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Scott Benner 0:00
Hello friends, and welcome to episode 994 of the Juicebox Podcast.

Today's guest is a returning podcast guest who is going to help me talk about the way people learn the way our brains take in information and the way it's taught to us by the people who are doing the teaching. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. If you're looking for a Dexcom on the pod, if you want to try us med a contour meter, learn more about touched by type one.org. Maybe in fact, you want to get better help, or save 40% off your order at cozier calm. If you need any of those things, or you just want to drink some ag one, please use my links there in the show notes of your podcast player, and at juicebox podcast.com. And these are the companies who sponsor the show, day in and day out year after year. If you want any of these things, or even interested in learning more, using my link is really helpful. I appreciate your consideration.

The podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapists who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and scheduled live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit, for any reason at all. You can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price. betterhelp.com forward slash juice box that's better help h e l p.com. Forward slash juicebox save 10% On your first month of therapy. All right, we're recording. And I think that even though I've spoken with you twice on the podcast, it would be smart of me to ask you to say your first name for me.

Tziporah 3:02
Sure. My first name is Sephora. Alright, um, already

Scott Benner 3:05
don't worry. You and I are going to talk set 1015 More times my life. And I'm and one day I won't go. Like it's T and then z. And what's the sound of that makes?

Tziporah 3:17
Uh huh. It's like the like the sound of hot oil hitting a pan,

Scott Benner 3:23
Zara Sephora, but then the piece there too. And the I need all the letters.

Tziporah 3:29
Yeah, I mean, it's it's phonetic, if you know how to make the first sound and then the rest of it just sort of unfolds

Scott Benner 3:35
support. Yeah, perfect. Well, I got it. It's like Sephora, but with a T and a Z. I'm on it. Right. Yeah. Alright. So you are, by the way, you've now been on the show once recorded another episode that people haven't heard yet. And you're back because I'm going to embarrass you a little bit. Great. You are a low key one of the smartest people I've ever talked to on the podcast. And I mean, low key because you don't you don't throw it at me. You don't throw it at people when you're talking. But I feel I feel like you're a muscle car that's cruising down the street at like 40 miles an hour. Does that make sense?

Tziporah 4:12
I mean, that is a visual I've never had about myself, but thank you. Well, now it

Scott Benner 4:16
is. So I'm just very interested in picking through something that I don't want people to turn off when they hear us. Like when they hear me say this, don't be like what is this? Nevermind, but just listen for a minute. It's called Bloom's Taxonomy. Is that right? Yeah. Okay. And why are you a good person to speak to about this?

Tziporah 4:39
Well, Bloom's Taxonomy is a way of thinking about learning. And so anybody who's in an education field, whether it's like primary school, education, college, and other kinds, I think has had some exposure to this. But it gives us a framework to think about how people take in new information and use it,

Scott Benner 4:57
okay. And when, when I intersected it I don't know when, for the first time, I thought kind of I kind of flipped backwards in my head, I said, Oh, this is how people are being taught. So like, whereas you would think of it from like a teaching perspective of, oh, we're gonna we'll put these six steps into place. And we'll use these words to try to get people to remember, understand, apply these things, right? What I saw was not manipulated. Don't if that comes out if this comes out this way. I don't mean it that like that. But but this is how people are approached, when they're taught something, they don't realize it's happening, very likely. But they are being approached by educators this way. Does that make sense? Yes. Okay. And I figure if this is a thing, that Blum came up with this in the 40s, I think, and early 50s, okay, and it's been manipulated a tiny bit, I think things have been reordered once, and they changed some wording on some things. But the idea has been around for 75 years, is what I'm gonna say. And it's a pretty good way of teaching people things, it's the way that people learn, kind of mirrored back at them. And anyway, when I, I don't know how I saw it the first time because I am not an educated person. I think we all know better for listening to the podcast. And when I intersected the idea, I thought, Oh, I did this with the protests, and the beginning stuff, and I didn't realize it. And so I thought, I think maybe there's a way here to let people in on it. The people listening to the podcast, you know, so that maybe they can, I don't know, if they understand why it's being taught to them this way, or presented to them this way. Maybe that would help them pick it up better, I guess, was my thinking. How do you use it professionally?

Tziporah 6:50
Well, I'm gonna get out front and say especially because I know there was already some discussion in the private Facebook group about this. There is sort of a counterculture about Bloom's Taxonomy, that it's antiquated that it leaves out some important domains. But I think many of us who are teachers look at it as a way to demonstrate the different domains of learning and understanding and that we probably need to use all of them. I think, probably the biggest criticism, and maybe we'll talk about this is that learning isn't necessarily all in a straight line, and in a certain order. So Bloom's Taxonomy makes it look like these things have to happen in a certain sequence, you have to get a bunch of information and be able to recall it in order to then demonstrate understanding or explain ideas. Whereas I think a lot of us in the real world, sort of enter learning and a lot of different places in this little pyramid that you're probably looking at. And we need all of them. So I just wanted to say that first. Okay.

Scott Benner 7:52
Yeah. And by the way, I'm not here like, ringing some bell. And I was like, you know, whatever Bloom's Taxonomy is, they're not paying me. I just, I just thought it was interesting that it never occurred to me, that there was a way I was being taught that it doesn't mean that I would learn that way. As a matter of fact, I was a terrible student. So maybe this isn't how my brain works at all. And, but I still think the ideas are here, right? Like, if you if you apply them to diabetes, so I guess yes. I mean, how long have you had type one? I've had type one for 42 years as a long time ago. A long time. Yeah, I just interviewed somebody else a 50 years. And it was very interesting to hear his process. But anyway, that's neither here nor there. When you were diagnosed, the world that diabetes was is not any longer. Correct, right. And so there's a moment when you say, I'm going to try this more modern way. And I think what happens is, you have some of this already, right? Like, you've been analyzing things, your whole life with diabetes, you know, you had to remember a ton of stuff that you didn't know before you got type one. Now, you know, after you use it for after you've seen it, and you over and over again, it's happening to you, you begin to understand it, then all of a sudden, you can kind of flip that understanding around and apply it, make some analysts, you know, analyze things, say, Oh, I did this, and then this happened. Maybe next time, I'll change it. I think that's, but you had to teach that to yourself. And yes, and as much as I want to think that people with type one are being taught these things, I don't think they are. So I mean, by some doctors, there's some terrific doctors out there don't get me wrong, but far and away I meet too many people who are told not told anything or you know, given kind of very limited things, tools to start with. So can you go over the it's a pyramid, right, but it's set up in six steps. Can you go over them for me? Absolutely.

