Something You Should Know - What’s Wrong With Healthcare & How Restaurants Work and Why So Many Fail

Episode Date: February 2, 2023

How can dirt be good for you? This episode begins with the proven benefits of playing in the dirt – or even gardening if that is more your speed. https://loganhailey.medium.com/can-you-actually-get-high-on-soil-use-dirt-to-elevate-your-mood-8680d3eb8e00 Healthcare is big business. And as you may have noticed, doesn’t always seem to work so smoothly. What’s wrong with it? What are patients complaining about. More importantly, how can you make it work right for you? Dr. F. Perry Wilson studies this and has some fascinating insight into the workings of the healthcare industry and how to navigate it so it works for you and your family. Dr. Wilson is a nephrology and internal medicine specialist and is on the faculty at the Yale School of Medicine. He is author of the book How Medicine Works and When It Doesn't: Learning Who to Trust to Get and Stay Healthy (https://amzn.to/3iZcb2F). The restaurant business is fascinating. It is also a very difficult business to be in. After all, most new restaurants fail within a few years. So what is it that attracts people to that business? How do successful restaurants operate? How can you get a table when a restaurant is packed? Here with the inside scoop on the restaurant business is Michael Cecchi-Azzolina who has worked in the New York restaurant business for many years and is author of the book, Your Table Is Ready: Tales of a New York City Maître D’ (https://amzn.to/3kKzTQG). Your dog probably hates it when you leave your home without him or her. Separation anxiety is a real big deal for a lot of dogs. Listen as I explain why this happens and what you can do to reduce the anxiety Source: Marty Becker DVM author of From Fearful to Fear Free (https://amzn.to/3JjjEnP) PLEASE SUPPORT OUR SPONSORS! Packed with industry-leading tools ready to ignite your growth, Shopify gives you complete control over your business and your brand without having to learn any new skills in design or code. Sign up for a $1/month trial period at https://Shopify.com/sysk to take your business to the next level today! Stop throwing your money away. Cancel unwanted subscriptions and manage your expenses the easy way by going to https://RocketMoney.com/something ! With With TurboTax, an expert will do your taxes from start to finish, ensuring your taxes are done right (guaranteed), so you can relax! Feels good to be done with your taxes, doesn’t it? Come to TurboTax and don’t do your taxes. Visit https://TurboTax.com to learn more. Intuit TurboTax.  Did you know you could reduce the number of unwanted calls & emails with Online Privacy Protection from Discover? - And it's FREE! Just activate it in the Discover App. See terms & learn more at https://Discover.com/Online Learn more about your ad choices. Visit megaphone.fm/adchoices

The search for truth never ends. Introducing June's Journey, a hidden object mobile game with a captivating story. Connect with friends, explore the roaring 20s, and enjoy thrilling activities and challenges while supporting environmental causes. After seven years, the adventure continues with our immersive travels feature. Explore distant cultures and engage in exciting experiences. There's always something new to discover. Are you ready?

Download June's Journey now on Android or iOS. Today on Something You Should Know, why we should all go play in the dirt as often as possible. Then we'll explore the inner workings of the healthcare system and discover why it is sometimes so hard to navigate. One thing that may startle people is that 70% of physicians in the United States are employed by a healthcare system. In other words, they are labor, not management. That is a major shift from when the vast majority of physicians were in private practice. Then why dogs hate it when you leave home without them. And a peek inside the

fascinating world of restaurants. How they work, why they fail, and how to get a table in a crowded one. Good maitre d's always have a table in their back pocket. There's always a way to find something. So if George Clooney calls and says Amal and I want to come in for dinner tonight, do you have a table? Yes, you're going to say yes. You're not going to say no. All this today on Something You Should Know. Bumble knows it's hard to start conversations. Hey. No, too basic.

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Download Bumble and try it for yourself. Something you should know. Fascinating intel. The world's top experts, and practical advice you can use in your life. Today, Something You Should Know with Mike Carruthers. Hello there. Welcome to Something You Should Know. When was the last time you got dirty? I mean, really down in the dirt dirty. I ask because it seems that playing in the dirt is really good for your mental health as well as for your kids' mental health. And if playing in dirt maybe sounds a little gross to you, gardening can do the same thing. Researchers

have found that dirt is a natural mood booster. There's good bacteria in there that acts like an antidepressant once it gets into your system. Being in dirt is a scientifically proven way to boost serotonin and dopamine levels while lowering stress and improving your quality of life. There's even evidence that the smell of soil microbes can make you smarter. Before modern conveniences, planting and foraging and hunting in order to survive kept our dirt exposure level high, and most of us could really benefit from getting a little dirty once in a while. Some experiments with soil bacteria have found that it's just as effective as antidepressant drugs. It can also improve your immunity levels along with physical and mental stamina.

