Denise 0:07
Myth, Magic, Medicine and everything in between. two doctors talking.
Hello, welcome to Myth, Magic, Medicine. I'm Denise Bellen-Mejia, a retired doctor now hypnotist and coach. My guest today is a personal friend, Dr. Judith Glasser, who is a DO, board certified in Physical Medicine & Rehabilitation, and a certified Medical Acupuncturist. After 13 years in clinical practice, Judith very recently transitioned to a non-clinical role in healthcare, and has agreed to chat with me about part of that journey.
So much due to for joining me today. It's so lovely to see I haven't spoken to you for quite a while. So can you tell me a little bit about your background? I think your dad was a doctor.
Judith 0:56
Yes. And thank you so much for having me. It is great to catch up. I know we talk on on chat. But it's nice to have the real live view of you.
Denise 1:09
A voice, yeah, i not just words.
Judith 1:12
So my Dad, he was actually my inspiration to become a doctor. He's one of the dinosaurs in medicine, and he just retired. He's a internist and cardiologist by training. And he did a lot of, you know, primary care, too. And he, he loves taking care of people he felt, you know, taking care of them and their families, it was a real honor for him. We live close, very close to where he worked. So it wasn't a challenge for him commuting, and he had flexibility because he worked for himself. But he definitely worked very hard, but it was rewarding. And I saw that growing up, I, he wasn't a doctor that said, 'Oh, don't go into medicine.' but I do have to say when we were when I was in med school, like once or twice when I called him feeling like overwhelmed before, like an exam, maybe it was like step 1 or something. I called him and he's like, and I was like, it's so much information and he said, "Yeah, it is like it's a lot." Maybe the first time that I heard anything like negative about medicine from him, but he really rode the wave with how healthcare changed. He never wanted to hire, you know, a mid level, Pa, very traditional, which was good, but then I think it was difficult to maintain when you get older, but he was 76 and I'm glad he finally just retired, in December, and now he's doing some non-clinical, you know, part-time work. And,
Denise 3:03
Of course, he couldn't really retire but ..
Judith 3:07
Yeah. But you know what? He likes working I think when you're I think this day and age people don't have like, people don't necessarily fully retire and when you're a professional, you do have options and doing some work, you know? So for him he likes it. It's like a new way of, he's told me about you know, a couple of cases just he finds it interesting. He's never been on that the non clinical side of medicine. So
Denise 3:37
Is he doing the reviews for cardiologists, opposite general medicine or anything that crosses his desk?
Judith 3:45
I think it's mostly radiology, cardiology, like interventional. Maybe that and like all the new like, cardiac MRIs, maybe also chest imaging. He was lucky the person before him was they were the cardiologist was retiring. So they were looking for a cardiologist. Okay, so he's now set up with the two monitors and all tech getting tech savvy
Denise 4:13
to work from home. It's wonderful, isn't it that you can work from home? Well,a mixed blessing you've got kids so how do you feel about working from home with children
Judith 4:23
so my son is is is respectful he's but used to be so before my daughter came in she she's learning she's learning she she but my but there's definitely a big maturity difference between four and six year olds hope Yeah. But I was I've been prepping them for it. And they actually were excited about me working from home because I used to go to like multiple places and no one knew where I was at a given time. Like my husband, he'd be like, where are you now? I get confused too. But so they're kind of, and some days when I was still doing that, they'd be like, where are you working today? You know, like, no one could keep track of it. But now, they know I'm working from home and I think they just, you know, like knowing where I am.
Denise 5:13
Now get used to it, we kind of skipped a step. So, you you grew up in a medical household, so you knew what you're getting into sort of you chose, is your father an MD or do as well?
Judith 5:26
He's an MD,
Denise 5:27
Was there a conscious decision not to become an MD because obviously you went to physical medicine. It was that was there a pull towards DO for you?
