Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Today is part two of a six-episode podcast miniseries we're launching over the next year to highlight the needs of an aging population and the evidence-based models that can dramatically accelerate care improvements for older adults.

Have you ever left a visit with your healthcare provider and felt that your main concerns were not addressed? Or have you ever had concerns about the number of medications prescribed to you by multiple providers? Or have you experienced growing concerns about your likelihood of falling, either due to medications or health complications, leading to reduced activity and mobility to minimize your risk of falling?

If you answered yes to any of these, or you have a loved one who might, today's episode will highlight an evidence-based framework for age-friendly care. In this episode, we're going to expand on the Four M's: what matters, medication, mind, and mobility. But first, let me introduce my guest, Dr Ellen Flaherty. Dr Flaherty is the Vice President of the Dartmouth Health Geriatric Center of Excellence and an Associate Professor of Medicine at the Geisel School of Medicine at Dartmouth. She's the principal investigator of the Dartmouth HRSA-funded Geriatric Workforce Enhancement Program and also one of the co-investigators of the American Geriatrics Society National Geriatric Workforce Enhancement Program Coordinating Center, funded by The John A. Hartford Foundation. Welcome to the WebMD Health Discovered Podcast, Dr Flaherty.

Ellen Flaherty, PhD, MSN, APRN: Thank you so much, Dr Pathak, for having me.

Pathak: I'd love to start off by having you give us the origin story of the Four M's and why that's such a core part of what we need to be thinking about in the care of older adults.

Flaherty: The Four M's are part of what we call an age-friendly health system. When this was developed by my close friend and colleague, Dr Terry Fulmer at The Hartford Foundation, the first thing they looked at was the research. The research has shown us that the most important things to pay attention to as we get older are these Four M's: most importantly, what matters most to an older person, medication, the mind, and mobility. We know that paying attention to these Four M's absolutely leads to improved outcomes for older adults.

Pathak: Thank you so much for clarifying that overarching structure. I'd love to dig into each of those Four M's and explore how they impact older adults, caregivers, and the shared decision-making process with healthcare providers. Let's start with "what matters," because this feels like the foundation for clear communication, treatment decisions, and identifying healthcare goals.

What matters is also incredibly personal to each of us, and many of us probably haven't given it extensive thought in terms of our wants, needs, and how our lifestyle will impact our healthcare options as we get older. One question I’ve found helpful when encouraging patients to explore this for themselves is: What do I need to know about you in order to give you the best care possible? It's not so much that I need an immediate answer, but it's an invitation for them to start thinking about what really matters, what concerns they have, and what they want others to understand about them.

I'm really interested in your experience with uncovering what matters most. Can you guide us through the process of figuring this out for the patient sitting in front of you, and how older adults can communicate those needs or any personal goals during appointments with their healthcare provider?

Flaherty: One of the most important things is that systems need to be in place to ensure there's an opportunity to have these conversations. That might mean additional time scheduled for that visit. When these systems are in place, we have tools that help the entire team have these conversations.

For example, if nurses begin these conversations with patients, we have a much greater chance of actually documenting what matters most.

Pathak: Can you share best practices for how to ensure that care plans—whether prior to an emergency or even in an emergency situation—reflect the patient's values and wishes? I'm especially thinking about multiple settings, such as advanced care planning and potentially end-of-life conversations.

Flaherty: Part of this is ensuring not only that you've documented and created a care plan as a result of conversations with the patient, their family, and partners, but also where that information is stored. For example, in patients' homes, we strongly encourage them to put their advance care plan on their refrigerator. That enables, say, an EMT who comes into the house to know exactly what matters most.

We also need to systematically put this in the electronic health record so it’s visible to an emergency department or another provider if the patient is admitted to the hospital. Having the conversation is critical, but so is documenting the care plan and making sure everyone across sites of care knows where to find it.

Pathak: I'm also curious—what does this look like in the real world? Particularly when things are emergent and the situation is fluid. Many people might relate to this in terms of a birth plan—you have a high-level idea of how you'd like everything to go but recognize there’s some flexibility. Can you talk about real-world examples of how to use the "what matters" information?

Flaherty: Sure. We've done a lot of work at Dartmouth focusing on reducing avoidable and unwarranted transfers from nursing homes. Very often, you have a patient in a nursing home who has made it very clear they do not want to be transferred back to the hospital. How do we ensure that happens during an acute episode?

