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Come with us as we talk to the clinicians making AI part of their daily workflows, and using it to build deeper connections with patients.
Welcome to Trust But Verify, the Evidently podcast. I'm Andre, and I'm joined by my cohost, Doctor. Kai Romero.
Kai Romero, MD:Hello.
Andres Krogh-Walker:If you don't know Kai, Kai is an emergency physician by trade and palliative care doctor and the head of clinical success here at Evidently. If you don't know Evidently, Evidently is a clinical data intelligence platform. We take everything in the patient record, the structured data, the unstructured data. We index it. We understand it.
Andres Krogh-Walker:And we turn it into insight for clinicians when they need it. And in the course of doing that, we we had this idea to start documenting some of these conversations that we were having with the clinicians we're encountering who are finding really, really interesting ways to amplify the work they're doing and their ability to treat patients.
Kai Romero, MD:Yeah, and I think like, there's, it's probably a cliche that if you start going down the path of optimizing technology that you just run into a bunch of human beings and their stories. Maybe I don't know whose cliche that would be, I think was it was surprising to us that in the process of trying to kind of talk through tech implementation and development, that what we ended up with was kind of just running into regular people who operate at the intersection of tech and health, and have gotten there in interesting ways, and have developed fascinating ways of thinking about the future where we seem to be heading, and how to make that future one that serves as many patients and clinicians as it can, as best it can. We were just really delighted to come across these folks who have thought deeply about these issues and wanted to make sure that you're able to share those with, the broader world.
Andres Krogh-Walker:Yeah.
Kai Romero, MD:All nine of you.
Andres Krogh-Walker:Soon to be 10. We started talking to some of these guests with, very few assumptions about how they got into technology, how they got into technology in their work life. And it's been fascinating to start to understand how a lot of these people came from very different, both educational backgrounds and then also have a common thread of all the enthusiasts for technology that amplifies rather than trying to replace.
Kai Romero, MD:I think we pretty quickly realized that like all of the a lot of the impressions that I think people have about who and how folks get involved in technology, even in this like kind of most cutting edge part of technology, are probably inaccurate. And they're especially inaccurate when you're running it up against healthcare, which is populated by people with a whole host of often very different paths to their current role. So we thought it was a good opportunity to get to learn about the people behind technology adoption in health care institutions and get to understand how they form their view of the world, of the tech that they incorporate or don't, and how we can do the very best job of making technology make our lives better. I think our first guest, Karen Sedivy, is a really good example of, you know, the conversations you have all the time when people talk about AI, they'll be like, Oh, is AI going to replace human physicians? And it's just so interesting kind of being on the software development side of things.
Kai Romero, MD:You meet folks like Karen, newly one of our coworkers, and you're like, Man, there's nothing about the lived experience of this person through her career as an economist, working in an HIV clinic, through the many, many places that she worked clinically before she moved into an executive role, like I'm not worried about the robots coming in and replacing all of that hard earned experience and judgment with an algorithm. It makes, well, A, you know, it makes, I'm sure for the folks that she's worked with, including me, aware of how much humanity you have to bring to the table in order to truly understand what people might need before you foist a solution on them. But it also is just this reminder that, like, we are human beings with whom other human beings resonate. So like, you know, you can bring as much technology to the table as you want to kind of help augment your skill set and augment the work that you're doing. But like, you know, I'm a human.
Kai Romero, MD:I like humans.
Andres Krogh-Walker:Yeah. We'll jump straight into the episode, but we'd love for you to follow us on the journey. We've got a lot of interesting conversations already lined up next. And we'd love your feedback. Like, we'd love to know if this is interesting to you, what you want to hear more of, you what wanna hear less of.
Andres Krogh-Walker:But without further ado, here's doctor Karen Sedivy. Alright. Welcome, Karen.
Karen Sedivy, MD:Thank you for having me.
Andres Krogh-Walker:Absolutely. Maybe we start with Karen. Like, tell us a bit about you, your background, like how you found your way into to health care.
Karen Sedivy, MD:Oh, I will try to do the short version of that, winding and convoluted road. How's that?
Andres Krogh-Walker:Deal.
Karen Sedivy, MD:All right. Best probably to start in college. So I grew up outside of Chicago and moved to Minnesota for college. And originally, my first year at my first incarnation, I was an English major for And a that was until I sort of got a little bit jaded with literary criticism. And my first semester of my sophomore year, I took an economics class with a professor who was absolutely brilliant and very charismatic.
Karen Sedivy, MD:And I took the class because I had hated my economics class in high school. And I figured I probably should get out of college without trying to do some economics. Fell in love with it, changed my major to economics, did not really have a single thought about medicine as far as I can remember all through college. And as a matter of fact, tested out of science. So I didn't even take any science in college because they required labs that were the middle of the afternoon, which was when I was always doing other activities.