Judith 5:36
I, at the time, I was applying all over and I that's where I got in New York College of Osteopathic Medicine and NYCOM and it was local, because I didn't live at home though, because even though it was relatively local, there was always a lot of traffic so... I lived near school. But I did one of my Dad's partners at the time was a DO and I thought it was interesting. I had originally wanted to, I thought I was going to go into primary care. And when I did a rotation in physical medicine and rehab, I was fascinated by neuroplasticity. There was a relatively young patient in her 50s I'm pretty sure, like early 50s, I don't think older than 55, but she had a cardiac procedure like a valve replacement, and during the procedure ended up having a massive stroke with you know, pretty significant hemiparesis she wasn't walking when she came on the rehab unit and over time, and back then 13 years ago people were able to stay in acute rehab a little longer. So
Denise 6:51
Not like it was back 40 years ago, you could stay forever but
Judith 6:57
Yeah, that was the story you could stay nine months 12 months till you renovate your home but I came in when they were starting to cut things but I just I still have the image of in my head of her walking after you know recovering and walking and I was it was a hemiparetic gait but she was walking with the quad cane you know her arm you could tell she was had hemiparesis but you know, I was just wow.
Denise 7:24
She had her life back...
Judith 7:24
She could you know she had to adapt you know we use adaptive equipment or but I'm pretty sure she was on her way to being you know, we'll be in rehab medicine modified independent using equipment or you know, walk relating with the cane or you know, and and then also the musculoskeletal aspect. I was always interested in muscles, and how the body moves. I was a former lifeguard and swim instructor so I thought it brought everything together. I ended up for my first job, primarily doing neuro outpatient neuro rehab, and I managed a lot of people with strokes and the long management of chronic management, strokes and brain injury. I ended up doing spinal cord injury too, because when I started the hospital job, you know, they were a lot of people had left. Even though I wasn't fellowship trained, I, you know, just had a residency I did learn a lot on the job, and which was good because when it came to oral boards, I really did not need to study because I saw everything. You know, I was doing EMGs and we had an interesting post-polio clinic. I got to present internationally at an international post-polio. People say oh, there's still polio.
Denise 7:31
Yes, there is still polio,
Judith 8:09
And I was living in Washington, DC, which is very international city. So you would get a lot of people who, you know, international immigrants and, and young mothers. Mothers, they, you know, they had polio when they were like five, six in India or Pakistan. And then they 25-30 years later, they're, you know, their moms, and they're struggling because they're also experiencing post polio syndrome.
Denise 9:32
Right. That's another part of it, that surprises people. That's one of the great advantages, I think training in New York because everybody, there's this. Every single country is represented in your patient population.
Judith 9:46
Oh, yeah.
Where I where I feel my training was really very inclusive of that. Like I had the private hospital, I had the city hospital, and the VA system. So I, we saw, you know
Denise 10:04
So you had traumatic stuff too?
Judith 10:08
I trained at Bellevue. And I remember at the time, there was like, a massive, like, crane accident in New York City. Oh, you remember that? Yeah. We met, you know, major trauma. It was a trauma level three, whatever, Trauma Center. We saw all the, the, the, the rehab, the patients. And then also seeing, I also was interested, or I guess it was nice, the experience of vets coming back and young vets or older vets in, with brain injuries. I mean, just having that aspect and avenues. So it was kind of very all inclusive.
Denise 10:57
So you really obviously loved that aspect of your work. What made you move towards thinking about having a private practice, which presumably wouldn't give you quite that mix? So let's do that bit first. What made you think, no, I want to be my own boss, and, and deal with all the business aspects as well as the medical aspects.
Judith 11:24
So it wasn't so much of a conscious decision. Like, like it was, it was more it flowed into that. I saw I was living in Washington, DC for two and a half years. And then I really missed my family. And I missed New York, if you've ever lived in Washington, DC, it like clears out on the weekends, and especially holiday weekends. And it was like a ghost town. And I just found myself always going back to New York.
Denise 11:54
Thankfully, not so far.
Judith 11:56
Right, it wasn't so far. But it but after what, you know, I was I was single at the time. And it was easy to go back and forth relatively except that, you know, with an employee job if you didn't have that you couldn't always go back when you wanted to. But I, I look, I didn't. I was a little bit. I guess lazy for lack of a better word, looking for a job. I thought oh, maybe I'll try to private private, I'll try something else. So I ended up taking a job doing inpatient subacute. And then also part time for an orthopedist. And after about a year, I was like, they just it was less than a year that I discovered it but I was made my exit plan. They they changed their tune with money and how much they're paying me and it it's a long story. And then I was like, I can't you know, I want to I need I can't do this. I mean,
Denise 13:03
a little autonomy would be good.
