Ep. 520 We Got Healthcare Wrong – The Biggest Flaws in Modern Medicine & How To Fix Them with Dr. Aaron Hartman

Today, I am thrilled to reconnect with Dr. Aaron Hartman, a triple-board-certified physician who recently wrote the book "Uncurable." 

In today’s expansive conversation, we delve deeply into the structural flaws of traditional allopathic medicine. Dr. Hartman shares how his own clinical approach has evolved and recounts Anna’s story, explaining how her experience became a turning point in his professional growth. We highlight the importance of lifelong learning, patient advocacy, and the benefits of removing restrictions to allow providers to deliver patient-centered care. We examine the legacy of the Flexner Report, the rigidity it introduced to modern medicine, and the broad potential of GLP-1s beyond weight loss. We discuss the hidden factors that shape medical errors, the effects of insurance reimbursement, the challenges of existing in the current medical system, and how fear of liability influences clinical decisions. We also explore the triangle of health and the effects of unresolved trauma.

This episode is packed with valuable insights, so you will likely want to revisit it more than once.

IN THIS EPISODE, YOU WILL LEARN:

• How traditional allopathic medicine is structurally rigid and limits patient-centered care

• Dr. Hartman shares how patient advocacy and curiosity-driven learning fueled his clinical evolution.

• How the Flexner Report created a hierarchy that discourages innovation and integrity

• The therapeutic potential of GLP-1s beyond weight loss 

• Why being open-minded as a clinician does not mean being reckless

• How insurance reimbursement models reward overdiagnosis and procedural volume instead of outcomes

• What the fear of litigation leads to, regarding defensive medicine and unnecessary testing

• How clinical decisions, overtesting, and overdiagnosis can inadvertently contribute to serious medical errors and harm patients

• What the triangle of health is, and how it underpins overall wellbeing

• Why unresolved trauma can cause physical illnesses

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“Western medicine is great at keeping you alive, but not necessarily at keeping you well.”

– Dr. Aaron Hartman

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Connect with Cynthia Thurlow  

• Follow on⁠ X⁠,⁠ Instagram⁠ &⁠ LinkedIn⁠

• Check out Cynthia’s⁠ website⁠

• Submit your questions to ⁠support@cynthiathurlow.com⁠

Connect with Dr. Aaron Hartman

• On his website

• Purchase a copy of Uncurable

Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:28] Dr. Hartman, great to have you back. Welcome.

Dr. Aaron Hartman: [00:00:30] Great, you're back. I'm super excited to have a conversation today.

Cynthia Thurlow: [00:00:33] Absolutely. What do you think is the single biggest structural flaw that you see in traditional allopathic medicine, and how has your practice model evolved over the last 20 plus years in response to your experiences, both personally and professionally?

Dr. Aaron Hartman: [00:00:51] That is a big question. The biggest structural flaw-- part of our strength is our weakness. We have this amazing educational system in the United States. You do four years of undergraduate, four years of medical school, three to seven years of a residency. So, you get this massive knowledge base when you get out of school. But the way it's set up, it's almost like you've arrived at the pinnacle.

[00:01:09] It's almost as if, at least in medicine, many times that once you get there, the curiosity, the hunger for new knowledge, it's not perpetuated. So, what happens is you get your board certification, you get your thing. It's like, “I finally reached the pinnacle. I'm a board certified XYZ.” The reality is, no, you've just got the ticket to show up. Congratulations, insurance pays for your time now.

[00.01:32] We get in these like these silos. It's partly, because of that whole educational system that-- I was literally forced out of against my own will, not by my own volition. And so, that's part of the reason why people jump from specialist to specialist, doctor to doctor, because once you get in your narrow pathways, we lose the ability to have that vision around us.

[00:01:51] In medical school, we did biochemistry. I was told in medical school, you'll never use this again, because just doing biochemistry, so you can pass your boards. Like, half of functional medicine is biochemistry, genetics, cell biology. So, it's interesting how something that was a throwaway in medical school was a standard in the functional medicine world. So, I think that's educational, that our strength is our weakness and just realizing once you get to a certain pinnacle, it’s like, now true education begins, because now you have the tools to build on. And that's not something that people leave their graduate level education with.

Cynthia Thurlow: [00.02:24] Well, I think it's so interesting, because I reflect back on 20 years in a traditional model, first in ER Medicine, then cardiology, and how frustrated I felt and constrained with the model where I was effectively told, “If this doesn't fall into the cardiology bucket, you refer them to a specialist, you refer them back to internal medicine 9 times out of 10.” I was told to stay in my lane.

[00:02:48] We're complex organisms. One system of the body does not absolutely integrates with other systems of the body. And to somehow suggest that if you are a gastroenterologist, you only worry about GI issues, or if you're a cardiologist, you only worry about cardiology issues, or if you're internal medicine or family medicine, you have to worry about everything, is in many instances, I think that your points about the siloed part of medicine combined with rigid dogmatism of, “Okay, I studied in the 1990s. That's when I trained. Therefore, everything I learned is all that I need to learn, and I don't need to continue learning.” 

[00:03:28] One thing that was really invested in us where I went to graduate school was that, you are a lifelong learner. You are expected to evolve, shift, and change. And so, help my listeners understand, what was it that happened with your daughter? You have this extraordinary family. You and your wife are just incredible individuals, and your children are also incredible. What was it about Anna's story for you and advocacy of her care that really was the catalyst to opening up your perspectives about the limitations of this traditional model?

Dr. Aaron Hartman: [00.04:01] It was basically out of desperation. It was nothing I chose. That's what was given to me. So, my wife is a pediatric occupational therapist, and Anna was one of her patients. Her foster home was closing down, so Becky asked me, "Hey, would you want to bring Anna in, foster her?" And so, my thinking-- You knew me. [Cynthia Thurlow laughs] My first question to Becky was, "Can we give her back?" Becky was like, being a loving wife, knowing that I would eventually fall in love with Anna, she's like, "Sure." We brought her in, and I really fell in love with this gorgeous little girl.

[00:04:34] But part of it was her feeding. Usually, kids with cerebral palsy have low amounts of body weight, failure to thrive was a big thing. And so, we worked on feeding her. I remember flying food into her mouth. My wife and I debate, how much of that I did. Vividly remember that. But she was still failure to thrive, she was still less than the fifth percentile. The GI doctor was like, “We're going to do the next standard thing, which is standard protocol. All these kids get is a feeding tube. We're going to cut a hole in her belly, placed a plastic tube in, so we can pour formula and put weight on her.” They didn't care if it was fat, muscle, whatever, just put some weight on her. 

[00:05:09] And from talking with Becky, one of her specialties was feeding, handwriting, all these fine-- as an occupational therapist, a lot of that kind of stuff. If the goal is that she's going to talk, even though specialists said she'll never be able to talk in her life because her brain damage was so significant, part of learning how to talk is chewing and swallowing is critical for speech development.

[00:05:28] Part of learning to walk is you first crawl. It's hard to army crawl when you have a plastic tube coming out of your belly. I had goals and dreams and visions that she's going to do these things regardless of what-- At that point in time, I wasn't thinking that clearly, like, “This is what she's going to do, right?” And so, we opted not to do that.

