Transcript

Will: [00:00:00] Knock, knock. Hi. Hey everybody. Welcome to knock, knock. Hi. With the Glockenfleckens. I am Dr. Glockenflecken, also known as Will 

Kristin: Flannery. I am Lady Glockenflecken, also known as Kristen Flannery. I went 

Will: with, Hey everybody, instead of. Hi. Hi. Welcome to Knock Knock High. What do I usually say? Hello. Oh, hello. I just say hello.

That’s right. I tried to try to mix it up a little bit. We’re excited to have you here. We have, this is a very exciting episode for us for a number of different reasons. One, we got two great guests. Yes. Dr. Chris Worsham and Dr. Anupam Jena. That’s right. And you may actually know Dr. Jena from, um, from the Freakonomics MD.

A podcast that he did for quite a while. And also him and Dr. Worsham [00:01:00] are accomplished researchers and Harvard docs, uh, and, um, and they just came out with a book recently called Random Acts of Medicine. 

Kristin: And you and Dr. Worsham have a connection that the listeners will have to continue 

Will: listening to. Yes, we do know each other.

And, um, um. And it was fascinating hearing their approach to research in a different, totally different way than what I have grown accustomed to research. 

Kristin: Well, they have an economics bent, and so it’s a little more social science y than your typical medical research. I like it. So yeah, I 

Will: like it. It’s really interesting.

I did like bench research. Yeah. What did you do? I did a phylogenetics of North American bats. 

Kristin: Oh, that’s right. That was in college, though. Yeah. Yeah. Did you have to do anything in med school? 

Will: Um, did I have to? No. Did I? Also, no. 

Kristin: Well, that was a weird way to say 

Will: no. I like dabbled in some [00:02:00] research, quote, research 

Kristin: projects.

Yeah, I remember you had to do something. Yeah, you know. It was like a thing at 

Will: one point. It was like a thing. Did it go anywhere? No. But, you know, I’m not a researcher. That’s why I’m in private practice, Kristen. I know. I could go back and do a research 

Kristin: career if you’d like. I would rather, you know, I mean, I mean you can do that But I don’t think I will be joining you 

Will: Research is only for some people it’s not for others and I am more than happy to leave it up to the dr Worsham and and dr.

Jenna’s of the world. 

Kristin: Yes They did a great job of it and it’s super interesting and and showing connections between things you would never guess exactly connections 

Will: But this is also a, a, a very important episode because we have officially been doing this podcast for a whole year. 

Kristin: That’s right. One year of Knock Knock High.

Happy Anniversary. That’s great. That’s 

Will: right. What have you learned over the net, over the last 52 weeks? I’ve 

Kristin: learned a lot about about medicine that I was just by not knowing before, [00:03:00] but now I know. I’ve 

Will: learned that we can do a podcast together and still be happy. Yeah, 

Kristin: we’ve spent a lot of extra time together over the past year.

Will: I’m enjoying it. Are 

Kristin: you enjoying it? Yes, I think it’s fun. I really like talking to all of the different people from different specialties and areas of medicine or sometimes just kind of related to medicine. I think it’s been really fascinating all the different topics that we’ve got to 

Will: explore. I have learned that there’s no way we could have done this without producers.

That is a hundred percent 

Kristin: true. 

Will: Like, I, I’ve just, I’ve learned just what goes into a podcast to make a successful podcast. And uh, it’s a lot of work. There’s 

Kristin: lots of things. There’s spreadsheets 

Will: involved. Lots of spreadsheets. Yeah. Uh, and, and schedules. And, um, just, and editing, and graphics, and sounds, 

Kristin: and words.

That’s all the things that are in 

Will: a podcast. I think that’s [00:04:00] all the things that are contained within a podcast. And a host! And hosts. Or two. Uh, and so, it’s, uh, just, huge thank you to everybody that’s helped us get to 

Kristin: producers in general, I feel like, are the unsung heroes of the entire entertainment industry.

So, props to our 

Will: producers. And just to everybody who’s like, who like, is working or thinking about some kind of side project, something that you’re, you think is gonna be fun. Like, it’s okay to Get yourself a producer. It’s okay to ask for help. You don’t have to do it all yourself. I think that’s 

Kristin: important to point out, and especially for, you know, someone like you, that you are seemingly everywhere all the time.

And what people don’t see is that it’s not just you that is going into making all of that happen. There’s actually Several people behind the scenes, uh, doing all of that. Definitely. I think that’s important to point out though because people compare themselves, and especially, you know, people in the medical profession, you guys tend to be perfectionists and kind of the, [00:05:00] a lot of you were like the straight A kids and there’s all this competition built into the system to make you compete with each other.

And I feel like that, you know, it kind of never fully goes away. It’s always in there somewhere. So just know, you know, it’s not as easy as it 

Will: looks. Go your own way. Yeah, but it’s okay to have help. You know, it’s like, I just, there’s no way I could do this on my own. So anyway, should we, uh, get to have any other thoughts about one year?

Um, are you ready to go for a second 

Kristin: year? I am ready to go for a second year. Yes. We’re going to, we’re going to have a new 

Will: I’m just kidding, Shahnti. Just kidding. We’re going 

Kristin: to have a new backdrop soon, so people can keep an eye out for that. We’re moving 

Will: our 

Kristin: studio here. Yeah, we’re just switching rooms in our home.

No big fancy move or anything, but you know, our kids want separate rooms, so now we all have to adjust. Yes. 

Will: Maybe we should save that for the next intro. Yeah. So let’s get to it, shall we? All right. Here we go. So here is Dr. Chris [00:06:00] Worsham and Dr. Anupam Jaina.

Today’s episode is brought to you by the Nuance Dragon Ambient Experience or DAX for short. To learn more about how DAX copilot can help reduce burnout and restore the joy of practicing medicine. Stick around after the episode or visit Nuance. com slash discover DAX. That’s N U A N C E. com slash discover D A X.

All right. We are here with Dr. Bapu Jenna and Dr. Chris Worsham. Thank you guys for joining us. It’s really an honor and a pleasure to talk with you. 

Dr. Christopher Worsham: Thank you. Thank you so much for having us. So I 

Will: want to start, uh, just by, uh, we got to address this, Chris and I. We’re in the same med school graduating 

Dr. Christopher Worsham: class, weren’t we?

That’s right. Um, but you were, you were in the year ahead of me and then, and then you joined my year to grad for fourth year. The thing about that fourth year of med [00:07:00] school is it’s so disjointed, right? That we’re not like, we’re hardly together. So you and I didn’t actually have that much overlap. 

Will: We didn’t, we did not have overlap.

Uh, it wasn’t, yeah, it was fourth year at Dartmouth. They let us, uh, split our fourth year into two years, which was, is that common do you think, or no, it’s not common. In fact, I think they, they don’t give you as good of a deal on tuition if you do that. No, I think they learned. Cause that was the thing, like you could do that and then you only have to pay like a fraction of, so it’s not like you pay an extra year of tuition.

Right. 

Kristin: She just got laid for the. The parts you were going to class 

Will: for. Yeah, and interest or whatever. 

Kristin: And that was so that you could explore other things, right? Like research or Or 

Will: in my case, I decided on ophthalmology so late that I had to do something else to like convince people to let 

Dr. Christopher Worsham: me in. So what, were you doing research or stand up comedy?

I 

Will: was doing research, yeah sure. Some very strenuous research electives that [00:08:00] I did also worked out because 

Kristin: we had a baby. Yeah. Yeah. And, um, he had a little cancer, you know, 

Will: just a bit of that. Yeah. But, but this is, this is great. I’m so glad to have you guys on and, and Chris, you, um, this is a good lesson for people like.

You know, some people, when they graduate med school, they go on to Harvard and do research and really important things like write books. Some of us join TikTok. Yeah. It’s, it’s, it’s just a difference, you know, of how, how people do things. 

Kristin: You came out of the same place. You went different. diverging paths after that.

That’s 

Dr. Christopher Worsham: right. Yeah, you know what though? I, I do remember, so we had a talent show that year. Oh no. And I, I, like on the one hand I could say, yeah, uh, you know, Will, you did some stand up that, uh, let’s say your, your comedy has matured immensely since then, but I’m really in no position, no position to, uh, Crack any jokes, because I sang in an acapella group in [00:09:00] that, uh, talent show, so that’s probably worse than bombing, uh, with a stand up bit.

Wait, what was the name of the group? Uh, the Dermatones, like, probably about three quarters of, uh, med school singing groups are called the Dermatones. Yeah. But, we were 

Kristin: one of them. Med school singing groups, I mean, I can’t imagine there are a lot of those. You’d 

Will: be surprised, it’s a huge deal in the medical 

Dr. Anupam Jena: community.

