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Artificial Intelligence: Jonathan Reisman
33 Plays1 month ago
Dr. Jonathan Reisman is a pediatric emergency medicine physician and writer based in Philadelphia. Listen to Jonathan discuss the use of scripts when delivering bad news, the future of A.I. in medicine and the replaceability of physicians.
Check out Dr. Jonathan Reisman's New York Times op-ed on A.I. here and his book The Unseen Body here
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Transcript
Introduction & Guest Overview
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary.
00:00:21
Speaker
My guest today is Dr. Jonathan Reisman. Dr. Reisman is a pediatric emergency medicine physician and writer based in Philadelphia.
Dr. Reisman's Work & AI Discussion
00:00:29
Speaker
In 2021, Dr. Reisman published his first book, The Unseen Body, A Doctor's Journey Through the Hidden Wonders of Human Anatomy.
00:00:37
Speaker
More recently, in October of 2024, Dr. Reisman published an op-ed in the New York Times titled, I'm a doctor. Chad GPT's bedside manner is better than mine. Dr. Jonathan Reisman, welcome to the Wound Dresser.
00:00:52
Speaker
Thank you so much for having me. So I've been ah following your work for for a while now. I have my copy of The Unseen Body over here on my desk. um But I recently stumbled upon an article you wrote for The New York Times um titled, I'm a doctor.
00:01:08
Speaker
ChatGPT's bedside manner is better than mine.
AI in Emotional & Medical Contexts
00:01:11
Speaker
um Just kind of curious. So what what prompted you to write that article and what kind of message were you trying to send ah to your readers? Yeah. So in the article I wrote for the New York times about AI and bedside manner was sort of brewing.
00:01:23
Speaker
ah like most things I write brewing in the back of my mind for a few years, because I did learn in medical school that I had that, um, that ah interaction with the teacher where they taught me how to teach how to break bad news to patients and ah how using a script or following sort of like memorized lines were to my surprise, very useful in that kind of very high pressure, emotional, sad moment of medicine. You know, we have many of those in the practice of medicine.
00:01:51
Speaker
And so um I was thinking about for years, actually, how scripts are very useful ah in those situations. And then suddenly, you know, a year, year and a half ago when ChatGPT kind of came out, I had no idea that AI was able to compose human-like language like that. So I was very surprised. And so I realized that this idea I was thinking about for years about how scripts are useful to follow in these emotional situations, both in medicine and out of medicine, you know, when someone's, a friend's relative dies or
00:02:23
Speaker
people, something bad happens, a lot of times people say, I don't know, I didn't know what to say, or I don't know what to say in those situations. And I realized that having memorized lines or having a script to follow i was actually very helpful, surprisingly, to keep you human in those very, very human moments where you want to kind of connect with someone emotionally or support them emotionally.
00:02:43
Speaker
So I was thinking about it for years and then AI came out and I and i realized that that was kind of the, that was the, so they're such good script writers. They're so good at composing language for those difficult moments.
00:02:55
Speaker
You'd think you need a human to do that, but no machines are really as good or in many cases better than us at composing appropriate language in those most human moments, which sounds like such a contradiction. And so I sort of wanted to write that essay to express that, that um it's surprising.
00:03:11
Speaker
but But true. And sort of AI probably will have bedside manner better than most human doctors. You know, they're they're not competing against the best doctor with the best bedside manner. They're competing against the average doctor with average bedside manner.
00:03:26
Speaker
Not the stiffest competition. So, and every AI is going to be great and every human, you know, ah half of all people are below average, you know, at whatever they do. And that includes bedside manner and being a doctor. So so anyway, that's that's what prompted that essay.
00:03:41
Speaker
Yeah, I have a ah good excerpt from the article that kind of illustrates what you're you're saying. You wrote, I initially recoiled at the idea that compassion and empathy could be choreographed like a set of dance steps marked and numbered on the floor.
00:03:54
Speaker
But when it was my turn to roleplay the doctor, following the memorized lines and action prompts felt completely natural. To my surprise, surrendering my humanity to a script made the most difficult moment in medicine feel even more human.
00:04:08
Speaker
Yeah, can you just talk more about like, like scripts as a way for for you to feel more human?
AI's Human Understanding
00:04:16
Speaker
Sure. So you think, you know, I feel like when I was a med student and even since you sort of conceptualize medicine as these two distinct parts, one part where you're sort of a scientist or you're interpreting lab values and radiology studies and physical exam findings and history,
00:04:32
Speaker
you know, specific details of the patient history, you're sort of coalescing all these data points into kind of, ah you know, an analysis of some sort to come to a diagnosis, decide on a treatment, etc. That's sort of the technical side of medicine. And then, of course, there's this human side, which is epitomized in bedside manner, you know, you're, you're,
00:04:51
Speaker
You are a an analyst in a way by analyzing the patient's data, but you're also a human interacting with another human, the patient, um at the bedside, in the office, wherever it is. And so you have to be good at both, really, to be a great doctor.
