Note: This episode contains talk of cancer, infertility, and access to abortion. If this is something that you'd prefer to skip we hope to see you back here next week.

Today we're talking to Dr. Coley Barbee, MD who is a practicing rural physician, YouTuber, and the one doctor brave enough to see Caite's family! Coley is working towards a double board certification in Integrative medicine and has a YouTube channel where she presents cooking videos featuring accessible vegetable based dishes for the "meat and potatoes" folks she sees. We also talked about the one thing she can't keep alive, why you shouldn't shave your legs before appointments, and why she'd love to be paid in chickens.

Thank you for joining us today on Barnyard Language. If you enjoy the show, we encourage you to support us by becoming a patron. Go to Patreon to make a small monthly donation to help cover the cost of making a show. Please rate and review the podcast and follow the show so you never miss an episode.

 You can find us on Facebook, Instagram, and TikTok as BarnyardLanguage, and on Twitter we are BarnyardPod. If you'd like to connect with other farming families, you can join our private Barnyard Language Facebook group. We're always in search of future guests for the podcast. If you or someone you know would like to chat with us, get in touch.

 We are a proud member of the Positively Farming Media Podcast Network.

I'll try now. Yeah, I don't think, yeah, that is better.

you fix something. That's good.

Yay, yay me.

I'm gonna go. Today we are excited to be talking to Dr. Koli Barbi, who's

a family physician in Iowa. We start each of our interviews with the same

question. So this is a way for you to introduce yourself to our listeners

and we ask, what are you growing? So for our farmers farming guests, that covers

crops and livestock, but it can also cover families, businesses, career,

all types of other things. So Koli, what are you growing?

I am currently, I am not at all a farmer, and currently actively killing

some basil, so. Ha ha ha.

Perfect.

to Iowa and once I was here learned a lot about farming. I'm originally

from Maine, there's a lot of aquaculture there so I know a lot about the

ocean and fishing. I know next to nothing about farming and am not a very

good grower but I try so hard. But my sad sad

Enthusiasm

basil,

counts for a lot.

yes my sad sad basil is kind of testament to my growing ability right now

I think so.

totally fair.

else. Yeah, no, I know

No.

it's me. I just wasn't sure if Koli had any career or family or anything that she

wanted to mention while she's at it.

Oh, well, I mean,

Besides

I

your

would

dead

say

basil,

that I'm...

which.

My dad basil. I am currently kind of growing my skills in integrative medicine.

I'm currently enrolled in an integrative medicine fellowship, so I have

about nine months left. And that has been a really good addition to my

family medicine practice. So I would say I'm growing in... knowledge and

commitment to using.

kind of holistic ways of treatment and healing in addition to Western modalities.

And that has been really exciting and interesting. I have about nine months left

in my program and then I hope to be double boarded in family medicine and

integrated medicine. So.

So can you tell us more about what integrative medicine is and why it's

Absolutely.

important?

Integrative medicine at its most basic really is looking at a person holistically.

I think family medicine in general does this pretty well. We don't look at people

as being just one body system. We look at you as a whole person, but integrative

medicine is kind of taking that to the next level. So you are looking at people's...

exercise habits, eating habits, their family, their spirituality, the community

that they're a member of. You are using, you know, you use all of the conventional

pharmaceutical medicines, but in addition to that, you know, work on... diet

changes to help with certain health conditions, supplements, just a more

holistic way of looking at medicine. So that's the brief definition. You could go

very in depth and there's a lot, it is a two year program that I'm doing,

so there's certainly a lot to learn, but that's the basic explanation.

So how did you end up in rural medicine and how did you end up in Waukon, Iowa? For

that matter. I mean it's not a... it's a nice town, don't get me wrong. But it's not

like a hotbed of

Yeah,

anything, really.

so the reason that I went to medical school is because I wanted to do rural

medicine. I grew up in a small town of about a thousand people. It was also

rural, kind of in the middle of nowhere. And what I noticed is it's really

hard to cobble together a living in a rural area sometimes. And people's health

suffers as a consequence. And one of the biggest... factors that determines

how healthy a person is, is actually the zip code they live in. I thought

that was deeply unfair, and so the whole reason I went to medical school

was to do rural medicine. I thought I might go back to Maine to do that,

but it turns out the Midwest is really a great place to practice family

medicine. You get to do a little bit of everything. And so... I did my residency

outside of Milwaukee. It was my first experience in the Midwest. And I really

loved it. And I honestly had interviewed at a job that some of my residency

mates thought that I might like the Prairie du Chien area, which is just across

the river in Wisconsin. And I honestly... said, well, if I'm going all

the way out there, I might as well do another interview and just literally

close my eyes, circle the finger and dropped and walk on. And so very much on

a whim, had never been here before, had never been to Iowa before. And

when I came, I met the people who worked in the clinic that I now work in

and just realized, these are my people. And just, I knew I wanted to work

there because the... group of people that I now work with I just love and

I said this is exactly the type of thing I want to do and where I work now

allows me to do a little bit of everything. I see patients mostly in clinic,

I also see patients in the hospital, I do some ER work. Up until about six months

ago I delivered babies and so I see a little bit of everything. I'm never

bored and I'm continuously happy that I moved here even though If you'd asked

me before I started here, Iowa would have been the absolute last place that

I saw myself. But I love it here and Midwesterners are very much like Mainers,

so it feels like...

Well, I have to say I'm incredibly glad that you ended up here, no matter how

randomly it was.

Me too!

For our listeners who might not have guessed yet, Colie is the family physician

that my family sees, and I have to say we're incredibly glad to have a family

doctor that sees all of us for everything that we need. Colie delivered our younger child,

she sees all four of us, and from an integrative perspective, it's amazing to see...

one medical team for everything, you know, and who sees our whole family, who sees

us for everything that we need, who's, you know, even if we have to be passed on to

a specialist, that we still have a team who knows us as humans, because especially

once you start getting shuffled up into larger facilities, you become a patient

number in a file pretty quickly, and it's really nice to have. somebody at home

who knows you for something besides, you know, what's in your chart.