Having the conversation before the episode is critical. When a patient is admitted to a nursing home, we have these conversations and clearly document what the patient wants. We have our own on-call geriatrics service, so medical directors and direct-care providers in nursing homes have a very specific care plan available to know exactly what that patient would want during an acute episode.

This is often done in partnership with families and caregivers as well. Having the conversation early and then ensuring the patient's wishes are followed is essential. We call that goal-concordant care—care aligned with someone's values that they've already discussed with a provider and documented.

Pathak: I want to follow up on that point with something personal. Recently, my father was hospitalized. We had a clear understanding of his overarching goals of care—what mattered to him—but there was still confusion in the acute setting. Questions came up like: Does this particular treatment align with that goal? Does this decision fit?

For listeners who might be thinking, "Now whatever I say is set in stone," and worrying that could become a roadblock to completing this type of documentation, can you explain how these documents remain fluid?

Flaherty: This is a great question. We often think in terms of categories of care. One category is that someone only wants comfort care and no interventions at all. In that case, we’d likely refer someone to hospice at the end of life if they were having symptoms.

At the other end of the spectrum, someone may want everything to be done. Most people, though, choose one of the two categories in the middle—what we call limited care. This is really the question you're asking: What does limited care mean?

Often, it means that if we can treat you in the hospital and return you home or to a facility at your prior level of function, would you want to be treated? For example, would you want an intravenous antibiotic for an infection? But you might prefer not to go to an intensive care unit or be put on a ventilator.

We document these conversations in a very structured way. We use something called a Serious Illness Conversation Guide, which doesn't just check boxes but asks patients about their values and records their answers.

Importantly, patients and families can change their minds. Situations change, and sometimes short-term measures—like temporary dialysis for a kidney issue—might be appropriate when long-term dialysis would not. These discussions happen in context, often during hospitalization when many things are happening, and we walk patients and families through the risks and benefits.

Pathak: I'd like to discuss another M – medication. Can you help our older adult listeners, or their caregivers or loved ones, understand how medications affect them and why it's so important for them to regularly communicate about medications with their healthcare providers and their loved ones who are helping them take their medications? And what does the term “medication reconciliation” mean, and how does that minimize drug-related harm?

Flaherty: So very often, what we see is that I may not be the only prescriber for this patient, right? This patient may actually be going to the orthopedist or the cardiologist, who may also be prescribing medication. So it's really important that we understand everything a patient is taking, including prescription and over-the-counter, non-prescription drugs.

One thing that we do is we ask patients to actually bring their medications in for a visit. We also have special events that we call “brown bag events,” where people can bring in their medications, and we look at that against our system to see what we have in our electronic medical record and whether that reconciles with what the patient is actually taking.

That's really critical to understanding whether there's potential harm or any interactions between some of these medicines.

Pathak: It's so interesting, especially when you mention brown bag events or medication bag events. We love to do this in my clinic as well because medication management, as you said, is a team-based sport. It's really helpful when patients bring all of their medications in, and then we can go through them and look at everything—things that are prescribed by us, things prescribed by other doctors, things that are prescribed or not prescribed, things they are taking over the counter.

Sometimes, as you said, we find multiple doctors are prescribing a class of medication, like a beta blocker, but it might be a different dose from the cardiologist versus a different dose from a different specialist.

So it's really important for listeners to attend those brown bag or medication bag appointments. They can speak with healthcare providers who will look at everything together to figure out the actual list of medications that the patient needs to be taking home.

Now I'd love to ask you about managing medications on a systems level so that our audience can have a better understanding of how they can work with their healthcare provider to catch harmful interactions, potential side effects, or to make sure that the dosages and sometimes even the medications are appropriate.

Flaherty: All of us often complain about the burden of the electronic medical record. But one of the benefits is that there are immediate alerts to a prescriber when there might be a medication interaction. That's extremely helpful. While this is not 100% foolproof, this type of decision support has really been terrific.

We're also very fortunate to have pharmacists on our team. When we think about team care and the system, that's really critical. One of the other things that we know is that patients don't always use the same pharmacy. If you have a prescription filled at your local pharmacy, very often that system will alert a pharmacist to some interaction with another medicine.

