Fixing Healthcare Podcast

Dr. Rod Rohrich has broken the unwritten rules of medicine across his career. He turned a traditional paper-only, medical journal into a digitized force, full of videos and evidence-based rankings that has become one of the best in the nation. And he revolutionized rhinoplasty surgery and plastic surgical education and training.   Today, Dr. Rod Rohrich is one of the most influential plastic surgeons in this century and continues to be voted the best in publications like Newsweek, US News and Harper’s. A proponent of social media as a tool for patient education, he has hundreds of thousands of followers on Instagram and Twitter and continues to break medicine’s outdated rules. In this interview, hosts Jeremy Corr and Dr. Robert Pearl—himself, a reconstructive and plastic surgeon—discuss the lines that need to be crossed to make medicine better for doctors and patients. Interview Highlights On how to know when a rule needs breaking In medicine, there are so many times we do things that have absolutely no rationale (for) but we’re told that that’s how we’ve always done it. And I was at one of those famous hospitals in Boston where we were told that all the time, and we did it without question. I think we need to now question that and say, “Is that really the best way to do it, or is there a better way? Is there a simpler way? Is there a best medicine way?” If it’s breaking the rules, so be it, but I think it’s really doing it to get us out of our cages that we’re in that really impede best care.” On tips for using social media “You should always be yourself and you should use social media to empower your audience and not to impress them. You should use it to educate them and not to overwhelm them. And I think people appreciate that. Because if you approach social media by educating them about their own health, how they can be better, how can they do things better, how they can find plastic surgery or doctors better, that’s a good thing.” On bringing medical specialties together “There was a great chasm between aesthetic surgery and reconstructive surgery for many, many years, and I think that’s come together in plastic surgery; but then there was even a deeper chasm between our specialty and our sister specialties, from dermatology to facial plastic surgery and otolaryngology, but I think that also has had a coming together. And I really think that social media has played a big part in that, and the ability for leaders to say, ‘Hey, we want to teach people to do the right thing and to provide best care.’ I personally do not care what your background is, I just care about how good you are and how good you can become to do and give great patient outcomes and do patient safety. And I think that hopefully is becoming the bottom line.” On academia vs. private medical practice “I think you learn the rigidity of academic medicine and the pros and cons, which are fantastic. When I helped build our incredible plastic security department at UT, it actually taught me the discipline of staying focused because there’s so many different ways where you can go by the wayside, especially in universities. Because there’s a lot of barriers to progression and advancement in academics, because there’s so much bureaucracy, politics, and red tape that are a burden … I think the private sector has been an epiphany for me to say, ‘Wow, I learned all these things in academics, but now I can apply them in the real world without all the impediments.’ So it’s been a total breath of fresh air.” On resisting complacency “The worst thing you can do is solve a problem and then say, ‘Oh, we solved it.’ You have to say, ‘We’ve solved this part of the problem, let’s see how it works,’ because it’s not a solution, it’s always an evolution. That’s really important, because times change, people change, and the processes change. So I think we need to keep working on it.” On the next-gen of rule breakers “I think that today, the Gen Zs and the Millennials, they aren’t rule followers. They actually like to break the rules. That’s their norm, which is a good thing, I like that. They challenge us, they want to know what we don’t know, and I really like that. They challenge us every day to say, ‘Hey, I learn differently. You need to teach me in a different way,’ and I think that’s good.” READ: Full transcript with Rod Rohrich * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #57: Dr. Rod Rohrich on how to change the rules of medicine appeared first on Fixing Healthcare.

The New York Times surveyed 362 school counselors on the effects of the pandemic on children. The results were both predictable and troubling. Not only have kids fallen behind in the basics like reading and math, but counselors also described students as “frozen, socially and emotionally, at the age they were when the pandemic started.” Nearly all counselors (94%) said students were showing more signs of anxiety and depression than before the pandemic. What can be done about these troubling developments? Are there reasons for optimism in the data? What’s new with vaccine approvals for young children? Jeremy Corr and Dr. Robert Pearl examine these questions and many others in this episode of Coronavirus: The Truth. You’ll find all the [time stamped] topics discussed during this show here: [00:51] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [03:08] There are new concerns about long-COVID. What have researchers found? [05:40] Listener question: “The World Health Organization estimates that 5 times more people have died from Covid-19 in India than reported. Is the same true for Africa?” [09:16] Listener question: “I feel fine, but I tested positive for COVID 10 days after coming down with infection. What does this mean?” [14:35] Dr. Pearl wrote a recent Forbes article titled “Why Omicron Is About to Make Americans Act Immorally, Inappropriately.” What did he conclude? [18:27] Will sporting events and indoor weddings see capacity crowds this fall? [19:46] For parents, is there any new research on kids and Covid-19? [23:03] Is a vaccine for Omicron coming soon? [25:00] What do we know about other Covid-19 vaccines in the works? [28:15] Listener request: “I listened to your show last month about monkeypox and hope you can provide an update during your next show.” [30:02] Listener question: “One of your episodes included data about how the U.S. spends so much more on medical care than other nations and yet trails other industrialized countries on all clinical outcomes. But isn’t cancer an exception in America?” [32:06] Listener question: “Almost everyone I know has gotten sick with Covid-19 lately. A few of them have been sick for several days, but none of them needed hospitalization or came close to dying. How dangerous is it  to get COVID now?” [34:12] Cohost Jeremy Corr’s had a recent experience with Covid-19. What happened? [35:51] What’s the big non-Covid-19 news story this month? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #62: Has the pandemic ‘frozen’ kids emotionally, socially? appeared first on Fixing Healthcare.

This Fixing Healthcare podcast series, “Diving Deep,” features a robust and probing discussion into some of healthcare’s most complex subjects and deep-seated problems. On today’s episode, Dr. Robert Pearl and Jeremy Corr dive deep into the unwritten rules of healthcare and American society. Together, they’ll ask the question, “What is it about Omicron that is making Americans act immorally and inappropriately?” They’ll also focus on the hidden causes of outrageously high drug prices. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a time-stamped discussion guide: WHY OMICRON IS MAKING PEOPLE ACT IMMORALLY [01:03] What was the inspiration behind Dr. Pearl’s popular Forbes article “Why Omicron is about to make Americans act immorally, inappropriately,” which was read by nearly half a million people? [02:40] Why are people’s behaviors starting to change? [04:07] What are “cultural norms” and which ones are changing because of Omicron? [05:44] What’s a culturally immoral act today that will be culturally appropriate in the near future? [07:33] Are people’s actions really “immoral” or are they to be expected given the nature of the disease? [09:30] How do external forces (like the virology of Omicron) change culture and behaviors? [15:04] What evidence demonstrates this cultural shift is already under? THE UNWRITTEN RULE THAT KEEPS DRUG PRICES SO HIGH [19:31] Do high-priced drugs in the U.S. overachieve, meet expectations or underachieve for patients? [20:40] Do drug makers lack the scientific knowhow to make highly effective drugs? [22:06] Why are drug companies so risk averse? Has it always been this way? [24:30] When did the unwritten rules of drug-industry profits begin to shift? [26:24] Don’t drug companies need high prices to protect R&D investments? [27:00] What are examples of high-priced medications that deliver limited or no value for patients? [30:11] What’s suspicious about the new FDA-approved breast cancer drug? [32:50] Are Covid-19 vaccines an exception to this rule? [34:09] Is there more to this rule listeners should know? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #56: Diving deep into odd pandemic behaviors and overpriced drugs appeared first on Fixing Healthcare.

