Latest / Becker’s Healthcare Podcast / Xiaofei Zhou, MD - Associate Program Director, Neurosurgery, Section Chief of Neurosurgery, Southwest General Hospital

Transcript

Xiaofei Zhou, MD - Associate Program Director, Neurosurgery, Section Chief of Neurosurgery, Southwest General Hospital · Becker’s Healthcare Podcast

• 0:00
  This is Carly Beam with the Becker Spine
• 0:02
  and Orthopedics podcast, and I'm thrilled to be
• 0:04
  joined today by doctor Sophie Zhou, a neurosurgeon
• 0:07
  at University Hospitals.
• 0:09
  Doctor Zhou, welcome back to the podcast, and
• 0:11
  thank you for being here today.
• 0:13
  Yeah. Of course. Thank you so much for
• 0:15
  having me.
• 0:16
  So before we, get started, can you just
• 0:18
  introduce yourself and share a bit about your
• 0:19
  background?
• 0:20
  Yeah. So I am,
• 0:23
  an assistant professor of spine surgery and neurosurgery
• 0:27
  at University Hospitals in Cleveland.
• 0:30
  I am the associate program director as well.
• 0:33
  So part of my role is to
• 0:37
  help guide new residents and new medical students,
• 0:41
  into the field of neurosurgery.
• 0:43
  It's one of the best parts of my
• 0:45
  job is to, you know, bring in the
• 0:49
  the new people, the new fresh blood into
• 0:52
  our field. It's,
• 0:54
  it's very, very rewarding.
• 0:56
  I bet. And, you know, we're recording this
• 0:58
  in December heading to 2026. And I'm wondering
• 1:01
  what are the most important shifts in spine
• 1:03
  neurosurgery
• 1:04
  education that we need to see?
• 1:08
  I think one of the things that really,
• 1:11
  we all focus on is surgery itself. Right?
• 1:15
  And I think when you go through neurosurgery,
• 1:17
  it's seven years of training. You do thousands
• 1:20
  of cases,
• 1:21
  and
• 1:22
  you come
• 1:23
  out very experienced
• 1:25
  in surgery.
• 1:26
  And you come out very
• 1:28
  nuanced in your,
• 1:31
  in your decision making. And I think that's
• 1:33
  across the field in all of the different
• 1:36
  programs that I've seen
• 1:37
  throughout The US. But I think one of
• 1:39
  the things that we don't have a focus
• 1:42
  on is
• 1:44
  how does that translate
• 1:46
  in the current
• 1:48
  medical
• 1:49
  world. Right? I think we see neurosurgery
• 1:53
  and surgery and any kind of medical practice
• 1:56
  as medicine itself, but it doesn't exist
• 1:59
  alone.
• 2:00
  It exists
• 2:02
  in our
• 2:03
  medical system. So I think there should be
• 2:05
  a broader
• 2:07
  teaching
• 2:08
  of how does that translate with insurance? How
• 2:11
  does that translate in private practice?
• 2:13
  How does that translate in academic medicine? What
• 2:16
  is an RVU?
• 2:17
  I think those are the things that we
• 2:20
  don't focus on as much because, you know,
• 2:23
  at the end of the day, our greatest
• 2:25
  focus is our patients, and that should always
• 2:27
  remain true.
• 2:28
  But I think to be a better
• 2:31
  physician, we should understand where our patients are
• 2:34
  coming from, the financial background.
• 2:36
  What does it mean to take care of
• 2:38
  our patients, not just in their disease process,
• 2:41
  but what does it mean to take care
• 2:42
  of them to
• 2:45
  get them access to care? I think that's
• 2:47
  a really important part
• 2:49
  of medicine nowadays
• 2:51
  that we really should refocus on.
• 2:54
  Definitely. And, I mean, I imagine for
• 2:57
  surgeon surgeons and patients are both navigating very
• 3:00
  different kind of elements of the health care
• 3:02
  system that still may be just equally as
• 3:06
  shifting,
• 3:07
  potential confusion,
• 3:09
  etcetera.
• 3:10
  I'd love if you could, dive a bit
• 3:12
  deeper into what you've been telling
• 3:14
  your own fellows and residents. How are you
• 3:16
  what are you doing in your own work
• 3:18
  to equip them with this,
• 3:20
  full
• 3:22
  spectrum?
• 3:23
  Yeah. So we really encourage our residents
• 3:26
  and our fellows to go out to courses.