When patients are using different pharmacies that may not have the complete reconciled medication list, that can often be challenging. So it does rely on us as the provider.

In geriatrics, we use something that's called the Beers Criteria, B-E-E-R-S, named after a well-known geriatrician, Mark Beers, who identified drugs that are generally not considered safe for older adults. Many of us have that built into our electronic health record, but we also walk around with index cards and train students around that, to really understand what those Beers medications are that you should never be ordering for an older adult.

Pathak: That's such an important point. Can you share a few examples of those medications for our listeners, about potential medication interactions?

Flaherty: A lot of them are pretty common medications in older adults. Some medications that we use for incontinence, like oxybutynin, we have to be careful with, and it's prescribed pretty readily. A lot of psychotropic medications—one of the most harmful things is that Tylenol PM has something called Benadryl in it, or diphenhydramine, and that's an over-the-counter drug that can often lead to delirium and cognitive issues.

That's something we often have to educate our patients about—that just because it's an over-the-counter medication doesn't mean that it's safe.

Pathak: I'm really glad that you mentioned that. Talk to us a little bit about some questions or concerns that listeners might have when they're discussing their medications with their healthcare provider, especially if they're wondering about scaling back on multiple medications without impacting the effectiveness or outcomes with regard to their health.

And really, it's interesting because as people age, there are different criteria for things like diabetes management and blood pressure. So how strict do we need to be as we age?

Flaherty: This takes a lot of conversations with patients to talk to them about what matters most, right? And Dr Pathak, I'm sure you'll empathize that very often, in the general adult population, something that, to good credit, is really focused on is hypertension and diabetes, and a lot of metrics focus on that.

But often with our patients, it's not that they're not concerned about their blood pressure or diabetes, but they're much more concerned about the numbness in their feet, which may be neuropathy or another neuropathic condition, or issues with their bowels. So getting back to what matters most, looking at that medication list and saying, “Are there medications here, based on what matters most, that we could slowly think about decreasing the dose of, or stopping altogether?”

Again, we rely heavily on our pharmacy colleagues to really help us with that because it does take time and conversations with patients who have often been taking these medications for years and are really concerned about stopping them.

Pathak: I think that's such an important point as well, and this is where I stress the importance of proactively bringing medication questions to your healthcare provider. It's important for older adults listening to this episode, but also important for this to be a discussion with family members and caregivers.

I find that sometimes older adults are really hesitant to give up a medication that they've been taking for a really long time. I see this often in some of the patients I work with, but then conversely, I have some older adult patients who are really asking to eliminate as many medications as possible, almost at any chance that they get.

So it's really a critical conversation that needs to happen.

Now let's move on to the third M, which is the mind. When we're talking about the mind, we're looking at a spectrum of things—from mental health and cognitive impairment to the impacts of medications and medical conditions.

Before we go on, I'd like to remind our audience that cognitive changes are a natural part of aging, but just because that's part of our experience later in life doesn't mean the experience is the same for every one of us. That's really the key: understanding our baseline through regular visits with healthcare providers and then communicating concerns about changes to physical health, mental health, cognitive issues, and the medications we're taking.

Can you talk to us about how cognitive impairment, delirium, and depression impact older adults, and how we can start discussing this during routine visits with a healthcare provider, particularly for under-resourced adults? What are the options for this type of assessment?

Flaherty: I'm sure many people have heard about something called the Medicare Annual Wellness visit. This is actually a free visit that's provided by Medicare, that started back in 2011 as part of the Affordable Care Act. The Medicare wellness visit is really a screening visit that focuses on prevention and health promotion, and part of that is to assess somebody using standardized tools to assess their cognition and to assess their depression.

So these are annual visits, free to the patient, and many states around the country are really looking at that mechanism to identify anybody who has cognitive impairment. And I think that has become increasingly more critical as we have treatments—and as treatments are developed—to be able to identify somebody who has any cognitive impairment.

Pathak: Many of our listeners might be unfamiliar with the types of diagnostic tools and assessments that are used in visits with their doctor when it comes to the mind. Some people have mentioned that in regular visits with their healthcare provider, a form is put in front of them without any explanation, and it has questions about their mental health.

