209. What Actually Matters for Longevity: Visceral Fat, VO2 Max, Muscle Mass, and Insulin Resistance | Sam Robinson, DO

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Welcome to Medicine Redefined.

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I'm Dr. Ultima Sharajah.

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And I'm Dr. Darsha.

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Let's put the hell back in healthcare.

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Today, we're joined by Dr. Sam Robinson, a board-certified family medicine physician and founder of Altura Health, a longevity-focused direct primary care practice in Folsom, California.

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After years of practicing in the traditional insurance-based healthcare system, Dr. Robinson came to believe that preventing chronic disease requires more than annual checkups and 15-minute office visits.

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And I'm sure that's not the first time you've heard that.

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His practice is built around affordable, evidence-based preventative care, giving patients more time, more personal guidance, and a greater focus on the lifestyle interventions that have the biggest impact on long-term health.

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But as our conversation unfolds, it becomes something much bigger than longevity medicine.

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We dive into one of the biggest questions facing healthcare today.

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How will artificial intelligence reshape the practice of medicine?

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We discuss whether AI will replace physicians or empower them, the future of direct primary care, wearable technology, and why prevention, not reaction, may ultimately define the next generation of healthcare.

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Please welcome Dr. Sam Robinson to Medicine Redefined.

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If you're a high performer who wants a clear plan for longevity, performance, and staying active with fewer setbacks, I'm now seeing patients through my telemedicine practice who are finding health and performance.

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I'm opening a limited number of founding member spots at refininghealthrx.com.

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All right, let's jump in.

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Why are family medicine doctors the true longevity experts?

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That's a great question.

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Yeah.

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Yeah, so I'm a family physician.

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I've been a physician for nine years, practicing an evidence-based space, an insurance-based practice for six years.

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In my training, we spend a lot of time in the hospital.

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We spend a lot of time in the clinic, and we spend a lot of time working with patients on preventing disease.

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And so I love that question.

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That's a really good question.

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Why are they the perfect longevity doctors?

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Family doctors have seen patients at the worst part of their disease, and so they know when and how they really should intervene before it happens.

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And that's why preventive health is such a big part of family medicine.

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And it should be, I think it needs to be a much greater part of it.

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So there aren't many people who haven't heard about the term longevity medicine nowadays.

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So let's say we found this one person living under the rock.

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How would you describe it?

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Longevity medicine, in my opinion, is advanced health optimization to prevent the things that are likely going to kill you and the things that are going to ail you later in life.

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So chronic disease.

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So we talk about the four things that are likely going to kill you if you don't die of some freak accident.

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And that's cardiovascular disease, metabolic disease, cancer, and a neurodegenerative disorder like Alzheimer's.

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I want to dig into each one a little bit more.

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And, you know, the reason I started with that question, it's funny because as longevity becomes more popular, different people have different definitions.

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And even your response with respect to end-of-life care, my initial thought was, well, why not palliative medicine?

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Then you pivoted to preventative medicine.

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And that, again, to my knowledge, I think,

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I think there, that might be a subspecialty occupational health and preventative medicine, but there are a lot of fields who do that.

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And so of course our bias is we're physiatrists and we take care of people from the cradle to the grave.

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And what we're dealing with are issues where it's the aging population.

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And so we'll see that.

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And we're dealing with every single system.

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And ultimately what I came to, the conclusion that I came to over the last couple of years as I've just much like yourself.

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So, you know, you and I have been going to,

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won some flag football championships together.

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Yeah, we did.

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And so we've shared these interests, but I think everybody's looking at the longevity problem and it's such a big nebulous problem, but we're looking at it from our own lens.

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And so I started out really narrow with respect to musculoskeletal health.

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I got broader and I think I still am, but I'm starting to get narrow again because I think...

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maybe that's what's going to be more beneficial.

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Because when the cardiovascular doctor is starting to talk about PMOS, it's maybe not as beneficial as when they're talking about coronary heart disease.

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And

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You, and I guess I'm saying this after listening to a bunch of different people really get excited on social media about, quote unquote, staying in your lane, you know, talking to physician colleagues about not talking about nutrition.

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It's like talking about nutrition with your patient is not your lane.

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That's a dietician's lane.

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I'm like, I don't know how the hell we can even do that.

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Like, this is an opinion.

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This is a popular opinion.

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And so by that metric, then I can't be talking to him about sleep and I can't talk to him about exercise because that's not my lane.

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That's what a personal trainer is for, right?

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And so I don't want to go off too much of a tangent, but I think that the longevity problem is really interesting because the lens really matters.

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And I guess you've highlighted that your lens is really to prevent those big four horsemen, if we can use that term.

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Mm-hmm.

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Yeah.

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Where do you think that, I want to take this from an evidence-based lens because you use that frame.

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Where do you think the evidence is strongest with respect to being able to prevent or mitigate the risk of, I think that's a better term, that's going to have the most benefit down the road in terms of delaying your lifespan and healthspent?

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Yeah, I think that right now there's a lot of clinics and a lot of companies that are trying to hijack.

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They're trying to hijack

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I think there's a lot of clinics and there's a lot of companies that are trying to hijack the term longevity.

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And they're not necessarily using evidence-based ways, but they're using treatments that make them the most money.

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And the reality is the evidence-based ways for prevention may not make a clinic the most money.

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And it's pretty simple.

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It's just mostly I think that people have a hard time sticking with it.

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And physicians in general, they don't have a lot of time to spend on it.

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But in my world, so my clinic at Altara Health, we're built around four major pillars.

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And so number one is decreasing the visceral fat.

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Number two is improve cardiovascular fitness.

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Number three is improve your strength and muscle mass.

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And number four is optimizing your internal health.

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And so that would be like the biomarkers, the labs, and all that stuff.

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But like, is there a way to down to, I don't know, building some sort of expensive treatment around this?

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I guess you could, but there doesn't have to be.

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What people mainly need is guidance.

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And if we need medications, we can use medications.

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And they need a little bit of skin in the game.

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They need to actually move forward with actually implementing the plan that is set forth to them.

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And so what we do in our clinic is we assess the visceral fat with a DEXA scan, which is the most accurate way.

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I mean, other than an MRI, but an MRI takes

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to do the whole body MRI, it'd take a couple hours, and it's just not very practical.

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Number two is we do a VO2 max test, and the VO2 max test, this is what's interesting about this test,

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is not only those that have a higher VO2 max score have a lower risk of cardiovascular disease and dying of heart disease, but they have a lower risk of dying of anything.

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And then number three is we can assess their muscle mass with a DEXA scan, but we try to make gains with their workout program.

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And then we do some pretty extensive lab testing.

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So is it, are we doing these really advanced treatments that cost thousands of dollars?

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No.

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But it definitely is the most meaningful, right?

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And I would say that when someone approaches the word longevity, there's certain treatments that are probably going to affect 90% of your longevity.

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And then there's other treatments that probably affect maybe five.

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And a lot of those treatments are the ones that make money.

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Maybe this is a good time for us to introduce you to the listener.

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Tell us a little bit about your background.

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You said you found the medicine.

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How did you get to put energy into solving the longevity problem from your angle?

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Why are you here?

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Passionate about this.

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Altura Health.

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Tell us a little bit about your clinic.

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Yeah, so I was in the insurance-based space for a while.

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I had 2,200 patients.

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I filled up very quickly and...

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I kept getting patients added on to my panel.

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It got to a point where I was booked out 13 weeks to see a patient.

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If one of my patients wanted to see me, they'd call up, and I was 13 weeks booked out.

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We had about 15, 20 minutes with each patient.

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And if, you know, in family medicine, patients come in with about five to eight problems at a time.

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And then we want to throw in a little bit of preventive medicine as well.

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A lot of those problems would actually mesh pretty well with prevention.

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Like, how is your exercise?

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How is your diet?

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What are you doing from a cardiovascular standpoint, from a strength training standpoint?

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Things like that.

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You know, what are you doing to lose weight?

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But it just was not feasible to practice the way I wanted to practice and make really good results and improvements in these patients in the 15, 20 minutes I had with that.

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And so I decided to start this clinic where it was built around a concierge style, a direct primary care style where patients pay a monthly.

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And I'm able to bring my patient panel from $2,200 down to about $300.

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And I spend 45 minutes to an hour with the patient.

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I have more time with them if they send in messages.

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I can write them back.

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I can call them.

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I include tests like the DEXA scan, the VO2 max, and I spend time working with them on a plan of how to improve this.

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I mean, so much to the point where I practice, we've got a little, you know, we've got some exercise equipment and I can just show them exercises to do right now.

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We're not a gym, but I'm just saying like to the point that I can show them that.

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I can actually spend the time.

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That's one of the most amazing things.

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How many doctors do you know have the ability to show them workout exercises to do at the gym or at home?

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So I became really passionate about preventive health because I have seen people

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that if we can get in front of the disease, we're going to have a lot less problems later on.

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You know, I mean, one example, right?

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We, in family medicine, insurance says we can screen for diabetes with a fasting glucose or an A1C.

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Okay.

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Medicare doesn't even let us screen for diabetes with an A1C.

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You have to have a high glucose level before you can order an A1C.

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I didn't know that.

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There's Medicare.

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There's so many different coding issues.

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It's nuts.

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You got to make your, you got to play around it.

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Do you think that's a regional thing, Sam?

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Cause you're in Southern California, right?

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I'm in Northern California, so I'm in Southern California.

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Medicare is federal, so it should be one system.

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But for example, if you get a fasting insulin on somebody, you can calculate something called a HOMA-IR, and we can start to see insulin resistance about 5 to 15 years before it even shows up as high sugar in the labs.

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And so, you know, we can get those levels, we can start to make prevention way before a lot of damage is done.

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Just experimenting, just practicing in this way, I don't use the term experiment, we're actually practicing medicine, but just practicing medicine in this way

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led me to be inspired to create a clinic where we can spend a little bit more time on this.

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But, you know, we talked about preventive health, occupational health.

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It's not, that's the thing, that specialty is not preventive health on an individual basis.

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It's more like you've got a company that needs to make some protocols for health for their overall team, for the overall workforce.

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But preventive health is not.

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It's also like from a society standpoint, right?

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Population health.

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What can we do?

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You're dealing with immunizations, vaccines, which is important.

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But from an individual standpoint, the preventive health experts are the family docs.

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But you get one physical per year.

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And it's probably only going to be 20 to 30 minutes.

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And it's a very small amount of labs that you're getting.

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And that one physical per year is just not enough to make meaningful change.

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Yes, we catch a few things, but it's not enough to make meaningful change.

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Every visit where a patient visits the family doctor, that should be a preventive health visit, okay?

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They need to catch things early in every visit.

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So that's essentially why I created this clinic so that I could bring my patient panel down to a lower level.

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I can spend a little bit more time with patients and I can order the tests that I really want to order.

