1 00:00:00,000 --> 00:00:03,040 These Afrinuk podcasts will be in two parts. 2 00:00:03,040 --> 00:00:06,160 The downside risks, like if I'm a software engineer, right? 3 00:00:06,160 --> 00:00:10,000 Like if I mess something up, usually it doesn't have catastrophic outcomes. 4 00:00:10,000 --> 00:00:16,080 You know, usually people don't die or get hurt, but you know, in medicine when you make mistakes 5 00:00:16,080 --> 00:00:20,880 or you do things incorrectly, you know, you can really damage somebody. 6 00:00:22,160 --> 00:00:26,240 I mean, I guess as a nuclear engineer, you got to be careful because you don't want your reactor to blow up. 7 00:00:26,240 --> 00:00:30,080 Welcome to part one of this episode with Dr. Gautam from Vision Radiology. 8 00:00:34,720 --> 00:00:37,600 Today I'm joined with Dr. Gautam Agrawal. 9 00:00:37,600 --> 00:00:43,360 Dr. Gautam is a nuclear engineer, also a consultant radiologist in the US. 10 00:00:43,360 --> 00:00:47,040 He is the founder and the CEO of Vision Radiology. 11 00:00:47,040 --> 00:00:51,600 Today, we are going to have a very deep and intense conversation with him. 12 00:00:51,600 --> 00:00:58,000 He's going to take us through his journey from being a nuclear engineer to becoming a consultant radiologist. 13 00:00:58,000 --> 00:01:04,800 This is like having two great safety conscious professions subsumed in one practice. 14 00:01:04,800 --> 00:01:09,840 So listen up and have a very good time with us today. 15 00:01:09,840 --> 00:01:15,120 And today I'm joined with a very seasoned radiographer. 16 00:01:15,120 --> 00:01:16,640 My name is Teodora. 17 00:01:16,640 --> 00:01:21,680 Hello and welcome to today's podcast. We hope you enjoy the session. 18 00:01:21,680 --> 00:01:25,760 Thank you very much. So without much ado, we want to dive right in. 19 00:01:25,760 --> 00:01:32,320 Dr, can you tell us about you and Vision Radiology just as a way of brief introduction? 20 00:01:32,320 --> 00:01:37,600 Sure, absolutely. So, you know, my name is Gautam Agrawal. 21 00:01:37,600 --> 00:01:42,800 I'm a practicing radiologist. My subspecialty area of interest is musculoskeletal and mirine. 22 00:01:42,800 --> 00:01:47,200 But I got my start, you know, kind of in nuclear engineering. 23 00:01:47,200 --> 00:01:51,520 I was at the University of Michigan many moons ago, just 30 years ago. 24 00:01:51,520 --> 00:01:59,680 And I learned quite a bit from that background and it has served me incredibly well in medicine. 25 00:01:59,680 --> 00:02:06,560 So we eventually then, you know, as I moved into medicine, kind of realized some of the power of 26 00:02:06,560 --> 00:02:12,320 telemedicine and how we could make and improve patient care. 27 00:02:12,320 --> 00:02:18,480 So we kind of formed this tele radiology company and, you know, 20 years later, things are still going. 28 00:02:18,480 --> 00:02:20,640 So that's the short introduction. 29 00:02:20,640 --> 00:02:29,920 Okay, that's quite interesting because I was like, okay, this is vision radiology and you have two hearts, I would say, on you. 30 00:02:29,920 --> 00:02:38,880 And I think safety, we will not have any root of escape because you will be very, very keen to details and also very careful. 31 00:02:38,880 --> 00:02:45,360 Both as a nuclear engineer and also a radiologist, you have keen attention to details. 32 00:02:45,360 --> 00:02:53,360 And I hope that your patients will be very grateful for this because it's a very rescue that you have brought it for. 33 00:02:53,360 --> 00:02:59,040 So this brings me to Rayleigh Ting because I kind of went through your website and 34 00:02:59,040 --> 00:03:09,920 I saw that you kind of do kind of online or do I say it's like it looks like an Uber kind of model business model. 35 00:03:09,920 --> 00:03:15,520 Can you like, I don't know, is it like an Uber kind of radiology or tele radiology or telemedicine? 36 00:03:15,520 --> 00:03:18,480 I'm used to telemedicine, but I've not heard of tele radiology. 37 00:03:18,480 --> 00:03:22,480 So what's the right 20 word for your personal model, please, doctor? 38 00:03:22,480 --> 00:03:28,320 Sure. So in fact, it is tele radiology and tele radiology essentially predates telemedicine. 39 00:03:28,320 --> 00:03:30,880 It was the first kind of area of telemedicine. 