as you know my dad is and was my role model in medicine here's a guy who
trained in India there was no CT MRI labs it was all about touch and
intuition and the art of Medicine spending time with patients like that
picture we saw of the doctor who just had his hand on the patient it's a
beautiful thing and when I shadowed him in his clinic I would learn this and I
remember one time I was I was shadowing him and he had a patient with right
upper quadrant pain and I said dad like we should get an ultrasound you know I'm
a college student he goes this does this thing that Indian dads do when they're
disgusted which is don't be an idiot
ultrasound no wonder you Americans are spending the
2.8 million dollars on the healthcare and getting worse outcomes in the
developed world you are burning money like it is growing on vines I have two
perfectly good two fingers we will figure this out said I gotta see this
goes up to the belly puts his fingers down starts freakin percussing right
over the liver the gallbladder wall is slightly inflamed about three
millimeters so I did I said you know medicine that's it I'm gonna do internal
medicine just like my dad and I went on my rotation it was UCSF and just like
these lovely medical students have the short white coat made me look like a
waiter I practically developed an Erbs palsy
just for a tip and I never I never got it and and we're on the third year
rotation we're only one of the four medical students on the rotation could
get honors and get a really fancy Swank residency and so everybody's super
competitive big team attending physician for the purposes of this talk let's call
him Flanders because that was in fact his real name
and it's vengeance time and and dr. Flanders said at the beginning of the
rotation to the whole team myself included listen guys we're here
to learn there are no stupid questions Flanders was a liar because I asked a
question to which he said in front of the team de manya you speak and then
think I would like for you to reverse that
two weeks later Flanders sis me down and is in in the evaluation and he says
where to begin and I was like dental school he said
look man de Manya you the problem with you is you don't understand that there's
a hierarchy in medicine that you have a short white coat I have a long white
coat you're making jokes on rounds you're comfortable you're acting like
you're an attending this is hurting you on this rotation and then he said but
you know I did something I went and talked to the rest of the team including
the other medical students and they said to one that on rounds you would use
jokes to put everybody at ease usually self-deprecating and that you
made everybody feel like they were an important part of the team the most
important part of the team you treated everybody like they were equals no
matter what the length of their coat was and then I talked to the nurse and the
clerk at the front desk and the person who serves the food and the janitor came
up to me and it turns out they all knew who you were which was unusual for
medical students because you treated them like they were the most important
person in the hospital and then I talked to the patients and they said something
really interesting that when you came in the room you would sit down and for the
minutes that you were there it was like nobody else in the universe existed
except for them and they felt heard and connected with and that in itself was
healing to them and it was an exception to the experience they were having in
the hospital and despite my better judgment I am forced to give you honours
in this rotation at which point a tear actually did start
to come down then I sucked it back up I was gonna lose my street credibility
that easily because then I'd have to kill a man to get it back and I was not
going back to jail I'll tell you what I see after 10 years
at Stanford when I see Winnie the Pooh I see an anxious effect concerning for
anxiety disorder not otherwise specified with likely to press his features I see
a black partially necrotic nose concerning for a chronic cocaine abuse I
see considerable central obesity concerning for insulin resistance with
likely metabolic syndrome confirmed and supported by the complete absence of
fingers and toes on all the paws
suggestive of diabetic polyneuropathy with auto amputation and despite his
name he hasn't concerning for diabetic gas drop D with constipation and despite
this litany of glucose related disorders mr. Pooh's Auto amputated right paw is
deep in the honey and you're thinking oh my gosh
nobody is incentivizing me to spend time with poo to get at the heart of the
matter to go poo what hole in your life could that honey be filling that you has
still got a paw in it despite the fact that we've told you it's killing you
could it be that as a society we've taken honey that used to be in trees
guarded by bees and put it in the supermarket made it cheap in a food
desert could it be that your social support system has fallen apart where is
Christopher Robbins he's your homey he's AWOL
what's going on with piglet is there abuse
have you been getting into Tiggers crystal-meth
no teeth people no teeth what if I actually used
humor made these kind of engaging videos in a way that we could reach out to
patients where they are and I looked up the meaning of the word doctor it comes
from the Latin root though chair a which means to teach was I teaching not really
could I teach what if I made some funny videos that had engaging hooks that
focused on disease prevention and also satirizing the system so we could maybe
rally people to do something about it what if I put them on YouTube and just
did that I ran it by my team and my department chair and they were like you
