Ethics, equity, and relational care in obesity medicine with Dr. Jerry Maniate

00:00:00:00 – 00:00:16:02

Dr. Jerry Maniate

You can simplistically label things and be horribly inaccurate because you’ve eliminated the person out of that story. Health has always been about a relational space.

 

00:00:16:04 – 00:00:49:07

Dr. Roshan Abraham

Hello, and welcome to the Scale Up Your Practice podcast, brought to you by Obesity Canada. I’m Doctor Roshan Abraham, family physician and associate professor at the University of Alberta. The science of obesity care is changing fast with new evidence, new frameworks and new treatment options emerging every year. But in real world practice, change is rarely that simple. So what does it take to keep patient care ethical, equitable, and genuinely patient centered when the system around us has not fully caught up?

 

00:00:49:09 – 00:01:18:00

Dr. Roshan Abraham

Maintaining professional standards is more than just reading the latest studies. It’s about actively dismantling the biases built into our clinics, and being open and humble enough to unlearn what we thought we knew. Before we dive into today’s conversation, this episode is supported by an unrestricted educational grant from Eli Lilly Canada. Today, we want to help you master the skills needed to apply best practices, navigate ethical challenges, and act on feedback in an evolving field.

 

00:01:18:02 – 00:01:32:21

Dr. Roshan Abraham

Our guest today is Dr. Jerry Maniate. Doctor Maniate is a clinician educator at the Ottawa Hospital and associate professor at the University of Ottawa, and the founding director of the Equity and Health Systems Lab. Welcome, Dr. Maniate. It is a pleasure to have you here.

 

00:01:32:22 – 00:01:36:16

Dr. Jerry Maniate

Thank you very much, Roshan. It’s great to be here. 

 

00:01:36:18 – 00:01:46:14

Dr. Roshan Abraham

So I wanted us to get started a little bit on why the topics of ethics and health equity matter right now for clinicians caring for patients living with obesity in Canada.

 

00:01:46:19 – 00:02:14:00

Dr. Jerry Maniate

I think the fundamental underpinning that we consistently keep hearing, not just in the conversation about patients living with obesity, but patients in general, is that there’s a lack of trust in our system. In the people that work in that system, who are there supposedly to care for individuals, there’s been a breakdown. There’s mistrust and distrust.

 

00:02:14:02 – 00:02:28:19

Dr. Jerry Maniate

And oftentimes, language is at the core of why that mistrust has built up and why distrust exists. And so we see this continuously weaving itself through the conversation.

 

00:02:28:23 – 00:02:52:05

Dr. Roshan Abraham

We want to delve a little bit more into your work at the Equity and Health Systems Lab. As the EDIA lead for the Team Primary Care project, you focus heavily on addressing systemic inequalities. With so much change in obesity science, why is it important to start with an ethical, equity driven approach before discussing or prescribing a treatment or even mapping out a care plan?

 

00:02:52:06 – 00:03:17:12

Dr. Jerry Maniate

I think it really fundamentally comes down to a real understanding of what is that role that a physician has, or a clinician has, in that moment, that the patient is actually engaging you. And so when you come into that room and the patient is there, what biases or what stereotypes might you’ve come in with?

 

00:03:17:14 – 00:03:55:03

Dr. Jerry Maniate

Are they related to your preexisting learning that maybe you had formerly or informally through your professional education process or through your own lived experiences and stories, that now it is coming out in how you’re providing care and an experience for the individual that’s in front of you at that moment. In that moment, the question has to be for that health professional, am I dated in that sense?

 

00:03:55:08 – 00:04:24:23

Dr. Jerry Maniate

Am I holding on to historical understandings or ways of thinking, or have I come into the current age of where the understanding is? When I speak to my colleagues, there is that tension because, while they will really want to focus on the science elements, right? “What is the latest management?” They haven’t thought about how they communicate.

 

00:04:25:01 – 00:04:56:06

Dr. Jerry Maniate

They haven’t thought about how they’re going to collaborate with colleagues. Their knowledge might be sound from a science perspective, but because they’re coming with preexisting prejudices or biases, the patient that is in front of them may not maximally benefit from the care because, as we know, it’s not just about medication. It is a much more holistic approach that one has to take.

 

00:04:56:08 – 00:05:18:18

Dr. Jerry Maniate

And creating a space where the individual, that patient, feels that they can trust you to unearth and speak up about some of the challenges and issues that they’re facing, is rather critical to helping them with those non-pharmacologic approaches as well.

