The Dr Louise Newson Podcast - 10 - Breaking down health taboos: Dr Karan Rajan on hormones, myths and patient power

Starting point is 00:00:02 So I've been speaking to Dr. Karen on my podcast. He is an author, he's a doctor, he's a medical educator, and he's also a podcaster for Dr. Karen Explores. I've met him before, but actually this conversation was even better. We talk about responsibilities of being educator. We talk about the joys and the thrills, actually, of educating people so they can make decisions that are right for them about their conditions. We talk about lots of things, how medicine.

Starting point is 00:00:32 and is sometimes a bit institutionalised and how we need to be the best advocates we can for our patients. It's a great conversation, so enjoy it. So Dr. Karen, you are in my podcast studio, whereas last time I was like in your seat somewhere else, wasn't I? I know, thank you so much for happening. It's a really nice, comforting place to be this is.

Starting point is 00:00:53 Yeah. Well, you know, I love doing podcasts. I don't know about you, but it's a real privilege to meet other people and have a bit of time because we're all busy. You never really get to know people properly. You see them on social media.

Starting point is 00:01:08 You see them whatever, but you don't really know the real person. So it's great, isn't it, doing podcasts? It's like a little confession box. It is, actually. It is.

Starting point is 00:01:16 It's good. So you are a doctor. You're a health educator. And I was trying to think, when I saw you a couple years ago, how many million followers you had on TikTok? I think it was like one, maybe? Something, yeah.

Starting point is 00:01:31 I mean, I used to care a lot more and look at the numbers, but who cares, really? But, you know, it's quite responsibility having a role of being an educator. Like, and I think things have really changed. I'm older than you, but education has changed for our patients, but also for healthcare professionals as well. And I've worked as an educator for like 20-odd years, done a lot of evidence-based medicine. So I've written four books on evidence-based. based medicine. They were hot topics for MRCGP. So people doing the membership of the Royal College of GPs. I, because I'm girly swat, I made loads and loads of notes. And then when I

Starting point is 00:02:12 got distinction in the exam, I was like, well, I want to share them with everyone else. And everyone's really busy to read the guidelines and read the papers. And because I've got a pathology degree as well, I like basic science. I like to know what's going on. So I thought, right, I will write a book because the internet wasn't really out there. quite the same. It was harder to get evidence. So then I wrote the book, but then you have to write the second edition and the third and the fourth edition

Starting point is 00:02:39 because evidence changes, guidelines change. But actually, I got a lot of credibility for the book it got in the number 10 for the BMJ bookshop. I was really proud of it. But then I had my second child and I was like, I haven't got time to write. But then when I started

Starting point is 00:02:55 Menopoul's work, I started to educate by Instagram, by media, just in different platforms. But somehow it doesn't, hasn't been so credible. Like people now sometimes refer to me as a social media influencer and seem to forget that I'm an academic scientist doctor. But actually, the people that I'm trying to educate, i.e. women, men, doctors really like it.

Starting point is 00:03:23 But it's weird, isn't it, how the, just because it's not a book, people think it might be different? Yeah, I think if you look back, back through history, things which are modern, revolutionary, which break trends are always, there's a lot of inertia behind those sort of movements. When people were writing letters and then when email first came on, people probably thought, oh, that seems really cheap and maybe unsafe. But now it's the standard of communication for, you know, business and other things as well, even entertainment. So I agree with you that sentiment of social media is cheap, it's fun, it's not real science,

Starting point is 00:04:01 it's not serious, I think we need to rethink that because there are so many educators online. It's the medium of choice for most people, not just, you know, Gen Z, Gen Alpha, but actually people in their 40s, 50s and 60s, they're using social media as a search tool. You know, it's the new Google. You're not going to look up on Google anymore how to build a cupboard or how to cure acid reflux. You're going to search on TikTok, on YouTube, on Instagram. So as educators, and not just you and me, because we have been adopting it for years, as educators, again, like, you know, as a collective, we need to look at those platforms.