Karen Sedivy, MD:So after college, I spent about five years in the Washington DC area doing public policy. And then I first did public policy with a consulting group that consulted with the Department of Housing and Urban Development for a few years. And then I switched over to an economic group that was doing econometric analyses of banks' fair mortgage lending. So I was doing a lot of data work and statistical analysis, like running regressions and that kind of thing. I found myself sort of wandering around the office, looking for folks to talk to because I found out straight up programming for twelve, fourteen hours a day was just not me.
Karen Sedivy, MD:And was also at the same time volunteering in an HIV clinic, giving counseling to folks who were prepping for HIV tests and then taking the test and getting better results and realized that I was a lot more invested and engaged in that than I was in my actual nine to five. Long story short, this is already too long, probably. Went to pre med then and did all my pre med classes in the year, took the MCATs while I was still finishing my science classes, which was a little challenging. And then actually moved down to San Francisco for a year to work for a breast cancer surgeon at UCSF in my gap year. Moved back to my hometown of Chicago for medical school and then moved to Minnesota for family practice residency and been here ever since.
Andres Krogh-Walker:Wow.
Kai Romero, MD:It explains a lot about my theory, which is that each time you like added one additional layer before a doctor becomes a doctor, you end up with a much more interesting doctor, like no offense to people that went straight through. But I think often that additional exposure to lives outside the pre med bubble add a lot of nuance and complexity to how you perceive of medicine as a whole, but also how you approach it day to day. It's so fascinating. So, you moved into your role as a family practice clinician initially, and then kind of moved through the ranks, at your organization to kind of become an associate CMIO, role. And what I wonder is kind of what made you passionate about that area of things?
Kai Romero, MD:Aware now that you had kind of this technical economic background in the sense that you were used to kind of analyzing data in a way that's really different from a lot of, the way that a lot of clinicians have access to, what do you think drove you there in the end?
Karen Sedivy, MD:Well, I would love to give an answer like I had planned it all along and it was all part of my grand life organization chart. But actually how I wound up in tech is really a microcosm of how I wound up in medicine.
Karen Sedivy, MD:It was
Karen Sedivy, MD:a very circuitous road without necessarily planning, but just in terms of taking advantage of opportunities that came my way and seemed interesting to me. So when I first got out of residency, I did full scope family practice with OB deliveries for about the first year. After that moved into a role where I was circulating among the different clinics. So after the first couple of years, I didn't have my own patient panel. I was filling in at a lot of the different clinics in our health organization.
Karen Sedivy, MD:I think I counted once and I ended up working at 30 or 32 different clinics. I got a lot of exposure the ways medicine was practiced just sort of in different patient populations and different cultures. And in one of those stays, one of my colleagues was transitioning away from her health IT job. That was before it was really a formal informatics position, but they did have a few docs who would sort of go into the corporate offices one day a week and work on one off EMR projects. And she recommended to her boss that I take her place.
Karen Sedivy, MD:And to this day, I don't know what about me drove her to recommend me. But when I found out about it, I thought, this sounds interesting, came in, had the interview and just wanted to try it. And very quickly realized that it brought together a lot of the things I just love to do. I think people sometimes feel that in order to be a physician in informatics, you have to be hardcore computer programmer, tech forward data person. But there's another component of it that is a very, I think of it to myself as much more of a softer side.
Karen Sedivy, MD:It's all about the people. It's about adaptive change. It's about figuring out what the real problem is, bringing the right stakeholders to the table, and then facilitating until you can find a solution that's not only the one that is technically the perhaps most efficient and most sensible one to put in that will benefit the most people, but also the one that operationally folks can buy into and clinically people feel is actually usable. And that is a real big series of challenges to try to get all that together. And it's always different, always interesting, depending on the different personalities you're bringing together and you're always learning something.
Karen Sedivy, MD:So that was the part that really drew me in and started and got me fascinated with the health IT aspect of the work. And then I think I started seeing results. So if you think about it as a family practice doc, I can go into the clinic and I can see one by one patients, probably if I'm maxing out and not as fast as most, I can maybe see 20 folks in a day. And so I've helped maybe 20 people. Health IT, you put in something that say ambient voice and you roll it out and suddenly you've got maybe hundreds of docs who are going home earlier, having dinner with their families, happier at their job, actually able to show up and concentrate on their patient doctor relationship instead of staring at the keyboard and typing.
Karen Sedivy, MD:And that's a huge, I feel like it's a force multiplier influence. And so that was really what got me addicted to the tech and staying. And then there's the tech itself changing so rapidly, always so many things on the scene. And it's just another fascinating subject area to learn.
Kai Romero, MD:I definitely think that sometimes when I think about what's appealing about technology, this notion that you touched on, it's a way of like showing care at its best, a way of showing care and attention to providers. Something that like very rarely are those folks getting as much recognition and awareness and being kind of a central part of the conversation in the way that you hope they will. And when tech is deployed well, that takes their preferences and their pain points into consideration, it can feel like it's really, yeah, a way of letting them know that they matter. And that part is really very, it's fulfilling for me for sure. And it sounds like it's for you as well.