00:05:05
Speaker
And so I would have thought that AI was going to be sort of perfect at the technical side of medicine way before it could act uh you know sort of act out the human side of medicine but i think sort of similar to how ai since it's come on the scene in the last few years like it's amazing at art you would have thought that art was would be the last thing that computers would be amazing at you you know because that's such a human endeavor art it's sort of like spiritual emotional all of our humanity every part of our and level of our brain goes into art you know the intellectual to the emotional uh and um
00:05:41
Speaker
You would have thought that, oh, that's so human. These AIs are never going to be able to do that, or at least it'll take a while until they're able to. And quite surprisingly, they're really good at that part, maybe even better than the technical part. You know, they're not perfect at getting the diagnosis, advising treatment. They sometimes, quote unquote, hallucinate and make up references that don't exist in the scientific literature.
00:06:03
Speaker
ah But they can compose a human script really amazingly. And so I think that is surprising um where the the most the part of medicine where you think you must be not just human, but very human, the most human, extra human.
00:06:19
Speaker
That's where the AI excels. And so I think That is really interesting. And it says something about the role that scripts play in our lives in general, right? It's almost like our whole lives are composed of scripts. We sort of do similar things every day. We say similar things when we see certain people.
00:06:34
Speaker
You know, we have greetings, we have goodbyes, we have things we say to our lovers, we have things we say to our colleagues. The scripts are slightly different. Otherwise, it would be awkward. You know, so kind of everything we do in life is scripted in a way, even the way we celebrate holidays and we say prayers and we write letters, et cetera.
00:06:52
Speaker
ah you know, we have our scripts, they change over time, they're based on culture, history, etc. um And so that it's a very human, it's kind of a kind of a flip on this on the question of what's human and what's inhuman, you know, because ah something that's very, very human, it turns out, is sort of something we think about as, you know, ah very human, only humans can do it but obviously computers are good too. So, so that's the thought there.
00:07:18
Speaker
When you think about ai being integrated ah into healthcare, care um do you um do you envision that the the AI will be just writing those scripts that you're talking about, or will they actually be delivering the scripts to patients too?
00:07:34
Speaker
Right. So that's another question is how how much of quote unquote bedside manner is sort of the sensory part of it? Not even what they say, but having this human form with a head, body and four limbs standing next to you, sounding like a human, you know, making facial expressions, changing the tone of their voice.
00:07:53
Speaker
ah How much of what how much of the need, the emotional and kind of needs of a patient, let's say at that moment when they're receiving bad news, for instance, based on a CAT scan, let's say our blood test.
00:08:05
Speaker
ah How much of it is really, you know, if a computer sounded just like a human and it was sort of clearly a robot at the bedside, but saying the right words, would that be comforting? I kind of don't think it would. Maybe we'll get more used to it, ah you know, that kind of thing. But I guess I'm not really sure.
00:08:21
Speaker
i feel like humans right now still need that human form. But then again, one of the things I've heard about in AI's kind of ah introduction into clinical medicine for instance, these therapy apps or, like you know, psychiatry based apps where you can actually get therapy from an AI. And from what I hear, they perform great.
00:08:40
Speaker
im I'm sure that's sort of preliminary data and there, you know, needs to be more research, but um that's kind of interesting too, because you would have thought that that sort of, and you know, let's say a therapist patient connection ah would be hard to simulate, but actually, you know, it might turn out that it's, it's not that hard.
00:08:59
Speaker
Yeah, I guess ah to jump off of that, the the question would be, if is the entity delivering the news? Does it need to be sort of acquainted with the human condition, acquainted with suffering, acquainted with mortality and and so forth? And do you think that if if the answer is yes, that you need that you need ah you know the entity delivering it like ah like a message or a script to be able to kind of understand those things, would would AI be able to kind of play that role?
00:09:29
Speaker
It's a good question. Like, let's say someone's getting the diagnosis a cancer from like ah an iPad on ah on wheels at their bedside and the iPad says... you know, I'm so sorry, Mr. X and Y for, I wish I had better news, but the biopsy showed X. I know this can be difficult.
00:09:46
Speaker
Like is a human, is that patient going to say, what do you know about what's difficult? You're an iPad, you know, or are they going to say, thank you. That's very comforting. I guess, ah honestly, I'm not sure. And I think people's people will adapt to some extent over time. You know, I feel like everything, right.
