The Role of Social Prescribing in Treatment of Chronic Illness: Special Series from The Cohen Center for Recovery from Complex Chronic Illnesses at Mount Sinai

Dr. Raven Baxter 

Hi everyone. I'm Dr. Raven Baxter, your host of this episode of the Raise the Line podcast. I'm a molecular biologist and director of science communication at the Cohen Center for Recovery from Complex Chronic Illness at the Icahn School of Medicine at Mount Sinai Hospital. At the center, we work to advance treatment and knowledge of long COVID, tick -borne and vector -borne illnesses, myalgic encephalomyelitis, chronic fatigue syndrome, and connective tissue disorders like hypermobile Ehlers -Danlos syndrome. 

This is a special series on post -acute infection syndromes, which are characterized by persistent symptoms that last for months or even years after the initial infection. Although we are developing our understanding of clinical manifestations of post -acute infection syndromes, as well as their potential treatment pathways, there is still a lot of progress that must be made on this front. And so, among the progress that needs to be made, it's important to consider the social aspect of being impacted by a post -acute infection syndrome. To help us learn more about this is Dr. Rose Perry, who will be sharing insights with us regarding how to navigate the social context of post -acute infection syndromes. 

Rose, thank you so much for your time. I'd love to have you introduce yourself to our listeners and share who you are and what you do. 

Rose Perry 

Yes, hi, thank you so much for having me. I'm Dr. Rose Perry. I'm a social neuroscientist. I hold a PhD in neuroscience and physiology from New York University School of Medicine. And I'm also the founder and executive director of Social Creatures, which is an applied research nonprofit organization that focuses on improving health and health equity outcomes by addressing one of the most overlooked social determinants of health, which is social connection. 

I also want to mention that I myself have a disability and chronic illness. I was born with Russell Silver dwarfism. I also have hypermobile Ehlers -Danlos syndrome and chronic Lyme. So, I'm going to be drawing not only from my professional expertise, but also my lived experience in our discussion today. 

Dr. Raven Baxter 

Absolutely, yes. And I appreciate that you shared that. It's also important for me to disclose, as I have in previous episodes, that I also am a chronic illness patient and I have long COVID. So, I think this is gonna be a great conversation because who better to speak about the community and social aspect of having a chronic illness than people with chronic illnesses?So, I'm really glad to have your insight here. 

So, let's talk about what your inspiration was to research these social aspects of chronic illness. 

Rose Perry 

Yeah, I mean, I think my initial interest in the field, broadly speaking, comes from my lived experience. So just experiencing things like social isolation and social exclusion as a result of my disability and illness and also, on the flip side, experiencing the benefits of it. So, when I had really supportive relationships and strong social connections, noticing that I was feeling better and doing better. Of course, it wasn't a cure or a silver bullet, but it definitely helped. 

And yeah, I'm also just fascinated about the intersection of the mind and body and how social connections can get under the skin to influence how our cells and physiology operate. So, I've always just had a lot of curiosity, just natural curiosity around that and I would say the combination of those two things ultimately led me into the social neuroscience and physiology field. 

Dr. Raven Baxter 

It's so interesting. I actually earlier this day had a conversation with someone who studies empathy and the, I guess, neuropsychology of empathy. And so with that being said, I'd like to dive a little bit into what it is like to experience having a disability or a chronic illness. From my perspective, it was very isolating because in my case, besides having ADH -- that wasn't necessarily isolating for me on a consistent basis -- but when I got hit with long COVID, my entire reality changed and lot of people didn't understand what I was going through and I didn't even have the vocabulary to express what I was going through. And not only that, but my physicians, and the people that I was relying on to take care of me didn't know what to do in 2021. Now I pray that it's better and it sounds like we've made a lot of advancements, but that's the purpose of this podcast. But yeah, what has been your experience and what are some things that you've seen from other people about their experiences? 

