Breaking Down Rheumatology w/ Dr. Rubaiya Mallay

Episode Information

June 8, 2021

Rheumatologist Dr. Rubaiya Mallay talks about her childhood adventures in Bangladesh and around the world, the specifics of autoimmune diseases, the challenges she faces in her work life, her love for laughter, and more.

Topics Include:

• Her memories from her childhood in Bangladesh and around the world
• Her introduction to rheumatology
• The specifics of autoimmune diseases
• New advances in the field
• The difficulties of juggling several roles at once in her profession
• Her experiences doing mission work in South America
• Her approach to interacting with her patients
• How she plans to contribute to Doctorpedia’s Rheumatology channel as CMO
• Why she believes in Doctorpedia
• Her favorite podcasts
• Her love for laughter

Highlights

• “When [my aunt] was going through med school, she had brought a box of bones, human remains, and she had put it under my bed and instead of being scared about it, I was like, “Oh, this is really cool!”
• “I always say that autoimmune diseases can not be cured, but we can certainly put it into remission or put it to sleep. So that’s my goal every day for my patients: what can I do to put your disease into remission and not have any other damage down the road?”
• “Sometimes you may not have the physical evidence [of an autoimmune disease]. You may look great outwardly, but you have a lot of problems going on inside.”
• “I think the one thing that we shouldn’t do is give [a patient] false information.”
• “I think just laying out what’s ahead, being truthful, is the best way to approach rheumatology and supporting your patients and helping them understand, and not to lose hope. Because there’s always something out there that we can do for sure.”
• “I’m not here to judge anybody. We all have issues. But I’m here to help. I never want anybody to not come see me because of guilt or not. I just want to be honest, and then we can move forward.”
• “Oftentimes, you have to click on 10 million things and you just don’t have the answer. I think it’d be nice to have a nice, easy channel or platform that you can go to and trust that information [that’s] coming straight from your doctor’s mouth.”
• “[My job is] serious business, but we don’t have to take it that seriously. So as long as we are doing what we’re doing, we can still have fun and enjoy ourselves.”

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs. Hello, and welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell, and I’m honored to be joined today by Dr. Rubaiya Mallay, how are you?

Dr. Rubaiya Mallay: (00:33)
I’m doing wonderful. How are you?

Daniel Lobell: (00:35)
Good, good. And I understand I’m talking to you and you are located in beautiful Florida as we speak, where a lot of people are moving I think by the day, by the hour… is your space getting cramped there? [Daniel chuckles]

Dr. Rubaiya Mallay: (00:53)
Yeah, we already had a lot of old people. It’s nice to kind of even it out with some young folks coming in and taking over the roads, but yeah, for sure. Traffic’s definitely getting busier.

Daniel Lobell: (01:09)
I wonder if the old people are upset about it, they’re like, “Hey, this was old country!”

Dr. Rubaiya Mallay: (01:16)
[Both laugh] I think they like it. I think they like it.

Daniel Lobell: (01:20)
So I like to start at the beginning with all the doctors and hear your story before we get into what you do. I like to know about the “why you do.” So where did you grow up?

Dr. Rubaiya Mallay: (01:35)
Yeah, I actually was born in Bangladesh. I was raised pretty much all over the world, so I was born in Bangladesh and then we moved to England from there. My dad finished his education in England. So we lived there for few years and then thought that most of my family’s actually in the States, so why not move there? So we moved from England to the States, grew up in New York. I was there until high school. And then moved further south to North Carolina to do some of my undergrad education, and then Virginia and now Florida. So it’s kind of, started on the East Coast and kind of worked my way down to Florida.

Daniel Lobell: (02:23)
Yeah. You really have been all over the place, huh? How was that for you as a kid? Was that exciting or did it make you feel unstable? I’m guessing different possibilities. What was it for you?

Dr. Rubaiya Mallay: (02:38)
Oh, it was just so much fun. I just remember, when we were in England and I was telling my friends I’m moving to the States, they just couldn’t understand why. And it’s funny, like now I look back, I remember one of my classmates was like telling me that if you ever have the electricity go out, you’ll get robbed. [Rubaiya laughs] So they’re like, just make sure the lights are always on. So I always was afraid that one day the lights would go off and we’ll just get robbed. So it was just funny what people thought, what the Brits thought of Americans and how different really it is when you move. But yeah. Me and my sisters — I have two sisters — it was so exciting. It was so fun to live in different parts of the world. It definitely gives me a different lens where, look at being a doctor and my patients, I certainly can relate to, we have a lot of people from all over the world in Florida, they all settle here. So it’s kind of fun to share stories and go from there.

