WEBVTT 1 00:00:02.080 --> 00:00:04.319 - There's a small circle of people who truly 2 00:00:04.319 --> 00:00:05.919 - understand what it takes to lead a health 3 00:00:05.919 --> 00:00:08.660 - system right now. The decisions are enormous. 4 00:00:08.960 --> 00:00:11.919 - The variables are constantly shifting, and the stakes 5 00:00:11.919 --> 00:00:14.099 - of getting a call wrong don't stay contained. 6 00:00:14.400 --> 00:00:16.904 - That's not a complaint. It's a structural reality. 7 00:00:17.204 --> 00:00:19.125 - And it's why the most effective c suite 8 00:00:19.125 --> 00:00:21.285 - leaders are deliberate about where they go to 9 00:00:21.285 --> 00:00:22.585 - pressure test their thinking. 10 00:00:22.964 --> 00:00:25.945 - Becker's fourteenth annual CEO and CFO roundtable 11 00:00:26.324 --> 00:00:28.564 - brings together more than 1,500 12 00:00:28.564 --> 00:00:29.864 - executive level attendees 13 00:00:30.239 --> 00:00:32.799 - and nearly 400 speakers for four days built 14 00:00:32.799 --> 00:00:34.739 - around growth, financial sustainability, 15 00:00:35.280 --> 00:00:38.079 - workforce strategy, and the leadership questions that don't 16 00:00:38.079 --> 00:00:39.140 - have easy answers. 17 00:00:39.679 --> 00:00:41.840 - Join us November second through the fifth in 18 00:00:41.840 --> 00:00:42.340 - Chicago. 19 00:00:42.880 --> 00:00:44.820 - For the agenda and event details, 20 00:00:45.195 --> 00:00:47.355 - visit beckershospitalreview.com 21 00:00:47.355 --> 00:00:49.115 - and click on the events tab in the 22 00:00:49.115 --> 00:00:49.935 - upper right. 23 00:00:50.875 --> 00:00:52.875 - This is the Becker's Healthcare podcast, and I'm 24 00:00:52.875 --> 00:00:55.355 - Molly Gamble. My guest today is doctor Bryant 25 00:00:55.355 --> 00:00:58.414 - Lynn, a primary care physician, educator, and researcher 26 00:00:58.475 --> 00:00:59.535 - at Stanford Medicine 27 00:00:59.929 --> 00:01:02.170 - who approaches all three with humanity at the 28 00:01:02.170 --> 00:01:04.409 - core. Doctor Lin first came onto my radar 29 00:01:04.409 --> 00:01:05.930 - in early twenty twenty five when I read 30 00:01:05.930 --> 00:01:07.530 - a New York Times profile of him under 31 00:01:07.530 --> 00:01:09.689 - the headline, when this professor got cancer, he 32 00:01:09.689 --> 00:01:12.015 - didn't quit. He taught a class about it. 33 00:01:12.254 --> 00:01:14.575 - That line captures his resolve, but also something 34 00:01:14.575 --> 00:01:17.215 - larger, what becomes possible when a physician lives 35 00:01:17.215 --> 00:01:19.215 - through health care from the inside out as 36 00:01:19.215 --> 00:01:21.055 - a patient and turns that experience into a 37 00:01:21.055 --> 00:01:23.775 - lesson for the rest of us. Doctor Lin, 38 00:01:23.775 --> 00:01:25.694 - welcome to the podcast. It's so good to 39 00:01:25.694 --> 00:01:26.834 - have you with me today. 40 00:01:27.650 --> 00:01:29.349 - Great to be here. Thanks for having me. 41 00:01:29.730 --> 00:01:32.370 - Absolutely. That was a a little glimpse into 42 00:01:32.370 --> 00:01:34.290 - you and your background, doctor Lin. But for 43 00:01:34.290 --> 00:01:36.849 - our listeners, can you introduce yourself more fully? 44 00:01:36.849 --> 00:01:38.290 - Tell us how you came to see health 45 00:01:38.290 --> 00:01:39.349 - care from all three 46 00:01:39.685 --> 00:01:41.605 - chairs at once as a a professor, as 47 00:01:41.605 --> 00:01:43.545 - a physician, also as a patient. 48 00:01:44.245 --> 00:01:46.165 - So, yeah, I've been on faculty at Stanford 49 00:01:46.165 --> 00:01:49.305 - for, jeez, twenty years now. Time time definitely 50 00:01:49.365 --> 00:01:49.865 - flies. 51 00:01:50.885 --> 00:01:53.064 - Also practicing primary care, 52 00:01:53.549 --> 00:01:56.109 - doing research. I cofounded the Center for Asian 53 00:01:56.109 --> 00:01:58.909 - Health Research and Education at Stanford about eight 54 00:01:58.909 --> 00:01:59.729 - years ago. 55 00:02:00.030 --> 00:02:02.509 - And one of our prior priority areas has 56 00:02:02.509 --> 00:02:05.390 - been around lung cancer in people who've never 57 00:02:05.390 --> 00:02:07.329 - smoked with a with a focus on Asians. 58 00:02:07.954 --> 00:02:09.974 - Ironically, in 2024, 59 00:02:10.354 --> 00:02:11.814 - I was diagnosed myself 60 00:02:12.194 --> 00:02:13.415 - with lung cancer, 61 00:02:13.875 --> 00:02:16.514 - stage four lung cancer. So, you know, I 62 00:02:16.514 --> 00:02:18.455 - I kind of had the opportunity 63 00:02:18.835 --> 00:02:21.219 - I always look for a silver lining to 64 00:02:21.219 --> 00:02:23.620 - experience health care from the vantage point of 65 00:02:23.620 --> 00:02:24.360 - a researcher, 66 00:02:24.900 --> 00:02:26.520 - you know, faculty member, 67 00:02:26.819 --> 00:02:29.240 - primary care doctor, but also now a patient. 68 00:02:29.379 --> 00:02:31.460 - And it's really, really been eye opening for 69 00:02:31.460 --> 00:02:33.379 - me. I mean, it's I I kind of 70 00:02:33.379 --> 00:02:35.080 - use this phrase with my students. 71 00:02:35.495 --> 00:02:37.655 - I knew, but I didn't really know. You 72 00:02:37.655 --> 00:02:39.974 - know, you don't really know, so you walk 73 00:02:39.974 --> 00:02:41.435 - in those shoes of the patient. 74 00:02:41.894 --> 00:02:44.294 - Mhmm. Mhmm. That's what we're gonna be I 75 00:02:44.294 --> 00:02:45.655 - mean, we're gonna be unpacking a lot of 76 00:02:45.655 --> 00:02:46.394 - that today. 77 00:02:47.509 --> 00:02:49.829 - I I've done some reading about you and 78 00:02:49.829 --> 00:02:52.150 - your story in the past, and you have 79 00:02:52.150 --> 00:02:54.409 - said in various interviews that doctors 80 00:02:54.949 --> 00:02:55.689 - are notoriously 81 00:02:55.989 --> 00:02:56.889 - bad patients. 82 00:02:57.669 --> 00:02:59.930 - Doctor Lin, what makes that true? 83 00:03:00.715 --> 00:03:02.395 - I think a couple of things. One, of 84 00:03:02.395 --> 00:03:02.895 - course, 85 00:03:03.194 --> 00:03:05.775 - maybe we know enough to be dangerous, 86 00:03:07.194 --> 00:03:09.115 - and, you know, we tend to like to 87 00:03:09.115 --> 00:03:11.275 - take care of ourselves, and we get a 88 00:03:11.275 --> 00:03:13.754 - lot of informal care. I I I've talked 89 00:03:13.754 --> 00:03:15.930 - about this a few times that when I 90 00:03:15.930 --> 00:03:16.590 - was diagnosed, 91 00:03:17.449 --> 00:03:19.610 - I have the great fortune of my own 92 00:03:19.610 --> 00:03:22.009 - primary care doctor. You know, his office is, 93 00:03:22.009 --> 00:03:24.729 - like, across the way from me. So rather 94 00:03:24.729 --> 00:03:26.509 - than getting an official appointment, 95 00:03:26.969 --> 00:03:28.969 - you know, an official visit, it's easy for 96 00:03:28.969 --> 00:03:31.364 - me to say, hey. You know, his name 97 00:03:31.364 --> 00:03:33.284 - is doctor Paul Ford. Paul Ford. I said, 98 00:03:33.284 --> 00:03:35.685 - hey, Paul. You know, can you write me 99 00:03:35.685 --> 00:03:37.784 - this prescription? I'm having this cough. 100 00:03:38.164 --> 00:03:40.564 - So when I was before I was diagnosed, 101 00:03:40.564 --> 00:03:42.164 - I had a cough for six weeks. So 102 00:03:42.164 --> 00:03:44.280 - it was very easy for me to, you 103 00:03:44.280 --> 00:03:46.039 - know, to talk to him about it. But, 104 00:03:46.039 --> 00:03:48.299 - you know, that's good and bad. Right? Sometimes 105 00:03:48.840 --> 00:03:51.000 - you do need that formal visit. You know, 106 00:03:51.000 --> 00:03:52.139 - you do need that, 107 00:03:54.039 --> 00:03:56.219 - structure around what you're doing. 108 00:03:57.004 --> 00:03:59.085 - And, also, you know, doctors tend to be, 109 00:03:59.085 --> 00:04:00.525 - at least in my case, I can't speak 110 00:04:00.525 --> 00:04:01.745 - for all doctors, but 111 00:04:02.045 --> 00:04:04.205 - I can speak for myself. We tend to 112 00:04:04.205 --> 00:04:06.224 - lag on kind of the regular maintenance 113 00:04:06.685 --> 00:04:07.185 - preventative 114 00:04:07.805 --> 00:04:10.949 - health care we're supposed to do. I'm, 52 115 00:04:10.949 --> 00:04:12.330 - now. I got my 116 00:04:12.709 --> 00:04:13.209 - colonoscopy, 117 00:04:14.150 --> 00:04:16.310 - which, you know, they changed the recommended age 118 00:04:16.310 --> 00:04:18.649 - on the guideline for 50 to 45, 119 00:04:19.110 --> 00:04:20.790 - and I got it at 49. 120 00:04:20.790 --> 00:04:22.550 - So, it was, you know, a few months 121 00:04:22.550 --> 00:04:24.925 - before I got diagnosed with lung cancer. So, 122 00:04:24.925 --> 00:04:27.085 - you know, an example of kind of, oh, 123 00:04:27.085 --> 00:04:29.264 - I understand this. I know. I know. 124 00:04:29.965 --> 00:04:31.725 - But, you know, it was really only because 125 00:04:31.725 --> 00:04:34.384 - my wife pushed me to get my regular 126 00:04:34.444 --> 00:04:36.525 - screening done that I did it. So, you 127 00:04:36.525 --> 00:04:38.850 - know, an example, I would say, I I 128 00:04:38.850 --> 00:04:40.529 - don't know I don't know any studies that 129 00:04:40.529 --> 00:04:42.370 - have been done on this, but I know, 130 00:04:42.610 --> 00:04:45.269 - several of my colleagues and myself who are 131 00:04:45.329 --> 00:04:48.610 - kind of somewhat, lagging on, preventative health care. 132 00:04:48.610 --> 00:04:51.345 - So just a couple of examples of how 133 00:04:51.345 --> 00:04:54.724 - patients, how doctors can be poor patients, unfortunately. 