Singers: [00:00:00] Knock, knock, hi.

Will: Hello everybody. Welcome to knock, knock. Hi. With the Glockenfleckens. I am Dr. Glockenflecken, also known as Will Flannery. 

Kristin: I’m Lady Glockenflecken, also known as Kristen Flannery. 

Will: Excited for you to join us this morning. We’re going to talk, evening, afternoon, whatever it is, we are, um, uh, we have a little bit of internal medicine for you today.

Kristin: Yeah. I hope 

Will: you’re excited for that. 

Kristin: It took me a very long time as a non medical individual married to a medical individual To understand what internal medicine meant. To me, that is just a 

Will: From an outsider, I can see how that could be confusing. It is nonsense. 

Kristin: It’s like, what does that even mean?

Internal medicine, as opposed to what, external medicine? Yeah, it’s like Like, isn’t it all internal? Like, it’s your body. 

Will: Everybody except dermatology. [00:01:00] 

Kristin: Right. Yeah, and then you explained it to me, not quite that way, but something similar. And it still, it took me a very long time to like, nail this down, what this is.

I 

Will: never really considered internal medicine. Since, uh, we’re going to be talking with internists, I figured now I would talk about why I did not choose internal medicine. 

Singers: All right. 

Will: Does that seem reasonable? 

Kristin: Yeah. 

Will: Okay. So I am not a hospital medicine person. 

Kristin: No, you don’t like the hospital. I do 

Will: not. I don’t like the hospital.

And I think it’s because I, I like, um, fast paced, my attention span wanes after so often. This is true. You absolutely know what I’m talking about. I 

Kristin: do. I have to, uh, shorten what I say to you every single day. 

Will: That might just be because I’m stupid, but um, 

Kristin: no, 

Will: I don’t. I can 

Kristin: just watch your eyes glaze over if I say like three full sentences back to back.

Will: That’s like, it’s like when a, when [00:02:00] a med student comes on to ophthalmology who just wants an easy rotation and I start talking about like glaucoma. Exactly. You can see the light drain from their eyes. And 

Kristin: they’re just hindering it. That’s, that’s how it is. 

Will: I’m just, just gibberish coming out of my mouth.

Kristin: Yeah. 

Will: Uh, so I, I didn’t like the hospital. I, I was, I, I didn’t like the pace. I didn’t like how long rounds were. You can tell because I make fun of it all the time. And, um, uh, and I liked having a defined end to my day. 

Kristin: Yeah. 

Will: And so outpatient medicine, like, that was like where I 

Kristin: needed to 

Will: be. Now, outpatient medicine is not perfect.

It’s, it’s tiring, it’s exhausting, but I know it’s gonna end. 

Kristin: Right, you know what time you’re leaving. Like, 

Will: I don’t, you know, I know I’m not gonna have to admit a patient at, you know, 5 o’clock right before I’m planning to leave, and that would prolong my being at work for a couple hours. That’s 

Singers: true. 

Will: Now, people are listening to this, they’re gonna say, well, internal medicine, like, does have clinic, you know, we’ll hear from, Dr.

Paul [00:03:00] Williams, who does a lot about patient, um, but there’s still a little bit of inpatient. I just, I just, I just, 

Kristin: well, I think in general, do they have, is internal, this is a serious question that might be a stupid question, but is internal medicine only academic? Like is there such a thing as private practice internal medicine?

Yes. 

Will: Yes, there is. 

Kristin: Interesting. 

Will: Yeah. 

Kristin: Okay. 

Will: There’s, there’s, there are entire hospitals that don’t have residents. Okay. That are that that have just doctors working. 

Kristin: Yeah, 

Will: now they might not be in private practice I mean be owned like, you know employed by the the hospital right system, but then some hospital systems Contract with, with private practices.

And so they, they like the contract says, okay, you have to come and cover our hospital. 

Singers: Right. 

Will: Same, same way. Like I cover certain hospitals on call. Well, same thing for internal medicine doctors. And so I know there’s like pulmonology, critical care, private practices. They do [00:04:00] weeks of inpatient service. So yeah.

Yeah. You can be in private practice or an academic. 

Kristin: Well, so what about private practice, internal medicine still know for you? Yeah. 

Will: Again, I, I think I, I like, um, yeah, no, still no. 

Kristin: Just the hospital. 

Will: I, I’m so, my mind is, it’s not just the hospital thing, but it’s also, I like, I like being very narrow focused onto one thing.

Kristin: Yeah, that is how your brain works. 

Will: Yeah, so like internal medicine, there’s so many organs. They all 

Kristin: work together. They’re 

Will: all inside and they’re, the body is full of them. 

Kristin: This is true. And 

Will: I, I just, it’s not my thing. It’s not my bag. I need one thing, one organ that’s two and a half centimeters long. 

Kristin: It’s just all making a lot of sense in a different way.

When I, when I think about it this way. 

Will: Well, should we hear from some actual internists? Yes. Let’s talk about our guests. We have, uh, Dr. Matt. Wado and Dr. Paul Williams of The Curbsiders. So if you guys aren’t familiar with The [00:05:00] Curbsiders. 

Kristin: What are you doing? 

Will: They’re for, for internal medicine education and also like practice management and leadership.

They go into lots of different areas. Uh, it’s, it’s phenomenal education. You get CME for it. 

Singers: Yep. That’s right. It’s, it’s, 

Will: uh, Check out their website, Curbsiders, they’re on a lot of the social media platforms as well. 

Kristin: Yeah, 

Will: and 

Kristin: anywhere you get your podcasts. 

Will: Yeah, and they have interviews with, I’ve been on there, I talked about the red eye with how it relates to internal medicine.

So they always relate it back to that, that field. And, um, yeah, and so it’s, it’s really cool to, to hear those in depth interviews, even as someone who’s not in internal medicine, I also enjoy hearing them talk about it. 

Kristin: And there you go. 

Will: Sometimes it’s in the vein of like, Oh, I’m so glad I don’t have to do that, but, but still it’s, it’s engaging and fun nonetheless.

It’s 

Kristin: almost like rage 

Will: listening. That’s right. Um, and, uh, and so these two guys, they’re, they, they started it and now they have a huge team. But, uh, Dr. Matt Watto. He [00:06:00] is an educator, obviously a clinician, a clinician educator, an academic internist at Jefferson Health, where he’s a clinical associate professor of medicine at Sidney Kimmel Medical College.

And Dr. Paul Williams, also a clinician educator, primary care internist, who also does addiction medicine. He’s a professor of medicine at Penn State Health, and they both together run the curbsiders. So let’s get to it. Here they are.

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. Matt [00:07:00] Waddow. Who told me I can call him Wado for this, uh, because everybody calls him Wado, at least his friends do. And Dr. Paul Williams, uh, the, the curbsiders are here. Thank you so much for coming on, you guys. 

Dr. Paul Williams: Excited to be here. Yeah, no, a pleasure. Thanks for asking. 

Will: So, so the last time we talked was, was pre pandemic.

I came on the curbsiders. I, I don’t, I think we talked about ophthalmology eyeballs, is that right? 

Dr. Matthew Watto: Yeah, well, we, we talked about the, uh, the red eye, I believe that was the title of the episode. And I think I shared a story that in college, I fell asleep too many times with my contacts in, and you, you told me that I deserve to not be able to wear contacts anymore, that I had lost my privileges.

And that’s, that’s stuck with me. 

Kristin: That checks out. It sounds about right. 

Will: As I have, have you, do you still, uh, take good care of your contacts? Is that, has that stuck with you? 

Dr. Matthew Watto: You know, I will, I’m happy to tell the listeners an update, uh, many years later that I am back in [00:08:00] context now, uh, on a limited basis, mostly for athletic pursuits.

Uh, so I, playing soccer, I don’t get my glasses smashed into my face, but yeah, I’m able to wear contacts again, despite you telling, so I guess my privileges are back, even though you told me they were permanently revoked. So I’m, I’m glad. 

Kristin: Maybe some kind of probationary period. 

Will: That’s right. And, and Paul, do you, uh, do you take care of your eyes?

