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Scott Webb: Obesity is a disease one that may require bariatric weight loss surgery in order for patients to be healthy and happy. And joining me today to discuss what makes Emerson's Center for Weight Loss and program unique for patients are Dr. David Lautz, he's the medical director of Emerson's Center for Weight Loss and Dr. Laura Doyon, she's a bariatric surgeon at Emerson's Center for Weight Loss.

This is the Health Works Here podcast from Emerson Hospital. I'm Scott Webb. So doctors, thanks so much for joining me today. We're discussing weight loss surgery at Emerson and what makes the program unique for patients. And Dr. Doyon, I'll start with you. What's the team's approach with patients and how does this differ from other programs?

Dr. Laura Doyon: That's a great question. There's a lot of weight bias in the field of medicine and many specialties and, unfortunately, including bariatric surgery, meaning that patients are judged for their weight rather than seeing it as a medical condition, which is what we now understand it to be. However, the tides are slow to turn sometimes and so many medical fields, including weight loss surgery still have a judgmental approach with their patient care and we try and do the exact opposite. We try and be very understanding of the struggles that the person has been through, help treat their weight as a condition rather than as a character flaw. And that really starts at the very beginning of their first visit.

Dr. David Lautz: One of the ways you see that the most is there are a number of programs out there who say that, you know, you need to lose a certain amount of weight to prove you're a good enough candidate. I've always felt that was really sort of prejudicial against patients who suffer from weight-related issues. And if you believe that obesity is a disease that does real harm, you're essentially restricting care. We're not here to judge you to make sure you prove yourself a good enough candidate. We're really just here to help and to try to get things on track.

Scott Webb: Yeah, I think you're so right, Dr. Lautz, and it does seem like it, and you can really see the shift in medicine and understanding of obesity as a condition, as a disease now, not a character flaw. And I want to follow up with you, you know, how do you as surgeons work with patients who've been struggling for years with obesity and, you know, may feel shame or certainly are frustrated?

Dr. David Lautz: I think our our approach is very much that this is a partnership, which means that, you know, the patients certainly has to own their piece of this in going through the process. Any of the procedures that we offer can be sabotage if the behavioral piece isn't in place, if they cheat with their diet, et cetera. These are really tools, they're not cures. So, you know, it's clear that the patient has to, you know, sort of do their part in being successful. But it's also clear that we need to do our part making sure the procedures are done the right way, making sure the preoperative and postoperative process is right.

And, you know, if you have a patient, let's say that hasn't lost as much as they wanted, a lot of programs will say, "Well, obviously you're not sticking to the diet. You're not doing your part. You know, go meet with our dieticians." I think our approach is much more, "Well, let's make sure you're doing your piece and let's make sure, you know, our side of it looks okay. So let's make sure the anatomy looks okay. Let's make sure your sleeve hasn't gotten bigger or your bypass looks okay."

So, you know, I think it's a joint piece of the surgeons and their staff have to make sure that the medical side of it is intact and then the patient has to do their piece of it. And we're in a sort of a strange specialty that we're changing anatomy, which changes the hormones, which then affect behavior. So they're not a disconnected thing. And so if you don't take the approach that we're in a partnership together to maximize the patient's success, it doesn't work as well.

Dr. Laura Doyon: I would add to that, that we meet with their patients at the initial visit, meaning the surgeons meet with the patients at the very first visit, so that it becomes a collaborative medical approach where we go through exactly what medical conditions they have, which may be contributing to their weight and require being addressed prior to or after surgery, in order to make sure that we're juggling all of the factors that contribute to weight gain and, you know, really help this person medically.

Dr. David Lautz: Yeah, there's a lot of programs that will, you know, you meet with the dietician and behavioral health people and get your preoperative workup done, but you're not going to meet the surgeon until, you know, you're six months, a year or whatever down the road, which is I think hard on the patients. They don't establish a relationship with the surgeon, et cetera. You know, you come to our clinic, you're going to meet Laura or myself, you know, on the first visit. So there's a different level of investment.