And

So

I

there's

love

that.

seeing the whole family and it is really a good opportunity for me too

to, you know, you might bring one of the kids in and I'll just say well,

how's that thing we talked about last time? And you know, it's a great way for

me too just to keep a good eye tabs on everybody and make sure everyone's

still doing really is healthy and doing well.

Yeah, and it is, it's nice too to know that our children can see the same doctor as

babies, as they do as children, as they can as adults, hopefully. I know I saw

the same doctor a few years ago that delivered my husband,

I'm sorry.

you know, so he saw patients that whole time and it's nice to have that continuity

of care with the clinic. especially if you end up seeing them a lot, like if you

have a higher risk pregnancy or something, and you're spending a lot of time there. It's

really nice to see the same folks. So we're gonna start with some super in-depth,

serious questions. First thing, do you notice it or care if patients don't shave

their legs? This is important stuff right here.

you know i never notice and people constantly apologize constantly so i

would say at least once a week someone says oh i'm so sorry i didn't shave

my legs i'm like oh my like it's winter in iowa do you think anybody is

like no so i honestly never noticed that what i notice more is people that

I would expect to have hairy legs that don't have hair on their legs because

then I worry, oh, do you actually have a vascular problem or diabetes?

Interesting.

So I need much more attention to that than I do people shaving their legs.

So what you're saying is we should not shave our legs so that you have a better

view of our cardiovascular health?

I think that would be very reasonable.

Cool. I'm gonna go with that, I like it.

especially

So,

in the wintertime.

yeah.

Especially.

I'm from Canada, so I don't want to shave my legs in the winter either.

Absolutely.

So the other thing that has come up in conversation fairly recently, why do we

all hide our underwear at the doctor? You know, we put on the gown and we fold our

clothes and we always put our underwear like hidden in there. Like presumably you assumed

that we're wearing them. So why do we hide them and do doctors hide them when

they go to other doctors?

That's a great question and yes we absolutely do. I fold up the little

So weird.

packet just like everybody

Yeah.

does with me and I have no idea why. Just fold them up in the pants, you know,

tuck them on the chair.

Yeah,

I

it's

have

so

no

weird.

idea why.

Yeah, I was talking to a friend about the fact that even at the fertility clinic

or going in for OB appointments that you still hide your undies despite the fact

that your doctor's gonna be in there. You're like,

Mm-hmm.

they can't know I was wearing underwear when I walked through the door.

hahahaha

I would think they'd want to know that you were wearing underwear. Anyway. Okay, well

now that we've... really hit the hard

Okay,

topics.

yeah,

We can move on.

that's the good stuff right there.

Burning questions.

Yeah, for sure. So you already touched on the idea of, well, I guess exercise

and nutrition and those types of things, but one of the things that that

kind of comes around to is weight, which ends up being one of those things

that gets talked about a lot, both in adults and children. How can we discuss...

weight as a possible risk factor when it comes to health, but also not shame

people into thinking that all their health problems would just disappear

if they were to lose weight. Because some fat people, you know, their experiences

with doctors is that their doctors won't even discuss their medical concerns

outside of telling them lose weight first and then we can deal with it.

I think that's an excellent question. I don't think it's ever helpful or

kind to shame someone for the way they look. And honestly, the conversation

tends to shut down. If that's the first thing that you lead with, no one

wants to talk about, well, how can I be healthier? But by the same token,

like you said, obesity is a risk factor for a lot of other disease processes.

in order to be healthy, being at a healthy weight makes it easier to avoid

some of those down the road health concerns. But like you said, there is

such a thing as skinny fat. So just because people have a BMI between 18

and 25, which is what we deem normal, does not mean that they're metabolically

healthy. There are actually estimates if you look at people's... So fasting

insulin levels is not a test that we do for very many people, but it is

one of the most sensitive indicators if people are metabolically healthy, like they

are processing their food and sugar in a way that, and how it's supposed

to. And there are estimates that up to 90% of Americans are not metabolically

healthy. If you look at those more sensitive indicators, which we are not

really trained to do, really the functional medicine doctors do that more

than pretty much anyone else. It's not very mainstream in Western medicine

to test those things, but when they look at population-wide studies, most

of America is metabolically unhealthy. And we know that leads to problems,

but. Like you said, I don't think that you can, you can't just look at

a person and say, you're metabolically unhealthy. You have people who maybe have an

elevated BMI, but are very physically active and fit. And that makes a big difference.

So I think it's a difficult and complicated question and one that I...

I think everyone struggles with. We all know that we need to do things to be

healthier, so we have a long life and a long health span, but it's a lot

easier said than done. And I don't think shaming people into improving their

diet is useful or helpful. I think you really need to be open about it.

have an honest conversation, but people need to be supported and not shamed.

I know, too, as a patient, it's a lot easier to address things like weight and healthy

eating when it's seen as one risk factor in a whole array of things versus it's your

fault because you're fat and that's the only thing we're going to talk about. And

also, anything else is probably because of your anxiety. So

I'm

that's

sorry.

it. Problem solved. Yeah. Um, Erlene, do you have anything else?

No, I don't think so. Sorry, we may have some gaps here today, just sometimes

it's freezing up on us, so we're, but then you kind of catch up and I

know it's recording on your end. So

So

I just

we'll

wanted

fix

to mention

it in

if

editing,

there's, yeah,

but...

if

Okay.

there are pauses, that's just because sometimes it's freezing on us, but

I know that you're still talking.

Okay.

So one of the things that's kind of like a stereotype of rural medicine is that,

you know, the doctor would fix your kit or something and they'd pay you in, you

know, a patient would pay in chickens or whatever. So if we were just going to skip

insurance and all that shit and go back to paying in trade, what would your preferred

payment currency be?

