We know in some instances what brings contentment
joy and sometimes happiness Nourishing and building
social relationships taking care of our minds
taking care of our bodies But we still find ourselves
chasing money status power and myself as well
My question to you is would you be open to an
AI solution? That tracks your your social activities
your social media your your email and even controls
it, tracks your biometrics, if it will lead to
more contentment in your life? Oh yeah, 100%.
Right? So happiness is the spikes that we feel,
the endorphins that we feel all the time. And
I think if we overwhelm our bodies with constant
endorphins, it becomes the new norm. And then
we're always seeking for the next pleasure, the
next day. I think that's what we see. We get
the money, it goes for our bank accounts, we
get that spike of endorphins, or I want more
of that. That felt great. How do I do this? Whereas
contentment is more so the state of I'm happy
with what I have. I'm not saying that you shouldn't
be striving for more. You should always be striving
for more. For me, it's education. Knowledge is
power. And so that gives me my contentment and
gives me this happiness. to know that I'm learning
something new. And so the two go hand in hand,
but they're not the same. And so absolutely,
I'd want an app that does contentment. I don't
want it to, I feel like sometimes social media
is there to give a rise out of somebody, right?
And so they can give you the middle ground, and
then occasionally they'll send you something
that they don't know whether or not you're gonna
suddenly be like, That's my guy, that's my gym
bro, that's my passion project, or I don't like
this politically decisive, I don't want to do
this anymore. And it's the reactions. You can
go back to Facebook all the way from back when
we were in high school, where you could like
something. And then people wanted the ability
to go beyond a like. Let's get a heart, let's
get a thumbs down. At one point I remember there
being a thumbs down, I'm not sure if you remember
that. Or a dislike. And then at one point it
disappeared again. I don't know what it is anymore
because I don't use Facebook anymore. I use Facebook
for marketplace. I need to sell stuff to my office.
But that's the rise we want. And then at one
point we wanted more people to have likes on
our posts. So then we'll say more controversial
things. And then Facebook will take that and
run it through everyone. And so I think that's
where we're starting to get into this endorphin
rush of I need to have this. I need to have this
dopamine rush. the addiction that we're looking
for. Contentment is the removal of that addiction.
I'm happy with where I'm at. I'm happy with my
own thoughts. I think that's the third part about
this, of this AI app, is does it make you think,
and does it make you think independently? Or
are you the type of person, I don't want to say
you, Rashad, I don't want to say anyone, are
you the type of person who listens to somebody
else, and if it sounds smart, You'll just say
yes Because your own thoughts are a scary place
to be How did you get interested in archaeology?
Oh That's from that's from job that I my mom
jokes. I just cuz I like gold. I like shiny things
and King Tut's tomb was shiny and gold My mom
used to teach us that Indian culture is very
similar to the African culture and Egyptians,
the Krishites, stuff like that. And, you know,
as a kid, your parents were always right. Now,
I just watched a National Geographic channel
yesterday, a video on the pyramids of Sudan.
And that's the ancient Krishite empire. I'm reading
into that as well. Yeah, yeah, all that stuff
actually is starting to line up. And, you know,
we also have studies that now show that Verbal
history is sometimes as good as written history
in cultures. And so I think from a young age,
my mom just kind of imbued that into me in terms
of explore the past, have an open mind. Just
because some experts said it doesn't mean that
it's factual. It doesn't make them a god. It
doesn't mean that they're 100 % right. Challenge
the status quo. If we don't challenge the status
quo, we'd still be using the Yellow Pages. because
that was the absolute best thing in the world
back in the day. So challenge the status quo,
I'd always ask questions. And if you prove it
to be incorrect, great, at least you proved it.
But to outright say no, because you don't like
it, that I can't tolerate. So that's how I got
into archeology, which is challenging the status
quo to my mom's... She's upset now because I
decided to take that to a whole different level
and started challenging what is Hinduism and
reading Vedism and reading the texts of the Vedic
texts. I've read the Bhagavad Gita. I've actually
gone off and read the Torah, the Bible, the Koran,
any religious text I could. I think it's a really
fascinating way of looking at how cultures change
over time and how people perceive and how cultures
perceive that change and what does... What is
the different culture of society? And so those
books are also, in a way, a historical archaeological
text, because it's the interpretation of reality
into a book. And then you also want to line that
with what the groups have with Strabo's books
and what Alexandria was. And that's kind of how
it all got together. As I said, it's all clear
pathways. And I think that's representative of
what our We are a mixed group of really smart
animals that figured out how to create a civilization
out of this today. Yeah. You know, when I did
residency, I was out in BC and it was really
my first exposure to indigenous culture. And
then they had us go to powwows. And it was very
interesting. And one thing that really, you know,
stuck with me as a almost a fact that we don't
respect Indigenous culture is that it's an oratory
culture. It's a verbal culture. Contracts are
verbal. They're not written. And we force their
leaders to adopt to our framework with written
contracts. He said something very interesting.
And I think the world would be a much better
place if our verbal word was a contract, if we
did not need written contracts. Now you need
proof of that someone said something and I think
that that's accurate but I don't think it needs
to be pen and paper or you know keyboard and
screen. What are your thoughts on verbal versus
written contracts and how did you learn that
a verbal history or storytelling and stories
are you know I'm curious because I would think
they're less accurate than written history but
from what it sounds like you're saying that they're
They're as accurate. Yeah, it depends on how
much emphasis on accuracy is placed, right? So
we all see the studies on court cases and forensic
cases where people will change what they remember.