That’s, that’s obviously important to know before we get started. Yeah. 

Dr. Paul Williams: So, well, I mean, I, I am also a contact lens wearer. I will say that 1 800 CONTACTS will give me the call and be like, Hey, you’re due for refills. And I’m like, Oh God, I have. At least 10 pairs left, so maybe, maybe less than pristine, but I don’t do a whole lot of sleeping in contacts, for whatever it’s worth, I just maybe wear out their welcome a little bit.

Will: Okay, I guess we can continue talking then. This is, this is a screening tool we do for all of our guests, whether or not we can continue with this interview. Um, uh, so the first question I’ve been dying to ask you, uh, the two of you, I’d love to get your opinion on ionized calcium. 

Dr. Matthew Watto: Everyone wants to know.[00:09:00] 

Paul, we just talked about this the other day with Joel, do you want to, I feel like I’ll let you take the first crack at this. 

Dr. Paul Williams: Oh, thanks, because otherwise I don’t feel like much of an internist, but it’s so nice of you to ask. I, you know, iodized calcium, a big fan. If you truly need to know the actual calcium, if it’s critically important, I think Probably, Will, what you’re alluding to is this idea of corrected calcium, which I think we, we talk about the words, we use the calculations, we show off to our attendings, but it turns out the evidence behind that is actually not all that strong and compelling.

And in fact, the lower, the albumin that you’re using the correction for the less accurate becomes. It’s actually based on the study of 200 patients at a single site, um, that this correction formula came from. So as, as we’ve done retrospective studies, it turns out that actually just the serum calcium is perfectly adequate.

And if you really need to know, then the ionized is the way to go. 

Will: I’ll be honest. I appreciate 

Dr. Paul Williams: the question. 

Will: I’ll be honest. I have no idea what ionized calcium is. I was just told by someone on Twitter to ask you that, uh, to make it seem like I have some street cred in internal medicine. Yeah, 

Dr. Matthew Watto: he didn’t follow anything you said.

I, I was very surprised that you went there as a, as a first question. That was [00:10:00] not what I was expecting. 

Will: Well let’s, let’s talk, I want to talk about curbsiders first, all right? Uh, we’ll get to some medicine stuff later, but This is when, when I, when I came on curbsiders to talk about red eyes and, and, and, you know, shame you for your contact lens wear, um, you, you guys were, had only done like 80 episodes.

It was relatively early. I guess you’d probably been doing it for over a year at that point, but I just, I just looked recently over 400 episodes. Incredible. Well done. 

Dr. Matthew Watto: Paul, uh, would probably blame me for this because at some point after the first year, which was a hard year, we were doing them every, we were doing two episodes a month, and I was like, we’re going to do an episode every Monday.

And we’ve pretty much stuck with that. We’ve been doing the show for over, we’ve been releasing episodes for close to nine years now. So it’s just been, it’s been pretty grueling. But we have a big team that helps out. And, uh, I, I mean, Paul’s always in a good mood about it. He loves it and there’s nothing he’d rather be doing, right, Paul?

Dr. Paul Williams: Yeah, ideally on the weekend, but you know, if we have to settle for a [00:11:00] Friday night, that’s fine too. 

Will: Well, because it was, it was just the two of you to start. 

Dr. Matthew Watto: We, we had a couple. No, we had this wacky guy, Dr. Stuart Brigham, who was, uh, he was our, he, he was our third co host initially. And then he, sometime over the past couple of years, I can’t remember exactly when he, he sort of, you know, took a, took a leave of absence that became like a long term leave of absence.

But we had, we recruited about two years in, we recruited people from, Social media like our followers. We were just like, hey, do some of you want to help us make the show? And it it became like this just kind of like remote working group and there was right now Our slack channel has 35 people on it and it’s that’s been pretty consistent you know some people come in and out but a lot of the people with us have been that with us for about seven years and Many of them have started their own shows and things now, too 

Will: I feel like I’m, I, I have a lot of like questions I want to ask just for my, um, from a selfish standpoint as like someone wanting [00:12:00] to sustain a podcast for years.

And so can you give us like a, a, a tip or Well, it sounds 

Kristin: like the key to longevity is to have 35 co hosts. 

Will: That’s good. I didn’t think about that. 

Dr. Paul Williams: Yeah. Well, it’s, it’s, I mean, you’ve, scutting is really, it’s the key to any success in medicine in general is if you can sort of get someone else to do the work, then you’re in great shape.

But I, I’ll speak like in seriousness, I’ll, I’ll let Matt answer too. But I, I think for me, part of it has been, you know, when we, when we early on, we recognized that we were our own audience. So it was important to us to make content that we would want to listen to, or that was important or interesting to us.

So, you know, we’ve, we’ve always made episodes about with clinical topics and came up with the questions based on things that we felt like we did know well enough or wanted to do better for our patients. So at least for me, and I think probably I’m sure Matt would say the same thing. The fact that it’s been able to kind of keep me up to date clinically and be able to take good care of my patients.

has been, um, motivating above and beyond sort of all the extracurricular stuff that has come along with it too. 

Will: Did you, did you struggle [00:13:00] to balance doing it? Because eventually this, it started to gain enough steam and, and to where you felt like you had to hire or bring in more people to do the co hosting, but you also have a, a, a clinical practice, right?

Both of you do. And so, Was there a point where you were like, Oh man, this is, it’s getting too untenable to keep doing both of these things. We need to expand and get more people in here. 

Dr. Matthew Watto: Yeah. I mean, that was, that was why seven years ago we initially recruited audience members. And then, uh, there was a time where Paul and I had the deal because I was the crazy one that wanted to do the weekly podcast that like, there was a time where I was like editing and doing the posts to the website and all those kinds of things.

And slowly over time, it started to wear on me to the point where I had to get someone else to edit. And then I had to find someone else to do the posts to the website. And we had to have other people checking over the blog posts before they went up. And so that’s kind [00:14:00] of where it evolved to allow us to keep doing this.

But we didn’t, um, you know, we just, we didn’t have that in place at the time when it started and it was slowly killing me. And, and then, you know, gradually we, I let go of that. I don’t know if you know this, but a lot of people in medicine are type A personalities and control freaks. And that makes it hard to, uh, let go of things when you’re running a podcast and you want, like, to have control over how many ums and ahs there are in the podcast.

Kristin: Oh, excuse me. 

Will: Oh man, she is, you are speaking Kristen’s language right here because I am the exact same way. Except with, with much lower stakes because all I do is, is wear costumes and pretend to be other people. You’re actually dealing with, you know, real medicine that you have to get accurate, like, or you’re going to hear from it, from hundreds of, of physicians telling you that you’re wrong.

And that I’m sure maybe you already do. Do you get a lot of pushback? Some, I mean, [00:15:00] I’m sure there are topics that are pretty charged in the academic medicine world. Do you, do you, does that weigh on you? Does that just make you want to quit sometimes? Paul, what do you think? 

Dr. Paul Williams: No, I, I think part of the genius, and I can say it’s genius because Matt is, is the one who came up with it, of the show is having somebody else be the expert.

So, you know, we do, we have a really fairly stringent vetting process and I think we try to be very explicit when we’re diverging from guidelines or we’re doing expert opinion, but for the most part, the medicine’s being taught, like that’s why we have someone who’s an expert in that field teaching the medicine.

So even if it’s something that someone’s not happy with. Um, they can’t be mad at us. We’re still able to shift the blame to somebody else to some extent. So some episodes we get a little bit of pushback on, but other episodes, for the most part, we don’t get a whole lot. 

Will: Uh, did you, did you get any people, uh, on my episode?

Uh, did they get mad at me? I, I, I didn’t, I didn’t hear about it if, if it, if it happened. 

Dr. Matthew Watto: I, I think when, uh, So we, we didn’t have it. I don’t think we have many ophthalmology listeners. And I think the average internal medicine listener, like you could have been [00:16:00] telling us all false information and no, none of our listeners would have known, you know?

So like, so it didn’t, that’s why it was, we knew you were a safe guest. We weren’t, we weren’t sure about, we knew you about your comedy skills. We weren’t sure about your actual doctor skills, but we, we were like, oh, this is, this’ll be fine. He could talk about a red eye. So, that’s why we had you on. 

