Franziska Haydanek: The way that we quickly lose this misinformation battle is our patient comes in and says, hey, you I read this thing. And then we go, ⁓ I don't trust anything you read online. Anyway, this is what we're going to be doing. And we walk out of the office. You know, that's what leaves the patient going, well, they didn't really listen to me. And you know, the person on Reddit actually did take the time to hear me. So we really have such a responsibility here to welcome this new age that we're in, where everyone is receiving so much information online. And we have to turn towards it. We can't just. be greater than and say, we're not going to engage. Welcome to I Did My Own Research. I'm Dr. Fran, and today I'm joined by Dr. Mahmoud Ibrahim. Dr. Ibrahim is a triple board certified physician in internal medicine. pulmonary disease and critical care medicine. He completed medical school at the Royal College of Surgeons in Ireland, Medical University of Baran, did his internship at Harlem Hospital in New York City, followed by an internal medicine residency training at the UCF HCA GME Consortium in Florida. He then completed fellowship training in pulmonary and critical care medicine at the University of Texas Medical Branch in Galveston. He currently practices as an attending intensivist and pulmonologist with a focus on evidence-based critical care and medical education. Dr. Ibrahim and I are also together on the Docfluencer MDO Medical Board, which is what brought us together. So thank you so much for being here today. you so much for having me. Now, that goes into your medical training and all the very smart and accomplished things that you've done so far. But how did that translate to you wanting to be online? Tell us that part. Yeah, definitely. I think it had been in the back of my head for a while that I wanted to be involved with medical education online. but there was a lot of imposter syndrome and a lot of maybe later, not yet. And then, you know, about a year or so into being an attending, I was working a two week on two week off schedule. And during my off time, I was really just kind of twiddling my thumbs. And I was like, I'm going to go for it and see what happens. And honestly, once I posted my first video, I didn't really know if I was going to share it with people or not. But then my wife saw it and she was like, I'm sharing this with everyone. And then it just picked up from there. I was so terrified and still am to some degree, I think with everything I post, but it was less, it was premeditated in a way, but I just, at some point I just jumped in. Yeah. I mean, you know, the ICU is my least favorite place to be in the entire hospital, right? If an obstetrician, gynecologist is in the ICU, it is not a good day for anyone. And I think a lot of times, at least my ICU doctors tell me the same. They're like, I don't want to see you up here. I'm like, I don't blame you. That's a hundred percent accurate. So, you know, the information about ICU is almost a little, you know, critical care and pulmonology are a little bit of a very specific portion of medicine that I think the majority of us don't understand well, especially those of us who don't practice like internal medicine, family medicine, right? Those of us who went into the more surgical things or like niche parts of medicine, I feel ICU is like this like black hole of like sad and like intense medicine. And bringing that online, I imagine, is a little difficult. For me, the field of OB-GYN touches so many parts of women's lives that they have a general idea of not only what my job is, but also they're looking for information. For you, your content is a little more geared, it seems, like, towards trainees, people who are working in the ICU, people who might be interested in the ICU. Do find that's correct? It is, it is. And I've considered trying to expand my reach a little bit, and I've had people reach out to me and say, should consider... you know, also creating content for the general public. And I'm definitely open to it. I think I just still haven't found the way into that. But yes, initially the thought was, how do I make this scary, intimidating thing less intimidating and less scary? The ICU is scary. There's a lot of noises that I don't understand, right? There's things beeping at me all the time. There's nurses who are fiercely protective of their patients who are like, do not touch that vent. And you're just like, okay. So I think, you know, it's a great resource for the people who are in medicine who don't always... Because you just talk about things that apply to me. You talk about fluid resuscitation, lab values, and like, I tell my residents all the time that I am like, medically dumb. I have like, raccoon hands and I can get babies out and like, that is my job, right? But you guys are so smart and you like, love like, electrolytes and you love to calculate ins and outs and I'm like, I can get a baby out. so inaccurate, you are extremely smart, and you're being very humble right now. And I will just, I will not allow it. No. But I do agree that there is ⁓ probably a big need for people to talk about ICU subjects online when it comes to the lay