Dr. Lindsey Migliore, also known as GamerDoc, is a licensed esports physician. While hiking the Appalachian Trail, she realized that only by abandoning her original goal of becoming an NFL team doctor could she combine her passions for medicine and video games. She now works with esports athletes to maintain and improve their health; and, as founder of Queer Women of Esports, she tackles the harassment and lack of sponsorship faced by female LGBTQIA+ esport athletes.
In this podcast, Dr. Migliore and I discuss the injuries that esports athletes experience, and the preventive measures they can take; the lack of educational materials for esport doctors; the challenges esport physicians must overcome to be accepted by both athletes and other healthcare professionals; why esports can be even more toxic than gaming in general; the difference between mentorship and sponsorship; and the roles of telehealth and VR in medicine.
Stream the audio edition of this interview below or from Apple Podcasts, Stitcher, Google Podcasts, Amazon Music, Spotify, Overcast, Pandora, Pocket Casts, iHeartRadio, TuneIn, RadioPublic, or the Internet Archive. Click past the jump for a transcript and links to resources mentioned in this episode.
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Related links
- Dr. Lindsey Migliore
- POG Prescription podcast
- Handbook of Esports Medicine: Clinical Aspects of Competitive Video Gaming
- Queer Women of Esports
- Dr. Caitlin McGee of 1HP
- “Insights into Sexism: Male Status and Performance Moderates Female-Directed Hostile and Amicable Behaviour” (aka “Male behavior towards female gamers“)
- Hidden Figures
Transcript
Voiceover: Welcome to the Polygamer podcast, where gaming is for everyone. Join us as we expand the boundaries of the gaming community.
Ken: Hello, and welcome to the Polygamer podcast, episode number 117 for Wednesday, September 22nd, 2021. I’m your host, Ken Gagne. I have interviewed multiple esport athletes on this podcast, people who are competitive gamers in everything from Call of Duty to Super Smash Bros. But what are the demands on those players? Other than being good at the game, being in esports, which is highly competitive by its nature can be very demanding on the body and the mind.
Ken: And so I thought today we would invite a medical healthcare professional onto the show to talk about all different aspects of esports and healthcare. Please join me in welcoming Dr. Lindsey Migliore, AKA GamerDoc, who is an esports physician, and the founder and executive director of Queer Women of Esports. Hello, Dr. Lindsey.
Dr. Migliore: Hey, Ken. How’s it going?
Ken: Good. How are you?
Dr. Migliore: I’m doing good now that I’m here, and now that I’m on audio and not video all day, so very happy.
Ken: Yes, me too. I’ve been on Zoom all day. This is a relief for me, so thank you.
Dr. Migliore: Yeah, Zoom fatigue is real.
Ken: And speaking of fatigue, I understand you just got back from PAX West, which at the time of this recording was less than a week ago. How was that?
Dr. Migliore: It was wild. It was a lot of fun. I’ve never been to PAX West before, surprisingly. And apparently this was like a shadow of its former self because of obviously a lot of people pulled out because of COVID, but I just had an incredible time. I met some really amazing people. The past year and a half, we’ve all been making these friends online and strengthen these relationships, but we haven’t met a lot of them. But I met some people that I’ve been working with, I gave a couple talks. It was fantastic.
Ken: And you felt safe there?
Dr. Migliore: Yeah. I mean, so I got COVID tested two days before I left. I’m fully vaccinated. I wore a mask indoors everywhere. Safety for me right now is I’m just following strict CDC guidelines in everything I do. Since day one, I’ve been following CDC guidelines. They’re smarter than me. And I’ve just been doing that. Luckily I don’t have any children at home, so that’s the biggest thing right now for me. I felt safe.
Ken: Good. Well, I’m glad you had a good time. I’ve never been to PAX West. I’ve been to every PAX East. I’m already wondering what I’m going to do next year, like six months from now. But in the meantime, we have so many other topics to talk about. Give us a little bit of background. You go by GamerDoc online. You’re GamerDoc_ on Twitter. Who or what is GamerDoc?
Dr. Migliore: I was in the traditional medicine field for quite some time, and I was obviously playing video games. I’m a gamer, I’ve been a gamer my entire life. And like any good gamer, when the times get tough, I play more video games. It’s a form of stress relief for me. It’s either I’m going to go for a run, I’m going to go rock climbing or I’m going to play video games. And so med school was a hard time, and so I played a lot of video games. And all my other med school friends were also playing a lot of video games, and we started to get injured or we started to have pain from gaming.
Dr. Migliore: And at the time we didn’t realize it was from gaming. We’re starting to get these injuries that are cropping up that are very strange. And you go to the doctor, as you’re attending you ask your boss about it and they’re like, “What is wrong?” I’m like, “Well, I play video games.” And so what do they say? They say, “Okay, if it hurts when you play video games, stop playing video games,” which to me is never, ever, ever, ever going to happen. I’m going to be that 95 year old rocking out an N64 Emulator in the old folks home.
Dr. Migliore: And so when I started to look up why am I … I’m a doctor, I look up why things happen. “Why am I getting injured when I play video games? What are the injuries? How do I prevent them?” There’s no information out there. And so I said, “Okay. Is this something that I’m okay with? Am I going to spend my life in traditional sports doing stuff that we already know exists, we already know it’s happening, or do I want to be the one finding the answers?” So that’s really how GamerDoc was launched.
Ken: And I understand that part of this realization came to you while you were hiking the Appalachian Trail.
Dr. Migliore: Yeah, I did. I did. There’s not a lot of times in life that I have sat by myself with no technology, right? Sitting by yourself with no technology. You’re not scrolling through Twitter, you’re not looking at Iwastesomuchtime.com, you’re not checking your stocks. You’re sitting by yourself, walking by yourself in silence. And I did that for two months. No technology, no one else on the trail with me. And so you start to realize things about yourself. You start to uncover parts of your personality you didn’t know were there.
Dr. Migliore: And one of the things that I realized was that I wanted to spend my life doing something that I was passionate about. And I thought at the time I wanted to be an NFL team doctor. I’m a big football fan. Go Lions. And I thought I wanted to be on the sidelines of NFL games, NFL football games, and I wanted to be treating those athletes. And then I realized, “Is that what I really want? Do I really want to make, like take these dudes who are millionaires, who are smashing their bodies into other people over and over again? Is that what I want?”
