The Top 5 Ways Andrew Huberman Changed My Medical Practice

From the door of my busy primary care practice I can walk to multiple Microsoft, Google, Amazon and Meta offices. And the people are back in the office.

This means my practice, in comparison to most primary care offices is full of young people. Well educated, high earning and technically proficient people who are no stranger to problem solving -- and what is the common approach to problem solving? Well, I'm sure it varies but undoubtedly a "data-driven" approach is as the heart of any problem solving strategy.

In the exam room, when gathering history, evaluating and then discussing a treatment plan for any given complaint I will often hear the request to gather more data.

X-rays. Blood work. CT scans. Urine tests. MRI scans. Hormone testing. DEXA scans. Colonoscopies. Echocardiograms. ECGs. Stool tests. Mammograms.

The training approach, entrenched methodologies and ethos in the art and application of the practice of medicine is very different from the journey that brings a person to being a top performing computer scientist.

Many of my patients are listening to a relatively new cadre of voices in the medical-media-blogosphere. Andrew Huberman, Dr Peter Attia and Tim Ferris, to name a few.

Here are the top 5 ways this new perspective of medical care and health optimization has changed how I practice medicine.

Number 5

With most other lists and thoughts on the overall state of healthcare here in the US one might see this particular thought much higher, here it serves as an underpinning of what may be a revolution in how medical care is delivered.

Our current system is broken and the foundations have been eroding (this is too passive of a take -- I should be more specific in preaching in no uncertain terms, that the wolves are in charge of the hen house and there ain't many hens left. Profit driven policy, railroaded through CMS and the other legislative bodies by industry pundits leaves all of us in peril when it comes to accessing basic care in an an affordable and time sensitive manner) and the structure is in danger of being condemned.

While the medical offices continue to be woefully understaffed, I'm spending more and more time with paperwork and "scut" work while I'm continuing to still see patients with any and just about every complaint one can imagine -- from potentially life and limb threatening conditions to spending 20 minutes reassuring someone they are not at death's door.

In the past few years, however, I'm having patients seeking guidance in how to optimize their health in ways beyond what I can provide -- beyond how my medical training taught me. They want to know how to maximize their physical, cognitive, emotional and of course, sexual performance. While there are doctors who specialize in these things, they are generally not at the local publicly owned hospital group -- which is where I work.

While anatomical, physiological and metabolic basics are known to me, I don't have the training, the time or even the ability to charge private insurances for a program like this. And, billing private insurance companies and Medicare or Medicaid is the only way I can generate income outside the random self-pay patient.

The 5th most impactful way Andrew Huberman has changed my medical practice is allowing me to see, even more vividly than before, that our approach and healthcare delivery system is woefully outdated and has been taken over by ruthless wolves.

Number 4

It hasn't been but a couple of years yet, but I remember the first time I recommended a patient listen to a podcast for help with a medical issue and it was the Huberman Lab Podcast. The Podcast has had some good advice, which is based in science, for simple ways to help with everything from anxiety and panic attacks, to how to maximize sleep and even how some drugs work -- namely stimulants used to treat ADD/ADHD.

One aspect that I take pride in in with my practice is being able to communicate complex physiology, pathology and even pharmacology mechanisms in an understandable ways. Andrew Huberman is also very good at this and when I have 7 minutes with a patient, I'm thankful that there is a resource that can provide some help and that I can trust to be scientifically valid.

The 4th most impactful way Andrew Huberman has changed my practice is by having a podcast that I feel comfortable (as of now) recommending to patients.

Number 3

I am a DO (Doctor of Osteopathic Medicine) but, I don't think my practice would be tremendously different had I gone to an MD school. Many of my patients seek me out because I am a DO. Now, this is a difficult thing to determine, as we have no idea where the road untraveled would take us and so, maybe I would be a very different doctor if I were an MD.

I do occasionally implement OMT (Osteopathic Muscular Treatment) in the exam room, usually to quite down an angry muscle. This is not in anyway a major part of my day-to-day but perhaps because I have this extra tool in the toolbox to help treat people, I'm more open to other ideas that may have not gone through extensive, triple blinded, peer reviewed studies in treating people.

As a side note -- I will forever be fascinated at the idea that it has been well established that we as human creatures, will still have benefit with a placebo treatment, even when we know it is a placebo. We're just cortex heavy animals at our core and we all seek comfort in the way we know. Perhaps I should be approaching certain treatment options with less truth in terms of what kind of benefit it will impair but instead reassure the patient this is definitely the salve for their ache. Placebo based practice kind of sounds fun.