Karen Sedivy, MD:Absolutely. I think one of the most rewarding parts of being an associate CMIO type is when you have folks, you roll something out and you have maybe a few providers who just, they don't like it and they write you and they tell you they don't like it. To be able to make them know that you are hearing them and that you are seriously responding to their question or their feedback and trying to do something about it. And if you can't explaining why you can't and then seeing how that fosters their engagement with tech more and their willingness to reach out and continue that feedback loop, I think is really rewarding. They may never love the tech that they're working with, but they will feel respected and valued in terms of their opinion.
Karen Sedivy, MD:And I think that's the most important thing. I think health IT, it comes down to relationships and it comes down to fostering and really giving people the sense that they are highly valued.
Andres Krogh-Walker:I've always been impressed by or kind of astounded by how many providers feel disenfranchised in the decision making process around tech. I think that's something that people outside of health care don't really appreciate the gravity of. And I imagine that's something you see on a daily basis.
Karen Sedivy, MD:Yeah, as a matter of fact, I just saw it earlier today. We were on a call, on a training call with a provider who had requested a meeting and they mentioned a couple of pieces of tech actually and said, this just came at us. Our group was never consulted. We were never asked. We were never even trained.
Karen Sedivy, MD:They said, I just figured this out myself. And so there is sort of that feeling that you just get what is on your plate and you just have to eat it all for dinner and there's no choice. And that does feel really disenfranchising to folks, I think. Of course, on the other end of the spectrum, it is literally impossible to get every single group of providers at the table in a large organization when you're making tech decisions about what kind of tech to go with. So it's a hard needle thread.
Kai Romero, MD:Yeah, and I think often the intentions on the side of the people in the administrative roles are to be helpful. And for the result to be that someone feels disrespected by a new technological acquisition, you're like, oh man, this was a real opportunity for kind of human connection that got lost
Kai Romero, MD:and
Kai Romero, MD:is impacting how the technology is then utilized or deployed more broadly because it becomes a font of rupture rather than its intention, which is usually helpfulness in some way.
Karen Sedivy, MD:If you look at all of the analysis of the tech space over the last few years, the pace of change in tech has just been increasing at an increasing rate over time. And I think that folks often forget that even change that is meant to be good is still change and it's still disruptive. Especially in the clinical world, inpatient, outpatient, doctors, nurses, the whole care team, everybody's been reeling ever since COVID. It's been change after change after change. And so I think a lot of times that's overlooked in this race to put in new technology as fast as they can.
Andres Krogh-Walker:What's brought you joy in your job over the years? What's the thing you look forward to every morning?
Karen Sedivy, MD:I think one thing that is sort of selfish is that I've always loved learning, and I can guarantee waking up every morning in a health tech job, I will always be learning something new and different and I never can predict exactly what it is. And that on a personal level is just truly rewarding. You can tell I'm sort of a liberal arts major, practice generalist kind of person. And I just love learning new topics and a little bit about everything that comes up. So that's one thing.
Karen Sedivy, MD:Think on on a level a where I'm more giving back, is forming and maintaining those relationships over time, not only with your colleagues that you're working with and understanding what the software engineers need and the user interface folks need and how everybody works together, but then also forming those long term relationships over time with providers. I think that's really important too, that it's not just that you meet them to solve their problem and sort of pat them on the head and set them on their way. It's more that you're walking side by side with them to give them support when they need it.
Kai Romero, MD:What would you say over the course of your career has gotten harder about being a physician?
Karen Sedivy, MD:Oh my goodness. That's actually not hard to think of what's gotten harder. It's hard to think of what's not gotten harder. So I think in terms of pay for performance, so folks are right now for better or for worse and a lot of folks think maybe for worse, healthcare is driven by how many patients you see or how many procedures you do and as the financial pressures on healthcare increase that pressure to quote unquote produce increases as well. And so you have docs who have to see more and more patients in a shorter and shorter time span while they're also handling all the side effects of technology.
Karen Sedivy, MD:So now that we've got an electronic medical record, we have increased pressures on documentation. It used to be back in the day you could walk out of the room with maybe a voice recorder and just sort of almost have your note be notes to yourself to what to remember for the patient next time. This time you're documenting for yourself, for any colleagues who might be seeing the patient, for the patient themselves, because there are federal regulations that all notes should be open and completely visible to the patient. And then also for the payers. So if you miss something crucial that the payers needed in a diagnosis, they may not pay for your visit after all, for instance.
