This is Carly Beam with the Becker Spine
and Orthopedics podcast, and I'm thrilled to be
joined today by doctor Sophie Zhou, a neurosurgeon
at University Hospitals.
Doctor Zhou, welcome back to the podcast, and
thank you for being here today.
Yeah. Of course. Thank you so much for
having me.
So before we, get started, can you just
introduce yourself and share a bit about your
background?
Yeah. So I am,
an assistant professor of spine surgery and neurosurgery
at University Hospitals in Cleveland.
I am the associate program director as well.
So part of my role is to
help guide new residents and new medical students,
into the field of neurosurgery.
It's one of the best parts of my
job is to, you know, bring in the
the new people, the new fresh blood into
our field. It's,
it's very, very rewarding.
I bet. And, you know, we're recording this
in December heading to 2026. And I'm wondering
what are the most important shifts in spine
neurosurgery
education that we need to see?
I think one of the things that really,
we all focus on is surgery itself. Right?
And I think when you go through neurosurgery,
it's seven years of training. You do thousands
of cases,
and
you come
out very experienced
in surgery.
And you come out very
nuanced in your,
in your decision making. And I think that's
across the field in all of the different
programs that I've seen
throughout The US. But I think one of
the things that we don't have a focus
on is
how does that translate
in the current
medical
world. Right? I think we see neurosurgery
and surgery and any kind of medical practice
as medicine itself, but it doesn't exist
alone.
It exists
in our
medical system. So I think there should be
a broader
teaching
of how does that translate with insurance? How
does that translate in private practice?
How does that translate in academic medicine? What
is an RVU?
I think those are the things that we
don't focus on as much because, you know,
at the end of the day, our greatest
focus is our patients, and that should always
remain true.
But I think to be a better
physician, we should understand where our patients are
coming from, the financial background.
What does it mean to take care of
our patients, not just in their disease process,
but what does it mean to take care
of them to
get them access to care? I think that's
a really important part
of medicine nowadays
that we really should refocus on.
Definitely. And, I mean, I imagine for
surgeon surgeons and patients are both navigating very
different kind of elements of the health care
system that still may be just equally as
shifting,
potential confusion,
etcetera.
I'd love if you could, dive a bit
deeper into what you've been telling
your own fellows and residents. How are you
what are you doing in your own work
to equip them with this,
full
spectrum?
Yeah. So we really encourage our residents
and our fellows to go out to courses.
Because I think when you go to these
national courses,
there there are always coding courses, and you
can learn more about, you know, what is
a code, what does it mean. I think
there's also,
courses about health care, and, you know, neurosurgery
also has advocacy
programs
that are involved in different aspects of health
care.
You know, we're involved in the Washington Committee
and things like that. So
I think,
really, just looking beyond
the pure medicine
and allowing your residents to have that kind
of focus
is
is critical. Because I think
there's such a lack of focus on it
in our training
that just by telling them this is an
aspect that you should focus on
is great. For example, when we went to
the Becker's meeting
last year in June, there was a real
drive towards understanding how does insurance work, how
does,
access to medicine work, and how do we
provide care at a sustainable, cost effective way.
And I think that kind of dialogue
between not just academic medicine, which really focuses
on, you know, patient outcomes,
but with private practice as well,
which, you know, has this other aspect, other
dimension of medicine. I think this kind of
dialogue is really what drives our understanding
of
medical care in The United States.
Definitely. And, hey, thank you for, the kind
words about our conferences.
You know, with spine surgery, there's always, you
know, a lot of new innovations coming out.
And I'm wondering how are you balancing between
teaching innovations,
but also, you know, restraining unnecessary
interventions?
Yeah. I think that's, like, such a great
question. Right? Because you we're always
at the cusp of the next new thing,
and you always think that the new thing
you're trying
well, you at least you hope the new
thing you're trying is going to be the
next biggest and greatest.
And I think one of the things that
you have to really
understand
when you try a new thing
is that you have to look at it
as,
does it effectively
change my management of my patients? Does it
provide
good quality care?
And
it's not just, oh, I have this new
cool
thing.
But really looking at it,
with some amount of focus on,
is it beneficial to my patient for the
cost? And is it beneficial to my patient
for the effort? Because sometimes
you can do something, but it may be
slower. It may cost more. And
does that time and money cost really,
really benefit the patient?
And I think one of the things that
academic medicine
does a really good job on
to try to create that balance
is that
we do research projects. Right? We look at
outcomes.
And I think really focusing on the outcomes
being driven by the data
is how you
discern what is good and what is just
flashy.
Mhmm.
Yeah. It's a great way to think about
it. And, you know, obviously, AI, it's just
it's everywhere in health care. There's always,
people are always exploring new
applications,
new, new tools.
How should spine surgeons and neurosurgeons be taught
to evaluate these,
applications so they don't over rely on, like,
black box decision support?
Yeah. I think the good thing about
our generation
of,
surgeons is that we're kinda growing up with
AI. Right? It's not like AI was something,
that
kind of occurred
twenty, thirty years ago. It's something that we're
integrating actively now into our practice.
So
as a practicing surgeon,
you are kind of looking at at AI
as it integrates into practices every day. And
one of the best examples right now is
how we use AI in dictations.
