DR. MIRIAM ZYLBERGLAIT LISIGURSKI: The 3G's for well-being: Goal, Grit and Growth & The Truth About Doctor Burnout

In Episode 69, Love Conquers Alz hosts, Susie Singer Carter and Don Priess, cover a wide range of timely topics with the extremely accomplished mother, wife, educator, and physician, DR. MIRIAM ZYLBERGLAIT LISIGURSKI. Dr. Z is a triple Board-Certified Physician in Internal Medicine, Geriatrics, and Obesity Medicine with extensive clinical and academic experience. 

Dr. Z is also a well-being advocate with a strong focus on burnout, mental health, and leadership development.  Dr. Z discusses how her advocacy led her to author, “The 3G Cycle of Life. The Secrets for Achieving Joy, Meaning, and Well-being,” in which she asks readers to imagine life as a sequence of cycles instead of a unidirectional line, where each cycle consists of basic three components: Goal, Grit, and Growth, as well as catalysts that may facilitate or hinder your progress throughout life. Dr. Z provides a broad vision of how to use each component of the 3G Cycle in your favor, even during the most challenging circumstances, to avoid the negative consequences of chronic stress and burnout. The book includes more than thirty experts' personal and professional experiences, evidence-based data, and Dr. Z's insights and stories.

 Dr. Z also candidly discusses the current phenomenon of “doctor burnout”.  She blames it on a Healthcare system that does not allow doctors to practice the way that they want to. Dr. Z says there is a very big gap between what many doctors think medicine should be and what they are doing every day.

 Originally from Peru, Dr. Z has two awesome sons, a caring husband, and and is a caregiver for her mother who was recently diagnosed with dementia. Her dream is to help others achieve lives full of joy, meaning, and well-being.

PURCHASE DR. Z'S BOOK HERE
FOLLOW DR. Z HERE

Transcript

Don Priess: 0:00

When the world has gotcha down, and Alzheimer's sucks. It's an equal opportunity disease that chips away at everything we hold dear. And to date, there's no cure. So until there is we continue to fight with the most powerful tool in our arsenal. Love. This is Love Conquers Alz is a real and really positive podcast that takes a deep dive into everything. Alzheimer's, The Good, the Bad, and everything in between. And now, here are your hosts Susie Singer, Carter, and me, Don Priess.

Susie Singer Carter: 0:35

Hello, everybody. I'm Susie Singer Carter.

Don Priess: 0:38

And I'm Don Priess. And this is Love Conquers Alz. Hello, Susan.

Susie Singer Carter: 0:42

Hi, Donald. How you doing?

Don Priess: 0:44

I'm tired. How are you?

Susie Singer Carter: 0:46

God, that's so coincidental. I'm exhausted.

Don Priess: 0:52

I know. Oh, my God. I know. I mean, why are we drawn is this is Austin, because there's so many reasons. But one of the main reasons is we are just in full, full force going towards this documentary. You know, that's, I mean, I know that you're living it. 24/7 I'm living it. 12 Seven, because the other 12 I'm working on my other job.

Susie Singer Carter: 1:15

I know. I know. You might hear a speaker in my house, but it's not really a cougar. It's a five pound dog. That sounds like a cougar. Let me know out there. Yeah, let me know. We're working on

Don Priess: 1:29

Gidget?

Susie Singer Carter: 1:30

Yes. Gidget. Is it the diva Cougar. Yeah, so we working on No Country for Old People. So if we don't remind you enough, but we're gonna remind you again, because we are doing something that we hope will create a lot of change. It's a it's a, it's a it's an expose a more or less about our broken healthcare system, which I personally experienced last year for six months straight and without, I had no idea how broken our system is and how it is affecting every aspect of it. And and it's not just the patients or residents living in assisted living or long term care or nursing homes. It's the doctors, it's the nurses, it's the provider, it's everybody that's involved in the industry of and it really is an industry because it's, it's, it's run by corporations now. And it's run by people that who have profit over, you know, their goal is profit over people, which is incredibly tragic, and the opposite of humane. And so we need to make this change. And so if I keep talking about it a lot, it's because it's very important. And it's because I didn't know. So you know, and I don't think a lot unless you're in this business, or unless you get pushed into somebody that needs care. And you fought that's when you find out and that at that point, it's a little bit too late. So that's why I'm hoping to take what I went through and share it with all of you and, and let's prevent other people from suffering, like my mom did last year. So that's what we're doing. And through this project, like everything, everything every every tough road brings you more experience and and closer to the path that you should be on. And that's why I really believe that and that's why I'm meeting such extraordinary people. Every single path, you know, like my mom and the girl remember, Don, we know

Don Priess: 3:33

it takes you a nominee. It's kind of like the Wizard of Oz. You're kinda like Dorothy, and just meeting all these magical people along the way better. I mean, you know, maybe a little better than scarecrows, and tin men, but it's really it's a great journey, the Scarecrow you know, and he had a brain in the long run. So we

Susie Singer Carter: 3:55

all have it, we have heart, we have brain we have courage, and we have read. But we do we do we really are, we can be really strong when we have to be. And we and you know, and that's a great metaphor, Don, I liked that you brought up the Wizard of Oz. Because you can use that walk through life. We don't realize that we have the brains, we have the heart and we have the courage to make change and do the right thing that

Don Priess: 4:24

will lead us and that will lead us home,which is you know where the heart is.

Susie Singer Carter: 4:27

There's no place like home?

Don Priess: 4:30

Well, let's go with a few more of these.

Susie Singer Carter: 4:33

Anyway, let's let I want to tell you Yeah, so So jumping off of my my rant my ramble, really about meeting wonderful people. I met a wonderful, a wonderful soul of soulmate, really. This woman who's a doctor, how am I meeting all these amazing people and then doctors and who are so a step that amazing careers would triple licenses and Like I like talk about talk about motivation and and resilience and and fortitude and all that stuff. Wow. I'm just I'm just humbled to meet all these people. So will you introduce our guest? I'm excited.

Don Priess: 5:16

I will Dr. Miriam Zylberglait Lisigurski or Dr. Z was born in Peru where she attended medical school and practice medicine for almost 10 years. In 2011. She left her parents, her friends and her job as an academic physician to come to the US to be with the love of her life. Now, she's a triple board certified physician in geriatrics, internal medicine and obesity medicine with extensive clinical and academic experience. In 2021, she was selected by the American College of Physicians to be part of the National Wellness and professional fulfillment committee, and in 2022, she joined the creators Institute at Georgetown University to write her first book about well being and growth. The 3d cycle of life the secrets of achieving joy, meaning and well being is an introspective journey that gave her the opportunity to heal, create new friendships, find her purpose, help others and create a meaningful impact. It includes more than 30 experts personal and professional experiences, evidence based data and Dr. Z's insights and stories. She has two awesome sons, a caring husband, a supportive family and although she is caregiving long distance for her mother, who was recently diagnosed with dementia, her dream is to help others achieve lives full of joy, meaning and well being. So please welcome the very irrepressible Dr. Miriam Zylberglait Lisigurski, MD. Hello,

Susie Singer Carter: 6:39

hi, hello, Dr. Z.

