WEBVTT

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We know in some instances what brings contentment

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joy and sometimes happiness Nourishing and building

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social relationships taking care of our minds

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taking care of our bodies But we still find ourselves

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chasing money status power and myself as well

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My question to you is would you be open to an

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AI solution? That tracks your your social activities

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your social media your your email and even controls

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it, tracks your biometrics, if it will lead to

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more contentment in your life? Oh yeah, 100%.

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Right? So happiness is the spikes that we feel,

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the endorphins that we feel all the time. And

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I think if we overwhelm our bodies with constant

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endorphins, it becomes the new norm. And then

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we're always seeking for the next pleasure, the

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next day. I think that's what we see. We get

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the money, it goes for our bank accounts, we

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get that spike of endorphins, or I want more

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of that. That felt great. How do I do this? Whereas

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contentment is more so the state of I'm happy

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with what I have. I'm not saying that you shouldn't

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be striving for more. You should always be striving

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for more. For me, it's education. Knowledge is

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power. And so that gives me my contentment and

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gives me this happiness. to know that I'm learning

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something new. And so the two go hand in hand,

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but they're not the same. And so absolutely,

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I'd want an app that does contentment. I don't

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want it to, I feel like sometimes social media

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is there to give a rise out of somebody, right?

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And so they can give you the middle ground, and

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then occasionally they'll send you something

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that they don't know whether or not you're gonna

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suddenly be like, That's my guy, that's my gym

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bro, that's my passion project, or I don't like

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this politically decisive, I don't want to do

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this anymore. And it's the reactions. You can

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go back to Facebook all the way from back when

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we were in high school, where you could like

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something. And then people wanted the ability

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to go beyond a like. Let's get a heart, let's

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get a thumbs down. At one point I remember there

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being a thumbs down, I'm not sure if you remember

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that. Or a dislike. And then at one point it

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disappeared again. I don't know what it is anymore

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because I don't use Facebook anymore. I use Facebook

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for marketplace. I need to sell stuff to my office.

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But that's the rise we want. And then at one

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point we wanted more people to have likes on

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our posts. So then we'll say more controversial

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things. And then Facebook will take that and

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run it through everyone. And so I think that's

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where we're starting to get into this endorphin

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rush of I need to have this. I need to have this

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dopamine rush. the addiction that we're looking

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for. Contentment is the removal of that addiction.

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I'm happy with where I'm at. I'm happy with my

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own thoughts. I think that's the third part about

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this, of this AI app, is does it make you think,

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and does it make you think independently? Or

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are you the type of person, I don't want to say

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you, Rashad, I don't want to say anyone, are

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you the type of person who listens to somebody

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else, and if it sounds smart, You'll just say

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yes Because your own thoughts are a scary place

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to be How did you get interested in archaeology?

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Oh That's from that's from job that I my mom

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jokes. I just cuz I like gold. I like shiny things

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and King Tut's tomb was shiny and gold My mom

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used to teach us that Indian culture is very

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similar to the African culture and Egyptians,

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the Krishites, stuff like that. And, you know,

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as a kid, your parents were always right. Now,

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I just watched a National Geographic channel

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yesterday, a video on the pyramids of Sudan.

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And that's the ancient Krishite empire. I'm reading

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into that as well. Yeah, yeah, all that stuff

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actually is starting to line up. And, you know,

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we also have studies that now show that Verbal

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history is sometimes as good as written history

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in cultures. And so I think from a young age,

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my mom just kind of imbued that into me in terms

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of explore the past, have an open mind. Just

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because some experts said it doesn't mean that

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it's factual. It doesn't make them a god. It

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doesn't mean that they're 100 % right. Challenge

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the status quo. If we don't challenge the status

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quo, we'd still be using the Yellow Pages. because

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that was the absolute best thing in the world

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back in the day. So challenge the status quo,

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I'd always ask questions. And if you prove it

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to be incorrect, great, at least you proved it.

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But to outright say no, because you don't like

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it, that I can't tolerate. So that's how I got

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into archeology, which is challenging the status

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quo to my mom's... She's upset now because I

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decided to take that to a whole different level

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and started challenging what is Hinduism and

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reading Vedism and reading the texts of the Vedic

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texts. I've read the Bhagavad Gita. I've actually

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gone off and read the Torah, the Bible, the Koran,

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any religious text I could. I think it's a really

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fascinating way of looking at how cultures change

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over time and how people perceive and how cultures

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perceive that change and what does... What is

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the different culture of society? And so those

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books are also, in a way, a historical archaeological

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text, because it's the interpretation of reality

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into a book. And then you also want to line that

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with what the groups have with Strabo's books

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and what Alexandria was. And that's kind of how

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it all got together. As I said, it's all clear

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pathways. And I think that's representative of

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what our We are a mixed group of really smart

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animals that figured out how to create a civilization

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out of this today. Yeah. You know, when I did

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residency, I was out in BC and it was really

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my first exposure to indigenous culture. And

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then they had us go to powwows. And it was very

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interesting. And one thing that really, you know,

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stuck with me as a almost a fact that we don't

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respect Indigenous culture is that it's an oratory

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culture. It's a verbal culture. Contracts are

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verbal. They're not written. And we force their

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leaders to adopt to our framework with written

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contracts. He said something very interesting.

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And I think the world would be a much better

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place if our verbal word was a contract, if we

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did not need written contracts. Now you need

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proof of that someone said something and I think

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that that's accurate but I don't think it needs

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to be pen and paper or you know keyboard and

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screen. What are your thoughts on verbal versus

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written contracts and how did you learn that

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a verbal history or storytelling and stories

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are you know I'm curious because I would think

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they're less accurate than written history but

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from what it sounds like you're saying that they're

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They're as accurate. Yeah, it depends on how

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much emphasis on accuracy is placed, right? So

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we all see the studies on court cases and forensic

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cases where people will change what they remember.

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And it's not maliciously, it's just the brain

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can fabulous and changes things. And so what

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they recollect even a day after a week later,

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whatever, is different. What I think the difference

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here though is, what do I remember unintentionally?

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I was walking down the street, I saw a car crash.

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What do I remember? And usually nowadays you

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and I, when you write down our statement right

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away, that reinforces what we remember. So it's

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less likely to change over time. If you don't

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have a written language, what is the next best?

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thing you can do to reinforce. You share that

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knowledge with somebody else. You share it immediately.

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You can either be doing it through song. So now

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you have a rhythmic pattern that reinforces a

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memory and grammates your brain. That if it doesn't

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rhyme or change with the tone, you know you missed

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the part. So now you're actually creating a checksum

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into the actual memory itself. Then you can translate

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that to the next level. So horizontally. through

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the generations and vertically through the generations.

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And that's what allows it to pass down from one

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generation to the next. And I'd argue that even

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if it's a written contract, it's not as accurate

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because it depends on the context of when that

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document was written and the environment around

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it. And also written from a physical nature point

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of view, written contracts actually don't persist.

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Let's think of the Dead Sea Scrolls, right? We

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need to use x -ray vision now to unroll them.

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They don't persist. We know they're really old.

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They're really ancient, but they're not as good.

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But oral traditions actually have that. So I

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think they both have their pros and they both

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have their cons. I think where the oral piece

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and the written piece differed, where I do like

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a written contract is I don't have time to put

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my EMR end user license agreement to a song.

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I could be singing for hours on end about why

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I can't. how we're going to get sued and how

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TELUS is not liable for anything. And so I think

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there's a value to that. But I think when it

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comes to things that are supposed to make us

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feel proud about our culture, to warn us about

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things that are important, to tell us about important

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milestones in our species' existence, song has

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a way of hitting different parts of our brain

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and making us feel differently. It's a reason

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why we sing the national anthem. A recent old

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day... back in school, because it brought us

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together and made us feel proud about being Canadian,

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that I know we're true north strong and free.

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And I will always be with me. I don't need to

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write that down. And I know that everyone else

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around me is the same. So I think that's the

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value of the written word versus the verbal word.

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And the culture of writing and stuff like that,

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I'm sorry, for the Inuit piece, you're right.

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We don't value that, unfortunately. We should.

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And we now know, and we have been saying this

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for ages. Well, they've been saying for ages

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that their written word has been accurate. We're

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confirming that with archaeological data. And

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it's because somebody challenged us as well.

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We said, oh yeah, 10 ,000 years ago, they came

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across the Bering Strait through Beringia. And

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that's how it happened. There was a study that

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came out two weeks ago that showed, hey, actually

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that may have been 20 ,000 years ago. Hey, by

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the way, there may have been three migration

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patterns in North America. And so, you know,

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Vikings at one point is a more modern one, but

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there's some talks about how, you know, other

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groups from Polynesia, they migrated over at

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a different stage. And so... We need to stop

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thinking about things in a two -dimensional state

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of, this happened, therefore this mustn't happen.

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And start thinking from an open mind of, yeah,

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we know one of the components. What else? How

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else? And we suddenly put an attachment to ourselves

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saying, let's imagine I'm an archaeologist. I'm

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not saying this is what archaeologists do, but

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I have heard stories and I have read books and

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papers and people who defend their theory so

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because they're tied to it. They spent 20 years

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doing this one research project. And for somebody

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to come along and question it, that's a whole

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challenge. Let's take Einstein. He does not agree

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with quantum physics. It goes against a lot of

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these fundamental values he had. And he actually

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spent the last little while trying to fight it.

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We know quantum mechanics works. We can't explain

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it. And maybe in some future state, we will prove

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again that quantum mechanics doesn't work. But

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we really need to be able to say, just fighting

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it, let's work with it. Yeah, sorry. Yeah, I

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think when it comes to things like quantum mechanics,

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we have an inherent desire to focus on causation

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and the why. But there is this school of thought,

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and maybe I'm the only person in the school of

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thought, is all we can know is correlation. I

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don't think we'll ever figure out causation.

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and we would advance our technologies and our

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society much faster if we simply focus on correlation.

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There's need for trying to figure out why, I

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think, as slowing us down considerably. Do you

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have any thoughts on that, on my belief there?

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And this belief kind of was supported by this

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investment firm called Renaissance Technologies.

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um the most successful investment firm ever,

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66 percent annual returns for 30 years, more

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than three times the Warren Buffett returns.

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Their whole philosophy is we will look at the

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correlation and they're their mathematicians

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they made an algorithm to do this between public

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equities and if you know the price of rice in

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Brazil goes up 10%. That means the price of Alibaba

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in China will rise 5 % tomorrow for six hours.

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And they're they're this precise, they're on

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the average whole time for stocks is two days.

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And then they invest, they remove the human element,

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because they say we worry about the why and the

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why is not what's important. Because the only

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thing that matters is the what and the correlations.

