On Episode 13 of the Arthritis Life Podcast, Dr. Magdalena “Maggie” Cadet, a board certified clinical rheumatologist, shares her reflections on how race and gender affect providers and patients with rheumatic diseases.
This episode includes a deep dive into:
- Why Dr. Cadet chose to specialize in Rheumatology
- What unique issues rheumatology patiences of color face
- Why racial representation is important for healthcare providers
- Dr. Cadet’s advice for rheumatology patients for how to get the most out of appointments and build a trusting relationship with your providerSpeaker bios:
Speaker bios:
Dr. Magdalena “Maggie” Cadet is a well respected board certified clinical rheumatologist in New York City. During her fellowship, Dr. Cadet was one of a small group of fellows to be selected to serve on the American College of Rheumatology subcommittees of Quality Measures. She has also been involved with advocacy work for individuals with Rheumatic diseases.
Dr. Cadet is an Associate Attending at NYU Langone Medical Center. She has been selected as a 2016,2017, 2018, 2019,2020 Castle Connolly Top Doctor and 2018,2019 Castle Connolly Exceptional Women in Medicine.
Dr. Cadet’s interests have always focused on women’s health issues such as osteoporosis, issues relating to arthritis, autoimmune diseases such as lupus, sports medicine, and motivating others to live a healthier lifestyle. As a former competitive figure skater, former ballet dancer, pianist and current long distance runner, Dr. Cadet understands the importance of keeping one’s joints, muscles, bones and immune system healthy in order to maintain an active lifestyle and avoid serious injuries. She has dedicated her career to raising awareness of arthritis and autoimmune diseases which may cause significant disability and chronic pain in people, especially minority women.
She is an active athlete and completed running six Shape Fitness Half Marathon races in NYC. For her knowledge in the area of sports medicine and autoimmune diseases, Dr. Maggie has also been featured in Essence, Prevention, Shape Online, Lifescript and Everyday Health. Her experiences as a rheumatologist were also captured in the book “Lupus: Real life, Real patients, Real Talk”.
Dr. Maggie plans to continue her quest in motivating individuals living with arthritis and autoimmune diseases to advocate for themselves and learn more about their disease and treatments while maintaining a healthy lifestyle.
Cheryl Crow is an occupational therapist who has lived with rheumatoid arthritis for seventeen years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.
Episode links:
- Free Handout: Cheryl’s Master Checklist for Managing RA
- Cheryl’s Facebook group: Arthritis Life Podcast, Practical Tips & Positive, Realistic Support
- This episode is brought to you by the Rheumatoid Arthritis Roadmap, an intensive online education and support program Cheryl created to empower people with the tools to confidently manage their social, emotional and physical life with rheumatoid arthritis.
- Medical disclaimer: All content found on the Arthritis Life public channels was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Episode breakdown
02:30 – How Dr. Cadet became a rheumatologist.
05:16 – The importance of being persistent as a doctor to find solutions to complicated problems.
08:00 – How Dr. Maggie was able to break societal barriers.
012:45 – Challenges women doctors of color face and how they advocate for themselves.
15:15 – Systemic racial disparities in healthcare among minorities.
19:30 – The importance of racial representation in healthcare for women of color and minorities.
24:00 – The importance of female doctor representation starting in childhood
27:15– What Dr. Maggie wants rheumatology patients to know
32:15- Doing your own research as a rheumatology patient is a job in itself
34:15 – Emotional vulnerability with your doctor about your symptoms to build trust
37:15- Other healthcare professions that help with the management of your disease
39:20 – Advice for patients to get the most out of their appointments
43:30 – Fatigue and pain medications for autoimmune patients
48:58 – Understanding that physicians are humans too
54:45 – Additional advice and insights for rheumatology patients
Full Transcript:
[00:00:00] Cheryl:
Yeah, like, ’cause, like — we’ll just edit out the beginning when we’re just chatting, but, yeah. So, at some point I might do little video previews. That’s why I like warn people. Yeah. Do you have any questions before we start?
[00:00:16] Dr Maggie:
No, I think I’m good. I think I’m good. I have — no, I think I’m good. Percentages. I just did, I have a couple of, yeah, I have a couple of statistics. I didn’t wanna like bog, go bog down into it and stuff, but we’ll wing it.
[00:00:36] Cheryl:
Oh, good. Yeah. Yeah. And I think that the personal storytelling is usually what people are hooked by. But then, if we sprinkle in the statistics. Yeah. And the other thing I’m just gonna, I forgot if I told warned you this last time that I’m gonna mute myself when you’re talking. Because there’s this thing that happens with Zoom — just in case you’re doing other Zoom interviews where if even if I make a noise, like, “Oh, okay. Yeah,” sometimes it distorts the audio when it hears two people talking at once. It’s weird. So, I don’t want you to think that I’m like, I don’t know, doing something weird. I’m just muting myself so that the audio’s better.
[00:01:14] Dr Maggie:
Now what if something, what if someone calls into me? You can edit it and stuff, right?
[00:01:22] Cheryl:
Yeah. Oh, absolutely. And like I have a medication reminder that goes off at 12:30. And so, I’m just gonna be looking at it and try to turn it off right before, but yeah, if anything, if you need to go to the bathroom or anything, I could pause the recording or be, like, yeah, if we get cut off somehow just come back into the Zoom meeting and I can start recording again. Awesome. Yay! I’m so glad this is — I’m in such a better mental space than the other time too, so it just was like, meant to be.
[00:01:52] Dr Maggie:
Read through things or think about what I wanna say without — it hasn’t changed that much. But again, you just, you wanna be, like, awake and alert.
[00:02:01] Cheryl:
Yes. I know. I was like, oh, I wonder if she’s like an evening person, like my husband who’s like more energetic at night. ‘Cause I was like, oh my God, I’d be so tired if I were her.
[00:02:11] Dr Maggie:
Usually I am. But it was just, like, during the week, it’s just so hard and crazy ’cause you’re just from thing to thing. So, at least like today, at least on the weekends, I’m able. Usually it’s busy on the weekends too, but I just made it a point to just have breakfast, spend time with my daughter. Like, she’s in the back. And I feel bad too sometimes when I’m away at work all day and then I come home and work. So, at least I’m like, all right, we spent time this weekend.
[00:02:38] Cheryl:
Perfect.
[00:02:39] Dr Maggie:
I’m cognizant of that.
[00:02:40] Cheryl:
I totally get it, but yeah, my son’s just playing a video game and he’s happy right now, but yeah. Yeah. Or he’s watching, sorry, he’s watching a YouTuber playing a video game.
[00:02:50] Dr Maggie:
I know, I know.
[00:02:52] Cheryl:
It’s such a genre. Oh yeah, sorry. No, I’m only trying to reign myself in ’cause I always get off track. I get distract myself. Okay. So, I’m so happy to have Dr. Maggie Cadet here today. Or wait, how — is that how you pronounce your last name? Cadet?
[00:03:09] Dr Maggie:
Kah-dei.