Dr. Miriam Zylberglait Lisigurski: 6:44

Thank you so much for having me. It's such a pleasure to be here.

Susie Singer Carter: 6:48

Thank you so fun to have you and I'm just I love everything you do. I'm just so impressed with you. And you have a body of work that's just so such a such a role model for so many people. And I think for I've always, you know, my company is Go girl media and you're such a go girl. You really are. Look, I mean, I don't need to repeat it, right?

Dr. Miriam Zylberglait Lisigurski: 7:14

Well, for me, I am very impressed by you. And I love the things that you are doing. And I am so grateful of having the opportunity to be part of your life and part of your project. So I feel like this is worthwhile. So

Susie Singer Carter: 7:30

wonderful. Me too. It's, it's really extraordinary. You know, when people have to, we don't realize it's difficult enough to go through med med school, right and get a B license, it's difficult, you know, to as a woman, let's face it, I don't know if it's the same in Peru, but you know, here, right? And all until you have all these achievements, and then you fall in love. Right? And then you and then you decide to pick up yourself and, and leave this this country that you know everything about it, including your degrees and whatever you you know, you, you pick up and come and start your whole life over again, more or less, in a new country without the language, you had to learn it on the trot. So, you know, and, and I know this is love conquers all, but I just think that the way that Marian has, has navigated her life is the way that we should with any kind of challenge, which is what I did with my mom is leaning into it and then you find the joy, which is, you know, so I mean, tell us it can't be that easy. So tell us a little bit how you how you got here like how did you pick yourself up again? And how'd you learn the language so quickly?

Dr. Miriam Zylberglait Lisigurski: 8:49

So So I used to read in English all the materials that are used to review in federal were in English. So I had this basic, you know, hello by how are you doing and stuff like that, but nothing more than that. So I really, I learned with my husband a little and then I was hired to do research. And in my office, I was only interacting with two medical students from India that were not able to speak Spanish and this is in Miami. So in Miami it was very difficult to only speak English except that you saved me with someone from India they not only became very good friends of mine, but really they helped me to you know, improve my English and I feel like my patients my patients are very, very kind also and my colleagues and my you know, my mentors is so little to you know, jump into the pool knowing the people will not be judging you but will be helping you um suddenly you're speaking English of course I can't even recognize when I make a mistake. And I'm like, in retrospect if like I said something wrong, right. Too late, and grammar Lee's wonderful. I'm doing some other with Grammarly but let's say that makes me look more professional now when I write English probably with the less less difficult part, the emotional, the most emotional part, the most difficult part was to leave my parents, I was very close to them. They didn't want to join me in this trip so they stay there even I really try. And it was scary also to start from zero my career not knowing that I will be able to make it because the percentage of people that applies to these residency programs and is able to go again and recover their careers. It's not super high, especially when you are older than the average was my case after 10 years of being a physician in my country. But I guess a little of luck a little off pushing hard and a lot a lot of support. I had the support of my family and I believe that that that's the reason why I am where I am right now.

Susie Singer Carter: 11:32

I agree. That's amazing. So what So the other thing that interests me is that you have three different focuses right? So you have you have your your an internal medicine, medicine, right. And then you are you have a geriatric focus and then you have an obesity focus. Let's let's cut let's, let's ask you why why obesity? Because, yeah, well, how do you fall into that?

Dr. Miriam Zylberglait Lisigurski: 12:00

Because they are not disconnected. They are absolutely connected, internalizing is just knowing how your body works. In general, geriatrics takes you to the next level where you see or learn how to apply this general knowledge in a more specific population, a population that is more frail. And I adds to the combination, their holistic approach where you don't only focus in livers and kidneys, bonds, but where you see the cognition and the emotional aspect and the social aspect. That's the part that I totally adore about geriatrics, and we see patients as human beings. And obesity, really, obesity, for me is a pandemic. It's affecting young and old population. And it's something that not only is preventable, but it's also treated, if you do it correctly. And I shall not be doing this for the elderly, probably when when we try to correct obesity in their lives, elderly, we are doing this stuff, you know, too late. It's something that is really prevention. And it's it's part of educating in appropriate lifestyles, which will prevent all of us to get to the elderly times. Right. And until, to be

Susie Singer Carter: 13:25

quality sick. Yeah, right. Yeah. quality to have. So it's end of life. So how do you so there is there's a big sort of stigma about talking about obesity, and you know, these days, because I remember, you know, just anecdotally, I had a friend who was, you know, gorgeous, but always, always a larger gal. And, you know, and she was, she had a, you know, she got to the point where she was like very, very militant about the fact that, you know, it was okay to be the way that she was, and it is, it's okay, you can choose what you want to do. But there was, you know, what we had, I remember having a discussion with her because I had mentioned that I had seen a family member who I hadn't seen for years, who was quite large when I saw them, and I was worried about them. And she was very offended, because she said, that's such a bias and a stereotype that just because they're big, that they're not healthy, but so I mean, how do you respond to that? Because I feel like you're it isn't healthy, to be overweight. So I mean, and how do you deal with that in this in this sort of climate of politically correct.

Dr. Miriam Zylberglait Lisigurski: 14:34

So I feel like we crossed the line. When we are trying to be diverse and inclusive, which I consider myself that I am I mean, being a woman and it may grant for sure I am part of minority. So I will get there number one who's saying like we need to be diverse and inclusive, if not, I am affecting myself. But one thing is to be diverse. inclusive and respected, respected with others. And the other is to cross a line when we are compromising our own health. Because we want to, you know, set a precedent or we want to establish something like, you know, I have the right to Yes, you you have the rights to everything, and we have the right to or the obligation of respecting others, when we don't cross certain lines, right when we don't cross certain boundaries. And when someone that has a medical condition, because obesity is a medical condition and and that's the wrong perception. We transform obesity in the way that you look. Right? In how sexy you are. Right? How How nice you look for others that are your size, but but obviously is is not how you look, obesity is a medical condition that reflects that your metabolism is not working well for some reason. And that will carry medical conditions as a consequence that will affect your quality of life, because you will live with back pain, the pain that will increase your risk of having diabetes of having cardiac problems or having cancer and strokes and even dementia. So yes, I have the right to be green, I understand you want to be green, you want to be yellow, you want to be purple, I understand. But when you are trying to fight for your right of being green, or yellow, or whatever, are you compromising your own well being?

Susie Singer Carter: 16:41

Right? Are we putting out the wrong message? Are we putting out the wrong message, the message is Yes to accept yourself and you can make the choice if you want to live, compromise your health, because that's what you want to do. That's okay. But it also it is a fact, like you said there's a line that when it becomes detrimental to your health. And so it's it's right to worry about someone that you love, if they if they've crossed that line.