Rose Perry 

Yeah, great question and happy to share. So, I would say for me, there's been times in my life where I have been objectively isolated, similar to how you're describing with long COVID, just because of my symptoms. Times where I've needed to be horizontal in my bed for various reasons and have a hard time leaving my house. And when my symptoms are on that level, that's by far when I'm the most objectively isolated. I do have a husband and a dog, so that helps quite a bit, but it's still not the same. And I know from my research that you need not only intimate relationships, but friends and family and even weak ties. So, you know, talking to a store cashier or just being around strangers when you're walking in the park is beneficial. So yeah, that's definitely been part of my experience. 

I also want to name that there's been times where I have felt alone even when there are others around me and I think you described elements of that as well. People not understanding your experience, not having that shared experience with others, feeling excluded because of that. I think that that's definitely been some of the more painful experiences that I've had when it comes to social aspects of my disability and illnesses is not always getting invited to things or the invites kind of slowing down because I haven't been able to always join or I've had to cancel because of my symptoms, and I think a lot of that stuff is really preventable. So I think it's important that we discuss that here. 

But yeah, I would say those two things are like the two sides of the coin for me is being objectively alone, but then you can also be surrounded by people and still feel alone and talking about both of those things is important. 

Dr. Raven Baxter 

I would love to learn about Social Creatures, which I find very fascinating. I did poke around on your website. Can you tell us a little bit more about the work that you do at Social Creatures? 

Rose Perry 

Yeah, so broadly speaking, we're really trying to put research into action about what we know in terms of how relationships can influence health. We're doing that through three core pillars of our work. The major pillar is innovation. So, we actually create social health programs that are designed to help various populations that are more at risk for social isolation and loneliness to hopefully feel like they have social support and to make relationships and subsequently then have positive downstream effects on physical health. 

We have a number of different programs. One of them does focus on disability and individuals with physical disability. Our biggest program right now is actually for new parents because becoming a parent is statistically like a very high-risk time for loneliness and isolation and there's a lot that can be done there in terms of connecting parents with one another and with providers and making sure that people are socially supported through that major life transition. So yeah, we design evidence -based programs. 

Then, we also do a lot of science communication and awareness-building around how social connections do influence health and how important it is for that. And then we do a little bit of advocacy work as well, especially in the Medicaid and billing space and trying to open up billing codes used to reimburse for things that support social health. I think that's a slow but growing area of healthcare and how the healthcare sector is operating over time. 

Dr. Raven Baxter 

I think that's extremely important and thank you for advocating for this and doing your part and making sure that this becomes accessible. I think that this episode is so important because we just don't exist in a vacuum, but sometimes it can feel like one.  I would say that a large part of my recovery in long COVID was getting out of bad relationships and going into spaces where I was being nurtured by the people around me and the interactions that I was having was really nourishing for me on top of time, on top of like listening to my body and all of these other things. So in a society that's largely individualized, I guess what would be a baseline to be like, okay, am I lonely or do I need social interaction? 

Rose Perry 

Yeah.  

Dr. Raven Baxter 

Does that question make sense?  

Rose Perry 

I get that question a lot and I'll do my best to answer it. I think it's useful to understand the definition of loneliness and just how it kind of functions. Everyone has a set point, so you can think of it kind of like a thermostat.  I want to preface my answer here with everyone has different social needs. We are diverse individuals. There are introverts, there are extroverts. Everybody needs social connections to thrive, but the dosage is going to look different for everybody. 

So, I think it's important to just try to get in tune with how social connections make you feel to figure out what your set point is and that just takes some awareness building and just kind of paying attention, similar to exercise. Like if I run for 30 minutes, I feel awful. It makes me feel terrible. But if I do 10 minutes, I actually can feel energized and good, and there's similar kind of check-ins that you can do with yourself for social interaction. So, I guess my long answer summed up is, get to know your set point. 