Starting point is 00:04:39 Because in five, 10 years time, there may be something else which is even more bizarre. And we need to be open to that. Yeah. And I think it's, I feel, and I still do every day, it's such a privilege being a doctor. Like, it's a massive privilege. And, you know, I learn, and I've learned so much from my patients. I've worked in all sorts of areas, very deprived areas in Manchester, which have been my favourite jobs, actually, reaching and talking to people that I never thought as a, as a, you know, school child that I would ever, you know,

Starting point is 00:05:09 at homes that I've been to, people have spoken to, you've done the same. And, you know, in hospital, people turn up in A&E and you're like, my goodness. But then actually this power to be able to reach more people is even more of a privilege, really. And it's a responsibility as well, though, isn't it? Yeah, I mean, in a clinic, I might be able to see 20 patients across three hours, and that's me going really fast and probably not giving enough time to each patient. If I make a video online, so the example I often sort of think about when I think about this is back in 2020, I made a video about hemorrhoids. Hemorrhoids is one of those embarrassing problems that a lot of people suffer from. There's a lot of taboo surrounding it because people don't want to own up.

Starting point is 00:05:53 They've got hemorrhoids. a lot of people listening or watching to this, probably have hemorrhoids. They're probably sitting in them right now. That video is not a sexy topic, but it got over 2 million views. And I'm not egotistical enough to assume that 2 million people are going to benefit from that hemorrhoid advice I gave. But even if a small fraction of a fraction, say 2,000 people took something away, that is a huge amount of people that I could, you know, see across 100 clinics and still not get to that number.

Starting point is 00:06:20 Yeah, it's really interesting. I used to work on embarrassing bodies. And my husband's a genitourinary reconstructive surgeon, so he was the penis doctor on embarrassing bodies. And he's got very dry sense of humour and it went down very well on television. And I worked as a medical advisor and there was like a live phone in

Starting point is 00:06:37 so we'd answer questions and that sort of thing. And that was, I think, really pivotal for the way the public learned things that, like you say, were a bit to be a bit embarrassing like piles. We've all had them at some stage, especially women after childbirth. Do I go to a doctor or do I buy something over the counter?

Starting point is 00:06:56 But then what do I ask? What do I do? Do I pretend it's for a friend? You know, whereas actually, you know, it's amazing some of the calls that you got. And I find it really interesting on those phones because people would phone up. And you're like, well, haven't you spoken to anyone? Have you not? Oh, gosh, no.

Starting point is 00:07:12 I wouldn't talk to my doctor because he's my mum's doctor or he's whatever. And he's like, gosh, wow, this is why it's so powerful that you are not judging anyone. Yeah. They are choosing to learn from you as well, which I think is the other thing that people forget, actually, when people are criticising whatever. It's like, well, they're choosing to learn from you. If they don't like the way you look or what you say, they can unfollow you, can't they? I think also the brilliant thing is that it democratises education. So someone who maybe English isn't their first language and would maybe be afraid to have this conversation can get that translated into Swahili, French, Spanish, Farsi, whatever they want because of the English.

Starting point is 00:07:53 auto caption function on most social media platform. So it's almost like a guilty pleasure. You know that, you know, I wouldn't want to admit to my friends that I love to listen to Taylor Swift. But it's that guilty pleasure. Like, oh yeah, I'm watching this hemorrhoid video in silence and no one's judging me. I think so. I think it's so, so important. And I like the way that you say about democratizing knowledge and education because as a doctor in the past, I was privy to reading all sorts of journals, all sorts of articles, that it was only me as a doctor was able to. And then years ago, I started working for patient. Info

Starting point is 00:08:31 and started writing patient information literature. Now, that sounds a bit weird now because everyone's got access. But Tim Kenny, who set it up, was amazing. Him and his wife were GPs. And they talked about the first patient they saw, who realized they needed more information, was someone that had raised blood pressure. It's very common, hypertension, isn't it?

Starting point is 00:08:52 There's a choice you can have an ACE inhibitor, you could have a calcium antagonist, different medication. But it's a lot in 10 minutes. So they decided to write a patient information, what is hypertension? What are the treatment choices? Give it to a patient. Like this is why you're having a blood test. And they said, gosh, it was amazing. The consultations were so much better afterwards.