Said ZDoggMD: “Oh, man, OK. You said, hey, let’s do a podcast together, Z. It’ll be fun, you said. It’ll be easy. It’ll be flow. Then you ask a question like this?”   Replied Robert Pearl, MD: “It’s easy for me to ask the questions, Zubin. That’s what I meant.” Welcome to Unfiltered, a show that brings together two iconic voices in healthcare for an unscripted, hard-hitting half hour of talk. In this episode, Dr. Pearl wastes no time getting serious with Dr. Damania (ZDoggMD). The two talk about the unseen forces holding healthcare back. These invisible elements including tribalism, bias, fear, inertia, hierarchical struggles and a cowboy culture that all combine to harm patients, increase medical errors and prevent high-functioning teamwork. A little history on the show: Prior to Unfiltered, Dr. Robert Pearl had twice appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who had twice appeared on the Fixing Healthcare podcast with Pearl, alongside cohost Jeremy Corr (see: here and here). For more, press play or peruse the transcript below. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Welcome to Unfiltered, our newest program on our weekly Fixing Healthcare podcast series. Joining us each month as Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes, he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare policy experts, they’ll apply the lessons they extract to medical practice. Then I’ll pose a question for the two of them as a patient based on what I’ve heard. Robbie, why don’t you kick it off. Robert Pearl: It’s amazing, Zubin, how fast a month passes. Feels like we just recording last month’s Unfiltered episode yesterday, and here we are recording the new one. Zubin Damania: The dirty secret, Robbie, that I’ve learned as I got older is the older you get, the shorter time feels because it’s a smaller portion of your overall life. For me, it’s like the days just go click, click, click, click, click, and then we’re doing another one. It’s kind of nuts. Robert Pearl: It’s just a question. When you’re having fun, time passes rapidly. Zubin Damania: Oh, the flow state argument? Robert Pearl: Yeah. Yeah. Zubin Damania: Yes. There’s that as well. There’s that as well. Robert Pearl: I thought of you the other day. I was talking with an ER physician and an ER nurse. They were passionate about patient safety and frustrated by how difficult it was to make systemic improvements. They reached out to me wanting my thoughts and advice on how to get people to do what seemed so logical: save lives. They pointed out the extensive research that had been done on the topic of safety, going all the way back to Ralph Nader, the car industry, aviation history. I acknowledged the frustration they felt. I talked with them about a personal experience. Chronicles my first book, Mistreated, about my father’s premature death from preventable medical error. I offered my view that when logical things don’t happen, like systemic improvements for patient safety, there’s always another factor, one that’s either not visible or not being considered. I said that based on my experience, you can’t solve the problem staring you in the face without bringing the other one out from the shadow and addressing it. If it’s okay with you, Zubin, I’d like to learn from your insights about what’s not being seen or said about a few of these seemingly obvious opportunities. Let’s start with patient safety. Over 200,000 people die every year from medical error. Research shows that most result from a combination of systemic problems and a failure of people to follow evidence-based approaches. Seems like a no-brainer to me to follow the experts. What’s not being recognized when it comes to patient safety? Zubin Damania: Oh, man. Okay. “Hey, let’s do a podcast together, Z. It’ll be fun,” you said. “It’ll be easy. It’ll be flow.” Then you ask a question like this. Robert Pearl: It’s easy for me to ask the questions, Zubin. That’s what I meant. Zubin Damania: I know. This is a question that I wrangle with almost every day, especially since my father is in and out of the hospitals these days. I’m always terrified because I know all the statistics you just said apply, and it’s not one of those vague things. They apply personally. You told your story about your father. I was there at Stanford, I think, when your father was there. Let’s speak about it honestly. A lot of it that’s unspoken is the shadow culture of medicine, I think, that really, it’s inertia-driven. We are fear-based, so errors of omission are actually punished or are considered more powerfully than errors of commission. What we fail to do is actually, we worry more about malpractice than what we actually do, so we tend to do a lot of stuff. Each thing tends to have its own downside, including a certain level of unnecessary testing and screening and treatment that has consequences. Iatrogenic, the physician-caused, medical system-caused consequences. But we’re acculturated to actually do things to people to some degree, to avoid getting in trouble for the opposite, which is failing to do something, failing to do the scan, failing to do the procedure that actually, it may have been better not to do. In the house of God, Sam Shem says, “One of the rules of the house of God is, do as much of nothing as possible.” I think there’s that cultural component, but then there’s the autonomy component where I think many people in healthcare don’t want to be part, or they want the support of a system, but they don’t want any infringement on their perception of autonomy. If you’re doing a root cause analysis or you’re going through a just culture algorithm for dealing with patient safety, I think some physicians feel like, “Well, they’re telling me how to practice. This is stepping on my autonomy and they are bureaucrats doing this.” To some degree, maybe that’s true in certain settings. But in others, this idea of a systemic, thoughtful and somewhat algorithmic, meaning there are some algorithms that actually are shown, hey, you just got to go through a checklist when you’re flying a plane. Why wouldn’t you go through a checklist in the OR? Why wouldn’t you make sure you’re not operating on the wrong side? All these other things. But we resisted as a culture, the culture of cowboy autonomy. The culture of individuality has been ingrained into medical training. Then the fear-based stuff, really, I think prompts us to do things to people that probably result in harm just in and of itself. That’s just a tip of the iceberg, I think, in terms of patient safety. Robert Pearl: Let me ask you about another area that I know is very close to your heart, and this is about high-functioning teams. We live in an era where medicine is complex. Patients often have multiple chronic diseases. You can’t achieve the best outcomes as lone cowboys and cowgirls, you just said, and yet rarely do we put in place highly effective, highly functioning teams. What’s not being said that’s getting in the way? Zubin Damania: I think again, it is we’re conditioned as these hierarchical agents in healthcare, that a team is another way of either saying, I’m the boss and you guys are going to listen to me, you’re my support. Or they’re trying to usurp my autonomy by giving me this “team”. I think that’s some subtext to it, not always. Again, we’re conditioned not to like our autonomy taken away. The other problem is I think we don’t allow people on the teams to really practice at the full extent of their abilities, with the support of the team. We give them these pigeonholed roles and that makes it difficult. Then we don’t have a culture that really elucidates the brilliance of a team as well. It’s still a lone wolf culture, but then we go, “Oh, but there’s a team.” Then it becomes a dominator hierarchy where there’s somebody who is the boss on the team and everybody else is just doing scat. That’s one outcome that can happen. We haven’t actualized team-based care. The real team-based care is everybody’s living their most actualized piece and it’s self-managing and self-governing. At our clinic, our team, there’d be a different member of the team that would lead the huddle every day, and that could have been a health coach with no formal medical training that was trained on the job or hired for certain attributes, and then allowed to use those in service of the team. It was a growth hierarchy that we were trying to build there, but it involves culture shift, training shift, system shift, technology shift. Why shouldn’t you be able to all write in the same note in the EHR at the same time? That was something that we explored when we were building our technology. Robert Pearl: All right. One more. How about the disparities and health outcomes based upon race? We certainly know they exist, but we don’t seem to be making any progress. What’s not being said here? Zubin Damania: Oh. Oh, man. You make it so easy, Robbie, so easy to hurt yourself. Really, would you hit those hard topics that are difficult? Again, there are so many people who can weigh in on this, and I’ve interviewed people like Ian Tong, Black doctor, and his perspective was very, very valuable in helping me understand it a little better. But yes, there’s unconscious bias. Yes, we use heuristics in medicine that are often unconscious, sometimes they’re conscious, to pigeonhole patients quickly. Could race be a part of that, that could then lead to unequal outcomes? Sure. But I think actually, there’s also the component of yet we don’t have enough minority physicians, physicians from different socioeconomic backgrounds that take care of patients, because that seems to be associated with better outcomes because there’s more understanding of the community. The way we tried to hack that problem is we would get health coaches who were drawn from the community they served, and often were in the same socioeconomic status as a lot of the patients we were taking care of. That helped a lot because they were developing these trusting relationships and really understanding the patients. Not just the social determinants of health, but what their goals and hopes and aspirations were, so that we could tailor care. But then there’s the bigger elephant in the room, which is we are dealing with the societal issue of inequity that has been generations in the making. It falls on the healthcare doorstep to say, “Hey, fix this problem.” But the truth is, this is a massive problem that comes from cycles of violence in communities of color and poverty. All the things we reduce to social determinants of health are actually incredibly nuanced and complicated things that don’t have a simple, let’s have a quality of outcomes answer, and even a quality of opportunity. How do you accomplish that? Even in medical admissions, how do you accomplish that? That’s where again, the further we get out from the original sin, say of slavery say, the further we get out from that, the more we have to think. Okay. We need to start to wake up in a broader way that changes society, that then will ripple through healthcare. But again, those things that are our direct purview, we need to address, but it’s hard. Robert Pearl: Let’s shift a little bit. Did you have a chance to read the report by the Surgeon General on burnout this week? Zubin Damania: Well, I just got to say one thing. I love it. You throw this on my lap, I answer the question in a hand-waving way, and then you’re like okay, moving on. I’m like, “What about you, Robbie? What do you think about it?” Because I know. I’ve read your books. You think about this stuff clearly. But all right. All right. Robert Pearl: No, I will answer you. To me, there’s a lot of unspoken things. I think each of these types of problems exist, and I think that there’s a level in which, and I will even say the majority of people have call it implicit bias, call it acting in racist kind of ways. They’re not consciously racist, but I think they make those decisions and they have trouble seeing that in the mirror. It’s uncomfortable, and that’s why I always bring up these issues. Because as long as we want to say that racism as an example, doesn’t exist, then we’ll talk about the problems, but we won’t solve it. To me, you look at the issue of gun violence. What do the gun proponents want to say? It’s all about mental health. Well, it’s not. But why do they say that? Because they can’t win the argument about keeping high-firing, multiple-round guns out of the hands of 18-year-olds who are socially isolated in high school. And the consequences are predictable. But if you don’t want to talk about the problem, you find someplace else to focus and you dismiss it. That’s who I see again and again in medicine. If we just look at this question, why don’t we have high-functioning teams, it’s what you said. Because people like their place in the hierarchy and they’re not about to give it up. On the other side, the question’s really going to be, how do you create a high-functioning, equal team of people with different levels of expertise and experience? Zubin Damania: Yes. Robert Pearl: This is the kind of questions we never address. My frustration, why I write the books, why I have the podcasts is for all of the time we talk about these things, when I measure progress, it’s in inches. It’s not in miles and hundreds of miles that we should be going. I look at the outcomes in medicine. What are we seeing? We’re twice as expensive as any other country in the world and our outcomes are lagging. I just can’t believe I look at data on maternal mortality and I see it’s four times higher than other countries. It just jumps out at me, and that’s again, why gun violence to me is another example of that. Look how many more guns we have in the United States. Look how many more people are getting killed. I think other countries have some mental health problems, too. So, why don’t they have the same level of difficulty? If it’s not the guns, what is it? It’s somehow sitting in the political process that we have. You’re hearing me just being frustrated by the slowness of change and the waste of human existence. Zubin Damania: What you’re pointing at is repression and denial, and projection and all. It always comes back to us. It always comes back to the human at hand. Personal growth, we’re avoiding that. When you talk about implicit bias, for example, yes, of course, of course, of course. You know how we know this is true? Because all of us have it. If you actually