[00:05:45] I talk about two inflection points in my book. The first inflection point was what happened when I said no. The result was my wife and I were reported to Child Protective Services for child neglect, because we refused to follow the doctor's orders. We chose to give her real food, not processed food, not do a surgical procedure. Now, because we were already in the system, I was a captain in the Air Force, we were able to navigate that. But most parents, most families, most foster families, don't, and the kid gets a tube and their trajectory has changed forever.

[00.06:15] So, I wasn't thinking that. I was thinking feeding her and getting her try to do balancing and all that stuff you do with a kid with a significant brain injury. But the other inflection point that became my weight, became my burden, became my duty-- I don't know if these are the right words to use, but six months later, Becky found a growth chart for kids with cerebral palsy which is the diagnosis Anna has.

[00:06:33] She was 50th percentile, so she was normal. This specialist had no idea that there's a growth chart for little girls like my daughter and was ready to start one surgical procedure, as you know, lead to another, lead to another, lead to another. Side point, Anna's 19 now, turning 20 soon. She's never had any surgical procedures. The average kid with her diagnosis has had 13 by the time of her age. So, at that point in time, I realized like, “Oh my gosh, the specialists don't know.” It became a weight. It was a burden I felt every day, because I have to get up, I have to figure it out, like, “Who's going to figure it out? The specialist can't figure it out.” And so, that was where I had to figure it out. 

[00:07:14] So, I got up early, 4 o'clock in the morning, started reading. At that point in time, there was not a lot-- still not today, a lot about cerebral palsy. With autism, with other neurodevelopmental things in kids, I started studying gene-based therapies, nutritional therapies. But that was like, what got me off course was necessity. Like, I had to figure it out. The system wouldn't listen to us, it was going to report us. The specialist didn't have the answers. 

[00:07:39] At that point in time, she was probably 14 months old. We had limited time. I had to figure out fast. I couldn't figure out over three to five years and get another board. I had to figure out quickly, and so that was a fire that got me up every morning super early over a decade.

Cynthia Thurlow: [00.07:52] It's an incredible story, because I think perhaps for listeners not understanding the concept of failure to thrive, that's quite a significant diagnosis. It can apply to infants, and children, and adults. But the concept of a feeding tube, let's unpack that for a second. Just from the perspective of allowing the lay public to understand when we're putting a feeding tube in an infant or a child or an adult, there are long-term ramifications of that.

[00:08:20] It's a portal of potential infection. It's a portal into-- As you mentioned, it would impede her ability to crawl, which would impede her ability to walk. It would impact her fine motor skills for chewing and swallowing, all of which are really important. When we talk about failure to thrive, just give us a high-level perspective of what that represents.

Dr. Aaron Hartman: [00.08:40] It's hard to say. It's like a stamp. It's a mark. It’s a mark [unintelligible 00:08:44] mark. Failure to thrive kids literally struggle with absolutely everything. They struggle with neurological development, they struggle with basic math, they struggle with sensory integration, they struggle with feeding, many times develop seizure disorders. So, it's like this mark where it's almost like triage.

[00:09:02] In the ER, you're in the ER triage, you know? Okay, we work really hard on them and they'll survive. Okay, this one, we do nothing. They'll be fine in six hours. Let's give them some ice chips and stuff. This one's not going to make it, so we make them as comfortable as possible. It's like this triage mark. This one? Yeah, not so much. It's a mark of this kid's not going to do well. It impacts you in ways you can't imagine.

Cynthia Thurlow: [00.09:22] Well, it makes it even more impactful when it's your child, and it's someone that you are invested and love and care for and have a truly vested interest in ensuring that you do everything you can to support them and protect them. I can imagine, as a physician, it must have been even more challenging, because you and Becky, she's also a healthcare provider, effectively being told that your advocacy of her is in some way in misalignment of her best interest. 

[00:09:52] And yet, as her parents, you knew that there was more to this than putting a feeding tube in, and then compound that with the fact that you were reported to Child Protective Services, which Child Protective Services is there for a reason, and certainly we could unpack what that represents, but I'm sure you probably were a little flummoxed when that happened, probably surprised as well.

Dr. Aaron Hartman: [00.10:14] Back then, I was still in my boyhead days. [Cynthia chuckles] I was in the military. I was very driven. It was more like an obstacle to get over, how do I fix this problem? I wasn't emotionally invested in my daughter at that point in time. I was like, “I have this responsibility.” Falling in love with her was a process. It was part of the whole process of fighting for her. “I had this child. These are things I need to do.”

[00:10:36] Becky took care of all. The nurse came by to investigate us and interview us. She was interviewing her, not me. She was taking care of all that stuff, my wife. Her caseload in Florida was all these rare genetic disorders that I'd never heard of. Kids with craniofacial mal-abnormalities, genetic things I'd only heard of in medical school.

[00:10:54] And so, part of her experience was a lot of these kids to parents that fight for them, will go to institutions. They'll be gaslit. Mom's crazy, dad's crazy. Are they hurting this kid? Are they Munchausens, which is people actually make their kids sick to get attention in the medical world. Just weird, weird thing.

[00:11:11] Some of them actually lose their kids for months, sometimes years, because the system is going into this. From Becky, I had this insight that tread lightly, not engage the system too much, but engage it enough, so that we are going the right direction. This thing in the back of our head, knowing that the system would push back, but it's different when it happens to you.

Cynthia Thurlow: [00.11:28] Yeah. It's humbling, it's frustrating. It is, in many ways, I think it brings you to a point of humanity and allows you to see your patients so differently. When you start to understand that everyone needs an advocate, and even more so for children and toddlers.

[00:11:45] Let's jump forward to how this process of caring for Anna, investing and advocacy for her led you to this functional integrative approach to patients and their welfare. I think in a lot of ways, when I think about the limitations to conventional medicine, I feel like a functional integrative approach in many ways is trying to address this. 

[00:12:11] I always say, “If there's an emergency or an urgency, traditional allopathic medicine, there's nothing better.” It's for most other things that there are limitations, that maybe if people are healthy, they may not perceive there are limitations. But it's when you get caught up in yourself being sick or a loved one, that all of a sudden you realize, there's a lot of what we refer to as blind spots.

Dr. Aaron Hartman: [00.12:32] Yeah.

Cynthia Thurlow: [00.12:32] What are some of the things that stand out to you that are unique about this functional integrative approach that allow you to care for patients in a very different and unique way?

Dr. Aaron Hartman: [00.12:40] I'm a super basic guy.

Cynthia Thurlow: [00:12:42] Really not. [chuckles]

Dr. Aaron Hartman: [00:12:43] I was trying to determine if I was going to do general surgery or family medicine. My goal was I'm going to be a doctor at a mission hospital somewhere in the middle of nowhere. Literally, you'll run hospitals with surgeons who’ve got [unintelligible 00:12:54] practice, and they run these hospitals in the middle of nowhere. So, that was where I was trying to figure out which one was the biggest scope, and I landed on family medicine.

[00:13:01] You get in these places where you get your training. But for me, the thing was, is that I always wanted to keep on learning. Learning new procedures. When I was in the military, we didn't have a dermatologist on our base, and I saw a patient with melanoma. You couldn't see a dermatologist for six months. Like, that's a life-or-death time.