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Yeah.

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Sam, I want to touch on the socioeconomics of longevity.

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You mentioned, this has been top of mind for me ever since the buzzword longevity has gone out there.

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And, you know, anytime there is an exciting field that has been created, I would say, right, this is not something new.

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We've always known whatever, however you're practicing is kind of the basics to what works, right?

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Good nutrition, good sleep.

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a stress reduction.

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So it's funny how we actually have to market that now.

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But anytime a new field emerges, there's always opportunity, right?

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And you're going to see that in this, what we call a K-shaped economy, where the wealthy becomes wealthier and there's now a disparate gap.

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I guess I'm curious to what is your ideal patient like?

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Because to me, when we look at AI, we look at the tech, and we look at what longevity can do,

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It's always been those with disposable income, I guess, that can really kind of experiment on themselves, use AI, buy different technologies.

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In the last year, how many more red light therapy companies are there?

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How many more sleeping, cooling companies are there?

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It's endless.

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So I'm curious about your ideal patient or who comes to you when you're talking about chronic disease.

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Are these patients already having chronic disease?

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Are they people that are coming to prevent?

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Talk to me a little bit about that.

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Yeah, that's a great question.

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I would say, and I can talk about even the demographics too.

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I mean, these are mainly patients in their 30s, but all the way up into their 80s.

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I would say that the socioeconomic is someone who would invest in their health enough to spend more than $100 on a gym membership, right?

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So I'm not saying that my patients all spend $100 on a gym membership.

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There are gym memberships that cost $30.

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And they're great gyms, but I'm just saying if you're motivated enough to maybe want something a little bit more out of your gym, then you're probably motivated a little bit more enough to go to a doctor that's going to work with you on these things.

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So my program is actually very affordable compared to programs like this in the Bay Area and in SoCal.

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I would say mine is about a third of the cost.

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But that's on purpose.

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That was my first impression going to your website.

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In my head, I'm almost like, man, how is this guy surviving being in California with your prices?

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I mean, absolutely amazing.

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Yeah.

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And it's been great.

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And I think that for the most part, I've received a lot of good feedback too on that.

214
00:16:04.058 --> 00:16:07.981
I've had multiple patients come in and say, and your prices are just spot on.

215
00:16:08.201 --> 00:16:08.761
They're great.

216
00:16:08.941 --> 00:16:09.602
I think that

217
00:16:11.315 --> 00:16:21.842
It's, I would say a lot of my patients actually at open enrollment, they lower their premiums by like three to 500 bucks to choose a little cheaper option.

218
00:16:22.162 --> 00:16:27.726
And then they pay not even the full difference, but a little bit of the difference to me.

219
00:16:28.367 --> 00:16:34.351
And they're getting a little bit more out of their health care because my program not only includes the consults with me, it includes all the tests.

220
00:16:35.231 --> 00:16:40.415
And it doesn't include medication costs, but I can still submit things to insurance.

221
00:16:41.265 --> 00:16:53.754
Just because I'm not working in an insurance, just because I'm not billing insurance doesn't mean that I can't order a test, order a referral, order an imaging, or even order a medication that insurance won't pay for.

222
00:16:53.834 --> 00:16:57.437
I'm still a doctor, I still have an NPA, I still have a license.

223
00:17:00.078 --> 00:17:11.507
I think that's actually a big misconception people have, just to clarification, is that if you're working with a direct primary care, direct specialty care, the medication, you have a separate prescription program.

224
00:17:11.748 --> 00:17:13.189
Almost every single insurance has built that in.

225
00:17:13.289 --> 00:17:14.730
And they have their own pharmacy benefit manager.

226
00:17:14.750 --> 00:17:15.831
We've done a whole podcast on that.

227
00:17:15.851 --> 00:17:21.656
We can plug that in for people if they want to take a listen to how that system works, which is its own problem.

228
00:17:22.296 --> 00:17:23.798
But yeah, that's important for people to know too.

229
00:17:29.122 --> 00:17:35.744
For any of my patients that want to me, for me to be their primary care doctor, it's just a little extra per month.

230
00:17:36.424 --> 00:17:39.284
Out here, we have a lot of Kaiser patients.

231
00:17:39.825 --> 00:17:40.845
Kaiser is an HMO.

232
00:17:42.285 --> 00:17:52.848
It's harder for me to be their family doctor because they truly, Kaiser will not pay for labs and imaging and all that stuff unless the Kaiser doctor actually orders it.

233
00:17:53.068 --> 00:17:57.269
But the patients still come to me for their longevity program, for my longevity program,

234
00:17:58.687 --> 00:18:00.408
they feel like they're gonna get way more out of it.

235
00:18:00.989 --> 00:18:07.314
And so they're coming to me for their preventive health, but then they go to Kaiser if they have a problem.

236
00:18:07.334 --> 00:18:08.835
The other interesting thing is,

237
00:18:10.092 --> 00:18:11.193
You touched on something really important.

238
00:18:11.233 --> 00:18:16.036
It's like sometimes there is, it's not the lack of knowledge or lack of information per se.

239
00:18:16.056 --> 00:18:18.017
I mean, we are flooded with the information.

240
00:18:18.037 --> 00:18:22.080
I think you touched on something and the concept that came to mind is adherence.

241
00:18:22.780 --> 00:18:25.962
It's hard to get these people to, guys, you know, something important, right?

242
00:18:25.982 --> 00:18:27.423
You're talking about this concept of adherence.

243
00:18:28.024 --> 00:18:33.727
And oftentimes I find, especially when you're talking to people who have interests, right?

244
00:18:33.747 --> 00:18:35.769
That ideal patient, the avatar that you described,

245
00:18:36.369 --> 00:18:37.890
who's willing to invest in their own health.

246
00:18:37.950 --> 00:18:38.990
And I love that you said that.

247
00:18:39.230 --> 00:18:40.551
They're an advocate for their own health.

248
00:18:41.231 --> 00:18:42.732
And they're an active participant in their own health.

249
00:18:43.912 --> 00:18:54.596
Because they're investing in their own health, they will take the time to either use their favorite AI, go to Google, whatever it is, have discussions, and try to seek that knowledge.

250
00:18:55.797 --> 00:18:57.357
It's the implementation part that's hard.

251
00:18:57.417 --> 00:18:58.978
It's the execution part that's sometimes hard.

252
00:18:59.178 --> 00:19:01.419
You also said having skin in the game.

253
00:19:01.899 --> 00:19:03.760
I guess my question for you is,

254
00:19:04.802 --> 00:19:20.050
Where do you think that us physicians, a lot of folks who are pivoting through the DPC, DSC space, maybe even concierge medicine, the longevity space in general, how are we providing value for them that's actually really moving the needle?

255
00:19:20.870 --> 00:19:23.711
I think that the needle will move for those patients.

256
00:19:24.671 --> 00:19:35.333
I think that the more people that join the DPC model of primary care, I think the needle will move for them because they're invested in it.

257
00:19:35.413 --> 00:19:37.253
They're actually putting money towards it.

258
00:19:37.934 --> 00:19:49.396
And so when they go to the doctor, what I have found is when they go to the doctor, when the doctor come, you know, when they come up with a plan together, they usually adhere to that more.

259
00:19:50.737 --> 00:19:56.602
When I was working in an insurance-based practice, I would say that most of my time was spent motivating the patients.

260
00:19:57.863 --> 00:19:59.705
Now, I don't have to motivate patients.

261
00:19:59.965 --> 00:20:01.166
They are motivated.

262
00:20:01.326 --> 00:20:02.707
That's why they signed up with me.

263
00:20:03.388 --> 00:20:04.448
And now I just get to work.

264
00:20:05.589 --> 00:20:07.911
I just get to give the recommendations.

265
00:20:08.112 --> 00:20:09.072
I get to do the tests.

266
00:20:09.132 --> 00:20:10.373
I get to explain the tests.

267
00:20:10.494 --> 00:20:11.875
And then I get to come up with a plan.

268
00:20:12.675 --> 00:20:13.956
And that's what's really exciting.

269
00:20:15.292 --> 00:20:18.154
And today, people are obsessed with data.

270
00:20:18.174 --> 00:20:23.157
There's so many wearables out there, but they just need a little bit more guidance.

271
00:20:23.577 --> 00:20:24.117
You know what I mean?

272
00:20:24.638 --> 00:20:27.760
And yes, there's a lot of AI out there, and I think AI can help.

273
00:20:28.000 --> 00:20:31.102
And could you DIY what I'm doing?

274
00:20:32.322 --> 00:20:34.023
Yes, absolutely.

275
00:20:34.724 --> 00:20:35.804
Would everybody do it?

276
00:20:35.984 --> 00:20:36.865
Not necessarily.

277
00:20:38.266 --> 00:20:43.129
Well, I think they probably couldn't because you need prescription power.

278
00:20:43.930 --> 00:20:45.771
You need, we need a license.

279
00:20:45.791 --> 00:20:47.852
You need somebody to be able to order this stuff for you, right?

280
00:20:47.892 --> 00:20:55.037
A lot of the looking under the hood that you had spoken about, you're not going to do that without working with somebody who has a license, who's going to be able to do it right for you.

281
00:20:55.417 --> 00:20:58.619
And then the other thing is, okay, let me go back.

282
00:20:58.659 --> 00:21:01.981
It's like, could you, maybe, should you, probably not?

283
00:21:02.721 --> 00:21:10.286
Because you said you're looking at all these things in detail and it's making sense of those, I think is really, really, really important.

284
00:21:11.150 --> 00:21:39.009
I'm sorry to kind of cut you off there, but I also wanted to make sure that I put that in there because this is something I think about a lot, Tim, is like as I'm thinking about opening up my own practice in a DSC model and I'm still working for an employer where I see a lot of patients and there are pros and cons, I think, to both spaces, but I've had enough people who've made the jump just like you and enough people who've come on here who've made the jump and some have had really positive experiences, others have had not so positive experiences.

285
00:21:39.983 --> 00:21:46.554
And there are enough people who are talking about how to leverage these LLMs to be able to synthesize this information for them.

286
00:21:47.055 --> 00:21:51.082
But then the execution piece is something that I just, I really find...

287
00:21:52.048 --> 00:21:53.069
that they don't know.

288
00:21:53.089 --> 00:22:01.217
And the other thing is, like, Darsh and I have talked about this, things that I don't have domain-level expertise, like deep expertise on, the other ones are phenomenal, right?

289
00:22:01.777 --> 00:22:05.541
But the problem is, I just don't know whether they're actually phenomenal or they just sound phenomenal.

290
00:22:06.222 --> 00:22:10.726
Because I will give it a very, I would consider elementary

291
00:22:12.047 --> 00:22:21.590
concept about strength and conditioning or from programming because I will routinely use book, cloud and GPT for my programming, just giving it all my constraints and creating something longitudinally.