introspect, you’ll see it arise, and instead of acting on it unconsciously and automatically, you’ll actually go, “Oh, wow. Well, there’s a little bias. Let me think about that and act more responsibly.” But it requires introspection. It requires looking at these difficult things, whether it’s guns, whether it’s race, and that’s why it’s so uncomfortable. We feel it. Even talking about it, it’s like, oh, I get a little constricted because you’re feeling your own stuff and you’re going, “Ooh, am I missing something in myself?” That’s why we got to have these conversations, brother. I ditched your question on the burnout thing because I haven’t read the report. So fill me in. Robert Pearl: He pointed out, as we all know, that it is a major problem. I don’t want to say he underestimated. I just don’t think he detailed it as much as he should. He talked about a variety of things. He said, there’s a need for living wage and paid sick time and family leave, evaluation of workloads and staffing, which is all true. He talked about reducing the documentation and other administrative burdens for healthcare workers. He talked about the need to have mental health support. He talked about the opportunity to protect healthcare workers from violence and unsafe conditions. He talked about a lot of the problems that clearly exist, we know exist, and people would like to see changed. But I raised the issue, Zubin, because again, when I look at burnout, I don’t know how long it’s been, at least a decade we’ve been talking about this. I don’t know about you, but I don’t see that things are very much better today than they were five years ago. The question I have is, if it’s not much better now than five years ago, why do we really think it’s going to be any different five or 10 years from now? Why are we paying that price? But more importantly, what can we do to avoid having to experience both the lack of fulfillment, the fatigue, the moral injury, and the implications for both doctors and for patients? Zubin Damania: I agree. It’s only gotten worse, and the pandemic’s only made it worse. You talk about the Great Resignation and people are just waking up to, is this really what I want to do with my life? Was this the calling I felt it was? I think what you’re pointing at is a fundamental … There’s a few issues, and you’ve brought up some of these in your books too, which is one of the issues is physicians in particular, they have a certain idea of what this thing was supposed to be and then they’re met with this kind of 2.0 version, which is mechanized and bureaucratized. There’s this administrative technocracy that seems to run it. It’s so discordant with what their image was and their own self-image of the cowboy doctor, that it creates this tension. But that’s a part of it. Obviously, it’s all those things. What’s required is a dramatic, and again, you said things are measured in inches, not miles. That may be true, but at some point, there’s a phase shift that happens where we just go, “Oh wait. Wait. Wait. We’ve seen some bright spots here. We know where this works there. They’re emerging in fits and starts.” Maybe well-resourced, team-driven, primary care that gives you the tools, the teams, and the trust to do your job, and actually systems that support that and a slow but steady culture shift towards this kind of team-based care, maybe that. Then we train our medical students like, “Hey, this is how it’s going to be”, so expectations and competencies are matched to what the actual system is going to be. Then we might start to see a shift. When you talk about teams, that’s when you start pulling in nurses and pharmacists and respiratory therapists, and everybody else on the team that has been suffering as well. Then look for bright spots within medicine. Who are the specialties and aspects of medicine where the self-reported signs of emotional exhaustion and cynicism and depersonalization, all the burnout, end-stage moral injury stuff, where’s that the least and what can we learn from what’s going on there? It’s a multi-factoral thing. I’m glad Vivek is talking about it. Vivek is such a compassionate, thoughtful guy, but again, it’s like we can list out the problems and knowing the problem is half the battle. But what’s the next step? We really have to start actualizing this stuff. Robert Pearl: Let me ask a, I’ll say uncomfortable question, which is- Zubin Damania: Oh, you haven’t asked any of those so far, Robbie. This isn’t- Robert Pearl: No, this is more so, Zubin, because I sometimes ask myself the following question. In the current world, a world that is the way it should be, with often two people working, I think you said last time that your wife’s a physician, is work-life balance possible without some kind of personal sacrifice being put into play? Zubin Damania: Ooh, and this is such a complicated issue because there are gender dynamics here. There’s socioeconomic dynamics, there’s race dynamics. But to put it as simply as possible, I think my late friend, Tony Hsieh, used to say, “There’s work-life balance and then there’s life.” If life is your thing, where everything is part of your life, then there’s not work and life. There’s just life, which means you better start to, first of all, understand that what you’re doing at work is an authentic expression of you, and figure out ways to integrate it into life and make it life itself. That could fly in certain industries very easily, but in medicine, we’re expected to do all these things, be heroic, especially women, and then come home and manage the kids, and come home to take them to soccer practice. Or if we have to hire someone to do that, then we have to work more shifts. We can’t go down to part-time to do those things, because then we can’t pay the nanny. Sounds like first-world problems until you experience them, and then you realize that man, this is as stressful and unhappiness generating. Then you look at the person living in a slum in Mumbai and you measure their subjective happiness and they’re happier, because they have community, they have support, they have some sense of higher purpose, even though they’re in economic squalor by our standards. Why is it that Americans seem just generally less happy? Well, because I think we fragment our psyche into this is work, this is home, this is responsibility and so on. Then we don’t have the social structures. We don’t have proper maternity leave, availability to breastfeed, paternity leave that some of the European nations have. We have the lowest ratio of doctors per capita, practically in the developed world, I think short off South Korea. We wonder why workloads are so high and we have a nursing shortage. Those are just the tip of the iceberg. I’m curious what you think, Robbie, because you’ve had to deal with this for so many decades as leader of such a large organization. Robert Pearl: Again, I’m focusing a lot on what’s not being said or not being, to use the word which you said earlier, that we’re denying. If I said to you, “Zubin, what’s it like for you to work full-time,” you describe a very fulfilling career, full-time with a certain amount of money that you’re earning, and I said to your wife, “Okay, you tell me what a full career for you,” she describes the same thing, and they’re both accurate, they’re both wonderful. Now, I say, is it possible to take these two pieces and have them coexist simultaneously? My conclusion is it may not be possible that someone’s going to pay both of you to be able to do that in a context where you’re going to have work-life balance. It may turn out that you both have to cut back on your both professional and economic expectations, and gain from it the fact that now you’ll have more time with your family, with your kids in your interpersonal life. You may not need the same size house. You may not have some of the other accoutrements of life. I don’t know where that would come, but we built professional expectations on the last generation, where you had one person working and not the other person working, and the dollars were adequate to support that family but it wasn’t a life in terms of possessions as we have today. I just wonder whether the societal expectations have exceeded the reality. All you have to do is look at the stock market these days to see that rebalancing that’s going on–on its own, and I just wonder whether that is what’s not being talked about in medicine. Zubin Damania: Ah. Once again, you’re pointing inward. You’re saying, what is it we value? What’s self-actualization? Is it acquisitions? Is it material wealth? Is it this socially validated esteem that we have from driving a Mercedes G-Wagon and so on and so forth? Or could we get away with the Camry, upgrade it to a hybrid, get a faux leather interior and be happy with a family life that’s more balanced? Again, with me and my wife, we’ve had to alternate the sacrifices. You asked about sacrifice. We’ve had to alternate. For years, I was a full-time hospitalist while she went back and trained because she had done internal medicine, board certified and realized this is not my calling. She realized it late, and that she was going by societal expectations or parents’ expectation. Then she went back and said, “I need to do radiology.” That’s another four years of training where I’m making 30 grand a year. I said, “Well, let me go ahead and work full-time, even though I don’t know that this is exactly the right path.” I did that. Then we shifted. We said, okay, now she wants to do more of the career building, and let me then do a career where I have more time to help with the kids to do these kind of things to be present. It is this kind of give and take, and you do have to understand what you value it. Now, if I was going by societal roles and this kind of thing, no, I have to be the co-breadwinner, at least, if not in a chauvinistic way, the guy who makes the most and does all of this. Then you’re trapped. Then of course, there’s going to be unhappiness and that mismatches your expectations. I’m with you, brother. Robert Pearl: I don’t know if you ever listen to Laurie Santos. She’s the Professor from Yale who runs the course on happiness that one-fourth of Yale students take. It’s the most popular course at the entire university and it’s available online for anyone who wants to do it. But she talks a lot about the way that we misinterpret and misanticipate happiness. One of the pieces that I was listening to the other day is she talked about the research that says there’s a level, and the level is somewhere between 100 and $200,000, beyond which there is not a single shred of evidence that more money adds happiness. Zubin Damania: Yes. Yes. Robert Pearl: Yet, as a physician, I don’t think any of us see that as a landing spot for us in our family. Zubin Damania: Especially if you live in a high-cost area. Then the truth is many physicians gravitate to these things and we start to accelerate our spending, and our outflows become so high that we’re goldenly handcuffed to a career path of FTE and workload that is unsustainable. It’s not what we wanted. Again, we think we’re chasing happiness. We’re not. I think that requires a reality check, a gut check. I think people are waking up more though. I think the next generation is changing its expectations. They’ll complain and they’ll say we have lesser quality of living, standard living than our parents for the first time. But to some extent, that’s an opportunity to go, what does that mean? What should you be doing with that extra time and space? Are there self-actualization things you can do that’ll lead to more happiness, family connections, relationships, et cetera? Robert Pearl: I think in our next conversation, I want to talk a lot more about some of these psychological areas, but let me raise one right now. Again, these are the things I’m thinking about a lot, which is that the research is very clear that gratitude and generosity are two of the best ways to maximize happiness, your own happiness. In fact, there’s a lot of data that says, if you give someone $20, as opposed to getting $20, you actually experience a lot more happiness, fulfillment, and joy in your life than whatever you’re going to do with the $20 that you receive. I don’t know, in medicine today, how much gratitude and generosity exists. I think there’s problems. There are reasons why it might not exist. But again, I’m just wondering whether we trip over our own feet in trying to get what we think we want, but in the process, actually rob ourselves of what we could have. Zubin Damania: Yeah. There’s no doubt that’s true. Just to some extent, the term mindfulness is misused. It really means remembering. At any moment that you’re mindful, you’re remembering what’s actually true in this moment, and gratitude is a powerful part of mindfulness because you remember how incredibly lucky you are, how much you’ve been given, how many mentors you’ve had, how many opportunities you’ve had that have led you to this part of your career in medicine. That mindfulness, that remembering can center you right in this glow of gratitude that reminds you of the compassion that was given to you. Then it comes out of you. It really is a powerful practice, and more and more doctors are actually, I think, waking up to this. I hear them talking about it more, these kind of practices, so that’s a good sign. Robert Pearl: I don’t want any of our listeners to think that in any way, I’m trying to minimize the problems that exist, and recognize the economic challenges people have or the bureaucratic tests that they have. Again, I’m always looking to say, is there a crack in the wall that is being missed? That maybe if we focused on that along with rebuilding the rest of the wall, we would end up being more fulfilled. I would also say, and I often think back to Kübler-Ross and the idea of acceptance, that if the reality is that we’re not going to be able to get the changes that would be optimal, that maybe we should get, that maybe we’re entitled to, but we’re not going to get it, what are we then going to do? How can we add joy and fulfillment into medical practice that maybe today we’re taking away? I know there’s a lot of fear that if in any way we acknowledge that somehow we’re not the victim, that people will not give us what we want. My observation is they’re not giving us what we want right now, so let’s look at these opportunities, whether through mindfulness or whatever other