Physician led innovation - Ed Lee, MD, MPH

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Our childhood defines us in some ways. There

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are things we learned from our childhood that

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we keep with us, and there are things that we

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have to unlearn and let go of. Talk to me about

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your childhood. What are some things you have

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kept with you and what are some things you've

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had to let go of? Gosh, that's a great question.

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And maybe a little bit of background about my

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childhood or where I grew up. So I was born and

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raised in San Francisco. like truly in San Francisco

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proper. And I'm the son of an immigrant family.

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My parents actually immigrated from Burma, now

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known as Myanmar, but from a Chinese culture.

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And so I lived with my parents. I lived with

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my two brothers and sisters and my grandparents.

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So in some respects, we had a sort of a traditional

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Chinese family that was always sort of proper,

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I'll say. You have to wait your turn, you have

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to exercise your manners to the highest degree,

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always respect your elders, and be in place.

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And I would say that those aren't bad things,

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of course. You want to be respectful. You want

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to honor the wisdom of people who have more experience

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than you. And at the same time, I think that

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some of that feels a bit restrictive, right?

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Because you always have to do things in sequence,

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wait your turn. be confined to some of those

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roles. But thinking about where I am today, if

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I had not branched out or reached out or done

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things outside of the box, I would not have had

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the great experience that I've been able to experience

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throughout my career in enjoying the ability

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to express my creativity and my innovation and

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making the impact that I feel like I would have

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otherwise not been able to make if I sort of

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stayed confined within sort of I feel like a

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box that a traditional Chinese family might put

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myself in. So that's some of what I think about

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in response to your question there. And I'm happy

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to expand if that's something we want to take

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take down the road here. If you go back to, say,

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your 20, 25 year old self when you were starting

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med school, what did you think your career trajectory

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would look like? And how has it differed in reality?

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Oh, gosh. Back then, you know, when you're when

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you're early 20s, you think you know everything

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already. Because, gosh, two decades on this planet,

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gosh, you know everything. You know where your

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career is going to go. You know what your family

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is going to look like. And there are so many

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twists and turns that have come up along the

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way that the vision that I had when I was 20

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is actually quite different than what's actually

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happened in reality. And quite honestly, I wouldn't

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change a thing. But back then, I was thinking,

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I'm gonna go to med school. I'm going to specialize

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in internal medicine, which I did. I'm gonna

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be a primary care physician, which I have been.

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And that's what I was gonna do for my entire

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career. I was really interested in having that

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sort of longitudinal care that primary care physicians

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get to have with their patients. um, to be expert

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in a lot of different conditions, the broad breadth

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of what internal medicine has to offer. Um, and

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I've really enjoyed doing that part of medicine.

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Um, and I've done that for, for many years actually,

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but along the way, I was blessed with the opportunity

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to expand outside of that. Um, and you know,

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one thing that happened early in my career, after

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I finished residency was that my medical group

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deployed EPIC, the electronic health record,

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one year into my practice, which was, I would

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say, life -changing in many ways and life -changing

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for a lot of people because, of course, you're

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no longer docking on paper. You're putting everything

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in the electronic health record now. But it was

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not long after that happened where the inefficiencies

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of dealing with electronic health record became

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very apparent. Don't get me wrong, I would never

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go back to paper. There's so many advantages

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of having things in electronic format that we

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would never go back. I would never go back. And

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the quality of care that we deliver now is so

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much better because of that. But as we all know,

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working within an EHR, all the clicks, all the

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keystrokes, all the different screens and all

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the administrative tasks that we're dealing with

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now, they became into play when the EHR was introduced.

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And so I saw opportunities early on after the

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deployment of the EHR around being able to improve

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the efficiency of which I was operating within

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the EHR and to help my colleagues who were equally

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struggling with getting through their day. Not

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only were they now faced with having to provide

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excellent care to their patients, they had to

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figure out, well, how do I get this ordered in

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the system? How do I place this referral? How

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do I do any of these electronic tasks now that

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are in there in a quick way so that I'm not spending

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twice as much time in front of the computer as

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I am, you know. in front of a patient. So along

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the path, I got to program tools into the system

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that improved our efficiency, that made us get

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through our day more quickly. I developed a program

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that went viral across my medical group very

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quickly, actually. And it's still actually used

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today. within the Kaiser Permanente where I was

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practicing in the past. And that was sort of

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my foray into creating technologies or leveraging

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existing technologies to integrate into the practice

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that allows us to get through our day more quickly

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with as little friction as possible. So, you

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know, it's been very fulfilling but at the same

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time, gosh, there's just so much more that can

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be done that I can see. And that's some of the

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work that I'm still doing now, even though I'm

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no longer with the current microgroups I'm at.

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I'm still doing work in technology, technology

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integration within healthcare. This transition

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from clinical medicine to physician, innovator,

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entrepreneur, and leader, was it? You following

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your natural curiosity at that point or was it

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something more planned? And something you had

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to train yourself to excel in I Would say it

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was not planned You know, there are some people

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out there. I think that have a grand master plan

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You know the the moment they were born or the

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moment they went to high school or college or

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med school wherever and they have a grand vision

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of this is where I need to be, this is where

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I want to be. Things for me kind of happened

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organically and naturally over a period of many

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years. And I have to give thanks to the many

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mentors that I had along the way who saw potential

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in me, who pushed me, who gave me opportunities

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to do things that they felt I could do that I

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even know I could do myself and helped me develop

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and help me grow into having those abilities

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to be able to do more than just clinical care.