40 00:03:30,880 --> 00:03:36,240 And part of the reason is that it became highly standardized in a sense. 41 00:03:36,240 --> 00:03:42,720 The way images are acquired, how they're transmitted, that was standardized 25 years ago. 42 00:03:42,720 --> 00:03:53,360 And so because everything got standardized, it allowed for rapid kind of dissemination of information in very uniform ways across the entire world. 43 00:03:53,360 --> 00:03:59,920 As the internet started to kind of grow as our ability to move this information from point A to point B expanded. 44 00:03:59,920 --> 00:04:11,760 It really dramatically changed our reach, our scale to the point where you should really mostly not be thinking about radiology in time and space. 45 00:04:11,760 --> 00:04:16,240 It can be very much made independent of time and space. 46 00:04:16,240 --> 00:04:18,880 And that's part of what we do within our company. 47 00:04:18,880 --> 00:04:26,560 So to think about, you know, when we say like, is this the, let's say the Uber of radiology? 48 00:04:26,560 --> 00:04:27,600 Yeah. 49 00:04:27,600 --> 00:04:29,120 The model, I think, is wholly different. 50 00:04:29,120 --> 00:04:38,240 You know, patient care and it's a very different, very real person to person type of interaction. 51 00:04:38,240 --> 00:04:44,560 Now, as a physician, you know, you frequently have interactions with your patients, right? 52 00:04:44,560 --> 00:04:46,400 You go to see your doctor, they talk. 53 00:04:46,400 --> 00:04:51,520 And it's a very human element. There's a lot of kind of things that you need to know about the patient. 54 00:04:51,520 --> 00:04:53,360 You talk, you examine them, you do this. 55 00:04:53,360 --> 00:04:56,160 As a radiologist, I don't see the patient. 56 00:04:56,160 --> 00:04:57,600 I see inside of the patient. 57 00:04:57,600 --> 00:04:58,160 Right. 58 00:04:58,160 --> 00:05:03,600 And so my role is actually one that partially exists in the background. 59 00:05:03,600 --> 00:05:09,520 So my goal is to help your doctor figure out what's going on inside of you in a way that they can help you. 60 00:05:09,520 --> 00:05:13,920 So I don't, I'm actually more a physician's physician, right? 61 00:05:13,920 --> 00:05:15,600 So my interaction is with the doctors. 62 00:05:15,600 --> 00:05:18,960 More so than the patient themselves. 63 00:05:18,960 --> 00:05:25,200 So in that sense, it doesn't have that very sort of direct to consumer approach, 64 00:05:25,200 --> 00:05:28,480 at least the way we practice tele-radiology. 65 00:05:28,480 --> 00:05:29,280 That's awesome. 66 00:05:29,280 --> 00:05:32,160 And it's kind of very unique. 67 00:05:32,160 --> 00:05:39,840 And I get to see that you get to interact with the doctors more than the patient from what you've explained. 68 00:05:39,840 --> 00:05:47,040 So, which means, I don't know, perhaps it's easier job, more, maybe makes you more specialized. 69 00:05:47,040 --> 00:05:47,920 I wouldn't know. 70 00:05:48,880 --> 00:05:51,040 In some ways, it's easier in some ways, it's harder. 71 00:05:51,040 --> 00:05:55,040 Right. Frequently, the patient tells you the answer. 72 00:05:55,040 --> 00:05:57,920 And if you don't necessarily, you know, because they have these symptoms, 73 00:05:57,920 --> 00:06:01,040 and if you can take the time to talk to the patient to examine them, 74 00:06:01,040 --> 00:06:06,640 frequently you can figure out the answer without going to any sort of imaging or other testing and stuff. 75 00:06:06,640 --> 00:06:12,000 But I think frequently in medicine, especially in much of the world, 76 00:06:12,000 --> 00:06:17,440 we're so pressed for time that we don't stop to take the time to listen to the patient carefully, 77 00:06:17,440 --> 00:06:21,520 because they've got the answers frequently, and you just have to tease it out. 78 00:06:21,520 --> 00:06:26,320 So in that way, I think that's a disadvantage not being able to talk to the patient. 79 00:06:26,320 --> 00:06:31,120 The advantage is that you can talk to the clinician, and frequently, you know, 80 00:06:32,160 --> 00:06:35,520 it's a much quicker interaction because you're both speaking the same language. 