practices it’s going to be, creating these high-functioning teams, even if it means a little bit less respect, seeing patients in a different kind of way, all the parts that we’ve talked about. Is there a way that we can uncover some of these unspoken aspects, have the conversations and come out of it, maybe not as great as we would like, but far better than today? Zubin Damania: You’ve said it perfectly, and the truth is it comes back. I keep bringing it right back to the self, the personal development. I’ll take it one step further and say, by doing those practices, you’re not giving up on the fight for all the things you talked about or fixing the system. What you’re doing is you’re enabling yourself to emerge a better system, because when enough people do that, they wake up themselves. Then actually the system starts to transform. In many ways, the system I think, and this is speaking kind of metaphysically, but also I think there’s truth here, the system is an emergent property of us. If we’re a mess in that way, then our system is a mess and it feeds back. What if we start to change ourselves? Well, our system will change, and maybe that’s why we’re at an impasse, Robbie. Maybe that’s why it feels so intractable. It’s always darkest before a phase shift, before you wake up. That’s when it’s darkest, and I feel like we got to talk more about those unspoken things that you’re pointing at. Robert Pearl: Well, I’m a big believer as you know that the first thing we must do, if we want to address the panoply of challenges that we have, is move from fee-for-service to capitation. Then in that process of doing that, we now can create the dollars and the resources to fund the things that need to happen. We can pull out those bureaucratic tasks. We can find opportunities to gain purpose, by being able to make the lives of people easier and better. And that standing in our way is this fee-for-service system that as you say, makes us run faster and faster and faster on a treadmill to generate more and more dollars. The insurance companies fight back by trying to limit what we do, because they can’t afford the dollars. The purchasers get somewhere in the middle of the battle, and in the end, as I say, a lot of smoke and very little actual change. Zubin Damania: Yep. That’s it. Our incentives matter. But again, I’ll bring it right back to us. Our incentives are an epiphenomenon of what we think we want. Fee-for-service is a lucrative, lucrative kind of like a carrot dangling there. Oh, if I just see more, if I do more, if I bill more, if I code more, I can get that Mercedes G-Wagon, which I’m expected to have, or whatever it is. We have to change, too. We have to change. In Europe, the doctors get paid less, but there are more of them so it’s a different balance. I don’t think any system’s gotten it perfect, so we learn what we can and then look for that phase shift in our own awareness. Robert Pearl: You said it perfectly. I can’t wait for our next conversation. Zubin Damania: Hey, me too, man. This is intense and fun. Jeremy Corr: Earlier, when you were talking about implicit bias, it made me think about a conversation I recently had with a couple of people who were upper-class, educated, East Coast liberals. It made me think about this. The nation is doing a lot now to address the inequities in minority communities. However, one of the things that I think has frustrated many in the rural communities, such as where I grew up, is how they feel as though there’s still a significant bias against them. They feel frustrated because they’re called deplorables or rednecks because they’re poor people from rural America with conservative values. It’s very frustrating to someone who grew up in a dying small town as the generational family farms are being lost to corporate farms and the downtown is dying to Walmart, maybe there might be a factory too in town or whatever. But you have somebody who maybe grew up with a meth addicted or alcoholic mom, an absent father who lives in a trailer park, yet they’re told they have white privilege just because of the color of their skin, in spite of growing up in very tragic circumstances, just like someone in a poor urban minority community. Many of these people feel like there’s a lot of implicit bias against them, and that’s the only kind of bias that is now still socially acceptable. They feel like their communities are often forgot about by the government and they’re spit on and laughed at by what they consider to be the coastal elites. As two Ivy League educated people on the coasts, I’m curious what you think about this. Zubin Damania: Oh, man. This is something that I talk about on my show a lot, because I actually grew up in rural Central California and I came from that community. It’s funny. I’d add another component into that. People who are obese get the same kind of discrimination still. It’s still okay to discriminate against the obese. This is my take on this is yes, this is a real phenomenon, at least at the level of the perception of the community in question. And so it becomes real. As a result yeah, that’s going to actually perpetuate further disparities, socioeconomic disparities. It’s also going to change politics in this country because with the electoral map, those communities have a lot of power too. We ought to be unfolding, especially in communities that value these progressive values, they should say, well, all right, one of the progressive values is inclusion, love, compassion, and understanding. So, why don’t we understand the moral palettes that folks that come from these communities have? And they’re powerful. When we travel around the country doing talks and stuff, when I go to rural Texas or Idaho or somewhere like that, I’m just struck by the warmth and the compassion. Yeah. These are very conservative politics. Okay. What is it about the environment and the community that makes that adaptive? Trying to understand that so then we can come up with compromises, allow a lot of local stuff to be hashed out at a local level and so on. It’s just even being aware of it, instead of the blindness that we show so often on all sides of this. A conservative in one of those communities would not understand a highly progressive San Francisco native, unless they’re opening lines of dialogue and understanding that they have common, actual, moral reasoning. Robert Pearl: My view, Jeremy, is that tribalism is built into human genetics. It’s the way you survived 20,000 years ago. You could never survive as an individual. But it was all within the people living in your set of caves, and that tribalism rears its head anytime a society or a group in that society is dropping. You see it come up in times of economic challenge, and that’s what we’re in right now. You see it come up in times of winners and losers, and that’s what we have right now. What you’re describing is a particular tribe, or two tribes. You can talk about it as an urban East and West Coast tribe, begins the Central part of the country tribe. You can talk about it in terms of race. You can talk about it in terms of religion. You can talk about it in a lot of different ways, and my own bias about what’s not being said is how the United States as a nation is slowly dropping from the dominance that it had in the past. Sir Michael Marmot, who’s a sociologist in England that I respect a lot, has written and talked about how what you experience when your status, when your hierarchy, when your position in whatever’s going to be, your local community, the nation, the world, starts to diminish, is when you become dissatisfied, unfulfilled, fatigued. In many ways, it’s the same symptoms that we have as burnout, and I think that’s what you’re seeing in the United States today. Robert Pearl: Instead of people coming together, as Zubin has talked about, to create a better future, they prefer to focus on someone else’s being the problem, the so-called classical scapegoat mentality, and feel like they’re getting left behind. Have we left rural America behind? Absolutely. They don’t have access to broadband. They don’t have the economic jobs that are in place. They’re working hard in the fields far longer than people in other places are working in industries that add no value and put no food on the table, and they’re not making much money. You can apply the same mindset inside of medicine. You can apply it as I say, to almost everything in our country, race being a classic example, but it’s far more than that. Education. As Zubin said, the people in the center part of the country, what do they value? Because culture is about what you value and you believe. They value family. What do the people on the coast tend to value? They tend to value education, jobs, titles. You come to the coast, the first question you get asked is, what do you do for a living? You go to the middle of the country, what do you first get asked? Tell me about your family. Tell me about your kids. Tell me about your relationships. It’s just different values. From my perspective, they’re both important. But that’s not the way it plays through. As I say, in a time of economic difficulty, there’s an expression someone once told me, “As the pie gets smaller, the manners deteriorate.” I think we’re seeing a lot of lack of manners, a lot of lack of civility, and my concern is it’s going to get worse before it gets better. Jeremy Corr: We hope you enjoyed this podcast and we’ll tell your friends and colleagues about it. Please follow Fixing Healthcare on Apple Podcasts, Spotify, your favorite podcast app. If you liked the show, please rate it five stars and leave a review. If you want more information on healthcare topics, you can go to Robbie’s website at robertpearlmd.com, and visit our website, fixinghealthcarepodcast.com. Follow us on LinkedIn, Facebook, and Twitter @FixingHCPodcast. Thank you for listening to Fixing Healthcare’s newest series Unfiltered with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Thank you very much for listening and have a great day. The post FHC #55: Is it time for doctors to temper their career expectations? appeared first on Fixing Healthcare.

Author and historian Dr. Lindsey Fitzharris is fascinated with medicine’s grisly past and the extraordinary physicians who changed the profession by breaking the rules. One of those rule-breaking doctors of yore is the protagonist of her newest book, The Facemaker: A Visionary Surgeon’s Battle to Mend the Disfigured Soldiers of World War I (available June 7). In it, Dr. Fitzharris tells the riveting and true tale of Sir Harold Gillies, a pioneering reconstructive and plastic surgeon. Set against the backdrop of the first World War, the book takes place in a time when military technology was radically outpacing the science of medicine. The machines of war were ravaging human bodies. And so, Gillies, a Cambridge-educated New Zealander, dedicated his career to picking up the pieces, rebuilding the broken and burned faces of frontline heroes. Along the way, the surgeon didn’t just break the rules of medicine. He rewrote them. This interview, the first since the book’s publication, pairs Fitzharris with hosts Jeremy Corr and Dr. Robert Pearl—the latter is, himself, a reconstructive and plastic surgeon who has published two highly acclaimed books on medicine. Interview Highlights   On plastic surgery 100+ years ago “It wasn’t really until the First World War that there was this huge need suddenly for facial reconstruction. And that had to do with the brutality and savagery of this kind of war. This was a time when losing a limb made you a hero, but losing a face made you a monster to a society that was largely intolerant of facial differences. So Gillies really filled in there to help these men, and to mend their faces and their broken spirits.” On advances in war vs. advances in medicine “[There were] so many advances in weaponry at this time that a company of just 300 men in 1914 could deploy equivalent fire power to a 60,000 strong army during the Napoleonic war. You have the invention of the flame thrower, the invention of tanks. You have chemical warfare at this time. So really the medical community was just playing catch up when all of this began. And there was this huge need to figure out how to mend these broken bodies.” On what made Gillies unique among his surgical peers “Harold Gillies, what is extraordinary about him is that he’s a very creative individual. He’s one of those annoying people that’s good at everything he does. He’s a competent artist. He’s a great sportsman. And that creative aspect to his personality served him very well going into reconstructive surgery. He’s also very collaborative. He’s willing to work with other technicians and practitioners at this time.” On Gillies’ ethical conflict as a wartime doctor “One of the terrible tensions for Gillies in World War I was the fact that he had a duty to his patients, but he also had a duty to the army. And so, in some instances, I’m sure he would’ve wanted to continue working on the reconstructive process, but perhaps the function had been returned to the face. And the feeling was that the man could be returned back to the trenches. And I think that was a really heartbreaking tension that played out throughout the war for him.” On staying positive in terrible circumstances “Gillies’ attitude, this positive attitude, and the way he could look at the humorous side of things, really served him well because he had such a heavy burden on his shoulders. If you imagine the psychological damage as well to these men coming into the hospital, I think he was really able to nurse them in many ways, not just fixing their faces, but he was able to fix their spirits.” On what connects history’s greatest rulebreakers “I think that the biggest trait is perseverance. When you look at Joseph Lister, he could have given up quite easily in the face of the pushback because he received enormous pushback when he started to champion germ theory … And it was a huge leap of faith, but he persevered. Also with Gillies after the war, he could have just given up and gone back to his old practice … But he really believed that what he was doing was transformative, that it was important, that it would serve humanity beyond the war.” READ: Full transcript with Lindsey Fitzharris * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #54: The incredible rulebreakers of medicine’s past appeared first on Fixing Healthcare.