292
00:22:22.410 --> 00:22:23.470
And it does a bad job.

293
00:22:23.791 --> 00:22:27.672
Something that in 2011 with an exercise science degree, I was doing a pretty good job.

294
00:22:28.512 --> 00:22:35.614
And despite having a 1 million token context window with all these things have, I don't really know what that means in terms of human brains.

295
00:22:35.654 --> 00:22:37.935
Like I don't know how many tokens our brains can hold.

296
00:22:38.671 --> 00:22:45.117
there's a comparison, but it seems to forget these constraints all the time, like all the time.

297
00:22:45.657 --> 00:22:49.040
And then I find myself yelling at it all the time, which is another thing.

298
00:22:49.080 --> 00:22:53.964
I'm told I shouldn't do that in case when they do take over, they'll remember I wasn't nice to them, but I digress.

299
00:22:55.085 --> 00:22:57.307
And you and you're welcome and be polite.

300
00:22:57.507 --> 00:22:58.048
Please, please.

301
00:22:58.068 --> 00:22:58.548
Yes.

302
00:22:58.648 --> 00:22:58.828
Yes.

303
00:23:00.069 --> 00:23:04.553
So sorry, I don't want to cut you off, but I, but I did want to put that in there because I, like, I think that it's a misconception.

304
00:23:04.613 --> 00:23:06.015
I think that society is, is,

305
00:23:09.058 --> 00:23:15.300
No matter where you go, there is a subset of people that are searching for something more.

306
00:23:16.880 --> 00:23:17.400
You know what I mean?

307
00:23:18.480 --> 00:23:25.202
They want a physician who's going to spend a little bit more time with them and explain a little bit more.

308
00:23:26.702 --> 00:23:36.084
And the best thing to do is to have physicians that are good at what they do be there for those people when they demand it.

309
00:23:37.498 --> 00:23:39.320
Everywhere, you're going to find those people.

310
00:23:39.540 --> 00:23:43.223
What I have found is some of these people, they end up in the wrong spot.

311
00:23:44.304 --> 00:23:50.990
And they could have ended up with a physician who uses evidence-based decision-making.

312
00:23:51.110 --> 00:23:56.335
And so I do think that people also just, they want to be heard.

313
00:23:57.676 --> 00:23:59.778
And they'd like a personalized plan to them.

314
00:24:01.533 --> 00:24:10.322
And even if the plan wasn't that much different than the last patient, at least you listen to them and verify that, yes, this is the right plan.

315
00:24:10.342 --> 00:24:11.423
This is what we want to do.

316
00:24:12.744 --> 00:24:14.946
And I think that goes a long way.

317
00:24:14.986 --> 00:24:16.788
There's a lot behind motivation.

318
00:24:16.908 --> 00:24:19.010
People still want a human touch.

319
00:24:19.070 --> 00:24:21.953
And I've thought about not to like transition to AI and medicine.

320
00:24:22.958 --> 00:24:24.559
But will it take over medicine?

321
00:24:24.899 --> 00:24:25.219
Yes.

322
00:24:25.500 --> 00:24:26.680
Will it replace doctors?

323
00:24:27.241 --> 00:24:28.141
I do not think so.

324
00:24:28.661 --> 00:24:31.663
I have had multiple people tell me that it's going to replace doctors.

325
00:24:32.123 --> 00:24:33.164
I don't think it's going to.

326
00:24:33.804 --> 00:24:35.405
Let's take a plane, for example.

327
00:24:36.166 --> 00:24:39.208
Does the pilot fly the plane or does AI fly the plane?

328
00:24:40.248 --> 00:24:42.069
AI does like 90% of it.

329
00:24:42.790 --> 00:24:43.070
Okay?

330
00:24:43.850 --> 00:24:48.013
But are you going to get in a plane that doesn't have a pilot?

331
00:24:48.653 --> 00:24:49.374
I'm not going to.

332
00:24:49.394 --> 00:24:49.494
Okay.

333
00:24:50.255 --> 00:24:52.415
I mean, I wouldn't know if there wasn't a pilot up there.

334
00:24:52.435 --> 00:24:52.756
Yeah.

335
00:24:53.576 --> 00:24:54.536
So, like, you could tell me.

336
00:24:55.236 --> 00:24:59.937
But could you translate this argument to, like, self-driving cars then?

337
00:24:59.977 --> 00:25:00.557
Maybe you could.

338
00:25:01.077 --> 00:25:01.657
Maybe you could.

339
00:25:01.797 --> 00:25:05.578
I don't think the stakes are as high with a self-driving car as a plane.

340
00:25:06.498 --> 00:25:06.718
But...

341
00:25:06.738 --> 00:25:08.339
I mean, you're still talking about lives, Sam.

342
00:25:08.939 --> 00:25:09.219
Yeah.

343
00:25:09.619 --> 00:25:10.319
No, it's true.

344
00:25:11.099 --> 00:25:11.539
It's true.

345
00:25:13.180 --> 00:25:14.540
Not in many lives at once, maybe.

346
00:25:14.560 --> 00:25:14.680
Maybe.

347
00:25:15.612 --> 00:25:18.117
but maybe, you know, I, I, I, yeah, I agree with you.

348
00:25:18.137 --> 00:25:22.906
This is not a conversation that we necessarily thought that we were going to step into, but it's an important one to have.

349
00:25:24.201 --> 00:25:29.404
because, I don't know if you know this, but I work with a lot of trainees, I work with medical students, I work with residents.

350
00:25:29.944 --> 00:25:36.987
Mm-hmm, same here, I've got, I work not as much with residents, but I definitely work with med students and PA students.

351
00:25:37.748 --> 00:25:41.029
Yeah, so I think about this a lot, and these are questions that they will ask me.

352
00:25:41.370 --> 00:25:48.953
One of our interns just started, she's a first year medical student, shout out to Haritha, and we have these deeper conversations about what the future looks like.

353
00:25:48.973 --> 00:25:51.515
I mean, for one, you wanna be prepared.

354
00:25:52.155 --> 00:25:54.757
the change has, it's been more rapid now than ever.

355
00:25:54.797 --> 00:25:56.719
But two, like anxiety is a very real thing.

356
00:25:56.779 --> 00:26:03.845
It's like, am I really going to put all this energy, put this time, this sacrifice to get to a future that was promised to me?

357
00:26:03.886 --> 00:26:08.049
I mean, that's what happened a lot to our generation in general by the boomers that they had promised.

358
00:26:08.069 --> 00:26:13.154
These people, oh yeah, go to college, get a degree, take out a lot of student loans and then you're going to have guaranteed jobs waiting for you.

359
00:26:13.674 --> 00:26:15.076
And then 15 years later, like psych?

360
00:26:15.096 --> 00:26:15.576
Psych.

361
00:26:16.058 --> 00:26:21.680
yeah, you can't afford a house now because they're really, really expensive and because of inflation, all of these things.

362
00:26:21.740 --> 00:26:25.422
And so medicine's an interesting thing that I wonder if that something similar's gonna happen.

363
00:26:26.222 --> 00:26:33.965
So this is where I think that we need to come together, either come together or we need to grow some brains.

364
00:26:34.705 --> 00:26:40.487
That's the problem is we were expected to be handed a nice job.

365
00:26:40.747 --> 00:26:44.469
We were expected to be handed a nice salary and a nice lifestyle.

366
00:26:45.522 --> 00:26:47.944
That's not how life works in any industry.

367
00:26:48.605 --> 00:26:49.145
You know what I mean?

368
00:26:49.726 --> 00:26:51.007
Look, we went to med school.

369
00:26:51.107 --> 00:26:52.128
We got the education.

370
00:26:52.248 --> 00:26:53.248
We went to residency.

371
00:26:53.329 --> 00:26:54.309
We got the experience.

372
00:26:54.650 --> 00:26:57.372
Now we need to go out into the world and we need to actually work.

373
00:26:58.221 --> 00:27:04.104
OK, we need to work for what we need to work for the patients and do right by them.

374
00:27:04.124 --> 00:27:07.046
And if we do that, then the patients will come to us.

375
00:27:07.146 --> 00:27:19.352
So so this is what I will say is right now I'm seeing a movement where potentially these health systems are starting to to maybe replace doctors with a protocols.

376
00:27:19.912 --> 00:27:20.132
Right.

377
00:27:21.113 --> 00:27:22.514
Why are we letting that happen?

378
00:27:23.914 --> 00:27:24.715
So here's a question.

379
00:27:26.135 --> 00:27:29.456
Why let the administrators replace doctors with AI?

380
00:27:30.536 --> 00:27:34.297
Why don't the doctors replace the administrators with AI?

381
00:27:35.017 --> 00:27:35.317
Okay.

382
00:27:35.777 --> 00:27:39.298
And that was what I found when I started my own practices.

383
00:27:39.318 --> 00:27:46.799
I was like, this is actually, we can, the business side of medicine can be very automated with AI.

384
00:27:47.459 --> 00:27:50.480
That I think that the return to private practice is,

385
00:27:51.385 --> 00:27:52.245
Like we're in a revolution.

386
00:27:52.265 --> 00:27:54.687
We're about to embark on a revolution right now.

387
00:27:54.887 --> 00:28:01.250
And I think doctors are going to be able to start their own practices more now today than ever because of AI.

388
00:28:01.950 --> 00:28:03.371
I have a couple thoughts on this.

389
00:28:03.551 --> 00:28:04.152
I guess I'll just.

390
00:28:05.412 --> 00:28:06.213
Darsh is so excited.

391
00:28:06.233 --> 00:28:06.673
He's shaking.

392
00:28:06.713 --> 00:28:07.113
I can tell.

393
00:28:07.733 --> 00:28:08.514
I'm just.

394
00:28:08.754 --> 00:28:10.015
My mind's going a bunch of places.

395
00:28:10.035 --> 00:28:10.515
Let me ask you this.

396
00:28:11.235 --> 00:28:17.939
What would it take for you to change your mind to say AI should replace doctors or will replace doctors in the future?

397
00:28:18.779 --> 00:28:20.500
If humans stop being humans.

398
00:28:22.114 --> 00:28:27.035
So what I mean by that is humans want interaction.

399
00:28:27.215 --> 00:28:43.838
They crave so much a physical touch and eye contact and just emotional cues as to someone of my same species is listening, paying attention and helping me and guiding me.

400
00:28:45.379 --> 00:28:49.439
Let me ask another question, not to bring religion and politics into this.

401
00:28:53.460 --> 00:28:57.662
replace religion and the leaders in religion and politics.

402
00:28:59.582 --> 00:29:10.126
I'm not saying that medicine's the same way, is the same thing, I guess, but I'm just, I'm being a little facetious here by saying that there's so much more to medicine than just information and treatment.