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Now, I kind of hate to say that because just

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clinical care, oh my gosh, it's such a noble,

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important thing to do. And at the same time,

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There are other things that can be done to help

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at a larger level, at a larger scale, which I've

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been fortunate enough to have those opportunities

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to do along the way. I would say it wasn't necessarily

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kind of, I wasn't born with that. It wasn't innate

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in me, but I learned that through the practice

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of what I was doing. educational courses that

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I attended, and of course the mentors that I

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had along the way who helped educate me, teach

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me, and build on what I had I think as the foundational

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aspects of what I could accomplish to where I

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have come today. For the physicians listening,

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A lot of them would like to cut back on clinical

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medicine and expand their scope in non -clinical

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sidekicks. What's stopping them is the immediate

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loss in income that you often see. What advice

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do you have to those physicians, and what made

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you take this leap into non -clinical medicine

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and be okay with the short -term loss in income?

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Yeah. Well, my leap into non -clinical medicines,

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like I mentioned, could happen over a long period

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of time. I started as a ten -tenths primary care

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physician, did that for a number of years, and

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over time, say, went from nine -tenths to eight

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-tenths to five -tenths, and so on. And I'll

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say that it was always important to me to continue

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to practice medicine because it was always, that

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was my goal coming out of medical school, to

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be a doctor. And even now, I still see patients

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because it's such a fulfilling part of what I

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do during my week, during my month, during the

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years. And it's such an important part of what

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I do in my non -clinical. because being able

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to see patients and understand the challenges

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and the joys of clinical care allows me to have

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a better understanding of how to shape the technology

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that I'm working on that is helping hundreds,

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tens of thousands, and hopefully hundreds of

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thousands, even millions of other clinicians

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out there eventually to be able to sustain their

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practice, to continue to build on their clinical

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careers. You didn't ask this question, but I'm

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going to opine a little bit here around why are

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people looking for side gigs and trying to get

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out of clinical medicine? And I think it's because

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clinical medicine is so hard. And it's hard for

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a number of reasons. It's hard because the demands

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of knowing all this information and trying to

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apply it to the best care delivery they can to

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the patients they're taking care of, it takes

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a toll. And that's why I actually am so enthusiastic

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about technology and artificial intelligence,

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because those are things that can help offload

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the cognitive burden of clinical medicine aspects.

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But on top of that, of having to deal with the

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clinical aspects, there's these whole administrative

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aspects that clinicians have to deal with, which

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when I was in med school, I didn't think about

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that. I didn't think about prior authorizations

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and clinical documentation and all the notes

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that we have to, things like that. I didn't think

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about that, but they're very readily apparent

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in today's clinical world that there are so many

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administrative burdens placed on clinicians that

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I think that's one of the reasons why they're

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very willing to try to give up some of their

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clinical time, even though it is as rewarding

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as it is to find things outside of clinical medicine.

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So advice that I would give, well, be true to

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why you're wanting to venture outside of clinical

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care. Because if it's to make money, as you just

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mentioned, there are probably better ways to

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do that. Or at least short -term because being

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a doctor, being a clinician has its financial

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rewards as well. But if you're not true to yourself

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and you aren't following your passions, what

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you stand for, what you believe in, it's going

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to make it that much more challenging. And for

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me, as I sort of decrease the amount of time

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I spent at the clinic, I felt like there was

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a a higher calling, a higher level of responsibility

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that I could have to have an even bigger impact

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aside from the individual patient that I was

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seeing within the office. And so putting that

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all together has continued to drive me to do

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the work that I do to have a larger impact across

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healthcare, across society. Another thing that

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physicians struggle with I think it's balancing

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finances, retirement planning, and lifestyle

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creep, especially as we get into our late 30s,

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40s. How do you think about these things when

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you make career decisions? And what is your general

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outlook on financial planning as a physician?

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Yeah, you know, I think it's hard to generalize

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because everyone's different in terms of their

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income earning potential, as well as what their

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lifestyle is. And if I, you know, it's funny,

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I talked to my wife this time, for good or bad,

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our lifestyle is fairly similar to when we first

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met in residency and we were working on a residency

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salary. compared to when we both became practicing

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physicians and had a much higher salary to live

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off of. And even at that, having had two kids

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now, we still live a fairly modest life. I mean,

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you know, we take our vacations, you know, and

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we like to enjoy the time we have with each other,

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you know, things like that, of course. And so

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for me, the financial aspects of it are obviously

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important. You know, we had to pay off school

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loans and, you know, we still need to take care

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of two kids and plan for their futures as well.

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But thankfully, because our lifestyles aren't

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necessarily extravagant, we're able to get by

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with what we've been doing. Now, I think it's

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absolutely critical, though, to do financial

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planning, because again, everyone's different.

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And if you have certain things that you want

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to accomplish in life, you want to do goals that

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you have, and they're expensive. you have to

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think about what you're going to do with your

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work and your earning potential. And I think

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of where I went in terms of my career, or if

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I had just stuck with being a primary care physician

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and my decision to go into primary care, if I

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had larger loans that I had to pay off, in deciding

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which residency to go into, which specialty to

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go into, I may have picked a completely different

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path. I may have tried to go into orthopedic

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surgery or become a cardiologist, some procedurally

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based specialty that pays more than a primary

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care physician. But thankfully, I was able to