Judith 13:06
Yes, so I ended up thinking about starting my an office. And at the same time, one of the subacute places I was going to ask me to stay independently. And that was really amazing. And I was there 10 years. And they grew a lot. I mean, I was the only physiatrist managing. Firstly, they opened up their new building, it was 50 beds of subacute rehab, gorgeous single rooms, which was amazing during COVID When everyone had to quarantine like coming in for and then then they also had kept some of their old unit for patients that needed more support some older patient more the older patients with dementia or more impaired and so I have one point before COVID I was managing 80 beds of subacute rehab all by myself. Yeah, I mean, as a consultant, I wasn't the primary
Denise 14:02
and it was sub acute.
Judith 14:07
Right, you're more medically stable, but as some as a physiatrist. I was seeing people more often than the primary like I picked up on sometimes acute myopathy, acute gout, DVTs, you know, and just also I loved just collaborating communicating with the, the physical therapist, they would always come to me for my input on someone who like wasn't progressing and I'd pick up orthostatic hypotension or, you know, especially the Parkinson's patients like get some of these orthostatic or what autonomic issues so it was very it was it was really interesting, and I did see a lot a lot of them. It was It was a variety of interesting, it wasn't. It wasn't the same. And then a few years, and so I did a little office work. So a little office work there. And then because of COVID, it was put on hold. And then got back into it recently. And I also a few years ago started doing utilization review. I forgot how I got into it. I don't know if a friend told me about it, but I was, I had gotten in before COVID, like in 2019. So I'm lucky. Luckily, when the census was very low, I was able to pick up on that more. And then things changed for me a couple years ago, more it was more than a couple of years ago. It was it's a long story, but I know
Denise 15:54
a lot of things - you got married, you have kids, there's a lot of things that go into being a doctor. But there's also risking your life going on.
Judith 16:03
Right? There's a lot and I you know, I ended up having some health issues not not terminal, thank God, you know, but like, that affects my lifestyle and affects the demands of being a physician. I was diagnosed with an autoimmune condition, and it took a long time to get a diagnosis. Of course,
Denise 16:27
... the story of autoimmune disease, it takes forever.
Judith 16:32
Yeah and then, luckily, I knew I had the diagnosis before COVID But I was waiting to see a rheumatologist. So it got delayed and the treatment got delayed because of COVID. But I was doing I was doing okay. And and still doing what I was doing practicing clinically and wanting to do more clinical work because I I felt inspired that least what I experienced, I get a lot of pain, unfortunately. And I was learning to manage it with non pharmacologic interventions, and oh, I also got certified in acupuncture in 2013 We could talk about that another time. But
Denise 17:18
oh, yeah, I'd love to talk about that.
Judith 17:25
So I that's, you know, I was I was directing my own care and felt because
Denise 17:32
I do yes, of course, because that's really a great idea. We were encourage that with paatients
Judith 17:37
I mean, I wasn't planning I was kind of like or what I really mean to say is coordinating my care okay. That's what I meant to say that's what I meant to say but a lot of someone I don't know if was you as someone else mentioned it there's outpatient oh no someone else another doctor I connected with who also is unfortunately going through health issues. She is struggling in going from doctor to doctor to get answers and there's a lot of disconnect in the outpatient setting in patients. And so I was I was a my coordinator and I was doing well for a while but I think what was lacking was that you know, you have you know, I have this condition I was it I don't you know, as doctors and specialists, we don't know everything about every condition. Of course, you know, I really didn't know what the future held or like what's my limitations and is my
Denise 18:38
course of anybody's disease to can change
Judith 18:41
Right and autoimmune you never know when you're gonna get a flare. And then when you're you're running around or on your feet it you just don't know and I started unfortunately, experiencing a significant flares, like months back, and I just, I didn't know till like may because my rheumatologist left the practice and they're trying to do rheumatologist and then fine and I was having a foot issue from not really realizing that it was part of what condition and now everything the last few months everything's coming together and I accepted the fact that like, the type of work I was doing was kind of a disconnect for a mismatch now that disconnect a mismatch for for me nd my body and my health, unfortunately and it was it was a hard decision but I so I just moved into full time utilization review. And I do use I'm using my medical background and as a physiatrist there's a lot of interesting work out there and I just started so I can't tell you too much but my but my day to day is controlled, I'm able to take breaks and stretch and I've been good about just trying to move in the morning. And
Denise 20:13
and presumably it's a more 9-5 kind of schedule, which will also enable you to plan things like doctor's visits and getting to exercise.