134 00:04:55.425 --> 00:04:56.964 - Yeah. I think it's an interesting 135 00:04:58.305 --> 00:05:00.384 - paradox there. And and it sounds like in 136 00:05:00.384 --> 00:05:02.164 - some ways, as much as they might lag, 137 00:05:02.544 --> 00:05:04.704 - there's also a different level or baseline of 138 00:05:04.704 --> 00:05:05.365 - of expectations 139 00:05:05.745 --> 00:05:06.404 - or experiences 140 00:05:06.720 --> 00:05:09.040 - firsthand with with health care and receiving health 141 00:05:09.040 --> 00:05:11.520 - care guidance or or treatment or or being 142 00:05:11.520 --> 00:05:13.600 - seen if by a colleague across the hall 143 00:05:13.600 --> 00:05:14.900 - in an informal way. 144 00:05:15.759 --> 00:05:17.379 - You the pace of your diagnosis, 145 00:05:17.839 --> 00:05:19.839 - you've you've kind of under you mentioned, like, 146 00:05:19.839 --> 00:05:21.855 - six weeks of having a cough. 147 00:05:22.415 --> 00:05:24.514 - This was in 2024 you were diagnosed. 148 00:05:25.455 --> 00:05:27.134 - It it took a span, right, of six 149 00:05:27.134 --> 00:05:29.795 - days from the chest X-ray to the pathology 150 00:05:30.014 --> 00:05:31.074 - result, and 151 00:05:32.095 --> 00:05:34.574 - it sounds like that's not the norm. That 152 00:05:34.574 --> 00:05:35.920 - is Can you That is, 153 00:05:36.720 --> 00:05:37.220 - unbelievably 154 00:05:37.520 --> 00:05:39.520 - fast. You know, I did you know, I 155 00:05:39.520 --> 00:05:41.600 - wasn't pushing I mean, this is another example 156 00:05:41.600 --> 00:05:42.339 - of sometimes 157 00:05:42.720 --> 00:05:45.439 - physicians can push push for tests early, so 158 00:05:45.439 --> 00:05:47.460 - I didn't push for an X-ray early 159 00:05:47.785 --> 00:05:49.704 - because of my cough, which is, you know, 160 00:05:49.704 --> 00:05:51.884 - common. A lot of people, not just doctors, 161 00:05:52.185 --> 00:05:54.365 - you know, request X rays for their cough. 162 00:05:54.504 --> 00:05:56.264 - You know, I'm very aware as a primary 163 00:05:56.264 --> 00:05:58.185 - care doc that, you know, most people don't 164 00:05:58.185 --> 00:05:59.785 - need an X-ray when they have a cough. 165 00:05:59.785 --> 00:06:02.389 - So I kinda tried the usual things. But 166 00:06:02.389 --> 00:06:04.069 - by the time I got to the point 167 00:06:04.069 --> 00:06:07.029 - where my cough wasn't getting better after about 168 00:06:07.029 --> 00:06:08.089 - five or six weeks, 169 00:06:08.550 --> 00:06:10.310 - an x-ray, I still remember it was a 170 00:06:10.310 --> 00:06:10.810 - Tuesday. 171 00:06:11.350 --> 00:06:13.350 - I got a CT scan the next day 172 00:06:13.350 --> 00:06:14.889 - because the x-ray was abnormal. 173 00:06:15.365 --> 00:06:17.785 - And then I had a bronchoscopy that Friday, 174 00:06:18.165 --> 00:06:20.644 - and the pathology results were back by that 175 00:06:20.644 --> 00:06:22.824 - Monday. So that was Wow. Six days. 176 00:06:23.444 --> 00:06:24.425 - So, you know, 177 00:06:24.884 --> 00:06:26.964 - I I think that is an example of 178 00:06:26.964 --> 00:06:29.860 - how our health care system can work very 179 00:06:29.860 --> 00:06:32.980 - well. Right? Mhmm. It's you know, that sounds 180 00:06:32.980 --> 00:06:35.060 - like an amazing thing, and it was amazing 181 00:06:35.060 --> 00:06:38.500 - because I have all the privilege. Right? Everything 182 00:06:38.579 --> 00:06:40.120 - I check off all the boxes 183 00:06:40.500 --> 00:06:42.180 - of how things can go well for a 184 00:06:42.180 --> 00:06:43.399 - patient. Unfortunately, 185 00:06:44.754 --> 00:06:46.675 - most people don't have those boxes checked or 186 00:06:46.675 --> 00:06:49.955 - any of the boxes checked. Right? So, that 187 00:06:49.955 --> 00:06:51.475 - shouldn't you you know, you and I are 188 00:06:51.475 --> 00:06:53.254 - talking about this as an exception. 189 00:06:53.875 --> 00:06:55.555 - It shouldn't be the exception. It should be 190 00:06:55.555 --> 00:06:57.735 - the rule. That should be what we're striving 191 00:06:57.795 --> 00:07:00.729 - to, and I hope we achieve that. So, 192 00:07:00.729 --> 00:07:02.750 - you know, what worked well for me? Right? 193 00:07:02.970 --> 00:07:05.529 - Number one and, actually, in my class, I 194 00:07:05.529 --> 00:07:07.610 - talk about this. I even wrote a book 195 00:07:07.610 --> 00:07:09.529 - about my class. I didn't even intend to 196 00:07:09.529 --> 00:07:11.209 - write a book about it, and I kind 197 00:07:11.209 --> 00:07:13.930 - of expanded on this really thinking about what 198 00:07:13.930 --> 00:07:15.389 - went right for me. 199 00:07:15.875 --> 00:07:18.354 - The number one thing, which actually the students 200 00:07:18.354 --> 00:07:21.154 - didn't pick up, was I speak English. I'm 201 00:07:21.154 --> 00:07:24.115 - a fluent English speaker. Mhmm. Right? That's a 202 00:07:24.115 --> 00:07:26.214 - huge barrier for many of our patients. 203 00:07:26.675 --> 00:07:28.595 - Even if you have a translator, the highest 204 00:07:28.595 --> 00:07:29.574 - degree of translator, 205 00:07:29.899 --> 00:07:32.220 - it's still an obstacle. Right? There's an obstacle 206 00:07:32.220 --> 00:07:32.879 - of understanding. 207 00:07:33.420 --> 00:07:35.420 - Know and then, of course, you know, all 208 00:07:35.420 --> 00:07:38.560 - the other aspects of of access. Right? So, 209 00:07:39.020 --> 00:07:40.620 - you know, we had in our class, the 210 00:07:40.699 --> 00:07:43.660 - our chief medical officer, doctor Nir Sehgal, was 211 00:07:43.660 --> 00:07:45.279 - there talking about access. 212 00:07:45.644 --> 00:07:47.185 - And, you know, I have insurance. 213 00:07:47.564 --> 00:07:50.384 - Of course, I have good insurance, standard standard 214 00:07:50.764 --> 00:07:52.064 - kind of standard insurance. 215 00:07:52.764 --> 00:07:55.485 - I have, you know, financial resources. I have 216 00:07:55.485 --> 00:07:58.204 - a job. I have flexible working hours. I 217 00:07:58.204 --> 00:08:00.365 - can, you know, ask my colleagues to cover 218 00:08:00.365 --> 00:08:02.430 - for me. You know, we don't often think 219 00:08:02.430 --> 00:08:03.949 - of that as for a doctor, but, you 220 00:08:03.949 --> 00:08:06.910 - know, doctors, we're we're constantly covering for each 221 00:08:06.910 --> 00:08:08.509 - other. If we're out sick, we're out for 222 00:08:08.509 --> 00:08:09.250 - other reasons. 223 00:08:09.870 --> 00:08:10.930 - Mhmm. I have transportation 224 00:08:11.389 --> 00:08:13.089 - that can get to and from 225 00:08:13.485 --> 00:08:15.485 - my appointments, you know, even though they may 226 00:08:15.485 --> 00:08:16.625 - be at different locations. 227 00:08:17.084 --> 00:08:18.524 - I can even get somebody you know, I 228 00:08:18.524 --> 00:08:20.685 - have a great care support network. I can 229 00:08:20.764 --> 00:08:23.485 - my wife's here with me. My older son 230 00:08:23.485 --> 00:08:26.204 - drives. Well, he's back from college for the 231 00:08:26.204 --> 00:08:28.044 - summer. So when he's here, he can drive 232 00:08:28.044 --> 00:08:30.230 - me. But, you know, my sister and her 233 00:08:30.230 --> 00:08:32.889 - her husband live nearby, and they drive. And 234 00:08:33.029 --> 00:08:34.870 - they can take me to my appointments if 235 00:08:34.870 --> 00:08:36.389 - if if I don't feel well or I 236 00:08:36.389 --> 00:08:37.529 - can't drive myself. 237 00:08:38.549 --> 00:08:40.309 - You know, so and then, you know, health 238 00:08:40.309 --> 00:08:42.169 - literacy. Right? I'm a doctor. I 239 00:08:42.514 --> 00:08:45.715 - theoretically know you know, have enough knowledge to 240 00:08:45.715 --> 00:08:47.014 - understand my care. 241 00:08:47.394 --> 00:08:48.835 - So all of these things and there are 242 00:08:48.835 --> 00:08:51.154 - many, many, many other aspects of access that 243 00:08:51.154 --> 00:08:53.875 - your listeners are honestly probably more expert than 244 00:08:53.875 --> 00:08:56.375 - me about, but, you know, I experienced these 245 00:08:56.970 --> 00:08:57.470 - firsthand, 246 00:08:58.649 --> 00:09:00.329 - about how things could go right for me. 247 00:09:00.329 --> 00:09:02.329 - I also know, of course, have connections. I 248 00:09:02.329 --> 00:09:04.409 - can call up somebody in my in my 249 00:09:04.409 --> 00:09:06.250 - hospital and say, hey. You know, can I 250 00:09:06.250 --> 00:09:07.149 - get an appointment? 251 00:09:08.329 --> 00:09:10.574 - So all of these things work worked for 252 00:09:10.574 --> 00:09:12.834 - me. They should be able to work for 253 00:09:13.054 --> 00:09:15.054 - everyone this way. And and I think we're 254 00:09:15.054 --> 00:09:16.514 - trying. Right? Patient navigation, 255 00:09:17.214 --> 00:09:19.394 - especially in oncology, is very common. 256 00:09:19.855 --> 00:09:21.054 - But, you know, I think we can do 257 00:09:21.054 --> 00:09:22.815 - better. I think we can definitely do better 258 00:09:22.815 --> 00:09:24.539 - across the board. Mhmm. 259 00:09:25.480 --> 00:09:27.559 - Doctor Lind, did the six day turnaround, did 260 00:09:27.559 --> 00:09:30.279 - it have a measurable difference in in your 261 00:09:30.279 --> 00:09:30.779 - treatment, 262 00:09:31.320 --> 00:09:33.720 - in in I I imagine the personal stress 263 00:09:33.720 --> 00:09:35.399 - that you must have felt or anxiety to 264 00:09:35.559 --> 00:09:37.320 - I think waiting is such a difficult part 265 00:09:37.320 --> 00:09:39.315 - of any health care journey. But can you 266 00:09:39.315 --> 00:09:41.075 - speak to what what was different about having 267 00:09:41.075 --> 00:09:42.835 - that turned around in six days versus the 268 00:09:42.835 --> 00:09:45.014 - baseline, which would be much longer? 