public. Because when I use social media to talk, when I am interested in something for myself as a patient online, I go to TikTok and look at people's experiences and try to understand things. And I'm sure that there are many patients, or probably not patients, but family members who find themselves in the predicament of having a family member in the ICU, and they just want to hear other people talking about it. What is life support? What does that mean? What is a vent? What is that catheter that's in someone's body? So I think there probably is a big need, and not so much in the way that my content is. It's more like lifelong and like... chronic conditions and like, how do we manage this thing that happens to you every single month versus the medicine that you practice is very acute and for most people, unexpected. Yeah, it's so true, Fran. Honestly, you're inspiring me right now to take the leap and do it, know, honestly, because I've been thinking about it for some time and I probably like most things, I think I just need to try it out and see and learn from it as I go. Obviously, though, you also consume content. And so, do you see... I mean, what you see in real life is you see... people who see content online in one way or another that can like permeate through their health and then they end up in the ICU with you. Do you feel in general though, because your medicine is so acute and unexpected for most patients that that online misinformation is a little less impactful to your day-to-day work when you are taking care of these patients or are family members coming in and being like, I heard... a ventilator is bad for you or ECMO is terrible for you. Like, do you encounter that though, too, that you have patients who have that information from online and come take that to the care in the ICU? Definitely the latter. You know, unfortunately, I think misinformation has really kind of spread its, you know, dark reach into all realms now, you know, and I think people are very scared and they don't have complete trust in what's happening. And so, yes, I have absolutely... I practice in a rural hospital in East Texas, and I've absolutely had people telling me like, ⁓ you don't put them on that ventilator. As soon as they go on it, it's going to kill them. And just a lot of misconceptions, even misconceptions around residual misconceptions from COVID around medications. You know, people refusing like the antiviral or people refusing steroids and, you know, just so much of it is still out there and very, very pervasive, definitely. When did you finish your fellowship? Only less than two years ago. It was June of 2024. Yeah. So you were really coming up through the field of medicine through COVID and really having to experience, I mean, really experience misinformation first line the entire time of your training and trying to get through that. So kind of actually a silly question for me to ask. Like, of course you were impacted, right? Like, COVID is probably the biggest field of misinformation of our lifetime where the online discourse really contributed to a lot of mistrust. and misunderstanding. And I think, you know, the thing with COVID is that the general public was learning what the scientific method is, right? There's this brand new novel virus that none of us have any way to prepare for that took over the planet. None of us have ever encountered that in our lifetime. And people realize, like, science is not perfect. Medicine is not perfect. We're learning every step along the way. But I think people prior to that kind of thought... that we had it all figured out or they weren't so intimately involved with the process of like figuring out how to manage a disease. So of course you were impacted by medical misinformation online. That's a silly question. No, it's not. It's a great question. It's a great question. And I think you're absolutely right. There was like this huge fracture that COVID created that I think we're still seeing the downstream effects of because for the first time ever people realize like, wait, doctors don't have all the answers and they don't know everything and they're still testing things. And then people got interested in how are they testing things and who's saying what. And there was so many different, you know, just people putting out information at the time. And I think we're still dealing with the downstream effect of that. There's so much emotion behind those topics, you know, COVID, mRNA vaccines, vaccines in general. It's a good way to get people really hot and bothered very quickly. And unfortunately, in 2026, we still haven't... It's not getting better. We're seeing it from our government on down and we're still struggling with those things. So I'm sure, you know, I see it too. Like I have patients who are like, I'll only accept a blood transfusion if it's from someone who hasn't had the vaccine. was like, that is not something I can promise you, unfortunately, but also help me understand why. And it's not because some nice ICU doctor was telling them about the, how well the COVID vaccine protects you from COVID. It's because someone online told them something differently. Yeah, and it's so tempting, right? I