Judith 20:28
Exactly. And not also I was always
Denise 20:33
and eat properly,
Judith 20:37
Right. And also, like, I think part of what a lot of autoimmune you have fatigue. So just having like, not having to pack myself up in the morning or, you know, pack my food up and a lot of things like that. It it's only been a week, full time. But no, I have my standing desk, I could take breaks when I need to and you know, a lot of things I'm still figuring it out. I spoke to another reviewer yesterday she has a treadmill desk. I don't I don't think I can do a treadmill desk yet I've with my foot but I do have I already had a standing desk and I have it and you would I don't know if you've ever looked on Amazon of all the different ergonomic gadgets you can get.
Denise 21:22
I have. Yes. I'm still looking for a chair that really works.
Judith 21:29
I'm also I'm in the market, I want to get a chair with a headrest, because yes, promote more like you're not going to be like resting your head back. But it's more of a posture reminder, because I tend to keep my head forward and that's not good. But also been looking for like foot rests. I have a mat, an ergonomic like a mat I stand on when I stand
Denise 21:54
You're doing utilization review really using your PMR background, or are you saying is everything that comes across your desk?
Judith 22:02
I was hired for for specifically PM&R, physiatry. But it but there's there's
Denise 22:10
this is utilization review. This is not? "No, you can't do that test if you haven't done this test first", you know, prior authorization.
Judith 22:17
Right, right. Well, it's the same it's sort of similar. It overlaps because a lot of the some of the PM&R equipment, things like that are very expensive. But you also have, there's a, there's a big mix of who's requesting it, there could be a lot of NPs or PAs, they don't know what they're requesting. Yeah. There's a lot of fancy gadgets out there that are not necessarily,not necessarily what you need to function. There's a big market out there. There's also it's actually it's doing it already as a contractor for other companies. But now this is on like a whole other level because I'm going to be, like, doing it all day. But like,
Denise 23:10
yeah, I would imagine it's somewhat like pharmaceuticals too, it's sort of advertised to the public, which is not really a great idea. There's only two countries that allow pharmaceutical advertising, there's us and for some strange reason, New Zealand. Which means that people come with a pre preconception that this pill work for you, I assume it's the same thing for robotic arms or whatever you are being asked to provide, that costs a ton of money.
Judith 23:34
Or you should have Oh, like that. There's actually something I don't think I knew about this and residency, there are people called like a, like technology specialist like the stands for ATP I'm blanking on, but they're not physical or occupational therapists. So there's rules with some of these equipments that you need to be evaluated by a PT or OT to get the right thing, but even even then, like, there's these they're durable medical equipment companies that you know, their profit, they're there for profit, they order they want to order, you know, there's a there's a lot of that, unfortunately, and it's not really about cutting dollars or trying to increase the company's revenue. It's really about getting people what they need in the right thing for what they need.
Denise 24:25
Are you able in your job to say, that seems like a funny thing to be asking for? Have you looked at this? Or are you able to interact with the person who's making the making the request?
Judith 24:40
Yeah, I think they're peer to peers. Because there's a there's a process if if something's denied before, you know, before it gets to appeals, but I'm not I know for other companies, some you can't. You can't say you should look at this. You can say They like, you don't meet necessity for that level wheelchair part, but you would meet for a lower level, right? That kind of thing. You know, so for, you know, based on their their physical functioning. So I'm still I'm still learning at least for this, you know the I'm in the learning phase of this company,
Denise 25:20
Can you tell yet whether this is something you're going to grow? Are you happy, like continuing at that level? Or do you think there's, there's a sort of career path? Or are you tapped out "I'm making money, I have kids, I've got enough on my plate. Thank you."