Dr. Migliore: And I realized my true passion at the end of the day, the thing that I can do over and over again without getting tired, without stopping is playing video games and talking about video games. And I had that realization, and I got back and I was like, “I’m going to do this. I’m going to make this a reality.” And it took me six years, no, five years, but it’s a reality now. So that’s great.
Ken: What exactly was it that took five years? This was just not an overnight, “Huh! I’m going to shift focus from traditional medicine to esports.”
Dr. Migliore: Traditional medicine is a very stereotyped path. If you want to go to med school, you are in under … In high school, you have to start shadowing people, shadowing doctors, getting that experience. In college, you have to do community service hours. You have to continue to shadow doctors. You have to volunteer in a hospital. You have to take your prerequisites. You have to take physics. You have to take anatomy. You have to take biology, chemistry. And then you get into med school.
Dr. Migliore: And once you’re into med school, your first two years are book learning and then you take a test at the end of the second year. And your third and fourth years are in the hospital. And then at the end of that, you pick your specialty you want to go into. And you get matched into your specialty and they find a job for you, they say, “Here’s your job.”
Dr. Migliore: And so you spend the next four or five years working in that job. There’s no choice. There’s no innovation. There’s no creativity. Once you get accepted to medical school, you come off that rollercoaster ride 10 years later and you haven’t made a choice about your career. Sure you pick your specialty, but you’re not picking where you work, you’re not making all these choices. And going from that to knowing that my career is laid out for me for the rest of my life, right?
Dr. Migliore: I could have went directly from residency into an academic job, made a crap ton of money and spent my life doing that. There’s no esports medicine job that I can go into. There’s no job that I say, “Hey, I want to apply for this,” I had to make it up. Right? I had to teach people. And as a doctor, I’ve never in my life been to someone and said, “Hey, you need me.” Right? That’s never happened. They just come to my clinic with pain.
Dr. Migliore: In esports, I have to go to people and say, “You need a doctor,” and they’re like, “For what?” I’m like, “Because you’re going to get injured,” and they’re like, “No, I’m not. Prove it.” So I have to prove that first. The first thing I had to do was create the culture and help cultivate this culture that QWE has been working on as well, telling people that they can get injured playing video games. It is preventable, and you need to see a doctor if you get injured. So that’s really why it took so long.
Ken: Is it a different kind of medicine? If you could have specialized in esports in med school, had that been an option, would this have made your career easier?
Dr. Migliore: 100%. And that’s one of the things that I’m working on. In med school, we take courses on different subspecialties of medicine, on pediatrics, on surgery, on cardiology, on pulmonology. And one of the things I’m working on is getting an esports medicine curriculum at certain schools, as an elective, right? Not everyone needs to know this. I mean, they do, because if you’re a pediatrician or a primary care doctor, someone’s going to come to you with an esports injury, or a gaming injury. If you don’t recognize it, then your patients are going to suffer. But that is the future I would like to see in like 20 years.
Dr. Migliore: But I’m working on creating esports curriculums at med schools and at residencies so that people can get training. And right now, I was at a medical convention right before COVID hit and I was talking about video game injuries. And I started talking and half of the audience laughed. I mean, they weren’t being jerks, they thought I was kidding. And then I kept talking and half of them were offended by the fact that I was talking about this at their esteemed medical convention.
Dr. Migliore: And the other half started to get interested. But the thing is, you’re not going to get 50, 60-year-old doctors involved. They’re in their career paths, they’ve done their thing. It really is about teaching the medical students and having them come up knowing that this is a career path, to be honest.
Ken: And part of you filling that educational gap is the publication of a book you edited earlier this year, Handbook of Esports Medicine: Clinical Aspects of Competitive Video Gaming. It just came out in May from Springer. I’m guessing from the price, this is more aimed at medical professionals as opposed to the casual reader.
Dr. Migliore: When I was a medical student, when I was a resident and an intern, if I had a question about basic science, right, basic science like, “What happens to your lungs when you smoke cigarettes?” Right? I can look that up in a textbook. I can go to my textbook, either my PDF or on my bookshelf. And I can open a book, I can flip to that page, I can read it. I can learn it. I can understand it. And that is how a lot of us learn. If you want to learn about esports medicine, if you want to learn about video game injuries, there is no resource. There was no resource on the collection of injuries and things that affect them, right?
Dr. Migliore: You can go to articles that I’ve written. You can go to different for-profit entities websites, and they’ll give you some resources, but there was no centralized place to find scientifically-backed information. Because that’s the thing about books, right? If you publish it through a medical publisher, it’s been peer reviewed, it has resources, it has references, it’s not just made up. And so I wanted to create a textbook for medical students and health professionals who wanted to get into video gaming.
Dr. Migliore: But my publishers came back to me and they’re like, “Look, you know who buys textbooks? Med students. Do you want to only sell books to med students?” And I was like, “No.” “We’re going to call it a handbook and you’re going to make it a little bit more user-friendly.” Yeah, it is similarly priced for a smaller-sized textbook. It took two and a half years of my life, so I wanted to charge like a thousand dollars a book.
Ken: I have my annual physical next month. I kind of want to buy one, give it as a gift to my doctor.
Dr. Migliore: Oh my God, please do it. Please do it.
Ken: Well, it’s heartening to know that the Kindle edition is more affordable. And especially with Kindle, you can search it more easily because it’s an e-book, so maybe I will pursue that option instead.
Dr. Migliore: Yeah. I have a couple of books that are going to be out in the next couple of years that are marketed towards the general audience. But if you want to, we have lots of people out there who want to help the performance of esports athletes and gamers, who want to treat video gamers. They want to create a livelihood off of gaming and esports medicine. If you want to have someone’s health in your hands, you could spend 80 bucks on a book. The rest of the audience, I get it. I totally get it, but that’s not an investment in your career. So don’t worry, there’ll be a book one day that will be like 30 bucks. I promise.
Ken: Oh, sure. I’ve been on an adjunct faculty in Boston. I’ve assigned textbooks and I’ve been a grad student, I know how much they cost.
Dr. Migliore: Yes.
Ken: I’m sorry if I implied that this is not a reasonable price, I just wanted to clarify the audience.
Dr. Migliore: No, you’re perfect.
Ken: And you said you got up at these conferences and you started talking about sports injuries. What sort of injuries do esports athletes experience?
Dr. Migliore: We all have seen traditional sports injuries, right? Because they get played on the news, they get played on ESPN over and over again. They go around Twitter, social media. We see Alex Smith’s get hit, get sacked. Right? We saw Alex Smith get sacked. We saw his leg turn sideways. It was very clear he broke his leg. We knew that his injury was from football. No one is arguing that Alex Smith got injured outside of football. That is not the case in esports, right?
