How AI Is Already Changing Medicine

If you think AI in medicine is still some far off future, it's not. >> In 7 seconds, this thing pumped out exactly the same plan that this oncologist, like 70, 75% of my notes complete. Why is that a big deal? The biggest reason from a physician point of view is burnout. >> Dr. Peter Weir is here with me today. He's a family physician, health system leader, and he's already watching how these tools are changing what happens in the exam room. That allows me to face the patient and be completely attentive to what that person is saying, rather than me on the computer. The more cognitive, the more complex the topic, the more AI will likely disrupt it.

AI makes stuff up with a lot of confidence. It does help right now in this stage of things to be a physician that's experienced to say, "Oh, I don't know, man. That doesn't sound right." And to check it. Where is Dr. Peter Weir? Dr. Peter Weir, welcome to the show. I thought maybe we could open with you giving us a little bit of detail about your background as a physician first. Sure, that'd be great. And I just want to say thank you, Nick, for inviting me on the show. It's uh it's an honor and a privilege to be here. I grew up in California in the Bay Area. I went to medical school at the Medical College of Wisconsin Milwaukee.

And then did my training at the University of Utah, where I stayed ever since. So, my residency was started in 2000. And I've been there since uh in various roles. My current role is the chief population health officer for the system. I'm a primary care physician. Family medicine is my specialty. And um I've for the talk today, AI is a topic of just interest for me. It's a real like kind of passion. Uh and I've done my best to learn as much about it, but I am not a technologically inclined or educated person. I'm a physician. Um and so I sort of see myself like if we were talking about baseball, I'm a baseball fan.

I'm in the stands watching the games and seeing what's going on, but I'm not a player and I'm not a coach. Um and so I'll give people hopefully a view of what how AI is being used in medicine and how I think it is going to disrupt medicine in the future and I think it'll be an interesting topic. Fantastic and I think that's a really interesting viewpoint because most people that are listening to podcasts about AI are not AI researchers, they're not actually building these models and yet what they're trying to do is figure out how to use it in their line of work and I'm really curious to find out how you are using it as a doctor.

Um before we jump into that though, we should state that all of your views today are your own and do not represent the medical center or the university. Yes, that's exactly right. I I uh I want to make sure it's clear that these are my own personal views as a as an individual, not as an employee of the University of Utah. Um I'm not here to create controversy, but I do want to be able to speak about how I feel about things and and and my views aren't meant to be like as a spokesperson for the University of Utah. Um so I just I thank you for saying that. I just want to make that really clear up front.

Well, let's let's start with how you're using AI in your practice as a doctor. Yeah, so um I think people might be surprised by how much AI is being used. It's being used in pockets. So it's certainly not universal, but it's being used in ways that might surprise people. So, um there's a couple areas that I don't know a ton about where it's being used and we can talk about those areas, but I think the the more interesting stuff would be what I'm actually doing and I can speak to you personally. So, first, um there's a um a technology that's used and I believe it's being used extensively across the US called ambient AI or ambient uh medical documentation.

Mhm. And what that is is um I'll go into a room and see a patient and I will um the we use a company called a bridge. There's many other companies. I I know Nuance is another big player in this space. And we flip I flip that on and the way I do that is actually through my cell phone. Um and when it's on, it's list {quote} {unquote} listening to the conversation between me and my patient. Now, my visits, the kind of clinic that I run and operate, we do very extensive visits. So, they're sometimes 45 minutes plus long. And it's listening in the background. And at the end of the visit, um it uh summarizes the conversation and it drops it into my electronic medical record and we use Epic for anyone who's interested.

That's probably the the biggest It's not the only electronic medical record by any means, but it's one of the bigger ones in the US. And so, it begins to construct my note. The way we write notes in medicine, we call them SOAP notes and it's an acronym for S for subjective, what the patient says, what the patient's concerns are. O, the objective part of the the the note, which would include vital signs, the physical exam, any kind of studies, labs, and then AP is assessment plan. So, assessment, what you think's going on, plan, what you're going to do about it. And so, this technology is really cool cuz it's listening and as I'm talking to the patient, I might jump into oh, you know, your hypertension, let's let's talk about that real quick.

And here's what here's what I want to do with the medicines, let's make some slight tweaks. Here's some advice I've said to you before, I'll say it again, type of thing. And it will organize that conversation into that SOAP format I just talked about in a very recognizable way. So that when I'm done with the visit, I can go back to my desk and I found personally, not every physician feels this way, but like 70 75% of my note is complete. >> Mhm. So, why is that a big deal? The biggest reason from a physician point of view is burnout and well-being. It is not fun to document, especially when you have to leave clinic and you've got a ton of charting to do at home with a young family, let's say, you're locked away in your room typing all these notes out.

So, it's a huge boost for efficiency. And what it does is it allows me to face the patient and be completely attentive to what that person is saying, rather than me on the computer and I'm awkward on the computer. I'm you know, like terrible typist. I'm making all kinds of mistakes. I'm clicking on stuff. I'm looking, you know, like it's very distracting to be on a computer. Now, some young docs, they're amazing at it. They're much better than I am. They can be on the computer and they seem to retain a pretty decent job of connecting with the patient. But I like to be like move my chair, my eyes, everything on the patient, watch their non-verbal cues and get a real sense of what's going on in the room.

And so, you can do that and have this machine that's essentially listening and summarizing. That's the key. It's not a transcript. It's not everything I said. It's taking the key elements and I'm shocked at how well it does it. So, I can have a 45-minute conversation all kinds of stuff and it will bring into my note just the relevant information and what was said by the patient in the case of the subjective portion as well as the assessment plan what we talk about and I can just speak out like this is what I'm finding on physical exam and I can say it as fast as my mouth will allow me and that thing will absorb it and take it in.

The medicines are spelled correctly that the medical conditions it certainly isn't perfect. But it is amazing how accurate it is and how much of a help it is. So I'll pause there and see if you have any questions or thoughts about that. Yeah, I mean that strikes me as a great example of the technology's ability to remove a piece of drudgery from someone's line of work so you can focus on what are those real value add pieces of your work which is looking into the person's eyes picking up on those non-verbal cues. Whereas if you have to be taking notes as you are talking to the patient probably both those things are a little worse off for having to do both at once and this thing that can just listen to all of it and do that for you I mean that seems incredible and I did notice in my research that ambient is a huge player in the medical field now and in recently it was reported that 2/3 of physicians are using some form of an AI tool in their in their line of work.

