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- This is the Becker's Healthcare podcast, and I'm
- Molly Gamble. My guest today is doctor Bryant
- Lynn, a primary care physician, educator, and researcher
- at Stanford Medicine
- who approaches all three with humanity at the
- core. Doctor Lin first came onto my radar
- in early twenty twenty five when I read
- a New York Times profile of him under
- the headline, when this professor got cancer, he
- didn't quit. He taught a class about it.
- That line captures his resolve, but also something
- larger, what becomes possible when a physician lives
- through health care from the inside out as
- a patient and turns that experience into a
- lesson for the rest of us. Doctor Lin,
- welcome to the podcast. It's so good to
- have you with me today.
- Great to be here. Thanks for having me.
- Absolutely. That was a a little glimpse into
- you and your background, doctor Lin. But for
- our listeners, can you introduce yourself more fully?
- Tell us how you came to see health
- care from all three
- chairs at once as a a professor, as
- a physician, also as a patient.
- So, yeah, I've been on faculty at Stanford
- for, jeez, twenty years now. Time time definitely
- flies.
- Also practicing primary care,
- doing research. I cofounded the Center for Asian
- Health Research and Education at Stanford about eight
- years ago.
- And one of our prior priority areas has
- been around lung cancer in people who've never
- smoked with a with a focus on Asians.
- Ironically, in 2024,
- I was diagnosed myself
- with lung cancer,
- stage four lung cancer. So, you know, I
- I kind of had the opportunity
- I always look for a silver lining to
- experience health care from the vantage point of
- a researcher,
- you know, faculty member,
- primary care doctor, but also now a patient.
- And it's really, really been eye opening for
- me. I mean, it's I I kind of
- use this phrase with my students.
- I knew, but I didn't really know. You
- know, you don't really know, so you walk
- in those shoes of the patient.
- Mhmm. Mhmm. That's what we're gonna be I
- mean, we're gonna be unpacking a lot of
- that today.
- I I've done some reading about you and
- your story in the past, and you have
- said in various interviews that doctors
- are notoriously
- bad patients.
- Doctor Lin, what makes that true?
- I think a couple of things. One, of
- course,
- maybe we know enough to be dangerous,
- and, you know, we tend to like to
- take care of ourselves, and we get a
- lot of informal care. I I I've talked
- about this a few times that when I
- was diagnosed,
- I have the great fortune of my own
- primary care doctor. You know, his office is,
- like, across the way from me. So rather
- than getting an official appointment,
- you know, an official visit, it's easy for
- me to say, hey. You know, his name
- is doctor Paul Ford. Paul Ford. I said,
- hey, Paul. You know, can you write me
- this prescription? I'm having this cough.
- So when I was before I was diagnosed,
- I had a cough for six weeks. So
- it was very easy for me to, you
- know, to talk to him about it. But,
- you know, that's good and bad. Right? Sometimes
- you do need that formal visit. You know,
- you do need that,
- structure around what you're doing.
- And, also, you know, doctors tend to be,
- at least in my case, I can't speak
- for all doctors, but
- I can speak for myself. We tend to
- lag on kind of the regular maintenance
- preventative
- health care we're supposed to do. I'm, 52
- now. I got my
- colonoscopy,
- which, you know, they changed the recommended age
- on the guideline for 50 to 45,
- and I got it at 49.
- So, it was, you know, a few months
- before I got diagnosed with lung cancer. So,
- you know, an example of kind of, oh,
- I understand this. I know. I know.
- But, you know, it was really only because
- my wife pushed me to get my regular
- screening done that I did it. So, you
- know, an example, I would say, I I
- don't know I don't know any studies that
- have been done on this, but I know,
- several of my colleagues and myself who are
- kind of somewhat, lagging on, preventative health care.
- So just a couple of examples of how
- patients, how doctors can be poor patients, unfortunately.
- Yeah. I think it's an interesting
- paradox there. And and it sounds like in
- some ways, as much as they might lag,
- there's also a different level or baseline of
- of expectations
- or experiences
- firsthand with with health care and receiving health
- care guidance or or treatment or or being
- seen if by a colleague across the hall
- in an informal way.
- You the pace of your diagnosis,
- you've you've kind of under you mentioned, like,
- six weeks of having a cough.
- This was in 2024 you were diagnosed.
