It’s Time for Physicians To Fight Back Against Insurance Companies To Save Our Practice With Dr. Elisabeth Potter

“I like doctors. I think we're good people, and I think we've been in an abusive relationship with insurance and we need to get out of it.”

Dr. Elisabeth Potter is a plastic surgeon and practice owner in Austin, Texas, who specializes in post-mastectomy breast reconstruction. In January, Elisabeth made waves on social media when she posted a video about UnitedHealthcare calling her during surgery, pulling her out of the OR to explain why her patient — who was already under anesthesia — needed to stay in the hospital overnight.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker talks with Elisabeth about dealing with absurd coverage requirements, calling out insurance companies for undermining patient care, and being the “face of medicine” in today’s climate. Elisabeth also discusses the most rewarding and difficult aspects of running her own practice, opens up about her viral video, and shares how she’s using social media to educate patients and push for policy changes.

Graham and Elisabeth don’t hold back in taking predatory insurers to task. Here are four highlights from their frank, in-depth conversation.

1. Running a practice has been rewarding, but also harder than Elisabeth expected — mostly because of insurance.

“It’s gotten to a point where it feels like this is almost like my do or die moment. If I don’t really lean in right now, in two years, my practice won’t be open.”

Growing up, Elisabeth had firsthand exposure to the world of independent medicine. Her father, who was double-certified in internal medicine and allergy, ran a solo practice with help from her mother, who was a nurse.

When it came time for Elisabeth to forge her own career path, she decided she wanted to work for herself. So, she turned down a job at a major medical center and opted to hang out her shingle. She’s glad she took the route she did. As a practice owner, she can go to greater lengths to advocate for her patients because no one can fire her for speaking out. But running a practice has also been full of challenges related to increasing overhead costs and administrative burdens. And then there’s the biggest pain point of all: dealing with insurance companies, which she feels devalue the services of physicians more every year.

Elisabeth points out that, unlike some doctors, she’s tried to push for greater access to breast reconstruction by working with insurance providers, rather than working around them. “I don’t balance bill; I don’t do the cash-pay game. I’m a good actor,” she said. But insurers have given her “zero credit for my decade-plus of advocating for access and doing surgeries for less than I should be paid.”

2. UnitedHealthcare’s response to Elisabeth’s viral video underscored how underappreciated doctors are.

“I perform — when I did the back-of-the napkin calculation — about 1% of the mastectomies for United yearly. I did 500 breast cancer surgeries last year. I just think they have no concept of what I have offered to their members. Now, their members have a really high concept of what that is. My patients are so appreciative.”

Elisabeth didn’t expect her video to take off the way it did, but she understands why it resonated so deeply. Insurance companies have gotten away with making coverage requirements more and more unreasonable, and they don’t have any justification for forcing physicians to jump through so many hoops. It’s all “theater,” Elisabeth points out. Her video helped pull the curtain back on an industry whose tactics have become predatory. UnitedHealthcare responded by sending Elisabeth a letter demanding that she remove her “defamatory” video from TikTok and Instagram and post an apology to the company.

As a business owner, Elisabeth thought UnitedHealthcare could have responded in a more constructive way, and shown that they were taking her concerns seriously. And as a surgeon who works tirelessly to do right by her patients, and has made an effort to cooperate with insurers for years, Elisabeth thought UnitedHealthcare could have acknowledged how much value she and other physicians bring. But they chose not to.

3. It’s time for physicians to be honest with patients about what insurance companies are doing.

“What’s really hard personally for physicians is that we don't have the power, but the patients think we do. It’s really hard to face another human being, a patient who has a problem, and say, “I actually don't have the ability to decide that. I know you think I'm in charge, but I'm actually not in charge anymore.”

It’s reasonable for patients to assume their doctors can effectively advocate for them. Elisabeth believed she’d be able to, back when she began her career. “I thought I was putting in all that time and effort to get the privilege of making sure that patients got what they needed,” she said.

But insurance rule-changes have led to physicians having much less control over decisions about access to care. Reimbursements for surgery have also become much lower than most patients probably realize, Elisabeth says.