[00:03:10] Cheryl:
Cadet. Oh, okay. Let’s start again. Okay. Yeah, I was like, I should have just asked that five seconds ago. Okay. So, hi everybody. I’m so excited to have Dr. Maggie Cadet here. She is an amazing rheumatologist in New York, and I’m just gonna jump right in. So, Dr. Cadet, can you tell me a little bit about yourself and why you became a doctor?
[00:03:32] Dr Maggie:
Thanks so much for having me. This has been something I’ve been looking forward to for a long time and I know use your platform to reach out to so many patients with arthritis and talk about so many issues. So, I’m excited to be part of this today. So, my journey into medicine. My dad is an OB-GYN and he immigrated from Haiti to come to the United States to seek a medical education. And I remember just watching him study and watching the joy he got from taking care of patients in general and really helping people. And as immigrants, really helping people of other ethnicities just navigate theirselves through the healthcare system.
And when I was younger, my pediatrician was someone I really looked up to. I felt comfortable going to the doctor’s office. I felt like he sat and listened to me. He heard what I had to say even when I was a child. And I knew that at that point that I wanted to do the same for other people, help improve their quality of life in some aspects, and also just be there to take care of them and know, help them know that there are people who care about them and are very aware of their health issues and will help them make their lives better. So, that’s the reason why I became a doctor. And we can talk about why I became a rheumatologist.
[00:04:52] Cheryl:
Yeah, you’re, reading my mind. Yeah. And that’s an amazing story, and it’s so powerful to have those experiences early on in life with doctors who are so loving and caring. Of course, your own father and your pediatrician, so that’s wonderful. And yeah. There’s so many different specialties you could have chosen. There’s pediatrics, there’s OB-GYN, there’s dermatology. So, what made you choose rheumatology?
[00:05:16] Dr Maggie:
Yeah, so as I stated, I thought I wanted to be a pediatrician like my entire life because of my experience initially. And then, in medical school I actually loved women’s health and was selected to go into OB anesthesia. But I had a few experiences in medical school that really made me rethink my specialty. And one of them was meaning a young female around my age. In her twenties, she was diagnosed with lupus. And at the time I had no idea what lupus was. We were just starting our rheumatology elective or autoimmune disease section. And I was starting to learn more about this. And what struck me with her was that she was my age. She was African American female. She was diagnosed with lupus, but really didn’t know much about her disease or really the complications of the disease. And she never really understood why she had to be on medications and just really wasn’t as informed as she probably should have been, and really didn’t feel like she had a good relationship with her own personal physician.
So, I was really interested in her disease process and as time went on, I watched her journey and she ended up passing away from complications of lupus. And I remember thinking to myself, how could this young woman this age really pass away from something that she really didn’t understand much about? And so, that kind of got my wheels turning in terms of what I wanted to do. And as I said, I mastered in anesthesiology. I was happy to do it, but it wasn’t until my internship year that I met a few women, actually, with lupus, who were dismissed with their symptoms. They were told they had viral illness or depression or fibromyalgia. And I was able to help them during their journey. And a lot of them were women, a lot of them were mothers. And I just felt that this was a disease that I could really make an impact on.
A lot of women are affected by autoimmune diseases. A lot minority women are affected. And I felt that they felt comfortable coming to me and that they knew that I could hear and acknowledge their symptoms and would not stop until a diagnosis was made, whether it was autoimmune disease or something else. And I just felt that there needed to be more awareness about lupus, rheumatoid arthritis, all these other autoimmune diseases that are really sometimes an enigma. And sometimes, the patients need some reassurance or they need someone to help guide them through the diagnosis. So, it was really my internship year that really solidified my choice. And then, I switched course all completely and decided to pursue a rheumatology fellowship at NYU.
[00:07:48] Cheryl:
That’s incredible. And yeah, I think that your statement about hearing how so many women had been dismissed will just really resonate with a lot of the listeners ’cause a lot of the listeners, unfortunately, are patients who’ve had that experience as well. And I can’t even imagine, like in my case, I’m a Caucasian woman, and I was dismissed by a lot of doctors, but I know there’s another layer of complexity when you add the racial differences in how women of color are treated when they present with pain and/or unusual symptoms. So, I think you’re just such an amazing example of somebody who, you know, the doctor that everyone wishes they could have. The doctor that listens and is empathetic and like you said, won’t stop, until you find an answer that’s those are like golden nuggets to any patient. They’re like, oh, my gosh, yes, let’s clone her.
[00:08:41] Dr Maggie:
And I may not know all the answers. And that’s something a lot of times as rheumatologists, we do like to speak with our patients because the immune system is so complex, there’s so many mimics of diseases. So, part of it is really trying to rule out other disease processes too, but with rheumatologists, we don’t always know the answer. And sometimes the journey is long and we are on the journey with you. So, as things are evolving in the immune system, the rheumatologist or the physician is also finding out more things, or things are becoming more clearer. So, it is something that I do tell my patients to be patient and to understand that we may not always know the answers right away, but we can try to help either exclude other diseases or try to hone in on a disease after several months.
[00:09:29] Cheryl:
Yeah. And but I think that’s such a giant paradigm shift from what I think a lot of us have experienced, especially with — and I think primary care is extremely hard specialty. There was, there’s a lot of people whose primary care physicians were like, “Your labs are fine, you’re fine. You don’t have anything.” As opposed to, I’m not sure what’s causing your symptoms. Let’s, like you said, go on this journey together. Like, when you feel like you’ve just been dismissed and the doctor’s like, “We don’t know what you, we don’t think anything’s wrong with you.” It’s a totally different psychological experience than saying, “We don’t know what’s wrong right now, but we believe you that you’re experiencing this and we will work with you to get,” and I think that’s why rheumatology is just like the unsung heroes. Or I mean that they’re being more sung now, right, because of the COVID.
But yeah, everyone’s like, the immune system, now we care about that now. But yeah, it’s just phenomenal. I’m sorry, I just have so many different like directions my brain wants to go right now, but back to the thread about you. I remember we talked earlier, you didn’t have a lot of experience with like doctors who, quote unquote, ‘look like you’ or have the same characteristics. So, can you explain a little bit about how that part of your journey motivated you in medicine and some of the experiences of how you broke barriers?
[00:10:55] Dr Maggie:
Absolutely. So, I mentioned I was lucky enough to have my dad as a role model and I actually do have many family members, extended family members, who are physicians. So, to me, it wasn’t something I ever thought about growing up because I saw them. But as I got into medical school, got into graduate school, college, I realized that there weren’t a lot of physicians that looked like me. In fact, for Black female physicians, we only make up 2% of the physician population, which to me is so astounding. And when you think of so many patients, especially in rheumatology, a lot of these patients experiencing lupus and rheumatoid arthritis and other diseases, many patients are minority patients. So, it is difficult sometimes for these patients maybe to be more compliant or maybe to feel comfortable expressing their symptoms or their questions because they are not finding a) a female physician. And then, b) someone, again, who is a minority physician.