Tziporah 9:58
So at the base of the pyramid is the domain, these are all sort of cognitive elements the way we think about things. So that first biggest layer is remembering and recall. So this is pretty basic, like, what is diabetes? What is insulin, it is sort of more like, what you'd be expected to regurgitate on a test that just demonstrates like you've got the idea, but that you just have to recall it or spit it back out, you just have to remember it, define it, maybe.

Scott Benner 10:30
Okay, so that that's the first concept of Bloom's, which is you need, you need to recall facts and basic concepts, be able to define them, you know, I guess there's more to it than that, right? Memorize it, define it, repeat it stated, I have it written down here, I should be looking at it. Okay, so now, once you're comfortable that that's it as a teacher, you move to understand,

Tziporah 10:52
correct or comprehension. So in this way, we might ask people to demonstrate, you know, their understanding of something by saying, Well, how would a low blood sugar lead to the symptoms? Or how would a high blood sugar cause complications? How would I interpret, you know, what my Dexcom is telling me? And, you know, figure out what to do based on what it's what it's saying.

Scott Benner 11:18
So not only am I remembering it, and can I define it, which is very kind of cold and clinical definition, but I can describe it, discuss it. And you can see, as the as the teacher, maybe the doctor, you can see that I have a grasp of it. Yes. And I'm putting it back into my own words and giving him giving it context from the way I understand it.

Tziporah 11:40
Yes, I'm gonna, like insert a thought bubble here to like, I know, I've talked in other podcast recordings about just sort of the relationship between patients and healthcare providers, and how our visits are not always set up to really give us room to say back what we understand or to demonstrate our capability to apply something. I don't think that's the fault of the person sitting in the chair in front of the computer. But, you know, so much of our visit time is spent receiving information as opposed to demonstrating understanding. So it is a cue for me that different kinds of visits with different kinds of people will give us sort of more or better room to do these steps

Scott Benner 12:20
and wonder if you even need to be with a person to demonstrate the understanding. Couldn't it be an online quiz? Yeah, right. Yeah. Okay. So silly putting this into real, again, to real diabetes terms and people's experiences. You're diagnosed, they throw a bunch of words at you. Yeah, this is insulin. These are your syringes. We're going to Bolus we're going to basil, we're going to do this. You know, like, it's all overwhelming. You don't? Yeah, I don't think you really recall any of it. I've described it on the podcast is as it's like, someone walks up to you with a big garden shovel wax in the side of the head and starts asking you math questions. Yeah. And you're like, I don't know what two plus four is like, please, please don't. But then we come back to that next event that next doctor's visit. That is what they're doing, isn't it? This is what's happening. It's just not working? Because they do they start to quiz you a little bit. And they try to get you to recall some things to talk to them. That is what's happening. But the problem is what they send you home, they're not there. There's no one to ask. There's nothing to refer to. And you don't know if what you're doing is right or not. So how do you know if you understand it?

Tziporah 13:36
You mean, aside from listening to the podcast? This is not a

Scott Benner 13:39
Yeah, of course. I mean, listen, we're not here to tell people. I'm a super genius. I'm gonna write. I'm a regular genius. But it's but but no, but the idea of that for most people, they don't have that. They also don't know, this is what's happening to them. And I think that's kind of the bigger problem is that you're still frazzled? Because Because what this chart doesn't take into account when you're talking about illness, is you're not just sitting in a room, like just hearing some facts and going, Oh, I'll remember that. 1492 he sailed the ocean blue, I'll write that down. You know, like, you're not you're not just doing that. You're, you're going through a personal crisis. And yeah, and it could be that your health is in question. It could be that your loved ones health isn't question. That's right. Yeah. It's not some simple thing. That's where it falls short.

Tziporah 14:31
Well, and I think, too, that's why you know, this, we're focusing really on sort of brain stuff as it relates to thinking and information but all of the things that you just described that complicate all of that is all in the feeling domain. It's all in the affective domain that a lot of educators don't integrate like Bloom's Taxonomy originally included that domain, did it? Yeah. Okay. So like our opinions, our fears, our worries, you know, those things influence the way we take in and use information all the time. When I read posts in the Facebook group or I listen to the podcast, so much of people's stories is shaped by all of that. It's not just about the rote memorization, or can I develop a sick day plan, but it's really like, holy crap, I just got hit in the head with a shovel. And now I don't know what to do. Or even if I could figure out what to do, I'm pretty frozen in feeling overwhelmed and terrified right now. And so I think, you know, one of the main criticisms of Bloom's Taxonomy includes that, it it sort of looks at every learner as the same kind of person and doesn't give as much regard for what are all those influences that make us more or less able to take in that information? And to use it in a helpful way?