[00.13:16] I got a textbook of dermatology, read it, signed up for courses at USF, and got some additional training in dermatology, and got good enough. Thus, started managing my own skin cancer patients. We also didn't have for a while-- Just people got deployed, we lost when the internist that was doing cardiopulmonary testing got trained on Holter monitor, got trained on stress tests, PFT testing, and started doing that for the base as well. So, keep on doing your stuff when you get out of your training. 

[00:13:38] And that's what you do. And so, with Anna, it became this thing that I knew how to learn new things. I kept on learning how to learn how to do new things. When we got her, I was like, “Oh boy. Like, it's more than just me having my next intellectual curiosity. It's like, it really matters.”

[00:13:55] 80% of people who finish the training, they just read the journal articles they get. You're a board certified in endocrinology, cardiology, family medicine. Your journal every month that has the updates in it and you keep updated in what an editorial board--

Cynthia Thurlow: [00.14:07] Decides is what's important.

Dr. Aaron Hartman: [00.14:09] Yeah. And so, you keep up to date, but in a very limited sphere. A great example of this. When I was in the military, and I had four or five journals I'd read because they all had little things. One was medical consultant. They talk about MRSA and skin infections and using vitamin A and Hibiclens and changing biofilms on the skin and a bunch of stuff. 

[00:14:27] I started seeing that in Florida with military people. Came to Virginia, actually mastered it pretty well. Came to Virginia right as MRSA was coming to Virginia. People like, “What do you do with these abscesses, these boils?” I'd actually seen that when I was in Ecuador in a mission hospital. Young, 27-year-old guys playing soccer get hit in the leg and get these actually muscle abscesses. I also learned those on nutritional basis. So, all of a sudden, I was like, “Cool, I already know how to take care of this. Y’all up here haven't seen it before.” Well, that's weird. 

[00:14:57] And so, you do that over and over again. All of a sudden, you get this confidence, I think I can keep on doing this. It's just with Anna, she threw gas and lit the fire. And so, it just supercharged everything. So, in the next seven years, I added on two additional board certifications, a bunch of other certifications.

[00:15:13] It's interesting how me doing that, for her, changed my practice of medicine, and it's affected thousands of people's lives who would, in Central Virginia, would have nowhere to go, except for now, our practice, which literally was built out of the fire and the struggle of taking care of my daughter.

Cynthia Thurlow: [00.15:27] It's like that story is one that personally resonates with me, professionally resonates with me, because the desire to continue learning and being a lifelong learner is something irrespective of what industry you work in. We should all be improving upon our knowledge base. As I jokingly say, know better, do better. Like, now we know better, so now we do better. But for full transparency, as I always share when we record together, your trajectory of your education has impacted our family as well in such significant ways.

[00:15:59] So, I feel so very grateful and appreciative that you have taken such a proactive approach to figuring out what other people maybe are not yet aware of. Like, the MRSA is a good example. For listeners, these are infections that generally are not treated with conventional antibiotic therapy. They sometimes can be more challenging. Now, we've got way worse things than MRSA. It's like, add on, times 10, all these other things.

[00:16:24] But let's talk a little bit about this root cause approach that you utilize in functional integrative medicine. I know there are some unique things that I have learned through you about autoimmunity, and gut, and hypermobility. But from your perspective, when we're looking at this functional integrative approach, what are some of the foundational aspects of that? When you're evaluating a patient, when you're talking to a new patient to help them better understand their unique bio individuality and to be able to serve them in a way that adds on to what a traditional lens would look at, but allows you to look a bit more deeply?

Dr. Aaron Hartman: [00.17:02] Okay. To answer that question from a two-pronged approach, the first prong is the count-- You know William Osler, right? Actually, he was-- You might know who that guy was.

Cynthia Thurlow: [00.17:10] I do. He's a big deal in Hopkins.

Dr. Aaron Hartman: [00.17:11] A big deal Hopkins, yeah. We learned about him in school. The idea is that 80% of all diagnoses can be made by history and physical. You can learn where'd you grow up, what'd your father do, your family environment, what you ate as a kid growing up, trauma, life experience, where you live now. Like, 80% of the diagnosis can be determined by history and physical alone. 

[00:17:32] I was taught that in medical school. But what's happened is through technology, now we've become this thing called-- I learned at a trauma conference, VOMIT syndrome. We're victims of modern imaging techniques.

Cynthia Thurlow: [00.17:42] VOMIT? That's a new acronym.

Dr. Aaron Hartman: [00.17:44] Yeah. It was actually a trauma conference I went to during I was in the military, because we had to do medical, biological, chemical warfare stuff. This was when the residency thing was changing to the 80 hours, and so they were like, “How are we going to have surgeons still learn liver repair in a regular surgery?” It was a lot of things. But the gist is that at that point in time, they were already saying, “We are becoming victims of technology.” I did a test, I did an imaging thing, there's nothing there.

[00:18:11] Well, William Osler had said, “Ask the patient, the patient will tell you.” In functional medicine, one of the main parts of it is going back to, “The patient will tell you what's going on.” “Did you have personal trauma? What'd you eat growing up? Did you live near a factory? Are you from Annapolis? You from Long Island? If you're a year from Phoenix, where all the fires--” They have the fires every summer, like all these small environmental things can impact the health of the people who live there. So, that's one aspect that's being lost. We hear about it in medical school, but no one does a two-hour intake to-- [crosstalk] 

Cynthia Thurlow: [00.18:41] They don't have time.

Dr. Aaron Hartman: [00.18:42] Yeah. We do it. It's almost reminding us of the ancient wisdom. The patient will eventually declare themselves, right? If you have the time, you make the effort, you ask the questions, you will eventually tell me what's going on. Fancy technology just helps clarify that. That's something I feel like in the biohacking optimal wellness world is absolutely forgotten. It's now, I got a new peptide, I got a new stem cell, I got a new thing, this will fix you. It's like, no one's spending two and a half, three hours to talk to the patients. And then, the longitudinal learning nuances which we can talk about more and more. But that informs what you do with the patient. So, part of integrative functional medicine is just expanding on old wisdom, old knowledge.

[00:19:27] There's the new stuff, which is systems biology, which is, okay, there's this thing called the gastro neuro-immuno-endocrinology. Fancy word. Your gut affects your hormones, affects your nervous system, affects everything about you. And so, it's interesting how you can go to institutions and get a PhD in this, but they talk to specialists and like, “I'm just the gut, I'm just the neurologist, I'm just the cardiologist.” 

Cynthia Thurlow: [00:19:48] They would. 

[00:19:49] Yeah, a salad. And so, part of what functional medicine does, it says, “Okay, you have your old toolkit. Keep it. Because if someone has appendicitis, you got to fix it. If you don't fix it, you might die,” right? You got to keep your old toolkit. We don't throw it away after you've had your heart attack or stroke. Can we make your calcium square go down? Can we actually make your Lp(a) lower? I've lowered people's Lp(a). Traditional medicine says, you do that with a medication called a PCSK9 inhibitor, right?

Cynthia Thurlow: [00.20:15] Yup. Repatha.

