Will: [00:00:00] Knock, knock. Hi.
Hello and welcome to Knock-Knock. Hi, with the Glock Flecking. I am your host, Dr. Glock fln, and I’m your
Kristin: co-host, lady Glock
Will: Flecking. Oh, we’re excited that you’re here and, uh, are going to spend some time with us today. We have a fun show for you, Dr. Eric Topples gonna be here.
Kristin: Yes, he is so
Will: interesting. Yeah.
We, we, uh, uh, have been reading up on artificial intelligence and Right. And preparation for having him on. And, uh, I’ve learned a thing or two about a lot of different things. He knows a lot more things about all this stuff and so all the things. Things all the, just all the things. Yeah. Uh, and, um, and so, you know, it’s, it was a, a fun conversation with him.
Before we get to that, We [00:01:00] just got back from a trip. We weren’t in Florida. Went to That’s right. Went to Fort Lauderdale. Mm-hmm. had a speaking gig. Yeah. And in Miami, spoke at a, a primary care conference and, uh, it all went, it was great. It was, it was a fun trip except for the fact that you had a rotting tooth in your mouth.
Hey, well now
Kristin: it’s not rotting. Get your facts straight. Why
Will: don’t you tell everyone what you
Kristin: had here. Alright. Well, so I did go to the dentist like the day before, the day before, the afternoon before we were leaving very early in the morning for this cross continental plane ride. Um, because I was having a lot of, of tooth pain.
And I, I’m the, you know, you’re the one with the sensitive teeth. I don’t really, my teeth hardly ever bothers
Will: me. This whole thing, this gives me shivers and
Kristin: this is my chance
Will: to get revenge. And I don’t handle teeth things very well. I hate the dentist. All the squeamish stories out there. , but your job sucks
Anyway, go ahead. [00:02:00] The scraping and the No. All right, go
Kristin: ahead. Okay. So it, it was giving me pain and there was like a, a, a bump forming. So I was like, this isn’t good. I need to go get this checked out before we leave just in case it’s something horrible. And it turns out it, you know, maybe, maybe not horrible, but not great.
Uh, the tooth was broken right at the root, just all the way across. Just clean break. I have no idea how it happened. Dennis said, usually there’s like some impact trauma and, and people can tell you why, like when and where that happened. But I have things you’re gonna blame the dog. I have no idea. Maybe the dog.
Probably the dog. I mean, that is one of the things that the dentist said can cause this and that does happen. We have a big dog. The dog will paw you in the face sometimes. Um, but there wasn’t like a particular time. But you know, this particular tooth has given me trouble over the years. It’s, it’s, uh, it’s got a crown on.
It’s got a root canal,
Will: and they wanted to do surgery to fix it. They wanted to have
Kristin: me the next day. Yeah. They wanted to have me come in the next [00:03:00] day and have it extracted and. And I get to have a bone graft. Mm-hmm. Yeah. Got that to look forward to. Uh, and then once that heals, you know, put in an implant.
But, uh, we of course had you were like,
Will: no, a trip. I’m sorry, I have to go speak as Lady Glock, flecking in Florida. Well,
Kristin: that’s, that’s not really how I said it or, or what I said, but I did say, Is it possible that we could wait a few days? Cause I knew we had that speaking gig and then we had this interview with Dr.
Eric Topel and I did not wanna miss either of those things. So we, we are putting it off until in a couple hours I gotta go. Yeah. Like
Will: we finish this, take care of, she’s going to get her. But I
Kristin: spent the whole time, two, three, we talked to what she said, I think almost 2000 people at the conference and we were a keynote and um, you know, they had the camera, we were like big on the screen.
And I spent the whole time just hoping that my tooth would not just fall out on [00:04:00] stage ,
Will: because it’s very loose in there. The only
Kristin: thing, oh, you’ll love this. The only thing still holding it in is the root can. Okay. It would’ve, it would’ve just fallen off because, you know, right at the gum is where it’s broken.
Will: So, oh, I’d rather have a cardiac arrest. .
Kristin: Well, you did, so I guess. There you go. Yeah.
Will: But it didn’t, it did not fall out on stage. It
Kristin: didn’t, and it didn’t fall out in this interview. And, and here it’s still there
Will: and you’re about to get it fixed still here. And so last
Kristin: time you’ll ever see this, maybe
Will: have fun with that.
All right, well, let’s, that’s enough. That’s enough about the teeth, . All right. Let’s talk to Eric Tobel. So Eric Tobel is a very fascinating guy. Yes. Um, he is the professor and Executive Vice President Scripps Research Translational Institute. Yes. Founder and director of the Scripps Research Translational Institute.
And, uh, does, has done so much, he’s had a. Impressive career. A lot of other accomplishments as well.
Kristin: I think he’s like literally written the book [00:05:00] on AI and medicine. Yeah. And
Will: deep medicine. He’s got a lot of, yeah. Several books. And so more, more much, many more books than, than I’ve probably read in like the last two, three years.
Cuz I don’t read that many books. Mm-hmm. It’s a low bar books. Yeah. You read more books than I
Kristin: do. I try. It’s hard when you have kids. These just
Will: people know. Anyway, let’s get to it. We’re excited about this one. So here is Dr. Eric Topple.
Dr. Eric Topple. Thank you so much Eric for joining us. Uh, it’s always a pleasure. I got to talk with you not too long ago, uh, on your, uh, uh, podcast, uh, you were doing. And so, uh, we’re happy to have you on ours now. So thank you so much for being here.
Dr. Eric Topol: Oh, I’m thrilled to be joining. You Will.
Will: Uh, so I was, uh, in kinda researching you a little bit and, and I was listening to a few interviews, podcasts you’ve done, and I heard something, uh, a little bit alarming.
I [00:06:00] heard that you haven’t used a traditional stethoscope in years. Is that right? It’s really true. What do you use as a cardiologist? That’s, that’s, that’s surprising. It’s
Dr. Eric Topol: like blasphemy, I guess, right? Um, no, I, I, um, I carry this stethoscope in my coat to look good so I can pass as a cardiologist. , well, I haven’t pulled it out for as long as I can remember.
The reason is I now use a smart. Um, ultrasound Pro. I used to use a handheld, uh, device called the vCAN, but that was replaced by all these smartphone probes. So now every patient I see in clinic, um, I do a, uh, echocardiogram and it, it’s great because hearing lub dub isn’t really as insightful as seeing everything and also showing it to the patient.
Um, that’s, so within seconds, just with a little gel on the tip of a probe, um, you know, we’re looking together [00:07:00] at a smartphone and seeing everything you can imagine about the heart. And, uh, it’s really great because the number of people have to send for an echocardiogram becomes very minimal, but the insightful information is just, is extraordinary.