 

00:05:18:20 – 00:05:47:01

Dr. Roshan Abraham

I think that perfectly sets the stage for what we’re going to be delving into next. That is absolutely a reason why we need more of an ethically, equity driven approach. Even before we enter into the room. So let’s discuss some of those systemic barriers that potentially introduce some of these biases. We know obesity is a chronic disease, and clinicians want to do the best for their patients,

 

00:05:47:03 – 00:05:58:11

Dr. Roshan Abraham

but the system often makes that hard, especially when access and affordability become the patient’s burden. How do you think about ethical care when barriers are built into the system?

 

00:05:58:13 – 00:06:33:09

Dr. Jerry Maniate

Roshan, and that is really the nub of the problem, right? And simplistically, a lot of health professionals simply view the health system as the health care system only. And yet we fail to appreciate the complexity that the World Health Organization gives us when it defines the health system as all those components that actually determine whether or not the person is going to have health, right?

 

00:06:33:11 – 00:06:56:04

Dr. Jerry Maniate

And so, yes, that acute care medicine space that I work in, that is one place. And you work in a primary care space. Those are two components. But is that it? No. We have to think about education. We have to think about access to clean drinking water. We need to think about how we need to think about food insecurity.

 

00:06:56:06 – 00:07:27:13

Dr. Jerry Maniate

These are real problems that impact and create barriers to the care that patients may want and desire that they can’t get. So, practical example: I still remember pre-medical school, one of the jobs that I had, I was very fortunate to work with the Canadian Red Cross, and I had the opportunity to go up north, in northern Manitoba, and do both safety education training in the school settings.

 

00:07:27:15 – 00:07:52:23

Dr. Jerry Maniate

What that experience did for me was a couple things. One was it forced me out of the city of Winnipeg, which was an amazing experience as a university student. But I went into First Nation communities, and I actually saw the housing, or the lack of housing or the inadequate housing that many families were struggling in. I saw the schools.

 

00:07:53:00 – 00:08:17:14

Dr. Jerry Maniate

There were schools, but they weren’t resourced the same way that I saw back in the urban settings. And practically speaking, when we needed to go get food, you know, we went to the local grocery store, and it was interesting what you would see in the local grocery store. Right? So, you know, that that four liter jug of milk, you know, was a certain price.

 

00:08:17:16 – 00:08:43:22

Dr. Jerry Maniate

And you looked at the two liter of Coca-Cola and it was a certain price. It was interesting because I was mentally doing the math that was like, well, this Coke costs the same here as it does in the city of Winnipeg, but this milk is triple the price. Right? So even if you were a mother who wanted to do the best for your kids, the dollars only go so far.

 

00:08:44:03 – 00:09:07:10

Dr. Jerry Maniate

And so you make tough decisions in that kind of space. Right? And so that’s just an example of how, you know, you see food insecurity playing an impact in the cost of food. And even within cities like, I live in the city of Ottawa. We have food deserts. It’s hard to believe. But what does that mean?

 

00:09:07:11 – 00:09:29:09

Dr. Jerry Maniate

It means that you don’t actually have access to groceries within a walking kind of space, or distance. That will impact, and significantly impact, the health of individuals because they may want to make those decisions that they have significant barriers that they’re facing.

 

00:09:29:11 – 00:09:53:09

Dr. Roshan Abraham

And I’m glad we’re highlighting these systemic barriers. Because those are areas for me personally, both in the education work that I do and as well as a clinician, that are front and center. When we talk about ethical care especially in obesity, and I know you’ve had a chance to work with some of some of our colleagues in Obesity Canada around this,

 

00:09:53:11 – 00:10:01:06

Dr. Roshan Abraham

What are some, some of those conversations that can come up, and how do we start thinking about ethical care, when these barriers are again built into the system?

 

00:10:01:11 – 00:10:33:16

Dr. Jerry Maniate

I think one of the things that we heard as we were working alongside colleagues at Obesity Canada, which for me has been an eye opening experience. This has helped me see things from a very different perspective. Especially engaging directly with those with lived experiences has been extremely powerful. And so as you were saying that you have these barriers, but one of the things that kept coming back to me was, was the choice of the language that we use, right?

 

00:10:33:22 – 00:11:08:22

Dr. Jerry Maniate

Can determine whether or not the individual will begin to trust me as a health professional. It could be very harmful for me to just sort of say, you know, “Just eat less, exercise more,” when the reality is it’s so much more complex. I’ve reduced this challenge to a simplistic answer. We know these are complex situations that require both pharmacologic and non-pharmacologic, and social supports and networks, to actually allow the individual to be successful.