Dr. Miriam Zylberglait Lisigurski: 17:08

Yes, however, society created this monster, society created this monster when we started to really a stigma, stigmatize obesity, right, and we started to okay, that person will not be invited to the, to the party, and that person will not find a nice dress in the store. So we create that in society and environment that is toxic. And what we are seeing right now is our reaction. Individuals that suffer from obesity are reacting and trying to defend themselves against the aggression, right of them by him. And and I understand I understand that, my, I guess that my point for them is to not put yourself in a situation that it's dangerous, just to make sure that you are respected, there are other ways where you can, you know, reclaim their rights and you have to be treated with respect be your how you look by gun, the color of your skin, this is not, this is different than when we talk about someone having an accent, like in my case, or being from one religion or another home one color of a skin or the other we are talking about, this is about your life, this is about your health. And I feel like we need to reassess what we are doing with obesity and the messages that we are sending, because the consequences are really tragic. And we will keep seeing them we started now to see them but But what then that then 20 years from now, we will have a very high level of patients with disabilities. Because obviously they will not kill you will turn you into a disabled person, a person that is suffering a person that is not able to work. And at that point, we as a community as a society, we will suffer too.

Susie Singer Carter: 19:07

Right. Thank you.

Don Priess: 19:10

Yeah. I mean, we don't we have to define it. We have to define what obesity is or what you know, because there is the the physical what we look and we see. And then there's some people who probably don't even look and are probably health compromised, and we don't know it. So how do we define that?

Dr. Miriam Zylberglait Lisigurski: 19:27

I love the question. And I was actually planning to answer to that when you ask. Yes. I feel like there's a big problem in how we define this. And yes, there are methods of course, this very well known BMI that is the relationship between your height and you're on your way, which is kind of the standard not necessarily appropriate for all the groups for elderly is not appropriate for people from China, for example is not appropriate. See Most of the characteristics of their body, right? So we cannot, we cannot necessarily we have to adapt the numbers that we use is not the same that we use in this in the United States. And then you have these body builders, for example, where they have a very high BMI that if you see the number, you will call them obese, and then you'll notice that fat percentage is very low. So we need to incorporate foreign fat percentage and the circumference of your, your body, your abdomen to incorporate extra data and really qualify someone as overweight or obese or morbidly obese. So that's, that's number one, it's a little more fancy that what we do, or what we know. But the second thing that I believe is even more important is that we need to understand that obesity is not the result of over eating or not necessarily in the in the, in all the cases that we the advantage, or have more technology and genetic assessments and the ability to see receptors in the brain, we have any identifying that there are some conditions that because of genetic reasons, or because of, you know, malfunction of areas of our brain conditioned individuals to or eat more because they cannot feel full. And they need to keep going or to have problems with the metabolism. So even if they may not eat a lot, they will gain this weight. So we weren't judging people because they eat too much. They are too lazy. They do not exercise. But the truth is that we may, we were being very unfair, we were just ignorant that there was a real medical condition, right? causing this condition. Okay. Yeah, conditions, actually. Yeah, yeah, it's plural. And we need to go back to the community and to and to add, okay, them. So we'll reduce the bias. No, just saying like, all everybody has the right to look the way they want, because that's a very wrong message is, yes, we need to be kind with people because it's the right thing. But because it specifically is this group is not like I say is not eating a lot. They have a medical condition equal than hypertension, or diabetes, or cancer or anything else, right? We will go in front of someone with cancer and tell them like, Oh, you look awful. Or you if this is your fault,

Susie Singer Carter: 22:36

that's your fault, right? Yeah.

Dr. Miriam Zylberglait Lisigurski: 22:38

You wish you would not go to someone that is obese and tell them this is your fault. You look like this? Because you want no, they don't want.

Susie Singer Carter: 22:46

It's like alcoholism, too. It's fine. You know, it was before it was always thought of as like, oh, well, you're indulgent. You can't. Why don't you just quit? And some, you know, and it's like, I don't I don't I don't have that, that predilection to be an alcoholic? I just wouldn't be that's just it's not in my genes where someone else can pick up and they can't. And like Don has, you have the Jethro syndrome? You never get full?

Don Priess: 23:11

I couldn't I well, I don't and you don't. And that's I've gotten older. That doesn't benefit me much. But it is it's it's it's it's a condition. It's not, you know, you know, look, there's always exceptions to the rules or some people who you know, but in general, it's not it. You know, we think of obesity. We've been trained to think of oh, it's because you overeat and you have no self control. gladness, you're

Susie Singer Carter: 23:39

being a glutton negative. Yeah, right. Yeah,

Don Priess: 23:41

therefore, you're bad. And it's not that

Susie Singer Carter: 23:44

I love that. I love that to change the perception because I think you're right, the pendulum had to swing very, you know, as it does when we're trying to make change, you have to swing it all the way. big and wide. So people will take it, you will pay attention. And that's what you've done, right? We've got so everyone is paying attention. That's why we see different bodies and ads. Now we see that and we are accepting of it. And I think now is I love what you're saying because now it is a good time to come back now. Because we did we did make a change in perception.

Dr. Miriam Zylberglait Lisigurski: 24:14

Yeah, we were to the we went to the extreme right. To the complete opposite. We need to go to this middle healthy place. Yeah. Where we will treat people with respect because that's what is correct. But we will also allow them to get to a condition or a situation where they are happy and healthy, healthy and right. And I say happy and healthy for one reason because obesity not only causes problems in your body is not something that will only give you diabetes or cancer or strokes, but also it's also related to depression, anxiety, isolation, high risk of suicide and etc. If you are a victim of abuse continuously on bowling and rejection, you're really hurting the soul of someone because of something that probably they have not enough control. And we need as human beings to be a little more kind. We we don't know when it will happen to us and I'm saying obesity but COVID Whatever, anything is a question of luck.

Susie Singer Carter: 25:29

I think it's a good, that's a great time to pivot into, you know, geriatrics because there's an I think, you know, which brings, which will tie this into No Country for Old people and your mom who has dementia and, and that area of medicine that is, is really underserved in my opinion. And, and even geriatric doctors, many of them don't know about a lot about the, you know, a certain amount of what they've been taught. And then, you know, unlike what you said in the beginning, that you you take in the whole person, I don't think that that that is incorporated in every doctor that I met during my mother's journey. So I love I love to, to pivot into that and to say, how do you, you know, we need to apply the same, the same idea, the same paradigm that you're talking about for obesity, for people that are older for people who have dementia, you know, and then you know, and the combination thereof, because that is the horse that is the worst combination in terms of living in society.