So, I realized that earlier on in my career, and so I just kept it going. I knew that this was something I wanted to do. I have never shied away from being someone who could fight for my rights. My mom was someone who was really inspirational with that too, and always taught me that you can do this. There’s no obstacle that’s big enough. And so, early on, I obviously tried to attend like the best schools I could get into. Obviously, I did know that academics did matter, especially for a lot of minority physicians. And I was able to get into a great medical school, which was one of the first medical schools that not only accepted women as applicants, but also had a large diverse class. So, I knew that I wanted to be part of that group. And again, it would’ve been great. I did have a good mentor, but I wanted more female mentors.
And I was lucky enough to find someone who inspired me to be part of the women’s health pathway. So, I knew I wanted to focus on an area in women’s health, and she was a Hispanic doctor. And I still communicate with her today. And she really helped me navigate through the women’s health pathway of my school. She helped me get into clerkships at Harvard for the summer, which again, was amazing because it did also promote a lot of programs for diverse students. And I was also selected as my graduation speaker, which, again, in the past there hadn’t been a lot of female minority females who had presented. So, it was great for other students and other people to see someone who looked like me, who could be a speaker and a champion for them during medical school education.
And then, as I went on, you know, again, there aren’t a lot of African American fellows at rheumatology fellowships and really ended up at a great institution, NYU Hospital, for joint diseases, which really promotes a lot of academic and clinical research. And I was able to participate in the American College of Rheumatology subcommittee as a fellow. Again, devoting my time to quality measures. Went down to Washington D.C. to advocate for the arthritis sponsorship bill for research and clinical funding. So, I’ve been able to do this. And then, as I worked my way up in my academic career, I was one of the youngest mentors as well as director of my department.
So, again, I’ve always tried to push through and even though I was young, I think I was two or three years in, I knew I had what it took to really establish a rheumatology curriculum. Again, be mentors for residents and fellows and medical students who rotated through the hospital clerkship. So, I’m continuing to do this by blogging, by really, again, encouraging students to go into the field because they may not want to, they don’t see people that look like themselves, or they may think it’s too hard or they can’t push through, or they’ll never attain a big academic or clinical position.
So, I hope I can continue to break through those barriers. And I have so many colleagues, that I’ve met on Instagram and other platforms that have also encouraged me. Great female physicians. I do love men too, of course, minority male physicians, of all races. They’re great advocates, but it really feels differently when you have a support group of female physicians behind you.
[00:15:35] Cheryl:
That totally makes sense. I’ve been having such a blast on Instagram and TikTok in particular following a lot of female physicians in general, and then female physicians of color. It’s just been really amazing. ‘This is what a doctor looks like’, I think was one of the campaigns, or this is what a physician, ’cause I know it’s so common to be, like, people will ask if it’s just a woman in general, but especially if it’s a woman of color. A patient will be like, “When’s the doctor coming in?” You’re like, “I am the doctor.”
[00:16:01] Dr Maggie:
Oh, it happens every day. Or they’re so shocked when they see or they say, “Oh, I’m waiting for the doctor still.” And meanwhile I’ve started my visit, I’ve introduced myself as doctors. But I’ll say this too, I, again, because autoimmune diseases do affect a large number of minority, patients, especially women, I have found so much gratitude. And a lot of these patients are so happy when they do see me and they do, you know, they do realize that I’m gonna be part of their care, or they congratulate me for sticking it through medicine. So, I have found those responses as well, which has been so encouraging and really makes me feel like I’m doing what I need to do. So, that’s one thing.
And then, recently on Instagram, we talked about Instagram being a great platform for physicians to meet each other and express themselves. During the summer we had the share of the ‘Medical Mic’ campaign, and it was a campaign started on Twitter actually, by a physician, Dr. Renee. And she and her colleagues invited me to participate in this campaign where there was 40 Black female physicians who took over account of 40 non-Black physicians. And we were able to speak about topics relating to like postpartum depression in the minority community, mental health issues, just any topic, medical issues like fibroids, arthritis, or immune diseases, how it feels to be a Black female physician in the world, healthcare world today. All these topics were covered.
And I’m so grateful that we had these allies, these amazing female physicians who gave us their Instagram accounts to reach a new set of audience who would listen to what we had to say. So, we are making strides, and again, the support is there. I still think that we need to do the work in terms of our healthcare disparities, and again, finding physicians who can relate to patients. And also, again, just make them feel more comfortable and not mistrust the healthcare system as much.
[00:18:14] Cheryl:
That was incredible. And I did see that campaign on Instagram, the takeovers, and it was really, really powerful. And for me, as a Caucasian person, I definitely was made aware of how not diverse my feed was previously, too. So, I think, there’s been such a shift in awareness, but we obviously still have far to go. Is there anything you wanna share? I know you already shared about lupus and some of the statistics around, racial disparities or the fact that people of color are more likely to develop, certain, autoimmune conditions. Is there anything more you wanted to share with the audience about like racial disparities in healthcare?
[00:18:59] Dr Maggie:
Yeah, I mean it’s, I think this year, especially with COVID, we are realizing that the minority populations are susceptible to COVID because of the underlying conditions like hypertension, diabetes, lung disease, like emphysema, asthma, as well as immunosuppressed patients with cancer. And we do know that minority communities, especially the Black communities have the worst outcomes when it comes to all of these conditions as well as mental health. So, it is something that we really do have to start paying attention to. Also, maternal fetal rates are more, are worse for the minority communities. Postpartum depression outcomes are worse and medications may not be provided to those individuals as much as maybe other races.
Even within arthritis, like rheumatoid arthritis, there are studies looking and seeing that minority communities are not being offered biologic therapies as much, or the patients are not taking the biologics because of a mistrust in the healthcare system and their physicians. So, it really does span so many medical specialties. It’s not just arthritis. It’s not just blood pressure. It’s not just diabetes. It’s not just cancer. It really is everything, including pediatric health, gynecological health. And that’s what’s really striking, is that we do have to do better because it really does run the gamut of conditions.
And we do have to develop more trust for these patients. We do have to maybe look into the other barriers, like access to insurance, whether testing is being done, preventative screening, even flu shots, vaccinations; are they being offered, are they being talked about? Even with arthritis, we know with rheumatoid arthritis, heart disease is one of the number one complications of rheumatoid arthritis and lupus. And these are the same diseases that are affecting minority communities. So, they’re all tied together.
So, I just want people to know that it’s not just one disease, it really runs the whole spectrum. And we as physicians, we as a public health community, the government, we really have to do better. And even with COVID, the vaccine trials are in progress right now. And we are again finding out that the ethnic communities, minority communities are not maybe being represented as much ’cause they don’t wanna participate. So, we do, again, maybe we need to find Black investigators, maybe we need more information about the vaccine, about what it can do to help all communities, and really push the effort to try to erase or reduce the health disparities and get more people involved in education.