Starting point is 00:09:12 So then my job was to write patient information. But we were always referenced to the guidelines, to the evidence. And I wrote about all sorts of conditions. I did it for 20 years. It was great. But then we realized after about 10 years that the doctors were reading it as it was coming out of the printer going, oh, I didn't realize that was, you know, first-line treatment or whatever

Starting point is 00:09:32 because it's hard to keep up to date as a doctor. So then we wrote Patient Plus, it was called. So it was more detailed for the doctors. So they had more information. But what was great about doing that was realizing that the patients actually sometimes wanted the Patient Plus version. and patients want as much information often as we know. And I think that's great.

Starting point is 00:09:55 But some doctors feel it's quite threatening if patients are really empowered and knowledgeable, don't they? Yeah, and I think that's really the sort of really archaic and bad way of thinking because that takes it to this paternalistic view of that doctor-patient relationship. And I think doctors shouldn't be gatekeepers of knowledge. No. They should be an advocate for the patient.

Starting point is 00:10:17 And when I've seen patients in clinic, I want them to come to the table on a level footing. So they know a lot more than the average person or then someone would expect a patient to know. So they get more out of the consultation. So the sad truth is that when we see patients in clinics or see them on ward rounds, you're not going to have more than 5, 10 minutes, 15 minutes at most with these patients. So instead of going over the basics, wouldn't it be far more useful to ask those sort of, specific questions like, okay, if this happens, what do I do? And they're actually asking really detailed personal questions to them. And we're not going over the basics again. Because all of that

Starting point is 00:10:56 can be covered at home with these leaflets, but now in video form. Yeah, of course. It's really interesting. So when I started my clinic, like, I only wanted to work one day a week doing menopause care. This was like nine years ago, 10 years ago nearly. I rented a room in a hospital because I couldn't get a job in the NHS doing menopause work. So they said, oh, it's just gynaecology. and there's no interest, and don't money, whatever. And I wanted to get my friends off antidepressants, so I said, okay, I'll just do this. So I started to see women who were more than just my friends who would travel a long time, and they'd say, oh, Dr. News and I think I'm menopause, or I haven't had a period for eight years,

Starting point is 00:11:33 having all these symptoms, but I tell you what, I don't want HRT. So I'd spend the whole consultation educating them about what hormones are, how they work, or the disease preventive effects, how we give the natural body identical hormones different to synthetic. all this stuff. And then I went home and I just thought, this is, this is really like, I feel like I'm not individualising care. I'm just a robotic person telling them the same things because they didn't have access to any information. So that's when I started to write my website. But then I'd come home and I'd be dictating my letters and then I'd realize most people had similar symptoms, especially mental health symptoms. Most people had joint pain. Most people had given up their job,

Starting point is 00:12:15 having really difficult times. And then I thought, I thought, well, actually, it was my daughter, we were just having suffer one day, and she was like, mommy, you keep telling me all these stories. They're awful about these women suffering. You need to post on Instagram. And I was like, oh, I don't even know. I'm really scared, but she was setting up her Instagram account,

Starting point is 00:12:32 and I thought, I need to just see what she's doing, you know. And so then I got her to like help me find pictures and to start to post. But then I started to get DMs from women all over the world to say, you struck a call, that is me. I had no idea. I thought I had fibromyalgia. I thought I had chronic fatigue.

Starting point is 00:12:52 Maybe it's my hormones. And that like that sort of sensation, like I love helping people that I don't know. And I'm sure you get it sometimes where you're like, wow, this is going to make a big difference to people's lives, actually. Yeah, I mean, people want their pain points addressed. They want the relatability. And then what you've done with the menopause education is there's a lot of women who, again,

Starting point is 00:13:16 don't want to seem like a burden to doctors. And they've been perennially told, traditionally told that those symptoms are just part of life and they maybe have to suffer through them for this period of time. And so they've been maybe reticent to go to a doctor thinking, oh, they're just going to maybe give me some antidepressants, they're going to give me some painkillers or, you know, maybe do nothing. So they actually suffer in silence. But then when someone is educating them and say, actually, there are some lifestyle factors I could change. There's some, you know, things I could actually get prescribed to improve my symptoms.