And that is something you should know. My sense is that you could ask just about anyone if they have some complaint or frustration or distrust about their doctor or some aspect of the health care industry, and you would hear yes. And you would probably get a story to go along with it. And the fact that there is trouble and distrust between patients and the medical profession has not gone unnoticed by some people in the medical world. One person in particular being F. Perry Wilson. Dr. Wilson is a nephrology and internal medicine specialist. He is on the faculty at the Yale School of Medicine, and he's author of a book called How Medicine Works and When It Doesn't,

Learning Who to Trust to Get and Stay Healthy. Hi, doctor. Thanks for being here. Thanks so much for having me. So as someone who studies this, is there really a problem here? Is this a perception problem or is the system working okay? I think it's pretty clear that it's not working okay from a variety of angles. The major issue that I see is really far-reaching, and that's the loss of trust between public and people who practice medicine, which includes doctors, nurses, and other practitioners. This has been going on, obviously, for a while.

I think a major culprit has to do with the healthcare system itself and for-profit insurance companies and whatnot. But it really has accelerated in the social media age for a variety of reasons. And what we're seeing is a lot of mistrust and doubt and outright cynicism with regards to medicine. And that can be bad for people because it can lead them to make bad decisions for their health. Is that mistrust warranted or not? Well, it depends who it's directed to. I think having a healthy amount of skepticism towards your health insurance company or even

large healthcare systems that are being run not by doctors and nurses and people who provide healthcare but by business people, we can view them skeptically, and we should. And we should seek some reforms there. I think the problem is that that skepticism, I should throw in pharma there as well, gets translated, it trickles down into the doctor-patient relationship. And part of what it's so important to realize for doctors and patients, I tell both my students this in the medical school and my patients this, is that we are on the same side, not just against disease, which is our major battle, but honestly, we're on the same side against the healthcare

system too. Well, see, that's where I think people get confused, where I get confused. You say that you, the doctor, is part of the fight against the medical system. But in my view, you are the medical system. You are the face of it in many ways. So how, explain that. One thing that may startle people is that 70% of physicians in the United States are employed by a healthcare system. In other words, they are labor, not management. That is a major shift from what it was like just 50 years ago when the vast majority of physicians were in private practice. They were small businesses. It allowed them to have a lot of control over their life and to make choices about what they wanted, how much time they needed to see a patient and all those kinds of things. 70% of physicians are not in that position anymore. Their schedules

are dictated by management. Their metrics are being tracked by management. And that is part of the major reason why you're getting rushed through your doctor's appointments. You're, you know, feel like you only had two minutes to speak to the physician. It's not because they don't want to talk to you and they don't want to hear about your problems. It's because they're not in charge anymore. And that's a big problem. So what changed? Because being in private practice obviously used to be a pretty good thing for doctors. Now it isn't. So why isn't it? What changed? There are a lot of causes here, but I think it just got too complicated for an individual physician to charge for their services. Back before the age of the

big insurance company, this was people paid the way they could pay. Physicians running their own practices would have sliding scales for patients. You've got a lot of stories of the small town physicians who were seeing patients for a dozen eggs and things like that. It was a lot more flexible. Once you have insurance companies in the mix, you've got individual physicians who need, in theory, to negotiate their prices, their rates with every insurance company in their area, lest that insurance company not allow their patients to see that physician. That administrative overhead is incredibly hard for a single practitioner to deal with, which is why another startling statistic, for every physician in the United States, there are 10 healthcare administrators. There are 10 people that that are needed to keep the system running, which speaks to how much bloat there is,

how much inefficiency there is, and why costs are so high. Physicians are trapped in this just like patients are. Part of what we need to do, again, is just realize that we are on the same side. If we start really working together and advocating for each other, we can actually make a difference. One of the things about this issue that I find particularly interesting, and it's a change that I've seen, is that when people go to the doctor today, they want something. They don't want to hear, you're fine, don't worry about it, or take a few days off and rest. Everything will be fine. They want a pill. They want a specialist. They want something else beyond just reassurance that everything's OK. And so doctors give them something. They you know, they give them pills. They give them. And that that's not helping this whole process.

Yeah, it's a major problem problem and i can say that in medical school you know we're sort of taught that way i i have old notebooks from medical school where i literally had you know the the disease name on one column and the drug name in the other column you know literally if this is the disease then this is the drug if this and you know i memorize all that to take some tests so there is that on the doctor's side. And of course, on the patient's side, there's this, like we all have, there's a desire for quick fixes. I think it's very natural for people to search for quick fixes in all aspects of their lives. But if we, you know, if we look deep within ourselves, we know that those quick fixes we've tried in the past are rarely very successful.

And I'll tell you what's really, you know, where quick fixes we've tried in the past are rarely very successful. I'll tell you what's really where doctors are missing the boat today. If you look at the number one cause of death in people in what you call the prime of life, ages 30 to 60, should be doing very well, healthy, et cetera. The number one cause of death, suicide, alcohol abuse, drug abuse. These are the so-called deaths of despair that you may hear about. Is there a pill that's going to stop that process? Is there something I can write a prescription for and you take it once a day and you're not going to have those suicidal thoughts? You're not going to be abusing alcohol, drugs?