81 00:06:35,520 --> 00:06:40,320 You're speaking medicine, and so you don't have to translate from, let's say, a lay person to a 82 00:06:40,320 --> 00:06:45,840 trained medical professional. So there are some advantages there, but overall, it's just a fabulous 83 00:06:45,840 --> 00:06:51,200 career. It's been absolutely spectacular, you know, kind of growing within the field and seeing 84 00:06:51,200 --> 00:06:58,160 how things have evolved. Oh, that's great. And then thanks for the insights you've given us 85 00:06:58,160 --> 00:07:03,520 as regards to your work. Do you think there's any edge being a nuclear engineer has given you 86 00:07:03,520 --> 00:07:11,520 over others in the field? Kind of like any benefits, additional benefits? Absolutely. So I think 87 00:07:11,520 --> 00:07:16,480 there's, so when you think about a background, an engineering background, but in particular, 88 00:07:16,480 --> 00:07:20,960 for me, a nuclear engineering background, you know, the things that were most important or the 89 00:07:20,960 --> 00:07:27,520 thing that I've most learned in my training and college and school and stuff like that was, well, 90 00:07:27,520 --> 00:07:32,560 how do I learn? Right? And I think that's the take home message from college. How do you learn 91 00:07:32,560 --> 00:07:36,560 the best most effectively? Because if you can teach yourself that the rest of your career is set up 92 00:07:36,560 --> 00:07:40,560 nicely because, you know, when you're done with college, I mean, most of your professional career 93 00:07:40,560 --> 00:07:47,040 is going to be when you know how to learn or how you learn best. I think it provides an incredible 94 00:07:47,040 --> 00:07:52,960 advantage to you. Nuclear engineering and engineering in general, I think, just as a problem 95 00:07:52,960 --> 00:08:01,120 solving thing, it focuses you in a very different way. And so I loved that about nuclear engineering. 96 00:08:01,120 --> 00:08:09,600 In addition, many times it's extremely precise. You know, I remember doing, you know, radiation 97 00:08:10,400 --> 00:08:15,040 measurements, right? And you do these experiments and you're like, well, like, you know, my best, 98 00:08:15,520 --> 00:08:20,960 you know, my best fit plot has an R squared correlation coefficient of 0.9999997, right? 99 00:08:20,960 --> 00:08:23,360 And you're like, wow, that's, you know, and you're sometimes you're wondering, well, where do the 100 00:08:23,360 --> 00:08:29,520 points here, there's two go, you know, in medicine, you get a 0.7, you're like, whoa, this is amazing, 101 00:08:29,520 --> 00:08:37,200 right? Biologic systems don't quite behave the way that these, you know, kind of physical systems. 102 00:08:37,200 --> 00:08:44,720 So in sort of a, you know, the advantage is it's rigorous, it's exact, it's precise, it's linear. 103 00:08:45,280 --> 00:08:51,200 The flip side of that same coin is that biologic systems are not that precise. And that was one 104 00:08:51,200 --> 00:08:55,920 of the hardest things I had to learn, right? Because I came from, you know, hard science, 105 00:08:55,920 --> 00:09:01,520 and now I'm going into a soft science, medicine, the body, biology is a very soft, almost a pseudo 106 00:09:01,520 --> 00:09:08,960 science, right? And so understanding that biologic systems don't behave the same way as physical 107 00:09:08,960 --> 00:09:12,560 systems like we think of, because there's way more variables than you don't even know about. 108 00:09:13,120 --> 00:09:18,160 And in case in point, right, like a person can be, you know, you can give a person a medication 109 00:09:18,160 --> 00:09:22,880 and they do great with it. And the next time you give them a medication, they have allergic reaction. 110 00:09:22,880 --> 00:09:26,480 And then the next time you give them that same medication, they don't have an allergic reaction. 111 00:09:26,480 --> 00:09:31,120 Now think about that, that's the same system in your mind, but in reality it isn't. And so you 112 00:09:31,120 --> 00:09:37,520 have to be able to understand that biologic systems don't behave as consistently as physical 113 00:09:37,520 --> 00:09:41,760 systems. So that was one disadvantage of being an engineer, right? Because I'm used to like, 114 00:09:41,760 --> 00:09:47,280 you know, with these inputs, I get this output. And it's just not like that, you know, frequently 115 00:09:47,280 --> 00:09:53,120 the output comes out unexpected and you then have to adapt. And that was that was a bit of a learning 116 00:09:53,120 --> 00:10:00,480 lesson for me. So in essence, you're trying to say that it wasn't right, easy for you to adapt 117 00:10:00,480 --> 00:10:05,440 from being a nuclear engineer to being a medical consultant, radiologist. 