And it's not maliciously, it's just the brain
can fabulous and changes things. And so what
they recollect even a day after a week later,
whatever, is different. What I think the difference
here though is, what do I remember unintentionally?
I was walking down the street, I saw a car crash.
What do I remember? And usually nowadays you
and I, when you write down our statement right
away, that reinforces what we remember. So it's
less likely to change over time. If you don't
have a written language, what is the next best?
thing you can do to reinforce. You share that
knowledge with somebody else. You share it immediately.
You can either be doing it through song. So now
you have a rhythmic pattern that reinforces a
memory and grammates your brain. That if it doesn't
rhyme or change with the tone, you know you missed
the part. So now you're actually creating a checksum
into the actual memory itself. Then you can translate
that to the next level. So horizontally. through
the generations and vertically through the generations.
And that's what allows it to pass down from one
generation to the next. And I'd argue that even
if it's a written contract, it's not as accurate
because it depends on the context of when that
document was written and the environment around
it. And also written from a physical nature point
of view, written contracts actually don't persist.
Let's think of the Dead Sea Scrolls, right? We
need to use x -ray vision now to unroll them.
They don't persist. We know they're really old.
They're really ancient, but they're not as good.
But oral traditions actually have that. So I
think they both have their pros and they both
have their cons. I think where the oral piece
and the written piece differed, where I do like
a written contract is I don't have time to put
my EMR end user license agreement to a song.
I could be singing for hours on end about why
I can't. how we're going to get sued and how
TELUS is not liable for anything. And so I think
there's a value to that. But I think when it
comes to things that are supposed to make us
feel proud about our culture, to warn us about
things that are important, to tell us about important
milestones in our species' existence, song has
a way of hitting different parts of our brain
and making us feel differently. It's a reason
why we sing the national anthem. A recent old
day... back in school, because it brought us
together and made us feel proud about being Canadian,
that I know we're true north strong and free.
And I will always be with me. I don't need to
write that down. And I know that everyone else
around me is the same. So I think that's the
value of the written word versus the verbal word.
And the culture of writing and stuff like that,
I'm sorry, for the Inuit piece, you're right.
We don't value that, unfortunately. We should.
And we now know, and we have been saying this
for ages. Well, they've been saying for ages
that their written word has been accurate. We're
confirming that with archaeological data. And
it's because somebody challenged us as well.
We said, oh yeah, 10 ,000 years ago, they came
across the Bering Strait through Beringia. And
that's how it happened. There was a study that
came out two weeks ago that showed, hey, actually
that may have been 20 ,000 years ago. Hey, by
the way, there may have been three migration
patterns in North America. And so, you know,
Vikings at one point is a more modern one, but
there's some talks about how, you know, other
groups from Polynesia, they migrated over at
a different stage. And so... We need to stop
thinking about things in a two -dimensional state
of, this happened, therefore this mustn't happen.
And start thinking from an open mind of, yeah,
we know one of the components. What else? How
else? And we suddenly put an attachment to ourselves
saying, let's imagine I'm an archaeologist. I'm
not saying this is what archaeologists do, but
I have heard stories and I have read books and
papers and people who defend their theory so
because they're tied to it. They spent 20 years
doing this one research project. And for somebody
to come along and question it, that's a whole
challenge. Let's take Einstein. He does not agree
with quantum physics. It goes against a lot of
these fundamental values he had. And he actually
spent the last little while trying to fight it.
We know quantum mechanics works. We can't explain
it. And maybe in some future state, we will prove
again that quantum mechanics doesn't work. But
we really need to be able to say, just fighting
it, let's work with it. Yeah, sorry. Yeah, I
think when it comes to things like quantum mechanics,
we have an inherent desire to focus on causation
and the why. But there is this school of thought,
and maybe I'm the only person in the school of
thought, is all we can know is correlation. I
don't think we'll ever figure out causation.
and we would advance our technologies and our
society much faster if we simply focus on correlation.
There's need for trying to figure out why, I
think, as slowing us down considerably. Do you
have any thoughts on that, on my belief there?
And this belief kind of was supported by this
investment firm called Renaissance Technologies.
um the most successful investment firm ever,
66 percent annual returns for 30 years, more
than three times the Warren Buffett returns.
Their whole philosophy is we will look at the
correlation and they're their mathematicians
they made an algorithm to do this between public
equities and if you know the price of rice in
Brazil goes up 10%. That means the price of Alibaba
in China will rise 5 % tomorrow for six hours.
And they're they're this precise, they're on
the average whole time for stocks is two days.
And then they invest, they remove the human element,
because they say we worry about the why and the
why is not what's important. Because the only
thing that matters is the what and the correlations.
and causations are impossible to know. There's
too many infinite confounding variables and factors
in our life. But we're still stuck on this, bringing
us back to the VC world and the venture capital
world. The biggest question is, why are the founders
doing this? And my thought is maybe that is not
the biggest question. The biggest question is,
will the founders stick around or are they capable
of doing this? And knowing why may or may not
lead to answering those those questions which
actually matter which is a what you know will
this be a unicorn exit so what are your thoughts
on correlation versus causation to be over indexed
for causation and are we hurting ourselves in
doing so so interesting um i think you're in
your own school of thought uh i'm happy being
in my own school of thought so that's amazing
frankly to me I disagree with that. I think the
why in the sense that VCs actually not even,
they do have a why. Their why is make money,
have shareholders, dividends. If correlation
gets them to that end goal, then Wyoming can't
go for it, right? I'm not saying that's wrong.