There isn't. What the underlying problem there, and in my opinion, is this increasing social isolation and loneliness that's been brought about in the modern age. I bet you, when you do see your doctor, he or she does not ask you if you're feeling lonely. Actually, that is a really important question. The fact that doctors and traditional healthcare providers are missing these important questions and focusing on what's your blood pressure and how do we get it lower means they're missing an opportunity to help an awful lot of people. And we need to educate them to that effect as well. But what would a doctor say? If you had a patient come in and you said, are you feeling lonely?

And they said, yes, there is no pill for that. So what would you say? Go get a friend. I mean, what would you say? Yeah, honestly, there is no pill for that. But believe it or not, you can write some instructions down on a prescription pad. This has been well studied. You can write instructions down on that prescription pad for non-pharmaceutical

interventions. This was done systematically over in Britain. So people will get a prescription to go to a spin class, a prescription to join a pottery group, a prescription to go to your local book club at the closest bookstore. And patients will do that. There's something about the sort of, maybe it's the authority that comes from that magical pad or what, but they will do that in much higher numbers than just sort of saying, well, why don't you put yourself out there?

I think the other thing doctors need to do in the social media age is to make sure that the social connections our patients are seeking exist in reality, are with real people. There's this tendency – we're all sitting in front of our computers a lot of the day – there's a tendency to build relationships online. Those relationships simply don't provide the sort of emotional nourishment that in-person relationships do. And, you know, for some people, believe it or not, I'm something of an introvert myself. And for some people, getting out there is a little bit hard, and they need that extra encouragement. Sometimes that can come from a

physician. We're talking about the doctor-patient relationship and how to navigate the healthcare industry. My guest is Dr. F. Perry Wilson. He's on the faculty at the Yale School of Medicine and author of the book, How Medicine Works and When It Doesn't. At Wealthsimple, we're built for whatever you're building. Built for Jane, who wants to break into the housing market. We're built for Ted, who's obsessed with what's happening in the global markets. And built for Celine, who just wants to retire and explore the world's flea markets. So take a

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If you look at survey data, most Americans at least rank our healthcare system quite terribly. They're very unhappy with the healthcare system. Most rank their personal physician, if they have one, relatively highly. So that one-on-one relationship still exists. Now, a lot of people don't have a primary care physician. Even people who have insurance, it can be difficult to find one. It can be difficult to make time to see them in various office hours. And so I think developing those relationships

and supporting primary care physicians as the sort of entryway and the signposts for the health care system is really important. They're horribly under-resourced and underpaid in primary care. That said, there is a substantial and growing fraction of society that has been so turned off and poisoned by the excesses of the healthcare industry, of pharmaceutical companies, and of insurance companies that they've thrown the baby out with the bathwater. These are people who get massively amplified online, particularly in social media, Facebook, Twitter, et cetera, and this sort of growing narrative that doctors are part of some vast

conspiracy paid for by pharmaceutical companies or whatever to not provide the best care we possibly can. This has existed for a while. I remember when I was a kid, there's some book called like miracle cures they don't want you to know about. And the they was doing a lot of work there, but it included doctors. I think some grifter who wrote this book,

but this has only increased and particularly in the coronavirus era, in the coronavirus vaccine era. And that mistrust is now seeping down into those interpersonal relationships. And it feels bad. When a patient is in my clinic room and I'm talking about what I think the next best step would

be to treat their kidney disease or whatever they have, every once in a while, I'm seeing them look askance at me. I see that they doubt that I'm necessarily coming from a place that's beneficent, a place that's designed to help them. Doctors need to acknowledge why that is. We're in part at fault for that because of the very things you say, the little amount of time we have, our over-reliance on medications. But of course, patients need to acknowledge as well that in this new information age, you can get some pretty bad information pretty deep in your brain pretty quickly. One of the fundamental changes that I've

noticed in my limited experience with the medical world is that it used to be that you would go to your doctor and say, you know, doctor, it hurts when I do this. And the doctor would say, well, then don't do that. Don't do that. But he would handle it. Now it's let me send you to a specialist. Why? What is that? Yeah, specialty care has exploded. And in part, that is because of the way we pay doctors. We pay significantly more for specialty care. Because of that, doctors in training often choose to become specialists because, you know, you just need to acknowledge that

when you have a choice of professions, the one that's going to pay better can be more attractive. That's human nature. You have a proliferation of specialists and the primary care doctors are completely overwhelmed. They are incentivized to move this case along. Yeah, they've got 10 minutes with you topped. They don't have time to go through this. And they are incentivized to send people to specialists. The specialists themselves are coming to those primary care doctors and saying, hey, I'm great.

You have patients with back pain. Send them to me. There is business here. There's business happening. And that's problematic. Unfortunately, those general practitioners, the primary care doctors are not compensated adequately, in many cases, to do more than just check boxes. Have you gotten your colonoscopy? Is your blood pressure under control? Is your cholesterol okay? Yep, it is good. See you next year.