You’re like the NSYNC of the class, right, or something like that? That’s 

Will: right. Well, Bapu, you’re, I mean, you’re no stranger to musical ability, uh, you used to freestyle rap, right? Is that? Uh, 

Dr. Anupam Jena: I, I, I did a long time ago. I retired, or I was retired from the game. 

Will: And that was on, uh, was that MIT? Yeah, 

Dr. Anupam Jena: and when I was in college, you know, MIT was a very hip place.

So, um, the standards was low to let people on the radio. 

Will: I was about to say, you have a lot of competition. No, you just 

Dr. Anupam Jena: need to have a pulse above, essentially a pulse above 40. Well, 

Will: um, I want to, I want [00:10:00] to start by just kind of framing what it is you guys do together. So we’re going to talk a lot about your book, uh, Random Acts of Medicine, which is currently on sale, right?

You can go out and get it right now. This is very instant after you listen to this, everybody. Not 

Kristin: on sale. For sale. Maybe it’s on sale. I don’t know. 

Will: That’s true. That’s true. For sale. 

Dr. Christopher Worsham: It may be both. That’s right. 

Will: Um, but the, it seems like the genesis of this type, this is very unusual, uh, way of looking at things in medicine and healthcare and Bapu and, and, uh, you’ve been doing this kind of thing for quite a while, uh, starting with the Freakonomics.

Uh, so what was, how did you kind of Combine the, this type of looking at economy and, and Freakonomics with medicine. What was the origin of, of thinking 

Dr. Anupam Jena: this way? First of all, I’m not that much older than you guys. I know it may sound like I am, but I just, just like a hair older. Just more 

Dr. Christopher Worsham: accomplished.

Dr. Anupam Jena: Exactly. I just, I just did a lot more in less time. I’m [00:11:00] not, I’m a decade older. Uh, you know, so I was, I was at the University of Chicago, um, in the early 2000s. And that was, uh, Steve Levitt, who was one of the authors of Freakonomics was there. And, uh, he was one of my thesis advisors. And so I kind of got the bug of thinking about the world a little bit like he did.

Um, but he was working on lots of interesting questions. Much of it was in crime and trying to understand whether, uh, law enforcement works and coming up with clever ways to do that. And uh, you know, I thought that those same types of tools, which were sort of using big data in very clever and creative ways.

finding these experiments that were happening to people in the real world, not like at the hand of an investigator who’s running a trial, those sorts of things were happening to people in medicine all the time. And I don’t think that we were looking at those kinds of questions so much. And so that’s sort of how I started down that path.

What was, what 

Will: was one of the first things that you looked at? Do you remember? 

Dr. Anupam Jena: Yeah, I do remember one was successful and one was not successful. [00:12:00] The first one that I remember the first idea I ever went to Steve with was looking at the impact of Viagra on divorce. And yeah, I was, I was in the library at the University of Chicago and was reading Yahoo News.

I don’t know if anybody reads Yahoo News anymore, but I was reading that. And there was some article about STDs going up in the elderly. And um, then there was an ad for Viagra placed on the side. I don’t know if it was targeted towards me or what the purpose was. But I was just like, wow, I just kind of two things came to my mind.

I was like, well, I wonder whether or not the increase that we’re seeing in STD rates in the elderly is because the introduction of Viagra, which came out like the 1990s, late 1990s, I think. And so I looked at that, but it was really hard to do because it was hard to get data on at that, at that point in time, people who were using Viagra, people who weren’t using Viagra, looking later to see whether or not they got divorced.

And then the bigger problem is, even if you had that kind of data, recognizing that people who are using Viagra are different than people who are not. [00:13:00] And so it’s not like a randomized trial where you say to a bunch of couples, here, half of you, you know, we’re going to introduce Viagra into the relationship and see what happens and half of you not.

But my idea was that Viagra could be destabilizing to the marriage because you had these couples who were sort of on the margins of staying together versus getting divorced. And if Viagra comes around and it could do one of two things. One is it could increase the value of the marriage for reasons that we won’t talk about.

And the other is that it could sort of increase the outside options for the, for the, for the man, but also for the woman too. Um, and so that’s what I thought was going to dominate, but there was some sort of suggested evidence that that was happening, but It never went full throttle. Oh, that was the first.

That was the, that was my baby. 

Will: Okay. So that was, that was the unsuccessful one. 

Dr. Anupam Jena: Oh, the successful one. 

Will: Yeah. The successful one. You said you’re batting 50%, which I’m not, I’m not a researcher. So I feel like 50 percent is pretty good for research. 

Dr. Anupam Jena: Right? We got about a 5 The second 

Dr. Christopher Worsham: one. We would love a [00:14:00] batting average of 50%.

Dr. Anupam Jena: The, all right. So the second one was looking at the impact of, uh, twins on divorce. And the origin story for that was I had been interested in whether or not children are stabilizing to marriage, um, which some people think of, they think of as kids could be the glue of marriage. There’s, you know, you stay together.

Have those people had kids? Yeah, exactly. Exactly. So as I was seeing at that point in time, friends of mine starting to have kids, this is not very stabilizing. It looks quite opposite. It looks like it’s like a hurricane coming through. And so the challenge though, is if you look at couples who have kids or couples who have more kids.

They’re different than couples who don’t. So you can’t establish anything about whether or not kids cause. good marriages or cause divorce on the basis of that just sort of raw comparison because the couples are different. And so my thought was, can we look at couples, this is now looking at it in the eighties, couples who were similar ages, but by chance one couple had twins and another one didn’t.[00:15:00] 

So it’s sort of shocking a family with an extra child to see what the effect of that extra child is on the marriage. And what we see or what we saw very clearly was that couples with twins were more likely to get divorced. And the effect was larger in couples with twin girls. And then second largest in couples with one girl and one boy.

And then in couples with twin boys, it was pretty similar to not having a twin. So there’s something about having a twin girl that was destabilizing to the marriage. I’m not sure what it was, but. That was a quote unquote successful, uh, idea. 

Will: We need more though, Bapu. I mean, come on. What is, what, what’s, what’s going on with the girls?

We have two daughters. 

Kristin: We have 

Dr. Anupam Jena: one to one, you know, my, you know, Chris has got, you know, two, two sons. So you’re sitting pretty. 

Dr. Christopher Worsham: Am I now? Okay, all right. I’m 

Dr. Anupam Jena: not commenting on your marriage. So the interesting thing was like the effect on divorce. didn’t happen early on. It happened when the kids were something like, you know, 10 plus years old, which kind of makes [00:16:00] sense.

Like when a, when a baby is a baby, there’s no difference between boys and girls really. The differences in personality and everything else start to materialize later on. And that’s when we started to see the divorces occurring, not in the first five years, but really sort of years 10 onwards. The other thing that we found was that the divorce effect was larger in less educated couples, lower income couples.

And so I think what’s going on is that You know, having two kids can be stressful. There might be something particular about girls at that point in age that is a little bit more challenging, but the effect really is driven among people who don’t have a lot of resources to mitigate all the sort of challenges that you might have to deal with.

Um, yeah, so it’s sort of an uplifting love story, if you 

Kristin: will. And tell me, you doctors, when does puberty start in girls these days? 

Dr. Anupam Jena: That’s a good question. I have no comment on that. That 

Dr. Christopher Worsham: one’s not for us. Yeah. Yeah. Yeah. Perhaps 

Kristin: somewhere around, you know, 10 

Dr. Anupam Jena: ish. Yeah. Just a thought. 

Will: So, but this, uh, [00:17:00] so you, you just kept.

You know, kept going with this line of kind of investigation and, and Chris, when did you, uh, you know, get involved in, in all of this? Yeah. 

Dr. Christopher Worsham: So we’re coming on, on maybe up on, on five years or so of working together. So I had gone through, uh, med school and residency and much of what sort of your

And I started taking an interest in, like, wait a minute, a lot of this is really messed up and doesn’t work particularly well. Um, and so I started on the path of getting into sort of, you know, quality improvement and what can we do on this unit or in the hospital. But as I kept moving, um, Along in my training and along in my practice, it dawned on me that we got to start looking at the larger level policies.

And so as I was doing the research portion of my pulmonary and critical care fellowship, uh, I, [00:18:00] uh, Basically, went out meeting with a bunch of researchers to see is there anyone out there who, who can help me learn how to study the healthcare system. And I always, I kind of think of it as like the healthcare system as an organism, right?

It, it has its own, um, pushes and pulls and, and little things that, that make it work and make it get, break and, and all of these things that, that, that you’re well versed in and, and your, your characters that I see on the wall, uh, back there are all contributing towards. Haha, yes. So, uh, I, I ended up meeting with Bapu who you can.