They obviously have proven that's right. I think
the beauty of this is can we translate that to
a different sector afterwards, right? So if that
rice price in Brazil goes up and Alibaba's whatever
goes up for five minutes. then knowing the why
underneath allows us to predict more. And I do
believe that at some point there is no such thing
as infinite number of variables, it's a finite
number of variables. We seek to achieve that,
figure out the digital twin, and then figure
out with that digital twin how does the universe
work. And it goes back to another philosophical
thing, if we know all the variables of the universe.
and we can put it into a digital twin, then we
just directly just create a copy of our own universe
digitally. Which then leads to the idea of are
we just all part of one large... Can we know
all the variables in the universe? Can we know
why? Or is it impossible to know why the price
of olive oil goes up because the price of rice
goes up? Is that a futile question? No, I think
we can. I think By saying we can't means that
we've given up. And that goes back to our question
of the status quo and stands still to go backwards.
Humans as a species moves forward. If curiosity
drives us that way. And correlation can show
us the why. Correlation gives us the patterns,
but we need to dive deep. I have decided in my
work and not my personal life to focus on the
correlation path. And I think let's have this
conversation in five years and see how we've
uncovered the truth and knowledge in the universe
and what, let's share notes then. But let's go
on these. Correlation is important. Correlation
gives us, you know, of all the things in the
universe, of all the variables, what are the
things that are related to each other? Yeah,
and my thought is that we can know we're not
smart enough information we're limited by five
senses I think and as we are now in humans in
2025 We can know that that's where I've kind
of Agree in 2025 humans can know we're not that
smart. I think that's a I do believe in a hybridized
world of AI Where is all correlation? Like AI
doesn't understand why there's no meaning or
significance. It's essentially, as you said,
it's all probabilities. It's what is the next
character? And it doesn't even know what a word
is. It says what is the next half a P or character
that comes after this? And the way it defines
character is very different. So if we're going
the AI path, then it's in my... you know, defense,
I guess. This is an interesting debate. It would
be all correlation and no causation, because
AI doesn't care. There's no caring or not caring,
right? It's just all probabilities. Do we, do
you think we're anchoring AI then by making it,
or forcing it to explain things to us? But if
we had to let AI go, it'll create its own language,
which we know it can do. and have a conversation
with itself, which we know it can't do, or with
another AI, it can run experiments to determine
why. It can't do that, right? It's a cold start
AI, we have our machine learning AI that can
then change its own base model for learning and
then re -evaluate a situation, exactly what we
do on a day -to -day basis. And so we're forcing
it to adhere to what we want. from a language
point of view of, yeah, P is the next letter.
But to be fair, we did the same thing, right?
I before E, except after C, and a whole bunch
of other weird and wonderful rules that we had
to memorize back in school, right? That's literally
what we're doing for AI that we had to do. And
we just programmed it into our brains. That's
what allows us to communicate with each other.
So we're teaching AI how to communicate. We're
also starting to teach it how to experiment.
And the more we get into it, experiments, the
more extrapolation it's going to be able to do.
I can tell you now, when I was a six -year -old
kid, extrapolation was pretty bad. I could hallucinate.
I could do make -believe things and imagine that
my Power Rangers toys were fighting the Transformers
and all that other wonderful stuff. And that's
imagination. That's hallucination. That's what
we, Google's had their AI data. turns off, right?
And we actually have a paper that came out last
year that showed that giving AIs and their models
of break in between will actually improve their
accuracy and AIs do fatigue. Interesting. Yeah,
yeah, so AIs fatigue is if you ask a complex
question, just like you and I, it will get decision
fatigue. And the answers get worse and worse.
You need to give it a break. And so It is coming
closer and closer to that singularity of being
smarter than us. That's okay. Because I think
it's smartness and our smartness are two different
smartnesses. And together that we actually can
become this newer species as a whole. I kind
of equated to the old schools. Are you a Star
Trek fan? No. Okay. Original series? Spock? Her?
Kirk is the emotional individual who's the lead.
Spock is the logical person who's the science
dude. Sorry, chunky fans who listen to this.
I said science dude. But the two together are
better than them individually. Us and AI are
better together. And if we don't go along with
it, sure. But that just means that you now have
a logical being. that is going to be pure logic,
which is bad. And we've seen that going bad.
Or you're going to have an emotional being, us,
that's going to go along on their own. And that's
bad too. We see that in the world today, that
logic and emotions, sorry, emotions in general
lead to war and hate and suffering. The two together
lead to something beautiful. I think there's
a full circle moment here where I'm maybe realizing
all causation is infinite correlation loops.
And if you're trying to figure out the why, you're
just trying to break down two things that may
not be linked. And you're breaking on the path,
and that's just predicting probabilities along
the way. I don't know if I explained that well,
but I'm kind of realizing causation just might
be, or the why might just be the what repeated
over and over again until you get to the why.
So why does a car go this speed while you break
it down? you know why do the wheels turn this
fast what's happening in the engine and it's
just all probabilities of what's um but you know
i think there's different paths to getting to
understanding the universe um i'll pick correlation
you'll pick causation and we'll see who gets
closer um and you know you make a good point
there like the y is actually just a high probability
of a correlation your correlation would be 99
or it could be one percent and so you have 99
percent you got your y That's one percent. There's
a correlation. Everything has a correlation being
on this planet is a correlation. But doesn't
mean that has causation. I can see what your
logic is coming from. Yeah. We are both physicians
in the innovation space. So, you know, maybe
let's talk about health care a little bit. Do
you have when do you have to go, by the way?