Will: Well, you and I have something in common. I, I also haven’t used a stethoscope in years, but I’d say I have a little bit more of an excuse as an ophthalmologist , but that’s, do you see, uh, that being. I impacting medical education because, uh, I mean, obviously, you know, a big part of learning the clinical exam is, you know, learning all the lub dubs and all the other extraneous noises that you hear, and I assume that’s not gonna go away.
But, um, and this has some applications with ophthalmology too, because we’re such an imaging based, um, uh, specialty. But do, do you see things moving in that direction where we’re all carrying around? Yeah,
Dr. Eric Topol: that’s one of basically handle that goes mistakes is that I thought we would’ve been there years ago.
I, I [00:08:00] thought that, um, we would’ve immediately seen that the stethoscope is obsolete. I mean, it still is useful, like if you’re going to innovate somebody, you’re just checking quickly for breath sounds or you’re, you’re trying to listen to for blood. Um, for the sounds mm-hmm. , but, you know, I used to be a fanatic about teaching medical students and interns and residents to hear paradoxical splitting and all the fine sounds and the bedside exam.
But the bedside exam now is done through ultrasound and of course it’s not just for the heart, it’s for every part of the body. Um, and I think except for the brain and, and perhaps the eyes, but you know, you talk to Yeah. . Yeah. All the body is so amenable to high resolution imaging and we should, we should be doing that.
The problem is, it’s actually has a much better, uh, acceptance in, um, the developing. Uh, because they’re not so fixated about reimbursement [00:09:00] and they have, uh, hunger for, uh, leveling the playing field of technology. So the other thing that’s really cool about it is now you can use the AI to help you acquire the image without even knowing what the hell you’re doing.
So, you know, an eight, an eight year old, like my grandson
Kristin: or an
Will: ophthalmologist, yeah.
Dr. Eric Topol: Yeah. Could actually obtain an echocardiogram, which is the hardest one cuz all the motion, uh, it says, you know, move up, move down as long as you know, like which is the left side of the chest and the pa and the patient doesn’t have sinus.
And versus you could actually get right an echocardiogram without even knowing what you’re doing. And then get an interpreter with ai. It’s wild
Will: and it’s. What’s interesting to me, you know, AI and kind of this type of advanced imaging, it, it’s, it’s an active area in ophthalmology because, uh, especially with diabetic retinopathy screening, I’m sure you are familiar with, you know, some of the AI work going on in that area, especially in third world countries.
It’s actually, [00:10:00] um, some places they’re really on the forefront of kind of introducing AI with, uh, screening for, um, for diseases that affect the retina. And, uh, I, I’ve always thought. It would, we really need this in our country a lot more, uh, especially in emergency settings because nobody knows how to look in the back of the eye anymore.
Uh, unless you’re an ophthalmologist, you don’t get that kind of training. And so, um, you know, I would love to see that in the eye space as well. You know? No,
Dr. Eric Topol: you’re, you’re actually right. Ophthalmology’s leading ai, uh, uh, India is a pioneer in diabetic retinopathy and retina screening, uh, with, um, ai. So yeah, I mean, this is so, so much.
Uh, the other thing just to note is the retina is the gateway to the body so that the picture of the retina or o c t of the retina, I mean, you can learn so much about almost every system of the body just from that snapshot, it’s. [00:11:00]
Will: I’m, I’m impressed you threw out ooc t there. You’re familiar with the OCTs?
Oh yeah. So this, uh, well we do, we
Dr. Eric Topol: we do ooc t of the coronary arteries, but, uh, o CT of the retina. Oh, that’s big. I mean, I, I,
Will: uh, so these are, I’m impressed for those are people who don’t understand, uh, O C T is, um, is a really high resolution. Where you can get a really, a cross-sectional view of the retina.
And it’s especially useful in diabetic retinopathy, uh, and other diseases that cause swelling in the retina, uh, that are related to cardiovascular health. And so, um, the ba able to, uh, have widespread imaging available for this, um, is, is just really helpful. I can tell you how many times I’ve, I’ve been on call and just, just, I really wish this was present in the emergency department and I think that’s probably the future.
I think we, just like you have, you know, a handheld, you know, ultrasound that you’re kind of going around and showing patients, I would love to have that, [00:12:00] um, uh, the ability to image someone’s retina. So for the
Kristin: record, I hear that you’re saying that you would like to have the ability to ultrasound. That’s what I heard.
Will: Whoa. This ultra, like a traditional ultrasound is a little bit different. So, uh, Eric, you mean? I don’t know if you’re familiar, but there’s, there’s obviously in, in the emergency medicine world, ultrasound is, is very important. And so, uh, it’s um, it’s, it’s a tool that they use frequently, especially with eyeball stuff.
Mm-hmm. And so that’s something I’m, I’m talking with, uh, emergency doctors about a lot and it’s, it can be helpful. He picked some fights with them about it. I do, you know, you know, I, I’ve gotten drawn into some arguments on social media. I’m, I, you’re, uh, probably very familiar with the, uh, some of the pitfalls but that come with social media cuz you have a pretty good social media presence as well,
Dr. Eric Topol: Right, right. No, But what
Will: wanted to do, uh, I want to talk, stay on this AI topic, uh, especially with chat, g p t. [00:13:00] Uh, and so I hope you don’t mind a lot of the questions I’ll be asking, um, are generated by chat GT G P T. Is that okay with you? Oh, oh, just kidding. Sure. That’ll be interesting. It would be. But I’m curious what your thought is on this, because it seems like the topic of AI has really come into the public consciousness a lot within the past year.
In part it seems because of chat, G G P T, everybody’s playing around with this tool. And so I’m curious what your thoughts are about this tool and how do you see it in the overall picture of artificial intelligence and
Kristin: have you ever asked it what it thinks about you, ? Oh,
Dr. Eric Topol: I haven’t done that yet. That’s a good one.
Um, I, I, I think it’s really interesting because obviously it is, uh, the craze now and everybody’s talking about mm-hmm. , not just chat G P T of course, but this [00:14:00] whole large language models, I kinda see it differently than many people. Um, I just see it as taking the, what we had with deep learning, which the only way we got the deep learning was having the graphic processing units that we got from video games to manage, you know, massive amounts of data.
Uh, and, uh, the ability, and that was using supervised learning largely where you had to have the images, mainly images that were, um, basically got ground truths with expert annotation, uh, in medicine. or any annotation outside of medicine. And so that together formed the year of deep learning. And what this basically is, is that on steroids where you have computing power taken to the nth power handling trillions of parameters, now even, uh, hundreds of trillions of parameters, and you get GPUs, the likes of which, you know, we don’t generally have in most places.
