Hello again and Welcome to Myth, Magic, Medicine with me, Denise Billen-Mejia, and today my guest is Case Troutman, who is a family medicine doctor and comes from the Philippines. She's going to tell us all about herself and her journey here. Hi Case. Thank you so much for joining us.
Oh, hi, Denise. Thanks for having me over. So I am Case Troutman, I'm currently a family medicine physician practicing obesity medicine full time. I came from Manila, Philippines. It's in SouthEast Asia. It's, I think, 7100 Islands, is how we are tag-lined typically. Lots of beaches and stuff. And I came here to the United States for my residency. 18 years? 19 years? I've stopped counting.
How long was medical school in the Philippines?
So, we have a four-year college degree and a three-year medical school with one-year internship.
Pretty much follows the American system. So, you you got through eight years of schooling there. Did you practice at all in the Philippines before you came to the US?
I did for like maybe 6 to 12 months? I've got to say when I graduated, my internship/medical school, in fact, in its entirety, I pretty much had my thoughts set in coming over to the United States. So I did some stints here and there while I was doing my Step 1.
Get through all this, all the hoops you have to jump through. Yeah. Where did you come to do the CS portion, when you still had to physically fly into the US to take that
I did. I went, I did it in Michigan if I remember correctly, I have an uncle who lives in Michigan. I have an aunt and uncle that lives in Michigan. And no, wait. I think I did it in Chicago, in Chicago. I remember I stayed in Michigan because that's where my uncle lives. And I went to Chicago and
they've currently I don't believe it's active. I think they stopped it during the pandemic and there's no news that they are bringing it back as far as I know.
I remember, very nerve racking, you know, like doing my, my CS the first step. I mean, obviously, I've been with patients in the Philippines but doing it in and we actually speak English as a mode of the language of instruction and in, in our school, but doing it in a different country and you know, someone I don't know, that was very challenging. I remember that.
But and it's an exam situation is quite different when you're the doctor in the room, as opposed to the examinee in the room. Quite different.
Okay, so you came over, you took your exams, you went back and wait for the results, I assume. And how long was it before you found a residency spot?
What's interesting is I actually applied for this for the Match. Right? And I actually did not match. I actually did, and I'm trying to remember the name after the match, what is that when when you have unfilled...
Scramble! Yes, I did the scramble. Yeah, I did this scramble. And right. At that time, I was staying with my friend in LA, and she got matched to a program in Hershey, Pennsylvania. And so, you know, I gotta say, I remember it was just crushing that you didn't get matched. And I remember like, oh, my gosh, what am I gonna do? So I kind of, and my friend, her name's Margaret, and in that program, I think they had like two slots that were open. So I participated in the Scramble, I sent my CV, along with other places. And I got a phone interview after I sent my CV to that program where my friend is, and that's actually where I got accepted. Good. Yeah. So really fortuitous, for sure. Yeah.
So it was also meant that you had a friend alongside you when you went through the agony of internship. Again, had she had Margaret trained in the Philippines also.
Yes, yeah. Yep. We actually were very good friends. We actually did different medical schools, but we were friends in college, really good friends in college, we went our separate ways. And then you know, we were both in that phase of trying to apply through residency. So that's why we kind of stayed together. You know, for that time while we were waiting for our Match and stuff because I remember like, Oh, do we have a phone line? Do you have a fax machine? I think that was fax machine back then or something like you had to have it handy. So that if you need to, like send your documents over, so yeah, yeah. And that's how I ended up in Pennsylvania.
So it was a three year residency.
Yes, Family Medicine.
Did you practice family medicine when you came out or?
Yep. So I came on I came on with our residency as a J-1 visa. Very common in International Medical grads. So after my J-1, after my residency, I did my J-1 Visa Waiver. And I actually did that in Rhode Island.
Okay. When did you develop an interest in obesity?
So yeah, that's a long story. And I love that story. Actually. So So I did family medicine for so I did three years in Rhode Island came here, because my husband's family is from Pennsylvania. Okay, we met while I was doing a residency in Pennsylvania. So three, and then three there, four 7, 10. So 10 years as a family medicine physician, you know, treating chronic diseases, right? And then it was like five years ago, 2018, when I, actually it really started with my own personal journey, you know, wanting to lose weight myself and looking into all these like data and how what's the best way to lose weight, and my own journey, and from there really dove into the science of obesity medicine, which is still is, you know, a relatively new field, or I should say, being recognized as the field because for too long, for the longest time, we've thought of obesity is just all about willpower. But no, it's a disease much like
So can I ask you, though, did you find where you had you put on weight during internship, or through medical school, was it stress-related for you?