Unknown: 26:37

I feel like we need to be kind in general, we need to be kind of an elevator, you know, where the person that is asking you to push number three, that will be the way that we manage ourselves in life and right now when everybody's suffering in some way, not only because of COVID but because of the economy or whatever is happening in their own lives. Being kind is just the little thing that we can do for others and for ourselves. That is free. You know, it's just a smile on like a tiny, nice word due to Agra, how are you doing, I wish you a good day the end and you may we change the complete date for that person free. In geriatrics. And, and I want to be careful on this. I don't think that you react is the only a specialty that she will have or that has this concept of a holistic or comprehensive approach. I believe that in a majority of the cases, that's what we will like every specialty to have sure right. Every doctor should practice like that. I receive extra training or extra, I will say encouragement to do so during my geriatric training in Peru, and also here in the US for some reason that is part of the philosophy that is included and you will see it also in palliative care, hospice. In many cases, we are seeing that transition also in the ICU in intensive care unit, but is not yet practiced all over, I will love internist to do it, and primary cares in general to do it. But I don't blame them. And I don't I don't judge them and the reason is that the system is not allowing us to practice the way that we want the thing, the fact that you are going to a physician office and you are not seeing this, when they are treating, you know, not necessarily reflect that they don't know or they don't want to do it is reflect that they have a manager in that clinic that scheduled 30 patients for the day, and that they have 30, no 15 minutes to see each of them. And then they have to document and click a lot of things in the computer to fulfill metrics and then call patients to give them results and refill things in the pharmacy. And this happened in a period of time that you will like to be able to you know, I extend that I mean there are no more hours in the day. So, I have my I have my doubts on how we will fix this because even you may have motivated healthcare workers. If the other side of the system right the administration doesn't get the point that we are not producing, you know bottles or whatever, that we are really rigid human beings. Yes and that not every appointment will last 15 minutes. Some of them may last 10 minutes because it's a healthy person that comes to say hello and have that checkup and the end but Add when you have complex patients, and they don't necessarily need to be elderly, I don't want to be biased. They may be a 30 -40 year old lady with cancer or with diabetes that already had a stroke or going through a divorce, right and very depressed or with suicidal ideas. So, especially in primary care, internal medicine, we see these variety of patients, and we don't know, just checking on the age of that patient, you will not know what is coming. And and trying to put everybody in this, you know, range of 15 minutes is enough, I believe that we are getting very short, sadly. And what happens is that you are not building this good relationship, this appropriate relationship with your patients where you can learn more about the social aspects and emotional aspects of their lives. Someone will not come to them for first time and tell you oh, I went through a divorce or my dog is sick, and I am living in a place that is not safe. And I cannot go and buy good food because I don't have the money and working in three places. They will try to give you the I have been here I'm paying there. And I have this black spot here. Right. So this takes time. And we don't have it sadly, and for me, personally, is heartbreaking. Very disappointed. And the reason the reason number one for me, personally, and for many doctors and other professionals to develop burnout, because there is a very big gap between what we want to do what we thought medicine should be, and what we aren't doing every day.

Don Priess: 31:53

Right. And that's part of the I mean, that's that's part of the diagnosis isn't it isn't like what's causing this pain? Well, it could be the fact that they're working two jobs, and they don't they're not sleeping and all those things, and you don't have time to talk about that, you know, you can't you can treat the symptom but you're not treating the cause? And does that all come down to money in the long run? Because we don't have enough time and staff? And you know, what, is that where it's stemming from? Because it seems like everything does? Yes.

Dr. Miriam Zylberglait Lisigurski: 32:24

It's a very interesting question that the quick answer could be yes, probably is because administrators and CEOs of healthcare systems has zero knowledge of medicine, they are not doctors or nurses or they never went to medical school. So they don't know what happened in the operation room, they don't know what happened in a room when you see a patient and you have to tell them that they have HIV or they have cancer. And you cannot do that in 15 minutes and think that life continues like nothing because we as as as human beings we have feelings to and then we have to go to the next room. Right? If you are pregnant, so I don't think that they have any idea of what happened inside and I will recommend any CEO to please take a few minutes to get the scraps and go into this rooms, I'm getting humanize because I feel like that is missing. That's number one. Number two, I have my doubts. So they understand really their industry of medicine, because if they will really pay attention to what medicine is about and the benefits of creating a good relationship with patients that not only increase the probability of that patient will come back and again and again to you because they like you and they trust you they will recommend more family members or friends. So that is good business. And number one, number two is that if they trust you, they will follow your advice meaning that they will recover easily from the medical conditions that they have. If you are talking about prevention, they will prevent right they will be compliant in anything that is related to commercial. So you will be reducing costs you will be reducing risk of disability you will reduce medical or or admissions visits to the to the emergency. So the cost of the healthcare system and the cost of Medicare Medicaid right will go down and you will have happy healthy people that also is producing better in their jobs. So I see this like Contra productive is like how he is that you are really avoiding physicians to do their job correctly so they can bring more money to the healthcare system to the to the country and I just don't I don't get it. I have been trying to find Understand, I don't forget about being kind for better, but about the emotional aspect. I'm not even trying the humanistic part, I am separating it. I'm just talking about money, money, money,

Susie Singer Carter: 35:14

money. Yes. But I think I think it's, you know, it really comes from a corporate mentality. And it becomes, you know, it's really down to two Ledger's and, and, you know, how can you when you've got, you know, stockholders and people that are having are so far removed from the actual business itself, that it just becomes an accounting? And how can you get the How can you get the most and the fastest, you know, and, and, and from, from everything I've heard read in my research over the last year, he, what is the most expensive part of any business is are your employees, right? So employees are the most expensive, so where are they going to make their first cuts is with employees, so they're going to try to get the most out of each employee that they have. So without, you know, and forgetting that these are human beings and not widgets, and not machines, you know, that, and you know, and if you burn out, well, then they'll hire someone else, because there's plenty, you know, there's a pool to pick from.

Dr. Miriam Zylberglait Lisigurski: 36:16

But again, that's the that's very poor understanding of the process. Because, first of all, a physician or a nurse, that is tire upset, not only will treat bad patients, so you will have less satisfaction, which is some of the wonderful metrics that we are supposed to measure right? In the hospitals. So you will have less patients satisfaction patient will not like to be admitted again, in that hospital, they will not recommend that hospital or that clinic. So not good for the business, then you have more more risk of medical errors, this count with Sue's right? Me too, I'm very bad advertisement. And last, but not least, if you have a physician or a nurse that quit their job, right, or that collapse in front of you on USI, that is not useful. At that point, what you have to do is to recruit recruitment, and retraining is so expensive, that is not worth it. So again, I can go back to all these removing the emotional aspect, just to money, money, money, and you try to get the numbers and doesn't make sense. I

Susie Singer Carter: 37:43

mean, you touched on something important, which is, you know, the, the cost of training and recruitment, you know, is is is is not, it's not something to to ignore. And I think because of that, this is why, and I'm going to, you know, turn it back into long term care and, and, you know, at nursing homes, things like that acute acute centers, because there's a lot of there's a lot of people working, that aren't trained now, because they're just putting them through, you know, the cursory training just to have bodies in there, basically, which is, you know, and I'm gonna, I'm speaking not technically so but I'm just saying, This is what I've seen. And this is why our system is is it's it's not a broken, it's frightening, because your your huge decisions are made by people that don't are not qualified.

Dr. Miriam Zylberglait Lisigurski: 38:38

Absolutely. And not only that, you don't have enough staff, but the staff is very low motivated and very inappropriately terrain. Yes, we are, we are rushing trainees and we are we are getting people that is not prepare. I am very respectful with what sadly we call providers that this pool of a lot of different professionals put all together under that same so you have nurse practitioners and PAs and etc. But even I am very respectful and I have very good friends that are pas and nurse practitioners and I know the value that they represent and their amazing knowledge on how much they care about patients. But they are excellent pas are excellent nurse practitioners, right. They are excellent doctors but you cannot do the job of others and they are trying to replace and give responsibilities at a level that does not represent your training. And that's not appropriate for patients. And that's not appropriate for the same individual that decided that wants to be a PA or a nurse practitioner and feels comfortable with that role but is not prepared to the responsibility than an other role will, you know, force them to. So that's a big problem. And of course, it is less expensive to hire people with less training, rather than to hire a physician. But that that's part of what is happening right now. And I feel bad for them because of the level of stress as is like dealing with sick patients, long term patients are counseling and emotional distress and, and, and the fear of doing something wrong when you don't have someone there that you can, because they suppose we should have someone available to also discuss the cases and feel that they are doing things correctly. And I have many of these nurse practitioners and PAs saying that it's like, we love what we do, we want to help but we know our limitations. And so it's not me as a physician, judging or underestimated the value of others is respecting that they have the right to work under their scope, because that's what they say for them. And that's what they want to do.