Oh my god, I have said so many times, I would love to just work on the barter

system. So I feel like, you know, we all have skills that we can offer.

So I'm, and I'm not picky, I'll take anything. I will take the chickens, I

will take the produce. I will like, you know. someone wants to trade their

skill in painting my house, like I don't care. I just, I love the idea

of the barter system because I do think we all have talents and gifts and

what a better way to share than just to offer somebody what you're good at

in return for what they're good at.

So the actual harder hitting side of that is, I know that I've seen more articles

and patients talking about, especially in bigger places, how much of their doctor's

salary and career path is based on patient satisfaction and reviews and how much

that impacts what kind of care doctors give because there's so much. so much weight

put on making people happy versus necessarily what is healthiest or most effective or telling

people no or whatever. So I'm wondering what your experience has been with that.

Yeah, the incentives in medicine are so backwards. Like, insurance will pay

for things that research has shown is not helpful. They will not pay for

things that take a little more time and might be more expensive but work a

lot better. They will pay for medicines but not physical therapy. Doctors

are paid to perform procedures that are minimally effective versus spending

time to actually... sit down and talk with patients, you know, and give

them an exercise plan and say, hey, this actually will fix your problem. But

they don't get paid to do that, they get paid to do the expensive $20,000 surgery

that may or may not be effective. So all of the incentives in medicine are so

backwards. I would say, I think it is true that more, more and more places

are going toward. using physician ratings and things like that as part of a compensation

package. I don't think we'll ever get to the point where it's the only consideration,

but it certainly is part of it. And I'm sure we've all received the questionnaire.

Once you leave your doctor's office, tell us how your visit went. and the

administrators really do put a lot of weight on your grade, I guess, from

patients. And it's sometimes really hard because, I mean, there's a lot

of health information out there now, which I do really think is a good thing.

I think informed patients coming in can be really helpful. But the flip side

of that is, There's a lot of information that isn't accurate, doesn't come

from reliable sources, and it's hard not being a medical professional sometimes

to differentiate between what's good information from a good reputable source

and what's not. And it takes a long time to kind of talk through people

when they come in and say, I want this, and you have to say, well, in my

medical judgment, I don't think that's a good idea and here's why, but it takes

a long time explaining. And when they want you to see more patients in

less time, sometimes it's easier to say, fine, whatever you want. But I've realized

any time I've done that, I've only gotten bit in the ass. So it's worth it

to me to take the time to say. I hear you, I understand what you're saying

to me. Here's why I think that's not a good idea and I'm not gonna do it. Um,

funny, a side story. My nine year old stepson, we have this constant battle

about screen time because there's all this research showing how detrimental excessive

screen time is for developing brains. But he, you know, he's nine and he

wants to watch TikTok and YouTube and play his video games. So it's this constant

battle. And we were negotiating recently. And he's like, oh, can I have 30

more minutes a day? And I was like, no, but it can cause brain damage. I

don't think it's a good idea. He goes, Cole, you can't believe everything

you read on the internet. Which I just thought was hilarious. And. But that's

like the conversation that I have a lot of times with patients, they bring

it to me and they say, well, but I read this and it has to be true. And

it just takes a while to explain, maybe not a good idea, but I mean, I definitely

have gotten poor ratings from patients who say, like, I went there and I

wanted an antibiotic and she didn't give me one and they're upset by it.

And I try to explain why I didn't think that was a good idea and. Some people

take it well and some people not so much. I just, I'm at the point in my

life where I've realized you can't please everybody. So let's stop trying.

We're all just doing the best we can.

Well, I'm gonna bump my next question up then and I wrote these questions at 4 a.m

So at first it just said doctors versus patients who's the bigger jerk and I wasn't

sure what I meant by that But I realizing I think what I meant was that this is one of

the other real benefits of seeing the same doctor Consistently is that it does make

it easier to know when your doctors saying no to something because it's actually

not the best option versus I don't give a shit what you think

Mm-hmm.

and I'm the doctor and I'm saying no. So I'm wondering how we can enable more patients

to advocate effectively while recognizing that doctors presumably know more about medicine

while patients presumably know more about themselves and what they're experiencing

and how we can do research without seeming and or being presumptuous jackasses

Okay

about what we're finding when we do it. I know I do really appreciate that generally

when I come to you with something I've found, I know there have been times that you've

gone a different direction, but it's nice to know that I'm being considered before

I'm being shut down on something, you know, and it's It's nice to have the relationship

where I trust that you are actually considering what I say, even if I'm totally

full of shit, and we both know it. So I'm wondering how we can empower more people

to have a good relationship with their medical staff.

I think I really like when patients come in with information. There's also this

thing in medicine where even really good research takes on average like

eight to ten years to trickle down to... to actual medical providers before

it gets incorporated into guidelines and before we're aware of it. And so I will

never say, oh, I know everything about this subject matter because I know that

I don't. So I think the best thing patients can do is if you find good research

and a good source, I am always happy to look into it because I know there's

stuff I don't know.

But you know by the same token, someone coming in and saying, well my great

aunt Sally on Facebook says doesn't hold the same weight as, look I found

this journal article, would you mind looking at it? So yeah, I think bringing

good quality research to your doctor is never a bad thing. And you know,

I will be totally, being totally fair. there absolutely are doctors whose ego

gets in the way and says, well, I know everything about this and I don't need

to listen to you. So there are those doctors out there. I will not pretend

that there aren't. But I think most of us, and I think especially like primary

care doctors who really do form long-term relationships with patients, by and

large most of us are very happy if you bring in something, a good. but a piece

of research that we can look at and say, oh, well, I didn't realize this,

but this actually looks like a pretty good study and that seems like a reasonable

thing to try. I think that's the best thing for patients to do to advocate

for themselves.