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and causations are impossible to know. There's

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too many infinite confounding variables and factors

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in our life. But we're still stuck on this, bringing

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us back to the VC world and the venture capital

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world. The biggest question is, why are the founders

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doing this? And my thought is maybe that is not

00:14:46.860 --> 00:14:49.240
the biggest question. The biggest question is,

00:14:49.379 --> 00:14:52.139
will the founders stick around or are they capable

00:14:52.139 --> 00:14:56.149
of doing this? And knowing why may or may not

00:14:56.149 --> 00:14:58.450
lead to answering those those questions which

00:14:58.450 --> 00:15:01.610
actually matter which is a what you know will

00:15:01.610 --> 00:15:05.070
this be a unicorn exit so what are your thoughts

00:15:05.070 --> 00:15:07.990
on correlation versus causation to be over indexed

00:15:07.990 --> 00:15:10.230
for causation and are we hurting ourselves in

00:15:10.230 --> 00:15:15.549
doing so so interesting um i think you're in

00:15:15.549 --> 00:15:19.669
your own school of thought uh i'm happy being

00:15:19.669 --> 00:15:22.610
in my own school of thought so that's amazing

00:15:22.610 --> 00:15:28.580
frankly to me I disagree with that. I think the

00:15:28.580 --> 00:15:31.120
why in the sense that VCs actually not even,

00:15:32.059 --> 00:15:34.879
they do have a why. Their why is make money,

00:15:35.679 --> 00:15:38.139
have shareholders, dividends. If correlation

00:15:38.139 --> 00:15:40.299
gets them to that end goal, then Wyoming can't

00:15:40.299 --> 00:15:42.580
go for it, right? I'm not saying that's wrong.

00:15:42.679 --> 00:15:45.580
They obviously have proven that's right. I think

00:15:45.580 --> 00:15:47.919
the beauty of this is can we translate that to

00:15:47.919 --> 00:15:50.139
a different sector afterwards, right? So if that

00:15:50.139 --> 00:15:53.019
rice price in Brazil goes up and Alibaba's whatever

00:15:53.019 --> 00:15:59.580
goes up for five minutes. then knowing the why

00:15:59.580 --> 00:16:04.519
underneath allows us to predict more. And I do

00:16:04.519 --> 00:16:07.159
believe that at some point there is no such thing

00:16:07.159 --> 00:16:09.320
as infinite number of variables, it's a finite

00:16:09.320 --> 00:16:12.639
number of variables. We seek to achieve that,

00:16:12.740 --> 00:16:15.820
figure out the digital twin, and then figure

00:16:15.820 --> 00:16:18.580
out with that digital twin how does the universe

00:16:18.580 --> 00:16:23.019
work. And it goes back to another philosophical

00:16:23.019 --> 00:16:25.460
thing, if we know all the variables of the universe.

00:16:25.519 --> 00:16:28.100
and we can put it into a digital twin, then we

00:16:28.100 --> 00:16:30.799
just directly just create a copy of our own universe

00:16:30.799 --> 00:16:34.100
digitally. Which then leads to the idea of are

00:16:34.100 --> 00:16:39.200
we just all part of one large... Can we know

00:16:39.200 --> 00:16:41.539
all the variables in the universe? Can we know

00:16:41.539 --> 00:16:46.279
why? Or is it impossible to know why the price

00:16:46.279 --> 00:16:48.519
of olive oil goes up because the price of rice

00:16:48.519 --> 00:16:53.720
goes up? Is that a futile question? No, I think

00:16:53.720 --> 00:16:57.490
we can. I think By saying we can't means that

00:16:57.490 --> 00:16:59.309
we've given up. And that goes back to our question

00:16:59.309 --> 00:17:03.129
of the status quo and stands still to go backwards.

00:17:03.909 --> 00:17:08.230
Humans as a species moves forward. If curiosity

00:17:08.230 --> 00:17:11.690
drives us that way. And correlation can show

00:17:11.690 --> 00:17:13.990
us the why. Correlation gives us the patterns,

00:17:14.369 --> 00:17:18.410
but we need to dive deep. I have decided in my

00:17:18.410 --> 00:17:21.390
work and not my personal life to focus on the

00:17:21.390 --> 00:17:24.299
correlation path. And I think let's have this

00:17:24.299 --> 00:17:27.519
conversation in five years and see how we've

00:17:27.519 --> 00:17:30.160
uncovered the truth and knowledge in the universe

00:17:30.160 --> 00:17:33.440
and what, let's share notes then. But let's go

00:17:33.440 --> 00:17:39.359
on these. Correlation is important. Correlation

00:17:39.359 --> 00:17:41.480
gives us, you know, of all the things in the

00:17:41.480 --> 00:17:44.059
universe, of all the variables, what are the

00:17:44.059 --> 00:17:52.039
things that are related to each other? Yeah,

00:17:52.039 --> 00:17:54.440
and my thought is that we can know we're not

00:17:54.440 --> 00:17:57.259
smart enough information we're limited by five

00:17:57.259 --> 00:18:03.240
senses I think and as we are now in humans in

00:18:03.240 --> 00:18:06.480
2025 We can know that that's where I've kind

00:18:06.480 --> 00:18:11.140
of Agree in 2025 humans can know we're not that

00:18:11.140 --> 00:18:13.680
smart. I think that's a I do believe in a hybridized

00:18:13.680 --> 00:18:19.809
world of AI Where is all correlation? Like AI

00:18:19.809 --> 00:18:21.829
doesn't understand why there's no meaning or

00:18:21.829 --> 00:18:25.549
significance. It's essentially, as you said,

00:18:25.730 --> 00:18:30.170
it's all probabilities. It's what is the next

00:18:30.170 --> 00:18:32.349
character? And it doesn't even know what a word

00:18:32.349 --> 00:18:36.910
is. It says what is the next half a P or character

00:18:36.910 --> 00:18:40.210
that comes after this? And the way it defines

00:18:40.210 --> 00:18:43.509
character is very different. So if we're going

00:18:43.509 --> 00:18:49.259
the AI path, then it's in my... you know, defense,

00:18:49.259 --> 00:18:53.680
I guess. This is an interesting debate. It would

00:18:53.680 --> 00:18:57.220
be all correlation and no causation, because

00:18:57.220 --> 00:18:59.359
AI doesn't care. There's no caring or not caring,

00:18:59.480 --> 00:19:04.400
right? It's just all probabilities. Do we, do

00:19:04.400 --> 00:19:08.240
you think we're anchoring AI then by making it,

00:19:08.720 --> 00:19:11.220
or forcing it to explain things to us? But if

00:19:11.220 --> 00:19:14.880
we had to let AI go, it'll create its own language,

00:19:14.920 --> 00:19:18.339
which we know it can do. and have a conversation

00:19:18.339 --> 00:19:20.500
with itself, which we know it can't do, or with

00:19:20.500 --> 00:19:24.160
another AI, it can run experiments to determine

00:19:24.160 --> 00:19:27.279
why. It can't do that, right? It's a cold start

00:19:27.279 --> 00:19:32.940
AI, we have our machine learning AI that can

00:19:32.940 --> 00:19:37.740
then change its own base model for learning and

00:19:37.740 --> 00:19:40.200
then re -evaluate a situation, exactly what we

00:19:40.200 --> 00:19:43.819
do on a day -to -day basis. And so we're forcing

00:19:43.819 --> 00:19:46.789
it to adhere to what we want. from a language

00:19:46.789 --> 00:19:48.450
point of view of, yeah, P is the next letter.

00:19:48.470 --> 00:19:50.950
But to be fair, we did the same thing, right?

00:19:51.230 --> 00:19:53.869
I before E, except after C, and a whole bunch

00:19:53.869 --> 00:19:56.470
of other weird and wonderful rules that we had

00:19:56.470 --> 00:19:59.029
to memorize back in school, right? That's literally

00:19:59.029 --> 00:20:02.069
what we're doing for AI that we had to do. And

00:20:02.069 --> 00:20:04.269
we just programmed it into our brains. That's

00:20:04.269 --> 00:20:05.809
what allows us to communicate with each other.

00:20:07.410 --> 00:20:10.349
So we're teaching AI how to communicate. We're

00:20:10.349 --> 00:20:12.609
also starting to teach it how to experiment.

00:20:14.289 --> 00:20:17.220
And the more we get into it, experiments, the

00:20:17.220 --> 00:20:19.539
more extrapolation it's going to be able to do.

00:20:21.460 --> 00:20:22.900
I can tell you now, when I was a six -year -old

00:20:22.900 --> 00:20:27.339
kid, extrapolation was pretty bad. I could hallucinate.

00:20:27.400 --> 00:20:29.940
I could do make -believe things and imagine that

00:20:29.940 --> 00:20:34.099
my Power Rangers toys were fighting the Transformers

00:20:34.099 --> 00:20:37.579
and all that other wonderful stuff. And that's

00:20:37.579 --> 00:20:39.539
imagination. That's hallucination. That's what

00:20:39.539 --> 00:20:44.339
we, Google's had their AI data. turns off, right?

00:20:44.460 --> 00:20:46.240
And we actually have a paper that came out last

00:20:46.240 --> 00:20:49.579
year that showed that giving AIs and their models

00:20:49.579 --> 00:20:52.700
of break in between will actually improve their

00:20:52.700 --> 00:20:58.119
accuracy and AIs do fatigue. Interesting. Yeah,

00:20:58.619 --> 00:21:00.900
yeah, so AIs fatigue is if you ask a complex

00:21:00.900 --> 00:21:03.539
question, just like you and I, it will get decision

00:21:03.539 --> 00:21:06.319
fatigue. And the answers get worse and worse.

00:21:06.740 --> 00:21:14.029
You need to give it a break. And so It is coming

00:21:14.029 --> 00:21:16.809
closer and closer to that singularity of being

00:21:16.809 --> 00:21:20.829
smarter than us. That's okay. Because I think

00:21:20.829 --> 00:21:24.670
it's smartness and our smartness are two different

00:21:24.670 --> 00:21:29.690
smartnesses. And together that we actually can

00:21:29.690 --> 00:21:33.069
become this newer species as a whole. I kind

00:21:33.069 --> 00:21:36.569
of equated to the old schools. Are you a Star

00:21:36.569 --> 00:21:41.450
Trek fan? No. Okay. Original series? Spock? Her?

00:21:41.740 --> 00:21:44.420
Kirk is the emotional individual who's the lead.

00:21:45.160 --> 00:21:48.940
Spock is the logical person who's the science

00:21:48.940 --> 00:21:53.200
dude. Sorry, chunky fans who listen to this.

