Ep. 33: From Bias to Breakthrough: Transforming Healthcare Conversations — with Dr. Sara Tariq, Internist

What if the most powerful thing a doctor can do isn’t prescribing a medication — but listening? In this episode, Dr. Regina Druz is joined by internist Dr. Sara Tariq for a candid conversation about the human side of medicine: the unconscious biases every clinician carries, the long shadow that adverse childhood experiences cast over adult heart health, and the trust that has to be earned before any treatment plan can work. Drawing on Dr. Tariq’s 22 years in academic medicine and Dr. Druz’s experience straddling an affluent suburb and an under-resourced inner-city hospital, they explore trauma-informed care, the mind-body-vessel connection, why concierge medicine buys back the time patients need, and where AI fits — and doesn’t — in the doctor-patient relationship.

Watch on YouTube: A video version of this episode is available on the Own Your Heart Health YouTube channel. Subscribe to be notified of new episodes.

Episode Chapters

[00:00] Introduction: The Patient Who Felt Heard
[03:28] Meet Dr. Sara Tariq: 22 Years in Academia
[05:30] ACEs: Childhood Trauma’s Long Shadow on the Heart
[09:34] Two Worlds: Bias in the Inner City vs. the Suburbs
[13:57] The Implicit Association Test & One Gentle Question
[18:21] The Mental-Emotional-Spiritual Center & Stress on the Vessels
[24:06] Why Concierge Medicine Buys Back Time
[29:17] AI, “Citizen Doctors” & the Need for Maternal Instinct
[34:38] Trust, Shared Decision-Making & Parting Wisdom

Transcript

[00:00] Introduction: The Patient Who Felt Heard

Dr. Regina Druz (00:02): Welcome to Own Your Heart Health. I’m Dr. Regina Druz, your holistic cardiologist. This week we’ll dive into common heart health concerns, uncovering root causes and unpacking scientific discoveries and controversies. The information provided does not constitute medical advice. Please contact your healthcare practitioner before making any changes that may impact your health.

Dr. Regina Druz (00:40): Welcome, everybody. I’m delighted to be with a great guest, Dr. Sara Tariq, who comes to us from Northern Virginia Family Practice, a concierge family practice she’ll tell us all about. The reason she’s here ties to something it took me years to learn. When I started my integrative and functional medicine journey, I thought it was mostly about supplements, diet, and the alternative care people weren’t getting elsewhere. Then one day a patient said something profound: ‘You’re the first physician who actually spent time listening to me.’ In that moment I realized that more impactful than any supplement or genetic test was simply giving that patient one-on-one time with a physician who would truly listen. Dr. Sara, welcome — you come from the world where you spent years trying to figure out how to make doctors listen to patients.

Dr. Sara Tariq (02:08): Thank you — it’s wonderful being here, Regina, and so lovely to meet you. I spent about 22 years practicing in academia at a medical school, much of it teaching medical students doctor-patient communication and how to care for patients with challenging histories. I was born and raised in the South, in a state that is unfortunately impoverished, with few resources and a lot of childhood trauma. As an internist I spent years experiencing the end result of that trauma — adults with many chronic diseases, struggling to make good decisions, and feeling their doctors didn’t listen. What they really need is time and depth, and modern healthcare doesn’t allow that: maybe 20 minutes for a return visit, 40 for a new patient, if that.

[03:28] Meet Dr. Sara Tariq: 22 Years in Academia

Dr. Regina Druz (03:28): I’m so glad you’re a recovering academician — having been one myself. A lot of doctors have been through this. I’m always curious where people come from — those childhood formative stories, what we call ACEs, adverse childhood experiences, and how they affect people’s health down the line. I wasn’t even born in the United States, so I’m an immigrant, and where people come from always interests me. How did you come to this work — was there an aha moment that we’re failing patients not because we’re not prescribing statins, but because we’re not asking the right questions?

Dr. Sara Tariq (04:45): You’re absolutely right. As a general internist I’ve always had an interest in women’s health, communication, and caring for the whole patient. Working in Arkansas, I was seeing a lot of chronic pain, out-of-control diabetes, heart failure, poorly controlled hypertension, obesity — and I realized many of these patients, particularly those with trauma, would avoid eye contact, answer in short sentences, and seem despondent because their chronic illness had taken over. Honestly, I was frustrated; I didn’t feel I was serving them, I was only on the surface.

