Q&A with Zubin Damania, aka ZDoggMD
G Guera
Posted onMar 29, 2019 at 9:00 PM
Updated onUpdated on Apr 2, 2019 at 7:10 AM
Zubin Damania, aka ZDoggMD, is a hospitalist and founder of Turntable Health, a direct primary care clinic in Las Vegas. He is known for his comedic sketches, parodies, and music videos about the healthcare system and common medical issues.
What was life like for you growing up?
I was actually born in New Jersey to immigrant Indian parents who were both doing their second residencies. As international medical grads their training in India didn't count, so they had to re-do residency. My mom was pregnant with me when she was doing a pathology internship and hated pathology so much that she switched to psychiatry. So in-utero I was exposed to the relatively toxic environment of a young, immigrant trainee that hated her residency. And it explains a lot…
My dad did internal medicine and pulmonology, but ended up just practicing internal medicine and moved us to California when I was 8. I went from this private school where there were a lot of gifted kids. It was just normal to try really hard, try to do well, and care about things like the arts… Then to be dropped into public school in rural Clovis, California, where it was racially different. Clovis is the most conservative city in California. Public school there was where you were ridiculed for being different, being smart, trying, looking like you cared about school. From the beginning, for me, it was kind of a struggle to fit in. The way I did that was using whatever few gifts I had. One of them was being able to read people pretty good. I guess they call it empathy or something now. But back then I thought it was some strange power that I could read how people were feeling. The second thing I had a gift for was making jokes to put people at ease. I ended up using humor as kind of a social lubricant to keep me from getting pantsed or getting a wedgie like Q1HR [a medical abbreviation for "every one hour"] around the clock.
Photo by Richard Ruffian
How did you get into medicine?
In undergrad it was clear that I was going to have to hedge; because [I was into music, but] I didn't have that raw talent or ambition in music to be a famous anything, not even a good anything. So I kind of hedged and did a minor in music… then a major in molecular biology so that I could keep the pre-med credentials on the off chance I wanted to go to medical school…[I] went through the pre-med path and realized that was kind of an interesting—it almost presented as a game… [I]f I can just move these pieces around…I have a lab where I can do work. I can do volunteer work here. I gotta' take the MCAT. I have to make sure my grades are "X." Doing those things was actually a fun kind of thought experiment.
At the same time it was sort of disconnected from, "I wanna be a doctor"… So when I got into UCSF [for medical school], I was like "Whooooa, what!?" And that's when it really hit me, like "Oh wow, this is real." When you get that acceptance letter, you go, "Oh…first of all I'm not worthy." There's an imposter syndrome immediately… The second thing that happens is that it dawns on you, "Wow, unless I really screw up, I am going to be a doctor one day, what an amazing gift." And that's when I really felt the calling of it, just getting that acceptance letter. It took me that long, really.
What surprised you about medical school?
And then going through school, UCSF was interesting because we had Wednesdays off… Those Wednesdays, what I used to do is teach MCAT for a company called Berkley Review.
[I]f you ever read one of those Gladwell books, like Outliers, [about] people who've made some dent doing something, what their story is—it turns out it's usually luck, being in the right place at the right time. It's usually falling into something that perfectly prepares them for what they end up doing later. For me, it was falling into the MCAT guide…. I ended up having to write these lectures: two hour lectures done three times a day, two days in a row when I started. Then it was just the Wednesday. It was basically like doing three comedy sets every single week in front of a hostile audience. To teach them and make myself feel like I wasn't completely idiotic, I would use comedy and humor and jokes, songs, things like that to try to defuse this deep insecurity about teaching a subject I knew little about. That was the sort of crucible that I realized in retrospect that prepared me better to learn how to be a doctor. Teaching is a great way to learn how to learn, right? The second thing was learning how to stand in front of a hostile crowd two hours at a time, on your feet. It makes you a performer. You lose stage fright and all that.
Why did you decide to specialize in internal medicine?
I did an internal medicine residency at Stanford. My plan was to do GI [i.e., gastroenterology] as a course because I kind of liked it, though GI was cool. I liked this concept of playing video games in peoples' butts all day. I thought, "Boy, this is romantic, right?" And then I get to the rotation and had a mentor. Then I was like, "I hate this so much." Coming to that realization in second year was kind of a "woke," destroying realization. Because this is what I had my mind set on, and then this, knowing intuitively that I can't do this for a career. I would never get to the fellowship, let alone a career of it.