That’s [00:15:00] why in some respects, OpenAI had to join forces. With Microsoft because Microsoft’s got a lot of GPUs or, or TPUs with the case of Google to work with. So I, I see it more as, you know, big expansion of computing power. And the big difference is we’re no longer relying on supervised learning. It’s unsupervised, self supervised.
So basically using tiny amounts of pre-training and, um, letting the computing power do a lot of the, uh, the, the learning. So what we now see is not just images, but what of course is fascinating people is that you take text to idio images and video or speech and, um, You know, I’d say, uh, present this, uh, uh, as in the style of Dr.
Claflin glaucoma, flein, , and, uh, you know, uh, and tell jokes like, and all of a sudden it sounds like, but of course it’s kind of,
Will: are you saying, are you saying I’m gonna [00:16:00] be replaced? Is that, is that what’s going on? Emulate?
Dr. Eric Topol: It’s a great, a great, uh, former flattery , but no, I, I, I think that the, the, the, the, uh, what’s amazing here, of course is, and it hits, it’s stunning because it mm-hmm.
it’s using context of large language input, but it’s still got a waste to go. I mean, we, G P T four, it’s just forthcoming and, and Sparrow and all these other ones, this shit, whatever we’re seeing right now is just gonna get better. Um, and so I do think ultimately it’s gonna have both the two-edged sword of, you know, ad advancing a lot of things and, and introducing lots of liabilities too.
Will: Uh, tell me about those liabilities. I’m kind of curious about that.
Dr. Eric Topol: Well, the fake stuff, you know, we live in this world of blurred truth and, um mm-hmm. Fact free and, you know, it’s definitely gonna exacerbate that. And so, you know, having avatars that look like any one of us that talk, just like any one of us, and say things we never [00:17:00] said, yeah.
You know, we’re gonna be seeing that. And, um, you know, so the fakeness no less the errors and the, the, um, the, the, the misinformation. Yeah. We, we live in a terrible era of mis disinformation and this just provides tools to take that to yet another bad, uh, extreme. And
Kristin: so how do you see that affecting medicine and, and what can we do about.
Dr. Eric Topol: Yeah, that’s a great one because, um, I don’t think we’re anticipating it as well as we should. Um, right. You know, with AI hasn’t really made that big a dent yet in medicine. I mean, basically it’s lots of algorithms in radiology and a few other specialties, uh, lots. Otherwise it’s, you know, mainly in the research domain and publications and whatnot.
But as it gets more and more into it, and so for example, uh, you know, we see it’s a way to liberate from keyboard. And so, uh, all of a sudden doctors are no longer [00:18:00] data clerks and their spirits are uplifted because the conversation is now virtually scribed, uh, better notes than what we got, even with human scribe, no less, uh, with doctors typing it themselves.
And of course it picks up the, uh, o uh, the orders for tests and the next appointment and medications and codes and, you know, does it all the stuff that replaces the, the clinician. However, what happens when that goes cuckoo? You know, when we have glitches and when we have deliberate Yeah. Uh, hacking. Um, and, you know, the whole idea is why would we ever have to deal with pre-authorization?
We would have the, the, um, the chatbot do that for us. Uh, but what happens when, when this all, you know, software is, is, is, uh, glitch prone, and then take that to another level is when you have deliberate adversarial attacks and what mm-hmm. we have don’t have in health systems now is any surveillance, you [00:19:00] know, it’s, it’s like trusting that the AI is gonna work, um, uh, in perpetuity.
Well, , maybe not . So these are some safeguards that are just not there yet. And so we, we haven’t seen the, the, the adverse potential, but we have to be anticipating. Mm-hmm. ,
Kristin: I’m curious too, you know, how health insurance companies are gonna come to interact with AI and, and what that’s gonna lead to. And I mean, probably nowhere good I would think.
Do you have any thoughts about that?
Will: Well, the first thing I imagine they don’t thinking about Yeah.
Dr. Eric Topol: You start thinking about the chat bots talking to other chatbots, you know, it’s gonna be really interesting because they’re gonna have their, their algorithms for, you know, not covering things, which is what they’re so well known for.
Kristin: Exactly. That’s kind of what I’m
Will: thinking of.
Dr. Eric Topol: Yeah. Yeah. And, and, and the doctors and the doc, the people in working with doctors and nurses, I mean, they’re gonna have their version, they’re gonna be really, it’s a collision of algorithms. Uh, no, I mean, it’s, it remains [00:20:00] to be seen, but, but clearly insurance companies are gonna be heavy into this, uh, because their efficiency as you know, well, uh, most of the, um, workforce in, he.
In this country. And most industrial industrialized nations have been in non, uh, patient care people. They’ve been all these administrative people that deal with things like insurance, uh, providers. Right. And we can’t, we can’t coders, uh, and all these things, back office operations. And of course, that’s what largely accounts for ridiculous costs of healthcare.
So we’ve got to do much better. Mm-hmm. , this is a way to get there, but it remains to be seen, you know, how well it’ll work.
Kristin: Yeah. Yeah. Do we see insurance companies investing in these spaces yet, or is that. It’s happening already
Will: very slowly. They’re, they, they move like
Dr. Eric Topol: a battleship , uh, and change in direction.
So United Health was kind of on a path. They had a, a very progressive [00:21:00] strategic group, and then they got all let loose. So they were going kind of backwards. Uh, blue Cross Blue Shield. Uh, not yet. Um, you know, I think maybe c v s Aetna, uh, because they’re kind of, uh, trying to do big things. It’s, but none of the big ones yet have done anything, uh, of substance so far.
Will: on and on the, the healthcare professional side, you know, So much of our time and effort is in getting the documentation just right to be able to send to United or Cigna to say, Hey, this patient needs this test or this treatment. Um, you know, I’ve crossed all my, I dotted all my Ts. You have to imagine that that’s something, hopefully you did that the other way around.
Cross my, cross my ts dotted my, I did I say that wrong? ? Hey. Yeah, yeah, yeah, yeah. You get what I, you get wanna say hopefully maybe, you know, AI can do a better job of that than I can. Um, but you know, that, that’s, that’s one obvious, you know, thing that you can think of would [00:22:00] be helpful is making sure you have that documentation right in order to maybe decrease the amount of insurance denials.