[05:30] ACEs: Childhood Trauma’s Long Shadow on the Heart

Dr. Sara Tariq (05:30): Then I came across a podcast on adverse childhood events and learned that Arkansas, where I was practicing, was either number one or two in the country for the percentage of adults who’d experienced at least two significant adverse childhood events — a parent incarcerated, early divorce, emotional neglect, physical abuse, poverty, proximity to drugs. There was a very significant study out of California from Kaiser Permanente that looked at roughly 16 to 17,000 adults, went backwards to assess their adverse childhood events, and examined the risk of lung cancer, heart disease (independent of smoking), diabetes, and obesity. What we now know is that chronic stress — and the chronically high cortisol that comes with it — has long-term vascular effects on blood vessels and blood pressure, and also shapes how the brain develops and how people process illness and complex decisions.

Dr. Regina Druz (07:21): It resonates with me deeply. A few years ago I was straddling two worlds: my private practice on the North Shore of Long Island, a fairly well-to-do suburb of New York City, while also serving as chief of cardiology at a community hospital. That hospital was in an impoverished area serving the second-largest Medicaid population in New York State. It was about a 40-minute drive between them, but every time I went I felt transported to a different planet. I’d explain a patient’s condition and the next steps — simplifying every cardiology term, drawing pictures — and see they weren’t processing it. It wasn’t the words. I realized these patients didn’t have hope; they didn’t believe they could improve. So the first intervention was to give them a sense of mastery and hope their adverse environment had taken from them.

[09:34] Two Worlds: Bias in the Inner City vs. the Suburbs

Dr. Sara Tariq (09:34): One hundred percent. Patients whose eyes cloud over because they can’t see the options — the doors in the mind that open when you say, ‘let me think about your treatment options and how you can get better’ — those doors never seem to open. And it leads us as physicians to feel frustrated, with an urge to dismiss them as uninterested or noncompliant, when in actuality there’s a much larger problem, and these are the patients who need the most help.

Dr. Regina Druz (10:25): My initial rationalization was, ‘maybe they just don’t like me’ — I don’t look or sound like them, I have an accent. But I came to understand it wasn’t personal; it was a defense shield built over many years. For them to trust someone and let their fears surface was a huge step. I’ll never forget a fairly young patient with end-stage heart failure who needed device therapy, on yet another emergency visit in acute heart failure. I called to transfer him to the tertiary center and was told, ‘We know him — he’s non-compliant, a former drug user, we’re not taking him.’ I went back to the bedside, told him what I’d heard, and asked about his history. He looked me straight in the eye and said, ‘Doc, you have to fight for me, because I’m fighting for myself.’ We did transfer him, and he got his therapy — but the institutional and personal bias against him was extraordinary, and it got me thinking that maybe I was part of that problem too, judging these patients without even knowing it.

Dr. Sara Tariq (12:50): It absolutely goes back to unconscious bias — all of us harbor biases we’re not even conscious of. We have data that people from certain races and socioeconomic classes have their chest pain dismissed as panic or anxiety, and we see it with women all the time. The system works against these people, and the cycles of poverty and lack make it worse. It’s a blessing your patient could say ‘fight for me’ — that’s unusual, because often they don’t trust their physicians, for good reason. Advocacy takes time and heart.

[13:57] The Implicit Association Test & One Gentle Question

Dr. Regina Druz (13:57): Exactly — there’s no billing code for advocacy. So what’s your approach? Do we have a system to identify this — I know there’s an adverse childhood experiences questionnaire — and how do we as practitioners become aware of the implicit biases we bring into patient interactions?

Dr. Sara Tariq (14:39): Two big questions: how to address unconscious bias systematically, and how to address trauma. On bias: I’ve trained as a facilitator for unconscious-bias workshops — we teach interactive sessions at companies, hospitals, and faculty groups, and have participants take the Harvard Implicit Association Test. It’s free, easy to find online, and has been validated across hundreds of published studies. You can take versions on weight (we physicians as a profession carry a bias against patients with obesity), on gender, race, religion, and LGBTQ identity. The first step in addressing bias is knowing you have it — which is scary, so we build training around that.

Dr. Sara Tariq (15:36): On trauma: I’m an internist, not a mental-health provider, and I don’t have time to dig into it — so I ask one question. I explain gently, ‘A lot of people have gone through significant trauma in childhood, what we call adverse childhood events. Have you ever experienced that?’ I ask it in a soft, slow voice and give space, because it can be triggering, and I wait. I don’t ask what it was. I say, ‘You’re not alone — it’s common, and we have resources to help if it’s getting in your way. You don’t have to answer today; just know we’re here.’ Almost 80 to 90 percent of the time I see relief on patients’ faces, because they feel seen. I’m not there to learn the details — I just want to acknowledge the source of the pain I see in the visit, and then I can refer to a trauma therapist.