Scott Benner 15:46
It removes the humanity from it. Yeah, yeah. But if you, but I'm trying to, in Devil's Advocate, if you apply the humanity to it, and you might take the learning out of it, because we might all get stuck on how we feel and never get to the understand, apply, analyze, etc. So that's where the doctors are falling short, then in my estimation, so you know, we blurt the facts out at you, and then we bring you back to see if you understand them, but in between there, that you should be directed to anything therapy, online support, go just blabbered as somebody like, Tom talk, and get out how you feel, and then find some level of comfort or pathway in return. Yeah,

Tziporah 16:31
I mean, I think what's even more challenging, maybe the way I see it is that all of these things are happening in real time. And all of the needs need to be met in the same moment. So you know, many healthcare providers do a nice job of talking about this is really overwhelming, you know, we're here to support you, or they schedule close visits. I mean, I do think people are increasingly aware of that feeling component. And it's one snapshot in time that they get to sit with us and all those other 15 minute segments or hour long segments in our lives between visits feels like forever.

Scott Benner 17:04
Yeah. And the doctors are unaware of what happened to you, they can only assume they must start doing that thing where they apply what's happening to most people to you. True, yeah. And then it gets away from them there. So this whole, so that so the reason I'm doing this with you now is that Jenny and I are busy in the background, putting together a series for physicians. And it'll kind of take this perspective of like, you know, how to, how could doctors be helping people more better, but at the same time, if you're a patient listening to it will put you in the mindset of this is what I should be expecting, like, this is the you know, this is the path someone's leading me on even though I can't see it ahead of me. And just to know that this is their expectations, and what they're trying to accomplish, for me, I think would be a bigger deal.

Tziporah 17:55
I don't know for sure. Yeah. I

Scott Benner 17:57
don't know that it wouldn't be prudent just to say to somebody, Hey, these are the steps we're going to try to take. So that you know, like, we're not going to take them all today. But this is the path we're going on. Because that's right. Yeah, I think that helps. Okay. So

Tziporah 18:12
I mean, even I was just saying, when when I think back to even my diagnosis, you know, which we we've already established within like the dinosaur ages. I think I had like a week long admission in the hospital. Really where my family? I mean, it was the 80s Yeah, and I was a sick kid. So they brought in my family, they did all the teaching, they included all these family members, I had this, you know, the benefit of so much more time than I think a lot of families have now their families on the, on the webpage or on the Facebook group who bypass and admission altogether. Yeah. And so when I think about how all of this has evolved in the last number of decades, not just with the technology, but also with how much time is spent up front to do all of the teaching and assessment and guidance and support. I do think it's really different now than it used to be.

Scott Benner 19:04
Well, you know what, it's gonna morph again, because COVID is going to COVID is going to teach the doctors that a lot of people didn't even come into the hospital, and they were still okay, so it's gonna push it more towards virtual and which, by the way, I don't think, I don't know, I can make an argument either way, Arden saw doctor for a couple of years for diabetes through virtual because of COVID. And it didn't change her care at all. And at the same time, we weren't looking for information.

Tziporah 19:30
Sure, you know, you had enough of what you needed to do some of the other levels.

Scott Benner 19:36
Right. Right. Yeah, it's so where does this fall apart? Is it in the quality to tell people what you do for a living? I'm sorry.

Tziporah 19:45
I teach and train medical providers, health care providers of all kinds, but I'm a family therapist by training. Okay.

Scott Benner 19:52
So is where we're falling apart. Is it the the experience or the quality of the person doing the teaching does that hurt? Like, because we're always training new people? You don't I mean, like, like, the person you see in? I don't I don't know what the numbers are, I'm guessing but a nurse you see in an emergency room, for example, I would think an emergency room nurse has a fairly short lifespan. I bet you that's a really crazy job. And I bet you people don't keep it for the most part for 30 years. So you're probably seeing a lot of new people or people like cycling through. And then in your endos office. Yes. You know, like, listen, Arden goes went to, you know, a quality Children's Hospital for her endocrinology care from two years old to 18 years old. And I can still count on 123, Arden's had five nurse practitioners, five, the end the same doctor, for she had the same, the same doctor for the first, maybe, I don't know, till she was maybe 15. So, you know, the first 1112 1314 years, I don't know that she saw that doctor five times in that time. So my point is, is that if five nurses, nurse practitioners, or CDs or whatever the hell they're calling them now, CDC s, I'm not sure. If that many people cycled through, then that means that those people were coming in knew they were green every time and I could tell they were, you know, so now you're starting over again, every time it's not like you're getting this increased understanding with this whiz and person who's been with you for 15 years. You know,

Tziporah 21:40
I mean, even as you're describing that phenomenon, it occurs to me that we are focused on the person disseminating information, as opposed to the other side of the equation, which is the patient and family on the other side. In my ideal world, there would be some easy way for that person's knowledge capability, you know, evaluative skills to be able to follow them from practitioner to practitioner so that it's not really starting all over depending on the skill and capability and experience of the practitioner. So if I get a new NP, you know, in my ideal world, there will be a way to say, okay, support has already mastered these things. This is sort of where she's focused. Now, she runs into trouble here, and that that person could pick up the ball and run with it. I think we don't really have as much of that in our healthcare system in general, we probably don't have it in education either. But those sorts of ways of putting the patient and family at the center and following the next steps based on what they need, I think is probably where some of it falls down.

Scott Benner 22:40
How do you imagine that working?

Tziporah 22:43
I mean, I, I am naive, for sure. And maybe fantastical. But like, if there was some way even in our health records to be able to have a, not a report card, but a file that says, I have observed this person to be able to do X, Y, and Z, or this is what we have talked about. And here's how it's worked. I mean, some way for the story to sort of be recorded in a way that gives guidance to the next steps, the way that a lot of healthcare people document their notes. You know, they document for lots of different reasons, it doesn't always serve as an effective handoff of this kind of thing. It doesn't always give us good feedback about what is this person's cutting edge in terms of their diabetes learning. And it makes it difficult, I think, for the next educator who picks up that case, to start where the patient is, in the alternative, the next person that picks up that kid, or that grown up, might open the visit by saying, let's just take a look at whether you want to use this taxonomy or something else. Let's take a look at where you think you are, and where you've already been in your diabetes care. And let's focus on what you need next. Right? I mean, that would be revolutionary. They almost

Scott Benner 23:58
like a black belt system that that you don't I mean, like what belt? Are you?

