Fixing Healthcare Podcast

Welcome back to the Fixing Healthcare series, “Diving Deep,” which features a robust and probing discussion about some of healthcare’s most deep-seated problems. In this episode, Dr. Robert Pearl Jeremy Corr dive deep into the unwritten rules of healthcare, which have long dictated for doctors “the right way to act.” Two examples featured in this show include the doctor’s use of intuition when making medical recommendations and the current rules surrounding hospital care, which lead to high prices but not necessarily better care. 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 discussion guide: When it comes to medical decision-making, where should the science end and gut-feelings take over? What is evidence-based medicine and why does it matter? Why do doctors (and people in other industries) distrust science-based guidelines? What can go wrong with intuitive medical decision-making? When (if ever) is intuition is better than science? Why don’t doctors have time to talk with patient about their hopes, fears and values? How can patients know whether or not a hospital offers good care? * * * 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 #50: Diving deep into physician intuition and hospital prices appeared first on Fixing Healthcare.

Welcome to Unfiltered, a new show that brings together two iconic voices in healthcare for an unscripted, hard-hitting half hour of talk. Dr. Robert Pearl has twice appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who has twice appeared on the Fixing Healthcare podcast with Pearl, alongside cohost Jeremy Corr (see: here and here). This episode ventures into uncomfortable territory. It starts with “the slap” at the Oscars and asks whether making fun of a medical condition is ever okay. Next up, the two doctors discuss emotion in medicine: should physicians show more of it at work? And finally, four existential questions for healthcare professionals, including: What’s our purpose? 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 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: Zubin, I’ve heard great feedback from our listeners about the first show and our willingness to tackle controversial issues. You’re my social media maven. And I have to ask you about the event that garnered twice as many social interactions than Ukraine, and four times as many as the president of the United States. And of course that was the confrontation between Will Smith and Chris Rock at the Oscars. But rather than talking about the slap, Zubin, I’d like to ask you a different question. Why do comedians think it’s okay to make jokes about people’s medical issues? Zubin Damania: Ah, well, boy, there’s so much here. I mean, the truth is comedians, like anybody, their job is to make people laugh or to point out absurdities and that kind of thing. Now, whatever Chris Rock knew or didn’t know about Jada Pinkett Smith’s alopecia, I actually am with Bill Maher on this, where again, there is a free speech protection here where Chris Rock can make jokes all he wants and Will Smith can protest verbally, legally, however he wants to do it. That’s fine. What’s inexcusable is hitting anybody and hitting a comedian for making a joke. Now, whether or not he knew, because Jada Pinkett Smith has been public about her alopecia, there’s a lot to nuance here. It’s more common in African American women. She’s a public figure. So it is traumatic for her. But as Bill Maher said, “If the worst thing you have to deal with is alopecia, I don’t think someone should slap somebody for making a joke about it.” So, I tend to fall on the free speech side on this one myself just being somebody who dabbles in comedy. Robert Pearl: Yeah. I agree with you completely. First of all, we both agree that the violence is inexcusable. So that’s why I didn’t want to talk about that. And I also agree with you on this free speech. He has the right, the legal right, the constitutional right to do so. I guess the question I’m really asking, is it worth the pain that’s inflicted? Zubin Damania: Mm, this is a great question. I mean, look, in comedy, you’re not supposed to punch down. Anytime you make fun of someone with a chronic disease, you’re punching down, kind of by definition, like Putin could suffer from end-stage renal disease. And if you make a joke about him being on dialysis, you’re still punching down because he didn’t choose to have that disease, and it doesn’t do well for other people with the disease, and it’s stigmatizing. So, as a general rule, right, you don’t punch down in comedy. Robert Pearl: Probably because I fixed so many kids with clef lips in the past, and I’ve heard all the jokes and I’ve seen the pain that they experience, I am overly sensitive about this issue. But I guess, as a physician, I would hope that we would keep people’s diseases out of comedy. It may be funny, don’t get me wrong, but I think the pain inflicted on the individual, now, if it’s the president of the United States or it’s Putin or someone, these are very public figures who are at the center of the discussion. If it was about Will Smith, you could say, “Okay, well he’s about to win an Oscar, but” his guest, who happens to be a public figure, but still, to make that be the brunt of the comedy, again, I’m probably overly sensitive, but I’m reacting as a doctor to this. And that’s why I wanted to ask you, because you’re a social media leader. And as you say, you’re quite a funny comedian. Zubin Damania: Well, I mean, that’s a great perspective, Robbie, that you’re bringing because you’re actually seeing the suffering that these diseases can cause. And so you compound the suffering if you’re making jokes about it as a public comedian and so on. This situation is a little murky. It’s just hard to know what Chris Rock knew about… Maybe she, in his mind, she had just chosen to shave her head as a style point, in which case, as a public figure, you’re fair game. Right? But I think your point is very well taken. And again, it’s a question of, are you generating net suffering in the world or are you generating net joy or well-being? And I think that’s a good moral compass for all of us. That’s why comedy, in general, I’ve seen comedy where I’m just like, “Yeah, that was just, not only was it not funny, but it was kind of hurtful.” So it’s kind of like, well, there’s no net benefit. Like I’ll defend your right to make the joke, but it’s just not good comedy. Right? So I think you bring a very valid point here. Robert Pearl: Zubin, your comments about the emotional aspect of this encounter, they make me think about a class that I took at the Stanford Graduate School of Business on politics and public speeches. It was about the relative power of emotion versus logic. My favorite clip was from Oliver North and his testimony to Congress in the Iran-Contra affair. It begins with one of the senators who wasn’t a fan of Colonel North showing a video of the FBI agents storming into his office in Washington, DC, as he sat at his desk, shredding all the incriminating evidence. The senator, certainly no fan of North, believes that he’s made Oliver look like a fool. He says, “What were you doing?” North says, “My job.” The Senator’s flummoxed, this is not what his prep team has predicted. The senator stammers. He asked the colonel, “Why do you think this is your job?” And in this totally unemotional calm face, he says, “If it wasn’t my job to shred documents, then why would the government have given me a shredder? And why would Congress have paid for it?” This complete lack of emotion is powerful. And in contrast, in the same class, the professor showed the 1988 debate between the democratic candidate, Mike Dukakis and the republican candidate, George Bush. The CNN correspondent Bernard Shaw asked Dukakis whether he would support the death penalty if his wife were raped and murdered. His response purely cerebral, “No, sir. I don’t see any evidence it’s a deterrent to deal with violent crime.” The pundits think he may have lost the election because of that one completely unemotional response. So now let me ask you, doctors are taught not to show emotion. Don’t cry, don’t yell. Don’t admit how unfair life can be when it comes to who gets cancer. And yet we’re expected to be authentic. How should we, as physicians, as clinicians, resolve this contradiction? Zubin Damania: Man, this is why I love doing this podcast with you, Robbie. I say no to every podcast invite I get. And Robbie’s like, “No, we’re just going to talk about this kind of thing.” I’m like, “Yeah.” So look, this is central to who we are as human beings. And you said the word authenticity. We’re expected to be authentic. And yet we can’t show what we are, which is largely emotional creatures with a little reason tacked on evolutionarily. We really are, as Jonathan Haidt says, “We’re all elephant with this limbic system that is evolved actually to keep us safe”. Emotions are there for a reason. They’re feelings. They call them feelings because you feel them in the body, they’re an energetic pattern. You ignore them or you repress them at your peril. And the reason, Dukakis lost that thing, the reason we loved Spock is not because he was all logic. It’s because you could feel clearly Spock was half-human. The underlying emotion was there and watching him try to repress it, watching him try to be a good Vulcan and fail very often was what made him human. And that’s why Kirk, at the end of Star Trek II, says, “Of all the souls I’ve encountered in my travel, his was the most human.” And that’s why in medicine, I think it’s important that we’re authentic with our patients. We do need to show some emotion, but we also need to have that kind of cognitive empathy that says, “You know what? Yes, I feel that you’re suffering. I know that you’re suffering and you can feel some of my emotion, but also I’m going to be a source of stability for you. So I’m not going to let it cloud decision-making. I may help with you to use our emotions together to inform what values matter to us.” And I think that’s important when we ignore that. When we ignore our own emotions, we end up with all kinds of problems. And physicians in particular are the masters and