when it is coming. You know we used to wait for the mail to come and if the mail didn’t come on Friday or Saturday, you wait until Monday.

That was just the nature of it and it was a sort of a forced relaxation because it was out of our hands as opposed to just getting buzzed and pinged and you know all of these forms of getting messages. That sort of chronic need for validation is more and more, I think a concern in your generation, unfortunately.

[0:45:49.0] SN: I think medical school is more of a stressful time than undergraduate to be honest because step one, you can only take once and at least the [inaudible] you can take multiple times if you don’t get the score that you want. You can take it again but step one is often for better or worst it is a metric for residency to evaluate. An applicant can send since the residency slots for some specialties are competitive, they use it as a metric to see who gets an interview or not.

So it really depends on that test and I know there’s your grades and other aspects but that is why I feel like medical school is a more stressful time and then a residency gets even more stressful based on the sleep deprivation. Just based on sleep deprivation but all of the health complications and then also the decision making impairment, I think that is what affects it. So those are like I think just having time for self-care is important in terms of taking –

[0:46:46.8] NS: It is and that can mean anything. That can mean just doing nothing. It doesn’t mean having to go to a spa.

[0:46:53.0] SN: Yeah, exactly and I think that for me it is doing some of this podcast and having mentors to talk to and that is why I started this podcast. You were saying the importance of a mentor. I was like, what if I had 50 mentors across the United States and how can I talk to them?

[0:47:07.8] NS: That’s great. That is wonderful, I love what you are doing it is great, really cool.

[0:47:11.1] SN: So again, thanks for coming on the podcast.

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