[18:21] The Mental-Emotional-Spiritual Center & Stress on the Vessels

Dr. Regina Druz (18:21): In the integrative and functional medicine community this is a rapidly growing space — there are wonderful programs teaching patients how to reprocess and reframe traumatic experiences, and I’ve seen patients benefit significantly. As a cardiologist I don’t do it myself, but I can ask and refer. Do you feel some form of this assessment should be part of every new-patient encounter? Patients can mask very well — they can look composed while internally carrying real fear. In cardiology I know that in the back of most patients’ minds it isn’t ‘what’s my cholesterol,’ it’s ‘am I going to die of a heart attack.’ So how do we even start the conversation — do we assess everyone?

Dr. Sara Tariq (19:48): Really good question, and honestly I haven’t fully operationalized it for every new patient — partly because I want to build trust first. But when I sense a roadblock, hesitation, or nonadherence, that’s when I ask. You make a good point, though: I always take a mental-health history as part of past history, and that’s a natural door to that one gentle question about trauma — without digging deeper. People mask this all the time.

Dr. Regina Druz (20:59): In functional medicine we have the Functional Medicine Matrix — a framework people can find online — and at its very center is a place called mental-emotional-spiritual. As a cardiologist and scientist, I like things I can measure to the millisecond, so at first I treated that center as a nice ‘soft spot.’ But it sits at the heart of the matrix, pun intended, and I came to realize that if you don’t address that center, you may make some progress, but there won’t be transformation — that’s where the real leverage is. There’s also elegant work from Dr. Peter Libby’s group on how mental stress mobilizes the immune system and creates an echo in the blood vessels that actually grows atherosclerotic plaque. Every day, that mental-emotional-spiritual influence imprints on our vessels.

Dr. Sara Tariq (23:17): Wow — it makes sense. More literature keeps coming out; I recall a study from Wisconsin, maybe five years ago pre-pandemic, looking specifically at stress and the blood vessels. In primary care we learn the bio-psycho-social model and then forget it when we practice. The social environment, where people live, their zip code — all of it influences their health. We can’t properly assess and treat the ‘bio’ without the ‘psycho’ and the ‘social.’ That’s probably why I went into primary care.

[24:06] Why Concierge Medicine Buys Back Time

Dr. Regina Druz (24:06): Let me ask a harder question. You transitioned from academia into concierge primary care — how does concierge or direct-pay primary care improve on the problem we’re discussing?

Dr. Sara Tariq (24:26): The honest main reason I moved to the DC area was family — I might never have left academia otherwise, because I loved teaching and patient care. But what was always missing was time. I could never dig as deep as I wanted in a 20-minute visit, and when I asked to see a patient back in two weeks, my nurse would say the next opening was three months out. Concierge is a membership, so I have time: I can see a patient every two weeks if they’re in crisis, or for 90 minutes if the problem is complex. I’d worried I no longer enjoyed primary care, but it turned out I just couldn’t practice it the way it should be practiced — with no pressure and the freedom to study the literature and truly serve.

Dr. Regina Druz (26:46): This rings true. Straddling those two worlds, I learned that for patients in adversely affected environments you don’t need dramatic interventions to move the needle — they need simple things, consistency, and someone they can trust. When that opportunity opens, the changes are amazing. Yes, concierge and integrative medicine aren’t accessible to everyone — a legitimate critique — but there are now many direct-payment models where patients can experience this style of care on a reasonable budget and make real improvements, instead of being stuck in the sick-care system year after year.

Dr. Sara Tariq (28:30): Absolutely. For us it’s a membership, and we still take your insurance — so you’re not facing huge unpredictable out-of-pocket costs if something serious happens; the membership covers the time and depth, and insurance covers the rest. That reduces the uncertainty about how much you’ll pay each visit.

[29:17] AI, “Citizen Doctors” & the Need for Maternal Instinct

Dr. Regina Druz (29:17): So it’s a hybrid model — a kind of plan B. Here’s something on a lot of doctors’ minds: our intake form asks, ‘What is your top health concern and how may we help?’ Recently a patient pasted a lengthy response — clearly from a generative-AI model — with an exhaustive lipid analysis, when I know their real top concern is ‘how do I not drop dead from a heart attack.’ There was even a JAMA study where people preferred generative-AI messages to physician portal messages. Where does that leave the doctor-patient relationship — do we lean in or lean out?