00:21:53.380 --> 00:21:58.259
I said science dude. But the two together are

00:21:58.259 --> 00:22:02.839
better than them individually. Us and AI are

00:22:02.839 --> 00:22:05.640
better together. And if we don't go along with

00:22:05.640 --> 00:22:09.960
it, sure. But that just means that you now have

00:22:09.960 --> 00:22:12.750
a logical being. that is going to be pure logic,

00:22:13.009 --> 00:22:15.210
which is bad. And we've seen that going bad.

00:22:15.710 --> 00:22:17.829
Or you're going to have an emotional being, us,

00:22:18.849 --> 00:22:20.950
that's going to go along on their own. And that's

00:22:20.950 --> 00:22:23.329
bad too. We see that in the world today, that

00:22:23.329 --> 00:22:26.789
logic and emotions, sorry, emotions in general

00:22:26.789 --> 00:22:31.589
lead to war and hate and suffering. The two together

00:22:31.589 --> 00:22:35.150
lead to something beautiful. I think there's

00:22:35.150 --> 00:22:37.890
a full circle moment here where I'm maybe realizing

00:22:37.890 --> 00:22:40.329
all causation is infinite correlation loops.

00:22:40.859 --> 00:22:43.579
And if you're trying to figure out the why, you're

00:22:43.579 --> 00:22:47.380
just trying to break down two things that may

00:22:47.380 --> 00:22:50.759
not be linked. And you're breaking on the path,

00:22:50.819 --> 00:22:53.640
and that's just predicting probabilities along

00:22:53.640 --> 00:22:55.619
the way. I don't know if I explained that well,

00:22:55.660 --> 00:22:57.980
but I'm kind of realizing causation just might

00:22:57.980 --> 00:23:02.420
be, or the why might just be the what repeated

00:23:02.420 --> 00:23:04.660
over and over again until you get to the why.

00:23:06.599 --> 00:23:09.640
So why does a car go this speed while you break

00:23:09.640 --> 00:23:11.940
it down? you know why do the wheels turn this

00:23:11.940 --> 00:23:14.440
fast what's happening in the engine and it's

00:23:14.440 --> 00:23:17.599
just all probabilities of what's um but you know

00:23:17.599 --> 00:23:19.119
i think there's different paths to getting to

00:23:19.119 --> 00:23:21.799
understanding the universe um i'll pick correlation

00:23:21.799 --> 00:23:23.900
you'll pick causation and we'll see who gets

00:23:23.900 --> 00:23:26.900
closer um and you know you make a good point

00:23:26.900 --> 00:23:30.000
there like the y is actually just a high probability

00:23:30.000 --> 00:23:33.140
of a correlation your correlation would be 99

00:23:33.140 --> 00:23:36.180
or it could be one percent and so you have 99

00:23:36.180 --> 00:23:40.680
percent you got your y That's one percent. There's

00:23:40.680 --> 00:23:42.819
a correlation. Everything has a correlation being

00:23:42.819 --> 00:23:45.519
on this planet is a correlation. But doesn't

00:23:45.519 --> 00:23:48.220
mean that has causation. I can see what your

00:23:48.220 --> 00:23:52.599
logic is coming from. Yeah. We are both physicians

00:23:52.599 --> 00:23:55.019
in the innovation space. So, you know, maybe

00:23:55.019 --> 00:23:58.700
let's talk about health care a little bit. Do

00:23:58.700 --> 00:24:02.579
you have when do you have to go, by the way?

00:24:03.240 --> 00:24:10.039
I got to go around. I got enough. What is the

00:24:10.039 --> 00:24:13.839
path to the AI clinical position? Should physicians

00:24:13.839 --> 00:24:16.420
be scared? And then where does the opportunity

00:24:16.420 --> 00:24:19.539
lie for physicians here? Yeah, and you know,

00:24:19.599 --> 00:24:21.779
that's a great segue there, right? So you're

00:24:21.779 --> 00:24:24.460
either the clinician who doesn't use AI, definitely

00:24:24.460 --> 00:24:29.019
do that. But there's a great book called Deep

00:24:29.019 --> 00:24:31.220
Medicine by Eric Topol. I'm not sure if you've

00:24:31.220 --> 00:24:36.119
read it. 2019, if I'm not mistaken. And in the

00:24:36.119 --> 00:24:40.640
book, He talks about how, you know, in that particular

00:24:40.640 --> 00:24:44.579
year, we as a species have identified 10 ,000

00:24:44.579 --> 00:24:48.539
diseases in humans. I am not memorized all 10

00:24:48.539 --> 00:24:50.619
,000. I'm pretty sure none of the doctors have

00:24:50.619 --> 00:24:53.700
been memorized all 10 ,000. And so that's where

00:24:53.700 --> 00:24:56.799
the value of AI is. It's protecting the patients

00:24:56.799 --> 00:25:00.019
in the sense of making sure that all the rare

00:25:00.019 --> 00:25:03.339
and weird conditions are identified and ruled

00:25:03.339 --> 00:25:07.380
out. It's ensuring that communication happens

00:25:07.380 --> 00:25:11.039
in a proper way, in a standardized way. There's

00:25:11.039 --> 00:25:13.700
good enough evidence now that shows that doctors,

00:25:14.019 --> 00:25:16.019
in the beginning of the day, spend more time

00:25:16.019 --> 00:25:17.519
with their patients than the doctors at the end

00:25:17.519 --> 00:25:20.440
of the day. If a patient's performance goes over

00:25:20.440 --> 00:25:23.000
time, then you're trying to get home. You need

00:25:23.000 --> 00:25:26.299
food. You need the meeting to go to. So you're

00:25:26.299 --> 00:25:28.160
more likely to give the antibiotics at the end

00:25:28.160 --> 00:25:31.259
of the day than at the beginning of the day.

00:25:31.559 --> 00:25:34.200
And that's not hard, right? Antibiotics harm

00:25:34.200 --> 00:25:38.029
people. communication improves people's lives,

00:25:38.130 --> 00:25:39.750
not just from a social perspective, but also

00:25:39.750 --> 00:25:41.569
from an understanding and compliance perspective

00:25:41.569 --> 00:25:44.230
as well. And so when we talk about clinicians

00:25:44.230 --> 00:25:46.390
being afraid of AI, we're essentially saying

00:25:46.390 --> 00:25:50.950
clinicians are afraid of finding a solution that,

00:25:51.210 --> 00:25:54.470
one, we may not understand, but two, we're actually

00:25:54.470 --> 00:25:57.109
afraid that could be our replacement. I'd say

00:25:57.109 --> 00:26:00.150
it's never gonna be our replacement. It could

00:26:00.150 --> 00:26:01.910
be. It could be our replacement, but I don't

00:26:01.910 --> 00:26:05.829
think that's gonna happen anytime soon. it's

00:26:05.829 --> 00:26:08.670
more likely to compliment us. And in fact, probably

00:26:08.670 --> 00:26:10.829
make it, most likely it will just make your jumps

00:26:10.829 --> 00:26:13.849
really easy. So one thing that we do right now

00:26:13.849 --> 00:26:17.170
in our office is we do our AI scribe. I've been

00:26:17.170 --> 00:26:19.890
doing it for about a year now. It builds my notes.

00:26:20.470 --> 00:26:23.890
And I've had three patients say, I like that

00:26:23.890 --> 00:26:26.210
note I wrote. Can you just email that to me so

00:26:26.210 --> 00:26:30.710
I can review it at home? Absolutely. Right? One

00:26:30.710 --> 00:26:33.210
patient hand out on some hip flexor stretches.

00:26:33.969 --> 00:26:37.470
great, go online, do a deep research on gen GPT,

00:26:37.789 --> 00:26:39.490
say I need some hip flexors, definitely check

00:26:39.490 --> 00:26:42.049
it, make sure it's correct, and then send it

00:26:42.049 --> 00:26:45.430
off to the patient, right? So instead of me having

00:26:45.430 --> 00:26:47.670
to spend the time with the patient, which I'd

00:26:47.670 --> 00:26:49.150
love to do, don't get me wrong, but there's only

00:26:49.150 --> 00:26:51.470
so much of my time that I have for my patients,

00:26:52.849 --> 00:26:56.170
for my patient who might have an amputation that

00:26:56.170 --> 00:26:58.970
I need to modify those stretches, they're getting

00:26:58.970 --> 00:27:03.019
a better quality of care. And overall, patients

00:27:03.019 --> 00:27:05.660
and community are healthier. So actually by not

00:27:05.660 --> 00:27:08.420
using AI, you're doing a disservice to your community.

00:27:09.599 --> 00:27:11.660
I think we need to start showing that ROI is

00:27:11.660 --> 00:27:13.440
back to the patient and to the clinicians. And

00:27:13.440 --> 00:27:15.059
we're seeing that, right? So AI scribes have

00:27:15.059 --> 00:27:17.539
gone from last year of 5 % market penetration.

00:27:18.500 --> 00:27:21.400
Last I heard in the Waterloo region, they said

00:27:21.400 --> 00:27:29.150
about 20%. So we've gone past the cancel. That's

00:27:29.150 --> 00:27:31.410
still low. I would think it would be more. There's

00:27:31.410 --> 00:27:33.069
a lot of physicians I know, and maybe I just

00:27:33.069 --> 00:27:37.470
have a different collection of friends here.

00:27:37.829 --> 00:27:39.910
Yeah, we have innovative friends, right? So within

00:27:39.910 --> 00:27:42.849
our circle, yeah, absolutely. They all use it.

00:27:43.730 --> 00:27:45.569
But it's the circle that we're not a part of.

00:27:46.369 --> 00:27:50.069
So if you think of our innovation curve, our

00:27:50.069 --> 00:27:52.970
innovators make up that first 5 -ish percent.

00:27:52.990 --> 00:27:55.150
We have the early adopters that push us to about

00:27:55.150 --> 00:27:58.230
that 9 % to 11%. then jump that chasm. We've

00:27:58.230 --> 00:28:00.390
jumped that chasm now. We're at the 20 percent.

00:28:00.430 --> 00:28:02.529
We're going to see a rapid uptake right now until

00:28:02.529 --> 00:28:06.410
we hit about 50 percent. It'll slow down eventually

00:28:06.410 --> 00:28:08.630
and we will never reach the last five percent.

00:28:08.630 --> 00:28:13.029
That's okay. They're either going to be retiring

00:28:13.029 --> 00:28:17.210
soon or they're going to miss the boat. When

00:28:17.210 --> 00:28:25.130
do you think the completely autonomous AI physician

00:28:25.130 --> 00:28:29.380
is happening Brian Marie Care. Ah, interesting.