[00:21:47] Cheryl:
That makes a lot of sense. You touched on all the different, like, systemic barriers. And I think a lot of times people can get really over simplistic about it and they’ll be like, “Oh, someone just needs to work harder to reduce their blood pressure.” It’s like, okay, no, there’s actually all these different systemic factors that contribute to that person maybe having high blood pressure or some other risk factors. Yeah.
[00:22:12] Dr Maggie:
And genetics plays a role. Like, in certain diseases like lupus. We do know that some medications that work for lupus, nephritis and Caucasians and other minor ethnic groups do not work as well in the minority groups, or like minorities have worse outcomes for kidney disease and neurological disease in lupus. So, there’s so many factors that really do need to be explored, but we also have to try to bridge the gap and reach, improve the communication and also improve the trust so that these patients are willing to participate in studies and we can find out more information about the genetic/socioeconomic factors that may play a role.
[00:22:53] Cheryl:
That makes so much sense. And I was just learning a little bit about like intergenerational trauma and how that can be coded into our biology as well. And just thinking about, yeah, how many racial traumas there have been, not even a hundred years ago, not even 50 years ago. So, I think it makes sense that this would be something that people have to look at, you know. And then, in general, is there anything more you wanted to say about representation in medicine, racial representation, or representation of women?
[00:23:30] Dr Maggie:
Yeah, absolutely. I think right now we know in medical school, there’s more than 50% of the applicants are females, which I think are great. We do know that women are still struggling to achieve high academic and clinical positions within healthcare systems or their practice. So, there still needs to be work done in that aspect. Obviously, Ruth Bader Ginsburg just passed away and she was a champion of gender equality and I was just listening to her story about how she graduated from like a top law school, obviously a Harvard, she went to Harvard first and then Columbia Law School and she was a mom and it was hard. Even though she graduated top of her class, it was so difficult for her to find a job. And I think women still face that same problem today. Even though in medicine we do make up half the medical school classes and other specialties, there are still barriers to us achieving high academic positions or clinical positions. And the same goes for, it’s even worse for minority physicians.
So, I think the first thing is to at least start in elementary school, high school. Having females, Black females, minority females, whether it’s Asian, native Americans, Hispanic, Latinos, having representation in the classroom so that these kids know that they can achieve great success in whatever profession they choose, that they can become a physician or a healthcare practitioner, even though it’s long work. It may be a lot of money, a lot of financial sacrifice, but there are programs out there that can help these students and it’s important for the mentors to be involved. So, we can tell the students that there are these opportunities.
And then, as they go into medical school and residency, it really is important to develop a network. Again, I’m actually going to be involved in doing that for my medical school, being involved in creating a diverse alumni consortium or network. So, that way these students have mentors. They know that these are the different specialties that are available to them; that they can do it. ‘Cause it’s so hard to look at the finish line when you feel like there’s so many obstacles in front of you, you may not be motivated to continue the path. So, representation does matter. It matters for students, for even attendings like me, in my stage of career. I wanna know that I can do other things aside from clinical medicine. There are people who are pharmaceuticals, who are in fitness, who we’re nutritionists, who are occupational therapists, speech therapists. There’s so many health-related fields, and people are not aware of that.
So, it’s important. And it’s important to find people that look like you because if you can see it, you can dream of it. And again, with Ms. Kamala Harris being the vice presidential candidate, now there might be some other girl out there looking at her, thinking about, “I can do this as well.” So, it really, representation really matters across the board. And again, it matters for patients too, because at the end of the day, they’re not gonna be compliant if they don’t trust their practitioner. It doesn’t matter what you say to them, what material you provide them. If they don’t trust their provider, they’re not going to do what is needed to be done to advance their lifestyle and their health.
[00:27:00] Cheryl:
That’s such a beautiful point. And it actually, thinking about my own story when it comes to trust, a lot of times people say, “Oh, was it hard for you when you were put on like methotrexate?” And, Enbrel very quickly. I first was put on Sulfasalazine, then methotrexate, and then my stomach didn’t like sulfasalazine. Then I was put on Enbrel like within four or five months of my diagnosis. It was like a really, you know, it was the classic like early aggressive therapy. And I was like, it was not hard because I just completely trusted her. Like, you know? And maybe on the one hand that is maybe a part of my privilege of being a, a white woman who has never been, like, I’m trying to think of the nice word of saying screwed. Or I have never been like systematically oppressed in a medical situation. But it didn’t even occur to me to look online or now this was 2003, so there weren’t like patient communities online that I knew of. But point being, you know, I know it’s actually a huge hump to get patients over the fear of medications. And so, I’m going on, yeah, that little tangent.
But the other thing I was gonna say is, I think you said it starts with childhood when it comes to the representation and it’s so true. I, one of my little acts of, I was gonna say acts of service, but I always write, when I see articles where they’ve automatically written the gender of a doctor as male, I always write to them and say you need to change that to he or she. Yeah. And it’s funny, I was always really, really careful about that with my son. If we were playing with Legos, Lego guys or girls, and it would be like, here’s the doctor, here’s the specific, she, the doc. And one time, he actually, when he was playing with toys or the Lego people. He said, he defaulted to ‘she’ for doctor, because all the doctors he had so far had been female. And he’s come with me to some appointments and he had seen a couple male doctors, but I was like, oh, my gosh. He defaulted to ‘she’. That’s awesome. Let’s talk, explain what happened. Like, when I was, even when I was little in the eighties, you just, it was like boys were doctors, girls are nurses, and not that there’s anything — nurses are incredible. It’s a very tough job a lot of people wouldn’t be able to do. It just, there was this, yeah.
[00:29:27] Dr Maggie:
It’s the assumption. Yes, absolutely. Or even early in my career, I would go to these conferences and look around, even with rheumatology initially. It was like purely a lot of men. And sometimes you, I would feel a little left out ’cause you would look around. Now that’s changed over the years, which is great. But I can imagine for patients, maybe a few years ago, like as a female, like a young female who may be looking into fertility options and worried about her self-esteem because she’s on steroids and has gained weight and acne. It might be more difficult for a male physician to empathize with why she wouldn’t wanna be on the medication or her psychological and emotional difficulties really dealing with her disease because she is a female.
So, I can relate to that ’cause I’ve been a female, I’ve gone through that stage. I have been self-conscious about the way I look or the weight. And so, I feel like it’s, it really is a better, sometimes, it is better for some females to choose another female physician if they feel more comfortable, or again, being able to relate about family planning, menstrual periods, other things. The male doctors are great of course, but again, sometimes there is a little, there is a little difference. And again, women sometimes tend to listen a little bit better or more carefully, or again, maybe a little less dismissive sometimes. So, I think it, there is a gift sometimes for these patients when they do find a same-sex physician.
[00:31:16] Cheryl:
Totally. And I think a lot of it too is just having choices, right? If your whole, if the only pool of doctors you can choose from as a patient is a homogenous group of like older white males, that doesn’t give you as many kind of personality options or different communication styles as like having a diverse group to pick from too. So, yeah, some people, even if they’re a woman, they might love seeing their male physician. That’s great. But if they had no choice, that’s the problem. And yeah, it’s just, it’s really, I just love this conversation.