Dr. Migliore: In traditional sports, we have what’s called acute injuries. You get hit, your ACL tears. You pushed your ankle, you sprain your ankle. In video gaming, we have what’s called acute and chronic injuries. A chronic injury is something that you’ve been dealing with for a while. You are a League of Legends player, and you have been spamming Q-W-E-R 1,000 in an hour, 10,000 times in a day for 4, 5, 6, 7, 8 years. Right?
Dr. Migliore: You’re clicking those keys over and over again with your pinkie, your ring, your middle and your index finger and your thumb. You’re moving your wrist around, your opposite hand is using the mouse and it’s moving it around to aim. And the tendons, right, those tiny little muscles in your hand and the tendons in your hand were not meant to do the things that we do, right? They’re not meant to click a button over and over and over again.
Dr. Migliore: The structure of the tendon wasn’t meant for that. The structure of the tendon was meant to reach up, grab and hold onto a tree and climb up. It was meant to be able to push yourself up from the ground to manipulate tools. And so what we see is over time, the tendons starts to change. It starts to become different, it starts to adapt. Because it gets little tears in it and that tear heals itself. But it heals in a different way to adapt for this new trauma that we have, right? This microtrauma, this repetitive movements, repetitive strain.
Dr. Migliore: And so eight years later, you have a tendon that is structurally and fundamentally different than it was when you started playing video games. You just got signed to a new esports org, and you want to get a hot body, right? You want to look sexy for all your new Twitter followers. So you go to the gym and you start working out, and you start bench pressing. And all of a sudden, you’re on your third day of bench pressing and you feel some pain in the back of your wrist during bench pressing, right?
Dr. Migliore: And you go to the doctor and they say, “Oh, you tore a ligament in your hand. You tore a tendon in your hand from bench pressing.” Is that injury from bench pressing? No, it’s from gaming. You just put a force that, that weakened tendon couldn’t handle during bench pressing. And that is really what we see in gaming, these repetitive strain injuries with the hand. We also see nerve compressions. We see nerve compressions at the wrist, at the elbow and the neck. We see a lot of postural issues that can have long-term consequences. So things really like that.
Ken: You mentioned that when doctors see injuries in traditional athletes, they treat the injury. And when they see the kinds of injuries that you just described in an esports athlete, they tell them to just stop playing video games. Why does that discrepancy exist?
Dr. Migliore: Truly they probably don’t realize or ask, but it is from video gaming, because we have this lack of knowledge around the fact that you can get injured playing video games. If you don’t know you can get injured playing video games as a player, when you feel that strain in your wrist when you’re bench pressing, you tell your doctor you got injured weightlifting. And your doctor doesn’t ask any follow-up questions because they probably don’t even know you play video games, and you’re not talking to them about the numbness and tingling you were feeling in your fingers for the past four years.
Dr. Migliore: The doctor doesn’t ask the question, the patient doesn’t volunteer the information, and so we all think it’s from weightlifting. And so we treat the injury like it’s weightlifting related. And so really, that is what we’re seeing most of the time. The fact is that doctors aren’t asking or attributing these injuries to video gaming. I’m working on that. I’m trying to work on educating the medical community on this fact that it can happen.
Dr. Migliore: That’s largely what the handbook is accomplishing, is that they get this idea in their mind. But it’s an uphill battle, and it’s hard because how do you fix an injury, how do you prevent injury you don’t know exist? And so that’s the first thing we’re really working on.
Ken: Why would healthcare professionals be aggrieved to hear you speaking about this? This seems like a great opportunity for them to become aware of something that they had previously overlooked and thus give a better diagnosis and treatment to their patients.
Dr. Migliore: You’ve met doctors.
Ken: I’ve met some doctors.
Dr. Migliore: We don’t want to know things that we didn’t know existed. That’s like a huge hit to our ego. But I mean, also medicine is evidence-based, right? We’re evidence-based. How do we know that ACL tears happen from basketball? Well, thousands and thousands of people a year get injured playing basketball present to the emergency room. And all that data gets recorded, it goes into a report.
Dr. Migliore: And the report comes out every 10 years and we get to write all these fancy papers off of it, and saying that, “Hey, we looked at all the injuries that happened because of football in the past 10 years and we found that the top injuries that football players face are concussions, ACL tears and leg injuries.” I just made that last one up because I can’t remember it. And so we have that data, and we base our treatments and we base our injury prevention protocols on that data. There is not currently that data that exists in esports medicine, a lot of what I’m saying, a lot of what’s written in that book.
Dr. Migliore: We’re very honest. In front of that book we say, “There isn’t as much data as we like, so these case studies we’re pulling information from is a patient population of 40,” or, “This paper that we’re pulling this information from is extrapolated from office workers.” There isn’t a lot of good data out there, because the people who are funding the studies, the people who are coming up with these studies are in the higher echelons of the organization. And they’re older and they don’t know about video game, they’ll play video gaming themselves, so they’re not allocating money to do the studies.
Dr. Migliore: If you’re not allocating money to do the studies, you don’t have the attention and the knowledge and the evidence to back it up. More data is coming, more papers are being published, and it’s fantastic. But we’re still not where we need to be in terms of data.
Ken: How do you convince people that they need you? You said that, that’s one of the things that is unique to your role, is that usually people come to doctors with pain and now you need to go to them. And how do you say, “Look, this is what’s happening to your body, and you need me.”?
Dr. Migliore: I bring the pain.
Ken: Oh, gosh.
Dr. Migliore: I bring the pain. I say, “Okay, I bet you I can find an injury on you,” and they’re like, “What? I don’t have any pain.” I’m like, “You don’t? So like you really don’t have any pain? You haven’t felt numbness and tingling in your wrist or in your pinky, in your ring finger after long gaming sessions?” They’re like, “Maybe. Yeah, maybe.” I was like, “You don’t wake up in the morning with cold hands you need to shake out? You don’t get blurry vision that goes away when you blink? You haven’t experienced those things?”
Dr. Migliore: Once you start getting into what the actual symptoms are, because these patients are young, right? They’re 19, 20, 21. They’re not at end stage carpal tunnel, but they do have early stage carpal tunnel, which is very uncommon in that patient population. You normally see that in 15, 16-year-olds. The warning signs are subtle, right? Numbness, tingling, these are early warning signs of nerve damage. It’s like if you sit on your foot and it goes asleep, right?