00:28:29.500 --> 00:28:33.339
Cool. So I just came to talk about this in Sarnia,

00:28:33.480 --> 00:28:39.660
actually, two days ago. We need to stop thinking

00:28:39.660 --> 00:28:47.720
about this as us as doing one thing. We do, in

00:28:47.720 --> 00:28:50.640
the sense that we ask questions, we find a pattern,

00:28:50.759 --> 00:28:53.420
diagnose this probability and correlation. That's

00:28:53.420 --> 00:28:58.150
what you said. We test that theory with our physical

00:28:58.150 --> 00:29:03.890
exam, our labs imaging, things we do, and then

00:29:03.890 --> 00:29:06.390
we go ahead and treat. And then we do a self

00:29:06.390 --> 00:29:08.250
-reflection saying, cool, did we do it well?

00:29:08.269 --> 00:29:09.890
Did we not? What did we miss? All that other

00:29:09.890 --> 00:29:11.109
stuff. We're getting better and better over the

00:29:11.109 --> 00:29:14.690
years. But we think it's this large continent.

00:29:14.869 --> 00:29:18.130
In fact, it's actually, we are a combination

00:29:18.130 --> 00:29:21.490
of different machine learning algorithms. We

00:29:21.490 --> 00:29:26.289
have our structured algorithm. We have our shortness

00:29:26.289 --> 00:29:29.029
of breath algorithm. We have our whatever else

00:29:29.029 --> 00:29:31.130
algorithm. Algorithms feed into other algorithms.

00:29:31.950 --> 00:29:34.250
And what we're probably gonna start seeing is

00:29:34.250 --> 00:29:39.730
an AI for cough, an AI for heart failure or shortness

00:29:39.730 --> 00:29:43.130
of breath, an AI for anemia. And what it's gonna

00:29:43.130 --> 00:29:45.089
start doing, it's gonna start branching off and

00:29:45.089 --> 00:29:50.230
taking off little chunks of our job. And it's

00:29:50.230 --> 00:29:53.349
a good thing and a bad thing. One, it helps to,

00:29:53.470 --> 00:29:55.750
scalable, which means more people have access

00:29:55.750 --> 00:29:59.509
to care. It democratizes health care. One of

00:29:59.509 --> 00:30:02.009
my whys, going back to what our car was fishing

00:30:02.009 --> 00:30:06.650
about an hour and 15 minutes ago, my why in life

00:30:06.650 --> 00:30:10.769
is universal health care for everyone no matter

00:30:10.769 --> 00:30:16.150
what. And if that means I lose my job, OK, because

00:30:16.150 --> 00:30:19.579
I need to make sure that I do no harm. And if

00:30:19.579 --> 00:30:22.380
the AI can give you the care you need at home,

00:30:22.400 --> 00:30:24.019
so you don't have to take time off work as a

00:30:24.019 --> 00:30:25.539
single parent or a person who has to work multiple

00:30:25.539 --> 00:30:27.920
jobs, that you have to decide between paying

00:30:27.920 --> 00:30:30.259
for food or rent and seeing me in my office,

00:30:30.259 --> 00:30:33.440
by all means, go use it at home. That's the most

00:30:33.440 --> 00:30:38.619
important thing, not my job. And so it will start

00:30:38.619 --> 00:30:41.000
picking up chunks off of my job. And we're going

00:30:41.000 --> 00:30:43.880
to have to, we're going to be forced to as clinicians

00:30:43.880 --> 00:30:48.299
to reinvent what our value proposition is. So

00:30:48.299 --> 00:30:50.579
we're not going to lose our jobs, but our value

00:30:50.579 --> 00:30:53.980
proposition is going to change. My value is no

00:30:53.980 --> 00:30:56.599
longer going to be like that prescription. And

00:30:56.599 --> 00:30:58.500
that's the debate we're having right now in Ontario

00:30:58.500 --> 00:31:02.819
where we're seeing other professionals doing

00:31:02.819 --> 00:31:06.519
things that we used to do, whether it's going

00:31:06.519 --> 00:31:08.779
to the pharmacy and getting a prescription for

00:31:08.779 --> 00:31:11.180
some basic things that it's seeing a nurse practitioner,

00:31:11.359 --> 00:31:14.160
whether it's seeing a midwife, whatever it is.

00:31:14.940 --> 00:31:18.519
And so we're seeing that as hey, is this something

00:31:18.519 --> 00:31:21.359
I used to do and now somebody else can do it

00:31:21.359 --> 00:31:22.940
and they're not going to say professionalism?

00:31:24.099 --> 00:31:26.779
We're probably going to see AI jump into that

00:31:26.779 --> 00:31:29.460
circle as well. We're probably going to start

00:31:29.460 --> 00:31:32.079
seeing it actually tackling some of these conditions

00:31:32.079 --> 00:31:35.519
that were delegated or that other professions

00:31:35.519 --> 00:31:38.480
have. I'd argue that the first sign that AI is

00:31:38.480 --> 00:31:40.500
coming after or is going to change our value

00:31:40.500 --> 00:31:42.640
prop is when it actually starts sticking on those

00:31:42.640 --> 00:31:46.380
17 conditions that pharmacists can give medications

00:31:46.380 --> 00:31:50.210
for. patients perceive this and know it's an

00:31:50.210 --> 00:31:56.009
algorithm that pharmacists have. Patients also

00:31:56.009 --> 00:31:59.829
are untrusted computers more than humans. We

00:31:59.829 --> 00:32:01.869
did a study in my office with the Canadian Mental

00:32:01.869 --> 00:32:06.730
Health Association on the use of tablets to screen

00:32:06.730 --> 00:32:09.529
for mental health conditions, depression, anxiety.

00:32:10.769 --> 00:32:14.559
And in this feedback form, the... The reason

00:32:14.559 --> 00:32:17.599
why people were more truthful on their tablets

00:32:17.599 --> 00:32:21.279
than talking to me was because, and I don't make

00:32:21.279 --> 00:32:23.700
you feel bad about the first anxiety, I recognize

00:32:23.700 --> 00:32:26.259
that as a condition, my patients know that, we

00:32:26.259 --> 00:32:31.420
have a great relationship, is that the perception

00:32:31.420 --> 00:32:35.740
that humans judge and the perception that computers

00:32:35.740 --> 00:32:38.700
are unbiased, we know AI is biased based on training

00:32:38.700 --> 00:32:40.160
data, but we're getting better at recognizing

00:32:40.160 --> 00:32:45.200
that. And so if our AI is unbiased, repeatable,

00:32:46.319 --> 00:32:49.839
can go beyond just the certain conditions, and

00:32:49.839 --> 00:32:52.019
I can still get the same service, well, I'm going

00:32:52.019 --> 00:32:54.599
to use the AI over by pharmacists to get my eye

00:32:54.599 --> 00:32:57.240
drops for my allergies, or to get my treatment

00:32:57.240 --> 00:33:00.480
for urinary tract infection. And that's probably

00:33:00.480 --> 00:33:02.359
going to scale up really quickly. So we're going

00:33:02.359 --> 00:33:04.240
to start seeing the pharmacist losing that volume.

00:33:06.440 --> 00:33:08.900
targeting us as well as clinicians. We're going

00:33:08.900 --> 00:33:12.339
to start seeing that volume drop as well. And

00:33:12.339 --> 00:33:15.640
we're going to start seeing just segments of

00:33:15.640 --> 00:33:19.059
our profession go away. What the AI is probably

00:33:19.059 --> 00:33:21.319
going to do that's going to be better than us

00:33:21.319 --> 00:33:22.960
is when they start taking all those different

00:33:22.960 --> 00:33:27.019
conditions, you build an orchestra of it. And

00:33:27.019 --> 00:33:30.420
that's your injected AI. And you correlate that

00:33:30.420 --> 00:33:33.539
runny nose and the itchy eyes together. You and

00:33:33.539 --> 00:33:37.220
I do that all the time. Allergies. But can the

00:33:37.220 --> 00:33:39.400
AI do that? The moment it can start correlating

00:33:39.400 --> 00:33:42.680
between them, that's when we start seeing our

00:33:42.680 --> 00:33:44.779
jobs being replaced completely. And we've got

00:33:44.779 --> 00:33:48.200
to change our value problem again. If I'm a founder

00:33:48.200 --> 00:33:50.920
building in the spaces, say that I'm building

00:33:50.920 --> 00:33:56.220
an AI diagnosis and prescription model algorithm

00:33:56.220 --> 00:34:01.059
for UTIs for bladder infections. What piece of

00:34:01.059 --> 00:34:03.940
advice do you have for me? And what do you what

00:34:03.940 --> 00:34:08.099
data do I need to present to the CPSO? For them

00:34:08.099 --> 00:34:10.820
to say, okay, I feel comfortable giving this

00:34:10.820 --> 00:34:16.579
AI a license to prescribe macrobate or UTIs because

00:34:16.579 --> 00:34:19.559
that you know once and this is already happening

00:34:19.559 --> 00:34:22.900
in the state there's a bill proposed and there

00:34:22.900 --> 00:34:26.860
are medical boards and They're open to looking

00:34:26.860 --> 00:34:31.480
at solutions and giving them a license to prescribe

00:34:31.480 --> 00:34:34.739
a medication. What are your thoughts here? What

00:34:34.739 --> 00:34:36.400
piece of advice do you have for founders? And

00:34:36.400 --> 00:34:39.000
then how should I be positioning myself to the

00:34:39.000 --> 00:34:42.019
college or the medical boards in the US for them

00:34:42.019 --> 00:34:44.760
to say, OK, I have to give this person a license

00:34:44.760 --> 00:34:47.860
because of the amount of lives you'll save or

00:34:47.860 --> 00:34:50.659
the decreased wait time or the and you know,

00:34:50.659 --> 00:34:52.760
the physicians will fight this. I think we both

00:34:52.760 --> 00:34:56.539
know that. What advice do you have for this founder?

00:34:58.820 --> 00:35:02.500
Because we hold technology to a higher standard

00:35:02.500 --> 00:35:06.679
than we hold humans, right? So let's take my

00:35:06.679 --> 00:35:08.539
stethoscope. Me and my stethoscope are about

00:35:08.539 --> 00:35:14.400
60 % accurate, right? Maybe 50 % to me. But we're

00:35:14.400 --> 00:35:19.539
not 100%. But the perception is that we're 100%.