But speaking of rheumatology in general, I think that, I am — Okay. I’m just gonna lay my cards on the table and say that I wanna give you a chance to demystify a few things about rheumatology or give you a chance to say what a few things maybe that you wish patients knew, because I know that, for me, so I’ll say something really quick. When I was diagnosed, it was six years before I became an occupational therapist or before I started OT school. And when I became a healthcare provider, I learned so much more about the system and how things are the way they are. And sometimes I realized I was being really unrealistic with what I was wishing for. So, I wanna give you a chance to maybe explain a little bit, like, why can’t I just talk to my doctor for two hours, or you know?
[00:32:37] Dr Maggie:
Yes. Patients would love that. Yeah. And honestly, I would love that too. And many years ago, I think, when my dad was a physician, he was able to spend a lot more time with his patients. I do talk to my patients and let them know that because of this healthcare system we are in now, physicians do have a lot of constraints. And unfortunately, it’s not something that we like because trust me, many physicians do talk about this and are not happy with the time limit. A lot of times visits are 15- to 20-, 25-minutes. And for rheumatology patients, that really is not enough. And honestly, for any patient, that’s not a lot because you are checking in with their, obviously, their psychological health, their mental health, their physical health, and just catching up and doing medication reconciliation and allergy check.
So, I just want patients to know that it’s — I know sometimes they may feel rushed, but there are constraints because the visits are lined up and there’s always someone behind them and it’s, we can’t cut into that other person’s time. And again, it’s, right now the insurance companies and other healthcare institutions have their guidelines that they provide to the physicians. So, that’s number one. I wish we could spend more time.
Number two, even with medication, there might be a medication we wanna place you on, but it sometimes it’s not up to us, you know. A lot of the insurance companies have a major role in what gets approved. So, even though you may read about something that you may want, like an injection infusion or even an oral medication, depending on the insurance company, the physician can try to explain why we think the patient should be on it, but it doesn’t always work out. So, just know that we are advocating for you, but we also have constraints as well.
Also, sometimes — I mentioned this earlier on — it’s frustrating for the patients. I get it. ‘Cause they feel a certain way. Sometimes the labs do not come back positive and there’s nothing there. And again, it sometimes, it’s very clear cut that it’s not autoimmune related and sometimes it’s not. But it hasn’t presented itself initially. So, you do have to be patient with us to come back maybe, two more or three more times during the year to see if the disease does evolve. But just because we can’t find something now doesn’t mean that it may not evolve.
And then, I would say, the last two things I would wanna say is, again, a lot of times with arthritis, it’s not just your joints. I know sometimes patients can say, “I don’t need the medication, it’s just my joints. I’m fine. I can get over it.” A lot of times, most of the times, aside from like local osteoarthritis or wear and tear arthritis, these other systemic joints are arthritis, inflammatory disease. They do have systemic consequences. So, I mentioned before, sometimes you can have atherosclerosis or heart disease. Sometimes there’s kidney disease, lung disease, eye disease, neurological disease. So, being aggressive and treating your disease early or trying to get diagnosed early is really important because it’s not just about your joints, often it’s about your whole body and other systemic organs that are being affected as well. So, just think about it as the whole body, not just localized to one thing. Obviously there are things like trigger finger, and again, osteoarthritis that can be local. But some of the other things like rheumatoid arthritis or Sjögren’s syndrome, vasculitis, myositis involves so many other organs.
And then, lastly is you can be your own advocate. So, I always tell my patients, read about the medications I’m giving you. You can trust me, but at the end of the day, you are the decision maker for your health and life. I want you to read the information. If you don’t understand something, ask me why. I see so many patients come in and there are medications and they have no idea why they’re taking the medication or if they don’t even know why they’re coming to a rheumatologist ’cause they were referred. Ask the questions. If you are not in charge of your life or your health, no one else will be. And yes, I’m the physician and I can guide you and give you the information and my advice, but ultimately you have to take the medication. You have to go get the test. You have to know why you’re on these medications. So, you have to be your own advocate.
[00:37:09] Cheryl:
Absolutely. The, metaphor I’ve been operating from a lot lately is that it’s a job to be a patient. Like, it’s a job that doesn’t come with an orientation manual except putting a quick plugin for my course. That’s why I designed my online course, the Rheumatoid Arthritis Roadmap. I guess it’s my own podcast, I can plug myself. But it’s like I realize there’s just so many skills that you learn over time as a patient. And there are some tips and tricks, of course, that different nonprofits give. Like, I’ve definitely learned all about advocacy from the Arthritis Foundation and I’ve learned so much from other nonprofits and patient education resources. But I think that the lack of a comprehensive like orientation to the disease is really a huge problem for a lot of patients because what they end up doing is they go to social media and they get extremely confused.
And I literally just had a phone call about someone about this with somebody who’s interested in my program last week, and they were like, “I got really, like, I’m even more confused. I like got all these different opinions.” Yeah, methotrexate’s amazing. No, it’s terrible. This is good. No, this is bad. You should change your diet. You should go vegan. No, you should go keto and eat a lot of meat. And they’re just like, “Ah, what do I do?!” And so, the, point being that it’s almost like if you grew up thinking of the medical system as like the old model of the doctor’s, quote unquote, ‘the voice of God’. And like you just, you’re passively receiving whatever the doctor says, it’s almost like a rude awakening, but it’s also empowering. It’s like a double-edged sword where you’re like, wait a minute, the doctor isn’t just gonna tell me what to do. I have to be involved in my care. This is a chronic, lifelong condition. So, you’re like, okay, this is an empowering thing, but it’s also like it’s work for me to now do. I did not go to med school for 10 years. Like, I need to learn, what is a TNF-inhibitor? What is it actually doing in my joints and in my body?
And a friend of mine, sorry, now another related point, but she did a little informal poll on Instagram. Very unscientific in the sense of real publishable science, but she was shocked that — which she has a couple thousand followers and probably a hundred people responded — 90% of the people said that they had minimized their symptoms when talking to the doctor. And then, when she followed up with some of them, they were afraid of the doctor saying that they needed to take more medicine ’cause they’re afraid of having more.
And it’s and it’s hard because, so yeah, like you said, it has to be built on a foundation of trust with your doctor. Like, I remember even with my rheumatologist, Dr. Gorman here in Seattle, I’m just such an, I’m such an optimist that after a while she realized that I’m not trying to minimize my symptoms specifically for any reason. It’s just that I’m always like, “Oh, it’s been a little bad this week, but it’s, I am sure it’ll get better or It’s fine. I just can’t really uncurl my fingers from a fist in the morning, but I’m sure it’ll get better tomorrow.” And she’s like, “Wait, no, that’s, we are not gonna skim over that. Like, we need to actually deal with this,” you know?