- It it took a span, right, of six
- days from the chest X-ray to the pathology
- result, and
- it sounds like that's not the norm. That
- is Can you That is,
- unbelievably
- fast. You know, I did you know, I
- wasn't pushing I mean, this is another example
- of sometimes
- physicians can push push for tests early, so
- I didn't push for an X-ray early
- because of my cough, which is, you know,
- common. A lot of people, not just doctors,
- you know, request X rays for their cough.
- You know, I'm very aware as a primary
- care doc that, you know, most people don't
- need an X-ray when they have a cough.
- So I kinda tried the usual things. But
- by the time I got to the point
- where my cough wasn't getting better after about
- five or six weeks,
- an x-ray, I still remember it was a
- Tuesday.
- I got a CT scan the next day
- because the x-ray was abnormal.
- And then I had a bronchoscopy that Friday,
- and the pathology results were back by that
- Monday. So that was Wow. Six days.
- So, you know,
- I I think that is an example of
- how our health care system can work very
- well. Right? Mhmm. It's you know, that sounds
- like an amazing thing, and it was amazing
- because I have all the privilege. Right? Everything
- I check off all the boxes
- of how things can go well for a
- patient. Unfortunately,
- most people don't have those boxes checked or
- any of the boxes checked. Right? So, that
- shouldn't you you know, you and I are
- talking about this as an exception.
- It shouldn't be the exception. It should be
- the rule. That should be what we're striving
- to, and I hope we achieve that. So,
- you know, what worked well for me? Right?
- Number one and, actually, in my class, I
- talk about this. I even wrote a book
- about my class. I didn't even intend to
- write a book about it, and I kind
- of expanded on this really thinking about what
- went right for me.
- The number one thing, which actually the students
- didn't pick up, was I speak English. I'm
- a fluent English speaker. Mhmm. Right? That's a
- huge barrier for many of our patients.
- Even if you have a translator, the highest
- degree of translator,
- it's still an obstacle. Right? There's an obstacle
- of understanding.
- Know and then, of course, you know, all
- the other aspects of of access. Right? So,
- you know, we had in our class, the
- our chief medical officer, doctor Nir Sehgal, was
- there talking about access.
- And, you know, I have insurance.
- Of course, I have good insurance, standard standard
- kind of standard insurance.
- I have, you know, financial resources. I have
- a job. I have flexible working hours. I
- can, you know, ask my colleagues to cover
- for me. You know, we don't often think
- of that as for a doctor, but, you
- know, doctors, we're we're constantly covering for each
- other. If we're out sick, we're out for
- other reasons.
- Mhmm. I have transportation
- that can get to and from
- my appointments, you know, even though they may
- be at different locations.
- I can even get somebody you know, I
- have a great care support network. I can
- my wife's here with me. My older son
- drives. Well, he's back from college for the
- summer. So when he's here, he can drive
- me. But, you know, my sister and her
- her husband live nearby, and they drive. And
- they can take me to my appointments if
- if if I don't feel well or I
- can't drive myself.
- You know, so and then, you know, health
- literacy. Right? I'm a doctor. I
- theoretically know you know, have enough knowledge to
- understand my care.
- So all of these things and there are
- many, many, many other aspects of access that
- your listeners are honestly probably more expert than
- me about, but, you know, I experienced these
- firsthand,
- about how things could go right for me.
- I also know, of course, have connections. I
- can call up somebody in my in my
- hospital and say, hey. You know, can I
- get an appointment?
- So all of these things work worked for
- me. They should be able to work for
- everyone this way. And and I think we're
- trying. Right? Patient navigation,
- especially in oncology, is very common.
- But, you know, I think we can do
- better. I think we can definitely do better
- across the board. Mhmm.
- Doctor Lind, did the six day turnaround, did
- it have a measurable difference in in your
- treatment,
- in in I I imagine the personal stress
- that you must have felt or anxiety to
- I think waiting is such a difficult part
- of any health care journey. But can you
- speak to what what was different about having
- that turned around in six days versus the
- baseline, which would be much longer?
- Absolutely. It did. I think,
- you know, even though my overall long term
- prognosis
- is number one, poor and number two, uncertain,
- I would say that short term anxiety
- of not having a plan
- is very, very stressful, very emotional,
- you know, especially at the beginning when you're
- being diagnosed. And, you know, I went through
- kind of all the five stages of grief
- in different order rapidly several times.