00:18:55.069 --> 00:18:58.970
balance the finances of it. and my interests

00:18:58.970 --> 00:19:02.849
and my passions to pursue a career where I thought

00:19:02.849 --> 00:19:09.630
would be professionally satisfying. And that's,

00:19:09.690 --> 00:19:15.150
again, how I ended up in primary care. So it's

00:19:15.150 --> 00:19:17.230
a tough question because everyone's different,

00:19:17.309 --> 00:19:19.569
everyone has different goals, and the situation

00:19:19.569 --> 00:19:24.460
varies from person to person. How do you think

00:19:24.460 --> 00:19:27.259
about balancing your personal life and your career

00:19:27.259 --> 00:19:31.519
life? Specifically with kids as well and there's

00:19:31.519 --> 00:19:34.339
something I've learned with kids is you can't

00:19:34.339 --> 00:19:37.960
be more Efficient at parenting because what kids

00:19:37.960 --> 00:19:42.900
want is your time And you know, you can't spend

00:19:42.900 --> 00:19:48.480
time You know, you can't spend ten minutes with

00:19:48.480 --> 00:19:53.759
them in a better manner they need more of your

00:19:53.759 --> 00:19:56.319
time every day, ideally. So how do you think

00:19:56.319 --> 00:20:00.420
about balancing your personal and career life

00:20:00.420 --> 00:20:03.259
and where does happiness lie for you on that

00:20:03.259 --> 00:20:08.900
spectrum? Wow. So you're right. I mean, kids,

00:20:09.319 --> 00:20:15.880
family, those are first and foremost the top

00:20:15.880 --> 00:20:21.279
of my priority. You know, talking about sort

00:20:21.279 --> 00:20:26.920
of traditional Chinese family. It was always

00:20:26.920 --> 00:20:31.779
family and health. Those are the two sort of

00:20:31.779 --> 00:20:35.099
untouchables. We always talked about that. And

00:20:35.099 --> 00:20:36.440
then it was like, well, how are you going to

00:20:36.440 --> 00:20:43.640
make a living? So that was secondary. And I think

00:20:43.640 --> 00:20:47.200
as you asked earlier, what have you carried into

00:20:47.200 --> 00:20:52.099
sort of adulthood and into your career? Those

00:20:52.099 --> 00:20:55.200
are things that I think about. And the things

00:20:55.200 --> 00:21:01.160
that allow me to find balance in my career and

00:21:01.160 --> 00:21:05.480
in my family life is having variety, I think,

00:21:05.720 --> 00:21:09.240
is one of the biggest things. Having variety

00:21:09.240 --> 00:21:13.259
and having challenges. Because let's talk about

00:21:13.259 --> 00:21:17.660
variety here. I mean, doing the same thing over

00:21:17.660 --> 00:21:22.369
and over, I think it'll be easy to get bored.

00:21:23.950 --> 00:21:27.170
And if you want to do something for the long

00:21:27.170 --> 00:21:32.289
haul, for an entire career, for your entire life,

00:21:33.450 --> 00:21:36.930
having that variety is, I think, one of the most

00:21:36.930 --> 00:21:44.210
important things to keep in mind. And I think

00:21:44.210 --> 00:21:46.369
that's one of the things and one of the reasons

00:21:46.369 --> 00:21:49.130
that I kind of took the leap of faith of leaving

00:21:49.400 --> 00:21:52.720
my practice of what I had for 20 years to do

00:21:52.720 --> 00:21:57.039
something different, to join an AI startup company,

00:21:57.259 --> 00:22:01.559
to work at a medical school, and to still maintain

00:22:01.559 --> 00:22:06.960
some clinical practice is that within my work

00:22:06.960 --> 00:22:09.740
life, I've got a variety of things that I get

00:22:09.740 --> 00:22:12.660
to work on that I feel like I'm having a positive

00:22:12.660 --> 00:22:17.079
impact on, either at an individual level, at

00:22:17.079 --> 00:22:20.000
a larger organizational level or the future lives

00:22:20.000 --> 00:22:24.099
of physicians or students who are training to

00:22:24.099 --> 00:22:30.880
be physicians. I always believe that if you're

00:22:30.880 --> 00:22:35.059
doing something fun and exciting at work, it

00:22:35.059 --> 00:22:37.819
often doesn't feel like work. It's just that's

00:22:37.819 --> 00:22:40.160
what you're doing during your day. And I feel

00:22:40.160 --> 00:22:43.660
like a lot of that is what I get to do during

00:22:43.660 --> 00:22:49.589
my professional time. But in terms of my family

00:22:49.589 --> 00:22:54.369
time, my time away from work, I've got two kids.

00:22:54.450 --> 00:22:58.789
They're both teenagers now. And you talked about

00:22:58.789 --> 00:23:02.430
time and spending time with them. And as I think

00:23:02.430 --> 00:23:05.470
about my daughter, who's 16, a junior in high

00:23:05.470 --> 00:23:08.990
school, my gosh, it's going to be like a year

00:23:08.990 --> 00:23:12.690
and a half before she's off to college. And the

00:23:12.690 --> 00:23:18.730
time that I get to see her every day and get

00:23:18.730 --> 00:23:20.690
to spend time with her and talk to her every

00:23:20.690 --> 00:23:24.769
day and to see her continue to grow into adulthood,

00:23:25.829 --> 00:23:30.329
that time is shrinking. It's sad to see, but

00:23:30.329 --> 00:23:36.630
also so exciting to have her be able to develop

00:23:36.630 --> 00:23:41.750
into her own and explore her own future. So just

00:23:41.750 --> 00:23:45.579
trying to cherish every moment that I have. with

00:23:45.579 --> 00:23:49.559
my 16 -year -old daughter, 13 -year -old son,

00:23:50.000 --> 00:23:57.579
with my wife, at home, traveling, experiencing

00:23:57.579 --> 00:24:02.759
different cultures, forming those core memories

00:24:02.759 --> 00:24:04.779
that hopefully they're going to remember the

00:24:04.779 --> 00:24:07.380
rest of their lives, where they took that trip

00:24:07.380 --> 00:24:10.700
with mom and dad, and they can tell their grandkids

00:24:10.700 --> 00:24:14.359
or great grandkids about, and just sort of...