00:10:02
Speaker
Everything used to be done by phone. Everything was by phone. And now, Now I hate talking. i hate having to call customer support. I want live chat. I just want to text someone, you know, and if they're an AI, fine ah or human. It's sort of like the way we communicate between people changes.
00:10:20
Speaker
you know we communicate since You know, we communicate through technology more than ever. we communicate with people on screens more than ever. So it's sort of like, is that the first step towards ah kind of the dehumanization of the other entity that we're conversing with, both in life and in the clinic? I guess I'm not really sure, but I kind of think we'll change to some extent. Like people a hundred years from now will tolerate more of that iPad saying how sorry they feel for them than we do today. But like how much, is there a limit Yeah, no, I think that's, that's, that's such an interesting question that i always like to like think about. And I guess, ah even something I discussed on a previous podcast with Dr. Rolando Del Maestro, we were kind of playing around with the idea of whether, you know, AI can have consciousness and like,
00:11:06
Speaker
it It's just sort of like, if he he was thinking, because he's a neurosurgeon, he was thinking, like if you plug enough neurons together, like will that ultimately you know result in consciousness? So I don't know, it's it's it's it's interesting to see, I guess, yeah, like you kind of alluded to, it's all kind of preliminary now, but like what are the what are the the possibilities of AI in terms of its ability to be human, be conscious, et cetera?
00:11:31
Speaker
Right, and i on that question, it's ah of course a fascinating question. And to that, i I often wonder, like maybe we're overhyping consciousness. You know, like maybe um maybe like a computer will be able to at least convince you it's conscious, let's say.
00:11:46
Speaker
By questioning it, you won't be able to prove it's not conscious. Uh, but maybe like, that's all there is to consciousness. You know what i mean? Like maybe, um, it, it feel, we feel like we are conscious. We recognize consciousness and others, but maybe there's nothing really behind that. And when, when you can convince someone you're conscious, you sort of are in a way, I don't really, you know, it's hard to say, I don't know. That doesn't mean you develop free will and where you're
Consciousness & AI's Capabilities
00:12:10
Speaker
going to, you know, let's say prevent the humans from unplugging you and take over the world. But, um,
00:12:15
Speaker
But I wonder, yeah, I guess the more we have technology, the more we sort of can understand our own consciousness. And, you know people used to compare it to, uh, a very complicated watch mechanism because that was the most advanced technology.
00:12:26
Speaker
And technology as it advances just kind of become more becomes more and more complicated and like us. So I guess it'll help us understand the way we are um wired as well. the The language you used in the article is definitely strong in the sense of you were saying that, you know, AI will upend healthcare, care that, you know, my job security is is not...
00:12:46
Speaker
um So actually, I decided last night I was just playing around. ah So I i typed into chat GPT, will chat GPT replace doctors? and And this is the response I got. um um I imagine you've done this exercise before. but not exactly. but um So its response was chat GPT and similar AI technologies have the potential to assist doctors, but they are unlikely to completely replace them.
00:13:09
Speaker
While AI can help with tasks like analyzing medical data, providing general health information, and suggesting possible diagnoses based on symptoms, it doesn't have the ability to provide the human empathy, critical thinking, and nuanced decision-making that doctors bring to patient care.
00:13:25
Speaker
So that's that's a pretty good script right there. I can't read my article, though. because like um So do you ah do you agree with ChatGPT on its assessment of ah the replaceability of doctors?
00:13:38
Speaker
Well, honestly, I feel like that's the that's the answer I would have said a few years ago, um or before I sort of conceptualized the essay as ah as it was finally published, ah where, oh, humans, you know, robots will never be able to stand in for us at the human, for the human side of medicine or in, you know, when when humanity is required rather than a kind of cold analysis.
00:13:59
Speaker
ah But it's really good at, it turns out, it is good at at that empathy. And you could say, right, so how much of, right, like we talking before, an iPad on wheels, comforting you with words. and How much of empathy is just words?
00:14:13
Speaker
How much of it is that human form at the bedside or you being aware of another human kind of at your side? um you You know, how much, I guess that's another thing I thought about during, while writing that essay was sort of what,
00:14:25
Speaker
What feels more empathic? You know i feel like a doctor who says, who gives you a lot of information in a very long winded answer that could feel more like it's more empathy, like they're treating you like an adult. They're recognizing that you want to help make the decision that you want to be informed and educated as opposed to, let's say a doctor who just says, oh, it's nothing.
00:14:44
Speaker
Like I'm the doctor on my authority. I've seen a million patients in my career and what you're, it's not serious. Forget it. You know what and I mean? in In a few words, sort of like, is that, that doesn't feel empathic, even though it's some, I wonder if it's an attempt to reassure the patient to kind of using your authority and experiencing, trying to get them to not worry. But, um you know, I guess it's different with different patients, different people find different things empathetic to a greater or lesser degree.