Will: People are still confused about what type of doctor I am.

So, whenever I do post a video where I actually give like ophthalmology advice and education, people are very surprised like, wait, I really thought you were a nephrologist. Which is, it’s a very, uh, you know, quite a compliment because I’m nowhere near as smart as a nephrologist. 

Dr. Matthew Watto: I was gonna say, all those characters you’re playing and you can’t blame people for being confused.

They don’t know which one’s real. I, I was talking to a colleague that I was telling them that I was gonna be doing your show, and she, her husband’s a neurologist and she said that all the neur. We’re upset that your reflex hammer wasn’t good enough and then another colleague mentioned that maybe you posted a Video [00:17:00] to make amends with that where you showed a drawer filled with reflex hammers.

Is that true? 

Will: Yes So so here’s what happened I did a video with my first neurology video was with the tomahawk like the orange one That looks like a triangle. I think they call it the tomahawk. I’m not sure But, uh, uh, then what happened was people mailed me reflex hammers. I had four or five reflex hammers that were mailed to my place of work because people don’t know.

Didn’t, I didn’t have a, uh, you know, an address, a P. O. box to, to, to send for people to send me things. So I got them at work and, and I was like, what, what are all these things? There, and I, now I have, I have four or five different types of reflex hammers. And so I featured them all in a video, kind of like, uh, um, some shady character would open up a trench coat and show like, you know, all kinds of stolen, like Rolexes or [00:18:00] fake Rolexes.

That’s, I think that’s the type of video I did, um, with, with all the reflex hammers I have, which are, what am I going to do with all these things? I don’t check. What was the last time I checked a reflex? I, I, I mean the cornea reflex? Maybe, but you know, that’s, is that a real reflex? Oh, it depends on who you ask.

Dr. Paul Williams: And also probably not using hammer for that one routinely, I would have to imagine. 

Will: We’re not hammering the, the, the cornea at all. All right, you guys. So, so I want to talk, I asked you guys to, to give us some stories like from your training, uh, because people love these, you know, just coming of age and medicine type of stories.

And this is great because we’re beginning the new medical year coming up. And so we’re going to have a lot of new interns, a lot of new fellows, a lot of new attendings. And, uh, and so, uh, Wado, I want to start with you, uh, because, because I would say what everybody, what’s, what’s, what’s always so, so concerning for new interns is like, [00:19:00] you feel like you need to prove yourself.

Like, like I, I deserve to be here. I have what it takes. And I can’t think of a way to do that better than saving one of your co residents lives. So can you just, could you please tell us the story? 

Dr. Matthew Watto: Yeah, so I had a charmed year my intern year, uh, and I think it, it, like this, this legend kind of grew, uh, because I was working with this very smart, uh, second year resident, but she was very accident prone.

And, you know, just had a, she just had seemed to be a little bit of a black cloud. And so we’re, it’s our first night on call. I’m really nervous. It’s like a 24 hour plus four hour call. So I’m going to have to stay overnight plus another four hours the next day, tying up my work. And I’m really nervous because we’re going to be admitting all these patients from the ER.

And she’s like, let’s go get some dinner. Then missions are going to start to roll in. And she’s just like talking to me, like casually. And she’s like filling up her soup and we’re at [00:20:00] like the, the, the station in the cafeteria. And she takes a sip of her soup just like as she’s talking. And then she starts like choking and she’s like, Oh my God, Watto, I’m choking my airway.

She’s like, I’m having stridor. I’m like, what are you talking? I thought she was just being, I thought she was just being dramatic. I’m like, yeah, right. I’m like, give me a break. Like you, you just took a sip of soup. Like what is blocking your airway? And so, like, we go sit down at the table, and there’s some other residents there, and, and she’s like coughing, and she’s like flipping out, like trying to drink water, so the other residents are like, wait a minute, now just, just calm down, like, this is probably just, you’re, you, I know you have bad things happen to you, but you just drank some soup, just, Give it a minute and see what happens.

So as we go up back to our call room, where we’re just like going to wait for, to get paged with admissions, like she starts to like hyperventilate and be like, why do I, I can’t breathe. I can’t breathe. So what really happened, I think, is we walked down to the ER, but it, this became that, like, I threw her over my [00:21:00] shoulder in like a fireman’s carry and, uh, took her down to the ER.

She was about to code and they actually did like, uh, the, the E and they had to call ENT emergently. They sedated her, which is, this part’s true. They sedated her ENT, like put a camera in her nose, down into her larynx. And there was a bay leaf that had been sitting on the top of her soup that it was, so it was actually like a hard piece of bay leaf that was like intermittently blocking her glottis.

And like, they had to remove it. And so she was just like, because they had given her all the sedation, she couldn’t work for the rest of the night. So I’m on call still and I’m still getting admissions and I just have like this like rotating group of senior residents that are just like, yeah, they’re just kind of like phoning it in and I’m here just like, you know, crapping my pants, uh, trying to cross cover calls from the nurses and do admissions.

It was an awful night, but, uh, I guess, I don’t know, Paul, from your perspective, this, this kind of like gave me a good reputation amongst the [00:22:00] interns. 

Dr. Paul Williams: It’s well, I don’t know if you all know this but Matt and I did residency together. We were in the same year We like couples matched through a bunch of rotations and he was there There was no brighter halo than Matt Waddow even before this happened So like I think half the reason the seniors were not too worried about him was because like he already had a reputation as being Amazing, but yeah, I think this probably helps solidify it.

Kristin: Oh My goodness. Well, thank you Goodness, he finally believed her. 

Will: Right, yeah, exactly. And, uh, And, Paul, when was the first time you saved your colleague’s life? 

Dr. Paul Williams: No, if anything, I feel like I push people closer to the brink. Whatever Matt’s doing, I’m doing the opposite. I’m 

Will: curious, what rotations did you guys start on your intern year?

What was your first?

Dr. Paul Williams: So I, we had this very bizarre thing, so I was, I was new to the, to the residency program. I didn’t do medical school at the same place. And so my first block was like this weird hodgepodge where I was on reserve but also did research and was supposed to do a QI project. And so, I was terrified as a new [00:23:00] doctor, but had no clinical responsibilities.

So like, I’m like, I didn’t know where the bathrooms were. Like, I didn’t know how to do anything. So my first real rotation was then the ICU where again, everyone was like already a month in, had a month of clinical practice and being doctor y. And meanwhile, I’d been like at home kind of making up QI projects and stuff.

So. My very first day, my upper year was like, okay, I need you to place three NG tubes in these three beds. I need you to do these three ABGs and then you’ll come back and we’re going to go over the sexual aids together. I’m like, I am so happy to do that. I also don’t know how to do any of those things.

And so it was the first rotation did not, it was fine. It worked out okay, but it was, it was my first one. My first real rotation was the ICU. So it was as bad as out of the frying pan and the fire as you could possibly get. 

Will: Oh, wasn’t 

Dr. Matthew Watto: that yours also? Yeah, I 

Will: was. Yeah, that was mine. Go ahead, Wada. 

Dr. Matthew Watto: I was gonna say, I was on Night Float, which is it, definitely, like, where they just, you just show up at work and they’re like, here’s 50 patients, you’re gonna get calls from nurses, like, just handle it.

And it was me and a, and a couple other interns and a couple So that second and third year residents covering the whole hospital at night and [00:24:00] running codes and rapid responses so it was definitely like a thrown into the fire type type situation and Fortunately, I was with a very good group of people and we had a lot of fun And they were there was a lot of pranking going on as well.

I would say not on patients on each other 

Will: That’s cool. I started my, my rotation, my first rotation intern here was, uh, was ICU in this, it was a small community hospital and I was, I was alone on nights, which in hindsight, like not the best for patient safety. I don’t know. Well, I’m 

Kristin: sure there were some, you know, Measures taken.

Will: I had backup. There was this, there was this remote ICU monitoring system that was the voice of God that would like reach, like would tell me things, uh, you know, whenever, I don’t know, something was happening. And so it was, but it was. It was terrifying. The first month, you know, you’re just, it is really trial by fire, you know.