Physicians aren’t inclined to discuss what’s hard about their jobs — especially with patients who are facing serious issues. But it might be time to talk openly with patients about coverage barriers and payment. If patients think doctors could do more for them but are choosing not to, they’ll jump to the wrong conclusions.

“If we don't tell them what's really happening, then they're just left wondering,” said Elisabeth. “They're like, is it your fault? Are you not doing it right? Do you not care enough? And that's not true at all.”

Giving patients more information might also help spur meaningful change, Elisabeth believes, because they’re the ones paying for insurance. As customers, patients have a form of leverage that physicians lack.

4. Physicians can use social media to equalize access to care and fight for policy changes.

“I had a woman who came in who was 70 years old. She's following me on Instagram and she knew all the things. Her daughter was like, “Check her out on Instagram. Watch these reels.” She came in with her list of questions and we went deeper than I would ever have in a consult.”’

Elisabeth sees social media as a tool with multiple functions (beyond calling out UnitedHealthcare). For one thing, access to care is a big problem in breast reconstruction. It can be hard just to get a consult with an in-network surgeon, Elisabeth explains. By putting out free educational content on social media, Elisabeth is reaching a broader array of patients. What’s more, patients show up to appointments with a higher baseline level of knowledge about the procedures Elisabeth focuses on.

Additionally, a few years ago, social media played a major role when Elisabeth was working to get a code changed by CMS. Patients saw her content and joined her advocacy efforts, which made healthcare organizations pay attention and lend their support too.

Connect further with Elisabeth on LinkedIn here.

To make sure you don’t miss an episode of How I Doctor, subscribe to the show wherever you listen to podcasts. You can also read the full transcript of the episode below.

Offcall exists to help restore balance in medicine and improve the wealth and wellbeing of physicians. Sign up for Offcall here to bring about more physician compensation transparency and join our physician movement.

Transcript

Elisabeth Potter:

I like doctors. I think we're good people, and I think we've been in an abusive relationship with insurance and we need to get out of it.

Graham Walker:

Welcome to, How I Doctor, where we're bringing joy back to medicine. I'm excited to talk with Dr. Elizabeth Potter today, because I think she represents a new type of physician advocate. In medicine, we're always taught to advocate for your patient, but traditionally, there's always been a sense of professionalism or a proper way to do that. It's completing prior authorizations after clinic, going the extra mile, doing extra work. The Hippocratic Oath tells us that we need to put our patients' needs above our own. But I think Dr. Potter is redefining what that means. Traditionally, physicians have assumed that because the patient comes first, we as doctors must always also come last, that our feelings, our needs and our well-being don't matter. I'm not sure we got that part right.

I first got to know Dr. Potter from a now viral video that she posted on TikTok one day about how UnitedHealthcare had called and demanded she leave the OR during a case to discuss the patient's coverage for an overnight hospital stay. The video sparked something inside me that said, "You know what? Hell, yeah. Why aren't we talking about this more openly?"

Dr. Potter openly shows the struggles physicians face when advocating for our patients, and she's transparent about why and how she advocates as well as the personal toll it takes on her. And I also think it's important to call out why Dr. Potter can speak so candidly. She operates her own practice. She's not someone else's employee. Physicians working for large groups or institutions might feel pressured to remain silent or fear repercussions from administrators who don't want them rocking the boat. I'm looking forward to exploring all of this with Dr. Potter today. Welcome to the show.

EP:

Oh, my gosh, that's the nicest intro. If all of those things are true, then I'm doing it right.

GW:Elizabeth, can you just give us your backstory to start?

Choosing Reconstructive Surgery and Private Practice

EP:

I grew up in a family where a medical practice was our family business, so I grew up in a small town in Georgia. My dad was an independent, he did allergy and immunology, so he was double certified in internal medicine and in allergy. My mom was a nurse. She worked at the hospital and at a state hospital and also helped run his practice. And we answered the phones, cut the grass, emptied the trash, worked with my dad when we were old enough.