Susie Singer Carter: 41:10

Right. And I actually I saw that firsthand, in my own experience, where some were a nurse who was not ready to take on a floor by herself was there all by herself and was an made horrific mistake. And, and it was and she was so overwhelmed that my heart broke for her. But it was for but it was to my mom. So here I am stuck in the middle of like you, you were put on this situation. And I feel sorry for you. i But but I feel sorry for my mom. I don't know, you know, everybody's got everybody's is a victim in this city in this bad situation.

Dr. Miriam Zylberglait Lisigurski: 41:49

Absolutely. I believe we are all we are all victims. Sadly, sadly, this is something that majority of individuals are not aware of, they see the nurse practitioner doctor, any of us her professionals as the monsters on the, you know, on this picture. And you don't want to give me this order, you don't want to submit to the court, or you don't want to prescribe that you don't want to be with me You care more about your computer. And, and yeah, that's how it looks. Really I will not say that that's not correct. Because when I remove myself from the white coat, and I am the mom or the wife or the daughter of someone, or I have to or the patient, right, I have to experiment the healthcare system. I am like, oh my gosh, this is how it looks. And the other day I went to see a physician as a family member. And I almost shocked him. It's like, May I hug you I am impressed. You were so kind your stuff is so kind and I was like looking like a crazy person. Like, you know, enjoying the fact that I'm feeling normal.

Susie Singer Carter: 43:06

I literally, I have the speech therapist, I hugged the speech therapist that came to assess my mom, the day and I and I think she looked at me like I was crazy. But it was like finally I had somebody that was a human being right. That I felt like it was like listening to me and like and, and and you know, validating what I was trying to get across but

Dr. Miriam Zylberglait Lisigurski: 43:30

your perception socio right, you thought that you were seeing finally a human being you in front of human beings all the time? They were so a stress in survival mode. Yeah, every five the next possibility of you know having an error. Already IBUs Yes, already abused by their boss says no leaders boss says and also be used many times by the patients that are frustrated or scared and that they are seeing just half of the story. Right? They don't hear the kinds of things

Susie Singer Carter: 44:06

what you're talking about is moral injury, because I hear this a lot right term. Okay. And I think that it's really important that you're bringing this up because we we as a patients, and we're not in the medical, you know, anybody that's not in the medical field at all? We don't know. So the only people we are interfacing with, are those doctors and nurses and nurse practitioners and PAs. And so we we really do we because we don't know now I know. But before if you don't know, you really feel like it's coming from them and that they could do better. But now you know, but we need to tell people that they can't do better. And that's why things have to change. Right?

Don Priess: 44:47

Expectations are when as as the patient or the family of the patient. You see somebody in the uniform, and you immediately think they know exactly what they're doing. They are educated They know exactly they know they can solve a problem just because you ask them, and it's not the case. And it's and it's an like Susie said she didn't had no idea until she went through it. And I think that's probably 98.7% of the people who are going to go through this. Just think that, oh, there's a nurse, there's, they've got that uniform on, they must know they can solve my problem. And it's not the case. And it's

Dr. Miriam Zylberglait Lisigurski: 45:23

no time, the time that we spend trying to convince, you know, a person on the other side of the phone, that my patient needs an MRI know that x ray, that needs to be normal, so I can do the CT. So then I can do the MRI, when I know that everything will happen, you know, will be normal, I will take three months to get to the MRI, if I am lucky. I don't need the other ones. I just need to place them the MRI, don't spend money and time into tasks that I know will be normal. I think that coming from someone, right? graduated from medical school, that concept shall be so easy, right? Right. That's an easy task and normal task is impossible,

Susie Singer Carter: 46:12

right? Because they're right, because the boxes need to be checked off. And those boxes, you know, equate to money. And they equate to money, because if they can charge for another x ray, they can charge for another, you know, CT scan, and all you want is an MRI will know this, then you're going to cut you're going to cut those two steps out. And that's money. So I have a question in that respect. So if you as as as providers to throw of net over, over all, all of you very nuanced, nuanced, skilled positions. What if you, what if you were transparent, and just said, I want to work with you more, I would like to spend, you know, more than 15 minutes, but this is the system, I just want you to know that and if everybody heard that from their, their provider, so that they got a sense of like, it's not my doctor, it's above the doctor. I mean, I think that maybe the doctors can be more transparent or is that put their their jobs in jeopardy? Yes, it's definitely

Dr. Miriam Zylberglait Lisigurski: 47:18

a shoo in for sure. retaliation, that clear? They fear inside of the system is unbelievable. And and the bystanders, right? It's impossible to believe you. Yeah, it's our pricing is very depressing, actually, to see how much people is ready to tolerate, to keep their jobs. And I understand why also. Because if you have kids at home, if you bought recently a house, or if you have parents that are elderly, I need to take care of them.

Susie Singer Carter: 47:58

I guess they have no choice, you have no choice.

Dr. Miriam Zylberglait Lisigurski: 48:01

And you have a non competes. And I don't know if you are aware of non compete non competes are things that you'll find in your contract that, that really limit your ability to find a second job, right, if you quit your job, you, depending of your specialty and the type of non compete, you might need to move from from from not only your city, but the state to practice for X amount of years in another state. So you can be a doctor or nurse on money. And then two years later, or a year and a half later, you can come back and you know, reunite with your family where you are

Susie Singer Carter: 48:42

that that makes me so angry, because it's very frustrating to hear that because it it seems like they they've created a system so that it does shackle for lack of a better word of shackles, you know, everybody's to do their job in a really profound way. So, if they can do if they can do that, if they can create that kind of, of a platform, why can't we do that in the way that it works? Because when I talk to people who are professionals, they say oh, it's so broken, it's so convoluted. It's such an a web, you can't you know, we can't pull it apart. We can't you know, there's just too many pieces. Well there was there's always too many pieces. They seem you know there there's a system in place that keeps everybody staying in this system. So that that you know it so we there is a way to change it, don't you think?