Kristin: I want to hear more [00:25:00] about these pranks 

Dr. Matthew Watto: though. Yeah. So this is, this is a little nostalgic too, because Paul, this was like 2010, right? So Netflix had had a streaming service, but it was still sending DVDs to people’s homes. So like when we had downtime, we would log into Netflix and just try to watch some stuff.

And, uh, I didn’t realize that I had left it logged in. So about a week into Nightfloat. I get home and my wife is like holding some like DVDs and she’s like, What’s, like, what’s wrong with you? Like, what’s happening? And the, the seniors had gotten in there and ordered like, Kama Sutra and like a whole bunch of like, late night like, Skinamax type films.

And my wife, uh, turns out was not into it. So that made me feel pretty good, uh, about myself. But, uh, yeah, I was like, what the, how did this happen? And then, you know, I get back to work and like, the seniors were like, so proud of themselves. I, [00:26:00] I’m still friends with these guys actually. And every time I talk to them, they still bring it up.

They’re like, remember that time I sent the Kama Sutra to your house? I’m like, yes, I remember that. Thank you. Yeah. 

Dr. Paul Williams: That’s a good one. This feels like an elaborate cover story still. 

Will: Yeah. 

Kristin: Yeah, exactly. 

Will: Uh, yeah, let’s see. The, the, the senior residents. Well, these, these 

Dr. Matthew Watto: guys went into GI fellowship, so come on.

It’s very believable. These guys went into GI fellowship. It’s that kind of character. It 

Kristin: checks 

Will: out. It’s making a lot of sense. Now, neither of you guys are. Did you guys, uh, after residency, what were your career options like? Did you, did you think about, you know, doing certain fellowships or going into private practice or what was, what was your thought process?

Dr. Paul Williams: I had no plans. Like I, it’s, I, I thought I, when I was in medical school, I was 100 percent sure I was gonna be an emergency medicine doctor. And then when I was in residency for a period of time, I was thinking about becoming an electrophysiologist, which is weirdly specific and also not anything I’ve interested in today.

So I, was offered a [00:27:00] chance to do the chief resident year, which I took in part just to kind of reassess where I wanted to go with my life, what I wanted to do with myself. And probably my third year of residency, I started to really like primary care, but wasn’t still convinced that was the job for me. So I did the chief year to kind of stall and figure things out.

I was torn between that and actually probably Palm Critical Care. But as I did more and more outpatient medicine, I really genuinely grew to love it. And then also, Um, additionally, I was just exhausted and the idea of doing more training sounded also terrible. So I, I stopped both because I liked primary care, but also the idea of doing additional three years of training, um, I don’t think was psychically tenable for me.

So I think I landed where I, where I belonged, um, both because of life circumstances, but also because I truly like it. 

Dr. Matthew Watto: I, I was in the Air Force scholarship program. So I had limited options in the sense that they, they, I would have had to do a fellowship within the Air Force, or I could just go right into the Air Force and work for them for four years, which I did.

And I had a charmed, again, once again, a charmed life. Like I, I basically [00:28:00] moved to San Antonio. I did some inpatient and outpatient medicine, pretty much the same exact job I have now. And, uh, it was working with residents and medical students and I never, never got deployed overseas to like a combat zone.

I was just like, the only thing different is that I would have to wear camo to work every day. And I would have to get past an 18 year old with like an AK 47 that was letting me onto the base. That was like the only difference between my current job and the, and that job. So it was, it was pretty seamless and.

I, I enjoy it. So I’m 

Will: glad you don’t encounter that in your normal job in civilian medicine. 

Kristin: 18 year olds with AK 47s, let’s hope not. 

Will: It’s a good, it’s a good career in general medicine. No, there’s electronic 

Dr. Matthew Watto: locks on the doors. You, they’re, they’re very serious about badging where I work, but they’re not, uh, it’s, it’s not as serious.

And, oh, and they would salute you too. That was the other thing. They would salute you. Cause like, if you’re a doctor, you’re automatically an officer. So. Yeah, you get this, I barely remember which hand to salute with at the time I first get down [00:29:00] there because I’m like the least military person ever, but uh, these, this kid’s saluting me with uh, while he’s wearing a machine gun, it’s great.

Will: Well, Paul, I’m with you. I was, after residency, I was like, I was done. And I would not have even done a chief year, if that was even a thing, to do an extra year. Because when you’re done with residency, I think the last thing most of us think is, Oh, I want more of that. That’s, yeah. But pay me even 

Kristin: less. 

Will: But pay me, let’s, let’s give me some more administrative burden and let me do another year of residency.

So I salute you for taking on a chief year of, uh, of, of residency. 

Kristin: That one is a figure. Yeah, I know there’s, 

Dr. Paul Williams: I feel like there’s a fair amount of discourse. About like, is there ability to achieve here, or are you just sort of being an indentured servitude and actually just sort of being, um, crapped on? I do, I will say, for my chief year, I found genuine value.

Like, I, you learn how the sausage is made for better or for worse. Like, you get an idea how to be an educator, you make connections, you figure out how hospitals work. [00:30:00] Like, so, if you’re interested in academic medicine, which I was, like, it was an extraordinarily valuable experience that I would never do again.

But I’m glad I did it that one time. Um, so it’s, I But I, I can, I can understand a wild lack of enthusiasm too. 

Will: Yeah, that, no, that’s actually a great point. I was just talking to somebody about that the other day and, and the, um, total lack of knowledge of how the healthcare system works that you get in, in residency, in, in med school.

Because you’re just so focused on learning the medicine. You need to like be able to feel confident in your job. and competent to do the work and it just, that’s the one thing that just totally goes by the wayside. And so I didn’t even think about that, that as a chief, that’s, you’re, you’re kind of functioning kind of as an attending in a way and so you’re going to be exposed to more of the, the healthcare system type of things.

Dr. Paul Williams: Yeah, and you sit on like the, the, the competency committees, which I don’t even think as a resident, I even knew existed where a group of leadership sit around and just talk about the residents and how they’re doing and how they, how we can help them do [00:31:00] better. And it’s just a lot of stuff that’s behind the scenes residency programs that I, I didn’t have any real concept of until actually doing my chief here, at which point you’re very much involved with the leadership.

So it’s, it’s not for everybody. If you, if you’re, if you’re itching to go out and practice and you’re not interested in academic medicine, there’s, I can’t think of any compelling reason to do it. But if you, if you want to be a part of, of academic leadership, I think, I think there’s real value to it.

Will: Alright, well let’s, let’s take a quick break and we’ll be right back.

Alright, we are back with Watto and Dr. Paul Williams. Uh, sorry Watto, I’m just gonna call you Watto. Watto M. D. Watto 

Dr. Matthew Watto: Fair enough. 

Will: And, uh, what we’re gonna do, I wanna play a game, uh, that I’m gonna, I call Internal Medicine Lightning Round. Uh, and, um, this is So I feel like one of the stereotypes that I play up in my internal medicine related videos is the fact that you all are so long winded [00:32:00] about, about so many things, which is, it’s fine.

Like that’s just, it’s just the way you are. And I think that’s what draws you to internal medicine because there’s a lot to discuss in internal medicine. So what we’re going to do is we’re going to do a form of rounds, but this is going to be lightning rounds. Alright, I’m going to just say a word or phrase and you have 60 seconds to explain that thing to people.

Okay? 60 seconds. That’s it. That is it. That’s all you get. Alright? Bonus points if you can do it in a shorter period of time. Are you ready for this? Oh, excellent. 

Dr. Matthew Watto: I am, but only if Paul goes first. We need to set a stopwatch. 

Will: Fair enough. Fair enough. All right. All right. Paul, you ready? 

Dr. Paul Williams: Yeah. Wait on me. 

Will: Okay.

First one. Perineoplastic syndrome. 

Dr. Paul Williams: Great. Thanks for starting with something easy. So, so [00:33:00] perineoplastic syndrome, if I were explaining to a patient, there are the direct effects of cancer and then there’s other weird stuff that cancer does that causes symptoms not directly related to the cancer itself.