- And, you know, having that diagnosis enables you
- to get a plan. But once you have
- the plan,
- at least in my case, and and I
- know just from experience as a primary care
- doc,
- that does settle people down, and that did
- in my case, you know, it settles you
- down. Hey. I have a plan. I know
- what to do. I have my appointments to
- go to. I have a follow-up scan. You
- know, that really enables you
- to live your life again. And I think
- that to me is the kind of one
- of the basic principles
- of health care should be
- how do we help people live their lives,
- not live medical lives, but live the lives
- of what they're doing.
- You know, in in our class, the lung
- cancer class, I structured it so
- that actually most of the sessions, most of
- the lectures
- were about what the patient experiences and not
- so much we had a few sessions on
- few lectures on the science and treatment and
- so forth. But, you know, we talked about
- nutrition, spirituality,
- caregiving,
- access, you know, all of these things that
- really the patient experiences most of the time.
- You know? But, you know, as doctors in
- the health care system, you know, we're we're
- there for them. You know? Again, I'm just
- arbitrarily putting a number,
- you know, a single digit percentage of their
- life. Right? They're in the clinic, a tiny
- part of their life. They're in the infusion
- center, in the scanner, a tiny part of
- their life. Even in the hospital. Right? I
- mean, hopefully, they're not in the hospital 80%
- of their life. They're in the hospital, you
- know, a single digits percent of their time.
- And, you know, what we should be doing
- is enabling, empowering
- patients like myself
- to live their lives, you know, as best
- they can outside of the medical system.
- And, you know, I I think that's that's
- that's the goal and really,
- you know, being a patient myself open that
- lens to me. You know, again, I knew.
- Right? Of course, patients are not in the
- hospital, not in my clinic,
- but that's not how you see them because,
- you know, you're seeing them in the clinic.
- You're seeing them in the hospital. So this
- is kind of the I knew, but I
- didn't really know.
- I I I'm fascinated by that distinction. It's
- like you you see things on paper. You
- see things in the textbook, and they make
- sense intellectually. But until you've lived it, it's
- a different level of resonance. And you you've
- mentioned your class. Let's let's talk more about
- your class. I mean,
- when I introduced you as having resolve, you
- you after your diagnosis, you built a course
- around your own diagnosis and you teach it
- to medical students,
- of everything in this curriculum, maybe to underscore
- the point we just made, but what's one
- lesson
- that you really want the next generation of
- physicians to carry forward, not just theoretically,
- but to really embrace maybe with a different
- level of
- intensity than they otherwise would if they had
- a professor who was teaching them purely from
- textbook?
- Yeah. I I I mean, it's a great
- question. I I thought about that a lot.
- I mean, my initial goals for the class
- were
- really,
- you know, seeing how we could encourage
- students to go into some aspect of cancer
- care, which which I think we achieved. And,
- obviously, that's a little bit self self fulfilling
- because you're not gonna sign up for the
- class unless you're interested in something about cancer,
- whether it's a researcher or a primary care
- doc. But to me, it really
- became about
- seeing patients,
- which, you know, that we do in education,
- but, again, adding
- emphasis to how patients are not patients. They're
- human beings. Right?
- They are out there living their lives. They're
- trying to find
- their happiness every day. Right?
- So, you know, I really wanted to put
- a face to that. In medical school so
- we had undergrads and medical students and different
- other graduate students as well, who's mostly medical
- students in our class.
- And, you know, you don't get much continuity
- in training. Right? It's just
- difficult to do. Right? You see one patient
- and then maybe for a few days, and
- then you see another patient.
- But, you know, I thought this was a
- unique opportunity for me to share my experience
- over,
- you know, ten weeks of a class, really
- a little bit more than ten weeks of
- the class,
- and from somebody who could speak to it
- as a patient and a physician.
- And, you know, really, to me, it was
- the emphasis that
- it's the holistic care we should be providing,
- not in the kind of, you know, I
- hate to say, kumbaya
- kind of way of holistic care. You know,
- I think that word has this stigma to
- it. Right? For some reason,
- you know, we should be providing
- holistic care, but maybe, you know, I I
- know semantics are important, so I would call
- it human care. And and, of course, in
- this day of AI,
- to me, that's just more important, you know,
- than ever
- to really emphasize
- to to our future doctors or future generations
- of not just clinicians, but researchers and health
- care administrators
- and, you know, all all the other clinicians,
- you know, not just physicians
- and, you know, all the staff, all the
- wonderful people providing the care
- that, you know, it's it's really
- about taking care of people as as human
- beings.