Tziporah 24:02
You are a yellow belt with one stripe? Yeah. Now, I mean, right? Right.

Scott Benner 24:06
And then that way, when, when you got to the new doctor, or the new practitioner came in, started working in your office, they could look at immediately and say, Oh, this is, uh, I understand about their level of proficiency.

Tziporah 24:20
What I think is tricky about it is, you know, something you you alluded to earlier in the discussion. You know, when I got diagnosed, I was on a regimen that looks zero, like what my current regimen looks like. And so with every new technological advance and pharmacological advance, there is something that happens to my expertise and proficiency. Like, it's not that I D skill, but it's like, Oh, I gotta make room for a new way of thinking, to learn about algorithm pumping, made me feel real stupid for a long time because I had been used to my sort of, you know, whatever the five and a quarter and floppy disk way of management, right? And so suddenly I'm like, Whoa, I feel very disoriented. I feel novice again. But now that I've got that I feel much more in control and can do other kinds of skills and applications that I didn't used to be able to do. So the dynamic fluid nature, I think of all the advances is great, and also probably makes us feel dumb lots of the time, right?

Scott Benner 25:26
I wonder what stops that because children don't feel dumb around technology. Right? And it's because they're immersed with it. Although it is interesting that the, the more stupid proof computers and phones get, the less people understand how to actually use them, or how they operate under the surface. I heard Arjun say to me the other day she was, I don't understand things that use Wi Fi. I was like, Okay, that's interesting. She's a bright kid. And, and I, I don't know if I've ever said this on here. I don't I have two children. And they're 23 and 19, at this point. And my son's really like a bright kid and math based in his mind, and great thinker. Art is a pretty deep thinker. And I don't think under penalty of death, either of them could explain what Wi Fi is to. So if we're in that situation, where, yes, I'm more comfortable being a user, but I am not an operator, if that makes, if that makes sense. How do we help people with their diabetes to continue to grow with technology, but give them enough of an understanding of it? That if they had to fix it on their own, or ask the right questions to get to a fix that they could, and that might that might end up being a hurdle? That's something actually Jenny and I've talked about privately that she's concerned about?

Tziporah 26:50
Well, yeah, I mean, I think if somebody doesn't already have number one, like some basic skills and problem solving, and I'm not trying to like combat anybody, but lots of us never got good training and how to systematically solve problems. So if we don't have that, and if we don't understand the components of the bigger, the bigger thing, the bigger concept, the the way a pump works, the way Basal insulin works, the way Bolus is work, then we're not going to be able to do that analysis to be able to kick into gear when something goes in an unexpected way. So is

Scott Benner 27:23
it possible that the thing I've set up with the podcast really is what's necessary, which is you get enough, you get the facts. And then you get to listen, until you understand then you go into your own life and apply it. And then you look back and see what you did you analyze it? And then I don't really see you anymore. Like I probably so we didn't go through this whole thing, right? But it's remember, understand, apply, analyze, evaluate and create. Okay, so let's do the rest of them. So apply, give me apply.

Tziporah 27:57
Okay. So apply is where you would, for example, be able to say, I need to exercise I need to manage my activity level, I need to, you know, add a routine that I don't currently have, I will be able to create a plan that demonstrates an understanding of how it's going to affect my blood sugar, and then adjust my Basal rates accordingly.

Scott Benner 28:24
Okay, and then the next step, analyze, draw connections among ideas. What does that what does that mean?

Tziporah 28:30
So this is I actually think you push a lot of this, which might encourage, for example, somebody to identify patterns. So you would encourage people to be good scientists, and to take note, whether it's for a particular food or looking at Basal testing, to give them the sort of lens is to say, I've noticed this pattern. And because of that, I want to make this adjustment.

Scott Benner 28:54
You again, you're, you're easily 40, like, 40, IQ points smarter than I am. And I appreciate you treating me like a regular person. But do you see it online? Right. When people ask a question, I don't respond with the answer. I ask another question to get them to think about it. Yeah, that's what I'm trying to accomplish there. Like

Tziporah 29:14
what I think is hard about that, I do see that. And what I think is hard about the Facebook group in general is that people are coming to that place in all kinds of sort of stages of readiness and capability to do the next thing. And so if I want to, like stoke somebody's ability to think it through themselves, I'm going to do what you did, which is say, Okay, well, what would you do next? Or what data would you want to look at in order to make this decision? But some people in the moment for all kinds of reasons just need the answer. And it's very hard to gauge in an online community, it's much easier to sort of navigate in a one on one or live

Scott Benner 29:51
Yeah, what it requires online is for the person the question asker to respond again, Yeah, and be honest, like, Hey, I don't have time for that the house is on fire, you know, like, and then I'll go okay, well, I would look at this, this and this. Yes. But I can also tell when they're interested in the back and forth. And also there are some people, and I don't know how it breaks out if it's stress in their life, you know, it, room they've got left in their brain at the end of the day or whatnot. But some people want it, they just want you to tell them, they don't care, right? They, they like that the phone works. I don't care what the Wi Fi is. There are some people who want to understand. And there are some people who are taxed in a way where they'd like to understand, but they just kind of can't. Yep, yeah, that's right. It makes me wonder as whether no matter what it is healthcare, teaching a four year old, middle something, whatever you're trying to do, I wonder how much of it at the end, like evaluate, create, almost the last half of it is not as much about being taught as it is about, like, learning on your own, like being off on your own. Like, I wonder how much of this humanity thing is, we put all the ingredients in for the soup? And we're going to turn the water up, and we'll shut it off, and we just have to trust it's going to work out? Yeah, yeah.