So I think from a really young age, I always felt like my parents' job were to take care of people, and I was always really proud of that. I didn't go right into medical school. I worked for five years after college and did drug approvals for a law firm in DC so I could see that side, which has been really helpful.

I want to be sitting squarely in something where I'm physically challenged, I'm mentally stimulated and satisfied, and I also feel like I am delivering something good for the universe. And so, being a doctor really checked a lot of those boxes. Being a surgeon specifically, I love working with my hands. I'm very detail-oriented. I like being tired, like physically tired at the end of the day. I recognized my own aptitude for it pretty early and realized I can make a difference here.

I went into microsurgery specifically. I had no desire to do plastic surgery whatsoever. I was only exposed to plastic surgery in a really negative way growing up. I didn't even really think of plastic surgery as an option. But I was at Emory Medical School on my surgical oncology rotation, and I saw a mastectomy. We were done with the mastectomy and my attending said that I could leave. The plastic surgeons came in the room and asked if I wanted to hang around, and I think maybe they wanted someone to help hold hook or whatever.

GW:Sure.

EP:

I saw them do what was then, it was a TRAM flap, a free TRAM. It was like an older version of the surgery that I do now, and I was completely gobsmacked. I had no idea those surgeries existed. I didn't know that you could use one part of your body to reconstruct another. I just fell in love with all of it.

GW:Yeah, we have a couple of things in common. I'm from Kansas. My dad's a psychiatrist, and my mom often would help run my dad's private practice as well. He finally retired last year, but she's still calling patients. Like, "Oh, a reminder you've got an appointment with Dr. Walker tomorrow."

EP:

That's awesome.

GW:And the other thing I loved was you said something that I think all doctors know, but that I think a lot of people don't really hear very often anymore is like, "I want to work hard. I like working hard." Nobody goes into medicine trying to just phone it in, make millions of dollars doing nothing, and just doing this as passive income. We all know we're going to work our butts off because medicine is hard work.

EP:

It's so funny, when I look at medical students now and I see a reel or something of a medical student studying for a shelf exam, and I remember that feeling of being in medical school and thinking, "This is just so hard and I'm so committed to this because I want to help people." Right? There's no other reason. At some point it doesn't make sense to do it for any other reason because it's just so hard. No one's paying you enough and no one's patting you on the back enough. It just feels so good to be in that space of committing your life to others. I like doctors. I think we're good people, and I think we've been in an abusive relationship with insurance and we need to get out of it.

GW:Just maybe tell me a little bit, what are the challenges you found about running your own practice?

Perks and Pitfalls of Running Your Own Practice

EP:

I was offered a position at MD Anderson, and I just never felt like I wanted to work for a big organization. I've always wanted to be my own boss and felt like I knew what best decisions to make. And I knew as a doctor that I wanted to be able to make those independent decisions. And looking at where I am now, I'm so thankful that I chose this path, because I've been able to have a much broader impact through advocacy because I am in my own practice and there's nobody who can fire me for speaking out.

And listen, there's a cost-benefit analysis for everything, and the headaches that come with running your own practice are large. I saw my dad run a practice, and I saw him do well and be able to provide for his family. We certainly weren't extremely, obscenely wealthy, but we had what we needed for sure. But I also saw him struggle with insurance over time. He started his practice in 1975, and then didn't retire until the early or mid 2010s. But I never expected my practice to be as hard as it has been. It's so very difficult to keep up with the overhead of running a practice with the increasing demands on the administrative side.

And then as insurance has become more difficult, and gosh, just routinely every year, it seems like devalued the services of physicians more and more, it's gotten to a point where it feels like this is almost like it's my do or die moment. If I don't really lean in right now, in two years, my practice won't be open.

GW:My dad left. He finally decided, I think it was Blue Cross of Kansas or Missouri, told him like, "Oh, well, we need to see all of your notes."

And he was like, "Those are my private psychiatry notes."