Daniel Lobell: (03:52)
I can imagine. And what a tight bond you must have formed with your family. Having been on the road, you guys kind of were like groupies in a rock band with your parents.

Dr. Rubaiya Mallay: (04:07)
[Rubaiya laughs] Yeah. And it’s funny because that’s exactly how we describe ourselves. I don’t know. My dad just likes to move. Even after we moved to the States, they’ve lived in different — my father has moved my sisters to other states. I always said I got off the bus early when I went to college and I didn’t move around as much, but my youngest sister had to move the most. But we learned a lot.

Daniel Lobell: (04:35)
And what do your parents do?

Dr. Rubaiya Mallay: (04:37)
I know that you would think they did an amazing job. [Daniel chuckles] My dad is a college professor and he teaches accounting and finance. So it really is like the most… It doesn’t require traveling at all. And he wasn’t like a scientist or…

Daniel Lobell: (05:00)
So he was just itching to get around, that’s it. He was just like — and I respect that. I mean, if we only have one life, as far as I know, he may as well experience as much as he can of it in this world and see as much as he can, live as many places as he can. I like that theory. I like that philosophy. I think your dad was onto it.

Dr. Rubaiya Mallay: (05:23)
I think so, too. [Rubaiya chuckles]

Daniel Lobell: (05:26)
So what inspired you, the daughter of an accountant, or a professor who teaches accounting, to go into medicine, which seems like a very different kind of field?

Dr. Rubaiya Mallay: (05:42)
Yeah, for sure. I really had a lot of exposure to medicine, obviously, there’s always a hospital around and I just had one of my family members that were going into medicine and I just — I would sometimes bring — my aunt in particular when she was going through med school, I just remember she had brought a box of bones, human remains, and she had put it under my bed and instead of being scared about it, I was like, “Oh, this is really cool!” So I just thought —

Daniel Lobell: (06:24)
I hope that that’s true. I hope that’s not just the story they told you. [Daniel laughs] “Why is there a body under my bed?!”

Dr. Rubaiya Mallay: (06:33)
Not body parts, but old skeletal remains under my bed. And I just thought that was really cool that you could take care of a human, but also know every little part, inside and out. So that’s really what got me really interested in learning about human anatomy and I’ve always been a people person. I love just helping others as a prototypical doctor, but my field in general, rheumatology, it’s looking at diseases, autoimmune diseases, and how it affects your bones. So from a very young age, I’ve always been kind of interested in the human anatomy and —

Daniel Lobell: (07:23)
Well that’s the best outcome that you can hope for when your kid is into skeletons, I think. Right?

Dr. Rubaiya Mallay: (07:28)
Yeah, right! [Rubaiya laughs] I could have definitely gone another direction with all this traveling.

Daniel Lobell: (07:34)
That’s like the beginning stories of a world-class doctor or a psychopath, you know?

Dr. Rubaiya Mallay: (07:40)
[Both laugh] Right. Yes. I definitely went down the right path, I believe.

Daniel Lobell: (07:45)
Or somebody who runs a Halloween store. I don’t know. [Both chuckle] But when I think of rheumatology, I would be remiss not to bring up the fact that I had an ex-girlfriend who passed away from an auto immune deficiency.

Dr. Rubaiya Mallay: (08:03)
Oh, wow. That’s awful.

Daniel Lobell: (08:04)
And so I can’t even talk about it without thinking about that. So rather than sort of skate around it, I’d rather bring it up and sort of face it head on with you. How common is that? Because I don’t know any other cases like that, is it fairly deadly in general?

Dr. Rubaiya Mallay: (08:28)
Yes. And I’m going to guess that you are pretty young from your voice. It affects young people, that we oftentimes think that autoimmune diseases, arthritis, is really what — rheumatoid arthritis is something just, as you get older, you get, something of the elderly, but it really — I have patients as young as 19. You can be born with an autoimmune disease. Children can have autoimmune diseases, but certainly it peaks in your teens and twenties. So yeah, it could be a very deadly disease because, when you’re young, you don’t think, and you can have bad health, right, you just go about your business. You have so many things going on and it certainly can be very deadly if, number one, you’re not diagnosed properly, or if you get to the doctor too late. And even with proper diagnoses, sometimes people have really bad autoimmune diseases and it can certainly lead to early death.

Daniel Lobell: (09:34)
So because I happened to have this unfortunate experience in my life to reflect on, I do know a little bit about autoimmune diseases, but I imagine the average listener doesn’t. And it might be helpful to have you kind of break it down. What is it, for their sake?

Dr. Rubaiya Mallay: (09:55)
So under the umbrella of autoimmune disease, and the way I kinda explain it to my patients is that that your immune system is there to protect you, right? So if you get a virus, if you get a bacterial infection, your body can pretty much get rid of it. But with autoimmune diseases, what happens is that your immune system turns against you and depending on what disease you have —

Daniel Lobell: (10:27)
It’s a traitor.