Then once you understand that, just doing some regular check-ins like, have you left the house when you were able to in the last few days? I think work from home and a bunch of stuff is making us increasingly isolated, whether we're living with chronic illness or not. And just kind of having these check -ins on, hmm, did I talk to anyone today? For how long? Who was it? Like, did I fill my social cup or do I not need to because I'm actually recovering from being at a party and I was overstimulated and there was too much and I need a day of solitude because solitude is also good for us. 

Anyway, hopefully that helps, but yeah, it's just getting in tune with your body. 

Dr. Raven Baxter 

It does help. And I think that  in terms of post -acute infection syndromes, it's really important for doctors to be aware of where people can find support. So like when I was bed bound and literally could barely leave my bedroom, I found a 24-hour Zoom room where there were other people who were also bed bound. A lot of the time we just wouldn't even talk, largely because we couldn't. But the company that we kept was so important. And it also made the interactions that we could have, where we could speak, even more meaningful because we knew how much energy it takes to even get out even two sentences of words, let alone a paragraph. 

So, speaking to the audience, I would I highly recommend that if there are common diseases that you see in your treatment room, I think that it would be really great for you to also be aware of the support groups that exist that your patient could check out and see if they feel like they wanna be a part of a support group and be a part of a community of people who may understand what they're going through, even if you don't as a care provider.

Rose Perry 

That's such a good point, Raven. And also the example that you shared, I think, highlights that you were in tune with your social needs, which is great. I think it's also important to note that if loneliness becomes chronic, it can become a little bit harder to do that. There is a lot of research that shows chronic loneliness kind of becomes this vicious cycle. You start to perceive social interactions as threatening, you become more socially withdrawn. So, I think it's important for medical providers to also know that and kind of assess for people's willingness to engage. You need to understand if it is ‘I like my solitude. I'm naturally introverted. I do still have social connections and they look like this’ versus ‘I don't want to, I have no interest, it's not appealing at all.’ That's a big symptom of chronic loneliness and something that's gone unaddressed for too long. 

Dr. Raven Baxter 

Wow, can you speak more to chronic loneliness? And also, do you have any information on the impact of chronic loneliness on the body? 

Rose Perry 

I would say the research -- especially when we're talking about loneliness that persists for at least a month, that's when it can start to become chronic – shows there are effects on the body. It really does make a difference with how your body is functioning. 

Let me try to summarize it. There's some very interesting population health epidemiological research on how loneliness can basically cause mortality, or at least increase the risk of premature mortality, is how I should say it. That's because it's been associated with things like increased risk of stroke, increased risk of heart disease. 

Before I continue listing all of these sad things, I want to refer all of the listeners to our Surgeon General's advisory on this that was released a year ago in May of 2023. It named loneliness and social isolation as a public health threat... 

Dr. Raven Baxter 

Wow. 

Rose Perry 

…because of this body of research on how it gets under the skin to influence health. So yeah, it definitely can increase risk for mortality. 

On the positive side, it also increases chances of survival and it can increase your lifespan. So there's always like a good and bad side to this. Let's see...it's been linked to increased hypertension. It's been linked to risks of declined cognitive function. I think in older adults, it's something like a 50 % risk of developing dementia is associated with chronic loneliness. 

This probably goes without saying, but it also increases mental health risk. So, instances of depression and anxiety and suicidality are all linked to chronic loneliness and I think a really interesting one, especially for the purpose of what you all focus on, is immune function. So, it actually alters the way your immune system functions as well. We're still understanding the biological mechanisms. I'm happy to talk a bit about that.

Dr. Raven Baxter 

Let's definitely talk about that! That's fascinating. 

Rose Perry 

Your immune function is altered. There's some very interesting viral challenge studies that have been done -- not in chronically ill patients so, I want to put that disclaimer -- but in people who have less social ties, especially if they wear fewer “social role” hats. So, if you think about I'm a mom, I'm an employer, I'm a husband or a wife...like what are all the different roles that you have socially? The fewer roles that you have, the more likely you are to develop a cold or influenza when you are challenged. Like, the researchers literally would quarantine the participants and give them nasal drops with those viruses in them and people with more social roles and more perceived social support were less likely to get sick. So, I find that fascinating.