About a month ago, Dr. Anthony Fauci said that the United States is “out of the pandemic phase,” but he later clarified that the country is, “out of the full-blown explosive pandemic phase.” Americans are decreasingly concerned about the distinction, as only 9% believe Covid-19 still represents “a serious crisis.” What’s the official status of the Covid-19 pandemic now? Meanwhile, several listeners wrote into the show with concerns about a recent outbreak of monkeypox, with 10 cases now confirmed in the United States and hundreds in Europe. The W.H.O. warns it could be just “the peak of the iceberg.” Is a new pandemic coming? Jeremy Corr and Dr. Robert Pearl examine these questions and many others in this episode of Coronavirus: The Truth. You’ll find all the [time stamped] topics discussed during this show here: [00:49] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [04:45] Worldwide Covid-19 deaths have surpassed 15 million. Why? [06:36] Looking at China: What went wrong? [08:37] What is the U.S. doing about the global toll of Covid-19? [09:55] Is the Covid-19 pandemic over yet or not? [15:11] What should parents know about Covid-19 now? [17:46] Does Paxlovid (the new oral medication) eradicate the Covid-19 disease? [20:22] Will unvaccinated people take Covid-19 medications once infected? [21:34] Based on new research, how many Americans would have lived if all were vaccinated? [23:38] Is it safer to host a small indoor event or a large outdoor one? [25:49] Listener question: Is monkey pox like COVID? Should I be worried? [28:16] For immunity, is Covid-19 infection ever better than vaccination? [32:37] What’s the big non-Covid story in healthcare this month? [34:25] Will the government try to drive lower prices and greater healthcare access? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #61: Is the Covid-19 pandemic over? Is a monkeypox pandemic next? appeared first on Fixing Healthcare.

Welcome back to the Fixing Healthcare series, “Diving Deep,” which features a robust and probing discussion into some of healthcare’s most complex subjects and deep-seated problems. In this episode, Dr. Robert Pearl and Jeremy Corr dive deep into the unwritten rules of healthcare, which have long dictated for doctors and patients “the right way to act.” This installment focuses on the hidden causes of physician burnout and the growing divide between the CDC and public sentiment when it comes to dealing with Covid-19. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, here’s a time-stamped discussion guide: On physician burnout [01:00] What was the most surprising insight from the 2022 Medscape survey on physician burnout? [03:46] Beyond the stress of treating Covid patients, how do doctors explain their burnout? [05:12] What then explains the significant uptick in burnout for OB/GYNs and pediatricians? [06:44] How do burnout rates compare between men and women physicians? [09:19] Studies show that work-related stress impacts a doctor’s personal life, but do problems at home spill over into a doctor’s job performance or feelings at work? [13:58] What solutions might address the hidden causes of physician burnout? On Covid-19 and public perception [18:56] How do Americans perceive the risks of Covid-19 and what do public health officials have to say about it? [23:28] If health officials and Americans can’t agree on appropriate safety measures, what happens? [24:39] Why do Americans believe the pandemic is over (even if the CDC hasn’t declared it)? [26:38] Does the CDC have any influence over the public’s perception of safety right now? [28:20] Given the change in public opinion, how can health experts and elected officials save the most lives? [29:25] How can we protect people who are at the greatest risk of dying from Covid-19? * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #53: Diving deep into physician burnout and America’s views on Covid-19 appeared first on Fixing Healthcare.

Welcome back to Unfiltered, a show that features two iconic voices in healthcare for a half hour of unscripted, hard-hitting talk. Dr. Robert Pearl has twice appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who had twice appeared on the Fixing Healthcare podcast with Pearl, alongside cohost Jeremy Corr (see: here and here). This episode (the third in this series so far) covers a lot of ground, starting with questions of censorship and medical misinformation as talks continue around Elon Musk’s pending ownership and overhaul of Twitter. Also in this episode: Financial incentives vs. intrinsic drivers: What motivates doctors? Should we do away with the MCATs and change physician education for good? Why are women physicians more burned-out than male colleagues? And, according to the latest surveys, why is the problem getting worse? To get started, press play or peruse the transcript below. * * * Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. UNFILTERED TRANSCRIPT Jeremy Corr: Welcome to Unfiltered our newest program in our weekly Fixing Healthcare podcast series. Joining us each month is Dr. Zubin Damania, known to many as ZDoggMD. For 25 minutes he and Robbie will engage in unscripted and hard-hitting conversation about art, politics, entertainment, and much more. As nationally recognized physicians and healthcare experts, they’ll apply the lessons they extract to medical practice. I’ll then pose a question for the two of them as the patient based on what I’ve heard. Robbie, why don’t you kick it off? Robert Pearl: Hello, Zubin. Zubin Damania: Robbie, always a joy. I look forward to this time. Robert Pearl: This is our third podcast and I wonder, would you feel comfortable with my asking you a personal question? Zubin Damania: It could have been the first podcast. You know I’m a bit of a scary open book. Robert Pearl: Well, I heard, Zubin, a rumor that you just paid $44 billion to buy Twitter. Is that right? Zubin Damania: It is. They say it’s Elon Musk, but when you rip off his latex mask, it’s that old man Damania underneath, just scared of those meddling kids. Robert Pearl: I see. Well, I’m always confusing you with someone else, but you do drive a Tesla, right? Zubin Damania: No. I’m not rich enough to drive a Tesla. I have a Camry hybrid, so I am gas efficient, but also cheap. Robert Pearl: Okay. But seriously, no, let’s put this potential change in a healthcare context for our listeners. I’d like to explore the dividing line between opinion and science. Free speech is a right in the country, but shouting fire in a crowded building is not. You can have an opinion that Putin is the most horrific human being in the world or the savior of Russia, or if you think that swallowing bleach is an effective way to cure COVID-19, telling others to do so is likely to lead to someone’s death. If Mr. Musk called you, wanted your opinion how best to draw that line, what would you tell him? Zubin Damania: This is such a challenge because, yes, there are certain types of disinformation, whether intentional or unintentional, that can lead to havoc. And I think this idea of yelling fire in a crowded theater is a good version of that. Remembering that our right to free speech, that’s government stuff. It does not apply to companies. So companies can do whatever they want to your speech, in theory. What I would tell Elon is, listen, don’t entirely abandon the idea that extremely dangerous and direct disinformation that is clearly outrageously wrong shouldn’t be removed from the platform. There is a certain responsibility, I think, to do that. Where it becomes difficult is where there’s scientific debate or there’s opinion or whatever that is and allowing that to air is very different. And I think who the arbiters are of that truth has become difficult. Dr. Vinay Prasad has looked at who are these sort of filters that some of the companies, the big tech companies, have hired to determine what’s disinformation. And often it’s just the loudest voices on Twitter. So that may stifle scientific debate. You do want to a very vigorous, open debate, especially in a time when we don’t know everything, the time of a pandemic. Robert Pearl: How would you set up the panel, the algorithm, the AI application? How would you set up somebody to make this decision? Zubin Damania: Oh, man. If I knew that … Honestly, because I am much more on the free speech angle of it, I think it’s really … I don’t know, Robbie. What would you do? I don’t know that it can be done well, honestly. Robert Pearl: I think when it comes to healthcare, I tend to be a bit more conservative than I am when it comes to almost any other issue. I’m not so in believing you should censor anyone’s opinion unless there’s an implication for others. I’m worried and bothered by the fact we crossed a million deaths in the United States. I don’t think we should have had anywhere near that number of people perishing from this virus. Yes, in the first year, we didn’t know quite what to do. But the second year, we really should have done a lot better. I don’t know whose responsibility it is, but I know that what whoever’s it was, it’s a failure. Not an easy question, but somehow we had to figure out a better way and be prepared at least the next time to do so. If anyone on Twitter wants to tell the world that you or I or Jeremy or anyone else isn’t very smart, our ideas are wrong, that’s okay. There’s no problem doing that. But I just really worry. When we have a means of being able to advise people positively and the risk is tragedy, not just for themselves, but their family, their kids, their loved ones. I just somehow feel that we need to do a bit more, because it is good public health. And that’s where I separate out medicine from everything else that I can think of. Zubin Damania: So this is interesting. I think actually what we find is when these companies did label these things as disinformation or block them or whatever, whether it’s a Marty Makary op-ed in The Wall Street Journal or something more even very much to the fringe like Robert Malone or Peter McCullough, these sort of anti-vaccine activist physicians. What we found is that this is the internet, so people will go somewhere else where they aren’t censored. And the very act of censorship confirms the conspiracy bias of a segment of the population that’s prone to believe these things for whatever reason. And some of that is just having a sense of control. They don’t understand how this could all be happening to us and so they’re looking for meaning. And when these guys say, “Oh, the government’s doing this or Fauci’s doing that,” they’re very receptive to that because they say, “Oh, well that at least makes sense. It’s this nefarious plot.” Zubin Damania: And my concern is when we start doing those things, we drive people to those other locations and it doesn’t solve the problem. But where I think we can do better as healthcare professionals is we need to step up and say, “Okay, well …” If we think there’s good things like, say, vaccines or certain interventions to prevent the spread of COVID, then we have to be vocal in a way that isn’t judgmental, that isn’t partisan, that isn’t overtly political because the whole thing’s been so politicized. And that would go a long way, I think. Having a louder voice for science and truth and process than for disinformation is one way to drown out the noise without canceling the noise makers that then confirms the bias of the people who are prone to believe it. Jeremy Corr: ZDogg, you bring up a very good point of the whole canceling people from those said platforms. For example, when you saw Trump get removed from Twitter and then he moved over to Truth Social and all these kind of right wing people that get banned from Twitter and then moved over to Truth Social or these other kind of platforms, they’re going to be in these echo chambers of people that only think the exact same way as them and spreading whatever information or misinformation or whatever you want to call it. But when you have Twitter as more of a public square type of thing, for example, when you had the QAnon phenomenon