Dr. Rubaiya Mallay: (10:27)
Yeah, exactly. You become the bad guy. And so it’s just constant attacking your own body. So you are fighting yourself and oftentimes you could have very, very mild symptoms. One of the most common ones is fatigue, tiredness. I mean, who’s not tired, right?

Daniel Lobell: (10:49)
By the way, half the listeners now think they have auto-immune diseases.

Dr. Rubaiya Mallay: (10:54)
[Rubaiya laughs] I know. Exactly. We’re all tired. But yeah, it is when your body turns on you basically, and all our meds are made to reverse that path, and make your immune system realize you are not the bad guy. And get you back to some type of balance.

Daniel Lobell: (11:17)
I imagine your field is front and center right now in the conversation in the medical world with regards to COVID-19.

Dr. Rubaiya Mallay: (11:24)
Absolutely. It is. And I’m sure for every — this is a novel disease where you have so many questions. They certainly have tried initially, obviously, they’ve tried some of medicines we use in rheumatology to see if it will help with the disease. But yeah, I mean, it is a topic of conversation for many of us, hours on end, for sure.

Daniel Lobell: (11:53)
What are some of the most common questions you’re being asked with regards to that?

Dr. Rubaiya Mallay: (11:58)
Yeah. So given that if you have an autoimmune disease, right, I have to put you on a medicine that we call as an immunosuppressant. So we lower your immune system. One of the myths or mis-characterization of auto-immune disease is that you are sick all the time. It’s actually the — in the sense that your immune system is too low. But in an autoimmune disease, your immune system is actually overactive and we need to like calm it down. So any medicine that we give you has to lower your immune system. But we don’t want to overlower it where you are more prone to infection. So we want to kind of get it to a balance where your immune system is not attacking you, but we’re not lowering your immune system so much where you’re more prone to infections. And so the question was — of course, is, still, — when you have a virus that our body has never seen before, what do I do about my medication? Am I at a risk by continuing a medicine that’s going to suppress my immune system, which is going to make it harder for me to fight the infection if I get it?

Daniel Lobell: (13:09)
What’s the answer? Is it a question mark, still?

Dr. Rubaiya Mallay: (13:12)
Ah, yes. So the answer is you should continue your medicine. Because when you are — when we have your disease under control, your immune system is actually now more open to fighting other things. So if you stop your medication, you’re actually at a higher likelihood of having worse outcomes because you stopped your therapy. So for the most part, most patients should continue their therapy.

Daniel Lobell: (13:44)
What do we understand about how people develop an autoimmune deficiency in the first place?

Dr. Rubaiya Mallay: (13:52)
So, I have a lot of patients that say “Why me?” or, “Why my daughter?” And so we actually don’t know what causes your immune system to just one day go haywire. We don’t know that. There’s some theories, it could be a possible infection. It could be… There’s some research with cigarette smoking, could make things worse. So there are some infections that could make this worse. But most patients are born with the genetic makeup for an auto-immune disease and something down the road will activate this, this process. A lot of stress can do it. I’ve seen, whether it’s mental or physical stress, something that your immune system doesn’t quite know what to deal with, do with, and then kind of progresses into the, I just call it, waking up your immune system. And unfortunately activating like an inflammatory process.

Daniel Lobell: (14:58)
Is there a way to put it back to sleep that we found? Is there a way to reverse that?

Dr. Rubaiya Mallay: (15:03)
Exactly. And that’s our job as rheumatologists. I always say that autoimmune diseases can not be cured. We have no cure, but we can certainly put it into remission or put it to sleep. So, yeah, that’s my goal every day for my patients, what can I do to put your disease into remission and not have any other damage down the road.

Daniel Lobell: (15:27)
I think there must be something exciting about being a doctor in a field where they haven’t found a cure for what you’re working on. Because in the same way that I think when we accomplish our personal challenges, while it feels great, there’s also this feeling of like, “Oh man, well, I went over that hurdle, right. But now it’s not there anymore. I don’t have that.” That’s why I think so many wealthy people get depressed because they’re like, “I did it!”

Dr. Rubaiya Mallay: (15:54)
“I got it all!” Yeah, I agree.

Daniel Lobell: (15:54)
Is there some kind of excitement being in a field where there’s so much still to figure out?

Dr. Rubaiya Mallay: (16:02)
Yes, absolutely. I’m part of a teaching program with a lot of residents and students and I tell them like this every week, once a day, I learn something new myself. And we even have new diseases that we’re naming, in 2020, 2019, we’re still like, “Oh, we should call it this!”