So if I had to explain perineoplastic syndrome. It would be sort of all the stuff that you don’t think of necessarily directly related to the cancer, but other symptoms that can happen because of a result of the chemical changes that happen with malignancy in general. 

Will: That was 29 seconds. That was fantastic.

Okay. Wado, you’re up. I don’t know if it was 

Dr. Paul Williams: correct, but I thought 

Will: that was good. It sounded great to an ophthalmologist here. 

Dr. Matthew Watto: That’s right. 

Will: All right, Wado. Delta, delta. 

Dr. Matthew Watto: Oh gosh. All right, I’m gonna, medical students, I don’t even find that thing to be very useful. I, I rarely use it and I, I won’t even explain it.

Oh, do you agree with me on that? 

Dr. Paul Williams: Yeah, I would say it’s a formula used to, for one internist to impress another, which is what most formulas are actually used for, not for any clinical value. 

Will: Okay. All right. 

Dr. Matthew Watto: I don’t, yeah. 

Will: That’s fair. Wado, I’ll give you a different one. I’ll go, I’ll move on for you. [00:34:00] Okay.

Here’s yours. Goal directed medical therapy. 

Dr. Matthew Watto: I think a cardiologist would get mad at you because they’re guideline directed. Right, Paul? I think we got, I think I, I maybe was scolded about that on air by a cardiologist. Uh, these are things mainly for heart failure or heart disease, medications that you should prescribe for patients because they’re written in the guidelines and the cardiology guidelines are so ironclad and supported by so much evidence that it just doesn’t make sense not to prescribe these things.

So that’s GDMT, guideline directed medical therapy. 

Will: Guideline directed medical therapy. Okay, so not goal. I had it wrong. Yeah. Guideline directed medical therapy. That’s how you can impress, impress a cardiologist. 

Dr. Matthew Watto: Yeah, just write, anytime you have a cardiology patient, just write, like, continue GDMT, guideline directed medical therapy, or start GDMT, and then, like, it’s always right.

Dr. Paul Williams: Love it. And 30 seconds. That’s good outpatient care, and just for the students and residents listening. Um, if you’re in the ICU, the answer [00:35:00] is always reduce afterload. If you say that and just nod knowingly, the cardiologists are going to be like, amazing, this guy, A plus, future cardiologist. So two inpatient outpatient tips for your learners out there.

Kristin: There’s some valuable tips being shared today. This is good. Yeah. 

Will: Yeah. I feel like I’m getting maybe like, uh, three weeks worth of, of internal medicine residency here. Okay. Alright, here we go. Uh, Paul. GFR. 

Dr. Paul Williams: Oh, uh, glomerular filtration rate, which is basically a rough estimate of how effectively the kidney is functioning.

Will: Done done. That’s great. Yeah, let’s see. See you don’t need to round forever you guys Look, this is look at what look at how much we’re accomplishing right now. Okay. All right Watto these are gonna get harder Watto. Potassium. That’s it. That’s all you get. Potassium. Potassium is an electrolyte. 

Dr. Matthew Watto: I would explain it to a patient, potassium is an electrolyte that we follow because it’s important for muscle [00:36:00] contraction, including cardiac muscle contraction.

So if it gets too high, way too high or way too low, you can die. 

Will: There you go. How do you die? 

Dr. Matthew Watto: Cardiac arrest. Arrhythmia, cardiac arrest. 

Will: There you go. God, they’re killing it. You guys are doing awesome. Okay. I think all of these answers have been under 30 seconds, which is incredible. Okay. Do you eat 

Kristin: enough bananas?

Will: I, I have, I love bananas. There’s lots of ways to get potassium. We never 

Kristin: found out why he, why he got his, why, uh, he had his cardiac arrest, so. Yeah, it’s still an unknown. Now I’m, now I’m curious if it was your potassium. 

Dr. Matthew Watto: Now that, that answer would take more than a minute. 

Will: That’s true. 

Kristin: And several caveats and disclaimers.

That’s 

Will: right. Okay, alright. Paul. Ahem. Admitting patients to orthoped No, sorry. Ortho Orthoadmissions. 

Dr. Paul Williams: Does it happen? Um, mythical admissions, um, that have, so I guess, I don’t know that I can do this under 60 seconds. Admissions to orthopedic surgery, [00:37:00] um, typically seen in patients that have absolutely zero medical complications, um, which in other words is no patients.

Will: Okay. 

Singers: Alright. 

Will: How about the other way around though? Tell me what you mean. Ortho admitting their patients to you. 

Dr. Paul Williams: Oh! It’s, uh, safe medicine, it’s co management by medicine team to ensure that patients have a safe, effective, uh, hospitalization and safe and effective transition home. 

Will: Are those ever tense conversations that you have with your orthopedic surgery colleagues or is that something that I made up in my head?

Dr. Matthew Watto: I’ve given up at this point. 

Dr. Paul Williams: Well, blessedly, I don’t do inpatient medicine. 

Dr. Matthew Watto: Yeah. Paul, Paul doesn’t do inpatient for the past few years. I still do inpatient. I, I rarely push back anymore. Like if it’s the surgical service, once the patient admitted to medicine, usually that means they’re better served there, but they, they usually have some kind of medical problem and they’ll say, admit to medicine, we will consult.

And that just means that we do the admission and discharge paperwork for them, basically. And, uh, [00:38:00] we, we manage all the medical problems. But yeah, I’ve, you know, as you get older, you just stop fighting some of these fights that just, you know, you’re going to lose the, the orthopedic surgeons are much more valuable to the hospital than us is.

Hospital as hospitalists. So you just got to take it on the chin. 

Dr. Paul Williams: There is an ICU doc, a cardiac ICU doc that Matt and I worked with when we were in residency. And you know, when you’re a resident, any, any admission is just another barrier between you and sleep for you and getting home. But you know, it’s, this guy, anytime the phone would ring, he’d pick up and you would just see him and be like, nope, we’re happy to have him.

Like no interrogation, no question. And I, it, he actually became a real inspiration to me. Like he just recognized that patients need care. And who better than, than medicine? So it’s, you know, if, if, if not us, then who, so why fight that fight? The patient’s gonna be better off with this. So it’s, it’s, yeah, I’m, I’m with Matt.

It’s even when, when you, when I was doing inpatient stuff, I. There’s no point in fighting. I think the patients get good care with medicine. Otherwise, what are we doing here? 

Will: I love that. That’s a good perspective. All right. So Paul, I’m gonna give you another one then since since Watto gave You know a lot of that answer [00:39:00] All right, here we go urine electrolytes 

Dr. Paul Williams: Oh, urinal electrolytes are when you measure electrolytes in the urine and when I do that specifically it means the patient is in deep trouble and headed for a nephrology consult.

Will: Explain that to me. Why are they in deep trouble? 

Dr. Paul Williams: Oh, I feel like it’s one of those things if you check your electrolytes when you’re just not really sure what’s going on. So like as you Like, there are certain things I feel very confident in, but once I start to look at what’s being, what’s actually in urine from an electrolyte standpoint, you know, then I’m worried about things like SIADH and other sort of more exotic things.

So at that point, it’s, if I’m looking, it means I don’t know what the answer is, which means that the patient is not in trouble necessarily, but it just means that I need more help than my own brain. 

Will: Got you. Okay. So it is a sign that there’s, there’s some unknowns and, and that, Things could be going better in terms of, yeah, that’s 

Dr. Paul Williams: great.

Donna Rumsfeld. Sure. 

Will: Yeah. Okay. Okay. Okay. 

Kristin: 50 seconds on that one. Not bad. 

Will: That was good. I was, I was, I was, you [00:40:00] know, when I, when you throw out electrolytes to a, to an internal medicine physician, it’s, it’s, it’s a mixed bag on how long they’ll talk. Okay. All right. Watto types of rounds. Let’s see, how about rounding strategies?

Rounding strategies. 