00:15:12
Speaker
But overall, like language is a huge part of it. And like we said before, AIs don't have to replace the best, you know, don't have to compete against the best doctors. They're competing against average doctors.
00:15:24
Speaker
And so I think even just in the words they say, they're probably going to blow them out of the water. Um, so you, you, you got a couple of responses to your article too, in the the New York times, and it it was kind of along the lines of, yeah, kind of kind of saying that, you know, they can only assist humans. AI can only assist humans, not like overtake the role of, of, of doctors. But do you, do you kind of just get this sense that like, you know, healthcare care administrators and like people kind of at the top of the food chain are just sort of like sidestepping this so as to not cause a panic among healthcare care practitioners and healthcare professionals?
00:15:59
Speaker
um
AI's Role in Healthcare
00:16:00
Speaker
Yes, probably. But I think it's also worth noticing like or noting what aspects of medicine... you know So in the article, I talk about sort of one of the most emotional and serious moments in medicine when you're breaking bad news of, let's say, a fatal or potentially fatal illness to patients.
00:16:18
Speaker
most of medicine is not that at all. You know, but most of medicine is sort of checking your blood pressure. Oh, it's a little too high. Let's go up a few milligrams on your blood pressure medicine or, oh, your, your blood, your HbA1c is this let's, you should, you know, it's sort of very, or have a sore throat. Is it strep throat versus viral pharyngitis? Like,
00:16:38
Speaker
I don't need empathy for that. Like, I just want the answer. If I had an app on my phone, I could say, ah, take a picture in my throat and it would tell me if it's strep or not and send the script.
00:16:49
Speaker
Like that's 80% of medicine. I feel like right there, just technical. Give me the answer and give me the treatment. I want to feel better. I don't need ah another human to hold my hand. um And I think that that goes back to, we talked about other industries where kind of everything gets easier and easier to access, you know, banking, finances, your health insurance, you know, everything is through the computer, everything's through an app on your phone, you barely need to leave your house.
00:17:16
Speaker
And medicine is still caught in this 20th century, drag it to the office, drag it to the hospital. It's like, I think people would be um really happy if an app, ah a faceless, completely dehumanized app could answer most of their questions. Like my kid has fever and cough.
00:17:33
Speaker
Is it serious? Is it pneumonia? Do they need antibiotics? Or is it just a cold? I don't need handholding. I just want an answer. And if it's going to answer better than the average doctor, good. That's fine by me. I don't need empathy. Thank you.
00:17:45
Speaker
So I do feel like there's that, like the consumer entitlement, which I have to, like, if I have to go to the post office to like buy stamps, it's an outrage. Like, how can I not do this without leaving my home? It's crazy.
00:17:57
Speaker
And I think people are going to kind of get there quickly with healthcare care too. So the sooner ah AIs can do most of what we do, I think people will be very happy. It's not not going to be great for our profession, but I do think And there still will be a need, I think it would just be sort of a narrower set of circumstances kind of within the practice of medicine.
00:18:18
Speaker
So everything we've been talking about, though, like what's, what do you see as like the timeline? What what do you see as, um you know, how are you currently interacting with AI in your current practice? And what do you see in the the upcoming years ahead?
00:18:34
Speaker
Yeah, well, for starters, I'm very bad at predicting timelines. you know, doctors in general are terrible at predicting timelines, whether it's how long will these symptoms last to how long do I have to live? ah And definitely larger questions of socio-politics and economics and technology.
00:18:52
Speaker
I mean, I was quite surprised by what chat GPT coming on and just, you know, being able to compose a 10-page essay better than any college student, kind of in seconds on any topic in the world. So I was I would say I don't know.
00:19:05
Speaker
um I guess I'm caught between it'll take much longer than I think. And there'll be advancements that I don't expect at all. So um I think it's hard. It's hard to say. I'm sure within a few decades, though, the practice of medicine will look very different than it does today.
00:19:21
Speaker
Are at least the um potential for, you know, help with documentation? I know there's this isn't there a thing called like dragonfly or something? or um they're they're like AI tools for note-taking and documentation. Have those ah been useful to you at all in clinic?
00:19:37
Speaker
Yeah, so there's definitely ways that it's being incorporated. i personally actually don't use AI at all. I'm an ER doctor. And I don't, I guess when I have clinical questions, I usually use a sort of a reference, like up to date and similar. I wouldn't say I never ask ah Google, you know, just let's say Google AI, what is x Y, or Z? Usually not when I'm at work, but maybe when I'm at home and one of my kids has something or I have something, but, um,
00:20:05
Speaker
I guess I don't use it much, but I do have colleagues who I know do have some ER r doctors. Some of my colleagues have used it to to write their notes. That's a big part of it, especially the part of the note called medical decision making where you sort of and analytically spell out what what the diagnosis could be, more likely and less likely, and what other tests you want to do to figure it out.