mistresses of emotional repression. Yeah. So to me, focusing deeper on understanding our own emotions and unrepressing them and really feeling them and getting rid of this stigma, oh, there are negative emotions and positive emotions. No. There are energetic patterns that we call emotions, e-motion, energy in motion. Let’s feel them because if you don’t, they’re not in motion, they almost become solidified. And then you tell stories about them and then you act unconsciously on them. So, you know what happened with will Smith? Undoubtedly, there was deep emotional repression for years of being a celebrity and having to swallow this stuff and whatever was going on with him and his wife. And then what happens? It comes out in violence. You don’t have to do that if you’re actually in touch with that stuff on a regular basis. Robert Pearl: Let me ask you where the line is. I was talking to a doctor who lost four COVID patients in the same day. This feels to me to be beyond the possible human tolerance. How are we going to address this? And how are we going to deal with the PTSD that invariably is now about to start in even greater force than during the pandemic itself. Zubin Damania: Yeah. You know what’s interesting is I think human tolerances are beyond our imagination. Like we, humans are able to tolerate insults and traumas that would just theoretically break anyone and they seem to do it. And some actually find meaning in it and grow stronger. But the difference is you have to have that, in my opinion, in medicine, what we miss is this communalization of pain. We don’t make it okay to talk about this stuff. We don’t make it okay to say, “You know what? I’m suffering too.” And that way, you could tell people, “Look, we’re all in this together. Yeah, man, four patients that we’ve known forever, and now they’re not here.” That is a trauma. So let’s sit and process that, let’s feel the emotion. It’s okay to have grief. That’s normal. If you’re suppressing grief, that’s what’s not going to be good for you. So providing the tools and resources to actually process that stuff will be important to mental health resources, et cetera, but just changing the culture to say it’s okay to feel these things. This is normal. In fact, if you don’t, maybe that’s the pathological state. And we ought to think about that. So again, I don’t have a magic answer, but I’d say that diving into the pure emotion of loss and grief… One of the things that happens when you go down any sort of self-realization or meditative path is strong emotions start to arise that were repressed by the mind for years and years and years. And they start to unrepress because the mind relaxes and the thought-based structures relax. And one of the things that can happen is you can feel unmitigated sorrow out of the blue, be driving and just burst into tears. And we have no societal container for that. So in medicine, it’s even worse. So we have to start building those containers and those structures to process. Robert Pearl: Well, I want to dive a tiny bit deeper and ask you how. Because I’ve seen the response that people have had to individuals who say, “I need therapy,” or “I’m not able to work to my best today because of the emotional experience I had.” I mean, I’ve seen people, a physician get a diagnosis of cancer in the morning and come back and take care of her patients in the afternoon. I mean, I just keep feeling as though this problem is going to be so hard to burst through. How can we start? Zubin Damania: Oh, my gosh, man. I mean, that stuff is heartbreaking and you’ve seen it so much as leader of the group. I’ve seen it when I was on the front lines with my own team. And people I used to work with still email me and they go, “I’m at my wits end. I don’t know what to do. Do you have any advice?” And I think… Okay, I’m going to give you an answer that is going to be unsettling for some people and they’re not going to like it. But the truth is, I’m just going to tell you what I know. Recently, I did like a six day semi-silent meditation retreat led by another physician. And they were all healthcare professionals, about six or seven or eight doctors, many nurses, physical therapists. And this was just in November. So COVID had been going on. People were traumatized and they came in. Many of them had never meditated and had never had this kind of practice, but they saw my show and they’re like, “You know what? I want to do this thing.” And what we found was people opened up and just torrents of emotion and sharing in the non-silent parts in the evening when we did group activities. And the being with yourself and processing that stuff, that unconscious stuff, in a safe space with other people who do what you do is so powerful, Robbie. When the thing was done, many of them were saying this was the most powerful experience they’d had. And that they went back with renewed sort of resilience to their careers. That doesn’t mean that’s the single answer, but you can see how powerful unrepressing that stuff, having a safe space with your colleagues and doing the deep work of actually introspection. We tend to externalize everything. We project everything we say, “Oh, this is the problem. It’s this guy or that guy.” But when you actually look inside, it’s really all right there, and we create the world. So that’s my really questionable answer to that. Robert Pearl: Your story, Zubin, reminds me of a talk I heard Yo Yo Ma give in Silicon Valley. And for any of our listeners who don’t know his background, he was a child prodigy. He performed from the age of four and a half. At something like five or six, he and his sisters gave a concert for President Kennedy at The White House. He’s recorded 90 albums, 19 Grammy Awards. He’s the best celloist of the time. At the event I attended, first he played a series of some of the most beautiful and moving cello pieces I’ve ever heard in my life. But then he talked about four existential questions that he said he often thinks about. He said that he wonders first, who am I? Second, what am I grateful for? Third, what is my purpose? And fourth, what do I want? Sitting in the audience, Zubin, I wanted to scream at, “Who are you? You’re the greatest living celloist in the world! You’re a musical genius! What do you mean, who are you?” But I didn’t. Fortunately, I didn’t. But it did inspire me, somewhat similar to your six-day event, to ask myself these kinds of questions at various points in my life. So let me ask you, as a profession in the 21st century, as physicians today, first, who are we? Zubin Damania: Oh, these are the easy questions, Robbie. These are the easy questions. They’re very hard. So here, okay. I’ll give you two answers to this question that I’ve struggled with myself. There’s a deep who am I question, which is one of the spiritual questions that we ask, who am I? And when you actually investigate and look for yourself in the present moment, keep looking, keep looking, because you will not find a solid self there. And as you keep looking, you may find something really interesting, the real self. And so that’s answer one. That is a little woo-woo for this talk. Answer two is your authentic self, which is in this present moment, you’re an expression of reality, you are. And what is that? So Yo Yo Ma probably knew from a young age, “Look, this is who I am and being authentically me is standing on stage in front of the Kennedys with my sisters doing this and talking about it,” and so on. Now, many of us in healthcare, we knew authentically. We were drawn to, it’s not something we chose. There was no agency involved in many ways. We were called to do this. And yet, we’re often made to compromise on what it is we know is authentically us. And I think that’s part of that moral injury component that we have to make these compromise. We have to do things we know are antithetical to, maybe not just… Forget about our interests and aptitudes. It’s more just what we fundamentally know we are, and that causes this tension, which you could call… The Buddhist will say is the nature of suffering that you’re diluting yourself by trying to be something you’re not. Now when you really… And that’s why I think that meditation thing was powerful because people could feel in. Like when I did it, what I realized was, I’ve often undervalued my own compassion. I feel like I’m not compassionate enough. I can be a jerk. I’m self-centered, all these other like me, me, me, me, me, beating yourself up type of things. But during meditation, I realized, wow, there’s an infinite well of compassion there. And I do express it. And sometimes you have to forgive yourself. And when you do that, you can then be authentic. You can say sometimes there’s tough love, like being a little bit hard with people is an act of compassion. And again, that’s connecting with your authenticity. So how do we train or create… It’s hard to train, right? You create a space for people to be them. And that means again, giving them tools, resources, and autonomy to be who they are, which some of its systems change. But some of it is working on ourselves. Robert Pearl: Are we healers, experts, teachers, businessmen and businesswomen? As a profession, who are we? Zubin Damania: Yes. All of those things. We could be any and all or none. I mean, we may be something totally different within there. And each person is different. Each person may have aspects of it. As a profession, I think it’s tough to paint us with a single brush. The people that we admire the most may have one or two or three of those aspects that are so powerful and we just really are drawn to it. And that’s why mentorship is so important, right? Because the mentors can show us who we, not only who we are, because that’s our aptitude or our draw, but who we can be. Right? So more mentorship, more openness about that stuff, and then we find out who we are. Robert Pearl: So then as doctors, what should we be grateful for? Zubin Damania: Gratitude is a central practice. It actually is an anchor through all kinds of suffering. Anytime, I was just talking to my mother and she’s now entering our 80s. And my dad is in his 80s and they have their problems. They have health problems. They have problems