Tziporah 31:09
I mean, so much of living with it is all of those other things, particularly at the levels of analysis and evaluation, but probably also application too. So you can have all the right inputs. But given the sort of dynamic nature of, you know, every day, plus or minus hormones plus or minus illness plus or minus stress plus or minus other health conditions, we have to be sort of nimble on our feet at those other levels, to be able to navigate it. And then if it doesn't go, Well, you know, the skill to be able to say, Okay, I had a sick day. That was a dumpster fire, why did it end up that way, requires a certain level of like, I know, to look back and to analyze it so that I can learn for the next time. And I don't know, if you know, in healthcare encounters that we have, I don't know how often that's sort of a regular feature. But if you were to ask anybody on the Facebook group, or anybody who's been on the podcast, how much of diabetes living has gone exactly the way you expected? I'm sure everybody would be like, zero. Yeah. So these other skills, I think, are really vital. But like, if you don't have that foundational knowledge, you're you can't do it.

Scott Benner 32:19
Wonder where in this process, remember, understand, apply, analyze, evaluate, create aware in that process, whether you're a physician helping somebody with type one diabetes, or you know, you're you've tried to teach somebody to build a structure to keep themselves safe and warm. When do you recognize they're not going to get this? But that doesn't mean they don't deserve to be safe and warm, or have a good blood sugar. Like when do you jump in and say, Okay, this, we've reached your ceiling? And, and maybe we can get you farther in time. And I still believe that that's true. But we don't want to waste health minutes right now. Is it? Is it watching them not be able to analyze? and evaluate is that about where you go? Oh, they're not getting it?

Tziporah 33:08
This is a really delicate question. I think, because there's lots of reasons why we might dismiss or have bias against somebody, we might assume that they can do something, but they really can't, or we might assume that they can't, which is dangerous, too. And so what I would love to see more of is some routine way. And I'm not subscribing to any particular method for health care, people, educators, providers, to be able to like assess with a patient and their family, like, how do you learn best? Will you let me know when you've had too much? Can you let me know when you need help? Like, there are certain things that I think will cue me to better care for you if I know those things upfront. But so much of healthcare in this country is like, this is what we have to offer. And you are one of however many patients I see. And this is how we're going to do it. So I think if we can move toward more personalization of the way we do the care, not necessarily the science or the algorithms or the evidence based protocols. But more like for every person who sits in front of me, let me stack a couple of minutes up front to do that assessment with you. And those are important minutes to invest. It's a hard sell sometimes to very busy people with busy clinics. I know that, but I think it would help us do better.

Scott Benner 34:27
I have to tell you, the more I talk about this and think about it, the more I come to the conclusion that you can get to more personalization by grouping people together.

Tziporah 34:35
Oh, yeah, there's actually quite a bit out there about the benefits of group medical visits. And there are some clinicians who say, this is the way to do it. You do it in community, you do the knowledge dissemination, first, you get all of that out front to a group of 10 or 12 or 15 people and then you can spend the rest of the time on analysis and having them support each other and how they do it. I mean, there's a lot of wisdom to that.

Scott Benner 34:59
I've CNET works so many times. So I'll go speak to a group of people. I don't know who they are, I don't speak to them first, right? I don't know their stories. Sometimes no kidding. 234 500 people in a room. And I'll give them kind of a primer for my thinking about diabetes. In the first hour in a second hour, I'll give them some more kind of drill down on some specific topics. And then I hang around in the afternoon, and I'll just stand up on a stage and like, go ahead, ask questions like, you know, then that's it. And so they see me maybe for three hours in a day, and over the next. It's not the first two months, but over the next like, third, fourth, fifth, sixth month, the amount of like emails for people that are just like, Oh, my God, I just want to say how great everything's going and appreciated seeing you there. And like, you know, thanks for making me think about a different way. There's no follow up. I never see them again, but you've, you've launched them in the right direction. Yeah. And then you kind of trust that the SERPs going to come together. And, and you can't, you know, I know you can't save everybody. That should be your goal. But you're not going to like, sometimes you just won't intersect people at the right moment in their life. But, but I still think that's the best way to get the most people to the finish line.

Tziporah 36:15
I do think that's, it's some of the impact of the podcast, frankly, yeah, you know, the scale of it is reaching a ton of people. And then you're hearing from people to say, hey, this really influenced the way I think about it, or I didn't know this before. And that's been a game changer. You're demonstrating it in the way that you're doing it.

Scott Benner 36:32
I also tried really hard to, like, I don't, I don't need your reviews. You don't I mean, like, I don't need you to come to me, every little thing you think I don't do right or wrong. I use people's feedback. But I do use people's feedback significantly. So but I use it to see where I'm headed. They're almost like my, like a map, like a celestial map. I'm like, okay, like, I sent out all the stars in the world, and I'm seeing where they're going. And I'm like, Okay, this did what I thought it would do, or this didn't work. And I'll like, drop it. I've started things before and been like, that did not go the way I thought like, boom, go get rid of it. And you know, and but when you start seeing people heading again, where you meant for them to go and where they wanted to go. You have to at some point, say to yourself, that works, do more of that. But you also have to be able to say that didn't work, stop, or I'm the wrong messenger, or whatever, you know, because listen, there's, I'm sure there are plenty of people saying things similar to me. But they're not gaining traction, and attract by traction. I mean, like, it's so I don't mean it like this. But it's a measurement, right? Like you have to like if something's working people tell their people about it. So if you've been making a podcast or a web series, or have been recording one minute videos on Instagram for six years, and nobody's it's not growing? Well, then it doesn't. It might not mean it's the information, it could be anything, you have no idea. It could be the color of the wall behind you. People might not like the nasally tone in your voice if there's no way to know, but it's not working. And you. And if you really want to help people, then you have to reassess and say, Okay, I've got good information here. I'm not getting it to them for some reason, and doctors have to do that same thing. Like if you don't I mean,

Tziporah 38:18
yeah, no, absolutely. I think there's a question behind that observation too, which is