Daniel Lobell: (16:27)
Hal? Has that been taken?

Dr. Rubaiya Mallay: (16:27)
With all the stuff we have [Daniel laughs] we are still coming up with new diseases.

Daniel Lobell: (16:35)
Ronny! [Daniel laughs]

Dr. Rubaiya Mallay: (16:35)
[Both laugh] Right. Let’s call it that. It is super exciting. And the other thing too, is that we have really advanced in this field. So my partner’s been in practice for the last 35 years and he would tell me, “Oh, I just had one or two things I could provide for my patients.” Now, if you watch TV, there’s ads for the medicines I use. And there’s tons of research because we know that it affects young people. And we’re living longer. So we’ve got to keep our people safe and healthy. So it is very exciting to be in rheumatology right now because I have options to give my patients that’s not one or two, after that you’re done. So I have a lot of great things to look forward to for my patients.

Daniel Lobell: (17:33)
Is there a point, I know you mentioned often it’s people in their teens or twenties that start to show the symptoms. Is there a point when you’re like, “You know what, I think you’ve crossed the line there in terms of us worrying about you.” Is there like an age where you say, “Okay, don’t worry anymore. I think you’re okay on this one.” Or does it show up for some people later in life?

Dr. Rubaiya Mallay: (17:55)
Yeah. The oldest person I’ve ever diagnosed with at age 94. I mean, 94. That was the first time he had symptoms. I mean, he probably had symptoms, but not enough to come to a doctor, but at 94, his daughter was like, “You got to help my dad.” So yeah, like I said —

Daniel Lobell: (18:19)
You’re never really in the clear.

Dr. Rubaiya Mallay: (18:21)
You’re never, unfortunately, in the clear. So you do have to be monitored pretty closely.

Daniel Lobell: (18:29)
94… Man, that guy put things off. He must’ve been a real procrastinator.

Dr. Rubaiya Mallay: (18:32)
Yeah. Yeah. But he did great once we got him on the right therapy.

Daniel Lobell: (18:36)
Thank God. And good work. [Rubaiya laughs] Let’s talk about arthritis. I know you were fascinated with bones. As far as I understand, arthritis is sort of like, your fingers start wrapping around each other. How is it that bones are so solid in some people and stop growing, and then in other people they just decide to look like the roots of an orchid?

Dr. Rubaiya Mallay: (19:05)
Yeah, exactly. Yeah. We don’t know, why some people have it so bad and some people do okay. And then you can have your fingers look like a tree root and have zero pain, and you can have one little joint that is angry, but it causes severe pain. So there’s no consistency there. It’s just, everybody is so different in how they present and how their disease progresses. And sometimes they could have a lot of joint deformities and have very little pain or vice versa. So a lot of times I have some of the drug companies ask me like, “What’s your number one drug, which one do you use every time?” And I say, “I don’t.”

Dr. Rubaiya Mallay: (19:54)
There’s every case, every person is different. I don’t have like a, “Every person that comes in with rheumatoid arthritis is going to get A, B, C, or D.” I don’t. Every person is different and their disease is going to be very different. Which makes it fun. And the other part of rheumatology I love is the connection I have with my patients. A lot of times I’m seeing mom, dad, grandma, two kids, because oftentimes these diseases run in families, but I get to meet the whole family and take care of them. So it’s definitely been a very fulfilling journey in the field of rheumatology to be able to do that.

Daniel Lobell: (20:35)
That’s really fascinating. I never thought about that in terms of genetic disease, but I guess there must be some comfort in, “Hey, we’re all in it together,” you know? Piling into the minivan, we’re all going to the doctor.

Dr. Rubaiya Mallay: (20:47)
[Rubaiya laughs] Exactly.

Daniel Lobell: (20:47)
Rather than, in the case of my ex-girlfriend, may she rest in peace, I think she felt alone because no one else in her family was dealing with it. And I don’t know that she knew any people…

Dr. Rubaiya Mallay: (21:03)
And that’s another aspect too. A lot of times, I heard that too. Like if you are the only one, or if you are a young person, sometimes you may not have the physical evidence you know, for example, lupus. You can have what’s called lupus nephritis. You can have kidney inflammation from lupus, but outwardly you look great. And so that’s often a problem too, that, “Hey, I feel terrible.” Or, “I have to get dialyzed,” or something. I have to go do whatever. But my work doesn’t understand, or my family doesn’t understand, my school doesn’t understand. So I see that too, where you may look great outwardly, but you have a lot of problems going on in the inside.

Daniel Lobell: (21:57)
How much of your job is supporting people emotionally?