00:35:19.539 --> 00:35:22.599
Or maybe, or it's not even 100%. Patients know

00:35:22.599 --> 00:35:24.400
that we're not perfect. And so maybe the perceptions

00:35:24.400 --> 00:35:29.099
are we're 70 or 80 % right. Right, I know. I'll

00:35:29.099 --> 00:35:30.519
just say one thing. This is very interesting

00:35:30.519 --> 00:35:33.820
because for pneumonia, the best and I did a presentation

00:35:33.820 --> 00:35:36.179
on physical exam finding, sensitivity, specificities

00:35:36.179 --> 00:35:39.880
and residency. The most accurate physical exam

00:35:39.880 --> 00:35:42.539
findings in pneumonia is a gopherny and tactile

00:35:42.539 --> 00:35:45.559
fremitas. It's not the stethoscope, but we still

00:35:45.559 --> 00:35:47.679
use stethoscopes. That's very interesting. We

00:35:47.679 --> 00:35:50.400
use that even though we know that that is not

00:35:50.400 --> 00:35:52.949
the most accurate. That's all right. I actually

00:35:52.949 --> 00:35:55.809
use, I use a Gopinia anticoagulant on all my

00:35:55.809 --> 00:36:02.789
patients. It works, man. It works. So I volunteer

00:36:02.789 --> 00:36:05.869
in Tanzania. I don't have x -rays there, right?

00:36:06.090 --> 00:36:08.929
I'm doing that, right? I'm identifying potential

00:36:08.929 --> 00:36:14.309
tuberculosis and bacterial pneumonia for an island

00:36:14.309 --> 00:36:16.489
of like, you know, this population of Kishore

00:36:16.489 --> 00:36:18.829
-Warelu is like 400 ,000 people on that island.

00:36:19.110 --> 00:36:22.369
And they have one x -ray machine. Right. And

00:36:22.369 --> 00:36:24.369
I'm pretty sure the dose of radiation would get

00:36:24.369 --> 00:36:28.269
off that thing is higher than the CT scan. So

00:36:28.269 --> 00:36:30.050
I feel like I'm really reluctant to my patients

00:36:30.050 --> 00:36:32.469
off that because it's not their fault, right?

00:36:32.510 --> 00:36:36.809
It's just older technology and we work in a capitalistic

00:36:36.809 --> 00:36:39.369
world right now. For the non -physicians, could

00:36:39.369 --> 00:36:41.630
you explain what a Goffini -intactile pharmacist

00:36:41.630 --> 00:36:43.449
does? Because I realize they might not. Absolutely.

00:36:44.329 --> 00:36:47.010
No, that's a good point. Yeah. So I love this

00:36:47.010 --> 00:36:49.010
topic because it has everything to do with physics

00:36:49.010 --> 00:36:53.039
and nothing to do with medicine. So sound travels

00:36:53.039 --> 00:36:56.860
further in liquids versus airs. That's why whale

00:36:56.860 --> 00:37:01.320
sounds can travel kilometers through the ocean,

00:37:02.019 --> 00:37:05.300
hundreds of kilometers, and sound travels through

00:37:05.300 --> 00:37:11.059
walls and solids better than liquids. So your

00:37:11.059 --> 00:37:14.960
lungs are filled with air, my apologies, and

00:37:14.960 --> 00:37:17.119
when you get the pneumonia, you get swelling.

00:37:17.360 --> 00:37:19.199
Just think how if you hit your elbow and get

00:37:19.199 --> 00:37:22.079
swelling, you get fluid buildup. So your lungs

00:37:22.079 --> 00:37:24.300
decay with the bacterial infection, your body

00:37:24.300 --> 00:37:26.719
starts to fight it, it swells up, you get liquid

00:37:26.719 --> 00:37:27.940
in it, and that's why it gets harder and harder

00:37:27.940 --> 00:37:29.960
to breathe because the air and oxygen can't get

00:37:29.960 --> 00:37:37.420
through. And so the sound of the letter B in

00:37:37.420 --> 00:37:41.099
air changes to bay. And so when you're putting

00:37:41.099 --> 00:37:42.619
the census scope on it, you get the person to

00:37:42.619 --> 00:37:45.519
whisper B. And it's not a full whisper, it's

00:37:45.519 --> 00:37:49.130
just a soft tone. There's a sweet spot. You should

00:37:49.130 --> 00:37:51.550
hear bay, and anyone can do this at home. Roll

00:37:51.550 --> 00:37:53.730
up a piece of paper, put one side against your

00:37:53.730 --> 00:37:56.150
ear, put the other side against somebody else's

00:37:56.150 --> 00:37:59.210
back, and tell them to whisper B. And if they're

00:37:59.210 --> 00:38:02.329
not sick, you should hear bay, bay, bay, bay,

00:38:02.329 --> 00:38:04.849
bay. And it's different from listening on a stethoscope,

00:38:05.030 --> 00:38:06.889
where you go, we call it the Christmas tree model,

00:38:06.949 --> 00:38:08.530
where you listen one side to the other, you compare

00:38:08.530 --> 00:38:11.329
in contrast, compare in contrast. With Agaphani,

00:38:11.369 --> 00:38:14.690
you go down. And so you do two long, sweeping

00:38:14.690 --> 00:38:18.309
lines of address. as we go bay bay bay bay bay

00:38:18.309 --> 00:38:22.789
but if you hear B then usually that means sounds

00:38:22.789 --> 00:38:25.989
are transmitted way better which means there's

00:38:25.989 --> 00:38:29.769
a consolidation now that consolidation just tells

00:38:29.769 --> 00:38:32.449
us the consolidation liquid is in there that

00:38:32.449 --> 00:38:35.110
could be heart failure that could be pneumonia

00:38:35.110 --> 00:38:39.570
that could be cancer and but the accuracy on

00:38:39.570 --> 00:38:42.170
cancer is really poor so i wouldn't i wouldn't

00:38:46.400 --> 00:38:49.780
Um, the second one is, uh, vibrations, right?

00:38:49.900 --> 00:38:52.139
The sounds of vibrations. The tactile, Fremidus

00:38:52.139 --> 00:38:53.699
is exactly what it sounds like. Tactile, you

00:38:53.699 --> 00:38:55.599
put your hands on the chest, and it can be through

00:38:55.599 --> 00:38:59.460
clothing, it has to be on the chest. And Fremidus,

00:38:59.460 --> 00:39:01.239
I don't know what the Latin etymology of that

00:39:01.239 --> 00:39:04.300
one is, but, uh, it is, you put your hands on

00:39:04.300 --> 00:39:06.199
it, and you can actually feel the vibrations

00:39:06.199 --> 00:39:08.099
on the sides of your hands. You gotta make sure

00:39:08.099 --> 00:39:10.699
you put it between the ribs, because the bones

00:39:10.699 --> 00:39:12.800
get in the way of the conduction. You can actually

00:39:12.800 --> 00:39:15.340
feel the vibrations, uh, through your hands.

00:39:15.940 --> 00:39:19.380
So two really cool and very accurate ways of

00:39:19.380 --> 00:39:21.880
diagnosing pneumonia and the old school way back

00:39:21.880 --> 00:39:24.880
before we even had x -rays. That's how the house

00:39:24.880 --> 00:39:27.239
call or how the doctor used to diagnose people.

00:39:28.739 --> 00:39:32.699
But yeah. Yeah, that's what I can put in the

00:39:32.699 --> 00:39:34.199
technical part is what was the question that

00:39:34.199 --> 00:39:36.519
we were trying to answer before? The question,

00:39:36.800 --> 00:39:40.179
you know, it was no, I apologize because I asked

00:39:40.179 --> 00:39:44.610
you. It was what advice do you have for founders

00:39:44.610 --> 00:39:47.869
who are trying to get a medical license for a

00:39:47.869 --> 00:39:50.969
solution to focus on the example I use with cystitis,

00:39:51.030 --> 00:39:54.429
but any one of these conditions? So imagine if

00:39:54.429 --> 00:39:57.570
I fell asleep in a lecture at a med school, and

00:39:57.570 --> 00:40:00.989
I'm really, really bad at the subject. The most

00:40:00.989 --> 00:40:06.309
damage I could ever do to a society is just the,

00:40:06.309 --> 00:40:08.630
you know, 1 ,500 patients that are in my practice.

00:40:09.670 --> 00:40:12.730
I don't have that high of a reach. Therefore,

00:40:12.989 --> 00:40:15.829
the damage to our society is a lot less. You

00:40:15.829 --> 00:40:20.889
give that to an AI and scalable, even if it makes

00:40:20.889 --> 00:40:25.130
a 1 % mistake, the impact and damage it can do

00:40:25.130 --> 00:40:30.369
will be far more than what I could do. And so

00:40:30.369 --> 00:40:34.389
the need to fix hallucinations is incredibly

00:40:34.389 --> 00:40:36.070
important. And I know there was a debate at one

00:40:36.070 --> 00:40:39.570
point saying, no, it's better than humans. No,

00:40:39.750 --> 00:40:42.650
no, no. When it comes to human health, and we

00:40:42.650 --> 00:40:44.929
do see ourselves as the dominant species on this

00:40:44.929 --> 00:40:51.389
planet, losing a person's life is bad, and we

00:40:51.389 --> 00:40:53.130
need to make sure we don't do that. And there's

00:40:53.130 --> 00:40:55.630
levels, right? Like, is this as bad as, hey,

00:40:55.750 --> 00:40:58.150
you bruised a finger, but what if that bruise

00:40:58.150 --> 00:40:59.929
isn't a bruise and it's actually a lymphoma?

00:41:01.369 --> 00:41:03.510
I just went to a dermatology conference. You

00:41:03.510 --> 00:41:07.530
saw lymphoma? Shows up as cutaneous. I can take

00:41:07.530 --> 00:41:09.550
a manifestation of that, right? That is something

00:41:09.550 --> 00:41:12.429
that we get wrong all the time as clinicians.

00:41:13.010 --> 00:41:14.730
And I hope AI can do it better than us. But what

00:41:14.730 --> 00:41:16.750
if that gets it wrong? What if the training data's

00:41:16.750 --> 00:41:19.110
off? And all that other stuff. So number one

00:41:19.110 --> 00:41:22.210
thing, you will never get a clinician who wants

00:41:22.210 --> 00:41:25.570
an autonomous on -zone AI. So number two is how

00:41:25.570 --> 00:41:27.369
do you bring the human into a loop? Because we

00:41:27.369 --> 00:41:29.449
need to make sure that that helps. And number

00:41:29.449 --> 00:41:30.889
three is how do you make sure that human does

00:41:30.889 --> 00:41:33.989
become complacent and just says, cool, the AI

00:41:33.989 --> 00:41:36.030
is right all the time. I'm going to just start

00:41:36.030 --> 00:41:37.949
saying, yes, yes, yes, yes, yes. What we actually

00:41:37.949 --> 00:41:41.900
need to do is. is get it to start throwing mistakes

00:41:41.900 --> 00:41:45.039
at us, that the AI know is a mistake, that keeps

00:41:45.039 --> 00:41:48.199
us on edge. So those are your big three. And

00:41:48.199 --> 00:41:50.019
knowing that when you submit for that application

00:41:50.019 --> 00:41:53.659
to Health Canada, that you save that. It's a

00:41:53.659 --> 00:41:55.579
novel idea, it's a new way of doing it, but actually

00:41:55.579 --> 00:41:58.239
it helps to build complacency, or prevent complacency.

