Latest / Becker’s Healthcare Podcast / Bryant Lin, MD on Humanity, Hope, and Redefining Care Through the Patient Experience

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Bryant Lin, MD on Humanity, Hope, and Redefining Care Through the Patient Experience · Becker’s Healthcare Podcast

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- There's a small circle of people who truly
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- system right now. The decisions are enormous.
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- pressure test their thinking.
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- Becker's fourteenth annual CEO and CFO roundtable
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- brings together more than 1,500
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- executive level attendees
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- and nearly 400 speakers for four days built
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- around growth, financial sustainability,
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- workforce strategy, and the leadership questions that don't
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- Chicago.
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- For the agenda and event details,
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- visit beckershospitalreview.com
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- and click on the events tab in the
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- upper right.
0:50
- This is the Becker's Healthcare podcast, and I'm
0:52
- Molly Gamble. My guest today is doctor Bryant
0:55
- Lynn, a primary care physician, educator, and researcher
0:58
- at Stanford Medicine
0:59
- who approaches all three with humanity at the
1:02
- core. Doctor Lin first came onto my radar
1:04
- in early twenty twenty five when I read
1:05
- a New York Times profile of him under
1:07
- the headline, when this professor got cancer, he
1:09
- didn't quit. He taught a class about it.
1:12
- That line captures his resolve, but also something
1:14
- larger, what becomes possible when a physician lives
1:17
- through health care from the inside out as
1:19
- a patient and turns that experience into a
1:21
- lesson for the rest of us. Doctor Lin,
1:23
- welcome to the podcast. It's so good to
1:25
- have you with me today.
1:27
- Great to be here. Thanks for having me.
1:29
- Absolutely. That was a a little glimpse into
1:32
- you and your background, doctor Lin. But for
1:34
- our listeners, can you introduce yourself more fully?
1:36
- Tell us how you came to see health
1:38
- care from all three
1:39
- chairs at once as a a professor, as
1:41
- a physician, also as a patient.
1:44
- So, yeah, I've been on faculty at Stanford
1:46
- for, jeez, twenty years now. Time time definitely
1:49
- flies.
1:50
- Also practicing primary care,
1:53
- doing research. I cofounded the Center for Asian
1:56
- Health Research and Education at Stanford about eight
1:58
- years ago.
2:00
- And one of our prior priority areas has
2:02
- been around lung cancer in people who've never
2:05
- smoked with a with a focus on Asians.
2:07
- Ironically, in 2024,
2:10
- I was diagnosed myself
2:12
- with lung cancer,
2:13
- stage four lung cancer. So, you know, I
2:16
- I kind of had the opportunity
2:18
- I always look for a silver lining to
2:21
- experience health care from the vantage point of
2:23
- a researcher,
2:24
- you know, faculty member,
2:26
- primary care doctor, but also now a patient.
2:29
- And it's really, really been eye opening for
2:31
- me. I mean, it's I I kind of
2:33
- use this phrase with my students.
2:35
- I knew, but I didn't really know. You
2:37
- know, you don't really know, so you walk
2:39
- in those shoes of the patient.
2:41
- Mhmm. Mhmm. That's what we're gonna be I
2:44
- mean, we're gonna be unpacking a lot of
2:45
- that today.
2:47
- I I've done some reading about you and
2:49
- your story in the past, and you have
2:52
- said in various interviews that doctors
2:54
- are notoriously
2:55
- bad patients.
2:57
- Doctor Lin, what makes that true?
3:00
- I think a couple of things. One, of
3:02
- course,
3:03
- maybe we know enough to be dangerous,
3:07
- and, you know, we tend to like to
3:09
- take care of ourselves, and we get a
3:11
- lot of informal care. I I I've talked
3:13
- about this a few times that when I
3:15
- was diagnosed,
3:17
- I have the great fortune of my own
3:19
- primary care doctor. You know, his office is,
3:22
- like, across the way from me. So rather
3:24
- than getting an official appointment,
3:26
- you know, an official visit, it's easy for
3:28
- me to say, hey. You know, his name
3:31
- is doctor Paul Ford. Paul Ford. I said,
3:33
- hey, Paul. You know, can you write me
3:35
- this prescription? I'm having this cough.
3:38
- So when I was before I was diagnosed,
3:40
- I had a cough for six weeks. So
3:42
- it was very easy for me to, you
3:44
- know, to talk to him about it. But,
3:46
- you know, that's good and bad. Right? Sometimes
3:48
- you do need that formal visit. You know,
3:51
- you do need that,
3:54
- structure around what you're doing.