mean, you you hear the term like mRNA and stuff, and then you're like, what MSG or messenger RNA? It's your DNA. They're changing my DNA. And, you know, just like they say, like fear just spreads so much faster. And this is something I've seen trying to do educational content online is, know, it's all about keeping people's attention in the first three seconds. And it's a lot harder to do that when you're telling the truth than when you're making stuff up. You know, if I tell you everything your doctor says is a lie. Like, I've got you hooked, you know? But if I tell you, like, let me explain to you the nitty gritty of mRNA vaccines like snoozefest, you know? So, it's, we're fighting a battle that, you know, we definitely don't have the upper hand in, especially because a lot of people are profiting from really painting doctors to be like the devil. It's a wild time to be in the medical field. Yeah, I mean, those content creators know how to really work on the emotions of people. We have a mutual hater of our docfluencer group who makes these... She calls herself a naturopath even though she doesn't even have a naturopathic training. Like, it is like she just gave herself a title. And makes these like very emotionally charged videos saying the worst things you could possibly say about a human about us. And the people eat it up and then they come into our comments and are saying... like terrible things to us because this person got them emotionally riled up. And like imagine, imagine the success we could have if we had no like boundaries that way, right? If we could just make up whatever we wanted and like sent people after each other. Like it's just, it's a little wild because you're right. If we could just start videos the way that we know that the hooks work, we would be extremely popular, but we have to kind of be boring and the medicine that we talk about is boring and it's really hard as a content creator to find that balance of... How do I have a nuanced discussion about evidence-based medicine while knowing how the algorithm is gonna reward me for this video? And I think that's something that we're all still trying to figure out. 100%, exactly like you said, you I think the less of a conscience you have and the less of an ethical and moral framework, the easier it is for you to have a broad reach, you know, and that particular person that you mentioned has hundreds of thousands of followers and, you know, claims, makes a lot of claims about us and really downgrades our board certified status, which is something we've all spent... you know, decades of training and rigorous medical education to get. And, you know, I've looked into her credentials and she practices in Canada and she has no certification whatsoever. And she offers some sort of a parasite declense for a fee, you know, so she's selling some unknown untested product and making profit of it and then accusing other people who are actually just trying to spread, you know, accurate information. So I'm not to, you know, fight fire with fire. It's just to point out that, you know, it's so much easier to tear something down than to build it up. Absolutely. And it's so much easier to give yourself a fake title than to actually earn one. And I think that's really important for those people who consume any content online about medicine is like, who's giving you this information, right? If you are someone who is in medicine, who makes content, I really highly encourage you to put your credentials right front and center of your bio because people deserve to know who's talking to them. Anytime I see something online where I'm like, ⁓ that is like a little suspicious. I promise you, it takes me about seven minutes to find their credentials because they hide it. some seventh page of their online blog to say what their degree actually is in. And that is always so suspect to me because if you're hiding what your doctor title is in, or you just call yourself a vague practitioner, then I don't believe anything you say, but unfortunately, many people do just believe you. And because it says doctor or practitioner, it's like nutritionist, those are very vague titles that aren't protected, it doesn't mean anything. It means something to be a triple board certified internal medicine, critical care, and pulmonology doctor. That is, we all know what that means and it's very easy to look up your credentials. Completely agree. Not only is it just kind of heartbreaking to have someone say like, to hear like in the comments, people like joking about how board certified means run the other way or something. And I'm like, do you have any idea, you know, how grueling it is to go through? Do you think they just let anyone, you know, become a practicing physician in America? You know, it's... It's insane to me how you're just kind of trampling down on expertise. And when I try to make the analogy in any other field, it just baffles me. Like imagine a pilot coming in and then someone on the plane just being like, ⁓ you know, I know you're a pilot, but I've, you know, I've done an air simulator and I've actually, I don't trust you. So I'm to go ahead and just hop in the front there and kick you out. Cause