00:41:59.059 --> 00:42:01.780
So number two then is, how do you, even if you've

00:42:01.780 --> 00:42:04.519
been in the loop, will ensure that humans don't

00:42:04.519 --> 00:42:06.239
feel like they're being replaced, and getting

00:42:06.239 --> 00:42:08.409
that, and then the... that actually leads to

00:42:08.409 --> 00:42:10.769
a medical directive. And so I don't actually

00:42:10.769 --> 00:42:12.849
look at this in terms of medical directives.

00:42:13.110 --> 00:42:16.590
The probability of a bill being passed, while

00:42:16.590 --> 00:42:19.170
it's being put in place for the Congress in the

00:42:19.170 --> 00:42:21.309
United States, I don't think it's passed there

00:42:21.309 --> 00:42:23.570
yet. And in Canada, it hasn't been put in place

00:42:23.570 --> 00:42:25.929
for it. We're still fighting interoperability.

00:42:26.130 --> 00:42:27.909
We don't have the equivalent of the Cures Act

00:42:27.909 --> 00:42:30.010
up here in Canada, unfortunately. We should,

00:42:30.190 --> 00:42:32.170
and it's kind of sad that we don't at this stage.

00:42:33.110 --> 00:42:37.090
But we need that. And so we got to start with

00:42:37.090 --> 00:42:39.500
medical directives. And that's something I've

00:42:39.500 --> 00:42:41.179
already looked into. And we're looking into doing

00:42:41.179 --> 00:42:43.199
medical directives for just putting a lot of

00:42:43.199 --> 00:42:46.239
algorithms in my clinic at this stage. And so

00:42:46.239 --> 00:42:49.380
by doing so, that's the first step. And if we

00:42:49.380 --> 00:42:52.699
show the value of that, and the scalability of

00:42:52.699 --> 00:42:54.300
that, and the life saved with that, just like

00:42:54.300 --> 00:42:56.480
what you said there, Rashad, then we can start

00:42:56.480 --> 00:42:58.219
saying, hey, what's the next step? How do we

00:42:58.219 --> 00:42:59.980
become autonomous? How do we help with the unattached

00:42:59.980 --> 00:43:02.300
patients? How do we ensure that we don't burn

00:43:02.300 --> 00:43:04.599
out our clinicians who are taking on more unattached

00:43:04.599 --> 00:43:07.519
patients? If you have clinicians in the loop,

00:43:07.659 --> 00:43:10.079
you have to pay them. And I think most clinicians

00:43:10.079 --> 00:43:13.360
are something that is completely automated. They

00:43:13.360 --> 00:43:17.019
would do it for $25 a pop if it takes a couple

00:43:17.019 --> 00:43:21.079
of minutes. But then you're increasing the cost

00:43:21.079 --> 00:43:24.079
of this solution, although still better than

00:43:24.079 --> 00:43:29.400
in person, because that's $37. Yeah, so I can

00:43:29.400 --> 00:43:35.389
see. I think that's a model that can scale. The

00:43:35.389 --> 00:43:36.670
other way of looking at this is if you're in

00:43:36.670 --> 00:43:39.869
a capitation model is the more patients you roster,

00:43:40.769 --> 00:43:44.110
the more money you can make as well. And so if

00:43:44.110 --> 00:43:49.289
you do a blood and capitation model, the more

00:43:49.289 --> 00:43:51.489
availability you have, the more likely you are,

00:43:51.650 --> 00:43:55.369
the more ability you have to actually attach

00:43:55.369 --> 00:43:59.050
more patients to. What tech are you currently

00:43:59.050 --> 00:44:02.489
using in clinical practice? Oh, yeah, that's

00:44:02.489 --> 00:44:08.639
a great question. the simple things, right? Like

00:44:08.639 --> 00:44:10.679
it's the stuff that has existed in every other

00:44:10.679 --> 00:44:13.320
industry except medicine for the longest time.

00:44:13.400 --> 00:44:15.719
We truly are one of the slowest industries to

00:44:15.719 --> 00:44:19.619
take on new tech. Voice over IT, right? Having

00:44:19.619 --> 00:44:23.900
a tree chain in our voice system allows us to

00:44:23.900 --> 00:44:26.960
actually help to navigate and coordinate patients.

00:44:27.800 --> 00:44:29.940
We use it, it's not technology. We actually use

00:44:29.940 --> 00:44:32.420
a call center for our phone calls for our patients.

00:44:32.840 --> 00:44:36.409
Makes it super easy in terms of... make sure

00:44:36.409 --> 00:44:40.130
that we have constant accessibility to our schedule

00:44:40.130 --> 00:44:42.710
for that patient, and for them to feel like they're

00:44:42.710 --> 00:44:46.750
getting cared for. Now, as anything, and I make

00:44:46.750 --> 00:44:52.210
this joke in regards to our emergency room wait

00:44:52.210 --> 00:44:54.690
times, if you make it more available, if you

00:44:54.690 --> 00:44:57.989
drop that call, the wait time on your call system,

00:44:58.429 --> 00:45:00.449
the volume will increase naturally. Because if

00:45:00.449 --> 00:45:03.150
you know it's easy to get a phone call in, you'll

00:45:03.150 --> 00:45:06.460
naturally just get more phone calls. It's an

00:45:06.460 --> 00:45:11.719
orborous, the state that needs itself. And so

00:45:11.719 --> 00:45:16.639
we're now looking at, okay, can we introduce,

00:45:16.719 --> 00:45:19.579
like almost like a Google Duo before it even

00:45:19.579 --> 00:45:23.699
hits our call center that then actually can answer

00:45:23.699 --> 00:45:26.400
basic questions. And we're trying to figure out

00:45:26.400 --> 00:45:28.940
how to solve this hallucination problem as well.

00:45:30.400 --> 00:45:34.429
Where does AI fit into this? Is it just? is an

00:45:34.429 --> 00:45:37.590
entire tree algorithm, and we just make it that

00:45:37.590 --> 00:45:39.750
easy, and then hit zero, you'll get a human,

00:45:39.909 --> 00:45:41.630
but you put across your answer through another

00:45:41.630 --> 00:45:44.690
way, or is there a different way? So we're experimenting

00:45:44.690 --> 00:45:47.730
with different AI algorithms on creating a phone

00:45:47.730 --> 00:45:52.409
tree that's adaptable. We're looking at, so that's

00:45:52.409 --> 00:45:54.250
option number one, and that's super cool. That

00:45:54.250 --> 00:45:55.869
one actually exists. There's a company called,

00:45:57.329 --> 00:45:58.989
there's a company I just spoke with, they're

00:45:58.989 --> 00:46:01.630
called Strelo. Strelo AI, they're out of Hamilton.

00:46:02.400 --> 00:46:06.940
And they actually have an AI secretary for your

00:46:06.940 --> 00:46:08.579
phone. So a couple of clinics actually already

00:46:08.579 --> 00:46:12.860
use them. Highly recommend trying it out. We're

00:46:12.860 --> 00:46:15.059
still doing our impact on that and trying to

00:46:15.059 --> 00:46:18.260
figure that out. The next one that we're using

00:46:18.260 --> 00:46:21.440
here is online appointment booking. So in order

00:46:21.440 --> 00:46:23.659
to reduce the volume of appointments online and

00:46:23.659 --> 00:46:25.559
for folks like you and I where we're just busy

00:46:25.559 --> 00:46:27.059
and I'm not going to stand on the phone saying,

00:46:27.659 --> 00:46:30.380
well, what about May 6th? What about May 7th?

00:46:30.400 --> 00:46:32.360
What about May 8th? No, I just want to look at

00:46:32.360 --> 00:46:36.260
your calendar and book it. And so that one was

00:46:36.260 --> 00:46:38.699
interesting because when we launched that in

00:46:38.699 --> 00:46:40.519
the Kishore -Warelu area, there were different

00:46:40.519 --> 00:46:43.679
clinicians with different hesitancies with using

00:46:43.679 --> 00:46:47.059
all -independent booking. No, I'm not a massage

00:46:47.059 --> 00:46:51.139
therapist. I'm not a manicurist. You need to

00:46:51.139 --> 00:46:54.440
be triaged. And I'm like, actually, to be fair,

00:46:54.480 --> 00:46:56.440
I don't need to triage my diabetic visits. I

00:46:56.440 --> 00:46:59.000
don't need to triage my hypertension visits.

00:47:00.280 --> 00:47:03.420
What I need to triage is if it's urgent. And

00:47:03.420 --> 00:47:05.619
right now, those urgent patients can't get through

00:47:05.619 --> 00:47:09.340
my phone lines. So I need to get all my non -urgent

00:47:09.340 --> 00:47:11.860
phone lines so that my urgent patients can get

00:47:11.860 --> 00:47:15.960
onto the phones. And in order to do that, there's

00:47:15.960 --> 00:47:21.380
a concept of where can you find the easiest solution

00:47:21.380 --> 00:47:23.500
as quickly as possible. It's not a concept, it's

00:47:23.500 --> 00:47:27.320
just common sense. If you log on to your doctor's

00:47:27.320 --> 00:47:29.639
portal, and the next available appointment's

00:47:29.639 --> 00:47:31.679
a month out, and you get angry. You're like,

00:47:31.780 --> 00:47:33.800
how could this doctor do this to me? Blah, blah,

00:47:33.840 --> 00:47:36.739
blah. And you call, and the secretary says, yeah,

00:47:36.739 --> 00:47:39.760
I can book you in in three days. Why would that

00:47:39.760 --> 00:47:41.800
patient ever go back to your online appointment

00:47:41.800 --> 00:47:44.699
booking platform if they knew they had an option

00:47:44.699 --> 00:47:47.239
for a non -urgent appointment to get it done

00:47:47.239 --> 00:47:51.340
in three days? Versus, if I threw 90 % of my

00:47:51.340 --> 00:47:54.880
appointments online, and you go online, and you're

00:47:54.880 --> 00:47:58.119
offered an appointment in two weeks, and you

00:47:58.119 --> 00:48:00.760
call into my office and you're offered two weeks,

00:48:00.960 --> 00:48:04.340
nothing changes. Then one, that patient's gonna

00:48:04.340 --> 00:48:07.860
be angry because it's two weeks, because expectations