- Mhmm. Not as you know, You know, we
- have to do numbers. Right? Of course. You
- know, it's all about quality and efficiency and
- so forth. But, you know, there are humans
- behind every number, and it should be there
- are humans first, and then there are numbers
- second.
- So I think it is easy to lose,
- and I've been guilty of this.
- It's easy to lose sight of that when
- you're so busy and you're trying to, you
- know, get health care systems run efficiently
- and not lose money.
- You know, the human should come first and
- the number second.
- So, you know, we were talking about kind
- of this old bio I had and, you
- know, how I described myself. And, you know,
- I really believe
- even when I wrote it years ago and
- and now that, you know, my focus is
- on, like, keeping,
- you know, technology, all of these great things
- we have, they're secondary to support of medicine,
- which is humans taking care of other human
- beings.
- Mhmm.
- I I think that is such a powerful
- message, and it sounds it it can sound
- trite or obvious, but I think to your
- point, unless you are really believing in it
- in the day to day, it is easy
- to get distracted by KPIs and all these
- other metrics, dashboards,
- efficiencies.
- But if if you lose sight of that,
- it it's it's you're really losing, I imagine,
- quite a lot in the world of medicine.
- So Absolutely
- insidious. You know? My even my 14 year
- old son has heard KPI before, which is
- funny. Right? Even a 14 year old kid
- would have heard that term. Right? You know
- what? That sort of filtered out through society,
- not just health care, like the idea that
- we gotta measure everything.
- I mean, we should measure things, but we
- should remember there there's there there are many
- other things more important than numbers.
- Completely
- agreed.
- Also, as you were
- did you receive
- care at Stanford? Were you kind of holding
- up a mirror with this course to your
- own institution?
- All my care has been at Stanford, and
- I have to say it's been amazing.
- You know, they have done an amazing job.
- You know, part of this, again, is my
- privilege. Right? I'm an insider. I've been there
- for twenty years.
- So, you know, but I I think,
- you know, I I
- am so grateful for the high level of
- care I've gotten.
- I think it's interesting.
- You know, the people I've spent most time
- with are actually the infusion nurses because you're
- sitting there for an hour
- kinda getting an IV. Originally, in my case,
- when I switched meds, I was there for,
- like, two nine hour days getting an IV
- infusion.
- And, you know, those would be that's the
- human face
- of your health care system.
- And, you know, I'm really grateful that you
- know, I'm grateful to all my doctors and,
- you know, my primary care doctor, my oncologist,
- doctor Heather Wakeley.
- But, you know, really, the people who are
- putting in,
- you know, the the face to face time
- because they can, but, also, they're they're so
- empathetic. I think that's where, you know, nurses
- appropriately get
- many of the kudos for,
- you know, being caring and and really supporting
- patients because, you know, that's really their job.
- Their job is the face, and that's why
- I think most of them go into the
- profession.
- You know, honestly,
- probably better than doctors at doing that. I
- think there have been there's been studies. There's
- evidence to show that. But,
- so, like, no. I'm really grateful for all
- the care, the amazing care I've gotten at
- Stanford. And this is this is not an
- advertisement. Nobody's paying me Of course. Of course.
- Salary, but not they're not paying me to
- say this.
- Of course. I think it's an important distinction.
- It's like you using the term you're holding
- a mirror up. It's it's this is this
- is your home in many more ways than
- one.
- What's maybe if you can recall as a
- patient, what's what's one of the more
- uncomfortable,
- I suppose,
- things that you learned, something that
- really looked pretty different as a patient than
- it does from the faculty level, from the
- c suite, and then something that our listeners
- just might be at risk of of underestimating.
- I think I think the whole prior authorization
- mess
- is really
- again, I knew it because I was on
- the doctor's side. You know? I filled out,
- you know, forms and provided
- letters
- to try to get things approved, you know,
- either imaging or medications for my patients.
- And, you know, it was kind of, you
- know, everybody hates doing all the doctors, of
- course, hate doing it. And Mhmm. It's a
- big burden on our system.
- But, you know, from the patient perspective, it's
- incredibly,
- I would say, stressful and and even damaging.
- So I I I can share two examples.
- One was early on. I had my X-ray,
- and and for some reason, the,
- I think the prioritization
- wasn't submitted in time. But, you know, I
- signed off to say, hey. I'd pay for
- it if it wasn't covered.