All of the above? So I it was funny, I I remember being chubby as a child, I lost weight before high school, gained weight during college, lost weight during and then then gained weight during medical school, you know, again, nights and chips and then lost weight after medical school. And then, I mean, it was like an up and down.
Like many of us, yeah,
yes. Yeah. Yeah.
So now that you concentrate solely on Obesity Medicine,
Yes. 100%, full-time Obesity Medicine, and I love it.
I really, do you work in a clinic or you have your own practice.
I work in a clinic, I work for a health center.
Okay, sounds like pretty standard medicine. But I will. I mean, it's very similar story to many people, including the Americans here. So what I would really like to explore with you is the differences you found in general life, from the Philippines to the US, but specifically around the the issue of health care and how people feel about. What do you think's the biggest difference for you?
The biggest difference I would say is in the Philippines, we don't really have insurances or health insurance, I should say. So when you're sick and you don't have money, that's it, you know, there's no insurance. So, so, I guess everything is cache, you know, so to speak. Preventative care is not as common. I mean, we would we do have it but it's kind of still cash-based. It's not like a okay, you know, part of your you pay a monthly bill insurance and you get are free.
So it's harder for people to prioritize that because it means taking the money out of something else. Yeah, we're talking about Yeah. Obviously, there are wealthy people in the Philippines, but the bulk of the population
And you know, in residency...so I did medical school three-year medical school and my internship, I actually did it in the premier hospital in the Philippines called the Philippine General Hospital. That is where really, people that have no finances have have nothing, that's where everybody goes. So it's interesting in there, that is where I saw patients that have like the biggest tumors, you know, patients that have the most advanced unfortunately advanced cancer because they didn't have any money to get treatment wherever they were, and they would come to where to where we train because it's free and you get all the best minds, you know, of that of the country. So, you know, I grew up in a middle class kind of category. So I would say growing up, I had you know, my well-child shots, I had my dental appointments, but there wasn't a lot of like, teaching about, you know, screenings and stuff like that.
They weren't teaching and basically medicine.
Oh, for sure not now. Sure, no, yeah.
So what was the biggest thing that struck you when you first came here?
Medical or non medical? Oh, well,
either, by all means, say when you first got off the plane the very first time we visited the US Well, apart from the fact it's large and loud.
Yeah, I'm sorry. I think I think I was just the roads were big. That's what I remembered. The highways was very, like, overwhelmed by that. I mean, actually, I grew up in the city. So you know, I'm used to tall buildings and concrete jungles, but not the wide....
I first came to the US when I was 19. Which is why I can't interview myself because I actually had experienced America for quite some time before I went to medical school. But I came here at 19. And driving back with the family I was with from the airport. I was just stunned by the eight lanes of traffic! It was it was just mind-boggling. But yeah, so what what, what else struck you when you first came?
I mean, you know,
Foods different. Sure.
Yeah, food. I remember seeing lots of cows. So I grew. So I came to Pennsylvania, right, which is Oh, yeah, Pennsylvania, I shouldn't qualify,
right? Yeah, I had to look up Lebanon when I was, because I used to live in Latrobe, which is outside Pittsburgh. So I sort of know, as I'm crossing the state, but I'm not specific. So you're not far from the Amish area. Lancaster area that Yeah, yep.
And Lebanon is definitely surrounded by a lot of
which will be a whole a whole nother discussion of medical care. They don't do insurance, either. They mean they do but they self-insure.
Right. Right. Right. Yeah. So.
So from a from a, from the way your patients view their health, if you can remember back 20 years to when you were practicing in the Philippines, and some things will have changed. What do you think is the biggest difference between attitude to health care between the two countries?
I mean, I guess the one thing that struck me or as I remember it from before, is honestly the deferential treatment, we would get as doctors back home. Like, and maybe it's not this is not answering your question about the care. But I just remembered like, in the Philippines, what you say, as a physician. People trust you and believe it, and I'm sure that's the same way it is here. But I think nowadays I find that patients, you know, tend to look at Google and then look at what you said. And
They look it up to see if you're going to be right. Yeah, right. Now, of course that that 20 years ago here, we didn't get quite as much., and forty years ago we had even less. So you might find things are different.