Dr. Rubaiya Mallay: (22:03)
Oh, I always say I’m a part-time psychiatrist and a part-time marriage counselor or a lawyer, I’m all of it. And I’m up for the challenge because this is a disease, like I said, it has no cure, so you’re going to suffer all your life. So you’re going to have different — if I diagnose somebody in their twenties, what do we do when they’re pregnant? Like you have to change therapies. What do you do when they travel? Like, we have to constantly put a lot of thought into their therapy. And I will do whatever it takes to make sure that the patient has the meds they need and the support. And my staff too, we know — we get a lot of phone calls. I have to have extra staff just to get phone calls and talk to patients. Because they do need a lot of hand-holding, but that’s okay because it is a complex disease. And a lot of it doesn’t make sense sometimes.

Daniel Lobell: (23:10)
Very, very frustrating, speaking from the experience of being with someone who had it. It’s so frustrating because they don’t have many answers to give you. So you go to the doctor, you want the answers, you want to be like, “It’s this and this and this.” And when you go in, and I remember with the case of my former girlfriend, that they didn’t have answers. And that would frustrate — I’m sure it frustrated her endlessly. It frustrated me as somebody who loved her and was like, “Come on, what do you mean they have no answers? What are they doing all day?” Come on! And it’s gotta be so difficult to tell a patient that. I’m older now and hopefully a little more mature, and I understand specifically with working with doctors that, yeah, there are no answers for some things, and it’s just about trial and error, but when you’re in that situation and you’re emotional and you’re dealing with the pain and fighting for your life, being told there’s no answers seems like an unacceptable answer. How do you handle that?

Dr. Rubaiya Mallay: (24:20)
You know, I think it all depends on the relationship you have with your patient. And relationships are very important to me. And I tell them the truth. I think the one thing that we shouldn’t do is give somebody false information.

Daniel Lobell: (24:42)
False hope.

Dr. Rubaiya Mallay: (24:42)
Yeah, exactly. And I always say, rheumatology is a field that there’s a lot of research going into and we will find an answer. I might just not have it today. And it can also happen where somebody comes with a whole bunch of symptoms and right then and there, I don’t have the answer as to what they have. But I always tell them like, “Hey, I’m going to search, do whatever I can to come up with what I think is happening to you. I might not have it today. I might have it a few months from now, who knows.” And so I think just laying out what’s ahead, being truthful, is the best way to approach rheumatology and supporting your patients and helping them understand, and not to lose hope. Because there’s always something out there that we can do for sure.

Daniel Lobell: (25:40)
What would you say has been your single greatest achievement as a doctor?

Dr. Rubaiya Mallay: (25:48)
Single? Goodness gracious. I don’t know if I have a single anything, really. I see patients in the hospital, I had a 28 year old girl who was flown in and she just — I honestly didn’t think she was gonna make it because she was so bad and was just already hospitalized for four weeks. She had a disease called vasculitis where literally every blood vessel is inflamed. And she walked out of the hospital. She was a hairdresser. She was cutting hair in the hospital, in rehab. So, I mean, that’s amazing. She came in just obtundent. Flown in. And she was giving haircuts at the end and walked out and went back to being a hairdresser. I have tons of stories like that, but it’s just, it’s a team effort. I wasn’t the only one. But when somebody is so sick and they can go home and live their normal life, that’s pretty amazing. So I don’t have a single one. I have lots of stories.

Daniel Lobell: (27:08)
Yeah. And that story is moving and I can see how that would be an incredible moment to — an achievement on your end, to be a part of that. I know also that on the other end of this spectrum, you probably have stories where you have unfortunately lost the patient. Do you have a hard time with that? Do you get attached to your patients and to their treatments and how do you handle it when things don’t work out as well?

Dr. Rubaiya Mallay: (27:44)
Yes. I get very attached to my patients and it is difficult when you hear that somebody didn’t make it. And it’s of course even harder because most of my patients usually come with a family member. Because that’s just how it is. And so I always, not only for the patient, I always worry and I feel so empty and sad for that family member that usually comes. But it’s, it’s life, right. It’s the cycle of life. Some of us make it, some of us don’t, but you want to — me as a physician, I want to make sure that your time, you don’t suffer needlessly. So I do the best I can to help get you through whatever hard times you’re going through.

Daniel Lobell: (28:46)
I have here in my notes that you also did mission work in the different countries that you worked in, which I think is interesting. I’d like to hear a little more about that.

Dr. Rubaiya Mallay: (28:56)
Yeah. The most exciting — so I traveled through undergrad. I was always, growing up, I was born in Bangladesh, so I know my language and I was always also really interested in different languages. So I really wanted to pick up Spanish. So in college I went to Spanish speaking countries so I could learn. And so then in med school, my dean was really into helping actually establish a clinic. So one of the things that is often said about these mission trips is that you go there help people and you leave. And so those people get some meds for a month or two, but then you never come back. So my dean’s approach was that we’ll go there, but we’re going to establish a clinic.

