What Personalized Medicine Can Really Do: Inside Concierge Medicine with Dr. Sunjay Mannan

What if your doctor had the time to really know you, your stress, your sleep, your goals, and the life you actually want to live?

In this episode, we sit down with Dr. Sunjay Mannan, founder of Health Is Wealth Concierge Medicine, to explore what proactive, personalized healthcare really looks like and why it may be one of the most powerful investments you can make in your future.

CHAPTERS:

00:36 - Welcome to Living Your Legacy
01:01 - Meet Dr. Sunjay Mannan
02:38 - What Is Concierge Medicine
04:00 - What a Patient Says About Sunjay
04:17 - Healthspan vs. Lifespan
05:08 - Sleep, Data, and Readiness
05:50 - The Concierge Model vs. Fee-Based Advising
08:15 - Using AI in Medicine
09:14 - Stress and How to Manage It
12:06 - What Does Concierge Medicine Cost
14:06 - Going Into Patients' Homes
14:38 - Lessons from a 104-Year-Old Patient
16:07 - Living Intentionally
18:36 - Exercise, ADHD, and Dementia
19:50 - What Exercise Really Means at 55
21:06 - The Diet Basics That Actually Work
24:02 - How Long Until You See Results
25:22 - Questions to Ask Your Doctor
27:54 - Women's Health and Hormone Therapy
29:45 - Legacy and Eulogical Values

GUEST
Dr. Sunjay Mannan — Founder, Health Is Wealth Concierge Medicine

HOST
Greg Weimer — Founder and CEO, Confluence Financial Partners

TOPICS
Health & Wellness, Growth, Faith & Purpose

Transcript

SPEAKER_00 0:00

These patients need an an outlet. And if you put them in a closed room with the screen, their brain is going to be bouncing around everywhere. Exercise is truly the longevity and health span.

SPEAKER_01 0:11

I was talking to a friend. He had a diagnosis and he said, I know way more than my physician, because I guarantee you my physician looked at my folder about 15 minutes before she walked in.

SPEAKER_00 0:21

It's been rewarding to practice this way to go someone's home and sit in their kitchen and talk to them for two hours about really what's going on versus the other model where you're driving to your doctor and you don't know whether your questions are going to be answered.

SPEAKER_01 0:37

Hello and welcome to Living Your Legacy Podcast. I'm your host, Greg Weimer, founder and CEO of Confluence Financial Partners, where our mission is to help people maximize their lives and shape their legacies. On this podcast, we will unpack the stories, strategies, and mindsets of individuals who are intentionally shaping their lives and the impact they leave behind. Learn what drives these individuals to push forward, to create, and to give back. And as I was reading your bio, man, you've done it all, right? Grow up in West Virginia. Go to WVU. Your major was in exercise physiology. You come to Pittsburgh, you go to Forbes Regional. And then I'm looking at all the background that you've done. And somehow you have, you know, you have time for your children. But between urgent care, high school sports, addiction centers, now you have now you have an interesting business called Health is Wealth Concierge Medicine. So you've done it all. Hopefully, what we're going to do today is uh give our listeners a couple things to think about on how to live an intentional life, maybe make some healthier decisions. And um, and one of the things with all of those backgrounds that you've had from, you know, assisted living facilities to working with kids and helping people with addictions is I'm guessing that you've learned a lot of lessons along the way from your patients. And I'm sure they've learned a lot from you. But uh, why don't you just give us a little bit about your concierge physician? And I think some people know the difference between a traditional physician and concierge. But um, you and I were speaking before, and you know, I have a concierge physician and uh Mary Lamb and Dr. Mary Lamb, and she takes care of my whole family. And I actually consider it's one of the best investments our family has ever made. So why don't you just talk about your concierge practice and how it's different than your standard physician?