00:24:14.599 --> 00:24:18.099
building that legacy for the future. Those are

00:24:18.099 --> 00:24:22.099
the things that I think about. I'm jealous of

00:24:22.099 --> 00:24:24.519
you and correct me if I'm wrong, but it sounds

00:24:24.519 --> 00:24:28.319
like your natural inclination is family, health,

00:24:28.380 --> 00:24:32.019
and then career. My natural inclination is career,

00:24:32.700 --> 00:24:36.599
family, and then health. And that's caused quite

00:24:36.599 --> 00:24:40.200
a bit of grief and a few episodes of burnout

00:24:40.200 --> 00:24:44.210
in my life. And I'm working really hard to change

00:24:44.210 --> 00:24:49.890
the order of that, too, as you said, family,

00:24:50.670 --> 00:24:57.490
health, and then career. I guess my question

00:24:57.490 --> 00:24:59.529
is, what piece of advice do you have for me?

00:24:59.849 --> 00:25:03.029
And people like me, and the people in the startup

00:25:03.029 --> 00:25:07.410
ecosystem are often like this. And as an investor,

00:25:07.490 --> 00:25:11.549
I look for founders, and maybe I shouldn't, who

00:25:11.549 --> 00:25:15.430
put their startup above all. So what advice do

00:25:15.430 --> 00:25:17.529
you have for me? And is that your natural inclination?

00:25:17.750 --> 00:25:20.690
Or have you had periods in your time where, and

00:25:20.690 --> 00:25:23.710
I'm sure you have, where your career asked you

00:25:23.710 --> 00:25:26.690
to compromise your family or your health, or

00:25:26.690 --> 00:25:30.750
you had opportunities which may lead to financial

00:25:30.750 --> 00:25:34.609
freedom in three, four years? but they would

00:25:34.609 --> 00:25:37.589
come at a cost of family and health. And how

00:25:37.589 --> 00:25:42.549
do you think about these things? Yeah. So you're

00:25:42.549 --> 00:25:44.829
spot on and very observant about what I feel

00:25:44.829 --> 00:25:50.670
like my priorities are. And, you know, I don't

00:25:50.670 --> 00:25:54.250
think these are necessarily fixed in place at

00:25:54.250 --> 00:25:56.910
all times, just as you mentioned, because there

00:25:56.910 --> 00:26:01.789
have been times where I've had to prioritize

00:26:01.789 --> 00:26:06.589
my career so that I could take care of my family.

00:26:08.430 --> 00:26:12.430
There are times that my health unfortunately

00:26:12.430 --> 00:26:15.470
has suffered because either I didn't get enough

00:26:15.470 --> 00:26:18.390
exercise, my diet was terrible, I just didn't

00:26:18.390 --> 00:26:21.549
have enough time for sleep because I was focusing

00:26:21.549 --> 00:26:24.710
on the career aspects and making sure that that

00:26:24.710 --> 00:26:28.309
piece was successful. And I'm not gonna say that

00:26:28.309 --> 00:26:31.799
someone who prioritizes and has their career

00:26:31.799 --> 00:26:34.160
at the top, and then career, family, and health

00:26:34.160 --> 00:26:38.180
in that order is wrong. I don't think it's wrong.

00:26:38.359 --> 00:26:40.480
I think it depends on... I think it's wrong.

00:26:40.799 --> 00:26:43.200
You think it's wrong? Okay. Yeah, go ahead. I

00:26:43.200 --> 00:26:45.400
think it's where you are in your life and where

00:26:45.400 --> 00:26:47.779
you sit and what your perspectives are, and I

00:26:47.779 --> 00:26:49.160
think people can have different perspectives,

00:26:49.180 --> 00:26:52.579
and I think it can be right. But the way I see

00:26:52.579 --> 00:26:58.140
it is this. If you don't have your health, And

00:26:58.140 --> 00:27:00.039
maybe I'm making a case for health being on top,

00:27:00.059 --> 00:27:02.559
but if you don't have your health, you're gonna

00:27:02.559 --> 00:27:05.619
have a much harder time taking care of your family.

00:27:06.039 --> 00:27:08.420
And if you don't have your health, you're not

00:27:08.420 --> 00:27:13.519
gonna be optimally performing at your job. And

00:27:13.519 --> 00:27:17.380
over the past several years, I've been very interested

00:27:17.380 --> 00:27:22.980
in lifestyle medicine and thinking about how

00:27:22.980 --> 00:27:27.170
physical activity, diet and nutrition, stress

00:27:27.170 --> 00:27:30.390
reduction, sleep, avoiding unhealthy substances

00:27:30.390 --> 00:27:34.089
and social interconnectedness, those pillars

00:27:34.089 --> 00:27:39.609
of lifestyle medicine play into family and work.

00:27:40.329 --> 00:27:43.470
And so I recently became board certified in in

00:27:43.470 --> 00:27:45.130
lifestyle medicine because I have such a strong

00:27:45.130 --> 00:27:49.289
interest in it and want to apply that to my own

00:27:49.289 --> 00:27:53.170
health and my own family, but also impart those

00:27:53.170 --> 00:27:55.089
principles to the patients that I see and the

00:27:55.089 --> 00:28:01.519
people that I work with. And so if you don't

00:28:01.519 --> 00:28:04.539
have your health, it just makes it more difficult

00:28:04.539 --> 00:28:08.759
to do those other pieces that we talked about.

00:28:09.099 --> 00:28:17.599
And the family aspect, I've had disagreements,

00:28:17.740 --> 00:28:21.279
fights with my immediate family. I think all

00:28:21.279 --> 00:28:26.299
families do. And I remember a time where I was

00:28:26.299 --> 00:28:29.619
probably in my early 20s and I had a big argument

00:28:29.619 --> 00:28:32.880
with my brother. I've got two brothers, one sister.

00:28:33.319 --> 00:28:35.960
And I didn't talk to that brother for months.