Maybe I haven't been home. So I don't know. That's true. That's true.
Yeah. Do you think there's as much reliance on lab tests and radiology studies and
Not as much because again, everything is cash-pay back home. So a CAT-scan is gonna cost somebody like a lot of a lot more money than it would probably be here. So I remember as a as a med student, really just seeing and maybe just my exposure is mostly just X rays. I remember some CAT scans, but I would say the more high tech, higher level imaging tests. I definitely just saw it here in the US, you know, I've heard about MRI and you know, stuff like that when I was in med school, but not as much. And again, maybe that's how it is back home now. And it just wasn't
right. Yeah, I think there was there's more tendency to
rely on it. I
think that things are advertised more to the public here than probably anywhere else in the world. So you do get more patients I think coming in with a with an idea of what they what they expect to happen anyway, no matter what the issue is they want it fixed. I think there's less and I think responsibility for their own behavior is changing what's happening but that may be changing in the world.
And I think it's also the demographic right so like I said, When I was when I was working as in medical school, because of my training, I'm the exposure I had was really more to the underserved for, you know, I didn't really see patients that were in the higher demographic, kind of where they probably wouldn't be, you know, have similar kind of point of view. Yeah, maybe so. So again, back then it was just like, so I remember. And again, this is probably off topic, I remember working and we call them wards back then, you know, and when you're when you're in, like, med school, you know, working, you know, long shift, and we didn't the scut-work all the time. But as with any place, right, I remember this. This dad, I was taking care of their child among many children in the pediatric ward. This dad gave me like a small container of spaghetti. And I was so appreciative of it. Even though they don't have much, they will just give you what they have, you know, they probably saw this poor intern, this poor medical student working so long and not having eaten. So I sure I OMG that was like, how many years ago I still have that memory in my my brain? Yeah, yeah.
Did you find that in some pockets of in the US, you'll find people bringing, and I have friends who practiced you know, 2030 years ago in rural America, and people would still try and pay them in chickens. Yeah. So if you were, let's suppose we have a well, I suppose you were transported back to the Philippines? Do you think that you would be able to practice Obesity Medicine, there ? Admittedly possibly with a different demographic?
Well, I mean, obesity is not just in the US. So it's worldwide, right. So it's a epidemic of utmost, you know, crazy proportions.
But do you think is recognized as a separate, as a specialty? No,
I don't think it is yet, as it is, I don't think obesity is recognized as a disease just yet in the Philippines. I think it's still and again, I haven't been home in a while. But
But surely, it's also a multifactorial disease, so many diseases are. What do you as an Obesity Medicine specialist bring to the table you think?
Oh, I mean, I think the best I would say the best thing I can bring to the table to my patients is hope. Hope that, you know, they're not they're not alone. Number one, number two, it is treatable. It is treatable. And I would say what I can give them is just really a path. You know, I think every you know, we have the four pillars of Obesity Medicine, specifically nutrition and physical activity, behavior modification and medication and, and just thinking about just nutrition -doesn't have to be one path. There's so many different ways of approaching nutrition, although we do have that underlying I'd say the important delineation which is it has to be low-calorie, but it doesn't have to be a certain specific diet. So and I would say the best thing about seeing an Obesity Medicine specialist is you can get that done in one visit. You know what I mean? You get those parameters discussed in one visit, as opposed to try to listen to one person one physician or healthcare provider and another healthcare provider said this and how do you kind of merge those two? Sometimes differing data? So you you would be the final say I would be the final say so to speak.
Are you able to practice with fewer time boundaries. Most of the doctors I listened to these days, 'cos I've been retired from medicine for a while, but most complained about the seven minute visits and the half the amount of paperwork Do you get enough time to talk to your patient.
So right now in my practice, in my practice in the health system, we do have a little bit longer appointment times than your regular primary care doctors. So which is a good thing and I don't think it's possible to do what we do in the seven minute appointment. So we do have a longer timeframe or a longer appointment slot for our patients.
Even when they've seen you and they've got their basic treatment, follow up appointments also can take as much time as needed.