SPEAKER_00 2:39

Love the intro there, Greg. I appreciate that. I mean, it just made me feel like I was going into a prize fight or something. So that was great. Um, so I think the main difference between the concierge model and what you're gonna get with a any healthcare system is the level of proactiveness um in really preventing things and preparing you for what day-to-day life or within the next 15 to 20 years, what could happen. Um, rather than that seven-minute appointment that you have with the doc where they say, hey, cut carbs and we'll see you in a year. Right. Um, so it's been rewarding to practice this way to go someone's home and sit in their kitchen and talk to them for two hours about really what's going on versus the other model where you're driving to your doctor and you don't know whether your questions are going to be answered. And if you have questions, they're they're then filtered out by multiple levels of staff, maybe to then do an appointment where it's taking up more of your time. Right. So you actually go into people's homes. Yep. So we're we're all home-based concierge medicine. So we do primary care, telehealth, um, exercise and nutrition counseling, and then that health span consulting, which it's kind of a buzzword right now, the health span, life span, what are the differences and how do we have a lot of people?

SPEAKER_01 3:54

Why don't you I have four questions based on what you already said. So but but uh by the way, I asked one of your patients in HIPAA, I'll be vague, but I asked one of your patients, I said, Hey, what do you like about Sanjay? And she said he's not just about medicine, he's about preventive. Like he's on he's on the same page as me and he's it's preventive, preventative. So the health span thing. I I I know I've read about it. Do you want to talk about that a little bit?

SPEAKER_00 4:17

Yeah, yeah. So so I would say health span at any point is just optimizing whether it's sleep, exercise, nutrition, whether it's supplements, medicines truly play a role as well. Um, so health span, some people refer to it as kind of disease-free life. So trying to put off that major event like a heart attack or stroke.

SPEAKER_01 4:39

Yeah. So it's not how it's not only how long you live, it's like how long you live with quality of life. Absolutely. But I also noticed notice you said about sleep. You have an aura ring on, right?

SPEAKER_00 4:48

I yeah, I do have, yeah, absolutely. All that data.

SPEAKER_01 4:51

Yeah, the data. I love it though.

SPEAKER_00 4:52

Yeah.

SPEAKER_01 4:53

For those of you that aren't like aura or the other ones, whoop, because sleep's a big deal. Yes. Like I can't wait to wait. When I wake up, I check it. I just like, I want to know, I want to know how I slept, and then I want to know my readiness. My readiness is good today. This is so this is good for today. Um, yeah, my readiness was good. We're in good shot, we're in a good spot. Um, so it's interesting when you when you say that because we we've built our business the same way. So instead of worrying about commissions and revenue generating activities, because we charge a fee and don't charge commission, we have the benefit of um of really spending time. Like, like, for example, this afternoon. This afternoon, there's a group of seven or eight of us. We'll get together for four or five hours and we'll look over portfolios. It is not a revenue generating activity, but because we're charging people fees, you're able to, we're able to spend that time. And I just think it's a better model and the concierge model, I think, is wonderful. Let me ask you. So um, what caused you? Was there a moment? Was it evolution? Was it a epiphany? What caused you to start thinking about that model?

SPEAKER_00 5:50

I think the the overlying theme is being unable to practice the way I want to practice with patients in a traditional healthcare system model, where you're seeing 18 to 22 patients a day and really giving them the bare bones of year to year and practicing population-based management of what's good for a population and building revenue versus individual personalized care. So definitely wanting to get to know my patients better and what their real concerns are. And so much of that is not in a lab panel.

SPEAKER_01 6:22

So here's the thing. So lab panel versus person, your relationship. Is your were you motivated to go down this road because you fell in love with medicine, or you really just love taking care of people?