going on. For every person that posted some crazy conspiracy theory, you had 20 people responding, being like, “Look, you’re being dumb. Here’s proof. Look, this doesn’t make any sense. Here’s why.” What are both of your thoughts around that, out of curiosity, about is it better to not censor them and engage with them further versus driving them into those echo chambers? Zubin Damania: So my take on the echo chambers is that it’s an existential threat, actually, to all of us, this idea that we are polarized into chambers that just reflect what we already hear. And those chambers don’t connect. They only connect through virtual violence. In other words, this antagonism. They’re almost these hive mind, group minds that form. And you’re right. Whether it’s a Truth Social hive mind or a Twitter hive mind or a Rumble hive mind or wherever it is, they tend to attract like minds and then echo the sentiment. So making that corpus callosum, those fibers that connect those different hive minds, is actually key, which means a dialogue. That’s why I’m … And I get it, Robbie. I totally get that this is healthcare and people’s lives are at stake, so we as physicians really want to intervene. And so the question then is what’s the best, most effective way to do that? I wish I had a direct answer, but it’s quite nuanced. Robert Pearl: Yeah. I think what you’re hearing from me is just frustration. I can’t stand to see human life wasted, and we wasted human life. And I’m looking for a better answer and that’s why I thought I would ask you about that. But let’s switch maybe to another topic. Zubin, our discussion of the four existential questions in the last podcast, it stimulated lots and lots of great conversation from our listeners. I heard from quite a number of them. And a physician and former student of mine at the Stanford Graduate School of Business asked if you and I could talk about the difference between transactional and transformational leadership. As you know, transactional leadership is quid pro quo. You increase your screening for colon or breast cancer in patients in the recommended age group from 50 to 60%, you get an extra $1,000 a year. You go from 50 to 70, you get $2,000 more. In contrast, transformational leadership, inspires people and attempts to improve medical outcomes by connecting with their inner motivation as people. You led Turntable Health in Las Vegas. What did you learn about the value and role of financial incentives versus intrinsic motivation? Zubin Damania: Ah, what a great question. This is the central piece because how do you motivate people through leadership rather than management, through, like you said, transformation instead of transaction? And what I think, I think the data shows this too, and what I found was that pay for performance just doesn’t really work. Doctors are intrinsically motivated to do the right thing. They’re also a bit competitive. They want to actually do better than their peers on average. They don’t want to be the one that’s the last in their class or whatever it is, or the one that has the lowest scores on whatever. They’ve always been intrinsically motivated. So how do you then lead in that sort of setting? And what it seems is, first of all, you got to just set this culture that we’re trying to do the right thing for patients and for each other. And then you provide the tools, the team, and the trust to actually accomplish that. Zubin Damania: And the tools will be the technology that’s actually there to enable what they’re trying to do to make them feel capable to do it. The teams are the support structures, the human support that allow everybody to do the top of their game and support each other too. And then trust is the key thing, which is where you’re saying, “Listen, I’m not going to nickel and dime you and give you an extra $1,000 for this outcome. I am going to actually give you the autonomy to accomplish what we have as goals here together that are partially intrinsically motivated, and then give you those tools and team to actually accomplish it.” And yeah, we may measure it as an outcome in a big sense, like how are we doing here, and then have the discussion as a group and maybe have a healthy competition around it. But pay for performance just is not going to motivate intrinsically motivated people. Robert Pearl: If that’s the case, and I concur with you, everything you said, why are financial incentives used so often by leaders across the United States? Zubin Damania: I think it’s a currency that they understand, especially non-clinical leadership. And I think they think that humans are motivated by that sort of financial reward. But these are medical professionals. After they reach a certain point, it’s more about that intrinsic motivation. For me, when I was practicing fulltime too, that’s how it felt. It’s like, I wanted to feel valued. I wanted to feel like I was providing value. I wanted to feel like I was part of a team that I felt responsible to, and that felt responsible to me. And I felt that I wanted resources to be able to do my job, meaning technological resources that didn’t suck. And I think when I had those, when everything was firing on all cylinders, giving great care just became the default and you are always striving to be better. But when it became about RVUs and when it became about productivity, when it became about these rewards for clicking the right boxes and getting the things done that way, it really stripped away the intrinsic motivation. And I think it had bad outcomes. But I think our leaders are conditioned that way, many of them, especially non-clinical leaders. Robert Pearl: Maybe a theme from today’s conversation, Zubin, is my frustration in how slow our progress is. And I want to figure out how we can make it happen faster. Earlier today, I spoke at Rochester at a really excellent organization that was there. And there was a dinner last night and we were talking about the fact that four miles from we were sitting, life expectancy was 10 years less than the people who were living in the area where we were. And I asked them, I said, “What’s going on to change that?” We know what many of those factors are. And the answer was in a motivated community, not much was occurring. How do we accelerate this change to get the best health for people? Zubin Damania: So much of it is all healthcare is local. So actually having members of the team from the community you’re trying to serve, who understand that community, having skin in the game, knowing that every community is different, is motivated differently. Not having a one size fits all platform, but maybe having a central thesis like, “These are the goals we want to accomplish. So how do we do it here, versus here, versus here and making it a priority?” We talk a lot about equity and things like that, but when the rubber hits the road, it’s really about financial outcomes or just playing the same old game. And I’m as frustrated as you are, Robbie. It’s very frustrating. Zubin Damania: There’s a female physician at Penn. I’m forgetting her name now, but she was on my show. And she works with health coaches from community areas that are zip codes of tremendously poor outcomes and found that bringing those health coaches that go to homes, that interact with the patients. We did this at Turntable, too. Driving these very empathic, motivated interviewers from the communities they’re going to serve. That was 90% of the battle. And then really tailoring it to how do those patients want to communicate? Maybe they don’t want to do a telehealth thing, but they would love to text. So can we set it up so that they can text us because that’s culturally what they do? Or whatever it is. It’s really being adaptable to the community at hand, and then having the motivation to actually want those disparities to go away. Robert Pearl: So let me be a little bit controversial and look at another area related to this, which is how we select medical students. Malcolm Gladwell popularized the 10,000 hour rule, implicit in the idea is that if you want to become, let’s say, a great guitar player, it takes that level of dedication and commitment. And maybe coincidentally 10,000 hours is about the amount of time a resident’s in a three year program like internal medicine spends. As you know, I think Malcolm is one of the most talented non-fiction writers, and he was a guest on a recent Fixing Healthcare podcast. But I’d like to add a second rule, and that I’ll label the three step rule. And just so listeners aren’t confused, unlike the 10,000 hour rule that has deep research background, my three step rule, it’s completely made up. I don’t have the least bit of scientific data, but it comes from my life. Robert Pearl: And the rule concept is that we all are born with intrinsic ability in each category, how high we can jump, how good looking we are, how well we do mathematics. And let’s just say we have a number between one and 10. With 10,000 hours of practice, we can go up, this is my hypothesis, three spots. I use my life as an example. One of the greatest gifts I ever got was how terrible I am at singing. I was between a one and a two. Had I been a five or six, I might have deceived myself into becoming a rock professional musician. But no matter how hard I worked, I knew the best I could become was five. So if you, at least for the time being, will agree that talent is equally important to dedication and hard work, let me ask you what are the skills we should screen for in medical students? We both know that traditionally we screened from memorization through Step One tests and MCATs and other pieces. But today with the smartphone, memorization is less crucial. Should we be screening for empathy? Should we be screening for communication ability? Should we be screening for ability to motivate? What do you think we should be screening for picking the next generation of doctors? Zubin Damania: Oh, all of those things. All of those things are crucial. And I love that theory. I think that’s fact. I’m going to go further and say for my own life, it’s the same thing. There’s this controversial thing in leadership. It’s like do you work on your weaknesses? Do you spend all this time working on these weaknesses where you’re at a one or a two, try to get it to a three or a four? Or do you really just boost those strengths? And I don’t know. I’m always a fan of boosting the strengths. So if you’re looking in healthcare, the truth is there isn’t a one size fits all because you need surgeons, you need urologists, you need psychiatrists, you need primary care doctors. They all do different things. My neurosurgeon doesn’t necessarily have to be the most empathic person in the world, but they better be a really disciplined technician and highly learned to be able to do what they do. Zubin Damania: So maybe you have some latitude for how you’re screening, but I would say the more we screen for things like communication, bedside manner, empathy, compassion, interesting stories that people have overcome adversity, the idea that they would then have real compassion for people who are struggling, those kind of things are … We always give lip service to it, but we’ve never really screened for it. We screen by, like you said, by the tests. And that’s why it’s interesting. A lot of times you’ll get into a school system like a D.O. School system where they screen maybe a little bit differently, and those doctors are trained differently too. And you wonder like, “Oh.” When you’re sitting in the room with them, it’s a different vibe and often in a good way. So it really … And again, I don’t mean to paint it with a single brush, but it really does speak to how we’re even picking people who go through medical school. Zubin Damania: Now, the other problem is if you screen based on empathy and those kind of things, and you do underemphasize the testing, then you may set up people for failure in a medical school education system that is designed to continue that process of test taking brilliance and not necessarily all those