Yeah, and because sometimes that's when the problem pops up. Because it's Chronic Disease. Right. So lapses are very common and you know, stuff, right? Yeah. Yeah. So yeah, I think if I, if I compare back home I'm trying to think. I mean, what I hear from my family is it's still relying on gimmicks and you know, pretty much the thing, the same thing that we're exposed to here -
The magic pill idea, for all aspects of medicine, just just fix it now. Boom. With no effort now. What do you most miss about Philippines? I assume even you can go home now and again, and there was there's quite a few places you can buy Filipino food but probably not Lebanon so much.
Right? Well, I'd say the food still ends up and that's interesting coming from Obesity Medicine doctor right, the food, but
it just got to moderation. It doesn't have to.
Yes, of course. That is my that is how what I preach to my patients and what I follow in my own life. I was the the food evokes a lot of emotions and you know, attachments and memory, so I think it's that and obviously my family's back home. All of my family still back home. Immediate family.
Your uncle and aunt are still in Michigan?
Yep. And I have another aunt who lives in San Francisco. So but my mom's back home. My my siblings are back home.
Do you have children?
Do I have children? Yeah. Two crazy teenagers.
Oh, fun. Hadvethey been to the Philippines?
Yeah, they have been. They've been there twice. I remember when we first brought them there. I think my kids were like five and six. So it was a very long plane ride. That was a very successful plane ride because I remember so it's a almost overall, I don't know, 28 hour flight. Maybe, you know. I remember for our flight. I was prepared. I had like a toy every hour to distract them. But they did pretty good, though. At that age.
Where do you you, you flew to California and the California direct. What do you have to stop?
So it was I'm talking about? I think it was New York and it stopped inJapan...
When I was in residency training. There were quite a lot of Americans who had gone to the Philippines to train. Oh, yeah, there was Mexico was the first major place that people went, Guadalajara, and then the Caribbean and a lot of a lot of Americans go to the Philippines to train or used to I don't know, I probably it's decreased in recent years. We've got more spaces in med schools...
Are Filipinos coming to America?
Oh, yeah. Well, there were several Filipinos in my training program in New York. But no Americans who had gone there and came back there was we actually had a code once it was we had a lot of Filipino nurses as well. We had Yes, somebody ran a code. I can't remember the name of your language other than it begins with a T. But they ran the whole code in your Philippino language,. Everybody could speak, except for me.
That is funny. Yeah, they are speaking Tagalog. So that's interesting, you know, so the Philippines is a country and the citizen is Filipino. And the language is Filipino as well. But in the Philippines, there's a lot of like dialects. I can't remember how many but Tagalog is the more that's the one only use which again, percentage wise, I'm not sure how many use it but it's common, like I speak Tagalog. Yeah,
A lot of our nurses, particularly in the NICU, were Filipina. Mm hmm. Yeah. Yeah. And so, so heavily Catholic community too or at least the immigrants that I knew were,
yep. Well, actually, I also grew up Catholic. I think it's like 90% or something of the Roman Catholic. And you'll see a lot of memes about you know, Filipino nurses and you know, like, if Filipino nurses go on strike the the hospital will not run or something to that effect, because there's a lot in
Our NICU wouldn't have I mean, there were there were nights when it was only Filipinos I swear and a lot of nurses are there as many coming now do you think?
That one I don't know. Yeah, I'm not sure.
How about in Lebanon, do you do have a large Filipino community?
So I'm actually not in Lebanon anymore. That's where I trained. So I live in a different, still in Pennsylvania but maybe like half an hour distance. Not a lot of Philippinos, there are some there definitely are some , maybe not as many as, like, New York or anything like that. But yeah,
I was. Yeah, there weren't very many American Americans. Some of us were immigrants before we were doctors, but
Where are you originally from, Denise?
I'm from Salisbury in England, and my husband in from the Dominican Republic hence the MEJIA, which confuses you. Of course, a lot of Filipinos also have Spanish last names.
Yes. Yes. Yes. So my maiden name is actually Fernando. So that Spanish I remember, in residency when they, the patients would see my name, last name, and, you know, I kind of look a little Hispanic, you know, probably, but, so they always assume I speak Spanish
Of course. Yeah.
Poquito Espanol. That's Spanish right?
You're correct. Yes.
Yes. haven't spoken in so long.
What's the predominant community where you are now?
This is I think, more Caucasian, white this? Where I am?
Is it a farming community? Or historically a farming community?