It kind of
increases our speed
in
writing documentation,
but it doesn't necessarily
change our decision making. It takes away some
of the busy work as of right now.
It helps with scheduling. It helps with some
aspects of medicine
that are tedious
but are very,
rote. There's also
AI
applications in imaging. Right? It helps refine
some of the reads, but
would I trust my
radiology partners over an AI read? 100%.
Because
there are just nuances
of
patients that
experience
teaches you. And that's the part
about AI that
will get better. Right? It's about training these
programs.
They also rely on experience,
and I just don't think we're quite there
yet.
But the greatest thing about
being a part of, you know,
growth in medicine
is that you start from the beginning. So
if you're one of those people who waits
until everything is already said and done, then
you're behind. But if you integrate as it
becomes,
available,
then you're part of the learning process. And
I think that's how you avoid the pitfalls
because you are able to look at it
from a perspective of
it's learning with me.
Yeah. And it's kind of like that approach
of curiosity and what can this do well,
where can we refine things.
Yeah. That curiosity, that's that's such a good
way of putting it. Because I think if
you
just trust it blindly because you're so far
behind,
and you're like, well, it must be good,
well, then you don't realize the pitfalls. But
subs you know, on the other hand, if
you're just like, I don't trust it. Nothing
about it is good, then you're gonna fall
out of favor. Right? Because the things that
are good about,
AI, you're gonna miss. So I think just
having that balance and knowing that it's a
tool and it's a tool that you can
help
make better,
I think that is what creates that balance.
Got it. And I want to pivot a
little bit. I was wondering, what part of
surgeon well-being do you think is missing from
today's education right now?
Oh my gosh. I think that's such a
good topic. Right? Because we're all humans at
the end of the day. And I think
that is the part we forget. There's so
much machine learning. There's AI. There's all these
things that,
you know,
are designed to make our practice better, to
make our patients better, but we forget that
we're human too at the end of the
day. And so we talk a lot with
our residents about,
you know, you have to focus
on
your own well-being.
And sometimes,
you know,
it's just taking a five minute breather
after a hard case or a hard outcome
and real realizing and recognizing
your own humanity.
And sometimes it's more than that. Right? Five
minutes may not be enough, but,
I think
eating right,
exercising,
having
a friend circle,
not making
this job your entire life,
and
having outside interests
are all critical
towards being a really good doctor.
Because when I have doctors that I really
respect that take care of me,
what I really love about them
is
that they're human, and they connect to me
on an emotional level. Right? And I don't
think they can do that if they were
burned out and
tired and can't even focus on themselves.
The best doctors I've ever seen have always
been able to talk to me
like I'm their friend. They ask me how
I'm doing,
how,
how things are going in my life. And
that's what I try to emulate
in my practice.
I always wanna know personal details about my
patients because I think it also
helps me focus
on
not just the medicine, but how their back
pain or how their
leg pain, how does it
it how does it translate in their life?
Because they're not just a spine that I
need to operate on. They're
a person who I can help.
And I think
if we look at ourselves that way and
treat ourselves as humans,
then
as we train and as we get better
and as we,
you know, evolve in our physician practices,
we're gonna be that much better.
I like that the way you're framing that
too. It's like the surgeon
takes care of themselves, then that
translates to just
the positive interactions with the patients, etcetera.
Yeah. I
mean, how many times have you ever had
a doctor
where you're like, wow. That guy is a
machine, and you think
he's probably technically really good,
but
is he gonna take care of me in
a moment of
hardship?
Like, is he someone I can trust and
talk to? I think
when you
really reflect on
the physicians that
kind
of have been great,
their technical skills
have to be good,
but it's their humanity that kind of
triggers that emotional response. Right? Because when I
want to take care of someone or when
I want someone to take care of me,
I don't want a machine.
I want a doctor who understands
there are nuances to my life. And so,
I think by embracing the nuances in your
own life
through training,
afterwards, throughout your entire career, and after,
I think that if you can focus on
those aspects of your life, you will come
out that much better of a doctor.
Very well said. And, doctor Jo, last question
I have for you. What are the three
top trends that you're following in health care
today? You can think broadly, spine specific.
Yeah. I think the things that we really
face are
the changes in insurance.
Right? There's just been so many,
issues with insurance companies
with the way that, spine coding
is,
going forward, whether or not we're gonna have
bundled care.
And then I think those aspects of medicine,
the financial aspects of medicine are a huge
component of how our patients receive care.
I think medical training
is also a huge trend or not trend,
but medical training and
access to training,
whether or not,
you know, medical students
can afford
to train,
and
whether or not they pick
specialties based on income
that is going to be huge as in
medicine in general, probably less so in subspecialties
like spine and neurosurgery,
but I think that is a huge player
in
medical education going forward.
And I think that
the biggest trend
in spine
is our embrace of,
you know, technology.
I think there are just so many different
inventions
coming forward
that we just need to be critical in
the way that we assess them. I think
we assess things
with research,
with
outcome studies. And now that large population databases
are so readily available,
I think we just need to be
really keen
on how we
integrate those things into our practice.
I think that we should embrace
change, but we shouldn't just rush into things
like we've always talked about.
Great. Well, doctor Jo, thank you so much
for joining us today. It's been a pleasure
to catch up, and I hope you have
a happy holiday.
You too. Thank you so much for having
me.