Dr. Miriam Zylberglait Lisigurski: 49:37

I well, I want to sing that. Yes. Because the other option is I have to quit medicine and that's something that I'm not doing. I love everything and I refuse to think that I will be miserable doing what I love. So yes has to be a way that the way exactly way, I don't know if but I can tell you something is in big part of what you are doing with your documentary could be, you know, a stone that is building in that direction, you need to create awareness, we need to remove the core things and allow patients to be empowered. And to understand that they are, I would like the word victim, but I will use it in this context that they are victims the same that we are victims of a broken system, that we are in the same site, and that we are supposed to collaborate. So reducing a little distress that healthcare workers are receiving from patients, that mistreatment from threat patients, and it's ridiculous, but when you you will imagine that a doctor will get hurt by a patient this is except except that these are psychiatrists. But but those things are happening you are you assaulted, I have been insulted by patients so many times because I am saying I cannot give you that referral, or I will not prescribe your antibiotic. You know, what

Don Priess: 51:12

insurance won't cover or you know, whatever. And that's, that's what's so counterintuitive about all of this is that if the system was running properly, everyone, including the insurance companies would they're paying out less, they're paying out less claims. Yeah, it's just it's insane. And it's also a little frightening. Yeah, go ahead says

Susie Singer Carter: 51:33

no, I was just gonna say that the people that it feels, you know, the way your your framing that if we really it is supply and demand, right, that's business at the end of the day, that's the simple version supply and demand. So we are, we are as patients were in demand, because without us, they're not going to make money. Great. Yeah. So so we we in essence, as a population of patients as right, we have power, because if we we demand it as a as a population, and we say, well, if you we're not going to go here to you, we're going to go to the places that provide us what we need, instead of just accepting it. Instead of going oh, this is the system, this is what we have to work within No, we are the we pay there, we pay the checks.

Dr. Miriam Zylberglait Lisigurski: 52:21

Well, I will tell you something I see doctors, including myself kind of fast, you know a restaurant or waitress in a restaurant or the cooker. You pay well you pay the owner of the restaurant because I don't get the money with the liner right. You and and I am supposed to give you these the Legions for that you will enjoy and you will live happy you cannot give me a tip is that is illegal in this country. You will not receive anything of course but but that's more or less their relationship I physicians, we are supposed to be servant leaders right in the community we are so physicians nurses on the complete team, right? We are supposed to serve the patients, the patients have the right and they have their shoe has the right to select who is a doctor what facility they go to? Who will see them or not, but that doesn't happen. Who decides all that is your insurance. You cannot pick up and then you go inside of the hospital and you have to see these gastroenterologist because that's the person that the insurance says and and you're like, why I hate that person? Yes, but But if not, you will have to pay this amount. So there is no transparency in the process. There is not really democracy in the process of health, if you want to call it like that where you can select and therefore your writer They do that because you don't you doesn't matter how much you will have, you know how big is your tantrum, but if your doctor or the doctor about you, one cannot see you or will you know will build you without insurance. Your hands are tied. So that's what makes complex a situation.

Susie Singer Carter: 54:11

Totally. And you know what it does? It brings us back it just makes me think about our metaphor from the beginning of the Wizard of Oz because we need to pull because behind the curtain is this ridiculously disgusting human being who's back there, you know, who's just about poser, and he's back there being or, you know, the big the big brand that everyone's afraid of and they think that this is the way it is. And then you know toto pulls the curtain back and we see it's just this really fumbling bumbling man. And now we've blown the cover. Well, we need to blow the cover. And we have the power to do that. We just can't be afraid and we have to do it because that's really what it is. And they're in such they're they've created such an illusion that we have no power but we do. In 30

Dr. Miriam Zylberglait Lisigurski: 54:57

years you have the power of physicians and healthcare workers. will have the power also to practice medicine in the way that they promised they will be and that is patients safety and right beneficence and you know, all the lives of these ethical concepts that are a should be priority. And a big part of, I will not say is a solution, but I feel like is, we need to start with healing, we need to start with self awareness, we need to start being aware, right as what is happening in the community needs to learn physicians, nurses, etc, we need to learn what is happening, we need to understand what is happening behind the scenes. And knowledge gives you power if you understand that this is not the only way that there are better ways or different ways. So for that probably medicine only as training is getting short right now you need to train physician leaders, nurses leaders, right you need to provide education and emotional intelligence leadership skills, self care to create a strong human beings leaders that will be using the white coat and a stethoscope and we'll add healthcare workers, but that they have enough knowledge to be able to understand the situation and to maintain their own well being so they can keep going and they can keep helping the community and raising their voices and helping themselves on under themes. Because right now, majority of us I mean, based on the statistics you have more than 60% 65% of physicians were in burnout right and you can change the name or a lien theory whatever anyone but they are not in a situation if they if they will be if they will be pilots driving a plane, they will not be driving the plane. Right? Because Bernau means that they have error. Yeah, risk of error, right? They are able to concentrate or they are tired, because they focus on or they are not motivated. You will not like that pilot to drive your plane. No, but they are doing Neurosurgery is

Susie Singer Carter: 57:22

right, right. And there's and the suicide rate is very high, right?

Dr. Miriam Zylberglait Lisigurski: 57:29

So three to 400 per year, as per data. What is very, very fine is that these numbers are before COVID. So probably we will get numbers that are worse now. And I clarify that because many have in trying to say well, this is because coffee than they were no no, this is not because coffee, this is because morally injury, right? And because of this gap between what we want to do on what are we doing. And it's terrifying because you are talking about one to two physicians dying every day in this country by suicide, and then you have nurses and other healthcare professionals. So under numbers are not necessarily better. Um,

Susie Singer Carter: 58:20

this is a disaster. It's no, it's a disaster. Because if we don't have we, as it is, we're don't have we don't we're not providing, you know, the, the the environment for doctors and nurses and providers to do what they do. And then on top of it, so they're either burning out and leaving the industry because they can't stay in it. And I've talked to a lot of doctors that are doing that, or they're taking their own lives which is which is so tragic. But then, you know, as as patients as human beings that need doctors, we now work now we're caught we're creating such an such a horrible crisis. But that's a whole nother Okay, I just feel like I have to talk about your book. And I want to, I want to, because it's getting so, so incredible. But it is it is connected, it is connected. But I want to hear about your the 3g cycle because I think I want to I don't I don't want to give it short shrift, but because this is love conquers all. I want to ask you one thing about in terms of geriatrics, and that and that, you know, that focus and how, you know, we as as caregivers of someone with dementia or Alzheimer's, and I know in my community, I hear it a lot that that that there's not enough. There's not enough information from the doctors that we go to, and how can we create? I mean, again, a big problem but how can we at the moment, help ourselves help our loved ones or if we're diagnosed with You know, early onset or whatever, we there's not enough people that understand it. And that's why they're, they are given short shrift, because there's not an understanding of it, you know,

Dr. Miriam Zylberglait Lisigurski: 1:00:12

well as Slimer is, sees a condition that, sadly, is very frequent in elderly population more than what we will like. But at the same time, even we may be able to do a correct diagnosis at some point, clinically, or now with more sophisticated tests, that treatment is the part that we really don't know. Right now we are seeing this controversy about a new medication that FDA is approving or already approved from many individuals in the scientific world are questioning the type of status and I feel like that's the big problem, we are really even we can diagnose, we cannot read and that's very frustrating for for the patients, especially for the family and for for us physicians to it's very important also for for those that maybe are not so used to the term Alzheimer and dementia to understand that they are. Dementia is a big, big ball that contains Ulzheimer and that there are other types of dementia, right, because sometimes we think that it's the same is not the same, the clinical presentation is different, the progress of the disease is different. And sadly, we don't have medication for the other ones either. So So that's again, a big a big problem. Right now, the only thing that we have really is the support of the family members on the support of the the multidisciplinary team, yes. To help the patient and the family, it's very hard to find that again, in a system that is broken, where you have a psychologist and a social worker and a physical therapist and psychiatrist, geriatrician, working together in order to get you know, the patient to have the best quality of life, that's very complex, when you have a system that