Tell, um, is taking a different approach, um, to figuring out how the healthcare system works. Um, and he’s also been taking advantage of the data that we have now that just wasn’t around, at least not in the quantities and the sort of accessibility, um, levels that we have it now. And, and so I, I basically, um, said, let’s, let’s learn how to do this together.

And we’ve been working on, on things now for, for about five years. [00:19:00] Yeah, 

it 

Will: was, you know, my, some of my, you mentioned my videos, like some of them make it seem like I know a lot about the healthcare system, but, but I, I had to learn a lot because we don’t get a lot of, a lot of training, a lot of education about, like, I didn’t know what a, what a pharmacy benefit manager was.

Like, I, I didn’t know what DIR fees are in the pharmacy world. And, and there’s so much that, that I had to just figure out on my own, try to find resources. And, um, and, and so it kind of sounds like very similar to, to your approach and, and finding somebody like Bapu where you could kind of combine forces and address some of these things.

Um, was that a challenge to, to. Like, did you find yourself having to get like a baseline level of knowledge? Like, how did you, how did you get there to where you are now? Uh, 

Dr. Christopher Worsham: a lot of it is just getting your hands dirty. [00:20:00] Um, and, and saying, you know what, if you were going around the hospital and things are happening and you say, wait a minute, this isn’t right.

Or something we constantly ask, like, well, what if what happened today didn’t. happen to go the way it did? What if by chance it went a different way? What would have happened, right? What if, um, an example from the book would be, you know, we both have kids born in August. Um, when we go in for their annual checkup, usually the flu shot isn’t available.

We have to come back and make another appointment, right? So, you know, this happened to Bapu, same thing happened to me. We said, well, what if our kids happen to have been born a couple weeks later in September? Then when they came in for the annual checkup, the flu shot would have been available and it would have meant we wouldn’t have to make an extra appointment.

We wouldn’t have to come back to the pediatrician, which is a giant pain in the butt, right? And it would be easier to get them vaccinated. And so we just take, that’s not, you know, you don’t need a lot of. training or to sort of ask yourselves these kinds of [00:21:00] questions. Um, it does take some practice to learn how to answer those questions in the data.

And that’s what Bapu’s been doing for a while. That’s what I’ve been doing for a couple of years. Um, and then we can start answering these questions when we have the right data. And so, you know, in this example, we just looked at what are flu vaccination rates when we break it down by birth month of a child, because that’s when they go to the doctor.

And lo and behold, the kids born in the summer, when it’s harder, when they can’t get their flu vaccine, they have to make an additional appointment. Their, um, flu vaccination rates are about 12, 13, 14 percentage points lower than kids who are born in October, who come in. When there’s always an abundant amount of flu shots available and they can just get it at their appointment, right?

So, so most of our studies, um, have some sort of like little story like that, that got us, um, going down a rabbit hole. And we go down a lot of rabbit holes and we don’t, we don’t always come up with, with [00:22:00] a diamond in the rough there. Uh, but, but occasionally, you know, we, we have the exact data to answer the questions.

We have enough evidence in the data to sort of. Um, back up what we think is happening, um, and those are the, the studies we run with. 

Will: You keep a, a, just a running list of rabbit holes that you want to eventually go down? Well, 

Dr. Christopher Worsham: it’s a Microsoft Teams page, but yes. 

Dr. Anupam Jena: No, but it’s bad though, because for example, like every, Chris, like, is it correct that every month when we, we, we like meet two or three times a week to talk about new ideas, we’re just like brainstorm.

And probably once a month, I’ll get on the call as I’m driving to play soccer and I’ll say to Chris and the others, I’ve got this great idea and I’ll start saying it. And it feels like an amazing idea. And Chris will say, Babu, you just, you said that last, you know, last month, it didn’t work out. And I’ll do the same thing every few months.

Kristin: Oh, that’s funny. I’m a September baby, so I was really interested to read. You have a couple of September baby findings, but I always enjoyed it because I [00:23:00] was one of the oldest kids. in my class. And so I was always very small, but I was, um, smart. And I think, you know, part of that at least was also because I was, you know, nine months older than, than some of the kids, at least in the early years.

I think that probably makes a difference. Can you talk about what other things? happen with September Babies versus 

Will: others? Why should we never have September Babies? Or why should we have only September 

Dr. Anupam Jena: Babies? Yeah, you want September Babies. I’m curious though, 

Will: um To hell with the August Babies. Yeah, that’s right.

We don’t want any August Babies. 

Dr. Anupam Jena: Never. Did you feel though, um, sort of more self, if you were to look back, and it’s hard to know, it’s like an N of one here, but do you think that you, you develop more self confidence as a result of just being older and a little bit smarter and faster than your, than your peers?

I 

Kristin: think so. I mean, look, I’m like 5’2 and at that age, I was like 40 pounds in third grade or something. I mean, I was a tiny kid, so I was [00:24:00] never going to be the most athletic. But, um, but I did feel like, um, There was like some social cachet in being older, right? And then especially like into high school, you’d start to like get your driver’s license.

So I was one of the first ones to get my driver’s license, things like that, um, I think definitely played a role with, with like intelligence. It’s harder because, um, there’s all, there’s individual differences in that across the board anyway, even if you could control for age. So that one, that one’s a little bit harder, but I did feel like, uh, things came easier to me than, than to some of the other kids.

Yeah. 

Will: Yeah, I think athletic ability too, you know, because maybe not for you. I was going to say, 

Kristin: well, I was a gymnast. I don’t know if age has anything to do with gym. I can’t think of how that would affect gymnastics. But, 

Will: but, but, you know, because our bodies change so rapidly at that age. And, and so, you know, the, the, the strength and the flexibility and athletic ability [00:25:00] of someone born in September versus.

Well, it depends on when the 

Kristin: season starts, right? Like there’s that famous study with the hockey January babies. Yeah. 

Dr. Christopher Worsham: And so I’ll let Bapu fill you in on the medical aspect of this in a second, but we actually talk about a number of studies in the book looking at sports, um, explicitly. So yeah, so there’s that hockey example that, that a lot of people, um, might’ve read in like a Malcolm Gladwell book.

It’s not just, there’s actually countless examples. So, um, one I really like is in, there’s a study of professional tennis players in Germany. Um, and the, the cutoff for tennis is January 1st. Um, and so what they found is that if you look at sort of the very. lowest levels of tennis rankings. People, their birthdays are kind of mixed.

As you get to higher and higher levels of the tennis rankings, they shift more and more and more towards having birthdays in January, February, and March. And the thought there [00:26:00] in sports is like, well, yeah, as a young child, maybe you’re bigger. Um, but you also get put in, like you might get better coaching, you might get put on a special team, um, and that just sort of is a self fulfilling prophecy that the kids who early on have an advantage, they continue to reap that benefit, um, over the, over their careers, all the way up to the NFL, uh, NHL.

Dr. Anupam Jena: Because, I mean, there’s like a complementarity to it, right? It’s not that everybody ends up at the same place. I think the point of these studies is that they don’t end up at the same place. So it means that when you’re young and there are those relative differences that you would expect would go away when you’re age 50, they may not because someone’s picking up on those.

They’re investing in you in a different way than they might invest in another child. And that has an effect on how you develop. A ripple effect. Yeah, it has a ripple effect. 

Will: One of the, the topics since we’re, since we’re talking about sports and like physical activity, um, I was really excited to, to, to hear that maybe, uh, running a lot is not good for you.

Uh, [00:27:00] this is with regard to marathons, exactly like, uh, so marathons, I believe they can be harmful to your just overall health, right? Cause I mean, it’s a lot of running, probably bad for your knees and stuff, but, um, what else should we know about potentially, you know, marathons and how they’re, they function.

Dr. Anupam Jena: So, um, I’ll say two things. One is, on your point, um, I wouldn’t be surprised Make me feel better about not running. Yeah, I don’t run marathons. The only marathons I’m a part of are, like, Law Order, SPU marathons, and Harry Potter. Those are the kind of marathons I’m a 

Dr. Christopher Worsham: part of. I mean, let’s remember, the guy who ran the original marathon collapsed and died at the end.

Right. Oh, I didn’t know that. I was not aware. Yeah. So just, we’ll keep that in mind. All right. 

Dr. Anupam Jena: That’s because he didn’t take vitamin C. That’s different. Exactly. Yeah, I’m sure. You know, so I mean, if you look at people who, who are training for a marathon, it’s, it’s obviously really intense, right? And it wouldn’t be surprising to think that that could have a negative effect on the body.

If you look, [00:28:00] for example, at. Um, cardiac biomarker measurements in people who just finished a marathon, they’re elevated, almost mimicking the pattern of a heart attack. So there’s some injury to the heart that happens when you run. So if you look at a bunch of people who are registered to run a marathon and some people by chance weren’t able to, maybe their flight was canceled from wherever they were flying from, or maybe they sprained the ankle the day before.