Dr. Matthew Watto: Bedside rounds. The two types of rounds I practice. Bedside rounds, uh, where you, you go around and see the patient at the bedside. The medic, the students in a residence present at the bedside, and then maybe once out of every two weeks that I work at the residence, I will try to have some breakfast rounds where we sit at the breakfast table and talk about the patients before we go to see them.

Those are the two types of rounds I would most highly recommend to people. 

Will: What is, what is more popular, would you say, among the trainees? 

Dr. Matthew Watto: I mean breakfast rounds is basically me pandering to the residents to give me a good evaluation. 

Kristin: Whatever works. 

Will: Yeah, fair enough. Gotta know your audience. 

Kristin: Yeah, free food is always a good idea.

Will: [00:41:00] All right, I have a few more. Paul, give us Your 60 second explanation of rhabdomyolysis. 

Dr. Paul Williams: Oh, gosh. So rhabdomyolysis, so the problem here, Will, is that rhabdomyolysis is cool. So it was actually first evaluated, um, or first really well described. I want to say it was in World War II, uh, as a result of crush injuries that happened during the bombing of London.

And so this is what was first characterized. And so what they were seeing is this massive breakdown of muscles. Um, that was leading to things like kidney failure, so they would actually track urine output and I, I, I can’t remember what electrolyte levels they were actually tracking at that time. But in any case, uh, rhabdomyolysis is typically caused by breakdown of muscle from any number of reasons that then leads to other metabolic complications because of all the myoglobin that’s kind of floating around.

in the bloodstream, but the history is super neat. 

Will: Yeah. You know, it’s, it’s actually, I I’m learning that there, there are so many advances and things in medicine that we’ve discovered through like war, which is unfortunate, but it’s like, so give me, let me give you an example in ophthalmology from World War II.[00:42:00] 

Um, now everybody gets cataract surgery. They get an artificial lens that goes in their eye. This lens is made of plastic. Well, the first artificial lens that was ever put in someone’s eye was made out of PMMA, which is really tough, hard plastic. And the reason that they knew this would work was because there was this one ophthalmologist who saw, uh, British RAF, like fighter pilots who would, um, who came back and they, when they, they had, um, shrapnel injuries where the, the cockpit glass.

Glass, plastic, whatever it’s made of, embedded in the pilot’s eye and the eye did okay. It didn’t, there was not this intense inflammatory response. Um, they, they were able to leave those little pieces of plastic in the eye and it didn’t cause any problems. And so they ended up making the first artificial lenses out of whatever that material [00:43:00] was, which I think it was probably PMMA.

How 

Singers: about that? 

Will: Yeah, there you go. That’s the, the, the birth of modern cataract surgery, basically. 

Kristin: Fascinating. 

Dr. Paul Williams: Spectacular. 

Will: Well, you know, me and Paul appreciate it. All right. So, you know, I don’t know. Alright, Wado, wait. 

Dr. Matthew Watto: Paul, you really took the bait on that last question. I was worried about the 60 second time limit.

Kristin: No, he was in at 35 and a half. 

Will: That’s good, that’s good. Okay, alright. In fact, I 

Kristin: think you talked longer. 

Will: I probably did. Get me on cataract surgery. I’ll talk like an internal medicine doctor. Okay, alright. Wado, tell me about the last ophthalmology consult you called. 

Dr. Matthew Watto: Oh, jeez. Uh, it was probably for someone that I, it was probably for someone with new floaters or flashes, which I was told by an ophthalmologist is like a heart attack of the eye.

It’s like, you gotta, you gotta get them there quickly. Maybe not within [00:44:00] 90 minutes, but you gotta get them there quickly. So usually that’s what it’s for. I just make sure that they’re getting in to see the person within 24 hours. If someone says I have new floaters or flashes. 

Will: Yeah, that’s good. Nice. 

Kristin: All right.

25 seconds. 

Will: 20. That’s absolutely, uh, 24 to, I would say 24 to 48 hours is okay for flashes and floaters, but yeah, right on the money. I, what I say is, is for local, you know, private practice ophthalmologists or, or optometrists, optometrists, they see flashes and floaters as well. They can do a good exam of the back of the eye.

Um, any. Private practice should be able to get a patient in within 24 hours, you know, maybe 48 hours. Uh, anybody who says that it’s going to be like more than that, they don’t know how to run a private practice. So that’s, that’s my, that’s my, I’ve got a bit of a, uh, what do you call the thing? Chip 

Kristin: on your shoulder?

Will: No, chip. The, the thing you [00:45:00] step on. Soapbox. Soapbox. That’s the words. It’s embarrassing not to have words when I’m speaking to interns, I don’t know. 

Kristin: I saw the pressure, you’re feeling a little bit like, you know, nervous in front of these people. I 

Will: do, I am a little, a little nervous about it. You’re just a lowly ophthalmologist.

I’m just a lowly ophthalmologist, that’s right. Okay, alright Paul, I got one more for you, okay? Alright, this is one that was recommended from, uh, from Twitter. Stress dose steroids. Is that a thing? I’m just 

Dr. Paul Williams: going to make it easy on myself and just say high dose steroids and just leave it at that. Oh, okay.

Alright, 

Will: alright. High dose steroids. Paul, are you with us? 

Dr. Paul Williams: Oh, no, I’m with you. No, that was as much as I was going to say. I’m just going to say very high dose steroids and leave it at that. Yeah. Listen, you can give me plenty of rope. I’m still not gonna hang myself. Like that’s 

Will: okay. All right. All right

Like they’re waiting for something and nothing was coming and so we were done. All right [00:46:00] in the last one Where are we with with acronyms? Oh, actually, let’s do this one. How about this? What is your favorite? Internal medicine acronym, mnemonic that you, that you use. Do you still, do you have one of these that you use still?

Dr. Matthew Watto: I do, I do not like them. Like if, if the, the funniest one, I will tell you my favorite one because it’s so terrible. And I apologize to the person who came up with this. It’s called Snoop 10 and it’s for, for migraine headaches. Like for when you should be worried about like secondary causes of headache and when you should think about like getting imaging.

And Snoop 10 has like, It’s, it’s spelled Snoop S N with like five O’s, a P and a 10. And it’s just like, it’s these 10 things that you should think of that might cause secondary headaches that are like alarm features. And it’s just such a long list. Like who is remember it? Like, they’re just, it’s the dumbest acronym.

Like it doesn’t help anyone remember it. It’s just someone just, you know, [00:47:00] probably spent like a couple hours writing out everything they could think of, and then they tried to like force it into an acronym. We come up with this a lot with trial names, right, Paul, where they’re just like, This is the PREVENT trial and then you like look and they just, where they get the name PREVENT out of the letters of the trial is just, it has nothing to do with it, so.

Yeah, Snoop 10, look it up, it’s terrible. 

Will: I think, I think that’s, I think that’s the most, uh, they’ve had to say about any of these topics. Yeah. Was, was the egregious use of acronyms. I guess that’s my soapbox. 

Dr. Paul Williams: No, I’m with Matt, I, my, because my brain is broken, like even when I was studying for step one, I, I, at the time I was like, I will just learn all of medicine, like I’m not going to use these, you know, mnemonics because I am not a child and then I, I did not do great on step one, but even still, like I just, I can’t, I I don’t remember what the mnemonic stands for if I try to do it and then I get myself into trouble.

So I tend to not, I tend to not use them any more than I need to. 

Will: I tell you, I’m also not a mnemonic guy. I don’t, I don’t, I just, my brain, I don’t know. Some people just swear by [00:48:00] them. They just, it’s like a big part of, of learning in med school and even in residency. But I, I don’t know. Maybe it’s good for test taking.

I guess, I guess today it’s probably not as useful when you’re out in the real world practicing, right? Because like, I could just go and look it up. 

Dr. Paul Williams: Right, yeah, that’s exactly it. Up to date exists for a reason. I don’t need to remember stoop time. That’s 

Will: right. Um, all right. And then what I want to finish with here, I got one more question for the two of you is, you know, you’ve been really at the forefront in a lot of ways of this just free medical education.