I think I can safely land this plane. mean, it's incredibly dangerous and bizarre, but you know, people seem to think there's no consequence with discrediting expertise, and we're seeing it today, you know, the largest measles epidemic in my lifetime in American history. And people want to say like, ⁓ it's nothing to do with the vaccine. It is directly related to the vaccine, you know? Yeah, or the lack of the vaccine. Lack of, you know, and to have people sitting in government hearings and in front of Congress and they can't answer a straight question that this is a safe and effective vaccine, I mean, that is dangerous, you know? So it's just, it's bizarre to me. It's bizarre. Do you find that outside of those examples, that there's any other things that you have noticed in your real life work as a critical care doc that is really almost like having people end up in the ICU? Or do you find like maybe like COVID is kind of like the big one still? Yeah, the biggest thing always to me comes down to vaccines. Because when I think of like the most effective public health campaign, aside from like washing our hands and like, you know, sanitary measures and pasteurization of milk, which are all like, you know... becoming areas of debate. But I think the biggest one is vaccines. know, I mean, especially in the elderly and people with chronic heart and lung conditions, you know, we've seen a lot of really bad influenza and really bad COVID and all these things are still happening, you know, and I think a lot of it comes back to the absence of vaccination and just, know, we always say like an ounce of prevention is a pound of cure. Like when someone comes to me and they've already got severe respiratory failure and, you know, bilateral pneumonia, know, reversing that is a lot harder than preventing it. And the medical interventions are a lot more intense. There's gonna be a lot more medical involvement there rather than the small amount of medical involvement of mRNA. I completely agree. Right? Like, a tube down your throat is a big deal. Having to be, like, prone for, like, days at a time on a vent is, uh, very invasive, and I wouldn't wish that on my worst enemy. So, a small vaccine has seemed so, so, so smart. We have so many smart scientists who have really figured out a way for us to survive, and it seems almost insulting to kind of spit in their face about it, but then come to the hospital when the consequences happen from the lack of vaccinations. Completely agree. So I've always been amazed at the irony of not trusting medical professionals, but then going to a hospital when you're sick. mean, it's just, the irony is incredible there, you know? And I completely agree with what you said. And I think, like you said, people really feed off of the emotion behind it, because... It's easy to say things like, well, why should I get the flu shot? I get the flu shot and I still get the flu. And it's like, yes, you may still get it, but you're going to have less severe consequences. Or yes, you may have symptoms after because you're getting part of the virus itself. There are these little like broken up pieces. If you spread them apart, you can make them how you want. But they do logically connect if you're interested in looking and asking people what the answer is. you know, one of my favorite things about your podcast here, Fran, is that You you say a big part of this is we need to take responsibility for how did we get to this point? it's easy. We really do, you know, and it's true. And that's part of what our presence on social media is now, you know, is why do so many people not fully understand how vaccines work and why you might have certain things and what the consequences are? Like, why is there such a gap in knowledge? And that has to be partly on us. It has to be, you know, so. How do we bridge that gap? Yeah. And I think that's the hard part with like going back to COVID is that we didn't have that knowledge at that time. We too were trying to do the best that we could with the information we had in that time. And then when again, people realize like, you actually don't know. It's like, I told you I didn't know. We were trying to figure it out like that it's hard, but in the greater sense, patients are frustrated with us not always being able to either have the time or the patience or the knowledge really to give like the care that they're desiring. And so then... they go to the people online who are there to validate them, give them a fix that the doctor didn't, really be a support that we aren't. So we definitely have a part in having that window of opportunity for people to like step in and be like, I am here. Everything that you say is true. What you experience is absolutely factual. And I know they said there's no cure, but I have one, but it's in my Lincoln bio and it'll cost you $72. And that's like... They get you all the way there and then they're like, and here, now you can buy this from me, right? And that's hard and it makes you feel a little gross inside. so you just want, I think there's probably nothing that you want more in your career than to have an empty ICU. Like if there was no one in your ICU bed, that would be