 

00:11:09:00 – 00:11:34:06

Dr. Jerry Maniate

Right? And so reframing that conversation in terms of, you know, saying “It’s important for me to determine what are some of the things that are in your control or not in your control. How can I help? How can we help as a system, to help you walk through those spaces?” And helping people realize that we’re here,

 

00:11:34:07 – 00:11:42:09

Dr. Jerry Maniate

we’re here for the long term and not providing just a prescription. It’s about journeying together in this space.

 

00:11:42:11 – 00:12:11:18

Dr. Roshan Abraham

You’ve highlighted some really important systemic gaps that we’ve seen in obesity care and in chronic disease management in general. And the stigma really thrives in these gaps. We often see, and this is a point of discussion for me with both junior and senior learners alike, professionalism used historically to maintain that status quo. Which in the case of obesity, has unfortunately included widespread weight bias and diagnostic overshadowing.

 

00:12:11:20 – 00:12:20:18

Dr. Roshan Abraham

How does systemic weight bias undermine our ethical standards? And how can clinicians start again, start to dismantle it in their practice? Because it’s not easy.

 

00:12:20:19 – 00:12:57:11

Dr. Jerry Maniate

So when you start unpacking that, right, the language that we have, can give all those that are within earshot a real sense of where you’re coming from. If I come into the conversation acknowledging the person as a person who has lived experience who’s dealing with a challenge as opposed to, you know, “The person in bed #4” or “Room 29 bed #1”, or you know, “49-year-old with obesity.”

 

00:12:57:12 – 00:13:33:19

Dr. Jerry Maniate

Like you can simplistically label things and be horribly inaccurate because you’ve eliminated the person out of that story. Getting to understand who the individual is, it allows for a rebuilding of trust. And that happens when the words you speak are followed up by the actions. And as a health professional, I happen to be standing there or sitting there in that conversation, I’m symbolically representing the entire health system in that space.

 

00:13:33:21 – 00:14:00:16

Dr. Jerry Maniate

And so how I conduct myself will determine whether or not the next conversation will be one where there’s maybe a bit more hope and a bit more trust. And I’d love to be part of a team in which people know us as people who care, people who want to journey with patients and people who want to look at the holistic person.

 

00:14:00:18 – 00:14:31:08

Dr. Roshan Abraham

And I, we’re going to get to some of the challenges of how we communicate with colleagues, both junior and senior colleagues alike. But I did want to spend a little bit more time on that ethical practice, right? Our CMA Code of ethics defines the ethical practice of medicine as a process of active inquiry, reflection and decision making, right, with virtues exemplified such as compassion, honesty, humility.

 

00:14:31:10 – 00:15:08:19

Dr. Roshan Abraham

But really, things that speak to me around obesity is the commitment to justice, commitment to the well-being of the patient. These are things that are embedded into our ethical code as physicians, and we can really see how those systemic weight biases can preclude us from factoring in a lot of the care that that would usually be provided to other patients who are dealing with a chronic disease, but that we don’t necessarily see with obesity as a result of of weight bias and stigma, especially at a systemic level.

 

00:15:08:21 – 00:15:31:16

Dr. Roshan Abraham

And so I think it’s imperative that we reflect and we consider the patient in front of us as that holistic person. And I’m wondering what the work that you’ve done, either with Obesity Canada or with other groups, have really highlighted the, I guess, the importance of something that is more structured when it comes to equity in ethics.

 

00:15:31:18 – 00:15:57:00

Dr. Jerry Maniate

I think I would have to look back on the approach that I personally have tried to take in my practice, Roshan, and I have also tried to instill into the work that we do at the Equity and Health Systems Lab. I see us as a lab that’s, not, theory-based, or focused, but rather values driven.

 

00:15:57:02 – 00:16:28:11

Dr. Jerry Maniate

And those values that underpin, I found, have allowed me to unlock conversations with any individual. Now, it doesn’t mean that those conversations are easy, but it’s allowed me to start those conversations. And so I walk into those conversations with a value of gratitude. To start off with, right? As I say, you know, I’m here, I’ve had this opportunity to practice, in this space.