It's not that they don't want to do more. It's that that's all they can afford to do. Many of these men and women have to see 40 to 60 patients a day to keep their practice meeting the metrics that those MBAs in the C-suite are dictating. Because again, they're not running their own practice by and large. These are employees. These are laborers. And just like a factory, they're being told from on high to churn out more, you know, sprockets from one year to the next. And we really need to start pushing back against that and demanding better for our patients and for our doctors. There have been for as long as I can remember, there have been theories that people have about conspiracy theories about big medicine, big pharmaceutical companies that, for example,

they have a cure for cancer, but they keep it from the public because there's more money in treating cancer than curing it. And they've been around, these theories have been around for a long time, but are they fringy? Are they growing? Are they receding? What? My sense is that they are exploding, to be honest. And there's some good research to actually support this. This is particularly through the coronavirus pandemic. The coronavirus pandemic was terrifying at the beginning, especially as a doctor. I was in the hospital in April of 2020 on a coronavirus ward,

wearing the same N95 mask for two weeks straight. I remind people what it was like back then before we had vaccines, before we had treatments even. I would come home and strip in my garage and then run straight up to the shower to sort of wash off so I wouldn't transmit anything to my family. We were all really terrified. And then, you know, we had these vaccines come out and there was a massive push for vaccination and appropriately, in my opinion, massive push for vaccination. However, the speed with which they came out, which something I viewed as incredibly impressive, if not miraculous, was viewed with great suspicion from large swaths of the country and even divided along political lines, which was really interesting. I hadn't seen that quite as much in COVID. What the research shows is that skepticism

about COVID vaccines and treatments has led people, again, largely via social media, to increased skepticism about all sorts of medical therapies. Other vaccines, absolutely. So the kindergarten vaccination rate for your traditional vaccines, MMR, is the lowest it's been in a couple of decades right now. And that's all just due to kind of add-on effects from skepticism of the COVID vaccine.

Even beyond vaccines, things like cancer chemotherapy, things like what are appropriate diet goals and things like that, all of that is being viewed with increased skepticism. It's almost as if Pandora's box was opened when influencers realized that they could get a lot of clout criticizing these essentially life-saving vaccines online. That market has only grown and I see it expanding and expanding unless we start to ask people to think a little bit more rationally. Is it problematic or a good thing that pharmaceutical companies advertise their drugs directly to consumers?

We're one of the few countries where that's allowed. And is that good that I know what's out there and I can come to you as my doctor and say, well, why don't we try this for my moderate to severe psoriasis or whatever it is? I am really not a fan of direct consumer advertising of these drugs. You know, a lot of times patients come in and they've seen these commercials and they ask if such and such a drug is right for them. And we say, oh, no, because that's not your condition. You don't have this kind of psoriasis. You have this other kind of psoriasis. And it, again, engenders this skepticism.

It's like, oh, I don't know. The commercials seem to say this would be great for me. What aren't you telling me? But honestly, what's worse is the economics of it all. Pharmaceutical companies in the United States spend more on marketing than they do on research and development. They won't tell you that when you complain about the price of drugs. If you complain about the price of drugs, they'll say, oh, well, we need to charge so much for these drugs because it costs

millions and millions, hundreds of millions of dollars to bring a drug to market. That's true. It is hugely expensive to bring a new drug to market. But what they won't tell you is that R&D is only a fraction of what's going on with these drugs. Much more is dedicated to marketing. And a lot of that is direct to consumer marketing in the United States. So those commercials you're watching are increasing the price of the drug that you're taking. Well, I think people will agree that medicine has certainly changed over the last several years and continues to change. And certainly our relationship with the medical establishment continues to change. It's interesting to see from your perspective what's going on.

Dr. F. Perry Wilson has been my guest. He is an internal medicine specialist. He's on the faculty of the Yale School of Medicine. And the name of his book is How Medicine Works and When It Doesn't, Learning Who to Trust to Get and Stay Healthy. And there's a link to that book in the show notes. Thanks, Perry. Thanks, Mike. It's been a real pleasure to be with you. Since I host a podcast, it's pretty common for me to be asked to recommend a podcast. And I tell people, if you like something you should know, you're going to like The Jordan Harbinger Show. Every episode is a conversation with a fascinating guest.

Of course, a lot of podcasts are conversations with guests, but Jordan does it better than most. Recently, he had a fascinating conversation with a British woman who was recruited and radicalized by ISIS and went to prison for three years. She now works to raise awareness on this issue. It's a great conversation. And he spoke with Dr. Sarah Hill about how taking birth control not only prevents pregnancy, it can influence a woman's partner preferences, career choices, and overall behavior due to the hormonal changes it causes. Apple named The Jordan Harbinger Show one of the

best podcasts a few years back, and in a nutshell, the show is aimed at making you a better, more informed, critical thinker. Check out The Jordan Harbinger Show. There's so much for you in this podcast. The Jordan Harbinger Show on Apple Podcasts, Spotify, or wherever you get your podcasts. People who listen to Something You Should Know are curious about the world, looking to hear new ideas and perspectives. So I want to tell you about a podcast that is full of new ideas and perspectives, and one I've started listening to called Intelligence Squared. It's the podcast where great minds meet.

