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The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Dr. Wei Wei Lee making a return appearance talking about, well, clinical excellence.
[00:00:12] Dr. Lee: I would say that, like, instead of having, you know, this really beautiful AI-generated response to a patient through the messenger app in Epic, sometimes it's more meaningful to just call that patient and say, "Hey, this is Dr. Lee. I was just thinking about you. Your results look wonderful," right? It's like, what are those points of human connection that we might be missing because we're really thinking about this efficiency, technology, artificial intelligence piece?
[00:00:35] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu, and today I'm joined by Dr. Wei Wei Lee. Dr. Lee is a general internist and professor of medicine.
Her academic research focuses on developing innovative, patient-centered models of care and improving patient-physician communication. She is the Associate Dean of Students at the Pritzker School of Medicine. She is also a fellow of the Academy of Distinguished Medical Educators and, as of summer of 2024, the Assistant Director of the Bucksbaum Institute for Clinical Excellence.
Wei Wei, thanks for joining me again.
[00:01:30] Dr. Lee: Adam, so nice to be here with you today.
[00:01:32] Dr. Cifu: So at this point in your career, you're kind of an old pro. And I say that metaphorically, not to date you or anything. But so I really like, big question, kind of, what does clinical excellence mean to you now? And do you think that definition has kind of changed for you over the years?
[00:01:51] Dr. Lee: That is such a wonderful question to ponder on because I certainly feel older but you know, the pro part, I think, is something that, you know, as a physician, I think we all continue to think about, you know, what that means to be, you know, professional, what it means to be a physician as you kind of move through the work and the relationships that we form.
So I would say clinical excellence, you know, I think when I started out, it really was a sense of that clinical acumen, like coming into the room and having your patients feel comforted by how much you know and how you're able to guide them, right, through really tough you know, situations and illness and things and questions that are coming up in their lives they might not have, you know, had to deal with before. But, you know, as I've kind of moved along in practice, I've really recognized more and more that it's, you know, the shared vulnerability that's really important. This ability to be present and listen and to know your patients and their stories and their values in a way that help you work together to kind of move through these decisions in a way that, you know, help serve them in what it means to be well, what it means to live a good life for them. And I think those are different things. It's important to have the skills and the knowledge, but it's really important to, I think, center your patient and their wishes.
[00:03:14] Dr. Cifu: That's so cool to hear you say that because it's one of those things that as I reflect as you say it, it really is true that... I think what you're most nervous about starting out is, like, do I not have the knowledge, right? And as you progress, you're like, in a way, the knowledge is easy because there's always someone or something you can go for the knowledge but the challenge is often the relational part of it, right? Which you sort of have no help with, right?
It's either you, and maybe it's that we've been doing it for long enough that we've recognized when we've been successful with that, and I'll just speak for myself, recognized when I've screwed up on that, and that's a little bit where the pressure is now.
[00:03:56] Dr. Lee: Yeah, agreed. I think it's that humility that's really important.
You know, I think in the beginning it was hard to maybe phone a friend or ask about, you know, something you didn't know because you're like, "Well, shouldn't I know that?" And in the end, it's really not about that knowledge because we all know, you know, who to ask and who to talk to to help with some of those clinical questions. But you know, when you're not feeling that connection with the patient or you know something is off, that is really, you know, I think where the art of medicine and sort of the way you can help someone comes in because I think unless there's that trust and that connection, it's very hard to move forward.
[00:04:32] Dr. Cifu: I was like, it's funny to hear you say art because what I sort of jotted down as you were talking was, you know, there's the science of medicine and the art of medicine. And maybe in the arc of a career, right, you go from the science being what seems challenging to the art being maybe what seems challenging. And often when we talk about assessing trainees, right? We talk about like knowledge, skills, and professionalism. And early on, the professionalism is a little bit like the softer part. It's like, we'll just tell people if they're doing a terrible job, and maybe later on, as you grow into it, that becomes a richer aspect of things.
So when you... And clearly, from hearing you talk, you know, you clearly reflect on what that excellence means, and you have some sort of bar that you hold yourself up to. What are sort of the biggest challenges for you in, you know, reaching your goals to provide excellent care? Because I'm assuming you're like me and you don't think you're always perfect in the office and there are days that you go home and you're like, "Nah, you know, not my best today."