the best day of your life. If I didn't have to go in the operating room when I'm covering labor and delivery, like that is a great day. That means amazing things were happening for everyone. And like, I'm so thrilled that like, Low intervention things happen for everyone. When people say, we're trying to keep people sick, it's like, that is the opposite of what I want. I don't want you at all. I never want to have to prone someone. I never want to have to do a crash C-section. Like, we do them because we're trying to save you, your baby, whatever, and, we've learned the skills to do so, but it's not because I feel this need to, and I think that's where the internet kind of, like, villainizes people. Because it's like, we want ICU beds full. No, we don't. I want no one here. That's exactly right. If you've heard any of like ICU staff, as soon as they walk into the ship, nobody walks in and sees a full house and goes, woo, like bonus day today. Everyone walks in and goes, ⁓ OK, we're going to have to really pull ourselves together. This is going to be freaking brutal, you know? And I understand the frustration behind the concept of sick culture. You know, and I understand the concept of, you you guys want to keep us sick because you profit off it. I can understand where it's coming from. And The frustration is real, but I think they're pointing at the wrong people. So I think, you know, I agree with you that there is a lot of things that need to change in America and in the world to reduce the preventable diseases that we have, like diabetes and hypertension, obesity. And probably a lot of that starts with not just making ads, you know, showing Mike Tyson biting an apple and saying, eat real food, you know, and shaming people for being obese, you know. It starts with giving people cheap, affordable options. Like even where I live here, for me to look around and find a cheap, healthy meal to have is almost impossible. Everything has like the daily amount of salt in it in every single dish, you know? So I think that's where we should be looking in terms of like, how can we make people less sick in this country? And then even look at like, is America like walkable? Like how easy is it to walk around here? I mean, you know, I'm... I'm from Egypt, you you were just from, like in Europe, like it's designed to walk. Like there's no place like you are supposed to walk, you know? And so those are the things that we should be looking at is how do we, from a system standpoint, make it easier for the average human being who is struggling to pay their bills and do things to be healthy? So the frustration is really real, but I think villainizing us, the people who spent decades in training and then decades paying for their debt. is really not the move here, you know? It also is pushing a lot of people in our fields who are great and talented to leave early because, you know, you don't want to go through all this just to have someone call you, you know, some terrible name at work. That's not fun for anyone. it's really the infrastructure of our country that is keeping our people sick, right? And we're trying to, like, save people as the boat is sinking and, throwing them life jackets. But the reality is I didn't hit the iceberg and I didn't build a shoddy boat, like... I am just trying to keep you alive as the boat is going down. And that's where I think like Maha, their goal is good, right? And like when people are like, you don't want people to be healthy? It's like, no, absolutely. I want that. But what Maha is arguing for is the wrong part of that. What we should be promoting is people taking their vacation time. It's that people should have an appropriate maternity leave. It's that people should have universal healthcare so that they don't get to the point where they end up in the ICU in heart failure. but they couldn't go see their doctor for 30 years and catch those problems, right? We don't have access to whole foods easily that is not covered in terrible pesticides because our government is like taking those environmental protections away. We don't, like you said, have walkable places to live. When I go home, I love that I can just like walk anywhere, go to the bakery, bread that was made fresh that day that isn't even gonna be good tomorrow anymore. that doesn't exist here. And part of that is we live in a huge country. Like, no one is walking across Europe either. But the fact of the matter is, even the cities that we have aren't walkable. And that is detrimental to us. And I have probably walked a thousand steps today because I had to drive everywhere. And that's the life I lead. And those things are in the long term what keeps us sick or just not healthy. But then... the doctors are blamed because we're like, you should get your vaccine so you don't end up in the ICU with pneumonia. And then it's like, you're the reason that people are sick. I'm like, that's not true. It's really not, you know? And then when someone shows up and they have all these downstream effects of their illness and, you know, they have uncontrolled diabetes and their hemoglobin A1c is 13%, then yeah, I mean, at that point, you you need the insulin, you need the GLP-1 and