with their house, the kind of things that happen with your elderly parents. And we were talking about it. And she said, “A year ago, I would’ve really been upset by all these things. And I would’ve stressed and we would’ve been anxious, and so on. But all I have to do is watch the news for five minutes to see people in Ukraine suffering, who didn’t ask for it. And I’m filled with the gratitude that I live here, where I have these first world problems and everything is great. It’s wonderful. It’s beautiful.” So that gratitude practice is so powerful. In healthcare, the gratitude that you can be with people when they’re at their most vulnerable and they open up in a way they don’t do for anybody else, and they let you be with them in that sacred space. That is deep gratitude. The fact that you are, regardless of your loans and all of that, you’re actually doing okay overall in the grand scheme of things. And you get to do a trade that, there’s almost no other profession on the planet where you get this kind of connection with humans and get to help people this way, no matter what aspect of medicine you’re doing. So there’s an immense well of gratitude there that’s available if you choose to be aware, make yourself aware of it. Robert Pearl: If we’re going to deal with burnout, should we be expressing a lot more gratitude about the positive things that we have than I believe we are today? Or is that just too Pollyannish? Zubin Damania: Ooh, burnout is such a… I mean, again, it’s that end stage of the chronic injury. So it has multiple facets. So yeah. Gratitude is a powerful prophylactic against… It’s like taking lisinopril when you have chronic hypertension. It’s going to protect your kidneys a little, protect your blood pressure and your heart a little bit, but it’s not the only answer. It’s a piece of it. You also have to stop eating the salt or stop stressing yourself out, so environment matters. Your own personal framing matters. And gratitude is a powerful piece of that. Some kind of spiritual practice, whether it’s prayer or meditation or looking at the night sky and with awe, whatever it is, that’s a piece of it. But then it’s also asking yourself, am I authentically me in this thing? And sometimes, Robbie, I hate to say this, but you got to stand up and say, “This isn’t me. I got to go do something else in medicine or out of medicine.” And for some people that is the answer and they know it, they know it. I had an OB reach out the other day on Instagram. I was taking a ask me anything thing. And she just said, “Look, I’m an older, morally injured, upset obstetrician. Should I retire?” And I said, “You know the answer if you actually feel into it. You know what the answer is. So why are you asking? You’re really asking for permission to do what you know is right already, whatever that is.” Robert Pearl: So that leads into the question of what’s our purpose? Because I’m thinking about that woman you just described. I’d hate to see her lose the purpose that she entered medicine for at the start of her career, maybe different ways she could express it. But as physicians, as doctors, what’s our purpose? Zubin Damania: Yeah. It’s great. It’s a great framing of it because if she really feels into what her purpose is, she will figure out a way to fulfill it, authentically. My feeling is I really like what writer Jonathan Haidt, the same Elephant and Rider writer wrote about purpose. He says, “The meaning of life, it’s not without, so it’s not outside us. And it’s not even within us. You don’t find meaning within. You find meaning between.” So humans are, we’re relational creatures. We find meaning in the connections between us and others. And so when we feel into our authentic selves and then we express it in the world in a way that connects with other people, that’s all the meaning you need, even if everything is empty void and it means nothing in that sense, it means something in the relational sense right here and now in this second. The universe, man, I showed my daughter a picture of the Andromeda Galaxy taken by Hubble. And as you zoom in at 8K on YouTube, you see every single star in that galaxy of a billion stars. And as you start to see, each of those stars has planets around it. And some of them probably have life. And you’re thinking, “God, I feel so small.” I could see her face start to just shrink in horror at the existential terror of that. What is my purpose when I’m this small? And then I told her, “Your purpose is right here. Look what’s happening right in this minute. You and I are having this connection. That’s a purpose. That’s all that matters. It’s right here right now.” So it’s the same with medicine, really focusing on what is and what our relations are with others. I think that’s where a lot of meaning can be found. Robert Pearl: I believe, and I hope again, that I’m being realistic, that the purpose of medicine is around health and that medicine today is focused on disease. And I think that a lot of the burnout type of experience, the lack of fulfillment, the lack of satisfaction we have, is that we’re focusing on the wrong purpose. Any thoughts? Zubin Damania: Oh, I mean, I think you’re absolutely right. Now, what people would say on the front lines is, “Well, of course, Robbie and Zubin can say that because they’re not having to chart 40 patients a day, and click all these boxes, and to get yelled at for low productivity, and so on and so forth.” And so sometimes it’s tough to see the purpose from the immediate feeling of lack or of overwhelm or of stress. And that’s absolutely valid, but there are solutions to these problems if we work together with people who lead rather than just manage. Right? So I do think reconnecting with what the purpose is means that you use technology to actually enable the purpose instead of using technology to enable an outside purpose of whatever it is, billing or nonsense like that. The technology ought to enable the human relationship that allows us to connect and heal with our patients and help each other. So if people have those tools, resources, and autonomy, then the purpose is the guiding beacon. But I think what we’ve done is we’ve made the purpose too skewed towards one thing or another, whether it be profit for an institution or whether it be quality measures that don’t measure quality, whatever it is, get those things right. And then the purpose shines through. Robert Pearl: We’re in complete agreement. I mean, I think the people who are experiencing these emotions, they’re the victims. There’s no question about that. The question is how to get from here to where we need to get to. And I think that by being able to understand the purpose and exactly what you said, figure out, how do we augment the things that we can do, use the technology to accomplish that, put together the teams to accomplish that? Then that is how we can eliminate our own pain, but more importantly, fulfill our purpose. So what do we want? Zubin Damania: Yeah. You’re the master of this, man. You’ve been doing this for so many years. I would be asking you this. But I’ll just say one thing, which is Garry Kasparov, right? With the chess champion who was defeated by Big Blue, the IBM AI, it was written about this quite a bit. He could have gone into a deep depression and felt a lack of purpose and so on when that computer beat him with mechanical intelligence. But what he said instead was, “No, this is a huge opportunity to use a tool, the AI, with a human, me, and I could beat anybody alive in any computer with that tool.” And that’s what we need in medicine is those tools, that technology that takes all the mechanical intelligence away, that it does it better than us. Let’s just be honest. And so then we get to do what only humans do with our awareness, our comprehension, our emotion, our intuition, our connection, those are the things, and our intelligence, that computers will never have that comprehension. So that’s what we need is those tools and resources that enable us to do the job better. And that means better systems thinking better individual awareness and awakeness, all those things are connected and integrated. That’s why it’s so hard. People say, “Oh, how do you solve this problem? It’s so complicated.” Well, you have to go in all the parts and they add up to bigger than the sum of the whole. So you have to work on everything. Robert Pearl: I love the answers and I hope the listeners learned a lot from it. Jeremy, your question as the patient listening to this conversation. Jeremy Corr: You both talked about grief and being authentic and being human. As patients, we often look up to doctors, especially in times of major crisis, such as early on in the pandemic, or if a loved one just got in a car accident as being almost above human, almost a godlike figure that can, I mean, essentially perform miracles, help us in our time of need and save lives. We expect perfection from doctors and almost stoic brilliance, but we expect human empathy from physicians, but we really do not allow them and maybe cannot allow them to be truly human. Humans get burned out at work, have marriage problems, have loved ones pass away, things that happen in their personal lives that can impact job performance. But we do not, as patients in our minds, view physicians as having the luxury of being human, making mistakes, having bad days. How do physicians deal with that pressure? And should patients look at physicians as being humans who can make mistakes? And is it dangerous to have patients lose that reverence for physicians? What are your thoughts? Zubin Damania: Hmm. This is something that I’ve personally struggled with because there is this aura around the physician that actually has a potential healing piece to it. There’s this therapeutic alliance. Now, what I’ve learned over my years is that the more honest, open, and authentic I can be with patients, the more they actually are able to connect within parameters. You’re not going to behave the way you behave with say your best buddy when you’re at the gym or something, making jokes with a patient. That’s just never going to work, right? So there’s the use of humor. You have to be very careful, and thoughtful, and