Where do we get our health information from? With Dr Brandi Sinkfield

[00:00:00] I'm always going to go back to the beginning of the pandemic. This is Brandy Sinkfield. She's an anesthesiologist and she's telling me the story of one moment that changed how she thought about the importance of women's health.

[00:00:16] Because I think I was very naive, I think in terms of its impact on women. I don't think I was really paying attention to what was going to happen to women until there was this moment.

[00:00:34] I was on call when I remember the scrub tech was running down the hall looking for surgical equipment and I'm like, I wasn't called. I'm hearing the OR what's going on. And they were like, we have a pregnant woman in the ICU who's intubated

[00:00:57] and we need to do an emergency C-section because she might die and we need to get the baby out. And I froze for a moment because I'm like, okay, hold on, stop for a second because what you're saying is that we're not coming to the operating room.

[00:01:13] You're going to do a C-section in the ICU. They were going to do in the ICU because her blood pressure and her heart rate were dropping. And so when that happens, that means that it causes distress in the baby.

[00:01:32] And she had COVID. There was no, okay, now this is 2020, there's no vaccine. But it dawned on me like, okay, this is before we had any literature about the implications of COVID on pregnant women. This is before all of this.

[00:01:48] And it dawned on me. I'm like, oh wait a minute, hold on a second. Now we're not just talking about one person. We're talking about two people, right? And now if something happens to this mom, if she has other children, now we're not just talking about two people.

[00:02:03] We're talking about her other children. We're talking about all the people that she supports in this community if she goes away. And so for me, the light switch slow, it was a flicker. I'm not going to say it was like a bright light all of a sudden,

[00:02:20] but it really started to dawn on me the impact and the consequences that this disease was going to have on not just the pregnant woman that was dying, but the entire community. How could you not understand the implications of this?

[00:02:46] That this is a critical part of your community. I'm still trying to contain my emotion around it and just focus on the work that needs to be done. But moments like that stay with me, that keep me going.

[00:03:02] You know, they remind me like, yeah you need to keep going. You need to keep going. You're listening to Overlooked and I'm Golda Arthur. Brandy Sinkfield thinks a lot about the health of women and its importance to society as a whole.

[00:03:23] She's the host of the Women's Digital Health podcast and we talk about digital health in this episode, that connection between health and technology and the impact that technology has on health literacy as well as health equity. Here's my conversation with Brandy Sinkfield. Hey Brandy, welcome to the show.

[00:03:47] Hey Golda, how's it going? Good. I'm so glad to be talking to you. I've been looking forward to this for a long time. Yes. And just so listeners kind of get a little bit of an introduction to you. You are the founder of Women's Digital Health.

[00:04:02] So tell us a little bit about that and the work that you do there. Oh well, there's a story there. So by clinical practice I'm a board sort of fighting a physiologist, but I also have a fellowship in something called digital health,

[00:04:15] which is this intersection between technology and health. And I did this many, many years ago. And I've used that training to ask the question, how might we improve the health of women? You know, and so at the foundation of Women's Digital Health is health literacy

[00:04:35] and talking about health literacy through the lens of technology, exposing women to different technologies that they can use to really improve their conversations with their doctors and be more mindful about their care. And so in our most recent series we've talked about mental health.

[00:04:53] We were talking about all the different technologies that are in the mental health space, whether it's mental health apps or telehealth, artificial intelligence in its role in mental health and just really exploring in a much deeper level what a woman could look for, what her experience could be

[00:05:15] if she's looking for technology to improve her health. And so when we talk about health literacy, what does that term mean to you and what do you think it means to most people? Do you think most people are health literate?

[00:05:30] So what I mean by health literacy is a sense of yourself that includes wellness and includes, you know, an ongoing continuous learning of your health. It seems to me that the stakes for health literacy are very high. Can you think of an example or way to illustrate

[00:05:50] just how high those stakes are? Like the idea of not having the knowledge of any given condition combined with not really understanding the way your own body works can have, you know, pretty hard consequences. Yeah, I can tell you from the perspective

[00:06:11] of what I see as an anesthesiologist that lends me to say that, okay, you're getting a lot of information, but in this high stakes emotional moment that I'm going to describe, I'm not sure if everything is coming together and that would be labor. That would be pregnancy.