00:28:38.859 --> 00:28:41.299
And my mom, she's like, well, you know what?

00:28:42.799 --> 00:28:47.200
He's your family. You're not going to build other

00:28:47.200 --> 00:28:50.640
brothers. She was done with having kids. She

00:28:50.640 --> 00:28:53.339
wasn't going to have any more brothers for me.

00:28:54.599 --> 00:28:58.579
And your family is your family. And when it comes

00:28:58.579 --> 00:29:00.759
down to it, at least within our culture and our

00:29:00.759 --> 00:29:03.980
family, there's no one that's going to have your

00:29:03.980 --> 00:29:06.000
back like your family. There's no one that's

00:29:06.000 --> 00:29:08.799
going to be there who's going to support you

00:29:08.799 --> 00:29:11.079
in your time of need. And there's no one going

00:29:11.079 --> 00:29:15.859
to be that is in tune with who you are, how you

00:29:15.859 --> 00:29:20.880
grew up, the culture that you are part of to

00:29:20.880 --> 00:29:25.750
be able to to have that level of support that

00:29:25.750 --> 00:29:29.490
others may try to give you. So I feel like that's

00:29:29.490 --> 00:29:33.970
why the family aspect is such an important piece

00:29:33.970 --> 00:29:36.450
of sort of that layering that we talked about

00:29:36.450 --> 00:29:40.549
here. Let's talk a bit more about lifestyle medicine.

00:29:41.599 --> 00:29:43.720
And, you know, lifestyle medicine and longevity

00:29:43.720 --> 00:29:45.839
medicine, they both still have somewhat of a

00:29:45.839 --> 00:29:49.160
bad rep in the academic and the clinical world,

00:29:49.180 --> 00:29:53.960
although I find it is changing slowly. What are

00:29:53.960 --> 00:29:59.839
some biomarkers that you thought were, you know,

00:30:00.039 --> 00:30:02.900
fufu, and when you did lifestyle medicine training,

00:30:03.140 --> 00:30:06.230
you've kind of changed your mind on? and you

00:30:06.230 --> 00:30:08.710
know maybe you'll surprise me and say cortisol

00:30:08.710 --> 00:30:12.509
levels but talk to me about because this is something

00:30:12.509 --> 00:30:15.150
I'm interested in as well and I think a lot of

00:30:15.150 --> 00:30:17.390
physicians are starting to get interested in

00:30:17.390 --> 00:30:22.029
there's a big push towards hormone balancing

00:30:23.409 --> 00:30:26.390
And you know, like if you're testosterone, and

00:30:26.390 --> 00:30:29.410
I'm used to the older scale is nine, which is

00:30:29.410 --> 00:30:31.230
within the normal range, like if you want it

00:30:31.230 --> 00:30:33.549
to be 1450, and you feel better, that's fine.

00:30:34.150 --> 00:30:36.990
But if you push it beyond the normal ranges,

00:30:37.430 --> 00:30:39.470
and then we can get into you know, well, how

00:30:39.470 --> 00:30:42.430
do the normal ranges exist? Is it based on a

00:30:42.430 --> 00:30:45.529
specific Western white male population? And does

00:30:45.529 --> 00:30:47.920
that apply? Like as a normal range of testosterone

00:30:47.920 --> 00:30:50.500
different for a different population at different

00:30:50.500 --> 00:30:52.900
age groups and um, you know, we just don't have

00:30:52.900 --> 00:30:55.859
the data for a lot of these things or maybe We

00:30:55.859 --> 00:31:00.099
do and i'm stuck in my med school Days or residency

00:31:00.099 --> 00:31:02.319
days. So talk to me about lifestyle medicine.

00:31:02.400 --> 00:31:05.420
What are some Some things you've um changed your

00:31:05.420 --> 00:31:08.220
mind on um by learning more and training in lifestyle

00:31:08.220 --> 00:31:11.240
medicine Yeah, um, so I mean I know you asked

00:31:11.240 --> 00:31:13.559
about sort of biomarkers and hormone levels and

00:31:13.559 --> 00:31:16.470
things like that and you know, when I think about

00:31:16.470 --> 00:31:18.710
lifestyle medicine, I don't, honestly, I don't

00:31:18.710 --> 00:31:22.130
think as much in terms of those terms as what

00:31:22.130 --> 00:31:26.269
I'm about to say that I think of in the terms

00:31:26.269 --> 00:31:29.930
that I consider lifestyle medicine. And some

00:31:29.930 --> 00:31:32.509
of the bad rap I think that you hear about or

00:31:32.509 --> 00:31:35.029
you think about that's out there is like, oh,

00:31:35.029 --> 00:31:38.029
it's just about, you know, eating plants and

00:31:38.029 --> 00:31:42.910
vegetables. You know, and it's about being Zen

00:31:42.910 --> 00:31:49.890
and just sort of disconnecting from all the evils

00:31:49.890 --> 00:31:54.630
of society. I'll just throw that out there. But

00:31:54.630 --> 00:32:03.630
there's real evidence around being able to use

00:32:03.630 --> 00:32:10.730
lifestyle medicine to treat diseases, to prevent

00:32:10.730 --> 00:32:16.759
diseases, and to reverse diseases. And so what

00:32:16.759 --> 00:32:21.099
we're talking about here are things like chronic

00:32:21.099 --> 00:32:25.059
diseases in general, obesity, diabetes, hypertension,