respectful with patients, but at the same time, some of it is an authentic expression of connection and a rapport. So I think what we, patients are already waking up to the idea that their doctors are not robots or superhuman, and they don’t want that, because a doctor who stares at the computer is not a good doctor in their mind. They want their doctor to make eye contact, to show a little bit of connection, at least probably more than a little. Surgeons, they’re a little more lenient with, but in surgeons, maybe there’s different degrees of this for different professions, but I’ll tell you for internists in general, they want a little bit of that connection in humanity. And I think that’s one of the reasons that whatever I do online is vaguely popular. As I think people are like, “Oh, this guy’s not so uptight like a lot of doctors that I’ve met. Maybe he goes too far, actually, in the other direction.” But it’s a balance that we have to strike. And some of it is modulating patient expectations, which happen when there’s a million doctors on YouTube making videos that are a little bit funnier and more open. Robert Pearl: My answer, Jeremy, is to start with what the data says, which is that paternalism, and now maternalism, doesn’t work. The top-down approaches to work. We know that patients don’t take the medications as effectively as they should, as in terms of their best health. We know that they don’t often follow up on recommendations that will improve their health. The current system doesn’t work and yet we ignore it. And I think physicians don’t recognize the gap between what could be and what is, because they believe that it’s time-inefficient to establish a real relationship with the patient. But I think that that’s what’s necessary. If you don’t have that relationship, and you don’t build the trust, if you don’t build the trust, you don’t develop a level of commitment. And without the level of commitment, the healthcare system doesn’t move forward. And I believe that that’s what we’re seeing today. And so I think it’s essential that physicians be able to be human. Now, the reality is the person who is sick has come to your office and you’re the healer role. You can go to someone else’s office and they become the healer for you. And you should do that as well. But if there is a complete lack of authenticity, to use Zubin’s word, or a complete lack of openness, then I think the patient leaves and feels like maybe they got some information, but they’re not sure that they’re really going to trust it, believe it, or follow up upon it. I think the teachings of the past around the lack of emotion was really a defense by doctors for their complete inability to treat almost every disease. I mean, if you think about it, doctors could repair lacerations for centuries. They could fix, put bones back in place. After anesthesia came along, could do appendectomy. But the kinds of problems that we’re facing today, the kinds of treatments that we have, they are so complex that if we don’t invest the time upfront to educate patients, to make certain that they understand the disease they have, the treatment that will make it most likely to get better, if we don’t have a mutual commitment coming out of that meeting, I think it is going to fail. I think doctors wanted to protect themselves from their inability and their lack of success. They saw their job as telling patients. And I think we need to ask more and engage more. And I know a lot of listeners are going to say, “We don’t have time.” Somehow we find the time when the complications happen to treat the problems that ensue, we need to figure out how we can invest in the front to improve the outcomes of the back end, and minimize the need for rework and treatment of medical issues that could otherwise have been avoided. 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 #49: An unfiltered chat about ‘the slap,’ emotional doctors, and more appeared first on Fixing Healthcare.

Season seven of the Fixing Healthcare podcast focuses on the unwritten and outdated rules of American healthcare—many of which Dr. Marty Makary would badly like to see broken. In this episode, the nationally renowned surgeon, author and educator sets his sights on the outrageous rules of medical education, healthcare spending, the “appropriateness of care” and much more. With cohosts Dr. Robert Pearl and Jeremy Corr, Dr. Makary shares his candid comments on the rules of American medicine that need to be broken. Interview Highlights On the ills of medical education “The AAMC continues to inflict tremendous damage on a generation of young people, who are trying to learn how to be great doctors. They’re forcing them to do all of this rote memorization, and it comes at the exclusion of other important skill sets … The AAMC has too much power. It’s the concentration of power in medicine, it’s not healthy. And by the way, many of these organizations lack diversity. Look at the editorial board of the New England Journal of Medicine and JAMA, I think it was like one African-American out of 50 editors.” On the cost crisis in healthcare “Well, I think the cost crisis in healthcare is really a function of three factors. One is pricing failures in the marketplace that enable price gouging, and they also enable the second factor which is a giant growth of a middleman industry. This is a group of thousands of millionaires that we’ve created who are not patient facing, who are not contributing to patient outcomes … And finally, the third biggest driver of our cost crisis is care coordination.” On the price of medicine “Financial toxicity is a medical complication, and billing quality is medical quality. These are things that are measurable, but up till now, we’ve only been measuring infection rates and readmission rates. We’ve got to start measuring billing quality performance and the price of services.” On end-of-life care “I can point and show you in detail areas of waste in healthcare where anybody, doesn’t matter what political party they have allegiance to, will agree that it’s egregious, it’s corrupt, it should stop, and it is wrong. Now, there’s a lot of those things in healthcare, actually. There’s a lot of area where there’s broad consensus, but reining in inappropriate care at the end of life is one of the most challenging, because it is still and always will be an art form. It’s not something that can be managed with policies or rules.” On the rat race in academic medicine “There was a time in the medical profession where in order to get a medical degree in the English empire, you had to have a degree from Oxford or Cambridge, at a time when neither Oxford nor Cambridge offered pre-medical education. It was just a royal lineage, if you will. It was an oligarchy, and they had all of these rules and we still have these rules in American medicine. And many of them live in this so-called academic promotion process, and that is a major barrier in my opinion to scientific advancement. People playing the game to get promoted, and we see that a lot.” READ: Full transcript with Marty Makary * * * 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 #48: Marty Makary on breaking the rules of medical education appeared first on Fixing Healthcare.

A group of researchers in the UK examined hundreds of brain scans that were taken both before and after people became infected with the coronavirus. The study, published in Nature, concluded that “there is strong evidence for brain-related abnormalities in Covid-19.” Some of the recorded disease effects included tissue damage, along with reductions in both grey matter and overall brain size, post-infection. This study raises more questions for scientists and medical professionals about the possible long-term consequences of Covid-19. Jeremy Corr and Dr. Robert Pearl examine these questions in this episode of Coronavirus: The Truth. You’ll find all the [time stamped] questions from this show in the notes below: [01:15] 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? [10:23] What’s the latest on Ivermectin, the Covid-19 treatment therapy? [14:41] How can patients distinguish science from pseudoscience? [16:48] Did researchers uncover data that shows brain damage after Covid-19 infection? [18:06] What do we know about “long Covid” now? [21:12] Is the CDC finally agree with the WHO on vaccines? [23:18] What’s good this week? [27:15] Why are medical workers abandoning the profession? [29:55] How do employer vaccine requirements and mask mandates affect local businesses? 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 #59: What does Covid-19 infection do to the brain? appeared first on Fixing Healthcare.

Welcome back to the Fixing Healthcare series, “Diving Deep,” which features a robust and probing discussion about some of healthcare’s most deep-seated problems. In this episode, Dr. Robert Pearl Jeremy Corr talk about two areas of medicine where the existing “rules” seem out of date. The hosts begin with a bizarre norm in healthcare: that technologies must, above anything else, boost the status of the physician. That’s followed by another odd norm: that primary care physicians, the doctors who save the most lives, are among the least-valued in the profession. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, each episode of this series will feature a time-stamped discussion guide (as follows): [01:07] Why is healthcare the only U.S. industry that has failed to use technology to lower prices or improve quality? [04:26] Why doesn’t medical technology improve life expectancy? [06:51] How are patients affected by the rules of health-tech? [08:58] Which technologies actually benefit patients? [12:36] What’s the difference between episodic and continuous medical care? [14:34] Which technology in medicine is most underutilized and undervalued? [18:37] How do we break the current rule of health-tech? [20:08] Why are primary care physicians undervalued in healthcare? [25:24] Can primary care solve our nation’s chronic disease crisis? [26:26] How do we break the outdated rule of primary care? * * * 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 #47: Diving deep into primary care & health-tech appeared first on Fixing Healthcare.