And just again, randomly, they didn’t run the marathon. I wouldn’t be surprised if you look at hundreds of thousands of those kinds of observations, the people who didn’t run the marathon for some random reason might fare better in the short term, maybe six months or a year, because they don’t have that just additional injury to the heart that comes from that 26 miles.

But the, um, the chapter in the book is about a different sort of effect and it’s based on my wife’s story. She was running a race in Boston. She wanted me to watch her on the race route. And so I said I was going to do that, but I thought I’ll park at the hospital where I work because I had a parking space there and it was right on the marathon route.

So as I’m driving down our main thoroughfare to get to [00:29:00] the hospital, I have to turn around because that road is blocked. And it’s because the race route was going through that area. And so I go back home an hour or two later, and I see my wife later in the day and I tell her what happens. And she says, well, what happened to everybody that needed to get to Mass General that day?

And I was like, that’s a really interesting idea. And that was just sort of an offhand comment. But to Chris and Chris, the earlier point is like, when you hear things like that and you start to think about the world like this, I just like, that’s a good idea. And so literally the next day, we started looking at, uh, routes of marathons, the major marathons in the U S we figured out what zip codes they go through.

We looked at data and found people who lived in those zip codes, people who lived in the surrounding zip codes. And what we were looking for was any evidence that older Americans were more likely to die because they couldn’t get to the hospital on time on the day that a city was hosting a marathon because all the roads were blocked.

And that’s exactly what we found. If you look on Marathon Day. in a city that [00:30:00] hosts a marathon, there’s an increase in mortality for people who have heart attacks or their heart stops like cardiac arrest. Um, and there’s no quote unquote marathon day effect for anybody in the surrounding towns that aren’t affected by the delays.

And the last data point we had was that we were able to get data from a subsample of those cities, maybe like three or four cities on actual ambulance transport times. And we can see in the mornings when the roads are closed during the marathon, the ambulances take longer to get to the hospital. And in the evening, There’s no more delays.

So it is something about delays in care that happened because the roads are being blocked. So that was, that was sort of the finding. That’s how marathons affect your health. And even if you’re not running. 

Will: I would 

Kristin: have been so mad if you hadn’t been able to get to the hospital because a bunch of people were running like, oh, 

Will: well, I just.

I’m so, I’m so impressed by just like how you’re, how you guys, how your brain works. Like, I, I would never, like hearing that, you know, from your [00:31:00] wife would be like Yeah, what would you, what would 

Dr. Anupam Jena: your reaction be? Everything, everything your wife says is important. Next question. 

Will: No, no, no, no, no. No, no, my, my reaction to hearing that story would be like Oh, I should make a skit about a marathon doctor and how they can’t, you know, it’s like, I would not think, Oh, maybe we can study this.

I guess that’s the difference between me and like a researcher, you know, that’s why, but to be fair, I’ve never, I’ve never more secure in my decision not to pursue research than in this moment. 

Dr. Christopher Worsham: The thing is, you know, Bob, Bob is a smart guy, but we also practice, like we practice as we, this is why we meet and have meetings like this, where we spit ball ideas.

A couple, like for 60 minutes, a couple times a week. How 

Will: does that work? What are those meetings like? Oh, 

Dr. Christopher Worsham: that’s fun. Tell me about that. I mean, some are, some are more fun than others, but, but it’s really just, you know, we, so we have people ranging from, we’ve had high school students, um, stop by our meetings all the way up to sort of seasoned professors of, of medicine, um, [00:32:00] like the, uh, elderly Dr.

Jenna here. And, um. And it’s just one of these, like, there’s no idea that’s too stupid. We have discussed some of the stupidest things you could imagine, and just once you’re talking about it Um, we build off of one another, um, we all have sort of different perspectives on things. We, we might know sort of, oh, we could use this data.

If we were going to use this data, how would we look at it? And most of the things we talk about go nowhere. Um, or most of the things we talk about rely on. Um, us trying to like get somebody to give us some data that we will never ever get because it’s proprietary or something. But once you know, maybe five or ten percent of our ideas we can actually go through and look at the data.

Um, and and then a subset of those we actually have really high quality evidence of what we’re looking at and those are the the ones that we publish and talk about. 

Kristin: What’s one of the craziest ideas you’ve had that did not work out? Like, what are we talking? Phrases. [00:33:00] 

Will: What’s, what’s Give us a rabbit hole.

Yeah. That is 

Dr. Anupam Jena: I’ll give you one, Chris. I’ll give you a moment to think. Cause I, I, I have one that just came to mind, which is, uh, and we wrote about it, I think, in our sub stack a couple months ago was, uh, when Ashley Madison, um, I don’t know how much you know about the website, but I will. The cheating website?

Yeah, exactly. Is that right? Cheating website. Yeah. Look, opportunity searching website is, I think, the way they frame it. Yeah. So people searching for opportunities. So, there was this big data breach and I remember hearing about it and I was like, first of all, I would love to scrape this data to figure out who’s there and see if we could link it to other things.

Um, but, uh, that was difficult. Uh, but I thought, 

Will: What did the IRB think of that? 

Dr. Anupam Jena: Yeah, exactly. We didn’t, we didn’t run that one, by the way. Um, but I was like, you know, that was a huge data breach. And so, I was thinking, I was like, you know, could it be the case that you would see an increase in heart attacks?

and, you know, middle aged men who might be the demographic that was using that. And so we basically look to see whether or not [00:34:00] there’s an increase in heart attacks when that data breach happened. And we didn’t see anything. But that’s sort of like, I mean, we have all sorts of like wild ideas like that, which they’re not that hard to investigate.

It’s a few hours of time. If they hit, they’re great. But you know, we can cut bait pretty quickly and say, okay, there’s nothing here. Yeah, we had 

Dr. Christopher Worsham: another one. So I’ve always just enjoyed watching like stand up comedy. I remember when I was like a teenager and I saw Robin Williams live on Broadway. Um, Like on DVD or something and I was hooked and I’ve always just sort of like watched stand up comedy as like a it’s it feels good, right?

Obviously you’re laughing but but there’s a lot of like empathy that you connect with with comedians as I’m sure you guys are aware Um, and so I was thinking well You know, we have now these like big comedy specials that come out on Netflix that like millions of people watch the day it comes out. So, we were curious, like, are those, is laughter the best medicine, [00:35:00] right?

is are people watching these specials and because when it comes to like if you’re depressed or if you have some other health condition right when that comedy special gets released on netflix is random as far as your your health is concerned right so it’s this randomly timed event wanted to see uh you know were mental health outcomes better shortly after these comedy netflix we didn’t find anything but um no matter how many times i email Netflix, they don’t ever want to share their data.

So if anyone’s listening. 

Will: Hey, if you want to do that same thing, but do Glockenflecken skits, I’ll give you all the data you want. 

Kristin: There we go. You may not want to know the answer. I don’t know. 

Will: Um, that, that’s, uh, yeah, I just can’t imagine the. I wish I could just be a fly on the wall and like the meetings with the IRB, honestly, cause like, like to, to come to, [00:36:00] to, with, with these ideas, um, it’s, it’s fascinating and I think it’s really cool too, because.

Now we can get data from so many different places and so many different formats. And like data has never been more easy to access. Right. So it makes sense to be like looking at anything, anything you can like to see if there’s something there. 

Dr. Christopher Worsham: Yeah. We got our hands on some data from the Florida highway patrol.

Um, this was actually the first project I worked on with Babu to sort of set the tone. Uh, but so we, we had this Florida highway patrol data and we, we linked it up with a physician database. to look at doctors who were getting speeding tickets in Florida. And we were trying to figure out which specialties were speeding, what kinds of cars they were driving, um, so any guesses as to which specialty was racking up the most tickets for excessive speeds.

So like, I [00:37:00] think, no, no, misdemeanor levels of speeding, like, I think 20 plus miles per hour of the limit. I would think emergency. Um, 

Will: I would, I would say, uh, some surgeons of specialties, uh, maybe even cardiology. I’d throw cardiology in there. Alright, so 

Dr. Christopher Worsham: the answer to that one is the psychiatrists. What?

Whoa, really? So now, now, now what about who was driving, who was most likely to be driving a luxury car when they got pulled over for speeding? That one, that one goes to the cardiologists. The cardiologists. 

Will: Okay. Alright. Uh, 

Kristin: that makes sense. Well, and speaking of cardiologists, we’re not gonna, they’re not gonna be very happy with this after this episode.