• 3:29
  Because I think when you go to these
• 3:31
  national courses,
• 3:32
  there there are always coding courses, and you
• 3:34
  can learn more about, you know, what is
• 3:37
  a code, what does it mean. I think
• 3:39
  there's also,
• 3:41
  courses about health care, and, you know, neurosurgery
• 3:44
  also has advocacy
• 3:47
  programs
• 3:48
  that are involved in different aspects of health
• 3:51
  care.
• 3:52
  You know, we're involved in the Washington Committee
• 3:54
  and things like that. So
• 3:56
  I think,
• 3:57
  really, just looking beyond
• 4:00
  the pure medicine
• 4:02
  and allowing your residents to have that kind
• 4:04
  of focus
• 4:06
  is
• 4:07
  is critical. Because I think
• 4:09
  there's such a lack of focus on it
• 4:11
  in our training
• 4:13
  that just by telling them this is an
• 4:15
  aspect that you should focus on
• 4:18
  is great. For example, when we went to
• 4:21
  the Becker's meeting
• 4:23
  last year in June, there was a real
• 4:26
  drive towards understanding how does insurance work, how
• 4:29
  does,
• 4:30
  access to medicine work, and how do we
• 4:32
  provide care at a sustainable, cost effective way.
• 4:37
  And I think that kind of dialogue
• 4:40
  between not just academic medicine, which really focuses
• 4:43
  on, you know, patient outcomes,
• 4:45
  but with private practice as well,
• 4:48
  which, you know, has this other aspect, other
• 4:51
  dimension of medicine. I think this kind of
• 4:54
  dialogue is really what drives our understanding
• 4:56
  of
• 4:58
  medical care in The United States.
• 5:01
  Definitely. And, hey, thank you for, the kind
• 5:03
  words about our conferences.
• 5:07
  You know, with spine surgery, there's always, you
• 5:09
  know, a lot of new innovations coming out.
• 5:12
  And I'm wondering how are you balancing between
• 5:15
  teaching innovations,
• 5:17
  but also, you know, restraining unnecessary
• 5:19
  interventions?
• 5:21
  Yeah. I think that's, like, such a great
• 5:23
  question. Right? Because you we're always
• 5:25
  at the cusp of the next new thing,
• 5:28
  and you always think that the new thing
• 5:30
  you're trying
• 5:31
  well, you at least you hope the new
• 5:33
  thing you're trying is going to be the
• 5:35
  next biggest and greatest.
• 5:37
  And I think one of the things that
• 5:39
  you have to really
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  understand
• 5:41
  when you try a new thing
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  is that you have to look at it
• 5:46
  as,
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  does it effectively
• 5:49
  change my management of my patients? Does it
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  provide
• 5:53
  good quality care?
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  And
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  it's not just, oh, I have this new
• 5:59
  cool
• 6:00
  thing.
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  But really looking at it,
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  with some amount of focus on,
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  is it beneficial to my patient for the
• 6:10
  cost? And is it beneficial to my patient
• 6:13
  for the effort? Because sometimes
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  you can do something, but it may be
• 6:19
  slower. It may cost more. And
• 6:22
  does that time and money cost really,
• 6:27
  really benefit the patient?
• 6:29
  And I think one of the things that
• 6:30
  academic medicine
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  does a really good job on
• 6:34
  to try to create that balance
• 6:36
  is that
• 6:38
  we do research projects. Right? We look at
• 6:40
  outcomes.
• 6:41
  And I think really focusing on the outcomes
• 6:44
  being driven by the data
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  is how you
• 6:48
  discern what is good and what is just
• 6:51
  flashy.
• 6:52
  Mhmm.
• 6:53
  Yeah. It's a great way to think about
• 6:54
  it. And, you know, obviously, AI, it's just
• 6:58
  it's everywhere in health care. There's always,
• 7:01
  people are always exploring new
• 7:03
  applications,
• 7:05
  new, new tools.
• 7:07
  How should spine surgeons and neurosurgeons be taught
• 7:10
  to evaluate these,
• 7:12
  applications so they don't over rely on, like,
• 7:15
  black box decision support?
• 7:18
  Yeah. I think the good thing about
• 7:20
  our generation
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  of,
• 7:23
  surgeons is that we're kinda growing up with
• 7:25
  AI. Right? It's not like AI was something,
• 7:31
  that
• 7:33
  kind of occurred
• 7:35
  twenty, thirty years ago. It's something that we're
• 7:37
  integrating actively now into our practice.
• 7:40
  So
• 7:42
  as a practicing surgeon,
• 7:44
  you are kind of looking at at AI
• 7:48
  as it integrates into practices every day. And
• 7:51
  one of the best examples right now is
• 7:53
  how we use AI in dictations.
