Q&A: New York-Based Endocrinologist Puts Lifestyle Before Medication

Image: shoot4pleasure/Shutterstock.com

Gregory Dodell, MD is an endocrinologist, based in New York. The owner of a private practice firm, Central Park Endocrinology, Dodell is also a board-certified nutrition specialist. He completed his professional training at Mount Sinai St. Luke’s, where he serves as an assistant clinical professor in Endocrinology, Diabetes, and Bone Disease. He is also active on social media, a platform he uses to educate the public on nutrition, health, and medical news.

1. How did you decide to pursue endocrinology?

It started in medical school. I had a very enthusiastic physician-professor in endocrinology. And, in that class, the science part of it just made sense and clicked to me.

Once I got to do my clinical rotations and moved further along in residency, I fell in love with the field, because (1) hormones affect everything in the body, and (2) it was a field [wherein], if you make the right diagnosis, you can help people pretty dramatically and pretty quickly. […] And, not only do you deal with chronic care of patients with diabetes and thyroid, but there is also an acute level of care that goes along with it, whether it’s an acute onset of diabetes, diabetic acidosis, or hyperthyroidism in ICU patients.

So, there’s a nice continuum of care — everything from acute to chronic. I also like the spectrum of treating people all the way from 18 year-olds to people in their 90’s or 100’s. [Additionally], hormones affect multiple systems, and not just one organ. So it’s not focusing on one specific entity, but really the whole body and the whole spectrum, and I love that.

2. In terms of your clinical practice, what are your specific areas of expertise and what types of patients do you tend to focus on?

I do general endocrinology, but around 40% of my practice is diabetes, 30% is thyroid, and the other 30% mostly falls into osteoporosis; and then I also do some pituitary disorders, polycystic ovarian syndrome, and hypogonadism.

3. Can you speak about your interest in nutrition?

I am a board-certified nutrition specialist, as a physician-nutrition specialist. I do have some chronic patients that I see for TPN, which is Total Parenteral Nutrition, so I am very involved in that sort of care. And, there’s not a tremendous amount of endocrinologists in the country that do that, so it’s pretty sub-specialized.

I am interested in overall nutrition because, for the people that I’m seeing — whether it’s diabetes, or osteoporosis, or thyroid disease — nutrition is a fundamental component of every patient-interaction that I have. If someone has diabetes, and I can find a way to help them eat healthier, it’s really gonna help their blood sugar, and I’d rather do that than put them on medication.

And same with osteoporosis. If the patients are not getting enough calcium in their diet, I can hopefully help them that way, rather than putting them on more and more medications.

4. How do you balance nutrition with medication in your practice?

Nutrition is certainly at the forefront of my mind all the time. When I first see a patient, I usually first run through a 24-hour diet recall, and ask them what they had for breakfast, lunch, and dinner, if they had any snacks, if they had any dessert. I run through all of that with them.

Depending on the severity of the disorder or diabetes, I might give it a couple months with making nutritional changes as well as increasing physical activity, and have them follow up with me to see if that does the trick. And if it does, great; then we just keep an eye on it without medication. And if it doesn’t, I add a little bit of medication in addition to lifestyle changes to get to our goal and keep their lifestyle as healthy as possible.

5. At a high level, how has technology affected your job as an endocrinologist over the past several years?

It’s really helps a lot. We do things in the office like continuous glucose-monitoring, which gives patients 24/7 recordings of their glucose or blood sugar levels. Then, when they come into the office a week later, we can upload that data and see exactly what their trends are, and we can adjust medication. Patients can see what specific foods and activity levels are doing to their blood sugar by having real time data, versus before, when they would only check it 3–5 times a day. That’s the best people could do before.

Also, with the advent of electronic medical records, I can be home at 10 at night, and can log onto my medical records, view data, and send patients emails. And, I can do this from anywhere. So, that’s been really helpful. […] Insulin pumps have also helped things a lot, along with new testing for diabetic neuropathy. There’s a lot of stuff out there.

