10 Things Your Doctor Wishes You Knew
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David asks Dr. Lara a lot of random questions. Has for a while. And somewhere in the middle of enough of those exchanges, an episode idea took shape — because some of what he didn't know, it turned out, a lot of patients don't know either. This list isn't about medical diagnoses or treatment plans. It's about how medicine actually works, what physicians are thinking behind the scenes, and where the gap between patient expectations and clinical reality tends to show up.
Dr. Jana Baatenburg helped build the list. Here's what they came up with.
10. Doctors don't know everything off the top of their heads
This one surprises people more than it should. Medicine is vast. Primary care physicians have to carry working knowledge of cardiology, endocrinology, dermatology, neurology, and every other major system in the body. That's breadth. When you get into rare diagnoses, specific mechanisms of action, or conditions that fall outside the everyday scope of a primary care practice, that's where depth comes in — and depth is what specialists are for.
Dr. Lara puts it simply: knowing that something is abnormal and knowing when to be concerned about it is a different skill than knowing the exact answer. If she's not certain what a skin finding is, she knows whether it needs a dermatologist or whether it can be watched. That judgment is what medical training produces. Looking something up in the moment isn't a failure — it's the job done right.
9. More testing is not always better
The internet has made patients very aware of tests they've never had. Imaging, blood panels, full body scans — people come in with a clear idea of what they think they need, and sometimes they're frustrated when a physician doesn't agree.
The rotator cuff data makes the point well. In a study of elderly patients who had shoulder MRIs, around 90% showed torn rotator cuffs. The vast majority had no symptoms. Finding something on imaging doesn't mean it's causing a problem. What it does mean is that now you know about it — and knowing about something that isn't actually affecting your health can cause significant anxiety.
Dr. Lara had a patient who got an elective full-body MRI. Two incidental findings came back, one on the pancreas and one on the adrenal glands, both almost certainly benign. That woman is now anxious about findings that probably don't matter and wasn't spared anything — she took on a worry she didn't need. More testing is not always better. Sometimes it just creates more uncertainty.
8. Symptoms don't always have a perfect explanation
This is one that social media has made harder to accept. On the internet, someone always has an exact answer. They know the root cause. They know the fix. They're certain.
David brings up the Dunning-Kruger effect here, and it's worth understanding. The pattern goes like this: a little knowledge produces massive confidence. More knowledge reveals how little you actually know. Real expertise — the kind that comes from years of research and clinical experience — produces people who speak in probabilities, not absolutes. The most knowledgeable physicians are often the least confident-sounding because they understand how complex the body actually is.
If someone online is telling you definitively that they have the answer to your symptoms, that certainty itself is a signal worth noticing. Dr. Lara says it plainly: medicine has significant limits, the human body is extraordinarily complex, and not having a clear answer doesn't mean something was missed. It may just mean the answer isn't available yet.
7. Medications are tools — not magic, and not the enemy
There are two camps when it comes to medications, and neither one has it quite right.
The first camp treats medication as the end of a conversation: cholesterol's high, give me a statin, done. The medication helps, but it doesn't address whatever drove the problem. The second camp refuses medication on principle, convinced that lifestyle or supplements can handle everything. Sometimes that's true. Sometimes it means spending years managing a condition that a medication could stabilize while lifestyle changes take hold.
David tells a story from his EMT days — asking patients about their medical history, hearing "no, nothing wrong," and then seeing a drug list that includes blood pressure medication, metformin, and a statin. You do have high blood pressure. You're just on something that keeps it in check. That's not the same as not having it.
The goal is to understand what a medication is doing, why it was prescribed, and what it isn't solving. That's a conversation worth having with your physician — not a conclusion to arrive at before you walk in.
6. Google and AI can help you — or send you in the wrong direction
Dr. Lara doesn't mind when patients Google things or bring in something they read. She's glad they're engaged. What matters is the lens they're using when they look.
Google is a search engine. It finds what you ask for. If you search "why are statins dangerous," it will return a lot of reasons why statins are dangerous — not because that's the complete picture of the evidence, but because that's what you asked. The Dunning-Kruger effect applies to how you search as much as to what you read.