What sort of gets in the way of that and maybe how do you respond to that?
[00:05:48] Dr. Lee: Yeah. You know, I think those are important questions because I think many times things move so fast in the work that we do, right, as medical students and then residents, and then moving on in your career, it just feels like, you know, there often isn't enough time to do all the things that you feel are important, right?
And when things don't go as well as you expect, sometimes it's easy to put it in a box and sort of not really think about it deeply in a way that can, you know, help you process and move forward and learn from that situation. I think, you know, it's hard. Many of us live with this inner imposter, right? That comes out every time something doesn't go right. You're like, "Ah! You know, well, a better doctor would have done this." Or, you know, really having that sort of self-doubt kind of creep in. And I do think that it's so important to give yourself grace as a human, as someone who doesn't always make the best decisions because there are things that are happening in our lives that you know, make it challenging in some situations to always do that right thing. But I do think that it really is important to kind of sit and reflect on those situations. And I actually find that doing that with my learners is probably one of the most meaningful kind of experiences. And talking about, again, that art of medicine, that idea of we are not infallible, that idea of you know, what can we learn together from the situation? How can we go back and make the situation right or better, you know, for the patient where, you know, we failed them in some way. And those are the hardest conversations to have but when I look back, those are probably the most meaningful ones that I've had with my learners, you know, and with myself, right?
[00:07:29] Dr. Cifu: You mentioned, you know, sort of all the other things in your life. I realized that the days that I feel like I do my best are often days that I'm like, "You know, I'm just not going to pay attention to anything else." And it often comes to me as like, I go into it feeling a little bit lazy. I'm like, you know, "I got 12 things to do, but today I'm just going to focus on, you know, Epic and seeing my patients." But that's not what our careers are like, you know, as academic physicians. We also have all the competing, you know, administration, education, you know, research, which for myself, I put in quotation marks and... But then any doctor, right, has all the competing aspects of life. How are you able to sort of keep that stuff at bay when you're supposed to be paying attention to patients?
[00:08:23] Dr. Lee: I love that you asked that question because that's sort of the second thing I jotted down as I was thinking about this question, right, is that, you know, I think, you know, there is the arc of a career when you're first starting out, you're really struggling with the "Am I good enough?" The knowledge piece, like really getting comfortable with the medicine and then moving towards, you know, what does it mean to be a better physician? Right? You know, one that you would want your family members to see. And I think the hard part is that, you know, as you kind of hit your stride maybe in understanding like, "Okay, I feel good about my relationships with my patients, I feel good about the medicine I'm providing. I feel like I'm doing an okay job." Then oftentimes, you know, I would say in academic medicine, there is this push, you know, for academic excellence, whether that be in research or some sort of national recognition, right? For the work that you're doing. And a lot of that work doesn't always center on the bedside or the care that you're giving your patient.
And so I do think that in that mid-career point, that's one of the biggest challenges is how do you make sure that, you know, the reasons that you went into medicine, you know, the human connection part, helping, you know, your patients, you know, through the relationship you have with them, like, how does that still become something that is you know, really important, you know, and part of what is valued, you know, with the work that you do. So I would say that even if it's not something that you think is, you know, valued or promotable or, you know, an institutional priority that it has to be centered as one that I think is going to give you more of that ability to love the work that you do and to find meaning in it.
And that's how I think you can really sustain yourself in a longer career because, you know, the thrill of having a paper published is short-lived, you know, because there's always the next one, but you know, your patient thanking you for having a heart to heart with them about something that, you know, has been really difficult for them to process or to think through about their health or their lives or their goals, like those things I think are, you know, what really line a meaningful career for many of us.
[00:10:37] Dr. Cifu: I wonder if we, when we think about our roles, and this is, you know, this is not a time to consider the promotion criteria at the University of Chicago, but I wonder if, you know, in our roles in the Bucksbaum Institute for Clinical Excellence, when we think about both work here and our efforts to have more of an impact nationally, you know, if it's figuring out a way that that clinical activity and clinical excellence can be more valued. Because I think we hear it everywhere, right? There are people who are successful in academics strictly for their clinical activity, but those people are rare, and I think, not to be too cynical, but they're often like, the money makers, right? The people who bring in people for a transplant center or something. It's not the person slogging away with the primary care drudgery for, you know, hundreds or thousands of patients every day.