6. What are your opinions on personal fitness/nutrition trackers or apps?

I think they’re great as well. I tell patients a lot — if they apologize for not taking their medications or not following up — I say, ‘Look, this is not about me, it’s about you. I’m just trying to give you the education that I can to keep you as healthy as possible.’

So, if these apps are making patients more personally engaged with their health, to track things like blood sugar, calories, and activity on a day-to-day basis, that’s amazing. That’s what it’s all about.

7. As a social media user and assistant clinical professor, how do you try educate others on issues of nutrition and health, and what is that experience like?

I love it. It’s a way for me to get outside of my physical space of being in an office every day — seeing limited amount of people — and have the ability, through social media, to broadcast facts that people hopefully get something out of. I’ve worked with a lot of different sites, and I think it’s great. It doesn’t take a lot of time, but it’s thousands of people reading these articles, which is many, many more people than we can help sitting in an office. […]

As an assistant clinical professor, it’s very nice to give back to the community. I work with endocrinology fellows. If the fellows in the hospital get new consults or patients, they’ll call me, and we’ll see the patient together and go over everything.

Basically, we use the patient as a tool to help train future endocrinologists. That’s pretty rewarding to do, because I had mentors during my training who did the same thing with me. If you can make some valid teaching points that people can [carry] with them for the rest of their careers, that’s really rewarding.

8. What are the biggest myths or misconceptions that patients have about their nutrition?

I think the problem is in crash dieting or fad diets. Patients come in saying they don’t eat carbs or fats, or they stopped eating dairy. Unless there’s a true allergy, I think dieting in general becomes a temporary thing. You get this yo-yo effect, where you’re switching from one diet to another, and you’re gaining and losing weight.

I think the misconception is that you should be eliminating ‘X’ food because it’s bad for you. My approach is that we should all be eating mostly whole, unprocessed foods, but it’s okay to have carbs, it’s okay to have fats, it’s okay to have protein — everything just has to be in moderation. People think that you have to be really restrictive in how you’re eating to be healthy, and I just don’t think that’s the case.

9. What would you say is the most rewarding part of your job?

I think it’s when you see good outcomes for patients, whether it’s lab values or just how they’re feeling. You know, it’s when a patient comes in saying ‘Wow, I just feel so much better,’ and they’re grateful, and they thank you.

That’s not what we should be looking for, but it certainly feels good to know that you put the time in and you got through to someone. You really made a difference in someone’s life, and that’s definitely rewarding.

10. Do you have any other areas of interest or hobbies in or out of medicine?

I’ve really been into yoga these days, so I’m trying to do more of that. And that’s something that I’ve even been trying to prescribe to patients. We work long hours, we work hard, we see a lot of patients in high volumes; so clinicians really need to take care of themselves.

I’ve found that yoga is a great stress release, and it’s really good physically and emotionally, so I’ve been really into that practice. I have a young daughter as well, so I like to also spend time with my wife and my daughter.

11. What do you think is the biggest problem in healthcare today?

Things are disjointed. It’s great that we have all these electronic medical records, but it’s still an issue if someone goes to a few different hospitals. I still have problems getting the records in those cases. It would be nice if there was a universal cloud-based platform, where I could just log on and get access to any doctor that they saw or any hospital they went to, and see what the lab notes say, what the labs are, what the CT scans show.

The other thing is, as an endocrinologist, a point of fact is that we’re one of the lowest paid specialties. I can spend 30 minutes trying to talk to a patient about nutrition and exercise in preventing diabetes or thyroid disease; but we are reimbursed much less for that preventive care than if someone does a procedure that takes 3 minutes. That doctor may make 5 times what we make in that short timespan. And, I’m not saying that they should make less, but I think that medicine is very much skewed towards procedures, rather than prevention and spending time with patients.

I think that if you can help someone make lifestyle changes that will keep them from having a heart procedure or surgery down the road, that should be valued.

More from Op-Med