269 00:09:45.554 --> 00:09:47.654 - Absolutely. It did. I think, 270 00:09:48.355 --> 00:09:51.554 - you know, even though my overall long term 271 00:09:51.554 --> 00:09:52.054 - prognosis 272 00:09:52.809 --> 00:09:55.309 - is number one, poor and number two, uncertain, 273 00:09:56.090 --> 00:09:58.910 - I would say that short term anxiety 274 00:09:59.690 --> 00:10:01.389 - of not having a plan 275 00:10:02.009 --> 00:10:05.070 - is very, very stressful, very emotional, 276 00:10:05.450 --> 00:10:07.129 - you know, especially at the beginning when you're 277 00:10:07.129 --> 00:10:09.294 - being diagnosed. And, you know, I went through 278 00:10:09.294 --> 00:10:11.054 - kind of all the five stages of grief 279 00:10:11.054 --> 00:10:14.195 - in different order rapidly several times. 280 00:10:14.654 --> 00:10:18.495 - And, you know, having that diagnosis enables you 281 00:10:18.495 --> 00:10:20.574 - to get a plan. But once you have 282 00:10:20.574 --> 00:10:21.235 - the plan, 283 00:10:21.699 --> 00:10:23.379 - at least in my case, and and I 284 00:10:23.379 --> 00:10:25.539 - know just from experience as a primary care 285 00:10:25.539 --> 00:10:26.039 - doc, 286 00:10:26.820 --> 00:10:29.379 - that does settle people down, and that did 287 00:10:29.459 --> 00:10:31.459 - in my case, you know, it settles you 288 00:10:31.459 --> 00:10:32.980 - down. Hey. I have a plan. I know 289 00:10:32.980 --> 00:10:35.220 - what to do. I have my appointments to 290 00:10:35.220 --> 00:10:38.075 - go to. I have a follow-up scan. You 291 00:10:38.075 --> 00:10:40.254 - know, that really enables you 292 00:10:40.794 --> 00:10:42.394 - to live your life again. And I think 293 00:10:42.394 --> 00:10:44.475 - that to me is the kind of one 294 00:10:44.475 --> 00:10:45.695 - of the basic principles 295 00:10:47.274 --> 00:10:48.975 - of health care should be 296 00:10:49.449 --> 00:10:51.870 - how do we help people live their lives, 297 00:10:52.089 --> 00:10:55.129 - not live medical lives, but live the lives 298 00:10:55.129 --> 00:10:56.269 - of what they're doing. 299 00:10:56.649 --> 00:10:58.409 - You know, in in our class, the lung 300 00:10:58.409 --> 00:11:01.230 - cancer class, I structured it so 301 00:11:01.955 --> 00:11:04.274 - that actually most of the sessions, most of 302 00:11:04.274 --> 00:11:04.855 - the lectures 303 00:11:05.315 --> 00:11:08.035 - were about what the patient experiences and not 304 00:11:08.035 --> 00:11:10.115 - so much we had a few sessions on 305 00:11:10.195 --> 00:11:12.434 - few lectures on the science and treatment and 306 00:11:12.434 --> 00:11:14.195 - so forth. But, you know, we talked about 307 00:11:14.195 --> 00:11:15.415 - nutrition, spirituality, 308 00:11:15.875 --> 00:11:16.375 - caregiving, 309 00:11:17.290 --> 00:11:19.210 - access, you know, all of these things that 310 00:11:19.210 --> 00:11:22.509 - really the patient experiences most of the time. 311 00:11:22.889 --> 00:11:24.410 - You know? But, you know, as doctors in 312 00:11:24.410 --> 00:11:26.889 - the health care system, you know, we're we're 313 00:11:26.889 --> 00:11:29.370 - there for them. You know? Again, I'm just 314 00:11:29.370 --> 00:11:30.990 - arbitrarily putting a number, 315 00:11:31.325 --> 00:11:33.325 - you know, a single digit percentage of their 316 00:11:33.325 --> 00:11:35.804 - life. Right? They're in the clinic, a tiny 317 00:11:35.804 --> 00:11:37.404 - part of their life. They're in the infusion 318 00:11:37.404 --> 00:11:39.485 - center, in the scanner, a tiny part of 319 00:11:39.485 --> 00:11:41.644 - their life. Even in the hospital. Right? I 320 00:11:41.644 --> 00:11:44.284 - mean, hopefully, they're not in the hospital 80% 321 00:11:44.284 --> 00:11:45.909 - of their life. They're in the hospital, you 322 00:11:45.909 --> 00:11:48.250 - know, a single digits percent of their time. 323 00:11:48.710 --> 00:11:50.470 - And, you know, what we should be doing 324 00:11:50.470 --> 00:11:51.850 - is enabling, empowering 325 00:11:52.230 --> 00:11:53.370 - patients like myself 326 00:11:53.750 --> 00:11:56.070 - to live their lives, you know, as best 327 00:11:56.070 --> 00:11:58.649 - they can outside of the medical system. 328 00:11:59.815 --> 00:12:02.054 - And, you know, I I think that's that's 329 00:12:02.054 --> 00:12:03.754 - that's the goal and really, 330 00:12:04.375 --> 00:12:07.034 - you know, being a patient myself open that 331 00:12:07.654 --> 00:12:09.975 - lens to me. You know, again, I knew. 332 00:12:09.975 --> 00:12:12.100 - Right? Of course, patients are not in the 333 00:12:12.100 --> 00:12:13.559 - hospital, not in my clinic, 334 00:12:13.940 --> 00:12:15.459 - but that's not how you see them because, 335 00:12:15.459 --> 00:12:16.980 - you know, you're seeing them in the clinic. 336 00:12:16.980 --> 00:12:19.059 - You're seeing them in the hospital. So this 337 00:12:19.059 --> 00:12:20.579 - is kind of the I knew, but I 338 00:12:20.579 --> 00:12:21.720 - didn't really know. 339 00:12:22.500 --> 00:12:24.705 - I I I'm fascinated by that distinction. It's 340 00:12:24.705 --> 00:12:26.384 - like you you see things on paper. You 341 00:12:26.384 --> 00:12:27.904 - see things in the textbook, and they make 342 00:12:27.904 --> 00:12:30.785 - sense intellectually. But until you've lived it, it's 343 00:12:30.785 --> 00:12:32.865 - a different level of resonance. And you you've 344 00:12:32.865 --> 00:12:34.945 - mentioned your class. Let's let's talk more about 345 00:12:34.945 --> 00:12:36.085 - your class. I mean, 346 00:12:36.830 --> 00:12:38.830 - when I introduced you as having resolve, you 347 00:12:38.830 --> 00:12:41.090 - you after your diagnosis, you built a course 348 00:12:41.230 --> 00:12:43.389 - around your own diagnosis and you teach it 349 00:12:43.389 --> 00:12:44.529 - to medical students, 350 00:12:45.309 --> 00:12:48.590 - of everything in this curriculum, maybe to underscore 351 00:12:48.590 --> 00:12:50.190 - the point we just made, but what's one 352 00:12:50.190 --> 00:12:50.690 - lesson 353 00:12:51.115 --> 00:12:52.955 - that you really want the next generation of 354 00:12:52.955 --> 00:12:55.695 - physicians to carry forward, not just theoretically, 355 00:12:56.315 --> 00:12:58.475 - but to really embrace maybe with a different 356 00:12:58.475 --> 00:12:59.455 - level of 357 00:12:59.915 --> 00:13:01.674 - intensity than they otherwise would if they had 358 00:13:01.674 --> 00:13:04.315 - a professor who was teaching them purely from 359 00:13:04.315 --> 00:13:04.815 - textbook? 360 00:13:05.660 --> 00:13:07.179 - Yeah. I I I mean, it's a great 361 00:13:07.179 --> 00:13:09.420 - question. I I thought about that a lot. 362 00:13:09.420 --> 00:13:11.340 - I mean, my initial goals for the class 363 00:13:11.340 --> 00:13:11.840 - were 364 00:13:12.460 --> 00:13:12.960 - really, 365 00:13:13.420 --> 00:13:15.120 - you know, seeing how we could encourage 366 00:13:15.660 --> 00:13:17.899 - students to go into some aspect of cancer 367 00:13:17.899 --> 00:13:19.965 - care, which which I think we achieved. And, 368 00:13:20.125 --> 00:13:22.625 - obviously, that's a little bit self self fulfilling 369 00:13:22.764 --> 00:13:24.445 - because you're not gonna sign up for the 370 00:13:24.445 --> 00:13:27.325 - class unless you're interested in something about cancer, 371 00:13:27.325 --> 00:13:29.325 - whether it's a researcher or a primary care 372 00:13:29.325 --> 00:13:31.184 - doc. But to me, it really 373 00:13:32.045 --> 00:13:32.945 - became about 374 00:13:33.485 --> 00:13:34.785 - seeing patients, 375 00:13:35.769 --> 00:13:37.789 - which, you know, that we do in education, 376 00:13:37.850 --> 00:13:38.829 - but, again, adding 377 00:13:39.610 --> 00:13:42.730 - emphasis to how patients are not patients. They're 378 00:13:42.730 --> 00:13:44.350 - human beings. Right? 379 00:13:44.809 --> 00:13:47.769 - They are out there living their lives. They're 380 00:13:47.769 --> 00:13:48.750 - trying to find 381 00:13:49.325 --> 00:13:51.825 - their happiness every day. Right? 382 00:13:52.205 --> 00:13:54.365 - So, you know, I really wanted to put 383 00:13:54.365 --> 00:13:57.245 - a face to that. In medical school so 384 00:13:57.245 --> 00:13:59.884 - we had undergrads and medical students and different 385 00:13:59.884 --> 00:14:02.445 - other graduate students as well, who's mostly medical 386 00:14:02.445 --> 00:14:04.225 - students in our class. 387 00:14:04.799 --> 00:14:07.139 - And, you know, you don't get much continuity 388 00:14:07.440 --> 00:14:09.220 - in training. Right? It's just 389 00:14:09.600 --> 00:14:11.600 - difficult to do. Right? You see one patient 390 00:14:11.600 --> 00:14:12.960 - and then maybe for a few days, and 391 00:14:12.960 --> 00:14:14.259 - then you see another patient. 392 00:14:14.639 --> 00:14:15.919 - But, you know, I thought this was a 393 00:14:15.919 --> 00:14:18.980 - unique opportunity for me to share my experience 394 00:14:19.120 --> 00:14:19.620 - over, 395 00:14:19.924 --> 00:14:22.164 - you know, ten weeks of a class, really 396 00:14:22.164 --> 00:14:23.605 - a little bit more than ten weeks of 397 00:14:23.605 --> 00:14:24.184 - the class, 398 00:14:24.564 --> 00:14:26.324 - and from somebody who could speak to it 399 00:14:26.324 --> 00:14:27.865 - as a patient and a physician. 