Dr. Aaron Hartman: [00.20:16] Yeah. One of the many ones, right? That's a part of functional medicine is this root cause looking how-- How does everything relate with everything else? You've got gut issues, and you've got brain fog, and you have joint aches and pains. We know from the association of your immune system, 80% of your immune system is in your gut. We know with neurotransmitters, 75% of all neurotransmitters are made in your gut. 90% of serotonin, 50% of dopamine.

[00:20:38] All of a sudden, if you have psychiatric issues, if you have an inflammatory condition, maybe, just maybe, this is actually an expression of your gut. And so, what functional medicine does is looks at the associations. There's system one, which is your adrenal gland, your thyroid gland, your pancreas.  The system two, which is your gut, your immune, your brain. There's system three, which is your cardiopulmonary, neurovascular, which is a fancy way of saying, arteries and nerves that connect your heart and your lungs and how they affect everything else. There's your detox system, liver, lymph, kidney, lymphatics. Then the last one is your hormones, sex hormones. 

[00:21:11] And so, all of a sudden, you think systematically, someone with heart disease might have a hormonal issue, because we now know females as well as males, your hormones being off, increase your risk for heart disease. Or, maybe it could be a thyroid issue. Maybe your thyroid's low increased risk for heart disease. It's not just a, “You have high cholesterol, take a statin,” kind of thing. 

[00.21:30] And so, looking at people as a complete whole, looking at your history, looking at your environment, and combine it with a systems approach, and then you basically [unintelligible 00:21:39] is just fill that in with deeper science, lipid medicine, mast cell stuff. I mean, hypermobility is one of the things we could-- It's one of my things I love talking about. [Cynthia Thurlow laughs]

[00:21:49] The thing is, every three, six, nine months, you add new skills, new tools to your toolkit, and all of a sudden, your toolbox is this massive thing. This is a mantra I say when I go to work every morning, “I ask to see where it can't be seen, hear what can't be heard, and diagnose what can't be diagnosed.” I do that every morning when I drive to work. It's interesting how I will sometimes read an article about--

[00.22:08] We're talking about IV phosphatidylcholine before we start. Something will pop up, and it's like, “Wait a second, I just read about that. Someone comes in, I can help them with that.” That happens so much. It keeps me on my game. I can't stop learning and stop reading, because I don't know what new person is going to call in my clinic-- If I don't have the knowledge to help them now, I need to be learning, so that whatever that gap is, I can fill it in. It's good medicine. It's the practice of medicine. We call it functional, integrative, translational, biologic, personalized, whatever you want to call it. But I just think it's just good-- It's good medicine.

Cynthia Thurlow: [00.22:42] Well, I think that every person listening deserves to have that. That is something that has been so affirmed for me, because the traditional model, in many ways, not meeting people's needs. I hear it when people say like, “I'm paying a lot for insurance.” And then, trying to figure out ways to budget for additional care, but-- 

[00:23:08] I always use my husband as a good example. Last year, listeners know that he had a healthcare hiccup. Initially, I was convinced he had lymphoma. Thank God, he didn't have lymphoma. But through a series of hospitalization, surgeries, and biopsies, we found out he had tuberculosis. The first person who said to me, “Cynthia, there's something deeper going on,” was not the pulmonologist, was not the surgeon. It was you, because you were thinking really broadly. 

[00:23:42] I was too immersed in everything that was happening, is what happens even to good clinicians, is that you're just like, “I can't see the forest through the trees, because I'm focused on a sick spouse.” My hope is that every person listening, at some point, will have a clinician that they can work with that thinks that way, because everyone deserves that level of care. That's the unfortunate thing. There's not enough of you to be able to support everyone. But I think things are improving. Like, clearly, more and more people, more and more clinicians are going to get functional integrative training, because they're seeing the limitations in the current medical model.

[00.24:24] What do you think is one of the ways that we, as a society, can better support the education and the advocacy for clinicians being able to utilize this training and do so effectively?

Dr. Aaron Hartman: [00.24:37] I think ultimately everybody who goes into healthcare goes into it to help people. They don't go into it, because they-- These days, they don't go into for money, because you can make more money just doing [Cynthia Thurlow laughs] something totally different. They go in, because they want to better the world. They want to their fellow person, they want to make the world a better place.

[00:24:54] I think the best thing that our system can do is just let you run your run. Leave them alone. Remove restrictions on having a membership model. Like, I had to spend $15,000 to consult a fancy lawyer to get paperwork that enables me to have a membership model, direct primary care. Like, there's so many limitations, malpractice.

[00:25:14] Even insurance, it's like, “Oh, that's not approved by the FDA.” Your vitamin D is still controversial, according to the Institute of Medicine, for whether we need that. It's like, “Really? Like, the literature's decades old. I've known about it for 20 years.” Everybody has a different perspective on things. Should the government pass new laws? Should we have new legislation? My response is, “That's not worked in the past.” We have enough people in our country who want to do good.

[00:25:39] Get the education, release the hounds, let them go. All you got to do to release the hounds is remove the barrier. What you do is ridiculously important, educate people. Because the only way we're going to release all those hounds, is if people demand it. If people say, “No, I want my doctor to have 45 minutes. I want them to have an hour with me. Why can't I use your insurance? If you want, I want to spend an hour with you, why can't I charge you a little extra? Why do I have to create this ridiculous model? Or, if I don't want to accept insurance at all?” Medicare says if you go bare, you can't sign back up for three years.

Cynthia Thurlow: [00.26:11] Yup. It's [crosstalk]

Dr. Aaron Hartman: [00.26:13] It's a big risk. So, now you're saying, “Oh my gosh, if I opt out of Medicare, I can't go back in for three years.” Like, why is that? It's a scare tactic to keep people in the system. So, my personal philosophy is we just need people demand more. Let's go start at the local level. Every state has its own board certification and their own license. The reason things are changing so quickly now is because more and more people are learning about it, and they're demanding it.

[00:26:37] I'm a bomb up guy. I think you just need to reduce limitations on physicians and providers. You need to let us run, not limit us to only things that the FDA says we can do. 

[00:26:47] It's really funny. I remember reading this one my journal articles not too long ago. 60% of medications used in the pediatric world are off label. Then why when I want to use vitamin D, and get your level to 100 because you've had breast cancer. Dr. Paul Merrick wrote this amazing book called Cancer Care that has 1,500 citations in it. It's almost 50 pages of citations. I was actually reading this one thing I read in the last month which was-

Cynthia Thurlow: [00:27:12] [crosstalk] for fun.

Dr. Aaron Hartman: [00:27:13] -just for kicks, because I got nothing else to do besides raise my kids and have a farm. [Cynthia [laughs] But it was interesting in that, multiple citation-- reason [unintelligible 00:27:20] citation, it's like he, at one point in time, was the most published [unintelligible 00:27:25] care specialist, I think, in the world. But it's crazy. If you have breast cancer, the risk for metastasis recurrence is equivalent to being on aromatase inhibitor.

Cynthia Thurlow: [00.27:34] Wow.

Dr. Aaron Hartman: [00.27:34] So you have breast cancer. I can give you this medication. They'll put you in medical menopause, you'll feel miserable, brain fog, you ache. Or, I can get your vitamin D level to 130. If you're worried about toxicity, I'll just check a PTH and calcium. That seemed like a no brainer. But if you mention that to other people like, “Oh, where's the literature? It's not evidence based.” I'm like, “Just read this book. There's 1,500 citations.”