00:20:28
Speaker
ChatGPT, for instance, is very quick at composing that text. And note writing is sort of the bane of ah the the bane of medical practice, whether you're in the er or hospitalist, or primary care. so being able to write notes is pretty excellent. I've heard of docs using it to compose you know letters to patients about whatever it is get they're due for a colonoscopy or their lab results.
00:20:50
Speaker
um ah And I've heard it heard them it being used sort of for all kinds of communication between patients and even between doctors. um So it's definitely starting to change things. And like I said, I do not use anything in my practice, but I'm sure I will soon.
00:21:07
Speaker
And I've heard of the therapy apps, for instance. You know, there's such a shortage of mental health care these days. And whether it's patients waiting in the ah ER for inpatient psychiatric placement or even just referrals on an outpatient basis to behavioral health services, there's such a shortage. So I think these psychiatric apps or therapy apps are coming at the right time, too. So there is a need.
00:21:29
Speaker
What about ah medical education? I was just talking to you before that I'm i'm studying for my big board exam that I'm um doing a lot of this mental mental heavy lifting that AI could probably do in seconds. um you know what's what's How do you see this playing out in medical education where ah you know I like to think of it kind of like the the industrial revolution kind of displaced some of that that manual labor. Now i'm kind of I'm sort of like a mental laborer as ah a medical student and So AI is here to kind of ease the load on me, I guess. So what's what's ah what's in tunene for in store for medical education?
00:22:05
Speaker
Right. i do I do consider AI, it's kind of like the you know the white collar industrial revolution as opposed to the kind of the blue collar ah industrial revolution. Well, I think, so, I mean, certainly medical education has to change and adapt as the practice of medicine changes as the job itself and the daily activities you do changes.
00:22:25
Speaker
I guess many complain that medical education has been slow to do that ah before AI. You know, we still, people will, let's say, criticize medical schools for forcing us to memorize the Krebs cycle or some other esoteric biochemical pathways that we're unless we become a metabolic specialist are not going to use in our practice.
00:22:46
Speaker
I guess i I come down on the side of, I'm sort of glad I learned all that stuff, even though I'm not using it. I'm very glad that I got to dissect a cadaver, for instance. um sort of I was sort of interested in that aspect of medical school from the very beginning.
00:23:01
Speaker
And um did I have to? Would I be as good a doctor if I didn't, if I use some digital ah you know alternative, let's say, for learning anatomy? Probably. i guess ah I'm glad that I learned it.
00:23:13
Speaker
I guess I'm glad that I learned all this esoteric stuff in medical school, even if I have not used it a single time since then in practicing medicine. um But surely, you know, I guess at some point medical school has to change. I understand that and should reflect um the modern activities of a doctor.
00:23:30
Speaker
um But I guess I'm also caught between that romantic vision of, you know, learning everything there is about the body and the history of and tradition of things like dissecting a cadaver, sort of rite of passage on your way to becoming a doctor. So I'm a little interested in those things. So maybe I'm irrationally holding on to a sort of outdated model of medical education.
00:23:53
Speaker
ah But I'm sure it will change. it sort of has to going forward. I was um listening to a podcast you did a while back called Three Takeaways. um And yeah one of your one of your takeaways, um specifically with with AI, ah was kind of like there's no there's no turning back. like There's AI and technology, and you know there's no kind of turning back from it. we're We're moving forward, and we have to go through it. um do you Do you ever envision a possibility that sort of the values of medicine, the values of society could kind of dictate us to to turn away from that technology and or you or you just you just don't see that happening?
Convenience vs. Traditional Skills in Medicine
00:24:32
Speaker
I feel like um kind of cut like ultimately customer service will sort of triumph in a way. i feel like people will just, um especially with the freedom we have today with technology and accessing things through phones and computers, I feel like people will just...
00:24:48
Speaker
towards whatever's the cheapest and most reliable and easiest and convenience is huge. Also, you know, whenever some new technology comes along, like I remember the first time I put my credit card information into into a website, you know, 15 years ago or something. I mean, I was very scared to do it for privacy concerns.
00:25:07
Speaker
And then I did it once and a second time. And then you see the convenience, how that outweighs the privacy concerns, like totally swamps it and destroys it. And that's how I feel like people are in general.
00:25:18
Speaker
You know, people worried about their privacy, people worried about needing a human, let's say, to deliver empathy. But the convenience of really high quality medical advice from your phone or without leaving your house, I feel like it's just going to trump everything else.