403
00:29:11.006 --> 00:29:12.587
And I've seen it because

404
00:29:13.752 --> 00:29:16.614
patients keep crawling back and saying, I need more.

405
00:29:17.294 --> 00:29:23.657
I want to ask an immediate question after a doctor answers my first question.

406
00:29:24.958 --> 00:29:26.299
They want true understanding.

407
00:29:26.379 --> 00:29:27.940
And could they get that from AI?

408
00:29:28.180 --> 00:29:30.421
Maybe, but it's going to take a lot of work on their part.

409
00:29:30.581 --> 00:29:31.401
And people are busy.

410
00:29:32.322 --> 00:29:34.223
So what would it take?

411
00:29:34.983 --> 00:29:39.926
I would say it would probably take a generation of people that aren't

412
00:29:41.669 --> 00:29:43.410
that do not care about human relationships.

413
00:29:44.270 --> 00:29:45.250
Interesting.

414
00:29:45.331 --> 00:29:56.135
It's very interesting to me because I think I often find myself seeing on the other side of this where AI is taking care of the patient almost 99, 100%, but the human is the one to control the AI, almost like a fleet.

415
00:29:56.615 --> 00:30:01.277
Like you have a fleet of AI doctors that you are then having their own silo or specific way, right?

416
00:30:01.297 --> 00:30:05.539
You have one AI that could do cardiology, you have one AI that could do nephrology or whatever it might be.

417
00:30:05.759 --> 00:30:10.101
And I got this idea from listening to a podcast, the founder of Zapier, I forget his name,

418
00:30:11.021 --> 00:30:16.326
but how much he's building out agents and how he thinks that's what the commerce world is going to look like.

419
00:30:17.006 --> 00:30:21.711
I know Mark Cuban came out with a tweet, Altamash, I don't know if you read this and I don't know if you've seen it, Sam.

420
00:30:22.231 --> 00:30:23.812
Yeah, it's on LinkedIn, yeah.

421
00:30:24.233 --> 00:30:28.116
Yeah, so I'm just going to read it real quick because I think it's just a good talking point too.

422
00:30:28.276 --> 00:30:31.259
It's a little long and he's a little jumbled, but I'll try to do my best.

423
00:30:31.279 --> 00:30:33.761
So he tweeted, human doctor to patient.

424
00:30:34.562 --> 00:30:35.182
You just puked.

425
00:30:35.202 --> 00:30:35.903
Let's find out why.

426
00:30:36.383 --> 00:30:36.923
An AI.

427
00:30:37.303 --> 00:30:39.405
Nothing AI can't see and reason in real time.

428
00:30:40.045 --> 00:30:41.506
Human doctor sees patient collapse.

429
00:30:41.626 --> 00:30:42.306
Does CPR.

430
00:30:42.666 --> 00:30:42.946
AI.

431
00:30:43.267 --> 00:30:45.088
Nothing AI can't see or do CPR.

432
00:30:45.768 --> 00:30:46.889
Human doctor sees patient.

433
00:30:47.209 --> 00:30:52.712
Discusses patients with other doctor who knows patient and discuss the fact that a parent was beating the shit of a patient.

434
00:30:53.212 --> 00:30:53.892
Shows empathy.

435
00:30:54.092 --> 00:30:54.933
Adapts care residents.

436
00:30:55.852 --> 00:30:56.532
AI, nothing.

437
00:30:57.193 --> 00:31:00.194
No doctor knows what will happen to a patient when it steps in their office.

438
00:31:00.534 --> 00:31:04.876
They have a real-time identification and response skill set that AI can't and won't have.

439
00:31:05.076 --> 00:31:09.898
SDOH will always matter, which I believe stands for Social Determinants of Health, will always matter.

440
00:31:10.518 --> 00:31:15.980
I don't see a world where AI has judgment and can know the outcomes of its decisions without a human in the loop.

441
00:31:16.621 --> 00:31:22.003
I'm obviously not a doctor, but there will be no point where real-time observation, communication, and context won't matter.

442
00:31:22.743 --> 00:31:26.345
A human can't consume and remember all the data and information AI can.

443
00:31:26.685 --> 00:31:28.285
So AI will always have value.

444
00:31:28.946 --> 00:31:34.828
Every single one of us has more variables in our body than can be quantified, let alone identified and defined.

445
00:31:35.608 --> 00:31:40.770
Once we can identify them all, or at least enough, AI will be able to personalize responses for specific issues.

446
00:31:41.111 --> 00:31:43.031
But that won't happen in the next five or ten years.

447
00:31:43.592 --> 00:31:45.953
It's a problem similar to dealing with CTE.

448
00:31:46.313 --> 00:31:49.014
You can't figure out what actually happened until the patient is dead.

449
00:31:49.374 --> 00:31:50.254
Tell me where I'm wrong.

450
00:31:50.574 --> 00:31:51.475
And that sparked a whole...

451
00:31:52.515 --> 00:31:53.758
thread, you know, with a lot of people.

452
00:31:53.778 --> 00:31:56.182
But I think what he's saying is kind of what you're saying, right?

453
00:31:56.243 --> 00:31:57.585
Where you need a human in the loot.

454
00:31:57.806 --> 00:32:00.712
But anyways, I just want to kind of bring that out there because I think it's a cool talking point.

455
00:32:02.072 --> 00:32:02.832
Darsh, that's interesting.

456
00:32:02.992 --> 00:32:04.993
When you first started, I didn't think that's where you were going.

457
00:32:05.053 --> 00:32:10.435
I think he had maybe posts on LinkedIn or tweeted a completely different thing where he talked about... What's up?

458
00:32:10.975 --> 00:32:13.556
About teaching patients or having doctors teach patients to use AI?

459
00:32:13.576 --> 00:32:14.116
Exactly, right.

460
00:32:14.136 --> 00:32:25.480
So he had talked about for private practice owners, he had said, hey, if I'm a private practice owner, I'm sitting down with the patient and calibrating their AI so they can learn and after hours they can do that.

461
00:32:25.500 --> 00:32:25.760
And...

462
00:32:26.300 --> 00:32:29.962
a physician colleague had said, clearly Mark Cuban hasn't spent any time in a room.

463
00:32:29.982 --> 00:32:38.407
Like, right, Sam, you've got 15 minutes in the room and you've got to go, their annual screening and stuff like that, and now you're going to sit there and program ChatGPD projects for them.

464
00:32:38.887 --> 00:32:40.588
Teach them how to log in.

465
00:32:40.608 --> 00:32:42.509
Right, teach them how to log in and do that.

466
00:32:42.529 --> 00:32:45.991
So, you know, I think that there is some merit to that, right?

467
00:32:46.031 --> 00:32:46.531
I think so.

468
00:32:46.771 --> 00:32:47.852
Ultimately, my take, I'm,

469
00:32:48.652 --> 00:32:49.993
and I know exactly what you're talking about, right?

470
00:32:50.013 --> 00:32:51.734
That's an MFM episode that I listened to.

471
00:32:51.754 --> 00:32:52.535
It was a good episode.

472
00:32:53.095 --> 00:32:56.498
I actually signed up for Zapier after that and I decided that wasn't valuable for me.

473
00:32:56.518 --> 00:32:58.960
And by the way, I think that it's super helpful.

474
00:32:59.100 --> 00:33:00.681
Look, open evidence is phenomenal.

475
00:33:00.801 --> 00:33:08.666
Every single day, if I have a question, I love to be able to collect all the evidence and just kind of get a broad oversight of what the evidence is.

476
00:33:08.727 --> 00:33:10.448
But it's still valuable for me to,

477
00:33:11.841 --> 00:33:23.955
pick up the phone and call my colleagues to get their real world experience one-to-one, which I wanna really get an understanding of how you would define evidence-based.

478
00:33:23.975 --> 00:33:26.918
You've used that term multiple times today, what that means to you actually.

479
00:33:27.848 --> 00:33:29.830
But ultimately, what you've been talking about is coaching.

480
00:33:30.070 --> 00:33:32.333
And I think, Darshana, you and I have talked about this a long time ago.

481
00:33:32.373 --> 00:33:34.475
Ultimately, I think that physicians are coaches.

482
00:33:34.595 --> 00:33:37.218
And this is a one-on-one coaching relationship.

483
00:33:37.879 --> 00:33:50.172
What has been the limiting factor a long time in primary care in particular, like you talked about, Sam, is like you cannot have an effective coaching session within 15 minutes when you are dealing with the urgent.

484
00:33:51.539 --> 00:33:52.600
You have to put out fires.

485
00:33:52.680 --> 00:33:53.841
That's all you have time for.

486
00:33:53.962 --> 00:33:56.344
Maybe even that's insufficient.

487
00:33:56.864 --> 00:34:08.636
And now we want to get really peeled the onion to figure out what it is that's important to you in life, why you, quote unquote, can't get out of your way to get to sleep on time, focus on your exercise regimen.

488
00:34:09.057 --> 00:34:13.821
Well, we really have to build this therapeutic alliance and that's not done in a 15, 10 minute visit.

489
00:34:14.342 --> 00:34:15.823
So that's where you need time.

490
00:34:16.764 --> 00:34:21.256
So if we could remove the administrative stuff like you talked about, right?

491
00:34:21.276 --> 00:34:25.006
So there are some LMs that are being built into or AI is being able to,

492
00:34:26.404 --> 00:34:28.485
into Epic at least, and I think other ones have that too.

493
00:34:28.525 --> 00:34:35.129
Darsh showed me one in Cerner that allows me to be able to extract a lot of the history and clean up my H&P.

494
00:34:35.509 --> 00:34:36.730
Well, that's the last time I'm charting.

495
00:34:37.610 --> 00:34:41.012
You know, again, you have automated scribes that are listening to it.

496
00:34:41.373 --> 00:34:46.435
In the future, we're going to have automated scribes who are going to help put orders in, which have to be reviewed over time.

497
00:34:46.816 --> 00:34:49.217
And this is now leading more to the point that, Darsh, you're talking about.

498
00:34:49.997 --> 00:34:54.400
I do think that it probably matters a lot in which specialty we're dealing with.

499
00:34:55.659 --> 00:34:58.860
A lot of people have been bashing on radiology, like radiology is going to be the first one to go.

500
00:34:58.920 --> 00:35:06.121
It's the most logical step that one radiologist can maybe now read three times as many imaging stuff because you just have to review.

501
00:35:06.661 --> 00:35:10.642
Although some radiologists will argue, well, that's how you're likely to miss.

502
00:35:10.842 --> 00:35:17.664
And the implications of getting something wrong are so severe that it's problematic.

503
00:35:17.724 --> 00:35:18.884
And so, I don't know.

504
00:35:19.564 --> 00:35:22.885
I find myself kind of going to the extremes and somewhere landing in the middle.

505
00:35:22.905 --> 00:35:24.205
I think that's usually a good place to be.