[00:06:33] That would be the time in which you are having a baby and my job as an anesthesiologist is to give you an epidural. It is a highly emotional, very vulnerable time in a woman's life and I get the sense that many of them are getting,

[00:06:49] they are going through this emotional roller coaster in their life at the same time that they are learning on the job, their body. Like it's all happening all at once. It's like a combination. It's the most stressful way to learn about your body

[00:07:05] and so I think that when we're trying to answer the question of how high the stakes are, I would say that given our maternal mortality rates is rising across all demographics that perhaps the stakes are so high that we probably need to revisit how we are giving,

[00:07:27] how we are people getting information about their health because it's such a critical moment and there are others, there are other moments but I would say that's probably the one that I see where the intersection between high emotion and on the job learning about your body

[00:07:46] seems to really be the most critical. And so part of the reason I even started women's digital health was because I realized that we did need a platform for people to get information about women's health because from my perspective, I just saw a lot of unpleasant things

[00:08:10] as a consequence of a lot of care being delayed and so I use social media to try to establish, hey listen like these are things that I want to make sure you understand about your body right now such that if a crisis happens

[00:08:26] you got this whole free wealth of references and resources that you can use to kind of understand like okay well you're not by yourself, these are the things that this one doctor is saying and social media gives you the option of choosing to go with multiple experts

[00:08:44] and you can pick and choose what you want which I think a lot of people are also having challenges with as they are navigating the health clinic experience and so we're just all navigating the messy middle and that's just how technology is.

[00:08:58] But something you just said resonates with me a lot which is that we actually have more power than we think in that we can pick who we want to be influenced by. Absolutely. We don't have to just be in passive mode kind of taking it all in.

[00:09:14] When it comes to trying to evaluate the information that we're all getting on social media I'm thinking particularly from one example and that is menopause. So I, right? Oh yeah. I went into surgical menopause in December of 2023 and my entire Instagram feed

[00:09:36] is just full of products that are being sold to me or healthcare startups that are being put in front of me or health influencers which is a really interesting term for the reasons that we talked about. What do you suggest that women do when it comes to,

[00:09:55] because also women's health is like super popular at the moment? Right. We're traveling. We're traveling and there's a lot of people trying to give us some things that are helpful, some things that are neutral and what would you say to people who's trying to navigate this

[00:10:13] overwhelming amount of information on social media? Yeah, great question. So I think definitely the first part I want to say about perimenopause and menopause is that I am very grateful for social media for actually opening up this conversation

[00:10:31] to a degree that people feel a lot more comfortable talking about it. When I speak to elders in my family, this was just kind of the change. It was the flash and that's all they said. All of these other signs and symptoms of perimenopause

[00:10:49] and menopause simply were not discussed. Going back to this question about social media, well at least now we're talking about it. But with regards to using these resources and how they might be, how we might discuss, I think that the key word would be ongoing conversations,

[00:11:11] meaning that part of the thing that I noticed in pregnancy and in perimenopause is that we're only talking about it when it's happening. So there's no conversations that are happening before. There's nothing that is like a just give me a small little, just a little bit of information.

[00:11:32] Just a small drip of it all the time is enough so that if when it happens to me, I am not so overwhelmed and I'm just like, just ravenously just seeking information. I think that that is probably something that may need to happen within the community of women

[00:11:51] and how we talk about health because I do think that shame is also a part of this conversation. Let's talk about shame. Let's talk about shame. There's a lot of shame that creates the barrier. So the barrier is if you're embarrassed

[00:12:05] and you don't want to talk about it, you're not going to ask your doctor. You're definitely not going to talk to your friends about it because there's an acceptance there. And so then the conversations, these small little drips of information get blocked.

[00:12:20] And so then you have this major event and then you're like ravenous. You're just trying to find anything because you haven't had anything until it happened. And so that's really what I think I'm excited about is because you now can, you can choose to do that.

[00:12:39] I still think that at the core of this is having this continuous conversation with your physician first to help guide you to credible resources and navigating what's unique and personal to your experience because everyone's experience is different. And so my kind of approach is to say,

[00:13:03] listen, there's an opportunity for you to kind of change the way the conversation in the clinic's discussions are going such that you lead that conversation. You have the questions. You have the things that you come to the table with.

[00:13:20] And in between those visits, you're mindful of your health. You're paying attention, you know, you're paying attention to things that are going on and it's not left to just your physician making the decisions at your next visit. You're not just waiting.

[00:13:34] So in that regard, I think the internet, social media, us having this conversation really puts those, you know, fills in those gaps that a lot of women have had throughout their healthcare journey because they can go, me too. Like I was so embarrassed to talk about this

[00:13:53] because it's been very shameful in my community to ever even mention something like this. But now that more women are talking, now some of the gaps are starting to get filled in. I mean, I could not agree with you more

[00:14:06] and there's so much in what you just said that I'd like to sort of try and pick and sort through. Sometimes when I hear myself speaking on a microphone like I am now about my periods, my menopause, my lack of ovaries, all of this stuff,

[00:14:21] I'm like, am I actually saying this out loud? Exactly. I can't believe it myself. But I feel compelled to do it. Our generation is talking about it now, right? Which is in a different frame and a little bit more emphatically, more geared towards like solution.