Not No, no, I think we're surrounded by some but suburban mostly.
Do you have anything else you would like to enlighten people with? You'd like to expand on the travel? The tourist advantages of going to the Philippines or anything else? Other than the 24 hour flight is required?
Yeah. So I mean, so. So I think the Philippines is well known for beaches, beaches, there's a lot the food because there's a different a fusion of different cultures and the food. And I think the people, you know, anybody that visits the Philippines always comes back with, I think, a true impression of how friendly people are, you know, even if people don't know how to speak English, they'll try their very best to kind of, you know, talk to you in their, in, you know, how you would, I would call it the broken English if they can't, you know, but I'd say the Filipino people as a whole there were very warm and open, and we laugh a lot, you know, so I think if anybody visits the Philippines, they would be, they will probably want to trip back. And it's funny, I was at church today. And I met a person who said, Oh, I just came back from the Philippines. And I thought it was such an amazing time. So you know, it's always here, and people come to the Philippines. So hopefully somebody that's listening will get to visit it someday and experience the beauty that our country has to offer.
As as to so many countries, it's nice to hear from everybody. One, one of the earlier interviews, I took this series as somebody from India, What inspired me to to do this series with immigrant doc, because honestly, it's just the anatomy and physiology is the same the world over. But our attitudes towards health and life in general. There's some cultural differences. And I think they're interesting to explore. Yeah, you feel Do you feel more American now? Or do you still feel sort of strong pull? 20 years? A long time?
Yeah, it is a long time. And I think my husband is also American. So I think there was a lot of kind of blending into the community as opposed to standing out. And actually, lately, in this point in my life in my career, I'm actually trying to trend back to just how do I say, really wanting to be more Filipino in a way if that makes sense. As opposed to just blending in, it's more like,
right, you filled out you can be yourself now you've established like, I wasn't
myself, but it was busy working and you know, just making life work, so to speak. And now like, you know, I'm in this point where it's accept, you know, this is part of me, my heritage.
Do you think either of your, do you have boys or girls?
I have one of each,
Oh, how nice. Do you think either your son or your daughter will go to the Philippines to study at some point ...
My daughter, I joke with my daughter, she's into theater. She's She's a singer, actress at school. I mean, you know, so I always tell her like Aspiring Right, right, right. I said, Well, I'll just, you know, you can go to the Philippines and then you know, you can be an actress. I joke. So I don't know if she might. I'm for sure they'll visit because they talk about coming there for a while now. Learn about staying, though. Not sure.
Is there much, can you go and take like a semester abroad? Can you take a year abroad? Can you go to the Philippines University and transfer back?
I'm pretty sure you can because I remember in medical school, we had a couple of classmates that actually grew up in the states and did their their medical school in the Philippines. Yeah. Yeah. So my kids don't want to be doctors. They told me that.
I'm a physician, obviously - my husband is an engineer, all three of my sons said, not going to do medicine not going into engineering. We've got one computer engineer and one physician. One kid managed to stay out of it. He's a city planner.
So there's still hope is what you're saying?
it's not it's not there's hope. At some point, they'll realize it. They don't have to fight it. It really is their decision what they do so they don't feel the need to tell you to back off. Yeah, I did not. I told them with that. Yeah, whatever they wanted to do had to be something really wanted to do.
Right. And I don't force my kids to we just like I just joke around I like okay, you know, this is gonna you're gonna be right. They have their own path to work. I know. Yeah. Yep.
Yeah, theater is hard. There's no, there's no set plan. So much of it relies on luck and being in the right place, and the right opportunities will pop up.
And it's totally different from where I grew up. And, you know, I grew up like science study hard. Theater is a art that, you know, right. It's the right side of the brain. And I,
it's great. I mean, there's a lot of creativity in medicine, too. That tends to be ignored. But you, you've at least got set goals that you have to hit at certain periods. You can mark your path a little more easily that way.
Yeah. Yeah. Right. Yeah. There's like guideposts. So yeah.
Benchmarks. Yeah. Makes makes it easier. It was really nice. Getting to know you a little bit. Thank you so much.
I love talking about my country. And you know, Obesity Medicine is, again, my love and passion. So thanks for letting me visit and talk to you about all that.
Yeah. And you're not very far from me. I'm in Delaware. So maybe I'll swing by sometime. Nice to meet you, bye Case.