I don't think it's been tested in chronic illness. I would love to explore that more. I think there is a research gap there, but there's a large theoretical underpinning that this would influence symptom management at the very least of folks with chronic illness, especially because in so many chronic illnesses, you do have altered inflammation and immune function. So, can we kind of turn the knob on that and kind of dial symptoms back? Or can they be worsened by lack of social integration, which happens a lot of times, and not enough social support, and also conflict? 

That was another thing that the research showed...that interpersonal conflict and relationships also increase the chance of getting a cold or the flu after viral exposure. So yeah, I think that's a pretty powerful example of how important relationships are. I mean Social Creatures is called Social Creatures because we are literally social creatures. We need social connections to survive. The research is pretty clear on that. 

Dr. Raven Baxter 

I mean, that is fascinating. And it's funny that you brought that up because a lot of people ask me, who are also chronically ill, Raven, how did you recover so well and so quickly? Like, I still have permanent hearing loss from COVID, unfortunately, but many of my other symptoms have resolved. The first thing that I say is I got a divorce. And I mean, you know, my friend said no good marriage ends in divorce, right? Like there are serious reasons and serious social violations that happen for the most part to cause two people to end a marriage. And I recognized I needed to do that so that I could heal. As soon as I made that happen, a lot of my symptoms started resolving and I was getting better and it's very interesting to see that there is scientific data that connects chronic illness and conflict like in your life. 

Then around the same time that I came down with long COVID, I was having really bad neuropsychiatric manifestations, like a lot of panic attacks. The first thing the psychiatrist said was like, I think it would be really great if you re -examined your relationships. And I thought that he was being kind of superficial, but he was really just trying to drill it in my head that there is a connection between your physical health and the conflict and the relationship issues that you're having. 

So, yeah, I made it my top priority to completely reorganize all of my social relationships. I was even reading books on how I could become a better friend. I was like, “Okay, everything is getting a makeover. No bad husband. I'm gonna be the best friend I can be so that my friends can do the same for me.” It has just paid off immensely for my health. Even joining things like a virtual crochet club.  

Rose Perry 

Amazing. 

Dr. Raven Baxter 

Yes, so we crochet, but it's become even more than crochet. Like, we support each other through major life events. People moving, you know...all of these things are happening in our lives. And it's been so important. In fact, we decided to name the crochet club the Elderberry Group because Elderberry is supposed to have -- this is not medical advice -- nice properties that could pose certain benefits to us. It's used in tea and whatnot as a holistic supplement. So, that's actually what we named the crochet club because we recognized that just keeping each other company was healing all of us. And so, yeah, I will stop blabbing, but I really loved hearing the biology part of this. 

Rose Perry 

Well, I'm glad it resonated. I think you have presented a really interesting case study, so to speak, of how powerful social connection can be within the healing process. I think it sounds like you also had really good providers around you too, because I think a lot of times as patients with chronic illness, these things are unnecessarily psychologized or you face medical gaslighting where doctors say it's all in your head. That happened with me. It took me like 10 years to get my chronic Lyme diagnosis… 

Dr. Raven Baxter 

No way. 

Rose Perry

…and I was basically just sent to therapy. I love therapy. I am pro-therapy. But I knew my body -- and it sounds like you're super in tune with yours too -- and I knew the difference between panic attacks, because unfortunately I had had them before, and what I was experiencing, which ended up being severe dysautonomia attacks, right? I was near fainting on the subway and they were telling me it was because of the stress of grad school and because I was planning a wedding. Everyone was well intended. I think there's a lot of good intentions that often lead to bad impacts in the health space and the provider space here, especially when you're not aware of some of this research that we're discussing today. 

I always like to add that disclaimer that A, I don't think lack of social connection is a cause of chronic illness. I also don't think it's a silver bullet. I think it's really just about setting conditions that make healing maximally possible. When those conditions aren't good, you can be like throwing gasoline on the fire and having your symptoms go crazy and with the other ways, you can kind of douse the fire a bit and get it smoldering and there might be periods where your symptoms are totally under control. I like to think of social connection more as that. 