Scott Webb: Yeah. I think you're so right. And I was just thinking about this as listening to you both, is that it does often seem like in surgery that the surgeon ironically is the last person you meet. You sort of, you know, get introduced on your way into the OR, "Oh, I'll be doing your surgery today. "Oh, great. Nice to meet you, doctor." So really great to hear that you meet with patients from the start. And I know, you know, we kind of skip past the front desk and everything when we think about doctor's offices and hospitals and things, but I know you've got this really unique team and really this journey for patients really does start like at the front desk. So maybe Dr. Doyon, you can take us through that. Take us through this journey for patients.

Dr. Laura Doyon: Our front desk staff are not just, you know, medical secretaries. They are incredibly passionate about what we're doing here. And they bring a level of warmth and understanding and kindness and acceptance to the patients that I think is palpable. Even from that very first phone call out to set up an appointment. And the front desk staff really love watching the patient's journey from being, you know, a little bit nervous at that first visit to just feeling fantastic in their new body, you know, a month to years after surgery. And watching that person's growth is just so gratifying for the entire clinic, that I think it kind of feeds this passion for what we're all doing. And so the front desk is really central to that feeling.

Dr. David Lautz: When we started the program, I came from another place where I ran another program and we had a lot of shared staff. You know, dieticians that did bariatrics on Tuesdays and Thursdays, and they did other things other days of the week and same thing with the front desk staff. One of the most important things that Emerson provided when we started the program and it's continued to this day is to have the staff that works in our program dedicated to us. And that means we have just a different level of buy-in in terms of the employees that work there, they have an inherent interest in these patients. They are empathetic to, you know, their needs and their journey. And that starts with the front desk. It goes to the dieticians, the behavioral health group, the administrators, and then up to the surgeons. And I think that's something that the patients that go through the system really sense.

Scott Webb: Yeah, I'm sure they do. And as we've discussed here, you know, this is life-altering surgery. This is body-altering, hormone-altering surgery. So I'm sure that comfort is a big factor for folks. And again, you know, we think about the things that people kind of often overlook. But in a situation like this, Dr. Lautz, you know, the chairs, the exam tables, things like that, all of that matters really, right? When we think about patient's trust, their comfort level. So maybe you can just kind of discuss, you know, I'm asking a surgeon to tell me about the chairs, but I want to know what's it like for patients when they come in and how comfortable would they be?

Dr. David Lautz: Right. I mean, if you go to many centers, you're going to go to one place to see one clinician, another place to see another clinician. It would be unusual that the place is designed for patients that struggle with their weight. And as a result, it's pretty onerous to go from making the first phone call as in someone interested in surgery to the surgical procedure and beyond, because you have to get cleared by the behavioral health group, you have to get cleared from the nutrition standpoint, and that is sort of endemic to just how most of these clinics are set up. And it's rough on the patients. I've seen it. You know, if you weigh 300 or 400 pounds and you have to walk down a three-block long hallway, sit in a waiting room not made for you and do that for every one of these visits, it's a lot to go through.

And so, you know, when we started the program, you know, they literally gutted the clinic space and redid the whole thing to make it appropriate for our patients. And I think our patients appreciate that. And we have all the clinicians in the same spot. Our dieticians and our behavioral health and group, their offices are next door and that allows us to collaborate and work with them much more closely. As I mentioned, all of the administrative staff only worked for the program. so it's just much more functional. It's more of sort of a multidisciplinary clinic, as you would see in at the Dana Farber or a place like that, where it's really set up to serve the needs of the patient.

And the hospital's invested in similar things on the inpatient side. You know, all of our patients go to one floor. That means that Laura and I are able to work with the nurses on the floor, much more closely and those nurses know our cell phones. If there's anything unusual, they give us a call. We have a group of mid-level PAs and nurse practitioners that work closely with us, both on the outpatient and on the inpatient side. They really are sort of the backbone of the service in many ways.

So, you know, there's a number of things that are set up in Emerson system to really, I think, make a very nice care experience for a patient going through the process of having these procedures.

Dr. Laura Doyon: Absolutely. And to echo that, you know, particularly thinking about the mid-level providers, you know, not to knock a training program because that serves a need in the medical community, but you know, we're not teaching fellows or residents or medical students how to take care of these patients. You essentially have experts taking care of the patients really from top to bottom. And I think that also makes a big difference in the care.