- But so, you know, the CT scan that
- diagnosed my lung cancer,
- just because the system didn't work, you know,
- I got a bill for that because the
- insurance just kept rejecting it and rejecting it
- because things weren't done in exactly the right
- checkbox order. Right? Even though it was Yeah.
- So I got a big bill for that.
- Right? I mean, for me, I could do
- it, but, I mean, luckily, we took care
- of it. But it's stressful to have to
- call and call and email and email
- to try to take care of this huge
- bill when you're dealing with, you know, a
- new diagnosis of
- terminal cancer. Right? So Mhmm. That was one
- where I I realized, and and I'm like,
- god. I'm never gonna sign that patient,
- you know, whatever they call it, patient agreement
- for financial responsibility form again. I'm never gonna
- do that because it was I mean, it
- got taken care of, but it's such a,
- you know, hassle and painful to do that.
- Right. So the other thing was, you know,
- for my medication. So,
- I in in last fall in 2025,
- I had progression of my cancer,
- and so I had to change treatments. My
- oncologist, doctor Heather Wakeley,
- good friend of mine, chief of oncology,
- one of the literally the most famous
- lung cancer, thoracic oncology
- oncologists in the world. Like, she was the
- president of one of the societies. And Mhmm.
- And so she's, you know, she's, like, you
- know, the expert,
- in lung cancer care. And in particular, my
- type of cancer,
- she's even more expert,
- if if one could say that. So, you
- know, she, of course, prescribed the medication,
- which so I was on
- evidence based treatment before a chemotherapy in Tagrisso.
- And then it was changed to
- Rybrevant
- and losertin in last clues,
- which is a antibody and a targeted therapy.
- And
- it was rejected by insurance. You know? So
- the oral therapy,
- the the last dose was rejected twice, and
- the IVU was rejected once. I still remember
- this is a Friday.
- And to start this medication, it's, you know,
- it's a lot, two nine hour days of
- infusion. So it was a infusion. So it
- was a Friday, and I got a message
- from the nurse saying,
- hey. Don't go because we haven't heard from
- your insurance. And then on the Monday,
- I, you know, they I I was on
- a video appointment with, my oncologist, and she's
- like, why aren't you at the infusion?
- And I said, you know, I because it
- was eight 8AM, so she hadn't seen her
- messages. And the the message was sent, like,
- late Friday. And I was like, jeez. I,
- you know, I heard insurance hadn't covered it.
- And she said, let me let me see
- what's going on. And it was rejected. So
- the IV treatment was rejected, and and I
- was so upset. I mean, so stressful.
- My, you know, my symptoms were getting worse.
- I had a horrible cough,
- and my my right lung was filling up
- with fluid. I had a pleural effusion.
- And,
- I was so mad, so I posted on
- LinkedIn. And and, you know, it went viral.
- I got you know, for LinkedIn, I had,
- like, a 100,000, 200,000, 300,000,
- I think, 500, 600,000,
- impressions by the next
- morning.
- And then, of course, once that went viral,
- it got approved, like, within two hours. Wow.
- So, you know, I have that again, I
- have this privilege because I have this platform
- to do that. But Yeah. You could imagine.
- Right? There's a delay. It takes time, and
- and, you know, I hear this number all
- the time. I don't know where it comes
- from. You know, these prior authorizations, once they
- go to external review,
- 80% of them are approved. So, you know,
- that doesn't speak well to how we're
- looking. And I I'm not blaming
- any particular insurance. I think it's just the
- whole
- system and the idea
- of prior authorizations.
- I know no one with cancer who's getting
- unnecessary
- cancer treatment.
- Nobody.
- I mean, I I don't see how you
- could argue that in, you know, an oncologist
- and the patient are doing things because these
- are unpleasant treatments. I mean, these are not
- fun to do.
- And if the oncologist thinks it's appropriate,
- you know, it should be covered, and the
- onus should be on the insurance company
- to really rather than not right now, the
- onus is on the patient and physician. And
- and, you know, we spent hours
- writing letters and things,
- you know, to get these these treatments approved.
- So, you know, to me, again, I knew,
- but I didn't really know
- how damaging,
- this idea of prior auths. And, again, I'm
- not blaming one because every insurance does this.
- Right.