So anyway, I just think that's an important disclaimer as we discuss all of this. It's not all in your head. It's literally in your body. The study that I just cited with the viral infection being an example of that, of like, you're literally modulating the way your immune system responds to viral activity and it's in the body is evidence in and of itself that it's not just in your head, but yeah, it’s important to name all of that because often it is the elephant in the room when we are talking together as chronic illness patients and sharing our experiences with providers. 

Dr. Raven Baxter 

Absolutely. Okay, I would like to know what are some practical strategies that healthcare providers could potentially leverage to address the psychosocial aspects of chronic illness? 

Rose Perry 

Yeah, so I would say the first thing is to believe the patients when they're coming to you and how they're describing their body and their experiences. Just going in with an open mind and just a position of validation of their experiences. I think that's like step zero, but then there's three major steps that come after that. 

I would say if you're a medical provider, you should just always be screening, whether that's formally or informally, your patient's social health. The World Health Organization literally includes social wellbeing in its definition of health. I think we've come a long way with physical providers referring to mental health providers and while it's not perfect, in our lifetime, it's gotten so much better. I would like to see that occur with social health as well. It starts with understanding how is the social health of your patients. 

It can be one question that takes two minutes, or you can use screeners that are like three items. The UCLA Loneliness Scale is one that's commonly used to just see if someone is presenting at high risk for loneliness or is actually lonely at that time. From there, there's lots of things a provider can do. 

I can give one example of what a provider did for me once that was incredibly helpful. It was related to my disability, Russell Silver, which is pretty rare. I grew up in a rural area. I've never knew anyone else that had it. When I moved to New York City, I saw this doctor who was like one of three in the world that specializes in my disabilities. It was the first time I was seeing her, and she heard that I didn't know anyone else who had it and within like that day, that night, I went to dinner with someone else who had it. 

Dr. Raven Baxter 

Oh my gosh. 

Rose Perry 

The doctor just sent an email. She's like, I actually just met a patient like you who doesn't know a lot of people and she's in New York just for this week. She came for this health appointment. I'm going to reach out to her and see if she's willing to be connected. Are you willing to be connected? I said, absolutely. She connected us. Her job was done. We met. That's it. So, I think that's like a very simple, powerful example. 

I also encourage providers to read about or learn about “social prescribing” -- that's what it's called. It's much more common in the United Kingdom but it’s starting to gain a little bit of traction in the States. I hope it continues to gain traction. Basically, social prescribing at its core is A, assessing if an individual is lonely or in need of social connections, and then B, having a list of options for them, whether that be support groups, knitting clubs...it doesn't need to be necessarily a support group around your illness, but just like gauging what is a person's interest and how can I get them more integrated in doing things. 

I know that this takes a little more forethought, but a lot of doctors will develop a resource list or will have a staff member develop a resource list so they can pull it up and then kind of match make. Social workers also are really good at this. So, for the extra busy doctor, I would say if you have a social worker in your clinic, you can pass the baton and just say, ‘hey, this patient's definitely lonely or our red cap data is showing they scored really high on the UCLA loneliness scale. I'm passing the baton to you.’  It’s similar to referring out to a therapist for mental health care. Like, a social worker can really help with the social health of an individual. So that's an example of social prescribing in action. And there's a lot in terms of billing codes that's opening up for all of that, too, so it can be revenue building for the clinics. I think it is also important to name that. I know doctors are busy, clinics are busy, but it can just help with the overall health of the clinic operations as well. 

I also want to name, as a final piece here, that follow up is really important and the doctors that are the most useful remember to kind of close the loop on this or they will bring it up again in follow up appointments and check in and see like, ‘how is knitting club? Did you ever join? Why not?’ things like that. Making sure that it's not just like checking a box, having this discussion, but that you're really integrating this into your overall view of what health looks like for your patients. 