you need the medication. I mean, that's... That's what you need because if you don't, then in a few years, you're gonna be in the ICU with a massive heart attack. So people get mad because they feel fine with all these chronic illnesses that have very vague, nonspecific symptoms and then someone tells them, oh, you're fine, just eat an apple. And it's like, that's really not what that works like. And people don't realize how privileged they are in a lot of the Maha movement. You're talking to people, a lot of them who are living at minimum wage and working 12 hour jobs. getting paid like $10 an hour and have like three kids and don't have health insurance because they can't afford it. Like the privilege to tell someone like that, ⁓ you just need to work out more and eat less. You're being fat and it's your fault is like insane. I mean, it's just it's it's that's not what a responsible person does. You know, you you look at the system. It's like when a mistake happens in a hospital. Do you just blame one person and kick them out and bad apple or do you look at the hospital system? and look at the Swiss cheese model and see how can we as a system make it impossible for this mistake to happen. One takes a lot of effort and one's really easy. So it just depends on what you want to do. I mean, I really appreciate you bringing up the point of privilege because that is a point I continue to make as well with Maha. And even when it comes to like RFK Jr. and Casey Means, then, you know, what they argue for is in so... many ways a privileged way. And the things that like, for example, Dr. Casey Means has talked about has always been from very much a place of privilege. And I don't know if that's because she's never had to work with not privileged populations. but almost all of us who work, especially for a hospital, those are the patients we take care of and we really know our patients struggles. And that's why we get so upset when it comes to people like Casey Means, who are like, well, all you need is like some whole foods and you should just go to the, I mean, she has said like, you should just go to the farmer's market and buy some whole foods and only eat that. I'm like, you know how many people have a farmer's market near that where they can like just go and like, I go to the farmer's market cause I like, like I need something to do with my kids on a Sunday morning, but I have. to me, and though food is expensive, you know, I have to spend a lot of money when I go to the farmer's market more than if I went to the grocery store down the street. And like, I am very privileged and I can do that, but the majority of the people in this country do not have the time, the energy, or the money to do that. And if we're not fixing that part, then we can't fix the thing that they're arguing for. Of course, we want everyone to eat fruits and vegetables, but that's not the reality of like, the very privileged, like, perfect world that we wish we were in. 100 % 100 % it's like there's so many areas that need to be improved in order to help people have access to good food and the opportunity for a healthy lifestyle and exercise. If I only had $10 in my pocket, you know, I wouldn't go to the HEB here or the Whole Foods, you know, I'd probably go to McDonald's because that's what I can get with $10, you know, so it's just insane. It's like people are running on a hamster wheel and breaking their back and then at the same time. someone is standing on a podium telling them that it's their fault. mean, that's just like, how is it their fault? And so, and then when they're frustrated and angry, because their back is breaking on the hamster wheel, then those people on the podium say, hey, by the way, the person who's profiting from you breaking your back is your doctor. You should go yell at them. And we're like, dude, we are not the enemy here. We're really not. And the problem is that they're doing that online, right? So it's not just like people who are watching Casey Means interview thing. This is like when they're scrolling on TikTok, they're seeing the people who are standing in the grocery store, in the cereal aisle, like, these are the things I would never eat. Here are the seven types of peanut butter you should never have. Here are the eggs that are the worst kind for you. And you're like, if someone's gonna eat eggs, let them eat eggs. Yes. I don't care if they're pre-boiled or if they're not the brown organic free range eggs. Someone wants to eat an egg, we're not gonna sit here and demonize them. People do because it's good reviews. It's like people like to watch it and then they're rewarded and they make more of it and it's just dangerous and it's privileged and harmful in the end to people. totally agree. I totally agree. You know, I see these videos of people like standing in the grocery aisle reading like all the chemical names of things and then saying, oh, this is super dangerous. This is what's killing you. This is what's giving you cancer. And it's like, sorry, you want to show me your chemistry degree? Like, what are you like? Who are you? You know, and it's just it's insane. It's insane. I think the recklessness of it. And again, the lack of