• 7:57
  It kind of
• 7:58
  increases our speed
• 8:00
  in
• 8:01
  writing documentation,
• 8:03
  but it doesn't necessarily
• 8:06
  change our decision making. It takes away some
• 8:08
  of the busy work as of right now.
• 8:10
  It helps with scheduling. It helps with some
• 8:13
  aspects of medicine
• 8:15
  that are tedious
• 8:16
  but are very,
• 8:18
  rote. There's also
• 8:21
  AI
• 8:22
  applications in imaging. Right? It helps refine
• 8:25
  some of the reads, but
• 8:27
  would I trust my
• 8:29
  radiology partners over an AI read? 100%.
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  Because
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  there are just nuances
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  of
• 8:39
  patients that
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  experience
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  teaches you. And that's the part
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  about AI that
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  will get better. Right? It's about training these
• 8:49
  programs.
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  They also rely on experience,
• 8:53
  and I just don't think we're quite there
• 8:56
  yet.
• 8:57
  But the greatest thing about
• 9:00
  being a part of, you know,
• 9:04
  growth in medicine
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  is that you start from the beginning. So
• 9:09
  if you're one of those people who waits
• 9:11
  until everything is already said and done, then
• 9:14
  you're behind. But if you integrate as it
• 9:17
  becomes,
• 9:18
  available,
• 9:20
  then you're part of the learning process. And
• 9:22
  I think that's how you avoid the pitfalls
• 9:25
  because you are able to look at it
• 9:28
  from a perspective of
• 9:31
  it's learning with me.
• 9:33
  Yeah. And it's kind of like that approach
• 9:34
  of curiosity and what can this do well,
• 9:37
  where can we refine things.
• 9:40
  Yeah. That curiosity, that's that's such a good
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  way of putting it. Because I think if
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  you
• 9:45
  just trust it blindly because you're so far
• 9:48
  behind,
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  and you're like, well, it must be good,
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  well, then you don't realize the pitfalls. But
• 9:54
  subs you know, on the other hand, if
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  you're just like, I don't trust it. Nothing
• 9:58
  about it is good, then you're gonna fall
• 10:01
  out of favor. Right? Because the things that
• 10:03
  are good about,
• 10:05
  AI, you're gonna miss. So I think just
• 10:08
  having that balance and knowing that it's a
• 10:10
  tool and it's a tool that you can
• 10:13
  help
• 10:14
  make better,
• 10:15
  I think that is what creates that balance.
• 10:19
  Got it. And I want to pivot a
• 10:21
  little bit. I was wondering, what part of
• 10:23
  surgeon well-being do you think is missing from
• 10:26
  today's education right now?
• 10:28
  Oh my gosh. I think that's such a
• 10:30
  good topic. Right? Because we're all humans at
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  the end of the day. And I think
• 10:35
  that is the part we forget. There's so
• 10:37
  much machine learning. There's AI. There's all these
• 10:40
  things that,
• 10:41
  you know,
• 10:43
  are designed to make our practice better, to
• 10:45
  make our patients better, but we forget that
• 10:47
  we're human too at the end of the
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  day. And so we talk a lot with
• 10:51
  our residents about,
• 10:52
  you know, you have to focus
• 10:55
  on
• 10:55
  your own well-being.
• 10:57
  And sometimes,
• 10:59
  you know,
• 11:00
  it's just taking a five minute breather
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  after a hard case or a hard outcome
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  and real realizing and recognizing
• 11:09
  your own humanity.
• 11:11
  And sometimes it's more than that. Right? Five
• 11:13
  minutes may not be enough, but,
• 11:17
  I think
• 11:19
  eating right,
• 11:20
  exercising,
• 11:22
  having
• 11:23
  a friend circle,
• 11:24
  not making
• 11:26
  this job your entire life,
• 11:29
  and
• 11:31
  having outside interests
• 11:32
  are all critical
• 11:34
  towards being a really good doctor.
• 11:37
  Because when I have doctors that I really
• 11:39
  respect that take care of me,
• 11:42
  what I really love about them
• 11:45
  is
• 11:46
  that they're human, and they connect to me
• 11:48
  on an emotional level. Right? And I don't
• 11:50
  think they can do that if they were
• 11:53
  burned out and
• 11:54
  tired and can't even focus on themselves.
• 11:57
  The best doctors I've ever seen have always
• 12:00
  been able to talk to me
• 12:01
  like I'm their friend. They ask me how
• 12:04
  I'm doing,
• 12:05
  how,
• 12:06
  how things are going in my life. And
• 12:09
  that's what I try to emulate
• 12:11
  in my practice.