118 00:10:06,480 --> 00:10:11,920 It's not, I don't think it was necessarily easy to adapt. But it was a, it was a perfect fit for 119 00:10:11,920 --> 00:10:18,000 me. I mean, I love, you know, kind of essentially all of science. I mean, there's very few areas 120 00:10:18,000 --> 00:10:23,280 where I don't, you know, just completely nerd out and geek out, right? I mean, I love quantum, 121 00:10:23,280 --> 00:10:30,080 I love, you know, coding, I love biology, I love materials. I mean, it goes on and on. 122 00:10:30,080 --> 00:10:36,800 Anything scientific or curious or interesting. So I think when you, when you have that interest 123 00:10:36,800 --> 00:10:42,160 or love, right, the transitions become kind of a pretty easy, right? Because it's just, you just 124 00:10:42,160 --> 00:10:46,400 follow where your passion goes. And that's, I think that's where I've been very lucky. 125 00:10:47,760 --> 00:10:54,960 That's true. Okay. So can you give us some insight why you found vision radiology and 126 00:10:54,960 --> 00:11:00,480 what were the circumstances when you did? Yeah. So if you'll allow me, because this story goes back 127 00:11:00,480 --> 00:11:06,480 a little bit before even founding vision radiology, and it's related to the nuclear engineering. So 128 00:11:07,120 --> 00:11:11,920 there's a fellow that you probably all know, his name is Glenn Noel. He wrote a pretty important 129 00:11:11,920 --> 00:11:16,480 book in radiation protection and measurements, right? It seems to be sitting on the, you know, 130 00:11:17,280 --> 00:11:24,080 desk of almost every reactor operator I've ever seen. So, you know, so Professor Noel, incredible 131 00:11:24,080 --> 00:11:30,800 teacher, incredible teacher and an absolute wonderful gentleman and human being. So in the, in the summer 132 00:11:30,800 --> 00:11:36,160 between my junior and senior year, you know, I was wandering around in the hallway. This was at 133 00:11:36,160 --> 00:11:40,960 the University of Michigan and the kind of in the department. And he's like, Hey, what are you doing 134 00:11:40,960 --> 00:11:47,920 for your summer project? And like, what summer project? He's like, Oh, this is unacceptable. 135 00:11:48,480 --> 00:11:52,480 So, so you wrote down on a piece of paper a gentleman's name, telephone number, he said, 136 00:11:52,480 --> 00:11:57,680 I want you to call this guy. And we'll come up with something for you. This fellow happened to be, 137 00:11:58,240 --> 00:12:02,720 his name is Jim Carrey, and not of course, the famous actor Jim Carrey, but James Carrey, he's 138 00:12:02,720 --> 00:12:10,400 he's the kind of director of the non physician director of the nuclear medicine department at 139 00:12:10,400 --> 00:12:17,920 University of Michigan hospital. So, you know, I met with him and we had a project on Isaac, 140 00:12:17,920 --> 00:12:22,880 I done 131 and spectral artifacts and things and how to minimize that better predict dose and 141 00:12:22,880 --> 00:12:28,560 you know, thyroid ablation and blah, blah, blah, fine. So the basic thing was I got into this nuclear 142 00:12:29,600 --> 00:12:36,320 medicine department. And you know, I was trying to apply the things that I learned from, from 143 00:12:36,320 --> 00:12:42,560 previous, you know, nuclear engineering, and it was great project with that. And then like a weekend, 144 00:12:43,360 --> 00:12:47,520 he's like, Hey, look, you know, I want you to go sit with the radiologists and just see what they 145 00:12:47,520 --> 00:12:54,320 do. And, and so I went in the reading room, which is where the radiologists, they kind of sit together 146 00:12:54,320 --> 00:12:58,160 typically, and they sometimes were collaboratively, but they'll be on their workstation. So I just sat 147 00:12:58,160 --> 00:13:03,360 with them and watched and watched and watched and I was like, God, this is the greatest thing in the 148 00:13:03,360 --> 00:13:08,080 world. This is like what I want to do with my life. It's like, I apply the technical parts of, 149 00:13:08,080 --> 00:13:14,320 you know, engineering science, I apply some of