consciousness of it. Like if I say the word wrong on one of my videos and someone points it out to me, I can't sleep that night and I'm editing it or I'm pulling the video down. But for people to put their head to bed at night and say like, ⁓ I did something good today when they have no qualification, but so much. I mean, we have a name for this, right? This is the Dunning-Kruger effect. It's the Mount Stupid thing, right? It's the idea that when you initially learn like 10 % of something, you're on the top of peaks Mount Stupid and you think you're a genius. But then as you expand and look around you in the field, you realize how much you don't know. And talk to all... I talk to the smartest people around me and no one I know goes around saying, I have all the answers. All of us are like, I need to read more and I need to learn more. But it's always the most confident people, unfortunately, who are the ones who seem to know the least. And I think, you know, when you know how much it takes to be like a board certified physician in your field, you know... how little you know about something else. So you'll never catch me making a video about the ICU other than to say, Fran doesn't like to be in the ICU and Fran leaves the ICU as quickly as possible, right? And I have never once seen you make a video about PAPs in your guidelines. you're like, I would rather not. I wouldn't dare Fran, I wouldn't dare. mean, like everything you said about me, I mean, I have tremendous respect for what you do, for primary care providers too, what neurologists do. I stay in my lane and if I'm going to... Veer outwards, I explain to people the limitations of what I know and don't know. You know, don't, I definitely am not qualified to be out there talking about PafsMir guidelines and the world of OBGYN. I have no, that's not my area, you know? So it's insane. wish more people listened to that and like understood what it takes to be an expert in something. And then being like, you know what? I shouldn't talk about this because I don't know enough about it. Like someone just sent me a video about... chiropractors talking about elective induction. I'm like, why are you talking about this? Why are you making a video about elective inductions? This has nothing to do with you. Please don't. So scary. And then to think that, you know, some, you know, someone who's pregnant out there who's looking for information stumbles across this page and then is convinced because they like the person or they seem knowledgeable or it's just, it's very reckless. And unfortunately, you know, Before I got on social media, did have this feeling of like nothing good can come from social media. And I just was like, I don't want to get involved. But then, you know, I felt like that's a cop out, you know, and you you need to meet people where they are. actually, now that I've been on it for over a year, I feel like a lot of good can come from social media. But it's true. mean, there's so much that we have to work to clarify and correct and hopefully re-earn people's trust again, you know? And I think there is a net positive when it comes to medical content online. I think we are all much more likely to talk about the negative, hence a whole podcast about it, right? But the reality is, that there are so many smart, engaging, funny, or creative, or straightforward, whatever people need, there's someone for you online who's gonna give you the information in a way that is digestible for you. And in the end, that's gonna make people feel... more empowered in their health, they're gonna feel more knowledgeable about what they're going in. Like I love when my patients come in and say, I saw this video about this test. Like, what do you think about that? Or like, have you heard of this medication? Does this apply to me? Cause you know what, like they're engaged in their health, they are seeking out information and then they're coming to me and saying like, does this apply to me? And like, I love that. Like we want informed, engaged patients and we need informing, engaging. doctors and other healthcare professionals to be there to provide that information for them, rather than leaving that window that we talked about for other people to step in. And so I think while it is tumultuous and there, you know, we could talk about it forever and it makes for a great story and makes them for a really great podcast. The reality is, is that I think it's a net positive and we just need to continue to make it more positive than negative. completely agree with you, Fran. You know, I think, you know... The way that we quickly lose this misinformation battle is our patient comes in and says, hey, you know, Dr. Reem, Dr. Fran, you I read this thing. And then we go, ⁓ I don't trust anything you read online. Anyway, this is what we're going to be doing. And we walk out of the office. You know, that's what leaves the patient going, well, they didn't really listen to me. you know, the person on Reddit actually did take the time to hear me. So we really have such a responsibility here to welcome. this new age that we're in where everyone is receiving so much information online and we have to turn towards it. We can't just