You have another finding about cardiology that you write in your book. Can you tell 

Will: us about it? Well, before we get to that, I have one more follow up question about the car, about the speeding thing. So, how did you, how did you find out the specialties? They matched 

Kristin: it up with 

Dr. Christopher Worsham: the physician database. Yeah, so you have, oh yeah, so you could, we could match by name.

One of us pays attention. You could match, you could match them on name and [00:38:00] region. And right, there’s going to, there, there might be a handful, um, where, where there’s like two people by the same name living in the same place. Um, but, but also that’s going to happen somewhat randomly too. So it doesn’t actually bias our results all that much.

Um, so yeah, it’s just a linking them up. A lot of this data is out there. Was it 

Will: hard to get that, that data or did you have to, uh, 

Dr. Anupam Jena: have Anything possible in the state of Florida. Yes, that’s 

Dr. Christopher Worsham: right, no rules. So someone had done a freedom of information request for it for another project and then we’ve re, we’ve repurposed it.

Gotcha. 

Kristin: Okay. How is AI kind of, is it making more things possible for you guys? Like is it, does it speed things up for you or do you still have to do everything 

Dr. Anupam Jena: yourselves? I’m actually an AI bot right now. I’m an AI bot. I’m 

Will: an AI bot right now. I’m Dr. Rupert. I’m 

Dr. Anupam Jena: actually an AI 

Dr. Christopher Worsham: bot right now. I’m Dr.

Rupert. We actually, we, we still do it, we do it the, uh, the old fashioned way. Yeah. But I, I will say 

Dr. Anupam Jena: two things. One is, um, [00:39:00] I do ask chat GPT, I’m like, you know, I’ll ask it for ideas. It’s like, all right, if you wanted to do this, how would you do it? And the ideas it comes up with are not, they’re not actually bad and they’re, they’re useful to sort of be a starting point.

Get the juices flowing. But like, just to give you an example, as Chris was telling you this story about the Florida data, when we’re in an idea meeting, we’re just kind of thinking off the spot. And the first thing I thought about just now is. And we have the data linked on who’s getting a ticket and we know when they’re, we know, we know the day that they’re getting pulled over and getting a ticket.

You could see, for example, surgeries that are performed by surgeons on the day they get a ticket versus the days before and the days after, because if you’re driving the office, if we know, if we know, for example, that the timestamp is in the morning and we know from the, the administrative health data that we use, that you were performing operations during the day, like you weren’t on call.

We know that those happen after you were pulled over. So is that enough of a distracting event that we see worse outcomes that day compared to the days before? [00:40:00] That’s not a bad idea, right? For office, you know, like three out of 10. Yeah, 

Will: that’s, that’s good. I’d also be interested in knowing which specialties are more likely to get let off of the 

Dr. Anupam Jena: warning.

Yes, that’s a great, yeah. So 

Dr. Christopher Worsham: the challenge there is that the, a lot of times warnings don’t get documented. So we don’t, we don’t 

Dr. Anupam Jena: know. No, but the way that you could do that, well, it’s like, so people have looked at racial bias and policing and they use, they use sort of the idea that. Um, if you’re right around like 9 or 10 miles, like you’re, if you’re at 9, the officer might put you over if they want to give you a ticket, if you’re, or they might round down.

So they look at sort of rounding behavior in the speeding ticket citations to get a sense of who might be exhibiting some bias in policing. So you could do the same sort of thing. We’re certain specialties to see if there’s certain sort of, uh, peculiarities in the distribution of speeding tickets. Like, where they’re getting ticketed, at what speed, that would indicate that some [00:41:00] people are sort of being let off a little bit easier.

A little bit more lenient. Right. This is why 

Will: he’s the Harvard guy. Yeah. 

Dr. Anupam Jena: I’m older. I’m older. 

Kristin: Older and wiser. Okay, but no, we got to circle back to the 

Will: cardiology thing. Let’s take a quick break and then we’ll come back and do that. Okay. All right. We are back with Dr. Jenna and Dr. Worsham. So we were just talking about how cardiologists are some of the ones that speed, but only Yeah.

Okay. Uh, no, no, they’re not 

Kristin: speeders. They’re, they’re the, they’re the luxury cars. They’re, they’re the luxury car speeders. Yeah. Nope. Just, just drivers. Just drivers. 

Dr. Christopher Worsham: No, no. They’re the luxury car speeders. And it’s this, they’re the luxury car speeders. Okay. They, it’s the psychiatrists are the extreme speeders, right?

That’s right. . 

Will: Uh, but yeah, go ahead. There was, you had a question about the cardiologists. 

Kristin: Yeah. The, I was just gonna say they’re not very, they’re not gonna be very happy with this after this episode. But, um, in addition to luxury car speeding, you have another finding about, uh, cardiologists. So could you tell us about [00:42:00] that?

Dr. Anupam Jena: Yes, um, yeah, the cardiologists don’t like this paper, but, uh, a few years ago, uh, we looked at what happens to patients who have heart problems during the dates when cardiologists are out of town at big meetings, like they go to the American Heart Association, American College of Cardiology, these big national meetings, and cardiologists will often leave town to attend for a lot of different reasons.

And uh, so we looked at what happens if you’re a patient who has an acute cardiac emergency by chance. during the dates of when these meetings, what happens to you? And I thought that you would do worse and I thought you’d do worse because I said, okay, the staffing is going to be lower. Maybe the quality of the doctors who remain behind is not as high as the people who are sort of the premier doctors who left to go to these meetings.

And we actually find the opposite. We find that mortality falls for people who are admitted to the hospital during the dates of those meetings. So there’s something. about the care that’s provided during the dates of those meetings, it actually leads to better [00:43:00] outcomes, not worse. And the other piece of information that’s important is that we find that rates of certain procedures fall by about 30 percent during the dates of the meetings.

So there is some indication that less is being done for people, for patients, during the dates of these meetings and somehow they’re doing better, which is sort of a paradoxical finding. It’s not sort of something you might want to hear as a cardiologist. 

Kristin: Right. Maybe fewer surgical complications or some, do we have any idea like why they’re not dying?

Yeah. 

Dr. Christopher Worsham: What do you 

Dr. Anupam Jena: think? I think what’s going on is, so yeah, there, there is, there is that, right? So any sort of procedure always entails some short term risk, but long term benefits. So you might think that if, if you’re doing 30 percent fewer procedures in that few days after the procedure where there’s always some risk, maybe you’re just shaving off some deaths that way.

And, but we actually find it’s not just that these are sort of, we find these long term effects. Um, so it’s not, it’s not only a short term thing that we find. I think what’s going on, it’s just [00:44:00] the appropriateness of who’s getting the procedure. And the story I’ll give you is imagine you’ve got two people.

One’s a 40 year old guy. who has no medical problems, and he just smokes, that’s all. And he’s working at a construction site one day, he has chest pain, and he gets taken to the emergency department. And they do some tests, and they figure out he has a heart attack. He gets a stent in his heart, arteries, and he lives a long, happy life.

The second person is a nine year old woman who’s got ten different medical problems. She lives in a nursing home, and she has the exact same chest pain as that first guy. She gets brought to the emergency room. They do the same lab tests, do the same EKG, and it looks exactly the same as the first guy. So they say she has a heart attack.

And what do they do? They say, we’re, we’re going to intervene on her. We’re going to open up her, her, her arteries. And they do that. But then she has a complication from that procedure. and dies, you know, a couple of weeks later. That kind of story, I think. resonates with most people. You don’t have to be in medicine to see how that could occur.

So I think it’s [00:45:00] just sort of like that risk benefit trade off is being done differently in non meeting days of the year versus on meeting days where you’re just sort of, they might be a little bit more cautious about who they intervene on. That could be harmful, but it might be helpful. Interesting. 

Will: And what did the, what did the cardiologists think whenever this came 

Dr. Anupam Jena: out?

Uh, I think, what did the president of the age fake news was? 

Dr. Christopher Worsham: Yeah, that was the, that that was the abbreviated version. Yeah. There was mixed reactions. The PG version. 

Kristin: What happens when all the ophthalmologists are 

Will: out of town? Well, see, that’s, it’s funny you should say that because that, that’s a, that’s a common joke, right?

Like, oh, all the emergency doctors are in Vegas or whatever. Like, you better not have an emergency. Same thing with eyeballs. Like, you know, who’s going to take care of the open globes? So it’s like They can all wait 

Kristin: till Monday. That’s what we’ve learned. 

Will: Well, yes, I mean, that’s ideally they would, but, um, and so, but now they’re like, they’re actually studying, you could do this in so many different, like, [00:46:00] areas of, of medicine, right?

That’d be 

Dr. Anupam Jena: with all these national meetings going on. It can wait till Monday, but it can wait till Tuesday if it’s a three day weekend. Is that correct? That’s yes. Medically, yes, of course. Yeah, whatever the next clinic day is. Whatever the next clinic day is, yeah. Exactly. 