 

00:16:28:11 – 00:16:48:05

Dr. Jerry Maniate

I get to be part of people’s journey, right? They are coming to us usually when they’re at their worst and how they feel on how they are going. I don’t know all the answers. There’s no way I can. I can strive to know as much as I can or find ways to get the answers, but I cannot know all the answers.

 

00:16:48:05 – 00:17:21:07

Dr. Jerry Maniate

So having that ability to engage the patient with that approach of humility is critical. That leads me to the curiosity questions, right? I wonder why or how is this, or how is this experience going for you? To allow me to ask those open-ended questions, to create space for the individual to respond back, to allow me to listen and reflect on what they are providing to me.

 

00:17:21:09 – 00:17:52:15

Dr. Jerry Maniate

You know, not “what’s the matter with you?”, but “what matters to you?” can give you completely different conversations, right? And it allows you to unlock what is the goal for this individual? Right? For some of us, as we work with patients who are struggling with weight, we may think, oh, it’s about weight loss or losing weight, but for some patients it might be I just want to get to my daughter’s wedding.

 

00:17:52:17 – 00:18:26:17

Dr. Jerry Maniate

And that’s a goal that’s articulated very differently. And if we don’t ask the right questions we will fail to appreciate the humanity of the person. And so going through these kinds of questions, these values and then going through this process of unlearning. Because, I tell my learners all this quite frequently, if I practice what I practiced when I graduated out of medical school, that would be malpractice at this point. Because a lot has changed by just the science and our understanding.

 

00:18:26:19 – 00:18:52:14

Dr. Jerry Maniate

But I would also posit a lot of the, quote, soft skills that we often talk about. And I put air quotes around that because we often denigrate these skills. These are the hardest skills because they’re human skills. These are interpersonal skills. We don’t do a great job of teaching them in, in, in undergraduate pre-licensure training. We don’t do a great job teaching it in post-licensure.

 

00:18:52:14 – 00:19:27:09

Dr. Jerry Maniate

We certainly don’t do a great job of it in continuing professional development. And yet these are the very skills that are critical to these types of conversations. You can know all you want about GLP-1s and all these other new drugs and opportunities that are going to come out and be able to explain how they work. But if you don’t care, if you can’t demonstrate authentically the compassion, it all falls to the side and really doesn’t have the same impact.

 

00:19:27:11 – 00:19:55:09

Dr. Jerry Maniate

And so having those values we have found, not just with conversations about obesity and weight stigma, but other isms and phobias, has been actually the way to unlock those conversations. You’re creating a space, a vulnerability as a health professional, which is weird because most times we want to be the heroic person with the cape, right, and have the answers.

 

00:19:55:09 – 00:20:22:20

Dr. Jerry Maniate

You know, the Sherlock Holmes kind of character as well, right? We want to have all these personas that place us on a pedestal. But the reality is we are in a journey of facilitation, of encouraging, of trying to help provide the skills and opportunities and expertise so that people can make decisions that are really, truly informed.

 

00:20:22:22 – 00:20:46:13

Dr. Roshan Abraham

I think we could spend days talking about how the intrinsic roles of our CANMed’s competency system, falls behind in priority to the medical expert and it’s not just our health care system in our education system that prioritizes that, it’s our society in general that seems to define that, that those values are a bit more important.

 

00:20:46:13 – 00:21:10:03

Dr. Roshan Abraham

And I do mean that when I say values and your statement about really appreciating what those values are for our patients, what those values are for us, can really set the stage for that framework, that ethical framework that we want to use. It’s embedded already, although values we don’t talk a whole lot about in the CMA Code of Ethics, we talk about humility,

 

00:21:10:05 – 00:21:32:18

Dr. Roshan Abraham

But, sort of those shared values as humans, I think it’s something that we owe it to our patients to have more conversations about that. So I do really appreciate that. In a busy clinic, and I run into this probably once a week, how does a physician practically solicit and apply feedback from colleagues, and from patients, to ensure their practice evolves alongside the science?

 

00:21:32:18 – 00:21:48:18

Dr. Roshan Abraham

And I think this is applicable to not just obesity medicine, but medicine and health professions in general. But there are some opportunities I especially think in weight bias and stigma where we can potentially facilitate the discussion. But I’d love to hear your thoughts, especially with the work that you’ve done.

 

00:21:48:20 – 00:22:13:10

Dr. Jerry Maniate

None of us in a busy clinic have time to stand there for an hour in front of a whiteboard and start, you know, talking away. We can’t. However, when you’re going in, you can prime the learner to watch for certain conversations. Watch what I said, how I said it, what were the words that I used in my conversation with the patient?