00:48:07.860 --> 00:48:09.840
are perceived for that, expectations will always

00:48:09.840 --> 00:48:13.300
be a challenge. But two, next time they need

00:48:13.300 --> 00:48:14.800
another appointment, they know that what they're

00:48:14.800 --> 00:48:16.380
gonna get online is gonna be exactly what they

00:48:16.380 --> 00:48:18.679
get on the phone. The only exception there is

00:48:18.679 --> 00:48:20.039
that we throw this on our online appointment

00:48:20.039 --> 00:48:24.780
booking that acute issues, not emergency, just

00:48:24.780 --> 00:48:28.880
acute issues call. But if you call expecting

00:48:28.880 --> 00:48:30.579
the same day appointment for a non -urgent thing,

00:48:30.659 --> 00:48:32.079
we're just going to give you the two week appointment,

00:48:32.500 --> 00:48:35.280
not the same day one. So that's the second piece

00:48:35.280 --> 00:48:39.460
of technology we use. Third piece of technology

00:48:39.460 --> 00:48:42.460
we use is PrescribeIt. It's a product that comes

00:48:42.460 --> 00:48:45.940
out of Canada Health InfoWave. It allows for

00:48:45.940 --> 00:48:47.659
two -way communication between pharmacists and

00:48:47.659 --> 00:48:50.860
primary care providers or clinicians in general

00:48:50.860 --> 00:48:53.119
because there's sometimes questions. Sometimes

00:48:53.119 --> 00:48:55.539
patients ask questions. Sometimes my prescriptions

00:48:55.869 --> 00:48:58.010
don't make sense or we need to make sure that,

00:48:58.010 --> 00:48:59.650
you know, the insurance companies will pay for

00:48:59.650 --> 00:49:02.210
it. And essentially, the fact is back and forth,

00:49:02.210 --> 00:49:05.269
which requires a fax to come in, my friends have

00:49:05.269 --> 00:49:07.449
to read it, identify the patient, put it into

00:49:07.449 --> 00:49:09.250
the right file for me to read it afterwards.

00:49:09.550 --> 00:49:11.809
This just goes directly to that patient's chart

00:49:11.809 --> 00:49:14.130
and messages the most responsible clinician.

00:49:15.750 --> 00:49:19.130
And so prescribing has reduced the turnaround

00:49:19.130 --> 00:49:20.929
time for our patients getting their medications,

00:49:21.150 --> 00:49:27.179
which increases their compliance. and improves,

00:49:29.480 --> 00:49:31.800
sorry, it decreases fax failures. Faxes fail

00:49:31.800 --> 00:49:38.119
all the time. It's a pain. Third technology we

00:49:38.119 --> 00:49:40.559
use, AI Scribe. I've been doing that for about

00:49:40.559 --> 00:49:43.179
a year. I actually used AI Scribe as part of

00:49:43.179 --> 00:49:46.300
my capstone project for one of my courses in

00:49:46.300 --> 00:49:49.500
my MBA, my executive MBA program. Back then,

00:49:49.500 --> 00:49:51.360
about a year ago, I only used it like that to

00:49:51.360 --> 00:49:53.539
host visits. I did that primarily because I wanted

00:49:53.539 --> 00:49:55.760
to make sure I had eye -to -eye contact. patients.

00:49:56.300 --> 00:49:58.679
I didn't want to have half by my heavy -inch

00:49:58.679 --> 00:50:02.639
and drop notes into a computer system. I am fortunate

00:50:02.639 --> 00:50:04.400
I can type and look at you at the same time,

00:50:04.400 --> 00:50:07.440
but it's still a divided detention. And so by

00:50:07.440 --> 00:50:12.320
having that two -way or that one -on -one session,

00:50:12.500 --> 00:50:14.099
talking to the patient, one, the visits are actually

00:50:14.099 --> 00:50:16.699
shorter now because I'm actually getting deeper

00:50:16.699 --> 00:50:21.019
and better quality visits. But number two, my

00:50:21.019 --> 00:50:23.099
notes are better. So what I need to advocate

00:50:23.099 --> 00:50:27.989
for that patient is time off. I can go back to

00:50:27.989 --> 00:50:33.070
my notes and articulate exactly why. I can provide

00:50:33.070 --> 00:50:36.130
the notes to the insurance company to tell them,

00:50:36.210 --> 00:50:38.389
yeah, this is pretty bad. This person's suffering.

00:50:39.230 --> 00:50:42.570
We need to support this individual. And so AI

00:50:42.570 --> 00:50:44.750
describe has changed that whole game. So insurance

00:50:44.750 --> 00:50:47.630
notes now. So historically, when I first started

00:50:47.630 --> 00:50:50.030
eight years ago, insurance papers used to take

00:50:50.030 --> 00:50:54.389
30 minutes to complete. They reduced down to

00:50:54.389 --> 00:51:00.420
about... 20 minutes with another technology I'll

00:51:00.420 --> 00:51:03.420
talk about, and now with the AI scribe, so we're

00:51:03.420 --> 00:51:05.719
looking at like five to 10 minutes. And that

00:51:05.719 --> 00:51:08.579
actually translates directly then to, these are

00:51:08.579 --> 00:51:10.980
all uninsured services, to my patients that are

00:51:10.980 --> 00:51:12.500
actually not having to pay for the right time.

00:51:12.599 --> 00:51:15.440
It's based on OMA's and physicians' hourly rates

00:51:15.440 --> 00:51:18.139
that we charge for these insurance forms. So

00:51:18.139 --> 00:51:20.699
my hourly rates that theoretically, the amount

00:51:20.699 --> 00:51:22.619
of time I spend on that form drops, and therefore

00:51:22.619 --> 00:51:26.739
my patients are paying in cash. And I don't feel

00:51:26.739 --> 00:51:29.280
as stressed. I hate doing forms. I don't feel

00:51:29.280 --> 00:51:32.559
as stressed anymore. The next technology we use

00:51:32.559 --> 00:51:36.139
is e -forms. So e -forms get sent out to the

00:51:36.139 --> 00:51:40.400
patient pre -visit. In that, they get their consent

00:51:40.400 --> 00:51:43.699
form for using an AI scribe. So they're made

00:51:43.699 --> 00:51:46.039
aware the entire time of what's happening. If

00:51:46.039 --> 00:51:48.420
they book a particular type of visit, hypertension,

00:51:48.739 --> 00:51:51.900
diabetes, IUD, weight management, things like

00:51:51.900 --> 00:51:54.480
that, they get a questionnaire that's just specifically

00:51:54.480 --> 00:51:57.440
tailored to that condition. And so then it asks

00:51:57.440 --> 00:51:59.360
them a whole bunch of questions, which then facilitates

00:51:59.360 --> 00:52:01.860
that conversation. Going back to mental health,

00:52:01.960 --> 00:52:04.659
it will do something called a PHQ -9 or GAD -7.

00:52:04.739 --> 00:52:09.539
Those are two questionnaires that help with monitoring

00:52:09.539 --> 00:52:11.440
a person. You know this, Rashad, but like for

00:52:11.440 --> 00:52:13.539
all the listeners, it helps to monitor some of

00:52:13.539 --> 00:52:15.599
these symptoms over a period of time. A lot of

00:52:15.599 --> 00:52:18.300
times when you're in the depths of a mental health

00:52:18.300 --> 00:52:21.840
crisis, even some improvements are hard to see

00:52:21.840 --> 00:52:24.880
because we're... we are a species that self -devocates

00:52:24.880 --> 00:52:26.900
ourselves. We're harder on ourselves, harder

00:52:26.900 --> 00:52:30.400
than others are on to us. And so by doing those

00:52:30.400 --> 00:52:32.219
questionnaires, it's an objective way for you

00:52:32.219 --> 00:52:33.920
to self -evaluate and do that self -referential

00:52:33.920 --> 00:52:37.300
meditation we talked about earlier. So by doing

00:52:37.300 --> 00:52:40.400
so, we now have objective measurements that we

00:52:40.400 --> 00:52:42.719
can say, hey, in transdefinite, this person's

00:52:42.719 --> 00:52:45.559
PHQ not iron went from like a six all the way

00:52:45.559 --> 00:52:49.340
up to a 17. And now with counseling, it's going

00:52:49.340 --> 00:52:51.420
back down to a 12, so please continue to pay

00:52:51.420 --> 00:52:52.800
for that counseling because it's helping this

00:52:52.800 --> 00:52:56.079
person. And so that's really changed the game

00:52:56.079 --> 00:52:59.059
there on the key forums. Let's go, only important

00:52:59.059 --> 00:53:01.579
booking. Oh yeah, e -referral. So the next one

00:53:01.579 --> 00:53:05.500
we use, and this, this goes back to like 2018,

00:53:05.739 --> 00:53:09.440
2017. Developed in Cambridge. Launched at Cambridge

00:53:09.440 --> 00:53:12.900
Memorial Hospital. Great innovative team down

00:53:12.900 --> 00:53:15.960
there in Cambridge. expanded Kitchener, Waterloo,

00:53:16.139 --> 00:53:20.360
and then expanded across the province, it allows

00:53:20.360 --> 00:53:24.340
us to try and send referrals to another source

00:53:24.340 --> 00:53:27.519
without using an access sheet. And the advantage

00:53:27.519 --> 00:53:29.820
of doing that was twofold. There's one disadvantage.

00:53:30.000 --> 00:53:32.900
The disadvantage is that my secretary having

00:53:32.900 --> 00:53:35.500
to build that referral, I do, but technically

00:53:35.500 --> 00:53:37.059
I could have made it that my secretary had to

00:53:37.059 --> 00:53:40.440
do it. So that's still a possible workflow. But

00:53:40.440 --> 00:53:42.719
for me, I just select all the things I want to

00:53:42.719 --> 00:53:46.260
send to that referral. Hit a second button, it

00:53:46.260 --> 00:53:49.800
attaches it, throws it into a browser that then

00:53:49.800 --> 00:53:55.099
sends it securely to the receiving sites. I don't

00:53:55.099 --> 00:53:56.880
really have to fill out that entire referral

00:53:56.880 --> 00:53:58.760
form because it automatically pulls it out with

00:53:58.760 --> 00:54:01.519
my electronic medical record. But I sit there

00:54:01.519 --> 00:54:03.099
with my patient, I turn the screen to them, I'm

00:54:03.099 --> 00:54:04.880
like, all right, cool, do you need an MRI? Type

00:54:04.880 --> 00:54:09.380
in MRI, hit wait times, and I'm like, oh, if

00:54:09.380 --> 00:54:11.559
you want to drive to Peterborough, I can get

00:54:11.559 --> 00:54:17.110
you an MRI in 50 days. If you only want to go

00:54:17.110 --> 00:54:20.409
to Stratford, sure, that's about a 10 week wait.