Because you know, seemingly for quality or that they didn't trust he was giving good care to patients he's cared for for like 30 years, literally. So he was like, "No, I'm out. I'm done. I'm not going to violate my patient's privacy and you know, I should retire anyway." He's 75. He said that same thing, "It's just like every year it gets worse. The requirements and the administrative work of doing this job that I love get harder and less enjoyable to me."

EP:

We're doing something wrong and we have to fix it. We talked about that group of people in medical school and what it was like to... You're attracting this group of people who want to help people and want to work really hard and have a lot of potential, and then just grinding them into the ground over time. So, we can do better. And I think what we're trying to get at, it's going to take having some of those conversations that we haven't had in public before or haven't let patients hear before.

GW:That made me think of your post. We didn't meet until I was just scrolling TikTok and then came across your post and I was like, "Who is this amazing plastic surgeon?" What made you decide to get out your phone and start recording?

EP:

That day... It wasn't a one-off, right?

GW:Yeah.

The Story Behind Elisabeth’s Viral Video

EP:

I posted after being called in the operating room by an insurance company and asked to basically justify why my breast cancer patient needed to stay overnight after her major surgery. And I just couldn't anymore. I try to be someone who's collaborative and I've actually really been a friend to insurance. I've advocated for access through insurance to breastfeeding instruction. I don't balance bill. I don't do the cash pay game. I'm a good actor.

And I think it was this... There were a couple of things. It was the fact that I realized they have no idea that I'm a good person. They're giving me zero credit for my decade plus of advocating for access and doing surgeries for less than I should be paid and all the things, right? And then also, just I felt this creep of being questioned as a physician over and over. And I'd say I was interrupted so many times in my clinical practice by insurance asking me for a peer-to-peer that this just felt like, "Are you kidding me? You're actually in the operating room? This is insane."

GW:It captured, I think, the quiet rage that many of us feel working in this system. It gets harder every year to do this thing that we love in the name of trying to help our patients. And, when does this end?

EP:

I'll do anything that you tell me will help my patient. I will jump through hoops. Give me that, what a doctor says I should do, right? I'll do all the work, and I'll look to my mentors and see like what's the best way to treat this problem and what new skillset do I need to obtain? And with this issue, navigating insurance, nobody has the answer. There's nobody out there who's done this successfully, right? There's nobody who's telling doctors, "Oh, this is the way that you can have a viable practice and deal with insurance."

I'm like, "We have to do something different." And I just felt like being honest has always been a good policy. You can build from there. And I felt like, "Let me just be honest about this thing that's going on." And it resonated in a way that I truly did not anticipate, but I am so very grateful for.

GW:Well, it feels like you're doing your end of the bargain of trying to keep up with the literature and come up with new techniques and find ways of saving time and being efficient and doing all the right stuff. You're doing the doctor part, and then the insurance people are supposed to do their part, too.

I remember I had this chief resident and he just said, "Graham, you got to do your job. That's all you got to do. It's not hard. Medicine's not hard. Just do your job and that's all you got to do."

EP:

I love it.

GW:It feels like the insurance people aren't holding up their side of the bargain, you know?

Why Doctors Are In an Abusive Relationship With Insurance Companies

EP:

It does. I mean, it does. I say this, and I'm not joking when I say it, the relationship between doctors and insurance companies has become an abusive one. And you know, we are underappreciated, and we're gaslit, and we're made to justify what we're doing all the time. And then questioned as though we're doing the wrong thing. Yeah, this is broken, and we do just want to do our job. I'm here for that. But you have to have boundaries in place, and you have to have actors involved that have similar goals. And our goals just don't seem to be aligned.

GW:I remember doing, you know, I think a care coordinator or somebody telling me, "If you don't do this," and not in a threatening way, but I took it that way. "If you don't do this 12 page form, your patient can't get discharged to where they need to go. And so, they're just going to sit here in the ER."

I had that same feeling. I will do anything for my patients. And it's the same thing I feel if I'm asking my resident or my med student to do something or a nurse, I am not above doing anything to help my patient. The concept of scut work, if you need to call the patient's family, you call the patient's family. But it feels like there's just... Every year there's more and more to this that makes it more and more challenging to, like I said, just do your job.