Dr. Rubaiya Mallay: (29:56)
So that way those people can come back and get help. And so all throughout med school, I was able to not only go there to establish these clinics, but return, and that way you were really able to help these patients up in the mountains where they didn’t really have a lot of healthcare, but they were able to come back and then the local doctors also volunteered there. So it was a great combination of being able to, number one, see disease states that we probably will not see in the States, and talk about being thankful. Those patients, those people are so thankful. It was just a really life-changing experience, and I went back multiple times to different countries just so I can contribute to the healthcare there.

Daniel Lobell: (30:49)
Unbelievable. That’s such a testament. If I ever need a doctor and I always pray that I don’t, I think it would be great to know that the doctor I have is so passionate about what they do, that they’re going around the world and helping people. I mean, what a great testament to your love of what you do. I think that’s fantastic.

Dr. Rubaiya Mallay: (31:12)
Yeah. I mean, I grew up, I was born in a third world country, and so I’m lucky. I’m lucky that I was able to come to the States and get a great education. And so I feel it’s my duty to help others. And any opportunity I get, I would love to go back and help out.

Daniel Lobell: (31:38)
How old were you when you left Bangladesh?

Dr. Rubaiya Mallay: (31:41)
I think I was eight, seven or eight.

Daniel Lobell: (31:44)
So you probably still have memories from those times.

Dr. Rubaiya Mallay: (31:48)
I do. I haven’t gone back in a long time, so I hope to go back sometime soon, but yeah, I certainly do.

Daniel Lobell: (31:57)
Are there any memories that stand out from your time as a child in Bangladesh, that when you look back at them, you go, “Wow. I can’t believe what a difference culturally.”

Dr. Rubaiya Mallay: (32:06)
Oh, well, so actually when we left Bangladesh, that was like one of the most interesting times. So we had like a — Bangladesh is known for floods. And that’s just a big deal they always have. And so it was like one of the biggest floods and here we are getting ready to leave Bangladesh and all the roads are flooded, the planes can’t land. And I just remember — and the water. So we lived in like a three story home and the water completely covered the first story and half of the second story. And so like everybody was moving from house to house in a boat, but first of all, the whole community chipped in and everybody helped each other. But as a kid that was kind of cool. Like now we don’t have streets. Now we have like boats here.

Daniel Lobell: (33:06)
It became Venice.

Dr. Rubaiya Mallay: (33:06)
I was on a boat. Yeah. And I just remember like, wow, finally I think the water subsided at the airports and the planes can land. And so I remember we were like halfway on a boat with all our suitcases and got to the airport. But as a kid that was so fun. But I’ll always remember like just the water and how everybody was just going around in boats.

Daniel Lobell: (33:34)
It sounds magical. Honestly, it sounds…

Dr. Rubaiya Mallay: (33:38)
[Both laugh] I’m sure it was super stressful for my parents, but me and my sisters were just having a ball and it was so cool.

Daniel Lobell: (33:44)
I’m imagining like you’re going, you’re paddling down the street and like tigers floating by on the other side. [Both laugh] Because that’s where the tigers are, right? They’re in Bangladesh.

Dr. Rubaiya Mallay: (33:58)
Yeah, Bengal tigers.

Daniel Lobell: (34:00)
Did you see them growing up? Was that like a squirrel? [Daniel laughs]

Dr. Rubaiya Mallay: (34:05)
No. Unfortunately in the city it’s so crowded, so the tigers obviously are much further away. I hope they don’t make it to the cities, but yeah. I mean, that’s where they’re from and we need to protect those tigers, they’re getting killed.

Daniel Lobell: (34:25)
Yeah. Wow. What a story. I’m just picturing it. It’s like a movie, the water and the whole family says, “All right, we’re moving.” Literally there goes the neighborhood! [Both laugh] We touched a little bit on the doctor-patient relationship, but specifically, what do you think is the most important facet of that relationship?

Dr. Rubaiya Mallay: (34:54)
Honesty. I’m honest with my patients, but I also want them to be honest with me. So I think sometimes patients just tell you like, “Oh yeah, I’m doing A, B and C,” but they’re not. Till their disease gets worse or something happens. So I’m always telling them, I’m not here to judge you. Or I have patients where — and I get it, like they’ve done well, they’re doing great, they’ve done… and so they stop coming to see me, which is not recommended, but I understand. And then when they come back, they’re so guilty that they haven’t seen me for whatever, but it’s okay. It’s life and who wants to be in a doctor’s office all the time? I understand. So that’s what I always say. My doors are always open. And things happen. I’m not here to judge anybody. We all have issues. But I’m here to help. I never want anybody to not come see me because of guilt or not. I just want to be honest, and then we can move forward.