My first question was does is it just taking the notes or is it helping with any of the diagnosis and some feedback for you? Yeah. Okay, so that's where I want to go next cuz that that's pretty superficial and a lot of people will hear that and be like okay big deal. Right that's a nothing and I agree at first glance it sounds rather shallow. However, it's not hard to start to see and connect the dots where it starts to get really interesting really fast. So, what I want to do if if I can is segue to clinical decision-making and how AI augments clinical decision-making. And then we can go back to how do you put these things together?

And again, this stuff isn't like all complete in in a finished state but as I watch this stuff evolve rapidly, it's not hard to see how we can start to connect the dots in a way where you can see how things will be significantly disrupted in medicine. So, and this is kind of a interesting maybe I I don't know if it's an irony here, but it it it it seems like it it might fit that word's description, which is the more cognitive, the more complex the topic, the more AI will likely disrupt it. Mhm. So, like the stuff that requires doing, like surgery. I mean, sure there's robotics, there's all kinds of advances there, but nothing like how the LLMs, the large language models have disrupted the cognitive component of decision-making.

The more complex it is, the more nuanced it is, the more information that's needed to make good decisions, that actually, interestingly, is like more disruptable because these AI um these LLMs have access to like all the available medical literature that's been published, for example. So, so let me take a step back in time cuz I've kind of lived through a really interesting era in medicine and technology um from the 1990s to the present. Um which is, you know, when when I first started, we were handwriting our notes. We were handwriting orders. And we went from that to like electronic medical records and inputting information in electronically.

Um so, back then, in the old days, like in the '90s, the really like the venerable physicians were these typically older physicians that had been around forever. And they knew everything. They had this incredible encyclopedic knowledge. Those were the people that were like at the top of the uh you know, the the status for as a physician. It was like this person knows everything and they can cite the literature and they can tell you what author wrote it and what year it was published and all that stuff. We had no other We didn't have a good mechanism to remember that stuff. So, it took human brains, which are very fallible.

Sure. Right? So, we used to carry around like books, like literally. Probably, if somebody listens to this that's a doc that's been around for a bit, the Washington Manual manual was a manual we all carried in our back pocket because we had to like reference a written text to get access to information. A and a technology came along called UpToDate, which is essentially an encyclopedia, but it's electronic. Most physicians prior to just a few years ago were using that as their one of their main sources of gathering information about treatment or diagnostic dilemmas, things like that. And it's like it's like interacting with an encyclopedia where you're looking up topics A through Z and you're reading 30-page articles to get to like the little tiny question that you have.

So, you can imagine like a a a a a a a a a a a a a a a a a a a a a a a a product like Chat GPT or and we'll talk about others, they can access this information in a way no human can possibly do it with not It's not perfectly accurate cuz there are some problems and we'll talk about that, but like wow, some of the stuff I've seen is absolutely jaw-dropping in terms of what it can bring to you at your fingertips in a matter of seconds in front of the patient. I don't need to go into the back room and look the stuff up on my own cuz it's going to take me 10 minutes to do it. I don't need to wheel out this big book to try to, you know, and that of course dates me, but like no one's doing that.

I have a a a phone or just the the desktop I'm using, I can immediately access one of these applications and get information that's like in an unprecedented manner with incredible accuracy. I mean, it it's a game changer. Yeah. And what I've noticed is sorry, uh I don't want to go on too long on my pedantic lecture here, but what I've noticed is it's really amplified and augmented me and what I do. And so maybe we can talk about that as a theme is like what what might be the disruption sequence here. >> Yeah. So I'll pause and get your kind of reactions. >> Yeah, what was one of those moments where your jaw dropped?

An example of that. Yeah. Okay, so I got a couple of good stories. The one I think on in this realm with just from a knowledge standpoint that kind of dropped my jaw was I had a friend come to me and say, "Hey, I've got a family member that's got this cancer and this cancer's very complex. There's lots of different forms of it. There's lots There's a lot a spectrum of severity and the treatment is also um equally complex. You adjust the treatment based on a whole bunch of factors. It's not just like age and it and uh the stage of the diagnosis, you know, the extent of the diagnosis, but it's also things like genetic markers, it's lab values, what the person's kidney function's doing, liver function.

It's just all these different parameters that go into it. So, I get a lot of questions like this from friends and family and of course there's, you know, I don't know. I'm not an oncologist. I have no idea. You know, I'm I'm not an expert in this field. So, I received a whole bunch of information about this particular person's case. I mean, four pages of data. Yeah. Studies and MRI, all kinds of stuff. So, without giving any personal health information to chat GBT, I dump all that information in and I say, "What do you think? Prognosis and treatment." You know, it was like 7 seconds. Right. All this information.

So, then my friend sends me the oncologist note and what they're going to do. And in 7 seconds this thing pumped out exactly the same plan that this oncologist who is this specialist in this particular type of cancer. Now, not if an oncologist is listening to this, they might say, "Well, it might just be a straightforward case." It was not a straightforward case. It was quite nuanced. And the genetic testing had an impact in terms of the treatment. It incorporated all those factors and put out it was four different meds, the dosing, the duration, the side effect profile, what med interactions to watch for.

This is in 7 seconds. Yeah. And I was astounded at the accuracy cuz I'm reading then the oncologist note and it is no different. >> Right. There's no difference in terms of the treatment recommendations and what was suggested. So, that made me realize like the power of accessing that level of sophisticated information. I mean, you could get that in Bangladesh or rural Utah or you know, wherever in the world that to access that that kind of information, that's when I was like oh, this is a game changer. >> Right. >> This is huge. Yeah, my father has, as it turns out, a very rare form of full body arthritis and he had multiple doctors trying to figure out what was going on.

It was not life-threatening, so it wasn't like all hands on deck, but it was going on for a long time and we were talking six, seven, eight months. And he eventually just dumped all his labs into ChatGPT, just like you described, and in similar fashion, in 7 seconds it said, you know, have you considered this this is it's highly likely this very rare prognosis. And he took that back to the primary care doctor who said oh, that's interesting. Maybe we should run this by the the rheumatologist, who then said that actually might be right. Uh and then it did turn out to be correct. And so it was even going beyond what the specialist would have recommended, it it helped get him the treatment that he needed before he would have gotten it.

Um and I that was a moment for me where I was like this is going to change everything in medicine. This is incredible. So what kind of my brain started ruminating on was most of medicine, the knowledge, the decision making is very algorithm-based. Mhm. If this, then that. That's like the wheelhouse of computers and machine learning, neural networks. I mean, it's like it is the wheelhouse. So, that's what medicine that's the foundation of it, that's what it's built on. So physicians aren't always great at following those algorithms every single time with perfect, you know, fidelity. Computers are pretty good at it.