Welcome to Unfiltered, a new show that brings together two iconic voices in healthcare for an unscripted, hard-hitting half hour of talk. Twice, Dr. Robert Pearl has appeared on The ZDoggMD Show (see: here and here) opposite Dr. Zubin Damania, who hosts of the internet’s No. 1 medical news and entertainment show. And twice before, Damania had appeared the Fixing Healthcare podcast with Pearl and his cohost Jeremy Corr (see: episode 1 and episode 26). In the first episode of their new show Unfiltered, part of the Fixing Healthcare franchise, the duo dives into the differences—and similarities—between generations: from Boomers on up to Gen Z. Along the way, they discuss everything from techno-economic structures of healthcare to cancel culture to rap lyrics. Press play now 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 will be 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. 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: Zubin, welcome back to the Fixing Healthcare show. Zubin Damania: Dang, Robbie, I’m ready to get Unfiltered. I don’t know what that means, but we’re going to do it. Robert Pearl: Okay. Let’s begin in a place you love, Broadway. I had the chance to see a remarkable show called The Lehman Trilogy. It traced the history of the Lehman brothers from when the first generation came to the U.S., middle of the 19th century. And then it ended at the financial collapse in the first part of the 21st. What was most interesting was the continual clash of generation. Three brothers began in the South manufacturing clothes from cotton, but the next generation, it realized that it was more profitable to become transporters of cotton from the South to the industrialized North. Then the next generation recognizes it’s more profitable to be the financiers of industry and they start banking. Then the next generation says, “Why not expand to all businesses?” And they create the stock exchange, or contribute to its founding. Robert Pearl: And, finally, the company no longer at this point led by the family, introduces an array of financial products that ultimately proved to be Lehman’s downfall. What was so powerful to me was watching this inevitable clash. Each generation with the one that follows, one generation holding onto power, the other one coming of age, embracing change, and rejecting the values of their parents. I’d like to start by hearing your thoughts on this issue of the generations battling, whether it’s society overall, or how it plays out in medical practice. What are your thoughts, Zubin? Zubin Damania: Man, I love generational conflict because first of all, it’s entertaining. Second of all, it is an indicator of the natural evolutionary process of everything, like the entire universe unfolds this way. So you have generation one, let’s call them the boomers, for example, who did things a certain way. They were actually the rebels of their time. They pushed the envelope. In the ’60s the emergence of this sort of cultural revolution and the plurality and multiculturalism and postmodernism and all of that. They were the leading edge of that evolutionary chain. And then the generations that followed kind of emerged, and each of them takes a tact of first kind of learning what the previous generation kind of did. And then dis-identifying from it saying, “Oh, this has this many problems, and I don’t really like this, and this is not how I want to live.” And then trying to grab a foothold in something new and saying, “Okay, well, no, this is what we are.” And identifying with that. Zubin Damania: I think where that becomes healthy is where you integrate what the previous generation was able to do and actually say, “Yeah, that was necessary, but it’s partial. We need to keep striving for whatever truth is.” But if you don’t integrate it, if you just reject it and you never integrate it, then you’re in a difficult situation, then you have this kind of conflict. Now I think some of that’s inevitable, but some of it isn’t. Zubin Damania: As I started growing older in medicine and having house staff you could watch this play out. First, you have me, Gen X and then you start having millennials and you see a kind of a contrast in styles and expectations in sort of work ethic in a sense of it’s not that the work ethic isn’t there. It’s just it’s a different balance of what they want. They’re quite clear of saying, “I actually want to learn.” Whereas, we were like, “Well, whatever we need to do, we’ll do to kind of power through.” And so this kind of conflict to me it’s fascinating. I think it’s necessary to some degree, but understanding it allows us to actually transcend to a more integrative evolutionary approach to generational kind of thinking. Robert Pearl: One of the things that’s fascinating to me is how the events of the time so shape a group of individuals. As you mentioned, you have the boomers, they watched a man land on the moon, and President Kennedy talking about getting to space in less than a decade, anything’s possible. And Gen X this is the latchkey generation. They watched the breakup of the family. I’m not so sure anymore that this hard pushing is the best thing for people. Gen Y comes along and there’s 9/11, the world, it could collapse at any moment. And then Gen Z, the people who grew up during the 2008 recession. Now they’re moving back, look a lot more than the boomers. Robert Pearl: My sense is that the underlying motivation of people doesn’t change. It’s not that one generation is more purpose-driven or mission focused. No, it’s how it’s presented out. Is it going to be in the external world? Is it going to be in the family? Is it going to be an accomplishment? Is it going to be individual? And I fear a little bit, and this is overall, but medicine in particular that we personalize it in a negative way. My approach is better rather than understanding how as humans, we’re all shaped by what’s around us. What’s your sense? Zubin Damania: It’s like every disease is biopsychosocial. It has biomedical component. It has psychological component. It has social and technological components and environmental components. Everything in generational thinking is exactly that. For example, for me, Gen X we were shaped by our memories are the Challenger disaster, and the ’80s. And like you said, the sort of slow decline of family, the culture wars, these kind of things kind of shaped us and destabilized us to some degree, but I think that interaction with the system, the environment, the techno-economic structure. Zubin Damania: In healthcare, it becomes really fascinating because you have Gen Z now and Gen Y that have a very different upbringing than we did. They are digital natives. They started with an iPhone in their hand, the Gen Zers. And they’re entering a system where we have fax machines still. We have pagers still. We have this archaic set of payment models and CPT codes, and all this stuff. And they look at it and they cannot understand why this exists, and that pushback that they might feel, or might exhibit can be interpreted through the older generation’s lens as you’re just not paying your dues. You don’t understand, this is how we’ve done it. And we got stuck with this crap and you should too, but I don’t think that’s the right way to look at it. Zubin Damania: What we have to do is understand that both the techno-economic structures of healthcare and everything, and society have to adjust and vibrate along with the generation that’s coming into being, that’s going to be the predominance of the workforce, and all that, instead of us, like a lot of Gen X attendings now are just, “Oh my gosh, these millennials and these Gen Zers they’re impossible to deal with.” I don’t think that’s the right way to look at it at all nor is it for a Gen Z-er. It’s usually millennials looking at boomers going, “Yeah, okay, boomer, you guys wrecked everything. You guys don’t even know what you’re doing. Like, let us handle this.” That’s the wrong way to look at it too. Robert Pearl: I’m just so excited I have to tell you about Gen Z. If I were back in college, I’d study Mandarin, because I’d see that as what the future world is going to be rather than what was in the past. I’d be really interested in this narrowing of the line between humans and robots and seeing a world in which we actually will interact with these technologically created creatures that biologically don’t exist, and yet in so many psychosocial ways do. It’s interesting that I somehow have this view of the future rather than the view of the present and the past. I think it’s true for you too, Zubin. Am I right? Zubin Damania: Yeah, this merging of, so you cannot separate our tools and toys and technologies from us. We are intertwined with that. I recently had a guy named Daniel Schmachtenberger on my show. And we talked about this, that technology and society those structures feed back on the human mind. They feed back on us in ways that evolve us that are beyond our DNA, actually. Although, some of it is our DNA, methylation, and these sort of Lamarckian effects on our DNA, but the truth is even beyond that we are absolutely changed by these structures, so we ought to actually approach the future with kind of a mix of kind of techno optimism, like let’s design systems that actually encourage the kind of outcomes that we want as a people, which right now we haven’t done. Zubin Damania: With social media, we haven’t done that. We’ve encouraged fear of missing out. We’ve encouraged bad body image. We’ve encouraged division and polarity with those structures because they are purely incentivized by money. So we have to change those sort of incentives and structures to understand what you’re saying, right, Robbie? Like to actually respect that so that we can create a world that actually is what we want as opposed to what’s just going to happen to us. Robert Pearl: There’s no way we can stop the progress, and so I agree with you completely. We should be trying to shape it in the best way power and recognize that some of it is beyond our simple control. Zubin, you are a musical genius. At some point on this show I’d love to have you sing for people and rap for people, but let me ask you now just for your perspective on the evolution of music in a generational context. Elvis to hip hop to heavy metal to rap, where are we? What’s coming next? What is exciting to you in the musical world? Zubin Damania: Man, this is, and by the way, I’m a real crappy musician, but the bar in healthcare is