Susie Singer Carter: 1:02:16

doesn't support that it doesn't support that. And I think what you said in the very beginning about taking into account into, you know, account the whole person, so when you have a misunderstanding of Alzheimer's, and and and so and you and as the physician not having the time to be able to take into account that, yes, it it manifests it, it shows up in different ways in different people. Yes, there are similarities, but one case is not every case, that's just the way it goes. So and because there's no treatment, we as a physician, as physicians, as the team, everyone needs to know that they understand it better, rather than dismissing it. I mean, I spoke to a professional who was very respected, you know, on a high level. Yesterday, I was interviewing him and he basically said, Well, I understand my grandma had Alzheimer's for 10 years and it was like she was dead already. But that isn't true. That is such a bias and such a stereotype to like to lump everybody you know, just say that they're not worthy or they're not alive. They're basically they you know, it's so that understanding is just i My heart was pounding yesterday

Dr. Miriam Zylberglait Lisigurski: 1:03:34

because I feel it in different ways right I feel it like the granddaughter I'm the daughter of someone that had the bench and I feel it like the doctor that decided to study geriatrics in Peru and came to this country and I'm trying again in geriatrics and I didn't do this because I think that elderly they don't deserve a good treatment or they don't deserve to be respected I did it because I believe that even until your last day you deserve to be treated as a human being that you are how many times we see this lady ladies or gentlemen that yes they may or may look like they are not there and maybe they are not it's hard for us really to say that they can understand or not we really we we don't know each case is different as Susie was saying. But if you go back on the story, they created something or they wrote a book or they have us I don't know a street with their name because they save lives. We cannot forget the past of these individuals we cannot forget that these individuals are our future. Tomorrow we will be them tomorrow we will be them. So we need to train the society okay the society okay, that word Kids in a way where they are kind and respectful with those in need with those that are frail, because tomorrow we will depend on the kindness of this new generation, they will be the one that are watching for us. And if the other way that we want to be referred as like we are that we are off chair we are, I feel like is a very non humanistic approach. And what happens is that, when we remove the human aspect of individuals, when we give them the title of providers instead of Doctor these nurse doc, right, right, patient number 45. Right, we do that we do it to remove, right, the concept of human. Yeah, that's right. And that's easier to treat someone that is not a human.

Susie Singer Carter: 1:05:57

Exactly, exactly.

Don Priess: 1:06:02

And it starts, it starts with education. And it starts with educate, we have to educate from a very young age, you know, to for the, not only the doctors, doctors don't even know, we need to teach the children, our children, we need to explain it don't avoid it, we have to explain what's going on. We have to, we have to demystify it. And they're still human beings. They're just different. They're the you know, like Susie always says, you know, you don't, you can communicate with a baby, they can't speak, but they can understand and they you can do it. And I'm not saying that they're babies, but you have to learn a new way.

Susie Singer Carter: 1:06:37

It's just that they've lost skills. They've lost a certain level of their brain, but there's other parts of their brain that are working. And so and they're very, and they're very, it's meaningful, because you know, to the day my mom died even without you should when she started to lose her, her speech. She was still speaking. And we in even, you know, in a different way, you tune into them and you can, my mom would laugh, She'd cry, she'd swoon, she'd kiss, because those are all those are emotions, those are feelings, those are instinctual there. Those will never go away. They're there.

Dr. Miriam Zylberglait Lisigurski: 1:07:17

Yeah, and again, he's we need to treat people the same way. I mean, my husband and I will repeat that at home all the time to our kids. We need to treat people the way that we want to be treated right and we need to lead by example. I see my mom today going through this. And the first thing that comes to my mom, to my mind is that she took her mom to our house when I was in medical school she moved her so she was living with us and my mom took care of her mom with dementia until the last day and my sister and I we were part of this process was a family you know a family commitment that they are you know, My Baba rasa was was my best friend and we love her until the last day and my kids are never met her. They talk about my barbero saw my grandma Rosa and they know that you know about hair and and they love her. And there is nothing wrong about having feelings there's nothing wrong about going through the sad process and the grief especially when you know that you are doing your best that you are trying your best and being respectful unkind. The other we can question or we can you know be respectful and open minded with those that believe that yes, they can care as they cannot hear as it is sometimes will be, you know, challenges improve that one thing or the other, except that we don't know protests or with the images and etc. But But beyond that, that person is still a person is still your mom or your dad or your friend. And now is when you show how much you love someone in parties and celebrations in good times. It's very easy to be there. Or to be surrounded by a lot of people. The question is who is with you when you you know you are in your most vulnerable stage.

Susie Singer Carter: 1:09:27

Amen. That's and

Don Priess: 1:09:28

how do you how do you as a physician because you have 40 patients and you don't you know, how do you with especially with with somebody with Alzheimer's? How do you get to know them enough that you spot things like Suzy sees things saw things or mom that the nurses the doctors would never know in a million years well how she was doing. How do you do that? Because you don't have the time you don't I mean, how do you get past Well, I

Unknown: 1:09:55

will refuse to see 40 patients if someone wants to hire me to see 40 patients I mean Believe me, the answer is no, I will not do if it goes against my ethics and my values. So no way. But even when you have a reasonable amount of patience, right, that allows you to stay one hour with the patient and allow them for a long time, you will not know that person as much as the family member. And that's why one of the most important members of the multidisciplinary team is a patient on the family. Yeah, and we cannot ignore that. And when you see a geriatrician talking about multidisciplinary or holistic or comprehensive approach, you will see the nurse and the doctor and the physical therapists and the, you know, the clerk and I love and you will see that in the middle in the center of this group is the face of the patient and the family behind them. Why because at the end, you need to adapt your therapy to the patient, the patient, again, the patient is the one that is asking, I want fish with the sauce or whatever, right? You you need to adapt yourself to what the patient feels.

Don Priess: 1:11:12

But it's such a struggle, because Susie, you know, would tell them no, you don't understand this is what she's doing. And they're just like, you know, they kind of go by the book, as opposed to by listening to the family member when they know. It's that's that's a problem. And it's a struggle is what Susie went through the entire time.