I got to go around. I got enough. What is the
path to the AI clinical position? Should physicians
be scared? And then where does the opportunity
lie for physicians here? Yeah, and you know,
that's a great segue there, right? So you're
either the clinician who doesn't use AI, definitely
do that. But there's a great book called Deep
Medicine by Eric Topol. I'm not sure if you've
read it. 2019, if I'm not mistaken. And in the
book, He talks about how, you know, in that particular
year, we as a species have identified 10 ,000
diseases in humans. I am not memorized all 10
,000. I'm pretty sure none of the doctors have
been memorized all 10 ,000. And so that's where
the value of AI is. It's protecting the patients
in the sense of making sure that all the rare
and weird conditions are identified and ruled
out. It's ensuring that communication happens
in a proper way, in a standardized way. There's
good enough evidence now that shows that doctors,
in the beginning of the day, spend more time
with their patients than the doctors at the end
of the day. If a patient's performance goes over
time, then you're trying to get home. You need
food. You need the meeting to go to. So you're
more likely to give the antibiotics at the end
of the day than at the beginning of the day.
And that's not hard, right? Antibiotics harm
people. communication improves people's lives,
not just from a social perspective, but also
from an understanding and compliance perspective
as well. And so when we talk about clinicians
being afraid of AI, we're essentially saying
clinicians are afraid of finding a solution that,
one, we may not understand, but two, we're actually
afraid that could be our replacement. I'd say
it's never gonna be our replacement. It could
be. It could be our replacement, but I don't
think that's gonna happen anytime soon. it's
more likely to compliment us. And in fact, probably
make it, most likely it will just make your jumps
really easy. So one thing that we do right now
in our office is we do our AI scribe. I've been
doing it for about a year now. It builds my notes.
And I've had three patients say, I like that
note I wrote. Can you just email that to me so
I can review it at home? Absolutely. Right? One
patient hand out on some hip flexor stretches.
great, go online, do a deep research on gen GPT,
say I need some hip flexors, definitely check
it, make sure it's correct, and then send it
off to the patient, right? So instead of me having
to spend the time with the patient, which I'd
love to do, don't get me wrong, but there's only
so much of my time that I have for my patients,
for my patient who might have an amputation that
I need to modify those stretches, they're getting
a better quality of care. And overall, patients
and community are healthier. So actually by not
using AI, you're doing a disservice to your community.
I think we need to start showing that ROI is
back to the patient and to the clinicians. And
we're seeing that, right? So AI scribes have
gone from last year of 5 % market penetration.
Last I heard in the Waterloo region, they said
about 20%. So we've gone past the cancel. That's
still low. I would think it would be more. There's
a lot of physicians I know, and maybe I just
have a different collection of friends here.
Yeah, we have innovative friends, right? So within
our circle, yeah, absolutely. They all use it.
But it's the circle that we're not a part of.
So if you think of our innovation curve, our
innovators make up that first 5 -ish percent.
We have the early adopters that push us to about
that 9 % to 11%. then jump that chasm. We've
jumped that chasm now. We're at the 20 percent.
We're going to see a rapid uptake right now until
we hit about 50 percent. It'll slow down eventually
and we will never reach the last five percent.
That's okay. They're either going to be retiring
soon or they're going to miss the boat. When
do you think the completely autonomous AI physician
is happening Brian Marie Care. Ah, interesting.
Cool. So I just came to talk about this in Sarnia,
actually, two days ago. We need to stop thinking
about this as us as doing one thing. We do, in
the sense that we ask questions, we find a pattern,
diagnose this probability and correlation. That's
what you said. We test that theory with our physical
exam, our labs imaging, things we do, and then
we go ahead and treat. And then we do a self
-reflection saying, cool, did we do it well?
Did we not? What did we miss? All that other
stuff. We're getting better and better over the
years. But we think it's this large continent.
In fact, it's actually, we are a combination
of different machine learning algorithms. We
have our structured algorithm. We have our shortness
of breath algorithm. We have our whatever else
algorithm. Algorithms feed into other algorithms.
And what we're probably gonna start seeing is
an AI for cough, an AI for heart failure or shortness
of breath, an AI for anemia. And what it's gonna
start doing, it's gonna start branching off and
taking off little chunks of our job. And it's
a good thing and a bad thing. One, it helps to,
scalable, which means more people have access
to care. It democratizes health care. One of
my whys, going back to what our car was fishing
about an hour and 15 minutes ago, my why in life
is universal health care for everyone no matter
what. And if that means I lose my job, OK, because
I need to make sure that I do no harm. And if
the AI can give you the care you need at home,
so you don't have to take time off work as a
single parent or a person who has to work multiple
jobs, that you have to decide between paying
for food or rent and seeing me in my office,
by all means, go use it at home. That's the most
important thing, not my job. And so it will start
picking up chunks off of my job. And we're going
to have to, we're going to be forced to as clinicians
to reinvent what our value proposition is. So
we're not going to lose our jobs, but our value
proposition is going to change. My value is no
longer going to be like that prescription. And
that's the debate we're having right now in Ontario
where we're seeing other professionals doing
things that we used to do, whether it's going
to the pharmacy and getting a prescription for
some basic things that it's seeing a nurse practitioner,
whether it's seeing a midwife, whatever it is.
And so we're seeing that as hey, is this something
I used to do and now somebody else can do it
and they're not going to say professionalism?