EP:

It's so, so true. I completely agree. And I feel like it makes me just look closely at what's actually happening to say, "I'm a physician. I have a patient who has a need and I can meet it."

GW:Yeah, "I can do this."

EP:

"I can do this."

And honestly, do we need insurance involved? So, here's your patient in the emergency room, and needs to be discharged. And someone's handing you 12 pages of paperwork to fill out before they can be discharged. In my gut, as you're saying that, I'm just thinking, "Let me show you how I can discharge this patient without that paperwork," and then just roll them out the door. It can happen. This absurdity, this theater, we've accepted it, and we all have to just end the show and get real.

GW:I love it. It is theater. It does feel like theater a lot of the time.

EP:

Yeah.

GW:Elizabeth, did you start to worry when the video went viral after the surgery? Were you like, "Oh, this is starting to do something?"

EP:

You know, that's so funny. I would say I pride myself on being, you know, pretty intelligent and aware, and I have a lot of common sense, but I wasn't worried. I wasn't worried. And I think I assumed that... I know that I'm a good person and that I've been a really good doctor, and that I always do the hard right thing, always. So if somebody like really looks at me and picks it apart, I do surgeries for free, I take TriCare, Medicaid, like I do all the things. I'm the safety net for women around the country. I wasn't worried. I just thought, "Oh, look, we're getting a voice."

And then as I'm coming into the hospital, there are people patting me on the back, like doctors, saying, "Thank you so much for saying what I couldn't say."

GW:Yes.

EP:

So I felt really good until I got a letter from United and that was like, "Whoa, okay."

GW:You did reveal this stuff that doctors have been doing for decades now that we've never shown, that we have never told anybody, is what we do. And I'm starting to see more and more physicians do this. There are physicians that read prior auths, theatrically. I've seen some medical practices that just record themselves on hold with the insurance company, and then they'll record like a 45-minute video and speed it up and just to show that it took 45 minutes of this person's time to get approved for some stupid thing like Zofran or amoxi... something that is not worth anyone's time for a generic drug that costs pennies. So I think we are starting to see more physicians like yourself, pull back the veil, show behind the curtain of what it's taking on the doctor's side or the doctor's staff's side to operate in this broken system.

EP:

I'm glad that we're doing that and I'm here for it and I support it. And I think you can do it with a sense of decorum.

GW:It would seem like a tremendous opportunity for United to say, "Hey, wow, we could really learn from this experience. And wow, this physician is someone that we work with, that we contract with, that we pay."

Me in my naive way, clearly, is thinking, "Gosh, what an opportunity to help provide better service to the doctors who are delivering care for the patients that we cover, that we insure."

United Could Have Responded Differently to Elisabeth’s Video

EP:

As a business owner, if I had someone bring to me a concern about a service that I was delivering, I would really analyze that. And I do, like, "Okay, where was the breakdown and how can I make that better? Why does this person feel this way?"

And, I think for me, I perform, gosh, I think when I did a back of the napkin calculation, about 1% of the mastectomies for United yearly. That's a lot.

GW:What?

EP:

I did 500 breast cancer surgeries last year.

GW:Wow.

EP:

I do a ton of surgeries. So I just think, yeah, they have no concept of what I have offered to their members. Now, their members have a really high concept of what that is. My patients are like, they're so appreciative, but they just don't get it. And you know, they chose one path, and I think it played out the way it did.

GW:In the same way that, I think, patients often feel like a number, and that I think you try to make your patients not feel that way, I think United probably thinks of you as a number as well. You're just another line on a spreadsheet of plastic surgeons who do mastectomies for them.

EP:

Of course. And I'm just over that. I'm over it. I'm really valuable, and every surgeon and every doctor is really valuable. It comes down to what is the product that they're selling, right? They're selling a product to their members and they're saying, "Here's insurance and it's great."