00:32:25.339 --> 00:32:30.480
heart disease, cancer, dementia, all those things,

00:32:31.180 --> 00:32:34.779
all those conditions, if we were able to fully

00:32:34.779 --> 00:32:37.480
realize the potential of lifestyle medicine,

00:32:37.880 --> 00:32:44.250
we could likely eliminate 80 % of those chronic

00:32:44.250 --> 00:32:49.269
conditions. We could save millions of lives,

00:32:49.349 --> 00:32:52.430
really, by practicing those pillars of lifestyle

00:32:52.430 --> 00:32:59.109
medicine. And there is real data. Like you think

00:32:59.109 --> 00:33:03.289
about studies in New England Journal of Medicine,

00:33:03.549 --> 00:33:05.829
animals internal medicine, JAMA, different things

00:33:05.829 --> 00:33:07.569
like that. There's real studies that have been

00:33:07.569 --> 00:33:12.829
done to show that I'm not I'm not just speaking

00:33:12.829 --> 00:33:14.950
fluff here. There are peer -reviewed journals

00:33:14.950 --> 00:33:18.150
that have shown the benefits of lifestyle medicine

00:33:18.150 --> 00:33:22.329
here. And so if we could impart even some of

00:33:22.329 --> 00:33:29.529
these principles to more of what we do in the

00:33:29.529 --> 00:33:31.170
care of our patients, I think we'd be so much

00:33:31.170 --> 00:33:36.640
better off. And I'm not also not saying we don't

00:33:36.640 --> 00:33:39.140
need medicine and we don't need procedures and

00:33:39.140 --> 00:33:42.700
you know that's definitely not the case. Putting

00:33:42.700 --> 00:33:48.039
those things in place and complementary with

00:33:48.039 --> 00:33:51.759
you know and then looking at the patient in a

00:33:51.759 --> 00:33:54.859
holistic manner we need all of that to take care

00:33:54.859 --> 00:33:56.579
of patients because despite our best efforts

00:33:58.070 --> 00:33:59.809
We're going to need medicine. We're going to

00:33:59.809 --> 00:34:04.690
need procedures to help treat and protect our

00:34:04.690 --> 00:34:07.789
patients. One thing I've noticed anecdotally,

00:34:07.890 --> 00:34:12.289
I've been prescribing with a lot of us, a decent

00:34:12.289 --> 00:34:17.980
amount of GOP1, Ozempic, Manjaro, Wigovy. is

00:34:17.980 --> 00:34:19.880
sarcopenia. And for those listening who are not

00:34:19.880 --> 00:34:24.059
medical, sarcopenia is this phenomena of muscle

00:34:24.059 --> 00:34:27.179
loss or loss of muscle mass as we get older.

00:34:28.300 --> 00:34:32.579
And it's been shown to be linked with mortality,

00:34:32.860 --> 00:34:35.840
morbidity, dementia, and muscle mass is very

00:34:35.840 --> 00:34:38.260
important, especially as you get into your 80s

00:34:38.260 --> 00:34:43.099
and 90s and maybe even 70s. What are your thoughts

00:34:43.099 --> 00:34:48.320
on And, you know, I'm asking this more as a personal

00:34:48.320 --> 00:34:51.900
thought because I think the evidence is still

00:34:51.900 --> 00:34:55.719
kind of out there of GLP -1 inhibitors. Are they

00:34:55.719 --> 00:34:59.960
the lifesaver that we think they are? Or are

00:34:59.960 --> 00:35:02.880
we going to get more data? And do you think it

00:35:02.880 --> 00:35:07.210
will kind of fizzle out? Gosh at the trajectory

00:35:07.210 --> 00:35:09.889
that it's been going in it's hard to imagine

00:35:09.889 --> 00:35:12.829
it fizzling out At the rate that we're going

00:35:12.829 --> 00:35:15.949
at right now with all the benefits that we are

00:35:15.949 --> 00:35:24.590
seeing with the GOP ones So much chronic disease

00:35:24.590 --> 00:35:28.650
out there is related to obesity and being overweight

00:35:28.650 --> 00:35:31.690
And that's why I'm a believer of lifestyle medicine

00:35:31.690 --> 00:35:34.469
too. I know it's it's it's you know, perhaps

00:35:34.469 --> 00:35:36.750
not as easy as, you know, prescribing a pill

00:35:36.750 --> 00:35:39.090
or prescribing an injection to help lose weight,

00:35:39.090 --> 00:35:43.710
but as patients do lose weight, you know, the

00:35:43.710 --> 00:35:46.309
diabetes disappears, the hypertension disappears,

00:35:46.309 --> 00:35:50.949
and we know what those conditions can lead to

00:35:50.949 --> 00:35:53.130
down the road after years and years of having

00:35:53.130 --> 00:35:54.750
that, or even not even that long of having those

00:35:54.750 --> 00:35:58.989
type of conditions. So I'm very much encouraged

00:35:58.989 --> 00:36:05.139
by what the GOP1s have been able to do. And sometimes

00:36:05.139 --> 00:36:08.940
we just, you know, the shortages that are seemingly