- And and it's very much, you know,
- very nitpicky. Right? I happen to follow not
- exactly
- because my treatment was cutting edge. It was
- approved FDA approved,
- but because I had already had chemotherapy,
- the the the guidelines, the NCCN guidelines, which
- are the standard
- cancer guidelines for treatment,
- didn't take that to account
- that, oh, you all would have already had
- it because they required
- approval. They would say, oh, you have to
- do chemo in addition. But it made no
- sense to me because I already had you
- know, for me, I already had chemo because
- that that standard of care had changed
- that for people like me, you would do
- Tagrisso plus chemo.
- So I I mean, I don't wanna get
- in the weeds of that. But, yeah, it's
- just very to me,
- you know, it's incredible, like, how many people
- may have just given up
- and not got treatment. I I mean, I
- give you an example. Later that week, because
- the treatment was delayed a week, I had
- to get one point three liters
- of fluid drained from my lung.
- Wow. Because I couldn't I was coughing and
- felt terrible. I couldn't sleep.
- And, you know, maybe. I don't know. Maybe
- that would not have been necessary
- had I started treatment when it was supposed
- to start.
- So, you know, it's it's it's upsetting
- to me as a doctor
- and even more upsetting to me as a
- patient
- that I had to do that.
- And it's challenging. And, you know, this happens
- all the time. It happens every day.
- Yeah. No.
- The the billions that prior auth cost in
- terms of, like, the administrative burden of it,
- the inefficiencies,
- but then I think beyond those big numbers
- that sometimes are a little numbing when you
- get to these stories about
- it it's not as though you were,
- for a nine hour, right, nine hour IV
- treatment session to be Two days. Two two
- nine hour days. Yeah. Yeah. It's not something
- I'm getting unnecessarily.
- You know? It's like Exactly. Oh, this is
- unnecessary. I mean, it's it's kind of amazing
- that Yeah. I mean, I can understand maybe
- for very specific things, but, you know, again,
- I've never met anybody who's gotten unnecessary
- cancer treatment.
- You know, we're we're again, this is the
- human insurances here
- supposedly to serve us. Right?
- Because we are mixing you know,
- I'm happy to pay in the system,
- you know, as a healthy person. I was
- healthy for many years, and I paid into
- the system. And that helped other people get
- their care. Right? That's the whole purpose of
- insurance. You've got healthy people, and you unfortunately,
- in my case, now I'm in the kind
- of unhealthy
- group that's eating up money, but that's why
- you have a, you know, a large pool
- of people so you can reduce that overall
- risk. Right? You shouldn't be nitpicking
- every detail of individuals
- because then it's I mean, that's not the
- point. The point is you have a pool
- of people and, you know, it's a subsidy.
- It's kind of a almost a Robinhood model.
- You could call it. Right? The healthy people
- subsidize the poor people because the the not
- the poor people. Subsidize the sick people because,
- that's the way the system works. That's how
- it can work. Mhmm.
- Something needs to change there. I know there's
- different initiatives in place to make it less
- burdensome, but it is what you just outlined
- is so highly intrusive.
- It's so,
- tightly wound at the front end. And then
- to your point about LinkedIn posts,
- it's it's, you know, it's addressed. So So
- it's amazing how these things do get resolved,
- but the time lost
- to to figuring this out while you're dealing
- with a new diagnosis and trying to update
- your your care, it's,
- it's intrusive to say the least. And it's
- not just the patient. It's the whole family.
- Right? Yeah. Very much so. The whole family's
- gotta put their lives on hold. They're stressed.
- You know?
- You know? What are you do you know,
- you're like, jeez. What do I do? Just
- like what I said earlier, when you have
- a plan,
- things calm down. When there's uncertainty,
- you know, that's really when the anxiety kicks
- in.
- Yeah. Doctor Lin, I wanna end on a
- note that I think is hopefully a hopeful
- and optimistic one.
- There is I talked to talked to numerous
- clinical leaders, clinicians,
- and there's a good amount of of worry
- as of late, probably a little bit more
- pronounced in the past two two to three
- years about the clinicians and the doctors coming
- up right now who are
- have Gen AI available to them, the instant
- answers fast instant
- like, so instant now more than ever that
- a lot of people worry will leave them
- lacking traits that the generation before them had.
- As as physicians,
- can you
- you you actually teach these students. You interact
- with them regularly.
- Is that fear right? And if you can,
- can you just tell us about a student
- or a moment in your classroom
- that has really left an impression on you
- and shown you that the people who'll be
- caring for us down the road are are
- gonna be just fine?
- So it's a great question. You know? I
- think this is not just a question question
- medicine.
- It's a question in across all of education.