Then I'm like, "Now what do I do?" Primary care looks terrible because of the way things are going. And hospital medicine is more of the same. So I was pretty dispirited and got pretty burned out by the end of my third year at Stanford. So I took a year off afterwards, which probably really upset my program because, you know, they like to have their statistics say "such and such got this fellowship" and "such and such got this job."
I ended up working for two tech startups that worked in the medical space, vaguely doing medical education and doing sort of web education for consumers… It felt empty, stupid, and meaningless. So when I got an offer to come back and become a hospitalist, I said, "Sure." Thinking it would last a year, I'd get my clinical feet to go do something else, or go do a fellowship. I ended up staying for 10 years and just really loving the practice of inpatient medicine.
So what led you to Vegas?
About year 5 of that practice, what I started to see… [t]he commodification and transformation of healthcare… We went from a partnership to a corporation… I realized this is no longer something concurrent with who I am as a human being. It used to feel like this was a real calling. Now it feels like I'm punching a clock and not being able to take care of my patients… In that sort of moral injury mode that I had, that's when I started making these videos and putting them on YouTube… I would put these videos out there, which were kind of inappropriate but educational. Like this piece called "Manhood in the Mirror." It was one of our first big-view pieces that was a parody of Michael Jackson's "Man in the Mirror." It was me talking about testicular self-exam in a robe with a Michael Jackson wig on in my bathroom with this handicam. I was screaming about "I'm checking out my nads in the mirror!"
The next thing I know Tony Hsieh, the CEO of Zappos, who actually knew my wife from back in the day, he reached out and said, "Hey, we're doing this thing in Vegas. We're investing in downtown. Maybe you wanna be a part of it. I saw your videos. You're clearly crazy. We need somebody crazy. If you wanna work on a medical thing, we have a little startup money, maybe build a clinic, do something that you're passionate about." There was no way I could say no, even though it was very hard to leave all that security. But it was the best decision we made. In 2012, we moved to Vegas, started our clinic, Turntable Health, based on these principles of what we call "Health 3.0," kind of re-personalized, collaborative medicine that uses technology in a different way. It's a very, very different model.
We ran for three years successfully. Then the biggest insurance company that was supporting us at that time went out of business, because it was one of those Obamacare funded cooperatives. So we had to close. The whole time I'm making videos, too. I'm creating this sort of national brand… [W]e built a clinic. We learned a lot. We now have the credibility to talk about this. We have a platform that's growing of almost 2,000,000 people across Facebook, Doc Vader, ZDoggMD, Instagram, Twitter… [N]ow we have this movement; so let's use it to actually help catalyze the transformation of medicine. It all then sort of fell into place. And now my burden, sort of when I wake up in the morning and sweat, is how do we do this in a way that is true to the values that we have and that gives people a voice? But yet isn't a slave to conventional wisdom. That's kind of where are now.
How do you balance your social media presence with you clinical duties, your family, and personal time?
It is a lot. It was much harder when I was a full-time hospitalist and doing it. It… was actually harder than that when I was running the clinic. But now that the clinic closed, my clinical duties are less. So I round at UMC hospital as a hospitalist with House Staff, but just a few days a month. Most of my presence or cycles are spent doing our show, traveling, and doing talks and performances trying to catalyze this movement, making these big music videos, working with sponsors and clients, trying to pay for it all. So I spend more time with my family now than I could when I was fully clinically active.
Are there any expansion or transition plans for ZDoggMD?
The next stage is to really get a bigger team. But we really need to montage it in a way that allows for growth. So we have a new subscription function on Facebook. We're part of a beta test for Facebook where super fans can sign up for $4.99 a month and they get personalized videos with me, where we all sit in an effective virtual room with 100 people and answer questions, sort of brainstorm ideas. I think that's one channel where we have corporate sponsorships, Patreon, and those sort of avenues of merchandise… It's always interesting to see how people monetize these things. And that then gives us the juice to grow the team to then improve our reach.