Scott Benner 38:27
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Tziporah 39:10
Question behind that observation too, which is, you know, people who are operating at like a really high level are also going to say what about that didn't work? What about that did work. So I'm going to do more of the thing that did work until it doesn't work. And then I'm going to think about why it didn't work here. And so whether that's at the patient level, like we have to do that all the time, but their level two. So why is it that when I do this visit in this way for a newly diagnosed family? Why did it go south with that kind of patient? You know, that level of analysis and curiosity I think helps them be more in line with that personalized approach that I was talking about. But I think they have to know to ask the question, as opposed to saying I'm doing what I always do in the fact that it didn't work. I don't know why

Scott Benner 40:00
Hmm, you also have to be willing as the patient, you really need to be willing to say what's happening, and not absolutely not like keep secrets, or be a person be embarrassed or anything like that. And that's, I mean, again, over and over again, for years now, I've talked to people who have grown up with diabetes, and they get older, and they'll start telling you about, like, you know, my health is not where I want it to be. And I look back and, you know, I was I make up numbers in a logbook every, every time going to the doctor's office. And, to me, that should have been an indication to the doctors, like, if you're a doctor, and it's 1985, and you pick up a logbook, and you think, all these are written in the same bank. Right, this was, this was just

Tziporah 40:43
you talked to my doctor. So rude. This is

Scott Benner 40:47
this is all in the same bank, this was clearly filled out in the parking lot. Instead of saying this person is not compliant, why not say, well, this isn't working for them. I wonder what might like and by the way, you could just ask them, you could just say, hey, look, I feels like you didn't fill this book out accurately, is there a better way we could be doing this? You know, instead of just labeling them writing something in their chart and being like, I did what I was supposed to do, and they didn't do what they were supposed to do. So I guess they get to die? Like, that's a bizarre thing. You don't I mean,

Tziporah 41:18
I mean, just in the defense of current healthcare, I do think more people are moving in that direction. I think the recognition of the person behind the condition is way more prominent now in medical training than it used to be way more. And so you know, when I'm sitting with a physician, or a nurse practitioner, or somebody who's learning, they are much quicker to wonder about what they're missing in that realm than, you know, than the kind of healthcare I experienced when I was six.

Scott Benner 41:45
Yeah. And all you have to do that's terrific. All you have to do to freely wander that is to accept that this is a doable thing for people. I think that's what stops in the past. I do. I do think that's where that thinking came from, like, oh, boy, there's a person who gets it. And over here, we have a person who doesn't get it, or they don't get it. So we put them in a different pile, we put them in the gonna need a leg pile, like you don't I mean, and then you start treating them that way. And then it's, you stop trying to bring them along. And I think that I think the podcast has taught me is that people come along at different speeds. So

Tziporah 42:23
I definitely had that experience as a patient for sure. I mean, there's something very fresh, that's coming to mind now where I think, you know, I fired somebody because they, they didn't see that I needed help coming along, they were just going to put me in another pile. And I'm not trying to sound big and bad that I fired somebody, but it was not a good fit for me, because what I really needed was for someone to recognize, oh, the reason you're having trouble with this is because it's scary, or because you don't have enough information, let me back up a couple steps. Rather than just tell you this is what I do. And if you can't do it, then you've got to go to this other place.

Scott Benner 43:00
Okay. Alright, so I'm sorry. So we recall our facts and basic concepts, we were able to regurgitate these ideas, but not just regurgitate them, actually describe them, discuss them, explain them, then we get to apply. To be able to execute, implement, solve that kind of stuff, analyze, I guess, with diabetes is going to be the part where you start looking at your boluses and your blood sugars and your food and saying, you know, when I ate that my blood sugar went up when I ate that it didn't, you know, that was 10 carbs that was 10 carbs. Maybe there's something about the quality of this food or the way my digestion works with this food or whatever that's causing this issue. Now, after you've analyzed that, I would see my brain goes back to a reapply. But that's not the next step. Right? Like,

Tziporah 43:45
well, it's only not the next step. If you think that this is a linear model, if things have to go in order. I mean, that's part of why people say Oh, I'm not really sure this is a great model, because we're going back and forth between these levels all the time. So you're thought to go okay, well, let me reapply it and try something different. That's 100%. Right. But I think, you know, the way Bloom's Taxonomy was developed with Saona are the next one is for you to evaluate or synthesize information to be able to do sort of the next higher level thing I think real life is that it's much more fluid than

Scott Benner 44:16
I would imagine, you'd bounce back and forth between analyze and apply until you had outcomes you were looking at. And then you can then the evaluation wouldn't be as much about, I guess what this chart initially meant, and more about you being able to look back, step back and look and say, Oh, well, here are the things I did the work so I'll put these in my this works toolbox and I'll take things over that didn't work put this in my didn't work toolbox. Exactly. Yeah, that's perfect. And the Create, to be honest, I don't know if that's really important to diabetes. I'm not sure unless I'm missing something, like produce new original work. I guess. Yeah.

Tziporah 44:55
I mean, when I see parents who say Oh, I created this type one diabetes to sheet for my kids classroom. That is a demonstration of that sort of skill. I don't think we all have to do that to demonstrate that we have aced diabetes. Yeah. Like, I don't think that's the thing.