quite low. So all I have to do is show up and I’m going to rap over a track, and I’m probably okay, but in the real world I would die instantly. So what I think about this is fascinating. It’s almost like karma, right? Cause and effect, like everything you do kind of ripples out and has effects on everything else. And it’s all a web of interdependency. Zubin Damania: So Elvis was basing his music on black music and blues and jazz, and that evolved into rock and roll, and that evolved into Prog rock, and that evolved into hip hop, and all these things kind of are interdependent. Everything is appropriating from everything else. When you talk to any good musician, the first thing they’ll do is tell you who their influences are. They never say, “Oh, I just made this stuff up from scratch.” No, they go, “No, no. I listen to this. I listen to that. I listen to this.” And they process it through their unconscious and out it comes. They open a hole in the universe. They take all this input and outcome something completely novel that’s actually made of these building blocks. So music is like that. Zubin Damania: So that’s why it’s funny as I get older, Robbie, I listen to new music and I go, “God, this sounds just like this, this sound just like this, this sounds just like this.” Because you start to pick out that karmic influence from all the generations before because you have the age and perspective to see it. Whereas, I think young people they’re just like, “This is my music. This is brand new. This has never happened.” And as they get older, they start to put it into the context of this evolutionary chain of music that’s beautiful. I mean, it goes back to the beginning of art the earliest Gregorian chanting, and before that cave singing, and all that, it all is this uninterrupted line as far as I see it. Robert Pearl: I read that unless you’re exposed to new music early in your life you’re never going to be able to embrace it. That there’s a cerebral neurobiological way that music gets incorporated into your brain, and yet you seem to keep evolving. I mean, I think the Super Bowl halftime show was one of your most favorite musical events. Is this your experience, or are you able to keep taking in the newest forms of music and finding value inside them? Zubin Damania: It’s a real challenge. I think that this window to novelty starts to close in our 30s. There’s been some data around that that if we’re not exposed to something new before we start hitting our 30s that novelty window closes and we’re more resistant. And some of it may just be biological conditioning. Some of it may be some other effects, but my experience is musicians who are the most open-minded they already emotionally personality wise they’re born with a set of tools, high openness to experience these kind of personality traits that allow them to be open to different things. Zubin Damania: And they’ll often say, “Oh, my parents played all kinds of music in the house, or my father was a musician,” or something like that. And that often opened their it’s like learning, like you said, you’d learn Mandarin. Like if you learn a bunch of languages before you’re 10, they’re really easy to learn. Once you get older the window of plasticity starts to close. It doesn’t close entirely. It never does, but it does make it harder. And I think the same is true with music. So some of the best musicians are the ones that had the most musical exposure when they were young. Zubin Damania: For me watching that Super Bowl show was like a take back to 1993. I was elated as a generational thing as Gen X going, “Oh, that was our music.” That was when I was in college. That’s when we were this was the edgiest, craziest music, and now it seems like classic rock it’s so crazy tame. And to watch them do it in the Super Bowl, and really crush it was just a lot of fun really kind of elating to see. Robert Pearl: I’ve heard that 50% of all music is about love either the unrequited love, the fulfilled love, the early love, the late love, the good love, the bad love. Does the music shape our view of relationships, or is that something, again, that we should be leading and directing? Zubin Damania: Ooh, what a lovely question. Man, I haven’t thought about this enough, but I’d say this, that it’s an epiphenomenon of our relationships and it also does shape our relationships. And in some ways it’s unhealthy because the concepts of romantic love often espoused in music are reductionist and a little cliche, and they don’t take into account the broad breadth of how humans are. So in a way romantic love is so interesting to begin with because you can contrast it in a meditative experience, or a spiritual context unconditional love, where you feel absolute acceptance unconditionally for all beings where we’re all one thing. And that kind of love feels very different than romantic love, which is in many ways kind of conditional and kind of dependent, and is dualistic in the sense that it has its highs, and then it has its very much lows, right? So music captures that because music is the emotional human state in a crystallized vibratory form. That’s why it triggers emotions, but it also is created by emotions in a way. So it’s mutually interdependent in my mind. Robert Pearl: I’m going to ask you a question that I would hesitate to ask to almost anyone else, but I’m very interested/really concerned about racism in medicine. I was at a karaoke club, believe it or not, about two weeks ago. And a lot of the songs were rap songs. And if they had come out of individuals who were white they would have been very offensive, I believe. Of course, the singers were black in this particular case. How do you view the language sitting in rap today that sits on this boundary around racism? Zubin Damania: Oh, that’s interesting because you’re talking about the N-word, which is used profusely, I think, in rap music. And it is, it’s not a word that say a Caucasian person, or me as an Indian American can use. It’s not a word that I think we can use. Now, in the music it’s interesting because it is in cadence, in incisiveness, in context of the experience of that community in the rap it is the perfect word in many ways. And so that’s the tension there and that’s art. Art is that kind of tension, the tension between society, between the social structures, between the weight of history, and between that performance in the present moment, right? So I think there’s no single answer to this. And if you asked 20 people they’ll all tell you different things depending on their background, their race, their own lived experience. Zubin Damania: I recently had a doc named Ian Tong on my show who is the chief medical officer of a company called Included Health. And he’s written extensively on race and medicine. He’s a black physician and he talked quite powerfully about his own experience. And I think what we have to do is listen to these perspectives and see how we can incorporate change in a systemic way, but at the same time we have to be careful about the reverse, where we’re starting to attack and marginalize say Caucasian people based on their race. Like we’re just assuming you’re a racist, we’re assuming this. And it just becomes this very self-fulfilling prophecy and a big mess. So I think just being open and authentic and honest in our conversations is 90% of the battle. And trying to really inhabit the other person’s lived experience and position as an empathic sort of exercise is crucial. Robert Pearl: When I was on your incredible podcast I think it’s the best one in all of healthcare. Congratulations on it. Zubin Damania: I’ll give you that honor, Robbie. Actually, my podcast kind of sucks for healthcare. Robert Pearl: You asked me a question about racism. We talked about the fact that early in the pandemic that when there was a shortage of testing kits that physicians under-tested black patients that when two patients came to the ER with the same symptoms, one a white patient, one a black patient, the likelihood was that the white patient got tested twice as often. And we talked about the nature of implicit bias that it’s biological most likely dating back 20,000 years we were cave people. Someone shows up at the door to the cave. We have a nanosecond to decide whether it’s someone we should welcome in and feed or throw a spear at because they’re coming to kill us. And that that biological piece isn’t an excuse for racism. Robert Pearl: And most importantly, that not recognizing it and not putting in place systems to be able to address it and prevent it that was racism. And I see that in medicine today. I see artificial intelligence as possibly being able to say, “Zubin, when you take care of this patient, usually you prescribe ex dose of medication. This patient you’re prescribing half of the pain medication, even though the pain is likely the same, do you want to reconsider?” And I don’t see medicine either acknowledging it. I mean, you can find it in the literature, but acknowledging it in how it’s changing. I don’t see residency building it into place. I don’t see technology coming in. I’m concerned and we’re seeing it in the data, women’s mortality who are black women in labor. We’re seeing this problem continue and actually become worse on what I’ve seen recently. Your thoughts on how we can best address racism in American medicine today? Zubin Damania: I mean, this is a massive topic. One thing you mentioned about AI is interesting because it’s a double-edged sword. AI is only as good as the information you feed it. And actually it can lead to perpetuating systemic bias if it’s fed information that is innately incomplete, or biased, and this has been something that’s been documented in AI in medicine too. And so what I think this is tricky because there are a lot of like sort of like when we point a temperature gun at someone’s head when they’re coming into a restaurant and we call that COVID screening, that’s called hygiene theater, right? It’s not really doing much of anything, but people feel better by having done it. Zubin Damania: I think some of the techniques and things that they’re doing in medicine are along those lines. They make people feel like, well, we’re doing something about race, but it’s really not doing anything. And what we really need to do is what you’re saying, which is look at our systemic structures and see, okay, are these contributing to this situation? And also we have to be careful about reductionist diagnoses of what’s going