Karen Sedivy, MD:So there are those pressures that have really multiplied just from tech. There is the fact that with electronic medical records, we have the ability to look through data on a larger population scale, which also drives more pressures in terms of calculating quality and trying to figure out how to improve quality metrics. Those are also pressures on physicians that weren't necessarily there in the past because they were harder to obtain. And then I think that especially from an ambulatory perspective, the in basket management is a whole another problem in itself that no one's really figured out how to tackle. The in basket in the ambulatory world is really the landing place for all the care you give to patients in between their So not only do you have appointments every day, but you have all of the folks that you saw yesterday or three weeks ago, or you're going to see in two weeks, and they all have questions or messages or, medications that need to be refilled or changed coming in as well.
Karen Sedivy, MD:And all of that needs to be managed. And then of course, there are the usual on call covering your colleagues, patients covering overnight. And then I would say finally, are the administrative parts of being an employed physician, which I don't think were present as much even ten or twenty years ago in terms of administrative meetings that you're required to attend and that kind of thing. So I think out of all of that, probably the thing that's been, I would imagine is hardest for a lot of folks is really maintaining the core of that rewarding relationship with the patient in the face of all these other things that they are responsible for and that are going on.
Kai Romero, MD:Yeah, I think one thing that comes to mind too about the in basket management is you're kind of this, as you said, it's like the holding area for all of their care. It also feels like it's the holding area for all of their fear, anxiety, worry, isolation, stress. And you think, you know, there people talk about the fact that kind of modern relationships are often due to the fact that everyone is more isolated than they used to be. We end up relying on our romantic partners in these like very intense ways to fill all of these roles. I think of the primary care doctor is doing something similar as like one person can't possibly hold the weight of all of these things that people are bringing to the table, but especially when you're dealing with an increasingly isolated population that's aging, that's seriously ill, that has very real reasons to be afraid about their health and is getting constant inbounds on their side from the media, from social media, from everywhere else, the primary care doctor becomes the holding tank for the weight of the world, in so many ways.
Kai Romero, MD:And I think, oftentimes I wonder, whether people realize that kind of beyond the administrative burden there's an emotional and psychological burden that we've asked primary care doctors to pick up as well. That turns their, and all of those don't just take like, you know, a psychological toll, but there's a literal time associated with that. Is just physically impossible to complete in a day. And every day as a physician and especially as a PCP, wake up and it's like, here's the weight of the world. I've got, you know, let's say twelve hours, eight of which I'll be paid for to get through it.
Karen Sedivy, MD:I would argue that it's also hospice doctors, Kai, and various types of specialists who follow their in baskets as well. And I think I agree a million percent. I think one thing that exacerbates that a little bit is again, the tech with the arrival of the ability to secure chat or instant message your doctor, or at least to patients, it feels like instant messaging. Doctors don't get this in actual real time, But as an ACMO, CMIO, you sometimes have to audit charts for different reasons. And so when I've audited charts of patient secure chats, it's astounding what folks will write, really just stream of consciousness, just as you said, Kai, about their day or they had wanted to tell the doc one more thing at their visit, so they just write them the next day and it ends up to be practically a diary entry for folks.
Karen Sedivy, MD:And then the doc has to try to read it and absorb it and suss out the medical question out of all of the other emotional type information that does take a toll.
Kai Romero, MD:Yeah, I do think about kind of like structurally, A, we don't have in my hospice work, we do have Epic. We don't have the patient ability to message their team primarily. We do have secure chats, but everything in our realm is filtered first by a nurse case manager. And wow does that impact. I mean, means also something about staffing, right?
Kai Romero, MD:We have tons of nurses around. But it makes a big difference if the message is triaged by a skilled clinician and then only sent to you if it needs doctor stuff. Because so many things are not doctor stuff. That doctors don't do particularly well. I mean, think the added challenge to it is like, you know, most of us aren't trained psychiatrists.
Kai Romero, MD:Most of us aren't trained social workers. Most of us actually don't have the skills to meet every single thing that a patient might need. And when the doctor's inbox is the shortest link to conversation with a skilled professional, then they become the point around which all these things pivot. And it's not, I think, to the patient's benefit. Like if you need a social worker, the shortest line should be to the social worker.
Kai Romero, MD:And I think in a lot of ways we, physicians, by being responsive, by being generally hardworking, by being willing to work after hours, and by, having more porous professional boundaries end up being the path of least resistance to care in a lot of different settings. And it's not necessarily the path to the care that person needs, but it's the path to the person that will respond.
Karen Sedivy, MD:And I think the two things that contribute to that would be one, know, there's the cliche, why did you go into medicine? Well, I wanted to help people. A lot of doctors actually do, and we take the Hippocratic Oath and medicine is still thought of as a calling for doctors and nurses and many people on the care team. So there's this sense of personal responsibility. Then for doctors in particular, are where the buck stops.
Karen Sedivy, MD:They are responsible for their patient care in the end and they're responsible for a lot of actions that folks with medical licenses that maybe have a more narrow scope are taking on their behalf for patients as well. So, there is that additional burden too. Kyle, you spoke to something I wanted to comment on. You had mentioned folks working fourteen hours or twelve hours and they're only getting paid for eight. I'm wondering if our listeners are familiar with a concept called pajama time.