other factors. I’m curious what you think, Robbie. Robert Pearl: Well, I think we need to change not just the acceptance process, but the educational process and the evaluation process. I believe, and I’ve written about it, that rather than banning cell phones from all these exams, you should be required to bring one. We shouldn’t be testing your ability to find the Kreb cycle. For listeners who aren’t doctors, it’s a very famous set of information that’s hard to exactly discern that physicians get tested on in their second year of medical school and never again ever use. So it’s the ultimate metaphor for the problem that we’re talking about. In fact, the entire step one examination is one that’s 16 hours of testing on about 10,000 arcane facts. Medical students spend six to eight weeks, 12 hours a day memorizing all of these, again, 95% of which they’ll never ever use unless they happen to be on the Amazon river somewhere in the jungle encountering some kind of protozoan that they only read about and they, of course, would never have the medication anyway. Robert Pearl: No. We’re in the 21st century. Smartphones are with us all the time. I think we should be evaluating people on their ability to take that information that’s readily available now and apply it to difficult situations, to be able to figure out with access to all of that smartphone what really is going on with this patient and this family and how am I going to impact that person’s life. We really don’t measure the change in the patient’s health. We measure simply the advice the doctor gave. And as you well know, we have major problems with patients getting prescribed maybe the right medication but not taking it, sometimes getting prescribed the wrong medication, but getting prescribed the right medication and not taking it. The opportunity to be able to engage in opportunities to improve and prevent chronic disease and treat chronic disease. Diet, nutrition, relaxation. There’s a whole litany of opportunities that exist and we don’t do a very good job of helping patients. Some is the system of medicine. Some is the society around it. Robert Pearl: But I personally think that the physician skills going forward in a world where increasingly there are patients with multiple chronic diseases, each of which interact with each other, all of which are overwhelming. The ability of the physician of the future, I think, will be very different than the past. I just wonder how you would screen the 50,000 medical student applicants for the 20,000 physicians that exist every year in the United States? Zubin Damania: Yeah. And the screening is one piece, but like you said, how we’re even teaching them medical school is such a … It’s not set up to manage all that chronic disease. It really isn’t. And I almost feel like you should have as part of medical training a week long silent meditation retreat where these students are forced to introspect for a week and come back very sensitive to their environment and very much using nonverbal cues and things like that where they get out of their head and into this space around them with the patient and with each other and with themselves. And I think that would really help open up the motivational aspects of how do you connect with another human being. We don’t teach it very well in medical school. More clinical stuff would be nice, starting very early and really saying, “Hey, this is what it is.” Again, that’s not to lessen if you’re going to be a pathologist or you’re going to do something that’s more research oriented. You want to accommodate for that as well, because that’s important. But man, we’re doing it wrong. Whatever we’re doing now, it’s not right. It’s not working Robert Pearl: Well, that’s also why I asked you about this rule of three steps, because unless you’re convinced that everyone who applies to medical school is a seven or eight in the ability to communicate, the ability to empathize, the ability to understand what an individual from a different background is telling you, then we probably do need to figure out the individuals best able to do that, if those are the skills of the future. But I also would agree with you. I think the classes should involve using that technology to be able to now understand, let’s say, the physiology of the heart or the pharmacology of the medications. Why should you have to memorize the dose of a drug when you can look it up with 100% accuracy rather than relying on your memory? But understanding things about lifestyle that affect the drug, that’s a different set of skills that I think we don’t focus on nearly as much. Zubin Damania: And I think that that speaks again to mechanical intelligence versus human intuitive connective intelligence, relational intelligence. Why don’t we optimize for that since the computers are going to take everything else and do it better than us? So I agree. I agree a hundred thousand percent. Everyone’s using Up To Date now anyways as a source reference for a lot of stuff. We ought to train how do you use that effectively? How do you overcome bias in it? How do you think from the human side taking that data? Absolutely. But we would just memorize stuff. I mean, that was our thing when I trained. Robert Pearl: And the errors in it, not because the science is wrong, but because the application is wrong, as you said, based upon a given population or given set of individuals. So let’s go one more step. I want to talk a little bit with you today about burnout among doctors. I don’t know if you looked at the most recent Medscape survey. It had the information that we would expect. Burnout’s gotten worse in the context of COVID. The two specialties that have been that at the highest level are the two you would predict, ER and critical care. These are the people who have had to deal with the majority of individuals who’ve gone on to die. These are situations where physicians have been overwhelmed by the sense of loss, the inability to change the trajectory of a disease, the frustration of being unable to be effective as doctors. You had the isolation with COVID and families not being there. On and on and on. Robert Pearl: But what struck me as being most interesting was the third specialty on the list. The third most burned out specialty today, it wasn’t true two years ago, is OB/GYN. Now OB/GYN physicians don’t have a lot of patients who had COVID. They didn’t see a huge number of deaths. And why did this specialty soar in burnout rates compared to the other specialties? And as I looked at it, my conclusion was it’s one statistical fact, 85% of physicians in OB/GYN are women. And they took on another job, eight to ten hours more work outside the medical office or the hospital because they bore the brunt of child care. And I haven’t heard a whole lot of physicians talking about, and I’ll call it the two-way flow of the world inside medicine and outside. It’s almost like, as you said, the corpus callosum which connects the two sides of the brain was severed. And our minds are, we either have a work environment or our personal environment, and maybe the work environment negatively affects the personal, but not necessarily that the personal affects the work. Robert Pearl: I wrote a piece for it on Forbes and I expected about a third of the people would say I was right, a third of the people would say I was a total idiot and I had gotten it completely wrong, and a third would’ve said, “Oh yeah. We knew this all along.” But instead I think there was a pretty good resonance, at least amongst the women responding, that this was the reality of the past two years. How do we have a more broad understanding of burnout to recognize what happens in our practices that we don’t control, what happens in our practices that we can control, and what happens in our life outside of medicine that impacts our satisfaction, our job fulfillment and our level of fatigue? Zubin Damania: I read your Forbes piece and I was actually really … I said, “Yeah.” And the thing is, it’s difficult because you and me are mansplaining this thing. But I would say this, I mean, my wife is a female physician and the truth is when you look at burnout, you have to look at it’s not work-life balance. It’s life of which work is an integrated piece and they all resonate together. So for men, they have this, at least in the typical roles that we see, they’re not necessarily always the primary caregiver also of children at home. They’re not caring for elderly loved ones directly. They can be, but it’s not the primary thing. We often see that to be more a female role historically in society. And it’s dragged into current where women are now a huge part of the medical workforce. Zubin Damania: So they go to work, they do all the stuff that we have at work that is hard for us, but then they have the extra element, which this is going to be controversial, but if you look at personality tests, women score higher on agreeableness than men. So when asked to do extra stuff, they tend not to say no as often as men do. Men are jerks on personality tests. Again, just trying to stick with the data here, Robbie. I’m editorializing occasionally. And so they get sucked into stuff at work. Then they go home. They’re the caregiver for the kids. They have all that other stress. And even if they’re part-time, it’s like the equivalent of 1.5 FTE full-time equivalent. Duh, it’s going to be harder for them in many ways. And so it’s not surprising to me that that OB/GYN and maybe pediatrics too, which is more female, higher up on the list of people who self-report burnout. Robert Pearl: Pediatrics was another specialty that went up quite significantly. But why don’t we talk about it? Why don’t we talk about gender inequality in the context of burnout? Why don’t we talk about the parents who are sick or other environment or personal issues? We just keep separating our work experience and our dissatisfaction, and there’s no question the bureaucratic tasks and the computer systems and all of the problems are very real. But these other pieces, when I look at the data, seem to be quite significant as well. And yet at least I don’t hear it. You talk to far more physicians than I do. Are you hearing this type of outside world impinging on our personal professional satisfaction? Are you hearing that discussed very much? Zubin Damania: Absolutely. And when I talk to male physicians who are experiencing high degrees of burnout, often they will report having a child who either has special needs or who is having difficulty through the pandemic and has required a lot more attention from the male parent. And so these things are absolutely intertwined but we reduce it to, well, it’s Epic or it’s an electronic health record problem, or it’s too much insurance interference. All that’s there and that’s been going on, but what is it that really this is about is we try to make doctors try to feel like they’re these invincible, off the grid kind of super humans. And in fact, we codify that in our cultural response to the pandemic and say, “Oh, heroes work here. These are healthcare heroes.” Zubin Damania: And so what is calling somebody a hero says, well, then you’re more than human. So you can take on all this stuff. And the truth is, no, we’re absolutely human. And the hero’s journey is the human going on the journey, right? And coming back and returning with new knowledge, new insight, new awakeness. But we’ve taken away the journey and we’ve said, “Oh no, no, no. You’re just going to do inhuman amounts of work and then suffer at home too with all the responsibilities you have.” And we’re not going to talk about it, Robbie, because you asked that. Why don’t we talk about it? Because it’s stigmatized. People are afraid to talk about it. They’re afraid of getting canceled for saying the wrong thing. They’re afraid of … You call this series Unfiltered. You and I will just say what we think, right? But there’s still that subtle fear, like, “Well, I don’t want to come off like I’m mansplaining about what women are going through.” And so everybody’s