Judith 25:41
You know, I'm not, I'm not sure how the career path goes. But I do know, so far, a lot of the doctors that I've met, and they vary in the stage of their career, whether they're, like me, maybe a little bit only, like 13 years clinical experience some are, you know,
Denise 25:58
Like your dad having, you know, a complete career, and they move into it, right?
Judith 26:02
Right, Well there are people, more maybe like 50 or 55. And some of them have, you know, climbed up or more manager positions? I'm not sure. I'm not I'm not sure yet. Where this would take me, but I did find out that I do get some CME reimbursement. And if it if it's, you know, maybe has to do with what I'm doing. So that would be interesting. If there's any kind of course, you know, I there are people on my team that have MBAs. I don't think I'm ready to like, go back to school, even I'm not, I'm not up for that right now. But there, I think there are other kinds of you know, whether it's maybe like, a public health degree, some, you know, it's interesting, because there's also opportunity to work on the policy. There are a lot of policies and they vary from state to state. I'm learning that there's, you know, a lot of it is government, there's government policies, there's state, federal state, and then just your local policy. So I'm learning all that.
Denise 27:08
And there's innovation all the time that you'll have to adjust for
Judith 27:11
that too. So then people request new things. And it's like, you know,
Denise 27:15
we don't have a track record on this yet. So we don't know
Judith 27:19
exactly.
Denise 27:21
It's exciting. I'm really happy that you, you look excited about this. I know it's only a week.
Judith 27:31
It's a week, but I finally woke up for my early morning walk without snoozing. So I'm getting int, I'm trying to find my routine, which I'm my body. I do have to say my body does feel better this week, not running around, and I didn't start my car all week.
Denise 27:54
Petrol prices are coming down, but still, really nice.
Judith 27:59
I know, I mean, we were thinking maybe can we get away with one car? But kids, with kids, you go into different directions?
Denise 28:12
Yeah, we're doing two kids, you'll probably find several directions, but it's great that you're going to be able to control your illness better, because it'll be just be such so much easier to manage. And yet, you're still using your degree, you're still able to, and I assume you have to maintain your license and all the rest of it. They're giving you CME, they must expect you to maintain...
Judith 28:36
I have to maintain my license and board certification or that I do want to send that note, I know, you know, I made this decision. I actually have a friend who also had a friend that I met through doing my contract UR, I think I spoke to her because she has a health condition. And, you know, it's a hard it's a hard decision to to I don't know what the future holds. I may go back, maybe I'll be able to go back when things are more under control. I don't know. But, you know, there are a lot of physicians that you know, have certain health conditions, whether you know, chronic or acute. And I think it's important to know that it's okay, that if you have to change gears to take care of yourself. We're always taking care of other people and pushing it that was my problem that I always push myself that I could get through this and I'll move on and it'll give
Denise 29:35
Really that's an unfortunate part of " I've got it. If I do this, I'll be in medical school."You know "If I do this. I'll be in residency". It's always it's just a life of delayed gratification for so long that you know don't know how to prioritize things other than "just do it".
Judith 29:54
Yeah, and I was for four years. I just kept going to doctor to doctor and I just had it in my head that I'm going to get get better
Denise 30:02
FOUR years to get the diagnosis?
Judith 30:04
Actually, it was like, so it was really like two and a half of really... and then I finally got the diagnosis, but I wasn't, was it two? I'm saying now it's been for four and a half years that I was really struggling I had it I got worse after my daughter was born four and a half years, which a lot of autoimmune things come out. But I had signs and symptoms signs of it earlier, but no one, it was hard to put the pieces together, then finally, it just got so bad, you can't move around. Um, so yeah, I think I think the message should be that it's, it's okay to what you said prioritize yourself. And
Denise 30:47
yeah, I mean, it can truly if you're, none of us want to practice substandard health care for anyone. And if you're not taking care of yourself, you cannot be performing at your best. So it's way better to find something where you struggle to really serve your patients just in a different way. Yeah. Just a little plug for hypnosis. Like, that's my pivot. They think that hypnosis is great. It doesn't cure cancer, but it's really helpful if you have cancer and you're going through that.