We're probably going to see AI jump into that
circle as well. We're probably going to start
seeing it actually tackling some of these conditions
that were delegated or that other professions
have. I'd argue that the first sign that AI is
coming after or is going to change our value
prop is when it actually starts sticking on those
17 conditions that pharmacists can give medications
for. patients perceive this and know it's an
algorithm that pharmacists have. Patients also
are untrusted computers more than humans. We
did a study in my office with the Canadian Mental
Health Association on the use of tablets to screen
for mental health conditions, depression, anxiety.
And in this feedback form, the... The reason
why people were more truthful on their tablets
than talking to me was because, and I don't make
you feel bad about the first anxiety, I recognize
that as a condition, my patients know that, we
have a great relationship, is that the perception
that humans judge and the perception that computers
are unbiased, we know AI is biased based on training
data, but we're getting better at recognizing
that. And so if our AI is unbiased, repeatable,
can go beyond just the certain conditions, and
I can still get the same service, well, I'm going
to use the AI over by pharmacists to get my eye
drops for my allergies, or to get my treatment
for urinary tract infection. And that's probably
going to scale up really quickly. So we're going
to start seeing the pharmacist losing that volume.
targeting us as well as clinicians. We're going
to start seeing that volume drop as well. And
we're going to start seeing just segments of
our profession go away. What the AI is probably
going to do that's going to be better than us
is when they start taking all those different
conditions, you build an orchestra of it. And
that's your injected AI. And you correlate that
runny nose and the itchy eyes together. You and
I do that all the time. Allergies. But can the
AI do that? The moment it can start correlating
between them, that's when we start seeing our
jobs being replaced completely. And we've got
to change our value problem again. If I'm a founder
building in the spaces, say that I'm building
an AI diagnosis and prescription model algorithm
for UTIs for bladder infections. What piece of
advice do you have for me? And what do you what
data do I need to present to the CPSO? For them
to say, okay, I feel comfortable giving this
AI a license to prescribe macrobate or UTIs because
that you know once and this is already happening
in the state there's a bill proposed and there
are medical boards and They're open to looking
at solutions and giving them a license to prescribe
a medication. What are your thoughts here? What
piece of advice do you have for founders? And
then how should I be positioning myself to the
college or the medical boards in the US for them
to say, OK, I have to give this person a license
because of the amount of lives you'll save or
the decreased wait time or the and you know,
the physicians will fight this. I think we both
know that. What advice do you have for this founder?
Because we hold technology to a higher standard
than we hold humans, right? So let's take my
stethoscope. Me and my stethoscope are about
60 % accurate, right? Maybe 50 % to me. But we're
not 100%. But the perception is that we're 100%.
Or maybe, or it's not even 100%. Patients know
that we're not perfect. And so maybe the perceptions
are we're 70 or 80 % right. Right, I know. I'll
just say one thing. This is very interesting
because for pneumonia, the best and I did a presentation
on physical exam finding, sensitivity, specificities
and residency. The most accurate physical exam
findings in pneumonia is a gopherny and tactile
fremitas. It's not the stethoscope, but we still
use stethoscopes. That's very interesting. We
use that even though we know that that is not
the most accurate. That's all right. I actually
use, I use a Gopinia anticoagulant on all my
patients. It works, man. It works. So I volunteer
in Tanzania. I don't have x -rays there, right?
I'm doing that, right? I'm identifying potential
tuberculosis and bacterial pneumonia for an island
of like, you know, this population of Kishore
-Warelu is like 400 ,000 people on that island.
And they have one x -ray machine. Right. And
I'm pretty sure the dose of radiation would get
off that thing is higher than the CT scan. So
I feel like I'm really reluctant to my patients
off that because it's not their fault, right?
It's just older technology and we work in a capitalistic
world right now. For the non -physicians, could
you explain what a Goffini -intactile pharmacist
does? Because I realize they might not. Absolutely.
No, that's a good point. Yeah. So I love this
topic because it has everything to do with physics
and nothing to do with medicine. So sound travels
further in liquids versus airs. That's why whale
sounds can travel kilometers through the ocean,
hundreds of kilometers, and sound travels through
walls and solids better than liquids. So your
lungs are filled with air, my apologies, and
when you get the pneumonia, you get swelling.
Just think how if you hit your elbow and get
swelling, you get fluid buildup. So your lungs
decay with the bacterial infection, your body
starts to fight it, it swells up, you get liquid
in it, and that's why it gets harder and harder
to breathe because the air and oxygen can't get
through. And so the sound of the letter B in
air changes to bay. And so when you're putting
the census scope on it, you get the person to
whisper B. And it's not a full whisper, it's
just a soft tone. There's a sweet spot. You should
hear bay, and anyone can do this at home. Roll
up a piece of paper, put one side against your
ear, put the other side against somebody else's
back, and tell them to whisper B. And if they're
not sick, you should hear bay, bay, bay, bay,
bay. And it's different from listening on a stethoscope,
where you go, we call it the Christmas tree model,
where you listen one side to the other, you compare
in contrast, compare in contrast. With Agaphani,
you go down. And so you do two long, sweeping
lines of address. as we go bay bay bay bay bay
but if you hear B then usually that means sounds
are transmitted way better which means there's
a consolidation now that consolidation just tells
us the consolidation liquid is in there that
could be heart failure that could be pneumonia
that could be cancer and but the accuracy on
cancer is really poor so i wouldn't i wouldn't
Um, the second one is, uh, vibrations, right?
The sounds of vibrations. The tactile, Fremidus
is exactly what it sounds like. Tactile, you
put your hands on the chest, and it can be through
clothing, it has to be on the chest. And Fremidus,
I don't know what the Latin etymology of that
one is, but, uh, it is, you put your hands on
it, and you can actually feel the vibrations
on the sides of your hands. You gotta make sure
you put it between the ribs, because the bones
get in the way of the conduction. You can actually
feel the vibrations, uh, through your hands.