Will: But you could do really, why did you not go into ophthalmology?

Come on, man. Like, it was right 

Dr. Christopher Worsham: there. I don’t have the patience for the little, so small. Little tiny things? I have, I have like a handful of procedures I do that the, you know, the jugular vein is way bigger a target than whatever you’re doing. 

Will: That’s the, you can’t see that thing though. I don’t know. That seems really hard.

Yeah. Yeah. So what’s, what’s, what’s, uh, what else is kind of just real, what are you ruminating on? Do you have any new studies, anything you’re, you’re interested in that’s coming down the pike? Or do we have to wait till 

Dr. Anupam Jena: your next meeting together? Chris, go ahead, share. We’re actively working on some interesting stuff now.

Dr. Christopher Worsham: Yeah, so we are, um, [00:47:00] One thing we’re working on right now is, uh, to try to figure out, uh, Remember, we had talked about the, uh, Birthdates and the flu shots that being sort of a, um, a randomizing event to sort of how easy it is for you to get your flu shot. Uh, but we also can say, well, it’s also a randomizing event as to when you get your flu shot.

And so we hear all the time that the kind of, it’s recommended that you get your flu shot in October. Um, but we don’t actually, there’s not like randomized controlled trials saying you get randomized to September, you get randomized to October, you get randomized to November, blah, blah, blah, to determine that.

And so one thing we’re, we’re looking into is to, to try to take advantage of that random birthday effect on the timing of influenza. Um, let’s see, what else to, we’re 

Dr. Anupam Jena: working on. So what do, you want to tell them what we find? 

Dr. Christopher Worsham: Um, yeah, so we’re working on this right [00:48:00] now, but what we find is that, uh, the patients who are born in October tend to, not surprisingly, get vaccinated a little bit earlier than people born in, December, and a little bit later than people born in like August.

Um, so not only were these kids most likely to get the flu shot in the first place, but they also are the least likely to get the flu among all the kids who got vaccinated. So something really special about these October kids, um, are, they are They are the best, they get the best outcomes for flu every year, these young children.

You’re an 

Kristin: October kid. I’m an October kid. 

Dr. Christopher Worsham: Congratulations. Lucky you. 

Will: Yeah. I know. I keep saying, I keep saying. And you’re September. Yeah. You’re pretty 

Kristin: close. I’m so bad. 

Will: I’m July. I’m screwed. Oh, you’re screwed. Yeah. Sorry. I’m amazed you’re 

Dr. Anupam Jena: still alive. I’m still here. Yeah.

Will: Well that’s, that’s, that’s just. That’s fascinating. And how [00:49:00] big is your team? Is it just you two doing all of this? No, we gotta have a bunch of undergrads. You gotta have, like, there’s gotta be a lot of med students that are dying for a publication that, uh, you guys can help out with. So it is, 

Dr. Christopher Worsham: it’s a small operation.

Yeah? Yeah. Okay. 

Dr. Anupam Jena: So we have Chris, myself, and we have an RA, Charlie. I mean, it’s, we’re sort of the core group. Dave Krohn is a surgery resident. I’d say probably four of us or the five of us, maybe. 

Dr. Christopher Worsham: But we also, we collaborate with a lot of people, um, who have expertise in, in things that we don’t know a lot about, but we will put in the effort into thinking like, well, how can we use the data in a creative way to, to answer a question and then get sort of a consult from.

Somebody else, so like, uh, You should put that 

Kristin: into AI, like say, so and so does this, we do this, create 10 mashups of like research 

Dr. Christopher Worsham: questions we can do. So we did this study collaborating with, um, economists who, who are really, um, good at using data about [00:50:00] the weather. Uh, that’s, like, not, like, very detailed data, um, this, uh, economist Eric Zhao at, uh, the University of Michigan, and we had heard, so there was, back in 2016, there was this big outbreak of asthma in Melbourne, Australia, where there was this thunderstorm, and then, like, thousands of people in the span of a couple hours had asthma attacks, and it completely overwhelmed their healthcare system.

It was this big thing. They now have, like, thunderstorm asthma. Alerts set up in that part of Australia, so we were thinking well This this is a little bit strange and we hear people talking about thunderstorm asthma. We wanted to take a look at it so teaming up with weather specialized economists who he was able to use this data from the lightning detection network literally every lightning strike that happens in the United States is recorded Like, for decades.

Um, and so we could look. This is when and where lightning struck. Could we look at [00:51:00] people getting asthma attacks or COPD exacerbations after lightning strikes there? And what we found was that actually what was happening was that people tended to get the most sick in the day before a thunderstorm than actually the day of or the day after the thunderstorm.

And the reason for that is probably The wind is blowing through. Yeah, exactly. So, so the, the Pollutants and humidity and air temperatures all rise right before the storm, and then the winds from the storm clear all that out and you’re left with better air after the storm. So most of the time that’s what’s driving breathing problems from a storm, but every once in a while you get these perfect storms like happen in Australia where they think what’s happening is the winds are blowing pollen in and making everybody really sick.

Will: See, I, this is interesting. Like if I, I’m just thinking, like, if I would have been exposed to, like, these types of questions as like a, a, a pre med med student, I’d have been like, hell yeah, [00:52:00] research. Let’s do it. Until you got 

Kristin: to what it takes to do that research, when you sat down at that desk as the RA, I promise you, you would not have.

Stuck around. 

Will: Just trying to envision a world in which I’m not a private practice ophthalmologist, instead I have a robust research career 

Kristin: in medicine. I cannot envision that world. 

Will: Well, I want to talk, uh, certainly about your, about the book that you guys have, have, uh, put out together, Random Acts of Medicine.

And so, um, Can you take me through the origin of this book, what made you want to put this together, and what do you hope people get out of this? 

Dr. Anupam Jena: So the book, I mean we struggled actually a lot with just the title, um, but the title actually says it all. The book is really about these random acts of medicine.

So the marathon story is a good example. You happen to live close to a marathon and by chance have a heart attack when the marathon is being run that day. It could have happened, you could have had a heart attack on any other day. [00:53:00] But it happened on that day, and that in fact affected the course of your life, uh, maybe even led you to die earlier than you otherwise would have died.

And so we talk about how there’s all these sort of random things that affect our health. And it’s not surprising to people when you think about randomness, right? Some people have cancer who didn’t have any risk factors for it. Some people might be hit by a car. All sorts of things happen. Um, and those are things that we can’t predict, you know, in hindsight, it’s hard to predict.

Why is it that someone got hit by a car when they’re walking outside? It’s totally random, but there’s nothing you can do about that. Um, in, in all of our studies, there is this component of randomness, but there’s also something that we can learn about it, about the healthcare system or our healthcare.

And probably from the marathon study, it teaches us that time matters a lot in medicine. And, you know, we were talking about delays of ambulances. And I don’t know that people would think that a few minutes would be life or death, um, um, if you’ve had a cardiac arrest, that’s already a really severe [00:54:00] place to be.

And nonetheless, we find that is the case. So all of these studies, all of the chapters in the book are about different things that affect us in sort of random ways. We can’t predict them when we’re kind of looking at the world, but in hindsight, they kind of make sense. And it teaches something about how the world works.

And, you know, we argue how to make medicine better. Okay. At least in some places. 

Dr. Christopher Worsham: And we also talk about, a lot about sort of, you know, healthcare is this, it’s a human endeavor. And with that comes all the messiness and imperfections. Um, a lot of the random acts of medicine we talk about are ones that are brought on by cognitive biases.

Where, you know, we think like someone who’s 39 years old is a young person and someone who’s 40 is, you know. middle aged and at risk for a heart attack, right? That’s, that’s random, but it’s also telling us something about how doctors think, um, how patients might think, anybody in the healthcare system thinks.

So we look at a lot of the sort of [00:55:00] human aspects of the healthcare system and, and as sort of problematic and messy as it is, um, it’s also, we, we talk a lot about how it’s our humanity that what is, what allows us to do our jobs. So it’s allows us to take care of any, any patient and understand their unique complexities.

And so we, we really, Look at the data to say, all right, this is what it’s telling us about the health care system. Here’s some ways we can improve it and here’s some explanations as to why things might be in, in certain situations, why things are the way they are. That’s really 

Kristin: interesting. 

Will: That’s, uh, Random Acts of Medicine, The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health.

You can find that anywhere books are sold. Uh, you also have a substack, right? I know you mentioned that, uh, RandomActsOfMedicine. com? Yep. Awesome. I’ve gotta check that. I wanna read more about these, these rabbit 

Dr. Anupam Jena: holes you guys go down. We gotta come up with the eye related [00:56:00] idea. I was just about 

Kristin: to say that!