[00:40:18] Dr Maggie:
Yeah. No, absolutely. You have to be honest about your symptoms. Yeah. Things that you’re on in terms of maybe herbal medications or other, that’s another thing too. There are patients because they’re in pain, they are in pain, that they take medications or other supplements. You have to be honest about it. Or if you’re smoking, obviously smoking is horrible for rheumatoid arthritis and other diseases in general, but really there’s been a correlation with rheumatoid arthritis. If you have to be — and I found like I could smell the smoke on these patients. When they come in the room, they say they’re not, and then it’s not until after some probing, that I found that they have minimized that detail in their life.
And then, also too, in terms of emotional and psychological health, I found that a lot — I’m more in tune with it — that I’ve had to ask a few patients whether they are severely depressed or they’re suicidal. Because, again, because of the chronic pain, a lot of them do dismiss it after a while. And I’ve had to really up my depression screening with a lot of these patients and just seeing them, you know, maybe someone’s not making eye contact or they’re a little bit more solemn than usual. So, these are all things that, we have to pay attention to as physicians. And I just wish again, that there was more time in the visit because then you could really address all these issues. But it really is, it’s not a paternalistic relationship anymore. And I definitely say that to my patients when they come in because they will say, “What do you want me to take?” And I could say, “These are the three or four things that I are available. You know, whatre you more comfortable taking?”
Because an example is something like methotrexate. If you’re a young person going out, drinking every week, it doesn’t matter if methotrexate’s the cornerstone therapy for rheumatoid arthritis, it is just not good because of liver abnormalities and other issues. So, that may not be the right option for you. Or if you are thinking about getting pregnant within the first two years, yes, methotrexate is a great drug, but again, I’m not gonna put someone on that if they’re thinking about starting a family ’cause it’s teratogenic. So, it’s, again, it’s, not paternalistic. You are a participant in your care. Yes, it’s more work. But I think especially with rheumatology, you have to be involved.
[00:42:49] Cheryl:
Totally. And I have to put a quick plugin for like occupational therapists or also like social workers too, it can really help patients develop these, like these skills that are under the umbrella of something called self-management. This, I know you know what that is, but for the people listening, self-management is like these skills needed to manage your disease on a daily basis and your health in general. Like, everyone could benefit from self-management skills. It’s like the psychological. The ways of getting yourself motivated to exercise or eat healthily.
And, in the case of managing a chronic illness, it’s also those, like, what I call the CEO skills or like executive functioning skills of tracking your symptoms, tracking your medications. Like, no one else is doing that for you. The computer system of your local doctor does have that information. Sometimes I’m like, don’t make me go through the whole list again. I know you have it on your computer. But anyway, it’s usually like when the medical assistant is like, “So, are you on any medications?” I’m like, yes, all the ones in the computer I’m on. But I’m like, if you wanna check, if you wanna run through them, I’m not, I’m doesn’t make sense for me to sit here and like spit regurgitate them to you ’cause they’re like on the computer.
But anyway, the patients need, if they need help with that, occupational therapy, our default visit is usually 50-minutes. So, we actually get longer. We feel, I feel lucky for that, but for some reason we’re not utilized very often in the management of like inflammatory arthritis, outside of like hand therapy, which is such a small sliver of what we can do. And it’s really important. Obviously, the hands are extremely important for function, but like we can also work on these executive functioning skills and these health — we have a whole, our occupational therapy scope of practice called health management and maintenance, and that’s all these skills.
I am hopeful and I’m getting involved in the American College of Rheumatology as an OT to, and, or sorry, the, yeah, the Association of Rheumatology Professionals to try to help. I know there’s some other amazing allied health professionals out there trying to elevate the role of the rehab professions like OT and PT. And of course in the care of people with autoimmune diseases, but also counseling and psychology, those are also places where you get like the default visit of 60-minutes. It’s like why do the physicians only get 15? Ugh.
[00:45:13] Dr Maggie:
It’s astounding.
[00:45:15] Cheryl:
It’s, yeah, we’ll have to go back to Washington D.C. again and advocate some more. But yeah, just so you know, the people listening, it’s not like your doctor doesn’t want to spend more time with you, depending, I’m sure some of them might be tired if it’s Friday, the end of the day. Yeah. Are there any pieces or nuggets of advice for patients to, like, get the most out of their appointments that you’ve seen? Like, patients that come with certain tools or skills?
[00:45:44] Dr Maggie:
Yes, absolutely. Being organized is a great thing. You touched upon some of them knowing your medications. It has to be asked at every visit ’cause it’s a medication reconciliation and it’s just helpful even if you don’t wanna go through it, just have a snapshot of the ones that you’re taking because again, there are medications that are maybe temporary that are still on your list and needs to be crossed off also.
[00:46:08] Cheryl:
That’s true. I didn’t mean to say it wasn’t important. Thank you for clarifying that. Yeah, it is important.
[00:46:12] Dr Maggie:
It is important. Exactly. Journaling your symptoms, again, recording when you have flares or if there’s any kind of trigger that you have identified is really important. I always like to have my patients get their blood work done before the visit so that way when they come in we can talk about it and it’s not, we’re not playing cat of mouse in terms of getting in touch with each other after the visit in terms of lab results. And then, that way you can construct a plan at the visit and be able to ask questions about what to do next. So, I like to, again, prepare before.
So, I would just say those are like the main things, like, having the labs done, being really organized with your medication, and journaling your symptoms. And if you’re a new patient, obviously you probably have a lot of information coming in. Maybe sending that information prior to the visit. I can’t guarantee, like, all physicians will get to all the information before, but at least it’s easier for them to see it in front of them and they can review some of it, maybe not all of it. So, again, just being prepared.
And again, being an advocate. If there’s something that you have seen or read about, bring it in. ‘Cause a lot of times patients will say, oh, I heard about this medication, but then they don’t have the medication in front of them and then they spend a lot, the next 10 minutes trying to figure that out. So, it’s like going to school or going to work, you have to be prepared because you do have a very finite amount of time and you wanna maximize that time to come up with a plan and really discuss your symptoms.
[00:47:49] Cheryl:
That makes so much sense. And yeah, I don’t know if everyone, if this is universal. It probably isn’t, but in my clinics here in the Seattle area, a lot of them use something called MyChart, which is like an email system that sometimes I’ll ping my doctor like a week before and say, okay, here’s like my four main questions. If one of these is, if you think it’s like a super simple answer. If you have time to let me know before, so we don’t end up, quote unquote, ‘wasting the time’ talking about it. So, yeah, one of them was like, should I get the flu shot a second time? Because I always have only gotten it once, but then I started hearing people say, you might need to get it a second. Those kind of things where you don’t necessarily need like a back-and-forth as opposed to a more difficult decision like, ah, I’m flaring, but I’m not, but I think this medication’s wearing off, but maybe we should stay on it a little longer. So, yeah.