Daniel Lobell: (36:19)
How has COVID changed things with how you interact with your patients?

Dr. Rubaiya Mallay: (36:23)
So COVID has changed a lot. Certainly a lot of times we are just chatting when my patients come and we’re catching up and now they can’t come in, we’re doing virtual visits, which I’m glad it’s something, I’ll be able to get their refills done, look at their blood work and things like that. But we’re missing that human connection. So I do miss it, but I also want my patients to be safe. I have lots of 90 year olds and 94 year olds. I don’t need them to come in right now. So I just tell them to wait. Our time will come to be together. So I do miss that human contact part. My patients do as well, but I always say it’s just temporary. It’s just what we have to do right now. And then we’ll go back to our normal [?].

Daniel Lobell: (37:18)
What do you wish your patients knew?

Dr. Rubaiya Mallay: (37:22)
Well, what I want them to know actually is, I want them to get the vaccine. I have a lot of patients, they’ve gotten misinformation about COVID and certainly the vaccine, but I 100% want them to get the vaccination. So I hope they know that.

Daniel Lobell: (37:48)
Interesting. So shifting gears for a second here, I know that you — and we’re excited as part of the Doctorpedia community, company, community, team. We’re very excited about the fact that you are the newly appointed CMO of Doctorpedia’s Rheumatology channel. What unique viewpoints do you have that you hope to contribute through that channel?

Dr. Rubaiya Mallay: (38:18)
Well, I think my unique points, I look at rheumatology and medicine from maybe a little different lens just because of all my travels and just living in also different parts of the state. So I have kind of a more geographical understanding of people and —

Daniel Lobell: (38:43)
Perhaps more fearless as well, thinking of how your childhood, you took a boat to a plane and most kids are scared of monsters under the bed. And you became friends with the skeleton underneath yours.

Dr. Rubaiya Mallay: (38:57)
[Both laugh] Exactly. And it’s a leap of faith. You’ve got to do it. So a lot of times, especially rheumatology, I can’t quite put it down on a piece of paper exactly what’s happening. And so then a lot of our meds, we don’t know exactly how it works. We just know it does. So it is a leap of faith sometimes to say, for me to be like, “Okay, you gotta take this shot once a week, but do it.” I ask a lot of the patients sometimes, but sometimes that’s the only way. And also as a being a female physician, I think I have a more unique approach than others. So I think all in all I hope to have more worldly thoughts and insights for Doctorpedia, even though I think I’m sure there’s a lot of doctors from all over the world on the platform. And I’m a younger generation, so I think the newer information will certainly — I think we as young rheumatologists tend to be a little bit more aggressive than maybe older ones, maybe that, I don’t know. So I think all of that would be probably my unique perspective on rheumatology in Doctorpedia.

Daniel Lobell: (40:24)
Very cool. What do you think about in terms of Doctorpedia itself? What do you think their objective should be in terms of the online health space? What do you think is their best approach?

Dr. Rubaiya Mallay: (40:36)
I like this approach of getting information from the doctors that see it every day. I like the approach of having un-advertised information, just pure knowledge and not misinformation, because we have just too much of that. And I want to feel — how often do I get a call from a patient that says, “Oh, my cousin’s neighbor told me that I shouldn’t do this,” or “This drug is bad.” I’m like, “Well, who is your cousin’s neighbor? What’s their background?” Why are we getting advice from people that have no medical background and believe it’s true? So it’s important to have good information that the patient could also get to. Oftentimes, you have to click on 10 million things and you just don’t have the answer, especially in rheumatology. There’s so many questions about a disease state that I think it’d be nice to have a nice, easy channel or platform that you can go to but know that you can trust that information and it’s coming straight from your doctor’s mouth, and it’s not biased information.

Daniel Lobell: (42:02)
Yeah. What apps, if any, or technology, do you use to engage with the online health space?

Dr. Rubaiya Mallay: (42:11)
That I use for online for my patients, you said?

Daniel Lobell: (42:14)
Well, I meant for yourself personally, but if you have some for your patients, I’m interested in that too.

Dr. Rubaiya Mallay: (42:20)
Oh, for like medical information?

Daniel Lobell: (42:24)
Yeah. I mean, in general, I think it’s something I ask a lot of the doctors because you find out about a lot of cool things that way.