And I wonder if, you know, making that more recognized and more valued in some way, and not just the people who like achieve the greatest, but, you know, top quartile or something could be a goal.
[00:11:53] Dr. Lee: I love that. We need that on the dashboard somehow. The depth of like the impact on a patient as opposed to the breadth of the number of patients you see, perhaps.
[00:12:03] Dr. Cifu: Right. Though again, it gets to like, this is probably something that's unmeasurable. That's something of the beauty of it, and probably it's part of why it's less valued because it's nearly impossible to measure, right?
[00:12:15] Dr. Lee: Yeah. Absolutely.
[00:12:17] Dr. Cifu: Anyway, those questions are too big for a podcast. So last question, and you alluded to this a little bit. You know, you spend a lot of time with our trainees, both students and residents, you've been active in lots of ways kind of over the years. And so rather than having you kind of look back and look at the present, which you were just doing, when you think about clinical excellence and you think about kind of the next ten years, what do you think are like the greatest threats to clinical excellence, either in providing that or in actually training the next generation?
[00:12:56] Dr. Lee: Yeah, you know, as I reflect on this question, you know, the talk of the time right now is this artificial intelligence, right? And so, you know, I think some of the AI sort of goals and aspirations really stem around this idea of efficiency. How can we get a machine to do the work that we don't want to do necessarily, you know, the busy work, the work that may be more tedious as physicians?
But you know, I do think that there is an importance in really making sure that as we are... And I don't think there's any way to stop it, right? AI is kind of here. It's continuing to be something that it's going to be revolutionary, I think, to medicine and the practice of medicine. But I do think that there are inherent threats, right? If we continue to think about the work we do in terms of efficiency, right? And thinking about how can I get through the most number of tasks, and offload that to a computer, and then what do you spend the bulk of the meaningful work that you're doing on, right? So I would say that, like, instead of, you know, having this really beautiful AI-generated response to a patient through the messenger app in Epic, sometimes it's more meaningful to just call that patient and say, "Hey, this is Dr. Lee. I was just thinking about you. Your results look wonderful!" Right? It's like, what are those points of human connection that we might be missing because we're really thinking about this efficiency technology, artificial intelligence piece? And I think it's bringing it back to the idea of what are those... You know, it doesn't take 20 years of a relationship with a patient to build trust. I'm pretty sure we've all had those moments of connection that are just so profound in such short periods of time.
And so how do you find those moments to make that time, make that excuse to go back to the bedside, to make that extra call, to be curious, ask that extra question, because you know, I think that's really what we need to be thinking more about as we move towards this idea of like efficiency technology, AI.
[00:14:57] Dr. Cifu: That's a neat point. And I will put in the show notes for this, both a link to Dr. Shah, who is on talking about artificial intelligence, and to a recent article, you know, about sort of fears about artificial intelligence in medicine. I think you're right in that, you know, there is, of course, something that is so human about medicine that will always, you know, require us to be excellent in the room with a patient.
My more recent fears are that maybe that's what will be left for us. And we will be there to get a thoughtful history and weigh the value of what people tell us, and then offer the assessment and plan that's given to us from a computer in a thoughtful way. And maybe everything else is taken from us, which is frightening as well but it's an interesting take on it, like, huh, maybe artificial intelligence makes us excel at the one thing that only we can do and medicine looks very different in 20 years and other people will be practicing it so we won't feel like we've lost something.
[00:16:11] Dr. Lee: Wouldn't that be delightful? I like your vision.
[00:16:14] Dr. Cifu: We can see it just as we go to the doctor and say what a nice person who doesn't need to think at all, you know.
[00:16:20] Dr. Lee: That's right.
[00:16:21] Dr. Cifu: Wei Wei, thanks so much for talking to us today and as I've said, I really look forward to working with you on all of these topics as we go forward. I'm sure there will be more challenges than we can even foresee just sitting here, right?
Well, thanks for joining us for this episode of The Clinical Excellence Podcast. We're sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas via the Bucksbaum Institute webpage.
The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.