SPEAKER_00 6:37

Uh it's the connection. So I'm definitely both. I'm definitely a connection guy. So I mean the science is evolving every year, right? So there's that statistic of what you learn in med school is obsolete in five to seven years. Right. It's like the basic science may be the same, but but how we implement it is a way different. So I guess another thing about this is it gives me time to stay up to date on what's the latest news coming out, what are the latest medications and strategies that are maybe costly and are actually prohibitive in the payment model for most patients nowadays, because physicians are being inclined to save money for insurance companies. So they may have great options for the patient that may be more costly. And they're kind of dinged for trying to do those things to be more preventative or to prescribe certain medications because they cost higher. So I don't want to be, I don't want to have the bounds of like, what's the payer? I don't want to think about your insurance when I treat you. Right. Like, what's the insurance company gonna think about me putting you through this test or you being on the phone? Well, how much is how much of that does affect you, though?

SPEAKER_01 7:39

I mean, because at the end of the day, you know, you have to get reimbursement, right? So, like, how much does that affect your ability to care for a patient? In a concierge medicine model? Zero. Zero. So, so, but, but, but if someone has blood work or something like that, that that is still reimbursed, correct? Uh from an insurance company.

SPEAKER_00 7:58

From an insurance company, the the insurance is billed for someone's lab panels or these things. So that yeah, they would get that that, but then not I wouldn't get anything out of it.

SPEAKER_01 8:07

So you don't, yeah. So you don't, you're not, you're not, um, you don't have any bias based on an based on insurance. Completely agnostic. That's a big deal. Yeah. And let me ask you this, you're treating patients from a medicine standpoint. How much do you use AI? Do you use it at all? And then I want to ask you about what is something about how you process things.

SPEAKER_00 8:24

But so it's interesting. I I am learning so much even from my patients today, they will bring up a particular supplement that I may not have heard of. And instead of just saying, okay, this is, you know, voodoo or witchcraft, you probably shouldn't take it, or is it say I get to then use AI to look up the latest research for something like a collagen peptide or uh bovine colostrum powder and what its benefits are. So I I use AI to stay up because every other, I mean, there's a new supplement coming at it. And is there smoke and then fire associated with it? Or is it something that's you know, signal versus noise type thing?

SPEAKER_01 8:59

So yeah, it's interesting you said it because like this afternoon, I know we're going through an investment that I have a bias against, I'll admit. Like I'd say it's a new, and I've and I was able to do eat research easily over the weekend just to prepare for this conversation this afternoon. So it certainly has accelerated our learning. Let me ask you this. So you it sounds like you have a great relationship, you're going into people's homes. This is more than this is personal. And and stress can really have a negative effect on someone's health. No question. How do you compartmentalize? Like how if you're if you're visiting with one of your patients that you've worked with and and they get a difficult diagnosis. And I mean, worry is part of it, right? I mean, I wish I could tell folks that I turn it off at five o'clock. Folks say, why should I work with you? It's like, because I'm gonna think about you in the middle of the night, I'm gonna think about you in the shower, I'm gonna think about you, you know, on an air. I just, it's constant. How do you compartmentalize that and how do you deal with your stress?

SPEAKER_00 9:58

So I deal with it the way I tell my patients to deal with it, which is be proactive and not reactive to stress. So I try to optimize sleep. I try to make sure that my workouts are in, I don't eat things that I know are gonna affect my mental state. So I the only thing that we can do is put ourselves in the best position to manage stress because that's gonna be there. Yeah. So to me, it's more about being proactive for the stress. I don't compartmentalize, but I prepare myself for what the stress may be so that I can handle it the best, be in the best state to handle it. And that's what I tell my patients as well.

SPEAKER_03 10:33

Yeah.

SPEAKER_00 10:34

Um, and then as far as their stress, that two hours that I'm spending with them, it could be a family member that's aging and now they're having to manage those decisions. We can come in and guide them as far as like this is the better option, these are your senior living ideas, this is how we get home health care involved. So, really getting to know how somebody maybe in their 40s and 50s that's caring for an aging family member, that's part of their health to me too, as well as what other stress is, whether it's their business or their kids are now going to college and they have stress there. Can we link them into a life coach or a business coach that can then kind of uh somebody who doesn't have a horse in the race to once a month sit down and kind of unload on um can be in value? Yeah, I've always had a coach. Yeah. And and I and that's been healthy for me.

