 and welcome to the latest edition of Tell Health in Hawaii. I'm Vikram Acharya. I'm your host. I'm very excited to be here today. I'm the Chief Executive Officer of Cloudwell Health, a local healthcare services provider based in Hawaii. We have a great show for you today. June of 2023 is Men's Health Month. What better an opportunity to discuss Men's Health and with a physician, Dr. Neil Chauhan, physician and co-founder of Cloudwell Health in Hawaii. Neil, how you doing today? Great. Yeah. Thank you for having me. Always a pleasure to talk to you and see you, Neil. Let's get right into it. To kick things off, you're a physician. Tell us a little bit about your background, where you're from, what type of medicine that you practice, what got you into the field? Yeah. So I'm Dr. Neil Chauhan. I'm a family physician by training. I actually did my training in the UK and moved to Hawaii about six years ago now. I've been an interesting journey. I did a lot of family medicine, urgent care, and then serendipitously, when I came to the US, I started doing telehealth for the UK and Europe. This was way before the pandemic, and then it was through those experiences, I started getting involved with telehealth here in Hawaii. So it's been a great journey. Excellent. Neil, the subject for today is men's health, and you're a family practice physician. You see thousands of patients on the telehealth platform. Walk us through a little bit about some of the steps men can take to improve their health. We're not always the best when it comes to being communicated about our health needs. We're not always the best when it comes to going to the doctor. What are some easier steps we can all take to improve our health and well-being? Yeah. I mean, that's a great question, and it's very good timing to kind of discuss that. And happy Father's Day to all the fathers out there as well. Same to you. So I mean, there definitely has been this difference in terms of men do not take quite as much of a proactive approach to their health care as women do. And there's multiple reasons for that. One I think is just kind of from a cultural context, the kind of the stoic kind of side of things, kind of just trying to do things yourself, not kind of showing signs of any signs of weakness, all these kind of societal pressures. And we're not the best that kind of maintaining or kind of being proactive with those things. And sadly, often the times that we do start to seek help is more of what we call reactive care. When something happens, that's when we start to kind of pay more attention to it. And medicine is changing in terms of, we've identified, we know that recognizing or capturing things early, trying to do more preventative health helps everyone in the long run, especially men. And there's big examples of that. For example, things like cardiovascular disease, hypertension, high blood pressure. So these things, you don't necessarily feel unwell with them until something bad happens, right? And the scary things being things like a heart attack or a stroke. So by identifying those things early before they cause issues, you know, doing kind of treatments. And sometimes those aren't big aggressive things. It can be lifestyle, right? In terms of diet and exercise and just looking after yourself can make kind of big, big steps in terms of improving your healthcare over your kind of lifespan. You know, one of the areas, and I'm sorry, I don't want to interrupt you. I think one of the areas that it's really important, and especially with the month that it is, is mental health, right? And there's definitely a kind of dichotomy in terms of how women approach mental health and how men do, right? And I think that would be an interesting to kind of talk about. Yeah, let's get into that a little bit because, you know, we all have the physical aspects of being well. Like you mentioned, cardiovascular health, digestive health, etc. But when it comes to mental health, what are some steps that when you look at, for example, how women take care of themselves from a mental health standpoint that men can also try and do? Yeah, and it's definitely, you know, there's a difference. So when there's a difference in terms of how you've managed, right, the kind of the different sexes, but it's also about the access to care. And I think, you know, traditionally, and the data we'll show this is, you know, women will access kind of behavioral health services, you know, help with their mental health much earlier than men do, right? And it kind of goes back to that reactive versus preventative care, right? And I think there's just a lot of pressure on men in terms of, you know, it's definitely been looked at as a kind of stigma topic, right, in terms of men and mental health. And I think we are making progress there in terms of trying to reduce those barriers, you know, trying to get people to access care, understanding the signs, the symptoms, and understanding, you know, it's okay to talk about mental health and everyone should. And it's about kind of having that access to care, right? You know, this day and age, everyone's busy, everyone's got so many things they're juggling, but it's important to take your health as a priority, and not just the physical health side of things like you mentioned, you know, making sure you're, you know, on top of your digestive health, and you're kind of cardiovascular heart health and so on, but also sense checking, are you good mentally, are things going okay? And I think it's a difficult time, you know, we're kind of post pandemic, but there's a lot of pressures out there, right? And finances being one, work the big one, you know, juggling family life and kids and so on. And often, men will kind of take that role of, you know, kind of suffer in silence, right? You know, I don't want to, you know, ask for help, because maybe that looks like I'm showing some weakness, but it's the total opposite, right? You know, I think it's my view on it. And, you know, we've done a lot of work on this. And, you know, we've tried these kind of proactive approaches to break down some of those barriers. It's almost like having a sense check, right? You know, you go into the doctors to get your blood pressure checked every few months. Well, why not have a chat with someone about how you're doing kind of mentally too, right? And sometimes