Listen in for some great talks on science, tech, politics, creativity, wellness, and a lot more. A couple of recent examples, Mustafa Suleiman, the CEO of Microsoft AI, discussing the future of technology. That's pretty cool. And writer, podcaster, and filmmaker John Ronson, discussing the rise of conspiracies and culture wars. Intelligence Squared is the kind of podcast that gets you thinking a little more openly

about the important conversations going on today. Being curious, you're probably just the type of person Intelligence Squared is meant for. Check out Intelligence Squared wherever you get your podcasts. There's one business that we've all interacted with, been fascinated by, and maybe even wanted to go into, and that's the restaurant business. Yet even though most of us spend a fair amount of time in restaurants, we don't fully realize

and understand what goes on behind the scenes. Maybe that's part of the mystique. How does a restaurant operate? How do they make all that food that's on the menu? How do you get a table when the place is packed? Is there some secret way? Why do some restaurants make it big while others fail? Well, here to shed some light on the mysteries of the restaurant business is Michael Cecci Azalina. Michael has worked in the New York restaurant business for many years, and he's author of a very successful book called Your Table is Ready, Tales of a New York City Maître D. Hi, Michael. Welcome.

Thanks, Mike. Nice to be here, sir. So most of us have heard that the restaurant business is a particularly difficult business. Many of them go out of business. It's a tough business. Why is it a tough business? What makes it so hard? Wow, so many reasons. It is an all-encompassing business. Look, it's not just about making food, which is complicated enough, but it's serving food, and it's dealing with the public on a daily basis. Then you're in competition with, well, especially in New York City, there's 25,000 restaurants. It's like that everywhere, but the competition is fierce and you've got to create something that people understand that will come into your door. And then the margins in the business,

the profit that you make is very, very slim because it's very costly to open and run a restaurant. So why do people, why do so many people go into it? do you think, with big bright eyes and this is going to be great? And when the odds are so stacked against you. It's a fundamental aspect of our life. Look, when COVID hit, restaurants closed. People were lost. Restaurants are gathering places, places we go to celebrate. We go to mourn.

We go on dates. We go to find dates. It's definitely part of our social fabric. It's the town hall. The most primal thing we can do to each other is feed each other. It nourishes life. So why wouldn't you want to be part of it? And part of it, it's very sexy. You've got a place that, especially the busy and successful ones, everybody wants a good table. You want to go see in BC and who's going to be there that night. There's a whole environment about it that is almost otherworldly. It sort of lifts you out of who you are. Look, successful restaurants, when you walk through the door, you're entering a whole nother dynamic. Hopefully you've left your life behind and you're about to

sit down for an hour and a half or two hours or three hours and have an experience given to you that's not like your normal day-to-day life. So why wouldn't you want to have something like that to own it, to create it, to run it? Is it true that restaurants, particularly, you know, upper-scale restaurants, really cater to the regulars, that that's where the money is, and that people that come in once and never come back, those people, you know, they're welcome, and that's great. But really, the focus has to be on the people that keep coming back. Yes, it is your regulars. I think the number one thing you want as a restaurateur are your neighbors, the regulars that come in, in any restaurant, even not the high-end ones, but you want those same people that come back, because that's your sustenance. And then you get people coming in for an occasion,

you get business meetings, you get tourists that are coming into town, but it is the regulars that keep you going. And high-end restaurants, though, like the really good ones, if you're in the Per Se and French Laundry level, they're full of tourists. They're coming that want to dine there. I don't have any regulars they have. I sure they have a handful but then that the the the breadth of your client base expands because you're world famous and people want to be there one of the things and i don't know that there's a simple answer to this but one of the things i find so fascinating about restaurants is that a restaurant can be hot today and so dead tomorrow. And who knows why? It seems. But why? It's very difficult to sustain what you get, the energy that you have

in the opening of a restaurant. Look, there's a restaurant in New York City called the Odeon. It opened, I think, probably 40 years ago. It it's still there it was the hottest thing in town but it was able to sustain itself because of its reputation because the food was always good and they always had the right people running it the person at the door was always the right person the bartenders were great it continued you have people opening restaurants especially ones that are hot you know they're trendy they're hot and everybody who wants to be seen is there and the celebs are there, but that's fickle. They don't last. They're not your regular customers, which is going back to what you asked earlier. You need your regulars and the regulars are not the superstars. The regulars

are not the uber wealthy who leave town for three or four months, five or six months a year, and you see them whenever they're in town once or twice. You need to sustain it with regular people. And a lot of those places don't know it. Whoever opens that, they sometimes don't have the experience. They think it's going to be sexy and fun. And look, I can make a reservation and I can sit down at a table and I can order food. Anybody can do this. It's not the case, not the case at all. So unless you're in it for the long haul and understand what it takes to do it every single day over and over and to keep it consistent and to keep the food good and the service good, you're doomed for failure. 85% of restaurants fail in New York City within a year, 90 within five years. What is it from the other side of the table, from the people who work in a restaurant, what do they consider a good customer?