SPEAKER_01 11:19

I I am best, and there's certain things I measure. Yeah. That if I'm measuring these certain things, I I know I'm gonna be at my peak performance. I'm gonna perform better for my clients and for my family. So there are those certain things. I learned from you before we even shook hands this morning, because um, as I was pouring, I think, my fourth or fifth cup of coffee, our receptionist said, Would you like another cup of coffee? And you were like, No.

SPEAKER_00 11:39

Yeah. Yeah. No, no, I'm like one cup in the morning, and that cup is usually six ounces and then maybe four ounces before two o'clock, because then that's gonna mess up my sleep if I do it. Yeah.

SPEAKER_01 11:51

I heard someone say that if you if you drink coffee after 12 in the afternoon, um, it'll affect your sleep. Sure. But but so now I drink like two pots of coffee before 12 in the afternoon. So I don't know, I'm not sure. I'm not sure that that's what I'm not sure that's that that's what they meant. Let me ask this what is what does a typical concierge physician charge? Like what does that cost?

SPEAKER_00 12:11

So it can be anywhere between 3,000 to 5,000, I think in the Pittsburgh market is probably common. Um, and it depends on the wraparound services as far as like are you getting exercise, nutrition? Yeah. Um, so we have like a two-week specialist kind of guarantee to where we're gonna get you into the top cardiologist, whether it's HIMARC or UPMC health system, which are the two major ones here. So I think it just depends on what you're getting. We do in-home physicals every six months, regardless of how you feel, because I don't like that I'll see you in a year. I don't trust my patients to carry out our plan. I want to be chasing my patients to make sure that they're doing things.

SPEAKER_01 12:50

You really are proactive.

SPEAKER_00 12:51

But yeah, because you're all in. I think the people who gravitate towards this model are very busy. Yeah. They can't make it to that annual physical because they don't know what they're doing a year from now.

SPEAKER_01 13:01

But call it $5,000. By the way, in other parts, if you're listening to this and you're in Naples or Chicago, expect a much bigger number. Way different. Way different. This is Pittsburgh, God bless.

SPEAKER_00 13:11

Like I've heard so I mean, even in Texas, I've heard of like six-figure concierge.

SPEAKER_01 13:15

And so, like here, and and you know, in our concierge system, I'm like, increase your prices. Because it's because yeah, I think I think it's that valuable. So for $5,000, what a wonderful investment that is.

SPEAKER_00 13:28

Yeah, and I'm like you're I'm a care about you guy, the whole business aspect of things. I'm actually learning from my patients who are all strong.

SPEAKER_01 13:35

Yeah, because you're gonna have a hard time. Well, you and I talked about it before. You're gonna have a hard time scaling this. Yeah. Because it's you, right? And so how do you scale it? Um, our concierge physician, I mean, she has a waiting list so long, your life expectancy is not as long as her waiting list. I mean, it's but that's great. That just means that that just means it's very valuable. And um, yeah, so I think it's for so for $5,000, you know, being cheap can be expensive in this, in some in when you're talking about things like this. And so not doing this can be really expensive. Um, let me ask you this. You you you I love your concierge model. I love that you go into homes, I love that it's every six months, I love that you're proactive. Um I also think everyone has a story. And the other, I'm just curious what you learned from your patients that some of our listeners can benefit from. Because if I think about if you spent a day in a nursing home or assisted living, the experiences and perspective those folks have. Um, I wonder if you learned any lessons. Do they have regrets? What have you learned from some of your patients?