You've been talking a lot about having relationships with people and especially

in rural medicine. I mean, those relationships often kind of extend outside

of the doctor's office, like for example, being on one of your patients'

podcasts. So what

Mm-hmm.

is it like for you personally to have to do things like give bad news to

people that you know well or, you know, even, you know, in a smaller scale,

like maintain boundaries around, you know. This is not a doctor's office. If

someone asks you for advice in the grocery store versus like in an appointment,

like how do you, I guess, how do you look after yourself being a rural doctor?

You know, the grocery store questions happen much less frequently than

I was worried that they would happen.

Well, that's good.

It is good. But you know, it is a balance to be part of a smaller community.

And you know, especially with, you know, the giving bad news. And you know,

frequently the bad news is something like... Oh, I think you might have a problem

that I don't know how to fix and you need to go see some specialist, you

know, you need to see oncology or surgery or cardiology and you know, a doctor

or provider with a skill set that I don't have. So one of the hardest things

for me is not. not having enough information to give to somebody to say, here's

exactly what the process will look like. You know, like if I have to hand

a patient off to a specialist because they have something that I don't know

how to deal with or I don't have the skillset to manage, yeah, one of the

hardest things is I can't answer their questions all the time, you know? I don't

know all the steps that are gonna come next. So that's really, that's difficult

for me. And I try to find out as much as I can before delivering the bad

news. Like, so I at least know the next step. Like we have this appointment

set up for you and you are gonna see the specialist type of thing. But you know,

it's challenging. And I like most of my patients. So it's never nice to

give bad news to someone that you like. But it's just, you know, fortunately

I don't have to do it. Fortunately, I get to give good news more than bad news,

I think.

It's my question, isn't it? I was just over here thinking about bad news. My next

question just says access to reproductive care, WTF. And I know this is something that's

connected with the having to give bad news to people and being a patient who's been

in that position with you. How can we...

I'm trying to even think of how to put this. How can we effectively stop the government

from inserting themselves in the doctor-patient relationship? When I was in the position of

having to make these decisions, I don't really want the state's opinion on it, and

I don't really want the state making that decision. When I was in the position of

having to decide whether... to abort the boy child for the safest treatment path

for the melanoma, I don't really want to have to skip all the doctors that are consulting

to go to a medical board at the state and get their permission to do something. So

I'm wondering what your thoughts are on this and how we can tell them to shut it

because Canada is a different situation but I'm sure they're not immune to these things

either.

This is a really difficult question and one that I am very passionate about. I

feel all the time, like all kinds of outside groups are inserting themselves

into the doctor-patient relationship. The one I honestly have the most difficulty

with is insurance companies. When I say, this is the best treatment, and

insurance company says, nope, sorry. Pick a different thing. We're not gonna

cover this one. And I don't have a good solution for that. And I also don't

have a good solution for how to keep

politicians and the state from inserting themselves, especially into issues

they don't understand, is the most frustrating thing as a healthcare provider.

When I see the debates on abortion happening and it is just... blatantly false

information. Like, we're just gonna...abortion doctors throw live babies

into trash cans and all this other ridiculousness. I'm just thinking, who

thinks this is true? But obviously people do. So everything is so caught up in

misinformation and just incorrect things not based at all on medicine or science.

That's what I find the absolutely most frustrating. So I keep telling people

to vote, but unfortunately that's not being very effective. So I'm not sure.

I'm not sure what the best course of action is, except for as medical providers

continuing. I write letters to my representatives all the time. every time

they vote on something stupid, I write a letter and I say, here's why you're

wrong. So I think that's a really important thing for medical people to do because

so many of these debates are completely surrounded by misinformation and

because, and there are not very many health care providers in legislators,

in legislatures at the state or the federal level. So. So it's challenging

because they're making laws on things that they don't, they're not fully

informed about, I don't think.

it seems like that's so much of it too from a patient perspective is if it seemed

like they had any actual knowledge about what they were legislating on

Mm-hmm.

and then they made a well-thought-out informed decision it might be different but

when it's people saying you know if a woman doesn't want to get pregnant her body

has ways of shutting that down and

Yeah.

you know no no abortions after six weeks when so many people don't know they're

pregnant until well after six weeks and this, that, and the other that I'm just

like, you guys, there's no actual basis in fact here. So no, I don't have a lot of

faith in your decision making at this point.

Yeah.

And yes, insurance companies, just insurance companies, whatever.

Yeah, and there are so many other layers to providing abortion care. You

know, a lot of residency programs actually take place in Catholic hospitals,

and so OB-GYNs coming out of those programs don't even learn how to perform

an abortion, or sometimes even like tubal ligations, because the Catholic

hospitals don't allow those procedures, and so where they train, they don't

learn how to do them. And... There's a lot of barriers set up. So for instance,

when I came to Wacom, I really wanted to, so the Mifepristone, which is commonly

known as the abortion pill, it's actually one of two pills that you use

for medical abortion, but you need to be specially licensed in order to prescribe

it. So not everyone can prescribe it. So when I came here, I wanted to do that,

and my employer basically said, well, if there are complications, you don't

have the surgical privileges to do a DNC if there's bleeding or complications.

So we're not gonna let you get your license to prescribe if prescribed. And

I said, well, then can you teach me how to do... DNCs and they said well what

happens when you're not there? There's no backup or coverage for you. So no

So it's really an uphill battle even for people like me for whom you know,

I I think abortion is a human right and Pregnancy is a very difficult journey

in life There's a very decent chance, at least in the United States, that

a woman dies during part of pregnancy and childbirth. And I feel like that's

not a decision to be taken lightly. And if there's any reason that you want an

abortion, you should have access to one. But even for me, feeling very passionately

about that and wanting very much to provide that care, there are all these

barriers. And so it's something that I've not been able to do.

That's so frustrating as a rural patient too, because I don't even

Mm-hmm.

know where our closest abortion provider would be, but I'm guessing it's at least an

hour and change away. And

I think.

that's not feasible. It's not.

