- Wow. Adam Conover from Adam Ruins Everything
responded to our reaction video.
And you critiqued it as well,
so we're talking about it on
this weeks Wednesday Checkup.
Beewoop. (upbeat music)
Just to catch everybody up,
a couple weeks ago, I did a reaction video
to the show Adam Ruins Everything.
The topic of the episode was hospitals.
So I was very comfortable giving
genuine opinion on the matter.
Since then, it got a lot of attention.
Over 11 thousand comments, two million views,
the host of the show actually
responded via twitter.
So I wanted to take some of his critiques,
some of your critiques, address them,
and explain to you how I film a reaction video.
Cause I think its important for you to understand
not only how my mind works, but how this
editorial process happens.
If you look at a TV show,
they have multiple rounds of revision.
They can film extra things, plug things in,
have experts come in, give extra advice.
I don't do that.
In this channel, it's myself,
my awesome videographer Dan Owens.
We sit down in front of the television
and we watch the episode for the first time.
I've never watched these episodes before
because I feel like if I go in
with some kind of preconceived talking points
it loses the genuine nature of the conversation.
And I feel like there's something special
when both you and I are watching
this episode for the first time.
When it comes to the editing process,
I never fill in information.
If I don't know something, I look it up on camera with you
or I don't include it in the final edit.
I don't know all the terms.
I don't know all the conditions.
But if there is something that I do know about
I chime in and try and present it
in the easiest, most fun, entertaining way
so that you can understand it as well.
That doesn't always hit home,
so if I discuss a subject that I feel
didn't come off well, or wasn't explanatory
in a way that's understandable
I'll edit that part out.
I will never edit it to make myself look smarter
or to make someone look stupid.
It's simply to make the information digestible,
interesting, and so that the pace of the piece
kind of moves quickly.
Now that you know the process I go through
in filming one of these, lets talk about
the comments and critiques you left underneath the video.
First you mentioned that you suspect
that I have a level of bias,
because I am employed by a hospital system.
Well, actually you're right. On two counts.
First, all humans have some level of bias.
In fact, those who are more educated
have a higher level of bias,
because they are able to convince themselves
by rearranging data and information
to suit their own beliefs.
Second, I do work for a hospital system.
I am an outpatient, office based doctor
so I'm not really in the hospital
but it sort of holds true still.
However, I have to push back a bit here.
What I'm most passionate about,
what I pride this channel on,
is that we identify bias, and we try and prevent it
from corrupting this information.
I try to present information as honestly
and accurately as possible,
without putting my own opinions in,
unless I'm explicitly saying that this is my opinion
and not everyone else's.
Or not matching of the facts.
I'm no stranger to controversy,
and I've covered some really
controversial topics on this channel
like polarization, diversity, telemedicine
statements made by politicians and health care professionals
and I'm not afraid to face my biases
and their biases head on,
so that we can have a healthy debate,
have an honest conversation.
And if you ever catch me being biased,
or I ever catch myself being biased
I'm going to be the first to admit that on camera.
The next point you've brought up
quite commonly in the comment section
is that you worry that Adam actually
explained certain points but I don't show that,
therefore I make it look
like I know something that he doesn't.
I don't edit in this type of bad faith.
If there was something that
I critiqued about the show,
and then he went on to correct it,
I would either a jump in and say,
oh, he pointed that out, so we're on the same page
or I would completely erase my critique
and not include it in the final cut.
To make someone look bad, just to make myself look better
that is something I absolutely abhor,
and will avoid doing at all costs.
And the final point that I saw a lot of critique on
and rightfully so, is that I didn't quite qualify
why I believed hospitals to be so expensive
if it wasn't just to make a buck.
The reason why I left that bit out,
is because when I explained it on that first take
I don't do extra takes
it wasn't clean when I looked back at the edit,
didn't explain it well,
and I felt it would slow down
the overall pace of the video,
so I just completely deleted it
and felt that if you wanted further clarification
I could do it in the comments
or do as I'm doing now.
But let's chat about why hospitals are so expensive.
I don't disagree with Adam,
that part of the reason why hospitals
have such crazy prices, is to make a profit.