the puzzle solving of medicine, the biology, and it 150 00:13:14,320 --> 00:13:19,280 was like such a perfect fit for me. I'm like, this is what I'm going to do. As you can imagine, now 151 00:13:19,280 --> 00:13:25,440 I'm, you know, just about ready to start my senior year, finishing a degree program and changing, 152 00:13:25,440 --> 00:13:31,600 you know, career paths was kind of a weird thing. And so, you know, but I knew that I wanted to do 153 00:13:31,600 --> 00:13:37,360 it. And so I basically said, Okay, if I'm going to go into medicine, I've got to make some, some, 154 00:13:37,360 --> 00:13:41,760 you know, I've got to take these classes that are fine. So I did that. And it turned out that I needed 155 00:13:41,760 --> 00:13:46,720 to actually take an extra year to complete all the prerequisites. And in that year, I ended up working 156 00:13:46,720 --> 00:13:53,920 with another mentor, Kim Kierfot, also at the University of Michigan, I did my master's degree in 157 00:13:55,600 --> 00:14:00,000 radiation, like protection and radiation safety, and, you know, basically as a medical physicist, 158 00:14:00,000 --> 00:14:05,600 right? And that was a great, it was a great transition between the nuclear engineering, 159 00:14:05,600 --> 00:14:09,040 kind of the hard science, and starting to move towards the biological or soft science. 160 00:14:09,040 --> 00:14:13,040 And so then I applied to medical school. And this is the part that was kind of interesting, 161 00:14:13,040 --> 00:14:19,040 because as I was working in radiology, I really found that the way radiology was being done in my 162 00:14:19,040 --> 00:14:24,000 mind, it wasn't, it wasn't that efficient. I was like, well, and so that this is in the early 90s, 163 00:14:24,000 --> 00:14:31,040 right? And so it's like, you know, I think we would be better served by pooling all these radiologists 164 00:14:31,040 --> 00:14:36,480 into a central area of reading from there, and then sending out information so you can pool an 165 00:14:36,480 --> 00:14:44,080 aggregate expertise. And the reason why, and so I ended up writing my entire med school application 166 00:14:44,080 --> 00:14:48,960 personal statement on this concept. And it wasn't called tele-radiology at the time, but I'd written 167 00:14:48,960 --> 00:14:55,680 out the, essentially the, you know, the diagram, the floor plan for how to build a tele-radiology 168 00:14:55,680 --> 00:15:01,360 practice, right? Not knowing that that's what it was. And back then we had things like ISDN lines, 169 00:15:01,360 --> 00:15:05,120 right? So I was like, well, you got to put it in Nebraska, in the center of the country, maybe Iowa, 170 00:15:05,120 --> 00:15:09,840 so that, you know, all the distance gets mitigated, and all this stuff. And written this detailed 171 00:15:09,840 --> 00:15:14,000 thing, as you can imagine, I got very few medical school interviews, because they were like, this 172 00:15:14,000 --> 00:15:19,520 guy's crazy. He's completely nuts, right? Like he's like off in his own little, you know, Jetsons 173 00:15:19,520 --> 00:15:26,480 Future Land. And so, but I did eventually, you know, get into medical school. And this stayed 174 00:15:26,480 --> 00:15:31,520 with me, but I kind of had to shut this off because now I'm training as a general, you know, 175 00:15:31,520 --> 00:15:36,400 medical school kind of thing. And radiology was still, you know, in excess of like five years 176 00:15:36,400 --> 00:15:39,920 away before I would even become a resident. And then another five years after that, before I'd 177 00:15:39,920 --> 00:15:46,400 finished, there's still 10 years out. Okay. This story I'll try to get it up, but it's a long story 178 00:15:46,400 --> 00:15:53,600 because that's what really, this is how it starts. So during, so, you know, I finished medical school 179 00:15:53,600 --> 00:16:00,960 and I got into residency program and as a second year radiology resident. So in my third year post 180 00:16:00,960 --> 00:16:08,640 medical school, my chief resident, Ray, said to me, Hey, you know, I would love to be able to work 181 00:16:08,640 --> 00:16:12,880 with you, you know, and I want to be able to work with like-minded people, you know, really 182 00:16:12,880 --> 00:16:18,000 conscientious, hardworking, dedicated folks. And so he's