Yeah, I think Des Moines is the closest, so

And

I

that's

mean,

what, four hours from here?

yeah, three and a half, four hours. So

more or less.

yeah, and I've had to have this conversation with patients before who say,

you know, I want an abortion for whatever reason, and it's really difficult

for me to counsel them about, well, you know, you're going to have to drive

hours and hours and hours away, or you know, or cross state lines and drive

hours and hours the other way. And so it's really challenging to know how

to best counsel patients that want that just because it is it's so difficult

to access that and the laws are changing constantly now since Roe v. Wade

was overturned. It's hard to keep. And we live in a corner of the state

where we're actually very close to parts of Wisconsin and Minnesota. And so

sometimes it's easier to get health care in a different state than it is

to drive to someplace within our same state where maybe the same service

is available. But you really have to keep up on the laws because the laws

are changing so quickly. on the in sorry the state laws are changing so

quickly. It's hard to keep up with well, where is it legal? Where can I send

you?

Yeah, sorry. My head's

Thank

going

you.

in a lot of different directions. And I know that my Canadianism is showing through

because there's so much of the insurance side that I just don't understand

at all, right? Like that doesn't compute, but I'm sure

Neither

that, you

do

know, there's,

I.

yeah, yeah, for sure.

Thank you. Bye.

And even, you know, the idea of writing your review of your doctor's appointment,

that is not something I have ever come across. Um, yeah, but I mean, access

to all health services by qualified medical professionals is something that people

in rural areas, I mean, that's who we're talking to, but you know, we understand

the limits of geography and all those types of things, but being able to

access the services we need when we need them is a human right, like you

said, right? And abortion is included in those services that we should have

access to if it's necessary for us.

I'm going to go into the direction of the kind of the more parenting questions.

So what is something that you wish you could tell us parents about our kids

in terms of, you know, like, not like the detailed medical stuff necessarily,

but what do you wish that you could get through to parents when they're in

your office or the things that we worry about?

You know, especially when I used to do OB and deliver babies, especially

first time parents were so nervous. Like, how am I going to take care of this little

human when I bring it home? And what I told all of them and that I hope

sunk in is, you know, infants need to be loved and fed. And that's basically

it. Like they're probably gonna be fine if they are loved and fed. Like that's

it. And if you have a worry, you come to somebody who knows how to evaluate

that worry. Like those are the important things. You know, it's not as important

to have, you know, all the fancy gadgets and things. And it really is, you know,

love your children. That's what you need to do.

Yeah. As they get older, you know, I know that sometimes parents worry about,

you know, whether you're worrying too much or not enough,

Mm-hmm.

right? How do you help people decide when they do need more help, whether

that's medically or developmentally, you know, milestones, all that kind of stuff?

How do you support parents who are in that kind of like, I'm just not

sure, or I think something's off, but I don't know.

I mean, I may see your child, like even in the early years when we're having

a lot of appointments, I might see your child 20 minutes every few months,

and you see them every single day. So I have come across parents who are...

you know, maybe overthinking it or over worrying. But most often I find

parents know their children best. Like if you think there's a problem,

probably there is. And, you know, hopefully I can help you figure out,

you know, well, where can we get you help? What additional help do they

need? You know, there are a lot more services now than there were even

20 years ago for kids with developmental delays. you know, chronic health conditions

or problems, you know, there's just, there's a lot more resources. And so,

you know, my general feeling is usually parents know their kids best. If

you think there's something wrong, it at least bears further investigation.

And, you know, hopefully your family doctor can be the person to say, well,

here's where I think you can get the help that you might need. So I consider

that really to be my role.

Oh, sorry, we had a little freeze up again. And I know as a parent, something

that has helped me is when you're not sure, or if you feel like your doctor

is maybe gonna be dismissive, is to have some documentation. Just write some

things down, like really have a list when you go in, because sometimes you

get in that office and you're like, I can't remember what it was I was actually

concerned about. But if you have the list of things, you're like, here

are the things that I'm seeing. that maybe are not the same as other kids or

not the same as my other children or that I'm noticing in these situations, they

might be more willing to listen to your concerns if you've got kind of a bit

of backup and also just that reminder to yourself to be like, these are

my concerns, don't let the office scare you into thinking, oh, I'm

Great.

sure it's fine. It's yeah, it's not really a big deal.

I think in general a symptom diary for anybody of any age is the best thing

to do. Like if you have a concern, write down, this is a symptom I had, this was

the day I had it, like these are the associated things. Because it is, there's

so many things, and especially when it comes to well child appointments, there's

so many things that we wanna ask to assess and make sure that. you know,

that we're happy with how your child is growing and developing and if they're

meeting their milestones and so forth. So there's a lot of talking we want

to do at you. And sometimes I think parents' concerns sometimes get a little

lost in the shuffle. And so, yeah, I agree completely. Writing down, writing

things down is the best way, I think, to really know. Because a lot of times

patients will come to me with a concern. And they'll say, oh, well this hurts.

And I say, well, where does it hurt? When does it hurt? What happens around?

And they say, oh, well, I don't know. And it gets hard to remember if this

is, you know, something that is

Right,

not.

and did it start six months ago or six weeks ago? I can't really

Absolutely.

remember what day or time or yeah,

So yeah,

if I was

writing

doing

down

a certain

symptoms.

activity.

Yeah, writing down symptoms is the best thing you can do.

I know too as a patient one of the worst things is when you leave an appointment

and realize that you forgot to ask about something or say something. And then

you have to do things like Facebooking your doctor about the arthritis in your foot,

which is embarrassing. But, yes, I'm also a huge proponent of writing things down

because otherwise I know for myself, especially with something with the kids, if

I'm worried about it, it seems like it happens every day where if I actually write

it down and then I can look back and be like, oh, it's actually only happening every

three weeks. It's just that I'm thinking about it, so it seems like it's an all-the-time

thing. Or, it actually is an all-the-time thing, but it

Ahem.

doesn't seem like a big thing, so I'm not thinking about it. And, oh look, it is

happening every day. Maybe I should concern myself with whatever this thing is.