Cynthia Thurlow: [00.27:57] That's completely reasonable. They talk about Flexnerism and how that has influenced medicine. I'll use a good example, and I'm not going to name names. But the utilization of GLP-1s as a good example. Yes, they came into their existence to help people with obesity and people who have comorbidities that are obese or overweight. I think there are so many people now that are utilizing these drugs off label, microdose that it's improving their autoimmune conditions, it's helping with inflammation, there's all these benefits.

[00:28:29] And yet, I sometimes will see-- I know they're well-meaning individuals, I won't even say like what their background is, but these are licensed medical people. They get very kerfuffled about utilizing, whether it's a GLP-1 or another drug. Utilizing it like, “Oh, where's the research? What's been done?” I think we're forgetting that one of the ways that we bring drugs to common acceptance, and trials, and being able to get to a point where we can eventually develop a randomized control trial is people using things off label.

[00:29:05] I think in many ways, this is one current issue that I see personally as well as professionally, that there's a lot of arguing on social media. Let me be clear. It's not like it's a layman that's suggesting this. It's healthcare professionals saying, “I'm seeing benefits my patients, and this is why I'm now utilizing this.” And then there are the Flexnerism and the Flexner Report.

[00.29:28] I know we've talked about it multiple times on the podcast. But the development of the Flexner Report in the 1920s revolutionized, not only the way medical education was taught but also impacted the siloed care that we have in medicine. That's very driven by diagnosis and not the root cause approach, but diagnosis driven, medication driven, screening driven, which is both good and bad. Do you have thoughts around that? You don't necessarily have to speak the GLP-1 piece, but--

Dr. Aaron Hartman: [00.29:55] I could talk about that too as well. [Cynthia chuckles] I try to think of things. Like I said, I'm a simple guy. I try to think things basically. I look at as academic versus practical. 

Cynthia Thurlow: [00.30:04] Ivory tower.

Dr. Aaron Hartman: [00.30:06] Yes. It's like the academic is great for getting your education, like, I went to university, I went to medical school, I've got five degrees of different things that I went to-- I've done a lot of things. But that gives you the tools. How does that work in the real world? That's the practice. This happens if you're an engineer, it happens if you're an accountant, it happens with any technical job of expertise that you have to learn the deep science information. 

[00:30:31] But how does it work in the real world? It's totally different. That's where clinicians who have been doing it for 30, 40, 50 years have experience. They're like, “This is how this really works in the real world.” That's where I think the academic side, ivory tower side-- In my mind, the ultimate science is the practice of medicine. Because you're taking astrophysics, you're taking the issue with astronomy, and you're taking environmental medicine, you're taking-- 

[00:30:54] If you could talk about the earth's magma and how it flows under the core of the earth creating electromagnetic fields called flux fields that affect human health, it gets really, really complicated. But then, people use that information and use pulse electromagnetic field devices to modify our physiology. It just makes sense. And that's what the practice of medicine does.

[00:31:13] GLP-1s are a great example. It was really funny. One of our friends and colleagues asked me about GLP-1s-- And put things in perspective-- Also had a clinical research company for almost 15 years, supervised over 70 clinical trials, and personally started using GLP-1s in 2006 with Byetta, then Victoza. I've been using them for a long, long time. This friend and colleague was like, "Hey, have you heard about microdosing?" [Cynthia Thurlow laughs] And this was November of a year ago. I'm like, “What? Whatever.” I was very polite and nice to her anyway. [Cynthia Thurlow laughs]

[00:31:47] And then, three months later in my MCAS group with Dr. Afrin who's the top MCAS guy in the universe, he's brilliant, a group of really brilliant people taking care of complicated patients. People are in there-- I've been microdosing with my MCAS people and having less food sensitivities, less chemical sensitivities. Their POTS is getting better. In this group, they're like, “So, how would that happen?” So, people are saying, “Maybe it's because it's affecting mast cells,” which is one of the things. GLP-1s are anti-inflammatories.

Cynthia Thurlow: [00.32:17] Yup.

Dr. Aaron Hartman: [00.32:17] It's not FDA approved for cardiovascular risk reduction, renal protection, and diabetics, treatment of sleep apnea. It's a diabetic medication. I'm not a big pharma guy. I use everything, like everything.

Cynthia Thurlow: [00.32:30] You’re fully open minded.

Dr. Aaron Hartman: [00.32:31] If it works and there's data behind it, let's do it. That can also mean if a culture has done something for 4,000 years. People forget the first stool transplant, fecal microbial transplant, occurred about 4,000 years ago. That was actually warm camel dung to treat cholera. People have been doing stuff, the stuff for a long time. And so, the point is that, this group, we're seeing people using it and having really great results.

[00:32:53] Well, I heard that, and it was funny because it was popping up on social media before me as a doctor, heard about it in my little group. So, I started trying it with people, with patients. And now, I'm like, “I love it. It works amazing.” People in the community are like, “What?” That's the reason why I'm in so many different groups with--

[00.33:09] I'm not on social media groups. I find these groups of really smart people tell my patients, is that I find the smartest person I can. I'm a leech. [Cynthia Thurlow laughs] I grab onto them, I read all their textbooks, I read their stuff, I take their courses. I just finished this past week in phosphatidylcholine certification course.

Cynthia Thurlow: [00.33:28] Of course, you did, in your spare time.

Dr. Aaron Hartman: [00.33:30] How can I help people, right? I take all the knowledge out, I fall off, I process it, how do I implement this? Sometimes it's just cool data points, and I put up my files out of a library on my computer of thousands of files, and then I find the next smart person. The caveat to what you said, it's amazing. 

[00:33:45] On this journey, one thing I've found that's amazing, there's so many smart people out there. Patricia King with lipid medicine been doing for 40 years. Dr. Afrin with mast cell stuff has been doing this for 20 plus years. There's so many people that figured things out. There's so much amazing information out there to be found to help people. You just got to look for it. And so, it's one of those things that when you realize that you're like, “Oh my gosh, I have people I can't help. I need to learn more.” It's really interesting.

Cynthia Thurlow: [00.34:11] No, it's inspiring. It's something that I respect about you enormously. That's why we are both doing Pam Smith's program, because I was like, “Oh, if Aaron's doing it, then I need to be doing it, because I can learn just as much as well.”

[00:34:22] One of the things about traditional allopathic medicine-- You look at things that create this sick care model. Again, I know I'm poking a bear, and this is not out of a lack of respect for what colleagues are doing. I just think there's limitations. What are some of the subtle ways that we unknowingly are harming our patients? You talk about in the book. I think this is worth addressing, because I think some of these, perhaps the lay public, might be surprising.

[00.34:49] Something that stood out to me when I was reading your book was, number one, normalization of procedures, surgery, and hospitalizations is being one. Maybe one or two others. We've gotten very normalized. I will give you an example. My father, before his death, wore it like a badge of honor that he got a colonoscopy every two years. I used to send him and say, “Dad, you're--" He was close to 80 years old. I was like, “Every time you go under anesthesia, that is a risk as you get older, you have to understand--” 

[00:35:19] Like, “Cost benefit. Is it worth it to go through another screening procedure that if you were to get a precancerous polyp and it wasn't removed, this is something you could probably go five years and you would be fine.” But I use that as an example that we have normalized a significant amount of screening over diagnosis, hospitalization, and surgeries as being normal.