Karen Sedivy, MD:It's a pretty common concept in medicine. All the docs will know what that means. But for folks who are listening, what you might not realize is after you go in to see your doctor during the day or after your doctor sees you in the hospital in rounds or the ED doctor sees you, they often have excess documentation built up during the day. So that's notes that they haven't finished, in basket messages they haven't responded to, prescriptions they haven't refilled, orders they haven't signed, all that stuff piles up and that needs to be finished at some point. So, what a lot of docs will do, especially docs who maybe have families or whatnot, is come home from work, have dinner maybe with their kids and put them to bed.
Karen Sedivy, MD:And then they'll be literally in the time when they should be in their pajamas sleeping, they'll go back to their computer and start documenting. So we saw this in my ACMIO position as well. If you look at the graph of when providers are on their computers during the day, there'll be a big spike maybe right before clinic, there'll be a spike throughout the day if they're lucky, a little fall during the lunch hour, spike up again for the afternoon, it may fall around 06:00. And then anywhere between eight and ten, you can see it spike up again. And some docs are up charting till two in the morning.
Karen Sedivy, MD:And then they do it again the next day.
Kai Romero, MD:The thing that comes to mind for me around kind of thinking about there's a romantic way in which we can look at medicine that really only makes sense with medicine as it used to be, where you were hanging up a shingle, you were running your own business, you were, you know, doing home visits. And essentially the administrative time was about running your business, right? It was about running the books in the back office. It wasn't about documentation. I remember seeing, actually my dad who's a family practice doctor, seeing some of his documentation in the 90s when I was growing up, and it was like hieroglyphics on a sheet of lined paper.
Kai Romero, MD:No one would ever, other than him, would ever know what happened during that visit. And he's still practicing now, at a site that uses Athena. And you realize like, A, in some ways you had this big attrition of physicians who weren't willing to make that transition over to the EHR. And you think like, okay, well, there's a sadness for the field when that happened. But then there's also like, what happened to those that stayed.
Kai Romero, MD:Either way, it was challenging. Either way, the outcome wasn't great. I don't know that you would have been better off staying or leaving if that was your pivot point at that moment in time. And I think that is a great way to move on to another question that I have about kind of what are some misconceptions that you think healthcare executives have around new technology implementation that you wish you could correct? And I'll say kind of specifically around AI because that is where a lot of the excitement is.
Kai Romero, MD:That's certainly where we operate. But I would say broadly any new technology innovation.
Karen Sedivy, MD:I would say that there are probably two main things that come to mind immediately. And the first would be the temptation to throw technology at a problem that is actually operative or workflow related. So, there is a real temptation to think that by doing that, maybe folks can solve a problem that's been long standing, say, improve provider resilience or relieve burnout or however you want to say it. And it's true that say you give all providers an ambient scribe that can really help them get through their day, but it may not address the true underlying causes of the other factors that are burning them out. And if that say ambient voice technology is given with an eye toward, gosh, wonder how many more patients the doctor can see now that they can go faster and are spending less time, then it really won't relieve the problem at all.
Karen Sedivy, MD:So that's the first thing that I really wish folks would be cognizant of is if this is a long standing issue and it keeps rearing its head every few years or every six months or whatever, most likely it's some kind of adaptive change issue and getting a magical keyboard to throw at it really is going to make the problem crop up again six months later now with a magical keyboard. So I think that's the first thing. I think the second thing is this idea that you can somehow give health tech or health users, I would say, not just providers, but nurses or anybody, a single training session or a single set of training sessions. And then all of a sudden they're perfectly versed in the new tech and they're off and running and they can just go. No maintenance required, no further learning required, no time needed to adjust a learning curve for being slower due to a change in their actual clinical workflow or just adapting to how to use the new technology.
Karen Sedivy, MD:I feel that that is a hidden cost in a lot of technical implementations that's often overlooked and can be a reason that a lot of new tech fails. Doctors do not get on board. They're not engaged. They don't see a great benefit to whatever is trying to be put in front of them, even if it's meant to help them. And they just stop using it.
Karen Sedivy, MD:Or they tell all their colleagues that it's horrible, and then everyone, the word on the street is that it's horrible and no one wants to
Kai Romero, MD:use Yeah.
Andres Krogh-Walker:So
Andres Krogh-Walker:here's something that I'm really interested in knowing about you, Karen, knowing you some and working with you some. My hunch is you're an early adopter of technology. I think a lot of us in this space kind of are or dabble both in our professional lives with AI and technology and outside and probably were early adopters before technology. Is that you or do you come from the other side or somewhere in between?