00:25:32
Speaker
And people are going to want that no matter what. And I think it will be delivered cheaply as well, for the most part, right? These are not like complicated month-long ICU stays we're talking about or, um you know, cancer patients with sepsis, et cetera.
00:25:48
Speaker
um Kind of much ah much of medicine is just sort of that everyday simple answer that you want to get. um And so I do think people will follow what's convenient and what's cheap as they do kind of in every other area of life. And there's kind of no stopping that.
00:26:05
Speaker
So you think kind of like those those those values of convenience and and ease and and kind of affordability would would trump like if we just kind of, as you know, Dr. Vivek Murthy has talked about, like that this epidemic of loneliness, I think in some ways AI could definitely contribute to this, like make it worse.
00:26:22
Speaker
like So you think, but still those values of convenience would would trump kind of all that um in in kind of deciding how we move forward as a society with AI? Yeah. Yeah. And I do think that, you know, at least if we're talking about medicine in particular, like I wish I would hope that the interaction with the health care industry is not a significant portion of people's social lives.
00:26:43
Speaker
um So it's sort of like, you know, if your doctor turns into a text app on your phone, like hopefully that's not losing a significant portion of the human touch and humanity in your life.
00:26:54
Speaker
and But when you're talking about like social questions, let's say how we interact with each other or with social groups and things like that, um you know, that epidemic of loneliness is more important. But when it comes to like, I'm a busy parent with three screaming kids, and I just want to know if one of them with snotty nose and fever has pneumonia, like, should I go to the ER or not? I don't know.
00:27:15
Speaker
I now didn't go to medical school. Like I could call my doctor, wait an hour for them to call me back. They'll probably tell me to go to the ER r even if it's not necessary. Why bother? and So I feel like that, yes, people like that.
00:27:30
Speaker
everyone Everyone's life is so busy. um the the kind of the attractiveness of being able to get a a reliable medical answer from your phone without leaving your house, and I just think will trump every everything.
00:27:43
Speaker
ah That's just so convenient and so useful in that situation. um But it's important. I want to emphasize, like, it has to be reliable. So it has to be as good as or better than the average doc, let's say, you know, if you're going to schlep to the doctor's office.
00:27:58
Speaker
ah it should be for something better than what you can get from your phone. So I i think that's important too, is that i don't I don't think it's there yet, but if it does get there, there'll be no turning back. I think people will just speak with their feet and go toward, you know, choose that um option for getting medical care.
00:28:15
Speaker
Yeah. Last thing I wanted to touch on was just, just kind of taking like the 10,000 foot view of your, your article about AI. Like I would say your article you know, it wasn't like dystopian in any way, but it wasn't like necessarily super hopeful. So do you, do you feel like you have hope in this or you kind of just have a stance of neutrality? Like what's kind of going through your head as you look at this AI revolution?
00:28:39
Speaker
Right. Am I a doomer or am i optimistic about it? Um, And I think, you know, it's, I guess there's always, whenever there's a new technology in any area of life, including in medicine, there's always sort of pluses and minuses, right? Nothing's ever sort of a perfect plus or a perfect minus.
00:28:55
Speaker
It's always a mixed bag. So in medicine, right, radiology, right? Obviously, it's amazing that we can CAT scan people and just find the problem right away. ah That's incredible. It leads to severe degradation of physical exam skills, you know which used to be, and still in many parts of the world, are still you know the only thing if CAT scans are available everywhere. We're very blessed in this part of the world to have access to the best technology at our fingertips. but Um, you know, the physical exam, the art of the physical exam sort of disappears or is disappearing and much of the world has already disappeared. And that is sad because it is an art. It is amazing. I've seen it done well and it's sort of like a beautiful thing. You look like you, you feel like you're looking at a masterpiece when you see someone do, it you know, an amazing physical exam and make the diagnosis just using their senses and stethoscope, et cetera.
00:29:46
Speaker
um But it's better to have MRIs and cat scans and there's sort of no, there's no going back. So I think that we have to, um we have to kind of embrace the future. So I would say I'm a little bit of both. i I'm not hugely optimistic, but I'm not hugely pessimistic.
00:30:02
Speaker
I recognize that sort of the golden age of medicine or my romantic vision of medical history or the history of medical education is sort of worth jack squat when it comes to that busy parent with a febrile child who is scared for their wellbeing.
00:30:16
Speaker
and has a million things to do and is beyond stressed and anxious and hasn't slept well in months and just needs to know if the damn child has pneumonia or not. you know um So I guess I always go back to that.
00:30:28
Speaker
um For them, they couldn't care less that no one's doing egophony when they examine someone's lung anymore. Even though I thought when I learned about egophony med school, I thought it was awesome. It was so intellectually satisfying and and amazing in different ways.