Dr. Migliore: And it starts to wake up and you feel that … It’s called parasthesia. That is one of the early signs of nerve damage. That’s one of the ways I find the pain. Another thing is pretty early on in my career, I realized that if I walk around telling people, “Listen to me, and it’s going to make you healthier,” no one cares. No one cares, especially not young people, because we all think we’re invincible. We’re never going to die. And the Mountain Dew we drink isn’t going to cause diabetes, until it does.
Dr. Migliore: The cigarettes we smoke isn’t going to cause lung cancer, until it does. The way we sit isn’t going to cause back pain, until it does. I spin it the way, “Hey, listen to what I’m doing and do these things because it’s going to make you play better.” And that’s something that I can prove, right? So warming up before you play video games is something we should all be doing. Every single person who plays video games should be warming up for at least 20 seconds prior to sitting down to play video games.
Dr. Migliore: Well, that is going to prevent injuries, but it’s also going to make your reaction time a little bit faster, and your hands easier to maneuver in the beginning. And that is something that I can prove immediately to them. And once you tell people it’s going to make them play better video games, then they’re like, “Yeah, let’s go.” So that’s really my strategies.
Ken: I’m familiar with warmups. I do vocal warmups before every podcast, but what sort of warmups do you do before playing video games?
Dr. Migliore: Now I want to know your vocal warmups though, Ken? Lanolin. Lanolin.
Ken: That will be the outtake for this podcast.
Dr. Migliore: Okay. Warming up is something that’s really interesting because why is it called warming up? Well, it’s called warming up because you are activating muscles. And activating muscles, your working muscles require more blood flow in order … Because they’re working faster, they’re consuming more ATP. They need more ATP, they need more blood flow. So your body opens up the blood flow to these muscles that are working, and that allows more blood to flow to the area. Well, blood is 98.6 degrees, so it raises the temperature of your fingers and your hands in 98.6 degrees.
Dr. Migliore: And at that elevated temperature, your enzymes work faster, your nerves conduct faster, your muscles are more elastic, right? So for warming up for gaming, what I say is, start with … It doesn’t have to be wild. It doesn’t have to be a super long warmup. I played college basketball and we’d warm up for 45 minutes, and I hated it. It was so boring. But for gaming, all you got to do is do some wrist circles, right? Do some wrist circles. Do some shoulder circles. Do some neck circles.
Dr. Migliore: This isn’t medical advice. My favorite gaming warmup is what I call star jump for your hand. So you start with a bald fist, right? You ball your hand up into a fist as tight as you can, and then you extend your fingers backwards and you pull them to the side and you extend your wrist back. Before you’re ready to punch someone, now you can slap someone. And then you go back into a closed fist and then you open up into the slap hand.
Dr. Migliore: And you do that as fast as you can, right? Go from closed fist to open hand as fast as you can. If you do that 10 times, you start to feel the muscles in your forearm fatiguing. You start to feel the muscles in your hands fatiguing. This is warming up all of those muscles so they’re going to be ready to virtually slap people. That’s what I recommends.
Ken: You mentioned that you could have pursued a career in traditional sports treating NFL athletes who make millions of dollars. People with millions of dollars can afford their own specialized physicians. Now you’re treating esport athletes, is the same budget there? How can they afford services like this?
Dr. Migliore: Early injury prevention protocols in traditional sports made one thing very clear, and that is preventing injuries shouldn’t be the responsibility of the individual player. If you want to prevent injuries in a middle schooler, you’re not going to tell the middle schooler, “Hey, these are all the things you need to do to not get injured.” Right? You’re going to talk to the coaches. You’re going to talk to the governing bodies. You’re going to talk to …
Dr. Migliore: The NFL was having all these terrible face injuries, and neck and face injuries. Face lacerations. People were getting hit by sticks and pucks in the face, disfiguring them. And so they said, “All right, you guys have to wear half shields now.” You can’t have an open face helmet anymore. All the new players can’t have that anymore. So they added an equipment modification that led to a decrease in injuries.
Dr. Migliore: USA Hockey noticed that all of the, I think it was 14 youth or 12 youth players, there is a higher incidence of concussions and body injuries at this level. And it was the first year that they had introduced checking. And they found that the kids were just a little too young to hit each other. They couldn’t protect their bodies. They didn’t know how to do it safely. They raised the age of checking by two years, and it drastically decreased the rate of injury, right?
Dr. Migliore: So they changed the rule and it led to the decrease in injuries. For esports, it’s the same thing. The onus should fall on the governing bodies and on the esports organizations. If you are a multimillion dollar esports organization, and you do not have someone on staff taking care of the health and wellness of your players, that’s your fault, right?
Dr. Migliore: It’s not the players fault if they get injured, if they’re working for a multimillion dollar esports organization. On Twitter, people will announce their retirement from gaining. And you read their tweet longer and it says, “I have this injury, and it’s been plaguing me for years. I can’t play video games without pain anymore.” And so you read what their injury is and it’s like, “I have head forward posture,” or, “I have mild scoliosis.”
Dr. Migliore: That is ridiculous to me that no one at their esports organization gave them the resources to rehabilitate themselves. Talk about Alex Smith. He fractured his leg and underwent something like 17 surgeries. His injury was so bad they almost had to amputate it because his injury was so bad. And that dude, two years later returned to football and took a bunch of snaps, and got tackled and his leg was fine, right? Alex Smith can almost lose his leg because his injury is so bad, but you’re telling me a 23-year-old with back pain can’t be rehabilitated? Right?
Dr. Migliore: That’s on the esports organizations. It is. We’re working on it. A lot more esports organizations are waking up to that fact. Immortals has. Robert Yip is the head of performance. CLG has Summer Scott. Misfits Gaming has Dr. Carolyn Rubenstein. They are waking up, but we definitely need, the onus needs to be on these orgs who can pay for these services.
Ken: I love the example you gave about the helmets, because it sounds like a lot of video game injuries may be stemming from ergonomics. As we all now work from home during the pandemic, I know how important it is to have the right desk and the right chair, and just not be hunched over your laptop all day. And so if the esports organizations can afford this equipment, they should invest in their players.
Dr. Migliore: Completely. Completely. When the work from home thing happened, it was also when I had stopped my full-time hospital job, and I was doing part-time esports and full-time hospital and then it switched. Also, COVID hit, so my wife was working from home and I was pushed into a small corner of our bedroom. And a real chair didn’t fit in the corner, so I was sitting in an Ikea dining room table chair. And I herniated a disk in my back. Two weeks before my wedding, I herniated a disk in my back.