And the truth is that that's just words. It's just words. It's all about the network that they have. It's about the physicians, and it's about the access that they can deliver to care. And when I see in a major metropolitan area that an insurance company will sell a product, someone will be insured, employed, and be diagnosed with breast cancer here in Austin, and then not be able to find, number one, a radiology facility that's in network to cover their mammogram. Number two, a breast surgeon who's in network to perform their surgery. And number three, a plastic surgeon that's in network to perform their reconstruction. I'm like, "I think you guys are selling goods that are flawed." Yeah, there's something amiss and the curtain needs to be pulled back.

It feels like people have bought into a gym membership that they're not using and the debit is happening, and they just want to get the heck out of it and they can't. Some insurance plans feel like that. It's just predatory. You're taking all this money and delivering nothing.

GW:Or that the gym is only... "Oh, well, you do have a gym membership, but it's only open from 11:45 to noon."

EP:

Yeah. And you're only allowed to go to that section of it on Tuesdays, and you don't get to use the pool, because you're not that person.

GW:Right.

EP:

When I grew up, insurance meant something. Being insured did imply peace of mind. And it's so sad that in 2025, being insured for my patients no longer means you have peace of mind.

GW:You felt that if something as devastating as cancer were to affect you, you're good. The doctors, the hospitals, everyone is going to help you manage that.

Insurance Used to Be Meaningful to Patients

EP:

Yeah. And that insurance was going to facilitate that and not obstruct it. And I think that you knew that if you got yourself in front of a doctor who recognized your problem, that that doctor had enough power and knowledge to see that you got the treatment you needed. And the truth is that now we don't. We don't. We can know all the things and can't get you the medicine or the surgery or the hospital or the rehab. We can't make it happen. Calling it insurance and comparing it to what insurance meant when I was raised in the eighties and nineties is not accurate. Post 2010, we have a completely different definition of insurance.

GW:The other thing that I try to tell people is that I think physicians are still the face of the healthcare system. And so, I think that's the other piece that is really hard personally for physicians, is we don't have the power, but the patients think we do. And at least we're the person who's supposed to be in charge. And so it's really hard to face another human being, a patient who has a problem and say, "You know, I actually don't have the ability to decide that. I'm know, you think I'm in charge, but I'm actually not in charge anymore."

EP:

Yes. It makes me so sad that we're having this conversation, because this is not what I expected when I graduated from medical school or when I chose to be a reconstructive surgeon. I thought I was paying in all that time and effort to get the privilege of making sure that patients got what they needed and the rules have changed.

GW:Yeah. And I think we all still view that as such a privilege. It is incredible that people have that level of trust in me, have that level of confidence in me. And it is so hard to see physicians leaving the practice for all of these reasons that are made up by ourselves. We could change this. America could fix the system. And all the reasons that... It's not like the medicine part is the part that's the frustrating part. I think doctors by and large love practicing medicine, because it's actually a great feeling to help another human being. It feels awesome. It's so great.

EP:

There's no better feeling.

GW:Yeah.

EP:

There's no better feeling. I think that being the face of medicine, gosh, I think we also have to be... We have to be like the heart of it, too. It's not in our physician DNA to talk about what's hard for us, especially when we're in front of a patient who clearly has more challenges than we do today.

GW:I think that's a really good point, yeah.

EP:

It's one of the reasons why we haven't had this conversation, because it's been distasteful to talk about things being hard for a doctor. But I would say it's important to get uncomfortable and have those conversations in a respectful way, because patients deserve to know why it's so difficult to get the care. They're at the end of the line here. They're experiencing how hard it-

GW:I know. Yeah.

Patients Deserve To Know What Insurance Companies Are Doing

EP:

And if we don't tell them what's really happening, then they're just left wondering. They're like, "Is it your fault? Are you not doing it right? Do you not care enough?"

And that's not true at all. So I think talking about it and saying, "My power has been diminished."

And even talking about reimbursements, talking about money with patients is really hard. But they need to understand that when I say, "The reimbursement for the surgery that I did for you is so low that I lost money doing it, and I need your help in fixing that."

They're so grateful for me to be honest, and for me to involve them, explaining to patients why they're experiencing healthcare in the way they are and being truthful about all of it is really what they deserve. I think that the voice of the patient who is purchasing the product from an insurance and who is voting, if we give the patients the information, then they actually have far more power than we do.