Karen Sedivy, MD:Honestly, I think I come from somewhere in between. Terms of if you ask about early adopter of technology in terms of have I always had the latest gadget or the latest iPhone? That's definitely a no. I think that comes from my upbringing. I come from a very frugal family.
Karen Sedivy, MD:The idea is you buy one thing once and you keep it for a really long time until it's practically on its last legs. And then you go replace it if you absolutely have to. And so we've always had that attitude toward any kind of disposable goods. And when technology really started being introduced, I carried that over to technology as well. So I've always tended to hold on to my personal computers or devices until the software just won't update on them anymore, and then I'll bring them in.
Karen Sedivy, MD:So I think in terms of, actual engagement with new software, though, that's a little bit different. I don't go out seeking what's the latest and greatest thing that I can get my hands on and experiment with for fun. I just have other things going on in my life. But when they come in front of me, I'm not afraid of experimenting and picking them up. Sort of, I would say the way a lot of doctors do, that's another reason doctors don't always love training is they're like, I'll learn it when I need to know it.
Karen Sedivy, MD:And when they need to know it is usually when they're right in front of a patient and they need to know how to put in the order or whatever. So, yeah, it might be surprising, but that's the truth about me.
Andres Krogh-Walker:What was your first exposure to AI the way all of us know it in the last couple of years?
Karen Sedivy, MD:I remember being in our, one of our maybe weekly IT meetings, and we were all talking about this new thing called ChatGPT, and we were talking about how the uses of it had just spun up exponentially over the course of maybe just the past couple of weeks and how it was worldwide and there were suddenly millions of uses and everyone was still trying to figure out sort of what was it and how did it work? And nobody really understood the concept behind predictive modeling or anything like that. So I think the first thing I remember is just this sense of being sort of, this sense of awe or being taken by surprise by something that was going much faster than anyone could really get their arms around or have a concept of.
Kai Romero, MD:Yeah, I really like that the illusion that you made to kind of how physicians think about learning. Like we've all been burnt by having to like learn anatomy period. You know like that was a moment in time when you just were slaving away trying to learn all of the bits of the body and it like no and you never remember it. And for the rest of your life as a physician you only know regional anatomy. So you only know the structures that are immediately around what you need to be doing in that moment.
Kai Romero, MD:And so that's kind of the pivot from medical student training to adult physician training. Like am I going to review which nerves are in the region of the place where I'm putting a needle in to drain someone's abdomen for a peristeosis? Yes, I am. And which vessels are there? Yes, I'm gonna remember those when I'm doing those procedures.
Kai Romero, MD:Am I gonna remember any of the other vessels that I don't need to remember? Like, no, absolutely not. So the sense that like you there's some absolute like have to know for what I'm doing that what's right in front of me. And like I literally have to let go of the rest of it. Otherwise I won't be able to get through my day.
Kai Romero, MD:I think that's such a that's such an apt observation for how physicians have to kind of engage with ongoing learning in their careers because you just can't possibly know it all.
Karen Sedivy, MD:I remember when I was a resident, was at an annual family practice conference and happened to be at lunch sitting next to a retired physician who still attended these just for interest and to keep his knowledge up. And he was telling me a story about when he started way back in the day, there were four antibiotics and he was like, not four classes of antibiotics, there were only four. And he said that, just the amount of knowledge that physicians are expected to at a minimum be familiar with, if not know, is just mind boggling because of how much medicine has really exploded in terms of treatment opportunities, diagnoses, everything.
Kai Romero, MD:Yeah, mean, will say that antibiotics are this one area where I find AI is so helpful. Like, you know, just remembering what's in a class, remembering which ones have cross reactivity, remembering which sensitivities matter. It's just so helpful for interpreting that and is a very good example of it's actually a decent amount of just retained data that you have to, you know, muddle through. But that brings me to my next question, which is something that I think is kind of a moving target for a lot of folks. You know, there's there's efficiencies that that many tools and new technologies promise and especially AI promises.
Kai Romero, MD:But beyond efficiency, beyond time savings, how do you measure whether an AI tool is actually working? Because, you know, we are in the space of trying to show value to our customers. But I'm curious about beyond what folks like us are saying about how to measure value. How did you know internally that a tool was working and measure that for yourself?
Karen Sedivy, MD:Think this is a very, the metrics are always very difficult. It can be really, really difficult to tease out what you want to measure, especially in the health world where there are so many things that are so subjective and a lot of it does rely on doctor patient relationships and that kind of thing. I think that doctors, however, have a very good nose for whether something smells authentic or not. And they are easily able to tell if they're being asked to do training that is perhaps something that they don't see a direct benefit from, or whether they're being asked to use technology that they actually can tell truly helps them with their role. And so I think what I look for is when I'm speaking with docs and they say, this really brings the joy back into medicine.
Karen Sedivy, MD:This is really helping make my day better. Ever since I've gotten this, it's been a game changer. I've heard people have comments saying like, I felt like the heavens opened when I started using this technology. So I just keep in mind a phrase that informatics colleague of mine used to say all the time when he was programming. He would say, if you build it, they will come, from that one baseball movie, remember that?