be, you know, greater than and say, ⁓ we're not going to engage. It doesn't work that way. We really have to say, ⁓ what did you read? And tell me more about that. And what do you want to know about it? And OK, well, based on my knowledge and experience, this is what I think. Like it is a partnership. You know, these days of like paternalistic medicine are very much behind us. It is a shared decision, you know. So but hopefully people can see that. we do have their best interests in mind. know, that's the part I think that creates the most moral injury for us as doctors is, you know, to know at the end of the day, after all this training and stuff, that there are people out there that genuinely believe that we like hurting them and profit somehow off of hurting them is really, really, it's a big stab to the heart. So that's the part that I have to kind of get past from day to day and focus on the positive. Because I know there are so many people out there who really appreciate what we're doing, but it can be tough sometimes. I mean, I don't, I never want to be in the ICU, but if I am, I would be honored to have you as my doctor. You just, I think, I think there's something to be said about our generation of physicians who are taught in a way that is trying to get back to seeing the whole patient, who understand those social detriments of health, who understand reading patients where they're at. I was not trained to make decisions for my patients. It sounds like neither were you. And I think... to have those conversations with our patients will in the end kind of swing back to a place where we can be in a really good working relationship with our patients. So I hope I'm never in an ICU in Texas, but if I am, I hope you're there with me. I would be honored to take care of you. And I would also trust you with my life, you know, and I'm sure my you were birthing a baby. If I was birthing a baby and if my wife was, I'm sure she would trust you too. Yeah. I'm gonna do a little rapid fire with you, okay? Let's do it. I'm down. All right. Which member of our docfluence or MDO panel would you lot operate on you? You. Like I said, if you ever need a C-section, I'm your girl. I trust you. I think you've got it. What is your favorite form of fluid resuscitation? Balanced crystalloids. I'll pretend to know what that means. Okay, sorry. I can clarify if you want, which is usually lactated ringers, we mean by balanced crystalloids. Yeah. Normal saline, I think, is not my default, with certain exceptions. I love that for you. ⁓ What is a health trend online that you think makes other ICU doctors cringe? There's a lot of them. I think I don't like hearing the word inflammation just kind of thrown about. I think when people really simplify inflammation to like, everything that's wrong with you is inflammation and everyone should take anti-inflammatory. It's very like simplistic. And I think, you know... the human body is way more complex than like one of its mechanisms for coping, you know. That's a great one. What is one thing that the general public probably really misunderstands about ICU care? Probably the seriousness of the long-term effects of it. And I think this is something even us as clinicians are still learning. Like you don't, most people don't go into the ICU and walk out exactly the way they walked in, you know. They're a really long-lasting, you know, mental, physical, cognitive, emotional... changes that come with being in an ICU, especially the longer you're in it. What's one thing that people can do in their life to avoid ending up in the ICU? Please get vaccinated. Please get a primary care doctor that you trust and get your labs checked and wash your hands and, you know, be kind and loving and all those things. Eat your vegetables. Eat your vegetables. Don't drink so much. Exactly. ⁓ good things. Don't go climbing on ladders if you're on a blood thinner. ⁓ my God. No smoking too while we're at it since I'm a pulmonologist. Okay, and last, what specialty do you like seeing least in the ICU? I think since we're doing this podcast, Ob-Gyn really does terrify me. Like genuinely, whenever we have an Ob-Gyn patient, want the Ob-Gyn doctor holding my hand the whole time. Yeah, it's really, really... Because you've got two patients and usually quite young and... Yeah. The physiology of pregnancy is quite different than the general other adult. And for us, we always say, like, our patients are really, really healthy until they're not. So they can, like, tolerate a lot, and they look like they're doing fine. And then, like, five minutes later, they are, off the deep end, and it is scary because you think they're okay, and then they're not. 100%. 100 % true. Well, thank you so much for being here. I think this was, such a great insight to the world of the ICU. and the space that you're gonna take up in that when it comes to educating the public. Where can everyone find you online? So, I'm on Instagram, TikTok, threads. My handle is almost always icuboy underscore med-ed, except for Facebook where it's just icuboymed-ed. Perfect. Everyone follow along. Mahmood, thank you so much for being here. Thanks so much for having me, Fran. This was wonderful.