That definitely exists, and I think that
certain hospitals, based on how much money they spend
on marketing, branding, hiring new talent,
innovation, all of these factors,
charge more money and they want to make more money
and it's a for profit business.
Whether you agree with a hospital
being a for profit business
is a whole different conversation.
But that is not the only reason
why hospitals charge so much.
And in fact, it's not the main reason either.
The major reasons of why hospitals charge so much,
first and foremost, is administrative costs.
When you look at a graph of how much physicians
have been costing the health care system
over the last 30 years, it hasn't really changed much.
The real uptick in spending has come from
the administrative burden placed on the system
and doctors as well.
In fact there's this whole spike
in doctors being unsatisfied with what they do.
It's not because medicine's changed.
It's because the administration of medicine has changed.
The reason for this uptick in administrators
comes from the fact that our system
is so complex and not intuitive at all.
When a patient is admitted into a hospital
from the emergency room, there has to be
three people to figure out how to
best bill that patients insurance
so that they approve the fee,
and get the hospital can get paid.
Then if I didn't fill out the patients chart
in a way that's applicable to that insurance policy
I have to then go and change the chart.
The system is so fraught
with inconsistencies, with redundancies,
that the cost goes up significantly,
to receive the same thing that
if you were in another country,
it would cost a portion of the price.
There was a great interview done in 2010
from a Harvard economist, who said that
as an example in Duke University hospital,
that there was a 900 bed hospital.
Means that they could fit 900 patients.
And they had 1,300 billing employees.
You don't even need 900 doctors
to take care of 900 patients.
But you need 13 hundred billing specialists
to take care of 900 patients.
Something's wrong there.
The second reason why hospitals are so expensive
is because doctors are afraid to get sued.
And they begin practicing what's known as C-Y-A medicine.
Cover your butt medicine.
This is where doctors order confirmation tests
or extra imaging, or prescribe unnecessary treatments
just based on the fear that they may get sued.
A great example of this is antibiotics
which Adam does a great job of covering in his video.
Where doctors are worried that if a patient
has a virus, but gets worse,
and they didn't prescribe antibiotics,
it could be blamed on them, and they may be sued.
So they prescribe unnecessary antibiotics.
I don't like when doctors practice
this type of protective or defensive medicine.
It's not honest, it's not ideal,
and you're not helping the human sitting in front of you.
The third reason why hospitals are so expensive
is because in the United States,
we have more specialty care,
than anywhere else in the world.
Specialists cost more money.
This is why I'm a strong believer
in primary care medicine, family medicine
what I do, because we not only
lower the cost of healthcare,
we prevent problems from happening,
and we educate our patients to live
the best quality of life possible,
to avoid these situations in the future.
I have no shortage of examples
of patients coming in, asking to see a specialist
for some very common conditions.
High blood pressure, high cholesterol,
skin biopsies, and I remind them
as a family medicine doctor,
I'm fully capable of taking care
of a lot of these common conditions.
That's not an exhaustive list
of why hospitals are expensive,
but I think those reasons are a lot more
important to take action on, and talk about,
than just the profiteering by some individual hospitals.
And that was my issue with Adams segment.
Again, he wasn't saying anything
wrong or innacurate, it's just the focus
of the piece was, I felt, a little misguided.
Let's move on to Adam Conovers tweet.
And I have to say at the outset,
I'm so happy that he did this publicly
that we're able to have our sort of
different point of views put out into the web.
Have a healthy conversation about it.
So that everyone learns what our points of view are
where we're coming from, because that's what it's about.
It's not about labeling someone,
or calling someone a name,
that's not ideal for this type of discussion.
I think the best way to do this
is I'm just gonna read a couple sentences of his tweets
and then just respond to them one by one.
In this video, real doctor mike
affirms that every factual point
that we make in our episode is correct
so we're off to a great start.
His only criticism seems to be of our tone.
I disagree with that a little bit.
While I did say a few things
about the tone of some of the pieces,
some of my critique comes from the focus.