You and I know that's the PHQ-9, or sometimes the PHQ-2, but sometimes what it is and how it can help the patient isn't actually explained. And understandably, they might be self-conscious, concerned, or feel nervous about the stigma associated with a mental health need. So can you help clarify what they can expect in a visit with a healthcare provider who's assessing their mental health?

Flaherty: So we do use these standardized tools, and some of them are more screening tools versus diagnostic tools. We use tools like what we call the Mini-Cog, and we ask each person about a number of different cognitive domains, including recall. There's a clock-drawing exercise, and we can follow that over time, even though that is a screening tool—similarly to how you would assess somebody's blood pressure.

So we do use the Mini-Cog over time. For depression, probably the most widely used tool is something called the PHQ-9. The beauty of that test is that there's a shortened version of it, so you can just ask a few questions about their self-perception of happiness and wellness.

If they don't answer positively, then we move on. If they do, then we move into asking more questions for the full PHQ-9 and identifying that. And I think the most important piece of this is that there is treatment. Right? We know that by treating people for depression, their risk of developing further cognitive impairment and their overall well-being goes up. So that's really the key to screening.

Pathak: I am really glad we're taking the time to hone in on the mind piece because there's so much to think about here. Sometimes, when these shifts occur, they can be alarming, abrupt, and impact the person's safety and quality of life. So I'm thinking specifically about delirium here, which, in the setting of an infection, is potentially something that is going to resolve. But sometimes cognitive shifts can be the result of something more long-standing, like mental health issues or cognitive decline because of dementia.

And that can be really confusing for caregivers. Their loved one might be shifting or changing slowly, and then there might be this rapid acute change. Can you talk to us a little bit about delirium and walk us through how this impacts older adults? And what are some of the red flags that caregivers may notice if their loved one is having an episode of delirium?

Flaherty: Delirium is an acute change in mental status, and that's really critical for us because that is often the first indication that something else may be going on—another medical issue.

We also see, conversely, that patients who get admitted for medical issues can develop delirium. This can be very subtle, so we need to use standardized tests, both in the emergency department, for example, and inpatient. We have to use these tools every single day, sometimes twice a day, to ensure that patients are not experiencing delirium. Because again, there's more treatment for that, and we know that short-term delirium can actually lead to more long-term memory issues.

So it is absolutely critical that we, first and foremost, listen to caregivers and family members who say, "My dad is not right. This is not how he usually acts."

Pathak: You know, in a previous podcast episode, I mentioned that when my father was hospitalized, it was in the setting of delirium. I thought it was really important for his healthcare team to understand the whole picture of who he was. Because sometimes, when a clinician is looking at their patient's chart, they see the numbers, they see the age, they see the patient presenting with certain symptoms.

They may start creating a story about this person and what their assumed baseline is. It's not intentional, but they're piecing together information based on what's in front of them at that particular moment. And it's understandably difficult to take the whole person into account or to understand what their baseline actually was, what they're expecting to get back to, or what their loved one is hoping that they'll get back to.

In my experience with my father, I was the caregiver, and in that moment, I felt the best way I could advocate for his needs was to make sure that everyone who saw him had a full understanding of who he was as a person—what he could do just a week before his hospitalization. I couldn't be at his bedside 24 hours a day, so I decided to put together pictures of him on a poster board. It was almost like an "All About Me" visual guide for any healthcare provider who treated him.

These photos were just of him being active with his grandchildren, and I even included text at the bottom saying, "This was me just two weeks ago."

The reason I'm sharing that is because it's so important to communicate and advocate for our loved ones and ourselves as caregivers. It becomes that much more complicated when we're talking about the mind and navigating this acute shift. It helps us clarify with ourselves, our loved one, and the care team that the goal is to return to his previous level of functioning.

So now I'd love to shift to that final "M," which is mobility. Can you help us understand why it's so important to maintain or improve physical functioning as we age, and how safety concerns or old habits come into play?

Flaherty: So when we talk to older people in general, we ask, "Where do you want to be in five years? Tell us about where you want to live." Most people want to live at home. Most people want to be independent.

One of the biggest fears people have is being dependent on others. Being able to be independent and live in a site of care like your own home requires being able to get around. While we certainly know that many people are wheelchair-bound and live at home, it's really critical for people to be able to be mobile and get around in order to live safely at home.