SPEAKER_00 14:43

Um I think this one woman comes to mind. She was 104. Dang. And uh, so she said, Doc, you know, I'm I'm just you everything's good. I'm just kind of tired. You know, like I'm more tired. I don't know if it's because I'm, you know, 104, like that I don't have the same pep that I did when I was like in my 60s and you know, just kind of giggle about that. Right. But I the one thing that stood out to me was that she was wearing high heels at 104. And uh I said, you know, where'd you get those high heels from? And she said, My son-in-law bought me these heels because he knew that I loved to, you know, wear, dress up and wear it in the nursing home. So she she always talked about the relationships. And I think sometimes her only regret was living more intentionally, that there are certain times in life for things, whether it's your kids in your are in your home for only 15 or so years. Right. Um, or then, you know, when the kids leave the home, you have so many active years with your with your partner. Yeah. So so to live intentionally for the, they call them like the uh the go-go years of retirement and then the slogo and then the no-go. So, you know, planning your vacations when you're still active to do Machu Picchu, maybe in like your upper 50s, low 60s, because then once you hit upper 70s, maybe you won't want to do that trip. So for her, it was living intentionally in relationships for sure.

SPEAKER_01 16:07

Yeah. Um, as you were saying, that's why I looked up a someone sent me a quote over the weekend. It says, if you knew you couldn't play tomorrow, how hard would you play today? Sure. And I think so many times, like, you know, we just go through the river of life and let it, and it's not intentional, you and I talked about, and you know, how many Christmases you have left and moments with your family, and um, whether it's the holidays, um, how how intentional you would be. And and I would think, because my guess is you had to deliver some difficult news to families. Sure. Um, and I would guess in that moment they probably wish they had some do-overs.

SPEAKER_00 16:52

Yeah, yeah. No, I think that's it, I think in those moments it's really important to remember whose wishes you're trying to respect. So when we're trying to battle regret towards those last moments, that did that individual live according to their wishes, or is what's happening around them what they would want to happen? Or are we holding on to something, or are we trying to have someone live longer, or just to make sure that we respect that person's wishes?

SPEAKER_01 17:23

It's interesting you say that. There's a friend of mine that asked me to part be part of a little group called understanding dying. And um like most people want to die in their home. Most people don't. So it's it's interesting. And and by the way, in some cases, they will keep, they meaning the the business of medicine will keep you alive even though your quality of life is gone. Um, so different, maybe a different, maybe a different podcast, but really making sure you are respecting and honoring the wishes of someone when they when they are in fact terminal.

SPEAKER_00 18:02

And I think that those physicians in that system that's trying to keep you alive too, that they're they're not doing it in a malicious way. I feel like I'm here to help. Get it, but they may not know what your wishes are. Yeah. And as soon as they know those wishes, then it's like, okay, well, maybe we're not trying to preserve stuff.

SPEAKER_01 18:18

I remember when my my concierge physician said to me, and it stuck out, I think it was like the first time we met. She said, I don't know as much as your cardiologist. I don't have a cardiologist, but I wouldn't know as much as your cardiologist or your oncologist, or and she went on and on. She said, But I know more about you. Sure. And she said, So I can play the point guard because I know about more about you. Think about those moments where you get that um diagnosed. Let's let's try to avoid those. Let's try to avoid those. And so um I know you've studied how exercise has an effect on ADHD and dementia. Do you want to talk a little bit about that? Yeah.

SPEAKER_00 18:52

So the role of exercise with ADHD, those studies and outdoor time specifically in ADHD. Um so basically, these patients need an outlet. They need, they have a lack of what's called dopamine. So their brain tries to fill that with certain activities. And if you put them in a closed room with the screen, their brain is going to be bouncing around everywhere. So what we found was that exercise is truly the longevity and health span pillow all on its own. So all the chemistry that happens along with that is definitely preventative towards some of those symptoms. Um, and the same thing with ADHD as being an outlet, exercise and outdoor time. And then with exercise, some of the research we did was insulin independent, how it takes the blood sugar out of the bloodstream and into the muscle cells was interesting research in that you can control your metabolic health a lot with implementing exercise, even as little as two days a week. We know that really exercise. I was gonna ask you that.