Dr. Sara Tariq (30:51): So many of us are grappling with this. I don’t think human communication can be replaced — there was even a study looking at AI as therapists, which boggles my mind. AI, used properly, is a wonderful tool: I can ask for evidence-based guidelines or a quick clinical answer and save enormous time. But for patients with complicated, multi-system issues, I think we’ll still need another human to put the pieces together. I’m cautious, not scared — though I might be naive.

Dr. Regina Druz (32:43): I’m with you. I heard Dr. Geoffrey Hinton, considered the godfather of AI, interviewed on CNN say we must give AI ‘maternal instincts,’ because if we don’t — his words — we’ll all be toast. I think he’s onto something, because at the soul of medicine is taking care of people, not information. No matter how good the output, it isn’t caring for a person, who is so human and multidimensional. But here’s an opportunity: could an AI tool screen patients for adverse childhood experiences and give both clinician and patient a gentle heads-up before the visit?

Dr. Sara Tariq (34:10): As a tool, absolutely — it has a role. But you and Hinton hit the mark: it has to have that maternal, deeply empathic instinct — the ping in your brain that says, ‘something about what you just shared isn’t right; I don’t know what yet, but I’ll find out, because I deeply care.’ At this point I feel cautious, but not threatened.

[34:38] Trust, Shared Decision-Making & Parting Wisdom

Dr. Regina Druz (34:38): At least not yet. What’s your advice on structuring the encounter? I recognize I may have a bias — but my patient may too. In integrative, functional, concierge medicine there are some very interesting biases that pop up: availability bias, recency bias — the classic being a patient who did a lot of lifestyle work, then saw a supplement online called a magic bullet, took it for three days, and feels remarkably better. Do you have a system?

Dr. Sara Tariq (35:54): My system starts with the human interaction and trust between physician and patient. On a first visit I share my philosophy: trust and shared decision-making. I don’t deserve trust just because I wear a white coat — it’s earned through authenticity, honesty, and sincerity. And I tell patients, bring me new ideas you’ve read or heard about; I’ll bring my 22 years of experience; let’s put it on the table in a neutral space and talk. I can tell you to take a statin all day long, but if you don’t trust it — if your aunt had a problem with it — you won’t take it at home. Acknowledging the power the patient brings to the table can mitigate those biases, or at least create space for the discussion.

Dr. Regina Druz (37:29): I love the table analogy. I tell patients it’s a partnership — and partners have responsibilities and accountabilities. There’s no magic bullet; the magic is inside each patient, and our job is to help unlock it. But that’s only possible in a true partnership, which is hard, because you have to be honest, communicate, and call things out when they’re not right. For those of us practicing in this space, it’s a real redefinition of what a doctor-patient relationship can be.

Dr. Regina Druz (38:45): Any parting words for our listeners wondering, ‘do I have a bias’?

Dr. Sara Tariq (39:06): I’m a big fan of the Implicit Association Test — it’s easy to take, with lots of teaching materials. And I’ll push this less on patients and more on us physicians: all of us should engage in bias testing, because once we’re aware of our own biases, we can talk about them and the awareness spreads. I don’t want to put the onus on the patient — we’re in a position of power and privilege — so I’d urge hospital and company leaders, especially in healthcare where lives are on the line, to support bias training. Now more than ever, in a divided world where social media leaves us isolated, human connection is where we have to go.

Dr. Regina Druz (40:21): Great words. We’ll include a link to the test — I’m going to take it myself — and I encourage all of you listening to take it too, to learn a little more about yourself and strengthen your own doctor-patient relationships. Thank you so much, Dr. Sara. Thank you for tuning in to Own Your Heart Health with Dr. Regina Druz. This podcast is powered by Holistic Heart Centers. If you enjoyed the show, please rate and review us on your favorite podcast platform. To learn more about our services, visit holisticheartcenters.com and subscribe to our YouTube channel — the link is in the show notes. See you next week.

Frequently Asked Questions

What are adverse childhood experiences (ACEs), and how do they affect heart health?

Adverse childhood experiences are significant early-life stressors — a parent incarcerated, early divorce, emotional neglect, physical abuse, poverty, or proximity to drugs. Dr. Tariq describes the landmark Kaiser Permanente study (about 16,000–17,000 adults) that linked a higher ACE burden to greater risk of heart disease (independent of smoking), diabetes, obesity, and more. The proposed mechanism is chronic stress and chronically elevated cortisol, which have lasting vascular effects on the blood vessels and blood pressure — and also shape how the brain develops and how people cope with illness and complex decisions. Dr. Druz adds that work from Dr. Peter Libby’s group shows mental stress can mobilize the immune system and accelerate atherosclerotic plaque. This is educational information about a researched association, not a personal diagnosis.