What do they like about customers? And maybe what's a crappy customer? Well, it's no secret, but it's the people that are kind. When people come in and they're kind and warm and treat you with respect, that's a great customer. Then if they tip well, that's an even better customer because obviously you're there to make money. But people who respect you, they respect your time, what you're doing, and treat you not as a servant. The worst customers are the ones who walk in the door and they've had a miserable day, a miserable life, a miserable upbringing, and all they want to do is take it out on a server or a bartender or a maitre d' or a host or by sending food back to the kitchen.

And these people exist and they come in and they're entitled. They feel entitled. They're demanding and don't acknowledge the person or people that are there to bring them their food. And those are very, very difficult people. And they're, sadly, it's the small percentage, but they take up most of your time when they're in the restaurant and no one wants to see them back. You know, now that everything's computerized and reservation systems are computerized, we make notes, you know, do not accommodate. And it happens to people because they are just louts. Really? So you basically keep a scorecard or a report card on customers and discourage their return?

Well, just like Yelp and all the social media sites keep a report card on the restaurants, yeah, you have to do it. We're judged every customer can go out and write a review. It used to be the newspapers did it, or the radio or TV reporter would come in. But now it's every single person that walks through your door, which is not a bad thing because, you know, good or bad, it's nice to get feedback, but it has to go the same way. If you have someone coming in that restaurant that is demeaning and rude to a server, we're not letting you back in. At least I'm not, or places that I've worked in, it's really discouraged. You don't want these people back. Who do those people tend to be?

It doesn't matter, all walks of life. But I find the most entitled ones are those with the most money, who probably spend the day getting exactly what they want, and people kowtowing to them, and all their needs are met. And when they walk into a place and you're not kowtowing to them and all their needs are met. And when they walk into a place and you're not kowtowing to them, a restaurant I'm talking, if you walk into a restaurant, you're not doing that. You're not as subservient as maybe their, their, his or her staff is that, that whole day long. They're pissed off and they, you know, you hear that, do you know who I am? Well, I guess we have your name and phone number. I don't know what you do all day long, but it can be really rough. And it's usually the uber wealthy, though there are many uber

wealthy people that are the loveliest in the world. But it tends to be the most entitled ones are the ones who generally get what they want all the time. And when they can't get it in a restaurant, boy, do they lose it. Do you know who I am? I love that. Do you know who I am? I know. Or do you, I know the owner. You don't have a table for me, I know the owner.

Well, if you knew the owner, why didn't you call him and ask to get a reservation? And if you know him and I've got, as you can see, the bar is 10 deep and people are waiting, call him now and see what he can do for you. It happens. bar is 10 deep and people are waiting call him now and see what he can do for you you know right it happens what are just just the sprinkling of maybe some of the most bizarre demands or requests or things that have happened to you just a couple of examples would be great i had someone called me and said look i'm this is when i was the the River Cafe. Someone called and said, I'm bringing in this woman that I'm in love with, but I'm bringing her in blindfolded. Can you make sure that no one

makes a stir about this? Well, you're bringing in a blindfolded woman to a restaurant. I think there's going to be quite a stir, mate. Or I had a rock star. This is when I was at Raul's, a rock star, very, very, very famous, very well known. And he was in a very back corner booth. And it was, I think it was probably eight or 10 of them. And he was stuck in the middle and he had to go to the bathroom. And he says, I can't get up. Can you bring me a wine bucket?

He wanted to use the wine bucket instead of using the toilet. I had a customer come in once and said, you're an actor. All right. And you know, I said, yeah. He says, I need you to marry me. What? He says, I need you to marry me. He said, I'm about to get married on Saturday. This is like the week before. And my wife won't sign a prenup or my wife-to-be won't sign a prenup. And her whole family flew into town. I have 80 people here. We're getting married on the roof. I need you to do a fake ceremony for me. And I did. Oh, you did? He paid me a lot of money to do it. But I'm not sure that's a restaurant request, but it's what people ask you to do. And then there's food requests that you get. I had a guy come in to Raul's, which is a French bistro. And it was about 10 o'clock at night. And he says,

can I please get bacon and eggs? And you know what? This guy was so nice and so kind. I went to the kitchen and said, chef, can you make him bacon and eggs? Chef said, sure, I'll do it for you. Actually, we had to go out and buy the bacon. Do restaurants mind special requests or are they a real pain in the neck or both? Oh, yeah. I think across the board, they're a pain in the neck,