Dr. Rubaiya Mallay: (42:33)
Yes. So I actually love podcasts. I love just putting in my headphones and I’m listening. So I like listening to something called RheumNow, which is from a rheumatologist and he just goes over information, but it’s easy to digest. It’s not those long, lengthy podcasts. So yeah, I like to listen to — there’s another one from Dr. Callery. Dr. Brown. So there’s certain podcasts I just like to listen to, and I get a lot of my information just kind of putting on my headphones and listening to it.

Daniel Lobell: (43:17)
Yeah. Well, obviously I love podcasts too, but I think it’s such an intimate way to reach people. Like you said, you’re in people’s heads, you know? And I suppose you’re in people’s heads as well, with playing psychiatrist, psychologist, doctor, and marriage counselor. And I don’t remember all the other things, but we’re both getting in people’s heads in one way or another.

Dr. Rubaiya Mallay: (43:44)
[Rubaiya laughs] Exactly. But I think more people probably like to laugh, I would say. [Both chuckle]

Daniel Lobell: (43:51)
Well, they say laughter is the best medicine. I don’t know if I believe that because a lot of times you need something stronger, but I’ll tell you, it’s probably the most fun medicine you can take.

Dr. Rubaiya Mallay: (44:04)
Yeah.

Daniel Lobell: (44:04)
I think laughter is really important and I think we need more of it in the world these days, I think. Do you ever tell jokes to your patients when they come in?

Dr. Rubaiya Mallay: (44:13)
Oh yeah. I have a couple of patients that love to tell me dirty jokes. [Both laugh] So they’ll have a bad joke they’ll tell me. As you probably can tell, I love to laugh, and my staff tells me, “Oh, we know Dr. Mallay’s in the office because we could hear her laughing.” [Daniel chuckles]

Daniel Lobell: (44:36)
And you have a great laugh by the way. It’s very comforting. As soon as I got on the phone with you and I heard you laughing, I said, “Oh, I’m in for a good time!”

Dr. Rubaiya Mallay: (44:45)
Yeah. I love to laugh, I love to make people laugh. This is serious business, but we don’t have to take it that seriously. So as long as we are doing what we’re doing, we can still have fun and enjoy ourselves. So yes, I don’t take myself too seriously. I don’t think anybody should because then you get depressed. [Both laugh] So it’s better to keep things light.

Daniel Lobell: (45:13)
Yeah, I agree. I agree. Let’s lighten up the world. And is there anything exciting on the horizon in rheumatology that you personally are like, “I think this is going to make a huge difference?”

Dr. Rubaiya Mallay: (45:28)
Rheumatology is constantly moving. There are always new medicines, new therapies, and I’m just excited to just have more options for my patients. So we don’t have one magic pill yet, however. Just having lots of great options for the patients, I’m excited about it. So hopefully as we get older, we’ll get lots of new therapies for our patients and maybe we’ll get a cure one day. We’ll see.

Daniel Lobell: (45:59)
God willing. I’m rooting for it. I’m rooting for rheumatology. [Rubaiya laughs] Silly, but it has a ring to it. I ask all the doctors just to round off the interview and I’ll ask you as well. Can I borrow five bucks? No, I’m kidding.

Dr. Rubaiya Mallay: (46:23)
[Both laugh] You know, whenever somebody asks for money, just ignore them. [Both chuckle]

Daniel Lobell: (46:28)
No, for real, what I ask all the doctors — I ask all the doctors at the end of the interview, and I’m going to pose this question to you as well. What do you personally do to stay healthy?

Dr. Rubaiya Mallay: (46:39)
I practice what I preach. I exercise. I think that’s super important. You gotta have something that you enjoy that’s apart from your everyday grind. So I think working out is wonderful. I love to cook. So those are my two things that I love to do.

Daniel Lobell: (47:06)
Yeah. Well, I think that’s good advice for anybody. Cook, laugh, exercise, and enjoy your life. And if you ever get the chance, take a boat to a plane.

Dr. Rubaiya Mallay: (47:20)
[Daniel laughs] It’s the best experience in the whole world.

Daniel Lobell: (47:23)
Yeah. What a positive spin on what was possibly a devastating thing!

Dr. Rubaiya Mallay: (47:35)
[Both laugh] Everybody recovered, the buildings were built, things changed, but as a kid, how cool was that to experience it.

Daniel Lobell: (47:46)
We all have to experience life through the eyes of a child with that unbelievable wonderment.

Dr. Rubaiya Mallay: (47:52)
That’s that’s the Florida way, the Disney way, right? [Rubaiya laughs]

Daniel Lobell: (47:55)
Yeah. Is that why you’re there, you’re in the magic kingdom? Well it’s been magical speaking with you, doctor. Thank you so much, Dr. Mallay.

Dr. Rubaiya Mallay: (48:04)
Yeah, it was awesome.

Daniel Lobell: (48:14)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.