will flush your career down the toilet that is a very bad I do not go on
YouTube and of course that made me want to do it even more and so I got a PC I
got a little handy cam and I started recording these little parodies and
editing them and trying to upload them to YouTube and it was a complete
freaking disaster like I couldn't even get the thing to upload to YouTube this
is 2010 then I got a Mac
eighty videos later and millions of views Z dog MD with two G's because one
is not sufficiently gangsta is in the house and I said wouldn't it be amazing
I wish that I could somehow translate this idea of engagement and Prevention
and and sort of passion into the actual clinical space now sometimes when you
make a wish and you wish hard enough a fairy godmother comes down and turns
your pumpkin into a chariot and this fairy godmother is a beautiful princess
looking creature in the real world the fairy godmother often looks like a dude
and is like this so this guy is Tony Hsieh he's and he says look man I
actually saw those videos you sent me you need a restraining order it's not
normal son but here's the thing you're just crazy enough to be interested in
something we're doing I sold Amazon made a bunch of money
stayed on as a CEO of Zappos why because I started studying cities Zappos needed
to grow it's in the suburbs of Las Vegas when you study cities you realize when
they double in size they actually become 15 percent more productive per capita
whereas when a company doubles in size what happens like what happens to epic
when it doubles in size it gets less and less epic doesn't it so the same thing
happens to companies because it's a pyramidal hierarchy just like Flanders
said Madison was right but in a city there's no hierarchy the mayor doesn't
tell you where to go you go where you're supposed to go and then you bounce
against other people in a dense urban space with lots of stuff to do and
serendipitous innovations spring from two interesting people colliding
together and sharing ideas and the more people you have in those spaces the more
innovation you have and what would it be like if we took Zappos this company
that's poised to grow and move it from the suburbs where it's walled off like a
googolplex in the way from the community and we dropped it into the heart of
downtown Las Vegas we said well look there's 18% of GDP that we don't
understand because we're tech people and we're logical and it's totally not
logical it's called healthcare you clearly are crazy
you whine about stuff all the time in these videos about how broken the system
is why don't you put your money where your mouth is quit your job at Stanford
what if we double down or triple down on primary care instead of 4% let's make it
8 or 12% let's start with prevention in primary care let's build a clinic and
let's fund it so that the doctors and the patients and the coaches and the
nurses and the social workers have the time and the resources to practice at
the top of their game scratch and so it looks like this this is Andrew he's a
health coach there are four health coaches to every doctor a health coach
rooms a patient for a 30-minute minimum visit and there are four health coaches
to a doctor which means four patients can be roomed at a time at 30 minutes of
pop and then the doctor goes room to room to room and ties it together
practicing at the very top of their license and it looks like this
Andrew was screened from five hundred people we did in a speed-dating thing we
got down to two that we hired Andrew was one of them screened based on what
empathy the ability to get a story out of patients to connect with patients 60%
probably of what we do in primary care doesn't even require a doctor it
requires a human being who can do what I used to be able to do as a medical
student sit down and be present with that patient and so what does it mean it
means we were talking about patient satisfaction being an oxymoron I'm not
gonna bore you with all the data showing outcomes in a year I'm gonna show you
the most interesting outcome Net Promoter Score how satisfied our
patients in the first year of us being open how likely are they a scale of one
to ten to recommend this clinic to their family and friends turntable health 90%
positive Net Promoter Score you can compare that to Amazon and then a
healthcare benchmark which is a large HMO bow out west that has one of the
highest Net Promoter scores at 35% it shows you that we might be doing
something right because patients are happy the outcomes I won't bore you with
but I'll show you the net cost outcome in a year in a sick population of
patients inclusive of eighty dollars per patient per month higher rates for
primary care they're normally like 20 or less in in Vegas
we saved oh sorry I forgot Comcast cable Oh where'd that come from I just made
that up but it feels right doesn't it this is a vision of Health 3.0 and the
emergent from that is even more it's a it's an almost sacred thing where that
human relationship that analog relationship comes back and that's what
we're trying to do and couldn't you imagine the Hundred Acre Woods in a
world like that he still has no teeth to wear if my daughter were to come to me
now and say daddy I want to be a doctor I would tell her I couldn't imagine a
more sacred calling where every day you give a piece of yourself and you get to
be with people that are at their most vulnerable who give you their story and
both of you are transformed by that encounter and a positive wave spreads
through the community affecting countless lives every single day lather
rinse repeat what a gift it is to be a healer
unfortunately since being in Las Vegas and watching my videos she now has
different career plans