So two really cool and very accurate ways of
diagnosing pneumonia and the old school way back
before we even had x -rays. That's how the house
call or how the doctor used to diagnose people.
But yeah. Yeah, that's what I can put in the
technical part is what was the question that
we were trying to answer before? The question,
you know, it was no, I apologize because I asked
you. It was what advice do you have for founders
who are trying to get a medical license for a
solution to focus on the example I use with cystitis,
but any one of these conditions? So imagine if
I fell asleep in a lecture at a med school, and
I'm really, really bad at the subject. The most
damage I could ever do to a society is just the,
you know, 1 ,500 patients that are in my practice.
I don't have that high of a reach. Therefore,
the damage to our society is a lot less. You
give that to an AI and scalable, even if it makes
a 1 % mistake, the impact and damage it can do
will be far more than what I could do. And so
the need to fix hallucinations is incredibly
important. And I know there was a debate at one
point saying, no, it's better than humans. No,
no, no. When it comes to human health, and we
do see ourselves as the dominant species on this
planet, losing a person's life is bad, and we
need to make sure we don't do that. And there's
levels, right? Like, is this as bad as, hey,
you bruised a finger, but what if that bruise
isn't a bruise and it's actually a lymphoma?
I just went to a dermatology conference. You
saw lymphoma? Shows up as cutaneous. I can take
a manifestation of that, right? That is something
that we get wrong all the time as clinicians.
And I hope AI can do it better than us. But what
if that gets it wrong? What if the training data's
off? And all that other stuff. So number one
thing, you will never get a clinician who wants
an autonomous on -zone AI. So number two is how
do you bring the human into a loop? Because we
need to make sure that that helps. And number
three is how do you make sure that human does
become complacent and just says, cool, the AI
is right all the time. I'm going to just start
saying, yes, yes, yes, yes, yes. What we actually
need to do is. is get it to start throwing mistakes
at us, that the AI know is a mistake, that keeps
us on edge. So those are your big three. And
knowing that when you submit for that application
to Health Canada, that you save that. It's a
novel idea, it's a new way of doing it, but actually
it helps to build complacency, or prevent complacency.
So number two then is, how do you, even if you've
been in the loop, will ensure that humans don't
feel like they're being replaced, and getting
that, and then the... that actually leads to
a medical directive. And so I don't actually
look at this in terms of medical directives.
The probability of a bill being passed, while
it's being put in place for the Congress in the
United States, I don't think it's passed there
yet. And in Canada, it hasn't been put in place
for it. We're still fighting interoperability.
We don't have the equivalent of the Cures Act
up here in Canada, unfortunately. We should,
and it's kind of sad that we don't at this stage.
But we need that. And so we got to start with
medical directives. And that's something I've
already looked into. And we're looking into doing
medical directives for just putting a lot of
algorithms in my clinic at this stage. And so
by doing so, that's the first step. And if we
show the value of that, and the scalability of
that, and the life saved with that, just like
what you said there, Rashad, then we can start
saying, hey, what's the next step? How do we
become autonomous? How do we help with the unattached
patients? How do we ensure that we don't burn
out our clinicians who are taking on more unattached
patients? If you have clinicians in the loop,
you have to pay them. And I think most clinicians
are something that is completely automated. They
would do it for $25 a pop if it takes a couple
of minutes. But then you're increasing the cost
of this solution, although still better than
in person, because that's $37. Yeah, so I can
see. I think that's a model that can scale. The
other way of looking at this is if you're in
a capitation model is the more patients you roster,
the more money you can make as well. And so if
you do a blood and capitation model, the more
availability you have, the more likely you are,
the more ability you have to actually attach
more patients to. What tech are you currently
using in clinical practice? Oh, yeah, that's
a great question. the simple things, right? Like
it's the stuff that has existed in every other
industry except medicine for the longest time.
We truly are one of the slowest industries to
take on new tech. Voice over IT, right? Having
a tree chain in our voice system allows us to
actually help to navigate and coordinate patients.
We use it, it's not technology. We actually use
a call center for our phone calls for our patients.
Makes it super easy in terms of... make sure
that we have constant accessibility to our schedule
for that patient, and for them to feel like they're
getting cared for. Now, as anything, and I make
this joke in regards to our emergency room wait
times, if you make it more available, if you
drop that call, the wait time on your call system,
the volume will increase naturally. Because if
you know it's easy to get a phone call in, you'll
naturally just get more phone calls. It's an
orborous, the state that needs itself. And so
we're now looking at, okay, can we introduce,
like almost like a Google Duo before it even
hits our call center that then actually can answer
basic questions. And we're trying to figure out
how to solve this hallucination problem as well.
Where does AI fit into this? Is it just? is an
entire tree algorithm, and we just make it that
easy, and then hit zero, you'll get a human,
but you put across your answer through another
way, or is there a different way? So we're experimenting
with different AI algorithms on creating a phone
tree that's adaptable. We're looking at, so that's
option number one, and that's super cool. That
one actually exists. There's a company called,
there's a company I just spoke with, they're
called Strelo. Strelo AI, they're out of Hamilton.
And they actually have an AI secretary for your
phone. So a couple of clinics actually already
use them. Highly recommend trying it out. We're
still doing our impact on that and trying to
figure that out. The next one that we're using
here is online appointment booking. So in order
to reduce the volume of appointments online and
for folks like you and I where we're just busy
and I'm not going to stand on the phone saying,
well, what about May 6th? What about May 7th?