- Right?
- What do we need to teach? What what
- do we need to encourage
- students, learners
- to to understand,
- you know, in this age of AI?
- You know, I don't have the answer to
- that because, you know, I it's interesting. I
- went to my son's in terms of what
- we need to learn, I went to my
- son's undergraduate
- school. He goes to Chapman. He just finished
- his freshman year. And, you know, they made
- a point. There's a faculty panel. Well, you
- know, we used to all need to learn
- how to spell. Right? Yeah. You know? But
- now nobody needs to know how to spell.
- I mean, of course, there's the wizard spellers
- in the spelling bee, but, you know, nobody
- needs to know how to spell, and nobody
- cares about that, honestly. I mean, very few
- people are, you know, saying, jeez. That's a
- that's a skill
- that we've lost and that was important. And,
- you know, same thing with handwriting and so
- forth.
- You know, in medicine, we've already seen this
- to a certain degree with the physical physical
- exam.
- So it used to be even when I
- was training, you know, whatever, almost thirty years
- ago,
- you know, the physical exam was really emphasized.
- You know, listening using
- the stethoscope, listening to the heart and lungs,
- you know,
- the neurologic exam, the eye exam, you know,
- all of these
- exam features.
- But now,
- you know, it seemed it's less emphasized because
- we have all these amazing tests. Right? You
- know, why you know, if if you're kind
- of
- you know, if you're not a cardiologist,
- you know, do you need to be a
- super expert to identify every little heart murmur
- when you have an echocardiogram, which is probably
- no matter how good you get at it,
- probably gonna better be better than you are.
- Right? Just period. Right? Because it's the gold
- standard. Right?
- So,
- you know, so that's very interesting. I mean,
- there's many arguments for
- continuing to be very good at the physical
- exam, but it's definitely something that I think
- we've all perceived that's been, you know, lot
- somewhat lost over the years of
- medical training,
- that emphasis and that that skill of the
- physical exam.
- But on the other side, it's like we
- have technology. Right? I still remember
- and sorry for the long winded answer. I
- was I I'm from Tennessee. We were during
- COVID,
- we took a road trip to the Smoky
- Mountains
- in Gatlinburg, Tennessee.
- And I'm a woodworker, and there was, like,
- this little, like, woodworking shop. And I'm like,
- oh, we gotta stop and talk to the
- guy.
- And the guy's, like,
- died, like, a to true Tennessee, and, you
- know, he's got his you know, he's got,
- like, sawdust all over himself. And and I
- saw he had some guitars, not just his
- furniture, but he had some guitars. And I
- said, hey. Did you did you make these
- guitars? He's like, yeah. I made these guitars.
- And I said, hey. Did you, you know,
- did you did you, like, hand plane everything?
- Did you you know? Because, you know, we're
- kind of obsessed nowadays with making things by
- hand. And he's like he just looked at
- me strange, and he looked at me and
- he said, I have electricity.
- So he's like, you know, why would I
- hand plane it when I've got these tools,
- like, these machines to do it? I'm sure
- he could do it. Right? But, you know,
- he was quite skilled. The the guitars looked
- beautiful.
- So that's the thing. It's like, yeah, we
- have electricity. We have technology. Why not use
- them?
- Mhmm. So so so, yeah, I don't know
- in terms of and it's hard to predict
- because
- we don't know what skills
- will be missing, what we needed. I think
- we need to continue to monitor. So this
- is the thing. I think what the way
- we can adapt to this AI
- world is really monitoring outcomes to make sure
- things don't get worse. Right? And and like
- we do with everything, you know, making sure
- we're improving quality. But on the positive side
- so, again, sorry for long winded answer.
- I've asked this question to a couple of
- different groups.
- And one group,
- was a group of,
- you know, kind of AI for this is
- a medical education conference at Stanford on AI.
- And
- and I asked them, I said, how many
- of you raise your hand
- if you
- are comfortable having an AI doctor.
- And, you know, a lot of people this
- is the AI, like, enthusiast audience. A lot
- of people raise their hand. And then I
- asked them,
- hey. How many of you would be comfortable
- having an AI doctor if you were diagnosed
- with stage four lung cancer?
- Fewer people raise their hand. And then I
- asked them the third question. I said, hey.
- How many of you
- would wanna have an AI doctor at the
- end of life? And
- still a couple of people raise their hand,
- but even fewer.