SPEAKER_01 19:55

So when so our client, a listener, 55, you know, typical 50 exercise. What does that mean? Is is walking enough? Do they need to get their heart up and run? Do you recommend uh weight training? If you think about organizing your week, what would that look like?

SPEAKER_00 20:15

Yeah. So if somebody is going from the couch to exercise, I would do two days of resistance training to start off with. And that might be the goal for two to three months of just two days resistance training, one day during the week, one day during the weekend, find 45 minutes where you can throw around plates. And I would probably get them with a trainer to learn some exercises so that everything is fruitful. We don't want to waste their time.

SPEAKER_01 20:39

So the building muscle is really important and just walking around the tracks, not enough.

SPEAKER_00 20:42

Yeah. You know, steps are good for mobility. But if someone comes in and says, Doc, I'm getting 15,000 steps, that does mean too much to me. It means that you're you're active and up, which is good. But but as far as health span, longevity, steps will not be enough.

SPEAKER_01 20:57

Steps not the thing.

SPEAKER_00 20:58

Yeah.

SPEAKER_01 20:59

So so much for our ring telling us how many steps we have.

SPEAKER_00 21:01

Yeah, closing those rings on the Apple Watch is great. And telling you when to drink, all great, but definitely need a little bit more.

SPEAKER_01 21:08

Okay. So now now look, so that's the exercise part. Um the diet stuff is confusing.

unknown 21:14

Yeah.

SPEAKER_01 21:14

And now there's medications. I don't even know if I want to go down that road because we don't want to make any recommendations. We have nothing to do. We're not, you are, I'm not. But but there's so many people taking pills. There's so many people doing different diets. Um I saw I saw a great uh on on social media, they showed like one of the marathons, and there was a woman holding a sign and it said uh to the marathon runners. And the sign said, This seems extreme, triozempic. Yeah. Yeah. So like that's sort of as our is our society today, right?

unknown 21:48

Yeah.

SPEAKER_00 21:48

So I would say the medications, there's a place for those. There, there are definitely tools in the tool belt.

SPEAKER_03 21:53

Yeah.

SPEAKER_00 21:53

If I were to give someone two things to think about, number one would be what's your budget? You can take a nutritionist out of the picture by just knowing what your budget is, just like in finance. If you're not tracking, and I say just do an audit, unadulterated, get one of those apps, lose it, MyFitnessPal. Don't change what you're eating at all. So it's called My FitnessPal. So MyFitnessPal or Lose It are two common apps that someone can download for free. And just start to track calories. So that's your just budget. Get a baseline. Where are you at? And then typically we'll calculate what's called your basal metabolic rate. And we start with an in versus out, how much are you burning versus your eating? This is just the starting point.

SPEAKER_03 22:34

Yep.

SPEAKER_00 22:34

And that budget you can use all throughout life, whether you're trying to gain weight or lose weight. And then the only other thing that I tell patients to track to start is protein. So how many grams are you getting a day? We know that the RDA, which is the recommended daily basically value of protein you should take, is not enough. So we shoot for one gram per pound of goal body weight and protein. So if you want to be 150 pounds, you need 150 grams of protein to kind of cover the spread.

SPEAKER_01 23:02

So what does that look like? Is that like I'm eating a whole cow? Like what is that?

SPEAKER_00 23:05

Yeah. So so there are now products out there. So the ones that I like, there's a ratio brand yogurt that's infused with 25 grams of whey protein. There's a famous brand Kodiak now with the grizzly bear you'll see. Yeah. And uh so they have a Kodiak oatmeal with 12 grams of protein. They just came out with one that was called the peak protein, which is 20 grams of protein. So there are ways that you can build these in without having to eat the uh the whole cow. Um and regardless of what diet, whether you are vegan to carnivore, to you're doing intermittent fasting, that budget and the grams of protein are the main things that still need to be implemented. Basics. So yep. And a lot of what you exercise and what you put in your body. Yep, yep. That's that's where you start. And then we can if someone says I have a beach trip and I want to really cut up, then six to eight weeks, we can make other changes to the diet to get them there. But from uh a year, if you're looking at a year and just trying to stay in a certain range, those are the two things you need to do.