What is unconscious bias in healthcare, and how can clinicians address it?

Unconscious (implicit) bias refers to attitudes we hold without being aware of them — and Dr. Tariq notes data showing that patients of certain races or socioeconomic classes, and women, often have symptoms like chest pain dismissed as anxiety. Her first step is simply knowing the bias exists, which she helps clinicians do through interactive workshops and the free, widely validated Harvard Implicit Association Test (with versions on weight, gender, race, religion, and LGBTQ identity). She emphasizes that the medical profession as a whole carries measurable bias — for example against patients with obesity — and that recognizing it, though uncomfortable, is what allows clinicians to talk about and reduce it. This is general professional education, not clinical advice.

How does concierge or direct-pay medicine change patient care?

For Dr. Tariq, the central benefit is time. In conventional practice she had perhaps 20 minutes per return visit and months-long waits for follow-up; in a concierge membership model she can see a patient every two weeks during a crisis, or for 90 minutes when a problem is complex, with the freedom to study the literature between visits. She notes her practice still takes insurance — the membership covers the time and depth while insurance covers serious care — which reduces cost uncertainty. Both physicians acknowledge the fair critique that concierge and integrative care aren’t accessible to everyone, but point to a growing range of direct-payment models that make this style of care available on a more reasonable budget. This is a description of practice models, not financial or medical advice.

Can AI replace the doctor-patient relationship?

Both physicians see AI as a powerful tool but not a replacement for human care. Dr. Tariq uses it to quickly find evidence-based guidance, but believes patients with complicated, multi-system problems will still need another human to integrate the pieces. Dr. Druz describes patients arriving with lengthy AI-generated analyses of their own labs — useful information, but not the same as addressing the fear underneath — and cites a JAMA study in which people sometimes preferred AI-written messages to physician ones. She references Dr. Geoffrey Hinton’s argument that AI needs ‘maternal instinct,’ because the soul of medicine is caring for a person, not processing information. They see promise (for example, AI gently screening for adverse childhood experiences) alongside a clear caution: empathy and trust remain irreplaceable. This is opinion and educational commentary, not medical advice.

Show Notes & Resources

Guest: Dr. Sara Tariq, MD

Dr. Sara Tariq is a general internist who spent more than 20 years in academic medicine — teaching medical students doctor-patient communication and caring for patients with complex, trauma-shaped histories — before joining a concierge primary-care practice in Northern Virginia. A trained facilitator for unconscious-bias workshops, she focuses on trauma-informed care, the bio-psycho-social model, and rebuilding trust as the foundation of healing.

Dr. Sara Tariq — Northern Virginia Family Practice (concierge primary care)

Resources Mentioned in This Episode

Harvard Implicit Association Test (Project Implicit) — free, validated tests of unconscious bias on weight, gender, race, religion, and more (implicit.harvard.edu)
The ACE Study — the landmark Kaiser Permanente study (~16,000–17,000 adults) linking adverse childhood experiences to later heart disease (independent of smoking), diabetes, and obesity
Adverse Childhood Experiences (ACE) questionnaire — a brief screen many clinicians use
The Functional Medicine Matrix (IFM) — a clinical framework with ‘mental-emotional-spiritual’ at its center; searchable online
Stress and the blood vessels — research from Dr. Peter Libby’s group on how mental stress mobilizes the immune system and accelerates atherosclerosis
Trauma-informed care — referral to trauma therapists and programs that help reprocess and reframe adverse experiences
‘Chat with the podcast’ on NotebookLM — Google’s public notebook loaded with OYHH episodes (holisticheartcenters.info/notebook)

Holistic Heart Centers

holisticheartcenters.com
HeartWell.ai — AI-powered cardiovascular risk assessment
Address: 55 Bryant Avenue, Suite #6, Roslyn, NY 11576
Phone: 877-511-5166
YouTube: @reginadruzmd
Instagram: @dr.reginadruz
Podcast: Own Your Heart Health — available on Apple Podcasts, Spotify, and all major platforms

Listen & Subscribe

If you enjoyed this episode, please rate and review us on your favorite platform — it helps more people find the show.

Apple Podcasts Spotify YouTube