Starting point is 00:13:50 That's when it becomes relatable and then they want to seek out more information. And ultimately, someone will only be educated if you provide them with the education. There's a desire for it. But then if there's a lack of education out there, then no one's ever going to raise their level of knowledge. Yeah. But sometimes, I don't know whether it ever happens to you, but I sometimes feel really guilty for what I do. Because I do a lot of education for healthcare professionals as well, which is great. but you can only change people that want to change

Starting point is 00:14:17 when you're talking about, you know, evidence and prescribing, especially when we're talking about testosterone as well as HRT. Lots of people are stuck and won't change the way they prescribe. But a lot of my work, like yours, is empowering people, women, especially with hormonal problems. But then what really makes me very sad is that I feel like I educate people and they say, gosh, maybe I don't need antidepressants, maybe I could take hormones.

Starting point is 00:14:46 They go to their doctor, he says, no, you're too old, you're too young. Of course it's not menopause. Where did you get this information from? Don't stop your antidepressant. Don't think that you're, whatever, that your joint pain, your poor sleep is due to that. And then they become really frustrated

Starting point is 00:15:01 because they can't afford private care. They're being told out-of-day information. And then they're almost worse. It's like dangling a carrot over them. And that's what I worry a lot about, like, have I got it wrong? Should I have not done this? But then it's not fair that I've got knowledge that others haven't got. Yeah, I guess what you're saying is you're giving them this forbidden fruit of knowledge, but then they can't access it through their normal roots.

Starting point is 00:15:27 And I think as doctors, sometimes, you know, the sort of medicine as an institution, it's quite rigid. We're sometimes reliant, and sometimes for good reason, relying on certain algorithms and flows of treatment and the pathways. And that's good because that gives us the evidence based to be safe. But sometimes that also limits us in terms of how open we can be to new evolving evidence. Just because something is emerging evidence doesn't mean it won't work for some people. And I think, you know, that's something I've suffered my stance on a lot over the years. So, for example, you know, something like magnesium as a supplement. You know, if you looked at use of magnesium for sleep, there's not reams and reams of literature out there saying that everyone should supplement

Starting point is 00:16:16 with magnesium for sleep. However, anecdotally, I've benefited from it when I suffered with insomnia years ago, and there are loads of people who also benefit from taking magnesium. And if you told those people, there's no evidence, that's not going to change their mind or stop them taking it. So it's actually finding what works for different people. And I think sometimes as doctors, we need to be receptive to looking at specific protocols and treatments for specific people. Because if we just dogmatically stick to algorithms, we are losing people for whom the algorithm doesn't work. And I think it's so right because medicine is a science and an art. You know, the science, of course, but the art is individualizing care. But the other thing is that even our guidelines,

Starting point is 00:17:00 people often read the top level. So lots of people say, Louise, you don't follow guidelines. Well, which bits? And there aren't any bits. And, you know, there's lots of people that think the guidelines say something. And when you question it, they're like, oh, no, that they told me there was something about this, like, treatment pathway in this guideline. Well, no, there isn't. And I know the guidelines black and white.

Starting point is 00:17:23 So then it's the way that the guidelines are interpreted as well. And in medicine, I think sometimes, and I'm sure it's because people are busy as well. There's a lack of professional curiosity. Like, if you said to me, the best of the best thing, treatment for haemorrhoids is, I don't know, smelling some flowers in this, you know, in the field. I think, well, that's a bit weird, but let's look at the evidence. How does that work?

Starting point is 00:17:45 Does it really make a difference? Rather than saying, no, that's absolutely rubbish. And, you know, when a new treatment comes out, one of two things happening, either everyone starts to prescribe it with very little evidence or everyone says, no, that's rubbish. And it all depends the way that what's in the guidelines, what, you know, who's marketing it, whatever. But I think sometimes in medicine, we get very siloed. We get very focused and we don't have this professional curiosity. And I think it's because people are tired as well, aren't they? There's very little bandwidth isn't there to expand your mind when you're working full time.