 

00:22:13:12 – 00:22:41:04

Dr. Jerry Maniate

When you come out providing some debriefing on what happened in the room, exploring the conversation, exploring how you wanted to engage the patient, will be critical. Providing feedback to the learner in real time, right? You know, “Hey, you provided that history. Instead of saying that, could you have said it differently?”

 

00:22:41:13 – 00:23:18:13

Dr. Jerry Maniate

That’s the way that you said it actually accentuated the bias or the stigma. But instead could you reframe it to talk about the strengths of this individual. What are the hopes and the aspirations of this individual? And so reframing, because how we speak enters into our documentation. Right? You think about that. When we read this quote “standard history” or the consultation note or the progress note, it captures how we think, right, and what we feel here.

 

00:23:18:15 – 00:23:55:05

Dr. Jerry Maniate

It comes out in written form. And so getting people to think differently is both a head and a heart issue. So that when they actually put it out there verbally, or written, there’s an alignment. Patients have access to their charts, right? Whether they’re in a doctor’s clinic or a primary care clinic or a hospital, like, I’ve got patients on Epic and they’re on my chart. So they have access to their notes and they will see how I write about them.

 

00:23:55:06 – 00:24:19:07

Dr. Jerry Maniate

Does that writing correspond or correlate with how I was speaking with them? There should be alignment. And so once again, pushing us to higher standards of communication skills is not just about, you know, good diction and grammar and editing, but rather the choice of the words that we’re using.

 

00:24:19:09 – 00:24:40:00

Dr. Roshan Abraham

When a clinician is actively and continuously unlearning bias and committing to equitable care. And this is difficult without hearing from a lot of patients. How does that change the experience for the person living with obesity sitting in the exam room? And again, we don’t necessarily have these large scale studies to sort of validate that.

 

00:24:40:00 – 00:24:50:14

Dr. Roshan Abraham

But I’m wondering with your experience in the lab, in speaking with some of our colleagues in Obesity Canada, what do you think? What do you think that could look like?

 

00:24:50:16 – 00:25:15:07

Dr. Jerry Maniate

One conversation at a time, right? When you work in a hospital system, we have Patient Relations offices that give us definitely, complaints if there are. And many are well-founded, they are well grounded in the issues that are problematic. And so I welcome that when patients do bring that. But you do also get the compliments.

 

00:25:15:09 – 00:25:49:05

Dr. Jerry Maniate

And still I think one of the interesting conversations I had recently with a learner who I was working with, who we were providing care for, a patient and their loved ones that were engaging what we thought was a, you know, a good conversation, became such an impactful conversation for that patient’s family. We didn’t realize it until the compliment came and the learner came and found me and said, I can’t believe it.

 

00:25:49:07 – 00:26:20:12

Dr. Jerry Maniate

Did you see that? And that spurred another 20 or 30 minute conversation of further teaching, of validating the importance of true, patient-centered focus and care and communication. And bringing dignity to the patient, validating the concerns of the family, like, these are things that are tough. They take more time believe me, they take more time. But we have to.

 

00:26:20:13 – 00:26:51:22

Dr. Jerry Maniate

I position it in the concept of, you know, what would I want my parents to experience in this space? Who would I want them to meet? Right? And I would hope that we would all position ourselves in realizing the person that’s in front of us is the loved one of someone else, and so why not think about the humanity of the individual, and then providing the care and the compassion in that space?

 

00:26:52:00 – 00:27:02:06

Dr. Jerry Maniate

And if that was the case, would we take an extra minute or two? I think we would. We do this all the time if it’s someone we know, right?

 

00:27:02:08 – 00:27:26:11

Dr. Jerry Maniate

We do this. We will even make our way to visit someone if we know that they’re in the hospital, if they’re a friend or family or someone. Think about it in that way. Just because we don’t know this person in front of us doesn’t mean that they’re not worthy of the humanity and the value and the care that we should and could provide.

 

00:27:26:13 – 00:27:28:08

Dr. Jerry Maniate

We can make time.

 

00:27:28:10 – 00:27:58:12

Dr. Roshan Abraham

I think that’s beautiful, because I think when we do make an active effort to unlearn, when we’re committed to equitable care, I think and this is something I tell my learners, it’s even things I tell my patients, again, with the relationship I have in primary care, is relationship. Right? Is the fostering of true relationships, and I would argue relationship-focused care is something that we need to work towards as a profession.