But then on the, on the flip side, it’s like, well now you’re. You know, you’re, you’re putting so much time and effort into, you know, I guess you still have insurance dictating what you’re doing. Yeah. And, and that’s a frustrating algorithm as well. Right, right. So, um, yeah, it’s, uh, it is kind of scary. It seems like this is all progressing so much more rapidly than, than we know what to do with, like, it’s almost like we’re flying blind, it seems at times.
Yeah. It’s like, we’re not sure, you know,
Dr. Eric Topol: it’ll, it’s it all, you know, the. The, the signal of the large language model era really only was selt in the last few months. And it’s, it’s going to get more, um, it, it, obviously, it wasn’t set up to do the things you’re just talking about, uh, to basically go through all of the patient’s records and tee it all up and, [00:23:00] and, uh, mm-hmm.
I, we’re gonna see this happening undoubtedly, uh, in the next year or two to, to, to a substantive level. So I think, um, there’s a lot of potential here as long as we keep our guard up that, you know, it’s not, um, something that the human in the loop part is gonna be right. Critical we, whether it’s in actual care of the patient or these ancillary aspects, um, that that’s never gonna go away.
The importance of it.
Will: I, I’m also interested in how this might, what the language learning. Models and AI in general, how it can affect medical education because, I dunno if you’ve heard that chat, G P T just recently passed step. Yeah. Yeah.
Dr. Eric Topol: Well, which, yeah. Well, first of all, you know, when you’re, when you, if you only need 60% to get passing to pass the US medical license exam, that doesn’t seem very like a very high threshold.
Right. [00:24:00] 60%.
Kristin: it’s step one. That’s why there’s so many
Will: steps. Yeah. Yeah. It’s also classically Yeah.
Dr. Eric Topol: One of the harder ones. So both, both, uh, Google’s Palm Med Palm and, uh, chat GPTs, uh, both did that recently. Um, and yeah, I mean, I think it’s interesting because, um, the, the part of memorization of mm-hmm of the, the dets, the details, that stuff is of course, um, gonna be comparable or.
In, in computing than in than humans. Mm-hmm. . But it’s, it’s all the human stuff that we need to emphasize more. And we haven’t done that yet in education medical school, as you well know, it’s, uh, what was your grade point average and what was your score on your MCATs? And unless you’re do exactly adequately on those, you don’t even, you know, get past square one.
So we’re, we cultivate brainy acts that memorized really well and our [00:25:00] interpersonal skills, communication, presence, trust, empathy factors, I hope that’s gonna be highlighted a lot more because the support of of us in in medicine, uh, with computing is going to keep getting better. Uh, but are we gonna keep emphasizing the things that are not as important?
I don’t know.
Will: And it, it’s, um, it’s also, uh, you know, a a, a big focus, and I know in, in the work that you do is making time. For us to cultivate those things, you know, that that, that were a part of medicine, you know, years ago that have, have gone away in the, in the time of kind of increased demands on, on a clinician’s job and, um, you know, pulling us in so many different directions with our time.
Kristin: yeah. So you’re speaking specifically of like the, the time with the patient, dr, patient relationship?
Dr. Eric Topol: Exactly. Yeah. Well, well before U2 came into the world, [00:26:00] um, when medicine was a very different era when I was just getting outta med school, you know, late seventies, early eighties, uh, there were, um, Typically a very precious, intimate relationship.
That patient doctor relationship, you know, you always knew the doctor had your back and you know, you could get in touch with that person to help you, uh, in any situation. And they listened. Uh, they didn’t interrupt you within seconds, and they had time much more time. Multiple four or five tenfold time to sit with you.
We don’t have that now because of the big business of medicine. Um, and it eroded steadily over the years, and we, we can get back to it. The gift of time that you referred to is the ultimate to me of what AI could, could bring us. If we, if we really push on it, it, it won’t happen by accident because we, we have overlords that want us to, to see more patients and read more scans and slides and whatnot.
So it [00:27:00] has to be that we work together to advocate for the, the getting the relationship back to where it was, or even better than it was.
Will: Maybe I’m just, maybe I’m just cynical, but it just seems like with, with a, an ever-growing population, it just seems really hard that we could ever get to that point again.
You know, because there’s, I don’t know.
Dr. Eric Topol: You could be right. I, I try to be optimistic that I like that. A lot of,
Will: we need, we need people like you,
Dr. Eric Topol: need, well, you know, a lot of the simple stuff, um, is gonna be algorithmically supported. So if it’s, um, you know, a ear infection of a child or skin infection or potential skin cancer, urinary checked infection, a long, long list of stuff that will be mm-hmm.
determined screening doctor less. With algorithms, persons capturing their own data, and then a lot of video visits for routine things that are quick and just saving the important meetings, uh, when you in person when [00:28:00] it’s, you know. Right. Big stuff. So I, I do agree with you that, uh, with, uh, increasing comorbidity and burden, uh, the population, uh, we have to come up with new ways to address this, but we have to think about that relationship, which has been seriously hurt over time.
Kristin: Do you think that the erosion of that dr patient relationship and the loss of time together, um, and the subsequent loss of trust perhaps that that brings, do you think that has contributed to this epidemic of misinformation now, especially in the medical realm and that maybe if we can repair some of that, that.
Get back to a little more, like you said, we’re living in a time of blurred truth. So do you think that this could, could help that issue?
Dr. Eric Topol: Absolutely. And I think it’s essential. It used to be that, uh, clinicians were regarded as the most trusted individuals, and that’s taken a big hit over time. Partly cuz they don’t, they, many patients feel that they don’t get the kinda, uh, attention, [00:29:00] uh, care, the true care that they deserve and need and, and, and want so badly.
So I hope that that will come as, as you, as you suggested. Yeah.
Kristin: Yeah. And maybe, maybe also breaking down some of the silos that exist in medicine. That’s one thing I’ve noticed, you know, from the patient family perspective. , it’s not very interdisciplinary right now. And, and sometimes that can make things, um, you know, inefficient at best and really problematic for the patient at worst.
So hopefully this, you know, ease of families
Kristin: as well, or? Yeah, and it just, you know, you have to have five different appointments with all the different subspecialists and they don’t communicate very well across specialties. And, you know, it can just introduce, um, you know, an additional burden onto the patient, let alone it gives opportunities for human error and for information to fall through cracks and nobody is seeing maybe potentially nobody’s seeing the greater pattern that might exist, especially in some of the more complex, [00:30:00] you know, diseases.
Um, so it sounds like this could be promising in that kind of area as.
Dr. Eric Topol: Absolutely. I mean, I think getting, um, different discipline expertise in the room with a patient and the patient’s family, uh, when that’s appropriate is a part of this gift of time that is essential. Um, rather than, you know, having these multiple appointments with redundancies and, you know, all sorts of things that are unnecessary.