Judith 31:17
Yeah, I'm gonna I'm gonna make an appointment with you. So when we get to I am I do believe in like the mind body, especially with managing pain and mind body connection. There is a lot of, as you know, you know, evidence based I think the next time we speak will be you'll you'll be hypnotizing me if you want you could do it on Zoom.
Denise 31:42
Well, I actually I don't I I am happy to hypnotize people on so that's that's where I see all my almost all my clients. But I don't ever air those things because I don't want people to be driving their car listening to an induction. Not really safe. And I also don't I don't see people without without medical involvement. It's like I don't I don't think of it like a party piece. That's my, I'm not sure if I'm going to cut this out or not because I don't want to offend my fellow hypnotists. I'm amazed at this the the speed with which some of this so skillful, but it really bothers me that it perpetuates the idea that it's a it's a trick that it's it's just for entertainment. I thought that your interest in acupuncture grew out of your illness. But you'd actually been interested in that before.
Judith 32:37
Yes. You know, I had a good friend in residency. She's a year ahead of me. She she was getting certified during residency. So I sort of like, was interested and my program director was certified but we didn't do we didn't weren't exposed to a lot of it unless you were really but I really think any a lot of physiatrists who manage pain should also be certified in acupuncture. It's just it's great modality but I think after I started residency after I started my first job, I remember going to PT for my knee and I had a hard time doing therapy because of pain, but there was like taking Motrin or Tylenol just didn't do it and a friend there was like, oh, go to my acupuncturist. I think that's what usually happens. Go to my acupuncturist. So I started going like, wow, like, it's amazing. And then when I left my first job, and I was single, so I had time I took the Helms Medical Institute course and I loved it and I did it at the facility and I did it outpatient and a lot of insurances cover it now. Actually, so Medicare started covering it for back pain, and they actually reimburse nicely. So I think maybe one day I would go back maybe only do Acc, like it really depends. I think when you do for me at least doing too many things, but I do still really love acupuncture and I'm trying to find someone again, like closer to me so I could go I did find a practice in the evening, but I yeah became I was interested before my diagnosis, but I really when I was after I was diagnosed, I start I like well once I was once the world was allowing doctor visits after COVID
Denise 34:42
After COVID?? No, we're not done yet. We're not done.
Judith 34:45
We're not done but the fall of 2020 I started going like eight nine months but my if your insurance doesn't cover it, it could it could get expensive but it's not something that you need to go to every single week. Definitely like it If you're going through an acute thing, you can go once a week, but then chronic, you could just go every three to four weeks. It's, it's really amazing what it does. It's really amazing.
Denise 35:11
Not something you could practice on yourself. I mean, it really is needles in your back would be harm, but are you able to use some of the techniques on yourself since you are trained?
Judith 35:23
So I do self acupuncture. That's, that's one of the things you do on the course, they want you to know what it's like to like, needle yourself. But there are a lot of good points on the leg. And from time to time, I'll treat myself I actually before during COVID When I was just like, couldn't get out and see anyone. I was doing some acupuncture on myself. But they're, you know, even on the hand, you know, like this point between your points. Yeah. Yeah. That's a very powerful point. So I actually also my friend that I mentored from, she also, she'll try to like treat herself, it's hard to treat you it's hard to treat your neck, you can't treat your neck. But there's points on the legs that are just general muscle relaxation, which is actually really good for me. I wish I had more time for that
Denise 36:14
yeah, me too, I also wish we had more time to talk. But I am going to say goodbye to you now, please. Let's have another meeting. Because I would love to talk more about acupuncture. I think it's really important to get the word out. Some people have not woo-woo, this is complementary. Nobody's saying throw away Western medicine. Let's just go with the woowoo stuff. It's we should use everything that's available to us
I would love to talk more about that. But it was so nice. And you soon.
Okay, bye.
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