You have a lot of material out there now, a lot of branding… So have you had any interesting fan moments, or interactions—either positive or negative?
What's really inspiring is the reach of the influence of this movement. We were hiking in Zion in Utah. We were on this pretty remote trail… And on that trail I got recognized five different times, nurses, doctors… And it happened in the Grand Canyon, too! What I noticed is that medical people, particularly doctors, they tend to be a little silent on social media. They lurk there… But they're absorbing all this stuff. The reach is even bigger when we think when we go out in the world and realize people will go deep, "I saw that interview you did with Dr. Duddy and gifted children and how challenging that is. I really wanted to thank you for that. It really changed the way I think about that." And I'm just going, whaaaaa? That to me is the reason we get up in the morning, that we can now have these conversations with the tribe of people that we care about, that influence a lot of people. You influence one doctor, one nurse, one respiratory therapist: they see thousands of patients… That's the great gift of being able to do this.
Do you have any advice for the future physicians?
In medicine, my advice for pre-meds is stuff like, "Look guys, if there's anything else that you think you should be doing in the world other than medicine, you should try to do that first." If you can make that work, then you should do that. If the thing you wanna do the most in the world is whatever path you're on, whether it's respiratory, pharmacy, medicine, allied health, nursing, then ABSOLUTELY pursue it with unwavering dedication. Because you will find within it the niche that you will fill is unique to your story. The thing is that you need to keep looking for it.
How did you destress during a time of burnout? How did you change things? How did you adapt from that experience?
At the time when you're in it, you're always looking forward to the next vacation. The problem is, during the vacation you're looking forward and dread your next shift. The question is, if you're always living in the future or worried about the past… It's interesting. I heard an interesting thing recently that's pretty spot-on: Depression and anxiety are the same thing. It's just the tense that's different. Depression is pain related to past stuff that's happened. Anxiety is pain related to worrying about future stuff that's going to happen or is currently happen. I think it's just the same thing. Both of them have in common that they're mentally time traveling.
The way to destress the best is to live as much as you can in the very present moment. In the worst moment you're having, if you actually sit and focus on what's happening in the present, you can find some source of comfort, something that's good and pleasant. That can be a good tool when you're having a difficult shift, or you're getting pimped on rounds, just humiliated, stuff that's happening. The second thing is to remember when you're really stressed that none of this is really about you. You can't take a lot of stuff personally. You have to own your own life and say, "Okay, this is not working. I'm going to go do something else." But really, all the stuff is not about me as a person, and especially in medicine, where patients are yelling, other people are yelling, it's really about them, their own reaction.
But in the end, those aren't the things that are causing physicians and medical students alike to burn out. The moral injury of having to do things that feel absolutely wrong, like click boxes instead of talking to patients, worrying about billing instead of sitting with a child. Those are the things that hurt us; and that hurt is what causes burnout. We blame ourselves. We feel a lack of self-worth. But it's really not that. It's this bigger system that we work in now. The thing is, where we are culpable and responsible, is if we fail to recognize that and stand up to say, "You know what. This is not okay. I'm going to do a little bit in my own way to try to make it better. Whether it's sit a little longer with a patient, see one less patient a day so that I can spend more time with the rest even though I'm getting paid less. And if my employer doesn't like it, I'll find a different employer."
Is there anything else you'd like to share with our readers?
I really want to say that I'm glad that SDN exists. It's created something I never had when I was training, when I was a premed, or even in medical school. There was this early internet. There weren't any forums or anything like that. It's a sense of a community where people can come together and feel a common sense of cause and purpose, and help each other, and show each other compassion, which is necessary. And you had mentioned early on that they helped you get into medical school. I could totally see that. If I had it then, I would've used it to the utmost. It's really a special thing. You guys should take care of it and make sure that it never falls into commercial abuse. It helps people, I think. I'd love to see it continue to evolve and address things like burnout, moral injury, and system changes.
Guera
Guera was born and raised in Los Angeles, educated in the South, and returned to the West for residency training. Self-identified as a genderqueer transwoman, she has remained dedicated to LGBTQ health policy, education, and activism, as well as basic science and clinical research throughout college... Guera was born and raised in Los Angeles, educated in the South, and returned to the West for residency training. Self-identified as a genderqueer tra...
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