Dr. Migliore: I did it when I was hiking, but it was because I was sitting in a crappy chair for eight weeks, for 12 to 14 hours a day, not getting up, not taking rests. Ergonomics are huge. A good chair can fundamentally impact the quality of your life. That pain can be debilitating. And it starts now, right? It starts when you’re younger, when you don’t have back pain. Preventative care is so much easier than treating a problem. And simple ergonomics need to be taught to everyone, right?
Dr. Migliore: When you’re sitting, your feet should be flat on the ground, your hips should be at your knee level or just above, never below. Your elbows should be no less than 90 degrees or a little bit more open. Your shoulders should not be shrugged up. And your screen should be an arms length ahead of you, in front of you. And the monitor should be just at eye level or a little bit below.
Dr. Migliore: But the problem is, is that if you want a chair and you want a gaming chair, and your under 5’6″, good luck. Good luck. Because most chairs, those gaming chairs were made from leftover luxury car seats that they had. And most gaming chairs are made for dudes 5’7″ to six feet tall. And so ergonomics are hard because even if you are paying attention to them, it’s hard to get the right equipment right now.
Ken: I guarantee you that everybody listening to this podcast, as you outline those basic ergonomics, immediately they straightened up, they put their feet on the floor. And I know this because I just did.
Dr. Migliore: Yeah, exactly. And even when you are in that good posture, right? My good friend, Cate McGee says, the best posture is your next posture. Movement is really good when you’re sitting. You always want to be getting up. Every hour and a half you’re sitting down, just get up and stretch it out just for a couple seconds. Right? The standing desk rage hit really hard and everyone was standing all the time. And all of a sudden we see people with back pain because their hips and their back aren’t used to standing all day.
Dr. Migliore: A standing desk isn’t the best all the time, a sitting desk isn’t the best all the time. It’s all about movement. It’s all about finding the next movement and not being static. We’re not static beings, we’re dynamic beings. Be dynamic.
Ken: Yep. One of the worst things, and there were many bad things about working at GameStop, was being on my feet all day. My goodness.
Dr. Migliore: Yeah.
Ken: So speaking of moving, have you started noticing different injuries coming from VR? I suppose that’s not really penetrated the esports world as much yet.
Dr. Migliore: I think VR is going to be really cool. I love to look at trends. I love to try and predict the future. And VR is going to be huge in esports and gaming in the future, and so is mobile gaming. And you take all the problems that we have with PC and console gaming, you multiply them by like a billion, and that’s what we’re going to see with mobile and VR gaming. VR gaming is going to be so interesting because you’re going to be moving, right? You’re going to be up and moving, but what are the movement patterns you’re going to be doing?
Dr. Migliore: We’re going to see different repetitive strain injuries. I think we’re going to see more, and we are seeing more injuries akin to the sport they’re mimicking. Right? If you’re doing VR Beat Saber, you’re doing a lot of hand and wrist movements and arm movements, and so we’re seeing more shoulder issues. And there’s zero data on this. This is all from my head and from what I’ve seen. But we’re seeing more shoulder injuries, more elbow injuries from like hyperextension. Yeah, it’s definitely super interesting, and I can’t wait to see the data and the future on it.
Ken: Well, another emerging trend we were talking about, working from home, had a lot of people in the last year not wanting to venture outside their house for safety reasons have relied on telehealth. Does that apply to the sort of esports practice that you do as well?
Dr. Migliore: Telehealth is going to be a huge frontier for medicine. There’s no reason you need to go to the dermatologist anymore. You can do a skin inspection at home. There’s no reason you need to go into the doctor for routine preventative care most of the time. There are certain things obviously that you need to go to the doctor for, but I think telehealth is going to be huge. But given it’s medicine, we’re always going to be behind in technology.
Dr. Migliore: I still have people I know who use paper charts. They don’t want to use electronic medical records. Telehealth, esports is a great venue and gaming is a great venue for telehealth, especially because people are all over the country, all over the world. I think it’s going to be a cool thing. I’ve been doing telehealth recently. It’s been fun, but a little side note, COVID kind of adjusted the rules around telehealth.
Dr. Migliore: If you practice telehealth, you have to be licensed in the state you are in and also the state that the person you’re talking to is in. But with COVID, they kind of relaxed those rules. I think the laws surrounding telehealth are going to change and how we see telehealth is definitely going to change.
Ken: The exact licensure requirements you just mentioned I have found very restrictive, because I’m a digital nomad. I’m in a different state almost every other month. And I can’t have the same practitioner online because I’m never in the same state that they are in.
Dr. Migliore: That’s why I’m just working on getting licensed in every single major state that esports is in, so it’s not an issue.
Ken: And you’re not exaggerating, you’re actually doing that?
Dr. Migliore: Yeah. My license for California and Washington state are pending right now.
Ken: Ugh! That’s fantastic. It sounds like a lot of work, but I hope it’s worth it.
Dr. Migliore: It’s a lot of work.
Ken: If you and the esports organizations with their millions of dollars collectively are helping to oversee the physical health of their athletes, is it also the esports organization’s responsibility to supervise the mental health, and who can they hire for that?
Dr. Migliore: Yeah. When I say health, I’m talking physical mental health. When I was doing more traditional medicine, every single visit, I would have at least a little bit of a mental health check-in. Because mental health is just not paid attention to. And then when you do pay attention to, there’s this huge stigma attached to it, right? People have no problem saying, “Oh, I sprained my ankle.” They want you to sign their casts when they break their arm.
Dr. Migliore: But if they have an ADHD diagnosis or they’re struggling with adjustment disorder, they don’t want anyone to know, because of the stigma that’s attached to it. And especially in gaming, we see a lot of burnout. We see a lot, a lot, a lot of burnout. And ADHD is also a big thing. There’s no data on this, just subjective, but, people who have ADHD are hyperactive and have issues with the tension, but then can hyperfocus on something, on very specific things.
Dr. Migliore: And gaming has always been one of them for a lot of people. And so in my opinion, in my experience, there’s a lot of people who are drawn to gaming who have attention issues, because it’s that one thing that you can focus on. And so we also see a lot of prescription drug use, a lot of Adderall abuse in esports, and depression and anxiety. You take people who have spent their whole lives training by themselves.