Scott Benner 45:11
Yeah. For me, once you've evaluated it, and it's working, I would turn that little tip of that, that pyramid, if for diabetes, I turned that into go back and live your life now. Like, you're done. You understand diabetes now? Right? Yeah, and still stay flexible, because things are gonna happen. I mean, that's the, you know, I was gonna say the bitch of it, but I don't feel comfortable cursing with you, even though I know you could because I think of you as an intellectual. But But, but you know that the thing is, it stuffs gonna change, like hormones will come into play, or even if you're older, your hormones might slow down or change, your activity could change, you're never going to be, you're never going to be at that spot where you're just Jay Z sitting on the boat looking out into the challenge. Yeah, that's not gonna happen, right? But you might, you're gonna get moments of it, where you're like, Oh, I got this, or when the wave comes in, you'll just say, I know what to do here. And it won't even become I like that it becomes unconscious at some point

Tziporah 46:12
for nothing, but when you're thinking about, you know, talking with healthcare, people about what some of the most important things are to teach about patients and living with diabetes. It's that, like, we our aim is going to be to have periods of stability, where you're like, I got this, I'm nailing it. I'm Jay Z sitting on the boat, there are going to be times where things feel confusing, unexpected. We're going to teach you how to solve those moments to like, if somebody came to me with that about diabetes management, I would say they get people, they get how hard this is, and they get how many variables are in the mix. This is not it's not linear, the learning is not linear for diabetes, especially.

Scott Benner 46:49
Right. Okay, this was very helpful. I appreciate you very much. Thank you. Yeah. Did I miss anything?

Tziporah 46:59
I don't, I don't think so. Well, maybe. Let me add one other point. The other thing that I think is like woven throughout our conversation today, and it sounds like in the work you're doing with Shani, it doesn't show up in Bloom's Taxonomy, which has to do with the way we're connected to other people, and the influence of those relationships on all of it. So if I'm in an environment or in a relationship, or in a health care clinic, where people are encouraging, they're telling me it's important, and that I matter, and they're invested in me, my motivation is going to be sort of stoked in that direction, too. If I'm in a place where people are dismissive, don't care, think I'm making a big deal out of nothing, don't get it. It's going to do something to my capability to take in new information and to do all these things. So I just, I feel like that's important to say, because I'm a relationship person. But I think healthcare people probably need to understand that too. And so do we, as patients, we have to have people around us who are like, in our corner saying this matters, you matter, you can do it, I believe in you. We're going to help you get there. Okay.

Scott Benner 48:03
Can I keep you for a couple more minutes? Sure. So I have the document open that Jenny and I are banging around in right now. And what I did was I went on to the private Facebook group, and I said, What would you guys wish your doctors would have done or known? Like, I kept it really kind of loose like that. And people came back with all kinds of examples. We broke, I broke the examples down into kind of like headers. And I'm wondering if you wouldn't listen to them and see what I'm missing. Okay. So as the steps, I have diagnosis, and hospitals kind of wanting to I think right away after that, in my opinion, understanding insolence got to be the first step. And I mean, by that, like, how it works, like you put it in here, and it does this, it might not, it might take a little more time, you know, perhaps, if your blood sugar is higher, it won't be enough like that kind of like, like just bare bones understanding of insulin. And then I think, again, you know, three and four with that is, is food, right? The same idea, like it's not just 10 carbs of this and 10 is 10 carbs of that, you know, Cheetos are not going to be as easy to Bolus for as you know, I don't know, something natural. And, and that now from there, to me understanding how to use your meter. And quickly being told what a continuous glucose monitor is, at the very least, if you want to slap it on somebody I um for in case anybody's wondering, but but at least understanding what it is so that when the confusion comes, you can say they did say there was this thing where I'd be able to see this so that you can start imagining what what that would look like and maybe cause you to ask about it. Then talking about pumping and understanding what a pump does so you can understand more about the manipulation of the insulin but then right after that I have humanity and mentality And then communication. And that's sort of where I'm at at the moment. What am I missing? That's glaring?

Tziporah 50:12
When you say communication, what do you have under that subheading, me scroll?

Scott Benner 50:15
A lot of scrolling. Okay, so what I have is some people's responses and like quick notes that I've made under them, I want my doctor to know that I am a whole person, not just the diabetic, this is not my whole life that it ebbs and flows. You already said that, how about that good. And that, under it, I just wrote treat me like a person and moved on. When I was diagnosed in 84, it was so dire, they told me, I'm going to probably go blind, my foots probably gonna fall off, I became jaded very quickly. And I was non compliant the person said, and then to avoid to avoid the pressure of this death, she didn't even go to an endo, she just went to a GP, trying trying to just say, like, Alright, I know, I gotta go and get these prescriptions. But I mean, if I'm just gonna die anyway, like, you know what I mean, like that kind of stuff. And what I wrote under that is that hope is important. And that initial messaging lasts forever. I wish they told me about being bold, that talks about the podcasts a little bit. And then I end my note under that is that goals can relieve stress. I would like my doctor not to be so by the book. And that went on for a little bit to that I said to the doctor, I think you you got to kind of turn yourself into a guru. Like, if you're going to do this for people, you're not just changing tires on cars, like you've got to, you got to know why they love the car. And you got to be part of the part of it not just standing on the outside in a white coat. I put here that honesty is got to be a bedrock of this whole thing. Based on somebody's text that just said, If you don't know something, as the Doctor, please tell me, because I'm sitting over here, imagining that you're, that you're God, you know, and that everything you're saying is, is set in stone. Anyway, it goes on like that. Think before you speak, meet people where they are create agency. This one was interesting about communication. This one talks about a teenager who goes to the doctor, and is told over and over again, you're doing great, you're doing great. You're doing great, but the moms like she's not doing great. grade one, C six and a half, it's good. It's not great. And there are a lot of things I'm seeing at home that she should be doing that she's not and that they're hurting her physically, emotionally. But she goes to the doctor, the doctor gives her the old Hey, 6.581 say you're doing great. And the mom says what happens is we walk outside at anything I tried to say after that is met with I was just told by a professional healthcare person. I'm doing great. So leave me alone. And that that's a problem. Isn't that interesting? Because super Yeah, because it's so reversed of what you might imagine. I wrote here that telling people they can't do something has no value at all. And that guilt is not a communication tool. So that's what I have for that section.