Dr. Aaron Hartman: [00.35:39] This is where my mind goes, is the idea of the blind spots, and one of those being a medical error. When I was in medical school, I was told that iatrogenesis, which is things we do, was the fifth most common cause of death in our country. Martin Makary wrote an article about medical aid. Is this the third leading cause of death in our country? As an academic at one of the most prestigious institutions in the world, definitely in our country, part of science is, I have a question, I have a thesis. Okay, I agree. I disagree. Let's make a study. Let's study this. Let's follow it.

[00:36:14] Well, he couldn't get it published in any American journal. So, he had to go to the British Medical Journal, where they actually like, “This might be a problem.” Because in America, they-- Actually, the editorial boards we talked about did not see medical area as a significant concern. So, the question is, where is he getting his data from? He was getting his data from Medicare registries. So, that's pretty legit. The NIH, big organizations do this.

[00:36:38] But my question to his question was, well, if this is Medicare registries, is it number two or number one? Because you're missing out pediatric stuff, you're missing out Medicaid, you're missing out on people, on insurance, you're missing out on a bunch of stuff. My question is, oh my gosh, we have to study this, because maybe it's not the third most common cause of death in our country. Maybe it's number two or number one. But in our system, the editorial boards of New England Journal, JAMA, etc., etc., that's not--

Cynthia Thurlow: [00:37:05] Bad for business.

Dr. Aaron Hartman: [00:37:06] It's not noteworthy. They had to go overseas, which is one of the things I do a lot is look at information overseas, study physicians, read journals, articles, researchers overseas. I've had to take my daughter out of the country before for [unintelligible 00:37:20] care. That's a big blind spot.

[00:37:22] Part of the Hippocratic Oath was [unintelligible 00:37:23] only for good. They realized that seeing doctors actually can be dangerous. When I was in Ecuador, we had a young guy come see us. He had an infection for weeks, and the mom eventually brought him to the hospital. He had meningitis, so we had to admit him to the hospital.

[00.37:36] Well, the mother in that culture, that indigenous culture in Ecuador, if you get admitted to the hospital, it means you're going to die. So, she withheld him going to the hospital, but they are stating that the hospital's a dangerous place. When we admitted him, she was like, “This means my son's going to die.” You can hear her wailing, like, down the hallways. It was this gut wrenching. It was crazy. He left a week later with his mom.

[00:37:59] But it was one of those things that, in that culture, they respected the hospitals are dangerous. In our system, we're like, “Get your procedures, take your medications, take your stuff.” When my dad had called me when I was in the military, "Hey, Aaron, I'm mowing the yard. My reflux is acting up." My dad is an ex-Marine, by the way. He's still a Marine at 80. I mow the yard, I get my reflux acts up, my heartburn acts up. Okay, what happens when you rest? It goes away. 

Cynthia Thurlow: [00:38:24] Hmm. 

Dr. Aaron Hartman: [00:38:25] If you start mowing the yard again, what happens? It pops back up. Can you get that looked at today? Went to his doctor, had an EKG, had a stent put in that night for a 99% blockage. You probably heard the story before. 

[00:38:39] Our country is the best in the world. If right now, I need to get a life-saving stent put in, I need to get thrombotic therapy for a clot, I can get done three hours right here in good old-fashioned Midlothian with my local community hospital, St. Francis. That's amazing.

[00.38:53] But for other stuff, chronic care stuff, engaging the system has risks. I think people don't appreciate those. That's where I think working with the provider, working with someone who respects. Our system is amazing in some things, and some things our system potentially is the number three, maybe higher cause of death in our country. I think that why can't we talk about both of those, why can't we have both? It's weird how everything's become politicized and everything's become like, “You're anti-medicine guy.” I'm like, “No, I got three board certifications. I'm a medical doctor. I'm pretty legit. I'm not anti-science. I'm pro human, I'm pro people, I'm pro patient.” And that trumps everything.

Cynthia Thurlow: [00.39:33] And that's the distinction, is that sometimes when we are in the system, we forget we are looking at people. And those people have vested interests in making sure they get to go home. I think the other piece of it is, and I would be the first person to say this, my husband got mediocre care in one hospital, better care in another. But we could make an argument, given the fact he had tuberculosis and was on a transplant service, which-- 

[00:40:01] That's a whole separate conversation. But I think in many ways, for each and every one of us, we want to know we've got a quarterback. We want to know we have a health care provider that is looking out for our best interests, so that we can navigate the system. I say that objectively, but also personally, having been on the other side last year, when sometimes you lose objectivity, because you're so caught up in the personalization of what's happening to your loved one.

Dr. Aaron Hartman: [00.40:30] There's a reason why I can't see my wife. It's too close.

Cynthia Thurlow: [00.40:33] Yeah. No, no, no. My husband kept saying, “I don't need a primary care provider.” I was like, “Yes, you do, because I can't be your primary care provider over diagnosis.” So, I mentioned the screening piece. And yes, it's important for us to, whether it's getting a colonoscopy or mammography or whatever it is that we're supposed to be looking for, how does over diagnosis complicate this system? Like, where is the happy medium of figuring out-- What is appropriate screening for that patient as opposed to applying it to everyone in a society?

Dr. Aaron Hartman: [00.41:08] The over diagnosis thing, it's tricky, because it's how we get paid. Every diagnosis, every ICD-10 code is weighted. When I put them in the EMR, I'll get a 0.3, I'll get a 1 point, I'll get a weight. That weight means if I put a billing code with it, I'm justifying my-

Cynthia Thurlow: [00:41:25] Existence.

Dr. Aaron Hartman: [00:41:25] -existence pretty much at my RVU value, because it's not based on how many patients you see, it's how many RVUs. You have this system that economically, the more diagnoses, the better.

[00:41:36] I used to work in the hospital for 15 years. If someone gets admitted for UTI, it's like, “No, Dr. Hartman, you want urosepsis.” I’m like, “Change the code, and let's do a 23 hour admit, because this person can actually get out in 24 or 25, and you actually will get more for a 23 hour admit.” 

[00:41:56] There's specialized nurses who literally, that's all they do in the hospital. I'm just trying to take care of people. So, I'm like, “Just put in my chart, take care of it.” whatever. But the system's actually driven by that. And so, you might have someone come in with a list of 30 diagnoses. And sometimes these lists are like, “How can one person have this much stuff?” But then, when you start thinking about things functionally, you're like, “You've got high blood pressure, you're diabetic, you have high cholesterol, you have osteoporosis, and you got gout, and you've got kidney stones.” It's like, “Hmm, those all can fall under metabolic syndrome,” which is a mitochondrial issue. So, “What's your nutritional status? How many nutritional labs have you had, fatty acid labs have you had?” The answer's none.

Cynthia Thurlow: [00.42:34] Yeah.