And we're gonna be getting into that
as we cover each point,
but know that my critique is not coming from
a producers standpoint, a TV executives standpoint,
entertainment standpoint, it's strictly coming
from a doctors concern of what an average person
may take away from one of these pieces.
He seems to have two complaints.
One, that we're being too mean
to hospitals that systematically
overcharge their patients,
two, that our mammogram segment
might frighten women away
from getting mammograms all together.
It's not so much that I care
that he's being mean to hospitals,
it's the fact that I feel the focus,
is too heavily places on profiteering
when I feel there's other systematic issues at play
that weren't adequately discussed within the episode.
And the second point, dead on.
I agree, that's what I was worried about
that the mammogram segment actually does
frighten women away from getting mammograms.
It's unclear why Mike believes
that hospitals should be above criticism.
He agrees that their pricing
is capricious and inflated,
and that it has devastating costs for the uninsured.
He even criticizes these practices
in the pharmaceutical industry, so why not hospitals?
First, I don't believe hospitals are above criticism.
I think no one is above criticism.
And I don't think criticism is even a bad thing.
You can give constructive criticism.
In fact in my residency program,
which is part of my hospital,
we consistently give criticism, to improve it.
So that where we work is a better place.
Next line, I do believe that these
crazy elevated costs are out of control
and they have devastating effects on the uninsured.
(ding)
totally see eye to eye on that one.
Mike claims that hospitals aren't in it for the money,
but there are thousands of for profit hospitals in the US,
and even non-profits wildly overcharge.
Yes there are many causes of high healthcare costs
but this is one of them, and it deserves scrutiny.
I don't think that I ever claimed
that hospitals aren't in it for the money.
I agree that for profit hospitals exist
and I think in the video I actually mentioned
that hospitals need to turn a profit.
I agree that it deserves scrutiny.
But I think the laser focus that was placed
on hospital profiteering, was a little misguided
because there's so many other things
that are contributing more so
to the rise of healthcare costs,
that weren't discussed.
My job is to use comedy to point out
bad business practices that hurt people.
I'm not in the business of protecting
the feelings of hospital bosses.
I respectfully reject this criticism.
I agree, I don't think he should
worry about offending hospitals.
And I don't think this is an issue of outrage
that I think that hospitals are being unfairly treated here,
and hospital bosses feelings should be under consideration.
No, this is a business, and it's a big industry
that effects millions of individuals.
So we should be criticizing it openly.
I just think that if we're gonna criticize any topic
or debate any topic, we need to think about
all the factors at play,
and if we're gonna be discussing any of them
at such a high stake and with such focus
it should be the ones that are
the major drivers of this problem.
And I just don't think hospital profiteering
is one of those main drivers.
It's definitely one of them,
and it deserves scrutiny,
but the other issues deserve more scrutiny.
That's all I'm saying.
Mike worries that we send the message
that no one should ever get a mammogram.
This is odd, since our episode clearly
and explicitly lays out that the United States
preventive services task force guidance.
You like how I know what that stands for.
That you should discuss routine mammograms
with your doctor starting in your forties.
Again, factually this is all good stuff.
And I don't think that there's a problem there.
My issue lies with how the average person
will interpret the way the information is presented.
The order, the tone, all of these things.
When we had the segment critiquing
antibiotic overuse and overprescription,
that's really good.
Because patients actually come in
requesting unnecessary antibiotics,
and doctors give it.
What happens much much less often
is patients coming in, asking for unnecessary mammograms
and then doctors giving them.
I don't think that this is even
a situation I've ever encountered
or heard of a doctor encountering.
Being a primary care doctor,
I have a pulse, that's funny that I used this metaphor,
but I have a pulse on what my patients
think about medicine, what their fears are,
what they think works, doesn't work.
and their feelings on mammograms are negative.
They don't want them, they're afraid of them.
They've heard that they hurt,
they'll do anything to get out of getting them done.
And when patients at baseline
are already scared of them, by presenting them information
the way that it was presented,
I think that it could turn them off even further.
Mike also seems to take issue with our
over criticism of how mammograms
were over promoted in the eighties.