Karen Sedivy, MD:But it's really true if you build tech that providers can very quickly and easily see has a pragmatic benefit in their life, they will use it. They will teach themselves to use it and they will go above and beyond out of the box and find ways to use it that you never even realized it could be used for. Then they'll talk about it with their friends and get all their friends on board to use it too. So that was the one thing I think it's hard to measure, but if you can get the sense that you've got a lot of provider folks who are saying that about whatever technology you're rolling out or training, it may take a while, but that's, I think the true measure of success.
Kai Romero, MD:So kind of like organic provider enthusiasm that's spreading without a whole lot of influence by anyone other than just really truly seeing the benefit internally.
Karen Sedivy, MD:Yep, absolutely. I think that docs, we often say that trying to do anything with a group of docs is like herding cats. I think most physicians would agree. But I think that if you can put something in front of them that they see immediately as beneficial, or that they very quickly ferret that out. And if they sense that benefit, they'll just go after it.
Andres Krogh-Walker:When
Andres Krogh-Walker:do you do deep thinking about your patients? Is that like a casualty of the productivity? Do you have to create space to do that? Does it just happen on the fly?
Karen Sedivy, MD:Without technology and then with technology, there have been two different ways that I do it. The first way is just a retrospective way. When you are driving home or making dinner or just not thinking about anything in particular, that's when sometimes ideas come to me that I didn't necessarily realize at the time in clinic that fortunately being an ambulatory doc and seeing patients longitudinally, you can follow-up with the patient and act on those ideas if you need to. So a lot of times it is just, as you referred to Andre, having the space to be able to just let your mind process without you actively sitting down and saying, okay, I'm deep thinking now. When just in the last, say, couple of years when Ambient Scribes came into play, the thing that really surprised me is that for me, they opened up another opportunity for deep thinking.
Karen Sedivy, MD:Because if you think about it, when you go into a room and you're on your own as a provider and you just have the computer and no ambient scribe, you are opening up the computer, you're putting in the orders, you are asking a question of the patient, listening to what the patient says to you, remembering that, translating that into your head as to how that's going to come out medical wise on the documentation, and then thinking still listening as the patient's talking and then thinking about what your next question is going to be. So you're probably doing four or five mental tasks at the same time just to type while you're talking to the patient. When you have an ambient scribe on board, the task of remembering, translating, and actually typing that down, those three tasks are gone. And so suddenly you are looking at the patient, you're asking them the question and you're actually present during their answer. And what I found is that all that cognitive energy that I was spending on the scribing part, I'm now actually thinking ahead to my differential is much broader.
Karen Sedivy, MD:I'm asking much better questions. I'm getting better information at the time of care and just making a better connection in general. And it's really about how technology can be helpful in terms of allowing docs to focus and be present in the moment and do some of their deep thinking at the time.
Andres Krogh-Walker:And it's not dissimilar at all from how people talk about creative flow. A lot of meditative practice also is very rooted in trying to find your way back to being present.
Kai Romero, MD:Yeah, absolutely. I find that, so hospice medicine is interesting in the sense that like it's actually used human beings to solve a lot of the problems, the modern problems of medicine. So, we don't have a lot of the same administrative burden when doing kind of daily tasks that most physicians do. And that does naturally open up more space for deep thinking. The deep thinking looks different because we're not trying often.
Kai Romero, MD:Often the deep thinking is not so much about diagnosis and treatment. It's about how to best manage a patient in a manner that's aligned with their goals and trying to figure out if that's still on hospice or not. Because patients often want care that's outside of the realm of what kind of might traditionally be thought of as hospice care. And one of the nice parts is that as a hospice medical director you get to decide like okay that's slightly outside the realm but makes sense in the grander scale. And so I find that often my deep thinking is actually has a lot more to do with distancing myself from like a rigid sense of the rules because sometimes you can get into like these are the rules we got to follow the rules and so for me I do my best thinking about patients when I distance myself from that rigidity and I back up and think about like what is their experience right now?
Kai Romero, MD:What are they hoping for? What is their actual goal when they're asking for this really aggressive intervention? And is there a way that we can speak to that, understand that, empathize with that and frame it accurately for the patient and their family while maintaining a boundary around what we really can and cannot provide. And so I actually think that my deep thinking is mostly in an attempt to kind of get out of my own head and try and do a better job of understanding the patient's experience and meeting them where they are. So that when I'm talking to them, there's always the potential that it turns into a tug of war over every little thing.
Kai Romero, MD:And that's unpleasant for everybody. What you really want is a clinician who can understand you and say, here's the big picture of what's happening. Here's my worry about where we're headed. I want you to feel like you can do everything possible for your family member. And I'm also worried that if we do these things, there won't be a lot of benefit and there might be more suffering.