So one of the big things, especially the last few years, has been physician burnout.

And I'm wondering how, as patients and as community members, we can be supportive

of our medical teams. Because you guys are really getting screwed from a lot of directions.

And especially with things like the patient satisfaction surveys and that, it's

really It seems really unfair and shitty because there's stuff that's not your fault

and there's stuff that you

Thank

cannot

you.

fix. I mean, that's just how it works. And you know, because we are in communities

with each other and in small towns and we know each other, it seems that much

more important to take care of people. And so I'm wondering how we can, besides, you

know, paying you in chickens or

Hahaha.

live basil plants. that you can then kill yourself, you know, how we can do better.

You know, I think honestly everybody is burning out right now. You know, not just

the medical professionals. The last few years have been really difficult for

people. A lot of the social norms that we had been accustomed to were completely

upended. There was a lot of... socialization that didn't happen the last couple

of years. So I feel like really everyone's burning out. I've started doing

a thing called joy prescriptions where I tell patients, you know, I want you

to do something every single day for five minutes that brings you joy. And

the number of people I get that say, well, I don't know what brings me joy

is terrifying. Then I say, well, that's your first assignment then. Figure out

like something that brings you joy. And then you have to do it five minutes

every day. And I really think that it's, you know, just doing, taking a little

time to take care of yourself pays dividends in the long run. And, you know,

I know I... for far too long just said, okay, yes, I will do everything.

I'm gonna do everything for everyone else and you empty your cup. And then

you, you know, there's nothing left for you. And so the other thing I've started

doing recently is saying no, and it's the best. Nobody says no enough. And

I've just recently started doing it and I love it.

and I'm really glad that you agreed to be on there.

I agree to do fun things.

I said no to something recently too and it was fantastic.

Yeah,

So

it's great!

you have a project coming up, which I'm assuming probably brings you joy.

You're starting a YouTube channel, is that correct? And what is it called and

what are you going to be doing on the YouTube?

I am. So we are, I'm in the process of making Cooking with Dr. Coley channel.

And this really stems from the number of times every single week I have to

fight with people to eat their vegetables. In the Midwest,

I'm guessing it's not just

everybody

the children.

tells me, well, we're meat and potato folks. It's not, no, I have like 70

year olds with like really terribly controlled diabetes and heart disease and well

we're just meat and potato folks and I'm like, I just don't want you to have

another heart attack. Like really, can we, like I'm not taking away the meat and

potatoes, like, but could you fill half your plate with veggies? And people's

idea of like a healthy vegetable is like. iceberg lettuce with ranch dressing

and I say, well, I don't think that's the healthiest choice. So I'm just,

I'm really tired of having the same conversation over and over again. And

I really, I really love to cook. It's what I do for like stress relief. And

I really, I was gonna offer a cooking class, but it turns out there's all

these... like for my patients, but it turns out there's all these rules with

Medicare that you can't give free stuff to people and So I couldn't offer

this class I wanted to and you know, we just have all these like older midwesterners

who are just like so set in their ways Right and not one of them wants

to eat a vegetable. So I figured well maybe an easier way to get this message

out broadly is to just to start a youtube channel and with just how to incorporate

vegetables into your life. Because people think that vegetables don't taste good,

they think they're expensive, and that really just isn't the case. So it's

gonna be not entirely vegetarian channel, but like plant heavy foods, because

I feel like that's what people have the most difficulty kind of incorporating

into their diets. so really heavy on vegetables like beans and legumes

just kind of plant forward cooking to to try to give people a resource to okay

it's not you know you can incorporate it like it's not doesn't have to be hard to

incorporate vegetables i won't even take away your meat potatoes just like

please eat some broccoli sometimes

So as the wife of one of your patients who might believe that iceberg lettuce with

Ranch bacon bits and cheese on top counts as a salad. Sorry Jim. Apparently it

doesn't Have you thought about

Belgium,

maybe

I apologize.

running like half a screen of tractor videos at the bottom of your cooking videos

so that they'll watch them or like Interspersing little videos of cows in between

to get them to like Or, oh, what's it called, um,

I love this idea.

when you, when you put in like little snippets of something that like your, your

brain doesn't consciously see? Um, like,

like the subliminal

yes,

messaging? Ha ha

yes.

ha ha.

We'll just start putting it in all the tractor videos on YouTube. There'll be

subliminal messaging for like

Perfect.

kale, you know. All these farmers are going to start asking it for like tofu and...

curries and kale and shit and everyone who cooks for these people is gonna be like,

what? Alright, you know, it's gonna be amazing. And my husband

I

is

think this

doing

is

better.

a brilliant idea.

I'll say that for him. He is making an effort. Yeah, I think subliminal messaging

or some tractor videos might be the way to go. Yeah,

I like it.

I think there is a real assumption that eating healthier means all tofu all the

time, and

Mm.

never eating anything that you actually want to eat.

And also not controlling your diabetes does really really really bad things so Yeah,

I think people miss What the fallout can be of that?

Uh-huh.

And I watched your intro video and it was adorable. So we'll make sure to put

a link

Thanks.

in so that people can watch you.

I just had, we've learned some things during filming. So my husband is helping

me with this. We are not videographers. We don't really

So we

know

ask...

what we're doing. So we said, we welcome feedback.

There you go. We ask all of our guests if you were going to dominate a category at

the county fair, what would it be? And categories can be real or made up to ensure

that you win.

mean I make an excellent cheesecake but those recipes aren't going on the channel.

That's only for the county fair.

I think I really could win a cheesecake making contest at the county fair.

I really do.

I think

but

I

you'd

could

probably

judge

put

a chicken.

fruit on it.

Yeah, totally.