However as he admits, those myths contributed
to a dangerous over diagnosis and over treatment.
Since they're still with us today,
it's important we correct them.
I don't think necessarily mammograms were over promoted,
because at the time, our best research
showed that getting mammograms was beneficial.
Now we know that starting later in life
is more beneficial and less harmful.
So, I wouldn't necessarily call these
myths that were propagated,
it was the best research that we had at the time,
but as we know now, that isn't the truth.
That's the thing with medicine.
A lot of the things I'm doing today,
that are accurate based on the evidence that I have
will be proven wrong in the coming years.
This is just bound to happen,
as more research comes out.
We need to not be afraid of that.
And while I agree we do need to point out
that advances in research,
and changes in guidance have happened,
that's really something for doctors to take note of.
Because if we overload patients
with when they should be getting this
and how these rules change year in year out
it'll cause so much confusion for the average person
that they won't be able to make and accurate decision.
The average person wants to avoid mammograms
and has an unfavorable view of them already.
And now were just throwing more fuel on the fire.
Finally, Mike says that as a doctor,
he may have presented the information differently.
I agree that when covering medical issues,
deferring to doctors is essential.
That's why our script was reviewed
by a physician, cancer researcher,
and our expert for this episode, Doctor Joan Elmore.
We did multiple rounds of revision on this script
based on Doctor Elmore's extensive notes
and feedback which drew from
her clinical experience treating cancer patients.
It was vert important to us and her
that the segment accurately represented
the advice she'd give in her office.
Again, I agree that this episode is factually accurate
and I loved the sit down interview
that was done at the end of the episode.
However that initial skit,
which is the most engaging part of the episode
and the first part of the episode,
that's where people pay attention to most,
really painted mammograms in an unfavorable view.
I understand that factually speaking,
it was painting them in an unfavorable view
when patients don't need them,
like getting them too early,
but I don't know if that was clear.
And I worry how that might affect somebody
who's already having a fear of getting a mammogram.
Which is most patients.
So if I was to redo this episode,
or do it on my own, all I would do to change it
is take some of the information
that was given in that sit down interview,
and incorporate it in that beginning skit.
Or, maybe make the beginning skit even clearer
that we're talking about people who don't need mammograms.
Cause there's a huge percentage of the population
who do need them, but are afraid,
and we don't want to scare them away.
Of course, we knew taking a comedic look
at such an important medical topic risked misunderstanding,
that's why this segment had one of the most thorough
fact checking and review process we've ever done.
We took it extremely seriously,
and sacrificed comedy for clarity many times.
That said, we were of course limited
by the six minute segment runtime,
that's why we brought Doctor Elmore in
for an extended interview on our podcast,
where she went deep on the nuances of the issue.
I think comedy's a great tool
to educate people about health,
and I think that simplification
is actually a good thing, because we want
the average person to understand the basic concept
get a level of general interest,
and then do a deep dive into the research.
What I don't think is ideal is oversimplification.
When we take a complex, nuanced matter
like why the American health care system costs so much,
and we just limit it to talking about one of the factors,
and its not one of the most important factors.
I think that can be deceiving.
I think that when we're talking about mammograms
and we don't focus on right away
the benefits that mammograms carry,
that's a little bi deceiving.
Because it's such a nuanced matter
that oversimplification can be dangerous at times.
We need to constantly reevaluate our good intentions
and see if they match up with good outcomes.
Again, I wanna give a huge huge thank you
for Adam Conover, for tweeting me this reply
so that we can continue this conversation
and really understand that we're not disagreeing on much.
The facts that are in this episode are accurate.
And the fact that we're talking about this
and getting people engaged on a topic
like the American health care system
and mammograms is amazing.
This is what I'm all about,
and I encourage all my patients
to educate themselves further.
This type of debate is healthy,
and I want to continue encouraging that
by telling you to go into the comment section
write up your response,
who do you agree with, do you have your own point of view?
I enjoy learning from you guys
as much as you hopefully enjoy learning from me.
So drop your comments your thoughts
your own point of views down below in the comments,
and as always, stay happy, and healthy.
(jazzy music)