So, um imagine now, let's go back to our previous example about ambient technology like HoHum. Okay, well, that's imagine that's in there listening to the case, listening to the You probably know where I'm going. And grabbing out of the EMR, which is electronic medical record, all kinds of data. Lab values, imaging studies. Pulling this information together and prompting the human to say, "Hey, there's a few other things you might want to consider." And I bet today, with the technology as it is, you could very much enhance and augment the care that's going on. I'll give you I'll give you another example.

There's Physicians aren't always great about following evidence-based guidelines. And there's a great example that's been studied really well, heart failure. And there's this uh area in heart failure that you're supposed to comply with as a physician called uh guideline-directed medical therapy, GDMT. It has a really fancy acronym. And all it is is here's four classes of meds that all reduce mortality if a patient meets these criteria for heart failure. And uh it's a specific type of heart failure. These four classes should Everybody should be on. And if they're not on it, it better be because of some intolerance or some allergy or some very compelling reason.

Well, how You would think physicians would be amazing at following that, right? They'd be doing all four things all the time. And it's not just the four classes, it's specific medicines within a class and at specific doses. And we're terrible at following it. At And cardiologists tend to be better than primary care docs, but primary care docs, I think I can speak for us as a group, we're just not that good at following that kind of stuff in a routine manner. Well, imagine how Like that again, like that would be the wheelhouse of a AI assistant that could say, "Hey, this guy's got heart failure.

Here's the four classes. He's on three. What's up with the fourth? And by the way, the one on the second, like the dose is screwed up. And by the way, you picked the wrong class. It should be, you know, this beta blocker, not that beta blocker." I mean, that kind of ability is already there. There's no question. >> Right. >> And so, being able to like manage chronic diseases and make guideline-evidence-based uh decisions and make sure it's maintained. Like that that to me is something that for sure is coming. The other area that you might find interesting is sort of decision-making. So, real-time decision-making.

So, you're out there, you're seeing the patient, you're trying to figure out what to do. And that's also been remarkable in terms of how much it's helped me. So, these will be like a maybe a diagnostic dilemma or something where you're not sure and you need some assistance to kind of help move you along. That's another area. It's just an algorithm, right? So, like a lot of medicine is built on here's the subjective complaints. Here's some objective information you can gather. Here's the differ- differential diagnosis what the possibilities are. And here's how you can begin to figure out what it's most what it what it is most likely.

Here's the workup is what it involves. So, I had a I had a good case that happened years and years ago that I tested these different AI models to see if it could figure it out. And so, I'll give you the quick story, which is young woman comes into clinic. She's about 38 years old. So, anyone under 70 is young in my eyes, especially someone in their 30s for heaven's sake. So, she's about 38. Young, healthy, very active, no cardiac risk factors, not a smoker, no diabetes, no hypertension, no family history, nothing. And she's got chest pain. But it's not typical cardiac chest pain. It's very atypical.

It's like, "I get pain. Last like an hour. It doesn't come on with exertion, doesn't get better with rest, kind of goes away on its own. Kind of right in the center of my chest. And I listen to the story and I was like, okay. She seemed like a real straight player, like very earnest, very sincere. I thought something's going on here. And I tried to figure out like the usual causes that can cause chest pain that's not cardiac and it just didn't fit with anything. That'd be like reflux and things like that. So, I So, anybody who watches any medical show knows like you got to order an EKG. So, okay, order EKG and it shows a very non-specific change.

It's not a normal EKG, but it's non-specific. Uh so, it's not necessarily showing ischemia of the heart, which is the scary condition that's like, you know, a person having a heart attack. That was a little unsettling for me cuz it would have been nice if it was just stone cold normal. So, I'm scratching my chin wondering what to do. And so, I did something I've never done be- before that, I've never done it since, which is I ordered a troponin in clinic, which if any doctors hearing this, they'd be like, no, no, no, that's terrible idea. And the reason why is when you order a troponin, what you're doing is you're trying to figure out if that person's having a heart attack.

And so, when the heart muscle is damaged, it releases this enzyme called troponin and it's very detectable in the blood. So, I um order the test, I get it back like in 2 hours. And the reason you're not supposed to test it in out the outpatient setting is once you're thinking you need a troponin, they should be in the ER and receiving like the full treatment for a presumed heart attack. On aspirin, on oxygen, the whole nine yards. So, it comes back just barely past positive and I was like, uh there's something going on here. So, I send her to the ER, she was her happy to go. They look at her, they're like, you're not having a heart attack.

But with something is going on. They do an echocardiogram, which is an ultrasound of the heart. And it shows she has this very rare condition called Takotsubo's cardiomyopathy, which is where called Takotsubo's cardiomyopathy, which is where the bottom part of the heart balloons out and doesn't work so well, and the patient starts to eventually look like they almost go into heart failure. And Takotsubo, that crazy name, is a Japanese term meaning Japanese octopus trap. So, the heart for some reason when it balloons out resembles a Japanese octopus trap. >> Okay. >> Which I know sounds crazy obscure.

So, she was treated. She was okay. It was a really rare condition. And it floated across, you know, my clinic and I saw it. So, I So, what I did, and I forgot one little element that I want to mention to people is that she mentioned to me 6 months prior her sister passed away. It was very emotional, very tough for her. And Takotsubo's is kind of famous because it's called the broken heart syndrome, where when someone undergoes like a big emotional distress, they it can trip them into this very unusual uh heart condition. >> Wow. Okay, so I tested the different Sorry, this is super long-winded. Different AI models to see Yeah, so I set up, you know, this is this is what I saw in clinic and I didn't give anything away, but I did mention the emotional distress of the recent loss.

I mentioned the EKG findings, the nature of the chest pain, her age, the cardiac rate, all that stuff. And every AI tool gave me a slightly different response. Some were very conservative, send the patient to the ER, no question. Mhm. Some were like, reassure the patient, all's good. But one, Chat GPT, said, "Huh, that's interesting. I wonder if this could be Takotsubo's." Which I was like, "What? How? How did >> Mind blown. How could it possibly And it it had a differential but one of them was Takotsubo's and it was just one among many. And it said, "You know what you should probably do is to close the loop check the troponin." Woah.

Now physicians don't use that term and I we don't say close the loop and order a troponin. That's like that's a non I've never heard anyone say something like that but I know exactly what that means and any doctor or any healthcare professional will know exactly what I'm talking about when I say that which is order the test and get a negative and then you don't have to worry about it. >> Right. Close the loop. What an interesting way to frame that. Yeah. And that's exactly what I ended up doing. That's exactly it was right. So I of course said to to ChatGPT, "Well, you nailed it. That's what it was." And I was like, "You know no big deal." Um but I I was I was struck at a rare case I mean a lot of primary care doctors have probably never see a Takotsubo's presentation like that fresh in clinic.