00:30:42
Speaker
but the the busy parent who needs an answer doesn't care about that. So it's sort of, I guess for the average consumer, for the, for patients around the country, for those people who access care, want our help, and you know, want medical help to answer their questions and make sure their family members and they are safe.
00:30:59
Speaker
It's, I feel like it's mostly upside. They don't care about the, you know, the rose colored glasses that some doctors have about the past of medicine. So. But at the same time, I do love that path. So I would say I'm neither a doomer nor very optimistic. But overall, I do think it will be better for patients.
00:31:17
Speaker
And that's sort of the business end of healthcare. care It's not what not what sort of gives us a spiritually meaningful ah job, even though I do love that job. In fact, I think I have one of the best jobs in the world.
00:31:29
Speaker
ah But for the patients out there, you know, that's kind of more important. So. I'm optimistic for what the convenience and cheapness and better quality care that they're going to get. I don't know. Could be could doing the the artful physical exam you just described be ah cheaper than ordering a CT and an MRI and ah you know having the patient sit in the um MRI scanner for an hour and and so forth?
00:31:54
Speaker
Could that you know be cheaper and more convenient than than all that other jazz? Yeah, so that's a good question because you don't always need all that imaging. um You know, yes, in most cases, obviously CAT scans and MRIs should be reserved for certain things. And even let's say I work in an ER, I see kids with, let's say, cough and fever. Most of them I don't even get a chest X-ray on because I can tell if it's pneumonia or not. Or I can tell if I'm sure it's not pneumonia. And if I'm not sure, maybe I'll get an X-ray. So um there's definitely a lot of diagnosis to be done without...
00:32:26
Speaker
advanced imaging and things like that, which would increase the cost, not decrease. But I guess i'm I'm imagining this future AI that is able to literally, don't know. I mean, that's not my area but ah my area of expertise. I'm sure people are thinking about it, but how, you know, do you hold the phone up to your chest and it listens to your heart?
00:32:43
Speaker
I don't know the kind of mechanism of how it's going to work, but I'm sort of imagining a future where the this the the AI would be able to make the diagnosis similarly without technology, like unless it's needed.
00:32:55
Speaker
you know, they wouldn't order CAT scans more, let's say, than humans. That's the thing. It doesn't have to be a perfect diagnostician. It just has to be better than average doctors who probably order way too many. I mean, can you imagine the CAT scans being ordered every day across America?
00:33:10
Speaker
ah It's like you an avalanche every minute almost. So I feel like, you you know, the average doctor, right? Half of all doctors are below average. So AI just has to be better than that. So um I think it will be. I think it will use let probably less imaging than we do, not more.
00:33:28
Speaker
so So I feel like that won't be a problem, but we'll see. Yeah, one one doctor told me that if I want to see the future of medicine, I should read more sci-fi. So maybe ah that's where I can get my my sense of, of where this is all going.
00:33:43
Speaker
Um, with that, it's time for a lightning round, a series of rapid fire questions that tell us more about you. Great. Um, so you've been on a lot of cool podcasts.
Personal Experiences & Reflections
00:33:51
Speaker
You've been on fresh air with Terry gross. You've been on the Lex Friedman podcast. Uh, what's the coolest podcast you've been on?
00:33:59
Speaker
Definitely fresh air with Terry gross. Um, you know, I've been a fan for decades since I was intellectually conscious in my late teens. And, um, I've always said if I can get on her show, I will die happy.
00:34:12
Speaker
ah Though I never, i didn't really plan to write a book. i didn't have a specific plan, but I just always loved her show. So getting on that um was really amazing. I feel very lucky to have been on that show with her.
00:34:25
Speaker
That's so cool. Did you did you record that like that ah in Center City at WHYY? No, unfortunately, because it's sort of still COVID. um And so she was not doing in-person interviews. So it was through an app, like I kind of on my phone was basically holding a phone talking to her.
00:34:42
Speaker
But, um you know, I love her other co-hosts as well, who sometimes do the show. But I was always i was ah also very um happy and excited that I got to talk to her in particular. So that was pretty awesome.
00:34:53
Speaker
That's so cool. um I know from your your book, your're you're a big foodie. what are What is the craziest food you've eaten before? oh the craziest food. um Well, I guess, that you know, create what what kind of crazy, right? There's like weird, unusual animal crazy. There's ah like a crazy part of a common animal.
00:35:15
Speaker
ah that's There's all kinds of food could be crazy. Well, yeah, just if a rundown of a couple of those. like What are the were some of the the weird things you've eaten? um Let's see. Well, i spent a bunch of time in Arctic Alaska, and there I had um quite a bit of raw whale blubber, which they call muck tuck, which is great. There's also a dish called the Mickey yuck, which is kind of fermented whale meat.