00:36:08.940 --> 00:36:13.380
easing up, but the cost is still very high. And

00:36:13.380 --> 00:36:16.719
so I worry a little about sort of the equitable

00:36:16.719 --> 00:36:19.460
distribution of these type of medications that

00:36:19.460 --> 00:36:25.179
we can apply to our populations. With that said,

00:36:25.440 --> 00:36:29.139
too, sort of the beautiful thing of medicine

00:36:29.139 --> 00:36:32.099
and academic medicine is that we are constantly

00:36:32.099 --> 00:36:37.869
learning. And the longer we use these type of

00:36:37.869 --> 00:36:39.969
medications, the more patients who are out there

00:36:39.969 --> 00:36:41.909
who have been exposed to them for a longer period

00:36:41.909 --> 00:36:46.010
of time, we'll learn more. There are potential

00:36:46.010 --> 00:36:48.210
side effects, as you know, of course, to these

00:36:48.210 --> 00:36:51.250
medications. And we'll find out potentially more

00:36:51.250 --> 00:36:56.329
side effects as the years pass. I like to bring

00:36:56.329 --> 00:37:00.989
up the example of FenFen. We thought it was such

00:37:00.989 --> 00:37:04.940
a great treatment for weight loss but it was

00:37:04.940 --> 00:37:07.000
shown to you know cause valvular issues with

00:37:07.000 --> 00:37:09.260
the heart and then so we you know we obviously

00:37:09.260 --> 00:37:11.559
no longer use that combination of medication

00:37:11.559 --> 00:37:15.500
but hopefully the GOP1s are not going to have

00:37:15.500 --> 00:37:19.460
that fen -phen moment and continue to prove to

00:37:19.460 --> 00:37:25.320
be safe and effective and life -changing in many

00:37:25.320 --> 00:37:30.340
respects. And talking about equity and medical

00:37:30.340 --> 00:37:34.480
treatment and care being equitable, and excellent

00:37:34.480 --> 00:37:37.940
medical care being ubiquitous and equitable worldwide,

00:37:39.480 --> 00:37:43.840
it seems like one of the costs of medical care

00:37:43.840 --> 00:37:48.039
that's been targeted is us as physicians and

00:37:48.039 --> 00:37:51.539
our salaries, which is entwined with our length

00:37:51.539 --> 00:37:57.860
of training. With the rise of NPs, it seems like

00:37:57.860 --> 00:37:59.840
there's a growing sentiment that maybe we're

00:37:59.840 --> 00:38:03.900
overtrained, overpaid. And with AI now and AI

00:38:03.900 --> 00:38:07.579
agents, there is also a growing trend that physicians

00:38:07.579 --> 00:38:11.059
should be replaced. So I'll ask a two -part question.

00:38:12.000 --> 00:38:14.659
What do you think is the role of physicians the

00:38:14.659 --> 00:38:18.699
next five to 10 years? And the second part is,

00:38:18.900 --> 00:38:25.150
if AI can replace us with the same accuracy for

00:38:25.150 --> 00:38:33.769
treatment and diagnoses, should it? Wow. That's

00:38:33.769 --> 00:38:35.849
going to be probably a billion dollar question

00:38:35.849 --> 00:38:40.150
here with respect to that. And the role of physicians

00:38:40.150 --> 00:38:42.730
over the next five years, I don't see the role

00:38:42.730 --> 00:38:47.440
of physicians. We're all I will as a physician

00:38:47.440 --> 00:38:49.699
maybe I'm biased but I think that we're always

00:38:49.699 --> 00:38:53.559
going to need physicians someone that has additional

00:38:53.559 --> 00:38:58.460
expert training in being able to Understand the

00:38:58.460 --> 00:39:01.699
disease processes and to be able to treat patients

00:39:01.699 --> 00:39:09.519
Can a computer do that Yes to degree but can

00:39:09.519 --> 00:39:14.559
the computer develop the empathy and understanding

00:39:14.559 --> 00:39:22.099
and sort of put in and compute aspects of a patient's

00:39:22.099 --> 00:39:26.300
situation that a human could do. I don't think

00:39:26.300 --> 00:39:29.659
you can do that at this point here, right? What

00:39:29.659 --> 00:39:32.420
if it can fake empathy? Is there a difference

00:39:32.420 --> 00:39:34.860
from the patient perspective if they can't tell?

00:39:35.420 --> 00:39:38.679
if the empathy is fake or real. Because our perception

00:39:38.679 --> 00:39:41.659
of reality is reality. And objective reality

00:39:41.659 --> 00:39:45.000
is hard to discern. Yeah. It's a good question.

00:39:45.679 --> 00:39:48.099
Because you're probably aware of the studies

00:39:48.099 --> 00:39:51.980
that have been done, too, around where some patients

00:39:51.980 --> 00:39:56.840
felt like the chatbot was more empathetic than

00:39:56.840 --> 00:40:03.219
the human physician. And so I think there's more

00:40:03.219 --> 00:40:08.679
to learn. um around there and um part part of

00:40:08.679 --> 00:40:14.019
I think that um the mission is some of the empathy

00:40:14.019 --> 00:40:17.639
that I think human physicians uh want to provide

00:40:17.639 --> 00:40:21.380
and can provide is based on some of the time

00:40:21.380 --> 00:40:24.960
constraints that um we're faced with some of

00:40:24.960 --> 00:40:31.019
the burnout issues that we all have and if we

00:40:31.019 --> 00:40:34.489
were able to use technology to offload some of

00:40:34.489 --> 00:40:36.769
those things that we, again, we don't have to

00:40:36.769 --> 00:40:38.150
do. I think the burnout will be better, the time

00:40:38.150 --> 00:40:43.530
screens will be improved. And I don't know, maybe

00:40:43.530 --> 00:40:48.909
I'm being a little old school here in thinking

00:40:48.909 --> 00:40:53.409
that we're still gonna need physicians. I really

00:40:53.409 --> 00:40:57.769
believe we are. Even as technology advances,

00:40:58.110 --> 00:41:00.969
as AI agents are out there looking at all this

00:41:00.969 --> 00:41:04.840
data, processing all of it, going out and doing

00:41:04.840 --> 00:41:07.940
tasks for us, and then bringing things back.