GW:I think we've been told for a long time that, well, talking about money dirties the profession. It's a calling. This is a thing that we do for the good of humanity, but it's not entirely honest or truthful. It's making me think of how doctors really don't like to say, "I don't know," like we're supposed to be experts. We're supposed to know everything. And that really scares a doctor to say, "Oh, actually, I don't know the answer to that question."

EP:

So, doctors aren't supposed to talk about money. We're supposed to only think about what's good for patients. So, I think that patients need to understand that we can think about both things. And parents and families and human beings do this all the time. They take care of their kids and they consider their budget and they do the best they can in the budget, right?

I think money exists and healthcare costs money. People need to understand that someone is going to be given the power to make the decisions in healthcare. Now, I would say, should it be the person or the entity that has absolutely no responsibility to also consider your health or to put patients first? Should it be an entity whose major responsibility is to make money? Is that where we want the power to be? Or do we want it to be with someone who has actually taken an oath to do what's right for you, right? If there's some coefficient, the money coefficient that needs to be applied to one group or the other, please give that power to the person or group who actually also cares about your health. Do not give all that power to the entity that really only needs to meet their fiduciary responsibilities. So we have to have the money conversation, or we're giving all of our power away.

GW:How do you view social media in fixing this medical advocacy?

EP:

I have found it to be an amazing tool for patient care and also for advocacy, and surprisingly for my mental health as a physician.

GW:Tell me more about that.

EP:

I think that being able to be honest about these hard things that we've all bottled up. I've been putting myself in the back corner and only thinking about patients and absorbing all of those things that hurt so deeply, all those interactions. I can talk about them with my friends or my family some, but I can't share them with a broader public. That hasn't been okay. That's why I've loved when I see a show like ER or something, or when I see someone showing what it feels like to be a doctor, it's like, "Oh, I feel seen."

GW:I know. Yeah, I totally agree.

Using Social Media for Patient Education and Advocacy

EP:

I feel seen, and I feel like in social media, it's helped me say, "This is hard, and I just want you to see behind the scenes that this is hard."

And it's not going to change the fact that I'm going to do all the right things face-to-face, but I think patients want to know that, and it's good to have a bit of an outlet for that, for patient education. I have patients who come in and see me. They already know me. They've watched a bunch of videos about breast reconstruction. They know how I feel about radiation. I had a woman who came in last week who was 70 years old. She's following me on Instagram, and she knew all the things. And so we had a really in depth conversation.

GW:That's fascinating, because she already knows the basics?

EP:

Her daughter put her on Instagram, "Watch these reels."

She came in with her list of questions and we went deeper than I would ever have gone four years ago in that consult because she had done her homework the way that was comfortable for her at home. I'm not gate-keeping this information anymore. You don't have to pay a consult fee to see me and learn this stuff. It's not behind some paywall in an article. It's out there free. It's free access.

GW:I love that.

EP:

So it's an equalizer. And in breast reconstruction, there's a real problem with access to the kind of surgery that I do, microsurgery. It's hard to find people in network to do it, and it's hard to even get a consult with someone in your network. And so, just having it out there is like, "Here we go. Let's just open access this." And I think in advocacy, holy cow, social media really played a huge role a couple of years ago when I had to work to get a code changed.

GW:I saw that story, yeah, for the deep flap.

EP:

Yeah, that's right. That's right. And so CMS made a decision. They actually unmade their decision. They had a hearing, and it was a year and a half of work. But they had a hearing, they listened and they changed their minds. And a lot of that was social media. It was patients weighing in. And then, once organizations saw patients leaning in and speaking up and writing letters, then they were like, "Oh, wait a minute. Okay." So I think it's an untapped resource for health advocacy, for really deepening the consult in an efficient way. And then, yeah, like I said, it's helped me feel just healthier about the stress.

GW:There are so many things that I'm able to release into the doctor's room of the ER, because just my colleagues who are amazing, we all get it. We all, "Oh, my God, can you believe this is happening with this person?" Just being able to decompress some of that and share it in the doctor's room is so nice.