learning the skills to one recognize, you know, when things might be, might be off, but also learning the skills, the kind of tools to kind of help you from a mindfulness standpoint, you know, taking, taking a break, knowing when you need to take a break. Are you looking after yourself? And huge overlap between your kind of mental health as well as your physical health. When you see your patients, and what types of questions do you ask to get the ball rolling around the, around the mental health? Like, obviously, there's the, let's call it the more concrete questions around, you know, here's your blood pressure, or this is your, you know, these are your vitals, but how do you kind of transition over into the mental health during your, during your assessments? Yeah, that's a great question, because I definitely don't think it's one of those where you can use a cookie cutter approach, right, in terms of the same, same questions for every person. And, you know, being totally kind of candid about it, you know, with men, you sometimes have to tread a bit more carefully, kind of just going straight into asking questions about kind of behavioral health or how someone's being, can sometimes be a bit intimidating or overwhelming, right? So, you know, I mean, a good example would be, you know, my practice, I like to make sure everyone's, everyone's having an annual review where we're kind of checking everything's good, kind of from a physical standpoint, but then also just checking in from a behavioral standpoint. And, you know, there's questions that can help kind of identify, you know, how's your sleep? How's your stress levels doing? How are things at home? How are things at work? You know, how much are you drinking? Has that changed? You know, sometimes you get little indicators there that, you know, maybe there is kind of more pressure, right? And often, you'll ask about things like stress levels, you know, on a scale from one to 10, how stressed are you feeling right now? And sometimes, you know, from there, you might learn that someone's, for example, changed jobs recently or they've been promoted and there's pressures kind of from that side of things. Or they might not recognize it themselves in terms of, you know, all these big things that happen, life changes, like a job or moving or a new child, right? And then before you know it, you know, oh yeah, my sleep hasn't been as good as it could be. And I am waking up sometimes in the night and I am a bit more tired, right? You kind of, you kind of get a sense from some of those questions, but it's kind of understanding each patient as an individual and kind of understanding what things they might be receptive to because you don't want to kind of overwhelm someone with these kind of big questions. Now you find, when you make that segue into mental health, most of your male patients are like, you know, maybe they're more closed about answering it initially or that, and then over time, the conversation becomes a little bit more open. Yeah, I think it's just how you approach it. So, you know, I usually kind of tell patients, look, you know, I want to kind of make sure everything's okay, not just from your physical health. And, you know, I'd like to just sense check how are you kind of doing in terms of your stress, you know, in terms of your mood. And I think it's a lot about one, how you phrase things, but also, you know, I like patients to feel connected and that, you know, we want to kind of help them in every way that we can, and to kind of break down those barriers, have ease of communication and access, right? So, one of the great things with, you know, Cloudwell and the telehealth side of things is you have that easy access, right? So, it's not a case of seeing a doctor once a year and being bombarded with all those questions, kind of spacing it out and kind of having time to kind of think through things, have that rapport with your clinic, your doctor, your clinician, and that way you kind of, you get a kind of more easy flow of communication on both sides. Yeah, yeah. Now, when you do these telehealth assessments, you know, Cloudwell does something very unique called a telephysical. Can you walk us through exactly what the telephysical is and how it also ties to mental health? Yeah, so a telephysical is very similar to what you would do if you went into office, right? The difference being you can do it virtually. So, you know, it's more convenient for those of us that are kind of busy and time-strapped and so on. You can kind of have that video consultation almost as like an annual wellness, you know? So, kind of checking in, making sure from a health standpoint, let's separate and so from a physical health standpoint, making sure everything's okay. You know, are there things that do you, for example, screening, a good example would be things like, you know, GI or kind of gut health and do you need a colonoscopy? Are you overdue that? You know, just making sure everything is where it should be in terms of your health maintenance, making sure, you know, things like your medications, if you are on repeat prescriptions, is everything okay? Are we on the right doses? Are there any blood tests that are needed to make sure these are all okay? So, I think it's kind of doing a thorough evaluation in terms of where you are with your health right now. Are there things that need to be reviewed? Are there referrals that need to be made? Are there screening things that are due? So, a good example is kind of comparing it to a car, right? You want to make sure you're having your regular maintenance so you don't have some big issue later, your car doesn't break down. And we know, you know, with the challenges that there are, sometimes getting in to see someone in person, when you feel okay is harder, right? It's a harder thing to invest your time into, whereas if you know you can do it from your phone or in your lunch break, makes it easier. And then, you know, we've done lots of kind of audit cycles and reviews. And what we've noticed is part of that telephysical includes behavioral health screening, kind of just like the things I was telling you about in terms of, you know, sense checking, how are things going? But, you know, sometimes it's a lot for one, you know, for one person in one consultation to do, you know, your physical health maintenance