00:41:08.500 --> 00:41:13.239
I think when it's brought back, I really do believe

00:41:13.239 --> 00:41:15.480
there needs to be that human in the loop that

00:41:15.480 --> 00:41:19.920
we talk about, that needs to have that trained

00:41:19.920 --> 00:41:22.800
clinician with years of experience who went through

00:41:22.800 --> 00:41:25.780
medical school, who have seen you know a patient

00:41:25.780 --> 00:41:28.059
in the past that reminded them this is what we

00:41:28.059 --> 00:41:30.380
need to look out for or this we need to take

00:41:30.380 --> 00:41:32.300
into consideration as we're treating this patient

00:41:32.300 --> 00:41:37.739
in front of me here and and taking that say AI

00:41:37.739 --> 00:41:44.340
agent recommendation and applying it as it has

00:41:44.340 --> 00:41:47.960
come back or tweaking it because you know this

00:41:47.960 --> 00:41:49.840
patient and you've treated this patient for 20

00:41:49.840 --> 00:41:54.570
years and and understand what their goals are,

00:41:54.670 --> 00:41:59.130
their beliefs are, and how they would want to

00:41:59.130 --> 00:42:02.929
be treated as a patient, which I think is hard

00:42:02.929 --> 00:42:06.190
to plug into a computer algorithm and to be able

00:42:06.190 --> 00:42:10.269
to put that all together. If your 16 -year -old

00:42:10.269 --> 00:42:14.230
daughter came to you today and said, Dad, I want

00:42:14.230 --> 00:42:17.010
to be a primary care physician, what would you

00:42:17.010 --> 00:42:21.179
tell her? I would say follow your dreams. And

00:42:21.179 --> 00:42:26.000
in fact, she has told my wife and I that she

00:42:26.000 --> 00:42:30.880
wants to be a doctor. She's 16. She's got time

00:42:30.880 --> 00:42:33.820
to think through whether that's the right choice

00:42:33.820 --> 00:42:38.519
for her. But I would love to support her in that

00:42:38.519 --> 00:42:42.460
decision, because I have had an amazing, fulfilling

00:42:42.460 --> 00:42:46.860
career being a primary care physician. I know

00:42:46.860 --> 00:42:48.340
that's not always the case. And I know there

00:42:48.340 --> 00:42:50.340
are a lot of doctors out there who said who would

00:42:50.340 --> 00:42:53.480
say don't go into primary care and don't become

00:42:53.480 --> 00:43:00.599
a physician. But I think it's such a. You know,

00:43:00.599 --> 00:43:03.619
you can give so much and you can get so much

00:43:03.619 --> 00:43:10.699
back. And you're you've got so much opportunity

00:43:10.699 --> 00:43:15.329
that you can. being a primary care physician,

00:43:15.789 --> 00:43:18.570
like where I went with my career, being able

00:43:18.570 --> 00:43:24.050
to see patients, being able to integrate other

00:43:24.050 --> 00:43:25.809
interests around things like lifestyle medicine

00:43:25.809 --> 00:43:28.710
and technology into my practice and into the

00:43:28.710 --> 00:43:32.590
work that I do, and being able to affect patients

00:43:32.590 --> 00:43:36.050
on an individual level or at a population level.

00:43:36.449 --> 00:43:40.389
And having that impact, and as I reflect on the

00:43:40.389 --> 00:43:45.650
career that I've had, um it's it's been so gratifying

00:43:45.650 --> 00:43:50.349
and if she wants to do that um whether it's a

00:43:50.349 --> 00:43:53.449
small part of that or a large part of that uh

00:43:53.449 --> 00:43:58.630
i would fully support her i'm mindful of the

00:43:58.630 --> 00:44:01.210
time do you have time for one more question yeah

00:44:01.210 --> 00:44:05.820
yeah sure If your 30 year old self saw where

00:44:05.820 --> 00:44:09.380
you were at from a career perspective today What

00:44:09.380 --> 00:44:11.880
would they think and where do you see yourself

00:44:11.880 --> 00:44:20.960
in 10 years from now? My 30 year old self um

00:44:20.960 --> 00:44:24.900
You know I I I mentioned earlier that I you know

00:44:24.900 --> 00:44:28.159
someone in my 20s or 30s a they wouldn't know

00:44:28.159 --> 00:44:30.239
what was coming or what would have happened here

00:44:30.239 --> 00:44:33.260
today. I think they would have been impressed.

00:44:34.559 --> 00:44:37.099
Like, gosh, you thought you were going to be

00:44:37.099 --> 00:44:41.880
on this particular career path, but you got to

00:44:41.880 --> 00:44:46.340
do so much more, experience so much more effect

00:44:46.340 --> 00:44:51.199
and have that impact that I would have never

00:44:51.199 --> 00:44:55.199
imagined. And so I feel like I am so fortunate,

00:44:55.659 --> 00:44:59.579
so privileged to have been able to go through

00:44:59.579 --> 00:45:04.340
what I've been able to, and to affect the lives

00:45:04.340 --> 00:45:08.840
that I've been able to make the people healthier,

00:45:09.000 --> 00:45:13.880
people happier, people be able to get through

00:45:13.880 --> 00:45:19.599
their day better. And where do you see yourself

00:45:19.599 --> 00:45:27.360
in 10 years? Gosh, I've been really enjoying

00:45:27.360 --> 00:45:32.420
what I'm doing now. It's hard to imagine doing

00:45:32.420 --> 00:45:36.539
something different than I'm doing now. But,

00:45:36.539 --> 00:45:45.679
you know, I'm basically mid to getting to the

00:45:45.679 --> 00:45:48.900
latter part of my career. And as long as I'm

00:45:48.900 --> 00:45:52.860
having fun and feel like I'm making an impact,

00:45:54.079 --> 00:45:57.739
I'm going to keep on doing what I'm doing. Thank

00:45:57.739 --> 00:46:00.199
you so much for joining me today. This has been

00:46:00.199 --> 00:46:02.739
a little bit of a therapy session for me as well,

00:46:02.760 --> 00:46:06.760
so thanks for doing that. Me too. Yeah, this

00:46:06.760 --> 00:46:09.320
has been amazing. Thanks, Ed. Thanks so much

00:46:09.320 --> 00:46:10.500
for having me. I appreciate it.