[00:14:41] Like nobody's going to suck it up and see, right? That's it. We're not willing to do that. And I think, you know, there's certainly the ability to talk out loud about it, to put stuff on social media is great. Love that. Applaud it.

[00:14:55] But time and time again on this podcast, I've talked to people and this word shame pops up so much of like, and this is, this is so much of the reason that we feel alone in our own health journeys. We make decisions based on that sense of loneliness,

[00:15:15] that sense of fear, which leads to another round of kind of misjudging things through misinformation and that kind of stuff. Stuff that's hard to say out loud to your mother, to your doctor, to your sister, to your best friend. And I absolutely know that it's there.

[00:15:32] Know why it exists. I know it's hard to change. Yeah. But it's just, it's still looming quite large, I think there. Yeah, I wholeheartedly agree. I think that, you know, even as physicians, especially when you talk about perimenopause, we are also learning, you know, this is not,

[00:15:52] perimenopause is not something that I think I got maybe a couple of pages of it, you know, and I got maybe some conversations when I was on my third year clinical rotations. But for the most part, perimenopause is not a part.

[00:16:08] It's not an integral part of our education. And so maybe even physicians are embarrassed to even disclose that, but it's true. Like we just don't know. I personally am going on my own kind of educational journey to educate myself about perimenopause and menopause

[00:16:24] because as an anesthesiologist, I realized that I have been taking care of perimenopausal and menopausal patients without the context of what that means, how I could better take care of them. Which also means that if I'm not knowledgeable, there's a whole peer group of other physicians

[00:16:46] that maybe aren't even aware that they don't know. Particularly as an anesthesiologist, I'm thinking about the cardiovascular impacts of perimenopause that just don't get discussed, that it can lend itself to the shame and embarrassment that you might feel because when you ask your doctor

[00:17:06] if they're not someone who specializes in women's health, they'll go, not because they're embarrassed but because they don't have any information to give you. They just don't. So there's a host of things that I think stand in the way including mothers and grandmothers didn't talk about it

[00:17:26] in the level of detail. The physicians don't really have that much education although that's changing, that is changing and I'm happy to see that. And the information that then it results in is kind of like stuff that's not tested, not necessarily guaranteed to solve your problem

[00:17:48] but at least somebody understands is listening, which can not always be in your best interest. And so that I think that that's where physicians have an obligation to really kind of understand this so that they can help their patients make better decisions for themselves.

[00:18:08] You know, this has come up a couple of times in the conversation that we've been having and it is something that is really important to me but this idea of your relationship with your doctor and how you talk to your doctor, right?

[00:18:23] And this is absolutely not about individual doctors or doctors themselves. It's just a complicated relationship, I think, from my point of view. There has to be two people working in the same direction. There has to be a sharing of knowledge.

[00:18:39] It's a bunch of different things to get right. From your point of view, do you see it as being a tricky relationship or no, is that just me? No, it's very tricky. When I started on social media that was kind of like our first themes

[00:18:52] is like women feeling dismissed, you know? And we had some interviews with people who were saying like this dismissiveness is not just an emotion. This is dangerous, you know? Because when you start to omit or dismiss women that can result in missing really important things

[00:19:11] that are critical to women's health. So I definitely resonate with the patient's experience. I also resonate with physicians who are under a lot of pressure to produce, produce like widgets. They are required to produce every 15 to 30 minutes, 30 minutes if you're lucky.

[00:19:33] And that is not always within their control. I think a lot of physicians, you know, when they are discussing physician to physician, really wish that they had more time, really wish that they have more opportunities to connect with their patients.

[00:19:48] But in order to keep the wheels of the clinic going, the expectation is that it's every 15 to 30 minutes. And that's unfortunate because that does result in the experiences that I think all people are experiencing. Not just women but all people are experiencing

[00:20:05] which is this very kind of fragmented kind of, okay, 15 minutes. I just sat down like, do you even have time to log into the computer in 15 minutes? You know, kind of experience that leaves people pretty underwhelmed with the experience in the clinic visit.