[00:48:41] Dr Maggie:
Simple questions can, yeah, definitely again, be addressed on the portal. But again, patients recognize that it’s hard to do a back-and-forth too, ’cause sometimes you’ll get a couple many questions and it’s just, one simple question is great, but back-and-forth, you really need to, you really need to discuss with your doctor because it’s very hard to articulate information over email. It really is because you can’t really explain. If someone comes in and they have a positive ANA, if I don’t really think it’s anything serious, it’s very easy when they’re in the office for me to explain, this can be seen in healthy individuals, but sometimes medications or viral illness or autoimmune disease, but I don’t think you have an autoimmune disease; versus doing it on email always leads to 10 or 14 different other questions. So, something like that really needs to be discussed in person.
[00:49:37] Cheryl:
That makes a lot of sense. Almost the difference between open questions and closed questions. If it’s like an open question, maybe wait for the appointment. If it’s a closed question, like a yes or no, should I get a second flu shot? Yes or no? Or they can say, actually that’s, we need to have a discussion about that, versus I can just tell you. And the other thing I wanna touch on briefly is just ’cause I think there’s a real lack of awareness that fatigue is actually — so, I’m taking it another direction here quickly. I didn’t know for a number of years that fatigue was actually related to the disease itself. One of the questions I’ve seen people floating around on social media is how come sometimes the medications work for both fatigue and pain, other times it seems that they only work for pain or only work for fatigue. Does that make sense of the question?
[00:50:32] Dr Maggie:
Yeah. Fatigue is something that a lot of autoimmune disease patients complain about. It’s a very blurry area because sometimes it could be fatigue from the chronic pain or chronic disability or deconditioning of the muscles and the joints. Sometimes it is from the disease itself, like uncontrolled activity, the uncontrolled inflammation. That’s why it’s important to get blood work done before, see if your inflammation markers are high. Is your disease activity not controlled? And maybe you need a higher dose. Are you having a flare that’s causing the fatigue? You might need like a steroid or something transient to help you with that. There are medications now, hepcidin, IL-6. Other factors are contributing to fatigue as well. So, there are biologic therapies that do target these chemicals or cytokines specifically. And then, patients do report some improvement in fatigue.
And sometimes it could just be from like anemia. Like we do know a lot of these diseases have anemia of chronic disease. So, again, sometimes patients don’t realize that. Because of their anemia, they’re having this fatigue. So, there is a lot of ideology from it. Most of the time it’s probably from uncontrolled disease activity. And that’s why you do need to increase your medications as much as sometimes you don’t want to. But it’s really, there are objective measures that the physician is focusing on, including inflammation markers, but also your clinical symptoms as well.
[00:52:03] Cheryl:
That makes a lot of sense. I just, yeah, I think that fatigue is also a difficult word to understand ’cause it could connote physical fatigue. Like, I mentally have energy to do stuff and I just can’t physically get myself out of bed. Versus the mental fatigue where it’s more like the kind of could be more the psychological kind of fatigue where you’re like, you’re depressed, but physically you could, if you got the motivation, you could get yourself up and do stuff. Or there’s that double whammy when you have both physical and mental fatigue. I can definitely feel one and not the other at times. And it could also be, of course, the great confounding variable of sleep.
[00:52:48] Dr Maggie:
Of course. Sleep is big. Sleep is definitely, sleep deprivation is big in arthritis. Patients obviously from chronic pain, if they’re having fibromyalgia, it’s like their, the tender points may really be obstacles to comfortable sleeping. So, again, having a healthy lifestyle does help. I know sometimes it’s hard for arthritis patients to focus on that. And it really isn’t just all about medication. It is really about eating a healthy eating regimen. Having incorporation of like fruits and vegetables, omega threes, different vitamins that help with the immune system. They are important. Really getting some exercise, and I’m not talking about, running a half marathon, although there are patients who can, but even walking like 20-minutes a day gets your heart pumping, oxygen flowing, your joints moving. All of these do play a role. And then, again, really instituting an adequate sleep regimen, turning off your electronics, again, exercise helps with this as well. Doing some meditation; doing some yoga. It really is not just a one-step, one-factor solution. It really is the whole package.
[00:54:10] Cheryl:
Yeah, I totally have experienced that. At first I felt oh, yeah, this is just the analogy I use, like, an ear infection where you just take the medicine and then it goes away. That’s how I thought it was at first, you know. But yeah, through time I realized, oh, wait, no, this is, yeah, this is something, but you’re — it’s, again, it’s empowering, but it’s also a little bit overwhelming to know that you do have a lot of choices in your daily life, in your lifestyle to influence the disease. And like you mentioned earlier, journaling and tracking can be such a powerful thing. It does take a certain level of like literacy and ability to sustain attention to it and follow through. But it can be really empowering to start realizing those correlations.
Like, oh, yeah, like, for me, I know my circadian rhythm is pretty predictable, that I feel great in the morning, and I definitely get a huge dip in energy in the mid-afternoon. And then, I feel better in the evening until I go to sleep. So, it’s like you can use that pattern to your advantage. I’m not gonna schedule the most important thing of my day at 3:00 PM which is when my brain wants to go take a siesta. So, knowing that, and the same with foods. Like, for me, I haven’t found any particular foods which correlate to my joint symptoms. But there’s so many patients who do, they’d be like, oh, my gosh, I ate a tomato and all of a sudden I’m having a huge amount of stiffness. And I went gluten-free and it didn’t have any effect directly on my joints that I could tell. But it had a huge effect on my digestion. Like, my digestion motility was so much better after I went gluten-free. That I just, my overall sense of like robustness and like comfort in my body was a lot better. I wasn’t constantly bloated anymore.
And there’s just so many things you can do to influence your health, your physical and mental health. So, it’s, yeah. Oh, my gosh. So much to talk about. Just a couple more things before we wrap up. In general, back to the patient-physician relationship, do you have any tips for patients to really have a good relationship with their provider? And we already talked about this a little bit, but was there anything else you wanted to share?
[00:56:20] Dr Maggie:
Yeah, just be open. Communicative, obviously. Please be honest about whatever you’re doing, the physician is not there to judge you. So, we’ve heard it all. I think patients forget that we’ve been doing this for a while. We have literally heard it all. So, no one’s judging you.
[00:56:40] Cheryl:
That’s such a good point.
[00:56:42] Dr Maggie:
Like, also, if you are not vibing or getting along with your physician for whatever reason, it is a relationship. And if you don’t feel that either he or she’s not listening to you or maybe you and she are not connecting, she or he, like, you honestly could always seek a second opinion because it’s like a relationship and sometimes personalities just don’t match. Or sometimes you may be looking for more alternative pathway versus a medical pathway. It really is what the patient wants. But just recognize too, like not all physicians are cut from the same cloth as well. So, if you find that you’re not having the best experience, it’s okay to go to another physician. I know so many patients who have stayed with physicians that they don’t really care for just because they were rheumatologists and there are other people that you can see. And especially now with virtual visits, it may not be the best thing to do initially when you’re meeting someone, again, if you can’t get to them all the time, there are those options now.