506
00:35:25.045 --> 00:35:30.891
But it is a conversation really worth having and for people to really sit there and explore.

507
00:35:30.991 --> 00:35:36.736
But I think ultimately, if I had to pick a camp right now, much closer to where you are, Sam, I don't think that therapeutic alliance can be replaced.

508
00:35:36.756 --> 00:35:45.244
And I think biologically, humans do have that need for connection pretty deeply, especially when you're talking about some things that require a lot of vulnerability.

509
00:35:46.305 --> 00:35:49.308
And not to mention, AI can't do a physical exam.

510
00:35:50.589 --> 00:35:53.830
There's the human connection, but there's also coordination, right?

511
00:35:53.930 --> 00:35:55.470
You talked about picking up the phone.

512
00:35:56.650 --> 00:36:01.071
You know, there's a lot that goes into primary care, for example.

513
00:36:01.771 --> 00:36:08.373
You are kind of a coordinator in a way, but like you kind of, you got to know a lot about a lot.

514
00:36:09.453 --> 00:36:19.075
Someone told me before I started residency, they said, you know, the easiest specialty to be is a family doctor, but the hardest specialty to be is a good family doctor.

515
00:36:19.475 --> 00:36:19.695
Hmm.

516
00:36:21.030 --> 00:36:23.693
And it was just, I'm not saying that's true.

517
00:36:23.753 --> 00:36:32.683
I'm just saying like, it got me thinking like, there's, you gotta know a lot about a lot so that you can actually get people to the right places.

518
00:36:32.963 --> 00:36:39.050
You're ordering the right tests before they see the oncologist, before they see the gastroenterologist, before they see the cardiologist.

519
00:36:39.751 --> 00:36:42.454
So that when the patient gets to those specialists,

520
00:36:43.231 --> 00:36:46.813
They're not like, it would have been nice if you had this test and this test.

521
00:36:47.353 --> 00:36:50.254
So I'm going to order these tests and then you come back for your second visit.

522
00:36:50.515 --> 00:36:55.357
No, my goal when I send a patient to a specialist is for everything to be laid out.

523
00:36:55.477 --> 00:36:56.998
And the specialist looks at it all and says,

524
00:36:58.327 --> 00:37:00.248
okay, this is what we need to do.

525
00:37:01.128 --> 00:37:01.368
You know?

526
00:37:03.169 --> 00:37:07.351
That's what makes a good primary care and a good family doctor.

527
00:37:08.512 --> 00:37:10.092
It's the setup, Ben.

528
00:37:10.272 --> 00:37:11.553
The setup is key.

529
00:37:11.653 --> 00:37:13.074
We can't spike the ball without a good setup.

530
00:37:14.094 --> 00:37:17.876
And you were in those volleyball tournaments in med school, weren't you?

531
00:37:18.356 --> 00:37:18.796
Yeah.

532
00:37:19.116 --> 00:37:20.817
Yeah, that was good times.

533
00:37:22.178 --> 00:37:23.318
I think we won that one, too.

534
00:37:23.759 --> 00:37:26.420
I wasn't good at spiking or setting up, but that's besides the point here.

535
00:37:27.078 --> 00:37:32.539
But I think that the doctors that don't use AI are the ones that are going to be left behind.

536
00:37:34.680 --> 00:37:44.542
When new processes, when you can implement new processes that make things more efficient using AI, you're going to be way more productive and way more accurate.

537
00:37:45.282 --> 00:37:55.565
So my EMR that I used that I got to choose myself, not only does it have an AI scribe, but at the end of the visit, it will literally pend all of the orders that I talked.

538
00:37:56.266 --> 00:37:58.087
And I can review it and press sign.

539
00:37:58.868 --> 00:38:11.216
If I said, hey, I need to refill your lisinopril, your atorvastatin, and I'm actually gonna start you on this, and I need to order this lab, this lab, this lab, at the end of the visit, it will have penned everything, and I can literally just say sign.

540
00:38:12.157 --> 00:38:13.278
And it made my note for me.

541
00:38:13.498 --> 00:38:22.664
And if patients message in, I can actually say, hey, can you generate a response that has to do with this answer, and it will.

542
00:38:23.425 --> 00:38:24.085
It's amazing.

543
00:38:25.084 --> 00:38:29.605
And this isn't the EMR that the hospital system chose.

544
00:38:29.625 --> 00:38:31.186
This is the EMR that I chose.

545
00:38:31.706 --> 00:38:33.906
And it will integrate.

546
00:38:33.946 --> 00:38:40.508
There's care quality, so everyone puts all their electronic medical records into care quality, and you can just kind of pull from it.

547
00:38:41.348 --> 00:38:51.171
But that's where medicine is getting really exciting, is a lot of the administrative things are being cut down, and we can actually start practicing medicine.

548
00:38:51.931 --> 00:38:54.092
So in some ways, it's a better time than ever.

549
00:38:55.562 --> 00:38:59.868
I think about your specialty, like how do you replace yours?

550
00:39:00.488 --> 00:39:03.913
You have to put your hands on the, family medicine, we have to put our hands on the patient, right?

551
00:39:04.974 --> 00:39:08.138
But I mean, you have to do a physical examination.

552
00:39:08.158 --> 00:39:09.960
A lot of procedures, yeah.

553
00:39:09.980 --> 00:39:12.423
A lot of injections, a lot of procedures, yeah.

554
00:39:12.804 --> 00:39:14.226
No, I think that the procedural stuff

555
00:39:15.709 --> 00:39:18.150
would be certainly later to go, right?

556
00:39:18.530 --> 00:39:25.411
You listen to a lot of these tech founders, they'll come on and AI doomers and they'll say, oh, you better become a plumber, better become an electrician.

557
00:39:26.031 --> 00:39:32.893
Well, I guess in medicine, orthopedics will define themselves as mechanics and I guess I'm some version of that.

558
00:39:33.013 --> 00:39:34.053
And so I do feel secure.

559
00:39:34.073 --> 00:39:38.034
But I think, again, now I'm going to pivot and go to the other side and make the argument.

560
00:39:38.314 --> 00:39:39.515
So I'm seeing both of you guys on my screen.

561
00:39:39.555 --> 00:39:41.515
It's like Darsh is on one side and Sam's on the other side.

562
00:39:41.715 --> 00:39:42.775
It's funny for me in my mind.

563
00:39:42.815 --> 00:39:45.196
I've created this, you guys are on the opposite extremes here.

564
00:39:46.095 --> 00:39:58.679
I don't think three years ago, I would have even been able to imagine, maybe four years ago, that GPT or Claude, like GPT-Astro-6 just came out last week and what is, Jensen Wong's like, oh yeah, AGI is here.

565
00:39:58.939 --> 00:40:01.460
And I haven't really put it to the test, but I don't know.

566
00:40:01.940 --> 00:40:04.681
But I don't think, I would have imagined that it could do that.

567
00:40:04.961 --> 00:40:13.123
So just because I can't imagine that it's going to have the coordination to be able to do an ultrasound-guided injection five years from now doesn't mean that's possible.

568
00:40:13.163 --> 00:40:15.124
So always keep that open.

569
00:40:16.386 --> 00:40:20.988
I do think that ultimately where you just, what you just highlighted is where it is.

570
00:40:21.208 --> 00:40:28.090
That coaching relationship, it actually frees up cognitive bandwidth for us to be able to focus on what's really important.

571
00:40:28.270 --> 00:40:32.011
To be able to focus on, I think why any one of us went to medicine.

572
00:40:32.451 --> 00:40:33.652
You'd be pretty hard pressed to find

573
00:40:34.572 --> 00:40:36.673
Somebody was like, yeah, I just love putting orders.

574
00:40:36.693 --> 00:40:38.273
That's why I went to med school.

575
00:40:38.353 --> 00:40:39.133
I love charting.

576
00:40:39.733 --> 00:40:41.494
That's, you know, that's not a thing.

577
00:40:41.694 --> 00:40:45.015
So yeah, it's actually, after talking about this, I'm quite excited, Sam.

578
00:40:45.515 --> 00:40:45.975
Thank you for that.

579
00:40:46.835 --> 00:40:50.296
Sam, do you think, so let me back up and put context on this.

580
00:40:50.776 --> 00:40:52.657
Rhonda Patrick found my fitness podcast.

581
00:40:52.677 --> 00:40:54.037
She had this longevity doctor

582
00:40:54.657 --> 00:40:58.959
or immunologist, aging researcher, doctor, I butcher this, Dr. Daria Unutmaz.

583
00:40:59.460 --> 00:41:02.221
So I think he's one of the consultants for OpenAI.

584
00:41:02.321 --> 00:41:07.084
And he says physicians who will not use or who don't use AI, it will be malpractice.

585
00:41:07.244 --> 00:41:08.605
Do you think that's too strong of a statement?

586
00:41:09.365 --> 00:41:09.545
No.

587
00:41:09.765 --> 00:41:14.048
Mainly because things are rapidly changing.

588
00:41:14.828 --> 00:41:16.629
Recommendations are rapidly changing.

589
00:41:17.750 --> 00:41:19.831
We used to go search up to date.

590
00:41:21.030 --> 00:41:26.451
Why not just cut that search down by a fraction of the time and just get the answer?

591
00:41:26.591 --> 00:41:27.132
You know what I mean?

592
00:41:27.152 --> 00:41:29.792
I use AI quite a bit.

593
00:41:29.832 --> 00:41:37.874
But here's the thing is like me using AI is way different than someone who didn't go to med school to use AI.

594
00:41:38.575 --> 00:41:38.815
Right?

595
00:41:38.855 --> 00:41:44.116
Like I understand a lot of what the AI is explaining.

596
00:41:44.136 --> 00:41:47.457
And it helps me still make a good decision.

597
00:41:48.377 --> 00:41:49.378
But you know, it's interesting.

598
00:41:50.018 --> 00:41:55.382
Another thought I had was, I actually encourage my patients to look stuff up on AI.

599
00:41:56.423 --> 00:42:00.746
It's funny because they come in and they say, they say, I know you don't like me to do this, doc.

600
00:42:00.766 --> 00:42:02.047
And I'm like, I've never said that.

601
00:42:02.347 --> 00:42:07.551
And I've actually encouraged my patients, if you're having an issue at home, go look it up on AI.

602
00:42:08.211 --> 00:42:10.153
Because they might actually answer the question.

603
00:42:11.153 --> 00:42:16.897
And you, without you having to come in for something that you probably didn't even need

604
00:42:18.935 --> 00:42:19.236
you know?

605
00:42:19.457 --> 00:42:23.590
And, because what I have found is that people that are using AI are,

606
00:42:24.933 --> 00:42:30.437
They're actually coming in and I'm able to diagnose things a little easier, you know?