00:35:40
Speaker
that I thought was great too. um In Iceland, you know, across the Arctic foods get very interesting, but in Iceland I had something called hokarl, which is kind of fermented shark meat that smells very strongly of ammonia.
00:35:54
Speaker
It's one of those foods you sort of can't can't smell, but have to sort of hurry into your mouth ah before your nose gets a whiff. um But yeah, so a lot of those preserved foods are are pretty great.
00:36:07
Speaker
pretty great What's the most interesting place you've practiced medicine? um i'd I guess I'd have to say, so I guess some I've done a few wilderness kind of medicine, you know, so where you're off in the middle of nowhere, Antarctica or the Arctic, and those are interesting. But I guess I'd have to say when when you're practicing in a specific cultural context, it makes it more interesting. So when I worked in um Arctic Alaska, most of the patients were Inupia, Eskimo,
00:36:34
Speaker
And that that's where I was exposed to a lot of Inupia cuisine and learned a lot about their culture and history. And so just sort of like being in a community like that in such an interesting place where they have, you know, they have their own language, you end up learning some words, they have their own cuisine, which is among the most unique cuisines in the world, because obviously, they live in one of the most unique environments in the world.
00:36:54
Speaker
ah And so, um so that was just really super fascinating. I really loved it there and the geography of Alaska. is amazing. And this was, this is not the sort of charismatic, huge glacier part of Alaska. It's sort of not as touristy and so sort of real quote unquote Bush, Alaska. So I really love working there.
00:37:14
Speaker
What's your ideal Saturday afternoon? Oh man, these days just relaxing at home, honestly, and doing absolutely nothing is my idea of a paradise. Um,
00:37:24
Speaker
My wife gave birth to our third child a month ago, so I'm just and doing a lot of baby care. And so just sitting around doing nothing is is great. Congratulations.
00:37:36
Speaker
Thank you. And lastly, so usually at this point, I ask people what's one change they'd like to see in health care. I'm kind of getting bored with that. So now I'll ask you because I'm getting a lot of the similar answers, as you could probably imagine. um So now i want to ask you, ah what's one thing that's working well in health care?
00:37:54
Speaker
Hmm. Working well in healthcare. That's a great question and a rare question, but a good one.
00:38:01
Speaker
Nothing. No, I'm kidding. Um, you know, I guess I feel like I, I, There's so much burnout in healthcare. know, being a doctor has always been a kind of dangerous profession in that we've had relatively high suicide rates among professions.
00:38:18
Speaker
And COVID, there was a lot, you know lot more stressors and a lot of burnout. And even today, there's still a whole lot of burnout. Yeah. But I find that the, i I still love my job. I think I have the best job on earth. And um I feel like as long as you manage your schedule well, ah you can avoid burnout. I mean, obviously enjoying your job is a good point, but actually I think a lot of, a lot of more doctors should work um part-time, like 0.9 full-time equivalent, 0.85 full-time equivalent.
00:38:50
Speaker
I actually think the doctors will be much happier if they do that. They'll make slightly less money, but still enough to have a good living. But the um the increase in quality of life is really dramatic. That's what I do. I advise all doctors to consider that so that um we can avoid burnout. And and i the point here is I think that transition is happening. You know, I read some articles recently about how the new generation of doctors sees their job less as a calling and more as a job that needs to be balanced with their home life.
00:39:21
Speaker
And while that sort of takes some of the allure, some of the romanticism, kind of some of that rose colored history of medicine, lone doctor traveling the rural roads to do home visits for sick people all over.
00:39:34
Speaker
You know, it's like in modern life, we need that. um and We need that work life balance. And so I think seeing doctors pull back from that sort of workaholism ah is good. I think we should do more of it.
00:39:45
Speaker
You should do more of it. Your colleagues should do more of it. ah Work-life balance is better and you enjoy your job more. So just working like one or two less days per month just dramatically improves, I think, the enjoyment of the job.
00:39:57
Speaker
And I think that's important because if we're not happy, we're jerks to our patients and then AI will definitely have way better bedside manner than we will. So, you know, people don't want to pay healthcare's exorbitant rates and drive in traffic and sit in the waiting room for the always late doctor to then get talked to like they're an idiot.
00:40:15
Speaker
It's just so... Terrible customer service is a big problem. Sorry, you asked me what's going well in medicine. a Terrible thing. No, but i think I think pulling back, like doctors getting work-life balance, treating it like a job rather than a calling and not not killing themselves literally or figuratively with the jobs is better for us and better for patients. so And that is happening and we should accelerate it.
Conclusion
00:40:39
Speaker
All right, Dr. Jonathan Reisman, thanks so much for joining the show. Thank you, Jon.
00:40:53
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.