like, look, I'm going to be going, you know, 183 00:16:18,000 --> 00:16:22,000 to Stanford for a year. And then from there, I'm probably going to move to Hawaii and you're going 184 00:16:22,000 --> 00:16:27,280 to be maybe finishing up residency. And then, you know, maybe going to Michigan. How do we work 185 00:16:27,280 --> 00:16:31,280 together? I'm like, well, kind of, you know, it's like, I've been working on this thing in the back 186 00:16:31,280 --> 00:16:36,240 of my mind for, you know, 50, 10, 12, 15 years. I wrote this up. This is something that we could 187 00:16:36,240 --> 00:16:41,120 potentially do this tele radiology. And little did I know that lots of things were going to change, 188 00:16:41,120 --> 00:16:46,640 right? Like the ubiquity of widespread fast internet started becoming real. And so it didn't, 189 00:16:46,640 --> 00:16:51,120 it didn't actually, you didn't have to put a facility in the center of the country. You could 190 00:16:51,120 --> 00:16:55,760 put, you could essentially put a server somewhere and everybody could read from remotely. And that 191 00:16:55,760 --> 00:17:00,960 was now a real thing that we could do. And so, you know, I, it took me about a year to figure 192 00:17:00,960 --> 00:17:05,200 out not only how to get the server in place, but how to create a redundant architecture so that we 193 00:17:05,200 --> 00:17:09,680 had, you know, immediate failover, because when you're dealing with these emergency patients, 194 00:17:09,680 --> 00:17:15,040 you know, time is of the essence, a few minutes can lead to negative outcomes for them. So I figured 195 00:17:15,040 --> 00:17:19,360 out, you know, how to do this in a way that we put, you know, one server on one coast, one server 196 00:17:19,360 --> 00:17:29,840 on the other coast. And I created at the time, this is like now, actually, two days from now will be our 17 year anniversary of reading our first case in 18 years that we started. 197 00:17:31,040 --> 00:17:37,840 But, but I put together what is now known as a cloud architecture, right? So I had the server synchronizing across a huge distance, 198 00:17:37,840 --> 00:17:46,640 keeping everything kind of redundant and want to, and so that's how it started. And we, you know, we had no idea what we were doing. 199 00:17:46,640 --> 00:17:54,160 We just went out and started telling people, Hey, we're, we're here, we can do this. And we're going to approach it in a very academic way. 200 00:17:54,160 --> 00:17:59,280 We're not going to do, you know, we're going to really take care of these patients with a white glove level of service. 201 00:17:59,600 --> 00:18:06,800 And the message took off. And, and, you know, that the company has just grown since then. It's been really extraordinary. 202 00:18:06,800 --> 00:18:12,480 It's been really fun. So that's a long answer to kind of a simple question. But it really. 203 00:18:12,480 --> 00:18:17,200 But very interesting. I open it too. 204 00:18:17,520 --> 00:18:28,880 Yeah. And it starts 30 years, you know, 30 years ago. And to me, the interesting thing about the whole experience was this idea of serendipity, right? 205 00:18:28,880 --> 00:18:39,040 Just by chance, a professor that, you know, I admired came to me and said, you need to do something here. And that led to an entirely new pathway. 206 00:18:39,040 --> 00:18:44,640 And so for, for people that might be listening, that may be students, right? I mean, these opportunities are all around you. 207 00:18:44,720 --> 00:18:50,720 And I would just encourage you as a student to kind of be very open and receptive to the ideas. 208 00:18:51,280 --> 00:19:02,480 Because these professors that you run into really have your best interest in heart and they will help shape your career in ways that you could never possibly imagine. 209 00:19:02,480 --> 00:19:08,240 So just beyond the lookout for these, these, you know, hugely, hugely helpful mentors in your life. 210 00:19:08,240 --> 00:19:20,480 Thank you so much. I sincerely appreciate this great expose. And, you know, you're giving so much information to us that we cannot really digest in one, in one go. 211 00:19:20,480 --> 00:19:35,920 So I was wondering, since you've given us a very detailed story of how your journey was and your interaction with your professor and how greatly favoured you are to get some asking from him. 212 00:19:35,920 --> 00:19:46,320 And we're like wondering, like, have you had this in mind what you are doing currently, like getting into the field, like this field of tele radiology? 