That's pretty unusual. And for a an LLM to get that diagnosis like out of the gate with minimal information and to make a suggestion like that that was like totally resonated with me as a physician. That's pretty amazing. And that's another one where we talked about kind of jaw-dropping moments. I just thought Oh my gosh, this is this is going to change everything. Well, you can easily see how that could have been overlooked in the moment by you. It's not a commonly ordered test given the presentation of symptoms. So you don't order it and it doesn't get discovered. In that case the if you had the ambient rolling and it was giving you real-time feedback that might save her life.

By with that quick instantaneous feedback says, "Hey, you might want to close the loop on this. Check this thing out." >> So, imagine Imagine all of that occurring in the medical record where I mean, at some point you sort of think, "Well, what's the point of the physician?" Which we can talk about. And And it's worth considering that, >> think there is a point of the physician, but I I would love to hear your thoughts on that as well. >> too. I just I think so, too. I'm not saying that there's that they're irrelevant. But, just imagine putting these pieces together where a a patient can explain what's going on, testing can be done, um a workup can be done and then sorted out and a diagnosis made, a treatment plan delivered, and you've got a human that has a broad understanding of how this stuff works, who's been augmented by this AI tool to ensure that the care they're providing is accurate.

And when there is a hallucination, quote unquote, which I don't I don't love that term. I prefer that term. It's my own, um confabulations, which is when AI makes stuff up with a lot of confidence, which is what patients do with like dementia. >> Mhm. Um it confabulates once in a while, but it does it with such confidence you don't know when it's doing it. So, it does help right now in this stage of things to be a physician that's experienced to say, "Oh, I don't know, man. That doesn't sound right." And to check it and to cross-reference it and find out indeed that's not true. That's happened to me also.

I've It's made me nervous when you see stuff that it gets just straight-up incorrect, but I have to say the as the models mature, it's getting less and less frequent. It's pretty darn amazing how good they are. They're not perfect, but It's incredible. >> So, yeah. So, So, what is the role of the physician? You know, I think it's really important that our world doesn't, I think, turn into a place where we're not interacting with each other. Um just like as an aside, I think social isolation is one of our biggest threats as humans from a health standpoint. I take care of a lot of people that really have a lot of social isolation, and sometimes I and our clinic staff are one of the few people in their lives that they come into contact with.

So, to lose that and to just delegate all of this to a machine seems like that sounds terrible. That's a very dystopian. It it it is I do agree. >> a real concern and I one of the things that came up when I was doing a little research on this was the rising cases of AI psychosis, which to put it simply is just a form of social isolation and people spending too much time talking to an AI because and that's their the bulk of their social interaction really does have a huge negative impact first on the mental health, but then also on their physical health. And so point taken on absolutely. We we have the answer for society is not to all silo off and and just hang out with the AI and have it answer all of our questions.

I to to set you up on the on whether the physician is necessary. So um I found this study Cedars-Sinai Medical Center in Los Angeles. They ran a study 42,000 patients were in the group where they had AI generated treatment recommendations and they compared that to a control group with physicians and these were non-life-threatening situations is my understanding in this study, but the let's use the exact wording here. Um 77% of the AI-generated treatment was rated optimal, whereas it was 67% for the humans. And granted, some of this was they were interacting with a nurse rather than a physician because these were low-level complaints.

When I got into the details of it though, it's certainly So, people were rating the AI recommendations highly, and it was also speeding up the process, and there was quicker access in getting them answers more quickly. They still wanted a human in the loop though. They was not a situation where these 42,000 patients said, "Oh, I Yeah, we should just use AI for all of our medical needs." They absolutely wanted humans in the process to make sure that what they were the information they were getting was accurate, and then with the follow-through treatments after that. Yeah. No, I I don't doubt that at all.

I think I think it is important to maintain human connection. Um it's a I mean, it's a big part of my style and the culture that we're trying to create. I realize that I'm talking maybe in a hyperbolic way about AI and what its potential is, which is it's fun to sort of dream. But it is worth bringing ourselves back and making sure that that things like uh the human connection is, you know, really of paramount importance. So, humans, like in my experience, it's all about trust. And earning trust is hard. It takes time. And so, usually people need some degree of connection over time and see a person's behavior, and they start to build trust.

And of course, a mistake can really lose trust quickly and be very hard to regain. So, it's a really important currency, if you will, if as a physician to earn trust among your patients that see you. And so, and probably people over trust certain individuals in our society and I would say, you know, there's docs sometimes doing stuff that I cringe at that their patients are like extremely loyal. So, you can it can go it can go in weird ways also. But, that aside I think if you had if you if we thought about this as AI augmenting physicians so that their decision making was enhanced, their guideline follow through was better their diagnostic reasoning was enhanced and workups were more complete.

Um medicines that are being prescribed like antibiotics would be a great example. There's a lot of overuse of antibiotics so Mhm. >> the uh appropriate management of antibiotics and things like that. But, filtered through a physician or a provider, let's say nurse practitioners and physician assistants which are also key members of the care team and nursing too. want to I don't want to also I want to make sure you mention them cuz they're an important part of the team. And pharmacists, there's a whole bunch. I work with a lot of different team members. But, like that communication to patients and here's another little important facet is sometimes people's preferences and values make it so that there isn't just one solution, right?

So, like let's say you've got a disease state here's the potential ways to treat it. You have to then customize like what what are we going to do and how are we going to do it for you as an individual. And some people might say there's some things that I care about a lot and there's some other things I don't. And I don't want to put up with this side effect to get, you know, like And so, those are really important to honor and to respect and also to know. Like I don't have to ask my patients a whole lot of questions cuz I kind of know how they feel and how they think. Doing um customizing and doing things based on patients' preferences, their goals, their values, I think is also a key.

But also, there's another element to this, too, of like the ethical part of things. So, making sure that we're doing things in an ethical manner, and making sure that the access that people have to treatment and medicine is fair, um and equitable, that type of thing. So, there's a lot of different, I think, elements to this that, um having a human in the loop, as as you put it, um will is a critical piece to all this, and that AI, at least at this phase, should be thought of as like an augmentor of the patient provider or yeah, patient patient provider relationship. Um So, I think that's going to be key to to maintain.