And just thinking about. Uh, different ways to educate, uh, you know, the next generation of physicians. Do you, where do you see it going, I guess? Like, what’s the, what, What are the pain points that you think we can, maybe I’m asking several questions here, but maybe I’ll just leave it, I’ll leave it vague and just say, [00:49:00] where do you see medical education going in the future?

Dr. Paul Williams: Paul? Yeah, I, I have a bazillion thoughts on this. Like I think there’s a national trend towards sort of shortening the preclinical years and getting people more clinical exposures, which I think is really meaningful and valuable. I think historically, uh, and I’m not sure this answers your question specifically, there have been.

Two different curricula happening at the same time in undergraduate medical education, specifically. So the medical students will go to the lecturers and they’ll hear from people and take notes and then they’ll study for the step one and step two examinations, which is an entirely different studying.

They’re using Anki decks, they’re using Sketchy Micro, they’re using resources that we’re not actually using in the medical school. So these four students have to put themselves through two different curricula in order to survive undergraduate medical education. And I think My hope is, is that we’re going to start to see those two curricula start to converge and as we’re more forward thinking, we’ll think about ways to actually make the undergraduate curriculum meaningful and directly relevant almost immediately as opposed to sort of the pure abstraction that it is right now.

So because right now they have to know what’s on the lecture and then [00:50:00] they also have to study for the board exams and those two things are often not concordant and I, I think that’s people are being very thoughtful about actually trying to merge those things and make things more directly clinically relevant which I, I think is way, way overdue.

So that’s. My hope and kind of the trend that I see. And I’m not sure if that answers your question. 

Will: Yeah, no, that was great. Absolutely. Wado, what do you think? 

Dr. Matthew Watto: Yeah, Paul, that was a, that was a good answer. I, the other thing I think about, obviously you got to mention AI with this is like, how is that going to factor in?

Because It’s going to be just so much quicker. Your iPhone has open AI or whatever built into it. And then you’re, you’re just going to ask chat GPT. So you’re still going to need to learn medicine. So you can, you can, but you’re, it’s going to be like interfacing with, with these technology tools for learning is I I’m curious to see how that plays out and whether or not a medical podcast will even still be relevant, Paul, if, you know, people are just going to have.

Like, I mean, they already have a super computer in their pocket, but I, I don’t, I don’t know how what we do right now is going to evolve as, as that gets [00:51:00] better. So that’s what I’m slightly worried about as far as the longevity of our podcast. And also just curious as to see how that plays into medical, medical education.

Dr. Paul Williams: No, I mean, so I, I could, sorry, I apologize. I could talk about this for hours, but I think. Like the, the, the AI, like the whole key is being able to ask the question that is most meaningful to it to get the answers that you need. Like, you can’t just be like, what is wrong with this patient? Have it barf out some information that’s useful because it lies and makes stuff up.

Like, you have to know what the prompts are before you can even get there. So you still need some kind of framework. I will say, along those lines, Matt, with AI, you made me think of the other thing that I think is exciting about medical education. As many thoughts as I have about maintenance of certification and the ABI of exams as they exist.

Like, I don’t know what you have to do for ophthalmology, but the longitudinal knowledge assessment that we’re doing now, or you at least have the option, where it’s open book, like you can go and look things up while you’re taking the examination to maintain your certification, is so much closer to the way that we practice than sitting in a classroom and trying to regurgitate, you know, all the knowledge in your brain for 10 hours.

So I do think the move towards test taking, reflecting more how we [00:52:00] practice as opposed to this artificial environment that is just purely a test of knowledge, which is I, I, I, I’m assuming that sort of assessment and education will always be moving in that direction, too. But I don’t think, Matt, we’re going to be irrelevant, at least not for the next two years or so.

Will: I, I think you, uh, you underestimate, you know, the people that listen, just, Paul, for your personality. I, I, I think you’re, Wado, like, okay, you know, you’re, you’re fine. But, uh, Paul, really.

Uh, great answers, you guys, uh, definitely, Wado, great points about AI, uh, but neither of you mentioned like teaching the, the fundus exam any better than we currently are, which I think is really probably the biggest thing that’s limiting medicine at this point from just really improving. But you know, maybe that’s just me.

Kristin: I’m pretty sure it is literally just you. No. No. Cool. 

Dr. Paul Williams: I will tell you, again another tip to the medical student listeners out there, like if [00:53:00] you say, and I performed a fundoscopic examination, and even though I’m not great at it, it looked okay to me, you will be carried around on the shoulders of your internal medicine attending like a conquering hero.

Like it just, no one, no one does it anymore. But if you do it for a headache or high blood pressure, at least if you try, like they will, they will think you are the greatest student to have ever walked into their institution. So I, I’m actually with you. I don’t think we do it nearly enough. 

Will: Paul, let me hand, I like you.

That’s fantastic. I’m going to start carrying 

Dr. Matthew Watto: around. Will, just for you, I’m going to carry around dilating drops. You’ll just have to tell me what those are. And then I’m going to just dilate eyes and look at the back of people’s heads when they come in with, uh, You know, any kind of CNS complaint. 

Will: Hey, I’ve been on, I’ve been on the war path to get people comfortable dilating eyes.

There’s 

Kristin: Well, you should give them your tip for using the slit lamp. 

Will: Oh, oh, I mean, I don’t think they, do you guys have access to a slit lamp? Probably. I mean, usually in the hospital But 

Kristin: it works for whatever, really. Any kind of, uh, uh, 

Will: Well, 

Kristin: how do you even say that word ophthalmologic? 

Will: Yeah. Well, what I, what I tell, what I tell [00:54:00] the, the emergency residents, like when I speak to emergency or emergency physicians, just all of them is, uh, is that when you sit down at a slit lamp, the first thing you say is, uh, who messed with this thing?

And to try to give yourself some time to figure out, you could do the same thing with a direct ophthalmoscope. Yeah. Like you say, all the settings are wrong on this. Oh man. Yeah. Yeah. And then you just, it just buys you like a little bit of time before the patient realizes you don’t know what you’re doing.

It’s just, just a, just a little tip just to, to, to make people a little bit more comfortable and not so scared, you know. That is so smart. Yeah. 

Dr. Paul Williams: Yeah. As you’re shining a thing into your own eyeball, you’re like, Oh God, someone had this all backwards. 

Will: Well, um, Wado, Paul, thank you so much for coming on. So we got, uh, just again, talk about your, your, the curbsiders.

Everybody needs to check it out. Uh, where can people find it? 

Dr. Matthew Watto: Uh, the curbsiders on Facebook, Instagram. I don’t know why I said Facebook, Twitter, [00:55:00] and, uh, now known as X. And, and then we have. If you really want bonus episodes and ad free episodes, patreon. com slash curbsiders is where you can get all our stuff and a lot of cool bonuses on there too.

Will: Awesome. And, uh, and just, I love what you guys are doing, just approaching education through a slightly different way than we’re used to seeing and it’s engaging. I loved being on your podcast. It was a lot of fun and, uh, just the, the, the breadth of topics you cover. And, uh, it, it, I think it’s, you’ve probably done a lot to help just show people what primary care is like and internal medicine and, and, um, and, you know, it just, I think you’ve done a lot of good for medicine.

So please keep it, keep it going. It doesn’t, I don’t care what AI does, as long as you keep doing the curbsiders, I think it’s really important to everybody. 

Dr. Matthew Watto: No plans to quit right now. We’ll, we’ll keep going, Paul. Right. We got to get at least 10 years. We got to go to at [00:56:00] least 10 years. Right, Paul? 

Dr. Paul Williams: Wait, how far are we in?

Dr. Matthew Watto: September 2025 would be 10 years. 10 years would be September 2025. 

Dr. Paul Williams: Oh, okay. Yeah. That we can do it. That seems achievable. 

Kristin: You’ve got that much gas left in the tank. 

Will: That’s right. Well, thanks again, you guys. It was a pleasure. 

Dr. Paul Williams: Likewise. Thanks so much for asking us. Thanks for having us.

Will: Hey Christian, you know how it’s kind of hard to make friends in your 30s? 

Kristin: Yeah, cuz you don’t see anyone or go anywhere. Life just 

Will: gets complicated, right, with kids and work. 