but we do it. Restaurants that I've worked in, as long as we had it and it wasn't crazy busy, if we had the ingredients in the house, we would do it. But it's very much frowned upon because if you want something special, look, I've worked very busy restaurants. And when you're that busy, things got to go and you're there, bam, bam, bam, bam, bam. When the special request comes in that the dish has to be changed and you need a different ingredient, it throws off the timing. And then a lot of the times when this happens because it's so busy and your cooks are working from muscle memory, instead of putting the, you know, this is a bad example, but instead of putting string beans instead of spinach on the plate, well, they're going to put spinach because they've done that 300 times already that evening. And then it goes out and the guest is pissed off and say, oh man, you know, you said you'd do this for me. So it takes much more attention and it can definitely disrupt the rhythm. But if we can do it, and especially when I open my restaurant, I will

accommodate it really as much as I can. As long as it's kind, you know, be kind. We'll take care of you. But a lot of times, I mean, you hear it all the time in a restaurant of, can I have it with no tomatoes? Can I have that on the side? Can you bring me this instead of that? They don't sound like big problems, but do they cause trouble and backups in the kitchen? They do, exactly, because like I said, it's that muscle memory, and you're used to doing something a specific way,

and suddenly it stops, and you have to change it with that, and someone has to make sure it's done that way. So the server takes the order. He's got to punch in a special request on the order. It has to be read correctly. It then gets called out to the cook who has to make it correctly. It gets plated. It gets put up into the pass where you pick up the food. You've got to check the dupe, make sure.

You've got to go to the table and make sure that's the customer who didn't want the tomato and all of that. So there's a lot of steps involved in it, quite a few steps. And it takes time away. And if you're very busy, there's a problem. And worse sometimes than when you're not busy and you just forget because things are so slow and it just, it just skips your mind. You know, you forget about it. But what you want to do with special requests when people have allergies, because you could, you could kill someone. So people always want to know, like, what's the secret to getting a table at a crowded restaurant when you don't have a reservation. And my experience is that there is no real secret, but does anything work?

Yeah. Well, look, if it's a very crowded restaurant and there's no tables, there probably isn't a table. Look, it's not that we don't want your business. We want your business. But if we can't accommodate you, or you're going to sit at the bar for an hour and a half and hate us, we don't want that to happen.

But in certain restaurants, and especially restaurants where there's a maitre d' at the door, good maitre d's always have a table in their back pocket. There's always a way to find something. So if George Clooney calls and says, Amal and I want to come in for dinner tonight, do you have a table? Well, yes, you're going to say yes. You're not going to say no. And it's because it's George Clooney. Well, yes, it's because it's George Clooney because you want him in the restaurant. But doesn't everybody want to see George Clooney in a restaurant? It's good. It's fun. It enhances the environment there. So you do your best to maybe make it work. And so if you're not George Clooney, what do you do? One way is be really nice and see what can happen and be

willing to wait. And also tipping, tip the person, say, hey, can I, will this help? And look, if someone's going to really break their back to try and get you a table and juggle other tables to get you in, there's got to be a reason to do it other than you're just nice. And a lot of time will be because it's a good tip. But tip up front front like here and not give me a table and then I tip you in in other words you know first you flash a little cash and then you get the tape yeah look my in my career is a maitre d I think most of the tips I got from the door of people on the way out because they were happy to be there I talked to them I did something special for them. Or even not, I made the reservations.

They did it. But if I didn't know the person and they walked in the door, they would come and say, hey, hi, I've never been here before. We're dying to dine here. And he puts his hand out or she puts her hand out. And then it is a $100 bill or a $20 bill or whatever. That will definitely help. Absolutely, it will help.

It's not going to hurt. We're in a tipping business. And people are there to make a living. that will definitely help. Absolutely it will help. It's not gonna hurt, you know? We're in a tipping business and people are there to, you know, make a living. I had a guy when I was at the River Cafe, it was a very, very busy Saturday night. Place was packed. I had people waiting for tables.

He came in and says, hi, table for four, please. I said, do you have a reservation? He says, no. And I laughed at him. I says, I'm sorry, sir. We booked two weeks in advance. They're gone in five minutes, I have nothing. He says, okay. And I laughed at him. I says, I'm sorry, sir. We booked two weeks in advance. They're gone in five minutes. I have nothing.

He says, okay, thank you. He reaches out and puts money in my hand, and I push his hand away. He says, no, I can't do anything for you. And he insisted. He says, look, you're a gentleman. Thank you very much. Well, it turned out to be a lot of money. And he was so nice, and it was a lot of money.

I got on the table. He wound up tipping me three more times that night and it probably came to about $1,000. And, you know, you love that. Who doesn't love that, you know? It's a fun thing. He got his table and became a regular, became a regular. I guess it's the concern is other people would see that

and go, wait, that's not fair. He got a, we were here first. No, you're right, it's not fair. He got it. We were here first. No, you're right. It's not. But what is fair? You know, I can't get tickets on the 50 yard line for a giant game or box seats at Yankee Stadium. There's there's privilege in all sorts of businesses and there's preferences in all

sorts of businesses. And that's kind of the way it works for better or for worse. Restaurants are not democracies. They never have been. That's why you go call a busy restaurant and you want an eight o'clock reservation and there are none. And you're told there's 530 or 830. Well, that's because you have your regulars and you have your celebrities and you have

friends of the owner and friends of the chef and they will come first. It's just the nature of the beast, nature of the business. Is it true that, like, I've gone to restaurants and they said, oh, it'll be about 15 minutes and there's a million empty tables. And they say, you know, you can wait in the bar. And I've always sensed that that's just to try to, you know, get us to spend some money in the bar before they see this. True or false? I hope that's not the case.