213 00:19:46,800 --> 00:19:53,680 Is this something like you have had in mind? At what points did you consider diving into this field, if I may ask? 214 00:19:53,920 --> 00:20:05,440 Oh, so really the point at which I kind of said, I'm going to do this, right? We are going to do this was when my, my chief resident and co-founder, Ray, came to me and said, look, I want to work with you. 215 00:20:05,440 --> 00:20:20,480 And I felt very blessed that somebody who I respect and admire, he's an incredible radiologist, incredible human being, you know, and so these are the people that you want to be around, people that teach you, that you can learn from, that you can be inspired by. 216 00:20:20,480 --> 00:20:22,240 Yeah, you said, you actually said that. 217 00:20:22,240 --> 00:20:30,240 And so that was the point, like, it's a very specific point in time when he said that he wanted to do this. 218 00:20:30,240 --> 00:20:39,120 And I'm like, boy, it was the, it was the culmination of lots of different steps. And I just, you know, in many ways, I was at the right place, right time. 219 00:20:39,520 --> 00:20:46,080 And even a tiny difference somewhere in my professional career could have made this whole thing not, not materialized. 220 00:20:46,080 --> 00:20:50,080 So I feel very blessed that all these, all the stars came into alignment for this. 221 00:20:50,720 --> 00:20:58,480 Yeah, great, great. From what you've said now, it shows the importance of mentorship, you know, having those above you, 222 00:20:58,480 --> 00:21:05,360 coming to your life to help stay in the right direction where you may not even have thought about. 223 00:21:05,360 --> 00:21:12,720 But at the time when you began this, when you had this concept, were there any strong competitors? 224 00:21:13,360 --> 00:21:16,240 Were there any difficulties you encountered? 225 00:21:16,240 --> 00:21:22,480 No, you said the, you had to go to the clinicians to tell them, I'm here and I do this kind of thing. 226 00:21:22,480 --> 00:21:26,240 So what were the difficulties you encountered at that point? 227 00:21:26,240 --> 00:21:34,240 Sure. So the first difficulties are always kind of getting people to understand what it is you're doing 228 00:21:35,200 --> 00:21:41,520 and why, and is it better than what is existing, right? Because in medicine, we have to be incredibly careful. 229 00:21:42,080 --> 00:21:47,440 You know, you're dealing with real human life and their consequences. 230 00:21:48,080 --> 00:21:54,480 And so when I have an existing process, right, if I'm going to introduce a new process, 231 00:21:54,480 --> 00:21:59,040 it's got to work and it's got to work better in multiple ways for the patient. 232 00:21:59,040 --> 00:22:06,640 So this testing validation, you know, early on in tele radiology, I think people were very hesitant to do this. 233 00:22:06,720 --> 00:22:11,200 And so we were early enough that we weren't, we certainly weren't the first people to do this, 234 00:22:11,280 --> 00:22:16,240 but we were early enough that the marketplace was fairly wide open. 235 00:22:16,240 --> 00:22:20,480 No, not very many people were doing it. And so that helped us a lot. 236 00:22:20,480 --> 00:22:26,240 I think if I had to start today, you know, with a, let's say, a developed, mature market, it would be quite a bit harder to do it. 237 00:22:26,240 --> 00:22:32,080 But I would also say that the way we do medicine, our company in particular, it's very different. 238 00:22:32,640 --> 00:22:37,040 It's very, very white glove communication oriented. 239 00:22:37,040 --> 00:22:42,320 And what I mean by that is most tele radiology, you know, you get the images, you look at the case, you, 240 00:22:42,320 --> 00:22:45,760 you know, dictate it, and then you send off the images, you send off the results. 241 00:22:45,760 --> 00:22:49,520 You know, somebody gets a fax or an electronic communication email or, you know, with that, 242 00:22:49,520 --> 00:22:55,520 we don't do that. I mean, we do that. But before doing any of that, I pick up the phone and talk to the doctor. 