- When I asked this question,
- you know, to physicians
- and students
- I mean, the older physicians got nobody even
- for the first question, nobody raises their hand.
- Like, they don't even wanna Right. But even
- with younger, you know, students' positions,
- you know, that's a much less they they
- wouldn't even for themselves,
- they recognize the importance
- of that humanity. So, you know, I've had
- almost nobody
- raise their hands for the second or third
- question when it's a physician or a student
- audience. So, you know, I I think that
- because they're talking about themselves. Right? So Right.
- You know, that's what they want for themselves.
- You know, that's hopefully what they're gonna be
- looking for, providing for their patients. So,
- you know, I do think they recognize that
- it's the humanity
- in medicine that's important,
- and AI is just a tool. It's just
- a tool.
- Again, I don't know. I I I I'm
- I don't think anybody knows kind of what
- are the skills we need, what are the
- skills we don't,
- and that's gonna shake itself out. I think
- we need to monitor and make sure, you
- know, we don't have descaling. Right? There was
- a study about
- people,
- gastroenterologists
- doing colonoscopies
- and, you know, people getting deskilled about identifying
- certain things.
- But, you know, we can measure that and
- we can adapt,
- to that.
- You know, and certain things AI is probably
- gonna be better than us. And it's like,
- well, if it's better than us,
- why do we need humans? Right? It's sort
- of like, jeez. If it was a Waymo
- world,
- you know, and there are no no card
- s, you know, maybe that's just a better
- world to live in. So, yeah, that part
- I don't know. But I'm very hopeful about
- the future of students and residents because,
- you know, I I think they're all even
- with all these tools,
- you know, they're all very aware that they're
- taking care of people and they're trying to
- help other people.
- Mhmm.
- I really like that three part question that
- you asked.
- And I think that to your point, it's
- I love the story too about I have
- electricity. I mean, that's that's so true. There
- is a lot of mixed feelings at times
- about AI in different fields, particularly in medicine
- and health care, but,
- I think you really in your front part
- of that answer helped explain the nuance of
- this, why
- medical students gravitating toward it or being more
- open to it than maybe others are is
- not a bad thing. But,
- to hear the hand raising ratios in those
- different groups, I think, really does sum it
- all up.
- Yeah. Doctor Lin Yeah. I I I just
- wanna thank you. Were you gonna add something
- there?
- No. No. No. I mean, yeah,
- I'm a positive guy. You know? Yeah. I
- tend to be I mean, obviously,
- if I weren't, I wouldn't be with I
- wouldn't be on the air with I wouldn't
- be on the podcast with you. You know,
- I'm generally very optimistic. I mean, this is
- why I teach. Right? Yeah. Teaching is so
- like, you see the next generation
- and, you know, of course, you see the
- things that always happen. Right? Oh, I remember
- when I was a student exploring and, you
- know, some things don't change. Like this question
- about technology. Right? You know, they ask these
- same questions a generation ago, two generations ago.
- Right? Such and such is ruining our profession.
- And and,
- you know, but, you know, I think students
- working with
- students and trainees always gives me hope. Always
- gives me hope. Both for my own case,
- you know. You know, I I it gives
- me hope that, you know, if I if
- I live long enough to the next treatment
- that these students will be taking care of
- me. Right? And coming up with the next
- wonder drug for me,
- you know, I I I think these these
- students give me hope, and it's part of
- why that's actually probably the main reason
- I teach.
- And, you know, I'm I write about my
- experience and, you know, come on podcasts.
- You know, I I I could do other
- things,
- you know, could be traveling the world. I
- could be on the beach right now.
- But, you know, I I think doing things
- that are hopeful is is really great, and
- these students
- and trainees, you know, they give me hope,
- and,
- it's fun. Give me a little bit of
- sunshine in my life every day.
- I I I can't thank you enough for
- sharing that with us,
- on this podcast with our audience today. To
- your point, you could be on the beach.
- You could be doing a lot of different
- things with your time, but your perspective is
- remarkable.
- Your students are quite lucky, and so are
- we to have the chance to get to
- visit with you like this and hear from
- you firsthand, doctor Lin. So thank you so
- much. Again, listeners, this is doctor Bryant Lin,
- primary care physician, educator, researcher, and as you
- just heard so much more at Stanford Medicine.
- Doctor Lin, I just wanna thank you again
- for being my guest today. Great to visit,
- and I hope we can do this again.
- Great. Thanks, Molly. Thanks for having me.