Did you get that? Wait, say it 

Dr. Christopher Worsham: again. I said an idea. 

Dr. Anupam Jena: She’s the pun 

Will: person of 

Dr. Christopher Worsham: the show. So here’s an idea. Do you get a lot of eye trauma from fireworks? Is that Am I? Oh yeah. 

Will: Yeah. Yeah. It’s a, it’s a common one. Eyes and hands. Yeah. Yeah. 

Dr. Christopher Worsham: So I’m, and I would imagine if you sort of plotted out eye trauma by day of the year, there’d be a little spike on January 1st and one on July 4th, maybe.

There should be. I’d be curious, you know, what you could do is you could look at, you know, if a state sort of implemented a fireworks ban. Right? That the year before versus the year after and you can sort of estimate exactly how many Eye problems are being caused by those those fireworks That’s a good one.

I bet if we tried harder we could come up with a better one No, let me 

Dr. Anupam Jena: ask you. I just had a random idea Uh, do you think Warby Parker has affected anything because the glasses are like really stylish Do you think more people [00:57:00] wear glasses now than would have worn them? I 

Will: think they Yes, I, I do think that it’s trendy to wear glasses now.

I thought you were going to say, um, does it hurt, uh, business like the, cause it’s all online, right? For most of my Warby Parkers, like, does that hurt like, uh, brick and mortar businesses? But that’s actually, I, I do think that’s true. I think glasses, you know, it. For a long time, it’s, it was, you know, kids didn’t want to have glasses right there.

It, it, it was, they get made fun of it would, you know, for years and years that was, it was kind of like, Oh, that’s, it’s nerdy to wear glasses. But now really starting in when I was in residency is when I first started seeing it, you’d have like kids that would get disappointed when you tell them you don’t need glasses.

Uh, and so I, I do think it’s, it’s. You know, in fashion, in vogue, I don’t know what the terminology is, but you know, glasses are in now. Right. Trendy. Do I sound natural? No. Not at all. Does that [00:58:00] 

Dr. Christopher Worsham: also correlate with a reduction in contact lens related problems? Ooh, 

Will: less pseudomonas. I, uh, I mean, you would think so because, um, you know, the more time you’re wearing glasses, obviously less time you’re wearing contacts.

Um, but yeah, I would love to, anything you can do to, to, to make people be more responsible with contact lens wear, I will, I will give you cold, hard cash. You should look at, 

Kristin: well, I don’t think you could probably have the data for this, but like, the, I, I wonder whether the, Invention of electricity led to more eye problems.

Will: Oh, what do you have in mind? Oh, because, because, because of uh, screen time or? Nope, 

Kristin: that’s why I said electricity, not technology. Like not, not devices and stuff or the internet. Yeah. I want to see if 

Dr. Anupam Jena: they can think of anything. Okay, so the innovation of electricity, um. Yes. Because eye problems. I mean, I was, I was thinking, I was thinking light, but I would have thought light would have made things [00:59:00] worse because you would be, or better rather, not worse, but it’s not Did 

Dr. Christopher Worsham: original light bulbs not have ultraviolet protection or something?

You could get cataracts. Oh, I don’t know. 

Dr. Anupam Jena: I think you stumped us. Give us like another hint. Well, 

Kristin: you can do a lot of, of different things with electricity. Then you can do without it. And so it will affect where you spend your 

Dr. Christopher Worsham: time. Oh, more time indoors, you’re saying? Yeah. 

Dr. Anupam Jena: More time indoors. So less, so you think it makes it, makes your vision worse?

Yeah, 

Kristin: because isn’t there some study from, like, South Korea or something? Yeah, there’s a lot 

Will: of, there’s a lot of studies that, that have shown, um, higher rates of myopia. Oh. Um, with, with more 

Kristin: time indoors, because you’re not looking far away as much, like off 

Dr. Christopher Worsham: into the 

Will: distance. Yeah, so there is, um, a lot of the, the big studies actually on myopia come out of Asian countries, um, that, where there are kids.

are spending a lot [01:00:00] of time at a desk, reading on a computer, just basically really using their near vision to an extreme degree and less time. In fact, I think they’ve had to, you know, there’s, there’s been efforts to change the, the laws and rules like forcing. Right. Like you have 

Kristin: to go outside. 

Will: Forcing kids to spend less time inside versus outside to be able to, to kind of relax their accommodation.

And so here’s what I mean. 

Kristin: Well, and didn’t Benjamin Franklin invent the spectacle? Bifocals. Bifocals? Oh, okay. Well, I’m just wondering if that, I mean, that’s a correlation, right? If those came about about the same time as electricity. 

Dr. Christopher Worsham: I just got a new alert on my phone that told me I was holding it too close to my face and to hold it farther away to reduce eye strain.

You can’t, 

Dr. Anupam Jena: you can’t talk in the phone like 

Dr. Christopher Worsham: this. It doesn’t work right here. No, but so it was more, it was, it wanted me to have like my elbow like outstretched to look at it. I wonder if, you know, before they institute that alert versus after they institute that alert, if you have, [01:01:00] you know, differences in eye strain problems.

Kristin: Yeah. Yeah. There you go. Well, we have probably lost all but the nerdiest of our listeners at this point. I 

Will: want to, before we let you go, I just want to end with one more question for Chris. Please tell me about the time you forgot your pants on the first day of your OBGYN rotation. First of all, where, because we both did that rotation.

Where 

Dr. Christopher Worsham: were you? So our medical school, Dartmouth Medical School, is not, like we don’t have a huge hospital, so we, a lot of us would go do rotations elsewhere. I was at Hartford Hospital in Hartford, Connecticut, which is drivable from New Hampshire, but you would, you would go for the week and then go home on the weekend, so you had to pack a week’s worth of clothes.

So I go down for my first day, I packed, um, they had us staying in, like, uh, an old nurses college that had been converted into call rooms. And i’m staying there with with another med student. Um, he’s he’s a neurosurgeon now, Sebastian Rubino. Sebastian, if you’re hearing this You’re a good guy in this story.

So, [01:02:00] uh, we like just hang out in our, you know, jeans from the day before, go to bed, wake up, we’re getting ready. On your first day of the rotation, you should look good. So I’m like getting a tie on and all that, and I’m like, oh no. Like I packed, I packed a shirt, I packed everything. I did not pack any pants.

All I had were like the dirty jeans I was wearing from the day before. And Sebastian is like, Do you want to borrow a pair of mine? Which was a really nice thought except that like I’m significantly heavier than he was and his pants didn’t make it past my like calves so that just wasn’t an option and so we start roaming the hallways and there’s like a clean ish looking pair of scrubs in the corner of Somewhere, um, that I’m like, well, it’s either this or jeans and I guess I’ll go with the scrubs.

So then we go in for our first day and I’m there in scrubs and he’s there in a, in a, like, nice tie and, and jacket. And the first thing they said, it’s like, all right, you guys got [01:03:00] to go to OR training. So Chris, you’re all set, but Sebastian, you’re going to have to go change. Oh no. I went and changed with him and got a fresh pair, but, uh, you know, little did any patient know later that day that I forgot my pants that morning.

Will: I can, I can feel the, like the, like the anxiety, like the terrible, that feeling that you get when you, when you realized you forgot 

Dr. Christopher Worsham: your pants. Oh my God. And then I went, went on a shopping spree at, uh, at Marshall’s that evening. Yeah. 

Kristin: I did a similar thing, if it makes you feel any better, not long ago, actually, I went on a trip for work.

Maybe like a year or two ago, and I had, when I was packing, I had little piles of things laid out. I forgot to grab my pants pile, and I didn’t discover that until I was already there. So I had to have him overnight them. 

Dr. Christopher Worsham: That’s exactly what happened, and I got home and there was my pants. pile right on the front of my bed laughing at me.

Kristin: Exactly. Oh, man. [01:04:00] Happens 

Will: to the best of us. Well, next time you guys have you on, we’ll have Bapu tell us his story about losing his pants. Exactly. So he’s got one at some point. Well, guys so much for coming on. This was really a lot of fun and, um, yeah, just fascinating stuff. Keep up the awesome 

Dr. Anupam Jena: work. 

Dr. Christopher Worsham: Thank you so much.

Thanks for having 

Will: us. Absolutely. So we’ll be right back with, um, some listener stories.

Hey, Kristen. Yeah? Our anniversary’s coming up. Yes, that’s right. You know what I got you? What? A bouquet! 

Kristin: Oh, you shouldn’t have. They’re 

Will: Dibadex mites! That’s why you shouldn’t have. And look how cute those faces are, and the little legs. It’s kind of cute, know what these things do? What? They cause you to have like, itchy red Irritated Eyelids.