Yeah, the story that pops in my head when you were saying that, my it was a number of years ago, but my mother-in-law was diagnosed with very late-stage ovarian cancer. The prognosis was extremely negative. And there was a line of treatment, which was going to dramatically lower quality of life for what she had left. It might extend her life a bit. And it was one of those Kobayashi Maru moments, where it was also like, maybe you just want to enjoy the time you have left might be a better treatment option in this moment. And I don't know that there was a right answer or a wrong answer. It was It was a very difficult one, um but like you said, meeting the patient where they're at, it's not as simple as here's the disease, this is how we treat it.

Um she really needed a human being in that moment to see the full picture and eventually decided on foregoing the treatment because the chances of it succeeding were exceedingly low and and chose to live out the time she had left as healthy and as vibrant as possible and again I don't think there was an easy good answer in that moment but that's that's when we need absolutely need a human in the process. Yeah. End of life issues for sure very sensitive time in somebody's life. And making sure we're able to have really nuanced and um sensitive conversations to respect and honor patients autonomy is really key.

Um a lot of times patients will say to me well what would you do? Right. As they're faced with like a dilemma of like an end of life is a common place for it to get really tricky and really hard. And having a human you know a fellow human a computer can say well let me give you the statistics again. Right. Like I don't need the statistics. Or you know are we going to really are you going to put your trust in a like tell me what you would do to an AI tool? Yeah. Cuz God knows what it's it's orientation is or what its biases might be that are built into it but a fellow human that by the way I'm mortal too.

Yeah. And I've got family that have been through things like this with you too. So we're all in it together and I think to be able to say to somebody I know you I've known you for a long time. Here's kind of what Here's here's a couple options. I don't want to I never want to tell people what to do. I kind of want to be more like a guide rather than that paternalistic like here's what you need to do. But being able to just say to people here's some thoughts in a really honest way and a vulnerable way, too. And that we don't want to ever lose. And so, I hope people listening to this have stuck around long enough to hear that message is that I'm not suggesting we replace all that, get rid of it.

Um I think that is a really essential part of what medicine is and we talk about the art of medicine a lot because it isn't just a science. It's There's a There's a lot to it that goes into the um how it's done and the relationships that that we make um are really um key elements and we we don't want to lose that. >> This episode of the Next Daily Show is brought to you by Zapier. If you've ever felt buried in repetitive work, copying data, moving files, sending follow-ups, you know it's like death by a thousand mouse clicks. Zapier has always been the tool that fixes that. It connects over 8,000 apps, Google Drive, Slack, Notion, Gmail, MySpace, you name it.

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So, like if you were to say, if I said to you, historically, do you think there's a mechanism to hold physicians accountable to the quality of care that they're providing? And if so, what would you guess that looks like? Gosh, I don't know that I've ever given that much thought, but I would guess that there is a system and some sort of oversight and reviewing there. Well, what There's certainly like mistakes. Like if you make mistakes, we're very good at picking up when things go wrong. Okay. So, a surgical site infection, a bladder infection from a catheter that was there too long, a central line that gets infected, things like that.

But, like how well do you think we measure when we do things well? Mhm. That's always a tough one. It's an interesting Yeah. It's an interesting question. So, population health, what that term, what it means is thinking about just just put simply, thinking about the health of a population of people and how to measure that. In medicine, we're taught to just focus on the person in front of you. And in medicine, we never really take a step back to say how well does Peter take care of people with diabetes? Right. And compared to what? Uh-huh. To his peers? To a center of excellence? To average? Like, what what's the benchmark?

Well, historically we just never did that. >> Mhm. So, population health, what it is at its essence is beginning to weave in that type of thinking, like how do we look at population at a at a population level and ask ourselves what are the outcomes that patients would care about that we can hold ourselves accountable to? So, I'll give you an example. Let's say I'm not a surgeon. Let's say I do knee replacements for a living. The way we're paid today is you just get paid per click. Every time you do a knee replacement, you get paid, right? There's no You don't get paid on how well you did it or how well the patient's doing 1 year later.

You don't go back and ask them, like, "Well, how are you doing? Do you regret having the surgery? Do you think it worked well? How's your pain level? How's your physical function? Is it better?" It's just did we do the procedure or not? And so, you can imagine the incentive structure there is to do as many knee replacements as possible. >> Sure. Which isn't always a bad thing. If you need a knee replacement, you want a doc that's doing a lot of them and be really good at it. That's not always bad. But if I need physical therapy instead of being cut open, I would also like somebody to say that. And I am kind of surprised.

I'm I'm a bit shocked that you're saying that there is not a follow-up system like you described in the So So there's So we're beginning to do that. And that's what this population health movement is. So this is where I think medicine's going is a greater sense of accountability for the care that we provide, a focus on actual outcomes, a focus on reducing unnecessary costs, Yeah. >> not really incentivized to do today, and changing some of the payment models to do that. So I think that's coming. But at the same time, AI, I think, becomes a very complimentary technology to reinforce and support that type of care.

>> Mhm. So imagine again now in the future, you've got a person that caring for 100 people with diabetes. And being able to give feedback to that provider. 20% of the time you're not doing what's actually considered standard of care. 10% of the time you're not ordering the tests that you should be ordering at the time frequency that is the evidence-based guideline. And then imagine putting in support structures, so it's not just all sitting on the physician structure shoulders. You know, you've got a team around you to say, "How do we all do this together so that the person's overall outcomes are optimized?" >> Mhm.

And you can like for me, the link with AI and being able to do that, measuring, suggesting, prompting, it's just a beautiful fit. So I see healthcare going that way. I think there's going to be a lot of especially when people feel like the costs begin to be a problem again, which is only a matter of time before that cycle is back in the into the political space. Sure. And as we take that more seriously, we start asking ourselves, how do we provide the right amount of care to the right people and try to reduce the unnecessary costs that health care systems tend to induce. I That's where I think medicine's going and I think CMS at the federal level is going to try to push that agenda and I think AI will be incorporated more and more into the care so that it's not just we just let the docs be completely autonomous and do what they want cuz they're the experts to and this a physicians might not like hearing this, but like really kind of watching like how do we make sure that the care that you're doing is the the best it can be and providing the resources around you so that you're supported in doing that.

That's in a general way where I see things going hopefully in the future and also way beyond perhaps my career and life. Well, and to support the the docs there, it's also asking too much of any single human to keep track of all that stuff, follow up with all that stuff. I mean, this is just more support for people who are excellent at what they do and helping to follow up around that. It seems another space where it could really AI could make a huge difference for medicine in that my understanding of it from talking to several other physicians including Dr. Paul for regular uh listeners of the show, they'll have heard from him before, is that there aren't incentives for proactive medicine.