Dr. Raven Baxter 

Thank you so much. Those are really important tools that people can use to better the patient experience. So, I have a question from personal experience and I'm sure that other people have experienced this too: what do you have to say to doctors who, out of an obligation, are doing the loneliness scale questions, and then it comes out that the person is very lonely or scores really high on this scale? In my experience, the tone of the appointment definitely changes after that. In my experience, providers kind of go into panic mode or are ready to throw you into a facility if you indicate that like you're super lonely.

It just doesn't seem like a lot of doctors know what to do if you tell them like, ‘hey, I'm struggling.’ Is there anything that you'd recommend patients say to their doctor to make sure that there is not a misunderstanding of like, ‘I don't think I should be locked up in a facility, I'm just feeling really lonely.’ Like, how can we make those conversations positive for these patients who are really lonely? 

Rose Perry 

Yeah, well, I would say that example kind of showcases that that doctor probably isn't fully aware of the social connection literature out there and kind of went from zero to a hundred with concern, which is better than not registering a concern at all, arguably. But yeah, I think that it's important to note that loneliness is a universal human experience. Everyone will experience it at some point. And unfortunately, lots of people are chronically lonely. It can lead to negative things, but it doesn't have to.

I think it’s about just having that discussion, doing patient education, if that's needed. Like, first of all, let's normalize this. It's a normal thing that happens. It doesn't mean you need to be facilitated, but it is something we should address as part of your overall health plan. Let's talk about what that might look like for you and what would work for you. 

So, I think it should evoke curiosity more than fear. If you go into the conversation with that mindset, on both ends, you'll more likely come up with a solution that works for the patient instead of like fear and maybe there's liability concerns there because maybe that doctor was keenly aware of the link between loneliness and suicide, which is serious, right? But it's also like lots of people are lonely and not suicidal, so you have to calibrate it correctly. 

But yeah, I think just leading with curiosity is a useful framework for a lot of these discussions, in general. 

Dr. Raven Baxter 

I think that's great. And so, for the doctors who maybe don't have like a lot of time with the patients in the treatment room, what resources do you know of where they could say, ‘hey, this is where you can find virtual ways to connect, and this is how you can find stuff near you if you want to walk or drive somewhere, if you can. 

Is there anything like that that exists that can kind of help the doctor address the issue? 

Rose Perry 

Yeah, there's some really good social prescription guides out there that include resources. I would look at what exists in your geographical area, though. I would highly recommend finding a staff member, an intern, or someone to just create a resource list that your office has so you don't necessarily have to have the conversation every time, because I understand being time poor. But you can at least give a pamphlet out to your patient at the very least. Like, here's some things that we know are in the area that we've organized by interest and by different illnesses. You should be able to find some stuff. 

I also will always endorse if there's any way you can have a social worker on your staff, they should really be the ones, especially if the doctor doesn't have as much time, to be having the more longer form discussions around all of these and kind of matchmaking the services with the person. And again, there can be a revenue building stream there. So, I know there can be concerns around how am I going to hire this? What's the barrier to entry for costs? But there's ways you can bill for these things, which makes that barrier to entry of having a social worker much lower.  

Dr. Raven Baxter 

I'm honestly curious about the billing aspect of this. What would that look like to have a social worker on staff to supplement the doctor visit? 

Rose Perry 

So, there's case management that occurs as a social worker in general. What it would look like is a doctor is working with a social worker to matchmake services to address like psychosocial needs. This can also include things like therapy, right? So, for the busy doctor that also can't give a therapist recommendation or help you search for one that takes your provider, insurance provider, social workers literally can do that. 

This is what we do at Social Creatures. We have social workers administering our programs. So, Social Creatures creates these social support group programs or different community -based programs, but we actually really want social workers in the actual clinics and healthcare settings to be the one to implement them because that's where systems change is going to happen. That's where we're going to start to see the health sector incorporate this rather than like, come to this nonprofit for these services, right? So yeah, you're really passing the baton to the social worker. And then depending on the program, there's group -based psychoeducation codes, billing codes that you can use for reimbursement. There's also group -based psychotherapy codes that can be used for reimbursement. 