What about May 8th? No, I just want to look at
your calendar and book it. And so that one was
interesting because when we launched that in
the Kishore -Warelu area, there were different
clinicians with different hesitancies with using
all -independent booking. No, I'm not a massage
therapist. I'm not a manicurist. You need to
be triaged. And I'm like, actually, to be fair,
I don't need to triage my diabetic visits. I
don't need to triage my hypertension visits.
What I need to triage is if it's urgent. And
right now, those urgent patients can't get through
my phone lines. So I need to get all my non -urgent
phone lines so that my urgent patients can get
onto the phones. And in order to do that, there's
a concept of where can you find the easiest solution
as quickly as possible. It's not a concept, it's
just common sense. If you log on to your doctor's
portal, and the next available appointment's
a month out, and you get angry. You're like,
how could this doctor do this to me? Blah, blah,
blah. And you call, and the secretary says, yeah,
I can book you in in three days. Why would that
patient ever go back to your online appointment
booking platform if they knew they had an option
for a non -urgent appointment to get it done
in three days? Versus, if I threw 90 % of my
appointments online, and you go online, and you're
offered an appointment in two weeks, and you
call into my office and you're offered two weeks,
nothing changes. Then one, that patient's gonna
be angry because it's two weeks, because expectations
are perceived for that, expectations will always
be a challenge. But two, next time they need
another appointment, they know that what they're
gonna get online is gonna be exactly what they
get on the phone. The only exception there is
that we throw this on our online appointment
booking that acute issues, not emergency, just
acute issues call. But if you call expecting
the same day appointment for a non -urgent thing,
we're just going to give you the two week appointment,
not the same day one. So that's the second piece
of technology we use. Third piece of technology
we use is PrescribeIt. It's a product that comes
out of Canada Health InfoWave. It allows for
two -way communication between pharmacists and
primary care providers or clinicians in general
because there's sometimes questions. Sometimes
patients ask questions. Sometimes my prescriptions
don't make sense or we need to make sure that,
you know, the insurance companies will pay for
it. And essentially, the fact is back and forth,
which requires a fax to come in, my friends have
to read it, identify the patient, put it into
the right file for me to read it afterwards.
This just goes directly to that patient's chart
and messages the most responsible clinician.
And so prescribing has reduced the turnaround
time for our patients getting their medications,
which increases their compliance. and improves,
sorry, it decreases fax failures. Faxes fail
all the time. It's a pain. Third technology we
use, AI Scribe. I've been doing that for about
a year. I actually used AI Scribe as part of
my capstone project for one of my courses in
my MBA, my executive MBA program. Back then,
about a year ago, I only used it like that to
host visits. I did that primarily because I wanted
to make sure I had eye -to -eye contact. patients.
I didn't want to have half by my heavy -inch
and drop notes into a computer system. I am fortunate
I can type and look at you at the same time,
but it's still a divided detention. And so by
having that two -way or that one -on -one session,
talking to the patient, one, the visits are actually
shorter now because I'm actually getting deeper
and better quality visits. But number two, my
notes are better. So what I need to advocate
for that patient is time off. I can go back to
my notes and articulate exactly why. I can provide
the notes to the insurance company to tell them,
yeah, this is pretty bad. This person's suffering.
We need to support this individual. And so AI
describe has changed that whole game. So insurance
notes now. So historically, when I first started
eight years ago, insurance papers used to take
30 minutes to complete. They reduced down to
about... 20 minutes with another technology I'll
talk about, and now with the AI scribe, so we're
looking at like five to 10 minutes. And that
actually translates directly then to, these are
all uninsured services, to my patients that are
actually not having to pay for the right time.
It's based on OMA's and physicians' hourly rates
that we charge for these insurance forms. So
my hourly rates that theoretically, the amount
of time I spend on that form drops, and therefore
my patients are paying in cash. And I don't feel
as stressed. I hate doing forms. I don't feel
as stressed anymore. The next technology we use
is e -forms. So e -forms get sent out to the
patient pre -visit. In that, they get their consent
form for using an AI scribe. So they're made
aware the entire time of what's happening. If
they book a particular type of visit, hypertension,
diabetes, IUD, weight management, things like
that, they get a questionnaire that's just specifically
tailored to that condition. And so then it asks
them a whole bunch of questions, which then facilitates
that conversation. Going back to mental health,
it will do something called a PHQ -9 or GAD -7.
Those are two questionnaires that help with monitoring
a person. You know this, Rashad, but like for
all the listeners, it helps to monitor some of
these symptoms over a period of time. A lot of
times when you're in the depths of a mental health
crisis, even some improvements are hard to see
because we're... we are a species that self -devocates
ourselves. We're harder on ourselves, harder
than others are on to us. And so by doing those
questionnaires, it's an objective way for you
to self -evaluate and do that self -referential
meditation we talked about earlier. So by doing
so, we now have objective measurements that we
can say, hey, in transdefinite, this person's
PHQ not iron went from like a six all the way
up to a 17. And now with counseling, it's going
back down to a 12, so please continue to pay
for that counseling because it's helping this
person. And so that's really changed the game
there on the key forums. Let's go, only important
booking. Oh yeah, e -referral. So the next one
we use, and this, this goes back to like 2018,
2017. Developed in Cambridge. Launched at Cambridge
Memorial Hospital. Great innovative team down
there in Cambridge. expanded Kitchener, Waterloo,
and then expanded across the province, it allows
us to try and send referrals to another source
without using an access sheet. And the advantage
of doing that was twofold. There's one disadvantage.