It is much more set up to be reactive to deal with problems as they arise and it does seem like AI could really help in the proactive space of medicine. Yeah, so that I think you make a really good point in using that word incentives because the incentives that's what impacts or affects behavior. And whether people like hearing that or not, that's just a truth. And so if you say to like a primary care doc, if you see more patients, you will make more money. If you can see them faster and more efficiently, your paycheck will grow. What if you said, if you can make the population you care for more healthy, you will be incentivized to do that.

Like that's a different incentive structure. >> Mhm. And so I see again AI as a complementary piece to this, but it cannot be a technology by itself. So like when we when we talk about the problem, it's really important to identify what the problem is and I think it's incentives. I think our incentives are totally screwed up in medicine. And when we begin to flip the incentives and align it with what the patient wants, which is better care, better outcomes, for less cost, when we start aligning those incentives, then you're going to start to have behavior that gets that done. And I think AI can be a companion to it and complement it and augment it and make it better.

Absolutely. But I think this conversation we're talking about is touching like the this is what I do day-to-day and it's a fascinating topic and I think it's uh the source for why a lot of health care is so confusing and puzzling to people. They scratch their head and wonder, why is it like this? Why is it so screwed up? Why are why is my pharmacy work this way? Why do my benefits work this way? Why do insurance work this way? Like all that stuff, it's a perfectly rational system that's operating perfectly as it's designed to achieve the outcomes that it's been designed to do. That that it is working exactly as designed.

But most people don't take the time to really dig in to understand it. And it's those incentives that are embedded in it that create all of this puzzling, strange type of behavior that people wonder, like, why is it set up like this? And really, what it is, ultimately, it's business. Medicine has been commoditized. It is a big big business that makes a lot of money. And there's a lot of stakeholders in place that are very intent on keeping the status quo. Sure. I dug this one up, um, just to put in perspective the size of the business of medicine, uh, because so you have the global AI market of health care at present is guessed to be around 20 to 27 billion dollars.

And in the next 10 years, it is projected to be over 600 billion dollars. And when I see numbers like those, well, clearly there are some very bright minds in this space who are looking at it and going, this is massive business. How do we get involved with these tools? But to your point, there's a lot of money floating around, and those incentives can get a bit off track from just healing people when there's that much money around. And I don't think it's bad actors in the space. I mean, any individual doctor is trying to feed their family, and they can't change the system by themselves. And they're they've got to work with the system that they're put into.

I mean, it's a big big system, and so changing that, in a way, is extremely difficult. Yeah. I So, thank you for saying that, cuz I agree with you. I work with some fabulous people, fabulous physicians, that care deeply about helping people and making them heal. No question. It's the system that we live in and a lot of physicians, you know, get frustrated with it. Um but I agree with you. There aren't necessarily bad actors. I mean, there are the once in a while, you know, oddballs that do some stuff that's not so great. But most, you know, in in the different parts of health system, I mean, insurance takes a lot of heat from a lot of people in the country, but like it has a purpose.

And they're willing to take the financial risk and bear it and somebody needs to do that. And so like there's a lot of elements and components to help the health system where we like to think of the world in black and white, like bad, good. >> Right. I work with a ton of people in a ton of different parts of the health system and they're genuinely really they're generally really good people. So I think that's really important to say. It's just it's the way the system is set up and again, it's not like there's some evil person behind the curtain. It's just through evolution in time and for a bunch of reasons, it is the way it is.

One little quick thing I want to say about AI though, I think it's worth saying if again, if people have stuck around this conversation is I love this this thing I found online, the Gartner hype cycle. Which is with any technology, there's initially a a a a this steep trajectory of expectations and hype. And also like fear. And with AI there's just so much of this going around. There's so much hype. I mean, you it's almost inescapable. Every day the news has story after story about AI. And then the money, you know, Elon Musk is going to get paid a trillion dollars. All this stuff. It's like, ah.

Inevitably, with every technology you peak and then you go down and and the there's a wonderful term the trough of disillusionment. Yeah, where people go through this thing like, "Ah, I knew it. It was It was not what it was purported to be, and it didn't turn out like I thought it was going to be, and it's all a bunch of a you know, like that type of stuff." And then there's the slope of enlightenment, and ultimately the plateau of productivity. So, I think just wonderful words and descriptions of how technologies go through this thing. And right now, to me, unquestionably, we're on this massive slope of inflated expectations.

And so, I think it's good for all of us just to take a step back and temper how we look at this, and say, "Yes, this technology is interesting. I feel like it's going to disrupt things. I think in a good way." But I also want to stay realistic, and make sure that we don't over over hype or over exaggerate what it can do, and make sure we stay aligned with what the technology can do. Um and so, I think that's just an important little little thing to bring into the conversation, so people understand that I'm not trying to um talk about this technology in a way that's like completely unrealistic or disconnected with reality.

Yeah, the Gartner hype scale, right? I It's funny because AI has pointed me towards that same thing as well. I researching something completely separate, um but it the I mean, a number of things there. I've talked to several people on the show about how with any new technology, the more transformative we can imagine it to be, basically the bigger that hype slope is initially. And then the deeper the disillusionment is with it. But eventually, we're usually right in the transformative capability of these technologies, like the internet being the perfect example. I mean, there were people in the early 90s who were like, this is going to change everything.

And by the end of the 90s, you had the dot-com bust and it was like, yeah, this is this gave us pets.com. It's really not that big of a deal. But now we look back on it in 2025 and it's like, oh, yeah, it did change all kinds of parts of society and daily life and in ways we could not even imagine in back in 1992 and it feels like this will be on a similar trajectory. It just might take a little longer than everybody thinks. I did want to ask you Oh, oh, go >> Just going to say I think it's inevitable that you're we're going to have a bubble of some type. And poor pets.com, I mean, everybody ref- references that one company.

I mean, I I somebody out there must be laughing cuz it's like, why do we keep getting heaped onto the like, okay, we were one among many. That's what I like, right? But everybody just hangs onto that one example. >> It was that Super Bowl commercial. >> for me. It's like a knee-jerk knee-jerk reaction. pets.com, right? >> Yeah. Um but yeah, I think these bubbles are inevitable and I think it's human nature to see something like, ooh, this is really cool. This is going to change everything. And then we, you know, come back to reality. There is no question in my mind that this is going to transform things for the long haul and make a new normal.