Kai Romero, MD:So, you know, tell me what makes sense to you. And I'll tell you if that if hospice is the right place for you to get those needs met. It's a much less fraught way to pursue that discussion than a, like, you can't have dialysis because you're on hospice. Like if you start from there, it's just tension and sadness from from the jump. But like, let's talk about what you're hoping for from dialysis.
Kai Romero, MD:And is there a way we can deliver that to you in your home? Whether that's, you know, relief from trouble breathing, whether that's a nurse that's right there visiting and caring to you, whatever it may be that people kind of are hoping for it. So, I'd say kind of one piece of that is kind of backing away from my own ego to make sure that I'm addressing the true patient need. And then I actually think a lot of my deep thinking ends up happening in conversation with patients there's patients and families I should say. It is truly, and I say this and it sounds kitschy, but it's true.
Kai Romero, MD:I really do believe that patients who are undergoing big life transitions like they are at the end of their life or at the beginning of their life for that matter are in this kind of walking on hollowed ground. And they're in this space of transition, physical transition, spiritual transition, emotional transition. And so if you can kind of get in there and witness it and and be there, there is a tremendous intensity to it. But I think there's also a lot of creativity and kind of a generative aspect to it where you can figure out. I had this happen a couple of weekends ago where I was talking to a woman, unfortunately a young woman whose husband was dying, who had three young children and she was talking, she was so clear minded and she was so graceful and how she was thinking through kind of all these challenges.
Kai Romero, MD:And I had kind of started out with a sense of like, you know, I don't know. I don't think we can get labs on this patient. And as I was sitting there in this conversation with her, was like, you know what? I think we should get labs on this patient. Like, like, really being in this place of like trying to not show up with too much, too many preconceived notions about what this care could look like if you were doing the very best thing at this moment in time for this patient is such a satisfying way to operate.
Kai Romero, MD:It's the very best I think that medicine has to offer is the ability to truly offer the best care at that moment in time, no matter what you think it might be. And so, yeah, I thought a whole lot before I talked to her. I thought a whole lot during that conversation. And then I thought a whole lot afterwards for like how to frame it to the nurses who are like, what are you doing, Doctor. Romero?
Kai Romero, MD:Why are you sending her to get 46,000 labs? But it felt so aligned with what she was hoping for, which was to rule out reversible causes of her husband's condition. It allowed her to stay on hospice or for her husband to stay on hospice. And so this is a really long answer except to say that like I do think one of the huge benefits to hospice medicine is that by virtue of the structures that it's created workflow wise, actually creates a whole lot more space for that than I think a lot of clinical settings do. And it makes me feel like the solutions to our challenges from a burnout perspective, from a physician engagement perspective, have to be technological and non technological in nature.
Kai Romero, MD:You can't you can't as you said earlier on, Karen, it doesn't work to throw a robot at a broken workflow.
Karen Sedivy, MD:It sounds like you're speaking to deep thinking as really part of the art of medicine. No, it might be another cliche or it might just be commonly said that there's an art to medicine, but I think this is exactly what we're getting at. There's another saying, patients don't follow the textbook. And that's what this is too. That's where you can learn all the science, but you really need to know how to approach from, as you said, a more creative or generative, open place to really get the best of what medicine can be.
Andres Krogh-Walker:There's an interesting thread through a lot of what you both have talked about to me in a world where it feels like everybody involved in delivering care doesn't have the control they wish they had over a lot of the parts of their environment and their workflows. It's astounding to me how many I've never met a provider who's not trying to install more control for their patients. And I think that's where you get the patient. Sometimes I'm that patient typing way too much into direct message to the provider. But I think a lot of times, it's out of a feeling of lack of control and that being a venue to get it.
Andres Krogh-Walker:It's incredible to me that there's so much focus from so many providers I talk to on making sure that patients feel like they have that control in a world where the providers and clinicians themselves are struggling to feel that way.
Kai Romero, MD:Yeah, that's such a good point. I think autonomy is for much of your life. It's kind of what we're all hoping for. It becomes a mirage. You know, it's a mirage at the beginning, it becomes a mirage at the end.
Kai Romero, MD:But the ability to kind of self determine and kind of forge forth into the future in whatever way that you choose feels like something that we hold so dear. I wonder too if it's a very American way of thinking about healthcare. Because I do think having had really mostly conversations with trainees who have been in other places and interacted with the medical system in other places, they're like, yeah, that's not a like self determination is not a thing. You do what the doctor tells you and you say thank you and that's the end of the conversation. And so I think there is very much a kind of cultural thing about self determination and control that is absolutely rooted in the kind of culture even beyond medicine, but American culture for sure.
Andres Krogh-Walker:You're listening to Trust But Verify, the Evidently podcast. You can find us online at evidently.com/podcast, and you can find us anywhere you subscribe to podcasts. See you next time.