on because sometimes we’re missing a broader problem that is contributing to an outcome, right? Because we want equality of opportunity everywhere we can. And so any way we can knock down barriers to that equality of opportunity we need to look at systems that do that, but it’s hard, man. It’s really hard. And people don’t even want to talk about it because it makes them uncomfortable. Zubin Damania: Whereas, every time when I would round and we’d have a multiracial team, which was every time, right? I would talk about race all the time because I wanted to put it. And by the end, everyone was like, “This is our culture. This is what we do.” And even just having an open dialogue and people are afraid. I could get away with it because I’m off white, right? So I felt like, oh, I can say this. I don’t feel bad about it. I think a lot of Caucasian people feel bad about doing that. They’re nervous about it. And I think we have to get over that too. And that’s going to take some generations probably. Robert Pearl: I heard an interesting dialogue between two physicians. The first one, this is relative to the issue of change how fast we can make it. One said, “Rome, wasn’t built in a day.” And the other one said, “But it could have been.” Zubin Damania: I like that, could have. That sounds like Gen Y right there. Just get on Instagram and take a selfie of you with Rome, and there it is, it exists, it’s there in the picture. Robert Pearl: How fast can we, and should we evolve the American healthcare system? Zubin Damania: Man, if I could wave a magic wand, I would just start entirely fresh. And that includes medical education. And that includes our concept of what wellness and health actually mean because that’s a cultural and personal context. And, again, biopsychosocial, there’s a whole wave of that. So if I could do it, I would completely reboot it, so I’m in the camp of like, hey, it could have been built in a day, right? Because in a way, trying to undo these legacy systems at some point it just gets to be you’re banging your head against the wall, which we’ve been doing for quite some time. Zubin Damania: At the same time it’s very destabilizing to even talk like that. Markets would collapse if we suddenly did that, although we’d get a lot of our GDP back, probably. So I’m somewhere in the middle on that. I think we need real disruptive change, but at the same time, we’re going to have to work with structures that we have. And we’re going to have to work with a legacy population of healthcare professionals that have been conditioned and cultured in a system that is no longer going to exist if we do things right. Robert Pearl: So I’d like to return one last time to the generational questions. You have a massive following on your podcast. How many people follow your podcast now? Zubin Damania: Well, on Facebook, it’s about 2.5 million. YouTube, about half a million. Instagram, about half a million. Robert Pearl: I’m guessing you have a pretty broad population of generations, ages, et cetera. Zubin Damania: Yeah. Robert Pearl: Do you see, do you hear, do people respond differently based upon the generations, and if so, how is that? Zubin Damania: Yeah, actually they do. And each platform has a different age mix. Instagram skews younger. YouTube skews more male and younger. Facebook skews female and older. And they all respond to different, like, I can put the same piece out on different platforms and the response may be a viral million hits on one, and 5,000 meh with no comments on another. And so different generations do respond to different material quite differently whether it’s a music video from a certain era, or whether it’s just a topic that they’re interested in or not interested in and there are gender differences for sure. So it’s a real cross section of all of healthcare actually are following. Some of it depends, too, on what their profession is. Nurses respond differently than doctors respond differently than physical therapists respond differently than respiratory therapists. So there’s just so much diversity there. It’s almost impossible to know what’s going on so you just try to talk about stuff you care about authentically. Robert Pearl: In the end my conclusion based upon everything I’ve just heard from you is that everyone is motivated to make positive changes happen. It happens across generations. It happens across training and backgrounds. And I think that the separations that we have done personalizing it around your generation is a problem. My generation is right. I think it’s standing in the way and I would encourage you on your show and continuing in our conversation on this show to look at the similarities, to find the ways that the motivation is the same. The driver is the same because as you’ve said, I have had really wonderful experiences in my medical career in training residents and working with colleagues regardless of the particular year they were born. We should understand those influences, but we shouldn’t let them stay in the way. That’s my view of generations. Closing thoughts by you. Zubin Damania: I think that’s spot-on. I think we should embrace these differences as part of the normal evolutionary wave of how humans are and try to really, really put ourselves in each other’s shoes. So if we can really feel what it’s like growing up as I say a Gen Z, you can actually feel a lot of love and compassion for their struggle too, as well as the opportunities that they have. I think we’re in a spot to do that, but I do think that we get calcified as we get older and we’re more resistant to that kind of thing. Whereas, the younger generations, I mean, we ought to just make it a cultural norm that that’s how we behave. Jeremy Corr: ZDogg and Robbie, you guys talked about the generational differences in healthcare. One thing I hear frequently in many industries is that the younger generations are too self-obsessed, self-righteous and arguably fragile, especially on social media. Social media is obviously a blessing and a curse. It gives people the ability to share with the masses in a way they’ve never done before, but also to attack and cancel people for what they believe is wrong things like never before. Jeremy Corr: We see people raising awareness for humanitarian crises all over the globe, but also mobs of people canceling people for things they tweeted, or said back when they were in high school. People feel so righteous to band together with people and be part of a cause on social media. I mean, we’ve seen misinformation spread as well as way, way, way too much censorship on topics that later are proven to be true. What do you both feel is kind of that right mix of outspoken step, or being able to speak their mind versus censorship versus kind of how the different generations see and use social media as well as kind of some of the pros and cons about it? Zubin Damania: Well, this is like one of the fundamental things we really try to address on our show is this idea of social media as a technological tool that kind of, again, vibrates with each generation differently in that it really does hack our limbic system. It’s a race to the bottom of the brainstem. We have these hyper normal stimuli in the form of these social media things along with this weaponized tribalism in the form of likes, dislikes. We almost instantiate these collective hive minds based on individual neurons, which are like, dislike, that’s our neurotransmitter in these social networks. Zubin Damania: And so you have generations now that are being judged on dumb stuff they said when they were 13, who didn’t? If you could pull up everything and I’m sure there’s stuff somewhere circulating around that I’ve said when I was 14, I would be done in this climate. They would eliminate me from the face of the earth and the truth is that’s not okay because these are neuroplastic children at that age too, right? So they can’t be judged on that. We should be able to be our authentic selves, but we should also have to, again, deal with the consequences of what we say, but not in a way where the mob comes and cancels you. And, look, I’ve been the victim of cancellation. I’ve tried to cancel other people. It’s so seductive on social media, Jeremy. We need to change those social media incentives in order to make it a little better. I think we can absolutely do that. There’s much smarter technology out there that can be used to actually generate consensus and connection as opposed to polarization and cancellation. Robert Pearl: What I see is technology becomes ever more powerful whether you want to look at Moore’s law doubling every two years, and what you’re seeing right now is incredibly powerful technology that can be used for good or bad. Technology isn’t an intrinsic force around morality or immorality. It’s simply a tool that people apply and societies and civilizations have to figure out how to use it. You can think of it as a nuclear power that can generate electricity to light the homes without affecting climate across the globe, or you can think about it as a tool to destroy civilization. I think the time has really come for us to ask how do we want to use this powerful tool? I believe for the best in people. I think we under-utilize it in medicine. I think we probably over-utilize it as Zubin has said in people’s early lives. Finding the right balance will be difficult. Everyone wants a simple solution, a clean solution. It doesn’t exist. This force will happen. It will grow stronger. And we, as humans will have to decide whether we control it, or it controls us. Robert Pearl: Zubin, it’s been great. I can’t wait for next month. This has been a fascinating view to me of the millennials and the Gen Xers, and the boomers, and the future Gen Zs. And now the new Gen A that is coming along. The world will be very different in the future. Together I’m hoping we can make it better. And as I always say at the end of my shows together we can make American medicine once again the best in the world. Thank you for being our guest today. Jeremy Corr: We hope you enjoyed this podcast and will tell your friends and colleagues about it. Please follow Fixing Healthcare on Spotify, Apple Music or other podcast platforms.  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 RobertPearlMD.com and visit our website at 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. Have a great day. The post FHC #46: An unfiltered look at medicine’s generational clash appeared first on Fixing Healthcare.