[00:20:25] I think that part of this is understanding what is the best way to communicate with your physician because not all clinics are set up the same. They all work differently. So I know it sucks to say like,

[00:20:38] I only get 15 minutes, my insurance and company only covers this one. But if you're going to take up some part of a new relationship of that physician visit, I would say spend at least part of that visit understanding

[00:20:52] what is the best way to get in touch with you. Because that's just a tone of, I have other questions that I'm probably not going to get to in this 15 minutes, right? But if I understand that there are other ways

[00:21:07] to connect with you that does not require me to physically be there, including a telehealth visit or using technology, I think that that may facilitate an opportunity for other questions that may not require a physical visit, at least initially, to get some of your questions answered.

[00:21:27] I do believe that most physicians would love to do a lot more for their patients and just some of this is out of their control. So I'm going to go back to the question. What do you think is the most overlooked in the healthcare landscape?

[00:21:50] Well, that brings us beautifully back to health literacy. And so just to close this conversation off, I want to ask you a question that I ask all my guests on the show, which is in what you're seeing from where you sit in the health landscape.

[00:22:13] What do you think is most overlooked and where is that inequality felt most deeply? Okay, what's most overlooked, I would say is investment in women's health, like by far. We can, we say it and we say it and we go, mm-hmm, yep, that's true.

[00:22:37] But to live it as a physician, as I explore more about the fact that the National Institutes of Health only started requiring women to be included in health clinical trials in the 90s. So if you start with that, right?

[00:22:55] It means that the research that we have about women, like required research is like 30 years old, right? Not to say that there wasn't women that are a part of clinical trials before that, but like actual, you know, trials that focused on women, women really like 30 years into this,

[00:23:17] which has huge implications on treatment, investment planning, research and development and budgeting for even private companies. They have limited data in order to support that this actually is one, if you're private profitable from a government standpoint, the understanding that to invest in women

[00:23:42] has a huge, huge return on its investment. You know, like these realizations I think are very much commonly overlooked. And I think it has, it does have implications on our health literacy, because what it means is that at the investment level, if we're not investing,

[00:24:01] then that also means that health professionals, not just physicians, but nurse practitioners, you know, all of these people who rely on the funding to get their education are being navigated through a system that says we only started looking at health information and research for women in the 90s.

[00:24:24] That's the best we can give you. And so it does determine, it does manifest itself in how they think they think about how a woman comes into a clinic. They have limited resources. They have some treatments, but it's not to the degree as men. And the investment trajectory,

[00:24:46] as I see it even today in 2024, is probably less than 5%, at least in the private equity sector. And you know, we just got what, 100 million from the White House, but hooray, but we need way more than that to really narrow this huge disparity

[00:25:07] in the way in which women's health is being invested. And so I do see it at the level as a physician, which is that we are struggling to find specialists in women's health. I can't tell you how many women I've talked to

[00:25:22] who tell me let's just take Fire Boys, for instance. I know a doctor who can do a hysterectomy, but all of these other things that could be offered for someone who would like to try alternative treatment, good luck trying to find one.

[00:25:37] Even in major cities, it's very difficult, and that's because the training for these physicians is limited. There is clearly like it's a waterfall effect. If there's no investment, there's no investment in education, there's no training, so there you go. You have no one to know,

[00:25:53] there's no specialists that are available. So you've got to travel to get those specialists. And that's just Fire Boys. I mean, cancer is a whole another conversation where people are traveling all over the world even to get care because of this issue. Well, thank you again.

[00:26:10] This has been just a marvelous conversation. We got to talk about so much and, you know, just starting from a place of just thinking about health, literacy, all the way to health equity and that kind of stuff. But thank you, Brandy. Oh, you're so welcome.

[00:26:25] I enjoyed this thoroughly. You made me think about a lot of stuff. And everybody, you guys could go check out Brandy's podcast. Do you want to say a quick word about your podcast so everyone can listen? Oh, sure. You can definitely check out my podcast,

[00:26:39] Women's Digital Health is the name of the podcast. You can definitely reach out to me on all the socials, women's digital health, subscribe to our newsletter where we are alive and well and we're just finishing up our three-part mini-series on the use of artificial intelligence and mental health.

[00:26:57] So if you're looking for mental health resources in your considering technology, definitely, definitely check that out. Awesome. Thanks again, Brandy. Thank you, Golda. I appreciate this. It's a pleasure. We're building a community around women's health so that no one is overlooked. Subscribe to the Overlooked newsletter

[00:27:17] so you can be part of that community. And head to overlookedpod.com for transcript and show notes on this episode. Overlooked is written and produced by me, Golda Arthur. Jessica Martinez de Hose is the show's associate producer. You can get in touch with the show

[00:27:34] by emailing overlookedpodcast23 at gmail.com. Thanks for listening.