It's got dairy in it.

That sounds delicious. So we'll go ahead and move into our cussing and discussing

segment. We've registered for an online platform called SpeakPipe where you

can leave your cussing and discussing entries for us and we will play

them on the show. So go to speakpipe.com backslash barnyardlanguage and

leave us a voice memo or you can always send us an email at barnyardlanguage.gmail.com

and we will read it out for you. Katie, what are you cussing and discussing

this week?

Well, I wrote down children are humans, but I do actually remember what I meant by

this. It's so, so easy, and I am saying this as a reminder to myself, it is so easy

to get so caught up in, my kids should be excited to go to school, they should do

all their chores without ever talking back, they should do this, they should do this,

they should never talk back or complain or want anything different or cause problems

or whatever else. And I mean, my kids are just barely six and four. And if I really

think about it, if somebody pushed me around to do all the shit that I expect

them to do without complaint, I would lose my mind. And, you know, the boy child

this morning was saying he didn't want to go to school because he doesn't want to

learn anything else. His brain is full, he's done, he wants to stay home and play tractors,

he doesn't want to go to school, he doesn't want to,

Thank

you know,

you.

he's done. And I'm sitting here thinking about I'm trying to learn this new editing

software for the podcast, and my brain is full after like five minutes of trying to

learn new stuff. But I expect my four-year-old to just trot happily off to school every day

to learn more stuff. You know, it can take me an hour to get going in the morning

and to get dressed and eat breakfast, but I expect them to be able to do it in 15

minutes when they don't get to choose what they're wearing or what they're eating

or where they're going, and that they should just shut up and go do it, and don't

give me a hard time about it. And... It is hard because on the one hand, just shut

up and go eat your breakfast. I, you know, you're four, I don't care what you think.

But I do very much care what they think. And it's hard to balance caring and wanting

them to feel like they have some agency in their lives with also knowing that sometimes

you just have to shut up and eat your breakfast and go to school. And it's hard to

take it too seriously when I know full well what he's learning in preschool. And it's

not like they're, you know, it's not like he's in a military academy or something.

So anyway,

Yeah,

children

it's

are

a hard

humans.

one to remember though, especially when it impacts your, you know, you've also

got in your head like, if you don't leave now, we're gonna be late, you know,

all the things that as adults we're keeping track of at all times, right?

Like if my kids are gonna miss the bus, then I'm gonna have to drive them,

you know, like all the down the road consequences where you're just like,

can you just do the thing? But

Let's

yeah,

just do it.

yeah. But they're also allowed to have feelings apparently. Ha ha!

All right, Colby, what do you have to cuss and discuss?

Oh goodness.

What have I been thinking about recently?

Mmm.

Is this something that I think about that makes me want to cuss? Is

It

that

can be, yeah, this

the point

is

of

just

this?

like, yeah, the random, either like the little tiny thing that bugged you

this morning to like society at large, whatever. This is free rein.

Gotcha. I've honestly been really thinking about how, like, why is winter so

long? I know this is something I can do nothing about, but we're only a month

in and I'm sick of it already. And

Agreed.

this is awesome. I just am thinking like, you know...

Can just the whole world just move south during the winter? Just... Or shouldn't

we all just live in the template zone? I don't know.

Yeah,

Maybe I just need to do that. Maybe I just need a vacation.

maybe.

Maybe

Yeah,

that's

that

what

could be

the...

it. Yeah. There's something about

Really?

the longer nights too, the darkness. You know, in the daytime when it's

cold, I seem to be able to cope better. But, you know, once it's dark

and cold, then that's a harder pill to swallow.

I agree.

I find that interesting, Arlene, because I prefer when it's dark, because then nobody

expects me to go outside. When it's light, I feel like there's some expectation

that I might leave the house.

Yes, but like today I'm looking outside and there's snow, but at least the

sun is shining. So it's like, you know, I can look out there and think that

it's, it's not that bad. But yeah, when it's dark at four o'clock, then

Mm-hmm.

yeah, I don't want to do anything, whether I'm inside or outside.

No. Okay.

So Arlene, what do you have to custom discuss today?

So this one is semi, like medically related, I suppose. And I'm not blaming anybody.

She's

It's

got

just

a rash

one of

to

those.

show you, Colleen.

No, I do not, no. It's just that thing where you call the doctor's office

and you need to book an appointment and it seems semi-urgent to you. And they're

like, ah, yeah, the closest appointment we've got is like six weeks or

two months away. And you're like, well, like. guess that's my only option,

I will take it. But then, you know, say that there's a prescription that

needs renewed or any of those types of things, then there's all those extra

hoops that you have to jump through where it's like, yeah, well, I don't

have another doctor's appointment for another two months, so I guess you have

to fax my doctor or whatever technology they use now to talk to doctors.

I think they still use faxes at my pharmacy. I don't know why they do.

They still use faxes. It's the most, that is worth cussing and discussing.

Yeah,

Why

the use

are

of fax

we still

machines.

using faxes?

Yeah, yeah, yeah. So then, yeah, that drawn out process of, okay, so yeah,

I do have a dark disappointment, but then the prescription is another whole

thing. And yeah, just the delays. And I get it, everybody's overworked. And sometimes

you can't fit more appointments into a day, but I just don't like waiting for

that kind of stuff. But.

Can I pick a new custom to discuss?

Absolutely, get another one.

Because I think this is, like understaffing of medical clinics, I think is

a problem in many, many places, but especially rural places,

Mm-hmm.

it is ridiculously hard to recruit people to come work. And it does mean longer

wait times for patients. And and that your medical providers are overworked

and you still aren't getting to see them in a timely fashion. A lot of people

in the US will say, oh, well, we can't have a single payer system or socialized

medicine because then care will be rationed. And I think what people don't

understand is that care is already rationed. We just don't ration it in an intelligent

or

in a way that makes any sense. We're not deliberate about it.