To me, there's no question. But I also want to again temper my like, it's not, you know, in the next hour. So, these things are going to come along. It's iterative. Often times when technology makes a giant leap, we think, well, it's going to look like that forever. Well, no, it never does. It doesn't stay on the same trajectory. It can't. Right. >> Things level off and like I think a great example is the iPhone. Early on, it was like every iPhone iteration was like, "Oh my gosh, this thing's even better than the last." Now, it's like, "Well, the camera's better. Has a slightly longer battery life." Like, it's plateaued in a huge way, but it changed the way we think about communication.

I mean, a million things, right? A a cell phone. So, um So, I think these bubbles, I mean, we should almost anticipate them. And of course, I don't have a lot of money to go out and spend billions of dollars on investing into these these technologies and and stuff, but certainly there's a whole bunch of people are. And some small percent are going to make gobs and gobs of money, and a lot of people are going to probably lose a whole bunch. So, I think that's true with every technology. I mean, you could probably go back to like the railroads and like come up with examples of like these guys thought the railroads were going to be all over the US.

Well, guess what? They were. And they they all thought they'd be in charge of it, you know? Well, only a couple that came the winners, and the other whatever hundred you never read about or hear about or anything else. So, I think it's probably true that this just is this cycle that repeats itself, and we are suckers to it every time. Sorry, I just I thought I'd throw throw that in there, that observation. Well, yeah, I think you're spot-on. And it's interesting, I am reading the book 1929 by Sorkin. Wrote that on the Great Depression bubble and then the burst. And he also wrote Too Big to Fail uh with the financial crisis bubble that then burst.

And wow, are the two books eerily similar? And wow, do they echo what we're looking at right now? And I'm not saying there's going to be a massive crash or depression. I don't want that taken out of context, but it does seem like some sort of pullback at some point as we hit that disillusionment trough would be reasonable to expect at some point. Yeah. And you know, I I studied economics in college actually. I was not a pre-med student and you know, one of the things that we're taught is uh the business like the business is business in the US anyway is the markets they're cyclical. They go up and down.

And it I'm always amazed at how people are like so quick to think, well, things are going great now. So there's you know, it's this it's this bias. It has a name um extrapolation bias. Like it's I'm going to take today's current trends in cryptocurrency or whatever it is and extend them out indefinitely. Like really? You don't think this is eventually going to turn? And it just look back at history. It's it's it always cycle you can count on it cycling. But I feel like um there's this weird human tendency to fall into these traps. And it's probably because we're we're not designed to think about like economic cycles, right?

We're designed to like do much more rudimentary type things like hunting and gathering and things like that. So I just don't think we have we our minds are built that way. So we have to kind of discipline ourselves and say I'm not going to fall for the trap. I'm not going to fall for the shiny new object. I'm going to have some restraint and some of that takes just life experience. Um and being stung and having a few uh scars battle scars. I am really into the AI agents right now and cuz I feel like that's on the cutting edge and I would be curious because you you seem to be very curious about how these technologies can help in the space and if that might be something that could aid in some of your work.

There's a video by the time this interview comes out it will have been released on on YouTube where I just using vibe coding just talking to an LLM through Zapier and you're able to build an agent that will go make choices on your behalf. And the one I built was an AI researcher that will go every Monday morning, it goes and looks, is there anybody coming out with a new book in the next couple of months on artificial intelligence? Who's been on the big podcast lately? And then it pulls their contact information, a summary of who they are, what the book is all about, they summarize all of that and then dumps it into a draft email in my inbox just waiting for me.

And of course, it takes a little I've got to do some edits and some touch-ups and put that human touch on the email, but it the number of hours it saved me is incredible cuz the agent is now up and running and the ease that there was to create this thing. I mean, it yeah, it requires some understanding of logic and if-then statements and decision trees, but I was able to do it on air, build the thing from scratch. I think it took me an hour of just recording and then the the video will be cut down to like half an hour on how to build it. And I just thought, wow, I I think when every when a lot of people catch on to what is possible with these things, you can apply it to any industry that you're in and become the AI expert in your office if you're willing to put in the time and explore.

Absolutely. And I think that might be like one of the the key kind of points to make today is that you don't have to be technologically you don't have to understand all of the the what goes on the guts behind these LLMs cuz it's like when people talk about it that are technologically inclined it's like going back to my baseball analogy like talking to a player in baseball, they're almost like, I don't know, I just I run the bases. Like, I don't know how to tell you how I do it. You just intuitively know when a ball's hit in such and such, you know, like that type of thing. And so, there And then also the the language is hard to access, and they're very precise about the language they use, and it's very hard to enter that space.

But I think people listening to this, a takeaway can be if we think of ourselves as users, or like you could even say super users of AI, those are people that I think are going to have a lot of value. And so, it's that person that's doing exactly like you described, cuz you could have an office full of 100 people, and there's going to be like five that are going to be like, "I'm all over this technology. I love it. I'm super curious about it. I want to learn everything there is to know, and I want to play around with it, and like during my off time, I'm playing around with it. And I'm finding use cases that I can do to amplify my work, to make it easier, to allow me to do more than what I could do without it, to become better at what I do, more precise at what I do, more accurate with what I do, to to amplify the quality of work I'm doing, to make me more valuable.

And the only way you can do that is to become an excellent user. So, I I teach a Masters of Healthcare Administration course at the business school, and one of the things I've learned is when I talk about AI, and I ask the audience, and these are young people, generally like late 20s, 30s, a lot of them will say, "I just think all this stuff is totally overblown. Like, a lot of hype, and I I just I don't really find it that interesting." And I'm like, "Hey, even if you don't think it's that interesting, you got to get into it. You got to like play around with technology. You got to start to use it, because there might be a day where, you know, the people that do well and excel are the ones that are really comfortable using it, are very creative about using it.

They're very good at prompting it. Like, prompting is a key core skill and the way to get better at it is not to take a seminar in it. Like pay somebody money to go tell you how to prompt. Just start doing it and learn. >> And you can learn really quickly because the quality of response you're getting is very evident based on how you prompt as an example. And so I think the people that are going to take the leaps are the ones that are like just naturally inclined to like use it and learn about it and play with it. Um so I love that your description of how you're doing things and I'm the exact same way.

I mean I'm using it constantly and I talk to people who are like, "Oh, I never use it." I'm like, "What?" Are you Like really? How are you not using this? Um When somebody says that, I feel like it's somebody telling me like, "Yeah, I don't have a cell phone." But Yeah. I mean I On that particular one, I tried to avoid using a cell phone for as long as I could and by I forgot I don't know what year it was. It was like 2000 or 01 or something. I'm like, "Okay, this is insane. Like this Luddite that's living a life where like, you know, I'm disconnected from the rest of the world." And so um I do think um though that for people listening that might be like, "Ah, I don't know about this stuff." Just start playing with it.