The disadvantage is that my secretary having
to build that referral, I do, but technically
I could have made it that my secretary had to
do it. So that's still a possible workflow. But
for me, I just select all the things I want to
send to that referral. Hit a second button, it
attaches it, throws it into a browser that then
sends it securely to the receiving sites. I don't
really have to fill out that entire referral
form because it automatically pulls it out with
my electronic medical record. But I sit there
with my patient, I turn the screen to them, I'm
like, all right, cool, do you need an MRI? Type
in MRI, hit wait times, and I'm like, oh, if
you want to drive to Peterborough, I can get
you an MRI in 50 days. If you only want to go
to Stratford, sure, that's about a 10 week wait.
But now we've increased transparency and we're
both balancing the whole system. And so now people
are getting, you can get wait times, you can
find services that you had no idea existed. I
just discovered one that does behavioral medicine
with CBT in Toronto. So I sent two patients off
yesterday with that. Great communication. So
we're going to see how that goes. And so e -referral
has changed. Oh, I forgot. E -referral has changed
the way I practice because it meant that I had
to get everyone's email addresses. But it also
meant that I actually had to start reading my
emails because if they wanted to know what their
next MRI was or what their book, they actually
had to go start reading their emails from Ocean.
We used Ocean for our e -referral platform here
in Waterloo. And so that was really helpful because
it offloaded my front staff for having to call
each person and say, hey. memorize books for
this particular date of time, this location,
to the entrance, as much parking cost, blah,
blah, blah. That's all gone. And patients are
there every step. They keep me accountable. They
know that I sent off the referral. When they
call in saying, we haven't heard back with that
referral, I'm like, yep, you know as much as
I do. If it says they accepted it, but they haven't
given me a date and time, I don't have a date
and time for you. When you know, I know, and
vice versa. we're looking at now is how do we
start automating the post -visit technologies.
Thank you for that very thorough answer, Neil.
There's a lot of physicians still purely clinical
and they're not doing anything outside of clinical
medicine. There's a big majority of them, I find,
that are wanting to get involved in startups
or consulting or innovation or entrepreneurship
or even doing something more administrative that's
non -clinical? What piece of advice do you have
for them? It's a great question. I was just at
a town hall for one of the organizations I'm
in Pfizer for. And something stuck with me. You
have to spend 95 % of your time to find the problem.
If you don't know what the problem is in your
clinic, You don't know how to advise startup
companies. So analyze yourself and analyze your
own clinic. And it goes back to that Chinese
proverb, if you're standing still, you're moving
backwards. If you think your clinic's perfect,
oh boy, you are so far behind. I have so much
knowledge in my office, we are still not there.
We're still trying to figure out what the next
step is. Because that's when ideation starts.
What is the problem we're trying to solve? and
then what's the solution to that problem. If
we start off with the solution, then we need
to create the problem to then solve it. There's
only ever been a handful of times when a solution
is a newer, better way than the problem itself,
but to be fair, the problem always existed. Nobody's
ever took the time to actually find it. So one
of the first things I did when I first started
So I'd say about nine months in, about a year
in, was I sat behind my friend's desk and told
them what it was about. I'm not here to criticize
you or judge you. I'm here to learn about what
your role is. Because if you guys ever need to
take time off or if we suddenly have something
that happens, I need to know what you guys do
so that I know how to do it myself. So how do
you put a fax in? Where are all the steps to
that center? What do you call patients for? How
long do those conversations take? I had a stopwatch.
I had time to end those conversations. Again,
not to criticize my front staff. They're a fantastic
group of people, but more so how can I help support
them? Then I also, at some point, I've done it
three times now because the roles change all
the time, is what does it cost you as a clinician
to rehire for that role of your front staff?
Because if you keep offloading all the stuff
you don't want to do to your staff, they will
burn out, and you will lose them. People will
look for a new job. And so loyalty is important,
though you're wrong. You can get loyalty, but
you can't buy loyalty. We have this perception,
we can't, and you can't. And so work with them,
figure out solutions, co -design with them. Will
this work? Will this not? No. people who don't
like change. And there's groups that do like
change. I think trying to find the right team
is really important. There are some teams that
don't like change and that's probably not the
right team if you're looking to do this. But
assuming that you do have the right team, yeah,
co -design with them, find the solution, implement
it, do it on a pilot basis. A lot of companies
will give you that pilot aspect or work with
a startup company and develop it. advise them,
help them pivot, try and figure out something
that actually solves the problem. Now if a company
comes to you and says, I have the solution, you
should always ask, what was the problem that
you were trying to solve? Well, and the number
one thing you should say is, well, when I was
a patient, I observed X, Y, and Z, and I'm like,
yeah, as a patient you saw the tip of the iceberg
and not all the stuff underneath it. Dive deeper,
what else? Who's your expert panel? Are you that
expert panel? Do they value your opinion, and
if they're dismissing you, run away. Because
patient experience and provider experience are
two very different things, and they both go hand
in hand, but one does not trump the other. So,
it's really important to co -design, figure that
out, and know what your office does for the demo.
And then go talk to one of your friends. What
do their offices do? How do they solve those
things? Because an N of one is not really valuable.
You need to know what other offices do. Thanks
for coming on, Neil. This has been great. And
thanks for being open and sharing your thoughts
on all the different things we covered. No problem.
My pleasure. Thanks for having me. Always happy
to be back.