607
00:42:31.458 --> 00:42:37.682
Not that I see a lot of common colds and UTIs and little pneumonias and sinus infections.

608
00:42:37.943 --> 00:42:38.903
I would love to see those.

609
00:42:39.424 --> 00:42:41.865
It's just, that's not the reality of primary care anymore.

610
00:42:42.326 --> 00:42:46.669
Primary care is very complex and that's what makes it fun.

611
00:42:47.349 --> 00:42:49.211
I loved seeing a sinus infection.

612
00:42:49.611 --> 00:42:52.073
It was so nice, took no brain power.

613
00:42:53.996 --> 00:42:58.939
But what I'm trying to say is I actually encourage people to use AI, interact with their health.

614
00:42:58.999 --> 00:43:06.684
They come in better educated so that when I give them an answer, a lot of them nod and say, yeah, I actually read about that.

615
00:43:06.784 --> 00:43:10.646
In fact, ChatGPT even said a very similar thing.

616
00:43:10.766 --> 00:43:14.708
And now that you're saying it, I'm actually feeling a lot better about what it said.

617
00:43:16.189 --> 00:43:20.251
A lot of patients may not use AI to validate you.

618
00:43:20.451 --> 00:43:21.912
They're using you to validate AI.

619
00:43:24.557 --> 00:43:26.178
What about fitness trackers?

620
00:43:26.498 --> 00:43:28.059
How do you interpret the data on those?

621
00:43:28.079 --> 00:43:36.123
If it's a whoop or I just got a Luna band, I know Apple Watch is a little bit more difficult to kind of extract data, but is there anything that you tell your patients in regards to the fitness trackers?

622
00:43:37.223 --> 00:43:42.986
Yeah, I think that fitness trackers are great for those that like them.

623
00:43:43.006 --> 00:43:48.689
I have a whole subset of patients that they just do not care, and it would not change the outcome if they used it.

624
00:43:50.003 --> 00:43:54.928
They're still gonna exercise, they're still gonna do what they're gonna do, or they're still not going to exercise, right?

625
00:43:55.128 --> 00:44:01.294
I find that patients that like the fitness trackers, it keeps them motivated and it works well.

626
00:44:02.115 --> 00:44:05.778
But I don't think you necessarily need it to have success.

627
00:44:06.611 --> 00:44:10.713
So that's where it comes to individualizing the plan.

628
00:44:10.873 --> 00:44:13.054
But you have, you know, the physician needs to know.

629
00:44:13.494 --> 00:44:18.036
So I have sat down with patients and I've said, okay, let's get this set up.

630
00:44:18.496 --> 00:44:19.457
You got your Oura Ring.

631
00:44:20.117 --> 00:44:21.778
You've got, what else do you have?

632
00:44:21.798 --> 00:44:22.978
We're going to integrate all of this.

633
00:44:23.018 --> 00:44:24.039
We can use Google Health.

634
00:44:24.079 --> 00:44:27.040
We can use Apple Health, whatever there might be.

635
00:44:28.541 --> 00:44:29.281
Now we have...

636
00:44:30.883 --> 00:44:34.726
a lot of these calorie trackers, you can literally just take pictures of your food.

637
00:44:35.767 --> 00:44:39.831
And then it just calculates your calories, calculates your macros, and that makes it easy.

638
00:44:39.891 --> 00:44:43.794
Before, when I would have to get patients to track food and

639
00:44:44.805 --> 00:44:51.069
And just to give a little caveat on that, I don't think tracking is for everybody, but I think that it can help some people.

640
00:44:51.870 --> 00:44:56.353
Before, they'd have to type everything in and they'd have to put in the serving size.

641
00:44:56.773 --> 00:44:58.514
Now they can literally just take a picture.

642
00:44:59.235 --> 00:45:01.336
And for the most part, it's pretty accurate.

643
00:45:01.857 --> 00:45:06.180
What I found is that sometimes it will underestimate on some foods and then overestimate on others.

644
00:45:06.460 --> 00:45:13.505
But at the end of the day or at the end of the week, it basically is the same amount of calories, whether you manually entered it or not or took a picture of it.

645
00:45:14.404 --> 00:45:16.325
Is there a specific one that you like?

646
00:45:17.606 --> 00:45:19.827
I personally like Cal AI.

647
00:45:20.348 --> 00:45:21.068
I like that one.

648
00:45:21.268 --> 00:45:23.009
And then Google Health has it as well.

649
00:45:23.910 --> 00:45:27.772
And it works really well.

650
00:45:27.792 --> 00:45:30.274
They do barcodes, but I mean, literally just the pictures.

651
00:45:30.314 --> 00:45:33.836
And so I'll get patients like, listen, I'm not asking you to type stuff in.

652
00:45:34.336 --> 00:45:37.919
All I'm asking you to do is just take a picture of your food before you eat it.

653
00:45:38.199 --> 00:45:38.419
That's it.

654
00:45:38.439 --> 00:45:38.539
Yeah.

655
00:45:39.600 --> 00:45:39.800
Yeah.

656
00:45:40.183 --> 00:45:41.684
And they're like, okay, fine, Doc, I'll do it.

657
00:45:41.864 --> 00:45:43.585
And a lot of times I start off with two weeks.

658
00:45:43.625 --> 00:45:45.146
Like, listen, just do this for two weeks.

659
00:45:45.206 --> 00:45:46.707
After that, I won't ever ask you to do it again.

660
00:45:46.727 --> 00:45:52.911
And then just by doing it for two weeks, they get their mind reset.

661
00:45:53.551 --> 00:46:00.375
I would say, the phrase that I hear so much is, Doc, I really don't eat that much, and I'm still not losing weight.

662
00:46:01.396 --> 00:46:03.577
Okay, well, let's see exactly how much you're eating.

663
00:46:04.438 --> 00:46:04.878
And we do.

664
00:46:05.218 --> 00:46:08.781
And I would say most of the time they come back and they say,

665
00:46:09.909 --> 00:46:12.570
okay, I guess I was eating a lot more than I thought I was.

666
00:46:13.011 --> 00:46:18.534
Or they came back, they come back and say, okay, I actually did stick to the calorie goal and I did lose some weight.

667
00:46:19.334 --> 00:46:27.598
But very rarely is it that patients stick to the calorie goal and don't lose weight if they don't have another physiologic disorder going on.

668
00:46:28.799 --> 00:46:30.900
Yeah, I mean, I think that's the perfect example, right?

669
00:46:30.920 --> 00:46:35.622
So to steal James Clear's third law of behavior change is...

670
00:46:36.906 --> 00:46:39.147
improving the, I think, the behavior response, right?

671
00:46:39.167 --> 00:46:40.787
And so what he talks about is reducing friction.

672
00:46:41.467 --> 00:46:55.072
And ultimately, we've talked about reducing friction with respect to our joy in practicing medicine or reducing friction for calorie tracking so you can hit your macronutrient goals if you're trying to optimize protein intake, maybe...

673
00:46:56.437 --> 00:47:01.382
not overdo it on cerebrocarbohydrates if weight loss is part of your journey or whatever you might have.

674
00:47:01.902 --> 00:47:06.426
And I think ultimately that facilitates that adherence to come right back to that thing that you talked about at the outset.

675
00:47:06.686 --> 00:47:14.353
So I think maybe if we bring it home for this one specific, this topic in general, it's a tool.

676
00:47:14.573 --> 00:47:17.876
And like any other tool out there, you can use it

677
00:47:19.046 --> 00:47:28.196
for good, for your benefit, or you could just use like pornography and keep talking to it over and over and over again and keep perseverating from it.

678
00:47:28.216 --> 00:47:40.250
To be honest with you, I've been guilty of getting into this rumination mental loop sometimes where I've had to build in guardrains and Claude is like, you've exhausted this decision is made, which is also something cool.

679
00:47:41.453 --> 00:47:44.394
So anything else on that, Darsh?

680
00:47:44.494 --> 00:47:51.218
If not, we can kind of just talk about the, come back to the four horsemen so we can make it a little bit more actionable for people and see Sam's take on that stuff.

681
00:47:51.778 --> 00:47:52.218
I'm good, yeah.

682
00:47:52.998 --> 00:48:00.842
So Sam, I, to come back, you said cardio, cardiovascular fitness, metabolic health, visceral fat?

683
00:48:02.185 --> 00:48:09.649
Yeah, so visceral fat, cardiovascular fitness, muscle mass and strength, and then the internal.

684
00:48:09.669 --> 00:48:12.950
Internal, right, which is kind of an umbrella and it's gonna touch on all the systems.

685
00:48:12.970 --> 00:48:16.092
It's an umbrella, but I think that it's important.

686
00:48:16.692 --> 00:48:20.294
I don't think that we order enough labs in medicine for prevention.

687
00:48:20.314 --> 00:48:21.094
What do you think we miss out on?

688
00:48:21.755 --> 00:48:27.898
You know, I think that there's a lot that we miss out on, and trust me, I have sat through these lectures

689
00:48:28.718 --> 00:48:34.700
about trying to cut down the cost of medicine and the benefits outweighing the risks.

690
00:48:35.481 --> 00:48:36.301
I understand that.

691
00:48:37.881 --> 00:48:48.465
And unfortunately, yes, when you order a lot of tests, you're likely to get a lot of false positives and you have to go down a rabbit hole and go spend a bunch of money and get anxiety about something that ended up being nothing.

692
00:48:50.186 --> 00:48:54.628
Give me an example of two or three that people will consider non-conventional.

693
00:48:54.688 --> 00:48:57.029
Maybe your colleagues will say, Sam, you're wasting time, you're wasting money.

694
00:48:57.529 --> 00:48:58.049
What are some labs?

695
00:48:59.368 --> 00:49:07.811
I would say that, hey, do you really need to be ordering a TPO antibody on a patient who doesn't have a TSH that's abnormal?

696
00:49:08.651 --> 00:49:13.693
Do you really need to be ordering a ferritin on a patient who's not anemic?

697
00:49:14.613 --> 00:49:16.554
So this happened last week.

698
00:49:17.615 --> 00:49:18.875
I had a patient come to me.

699
00:49:20.222 --> 00:49:20.883
in his 50s.

700
00:49:22.244 --> 00:49:33.934
He came in, he's like, hey, so I had this episode, I was having a little bit of shakes, a little bit of sweats, it was kinda weird, lasted for a little bit, happened six months ago, and it went away.

701
00:49:34.194 --> 00:49:36.436
And then literally last month it happened twice.

702
00:49:37.477 --> 00:49:39.259
And I just, I don't know what that is.

703
00:49:40.179 --> 00:49:49.167
And now he had come in for his first consult, which for their first consult, I order a big, huge biomarker assessment of like 90 plus biomarkers.

704
00:49:49.827 --> 00:49:53.430
So I had this full test in front of me as he's telling me this.