00:54:21.050 --> 00:54:23.449
But now we've increased transparency and we're

00:54:23.449 --> 00:54:26.670
both balancing the whole system. And so now people

00:54:26.670 --> 00:54:28.949
are getting, you can get wait times, you can

00:54:28.949 --> 00:54:31.269
find services that you had no idea existed. I

00:54:31.269 --> 00:54:34.050
just discovered one that does behavioral medicine

00:54:34.050 --> 00:54:38.269
with CBT in Toronto. So I sent two patients off

00:54:38.269 --> 00:54:42.130
yesterday with that. Great communication. So

00:54:42.130 --> 00:54:45.780
we're going to see how that goes. And so e -referral

00:54:45.780 --> 00:54:49.940
has changed. Oh, I forgot. E -referral has changed

00:54:49.940 --> 00:54:51.860
the way I practice because it meant that I had

00:54:51.860 --> 00:54:54.480
to get everyone's email addresses. But it also

00:54:54.480 --> 00:54:56.280
meant that I actually had to start reading my

00:54:56.280 --> 00:54:57.940
emails because if they wanted to know what their

00:54:57.940 --> 00:55:00.280
next MRI was or what their book, they actually

00:55:00.280 --> 00:55:02.360
had to go start reading their emails from Ocean.

00:55:02.800 --> 00:55:04.880
We used Ocean for our e -referral platform here

00:55:04.880 --> 00:55:08.940
in Waterloo. And so that was really helpful because

00:55:08.940 --> 00:55:11.019
it offloaded my front staff for having to call

00:55:11.019 --> 00:55:13.500
each person and say, hey. memorize books for

00:55:13.500 --> 00:55:15.960
this particular date of time, this location,

00:55:16.639 --> 00:55:19.059
to the entrance, as much parking cost, blah,

00:55:19.139 --> 00:55:22.780
blah, blah. That's all gone. And patients are

00:55:22.780 --> 00:55:25.559
there every step. They keep me accountable. They

00:55:25.559 --> 00:55:28.599
know that I sent off the referral. When they

00:55:28.599 --> 00:55:30.159
call in saying, we haven't heard back with that

00:55:30.159 --> 00:55:32.500
referral, I'm like, yep, you know as much as

00:55:32.500 --> 00:55:35.039
I do. If it says they accepted it, but they haven't

00:55:35.039 --> 00:55:36.880
given me a date and time, I don't have a date

00:55:36.880 --> 00:55:39.719
and time for you. When you know, I know, and

00:55:39.719 --> 00:55:44.659
vice versa. we're looking at now is how do we

00:55:44.659 --> 00:55:47.800
start automating the post -visit technologies.

00:55:49.400 --> 00:55:51.000
Thank you for that very thorough answer, Neil.

00:55:54.039 --> 00:55:57.460
There's a lot of physicians still purely clinical

00:55:57.460 --> 00:55:59.920
and they're not doing anything outside of clinical

00:55:59.920 --> 00:56:03.260
medicine. There's a big majority of them, I find,

00:56:03.380 --> 00:56:05.860
that are wanting to get involved in startups

00:56:05.860 --> 00:56:08.579
or consulting or innovation or entrepreneurship

00:56:08.579 --> 00:56:13.940
or even doing something more administrative that's

00:56:13.940 --> 00:56:16.639
non -clinical? What piece of advice do you have

00:56:16.639 --> 00:56:21.699
for them? It's a great question. I was just at

00:56:21.699 --> 00:56:24.320
a town hall for one of the organizations I'm

00:56:24.320 --> 00:56:31.800
in Pfizer for. And something stuck with me. You

00:56:31.800 --> 00:56:36.280
have to spend 95 % of your time to find the problem.

00:56:37.639 --> 00:56:39.980
If you don't know what the problem is in your

00:56:39.980 --> 00:56:42.730
clinic, You don't know how to advise startup

00:56:42.730 --> 00:56:46.409
companies. So analyze yourself and analyze your

00:56:46.409 --> 00:56:49.130
own clinic. And it goes back to that Chinese

00:56:49.130 --> 00:56:50.849
proverb, if you're standing still, you're moving

00:56:50.849 --> 00:56:53.949
backwards. If you think your clinic's perfect,

00:56:54.789 --> 00:56:58.369
oh boy, you are so far behind. I have so much

00:56:58.369 --> 00:57:00.889
knowledge in my office, we are still not there.

00:57:01.070 --> 00:57:03.869
We're still trying to figure out what the next

00:57:03.869 --> 00:57:06.590
step is. Because that's when ideation starts.

00:57:07.730 --> 00:57:10.780
What is the problem we're trying to solve? and

00:57:10.780 --> 00:57:13.699
then what's the solution to that problem. If

00:57:13.699 --> 00:57:15.679
we start off with the solution, then we need

00:57:15.679 --> 00:57:19.579
to create the problem to then solve it. There's

00:57:19.579 --> 00:57:23.079
only ever been a handful of times when a solution

00:57:23.079 --> 00:57:27.820
is a newer, better way than the problem itself,

00:57:28.460 --> 00:57:30.480
but to be fair, the problem always existed. Nobody's

00:57:30.480 --> 00:57:35.179
ever took the time to actually find it. So one

00:57:35.179 --> 00:57:37.579
of the first things I did when I first started

00:57:37.559 --> 00:57:39.820
So I'd say about nine months in, about a year

00:57:39.820 --> 00:57:47.579
in, was I sat behind my friend's desk and told

00:57:47.579 --> 00:57:49.280
them what it was about. I'm not here to criticize

00:57:49.280 --> 00:57:51.659
you or judge you. I'm here to learn about what

00:57:51.659 --> 00:57:55.039
your role is. Because if you guys ever need to

00:57:55.039 --> 00:57:57.619
take time off or if we suddenly have something

00:57:57.619 --> 00:58:00.440
that happens, I need to know what you guys do

00:58:00.440 --> 00:58:03.679
so that I know how to do it myself. So how do

00:58:03.679 --> 00:58:06.170
you put a fax in? Where are all the steps to

00:58:06.170 --> 00:58:08.389
that center? What do you call patients for? How

00:58:08.389 --> 00:58:11.369
long do those conversations take? I had a stopwatch.

00:58:11.389 --> 00:58:14.409
I had time to end those conversations. Again,

00:58:14.409 --> 00:58:17.250
not to criticize my front staff. They're a fantastic

00:58:17.250 --> 00:58:19.869
group of people, but more so how can I help support

00:58:19.869 --> 00:58:23.230
them? Then I also, at some point, I've done it

00:58:23.230 --> 00:58:25.889
three times now because the roles change all

00:58:25.889 --> 00:58:29.050
the time, is what does it cost you as a clinician

00:58:29.050 --> 00:58:33.230
to rehire for that role of your front staff?

00:58:34.050 --> 00:58:36.730
Because if you keep offloading all the stuff

00:58:36.730 --> 00:58:40.449
you don't want to do to your staff, they will

00:58:40.449 --> 00:58:44.150
burn out, and you will lose them. People will

00:58:44.150 --> 00:58:48.070
look for a new job. And so loyalty is important,

00:58:48.130 --> 00:58:49.929
though you're wrong. You can get loyalty, but

00:58:49.929 --> 00:58:52.969
you can't buy loyalty. We have this perception,

00:58:53.190 --> 00:58:57.630
we can't, and you can't. And so work with them,

00:58:57.849 --> 00:59:01.210
figure out solutions, co -design with them. Will

00:59:01.210 --> 00:59:05.500
this work? Will this not? No. people who don't

00:59:05.500 --> 00:59:08.639
like change. And there's groups that do like

00:59:08.639 --> 00:59:11.480
change. I think trying to find the right team

00:59:11.480 --> 00:59:13.420
is really important. There are some teams that

00:59:13.420 --> 00:59:14.940
don't like change and that's probably not the

00:59:14.940 --> 00:59:18.659
right team if you're looking to do this. But

00:59:18.659 --> 00:59:21.139
assuming that you do have the right team, yeah,

00:59:21.320 --> 00:59:25.179
co -design with them, find the solution, implement

00:59:25.179 --> 00:59:27.599
it, do it on a pilot basis. A lot of companies

00:59:27.599 --> 00:59:29.619
will give you that pilot aspect or work with

00:59:29.619 --> 00:59:33.090
a startup company and develop it. advise them,

00:59:33.230 --> 00:59:35.090
help them pivot, try and figure out something

00:59:35.090 --> 00:59:36.989
that actually solves the problem. Now if a company

00:59:36.989 --> 00:59:39.730
comes to you and says, I have the solution, you

00:59:39.730 --> 00:59:41.530
should always ask, what was the problem that

00:59:41.530 --> 00:59:43.670
you were trying to solve? Well, and the number

00:59:43.670 --> 00:59:45.869
one thing you should say is, well, when I was

00:59:45.869 --> 00:59:48.570
a patient, I observed X, Y, and Z, and I'm like,

00:59:48.769 --> 00:59:51.909
yeah, as a patient you saw the tip of the iceberg

00:59:51.909 --> 00:59:54.849
and not all the stuff underneath it. Dive deeper,

00:59:55.110 --> 00:59:57.630
what else? Who's your expert panel? Are you that

00:59:57.630 --> 01:00:00.800
expert panel? Do they value your opinion, and

01:00:00.800 --> 01:00:04.380
if they're dismissing you, run away. Because

01:00:04.380 --> 01:00:06.320
patient experience and provider experience are

01:00:06.320 --> 01:00:08.239
two very different things, and they both go hand

01:00:08.239 --> 01:00:13.179
in hand, but one does not trump the other. So,

01:00:13.619 --> 01:00:15.239
it's really important to co -design, figure that

01:00:15.239 --> 01:00:17.400
out, and know what your office does for the demo.

01:00:17.659 --> 01:00:19.579
And then go talk to one of your friends. What

01:00:19.579 --> 01:00:22.460
do their offices do? How do they solve those

01:00:22.460 --> 01:00:25.659
things? Because an N of one is not really valuable.

01:00:26.059 --> 01:00:29.159
You need to know what other offices do. Thanks

01:00:29.159 --> 01:00:31.579
for coming on, Neil. This has been great. And

01:00:31.579 --> 01:00:33.960
thanks for being open and sharing your thoughts

01:00:33.960 --> 01:00:38.139
on all the different things we covered. No problem.

01:00:38.239 --> 01:00:40.300
My pleasure. Thanks for having me. Always happy

01:00:40.300 --> 01:00:40.699
to be back.