400 00:14:28.804 --> 00:14:30.644 - And, you know, really, to me, it was 401 00:14:30.644 --> 00:14:32.024 - the emphasis that 402 00:14:32.570 --> 00:14:34.909 - it's the holistic care we should be providing, 403 00:14:35.610 --> 00:14:37.529 - not in the kind of, you know, I 404 00:14:37.529 --> 00:14:38.990 - hate to say, kumbaya 405 00:14:39.450 --> 00:14:41.610 - kind of way of holistic care. You know, 406 00:14:41.610 --> 00:14:44.169 - I think that word has this stigma to 407 00:14:44.169 --> 00:14:45.470 - it. Right? For some reason, 408 00:14:45.769 --> 00:14:47.149 - you know, we should be providing 409 00:14:47.565 --> 00:14:49.165 - holistic care, but maybe, you know, I I 410 00:14:49.165 --> 00:14:51.644 - know semantics are important, so I would call 411 00:14:51.644 --> 00:14:53.965 - it human care. And and, of course, in 412 00:14:53.965 --> 00:14:55.585 - this day of AI, 413 00:14:56.365 --> 00:14:58.365 - to me, that's just more important, you know, 414 00:14:58.365 --> 00:14:59.105 - than ever 415 00:14:59.589 --> 00:15:01.049 - to really emphasize 416 00:15:01.509 --> 00:15:03.929 - to to our future doctors or future generations 417 00:15:03.990 --> 00:15:07.350 - of not just clinicians, but researchers and health 418 00:15:07.350 --> 00:15:08.009 - care administrators 419 00:15:09.190 --> 00:15:11.610 - and, you know, all all the other clinicians, 420 00:15:11.669 --> 00:15:12.970 - you know, not just physicians 421 00:15:13.824 --> 00:15:15.345 - and, you know, all the staff, all the 422 00:15:15.345 --> 00:15:17.365 - wonderful people providing the care 423 00:15:17.745 --> 00:15:19.605 - that, you know, it's it's really 424 00:15:20.144 --> 00:15:22.945 - about taking care of people as as human 425 00:15:22.945 --> 00:15:23.445 - beings. 426 00:15:23.904 --> 00:15:26.339 - Mhmm. Not as you know, You know, we 427 00:15:26.339 --> 00:15:28.339 - have to do numbers. Right? Of course. You 428 00:15:28.339 --> 00:15:31.079 - know, it's all about quality and efficiency and 429 00:15:31.299 --> 00:15:33.379 - so forth. But, you know, there are humans 430 00:15:33.379 --> 00:15:36.019 - behind every number, and it should be there 431 00:15:36.019 --> 00:15:37.860 - are humans first, and then there are numbers 432 00:15:37.860 --> 00:15:38.360 - second. 433 00:15:38.694 --> 00:15:40.534 - So I think it is easy to lose, 434 00:15:40.534 --> 00:15:42.394 - and I've been guilty of this. 435 00:15:42.934 --> 00:15:45.014 - It's easy to lose sight of that when 436 00:15:45.014 --> 00:15:46.855 - you're so busy and you're trying to, you 437 00:15:46.855 --> 00:15:49.034 - know, get health care systems run efficiently 438 00:15:49.654 --> 00:15:50.875 - and not lose money. 439 00:15:51.799 --> 00:15:54.120 - You know, the human should come first and 440 00:15:54.120 --> 00:15:55.259 - the number second. 441 00:15:55.799 --> 00:15:57.480 - So, you know, we were talking about kind 442 00:15:57.480 --> 00:15:59.720 - of this old bio I had and, you 443 00:15:59.720 --> 00:16:02.200 - know, how I described myself. And, you know, 444 00:16:02.200 --> 00:16:03.259 - I really believe 445 00:16:04.514 --> 00:16:06.355 - even when I wrote it years ago and 446 00:16:06.355 --> 00:16:08.514 - and now that, you know, my focus is 447 00:16:08.514 --> 00:16:09.574 - on, like, keeping, 448 00:16:09.875 --> 00:16:11.954 - you know, technology, all of these great things 449 00:16:11.954 --> 00:16:14.934 - we have, they're secondary to support of medicine, 450 00:16:15.074 --> 00:16:17.634 - which is humans taking care of other human 451 00:16:17.634 --> 00:16:18.134 - beings. 452 00:16:18.595 --> 00:16:19.095 - Mhmm. 453 00:16:20.370 --> 00:16:21.809 - I I think that is such a powerful 454 00:16:21.809 --> 00:16:23.649 - message, and it sounds it it can sound 455 00:16:23.649 --> 00:16:25.250 - trite or obvious, but I think to your 456 00:16:25.250 --> 00:16:28.129 - point, unless you are really believing in it 457 00:16:28.129 --> 00:16:29.970 - in the day to day, it is easy 458 00:16:29.970 --> 00:16:32.934 - to get distracted by KPIs and all these 459 00:16:32.934 --> 00:16:34.235 - other metrics, dashboards, 460 00:16:34.615 --> 00:16:35.115 - efficiencies. 461 00:16:36.054 --> 00:16:37.815 - But if if you lose sight of that, 462 00:16:37.815 --> 00:16:40.134 - it it's it's you're really losing, I imagine, 463 00:16:40.134 --> 00:16:41.834 - quite a lot in the world of medicine. 464 00:16:41.894 --> 00:16:43.034 - So Absolutely 465 00:16:43.414 --> 00:16:45.669 - insidious. You know? My even my 14 year 466 00:16:45.669 --> 00:16:47.990 - old son has heard KPI before, which is 467 00:16:47.990 --> 00:16:50.470 - funny. Right? Even a 14 year old kid 468 00:16:50.470 --> 00:16:52.389 - would have heard that term. Right? You know 469 00:16:52.389 --> 00:16:55.110 - what? That sort of filtered out through society, 470 00:16:55.110 --> 00:16:57.029 - not just health care, like the idea that 471 00:16:57.029 --> 00:16:58.330 - we gotta measure everything. 472 00:16:59.154 --> 00:17:00.674 - I mean, we should measure things, but we 473 00:17:00.674 --> 00:17:03.154 - should remember there there's there there are many 474 00:17:03.154 --> 00:17:04.934 - other things more important than numbers. 475 00:17:05.474 --> 00:17:05.974 - Completely 476 00:17:06.275 --> 00:17:06.775 - agreed. 477 00:17:07.555 --> 00:17:08.755 - Also, as you were 478 00:17:09.315 --> 00:17:10.134 - did you receive 479 00:17:10.674 --> 00:17:12.755 - care at Stanford? Were you kind of holding 480 00:17:12.755 --> 00:17:14.549 - up a mirror with this course to your 481 00:17:14.549 --> 00:17:15.769 - own institution? 482 00:17:16.150 --> 00:17:18.650 - All my care has been at Stanford, and 483 00:17:18.710 --> 00:17:20.809 - I have to say it's been amazing. 484 00:17:21.109 --> 00:17:23.289 - You know, they have done an amazing job. 485 00:17:23.669 --> 00:17:25.109 - You know, part of this, again, is my 486 00:17:25.109 --> 00:17:27.190 - privilege. Right? I'm an insider. I've been there 487 00:17:27.190 --> 00:17:28.250 - for twenty years. 488 00:17:29.294 --> 00:17:31.154 - So, you know, but I I think, 489 00:17:31.454 --> 00:17:32.674 - you know, I I 490 00:17:32.974 --> 00:17:34.815 - am so grateful for the high level of 491 00:17:34.815 --> 00:17:35.714 - care I've gotten. 492 00:17:36.174 --> 00:17:37.315 - I think it's interesting. 493 00:17:38.255 --> 00:17:40.095 - You know, the people I've spent most time 494 00:17:40.095 --> 00:17:42.255 - with are actually the infusion nurses because you're 495 00:17:42.255 --> 00:17:43.634 - sitting there for an hour 496 00:17:44.119 --> 00:17:46.119 - kinda getting an IV. Originally, in my case, 497 00:17:46.119 --> 00:17:48.119 - when I switched meds, I was there for, 498 00:17:48.119 --> 00:17:50.359 - like, two nine hour days getting an IV 499 00:17:50.359 --> 00:17:50.859 - infusion. 500 00:17:51.559 --> 00:17:53.559 - And, you know, those would be that's the 501 00:17:53.559 --> 00:17:54.460 - human face 502 00:17:54.840 --> 00:17:56.299 - of your health care system. 503 00:17:56.600 --> 00:17:59.075 - And, you know, I'm really grateful that you 504 00:17:59.075 --> 00:18:01.234 - know, I'm grateful to all my doctors and, 505 00:18:01.234 --> 00:18:03.234 - you know, my primary care doctor, my oncologist, 506 00:18:03.234 --> 00:18:04.295 - doctor Heather Wakeley. 507 00:18:04.835 --> 00:18:06.914 - But, you know, really, the people who are 508 00:18:06.914 --> 00:18:07.734 - putting in, 509 00:18:08.275 --> 00:18:10.674 - you know, the the face to face time 510 00:18:10.674 --> 00:18:13.690 - because they can, but, also, they're they're so 511 00:18:13.690 --> 00:18:16.429 - empathetic. I think that's where, you know, nurses 512 00:18:17.049 --> 00:18:18.190 - appropriately get 513 00:18:18.809 --> 00:18:20.509 - many of the kudos for, 514 00:18:21.130 --> 00:18:23.630 - you know, being caring and and really supporting 515 00:18:23.849 --> 00:18:26.694 - patients because, you know, that's really their job. 516 00:18:26.694 --> 00:18:28.794 - Their job is the face, and that's why 517 00:18:28.934 --> 00:18:30.535 - I think most of them go into the 518 00:18:30.535 --> 00:18:31.035 - profession. 519 00:18:32.214 --> 00:18:33.115 - You know, honestly, 520 00:18:33.654 --> 00:18:36.615 - probably better than doctors at doing that. I 521 00:18:36.615 --> 00:18:38.859 - think there have been there's been studies. There's 522 00:18:38.859 --> 00:18:40.779 - evidence to show that. But, 523 00:18:41.259 --> 00:18:42.940 - so, like, no. I'm really grateful for all 524 00:18:42.940 --> 00:18:44.700 - the care, the amazing care I've gotten at 525 00:18:44.700 --> 00:18:46.380 - Stanford. And this is this is not an 526 00:18:46.380 --> 00:18:48.619 - advertisement. Nobody's paying me Of course. Of course. 527 00:18:48.700 --> 00:18:51.019 - Salary, but not they're not paying me to 528 00:18:51.019 --> 00:18:51.679 - say this. 529 00:18:52.059 --> 00:18:54.184 - Of course. I think it's an important distinction. 530 00:18:54.184 --> 00:18:56.345 - It's like you using the term you're holding 531 00:18:56.345 --> 00:18:58.105 - a mirror up. It's it's this is this 532 00:18:58.105 --> 00:18:59.705 - is your home in many more ways than 533 00:18:59.705 --> 00:19:00.205 - one. 534 00:19:00.744 --> 00:19:02.505 - What's maybe if you can recall as a 535 00:19:02.505 --> 00:19:04.205 - patient, what's what's one of the more 536 00:19:04.744 --> 00:19:05.244 - uncomfortable, 537 00:19:05.545 --> 00:19:06.125 - I suppose, 538 00:19:06.424 --> 00:19:08.285 - things that you learned, something that 539 00:19:08.619 --> 00:19:11.019 - really looked pretty different as a patient than 540 00:19:11.019 --> 00:19:13.339 - it does from the faculty level, from the 541 00:19:13.339 --> 00:19:15.740 - c suite, and then something that our listeners 542 00:19:15.740 --> 00:19:17.599 - just might be at risk of of underestimating. 543 00:19:18.539 --> 00:19:20.960 - I think I think the whole prior authorization 544 00:19:22.325 --> 00:19:22.825 - mess 545 00:19:23.125 --> 00:19:23.765 - is really 546 00:19:24.404 --> 00:19:26.164 - again, I knew it because I was on 547 00:19:26.164 --> 00:19:28.644 - the doctor's side. You know? I filled out, 548 00:19:28.644 --> 00:19:30.265 - you know, forms and provided 549 00:19:30.644 --> 00:19:31.144 - letters 550 00:19:31.525 --> 00:19:33.765 - to try to get things approved, you know, 551 00:19:33.765 --> 00:19:36.984 - either imaging or medications for my patients. 