705
00:49:53.610 --> 00:49:56.392
And for the most part, all of his tests were normal.

706
00:49:57.513 --> 00:49:58.734
But his ferritin was 755.

707
00:50:01.242 --> 00:50:01.522
Okay?

708
00:50:02.022 --> 00:50:06.203
And his saturation pointed to the fact that he has hemochromatosis.

709
00:50:06.403 --> 00:50:07.703
He was iron overloaded.

710
00:50:09.224 --> 00:50:12.204
His hemoglobin was completely normal.

711
00:50:13.244 --> 00:50:19.226
And so I'm sitting here afterwards, and I'm, well, first of all, I was like, hey, we need to get this genetic test.

712
00:50:19.246 --> 00:50:21.286
We're going to get an HFE gene.

713
00:50:21.766 --> 00:50:22.926
I want to get a repeat test.

714
00:50:22.946 --> 00:50:24.187
Then you're going to go get a phlebotomy.

715
00:50:24.887 --> 00:50:26.067
But I'm sitting here

716
00:50:31.924 --> 00:50:33.966
How would I ever have arrived at a ferritin?

717
00:50:34.347 --> 00:50:34.607
What?

718
00:50:35.588 --> 00:50:37.170
His liver enzymes were normal.

719
00:50:37.971 --> 00:50:39.112
He wasn't anemic.

720
00:50:40.053 --> 00:50:43.497
His everything was normal except for that ferritin.

721
00:50:43.897 --> 00:50:49.043
And I'm just like, I don't think I would have found it in the way that I was practicing before.

722
00:50:49.988 --> 00:50:51.428
You know, so that's just one example.

723
00:50:51.468 --> 00:50:53.749
I think that we could be a lot more thorough.

724
00:50:54.549 --> 00:51:00.391
And I think that, like, for example, Function Health, you know, it's over a, what, two plus billion dollar company right now.

725
00:51:00.651 --> 00:51:03.871
Patients can get a very extensive lab test for less than $400.

726
00:51:03.931 --> 00:51:10.093
And I think it's doing a lot of good.

727
00:51:11.054 --> 00:51:12.936
does it cause anxiety in certain people?

728
00:51:13.116 --> 00:51:13.397
Maybe.

729
00:51:13.537 --> 00:51:14.879
It probably gets them to the doctor.

730
00:51:15.099 --> 00:51:20.405
As a physician in an insurance-based practice, I had tons of patients bringing in their function health labs.

731
00:51:21.066 --> 00:51:22.407
And they'd be like, Doc, explain this to me.

732
00:51:22.427 --> 00:51:24.590
I'm like, Well,

733
00:51:26.576 --> 00:51:28.718
I know you came in, you have about four problems you want to talk about.

734
00:51:28.738 --> 00:51:32.020
We have about 15 minutes, but yes, I'd be glad to go over all these labs with you.

735
00:51:32.660 --> 00:51:36.944
You know, but I think that function health really touched on something.

736
00:51:37.424 --> 00:51:41.066
And it's bringing out a passion that people have for their own health.

737
00:51:41.867 --> 00:51:42.407
It really is.

738
00:51:42.447 --> 00:51:49.673
I have a lot of people that are so interested in it that it makes them more interested in their own health that they're actually making changes.

739
00:51:50.677 --> 00:51:54.179
And so that's actually something that I've implemented in my practice.

740
00:51:54.199 --> 00:51:55.199
I don't use function health.

741
00:51:55.219 --> 00:51:58.081
I actually built my own panel that I like a little bit more.

742
00:51:58.101 --> 00:52:00.162
I think function health is great, but I like my panel more.

743
00:52:00.942 --> 00:52:08.606
And the first thing that patients do when they come to me is they get that full lab assessment and then we go over it and we identify all the deficiencies.

744
00:52:09.627 --> 00:52:15.049
But what's good is they get to go over it with a doctor instead of get some AI response back, right?

745
00:52:15.990 --> 00:52:18.391
And they come to me and they're like, doc, my bilirubin's high.

746
00:52:18.431 --> 00:52:19.031
What do I do?

747
00:52:19.051 --> 00:52:20.132
It's okay.

748
00:52:21.075 --> 00:52:21.936
Everything else is normal.

749
00:52:22.537 --> 00:52:25.001
You probably have Gilbert syndrome.

750
00:52:25.923 --> 00:52:27.084
Oh, so I'm okay?

751
00:52:27.184 --> 00:52:27.886
Yeah, you're okay.

752
00:52:28.366 --> 00:52:32.212
Like most patients come in with a high belly or just other little things, you know?

753
00:52:33.218 --> 00:52:36.140
I give a lot of reassurance, like, don't worry about that one, that one's okay.

754
00:52:37.221 --> 00:52:38.923
A lot of it's like on a CBC differential.

755
00:52:40.164 --> 00:52:44.167
You know, like, their MCHC is high, or whatever.

756
00:52:44.187 --> 00:52:45.969
Like, what do I do about this?

757
00:52:45.989 --> 00:52:48.110
I'm like, we don't care, you're fine.

758
00:52:49.291 --> 00:52:53.655
And patients want to hear that, you know, they want to know that they're fine, we give a lot of reassurance.

759
00:52:54.436 --> 00:52:56.217
What's your take on full body MRIs?

760
00:52:56.998 --> 00:52:57.878
That's a great question.

761
00:52:58.419 --> 00:53:00.621
I think that I'm definitely not against them.

762
00:53:02.314 --> 00:53:07.298
if there's a chance we could find something early, by all means, let's do it.

763
00:53:08.578 --> 00:53:21.808
But when I talk to patients about it, I say, listen, we're going to find something, whether it's even whether it's something that's going to kill you, whether it's something that's nothing.

764
00:53:22.808 --> 00:53:23.808
We're going to find something.

765
00:53:23.828 --> 00:53:26.269
So I want to prepare you for that first and foremost.

766
00:53:26.709 --> 00:53:26.949
Okay.

767
00:53:27.169 --> 00:53:48.054
If we order this test and if we find something that we have to go down a rabbit hole and we ended up getting a biopsy and finding out that it was benign all because of this MRI and you just spent four months of anxiety worrying about this mass that they found, are you going to regret getting the MRI?

768
00:53:49.601 --> 00:53:57.428
And so I have a very serious talk with the patients before we would even get to that stage where we order the MRI.

769
00:53:57.809 --> 00:53:58.249
You know what I mean?

770
00:53:58.670 --> 00:54:01.813
And if they're like, yeah, no, I can stand it.

771
00:54:02.153 --> 00:54:03.074
Okay, then let's do it.

772
00:54:03.654 --> 00:54:04.695
If you want it, let's do it.

773
00:54:05.876 --> 00:54:11.522
But if a patient's like, I don't think I could take the anxiety and the stress behind that.

774
00:54:11.802 --> 00:54:12.663
Because I've seen it.

775
00:54:12.923 --> 00:54:15.085
I have seen patients just be erect.

776
00:54:16.288 --> 00:54:19.290
for four to six months until they finally get a final diagnosis.

777
00:54:19.871 --> 00:54:21.352
You know what I mean?

778
00:54:21.372 --> 00:54:32.821
Sam, I can see how your experience for six years as FM in the health system itself with insurance plays a big role in kind of how you think about how to help your patients now in a DPC model, right?

779
00:54:32.861 --> 00:54:34.922
Loopholes that you have to think of, labs that you might do.

780
00:54:35.829 --> 00:54:54.433
For those providers who are now getting into DPC, longevity, concierge, but may not have that type of hospitalist or family medicine background, what are some tips that you can give them when it comes to critically thinking about how to best care for their patient, whether it's lab work, maybe some loopholes, how to kind of think about insurance and super billing, whatever you think.

781
00:54:55.454 --> 00:55:04.696
Yeah, I think that number one, you need to brand yourself as to what value are you giving the patient?

782
00:55:05.704 --> 00:55:06.465
Is it access?

783
00:55:07.566 --> 00:55:08.787
Is it expertise?

784
00:55:09.888 --> 00:55:10.988
Is it a curriculum?

785
00:55:11.369 --> 00:55:11.969
What is it?

786
00:55:12.250 --> 00:55:13.050
And brand that.

787
00:55:13.411 --> 00:55:16.933
Once you've branded that, then you can kind of go from there.

788
00:55:17.654 --> 00:55:26.201
Like I've, I know some concierge doctors here that the way that they brand their practice is, look, we are available 24-7.

789
00:55:26.241 --> 00:55:27.722
You can call us anytime.

790
00:55:27.863 --> 00:55:30.705
We keep our patient panel down to less than 200 patients.

791
00:55:31.045 --> 00:55:32.667
You will always be able to reach us.

792
00:55:33.663 --> 00:55:34.663
And that's their brand.

793
00:55:34.923 --> 00:55:37.364
That's what some people just want access.

794
00:55:37.384 --> 00:55:45.007
You know, the way that I branded mine was I am a longevity clinic, a true longevity evidence-based clinic.

795
00:55:45.847 --> 00:55:47.848
If you want me to do your primary care, I will.

796
00:55:48.008 --> 00:55:53.289
And all of the primary care will be meshed in with the goals of the longevity program, which is nice.

797
00:55:53.569 --> 00:55:54.690
And some people like that.

798
00:55:55.597 --> 00:56:03.901
And then I know other DPC that they're very big into potentially women's health or even sports medicine, whatever that might be.

799
00:56:04.081 --> 00:56:06.502
And by the way, I do a lot of sports medicine.

800
00:56:06.902 --> 00:56:08.583
I didn't do a fellowship in sports medicine.

801
00:56:08.603 --> 00:56:11.745
I did an area concentration in sports medicine in my residency.

802
00:56:12.365 --> 00:56:14.566
And right now I'm on the sports doctor.

803
00:56:16.430 --> 00:56:19.472
of our local high school football and lacrosse.

804
00:56:19.533 --> 00:56:21.454
And I go to training rooms every week too.

805
00:56:21.974 --> 00:56:23.255
And so it's just kind of a way to give back.

806
00:56:23.315 --> 00:56:25.797
But I have a big passion about sports medicine.

807
00:56:26.278 --> 00:56:34.164
But so I think they need to come up, they need to brand what they are providing and they need to just be excellent at it.

808
00:56:34.244 --> 00:56:37.186
And if they're excellent at it, then the word's going to get around.

809
00:56:37.507 --> 00:56:40.389
They need to focus on how to be good at it.

810
00:56:42.668 --> 00:56:51.998
We don't have to convince too many people to be our patient if we're just really, if we're providing to the patients what they really need and want.

811
00:56:54.585 --> 00:57:02.008
need and what they need and what they want might not be the same, but they need a doctor who's willing to walk them through that.

812
00:57:02.228 --> 00:57:04.709
As far as super billing, I think super billing is a great idea.