Tziporah 53:30
Okay, those are all great. They could be chapters in your next book for sure. I'll add a few others maybe for consideration, I'm here. One, I would probably call something like labels, or documentation. And the reason I am raising this is because what somebody says to you in the room is one thing, and then what they put in your chart is another thing. So the language around being non adherent, non non compliant, out of control, whatever, those things have some cachet in the healthcare world. And sometimes the way people put that in their notes then becomes part of the narrative that gets shared with other people too. So I would want people to be aware of how what they write about me in the chart, sort of precedes me and describe something about me that may or may not be the whole picture.

Scott Benner 54:24
Okay, so have it. So I have it as labels for documentation, language, like non compliant, etc. Do better charting, because your charting will proceed patients and limit a full understanding of who they are.

Tziporah 54:42
Yeah, I mean, I'm not for nothing, but I, I read the notes. You know, there has been a huge movement at the federal level to make it accessible to us, as patients to be able to see the documentation from these visits. And so when I read something that I'm like, oh, that that doesn't feel great. It is adding is a sort of dimension of complexity to my relationships with my healthcare people, because I see either what they really think, or I see how quickly they're moving, or, you know, lots of things. So this is why

Scott Benner 55:13
I would never look at my wife's texts. Sure, she doesn't like

Tziporah 55:19
me mean, you know, it's good to know your audience there. But the second thing that I was going to say relates to that first thing, which is, this is a relationship. So it's a relationship between the patient and the condition. It's a relationship between the patient and the healthcare provider. And one of the most important ingredients, I think, for any healthy relationship is having clear expectations, knowing what the other person can and can't do, does or doesn't prefer, how they work best what their strengths are. But that goes in both directions. So some of the comments that you talked about already having gotten from the group, echo that, but it's about level setting. So even for someone to say I'm not an expert on pumping, I work with, you know, CDs who are, so I'm not going to focus on this, I'm going to focus on these other things, that is a clear expectation. But so too, would it be for me to say, I just want you to know, this last six months since I've last seen you has been really stressful. And I'm open to what we're going to talk about, but I have not been able to focus on diabetes. So those those are markers of like, how safe do I feel in this relationship to be upfront with you about that?

Scott Benner 56:29
Okay. All right, I got it.

Tziporah 56:33
Sorry, I use a lot of words, but

Scott Benner 56:35
don't know where I broke it down a little bit for myself so I can fall. Okay, relationships, person, the first person that diabetes, clear expectations level setting need to feel safe. Freedom to freedom to express things that, you know, the doctor doesn't want to hear. And my explanation of that is example. I didn't do the thing. I said I was gonna do I

Tziporah 57:13
mean, that's psychological safety. Like, can I can I say something without fear of you? guilting or shaming or yelling at me?

Scott Benner 57:19
Okay, so I'm just gonna put psychological safety. You know, I do this. This week, Ovi diary. And like last week, I didn't lose any weight. And I sat down to do the recording. And I think I just said this last week didn't go great. I made some bad choices. And going to inject the week over and I'll be back in a week. I think the whole recording was like a minute and a half long, and I injected it, I got up and I shut the microphone off. I was like, I was like, that's all I had, honestly, I could have sat there and pontificated and made up reasons why it didn't go the way I thought and I actually have some real thoughts about why it didn't go away, I thought, but that week, I didn't have it in me to share it with anybody. Just like I had some stuff I shouldn't have. I'll see you guys in a week. And by the way, didn't gain any weight. I just didn't lose any weight. So anyway, I see that as like, kind of that psychological safety. For sure. Yeah. Okay. I, you know, I, I'm trying very hard not to give you a job, because there's part of me that wants to record this with Jenny, and then let you listen to them and come on and do 15 minutes on every episode.

Tziporah 58:31
So I mean, you know, I mean, if you want to chew on it, I'm happy to do it. This is like I enjoy this stuff. A bunch. Good. So,

Scott Benner 58:38
yeah, well, you've got everything I need. You got a good microphone, and you're smart. And I love talking to you. Appreciate it. I do too. Yeah, I feel like we're friends who will never meet each other.

Tziporah 58:50
Like if we meet I mean, maybe we would.

Scott Benner 58:52
Well, I mean, like if we met at a dinner party. We we'd be okay off in a corner. Oh, yeah. Yeah, yeah, for sure. I do really enjoy this patient. I thank you so much for doing this. Thank you.

Well, a huge thanks to support her for coming on the show and sharing her insights with us. I also want to thank better help for sponsoring this episode of The Juicebox Podcast and remind you that at my link better help.com forward slash juice box you can save 10% off your first month of therapy. And you'll get that savings just by signing up through that link. Heads Up a little programming note coming episode 999 is coming up quickly. It will be with Arden it'll be her third appearance on the show. And then at episode 1000. We're going to begin delivering the remastered diabetes Pro Tip series. It sounds terrific. Completely remastered audio is amazing. Same great diabetes Pro Tip series. I can explain to you how I'm going to do it but He's going to explain it 999 I'll explain it two different ways. Here's what I think I'm going to do. Episode 1000 probably comes out on a Monday. So we're going to do 1000 1001 with us to win five days in a row, right, you're gonna get five, the first five episodes of The Pro Tip series. And then over that weekend, the rest of the series will be delivered over the weekend. So that way, the episodes will be concurrent in your player for when you want to go back and visit them again. Right now they're spread out all over the place because they were recorded at different times and produced at different times. Now, they'll all be in one place. So they're very findable. I hope you can, excuse me for the way I have to put them out. But, you know, this is the only way that podcast apps let you do this. So in order for me to get them concurrent in your player, I have to put them out in order. But obviously I don't want to take a you know, a month to put them all out. So we're gonna do the first five over the week, and then the rest of them over the weekend. They'll all be in your player if you want them or not, doesn't matter. And then that following Monday, the next episode will go up and the podcast will be back to the way it usually is. So be a little special for a week. Little different. And then right back to it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.