stuff, and then actually checking on your mental health side too. And so, you know, we've decided we want to split those up, right? So someone has an annual wellness, kind of telephysical check for their physical health, and then also one to kind of check on their mental health as well, just to make sure everything's okay. And like I said, you know, there's a lot of stigmas attached to behavioral health, mental health, but, you know, if we can break those down, if we can make it easy to access, and it's more of a chat, you know, it's a friendly chat with your kind of clinician, your provider, to kind of get an idea of how things are going. And sometimes it's great, you know, not necessarily all doom and gloom, it can be, you know, life is great, and, you know, in a great place, and all these exciting things are happening. And that's good for us to know too, right? But on the other side, it's good to kind of, you know, hear if there is something that you could benefit from some help with. You know, I mean, I could talk all day about, you know, I had a patient yesterday, a good example was, you know, he had booked the appointment because he was having trouble sleeping, and he kind of noticed that he wasn't working quite as well productivity-wise at work. And he hadn't quite kind of put the pieces together, right? And just by us taking 20 minutes to talk through things, what's going on, he had a lot of stresses, you know, he'd been promoted at work, but didn't feel very supported. He had a new baby at home. And then I think there was some, you know, health concerns in the family. But there was a big stressors, which, you know, he felt as a guy, he'd totally be able to kind of manage and everything should be fine, right? But it was clearly affecting him, and it was affecting his sleep. And as we got into it, you know, he was staying up at night thinking about these things, and how can he solve them and what's going to happen? And then he wasn't able to sleep. And then it was affecting his daytime work. And so we were really able to kind of, you know, it sounds pretty simple, right, in terms of putting those blocks together, but then kind of coming up with a plan in terms of, okay, like we've got, you know, sleep hygiene, so things that can help you kind of have a good routine when it comes to sleep, you know, having a healthier kind of routine there, you know, do you have a support network around you, people that you can talk to, you know, some resources, and then actually referring to talking therapy. So being able to talk to a therapist, just to help process, to have that kind of access point, and also to learn kind of tools that when he does feel kind of stress or he realizes what's happening, you can kind of, you know, decompress, and, you know, I think that was going to be really helpful for him. Yeah. Yeah, I was going to mention, when you start to find that you're starting to get concerned that someone might actually have, you know, fairly significant mental health issues, what are the next steps from a physician's standpoint that you do for patients when you start to see that, you know, we may have, we may have to, we may have a deeper, some deeper things that need to be resolved here. Yeah, I mean, you know, there's a spectrum, right? So, you know, under, unfortunately, on the kind of, you know, rewiring side of things, you know, someone's feeling so low that they, you know, have the thoughts of ending their life, and all kind of, you know, self-harm thoughts, that's an emergency, right? And we kind of coordinate emergency care and make sure that patient is safe at that, exactly at that point in time and ongoing care. You know, a few steps back from that, it could be someone that, you know, started off as a smaller issue, but has escalated, right? And then they could be suffering from, you know, significance. You've got the behavioral health, you know, therapy side of things, you've got medication, and then there's all the things in between, right? The support network, kind of making sure they're safe. Have they got kind of people around? Are they kind of supported at work? Do they need some time off from work? You know, are there kind of potential risk-taking behaviors, which people don't realize, right? So, sometimes having a few drinks or kind of things like that can escalate. So, it's kind of having that support and that kind of access to make sure you're being sense-checked, right? In terms of, am I doing the right things? And then on the kind of, you know, the milder kind of side of things, you know, sometimes it's not recognizing that this could cause an issue later, right? So, like I mentioned, you know, that example patient, you know, it could be that if it wasn't addressed at that time, things could get worse. So, it's about, you know, identifying those things early and kind of getting the right access to care. So, for him, it was really nice for him to know, okay, he's got access to us whenever he needs it. He's got access to therapy whenever he needs it. And then all these additional resources that we kind of provided that can, he has tools to learn himself as well. And so, yeah, you know, there's so much information and resources out there. I think one of the key things is knowing how to access them and trying to access them early. Right, right. Now, many of your patients you find when you come back to them, you know, and they go to therapy, they speak to a therapist, they come back and say, wow, especially men, like this is much easier than I thought and I really enjoy it. What's the feedback you get? Yeah, you know, it's really interesting. When you first mention it, a lot of the times it's like, oh, I don't know about that, not sure. I don't know if I want to talk about my feelings with someone, right? The typical things you'd expect, but you know, try and encourage them. Say, like, you're not bound to do this, you don't have to, but it's worth it. Try it out and see. And actually vast, vast majority, they find it really helpful, right? I think it's the ability to have someone that you can talk through these things with that can help possess it and can help learn tools, techniques that can help you into the future as well. So not just for that particular moment, so it's that preventative piece. And what's really nice is, you know, you see it, that so, you know, patients