Just start looking at it. Um check out some of the different products. Um a lot of them are free. Um sometimes I think people get nervous about the privacy issues. You don't have to put any privacy, you know, anything private in there. Um so you can keep your questions and stuff like so you feel really comfortable with what it's learning about you. Although it is scary how much Chat GPT knows about me. In fact, if you If anyone uses this stuff extensively, ask it to tell you about all that it knows about you and you'll be shocked at what it says cuz every single thing you've said is remembered.

>> Yeah. Um so that's scary. There's a bunch of scary stuff with it, no doubt. Um privacy being a huge one. Um and all kinds of, you know, things that we didn't get into, but but uh I just I would encourage people just um if you're wondering like I just don't get it. I don't understand what all the excitement is, just just get in there and start playing around with it, start asking it questions, and start noodling, and you'll I think you'll see it just starts opening doors, and you'll start being surprised at what's possible. Quick pause. This is important. There are only three things you can train in life.

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Just a genuinely solid tool if you're serious about getting better. I think that's fantastic advice. One more question for you regarding where medicine's headed with artificial intelligence and all of it. If you are advising a young person today, would you still encourage them, if they're so inclined, to get into the field of medicine? 100% for me. I love it. I love my job, and um I have three children myself that are all in college or near college, and I definitely tell them if this is of interest, you should definitely pursue it. I think it's always tricky if you're a young person trying to say, "I'm going to guess where technology is going and try to change my career based on where it's going." You can do that, but boy, there's a good chance you'll just be dead wrong sure in terms of where things go.

It's so hard to know and predict. That being said, there's also some things that are becoming more and more evident. So, I think in medicine, my guess is the highly cognitive specialties, where it's a lot of thinking, accessing literature, what's the newest latest thing, those feel to me like the most disruptable, but it doesn't mean we're not going to be hiring doctors, but it might be less numbers of them than before. Um that's just a guess. I don't know if that's true. And so, I think if somebody's passionate about a field in medicine, let's say, then pursue it. Don't I think it's important to for people not to get too caught up in like, "Well, there's not going to be any jobs for me.

There'll be nothing left." That's very hard for me to believe that we won't need expertise in all these areas. It might look different. It might change. What you're doing might change, but I would hate to stifle someone's interest and passion in a topic because of where we're trying to guess where the trajectory is going. So, um I don't know if that answered your question, but for young people, I think medicine's a fabulous uh profession, and I love it, and the change is really interesting and fascinating to watch. And is it scary? Absolutely. Is it frightening? Yes, of course it is, but it's also like really exciting to be a part of, and I'm looking forward to seeing where it goes.

Love it. Well, thank you so much, Dr. Peter Weir, for your time today. This was an absolute pleasure. And thank you to our mutual friend, Kurt, for connecting us. Thank you very much. And again, uh it's a real privilege to be on, and uh I hope it was interesting for uh for our listeners. I have no doubt it will be. Um Yeah, yeah. So, I'm I'm not like a social I don't have a social media presence. I'm on LinkedIn and I do have an email that's publicly available that anybody can find at the University of Utah and I have no problem with people reaching out and connecting with me um in those two ways.

I think I'm not sure my LinkedIn allows like people I don't think I have like a proper subscription that allows me to communicate to people. But email is probably the best way um and I guess I'm I'm dating myself, man alive. Well, who knows? Your LinkedIn may blow up with requests after this. Yeah. I I just find You can probably tell I find this stuff so just totally fascinating and interesting that I love talking about it and thinking about it and meeting people that want to talk about it and think about it. So, to talk about it with you and just let it like rip is really fun Yeah. for me. Um it's like a a dopamine squirt of fun to just process and share and knock things around, you know?

I agree completely and it's funny how the show we you know, we started out focused on college admissions cuz that's the line of work that I was in before this and then it just started expanding by talking to a couple of friends on air about what they do and man, people tuned in for that a lot more than the college admissions stuff and it made sense because I was so much more excited to talk about topics I didn't know anything about. And so, it started really expanding into our an array of topics and now it's really niching down again where I'm going like I am all in on understanding artificial intelligence and there's so many facets to it and so many ways it can be applied.

It's yeah, an interesting arc of the show. Yeah. So, I think an another thing for you to consider if you ever want to do any follow-up is and I don't know if it interests you, but the medical the healthcare industry and where it's going is that's what I do day-to-day I and I love that topic, too. And it's filled with a lot of um, uncomfortable components. >> Yeah. Um, what I mean by that is people have a sense of what they think it is and what it really is is like a little bit different than what people's expectations are. And I love deconstructing how it works so people can understand why it does the things it does.

Now, that's my passion for sure and it may not be others, but if you do get any feedback, the little bit that we got into that that people want to hear more about that, I'd love to talk about that further, um, if that's of interest. Sure. Yeah, I think it's a very interesting topic. Where it gets tricky is a the people who really know what's going on in the system often feel like they can't speak at liberty about it for one reason or another. But, I think most laymen, we have some sense of like there's got to be a way we could do this better. Like something's not quite aligned the way that it should be.

>> Right. Yeah, and I would I think um, that could be an interesting topic is to to discuss how we get healthcare kind of back on track so it's more aligned with what people need. And I do think what's what might be really interesting also is to discuss how disruption in healthcare will likely come from the outside. It's not going to be fixed from the inside. I can tell you, I'm an insider. I see it all. And the way it's going right now, the status quo is absolutely to everyone's liking. Do they want to make it better? Of course. Do they want Do they care about people? Of course, they do. But, the incentive structure is so messed up that and we we were getting around this that it creates a real um it people are frozen in doing things because they don't want to disrupt the the magic, if you will, the margin.

And so, I think you're going to see some really interesting things happen from the outside. It's already happening at small levels and it's very hard to penetrate cuz the stakeholders that hold the healthcare system are very much uh insulated. But, uh I do think especially employer space cuz they're the ones eating the majority of these costs. Um and we saw some attempts by Amazon and others, Google, to do some of this stuff. But, uh that's where I think we'll see some interesting headway. Yeah, I think that's an interesting topic and the Dr. Paul, who I mentioned earlier, he's been on the show a couple of times cuz I'm good friends with him.

He's an ER doctor. He's also very Mhm. interested in this topic and how things need to change cuz he feels like he's on the front lines of perverse incentives. Um So. Well, yeah, okay. >> Anyways. >> And you know what? I forgot >> That was I forgot >> Yeah, what was that? Stop. Okay, everybody, until next time. Ask questions. Don't accept the status quo and be curious. The next daily show.