Dr. Miriam Zylberglait Lisigurski]: 1:11:31

And that's and that's a very big problem. And and I I would like to tell you that that this is one case in Emilian. And sadly is not one case in Emilian. We are living in compassion, fatigue, and party fatigue, you have people working just because they have to surviving day by day. This doesn't. I want to clarify that I don't think that these justify mistreatment or lack of respect or medical errors. Now just explain why this why it's happening. Yeah, but but but that's unjustified, right? This never happened. But but you have and then you have individuals that are not well trained remember something. There are not many geriatricians in this country. Many of them they don't want to even go there because it's not there are no jobs for the repetitions because there are no geriatric centers. Because there is like, if you want to work in a hospital, there are not even geriatric doctors to do consultations, because that goes against the metrics of the hospital, a patient will have to stay longer because needs physical therapy, and needs evolution of this and it's and that mess, metrics. No. So yeah, geriatricians we work I have to admit and Brooks breaks my heart that I have to work as an internist, a little more sophisticated internist. But that's my role in this country because except that you go to specific places. You cannot work as a geriatrician, I apply what I learned geriatric for young people to write. But there is not a way to do geriatrics. And as a result, as a result, you have a lot of geriatricians that are not geriatricians, that they were trained in places that are not preparing them to be geriatric doctors, because there's no opportunity.

Susie Singer Carter: 1:13:29

There's no opportunity. That's, that's so sad. Well, let's let on that note, let's talk about the three G. Let's talk about your book, which isn't sad. It's the three G psych cycle of life the secrets of for achieving joy, meaning and well being. Right, yeah. So tell us in a, you know, because I want everyone to go out and get your book, which is it is totally charting, as they say, on the charts on Amazon, and which so congratulations. But get give us the gist of the three G's, what it stands for, and how you came up with it and why everyone should read it.

Dr. Miriam Zylberglait Lisigurski: 1:14:09

So the three D is a result of me fighting burnout and trying to find my purpose again, and you know, escaping the dark hole of the system, plus COVID and I have been very resilient all my life and people used to ask me how and I never pay attention to that I saw that it's so normal on that stuff, how I am doing COVID And with everything that was happening in my life, I was not able to leave this to good luck, right? I was supposed to understand what is happening, how I do it, how I replicate this and get the help that I needed to make sure that those around me will be okay too. And that's how I came with the 3d I function or identify functions. Thinking that life is kind of a video game, I go level after level, and I don't think that I die, I see a lot of other, you know, hearts in the game that give me extra life and I learn the new tricks and I adapt. And I try again and again till I am able to, you know, get more savvy and go to pass the level and go to the next level. So that's the concept of the 3d cycle is life us cycles one after the other. And the components for the cycle are the components that I found that are keeping me alive and I'm director. And they're first of all goal, I start every process thinking about what is my goal? What do I want to achieve, and will be something mandatory finished medical school or get married or have kids whether society force you to do, but could we write a book or go to Italy, something that could be a dream. And then to be able to continue to recycle, I need energy, this fuel right that I call grid, which is a second year, goal grid. And some things come from inside myself. And sometimes it's people cheering me up like you can do it, right, which is also very important, I need it. And you will see that at the end of that cycle, you will achieve your goal and you will close with a second right with that with that G up from God. But the truth is a majority of the times in life we don't achieve our goals are not the way that we expected or the way that we wanted. And many times what happened is that we changed our mind at that red Ferrari that was important when we were 15 is not so important when you are 40. And you have to take your kids to soccer, right and you need a van. So we we may adopt even our goals. And that doesn't mean that we are failing, it's just that we are growing, and we are learning something new. And we are developing new skills. And that's the last G from the 3g cycle growth. So go great growth. And I use that perspective to navigate different catalysts in life, that could accelerate the process to achieve our goals for that pool, you know, make us go challenge after challenge. And I was very lucky to interview more than 30 amazing individuals, from medical students to lawyers, book, Buddhist monks, Wall Street people, professional athletes, and four continents involved. And they were sharing their stories of challenges and their opportunity to grow after adversity. And they were sharing also their knowledge explaining different techniques that they use that after I investigate them, I back up in the book with some evidence, scientific evidence to explain why they work and why they call work for you too. And in between I have some of my own stories and stories from my family and my kids and my husband and I added some art that my kids created for me so they feel part of the combination and this is a family this is theta started us as a very lonely journey and ended Vienna collective journey where I have family members and friends and colleagues and mentors involved.

Susie Singer Carter: 1:18:35

It's it's I can't I can't think of I was trying to see if I could remember it. But I posted this quote about you know, when you're taken off your path and from a from something, you know, difficult something very difficult and we think that we are taken off our path and and we're mourning that loss as well. And then you that it but then you lean into it like like anything else. When you lean into something that's difficult, then you realize that it's actually the gift because it's brought you to a different path that you that you belong. And so if you can look at the other one as not being a loss, but as a door, then then you you are your you can only win. You can only

Dr. Miriam Zylberglait Lisigurski: 1:19:18

win. And that comes from talking about science, right? What's the science behind this concept? If you think about positive psychology, they have a concept that is called Post Traumatic Growth. Normally we talk about resilience in resilience to bounce back. So you go in life, this is your baseline, something bad happened to you. And then you go back to your normal or if that's not the case, you succumb and you have you know, depression post traumatic stress suicides. Post Traumatic Growth takes resilience to a different level. You get to your baseline but then And you learn from the adversity, you use adversity in your favor. So you don't stay here. But actually, you progress, you go to a next level. And what is wonderful about that, and and this is perfect, I could use steel. So see as a perfect example, right you, you went through adversity with your mom, you saw so many things happening you were able to decide to be cranky and upset and get your tantrum and maybe get depressed or whatever, or you decided to probably go through it also, right? Like we are humans, we have to go through the process. But then you went back and you go stay in your baseline, you could be just resilient, but you decided to not I will not stay here, I will use everything that I learned I will use even the pain in my favor. And now I will grow and I will do something that is the typical what happened with people that grow, I will help my community I will do some forward.

Susie Singer Carter: 1:21:03

Yeah, papers.

Dr. Miriam Zylberglait Lisigurski: 1:21:05

And that's, and those stories are so inspiring, because you don't need superpower for this right. You don't need to be super girl or whatever. You just need to be a human being with you know, a clear purpose and in life and to keep going and to accept also the help of those that are surrounding you. Because we don't grow by ourselves, we we grow with all they're supporting us. And that's what they want to inspire with the with the book that we are not victims of our lives, that we cannot live our life complaining of what happened to us, we need to use the things that happened to us in our favor, and we need to keep going and we need to keep growing. Right?

Susie Singer Carter: 1:21:53

I'm totally totally I mean, I feel like everything that you've you say, has one big giant theme, which is the theme of our show, which is love. It all comes from love, right, Don? Because we always say that you know

Don Priess: 1:22:06

why? Why we do say this, that love is powerful. Love is contagious. And love conquers all. This was an amazing time.

Susie Singer Carter: 1:22:16

It really does. Look at her. Yeah, it does.

Don Priess: 1:22:20

And, and we we have so much more we didn't cover and we'll do that again another time. But we hope everyone enjoyed this episode. If you did, please like, share. And please, if you can, you know, check out what we're doing with No Country for Old people. We do need financial support. We're not you know, we're not proud. You're gonna say it, we do. And it's all tax deductible. 100%. And if you feel you want to be part of this movement, please,

Susie Singer Carter: 1:22:50

please, please donate whatever you can. We'll have it in the show notes. And we'll have all of Dr. Z's information in the show notes and how you can reach her and how you can get her great book. And, and we love you and we'll see you next time. Absolutely. Thank you. Thank you so much. All you gotta do is sing a song