• 12:12
  I always wanna know personal details about my
• 12:15
  patients because I think it also
• 12:18
  helps me focus
• 12:20
  on
• 12:21
  not just the medicine, but how their back
• 12:24
  pain or how their
• 12:26
  leg pain, how does it
• 12:28
  it how does it translate in their life?
• 12:30
  Because they're not just a spine that I
• 12:32
  need to operate on. They're
• 12:34
  a person who I can help.
• 12:37
  And I think
• 12:39
  if we look at ourselves that way and
• 12:42
  treat ourselves as humans,
• 12:44
  then
• 12:46
  as we train and as we get better
• 12:49
  and as we,
• 12:51
  you know, evolve in our physician practices,
• 12:54
  we're gonna be that much better.
• 12:57
  I like that the way you're framing that
• 12:59
  too. It's like the surgeon
• 13:00
  takes care of themselves, then that
• 13:03
  translates to just
• 13:05
  the positive interactions with the patients, etcetera.
• 13:09
  Yeah. I
• 13:11
  mean, how many times have you ever had
• 13:12
  a doctor
• 13:13
  where you're like, wow. That guy is a
• 13:15
  machine, and you think
• 13:17
  he's probably technically really good,
• 13:20
  but
• 13:21
  is he gonna take care of me in
• 13:22
  a moment of
• 13:25
  hardship?
• 13:25
  Like, is he someone I can trust and
• 13:27
  talk to? I think
• 13:29
  when you
• 13:30
  really reflect on
• 13:32
  the physicians that
• 13:34
  kind
• 13:36
  of have been great,
• 13:38
  their technical skills
• 13:40
  have to be good,
• 13:41
  but it's their humanity that kind of
• 13:44
  triggers that emotional response. Right? Because when I
• 13:47
  want to take care of someone or when
• 13:49
  I want someone to take care of me,
• 13:51
  I don't want a machine.
• 13:53
  I want a doctor who understands
• 13:55
  there are nuances to my life. And so,
• 13:58
  I think by embracing the nuances in your
• 14:01
  own life
• 14:02
  through training,
• 14:03
  afterwards, throughout your entire career, and after,
• 14:07
  I think that if you can focus on
• 14:09
  those aspects of your life, you will come
• 14:11
  out that much better of a doctor.
• 14:14
  Very well said. And, doctor Jo, last question
• 14:17
  I have for you. What are the three
• 14:19
  top trends that you're following in health care
• 14:21
  today? You can think broadly, spine specific.
• 14:26
  Yeah. I think the things that we really
• 14:28
  face are
• 14:29
  the changes in insurance.
• 14:32
  Right? There's just been so many,
• 14:36
  issues with insurance companies
• 14:38
  with the way that, spine coding
• 14:41
  is,
• 14:43
  going forward, whether or not we're gonna have
• 14:45
  bundled care.
• 14:46
  And then I think those aspects of medicine,
• 14:49
  the financial aspects of medicine are a huge
• 14:52
  component of how our patients receive care.
• 14:55
  I think medical training
• 14:58
  is also a huge trend or not trend,
• 15:01
  but medical training and
• 15:03
  access to training,
• 15:05
  whether or not,
• 15:06
  you know, medical students
• 15:08
  can afford
• 15:09
  to train,
• 15:10
  and
• 15:11
  whether or not they pick
• 15:14
  specialties based on income
• 15:17
  that is going to be huge as in
• 15:19
  medicine in general, probably less so in subspecialties
• 15:23
  like spine and neurosurgery,
• 15:25
  but I think that is a huge player
• 15:27
  in
• 15:29
  medical education going forward.
• 15:31
  And I think that
• 15:33
  the biggest trend
• 15:35
  in spine
• 15:36
  is our embrace of,
• 15:38
  you know, technology.
• 15:40
  I think there are just so many different
• 15:42
  inventions
• 15:43
  coming forward
• 15:45
  that we just need to be critical in
• 15:47
  the way that we assess them. I think
• 15:49
  we assess things
• 15:51
  with research,
• 15:53
  with
• 15:54
  outcome studies. And now that large population databases
• 15:58
  are so readily available,
• 16:00
  I think we just need to be
• 16:02
  really keen
• 16:04
  on how we
• 16:05
  integrate those things into our practice.
• 16:08
  I think that we should embrace
• 16:11
  change, but we shouldn't just rush into things
• 16:14
  like we've always talked about.
• 16:17
  Great. Well, doctor Jo, thank you so much
• 16:19
  for joining us today. It's been a pleasure
• 16:21
  to catch up, and I hope you have
• 16:23
  a happy holiday.
• 16:24
  You too. Thank you so much for having
• 16:26
  me.