552 00:19:37.809 --> 00:19:39.330 - And, you know, it was kind of, you 553 00:19:39.330 --> 00:19:41.250 - know, everybody hates doing all the doctors, of 554 00:19:41.250 --> 00:19:43.170 - course, hate doing it. And Mhmm. It's a 555 00:19:43.170 --> 00:19:44.630 - big burden on our system. 556 00:19:45.009 --> 00:19:47.490 - But, you know, from the patient perspective, it's 557 00:19:47.490 --> 00:19:47.990 - incredibly, 558 00:19:48.930 --> 00:19:49.430 - incredibly, 559 00:19:50.684 --> 00:19:53.264 - I would say, stressful and and even damaging. 560 00:19:53.804 --> 00:19:56.224 - So I I I can share two examples. 561 00:19:56.684 --> 00:19:58.865 - One was early on. I had my X-ray, 562 00:19:58.924 --> 00:20:00.924 - and and for some reason, the, 563 00:20:01.724 --> 00:20:02.704 - I think the prioritization 564 00:20:03.085 --> 00:20:05.549 - wasn't submitted in time. But, you know, I 565 00:20:05.549 --> 00:20:07.390 - signed off to say, hey. I'd pay for 566 00:20:07.390 --> 00:20:08.690 - it if it wasn't covered. 567 00:20:09.470 --> 00:20:11.710 - But so, you know, the CT scan that 568 00:20:11.710 --> 00:20:13.250 - diagnosed my lung cancer, 569 00:20:13.789 --> 00:20:16.509 - just because the system didn't work, you know, 570 00:20:16.509 --> 00:20:17.789 - I got a bill for that because the 571 00:20:17.789 --> 00:20:19.869 - insurance just kept rejecting it and rejecting it 572 00:20:19.869 --> 00:20:22.615 - because things weren't done in exactly the right 573 00:20:22.615 --> 00:20:24.815 - checkbox order. Right? Even though it was Yeah. 574 00:20:25.734 --> 00:20:27.095 - So I got a big bill for that. 575 00:20:27.095 --> 00:20:29.015 - Right? I mean, for me, I could do 576 00:20:29.015 --> 00:20:30.615 - it, but, I mean, luckily, we took care 577 00:20:30.615 --> 00:20:32.309 - of it. But it's stressful to have to 578 00:20:32.549 --> 00:20:34.730 - call and call and email and email 579 00:20:35.110 --> 00:20:36.630 - to try to take care of this huge 580 00:20:36.630 --> 00:20:39.590 - bill when you're dealing with, you know, a 581 00:20:39.590 --> 00:20:40.890 - new diagnosis of 582 00:20:41.269 --> 00:20:43.830 - terminal cancer. Right? So Mhmm. That was one 583 00:20:43.830 --> 00:20:45.990 - where I I realized, and and I'm like, 584 00:20:45.990 --> 00:20:47.850 - god. I'm never gonna sign that patient, 585 00:20:48.365 --> 00:20:49.965 - you know, whatever they call it, patient agreement 586 00:20:49.965 --> 00:20:52.765 - for financial responsibility form again. I'm never gonna 587 00:20:52.765 --> 00:20:54.525 - do that because it was I mean, it 588 00:20:54.525 --> 00:20:55.884 - got taken care of, but it's such a, 589 00:20:55.884 --> 00:20:58.305 - you know, hassle and painful to do that. 590 00:20:58.525 --> 00:21:00.525 - Right. So the other thing was, you know, 591 00:21:00.525 --> 00:21:02.144 - for my medication. So, 592 00:21:03.569 --> 00:21:06.450 - I in in last fall in 2025, 593 00:21:06.450 --> 00:21:07.990 - I had progression of my cancer, 594 00:21:08.609 --> 00:21:10.690 - and so I had to change treatments. My 595 00:21:10.690 --> 00:21:12.230 - oncologist, doctor Heather Wakeley, 596 00:21:12.690 --> 00:21:14.549 - good friend of mine, chief of oncology, 597 00:21:15.169 --> 00:21:17.750 - one of the literally the most famous 598 00:21:18.454 --> 00:21:20.234 - lung cancer, thoracic oncology 599 00:21:21.015 --> 00:21:23.095 - oncologists in the world. Like, she was the 600 00:21:23.095 --> 00:21:25.454 - president of one of the societies. And Mhmm. 601 00:21:25.575 --> 00:21:28.214 - And so she's, you know, she's, like, you 602 00:21:28.214 --> 00:21:29.275 - know, the expert, 603 00:21:30.055 --> 00:21:32.934 - in lung cancer care. And in particular, my 604 00:21:32.934 --> 00:21:33.835 - type of cancer, 605 00:21:34.190 --> 00:21:35.569 - she's even more expert, 606 00:21:36.190 --> 00:21:38.429 - if if one could say that. So, you 607 00:21:38.429 --> 00:21:40.369 - know, she, of course, prescribed the medication, 608 00:21:42.109 --> 00:21:43.569 - which so I was on 609 00:21:44.190 --> 00:21:47.089 - evidence based treatment before a chemotherapy in Tagrisso. 610 00:21:47.674 --> 00:21:49.855 - And then it was changed to 611 00:21:50.234 --> 00:21:50.734 - Rybrevant 612 00:21:51.115 --> 00:21:53.214 - and losertin in last clues, 613 00:21:53.674 --> 00:21:56.414 - which is a antibody and a targeted therapy. 614 00:21:56.634 --> 00:21:57.134 - And 615 00:21:57.515 --> 00:22:00.210 - it was rejected by insurance. You know? So 616 00:22:00.210 --> 00:22:00.869 - the oral therapy, 617 00:22:01.490 --> 00:22:03.909 - the the last dose was rejected twice, and 618 00:22:04.049 --> 00:22:06.710 - the IVU was rejected once. I still remember 619 00:22:07.009 --> 00:22:07.990 - this is a Friday. 620 00:22:08.450 --> 00:22:10.849 - And to start this medication, it's, you know, 621 00:22:10.849 --> 00:22:12.609 - it's a lot, two nine hour days of 622 00:22:12.609 --> 00:22:13.634 - infusion. So it was a infusion. So it 623 00:22:13.634 --> 00:22:15.075 - was a Friday, and I got a message 624 00:22:15.075 --> 00:22:16.134 - from the nurse saying, 625 00:22:16.434 --> 00:22:18.914 - hey. Don't go because we haven't heard from 626 00:22:18.914 --> 00:22:21.255 - your insurance. And then on the Monday, 627 00:22:22.674 --> 00:22:25.075 - I, you know, they I I was on 628 00:22:25.075 --> 00:22:27.819 - a video appointment with, my oncologist, and she's 629 00:22:27.819 --> 00:22:29.440 - like, why aren't you at the infusion? 630 00:22:29.819 --> 00:22:31.740 - And I said, you know, I because it 631 00:22:31.740 --> 00:22:33.740 - was eight 8AM, so she hadn't seen her 632 00:22:33.740 --> 00:22:35.980 - messages. And the the message was sent, like, 633 00:22:35.980 --> 00:22:37.980 - late Friday. And I was like, jeez. I, 634 00:22:37.980 --> 00:22:39.740 - you know, I heard insurance hadn't covered it. 635 00:22:39.740 --> 00:22:40.859 - And she said, let me let me see 636 00:22:40.859 --> 00:22:43.065 - what's going on. And it was rejected. So 637 00:22:43.065 --> 00:22:45.144 - the IV treatment was rejected, and and I 638 00:22:45.144 --> 00:22:47.325 - was so upset. I mean, so stressful. 639 00:22:48.025 --> 00:22:50.184 - My, you know, my symptoms were getting worse. 640 00:22:50.184 --> 00:22:51.325 - I had a horrible cough, 641 00:22:51.785 --> 00:22:54.345 - and my my right lung was filling up 642 00:22:54.345 --> 00:22:56.204 - with fluid. I had a pleural effusion. 643 00:22:57.019 --> 00:22:57.419 - And, 644 00:22:57.819 --> 00:22:59.579 - I was so mad, so I posted on 645 00:22:59.579 --> 00:23:02.220 - LinkedIn. And and, you know, it went viral. 646 00:23:02.220 --> 00:23:03.579 - I got you know, for LinkedIn, I had, 647 00:23:03.579 --> 00:23:06.159 - like, a 100,000, 200,000, 300,000, 648 00:23:06.220 --> 00:23:08.240 - I think, 500, 600,000, 649 00:23:08.539 --> 00:23:10.000 - impressions by the next 650 00:23:10.634 --> 00:23:11.134 - morning. 651 00:23:11.595 --> 00:23:13.934 - And then, of course, once that went viral, 652 00:23:14.154 --> 00:23:16.894 - it got approved, like, within two hours. Wow. 653 00:23:17.595 --> 00:23:19.355 - So, you know, I have that again, I 654 00:23:19.355 --> 00:23:21.215 - have this privilege because I have this platform 655 00:23:21.434 --> 00:23:23.515 - to do that. But Yeah. You could imagine. 656 00:23:23.515 --> 00:23:26.015 - Right? There's a delay. It takes time, and 657 00:23:26.369 --> 00:23:27.809 - and, you know, I hear this number all 658 00:23:27.809 --> 00:23:29.170 - the time. I don't know where it comes 659 00:23:29.170 --> 00:23:32.529 - from. You know, these prior authorizations, once they 660 00:23:32.529 --> 00:23:33.829 - go to external review, 661 00:23:34.130 --> 00:23:36.450 - 80% of them are approved. So, you know, 662 00:23:36.450 --> 00:23:39.109 - that doesn't speak well to how we're 663 00:23:39.434 --> 00:23:40.815 - looking. And I I'm not blaming 664 00:23:41.115 --> 00:23:43.355 - any particular insurance. I think it's just the 665 00:23:43.355 --> 00:23:43.855 - whole 666 00:23:44.234 --> 00:23:45.615 - system and the idea 667 00:23:46.154 --> 00:23:47.294 - of prior authorizations. 668 00:23:47.595 --> 00:23:50.634 - I know no one with cancer who's getting 669 00:23:50.634 --> 00:23:51.134 - unnecessary 670 00:23:51.514 --> 00:23:52.335 - cancer treatment. 671 00:23:53.009 --> 00:23:53.509 - Nobody. 672 00:23:54.049 --> 00:23:55.410 - I mean, I I don't see how you 673 00:23:55.410 --> 00:23:57.990 - could argue that in, you know, an oncologist 674 00:23:58.130 --> 00:24:00.210 - and the patient are doing things because these 675 00:24:00.210 --> 00:24:03.170 - are unpleasant treatments. I mean, these are not 676 00:24:03.170 --> 00:24:04.070 - fun to do. 677 00:24:04.529 --> 00:24:06.710 - And if the oncologist thinks it's appropriate, 678 00:24:07.265 --> 00:24:09.184 - you know, it should be covered, and the 679 00:24:09.184 --> 00:24:12.005 - onus should be on the insurance company 680 00:24:12.305 --> 00:24:14.625 - to really rather than not right now, the 681 00:24:14.625 --> 00:24:17.105 - onus is on the patient and physician. And 682 00:24:17.105 --> 00:24:18.805 - and, you know, we spent hours 683 00:24:19.184 --> 00:24:20.884 - writing letters and things, 684 00:24:21.279 --> 00:24:24.319 - you know, to get these these treatments approved. 685 00:24:24.319 --> 00:24:26.319 - So, you know, to me, again, I knew, 686 00:24:26.319 --> 00:24:27.859 - but I didn't really know 687 00:24:28.400 --> 00:24:29.140 - how damaging, 688 00:24:30.799 --> 00:24:33.119 - this idea of prior auths. And, again, I'm 689 00:24:33.119 --> 00:24:35.940 - not blaming one because every insurance does this. 690 00:24:36.000 --> 00:24:36.500 - Right. 