So, yeah. Uh, if we’re gonna do this right, we know what it takes. And having transdisciplinary, um, fusion of effort is, is really critical. Well, I’ll tell
Will: you, I, I, I would have a lot more time if I just spent less of it on TikTok, , , can I help with that? And so I don’t, I don’t know, uh, Eric, if you, if you have TikTok on your phone, if you don’t, I I highly encourage you to avoid that.
Okay. It’s, I haven’t done that yet. I,
Dr. Eric Topol: okay. All right. Yeah. But I, I know you have a big presence there along with all the social media [00:31:00] mean your, well, your sense of humor in medicine is unprecedented. And so yeah. TikTok would
Will: be great. Oh, I appreciate that. Right. Well, I, I honestly think that social media, I mean, cuz you had do have a, you have a big falling on social media too.
That’s the first, the first, uh, time I actually heard about you was on Twitter and seeing some of, you know, content come through. So, uh, and I, I think that’s going to continue to be more important. Just because that’s where patients are and, and I think there’s actually a lot of AI work that’s going to hit social media as well in, in like predicting virality.
Like what makes something go viral? What are the things that people are paying attention to? And I think that’s important for healthcare professionals because, uh, that’s, that’s where patients are. Yeah. And so, uh, and, and, we’ll, we need trusted. Care voices to battle all that misinformation. Yeah.
Kristin: Social media is kind of an extension of the doctor-patient relationship.
Will: Yeah, yeah. [00:32:00]
Dr. Eric Topol: In some respects. And the problem we have really is we don’t have many choices there. You know, when mm-hmm. , when Twitter has been threatened with how it’s gonna run and get politicized more, and then there is no other real platform that you can reach to patients and to help to provide good information.
So hopefully over time we’ll either see, you know, better, uh, alternatives or the ones that we have will be more functional and less. Um, I, I think unfortunate right now is that, you know, we’ve seen, um, some trouble troubling aspects of, of Twitter where, you know, bringing back some of the masters of misinformation.
Okay. You know, that, that, that wasn’t particularly in the myths or the tale of a pandemic, you know, that’s not the kind of stuff we really need.
Will: Yeah. Well, let’s take a quick break and then we’ll come back with, uh, Dr. Eric Topel.
Big thank you to all [00:33:00] our listeners. Spread the Love, share this podcast with everyone right now. Go share it. Share now. Let’s do it. , leave a rating and a review. You can be honest with us. I’ve been on social media long enough. I can take the criticism or the happiness. If you wanna give happy
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Will: today. We’re gonna share some of your own medical stories. You can share yours, knock, knock email@example.com. We have a Patreon as well. Hang out with other members of the Knock Knock High community early episode, access Check out bonus episodes, including this whole other monthly show that we do, uh, where we react to medical shows and movies, like, uh, anything From House to Mash to Monty Python, all kinds of stuff.
Uh, next week. We have a new monthly eye exam. That’s great coming out. All right, so look out for that. Let’s get back to Dr. Eric Topel.
All right, we are back with Dr. [00:34:00] Eric Topel. So Eric, uh, I wanted to just do something here, uh, which I think I might be kind of fun. Maybe not. I don’t know. I assume it’s gonna be fun. Uh, so, uh, it’s this little game that I call Can AI do this? Can ai, I’m just gonna throw out some things and then I want, we will talk about okay, whether or not this is like an actual thing that can happen, uh, with the use of ai.
Maybe now, maybe like 20, 30 years from now, maybe we’ll be able to tell the future. I don’t know. Um, but one thing, whenever ai, the topic of AI gets out there, uh, especially on social media, there’s always some talk about replacing physicians, replacing healthcare workers. Is that, is that ever in your mind?
A possibility that some kind of doctor, ophthalmologist, radiologist, internist, could ever be replaced by
Dr. Eric Topol: ai. Yeah. I, I really don’t see that. Um, it may to some extent limit [00:35:00] the growth of, uh, a specialty. But, uh, you know, when I tried to put a lot of thought into this, when I wrote Deep Medicine and radiologists were the ones that were, you know, the father of deep learning, Jeffrey Heaton says, we don’t need ’em anymore.
Well, guess what we do. Um, because obviously you don’t, you don’t want to trust, um, an algorithm that, to interpret a scan that could be determining a patient’s life or death. Uh, but more, more importantly, this gives an opportunity for specialties like radiology to take on things that they haven’t done, which is actually talking to patients because they’re the ultimate.
Potentially, you know, honest, independent broker, like, do I really need this surgery? Um, or you know, did they, did they really wanna live in the basement in the dark and have patient contact? But also, what about all these scans that are done? Yeah. Uh, unnecessarily with radiation exposure. Shouldn’t they be more gatekeepers?
So any way you look [00:36:00] at it, there’s a way for that specialty to take on other, uh, facets of care that they don’t necessarily today. So I don’t see any specialty being Xed out, but it is possible that, um, that with the support augmented efforts of ai, that, that we wouldn’t need as many. Or, you know, when I did the UK review, it was more, can we get away without having to, you know, train a gazillion more, uh, specialists that kind of.
Will: Hmm. Um, well, as so as, basically what I’m hearing is as long as the humans are smarter than the ai Yeah. And also most of us,
Dr. Eric Topol: we can, there are exceptions, but most of us would rather entrust, uh, the, the physician with a key decision rather than the output of the, of the ai. Yes. Um, so that Newman in the loop factor.
Now, I know some people, particularly computer scientists, that say they’d rather trust the algorithm, but I don’t think that’s the typical scenario,
Will: uh, based on what I’ve [00:37:00] seen from chat G P T, I think, uh, I think we’re safe in a lot of ways. So, , all right, here’s, here’s another one. All right. Can AI make internal medicine rounds more E.
That’s a hard sell. I know. Can, do you think we can cut down on rounds by a couple hours least? Oh yeah. I don’t know. What are your thoughts?
Dr. Eric Topol: Well, especially, you know, think about the poor medical student or intern. Resident has to go around an hour or two before starting at, you know, five, six in the morning to get all the data together.
Yeah. With the a Yeah. Free, round, round, free round, pre-rounding. That much better. Of
Will: course, that should be the first thing to go away. Also in the round.
Dr. Eric Topol: That should be the first thing to go away with the people that are trying to be, you know, the showoffs about knowing the literature. The AI will have a co total command or the literature to that moment.
Um, so no, there, a lot of that stuff will change. Um, and so yeah, I think that’s a, a great opportunity that rounds will be infiltrated with support of ai.