Mm-hmm.

So instead what happens is there aren't enough healthcare professionals and

where there are some mostly suburban type environments where there are

plenty of doctors and you don't have to wait. but in the more difficult places

to practice that have fewer resources like rural places and like urban

places, we are rationing care, we're just not talking about it.

Yeah,

So.

and it's probably not being done in an equitable, across the board way,

right? Where

No. Not at

some

all.

people are maybe not seeing that it's being rationed because they're maybe

in a different system than the other people who are waiting.

Yeah, absolutely.

Arlene, I'm going to add a second cussing and discussing too,

Bring it on.

since we have fun.

I'm going to go ahead and turn it off.

It's a double cussing kind of week.

This concept of the way the government controls prescription writing, if it seemed

like it was actually fixing the opioid epidemic, fine. But this crap about things

like not being able to get ADHD meds for more than 28 days at a time, if I didn't

need meds to make my brain able to remember things... I might have a chance of

getting my meds filled on time, but there should be some route that if I can prove

that I'm taking my meds and I'm a 41-year-old mother, I'm not selling my meds to a bunch

of college kids on the street, I feel like I should be trusted with more than 28

days' worth of medication. Or... when, say, my insurance company refills... refuses

to pay for a prescription because they disagree with my doctor about what my prescription

should be or pharmacies that second-guess your prescriptions or anybody else I just...

you know... it's... if it seemed like it was fixing anything it would be different

but we still have all these drug problems and it's... It's still a pain in the ass to

get stuff filled. So that's my thoughts

Well,

on

and

that.

it just, it really is, I mean, it makes life harder for patients and for medical

providers because, I mean, if somebody is stable on a medication, you know,

on their blood pressure medication, I will give them a month's worth with a few

refills and say, you know, hey, come back for a recheck in six months or whatever.

But you know, I can't do that on... with the controlled substances. Like

I need to write a new prescription every single month after you call in and request

it. So it's harder for everybody.

Yeah, I think

Yeah, that's exactly the problem is that it's not in any way efficient for anyone

involved. It's not efficient for the pharmacy either because they have to, you know,

jump and do it when it does finally come through. And it's just a pain in the ass.

Anyway, Arlene, did you have a second cussing and discussing you wanted to add?

I think I'm good for today. I feel like I'm gonna, as a Canadian, I need

to curtail my comments a little bit, other than saying, yay, socialized medicine.

I know there are problems in the system, but yeah, I know that hearing the

two of you talk about it and all the other stories that we hear from here,

you know. yes, there's issues in our system, but don't let your politicians

and your insurance companies convince you that it's all that bad because

there's a lot of good that's happening. I think that

Mm.

hopefully that if other systems are looked at critically and without all the

biases and often that comes from that's... where it's coming from, who's

getting paid, right? So, but look at what other countries are doing and

actually, yeah, make some decisions based on facts rather than believing the stories.

Anyway, thank you so much, Dr.

Thank you

Coley,

guys, this has

for

been so much fun.

joining us today. If someone wanted to get in touch or follow your YouTube

channel, not in get in touch in terms of like asking for medical advice.

But yeah, if people want to watch your cooking videos, where will they

be able to find you?

So the channel is just called Dr. Coley. So like D-R-C-O-L-E-Y.

That is great. We will look forward to watching them and see whether there's

a tractors involved or not.

Gonna add some now.

Maybe you could even just line some toy ones up on your counter

Mm-hmm.

Or just some tractor books or something. We have

I'm

some

going

you could

to

borrow

go to bed.

if you need

There you go.

Sorry.

them

Thank you so much.

Yeah, thank you.

Yeah, it was super fun.

You know, it's really, well, and it's really hard because it feels like,

you know, it's, it's kind of a boundary. Like, I honestly, I do have this

collection of patients who I'm just like, I want to be their friend, but I

mean, it's hard to make friends as an adult, I feel like, anyway. And then

you add that extra layer in and it just gets kind of, you're like, is it

weird? But like. Right? I think so too. But yeah, I get, I'm like, is it weird

to, like, I don't want, it's not awkward for me, but I'm always kind of

like, I don't know, like maybe many people don't want to share their medical

problems with their friends. Like, where, you know, I just, I look at, maybe

it makes them uncomfortable if their friend looks like, looks at their

vagina, like, I don't know.

And I'm just like, oh, I don't know.

It honestly doesn't... I mean, all like, and I go, at first, at first I was

kind of like, I was, I was in the same boat, because I needed my IUD changed.

And I was like, ah, should I go all the way up to gynecology? Because that

is just kind of a pain. And then I decided I was just going to have Jenny

do it. Jenny's one of the PAs that works in our clinic. And so, you know,

we're, we're friends and we hang out outside of work. We work together

every day and I'm just like, Jenny, can you change my IUD? And she's like,

sure, no problem. So that's what we did.

Mm. You know, everyone's intestines look pretty much the same. Ha ha ha ha ha.

Cheers.

Yeah.

So they actually, like right before I stopped doing OB, they actually got

like the clear drapes so that you can see now. I know, and I was just like,

why couldn't we do this a few years ago? I brought it up and everyone just

acted like I was like insane, but.

Yeah, so they got him on board. Yeah, yeah, exactly. So like, you know, you

just yeah, you can see through it. It's just like clear plastic instead of,

you know, normally it's like paper. You can't see. So yeah, somehow they

got Yi on board. And and so that's what they do now. You can have the option

of a clear plastic drape so you can see. I have another one so you can

have that experience.

I know, I know, right?

That's really nice.

That's a really nice benefit though.

Hmm.

Uh-huh.

It looks real sad guys, real sad.

Yeah. Mm-hmm.

So what do I need to do to make sure it uploads? It's just going to do it automatically.

Okay, so I can hang up and then just leave this open? Okay, perfect! Alright,

this has been really fun guys, thank you! Yeah, good to meet you! Bye-bye!