Starting point is 00:18:19 Yeah. And I think that is something, right? We were talking before about, you know, you're publishing books and then you had to keep publishing further additions because as soon as you publish something, it's out of date because of involving evidence. And it's the same with what we learn in medical school is out of date once we leave medical school, a lot of it. I mean, anatomy is the same. I mean, our bodies don't evolve in that short time scale, but there are certain guidelines for managing specific conditions which change. But yeah, as you said, if you're working 12 hours a day as a doctor, as a healthcare professional, what extra time do you dedicate to looking at new research? And I think that's where it's key. We actually have to say, hang on, this sounds weird, but is there any evidence

Starting point is 00:18:55 behind it? Is it safe? What's the sort of risk benefit ratio? Even if the evidence isn't strong, could it work in a safe capacity and offer a relatively low side of vect profile to someone, but have huge upsides? And I think it's just being really open to, I don't want to say experimental things, but things which, you know, won't be suitable for the mainstream population, but for those specific people for whom the mainstream treatment hasn't worked, could it be an option for them? Yeah. So I remember when I came on your podcast before, you were talking about a time.

Starting point is 00:19:30 when people have had a surgical menopause, so ovaries removed. It might be because they've had bowel surgery. They might have had endometriosis, for example, and you've been involved as a bowel surgeon, and the ovaries have been removed. And like many doctors, not always thinking about, actually, I'm removing their hormones as well. And I remember you saying that was quite a,

Starting point is 00:19:49 almost like lightbulb moment, thinking about the hormones that these poor, younger women weren't getting. I mean, I think sometimes we get such tunnel vision. like as a surgeon, you think, okay, we've got to remove the cancer, got to remove that organ, got to remove this disease. And that's almost compartmentalizing the human body into specific parts. But as we know, everything's interconnected. The ovaries are not just a reproductive organ.

Starting point is 00:20:16 It's an endocrine organ. It's a metabolic, you know, it produces like various hormones which influence metabolism, influence mood, memory, all these other things. So the knock on effect of the bowel surgery could be sustained. And for me, I didn't realize actually chemotherapy, bowel surgery, removing, you know, these organs can have ramifications beyond just that target organ. And there's, you know, huge cohorts of women who suffer from surgical menopause because of, you know, those things aren't maybe pre-planned or part of that treatment conversation where the surgeon talks about the complications for the bowel surgery. but have you mentioned the gynecological, metabolic, endocrine complications that could arise as well and that could doggie for the rest of your life?

Starting point is 00:21:05 Yeah. So we did an audit which we just presented at a conference looking, I won't say the names, but three teaching hospitals in London. These were young women that had a surgical menopause for benign conditions, so not for cancer. They had their ovaries removed. The guidelines are very clear these women should have their hormones replaced because of the long-term health consequences. consequences of not having hormones. Guess how many were offered or prescribed HRT? On 10%? Less than 5%. Wow. And then how many do you think were prescribed testosterone?

Starting point is 00:21:39 Probably a similar amount or less than 1% maybe. Zero. Zero. Zero. There's none. At all. Can you imagine removing someone's thyroid and then never giving them thyroxin? Yeah. That's really worrying, but also I I'm not shocked because in my own experiences of dealing with these patients working as part of a team, it's not a conversation that would be at the top of the radar. So I also think, you know, how I was involved in that sort of treatment flow over the years as well. So it's not surprising. But, you know, I said to my husband a couple of years ago now, like, Paul, if you remove someone's testicles, both of them as a man, like if you remove their testicles so they had no test. because obviously test is produced testosterone, would that man get testosterone replacement?

Starting point is 00:22:32 Yeah. Do you know what he said? He said, of course, these poor men, they'd have awful symptoms. They would have brain fog. They would have reduced memory. They'd poor concentration. They would have erectile problems. Yeah.