That’s not cute. Well, it’s a disease. It’s actually a pretty common disease called Demodex Blepharitis. 

Kristin: How do you know if you have it? What does it look like? Well, 

Will: you end up with this crusty, flaky buildup on your eyelashes, and it’s pretty easy to see if you just [01:05:00] look at them under a microscope. Pretty gross, though.

Yeah, yeah. So Well you don’t get grossed out. Okay. 

Kristin: You gotta get checked out. Okay, that’s a fair point. Yeah, you gotta go 

Will: in and we’ll look at your eyelids. You just go to eyelidcheck. com to get more information. All right, that’s e y e l i d check. com to get more information about demodex blepharitis.

These cute little guys. Yeah, it’s the most 

Kristin: romantic anniversary gift you’ve ever given me. You’re welcome.

Will: All right, we have a fan story from Delia. Delia says, I was listening to your podcast with Dr. Soderdahl just now, and it reminded me of a funny urology story. Uh, in quotes, urology story that happened in my work. I’m a Dutch veterinarian, and when this happened, I was on call for the weekend. On Saturday, someone called me that while they were walking their shepherd, The dog had an unfortunate accident, and instead of jumping over a fence, he landed on the fence with his [01:06:00] lower abdomen.

The dog seemed like he was in a little bit of pain, but overall wasn’t in bad shape, except that he was peeing blood. Ugh. Not good. I had to come in and examine the dog, trying to assess the source of the bleed, as well as the extent. He was a young, excitable dog, as shepherds tend to be, and while I was examining his penis, by manipulating the penis and pulling back the prepuce, He gave us a little surprise, and a little puddle of liquid landed on the exam table.

No blood in the liquid, and the owner was relieved. That looks a lot better! I then had to tell him, that’s not urine.

So Delia gives us a little background. Apparently male dogs can be quite easily aroused. And some dogs only need a little bit of pressure on the right spot to ejaculate. Did you know that? 

Kristin: I happily did not know that. We 

Will: do. Yep. In the end, the dog was fine and the owner went home relieved, albeit [01:07:00] a little bit embarrassed.

And I had yet another addition to my funny animal penis stories. Imagine having more than one of those. Right? Veterinarians must have a lot. Thank you, Delia. That was, I, I’m so glad I didn’t read that ahead of time and I just read that live for the first time. That was great. Send us your stories, knocknockhigh at human content.

com and they can involve ejaculate. It’s, uh, it’s, it’s totally up to you, whatever you want. Well, what a fun conversation. Yeah, that 

Kristin: was fun. Does that make you want to do research? I’ve been there, done that. I’m good. 

Will: Yeah. That’s like fun research though. Sure. Maybe they just make it sound really fun. Yep, that is what’s happening.

Is that it? Is that it? They make it sound like really exciting? That’s the fun part 

Kristin: of research is when you get cool findings, right? But like everything that leads up to that, it just made my soul wither and die. Oh, man. Yeah, that’s why I don’t do that anymore. 

Will: But that’s, I definitely want to check out their book though.

Yeah, for sure. [01:08:00] Random Acts of Medicine. That sounds awesome. Uh, and let us know what you guys think, um, and if you have any guest ideas, or ideas for games, we have time, we didn’t do a game today, but it’s okay, it was, we had a lot to talk about. You can email us, knockknockhigh at human content. com, hang out with us on all our social Media platforms.

You can also did Chris tell me I wasn’t I used to not be as funny as I am now He said you did 

Kristin: a stand up set that bombed. I think that’s what he said. I think I heard that. 

Will: I think so I’ll 

Kristin: take it. I’ll take it. I mean sure any any comedian was going 

Will: to You get better you get better Well, you can hang out with us and our human content podcast family on Instagram and TikTok at humancontentpods.

Thanks to all the wonderful listeners, leaving feedback and reviews, not just any reviews, awesome reviews. That’s right. If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out. Like Emilio G. on Spotify said, Listening to this from Mexico, I love your content and it makes med school more fun to be in.[01:09:00] 

Oh, thank you, Emilio. Uh, that’s very kind of you. Good luck to you on your future career as an ophthalmologist. And um, also full video episodes of this podcast drop every week on YouTube at DGlockenflecken. We also have a Patreon. Lots of cool perks, bonus episodes, or react to medical shows and movies.

Hang out with other members of our knock knock high family. It’s not a member community anymore. It’s a family. We’re a 

Kristin: family That’s a little red flag for me. You know, it’s like in the workplaces where they say they’re a family That’s like code for we’re dysfunctional Kind of yeah, not a cult 

Will: We’re normal functioning group of people and we’d love to have you in our non cult 

Kristin: Knock knock, hi.

Don’t become a salesperson, don’t quit your 

Will: day job. Early ad free episode access, interactive Q& A live stream events, and much more. Patreon. com slash Glockenflecken, or go to Glockenflecken. com, not a cult. Speaking of Patreon community perks, new member shoutouts, [01:10:00] Kaitlyn E., Peter S., Medical Mag, ooh, he got a medical mag.

Ooh, I like that name. And Genevieve F. Uh, welcome all, thank you all for joining our 

Kristin: I love a good, a good, like, alliteration. That’s right. That’s a double letter alliteration, too. That’s good. It’s a meh 

Will: meh. Medical Meg. Uh, shout out to all the Jonathans. We have Patrick, Lucia C, Sharon S, Omer, Edward K, Steven G, Jonathan F, Marion W, Mr.

Grindeady, Kaitlyn C, Brianna L, Dr. J, Ross Box, Trevor W, Leah D, K L, Rachel L, Ann P, Keith G, JJ H, Abby H, Derek N, Jonathan A, Mark, Mary H, Susannah F, Mohamed K, Aviga, Parker, Medical Meg, Bubbly, Salt, and Hink Macho! A virtual head nod to you all. Patreon roulette, random shout out to someone on the emergency medicine level of our non cult.

Shout out to Chris M for being a patron and thank you all for listening. We’re your hosts, Will and Kristen Plannery, TheGlockenFlocken. Special thanks to our guest today, Dr. Krish Worsham. [01:11:00] And Dr. who what now? Dr. Chris Worsham. Worsham. Worsham. Chris Worsham? Chris Chris Worsham. Worsham. I said it right there.

The pronunciation’s right there. Yes, 

Kristin: that’s correct, but you said Chris. Chris. 

Will: Oh, Chris. Chris Worsham and Dr. Anupam Bapu Jinnah. And I got that one right too. Our executive producers are Will Flannery, Kristen Flannery, Aron Korney, Grob Gol Grob Grob Roldman. Rob Goldman and Shahnti Brooke. Our editor and engineer, Jason Portizzo.

Our music is by Omer Ben Zvi. To learn about our Knock Knock Highs, Program Disclaimer and Ethics Policy, Submission Verification and Licensing Terms, and HIPAA Release Terms, go to Glogonplugin. com or reach out to us at knockknockhigh at human content. com with any questions, concerns, or fun medical puns.

Oh wait, we can’t finish because Shahnti had A joke we have to tell, and we’re gonna save it for later. 

Kristin: Do we 

Will: have a medical pun? This is a medical pun. Okay. From Shahnti. [01:12:00] What part of the body dies last? What? The pupils. They die late.

Knock Knock High is a human content production.

Knock knock, goodbye.

Hey, Kristen. Yeah. You know, sometimes I come home from work and I just, like, feel really run down. Yeah, because, 

Kristin: you know, despite popular opinion, you actually do see a fair number of patients every day. 

Will: I do. My clinics are pretty busy, but I’m not the only physician that feels that way. So many people feel overwhelmed and burdened, so much that work life balance feels impossible.

Yeah. 

Kristin: Nobody gets into this job for the 

Will: paperwork. Most people. Definitely not me. And, uh, but let me tell you about the Nuance Dragon Ambient Experience, or DAX for short. Tell me. This is [01:13:00] AI powered ambient technology. It sits down in the room with you. It’s transforming healthcare with clinical documentation that writes itself.

Ooh, that sounds nice. It’s like having 

Kristin: a Jonathan there. Yeah, perfect. And I got some stats 

Will: for you. Ooh, I love stats. You’re going to love this. Seven minutes is saved per encounter by reducing clinical documentation time. 

Kristin: Seven minutes. That’s an entire surgery 

Will: for you. Yeah, that’s what DAX can do for you.

And, uh, across all specialties, 70 percent of physicians report a reduction in feelings of burnout and fatigue. That’s pretty incredible. It really is cool technology. Uh, to learn more about the Nuance Dragon Ambient Experience or DAX, visit nuance. com slash discover DAX. That’s N U A N C E dot com slash discover D A X.