Dr. Migliore: There’s no really prescribed path to pro in the US right now. The collegiate scene isn’t as built out as we would like to see it. When people show up to their first day of their team, it’s the first time they’ve worked in this environment. And it’s stressful, and they oftentimes are in a different country, a different city, and so they don’t have their support systems. And depression and anxiety are things that can hit in those situations. Whoever is taking care of their health, should be to be talking about all of the aspects of health, not just physical health.
Ken: And if there are so few physicians so far with the specialty on esports and video game injuries, where do people go to find somebody like you besides Gamerdoc.net?
Dr. Migliore: In traditional sports, if you want to work with … If you’re on a football team, you’re not seeing the doctor every day. You’re probably only seeing them two or three times a year, right? The major liaison to health in traditional sports is the athletic trainer. And they are the ones who are there every day in the training room. They’re the ones taping ankles. They’re the ones referring to the dietician, referring to the doctor saying that this person needs an x-ray.
Dr. Migliore: And right now in esports, that’s the coach, which is an issue because they are often just former players themselves and don’t have any medical training. What we’re seeing in we’re seeing is the influx of performance coaches. And these are people usually with master’s degrees or strength and conditioning certifications, things like that. And so we’re definitely seeing an influx of that right now. But the certified people are getting scooped up immediately by organizations.
Dr. Migliore: So if you are having esports or video gaming injuries, and you don’t want to talk to me, I recommend Cate McGee at 1HP, 1-hp.org, .com. I’m not sure. You can just Google 1HP or Dr. Cate McGee. She’s also a co-editor on my book. 1HP has a very rich network of resources that can help you out, so I definitely recommend them.
Ken: Awesome. Thank you. And there’ll be links to all those in the show notes at Polygamer.net. Let’s switch to talking about your other organization, Queer Women of Esports or QWE. What is the mission of QWE?
Dr. Migliore: The mission of QWE is to make gaming fun for everybody. There’s all these ways we can say it, but gaming should be fun for everyone and esports should be open to everybody. So if you want to be the best at a sport, you have to train in that sport, and you have to train against people who are as good as you, if not better. And in esports, in video gaming, if you want to train with people who are your level or better, you have to use voice communication. You have to use voice comms, especially if it’s a team game.
Dr. Migliore: Most games you have to communicate with your teammates. And the toxicity in online video gaming is disgusting. It is terrible. I will turn on my voice comes and play Squad Fill every month or so, just to remind people you don’t take video and just to remind people of what happens. As soon as you open your mouth as a woman, it’s terrible. The toxicity is terrible. It’s people of color, for queer individuals. Toxicity in gaming is not great. They did this really interesting study, it’s cool, but it’s sad.
Dr. Migliore: And they had a computer play Halo. And they had a computer play Halo at either being good, bad or mediocre at Halo. And then they had the computer have set phrases it would say in either a female voice or a male voice. And what they found was if there was a female voice, the toxicity they received was swift and immediate. The male voice, even if they were the same skill level as the female voice would receive much less hate, much less negative comments. And the most interesting part of this study in my mind was the people who gave the hate to the female voice were the lower skilled male players. The worse you were at Halo, the more likely you were to be toxic to women. It’s just-
Ken: Not surprising.
Dr. Migliore: … not surprising at all. When I tell people that they’re like … I’m like, “Yeah, women face toxicity in gaming,” they’re like, “Yeah, everybody does,” and I’m like … What I don’t understand is how they’re okay with that. It’s being like, “Yeah. Sometimes when I go outside, acid rain hits me right in the face. It just melts all my skin off.” It’s like, “What? We’re cool with this?” What QWE is doing is trying to eliminate toxicity in gaming and also a bunch of other stuff too.
Dr. Migliore: If you don’t play against the best, you’re not going to be the best, you’re not going to get the job, you’re not going to get the experience in esports. Even if you don’t want to be a professional player, you still need esports experience to work in the industry. They don’t have any sports experience because they’re pushed out because of toxicity in online gaming, thus they don’t get the jobs, and thus they don’t get the career advancement and thus we see the esports industry like we see it now. That’s really what we’re working on.
Ken: I think this is the same study you’re referring to, a 2015 study regarding Halo 3. It said that lower skilled male players were more hostile toward teammates with a female voice, but behaved more submissively to players with the male voice. The authors of the study argued, “Female initiated disruption of a male hierarchy insights hostile behavior from poor performing males who stands to lose the most status.”
Dr. Migliore: Yeah, I love that study so much. I would encourage you to read the whole thing because it’s so cool, but it’s basically like there’s this pool of people playing Halo who are competing to be the best, right? And there’s, let’s say there’s a hundred people and they’re all dudes. As soon as you open up the circle and include women, so now it’s 200 people, that worse dude, instead of being in 100th place is now in 200th place, right? He stands to lose the most from inclusion because he has more competition, and he’s going to realize how terrible he is at video games. And it’s just it’s an incredible study. I love that line, and I love that you just brought that up.
Ken: Well, thank you for the reminder. I hadn’t thought of that in at least a year, so it’s always going to be remembered. I’m looking at the website for Queer Women of Esports, which is queeresports.org. And one of the lines you have is, “Gaming is for everyone. Esports isn’t yet.” And we kind of just touched about how toxic that environment can be. But also, Gamergate was seven years ago last month. Games, although this Polygamer Podcast opens with the statement, “Games are for everyone,” I consider that the ideal and not the reality, unfortunately. So our esports like Gamergate, theoretically had nothing to do with esports specifically. Is esports even more toxic than traditional games?
Dr. Migliore: 4 million thousand times.
Ken: Oh, that’s awful.
Dr. Migliore: So much more. I mean, you have Gamergate, you had what happened with Riot a couple of years ago. We have Activision Blizzard recently. Gaming itself, it really isn’t for everyone yet. But it’s better, it’s certainly better than esports, because in order to get involved in esports you have to go full gaming, right? You have to be your gaming all the time. A lot of us are gaming on the weekends or at night. But in order to be involved in esports, it’s always games, culture all the time. And it’s competitive and it’s a different mentality than gaming. And so it’s just, it’s exponentially worse, unfortunately, but we’re working on it.
Ken: What’s the solution for those who do want esports to be a safe environment? Should there be gender-based teams and competitions?
Dr. Migliore: Very good question. The first thing is if you witness something that is discriminatory, speak up, speak up. In order for this industry to change, it’s not going to change by women saying, “Please include us,” it’s not going to change by people of color saying, “Please include us.” It’s going to change by the people who are already included, speaking up and saying, “You know what, that gay slur you just said, not acceptable. That’s not unacceptable.” That’s just not how we speak to each other.