Kristin: Right. 

Will: Well, I brought some friends for you. 

Kristin: Aww, 

Will: who? Demodex. 

Kristin: Okay. 

Will: Demodex mites. 

Kristin: You shouldn’t have. 

Will: You can, they can just live with you, on you, all over you.

Yeah. What do you think? Aren’t they cute? 

Kristin: Well, these ones are, but I don’t think the real ones are quite this cute as the stuffed ones. 

Will: They’ll listen to you. They’ll listen to your secrets. Oh. And 

Kristin: keep them locked away in their ribbed bodies. So 

Will: these little guys, they live on your eyelids and they can cause a [00:57:00] disease called demodex blepharitis.

Kristin: Yeah, like itchy, crusty, red, flaky. 

Will: Irritated eyelids. Yeah. That’s right. No one 

Kristin: wants that. 

Will: No one wants it. But it’s important that when people hear this, they don’t get freaked out by this. You gotta get checked out. True. Checked out, not freaked out because you know, coming to the eye clinic, we’ll talk to you about Demodex and Demodex blepharitis and see what’s going on.

To find out more, go to eyelidcheck. com. Again, that’s E Y E L I D check. com to get more information about Kristen’s new friends here, Demodex blepharitis.

So Kristen, given what you know about enteral medicine physicians, do you think I could have been one of them? Why? 

Kristin: You don’t like words enough. Like talking. 

Will: You don’t like, yeah, 

Kristin: you don’t like talking, you don’t like academics. 

Will: You can’t say I don’t like talking on a podcast. [00:58:00] 

Kristin: Well, it is a mystery how you ended up with a podcast, but generally speaking We have 

Will: some very persuasive producers.

Kristin: That and you, uh, you know, I had to come on to help fill the dead space from when you didn’t want to talk. Yeah, I’m not wrong. 

Will: Okay, alright, you’ve got a point. 

Kristin: People may not know this about you because you put on this, like, performance when you’re Dr. Glockenflecken, but Will Flannery, MD, does not really enjoy the long drawn out conversations.

Listen, don’t ask questions that you don’t want to know the answer to. 

Will: I feel like once I get to know somebody, I do open up and I can talk. 

Kristin: I have been married to you for 15 years, almost. No, you hate conversation. It’s gotta be, I have learned in fact, over the years, some tips and tricks for like dealing with you.

And one of them [00:59:00] is, um, I have removed any unnecessary words from any sentences. Like I don’t send you sentences. I send you. Like, remove any be verbs, you know, remove any the, a, an, no, unnecessary. Just like two to three words. You got the noun, you got the verb, and then you got the punctuation mark that indicates whether it’s a question or not.

Sometimes you don’t even put in the punctuation. 

Will: Okay. Well, to all our former or future guests on this podcast, I do like having conversations with you all. 

Kristin: Yeah, it’s not that you don’t like the people. It’s that you don’t like talking. You don’t like moving your mouth. 

Will: And, 

Kristin: and sounds come out and 

Will: so, yeah.

That is hard sometimes. Yes. Okay. All right. 

Kristin: You’re making it seem as though I’m just like insulting you or being hard on you, . You’re 

Will: not, you’re, you 

Kristin: know this about yourself. I 

Will: know, I know. I just admit it to the people. Maybe I just wish it wasn’t true. Uh, ’cause that’s, does 

Kristin: doesn’t mean that you’re not friendly or something.

You just, you per, you’re a man of few [01:00:00] words if you’re, yeah. If you have your druthers. 

Will: Okay. You guys get what she’s saying? Hopefully. All right. 

Kristin: I should send, I should do a screenshot of like our text exchanges. And people will see what, what I mean. 

Will: Show Patreon. Yeah. If you guys want to see our private texts to each other, join Patreon.

Uh, by the way, we have a Patreon. Did you know that? Yeah! Uh, fun perks, bonus episodes, or react to medical shows and movies. Uh, we, we’re there, we’re active in it, we’re sharing our deepest, darkest secrets with you all, apparently. And uh, so you should definitely come check it out. Uh, we also, uh, you can also hang out with us in our Human Content Podcast family, we’re on all the social media networks, uh, at humancontentpods, uh, for that.

And, uh, also let me shout out to all the wonderful listeners leaving feedback and reviews. Love 

Kristin: those reviews. Yeah. 

Will: If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out. Like at Tony P on YouTube said, [01:01:00] this was such a delight to listen to. If it was three hours long, I would listen to it all.

Kristin: Well, we’ve just established that it will not be, but thank you, Tony P. 

Will: Full video episodes are up every week on our YouTube channel at Glockum Fleckens. Thanks. Uh, we mentioned the Patreon, and we also had Patreon. com slash Glockenfleck, and that’s where you can find it, by the way. We also have, uh, uh, Patreon Community Perks.

Mm hmm. Let’s do that. New member shout out, Michelle W., Jeff V., and Esperanza I. 

Kristin: Welcome. 

Will: Welcome. Thank you for joining our little community here. That all, we all love talking to each other. Shout out to all the Jonathans, as always a virtual head nod to you all. Patrick, Lucia C, Sharon S, Omar, Edward K, Stephen G, Jonathan F, Marion W, Mr.

Granddaddy, Caitlin C, Brianna L, KLG, JJH, Derek N, Susanna F, Mary H, Ginny GA, Muhammad K, Aviga, Parker Ryan, Muhammad L, David H, Jack K, David H, Gabe, Gary M, Medical Meg, Bubbly [01:02:00] Salt, and Pink Macho. I tried to cover it up that time. There’s gotta be some kind of psychological thing going on. I, I can’t get the G of a J.

You really want that 

Kristin: to be Jenny G. 

Will: I think, I wonder if it would change if I moved Jenny J to a different part of the script. I don’t know. 

Kristin: I don’t see why. Petron 

Will: roulette time! Random shout out to someone in the emergency medicine tier, Sally! Thanks, Sally, for being a patron and thank you all Christenblad.

You’re also known as the Glockenfleckens. Special thanks to our curbsiders, Dr. Matt Begley. Wado, and Dr. Paul Williams. Thank you. Our executive producers are Will Flannery, Chris Deflanery, Aron Korney, Rob Goldman, and Shahnti Brooke. Editor in Engineer is Jason Portizzo, or his music is by Omer Ben Zvi. To learn about Nutpack High’s Program Discipline and Ethics Policy, Submission Verification and Licensing Terms, and HIPAA Release Terms, Hey, that’s a lot of words for me.

Kristin: Yeah, and what do you do every time we finish this part? 

Will: I think I’m saying them very fluently and excitedly. 

Kristin: I’m not saying you’re not fluent. 

Will: You can go to glockenflecken. com or reach out [01:03:00] to us at knockknockhi at human content. com with any questions, concerns, or fun medical puns. Knock Knock Hi is a human content production.

Singers: Bye.

Will: Kristen, what would you say is the most important part of my job as an ophthalmologist? 

Kristin: Helping people see better. 

Will: That’s a much better answer than getting home at five o’clock every day. 

Kristin: Yeah. I mean, I do like that part too. That’s good. 

Will: The most important part of my job is not clinical documentation.

Kristin: Right. That is the most worst part of your job. 

Will: I have to do it. It’s important. But I like doing other things too, like restoring eyesight, talking to my patients, developing those relationships. 

Kristin: Looking at them in the eyes. Yes. 

Will: You know what helps me do that? The DAX co pilot for Nuance. That’s true. Yeah, it’s ambient [01:04:00] technology, AI powered.

It helps me actually like maintain those relationships. I can actually Develop a rapport with patients that you can’t do otherwise. 

Kristin: People tend to prefer it when you’re looking at them when you talk instead of typing. 

Will: 80 percent of patients say their physician is more focused with DAX Copilot. 85 percent say their physician is more personable and conversational.

Kristin: Well, how about that? You could use a little help in that area. I 

Will: need a little, a little boost from time to time. To learn more about the Nuance Dragon Ambient Experience or DAX Copilot, visit nuance. com slash discover DAX. That’s N U A N C E dot com slash discover D A X.