813
00:57:05.290 --> 00:57:06.930
I would definitely not give guarantees.

814
00:57:07.231 --> 00:57:09.472
And that's why I tell patients, I say, I will give you a super bill.

815
00:57:10.052 --> 00:57:10.992
I'd be happy to do that.

816
00:57:11.633 --> 00:57:12.153
I will not,

817
00:57:12.773 --> 00:57:15.694
contact the insurance, I will just give you the bill and you can deal with insurance.

818
00:57:15.814 --> 00:57:18.756
Whether they accept my super bill or not, that's not on me.

819
00:57:19.036 --> 00:57:21.057
So I always like protect myself there.

820
00:57:21.157 --> 00:57:28.401
But I, my advice to docs that, that want to go DPC, my first advice is do it.

821
00:57:29.841 --> 00:57:30.602
Don't hesitate.

822
00:57:31.402 --> 00:57:35.104
Like you, there is a market for people.

823
00:57:36.164 --> 00:57:36.965
They will find you

824
00:57:37.927 --> 00:57:39.088
You will get patience.

825
00:57:39.889 --> 00:57:45.475
As long as you focus on delivering the right product, you're going to get patience.

826
00:57:45.555 --> 00:57:46.276
People want it.

827
00:57:46.316 --> 00:57:48.118
They are so fed up.

828
00:57:49.259 --> 00:57:55.346
The next thing is I would say automate your processes as much as possible.

829
00:57:56.307 --> 00:57:58.850
And what I mean by that is use the latest technology.

830
00:58:00.518 --> 00:58:13.641
EMR, the latest billing, the latest AI software integration, because you are going to be able to focus so much on medicine when everything is just automated.

831
00:58:13.741 --> 00:58:15.682
And do you need a medical assistant?

832
00:58:16.462 --> 00:58:18.322
That's a good question.

833
00:58:18.342 --> 00:58:20.963
And I think it just has to come down to what do you want?

834
00:58:22.108 --> 00:58:23.408
I have a medical assistant.

835
00:58:23.728 --> 00:58:27.629
I absolutely love having my medical assistant.

836
00:58:27.669 --> 00:58:29.869
My patients love having my medical assistant.

837
00:58:30.589 --> 00:58:31.490
And that's all.

838
00:58:31.510 --> 00:58:33.850
It's just me and one medical assistant.

839
00:58:34.170 --> 00:58:39.511
And we are able to provide pretty dang good care just with that model.

840
00:58:40.551 --> 00:58:43.812
But, you know, there's other things you can do for medical assistants.

841
00:58:44.072 --> 00:58:45.612
You can outsource.

842
00:58:46.552 --> 00:58:50.053
You know, like MedVA, they use medical assistants from the Philippines.

843
00:58:51.941 --> 00:58:56.064
the labor is a lot less and you're getting good quality medical.

844
00:58:56.104 --> 00:58:57.405
They can do all your prior office.

845
00:58:57.425 --> 00:58:58.286
They can do your scheduling.

846
00:58:58.306 --> 00:58:59.387
They can be your receptionist.

847
00:59:00.488 --> 00:59:04.411
But there's a way to automate all of the administrative tasks.

848
00:59:04.811 --> 00:59:10.715
And that's where I'm saying, listen, as physicians, I think we need to take that power back.

849
00:59:11.516 --> 00:59:13.638
And then, you know, I think just have fun with it.

850
00:59:13.658 --> 00:59:14.138
Enjoy it.

851
00:59:15.199 --> 00:59:15.899
I will tell you,

852
00:59:17.165 --> 00:59:20.528
I didn't realize how much I was drowning in insurance-based practice.

853
00:59:21.108 --> 00:59:31.017
I mean, I knew I was drowning, but I didn't realize how much I was drowning until I was in my own practice for a month, and then I was like, there's just so many things I'm not worried about.

854
00:59:32.298 --> 00:59:32.838
It's crazy.

855
00:59:33.719 --> 00:59:34.840
I mean, just like simple things.

856
00:59:35.160 --> 00:59:44.468
Messages, they would go through like so many hands, and then they would get to me, so by the time they got to me, it was like three to four days later, and then it takes about a day or two for me to respond.

857
00:59:45.337 --> 00:59:47.941
Now, I mean, just patients, the messages go straight to me.

858
00:59:47.961 --> 00:59:50.305
I can answer them quickly.

859
00:59:51.467 --> 00:59:51.888
It's easy.

860
00:59:52.649 --> 00:59:59.060
One of the issues that we get in family medicine too is like, right now, a lot of family doctors are paid based on production, which is fine.

861
01:00:00.200 --> 01:00:07.628
But the issue is, is like a lot of that coordinating care, you're not compensated for, and so you resent it, right?

862
01:00:07.868 --> 01:00:11.552
And in direct primary care, that's what you're being paid to do.

863
01:00:11.813 --> 01:00:18.040
And you don't feel bad about doing it, and you don't hate it, because you only have 300 patients.

864
01:00:18.440 --> 01:00:21.463
You know, direct primary care practice, I think they're anywhere from three to 600 patients.

865
01:00:22.624 --> 01:00:29.950
You have a six to a third of the patients you had before, and so you're actually able to do it, and you feel good about it.

866
01:00:30.690 --> 01:00:31.210
I love it, Sam.

867
01:00:31.230 --> 01:00:35.693
I think that my favorite thing is this idea of turning the tables, right?

868
01:00:35.973 --> 01:00:52.742
I think we've talked about how over the last 25, 30 years, if the global burden, not just global, but the US burden on the economy because of healthcare spending is increased, that's because doctors are making the same amount of money since the 1970s or less, probably if you account for inflammation, actually.

869
01:00:53.703 --> 01:00:55.164
Inflammation, that's how you know.

870
01:00:55.604 --> 01:00:56.565
Inflation, excuse me.

871
01:00:56.765 --> 01:00:56.885
And

872
01:00:58.924 --> 01:01:02.105
That deficit can be explained by admin.

873
01:01:02.305 --> 01:01:05.866
And you're proposing that we flip the tables, right?

874
01:01:06.106 --> 01:01:11.568
This whole conversation that we've been having, a lot of people are like, is AI going to replace doctors?

875
01:01:11.648 --> 01:01:13.369
And today might be the first time.

876
01:01:13.709 --> 01:01:17.530
Although I'm doing it and we're seeing it, it's the first time somebody actually is...

877
01:01:18.310 --> 01:01:22.895
is it the admin that we can get rid of who's making a lot of money and decrease that deficit?

878
01:01:22.915 --> 01:01:30.362
So I think from a policy perspective, that is an area really worth concentrating for us physicians.

879
01:01:30.382 --> 01:01:31.503
So I love that.

880
01:01:31.543 --> 01:01:33.205
It's a fight worth having or fighting rather.

881
01:01:33.846 --> 01:01:35.787
And yeah, man, I'm super excited.

882
01:01:36.468 --> 01:01:39.771
So Altura Health, tell the people where they can connect with you.

883
01:01:39.932 --> 01:01:41.033
Where can they find out what you're doing?

884
01:01:42.007 --> 01:01:45.372
Yeah, so I'm located in Sacramento, in Folsom, actually.

885
01:01:45.472 --> 01:01:46.954
It's a suburb of Sacramento.

886
01:01:47.876 --> 01:01:52.723
So it's just Northern California, about an hour and a half from Lake Tahoe, which is a really nice place, but.

887
01:01:53.688 --> 01:01:55.009
So right now we've got one location.

888
01:01:55.029 --> 01:01:57.070
We do all the testing on site.

889
01:01:57.270 --> 01:01:57.670
It's great.

890
01:01:58.151 --> 01:01:58.931
Patients can sign up.

891
01:01:58.951 --> 01:02:00.992
We can actually do some virtual stuff.

892
01:02:01.072 --> 01:02:06.716
It's just they have to be physically in the state of California for me to do any virtual stuff.

893
01:02:07.176 --> 01:02:11.739
And so, but I would absolutely, they can go to my website, altarahhealth.com.

894
01:02:11.759 --> 01:02:14.361
That's A-L-T-A-U-R-A health.com.

895
01:02:14.781 --> 01:02:15.821
They can sign up.

896
01:02:15.841 --> 01:02:16.842
They can send me an email.

897
01:02:16.902 --> 01:02:19.744
I'm happy to answer any questions.

898
01:02:19.764 --> 01:02:21.605
You can send me a DM on Instagram.

899
01:02:21.805 --> 01:02:23.326
Happy to answer any questions as well.

900
01:02:24.923 --> 01:02:26.584
So yeah, I'm pretty excited.

901
01:02:26.705 --> 01:02:31.148
You know, we're just trying to change how medicine is done.

902
01:02:31.328 --> 01:02:35.232
We want to take preventive health to the next level and just get people as healthy as we can.

903
01:02:36.012 --> 01:02:36.253
Love it.

904
01:02:36.453 --> 01:02:37.474
Appreciate you coming on, Sam.

905
01:02:37.754 --> 01:02:38.094
Thank you.

906
01:02:38.314 --> 01:02:41.277
Yeah, I really, really appreciate you guys having me on the podcast.

907
01:02:41.657 --> 01:02:42.598
And it's been a pleasure.

908
01:02:43.339 --> 01:02:44.099
Yeah, absolutely.

909
01:02:44.119 --> 01:02:44.360
Thanks.

910
01:02:44.460 --> 01:02:44.740
Thanks, Sam.

911
01:02:45.660 --> 01:02:47.942
Thanks for listening to another episode of Medicine Redefined.

912
01:02:48.563 --> 01:02:52.327
If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes.

913
01:02:53.047 --> 01:02:57.372
Please also check out our social media platforms where you can find more content like this.

914
01:02:57.992 --> 01:03:02.176
You can follow us on Instagram, Twitter, and TikTok at MedRedefined.

915
01:03:02.997 --> 01:03:11.961
We also want to thank our team for the production of this podcast, specifically Ethan Ju on video, Harita Yekori on social media, Zanab Lugmani on research, and Saira Khan for newsletter.

916
01:03:12.502 --> 01:03:18.745
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917
01:03:19.545 --> 01:03:25.408
Also, if you enjoy this show, please be sure to subscribe, review, and share with anyone who you think will gain value from this as well.

918
01:03:26.288 --> 01:03:29.270
Now, time for the ever-so-important disclaimers.

919
01:03:30.105 --> 01:03:34.150
This podcast is intended for general public use and is for educational purposes only.

920
01:03:34.791 --> 01:03:38.095
It does not constitute the practice of medicine, nor should be construed as medical advice.

921
01:03:38.675 --> 01:03:44.102
No physician-patient relationship is formed, and anything discussed in this podcast does not represent the views of our employers.

922
01:03:44.703 --> 01:03:49.549
We recommend that you seek the guidance of your personal physician regarding any specific health-related issues.