Dr. Migliore: It’s going to start by if you’re in voice comms and a woman’s voice pops up, and the person you’re playing with starts to get toxic, being like, “Dude, just chill out. Just be cool.” We start by changing the culture, and saying that behavior is unacceptable is really the first step. It’s not the last step, it’s not the only step, but it’s definitely the first step. All-women tournaments are really interesting, because people are polarized over the fact.
Dr. Migliore: But there’s this thing in life called stereotype threat. If you are aware of a stereotype, you’re going to be more likely to fulfill that stereotype. There’s the stereotype that women are bad at math. If you tell women they’re bad at math before they take a math test, they’re going to perform worse than if you would not have told them that. And they took it one step further. Here’s another great study around video gaming.
Dr. Migliore: They had male and female avatars, and they had men or women controlling each one. It was mixed. And they found that if they told the people who are controlling female avatars that women were bad at math, the female avatars would perform worse on math problems in the game, regardless of whether they were controlled by men or women. We have the stereotype that women are bad at video games, right? We have a stereotype that exists, and so women are less likely to enter tournaments.
Dr. Migliore: Young girls are less likely to pursue careers in gaming. Women-only tournaments allow people to have that experience of participating in this tournament when they otherwise probably wouldn’t have entered it all. Women-only teams and organizations have … We have this experience of being able to train and compete at a higher level without toxicity. I think it’s definitely necessary for now. We definitely need spaces that are safe and inclusive and have a lower barrier to entry for now.
Dr. Migliore: People say, “How do we know when we have an inclusive esports center, an esports industry? We don’t need women-only tournaments anymore.” That is, to me, when we don’t need women-only tournaments anymore, that’s how I know esports is inclusive
Ken: And speaking of being inclusive and being diverse, I saw in one of your previous interviews you commented that high school esports teams tend to be more diverse when they don’t have funding. Why is that?
Dr. Migliore: The study came out, God, I think earlier this year or maybe last year. And it looked at a bunch of programs and it looked at the demographics, and it found that high school esports organizations that where student run their clubs had amazing diversity. Amazing, amazing, amazing diversity. But then as soon as you injected funding or made it a part of the high school officially, all that diversity got eliminated.
Dr. Migliore: And they interviewed the people who were on these teams and they said, “What happened when you got funding?” And they said, “Well, we cared about winning. And the women weren’t as good so we cut them. We cut them off the team.” Once you inject money and funding into it, women and people of color start to taper off. And is it because they’re bad at video games?
Dr. Migliore: I’m going to go with no. It’s a really good question. There’s lots of reasons. When I showed up to the first day of my job at Georgetown, they had only had one woman in six years before me. And they say, “Okay, we’re going to get you custom scrubs. All right, so tell us your size,” and I said, “Okay, it’s a unisex scrub. I’ll take an extra small,” and they said, “Oh, we don’t have extra smalls.” I was like, “Okay, what’s the smallest size you have?” They’re like, “We have mediums. Mediums.” And I was like, “I don’t fit into a medium scrub. The V is going to be so low that my patients aren’t going to take me seriously. They’re really staring at the low V the whole time.”
Dr. Migliore: And that’s a barrier to inclusion, right? You don’t hire women, and maybe the women don’t want to come there because you don’t make clothing for them. If you’re on an esports team for high school and you’re going to travel for a competition, where are the kids rooming? Right? Are they all in one hotel room? Is there four in a hotel room? Is there a separate space for the girls to sleep in your event? Are there bathrooms for women? We say that like it’s a joke and people are like, “Of course there’s bathrooms for women.”
Dr. Migliore: When Hillary Clinton was running for president, she was debating on stage with the rest of the Democratic candidates, and she was late after a commercial break. The reason that she was late was because the women’s bathroom was like a quarter of a mile away from the stage. All the men just went off backstage, bathroom right there, boom, boom, boom, boom. She had to walk for like 10 minutes to get to the bathroom. 10 minutes is an exaggeration, but she came back and she was late, and late on air and flustered because she was running to get back from the bathroom. There’s small barriers to inclusion that build up and start to push people out because they don’t feel comfortable.
Ken: Oh my gosh, that reminds me of the scene from Hidden Figures where she had to walk across campus to go to the bathroom, and it impacted her performance. And her boss, regardless of whatever his racial views were, was just focused on the bottom line, he’s like, “It’s not good for business to have separate bathrooms.” Speaking of business, you had also said that women tend to be over-mentored and under-sponsored. What does it mean to be over-mentored? I feel like being mentored is a good thing, so how can it be too much?
Dr. Migliore: Mentorship is when you provide people advice, right? Career advice. You say, “Hey, this is where I think your career trajectory should go. Here’s where I think you have lapses in your career. Here are some things I think you should do in the future.” People love to give women advice. People love to tell us what to do. I’m at the gym three, four times a week. I know what I’m doing. And people will come up to me and tell me that I’m lifting wrong. I know I’m not. I know I’m not. Or I’ll be climbing and I’ll be sitting there. And one of my favorite things about climbing is trying to figure out how to get up, right?
Dr. Migliore: “There’s more than one way to skin a cat. How am I going to get up this wall?” And dudes will come over and be like, “Oh, you can do this, this way,” and I’m like, “I know. Just let me figure it out myself.” There’s actually a big sign in both of the bathroom that says women are something like 90% more likely to get advice from men in the climbing gym. We don’t need advice. We don’t need advice. We need to be hired. We need to be given opportunities.
Dr. Migliore: Sponsorship is active mentorship. Sponsorship is saying, “Hey, I have an opportunity and I would like you to do it. I have a paper that I’m writing, I would like you to be my co-author. I have a book I’m writing, I would like you to author one of the chapters. I have a panel that I’m on, I would like you to moderate it.” That is sponsorship. Active direct opportunities, right? It’s a difference between holding the mic in your hand and holding it in front of someone’s mouth versus actively handing the microphone to them.
Dr. Migliore: And QWE has a mentorship program, but it is a sponsorship program, because if you use sponsorship, everyone thinks of AA. But that’s really the difference and that is what everyone should be thinking about. When you want to make this space more inclusive, are you giving advice or are you giving opportunities?
Ken: It’s both a issue of giving too much advice and also the issue of the advice being disproportionate to these sponsorship opportunities.
Dr. Migliore: Exactly. It’s performative allyship at the end of the day. You’re putting on a performance to make yourself feel good versus actually doing things to help enact change.