691 00:24:36.984 --> 00:24:39.164 - And and it's very much, you know, 692 00:24:39.464 --> 00:24:41.944 - very nitpicky. Right? I happen to follow not 693 00:24:41.944 --> 00:24:42.444 - exactly 694 00:24:42.984 --> 00:24:45.625 - because my treatment was cutting edge. It was 695 00:24:45.625 --> 00:24:46.845 - approved FDA approved, 696 00:24:47.625 --> 00:24:49.565 - but because I had already had chemotherapy, 697 00:24:50.024 --> 00:24:53.089 - the the the guidelines, the NCCN guidelines, which 698 00:24:53.089 --> 00:24:53.829 - are the standard 699 00:24:54.210 --> 00:24:55.990 - cancer guidelines for treatment, 700 00:24:56.769 --> 00:24:58.230 - didn't take that to account 701 00:24:58.849 --> 00:25:00.369 - that, oh, you all would have already had 702 00:25:00.369 --> 00:25:01.509 - it because they required 703 00:25:01.890 --> 00:25:03.329 - approval. They would say, oh, you have to 704 00:25:03.329 --> 00:25:05.275 - do chemo in addition. But it made no 705 00:25:05.275 --> 00:25:07.195 - sense to me because I already had you 706 00:25:07.195 --> 00:25:09.195 - know, for me, I already had chemo because 707 00:25:09.195 --> 00:25:11.615 - that that standard of care had changed 708 00:25:11.914 --> 00:25:13.595 - that for people like me, you would do 709 00:25:13.595 --> 00:25:14.974 - Tagrisso plus chemo. 710 00:25:15.434 --> 00:25:16.714 - So I I mean, I don't wanna get 711 00:25:16.714 --> 00:25:18.474 - in the weeds of that. But, yeah, it's 712 00:25:18.474 --> 00:25:19.934 - just very to me, 713 00:25:20.410 --> 00:25:22.569 - you know, it's incredible, like, how many people 714 00:25:22.569 --> 00:25:23.869 - may have just given up 715 00:25:24.490 --> 00:25:25.849 - and not got treatment. I I mean, I 716 00:25:25.849 --> 00:25:28.009 - give you an example. Later that week, because 717 00:25:28.009 --> 00:25:29.769 - the treatment was delayed a week, I had 718 00:25:29.769 --> 00:25:31.390 - to get one point three liters 719 00:25:31.849 --> 00:25:33.470 - of fluid drained from my lung. 720 00:25:34.329 --> 00:25:36.994 - Wow. Because I couldn't I was coughing and 721 00:25:36.994 --> 00:25:38.694 - felt terrible. I couldn't sleep. 722 00:25:39.154 --> 00:25:41.234 - And, you know, maybe. I don't know. Maybe 723 00:25:41.234 --> 00:25:42.615 - that would not have been necessary 724 00:25:43.234 --> 00:25:45.714 - had I started treatment when it was supposed 725 00:25:45.714 --> 00:25:46.375 - to start. 726 00:25:47.075 --> 00:25:49.174 - So, you know, it's it's it's upsetting 727 00:25:49.474 --> 00:25:50.534 - to me as a doctor 728 00:25:51.119 --> 00:25:52.880 - and even more upsetting to me as a 729 00:25:52.880 --> 00:25:53.380 - patient 730 00:25:53.920 --> 00:25:55.539 - that I had to do that. 731 00:25:56.079 --> 00:25:58.079 - And it's challenging. And, you know, this happens 732 00:25:58.079 --> 00:25:59.539 - all the time. It happens every day. 733 00:25:59.920 --> 00:26:00.900 - Yeah. No. 734 00:26:01.680 --> 00:26:04.154 - The the billions that prior auth cost in 735 00:26:04.154 --> 00:26:06.475 - terms of, like, the administrative burden of it, 736 00:26:06.475 --> 00:26:07.134 - the inefficiencies, 737 00:26:07.515 --> 00:26:09.515 - but then I think beyond those big numbers 738 00:26:09.515 --> 00:26:11.674 - that sometimes are a little numbing when you 739 00:26:11.674 --> 00:26:13.195 - get to these stories about 740 00:26:13.995 --> 00:26:15.434 - it it's not as though you were, 741 00:26:16.740 --> 00:26:19.140 - for a nine hour, right, nine hour IV 742 00:26:19.140 --> 00:26:21.779 - treatment session to be Two days. Two two 743 00:26:21.779 --> 00:26:24.660 - nine hour days. Yeah. Yeah. It's not something 744 00:26:24.660 --> 00:26:25.640 - I'm getting unnecessarily. 745 00:26:25.940 --> 00:26:27.779 - You know? It's like Exactly. Oh, this is 746 00:26:27.779 --> 00:26:30.099 - unnecessary. I mean, it's it's kind of amazing 747 00:26:30.099 --> 00:26:32.454 - that Yeah. I mean, I can understand maybe 748 00:26:32.454 --> 00:26:35.095 - for very specific things, but, you know, again, 749 00:26:35.095 --> 00:26:37.434 - I've never met anybody who's gotten unnecessary 750 00:26:38.214 --> 00:26:39.194 - cancer treatment. 751 00:26:39.654 --> 00:26:41.575 - You know, we're we're again, this is the 752 00:26:41.575 --> 00:26:43.194 - human insurances here 753 00:26:44.250 --> 00:26:46.430 - supposedly to serve us. Right? 754 00:26:46.890 --> 00:26:48.990 - Because we are mixing you know, 755 00:26:49.369 --> 00:26:51.150 - I'm happy to pay in the system, 756 00:26:51.609 --> 00:26:53.130 - you know, as a healthy person. I was 757 00:26:53.130 --> 00:26:54.809 - healthy for many years, and I paid into 758 00:26:54.809 --> 00:26:57.394 - the system. And that helped other people get 759 00:26:57.394 --> 00:26:59.234 - their care. Right? That's the whole purpose of 760 00:26:59.234 --> 00:27:02.454 - insurance. You've got healthy people, and you unfortunately, 761 00:27:02.674 --> 00:27:04.194 - in my case, now I'm in the kind 762 00:27:04.194 --> 00:27:04.934 - of unhealthy 763 00:27:05.315 --> 00:27:08.035 - group that's eating up money, but that's why 764 00:27:08.035 --> 00:27:09.954 - you have a, you know, a large pool 765 00:27:09.954 --> 00:27:12.609 - of people so you can reduce that overall 766 00:27:12.669 --> 00:27:14.289 - risk. Right? You shouldn't be nitpicking 767 00:27:14.829 --> 00:27:16.210 - every detail of individuals 768 00:27:17.069 --> 00:27:19.149 - because then it's I mean, that's not the 769 00:27:19.149 --> 00:27:20.769 - point. The point is you have a pool 770 00:27:21.069 --> 00:27:23.755 - of people and, you know, it's a subsidy. 771 00:27:23.755 --> 00:27:26.075 - It's kind of a almost a Robinhood model. 772 00:27:26.075 --> 00:27:28.315 - You could call it. Right? The healthy people 773 00:27:28.315 --> 00:27:30.474 - subsidize the poor people because the the not 774 00:27:30.474 --> 00:27:33.694 - the poor people. Subsidize the sick people because, 775 00:27:34.795 --> 00:27:36.394 - that's the way the system works. That's how 776 00:27:36.394 --> 00:27:37.934 - it can work. Mhmm. 777 00:27:38.429 --> 00:27:40.109 - Something needs to change there. I know there's 778 00:27:40.109 --> 00:27:42.269 - different initiatives in place to make it less 779 00:27:42.269 --> 00:27:44.190 - burdensome, but it is what you just outlined 780 00:27:44.190 --> 00:27:45.409 - is so highly intrusive. 781 00:27:46.029 --> 00:27:46.589 - It's so, 782 00:27:47.710 --> 00:27:49.389 - tightly wound at the front end. And then 783 00:27:49.389 --> 00:27:51.009 - to your point about LinkedIn posts, 784 00:27:51.470 --> 00:27:53.184 - it's it's, you know, it's addressed. So So 785 00:27:53.184 --> 00:27:55.025 - it's amazing how these things do get resolved, 786 00:27:55.025 --> 00:27:56.644 - but the time lost 787 00:27:57.265 --> 00:27:59.825 - to to figuring this out while you're dealing 788 00:27:59.825 --> 00:28:01.585 - with a new diagnosis and trying to update 789 00:28:01.585 --> 00:28:02.705 - your your care, it's, 790 00:28:03.184 --> 00:28:05.265 - it's intrusive to say the least. And it's 791 00:28:05.265 --> 00:28:07.105 - not just the patient. It's the whole family. 792 00:28:07.105 --> 00:28:09.330 - Right? Yeah. Very much so. The whole family's 793 00:28:09.330 --> 00:28:11.509 - gotta put their lives on hold. They're stressed. 794 00:28:12.130 --> 00:28:12.869 - You know? 795 00:28:13.330 --> 00:28:14.529 - You know? What are you do you know, 796 00:28:14.529 --> 00:28:16.529 - you're like, jeez. What do I do? Just 797 00:28:16.529 --> 00:28:17.890 - like what I said earlier, when you have 798 00:28:17.890 --> 00:28:18.549 - a plan, 799 00:28:18.930 --> 00:28:21.214 - things calm down. When there's uncertainty, 800 00:28:21.674 --> 00:28:23.914 - you know, that's really when the anxiety kicks 801 00:28:23.914 --> 00:28:24.414 - in. 802 00:28:25.355 --> 00:28:28.075 - Yeah. Doctor Lin, I wanna end on a 803 00:28:28.075 --> 00:28:30.394 - note that I think is hopefully a hopeful 804 00:28:30.394 --> 00:28:31.595 - and optimistic one. 805 00:28:32.390 --> 00:28:34.730 - There is I talked to talked to numerous 806 00:28:35.029 --> 00:28:36.650 - clinical leaders, clinicians, 807 00:28:37.910 --> 00:28:39.850 - and there's a good amount of of worry 808 00:28:40.230 --> 00:28:42.150 - as of late, probably a little bit more 809 00:28:42.150 --> 00:28:43.990 - pronounced in the past two two to three 810 00:28:43.990 --> 00:28:46.549 - years about the clinicians and the doctors coming 811 00:28:46.549 --> 00:28:47.850 - up right now who are 812 00:28:48.765 --> 00:28:51.404 - have Gen AI available to them, the instant 813 00:28:51.404 --> 00:28:52.845 - answers fast instant 814 00:28:53.484 --> 00:28:56.125 - like, so instant now more than ever that 815 00:28:56.125 --> 00:28:57.644 - a lot of people worry will leave them 816 00:28:57.644 --> 00:29:00.705 - lacking traits that the generation before them had. 817 00:29:01.244 --> 00:29:02.384 - As as physicians, 818 00:29:03.164 --> 00:29:03.484 - can you 819 00:29:04.470 --> 00:29:06.650 - you you actually teach these students. You interact 820 00:29:06.789 --> 00:29:07.690 - with them regularly. 821 00:29:08.630 --> 00:29:11.269 - Is that fear right? And if you can, 822 00:29:11.269 --> 00:29:12.630 - can you just tell us about a student 823 00:29:12.630 --> 00:29:14.009 - or a moment in your classroom 824 00:29:14.470 --> 00:29:16.230 - that has really left an impression on you 825 00:29:16.230 --> 00:29:17.669 - and shown you that the people who'll be 826 00:29:17.669 --> 00:29:19.525 - caring for us down the road are are 827 00:29:19.525 --> 00:29:20.744 - gonna be just fine? 828 00:29:22.644 --> 00:29:24.644 - So it's a great question. You know? I 829 00:29:24.644 --> 00:29:26.984 - think this is not just a question question 830 00:29:27.125 --> 00:29:27.625 - medicine. 