There are increasingly even like diagnostic codes that are related to social context and situations that can be linked to those billing codes that insurers are using. Again, it's an evolving space. So, it's something that we actively test out with our programs and have had success with. There's a lot of existing billing codes out there that social workers can drop for group -based care, in general, as long as it's curriculum based or psychotherapy based in some way in a group setting. 

Dr. Raven Baxter 

I've learned so much. Thank you so much for sharing all this.  I'm really curious to know if there's anything that you're excited about that's in development or new technologies or new trending ideas at the forefront of your field. 

Rose Perry 

Well, I want to name one thing that's related to the billing codes.  

Dr. Raven Baxter 

Okay. 

Rose Perry 

I'm based in New York state and in October of last year, New York state Medicaid basically made it possible for community health workers -- which are different than licensed social workers -- to use billing codes that have to do with patient education. We often use those billing codes for these sorts of discussions, whether it's one on one with the doctor – so, you're getting reimbursement for that busy doctor's time -- or in a group-based setting, because the codes that exist for one-on-one are also group based use cases. So, I think that's huge, because now you don't even need to have a social worker. You can have a community health worker that can come from the communities that you're serving and they can be administering some of these services and you can be generating revenue that basically incentivizes spending the time.

It is sad that this is the system we're operating within without having universal health care, but we work with what we have here and I think that that's a huge advancement and I'm very interested to see how that changes the field. I can say in our work with Social Creatures, we've run up against barriers with social workers not speaking all the languages that we need them to speak to be able to offer our programs in the most inclusive way, whereas community health workers also kind of fit that gap. So, it's even better for the social inclusion piece, which is, as we already talked about, also really important for health outcomes. 

Dr. Raven Baxter 

Yes, absolutely. wow, we covered so much. Rose, throughout all of the episodes that we filmed, there has been a consistent message of listen to your patients. Don't be afraid to not know things. Be curious about your patients. Be curious and take on the adventure of finding answers. Advocate for better testing. There have been so many important nuggets that have been consistent across the videos. So Rose, I would love to, for our final episode, hear from you about what you envision our medical students putting into practice after watching our series. 

Rose Perry 

Yeah, when I get a question like this, I always think of the Hippocratic oath that doctors take, so the medical students will take it when they're completing their training. I know there's a more modernized one now, but there's a line from it that I really like, which I will read right now, that says, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being whose illness may affect the person's family and economic stability.” 

I think that that highlights a lot of what we talked about and I'm sure other things that you covered in the podcast series. That as a doctor, you're treating a human being, you're treating the whole human. And the fact that you're listening to this podcast tells me that you care about the whole human and you want to learn from their experiences and how to show up for that human and not just to cure or provide symptom management. 

I would say as well that when you're treating a whole human, you need to think interdisciplinary, So while you're in training, especially, this is your time to really be as interdisciplinary as possible. You have a little more freedom to learn about a lot of different things. Basically, you're becoming increasingly specialized over time, so now's the time to really learn the landscape...to understand how physical health, mental health, social health all interact and to develop relationships with people working across those fields so that you can take that into your practice and refer your patients on to folks that specialize in areas other than yours, but never losing sight of the whole human as you become increasingly specialized. 

Dr. Raven Baxter 

Thank you, Rose. That is amazing advice for our medical students. And I'd like to thank you for your time and all of your very valuable insights into the social aspects of chronic illness. 

Rose Perry 

Thank you for having me. 

Dr. Raven Baxter

Well, that concludes our ten-part podcast series on Post Acute Infection Syndromes.  I want to thank all of our guests for sharing their knowledge and wisdom with us, and thank all of you for listening.  To learn more about the work of the Cohen Center for Recovery from Complex Chronic Illness visitwww.mountsinai.org. Bye everyone!