I've never experienced that as in any of the restaurants I worked in. The reason why those tables are empty is because they're being held for reservations, for reservations, the people that are coming in. And while it might not look like, you know, the restaurant's full, your book is packed, and some people are late and some are coming in. So you really can't second guess that. But also if you walk in and then you go to the, they told you wait at the bar because there, you know, they didn't have a table or no tables. Then you go and have dinner and there's still 10 tables left. But that's a problem.

I would rethink about going back to that restaurant. Yeah. Yeah. Well, I mean, everybody's, when you serve that many people in a restaurant every night, I mean, there's bound to be, there's going to be experiences where, you know, not everybody's happy. That's just, that's true in any business. You know, if you've got a lot of customers, some people are going to be mad. I've been cursed at, I've been punched, screamed at, called names, and I've been hugged, you know. It's a battle sometimes and you're trying to,

you know, you can't placate everyone, but you have to take care of your regulars first and people you know, because they expect that and that's why they're regulars. But look, if you're not known and you go into a restaurant for the first time and you love it, well, you know what? A tip will help and say, look, I'd love to come back. You leave a generous tip at the table. You will be remembered. That might not seem fair, but you will be remembered and you'll get that reservation and people love to have you back. Now, do you have to keep over tipping every time you're there?

No, not at all. But how do you become noticed? Be nice, tip well, and then we want you to come back. My biggest peeve at a restaurant, and I'm pretty easy normally, I mean, it's when they seat you down and they hand you the menu and they say your server will be with you shortly. And 20 minutes goes by and you haven't seen a soul. I hate that.

That is my big peeve. Yes. So there's a time limit that we set in the better restaurants or well-managed restaurants. And it is that you have to be at that table within two minutes. If you're not there within two minutes of that table being seated, then you've failed. Already you're off on the wrong foot. You don't want anyone sitting there 20 minutes. Look, even no matter how busy you are, you can always get there or in a well-managed restaurant, the manager will see that. He or

she will go over. The server in the next section will see that. They'll go over and cover you because they know what's going on. In well-run restaurants, that should almost never happen. Look, sometimes the proverbial crap hits the fan and you're buried and you're in the weeds and it's a problem. But then you profusely apologize and buy that first round, whatever you have to do, but no one should sit there for 20 minutes. You know, I wanted to ask you, at restaurants when they have specials, well, are the specials special? Depends. There are times when you have product that you'd like to get rid of and you repurpose it and you make it a special. Now, is the food bad or old? Well, it's probably close to getting to that point. In fine dining restaurants, that probably would never happen.

So it really depends. I go back to what Bourdain said 30 years ago when Kitchen Confidential came out, is don't eat fish on Sunday. I still won't eat fish on Sunday and sometimes not on Monday because that weekend fish, if it's a small little restaurant, that fish that was ordered on Saturday is probably being served on Monday if they didn't sell it. Well, I've always had this desire to own a restaurant. I think a lot of people have that desire to own a restaurant.

It just seems, as you said in the beginning, it's kind of a sexy business. It seems kind of cool. But after listening to you and hearing the stories of failure in the restaurant business, perhaps it's better left a fantasy. I've been talking to Michael Cecci-Azzolina. He's author of the book, Your Table is Ready, Tales of a New York City Mater D. And there's a link to his book in the

show notes. Thanks, Michael. This was fun. Thank you, Michael. If you have a dog, you've probably noticed the dog doesn't like it when you leave. Some dogs will bark a few times or look out the window looking heartbroken as you leave without them. Other dogs really freak out.

According to pet expert Marty Becker, separation anxiety in dogs can be a really big deal. Dogs with this disorder are really fearful that you're not coming back. They will often attack the area where you leave, tear up the door frame, or just generally be destructive. If you find damage or accidents on the floor when you get home, your dog's separation anxiety needs to be addressed. If you'd like to try some basic training yourself, you can try this. Put your coat on, grab your keys, leave, stand

outside for 30 seconds, then come back in. Then do it again for a minute and come back in. Then do it for five minutes and come back in and build from there. It's also a good idea to give your dog a treat when you leave or use an interactive food toy to keep them distracted. And if those ideas don't help, talk to your vet or animal behaviorist. And that is something you should know. If you find this podcast enjoyable and fun to listen to, imagine what your friends will think. So please tell your friends about it and ask them to give a listen. I'm Mike Carruthers. Thanks for listening today to Something You Should Know. Hey, hey, are you ready for some real talk and some fantastic laughs?

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