So, I would just say, again, be also cognizant, as we talked about, that the physician cannot be in the office meeting with you for 30 or 40 minutes, or if you’re late too. We get that a lot, that it’s not that the physician does not wanna see you, but it also cuts into time for the next person. And as I can speak for myself, I wanna be cognizant of the next person. So, I’m always thinking too about like, how would I wanna treat you? How would I wanna treat the next person? And if you’re running like 20- or 30-minutes late, it’s just not enough time. So, a rescheduled visit doesn’t mean that the physician’s upset with you, doesn’t like you. It’s just like that’s the way it has to be so that everyone has a fair chance or access to the physician.
And again, it’s a process. And it’s a journey. Not all answers are answered at each visit and not, you know, the physician may not know sometimes where to go next. So, again, a second opinion is always welcome. Or you just speak to your physician. If there is some kind of lack of communication, just speak to the physician because maybe the physician’s having a bad day. Maybe there was something that happened in that person’s life too and just had an off day. So, just be conscious that we’re all human beings, and physicians should definitely take into account that the patients are struggling and they’re in pain and it’s their job to help them. And also too, it’s the patient’s job to also recognize that the physician is there to help you. And that listening to some advice following, like, medication adherence is important as long as that’s been discussed. It’s, we all have our part to play.
[00:59:41] Cheryl:
That makes a lot of sense. And really, yeah, understanding each person is a human being, like you said, is so important. And I know that when people are — it’s a really emotional experience to be a patient and to feel vulnerable and to feel like your life has just been changed. I, one of the patients that called in, I did an episode that was all about advice for newly diagnosed patients. They used the analogy that getting diagnosed with RA for them felt like having a grenade thrown in their life. Just like a big explosion, and recognizing that, you know, maybe if you’re in that emotional state, you might end up taking it out some of the frustration or the fear out on your doctor, or you might want, your brain might want to do that and to try to remember that this is the person that’s there to help you. The messenger kind of thing.
I’ve seen that before with people at the front desk too. It’s like a psychology study in the waiting room sometimes, but seeing people yell at the person at the front desk because there can’t be an appointment earlier. It’s like they can’t, they don’t, they’re not God, they can’t like make more time in the day. Like, I mean, again, I always — I’m always, like, one of my best friend’s moms used to say this when we were a teenager. She’s like, “I understand, but I don’t approve.” That was like a distinction. You’re like, I understand feeling upset. I don’t approve of taking it out on the messenger, you know? So, yeah. Is there anything else you wanna share? You have a platform to share any message about rheumatology or life?
[01:01:25] Dr Maggie:
No, just I’m grateful to be part of the rheumatologist community. To be a Black female rheumatologist is a very, very, very small percentage. I think it’s like less than 1%. Being a physician in general is like 2%. So, we’re, again, a very small population, but I am happy to be there to, again, be there for my patients, let other female physicians know that I’m there as a resource and they can do it too. And just, like, to all arthritis patients. So, obviously I am, a champion of minority health and female health. We’re here to take care of everyone. And my belief is like everyone should have the same access to care and same opportunity. So, it’s not just about just focusing on one group. Some groups need more help than others, and that’s just a fact. And I’m here to help the groups, but I am here to help everyone and also educate people about arthritis and autoimmune diseases. And the other complications, again, like heart disease. Things that are not really talked about often that are true, trye problems associated with this disease.
And also, that arthritis patients can lead a healthy life. It may take some time, but be persistent, be consistent as well. And just communicate with your physicians. Find support among people in the arthritis community like you who are doing so much to help patients. ‘Cause it is different. As much as I wanna help patients, it is different coming from a physician perspective. And I do have people who are close to me who do have arthritis and inflammatory disorders, and it is very different seeing them as their friends or loved ones versus being a physician. So, I get it and I understand and I see them struggle and they’re in pain. And it’s very humbling when I can’t help them. So, I understand like pain really does affect every cornerstone of your life, and I as a physician will do my best to help that. I can’t guarantee I’m always gonna have the answers, I’m here to, again, just educate people and just again, even if it’s just putting them in the right direction, sometimes that’s all that’s needed. So, people can leave healthy lives. Having arthritis or autoimmune disease is not a death sentence. It just takes some time, like you said, some work, some engagement and like hope.
[01:04:05] Cheryl:
Absolutely. I feel like I refer to this philosophy every episode, but the Acceptance and Commitment Therapy approach is what I learned when I went to therapy with a psychologist and a psychiatrist. And it’s like about saying, it’s not about eliminating all pain and suffering from your life ’cause that’s inevitable, whether you have arthritis or not. There’s gonna be some sort of suffering. There’s gonna be pain, whether it’s physical or psychological or both. And so, learning how to face those things head on and not say, “I have to resolve all these issues before I lead a life that I love,” or so, yeah, that just really, really resonates with me. I think for what you were saying is the physician doesn’t always have the answer to make the pain go away, but just the empathy that you can provide, at least in that orientation of I’m here to support you, versus I’m here to dismiss you, is such a huge gift that you can give to somebody who might have been dismissed or felt dismissed previously by other professionals, whether they intended to or not. So, I’m so grateful to have you on the podcast and I know I’m gonna put all the links in the show notes, but I wanna give you a chance to say it out loud in case there’s like maybe some auditory learners who are like, ah, I don’t wanna look for the show notes. Where do people find you?
[01:05:22] Dr Maggie:
I know there’s a lot of information out there, I get it with the reading, but you can find me on Instagram at Dr. Maggie Cadet. C-A-D-E-T spelled like cadet, but pronounced kah-dei. I am always on there educating people about different types of arthritis and just being a physician and parent. So, it’s a multi — and fitness too.
[01:05:42] Cheryl:
Yes. So, much. I love your posts.
[01:05:44] Dr Maggie:
It just, it’s a lot. It’s a lot, but I do love it. And also, I have a website, www.maggiecadetmd.com, where if you have the time, there are longer blogs. There’s more information about the individual arthritis conditions and autoimmune conditions. So, the Instagram is just a snapshot. And then, if you really wanna know more, then just go to my website and I’ll be doing work with the Arthritis Foundation and Lupus Research Alliance and just doing some, you know, just keep going.
[01:06:20] Cheryl:
Yeah. I really appreciate taking your time outta your busy schedule ’cause you’re being interviewed by lots of different places I know and you’re keeping up on your arthritis awareness and other autoimmune disease awareness on your social media. So, I really appreciate it. And yeah, I look forward to hearing people’s, responses and comments after putting, making this live. So, thanks again.
[01:06:47] Dr Maggie:
You can DM me or again, tell me if there’s something that you want to hear and I will do my best to do it. Just gimme a few days.
[01:06:56] Cheryl:
Oh, yeah. I don’t even know how you manage your inbox. It’s a full — you need an assistant. Put your daughter the work. No, I’m just kidding.
[01:07:05] Dr Maggie:
I know, I know. She’s not ready. She does — She holds the phone.
[01:07:09] Cheryl:
Oh, she does? I was gonna say, who takes your pictures? They’re so good. It’s your daughter?
[01:07:12] Dr Maggie:
Yeah.
[01:07:14] Cheryl:
She’s incredible. Okay, I’m gonna stop, I’m gonna stop the recording and then we can keep talking.