The Fixing Healthcare podcast welcomes back Ian Morrison, a globalist, futurist and popular returning guest who, in Season 1, taught us that “every healthcare system sucks in its own unique way.” Now in Season 7, podcast cohosts Jeremy Corr and Dr. Robert Pearl are focused on breaking the unwritten rules that hold doctors (and the entire U.S. healthcare system) back. They asked Ian for practical tips on breaking the rules that currently govern: healthcare technology, the revenue obsession in hospitals, the incumbency of industry leaders and asymmetry of information between doctors and patients.   Ian Morrison Interview Highlights On the challenge of breaking the rules “I think the resistance of an industry [must be overcome], because I think the unwritten rule of medicine … is that this is not a profit maximizing industry. It’s a revenue maximizing industry. It seems to me all these board retreats in hospitals, every single one of them has in their top five imperatives ‘growth’ and guess what? We grow. The revenue keeps going up … And I think the U.S. is sort of addicted to growth. And the other one I would point to is addicted to self-insured employers, writing a very big check, massively larger than the actual cost of delivering care. I think those are the two sort of fundamental issues that we need to reevaluate.” On the biggest threat to changing healthcare “I think incumbency … I always say, if you’re going to disrupt American healthcare, the American healthcare system is larger than the entire Italian economy and about as well organized, right? So if you’re going to disrupt healthcare, it’s a bit like disrupting Italy, good luck with that … The thing that prevents us from doing it is incumbency, quite frankly. And we have a lot of institutions who are on this revenue-maintenance track. And it’s very hard to disrupt that at the scale that we currently have invested in the American healthcare system. Not that it’s all wasteful, but that there is considerable power to that incumbency.” On the problem with consumerism in healthcare “It’s a tough industry because of the asymmetry of information. You’re a doctor, you know stuff I don’t know as a patient. And therefore, as a transaction, when I’m purchasing health services or I’m seeking health advice, I really have to rely on your agency to help me get through the difficult times. And that tends to be the experience patients have, having been a patient not that long ago, you cease to be sort of a rational consumer and become a kind of frightened human where you defer to expertise. And I think that is a fundamental barrier that exists to actually having a more market-like or consumer-responsive health system. But that shouldn’t excuse us in healthcare.” On the drop off in telemedicine usage “If all we do is pave the cow path, in other words, substitute an e-visit or telehealth visit for an in-person visit, all we’ve done is really save travel time and parking, right? What we really want [are] productivity enhancers. And I think that requires … rethinking end-to-end clinical processes to be more digital in their mix. And that’s easy to say as a futurist, it’s hard to do because it really requires rethinking the way in which clinical services are organized and delivered … It takes clinicians with the right technological support to really redesign those delivery models for the future.” On the unaffordability of healthcare today “In 1970, if you provided health benefits to a family, it cost about 10% of the minimum wage. Today, it’s 150% of the minimum wage. And … what that leads to in terms of behavior, particularly with the rise of high deductible health plans, has been people foregoing care and about a third of Americans claim they do that. And it was exacerbated through the pandemic … I think the long-term answer of affordability is change the way we do what we do, which is what you and Robbie, I think are trying to do with this series is to draw attention that to fix healthcare, you’ve got to actually fix the care-delivery process going forward. READ: Full transcript with Ian Morrison * * * 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 #45: Drs. Alexa and Siri? A healthcare futurist weighs in.   appeared first on Fixing Healthcare.

After more than two years of Covid-19 restrictions, most parts of the country are dropping mask mandates per new CDC guidance. It seems government officials are more confident than ever that life is returning to normal. “With 75% of adult Americans fully vaccinated and hospitalizations down by 77%, most Americans can remove their masks, return to work, stay in the classroom, and move forward safely,” said President Biden during his State of the Union address on March 1. But are we really out of the woods? Cases of a highly transmissible omicron subvariant (the BA.2 or “stealth” variant) are doubling in the U.S. every week, now accounting for 8% of all new infections. Will removing our masks give way to yet another wave? Jeremy Corr and Dr. Pearl examine the present and future of Covid-19 restrictions in this episode of Coronavirus: The Truth. You’ll find that discussion along with these [time stamped] questions: [01:03] 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? [05:35] Is a fourth vaccine shot on the way? [06:54] How has the war in Ukraine affected Covid-19 coverage and concern in the U.S.? [08:53] Masks: do we need them anymore? [10:57] How did the Covid-19 pandemic begin, based on new findings? [13:22] Any truth to the rumor that Covid-19 vaccine can lead to sudden hearing loss? [16:56] Does the Pfizer vaccine work in kids under 5? [20:51] What’s good this week? [22:26] Beyond Covid-19: Do Americans get the healthcare they pay for? [28:05] How are local communities handling vaccinate and mask mandates now? 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 #58: Are Covid-19 restrictions gone for good? appeared first on Fixing Healthcare.

Welcome to the new Fixing Healthcare series, “Diving Deep,” which features a robust and probing discussion about some of healthcare’s most deep-seated problems. With cohosts Dr. Robert Pearl and Jeremy Corr, this series will be hard-hitting, honest and undoubtedly controversial. In this episode, Pearl and Corr talk about two areas of medicine where the existing “rules” seem out of date. It begins with an up-close look at how medical schools and residency programs select future doctors, a process that quickly reveals itself as obsolete in the 21st century. That’s followed by an in-depth review of the current (and outdated) rule used to determine how doctors are paid. For more information on these topics, check out Dr. Pearl’s latest healthcare columns on Forbes and LinkedIn. For listeners interested in show notes, each episode of this series will feature a time-stamped discussion guide (as follows): [01:00] Before we dive deep, what are the “unwritten rules” of healthcare? [02:01] How do these rules impact doctors and patient care? [03:52] What’s the rule for selecting and training future physicians? [06:10] Why is this rule now obsolete? [07:43] How do we break this rule and bring it into the 21st century? [10:38] Next rule: What’s wrong with paying physicians this way? [13:27] Diving deeper, how exactly do doctors get paid? [15:04] Does this payment rule lead to physician burnout? [17:23] After 90+ years, is it really possible to change the rule? [21:08] What are the pros of a relationship-based payment model? [21:58] Can we make docs happier and lower healthcare costs? * * * 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 #44: Diving deep into how we select and pay American doctors appeared first on Fixing Healthcare.

Research on 4,000 women over six months found that Covid-19 vaccines are linked to a small increase in menstrual cycle length. Such a delay is common when a woman’s body mounts an immune response, says cohost Dr. Robert Pearl. Other scientific studies have examined the link between vaccine status in pregnant mothers and relative immunity in their newborn children, as well as the link between vaccination and fertility in men. Jeremy Corr and Dr. Pearl dive into the data on this episode of Coronavirus: The Truth to examine those topics and the following [time stamped] questions: [01:01] 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? [06:04] Australia shifted its public health measures from highly restrictive to incredibly lax. Why? And is it working? [09:04] Is it the responsibility of U.S. elected officials to protect the unvaccinated by restricting the vaccinated? [10:57] The courts have ruled that federal government can’t mandate vaccination for workers. How does this affect private businesses? [13:29] Where does the FDA stand with approving vaccinations for kids 5 and younger? [18:05] Anything new on the BA.2. variant? [19:48] Listener question: Does the coronavirus vaccine affect my menstrual cycle? [22:26] How many total deaths in the United States can be attributed to the pandemic? [23:36] What’s good this week? [25:29] Beyond Covid-19: What’s happening with healthcare technologies? [28:29] Is AI something to fear or celebrate in healthcare? 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 #57: How do Covid-19 vaccines alter fertility, childbirth, menstrual cycles? appeared first on Fixing Healthcare.