Starting point is 00:22:46 Yeah, but that's what women are having. They're having a castration. Like 50% of our testosterone is in our ovaries. Yeah. And I think also, I guess, you know, interestingly, maybe for men it becomes more, well, for men, the degradation and the loss of testosterone production is insidious over many years. And you almost don't notice it. So a man in his 20s who eventually becomes 50, 60, he's not going to notice an immediate cliff of a drop off. But in women, there is that obvious cliff of a few months or, you know, that sort of time.

Starting point is 00:23:25 period in their life. But even despite those obvious manifestation of those symptoms, it still strikes me as odd that even though there's more awareness now, there's still not enough being done for enough women. I don't understand, especially young women. So young women really worry me because their risk of future inflammatory diseases, like heart disease, osteoporosis, diabetes, dementia, mental health, clinical depression really increases. Even study shows that women are more like to have Parkinson's disease, more likes have neurodegenerative diseases when they don't have their hormones longer. So especially these young women. But there are also studies from the 80s showing that women who have testosterone in addition to estrogen after having their ovaries removed have better

Starting point is 00:24:08 well-being, better cognition. But most women, if they get hormones, it's only estrogen. And there's this like myth about testosterone. I don't really understand. I know it's labeled from the testosterone, but it's a female hormone as well. Yeah, I think the problem is labeling those androgens or those sex hormones as the male hormone, the female hormone. I mean, men have estrogen as well. They have a small amount of estrogen. If you increase your adiposity or you're obese, you'll have more estrogen. So I think, you know, genderizing those hormones is also not beneficial as part of educating people on that and almost you know you you this really is evident in the fitness space where yeah historically women have shied away from weight lifting because they assume that lifting weights

Starting point is 00:25:01 will boost testosterone and boost their muscle mass and they look muskily and not you know so aesthetic but it's not doesn't work as simple as that and i think it's you know almost saying testosterone is the male hormone is not only wrong but also harmful and misleading in the long-term conversation. Yeah, and I think also a lot of people, men more than women, inject testosterone, which is synthetic. So it's not pure testosterone. So when people worry about the risks of heart disease, for example, yes, with a synthetic, chemically altered artificial testosterone, but not with the natural. And I, it took me many years to realize the difference between natural and synthetic, the same with contraception, you know, ethanol,

Starting point is 00:25:46 eustodial, a chemically altered artificial estrogen is not going to be the same as estradiol. They're completely different. But it takes a while to realize that. And until you realize that, it's very hard to sort of look at the difference and work out the difference metabolically and with risks as well. Yeah, I think generally when, you know, I've seen, I've learned a lot more about menopause and the perimenopause or the transition over the years.

Starting point is 00:26:16 because there's been more voices like yourself talking about it. And so I think, you know, that's actually a positive thing. But it, you know, does that then trickle to the people who need it most? And sometimes you wonder, does it just reach people who are in those certain echo chambers? Because then there's still a huge population of people who it's not reaching. And because the people who are reached right now, they may already be educated. They may be listening to podcasts like yours and already be doing the things that you're telling people to do. But what about those people who don't listen to those podcasts and other things?

Starting point is 00:26:51 Because they're going to get their education from the average person who is a bit more savvy. So, you know, it's sort of getting that information trickling to everyone. And that's why it's great when doctors like you, others will talk about hormones. You know, you mentioned about endometriosis a while ago. And everyone's like, wow, he's talking about it, which is brilliant. Sometimes, though, I've seen a comment once on a video where I think I was talking about some women's health thing and how it affects the gut or something like that. And someone commented, great information would prefer if it came from a woman. Oh, really? Yeah.

Starting point is 00:27:30 And I was just a little bit shocked. I mean, like, why does my gender matter if the information is still evidence-based? And sometimes, and I feel that comments like that could actually prevent, you know, more male educators from talking about women's health issues if they do get, you know, feedback like that. You see, I think, like, a lot of my work is not thinking about women's health. It's about thinking of health of women. Yeah. So then if I'm really worried about cardiovascular disease, like, I personally take hormones to reduce my risk of osteoporosis. I'm really scared of osteoporosis.