And then to go back to that question about the comfort in the clinic, you know, obviously there's this physical comfort that were mentioned, but I think also just the personable experience leads to a level of comfort, which is critically important to that person maintaining their weight loss as time goes by. You know, we want the weight loss surgery to be successful and there's a level of maintenance, you know, trust in your care team, really what's happened versus if you don't feel comfortable coming back to the clinic for whatever reason because you've had some struggle and now you're ashamed because, you know, society teaches you to be ashamed of your weight and you're not comfortable in the clinic, then you can see how that can spiral. However, you know, I think we have a lot of protection against that because of the attention to the specific issue that we give.

Dr. David Lautz: Yeah, that's a great point. I mean, I think there's so much shame around obesity that we see in our patients. And, you know, if you go through these procedures, you're probably going to struggle at some point with your diet or staying on track as your life gets busy and life goes on. And if you don't trust your team and you're willing to come in despite what shame you may feel around that, then you're not going to seek care and you're not going to do as well. And I think we have the type of program that, you know, is more welcoming and non-judgemental, and we're here to help you. You know, if you're off track, let's get you back on track and figure out how we can help you get to where you want to go.

Dr. Laura Doyon: I feel as good to be able to offer, you know, high quality results right after surgery, but also in the years to come. I think that makes us feel really proud of this program.

Scott Webb: Yeah, well, you should be. And it's just music to my ears and I'm sure listeners as well. Just an environment of respect and trust and understanding and knowing your patients, knowing that slightly larger chairs, you know, or exam tables, or shortening the distance in the hallways, all of that, really dotting the I's, crossing the T's, putting the patients first, really amazing.

And as we wrap up, Dr. Lautz, I want to give you a last word here. What inspires you? You know, the work you do every day with your patients, what really inspires you?

Dr. David Lautz: I mean, I think for me, it's really important to be able to do these procedures to improve somebody medically, get them off their diabetes meds for instance, or off their high blood pressure medications. But the thing that really, I think, affects me the most is seeing their improvement in their day-to-day quality of life. We're not just lengthening their lives and improving their medical problems, but we're giving them a palpably improved quality of life that you can see when they come back to see you in the clinic. I mean, many of our patients come back and they're somewhere between happy to ecstatic, that they're living a life that they in many cases can never have conceived of before.

And it's amazing to me how weight will affect so many different aspects of your life. It makes you feel older and makes you more tired. There's just a number of ways that it affects you, that a lot of patients I don't think are really aware of until the weight's corrected. So that to me is what has always inspired me about this field.

Scott Webb: I'm sure it's so gratifying. You know, when you see a patient, you start that journey with them, the first time you meet them and then you see them six months, a year or years later, and you see that they're perhaps, you know, half the size that they were and probably just a completely different person, right? You've changed their lives. You've changed their bodies. You've changed everything for the good. Of course, as you've mentioned here today, they have to do their part as well, but it really is this team effort. And it really starts when they walk through the doors of Emerson. And Dr. Doyon, I'm going to give the last word to you. What inspires you in the work that you do every day?

Dr. Laura Doyon: There are very few actual cures to chronic medical conditions. So seeing somebody's, you know, high cholesterol or diabetes being reversed is clinically very exciting. But on a human level, I love watching the patients, you know, come from a place where they're not sure of theirselves and they feel ashamed and maybe they feel like they're hiding in their lives to just more fully embracing life and what they really want to do in life. Because I think that for the person who's struggled with weight and has had yo-yo weight loss and then weight gain and feeling like they're a failure on some level because they can't keep the weight off, when the weight finally does come off, that confidence boost, I think lets people do things in their lives That they never would've done before. We see a number of people pursue a career or go back to school or start dating again, things that, you know, as humans, we all want to live our best life. And so to be able to help people achieve that is just so gratifying.

Scott Webb: I'm sure it is. And today's conversation has been really inspiring as I'm sure it has been for listeners as well. So thank you both for telling us about weight loss surgery at Emerson, what makes the program special, telling us really your perspective on patient care and outcomes. Fantastic. Thank you both and you both stay well.

Dr. David Lautz: Thank you.

Dr. Laura Doyon: You too. Thanks so much.

Scott Webb: For more information, visit emersonhospital.org/swl. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple, Google, Spotify, or wherever podcasts can be heard.