EP:

There's this whole town and gown situation with doctors and patients, and what I'm talking about is like taking that away, too. So the fact that you can be real with patients that... So, I can go into the doctor's lounge and have a conversation and feel seen, and patients can maybe go to a patient group and have a conversation and feel seen.

GW:Oh, sure.

EP:

But I want patients and doctors together to feel seen so that we all get that there's like another layer here that we're both navigating. If we don't talk about it, it doesn't mean it's not there. And if it's getting in the way of delivering your healthcare, then we need to talk about it.

GW:I saw a great TikTok post from another breast surgeon, I think a plastic surgeon, who went through her entire consent discussion with a patient. Obviously, not showing the patient's identity or anything, but just both normalizing what an informed consent discussion includes. And also, I felt like, "What a great way to teach medical students, residents, fellows, 'Here's how I do informed consent in my practice. Okay, we're going to do a breast reduction surgery. Here are the things that you should expect. Here are the things that might happen.'" I just thought it was such a great way of educating patients about what they might expect so they come in more informed, and also educating trainees as well. It was brilliant. I absolutely loved it.

EP:

I am like, "I need to go record a bunch of informed consent for all my procedures because I don't have that." And that is genius.

GW:It's genius, right?

EP:

Genius, because you want someone in the comfort of their home, not in this rushed way with a paper where they're signing and initialing and they're just thinking, "Please take care of me," they could really read and really listen. I love that.

GW:Isn't that great?

EP:

Yeah. And what a great example of how social media and just... Patients are telling us they need it. They're telling us they want it. They're telling us that this is where they want us to meet them. And honestly, I learn from my patients. They ask me questions on social media that make me go, "Oh, my gosh, I didn't know that that was a misunderstanding." I'm just so appreciative of the feedback. As a doctor, I want to get better, and it's a way for me to listen to their questions and consider, "Oh, okay. I need to do that a little differently."

GW:Elizabeth, I know we have to wrap up here. If you can just maybe give a message that you would like to share with your physician colleagues who feel disempowered by the current landscape. You have so much fire and energy and passion for this. What would you tell your colleagues who are not feeling great about the system right now?

EP:

Be supportive of your colleagues who are doing this. Like you, what you're doing, it's opening doors for all physicians. And maybe engage in that way. Engage with your colleagues who are using social media and learn from them about how to do it.

Thinking about hopelessness and power, sometimes you need to be cheered on and you need a coach, and you need someone to tell you that they can see that this is where this could go. If we do a really good job, we could win. If we really lean in and do the hard workout for months when it comes to the championship, I think we can win this race. I feel like we can win. I really do feel like there are things that we can do, and this is one of them. This is actually part of getting back to a place where we have the power to take care of patients in the United States.

GW:You know, Elizabeth, you were reminding me that everybody that is practicing medicine has done really hard things. We gave up our twenties to this profession.

EP:

We lost sunlight, yeah.

GW:I think I've worked every single Thanksgiving in the past 10 years. We've done residency, we took the boards, we sat for our board certification exams. We have all done really hard things in our lives, and we all knew that if we did the hard work, we would get there. We would win.

EP:

I love that. And this is no different. We just can't keep doing the same things.

GW:Well, Elizabeth Potter, thank you so much. This has been such a great start to my morning to get to talk with you and just share so much energy and passion around just medicine and practicing medicine.

EP:

Well, so much respect for you and what you're doing. Thank you for having me on, and we'll put this out into the universe and see if it helps.

GW:Thanks for joining me today. For interviews with physicians creating meaningful change, check out OffCall.com/podcast. Make an account on OffCall to confidentially share your details about your work, and sign up for our newsletter where you can hear more about the latest trends we're seeing in physician pay. You can find, How I Doctor, on Apple, Spotify, or wherever you listen to podcasts. We'll have new episodes weekly. This has been and continues to be, Dr. Graham Walker. Stay well, stay inspired, and practice with purpose.