Ken: And inviting somebody to say, “Come to PAX East to moderate a panel and pay their way.” Not everybody has the budget to do that, but there are sponsorship opportunities that are less expensive, like just making introductions and giving opportunities.
Dr. Migliore: Exactly.
Ken: Excellent. Let’s take a quick look backward. You said that you were working on the book that came out this year for two and a half years, which means you started in late 2018. But as far as I know, the identity of GamerDoc didn’t start until summer of 2020. What initiated that transformation?
Dr. Migliore: I was in a restrictive contract where I could not start a business until then. I couldn’t take money for things. I couldn’t start providing services that I charged for. I created a social media profile. I was really active on Twitter, and I started using GamerDoc back then, and was just providing free educational content. I was speaking on panels, I wasn’t charging. I was providing educational resources, I wasn’t charging doing events. I wasn’t charging. And I did that for a while, a long time, and then got out of my contract and finally could officially call it a business, and it was fantastic.
Ken: You did that around the same time that you launched Queer Women of Esports. So those have both been around for a little over a year now. What are some of your proudest moments or accomplishments in the year of the existence of those two entities?
Dr. Migliore: I mean, the book was fantastic. I did not expect the emotion that I felt when I held that book in my hands, because I was already done, right? I didn’t know how to publish books. No one knows what they’re doing until they figure it out. But I thought how you publish a book was you write the book and then you find a publisher, when in actuality it’s you have the concept for the book, you find a publisher, and then the publisher says, “Okay, now write the book on this timeline.”
Dr. Migliore: And so I started writing the book and I started recruiting authors, and everyone was like, “Okay, well, who’s your publisher?” I was like, “I don’t have one yet. We haven’t finished the book,” and they’re like, “What?” So I reached out to Springer and submitted the book proposal, and they got back to me and they’re like, “Okay, when can the book be done?”
Dr. Migliore: And I was like, “Well, it’s done.” “What do you mean it’s done?” “It’s done.” So you send them the book, and they take two months, and they send them you back their edits and they say, “Okay, do this, do this, do this.” So you rewrite and they send it back to you. It’s a long drawn out process. The book was done for a while. But then the moment when I physically opened the box and held it in my hand, I was just overcome with emotion because it was a real thing.
Dr. Migliore: It was a real thing I was holding in my hand. It wasn’t just a Google Doc that I’ve been editing for thousands of hours. For GamerDoc, that was really the best moment this past year. PAX West, that was a wild moment too. I was giving a solo talk on how to get better at gaming. And the attendance for PAX West wasn’t great. The first panel I gave was like halfway empty. And this was a solo talk, so I was like, “Oh my God, if people don’t come it’s because of me. I can’t blame it on anything else rather than me.”
Dr. Migliore: I’m a good little doctor, so half an hour early, the opposite of being a good doctor. But I’m half an hour early and I walk up the escalator, and I hear someone yelling, “If you’re in line for how to get good at gaming, the end is upstairs.” And there’s like a hundred people in line to see my talk half an hour early. And we actually had to turn away more people than we could let in because of the capacity of the room, and that just made me feel good.
Dr. Migliore: For QWE, I would have to say it’s our mentorship program. It’s just amazing. Special thanks to our sponsors at Aim Lab. They have just been really incredible with sponsoring the program. Wayne Mackey really puts his money where his mouth is. But just hearing the feedback from our mentees who have had career opportunities come out of in our second cycle, having career opportunities come out of their experience with us has been outstanding, and it’s been a great time.
Ken: That’s wonderful. And congratulations again on the book. One of a guest on the Polygamer Podcast earlier this year, Maia Weinstock, has written a book about Mildred Dresselhaus, a MIT professor. And that book is coming out next year from MIT Press. And she and I are Facebook friends, so I see all the different rounds of edits and revisions. And she’s been involved in this process at some point for years. And even after she turned the book in, it’s not done because it just keeps going.
Dr. Migliore: Mm-hmm (affirmative). Mm-hmm (affirmative). Exactly.
Ken: That’s our look back. What do you have coming forward? Anything that you want to tease that is coming on the pipeline?
Dr. Migliore: Okay. When you start something, right, when you’re one of the founders of the field, you get to create your own job, right? Your job doesn’t exist, you get to create your own job. I’ve spent the past year, six months doing some soul searching and being like, “What do I want to do in my day-to-day? What do I want my life to look like?” And I don’t really know. I’m just doing what I love right now, which is great. But I think I’m going to join an esports organization. I think I am.
Dr. Migliore: I think I’m going to join an esports organization, and either come on as like their chief wellness officer or performance or something. I’ve been talking to a couple orgs about it. Now, it might happen soon, it might not. I might change my mind. And I’m also going to have some … I’m joining some more advisory boards with some gaming companies that are pretty big name coming out in the next couple of months, and helping them produce products that are more ergonomic and safe. I can’t really say names of either of those things yet until the contract is inked, but lots of big things coming soon.
Ken: Well, that’s really exciting and a lot to look forward to. Whatever they are, congratulations.
Dr. Migliore: Thank you.
Ken: As I’ve mentioned, you can be found on the website at gamerdoc.net, on Twitter @GamerDoc_. The Queer Women of Esports is queeresports.org. Is there anywhere else you want to plug today?
Dr. Migliore: No, I mean, that’s pretty much it. If you’re interested in treating video gamers, if you’ve made it this far into me talking, then buy my book. But otherwise, yeah. Oh, oh, TikTok, guys. I’m trying to get into TikTok. The 14-year-olds are so mean to me.
Ken: Aw!
Dr. Migliore: I post a funny clip of me playing Fortnite. I’m not trying to be a pro gamer, I’m not trying to do anything, and they’re like, “You’re bad at gaming.” I’m like, “Yeah, I am. What’s your point?” So follow me on TikTok and say nice things in the comments. GamerDoc is my username.
Ken: We will flood you with positivity.
Dr. Migliore: Please, the 14-year-olds, they’re so mean.
Ken: How dare they, honestly? Let’s put them through med school and see how they feel.
Dr. Migliore: Yeah.
Ken: Honestly. And do we need to offer any disclaimers about even though you’re a medical professional, the advice on this podcast we’re not held viable for?
Dr. Migliore: Yeah, that’s perfect. Yeah. This is not medical advice, this is educational. This is not a doctor-patient show.
Ken: Fantastic. Dr. Lindsey Migliore, thank you so much for your time.
Dr. Migliore: Thank you, Ken.
Voiceover: This has been Polygamer, a Gamebits production. Find more episodes, read our blog or send feedback at polygamer.net.