243 00:22:55,520 --> 00:23:03,520 Okay. And that's nearly unheard of. I believe we're the only company in the country that will routinely call on every case or nearly every case, 244 00:23:03,520 --> 00:23:11,360 negatives, positives. Right. So, so one of the things in medicine that is very difficult is over these large distances, 245 00:23:11,360 --> 00:23:15,360 I don't have access to all the information, you know, you're reading it a little bit of a disadvantage. 246 00:23:15,360 --> 00:23:20,720 And so we call and we talk to the doctors. And, and it's amazing what you learn because, you know, 247 00:23:20,720 --> 00:23:25,520 sometimes the history or the information that you get is so limited that the moment I talk to the doctor, 248 00:23:25,520 --> 00:23:29,920 and that doctor's seeing the patient, I can produce very specific and very accurate results, 249 00:23:29,920 --> 00:23:34,640 and sometimes very sensitive results, meaning I can pick up things that I otherwise would have missed 250 00:23:34,640 --> 00:23:40,800 when I know, you know, more specifically what's going on with the patient. So I think this, 251 00:23:40,800 --> 00:23:46,400 this value, even though it's slower, right, to pick up the phone to call, it's very anachronistic in these days, 252 00:23:46,400 --> 00:23:50,800 right, like, you know, because we're all about emails and texts and this and that, and this asynchronous communication. 253 00:23:50,800 --> 00:23:57,280 But medicine, again, I'll reemphasize is a very human thing. It's a very human to human thing. 254 00:23:57,280 --> 00:24:04,800 And the way this practice works, it's, it, there's a lot of direct physician or clinician communication. 255 00:24:04,800 --> 00:24:12,480 And that has a net benefit. And we, in fact, studied this. And I'm happy to go over some of the data 256 00:24:12,480 --> 00:24:19,360 that we found when we looked at, well, what's the net benefit? Because it was stunning to me when we, 257 00:24:19,360 --> 00:24:25,040 when we talk, like, I did a survey of every one of our ER directors, right? And it took like two hours 258 00:24:25,040 --> 00:24:30,960 to do this survey for those ER directors. And we had a 93.5% completion rate on a survey 259 00:24:30,960 --> 00:24:35,840 uncompensated. We didn't pay them to do this to take up two hours of their own time, right? And they 260 00:24:35,840 --> 00:24:40,000 finished the survey and I was like, wow, this is unbelievable. Because if you do a survey and you 261 00:24:40,000 --> 00:24:47,600 get 10 or 15% participation, you feel happy, right? This was almost every ER director, these are directors 262 00:24:47,600 --> 00:24:52,400 of emergency departments at hospitals, right, took the time to do this survey and they give us data. 263 00:24:52,720 --> 00:24:58,960 And there are two fascinating things we found. One is that when we started coming on to do work, 264 00:24:58,960 --> 00:25:05,760 the sites would order 12.5% less cases, less cases than when either the local radiology group or 265 00:25:05,760 --> 00:25:10,400 another teleregular group that was there before us was there. In addition, they ordered less clinical 266 00:25:10,400 --> 00:25:16,720 consults, which means they ordered less other physicians to come in to see the patient, 1.4 267 00:25:16,720 --> 00:25:24,000 less of those per 100 patients. What's actually contributed to this? Yeah. Yeah. Yeah. So that 268 00:25:24,000 --> 00:25:29,600 was a head scratcher for me. So I was like, well, why does this happen? And so I started talking to 269 00:25:29,600 --> 00:25:35,040 these guys and say, well, what's going on? Why would you order less? And at first I thought, 270 00:25:35,040 --> 00:25:38,880 oh, well, you know, we're working sometimes late at night and they don't have access to the MRs and 271 00:25:38,880 --> 00:25:42,640 need this and that and the other scanners, that had nothing to do with it because we could control 272 00:25:42,640 --> 00:25:47,840 for that. And we saw that that wasn't the case. And they said, simply, I just feel way more confident 273 00:25:47,840 --> 00:25:54,160 after I've talked to you as a physician and we've had that exchange. And it just reemphasizes this 274 00:25:54,160 --> 00:25:58,240 idea that medicine is still a very human process. 275 00:25:58,240 --> 00:26:16,720 Let's continue to part two.