So that's tying those M's together. What matters most? It matters to me that I can be independent, that I can live at home. And that comes into talking to people about moving—how critical it is to have people move around for a whole host of reasons, but really to meet their goals of care and where they want to live. It's really critical.

Pathak: What can older adults expect when they discuss mobility with their healthcare provider? How is mobility assessed, and how do you identify mobility goals? In that mix, can you describe how fall risk is determined and discussed with patients? I'm asking because I think it's empowering for listeners to understand the process, the tools, and the goals so that they can participate in shared decision-making with their healthcare provider.

Flaherty: So we use some very simple screening questions. We ask people if they have had more than one fall, or a fall where they had a serious injury over the past year, or if they have a fear of falling.

If a person responds "yes" to one of those questions, then we move into doing more balance testing. That can be pretty simple as well. It can be everything from walking speed to simple sit-to-stand tests that we can easily do in the clinic.

Then, based on that, we can actually use some motivational interviewing techniques to talk to people about enrolling in an evidence-based falls prevention program. Today, not only do we have those in person, but those programs can be participated in remotely, very often in environments with little or no cost.

Pathak: Can you share some examples of activities or programs that offer balance exercises, muscle strengthening, or assist in reducing fall risk? Sometimes these programs include alternative modalities that might be new to our listening audience. So let's unpack some of those resources.

Flaherty: Yeah. We offer a number of programs here at Dartmouth, but we offer a program called A Matter of Balance. That program, while it includes some exercise, actually focuses on helping somebody reduce their fear of falling because we know that is a very big risk factor for falling.

We encourage people to participate in something called TJ Kwan Moving for Better Balance. That's Tai Chi, really focusing specifically on balance. Folks can participate live, in person, or remotely. These are just two programs that are supported across the country by a number of different grants and opportunities.

Pathak: I imagine that for many of our listeners who are older adults, the idea of changing their routines or incorporating more physical activity might seem overwhelming or unnecessary at this point. Maybe they haven't had a fall yet, maybe they have full mobility, and it might seem like we're talking to someone else and not to them and their specific situation. But I'd really like us to drive this home and discuss why it's so important to maintain proactive movement versus reactive movement after a fall or a mobility challenge. Why is it so important to start now?

Flaherty: So what we know is that, for example, we talk a lot about steps, right? People have Fitbits, and we strongly encourage people to move around and to actually measure how much they're walking. And that really enables people to see, just like when we encourage somebody to drink X amount of ounces of fluid a day, well, that is a very prescribed measure, just like your steps. So not necessarily even engaging in going to a gym, but moving around safely, just by walking, is absolutely critical.

Pathak: Can you share examples from your own experience from your clinic around the importance of mobility and how you have encouraged that in a patient of yours?

Flaherty: So, I have one particular patient. I would say COVID had such a significant impact on her life, not due to her own illness, but the social isolation. And what that did was significantly reduce her mobility, right? She didn't go out much. She just walked around the house, and she was so fearful.

And what happened, even in that relatively short period of time, is that she sustained muscle atrophy, right? Which means that her muscles got pretty weak, which then made it more difficult for her to walk. And so the conversations that we had, again, back to those four Ms, is that she actually had some depression.

So this immobility, this fear, led to her not being able to walk, not being able to get out as much, and then leading to social isolation and depression. We referred her to the area senior center, where she could not only engage in some exercise classes, but she would have some companionship and get out of the house.

So that was really, really critical for her to get back to being more mobile and also to be less socially isolated.

Pathak: And now I'd love to ask about resources. For example, the My Health Checklist, which I think is a fantastic resource that's available through The John A. Hartford Foundation. And for listeners who might be unfamiliar with this, the My Health Checklist is a workbook that supports people 65 and older in preparing for healthcare appointments.

It helps them think through all aspects of their health, from what's going well to what could be better, and highlights their questions and concerns. The tool also helps older adults prioritize their top questions about what matters most to them for more productive conversations during medical appointments.

We'll be sure to provide a direct link to this resource in our show notes. So can you share a little bit more about how you use this resource?

Flaherty: So this is a very specific tool that was developed by The John A. Hartford Foundation around the four Ms, and is available in a number of different languages, and can easily be accessed through the internet and downloaded.