AI works a little differently, but selection bias still operates. The question shapes the answer. If you come into an appointment ready to argue with your physician based on a WebMD page or a TikTok video, that's not going to be a productive visit for either of you. If you come in curious and willing to discuss what you found, that's a different conversation — and a much more useful one.
5. Physicians do not get paid to prescribe medications
It's illegal. They've said it before on this podcast. They'll keep saying it because people keep not believing it.
The math was covered in a previous episode: the total pharmaceutical spend on physician gifts over a ten-year period, divided by the number of physicians who received anything, comes to roughly $51 per week — and most of the time, that's a lunch that the office staff eats. The physician speaking circuit is a separate thing and a legitimate conversation, but it's not the same as being paid per prescription.
David talked about this on his bachelor party weekend. Smart people who have no particular reason to distrust medicine still assume their doctor is getting some kind of kickback. The belief is widespread and persistent. It's also wrong, and it undermines the trust that good medical care requires.
4. The boring stuff is what saves lives
Hormones, longevity protocols, obscure blood markers, biohacking — these get attention. Blood pressure, cholesterol, blood sugar, sleep, and muscle mass are what actually determine most people's long-term health outcomes. The basics don't get clicks. They do keep people out of the hospital.
Dr. Lara had a patient in his early 60s with a blood pressure of 190/110. He refused medication. He refused to treat it. Months later, he had a stroke — one of the worst she'd seen. He is now in a wheelchair, cannot speak, and cannot care for himself. She believes treating that blood pressure would have made a difference.
People will line up for an LP(a) test they've never heard of because it feels like insider knowledge. Blood pressure doesn't feel like that. It's too familiar. But the familiar things are familiar for a reason — they're what the evidence keeps coming back to. Pay attention to them.
3. Chronic conditions have a significant lifestyle component
David says this one gets people defensive, and he understands why. He also says it from a position of direct experience: pre-diabetic at 15, blood pressure requiring medication, 400 pounds by 18. His last A1C was 4.2. No medication reversed that. Losing 200 pounds of body fat did.
Dr. Lara brings up a condition that surprises most men when they learn about it: erectile dysfunction is highly lifestyle-driven. Endothelial dysfunction, nitric oxide availability, cholesterol, physical inactivity, smoking, obesity — they all connect. Men who come in looking for a prescription for Cialis often haven't been told that what they're experiencing is a cardiovascular signal. It's worth investigating, not just treating.
Whatever the condition, the lifestyle component is real. That doesn't mean lifestyle is the only factor, or that people are at fault for being sick. It means that how you live has to be part of the conversation about your health. There's no way around it.
2. Doctors want a partnership, not perfection
People cancel appointments because they didn't follow through on what was discussed at the last one. They come in apologetic, head down, expecting to be lectured. Dr. Lara's response: she would rather have the conversation about what got in the way than not see the patient at all.
A good physician isn't keeping score on whether you did what they said. They're trying to understand what's working and what isn't, and adjust from there. If you feel like your physician is making you feel bad for not being perfect, that's worth paying attention to — but canceling appointments because you're not ready to have that conversation helps no one, least of all you.
Come in anyway. Talk about what happened. That's what the relationship is for.
1. Healthcare is uncertain — more than most people realize
The most fundamental thing on this list. Medicine operates in the gray. Even the clearest-cut interventions — an antibiotic for a known bacterial infection — carry caveats. Resistance exists. Individual variation exists. What worked for someone else, at a different age, with a different genetic makeup, may not be what works for you.
Anyone who tells you with complete certainty that something will fix your problem is probably not the right person to be listening to. Real clinical expertise looks like probability, not certainty. It looks like "this is likely," not "this will definitely." That's not a failure of knowledge — it's an accurate representation of what medicine actually is.
Living in the uncertainty, staying curious, and staying in a relationship with a physician who has enough time to actually know you — that's the closest thing to a reliable answer this field has to offer.
Vitals & Values is the podcast of Concierge Medicine of West Michigan, hosted by Dr. David Roden and Dr. Lara Baatenburg. New episodes available wherever you listen.