Will: Because right now, you know, a lot of, [00:38:00] at least right now, I say that it’s been like eight, eight years since I was a part of internal medicine rounds. But, uh, you know, there was a lot of, oh, let’s, you know, stop for a second and look this up.
Let’s get on up to date. Let’s, and so, you know, are, are we moving to a world where you can just, you know, verbalize a question and then it’s just, it’s there. Or maybe, maybe AI is listening to rounds and pulls up, you know, automatically kind of brings in information into the conversation in real time. Oh yeah, it would, I don’t know.
Dr. Eric Topol: just like you’re bringing up really good points. So, you know, the attending would say to the team, uh, what is in a differential diagnosis? and the, uh, chatbot will after they, after they’ve all talked about, well, you haven’t considered such and such, and the probability of that’s 38%. Yeah. And here’s why.
Yeah, absolutely. And even the tending didn’t, didn’t think of it, you know, so, sure. I, you know, one of the things that we have to respect is we make a lot of [00:39:00] diagnostic errors, and that’s where having command of all the data and all the literature, uh, we can be, uh, supported for that. Be better,
Will: sharper. Yeah.
And that was gonna be my next ask about whether ai, what AI can do is, can it help us to diagnose like some of the more complex, the rare diseases that, like you said, maybe we’re not thinking about, you know, connective tissue diseases that are sometimes really. Like Ed or Yeah. Other things that are just more difficult to diagnose.
Um, idiopathic cardiac
Will: Yes. Yeah, I’ve heard of that. Yes, exactly. Yeah. Yeah. . Yeah.
Kristin: That’s, that’s like, why do those happen? We don’t know. Right. Maybe AI can figure
Will: it out. Like what I’ve, what I’ve learned through my recovery from my cardiac arrest and talking with other survivors, it’s, it’s actually relatively common for young people to not really have an answer.
Well, this, this one drives
Dr. Eric Topol: me nuts because we have almost 97% of the people who have a defibrillator put in, never use it for [00:40:00] their life, the rest of their life. And how can we be that dumb? , and then all the people that could, should get a defibrillator who then have, uh, this, uh, uh, arrest who don’t have that benefit.
So we have to get smarter with that, and that likely will happen when we understand all the things like, you know, the genomics and the image processing and, you know, all the pieces, the, the so-called multimodal ai. So I think we’ll get much better. But, um, yeah, our ability Now, the problem is when we don’t know a diagnosis, we send the patient for every lab test known to mankind, we do these, you know, uh, hunts, uh, that are absurd, that are very costly and also taxing to the patient, sending them for, you know, this and that.
And we can cut down a lot of that, um, you know, waste and kind of rabbit hole stuff. Mm-hmm. . And we, we can be much sharper Yeah. Uh, about how we process, uh, uh, a, uh, possible, you know, entertain the [00:41:00] differential
Will: diagnosis. Well, I think, I think part of that, so it might be the human element, like we’re, we’re just, we’re afraid of things that we don’t know and we don’t understand.
And, and so I think maybe part of the reason we do these workups is because we’re chasing after, uh, you know, the extremely rare diseases. And so could AI be this? I don’t know. In some ways more, a more detached observer that is just looking at the statistics of, okay, this X percent chance of this and so it’s not worth it to do this, this thousand doll, 10,000 hundred thousand dollars workup.
Dr. Eric Topol: Exactly. No, I think that’s where the long tail of all these, you know, unusual conditions and syndromes and whatnot, that’s gonna be a big mm-hmm. Plus for, cuz unless you’ve seen one. Or you’re, you’re familiar with it, you’ll, you easily could miss that diagnosis. Sure.
Will: Well, another one that we, we talked about a little bit already is, can AI [00:42:00] eliminate insurance claim denials?
Uh, I have my doubts. They’re, I think they’re gonna find a way around it. Yes. Um, and, uh, I, I think we’re gonna put it down in it though. Yeah. I don’t know. I think the,
Dr. Eric Topol: the bird, you think so teeing that up on the, on the clinician side will be less whether they’ll be able to, do you think it’ll make it No.
Whether they’ll be anti up is gonna be interesting, but
Kristin: Do you think that’ll make it a little more transparent though? I mean, if it’s all gonna be algorithms, You know, going back and forth to try to beat who can deny what, somewhere someone has to be able to read that algorithm. So do you think that it’s gonna make it a little bit easier to kind of learn the strategies that are being used to just deny everything And you know, I’m thinking of that ProPublica article that just came out.
Will: Um, Looking at the inner working zone
Kristin: different. Yeah. The insurance companies make the, the inner workings may be a little bit more visible because it has to be literally written down somewhere in code. Yeah. We
Dr. Eric Topol: have to crack that code. Uh,
Will: [00:43:00] yeah, ,
Kristin: that’s true. I’m sure they’ll
Will: protect that, but, but
Dr. Eric Topol: they’re right.
You know, I think, um, the insurance companies, um, our, their, their reputation that has been so adversely affected by denying, uh, people’s coverage that they are entitled to. And so, you know, I think the momentum. With this power of AI will help to some degree, but we’ll have to just see how it plays out. The, the power of insurance companies, um, yeah.
Is, uh, is overwhelming. Uh, obviously, um, you know, it, it probably couldn’t get worse than it is, so I, again, I, I always try to, my default is to have some optimism that we can improve this. Oh man. But I, I, I share your concern. I’m with you.
Will: I, I, I hope to God you’re right. I hope it can’t get worse. . And the, the last thing was just again, with this something we kind of touched on earlier.
Do you think AI can make medically themed comedy skits on TikTok? That’s a good word. [00:44:00] I don’t know. Well, I guess we’ll find out, right? Uh, you know, that, that might be the, the last thing because there’s so many more important things for ai. I do. I think the reason is,
Dr. Eric Topol: after all that the training from you, it’s gonna be, you know, it’s, it’s got powered.
Kristin: you’ll be the input, input
Will: gonna, they’re gonna be looking at all your
Dr. Eric Topol: tos and all your Oh man, um, skits and, you know, I’m
Will: gonna, that’s
Kristin: way too much power for you to have . I’m, we’re,
Will: I’m, we’re in trouble. I’m replacing myself. . There’s probably ai. Listen, is
Dr. Eric Topol: there, is there a, a, uh, specialty you haven’t hit yet?
Because I’m sure we could have transfer learning for
Will: that. Uh, Yeah. Yeah. Right. Actually, that would be really helpful help with your research. I haven’t there plastic surgery yet. Mm. Yeah. I need, uh, I need that. I need AI to help me with that and, um, get a lot of
Kristin: radiation. What is it? Radiation? Radiation.