Starting point is 00:28:07 Like you as a man, male doctor, should know everything about osteoporosis, whether it's in a man or a woman. But if we talk about health of women, I think it's fine that you're a man. Somehow women's health is about argony bits and it's a bit embarrassing and, oh, I don't want to talk about it. So I think this genderized medicine really worries me because then it's like thinking my ovaries are only about reproduction. Yeah. Of course they're not. You know what? That's really good.

Starting point is 00:28:35 And I think actually reframing women's health as health of women is spot on because even if you, if we continue to talk about endometriosis, endometriosis is labeled as a gynecological disease. It's not. Because number one, it's probably part autoimmune, probably part inflammatory, probably part dysbiosis of gut microbiome, genetic, environmental. And the ramifications of endometriosis are systemic. It affects hormones, metabolism, mood. So actually, it's a systemic issue, not a gynecological issue. Because then by labelling it a gynecological issue, you're almost, you know, psychologically preparing women to accept that the symptoms would be vaginal, pelvic pain, things like that, period-related. But actually, as we know, you can get full body symptoms with endometriosis. So actually, your point of health of women is apt for basically any... Everything.

Starting point is 00:29:34 Anything. I totally agree. And I think having that mind shift, then hopefully will help doctors to be educated in different ways as well. Because, you know, I'm not a gynecologist. It wasn't multi-system enough, if you sort of mean. And being holistic as a doctor and an educator is really important. I mean, me neither, I'm not a gynecologist. I've had interactions with young women who I've eventually referred to gynecologists. I've scrubbed in in joint operations with gynecologists and I've seen endometriosis.

Starting point is 00:30:02 And honestly, when I first saw endometriosis, I, didn't know what I was looking at. I called the gynecologist in. They said that could be entomitriosis and I realize if I'm going to be a holistic surgeon, I need to go to more gynecology operations and look at what things could be overlapping with mine. And that's again, part of that education that we're talking about. I learn general surgery, but general surgery is a very narrow field. It requires input from vascular surgeons, urologists, gynaecology, sometimes cardiothoracic surgeons. So actually going into those other surgery and learning more about those things

Starting point is 00:30:39 are as important as become a specialist in your specific area. I totally agree. I think the more we can work with others, collaborate, but think about the person as a whole. It's so important. There's so much, really, to unpick. But I just wanted three take-home tips. Is it possible three things that you are most proud of that you've done as an educator?

Starting point is 00:31:03 I think number one has to be advocating for people and patients and knowing that they don't have to just accept information that's given to them. They have, you know, the option to counter that and seek second opinions and go to the table with more knowledge. Secondly, would be trying to laymanize medical education as much as possible. And I feel I've really kind of, you know, that's the hill I'm willing to die on. I mean, I think that's what's needed. There's a lot of jargon that we still use. I probably still use as well. And it's making that accessible to as many people as possible.

Starting point is 00:31:41 And thirdly, it's de-tabooing the taboo, whether it's, you know, health of women or weird things talking about constipation, about bottoms, about discharge, about all sorts of other things. And I think breaking the ice. So it's no, that word taboo should not be associated with any disease or condition. Because your mother, your father, your sister, your wife may suffer from these things. So, you know, why should it be? There are people who die of embarrassment. You know, I had a patient of mine years ago who had metastatic colorectal cancer. It spread throughout the body.

Starting point is 00:32:18 It could have been picked up earlier. They had six weeks of painless rectal bleeding. And they were just embarrassed about going to the doctor. And it could have been caught up then. So that person in that case was literally dying of embarrassment. You're at home, you've got bleeding and you're too embarrassed. And I think that's also quite something I'm proud of. Really important.

Starting point is 00:32:38 So keep going and keep educating. So thanks for coming today. Thanks for having you. Subscribe to my newsletter for exclusive insights and updates on new episodes.

The Dr Louise Newson Podcast - 10 - Breaking down health taboos: Dr Karan Rajan on hormones, myths and patient power

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