SPEAKER_01 24:02

So if I start today, if if a listener's like, you know what, Sanjay, I'm all in. I might want to start. How long does it take? Like, what's a reasonable amount of weight you can lose in a 30, 60? You make up the time, 90 days.

SPEAKER_00 24:16

Like, what's so it's interesting because your body will fight any change to start off with. I mean, there's a a set point theory out there that some people buy and some people don't, but your body will try to reallocate nutrients and calories to maintain the weight you're at. So it may be six weeks until you see the scale go down, which can be disheartening for people.

SPEAKER_03 24:34

Yeah.

SPEAKER_00 24:34

Um, but but typically So then they quit. Yeah, yeah. Typically, we think a half a pound to a pound isn't um isn't unreasonable a week if someone starts to implement this, but it could take four to six weeks to see that start to change because your body's gonna fight it initially. Got it. Very helpful. And then if you're not optimizing sleep with that, so sleep and stress, that increases uh hormones. Stress is dangerous, right? I mean it's yeah. So you can't it's hard to lose weight if you're not sleep optimized.

SPEAKER_01 25:04

Got it. Um I was sleep optimized last night, and then truly, this is not a commercial. We let we were watching the news, which I know is bad when you fall asleep, but the news is on, and I wake up to a confluence commercial. I guess because I was sort of high like you know what I mean? I heard the confluence commercial company startled me. So, anyhow, um let me ask you this What question should our listeners be asking their physicians that they're not? Like when I get, you know what I mean? When you go in, what should they be asking their physicians?

SPEAKER_00 25:34

So I think about proactive aggressiveness. I'm gonna be one of how many patients? How many patients do you have now? How many patients do you intend on taking? What's the most interesting thing you recently learned to make sure that they're up on things? I think a hot topic right now is uh perimenopausal and menopausal treatment in women that we've let several generations of women just kind of hang with these symptoms of uh five to seven pounds of resistant weight uh weight gain. Um can unpack this for me. So hot flash of sleep disturbances. So basically there was a women's health initiative study that came out, came out and made some claims about increased risk for breast cancer, um, increased risk of blood clots and cardiovascular disease, and they took all hormones just off the table. And the the interesting thing was that the clinicians that were prescribing estrogen and progesterone at the time were saying that we're not seeing this increased risk in breast cancer, all these negative things that you're saying, we're not seeing in our patients. But patients and clinicians both were like, okay, we're scared of taking estrogen. Clinicians are like, we're no longer gonna give you your estrogen. And that probably went on for 20 years or so. And unfortunately, what happened there too was that doctors weren't being trained in it too. So now you have two generations of doctors, two or three generations of doctors that are not trained in treating perimenopause and menopausal symptoms. Uh, and so now they've gone back to that data, looked at it, and said, wait, this risk is not actually there. And if it is, it's minuscule. Right. And there's no increase in death in actual women from breast cancer because we're catching things early with mammograms regardless. So now it's back on the table. So it's just the pendulum is swung back, and uh hormone replacement therapy is back for women. As and I've seen women as young as 38 suffering from symptoms of perimenopause, whether it's the brain fog, the sleep disturbances, mood lability. They're like, I just don't, I'm not acting or feeling like myself. And there may be really small changes. And you put this person on an estrogen patch and they're like, oh my God, my life. Yeah, progesterone pill and 9, like, oh my God, I'm good to go.

SPEAKER_01 27:33

It is one of the challenges with medicine that I can't imagine being in the business is how quick or how how the research does change.

unknown 27:40

Yeah.