Will: Oncology, yeah. Yeah. I, I, I, I’m, I’m missing the specialties that I have rarely, if ever interacted with. [00:45:00] Now I’ve interacted with cardiologists a lot. I’m aware of that. Uh, and, um, . Yes. So that’s shows in your content. That’s my go-to if ever I run out of ideas, I, I know I can always, uh, hit up cardiologists for something, so.
That’s right. .
Kristin: Well, it sounds like it’s a good time for doctors to, um, get a, a side job in computer science or learn some computer science. It sounds like maybe there’ll be some new job opportunities opening that we need physicians to be able to, you know, help these algorithms.
Dr. Eric Topol: That’s a great point for everyone to get at least some knowledge.
Uh, I think this is gonna take more. Place in our lives. And a lot of people envision and have to understand the nuances. Not, not necessarily you know, how to code or getting deep into it, but you know, just what if it’s, it’s potential limitations. The caveat’s really important.
Will: Well, thank you so much for joining us, uh, Dr.
Topol. Eric, this has been, uh, uh, you know, pleasure
Dr. Eric Topol: to, I thought you’re gonna My most embarrass pick your braining [00:46:00] event. .
Will: Oh yeah. Let’s, I had it already. Absolutely. Let’s do it. Okay. Lemme hear it. Let’s go back to,
Dr. Eric Topol: uh, 1984, long time ago. So, uh, at the time, you know, I was, uh,
Kristin: well not, not too long ago, Dr.
Tobel, because you see that I was born
Will: That’s right. I mean, a long time ago. , uh, that’s right. So, no, no. Uh,
Dr. Eric Topol: anyway, I’m I, Johns Hopkins, uh, the cardiology fellow, and, uh, I was very much involved early in this, uh, clot busting drug called tpa tissue plasma activator. And so we treated the first heart attack patient ever with TPA in 1984, February, 1980.
Wow. Almost to the day of this interview. Really? And, uh, wow. Anyway, uh, Johns Hopkins wasn’t really known as a heart attack center, and so they wanted to have a press conference that we [00:47:00] treated the first patient in the world. With tpa and because I was a fellow that had been working hard in this, you know, I was part of the press conference.
Now, in those days, we had to do a cardiac catheterization first to, and take a picture of the artery to show the blood clot. Okay? And then we could give the medicine in, in the vein. Of course, eventually that led to you just give it in the vein from the cardiogram. You didn’t have to have the angiogram first.
But remember, this is the very first patient. The most embarrassing thing that happened to me ever in his, my history of medicine was at the press conference. So the Bal Baltimore, uh, newspaper, um, the Baltimore son, uh, the normal, uh, journalist, a woman was sick that day. And they sent in this guy who’d never done any medical story or maybe any story for how I know.
So he says, well, Dr. Topol, oh, yes. Um, you know, how, how do you do this catheterization? And how do you, how do you do all this? And so I explained it to him about the, [00:48:00] you know, we put a catheter in the groin and numb up the groin area, put the catheter in the groin, and, you know, take pictures of the artery.
So in the front page of the Baltimore Sun, the next day it said, Dr. Topol explained how the catheter is inserted into the genital tract. And, and snaked into the heart without any pain for the patient. Oh, no, . And, and little did I know I had invented the field of Euro cardiology, um, and, uh, you know, a day in infamy.
Um, so anyway, that I learned a lot from my experience.
Will: I learned that, you know, you have to be
Dr. Eric Topol: really careful how you communicate to a journalist who don’t kind of look at you like, what’s the groin? You know, maybe you should say no, the groin is not the genital track. But anyway, um, I thought,
Will: I thought, well, you’ve given me a, you’ve given me a great idea for a Oh, good for ski.
Thank you. I thought you’d like that story
Dr. Eric Topol: because it’s really, it was, it was terribly. You, you, can you [00:49:00] imagine the people that contacted me after reading this article? Uh, yeah. Yeah.
Will: Oh, I bet you didn’t hear the end of that for
Dr. Eric Topol: a while. All these years later, I’m still, I still hear about that one.
Kristin: Well, it made you the science communicator, oh gosh.
That you are today. So, oh, there you go. A good tough
Will: start. Are you happy with, are you happy with where TPA is now? That, where how many years later, like 40 years later. Oh,
Kristin: right. Gosh, you, no, we’re not gonna say how many.
Will: Yes, almost no.
Dr. Eric Topol: It kind of gave way to, you know, just opening the artery with a balloon catheter directly over time.
But at that time, that wasn’t really, um, uh, in play, but it’s still being used to treat heart attacks and strokes, uh, along with other clot dissolving medicines. But, um, you know, it was, it was a very exciting time to be, uh, in medicine, but, and also to learn how you can make big gas without even trying.
Will: How, how did the, the, the [00:50:00] first, uh, we’ll say the first 10, 15 patients you used TPA on, it was actually
Dr. Eric Topol: amazing because we didn’t even know what the freaking dose was and most of the clots opened up . So the funny thing you’re asking about is, and this is what’s so crazy, when you inject the artery, we die.
It’s under pressure, you know, just shooting dye. So we probably were opening some of these arteries with the dye shoot, not through the medicine. Oh. So we were helping it, you see, we were like massaging it for the, the low purpose of T Yeah, yeah. So it was working like in almost every patient. And then, so we thought, well, gee, this, this thing’s really potent and we could, you know, getting the right dose and figuring out this whole equation of, um, you know, when you just give it in the vein and you don’t have, uh, a catheter in the artery.
We had to learn that it took, it took more than the first 10 or 20 patients, but eventually we got the right dose. But it just shows you how when you do a contrive thing, Where you’re, you know, you have this extra aspect that wasn’t part of the practical way of giving the medicine. It [00:51:00] buggers things up and it obfuscates, uh, what’s going on.
Will: Wow. That’s great. I love that story. Yeah. , who knew? That’s awesome. . Um, you know what we’re gonna keep you on actually for, uh, we have a couple of fan stories. Mm-hmm. , so our listener mailbag. So we’ll take a quick break, we’ll be right back with those.
All right. We are back, uh, with Dr. Eric Topel. So Eric, we’re gonna, we have a couple of stories here. We want you to listen to these, uh, with us here. So the first one, um, is from Riley. So Riley says, We’ve always joked in my family that my dad, a classic ortho bro is the worst patient. I’d say most doctors are, yeah, really terrible patients.
Very bad. He rarely gets sick, but when he does, he absolutely refuses to be taken care of. He was particularly non-compliant as a neuro ICU patient. It’s probably not the place you wanna be. No be, have trouble there. There. After waking up and getting extubated, he started demanding that we give him a syringe.