Dr. Aaron Hartman: [00.42:35] And so, all of a sudden, these five or six diagnoses are some basic foundational things. What's the code for this over here that pays? The answer is not really a good one. Then what's the specialist? I have a specialist for blood pressure, and cholesterol, and gout, and rheumatoid, and all these things. But what's the specialist for this? That's where it's extra training, which by the way is not recognized by insurance companies. So, you won't get paid for anything you do with that board certification or extra training.

[00:42:59] If you have a malpractice thing and go before the state board of medicine, they'll be like, “What approved diagnosis?” Dr. Mark Houston, who wrote the textbook of vascular biology-- He's at Vanderbilt at the-- That's what he does, you know? But in court, does that hold up? No. That part of the training, it's so amazing is like, the people we learn from. Dr. Fasano, who discovered how celiac disease discovered zonulin, he's up at --

Cynthia Thurlow: [00.43:25] People thought he was crazy.

Dr. Aaron Hartman: [00.43:26] Well, even Dr. Marshall. This is a great example. Dr. Marshall. Brilliant segue. So, this is a GI doctor in Australia who said-- One day he's like, “I think maybe bacteria might cause stomach ulcers.” “You're crazy. There's no way.” Ostracized. So, what'd this guy do? He found this thing, he cultured it, and he scoped himself first, which is--

Cynthia Thurlow: [00:43:50] Impressive.

Dr. Aaron Hartman: [00:43:50] I know. [chuckles] He swallowed it, started feeling sick, scoped himself again, stomach ulcers, gave himself an antibiotic. How many years later? He got the Nobel prize. And now, we know that stomach ulcers are actually caused by a bacteria, Helicobacter pylori. A surgical procedure, a vagotomy, which used to be done often. Actually, we'd send patients to Hopkins, because they had that big center there who'd specialize in doing that thing.

[00.44:13] No one knows how to do it anymore, because they don't do it anymore. But he was ostracized, he was ridiculed, and now-- Everybody knows that there's a bacteria that causes this. So, that happens all the time. It's happening now. And so, part of this whole thing is like, when I see people like, “What's being missed? What's the blind spot? What is the thing that 20 years from now Aaron will be like?” “Oh, my gosh, I can't believe.” It's amazing if you practice like that and think like that, you'll see so much stuff.

Cynthia Thurlow: [00.44:41] Many healthcare professionals have a fear of being sued, and that oftentimes is what drives over screening, over diagnosis, too many procedures. You talk about in the book The Liability Trap.

Dr. Aaron Hartman: [00.44:58] Yeah.

Cynthia Thurlow: [00.44:58] Help listeners understand how that is affecting medicine significantly and profoundly. I know in cardiology, when I had students with me, I used to tell them especially if we were in clinic, I was like, “What are the three things if someone comes in with chest pain that you have to rule out, that you can comfortably go home and sleep at night?” 

[00:45:19] We would talk about this because I would say, “If you miss one of these, the patient will die.” And that is at least how I would encourage my students to be thinking proactively. But in many ways, it's that mindset that in many ways is encumbering the system and making it challenging to practice within.

Dr. Aaron Hartman: [00.45:39] Yeah, I learned in 1996 that every patient is a potential lawsuit.

Cynthia Thurlow: [00:45:43] Yup.

Dr. Aaron Hartman: [00:45:44] And so, back while I was doing my ER rotation, I had a young lady come in with abdominal pain. Went and pushed on her. In family medicine, we learned how to do a clinical exam. We learned, if you push it, no rebound, no Courvoisier sign, no fever-- It's not appendicitis. I would go present to the ER doctor and he's like, “So, you can do a CAT scan?” Like, “Why don't I do a CAT scan?” She's like, “Okay. Student Dr. Hartman, we're in court now. I'm the judge. This patient, young lady, was concerned enough about her health to come to your institution at a Friday night at 11 o'clock for her abdominal pain, and you didn't order any testing, you didn't do a CAT scan, you didn't do an ultrasound. Why? Then you're like “The, the, the, the--” [Cynthia Thurlow laughs]

[00:46:30] And you're like, “Okay, I'll go in and get CAT scan.” Feels normal, she went home. Why was he framing it like that? Because the medicolegal. And so, there's that aspect. There's also the aspect that if you come to me, I give you medication. Like, how many physicians have been sued for giving someone Vioxx and having a heart attack? The physicians weren't sued for that. How many physicians have been sued for giving patients birth control pills? They get a clot, they get DVTs. You don't. Because the liability is off. But if you don't give someone a medication, you don't treat something and they have a bad outcome and you get sued.

[00.47:00] And so, all of a sudden, there's this impetus to over test, to not miss stuff and over diagnose-- If you go get a colonoscopy, it's accepted. You have a punctured bowel? Well, that's an accepted risk. I miss a colon cancer? That's an unacceptable risk.

Cynthia Thurlow: [00.47:17] Let's make sure we at least touch on the triangle of health for you. When you're talking to your patients, when you're talking about options of an approach to lifestyle as medicine-- Let's unpack this, because I think this is applicable for most people listening. These are things that are very important that do have a large in an impact on your health.

Dr. Aaron Hartman: [00.47:39] So, it's something I developed, because you'd see patients, complicated issues come to you, and you create this massive protocol. It's complicated. People get confused, right? And then, you walk this process and people get stuck, like, “I'm not healing. I'm a little better. I'm 20% better. My A1C is a little better. I've lost a little weight.” Where are people getting stuck? Where are people's leverage points? Where are the places that if I focused on them, and find, and just really hammered them, that I'll get 80% of the outcomes, okay?

[00:48:05] Or, when people are going through the healing process, they get stuck and they don't go past that. That's basically your gut, stress, and sleep. So, your gut is this big world. Yes, it includes fancy data and PCR and microbiome testing, all that stuff. But guts also, like, what you eat, which can be as really super complicated. Or, it could be simply just eat real food, unprocessed, mostly plants, however you want to say that. But gut health is a lot of different things.

[00:48:32] Stress. There's stress like, “Hey, I'm stressed, we're all stressed, et cetera, et cetera.” But I look at it as different levels of trauma. Your T trauma, t trauma. So, if you had a MACE event, Major Adverse Childhood Event, then that's going to set up your nervous system and your immune system, the whole psycho, neuro, immuno, gastro, endocrinology thing. You see, your brain controls all those fancy things. Or, it could be the trauma or stress of a kid with health issues, a special needs kid. Every mom of a kid with special needs I've seen has trauma from that kid.

Cynthia Thurlow: [00:49:03] Of course.

Dr. Aaron Hartman: [00:49:04] Almost dying multiple ER visits. I also see this with people caretaking for an adult parent with Alzheimer's dementia. So, looking at how that impacts someone's health is huge, and there's so much you can do for that.

[00:49:16] And then sleep. It's when your body heals, it's when it repairs. There's an epidemic of insomnia. Maybe not insomnia, but sleep deficiency in our country. The average American is getting six or six and a half hours of sleep a night. When you're adult, you need eight hours. That's only two hours. But if you're a kid in first grade who needs 10 to 12 and you're like getting the school bus, getting to school, then all of a sudden, it's like kids are getting sleep deprivation from a young age. And so, those are three things I found that have a massive impact on people's health, that if we get those right, a lot of our things will fall into place.