SPEAKER_01 27:41

It's a it evolves, doesn't it? And it uh yeah. And so that's that's why anytime something new comes out, I'm like, I'm hesitant. Because I'm like, I don't know. I feel like I could be on Oprah in 20 years saying, You were the one that tried this. Yeah. I worry about it.

SPEAKER_00 27:52

So you're asking your doc, what are they excited about?

SPEAKER_01 27:54

Yeah. What do we do? So that you know that so that you know that they're actually a student of the business.

SPEAKER_00 27:59

Yeah. Are are they taking time to educate themselves or are they still in the system saying 22 patients a day and then closing those 22 notes and then going home and trying to like whatever they have left give back to their family.

SPEAKER_03 28:12

Yeah.

SPEAKER_00 28:12

Um, that doctor, as well intentioned as they may be, they just may not have the time to get you like the latest and greatest.

SPEAKER_01 28:20

I gotta tell you, our business is the same in that the client goes in to visit the sometimes the financial advisor. And the financial advisor, I'm gonna tell you when they looked at the portfolio last, was about an hour before you came in. And they didn't, they're not spending all afternoon like we are, you know, really studying portfolios and making sure we understand the outcomes, the desired outcomes, the unintended consequences. Same with you, right? I was talking to a friend, he had a diagnosis, and he said, I know way more than my physician, because I guarantee you, my physician looked at my folder about 15 minutes before she walked in. And, you know, they only they only make money when they when they go room to room. And so, same with our our business. If you're a commission-generated person, that does not mean that there aren't great physicians out there that use that model. That doesn't mean there's not great financial advisors that use that model. It's just uh the incentives really aren't aligned.

SPEAKER_00 29:08

It's like you're saying they're well-intentioned. Yeah. They're well-intentioned investors, they're well-intentioned physicians. It's just they don't have the time. Um and I love, I'm looking for like patients who are chat GPTing stuff, they're Googling stuff, they're coming with questions. Uh, you know, there are some um providers that are out there that'll say, hey, like, oh my God, here comes this patient, they're gonna Google everything, their Google Docs themselves. Right. Like, I love that stuff. Like, come with questions, let's have a conversation about it. And then it's always a team approach. So just because I make a suggestion doesn't mean paternalistically you're gonna have to do it. Right. But but what's gonna work for you?

SPEAKER_01 29:43

So yeah, yeah. Well, you've had an amazing career so far and you've got a long way to go. As you look back, though, someday, you know, we're not gonna be able to play anymore. As you look back, what do you want your legacy to be?

SPEAKER_00 29:56

Yeah, I th I thought about that question. So I think what would I want my children to kind of see me and take it? And so for me, it would be that I was I'm modeling like self-care and autonomy for them. So whatever profession they choose to go in, they try to live in it autonomous and they're able to make decisions on how they want to make their life. Whether it's, you know, putting my my daughter on the bus in the morning and then being there for like a Boy Scout meeting in the in the evening. Um I've actually taken her on several patient encounters and she sees that uh 45 minutes to an hour there for a blood pressure visit and talking to them. And so just modeling connection and autonomy.

SPEAKER_01 30:38

It is important your children see that, right? It's really important that I think my kids growing up new and today, if they need me, I'm there, period. No comma.

unknown 30:46

Yeah.

SPEAKER_01 30:47

And at the same time, they see you doing the blood pressure, they see me work. Yeah. And they they can they they'll they'll see me on a Saturday working. And and I think both are just really healthy.

SPEAKER_00 30:57

Yeah. Yeah. So like I think there's the I think the Road to Character may be a book, um, but it talks about you eulogical values versus the values that are on a C V. Um so at you know, at your funeral, no one's gonna talk about your portfolio is this and you have this many clients. So I I would hope that my legacy would be how I how I live, like with those used values.

SPEAKER_01 31:19

Um, Sanjay, absolutely enjoyed the conversation and uh wish you all the all the best in the future. And uh I look forward to continuing the conversation. Thank you.

SPEAKER_00 31:31

Sure. Thank you.