831 00:29:28.085 --> 00:29:30.184 - It's a question in across all of education. 832 00:29:30.244 --> 00:29:30.744 - Right? 833 00:29:31.365 --> 00:29:34.019 - What do we need to teach? What what 834 00:29:34.019 --> 00:29:35.160 - do we need to encourage 835 00:29:36.019 --> 00:29:37.000 - students, learners 836 00:29:37.299 --> 00:29:38.440 - to to understand, 837 00:29:39.380 --> 00:29:41.000 - you know, in this age of AI? 838 00:29:41.700 --> 00:29:43.059 - You know, I don't have the answer to 839 00:29:43.059 --> 00:29:45.220 - that because, you know, I it's interesting. I 840 00:29:45.220 --> 00:29:46.660 - went to my son's in terms of what 841 00:29:46.660 --> 00:29:48.335 - we need to learn, I went to my 842 00:29:48.335 --> 00:29:49.474 - son's undergraduate 843 00:29:50.335 --> 00:29:52.815 - school. He goes to Chapman. He just finished 844 00:29:52.815 --> 00:29:55.615 - his freshman year. And, you know, they made 845 00:29:55.615 --> 00:29:58.174 - a point. There's a faculty panel. Well, you 846 00:29:58.174 --> 00:29:59.375 - know, we used to all need to learn 847 00:29:59.375 --> 00:30:01.569 - how to spell. Right? Yeah. You know? But 848 00:30:01.569 --> 00:30:02.849 - now nobody needs to know how to spell. 849 00:30:02.849 --> 00:30:05.169 - I mean, of course, there's the wizard spellers 850 00:30:05.169 --> 00:30:07.409 - in the spelling bee, but, you know, nobody 851 00:30:07.409 --> 00:30:09.269 - needs to know how to spell, and nobody 852 00:30:09.649 --> 00:30:11.490 - cares about that, honestly. I mean, very few 853 00:30:11.490 --> 00:30:14.049 - people are, you know, saying, jeez. That's a 854 00:30:14.049 --> 00:30:14.950 - that's a skill 855 00:30:15.335 --> 00:30:18.214 - that we've lost and that was important. And, 856 00:30:18.214 --> 00:30:20.055 - you know, same thing with handwriting and so 857 00:30:20.055 --> 00:30:20.555 - forth. 858 00:30:21.015 --> 00:30:22.855 - You know, in medicine, we've already seen this 859 00:30:22.855 --> 00:30:25.414 - to a certain degree with the physical physical 860 00:30:25.414 --> 00:30:25.914 - exam. 861 00:30:26.375 --> 00:30:28.055 - So it used to be even when I 862 00:30:28.055 --> 00:30:30.454 - was training, you know, whatever, almost thirty years 863 00:30:30.454 --> 00:30:30.954 - ago, 864 00:30:31.730 --> 00:30:33.890 - you know, the physical exam was really emphasized. 865 00:30:33.890 --> 00:30:35.430 - You know, listening using 866 00:30:35.730 --> 00:30:37.990 - the stethoscope, listening to the heart and lungs, 867 00:30:38.450 --> 00:30:39.109 - you know, 868 00:30:39.410 --> 00:30:42.369 - the neurologic exam, the eye exam, you know, 869 00:30:42.369 --> 00:30:43.190 - all of these 870 00:30:43.890 --> 00:30:44.869 - exam features. 871 00:30:45.490 --> 00:30:46.470 - But now, 872 00:30:47.305 --> 00:30:49.545 - you know, it seemed it's less emphasized because 873 00:30:49.545 --> 00:30:52.424 - we have all these amazing tests. Right? You 874 00:30:52.424 --> 00:30:54.505 - know, why you know, if if you're kind 875 00:30:54.505 --> 00:30:55.005 - of 876 00:30:55.305 --> 00:30:57.005 - you know, if you're not a cardiologist, 877 00:30:57.945 --> 00:30:59.545 - you know, do you need to be a 878 00:30:59.545 --> 00:31:02.980 - super expert to identify every little heart murmur 879 00:31:02.980 --> 00:31:05.960 - when you have an echocardiogram, which is probably 880 00:31:06.099 --> 00:31:07.960 - no matter how good you get at it, 881 00:31:08.099 --> 00:31:10.339 - probably gonna better be better than you are. 882 00:31:10.339 --> 00:31:12.980 - Right? Just period. Right? Because it's the gold 883 00:31:12.980 --> 00:31:13.960 - standard. Right? 884 00:31:14.259 --> 00:31:14.759 - So, 885 00:31:15.140 --> 00:31:17.275 - you know, so that's very interesting. I mean, 886 00:31:17.275 --> 00:31:18.815 - there's many arguments for 887 00:31:19.434 --> 00:31:22.154 - continuing to be very good at the physical 888 00:31:22.154 --> 00:31:24.715 - exam, but it's definitely something that I think 889 00:31:24.715 --> 00:31:27.914 - we've all perceived that's been, you know, lot 890 00:31:28.154 --> 00:31:30.095 - somewhat lost over the years of 891 00:31:30.420 --> 00:31:31.320 - medical training, 892 00:31:31.860 --> 00:31:33.940 - that emphasis and that that skill of the 893 00:31:33.940 --> 00:31:34.840 - physical exam. 894 00:31:35.380 --> 00:31:36.820 - But on the other side, it's like we 895 00:31:36.820 --> 00:31:38.920 - have technology. Right? I still remember 896 00:31:39.380 --> 00:31:41.700 - and sorry for the long winded answer. I 897 00:31:41.700 --> 00:31:44.180 - was I I'm from Tennessee. We were during 898 00:31:44.180 --> 00:31:44.680 - COVID, 899 00:31:45.095 --> 00:31:46.775 - we took a road trip to the Smoky 900 00:31:46.775 --> 00:31:47.275 - Mountains 901 00:31:47.575 --> 00:31:48.875 - in Gatlinburg, Tennessee. 902 00:31:49.494 --> 00:31:51.494 - And I'm a woodworker, and there was, like, 903 00:31:51.494 --> 00:31:53.494 - this little, like, woodworking shop. And I'm like, 904 00:31:53.494 --> 00:31:55.015 - oh, we gotta stop and talk to the 905 00:31:55.015 --> 00:31:55.515 - guy. 906 00:31:55.815 --> 00:31:57.035 - And the guy's, like, 907 00:31:57.589 --> 00:32:00.150 - died, like, a to true Tennessee, and, you 908 00:32:00.150 --> 00:32:02.549 - know, he's got his you know, he's got, 909 00:32:02.549 --> 00:32:05.509 - like, sawdust all over himself. And and I 910 00:32:05.509 --> 00:32:07.109 - saw he had some guitars, not just his 911 00:32:07.109 --> 00:32:08.630 - furniture, but he had some guitars. And I 912 00:32:08.630 --> 00:32:10.710 - said, hey. Did you did you make these 913 00:32:10.710 --> 00:32:12.730 - guitars? He's like, yeah. I made these guitars. 914 00:32:12.974 --> 00:32:14.414 - And I said, hey. Did you, you know, 915 00:32:14.414 --> 00:32:16.674 - did you did you, like, hand plane everything? 916 00:32:16.815 --> 00:32:18.734 - Did you you know? Because, you know, we're 917 00:32:18.734 --> 00:32:21.615 - kind of obsessed nowadays with making things by 918 00:32:21.615 --> 00:32:23.535 - hand. And he's like he just looked at 919 00:32:23.535 --> 00:32:24.974 - me strange, and he looked at me and 920 00:32:24.974 --> 00:32:26.480 - he said, I have electricity. 921 00:32:29.819 --> 00:32:31.180 - So he's like, you know, why would I 922 00:32:31.180 --> 00:32:33.180 - hand plane it when I've got these tools, 923 00:32:33.180 --> 00:32:35.099 - like, these machines to do it? I'm sure 924 00:32:35.099 --> 00:32:37.259 - he could do it. Right? But, you know, 925 00:32:37.259 --> 00:32:39.259 - he was quite skilled. The the guitars looked 926 00:32:39.259 --> 00:32:39.759 - beautiful. 927 00:32:40.765 --> 00:32:42.125 - So that's the thing. It's like, yeah, we 928 00:32:42.125 --> 00:32:44.444 - have electricity. We have technology. Why not use 929 00:32:44.444 --> 00:32:44.944 - them? 930 00:32:45.244 --> 00:32:47.805 - Mhmm. So so so, yeah, I don't know 931 00:32:47.805 --> 00:32:49.644 - in terms of and it's hard to predict 932 00:32:49.644 --> 00:32:50.144 - because 933 00:32:50.765 --> 00:32:52.464 - we don't know what skills 934 00:32:53.325 --> 00:32:56.049 - will be missing, what we needed. I think 935 00:32:56.049 --> 00:32:58.049 - we need to continue to monitor. So this 936 00:32:58.049 --> 00:33:00.529 - is the thing. I think what the way 937 00:33:00.529 --> 00:33:02.630 - we can adapt to this AI 938 00:33:03.250 --> 00:33:06.549 - world is really monitoring outcomes to make sure 939 00:33:06.849 --> 00:33:09.224 - things don't get worse. Right? And and like 940 00:33:09.224 --> 00:33:10.984 - we do with everything, you know, making sure 941 00:33:10.984 --> 00:33:13.384 - we're improving quality. But on the positive side 942 00:33:13.545 --> 00:33:15.724 - so, again, sorry for long winded answer. 943 00:33:16.345 --> 00:33:17.945 - I've asked this question to a couple of 944 00:33:17.945 --> 00:33:18.765 - different groups. 945 00:33:19.785 --> 00:33:21.325 - And one group, 946 00:33:22.279 --> 00:33:23.500 - was a group of, 947 00:33:23.880 --> 00:33:25.480 - you know, kind of AI for this is 948 00:33:25.480 --> 00:33:28.200 - a medical education conference at Stanford on AI. 949 00:33:28.200 --> 00:33:28.700 - And 950 00:33:29.000 --> 00:33:30.599 - and I asked them, I said, how many 951 00:33:30.599 --> 00:33:32.539 - of you raise your hand 952 00:33:32.839 --> 00:33:33.500 - if you 953 00:33:34.424 --> 00:33:36.525 - are comfortable having an AI doctor. 954 00:33:36.904 --> 00:33:38.184 - And, you know, a lot of people this 955 00:33:38.184 --> 00:33:40.345 - is the AI, like, enthusiast audience. A lot 956 00:33:40.345 --> 00:33:42.105 - of people raise their hand. And then I 957 00:33:42.105 --> 00:33:42.845 - asked them, 958 00:33:43.705 --> 00:33:45.384 - hey. How many of you would be comfortable 959 00:33:45.384 --> 00:33:47.565 - having an AI doctor if you were diagnosed 960 00:33:48.019 --> 00:33:49.639 - with stage four lung cancer? 961 00:33:50.259 --> 00:33:52.740 - Fewer people raise their hand. And then I 962 00:33:52.740 --> 00:33:54.659 - asked them the third question. I said, hey. 963 00:33:54.659 --> 00:33:55.720 - How many of you 964 00:33:56.179 --> 00:33:58.259 - would wanna have an AI doctor at the 965 00:33:58.259 --> 00:33:59.559 - end of life? And 966 00:34:00.339 --> 00:34:01.940 - still a couple of people raise their hand, 967 00:34:01.940 --> 00:34:03.319 - but even fewer. 