Cynthia Thurlow: [00.49:51] I'd love for you to just wrap the conversation up today addressing the trauma piece. Because I've learned a lot through you, and I think that there are a lot of women who perhaps very high functioning. They maybe didn't experience T trauma, which is what I was taught, “That's trauma.” So, I was like, “I haven't had any trauma in my life.”

[00:50:11] I think for a lot of individuals, when they start to look at, maybe their internist, their primary care provider who is encouraging them to walk through the adverse childhood events scoring which you can get online, which is accessible to everyone and they find out, “Oh, yeah, I have experienced quite a bit of adverse childhood effects.”

[00.50:29] From your perspective, when you're doing these deep dives, you're spending an hour and a half, two plus hours onboarding new patients, or you're looking at middle-aged women who are coming in, who are perhaps struggling with a multiplicity of constellation of symptoms that so many of us do. What is your approach that you take around these kinds of conversations? Because I would imagine for some people, they may not be ready for those conversations.

Dr. Aaron Hartman: [00.50:56] Most people as of now that I meet aren't quite ready for the conversation. Because you're a strong person, you're a strong woman, you can do it all, you're a professional, you can run three businesses and have a family and navigate all this. “What do you mean this event that happened to me 20 years ago?” No way.” “What do you mean about the stress of this kid who almost died two years ago?” “What do you mean?”

[00:51:20] So, part of it is just like I collect the history and I write down the things that mean things for me. As you know, when I look at people's charts, I can scan on the left side and I'll sometimes pop down, jog my memory, what happened to you when you're a kid, right?

[00.51:33] We'll go through the process. Sometimes it's three months in, sometimes it's six months in, sometimes just three years in, four years in, where someone's like, “I think, we've been doing this. There's no mold, there's no Lyme. “Dah, dah, dah, dah, dah. “My hormones look okay on lab tests.” [Cynthia Thurlow laughs] “I still feel horrible, but my labs look great.” “My core is still jacked up. Is there unresolved trauma?”

[00:51:55] I had one patient. It was really interesting. She was in her 80s. I've been talking to her. She had issues with her mom. Mom was dead, and so it was funny. For some reason, that point in time. I was watching Dr. Phil for a little bit. I had a Dr. Phil moment there and I said, “What you need to do is you need--" Her mom was buried in Florida. “You get in your car, drive to Florida, go to your mother's grave.” 

[00:52:18] Maybe Dr. Phil wouldn't say all this, but that was my interpretation in my younger years. “You need to curse at your mother, tell her everything she did wrong. You need to forgive her.” She had no problem with the first two. It was a forgiveness that, she was like, “No, I can't do that. I can't do that.”

[00:52:32] Eight months later, I saw her, and she came in and she was totally different. She was bright, she was happy. She was a different person. She's like, "Dr. Hartman, I did it." What she told me she did, "I forgave my mom." She didn't tell me she went there and cursed her and told her that. She's like, “I forgave her.” She's in the late mid-80s. It's like she was 82 or 83 at that point in time.

[00:52:51] And so, it's amazing how just a difficult childhood, and how you could hold that for your entire life. And so, it could be forgiveness. It could be meditation, it could be prayer, it could be EMDR, it could be tapping, it could be somatic work. I have like this handout that I probably sent you before [chuckles] that has all these things on there. It's like a buffet of what resonates with you. Some people, prayer resonate with them. Some people like, “I am so wired. I need technology.” And so, maybe you do neuro biofeedback. Maybe you do tapping EMDR. There's so many things that can help just calm and rewire your brain. But it becomes a big deal. It's crazy, crazy common.

Cynthia Thurlow: [00.53:24] Well, it's interesting that the power of forgiveness is not about them, it's about you. I think for so many people, it is so important to give yourself that gift. I mean, listeners know the whole story with a lot of the things about my father. But the reason why I was at peace when he died was because I had done so much work to forgive him. 

[00:53:48] In the last moments of his life, I think in many ways, it was some type of an understanding between us both where we were like, “There's been a lot that was not ideal, but in this moment, I'm doing everything I can to forgive you, send you to heaven or wherever else you're going, and do so in a way where you're at peace and I'm at peace.”

Dr. Aaron Hartman: [00.54:08] Yeah. But it's a big thing. It's common and it happens at every age. And so, if someone's listening to this, and they're stuck in their healing process and they're having their hormones checked, and “I can't even get them right. I can't ever get my thyroid right. My gut's all is off.” Like, I've been all the people, even the functional-- This is something that a lot of the functional people miss, because it requires a different level of intimacy with your patient.

Cynthia Thurlow: [00:54:32] Correct.

Dr. Aaron Hartman: [00:54:32] Almost vulnerability with a doctor. Because it's not a scientific. It's not as fancy.

Cynthia Thurlow: [00:54:37] It's feelings.

Dr. Aaron Hartman: [00:54:38] It's not as like, “I read this new article and five new textbooks” thing. It's for many reasons. It's something we neglect. If your body's going to self-heal and self-repair, if you don't, your nervous system, your spirit, soul, body like aligned, which sometimes sounds, can't believe I'm saying that sounds -- It's going to affect how your body heals.

Cynthia Thurlow: [00.54:55] Absolutely. It's interesting. Last night, I was having a conversation with a fellow Nurse Practitioner Heather Quaile. We were talking about how in many ways we're so grateful that perimenopause, menopause is having this incredible moment. There's a lot of awareness, a lot of money being spent on better understanding women at this time in their lives. But I said, we are oversimplifying things by just making about replenishing hormones. And to your point, it is a lot harder to deal with the internal work than it is to just slap a patch on. But equally important.

[00:55:27] Please let listeners know how to connect with you outside the podcast, how to get access to your new book. There's a ton of content in this new book. We touched on about a 10th of it. Thank you for writing this. I really enjoyed reading, and I know it's going to help a lot of people.

Dr. Aaron Hartman: [00.55:39] If you want to learn more about me, there's aaronhartmanmd.com, which is my website. And that takes people to my website for my practice, my podcast, my blogs. I'm really big in education, so we have over 300 blogs. We have so much information. As far as the book, it's uncurablebook.com. It's basically my story of interacting with healthcare system, what happened with Anna, and my development as a person, how she's progressed. Spoiler alert, she's turning 20 next year, and will be probably my first child moving out of the house.

Cynthia Thurlow: [00:56:09] Wow.

Dr. Aaron Hartman: [00:56:09] So, she's come a long way. The point of the book in my mind is like, if this little girl who was exposed to crystal meth has stroke before she was born, was born functionally blind, if she can do it, you can do it, too. It's like cool stories, her story, but also it's supposed meant to be inspiration to people that you can do this, too. It's a journey, but you can do it.

Cynthia Thurlow: [00.56:31] Well, when I read the book, I wanted to text you, but I didn't want to text you and Becky on a weekend, but I was like, “What an incredible story.” I don't think I fully appreciated and understood the journey that you all have been on. But thank you for what you do.

Dr. Aaron Hartman: [00.56:43] yeah. Thanks a lot. Appreciate it.

Cynthia Thurlow: [00:56:44] You're welcome.

[music] 

Cynthia Thurlow: [00.56:47] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.

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