will quite often have that regularly, right? Once every few weeks, once a month, but they now have that kind of access of care and something new that they know can really help them out. Yeah, no, definitely. And the opportunity I would feel, Telehealth is one of those unique assets where you can get therapy when you want it and when you need it. So for many of us, we're very busy in which you raise a good point. If during the day, your work schedule does not allow you to receive those critical services, you can log in at 7pm, 8pm in the evening, and speak to a therapist. And that can be very beneficial, I would think, because then you're hopefully a little bit more decompressed from work, you have a little bit more dedicated time to talk to a therapist and really make the most of it, I would think. Exactly. I mean, I think that's been a potential issue in the past, which is, you know, let's say you've taken those steps and sometimes the hardest steps are the first in terms of I need some help, I want to access that, right? And so you get over that hump and then to be told, oh, you've got to wait a few weeks and you've got to go to this place in person. There's just barriers there, right? And then if you've got a busy life and all these things you're juggling, it isn't conducive to kind of getting the help that you need at the time that you need it, right? And that time passes, things kind of got worse. So by having kind of access, you know, literally the kind of touch of your phone, it gives you that kind of option to get it exactly when you want it and kind of that luxury of choosing the time. So you make a good point, you know, might not be the thing you want to do in the middle of a busy workday, right? Or kind of taking time off from work, but, you know, being able to, you know, think it through, have that kind of appointment in the evening when you are a bit more decompressed and relaxed, it's conducive, right? It helped. Yeah. Yeah. Now, are you finding, you know, we've, there's been a lot of information that's being put out there now that many people have not seen a physician, you know, at least a couple of years because of the impacts of the pandemic. As people are trying to return to a normal life, are you finding that men are increasingly under higher levels of stress going back to work, newer challenges maybe that they're facing that they didn't face before from a mental health standpoint as we try and get back to the new norm, so to speak? Definitely. I mean, there's definitely kind of new levels of stress that, you know, the world's changed in so many ways. And I think, you know, there was a lot of kind of changes that happened around work. There was a lot of kind of financial pressures, which I think we're all feeling the ripple effects of. And, you know, I think that whole change from working virtually for a lot of us, to then kind of going back into the office and the adjustment that that kind of required, I think that's kind of potential stress on people too. So yeah, I think it's a good time to be able to do that preventative approach to behavioral health, kind of to sense check, kind of checking, you know, self-regulate in terms of, you know, how are you doing in terms of your stress? Do you have kind of people that you can talk to? How has my work, for example, kind of changed, you know, my kind of outlook on things? Yeah. Yeah, I was going to ask, what are some of the, you know, if we're not seeing a physician on a regular basis, or we don't sign up for a telephysical, for example, what are some questions men can ask themselves periodically from time to time really self-check stress levels and the need for mental health support? What can we do? Yeah, it's a good question. And, you know, I think there's overlap in terms of, you know, the things, the signs or symptoms that both men and women can suffer with, right? But then there are some kind of differences in terms of some of the behaviors and things that as a man you might notice. So sleep is a big one, right? So things like difficulty falling asleep or waking up, right? If you kind of notice you're sleeping more than usual as well. Interesting. I think sometimes you can sleep a lot less in terms of the hours. Sometimes you can sleep more. And it's things like the fatigue. So, you know, even if things are okay from a sleep standpoint, are you just always more tired than you used to be? I mean, there's clearly lots of physical things that can cause that, but it can be your mental health too, right? So definitely kind of looking at that whole kind of global picture of kind of sleep and your energy levels. And it can be like behavior, you know, are you more irritable than kind of normal? Are you kind of noticing yourself snap or kind of have less patience than you used to, right? Then it can be things like risk-taking behavior. So are you doing, and sometimes it can be subtle, right? So it can be things like, oh, am I drinking more? Is there any illicit substance use? Am I speeding? Am I doing things that I wouldn't normally do? And what's the reason for that? Then it can be things like, you know, finding, trying to find comfort. So overeating, right? Some people will see a drop in their exercise and just their kind of lifestyle. That's if they previously were exercising three, four times a week. And then, you know, there's this little drop and it kind of can kind of get worse and worse, right? In terms of if you go back, you look past and you're like, oh, I'm not exercising at all anymore. And there's nothing else that's really changed. I just don't feel motivated to, right? And then the motivation thing. So, you know, that drive that people have to get all these things done. In fact, you notice that starting to kind of go down Dr. Chauhan, I can't thank you enough for your time today. The information you've provided around the steps that men can take to improve their health, specifically around mental health, which we don't talk about very often, is invaluable. There's a lot of resources out there that we can all use to make sure that we're not only sound from a physical standpoint and asking ourselves the right questions, but also equally important asking ourselves the right questions from a mental health standpoint as well. And for that, I thank you very much. Very grateful for your time and your insight. Mahalo.