There are techniques for breathing, gaze placement, mental tools and much more, much of which isn't his original research, but he has been the catalyst for many of these tools to be brought to my awareness and patients want my input on these approaches.

The 4th most impactful way Andrew Huberman has changed my practice is by bringing non-pharmacological treatment options for panic and anxiety which, verily I say unto thee, the frequency in which I discuss these topics is frighteningly high and seems to be worsening.

Number 2

A patient came back to the clinic after about 3 years and I had only seen her that one time. In reading my note from our first visit I saw the she had asked for an order for a whole body MRI and to do VO2 testing to help guide her in her athletic endeavors. I try to get patients to understand that these are things that insurance companies will not pay for, especially when done outside of illness or disease.

The Andrew Huberman and similar podcasts will tout the benefits of various types of imaging and blood tests which, understandably so, are things that I'm then asked to order. Some I can do, and some are just not feasible with my current role.

It turns out the patient hadn't heard of the relatively new full body MRI scanning venture, which is a cash situation where $2500 buys you a scan which, if there is any concerns found, you then take to a guy like me and we figure out which is in need of further work-up and which is not. She did, however, get her V02 max done and a DEXA scan and it was helpful in achieving her goals. She paid out of pocket.

The 2nd most impactful way Andrew Huberman has changed my practice is by having to disappoint patients more frequently than even before by informing them insurance won't pay for much of the testing they desire.

Number 1

And the most impactful way Andrew Huberman has changed my practice is by allowing me to see beyond our current system of healthcare delivery.

I can manage diabetes, hypertension and hyperlipidemia at this point, and I do, all day most every day. The 7 minutes I get for a follow up discussion for a recently elevated A1c and LDL does not allow for a nuanced discussion of lifestyle changes. It doesn't allow for much other than me feeling pressure to meet the metrics that say I have to get this A1c under 7% and that they should be on a statin as the guidelines state. In fact, there are all sorts of metrics that if I don't meet on an annual basis, I have money taken from me. If not enough of my patients over 65 years old haven't had their pneumococcal vaccine, I have money taken from me. If not enough of my patients have head a pap-smear, I will have money taken from me. This dynamic puts doctors, at times, at odds with their patients. I will allow that usually these patients should have these things done. However, putting the responsibility of a patient's behavior on the physicians shoulders and having it affect compensation has been recognized as a tragedy all around by those who are paying attention. It erodes the patient - doctor relationship.

There is not a situation more egregious than having patient satisfaction scores affect a physician's pay -- I'm in the business of giving bad news and trying to talk people into changing their behavior in ways that they often don't want to do. I'm tasked to be a steward of antibiotics and giving a Z-pack for what is clearly a viral upper respiratory infection makes some patients happy, but is harming them and all of us in the long run. The pressures to perform more testing and prescribe medications un-necessarily is high when a doctor's pay is tied to what is in essence their Yelp review.

Medications are a tool. I try not to be a tool when recommending medications. Some doctors will actually hand a patient a prescription written out with the amount of exercise they should be doing in a week. Some people should absolutely be on a statin -- many people are in grey areas where time has to be taken to better understand their family history, resources used for more testing so a more data-driven decision can be made. CT scans showing how much calcium is in the coronary arteries, for instance, is quite helpful and many times insurance companies will not pay for this test when I would like to have it done. Genetic testing holds promise in terms of how aggressive one should be in treatment approach to mitigate any given risk.

I don't hold out much hope, at this point for the healthcare system in this country to turn around and become a better situation for the patients and those who are engaged in direct patient care. It will continue to get better for the MBAs and C-suite crowd who are now squeezing blood from a stone.

However, I can only control what I can and I'm looking to join the voices of reform and who are plotting to kick the wolves out of the hen house.

On a personal level, I identify with Andrew Huberman, PhD in that we share a background in skateboarding. We are roughly the same age and his experiences and impressions from 90's skateboarding feel like my own. The path to becoming a PhD and having his own laboratory and professorship at Stanford University mirrors my own in terms of length and intensity. While I was never a skateboarder of any note or success, the lessons gained from efforting to be such a skateboarder provide the resilience and at times, raw stubbornness to achieve the goals I set forth for myself. Andrew Huberman has said the same on many different podcasts.

A mindset that allows the throwing one's self down a stair set over and over is surprisingly similar to persevering a 36 hour shift in the hospital while trying to figure out how to keep patients alive. I will always be thankful for what ended up being mental fortitude that was shaped in the kiln of the skate-rat years of my youth.