just all uptight about it. We just need to have these open conversations. You’re very good at that. Your book about physician culture was … I mean, I was like, “This is it right here. And it’s going to generate anger.” But, man, that’s what we need to do. Jeremy Corr: All right. So I guess my final question for you both is in 2021, 107,000 people died from a drug overdose in the US, roughly a quarter of the number of deaths attributed to COVID during the same time period. The opioid epidemic is something you hear about in the news significantly less, yet I do not think there’s a single person who has not had a friend or family member that’s been impacted by the opioid epidemic, many of them due to fentanyl. There’s also a massive mental health crisis in this nation that’s been very much exacerbated by the pandemic. I didn’t see the 2021 numbers for suicide, but in 2020, there were over 45,000 deaths by suicide in the US. And a couple days ago, the House overwhelmingly voted to send $40 billion in military aid to Ukraine. This is during a time of record inflation, gas prices, baby formula shortages. Jeremy Corr: And I saw one comment on Twitter that I found fascinating that I wanted you both to discuss. I saw someone say that if a member of the House proposed $40 billion to fight the opioid epidemic or mental health crisis here in the United States, they’d be laughed out of the room. I understand that to an extent. This is an apples and oranges comparison. But as healthcare experts, what are your thoughts on this? And why isn’t more being done to address the domestic issues around the mental health crisis and opioid epidemic? Zubin Damania: Jeremy, this is what some friends of mine call COVID myopia, for example. We’re so focused on what’s an obvious pandemic, a million dead and so on, that we’ve always ignored actually a very iatrogenic, medically caused epidemic, the opioid epidemic that, like you say, is a significant fraction of the COVID deaths, but it continues year after year after year and only seems to get worse. And the pandemic does not make it better. And so to some degree, our shortsighted responses to one thing tend to either exacerbate, because it’s all connected. During the pandemic, of course, seems like drug use, mental illness has gotten worse because we’ve destabilized society with some of the response to this, which again, gets back to our original discussion of like, well, do you censor people’s discussions when they disagree with our response? Zubin Damania: And the answer is no, because some of them may be looking at bigger picture stuff. And sending money to Ukraine, we’re printing that money. It’s not like … We’re just deficit spending. So our children are paying for that and they’re going to pay for the opioid crisis that the Sacklers helped create. And it just becomes a very frustrating stew of not being able to see context and the holistic picture of what’s going on. And I think that really has come to a head here with this. Robert Pearl: My take is that in our nation, we do not see all lives the same. And if you are in a group such as someone with mental health illnesses, someone with opioid addiction problems, heroin issues, someone who’s very old with lots of chronic disease, our nation doesn’t value those lives, doesn’t see them as being productive and doesn’t make the investments. Whether they spend the money someplace else, and I personally believe that the war in Ukraine is one that’s vital for our future, because I think the aggression that Russia has shown is only the start. We’ve seen it many times in the past. But that’s my political views. As a physician, my view is that all lives are not the same. I mentioned earlier, the zip code four miles away, people are living. You can run there in 40 minutes. And yet the people dying 10 years earlier are simply not seen as being as important lives worth saving as the people living in the houses surrounding your own home. Robert Pearl: This, I think, is a part of the human existence. In particular, we know this from implicit bias that people who look like you, act like you, talk like you, believe like you are ones whose lives you think are more significant. And I think what you’ve pointed out, Jeremy, is the price that we pay, 107,000 people dying now. It was 60,000. We didn’t notice it back then. It could be 125,000 a year from now. And maybe I’m just an idealistic doctor. I just think that every life that is lost unnecessarily and not from a disease we can’t control, but for a problem we could take care of is simply a tragedy. And we have a growing number of tragedies across our nation. Jeremy Corr: We hope you enjoyed this podcast and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Spotify, Apple Podcast, your favorite podcast platform. If you liked the show, please rate it five stars and leave a review. If you want more information on healthcare topics, please go to Robbie’s website at robertpearlmd.com and visit our website at fixinghealthcarepodcast.com. Follow us on LinkedIn, Facebook, and Twitter at Fixing HC podcast. Thank you for listening to Fixing Healthcare’s newest series, Unfiltered, with Dr. Robert Pearl, Jeremy Corr, and Dr. Zubin Damania. Thank you very much, and have a great day. The post FHC #52: The future of medical misinformation, education and motivation appeared first on Fixing Healthcare.

One hard part about interviewing Dr. Eric Topol is knowing where to begin. Topol wears a seemingly infinite array of hats: He is the director of Scripps Research Translational Institute. He’s a professor of molecular medicine. He’s an expert on artificial intelligence, Covid-19, genome editing and precision medicine. He’s a bestselling author, the editor of the popular healthcare publication MedScape, and one of the most followed physicians on Twitter. Thus, another hard part about interview Eric Topol is knowing you’ll always have far more questions than time to ask them. For this interview, the questions of cohosts Jeremy Corr and Dr. Robert Pearl center on rule-breaking in medicine—and, specifically, the unwritten rules doctors follow. Who better to ask than Topol, one of healthcare’s biggest rule breakers?   Interview Highlights On precision medicine “We have a huge number, every year, of serious diagnostic errors. And our treatments are based largely in clinical trials, where maybe 10 people out of 100 in a really good trial might derive benefit. But the 90 people who don’t derive benefit, we give them the same therapy. That’s not exactly an accurate and precise way of delivering care. So, we can do far better, but it involves dealing with lots of data, a tsunami of data. And we aren’t well equipped to do that yet.” On doctors who can’t handle the data “The way things are in medicine, we can’t handle the data. So, we need to acquiesce and we need to say, ‘We need help.’ You’re well aware of the crisis, the global crisis we have of burnout, and disenchantment, and depression. Part of that is non-ability to care for patients because of being overwhelmed. And part of that being overwhelmed … is not being able to get our arms around all the data of any given patient because it takes time. But that’s what machines are really good for.” On using smartphones in medical practice “Part of the unwillingness for cardiologists to accept smartphone ultrasound is that their first reaction says, ‘Well, I don’t want have to do that. That’s what ultra-stenographers are for. I don’t want to have to acquire the images. That takes time and I’m not getting reimbursed for it,’ and every possible excuse. But in reality, every cardiologist should know how to acquire an echo … It takes just a minute or two. It’s so much more effective in time-use than with a stethoscope because you’re seeing everything.” On what patients want “They want to be more autonomous than they are, not so dependent. And we have the tools to do that. Already, we have emerging tools to deal with very common conditions like skin rashes and lesions through a smartphone picture and AI algorithm, ear infections for children, UTIs with an AI kit, heart rhythms through a smart watch. I mean, we have a lot of common diagnoses that are not life threatening that can be screened by patients and that list is just going to keep growing.” On the Covid-19 vaccine-booster fiasco “The biggest thing in my concern about the way the pandemic has been managed actually with the boosters, Robbie. I think this has been a fiasco. I think that we, as a country, are ranked 70th in the world for boosters in our population. We’re only at 30%, whereas most countries that you would consider peer in Europe or Asia are 70, 80%. And most importantly, in people over age 50, where in the US, 1 out of 125 Americans have died over age 50. And that’s for confirmed deaths, not even excess mortality in the COVID era. And we know that booster shots reduce death. They also reduce hospitalizations. They reduce long COVID.” On fighting medical disinformation “I’m very into free speech. However, we need to, in my view, at least draw the lines about when there’s clear, unequivocal, medically harmful disinformation, lies, misinformation, fabrication, because we’re talking about people being hurt or dying from it. And so that’s different than expressing opinions or providing data that’s real instead of just making things up. And there’s been a lot of that. We’re not talking about Galileo here. We’re talking about people who are purposefully, if not unwittingly, trying to hurt a lot of people.” READ: Full transcript with Eric Topol  * * * Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders. Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn. The post FHC #51: Eric Topol on breaking the rules and putting patients in charge   appeared first on Fixing Healthcare.

The biggest Covid-19 news of the last month came out of Florida, where a federal judge struck down the CDC’s mask mandate on planes, trains and in transportation hubs. As Americans jubilantly removed their masks, the Justice Department quickly filed an appeal. Importantly, however, the DOJ did not immediately request a stay on the ruling in Florida. Thus, Americans will be flying mask-free for months before the appellate court can hear and rule on the appeal. What does this mean for Covid-concerned travelers? Are masks as good as gone or could they still make a comeback? Jeremy Corr and Dr. Robert Pearl examine these questions and many others in this episode of Coronavirus: The Truth. You’ll find all the [time stamped] topics from this show below in the notes: [01:18] Each show begins with the most recent and relevant facts concerning the Covid-19 pandemic and its impact on American life. What’s happening and what does it mean? [02:58] Why are masks no longer required on planes and public transportation? [04:16] What should we know about the new strains of Covid-19? [07:02] If VP Kamala Harris tested positive for Covid-19, but didn’t have any symptoms, does this mean she’s not contagious? [10:55] Survey says: Are Americans worried about Covid-19 anymore? [13:12] What’s the latest science on Covid-19 and young kids? [18:18] How are healthcare workers coping today with the trauma of Covid-19? [22:42] Do patients think about how their actions affect doctors? [23:50] How are teens coping with mental health challenges of the pandemic? [24:56] Why are so many elected officials getting Covid-19? [27:17] What’s good this week? [30:11] What’s the biggest non-Covid story in healthcare? [32:19] Do Americans still believe U.S. healthcare is best in the world? This episode is available on Apple Podcasts, Google Play, Spotify and other podcast platforms. If you have coronavirus questions for the hosts, please visit the contact page or send us a message on Twitter or LinkedIn. *To ensure the credibility of this program, Coronavirus: The Truth refuses to accept sponsorship, outside funding sources or guests with any financial or personal conflicts of interest. The post CTT #60: Will mask mandates return to planes and trains? appeared first on Fixing Healthcare.