My mom and I were confused, but he was [00:52:00] adamant about getting that syringe. We asked his nurse if she knew why he was so fixated on it. He wants to take out his Foley. She said, my dad didn’t know what year it was, but he knew he wanted to take out his own fully catheter . Obviously no one ever gave him that syringe.
He made a full recovery. Uh, and so we constantly tease him about his antics as a belo. I’m
Dr. Eric Topol: impressed with his cognitive state, rather than just pulling the darn thing out without taking the balloon down, you know?
Will: That’s an an excellent point. I, you know what, it’s, I don’t, I don’t think I’ve ever told you this, Kristin, but when I, oh no.
When I woke up in the icu, yeah, that was, I, that was one of my first thoughts to take out your folate. No. Was do I have a FO catheter , because that’s like something I’ve never wanted to have. And I was, I was, I remember like thinking, ohoh, what’s going on down there? Do I have, what, what’s my situation going on
Um, and so I probably would’ve been very much like this [00:53:00] Doctor . I’m sure you would have. All right. Our next story, uh, comes from Ava. So a or Eva, sorry if I got your name wrong there. Uh, so we did a, there was a, a previous listener’s story about cockroaches that were found in a call room. Mm-hmm. . And so this prompted another story from her.
So before I started doing urgent care, I was trained in family practice and worked in a small rural practice in Maine. My partner says that while long call, he received the following phone call from one of his older patients, doc. I’m out to my, I’m out at my hunting camp and I just drank a pot of coffee.
When I went to make another pot of coffee, I discovered there was a dead mouse at the bottom of the coffee pot. What should I do? Oh, no. My partner says he was so taken aback that he paused and said nothing. Not sure how to answer. The patient then said, you know, don’t worry, doc, if I grow fur in a tail, I’ll call you back,
Kristin: So, was this a farmer ?
Will: I, it sounds like a farmer. Uh, but, uh, [00:54:00] this, uh, this just ends this, uh, note by saying, I can’t help but wonder how you cannot taste essence of boiled mouse. Ooh. In this situation. So gross. The, the mouse was cooked in with the coffee pot. Hopefully it was in there. Very hot coffee. Wow.
Yeah. There you go. I’m not sure what kind of infectious diseases you’re opening up, uh, with that situation. Rewrite that outside. I had to figure that one
Dr. Eric Topol: out. .
Kristin: you go. That’s right. Ask it what to do when you drink Boiled Mouse.
Will: So if you guys have any stories, send us your stories at knock-knock high human content.com.
Dr. Topel, Eric, thank you so much for joining us. Oh, I really enjoy it. Keep up
Dr. Eric Topol: the great work that you were doing and, uh, we a thrilled to have a chance to have this conversation, hopefully many more in the
Will: years ahead. Oh, at some point I hope I, I want to hear more like TPA type stories. I could come up with a few more.
I’m sure. You’ve seen a, you’ve seen a lot of medicine over the years, and so, uh, but, and again, thank you for [00:55:00] taking the time being here. Thank you. We really appreciate it. We’ll see you next time. Bye-bye now. Goodbye.
Well, that was great. That was fun to talk to, to, yeah. So fascinating. Very, it’s just so knowledgeable about so many different things in medicine, so, and there was so
Kristin: much more we could have talked to him about. I didn’t even scratch the surface. So maybe we’ll have him back
Will: on sometime. Um, so do you have any stories to share?
We’re we, we would love to hear ’em. Please share. I, we, I love hearing the stories from people because as I, there’s just so much of that, uh, so many weird things. And mouse at the bottom of the coffee pot. Yeah. What would you do in that situation?
Kristin: Oh, scream. Throw the coffee pot. Yeah. These are just things I know about myself.
Those two things would happen immediately, but
Will: I don’t know what I would do.
Kristin: And then maybe try to make myself throw it. I think I would try to
Will: throw up It would, yeah. That would, that would be a decision to make . Uh, but at that point it’s like, it’s already going through your system. I don’t know. Yeah. Uh, you just, that’s something you’d [00:56:00] probably like, wake up in the middle of the night thinking about.
Well, he didn’t seem
Kristin: too bothered though. Yeah, I guess so.
Will: It all turned out all right. Um, and, uh, tell us what you know about the episode today. Tell us what, you know, tell us what do you know about our episode now? What do you think? Uh, do you know somebody, another doctor who we, or, or any other healthcare professional who could come on and, uh, you know, chat with us?
Uh, there’s lots of ways to hit us up. You can email us. Knock, knock firstname.lastname@example.org. Vi visit us. I’m having trouble talking all of a, visit us on our social media. Uh, we are on, uh, uh, YouTube, T TikTok. Mm-hmm. Twitter. Twitter. Uh, and also you can hang out with us in the Human Content Podcast family on Instagram and TikTok at Human Content Pod.
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Hang out with the knock, knock, high member community. We are active in it, posting videos, polls, jokes, pictures, comments, videos, all kinds of stuff. You said videos, uh, and I did. But more video, more and more early ad-free episode. Access on Patreon, [00:58:00] interactive q and a livestream events, lots of things. Uh, patreon.com/glock flein, or go to glock flecking.com.
Speaking of Patreon, community Perks, new members, shout out. Laura, Liam, Betsy. H Maggie, S, Joan I, Corin. B. Thank you. Thank you. And welcome. Also, shout out to the Jonathans. We have Patrick with C. C, Sharon S Omer, Edward, k Abby, H Stephen, g Ros Box, Jonathan f Maram, W Mr. Granddaddy, Caitlin, c Brianna, Ellen, Becky, uh, a, a virtual head nod to you.
Patreon roulette. This is when we take a member of the Patreon emergency Physician Patreon level and give you a random shout out. So I’m gonna do my little, uh, drum roll, my little drum roll. Shout out to Joan. I, Joan I, for being a patron. Thank you, Joan. I, uh, and, uh, also thank you to everyone for listening.
[00:59:00] We are your host Will and Kristen Flannery, also known as the Glock Flecks. Our special thanks to Dr. Eric Topel, our guest for today. Our Executive producers are Will Flannery, Kristin Flannery, Aron Korney, Rob Goldman, and Shahnti Brooke. Our editor and engineer is Jason Port Ortiz. Our music is by Omer Bins V.
To learn about our knock-knock highs program, disclaimer and ethics policy submission, verification, licensing terms, and HIPAA release terms, you can go to glock flecking.com or reach out to us at nun knock high human content.com with any questions, concerns, or jokes or jokes. Or puns. Or puns? Preferably puns.
You have to, I’m not a big fan. Knock knock. High is a human content production,