 

00:27:58:12 – 00:28:30:08

Dr. Roshan Abraham

Patient-centered care has its benefits and it’s something that was started many years ago and continues to underpin a lot of what we do in family medicine. But ultimately, what connects us to our patients and what connects them to the health care system and makes them feel that they can trust the health care system, like you talked about at the beginning, is a good relationship, and especially with patients with obesity, the relationship is just not there with either the system or with yourself

 

00:28:30:10 – 00:28:46:00

Dr. Roshan Abraham

as the practitioner who represents the system. So continuously unlearning that bias, committing ourselves to equitable care ultimately results in something that’s reciprocal, that has reciprocity associated with it, and that is relationship focused.

 

00:28:46:02 – 00:29:13:01

Dr. Jerry Maniate

And Roshan, I love that word “relational” because what it does is it pushes back against a very transactional health system. Right? Especially our health care system in Canada, in Western societies has become very transactional. Right? We talk about numbers, we talk about weight lists. We talk about, you know, how many hours, you know, all this kind of stuff.

 

00:29:13:07 – 00:29:55:13

Dr. Jerry Maniate

We actually never talk about the person. Right? And if we actually create space where people are starting to trust, it is the foundation to that relational space, right? And once you start getting into that space, magical stuff starts to happen, right? Like in terms of unlocking deeper understanding and conversations, it furthers the trust. It also creates space where if there’s enough trust that’s been built when things do go wrong, as they can in a complex system, there’s grace provided in those spaces.

 

00:29:55:15 – 00:30:27:21

Dr. Jerry Maniate

People understand because people understand that people are working hard. And there is that grace understood. So in but it’s gonna take a real shift. It’s not just ground level, right? So I think about health professionals that might be listening to this podcast, but I’m, I’m looking at our senior leaders, right? The senior leaders in the health system as well as in the ministries of health and the political kind of venues.

 

00:30:27:23 – 00:30:39:16

Dr. Jerry Maniate

That’s where the shift also needs to go. So it has to occur on both sides. The recognition that health has always been about a relational space.

 

00:30:39:18 – 00:31:06:00

Dr. Roshan Abraham

Doctor Maniate thank you so much for being here today. For our listeners, we covered how to apply some ethical frameworks to navigate the evolving science of obesity care, the importance of interprofessional feedback in our own unlearning, and how dismantling weight bias is a core requirement of our professional standards, especially if we’re working towards that reciprocal relationship with patients and the health care system.

 

00:31:06:02 – 00:31:30:06

Dr. Roshan Abraham

If you’re listening and would like to learn more about obesity care, Obesity Canada offers free courses that can help you build that knowledge and put it into practice. We’ll include those links in the show notes along with the resources discussed, including the Equity in Health Systems Lab and the Canadian Adult Obesity Clinical Practice Guidelines. Please visit them to dig deeper into the evidence.

 

00:31:30:06 – 00:31:37:07

Dr. Roshan Abraham

And again, a very, very big thank you to Dr. Maniate today. What a wonderful conversation. Thank you again.

 

00:31:37:09 – 00:31:39:19

Dr. Jerry Maniate

Thank you Roshan. It was great to be here today.

 

00:31:39:21 – 00:31:59:14

Dr. Roshan Abraham

For our listeners, new episodes of Scale Up Your Practice drop every second Thursday. So make sure you are subscribed so you never miss an episode. If you found value in today’s discussion, please leave us a rating or review on your favorite podcast platform or share it with a colleague. It helps other clinicians find this podcast and join in on the conversation.

 

00:31:59:16 – 00:32:11:04

Dr. Roshan Abraham

Until next time, stay curious, stay kind, and keep Scaling Up Your Practice.

 

00:32:11:06 – 00:32:42:08

Dr. Roshan Abraham

This podcast is intended for informational and educational purposes only and does not constitute medical advice. The content shared in this podcast should never be used as a substitute for professional medical advice, diagnosis or treatment. Always seek the guidance of a qualified health care professional with any questions you may have regarding your health or a medical condition. The information and treatments discussed in this podcast are based on Canadian guidelines and approved practices as of the time of recording.

 

00:32:42:10 – 00:33:04:00

Dr. Roshan Abraham

If you are listening from outside of Canada, please consult your local health care professional to ensure compliance with your region’s medical standards, guidelines and recommendations. The creators of this podcast disclaim all liability for any decisions or actions taken based on the content discussed. Listening to this podcast does not establish a professional or patient client relationship.