968 00:34:03.694 --> 00:34:05.075 - When I asked this question, 969 00:34:05.855 --> 00:34:07.474 - you know, to physicians 970 00:34:07.775 --> 00:34:08.594 - and students 971 00:34:09.375 --> 00:34:11.295 - I mean, the older physicians got nobody even 972 00:34:11.295 --> 00:34:13.135 - for the first question, nobody raises their hand. 973 00:34:13.135 --> 00:34:15.534 - Like, they don't even wanna Right. But even 974 00:34:15.534 --> 00:34:17.875 - with younger, you know, students' positions, 975 00:34:18.320 --> 00:34:20.719 - you know, that's a much less they they 976 00:34:20.719 --> 00:34:21.940 - wouldn't even for themselves, 977 00:34:22.559 --> 00:34:24.260 - they recognize the importance 978 00:34:24.639 --> 00:34:27.380 - of that humanity. So, you know, I've had 979 00:34:27.679 --> 00:34:28.579 - almost nobody 980 00:34:28.960 --> 00:34:30.880 - raise their hands for the second or third 981 00:34:30.880 --> 00:34:33.355 - question when it's a physician or a student 982 00:34:33.355 --> 00:34:35.674 - audience. So, you know, I I think that 983 00:34:35.994 --> 00:34:38.714 - because they're talking about themselves. Right? So Right. 984 00:34:38.755 --> 00:34:40.574 - You know, that's what they want for themselves. 985 00:34:40.954 --> 00:34:42.954 - You know, that's hopefully what they're gonna be 986 00:34:42.954 --> 00:34:45.775 - looking for, providing for their patients. So, 987 00:34:46.110 --> 00:34:48.190 - you know, I do think they recognize that 988 00:34:48.190 --> 00:34:49.090 - it's the humanity 989 00:34:49.789 --> 00:34:51.170 - in medicine that's important, 990 00:34:51.789 --> 00:34:53.950 - and AI is just a tool. It's just 991 00:34:53.950 --> 00:34:54.610 - a tool. 992 00:34:54.910 --> 00:34:57.070 - Again, I don't know. I I I I'm 993 00:34:57.470 --> 00:34:59.390 - I don't think anybody knows kind of what 994 00:34:59.390 --> 00:35:00.750 - are the skills we need, what are the 995 00:35:00.750 --> 00:35:01.809 - skills we don't, 996 00:35:02.164 --> 00:35:04.005 - and that's gonna shake itself out. I think 997 00:35:04.005 --> 00:35:06.085 - we need to monitor and make sure, you 998 00:35:06.085 --> 00:35:07.925 - know, we don't have descaling. Right? There was 999 00:35:07.925 --> 00:35:08.905 - a study about 1000 00:35:09.204 --> 00:35:09.684 - people, 1001 00:35:10.164 --> 00:35:10.664 - gastroenterologists 1002 00:35:11.204 --> 00:35:12.105 - doing colonoscopies 1003 00:35:12.644 --> 00:35:15.385 - and, you know, people getting deskilled about identifying 1004 00:35:15.605 --> 00:35:16.664 - certain things. 1005 00:35:17.210 --> 00:35:18.650 - But, you know, we can measure that and 1006 00:35:18.650 --> 00:35:19.469 - we can adapt, 1007 00:35:20.730 --> 00:35:21.469 - to that. 1008 00:35:22.170 --> 00:35:24.409 - You know, and certain things AI is probably 1009 00:35:24.409 --> 00:35:25.769 - gonna be better than us. And it's like, 1010 00:35:25.769 --> 00:35:27.069 - well, if it's better than us, 1011 00:35:27.449 --> 00:35:29.769 - why do we need humans? Right? It's sort 1012 00:35:29.769 --> 00:35:32.144 - of like, jeez. If it was a Waymo 1013 00:35:32.204 --> 00:35:32.704 - world, 1014 00:35:33.244 --> 00:35:34.924 - you know, and there are no no card 1015 00:35:34.924 --> 00:35:37.005 - s, you know, maybe that's just a better 1016 00:35:37.005 --> 00:35:39.324 - world to live in. So, yeah, that part 1017 00:35:39.324 --> 00:35:41.824 - I don't know. But I'm very hopeful about 1018 00:35:42.045 --> 00:35:44.545 - the future of students and residents because, 1019 00:35:44.859 --> 00:35:47.099 - you know, I I think they're all even 1020 00:35:47.099 --> 00:35:48.239 - with all these tools, 1021 00:35:48.780 --> 00:35:50.940 - you know, they're all very aware that they're 1022 00:35:50.940 --> 00:35:52.699 - taking care of people and they're trying to 1023 00:35:52.699 --> 00:35:54.079 - help other people. 1024 00:35:54.539 --> 00:35:55.039 - Mhmm. 1025 00:35:55.420 --> 00:35:57.739 - I really like that three part question that 1026 00:35:57.739 --> 00:35:58.425 - you asked. 1027 00:35:58.985 --> 00:36:00.744 - And I think that to your point, it's 1028 00:36:00.905 --> 00:36:02.664 - I love the story too about I have 1029 00:36:02.664 --> 00:36:04.744 - electricity. I mean, that's that's so true. There 1030 00:36:04.744 --> 00:36:06.664 - is a lot of mixed feelings at times 1031 00:36:06.664 --> 00:36:09.545 - about AI in different fields, particularly in medicine 1032 00:36:09.545 --> 00:36:10.440 - and health care, but, 1033 00:36:11.000 --> 00:36:12.920 - I think you really in your front part 1034 00:36:12.920 --> 00:36:14.920 - of that answer helped explain the nuance of 1035 00:36:14.920 --> 00:36:15.819 - this, why 1036 00:36:16.199 --> 00:36:18.440 - medical students gravitating toward it or being more 1037 00:36:18.440 --> 00:36:20.280 - open to it than maybe others are is 1038 00:36:20.280 --> 00:36:21.659 - not a bad thing. But, 1039 00:36:21.960 --> 00:36:24.359 - to hear the hand raising ratios in those 1040 00:36:24.359 --> 00:36:26.635 - different groups, I think, really does sum it 1041 00:36:26.635 --> 00:36:27.215 - all up. 1042 00:36:28.155 --> 00:36:30.315 - Yeah. Doctor Lin Yeah. I I I just 1043 00:36:30.315 --> 00:36:32.235 - wanna thank you. Were you gonna add something 1044 00:36:32.235 --> 00:36:32.735 - there? 1045 00:36:33.114 --> 00:36:34.494 - No. No. No. I mean, yeah, 1046 00:36:34.795 --> 00:36:36.875 - I'm a positive guy. You know? Yeah. I 1047 00:36:36.875 --> 00:36:38.575 - tend to be I mean, obviously, 1048 00:36:38.969 --> 00:36:40.409 - if I weren't, I wouldn't be with I 1049 00:36:40.409 --> 00:36:41.849 - wouldn't be on the air with I wouldn't 1050 00:36:41.849 --> 00:36:43.690 - be on the podcast with you. You know, 1051 00:36:43.690 --> 00:36:46.010 - I'm generally very optimistic. I mean, this is 1052 00:36:46.010 --> 00:36:48.409 - why I teach. Right? Yeah. Teaching is so 1053 00:36:48.570 --> 00:36:50.030 - like, you see the next generation 1054 00:36:51.050 --> 00:36:52.570 - and, you know, of course, you see the 1055 00:36:52.570 --> 00:36:55.114 - things that always happen. Right? Oh, I remember 1056 00:36:55.114 --> 00:36:57.275 - when I was a student exploring and, you 1057 00:36:57.275 --> 00:36:59.034 - know, some things don't change. Like this question 1058 00:36:59.034 --> 00:37:01.194 - about technology. Right? You know, they ask these 1059 00:37:01.194 --> 00:37:04.074 - same questions a generation ago, two generations ago. 1060 00:37:04.074 --> 00:37:06.875 - Right? Such and such is ruining our profession. 1061 00:37:06.875 --> 00:37:08.094 - And and, 1062 00:37:08.714 --> 00:37:11.039 - you know, but, you know, I think students 1063 00:37:11.579 --> 00:37:12.319 - working with 1064 00:37:12.619 --> 00:37:15.500 - students and trainees always gives me hope. Always 1065 00:37:15.500 --> 00:37:17.819 - gives me hope. Both for my own case, 1066 00:37:17.819 --> 00:37:20.059 - you know. You know, I I it gives 1067 00:37:20.059 --> 00:37:21.980 - me hope that, you know, if I if 1068 00:37:21.980 --> 00:37:24.059 - I live long enough to the next treatment 1069 00:37:24.059 --> 00:37:26.344 - that these students will be taking care of 1070 00:37:26.344 --> 00:37:28.824 - me. Right? And coming up with the next 1071 00:37:28.824 --> 00:37:30.125 - wonder drug for me, 1072 00:37:30.905 --> 00:37:32.824 - you know, I I I think these these 1073 00:37:32.824 --> 00:37:34.984 - students give me hope, and it's part of 1074 00:37:34.984 --> 00:37:37.085 - why that's actually probably the main reason 1075 00:37:37.389 --> 00:37:38.130 - I teach. 1076 00:37:38.590 --> 00:37:40.590 - And, you know, I'm I write about my 1077 00:37:40.590 --> 00:37:42.769 - experience and, you know, come on podcasts. 1078 00:37:43.309 --> 00:37:45.070 - You know, I I I could do other 1079 00:37:45.070 --> 00:37:45.570 - things, 1080 00:37:46.429 --> 00:37:48.349 - you know, could be traveling the world. I 1081 00:37:48.349 --> 00:37:49.889 - could be on the beach right now. 1082 00:37:50.525 --> 00:37:52.204 - But, you know, I I think doing things 1083 00:37:52.204 --> 00:37:54.364 - that are hopeful is is really great, and 1084 00:37:54.364 --> 00:37:55.105 - these students 1085 00:37:55.724 --> 00:37:57.644 - and trainees, you know, they give me hope, 1086 00:37:57.644 --> 00:37:58.144 - and, 1087 00:37:58.765 --> 00:38:00.285 - it's fun. Give me a little bit of 1088 00:38:00.285 --> 00:38:01.985 - sunshine in my life every day. 1089 00:38:03.050 --> 00:38:04.730 - I I I can't thank you enough for 1090 00:38:04.730 --> 00:38:06.010 - sharing that with us, 1091 00:38:06.570 --> 00:38:08.570 - on this podcast with our audience today. To 1092 00:38:08.570 --> 00:38:09.769 - your point, you could be on the beach. 1093 00:38:09.769 --> 00:38:10.889 - You could be doing a lot of different 1094 00:38:10.889 --> 00:38:13.530 - things with your time, but your perspective is 1095 00:38:13.530 --> 00:38:14.030 - remarkable. 1096 00:38:14.650 --> 00:38:16.570 - Your students are quite lucky, and so are 1097 00:38:16.570 --> 00:38:17.655 - we to have the chance to get to 1098 00:38:17.655 --> 00:38:19.335 - visit with you like this and hear from 1099 00:38:19.335 --> 00:38:21.335 - you firsthand, doctor Lin. So thank you so 1100 00:38:21.335 --> 00:38:24.635 - much. Again, listeners, this is doctor Bryant Lin, 1101 00:38:24.934 --> 00:38:27.574 - primary care physician, educator, researcher, and as you 1102 00:38:27.574 --> 00:38:29.755 - just heard so much more at Stanford Medicine. 1103 00:38:30.153 --> 00:38:31.913 - Doctor Lin, I just wanna thank you again 1104 00:38:31.913 --> 00:38:33.433 - for being my guest today. Great to visit, 1105 00:38:33.433 --> 00:38:34.653 - and I hope we can do this again. 1106 00:38:34.793 --> 00:38:36.813 - Great. Thanks, Molly. Thanks for having me.