It really empowers people to not only control what happens to them, but to really have that dialogue and be an educated consumer with their providers. And that really helps when patients actually demand four M care and really educate providers as well as to what that means.

And that's one tool that can really help empower people. So I really strongly recommend that. And as a provider, as I'm sure you would agree, it's so helpful when patients come in and they have either a specific list of questions or they're able to immediately share what their concerns are around, again, these four Ms, for us to really help them.

Pathak: How can we, as caregivers or patients who are aging, find providers who are really integrating the four Ms into their practice?

Flaherty: So, practices right now can be recognized by the Institute for Healthcare Improvement to be age-friendly. That demonstrates that they have somehow measured that they are actually providing what we call four M care. And they can do that in a number of different ways, but that designation really helps patients identify and potentially select practices that are considered age-friendly.

As we move forward in terms of acute care hospitals and becoming recognized, Medicare has actually created what we call structural measures for age-friendly care. And really, what that means in layman's terms is that an acute care hospital or academic medical center has to demonstrate to Medicare very specifically how they are providing four M care, and that is tied to their reimbursement. So that has really been a very critical factor, which just started this year, to ensure that hospitals are providing age-friendly care.

Pathak: So critical. I can certainly attest to that as a caregiver myself. I would love finally to end this episode with your key takeaways for someone listening right now so that they can bring this conversation into the office with their provider to ensure that they're optimizing their own health and the health of their loved one in these categories.

Flaherty: We can't reiterate enough that the My Health Checklist is really important. And very often, it does become challenging when somebody has multiple issues—how do they begin to kind of tease away and have those conversations? So using that four M framework: Have you talked to your provider about what matters most? How do you get the conversation started?

There are also many places where you can have advanced care plans completed in communities, which you can, of course, bring in and talk to your provider about. Your advanced care plan and what matters most, of course, mobility and medications, is something that you talk about all the time.

And then ensuring that you're communicating with your provider around concerns about social isolation, loneliness, and feeling down, because there is treatment. So always think about it as having a conversation with a team. Very often, when patients call, they speak to another member of the team.

So I encourage patients to call the office and potentially talk to even the medical assistant or the nurse to say, “These are my concerns. Do you think you could alert Dr X that I'm having these concerns?” And that is also a good mechanism to communicate back and forth with the entire team.

Pathak: So critical. I think as you were speaking, what resonates with me is sort of “what gets mentioned gets managed.” So if you mention it, if you bring it up—maybe that's a fifth M—it is to mention these four Ms so that you can work together with your care team to ensure that you're optimizing all of these.

And the Ms, again, for everyone listening, are one: What matters, two: Medications, three: The mind, and four: Mobility. And I want to thank you so much, Dr Flaherty, for this very important conversation.

Flaherty: Absolutely. Thank you for having me.

We've talked with Dr Ellen Flaherty about the four Ms of age-friendly care. My key takeaways from this discussion are: first, the importance of viewing your healthcare needs and goals through the lens of the four Ms, and using the four Ms or resources like the My Health Checklist as both a foundation and guide for every healthcare visit.

Pathak: These four evidence-based pillars lower complications, shorten hospital stays, and reduce readmissions. Second, a perspective shift can drive a lifestyle shift. Swapping fall prevention for mobility promotion encourages us to take a proactive versus a reactive approach to our health and wellness.

Third, it's important to recognize that our needs, goals, and baselines will shift throughout our lifespan. So it's really important to recognize what matters most and to be able to have regular and clear communication with your healthcare providers. It also means availing ourselves of resources and best practices: everything from brown bag events for medication assessments to support groups, to evidence-based resources, from monitoring our healthcare milestones, understanding our baselines, and then recognizing our needs.

And finally, age-friendly care is healthcare that is safe and based on what research shows us are the most important things to pay attention to as we get older. It can help us enjoy a better quality of life. So it's not just about the conditions that are being treated, but all of the things that matter the most to you.

We hope that today's discussion encourages all of our listeners to think about ways to incorporate the four Ms into their healthcare experience, to advocate for their needs, and clearly communicate them with a healthcare provider. To find out more information about The John A. Hartford Foundation, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform.

If you'd like to send me an email about topics you are interested in or questions for future guests, please send a note to [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered Podcast.