3:57
- And, also, you know, doctors tend to be,
3:59
- at least in my case, I can't speak
4:00
- for all doctors, but
4:02
- I can speak for myself. We tend to
4:04
- lag on kind of the regular maintenance
4:06
- preventative
4:07
- health care we're supposed to do. I'm, 52
4:10
- now. I got my
4:12
- colonoscopy,
4:14
- which, you know, they changed the recommended age
4:16
- on the guideline for 50 to 45,
4:19
- and I got it at 49.
4:20
- So, it was, you know, a few months
4:22
- before I got diagnosed with lung cancer. So,
4:24
- you know, an example of kind of, oh,
4:27
- I understand this. I know. I know.
4:29
- But, you know, it was really only because
4:31
- my wife pushed me to get my regular
4:34
- screening done that I did it. So, you
4:36
- know, an example, I would say, I I
4:38
- don't know I don't know any studies that
4:40
- have been done on this, but I know,
4:42
- several of my colleagues and myself who are
4:45
- kind of somewhat, lagging on, preventative health care.
4:48
- So just a couple of examples of how
4:51
- patients, how doctors can be poor patients, unfortunately.
4:55
- Yeah. I think it's an interesting
4:58
- paradox there. And and it sounds like in
5:00
- some ways, as much as they might lag,
5:02
- there's also a different level or baseline of
5:04
- of expectations
5:05
- or experiences
5:06
- firsthand with with health care and receiving health
5:09
- care guidance or or treatment or or being
5:11
- seen if by a colleague across the hall
5:13
- in an informal way.
5:15
- You the pace of your diagnosis,
5:17
- you've you've kind of under you mentioned, like,
5:19
- six weeks of having a cough.
5:22
- This was in 2024 you were diagnosed.
5:25
- It it took a span, right, of six
5:27
- days from the chest X-ray to the pathology
5:30
- result, and
5:32
- it sounds like that's not the norm. That
5:34
- is Can you That is,
5:36
- unbelievably
5:37
- fast. You know, I did you know, I
5:39
- wasn't pushing I mean, this is another example
5:41
- of sometimes
5:42
- physicians can push push for tests early, so
5:45
- I didn't push for an X-ray early
5:47
- because of my cough, which is, you know,
5:49
- common. A lot of people, not just doctors,
5:52
- you know, request X rays for their cough.
5:54
- You know, I'm very aware as a primary
5:56
- care doc that, you know, most people don't
5:58
- need an X-ray when they have a cough.
5:59
- So I kinda tried the usual things. But
6:02
- by the time I got to the point
6:04
- where my cough wasn't getting better after about
6:07
- five or six weeks,
6:08
- an x-ray, I still remember it was a
6:10
- Tuesday.
6:11
- I got a CT scan the next day
6:13
- because the x-ray was abnormal.
6:15
- And then I had a bronchoscopy that Friday,
6:18
- and the pathology results were back by that
6:20
- Monday. So that was Wow. Six days.
6:23
- So, you know,
6:24
- I I think that is an example of
6:26
- how our health care system can work very
6:29
- well. Right? Mhmm. It's you know, that sounds
6:32
- like an amazing thing, and it was amazing
6:35
- because I have all the privilege. Right? Everything
6:38
- I check off all the boxes
6:40
- of how things can go well for a
6:42
- patient. Unfortunately,
6:44
- most people don't have those boxes checked or
6:46
- any of the boxes checked. Right? So, that
6:49
- shouldn't you you know, you and I are
6:51
- talking about this as an exception.
6:53
- It shouldn't be the exception. It should be
6:55
- the rule. That should be what we're striving
6:57
- to, and I hope we achieve that. So,
7:00
- you know, what worked well for me? Right?
7:02
- Number one and, actually, in my class, I
7:05
- talk about this. I even wrote a book
7:07
- about my class. I didn't even intend to
7:09
- write a book about it, and I kind
7:11
- of expanded on this really thinking about what
7:13
- went right for me.
7:15
- The number one thing, which actually the students
7:18
- didn't pick up, was I speak English. I'm
7:21
- a fluent English speaker. Mhmm. Right? That's a
7:24
- huge barrier for many of our patients.
7:26
- Even if you have a translator, the highest
7:28
- degree of translator,
7:29
- it's still an obstacle. Right? There's an obstacle
7:32
- of understanding.
7:33
- Know and then, of course, you know, all
7:35
- the other aspects of of access. Right? So,
7:39
- you know, we had in our class, the
7:40
- our chief medical officer, doctor Nir Sehgal, was
7:43
- there talking about access.
7:45
- And, you know, I have insurance.
7:47
- Of course, I have good insurance, standard standard
7:50
- kind of standard insurance.
7:52
- I have, you know, financial resources. I have
7:55
- a job. I have flexible working hours. I
7:58
- can, you know, ask my colleagues to cover
8:00
- for me. You know, we don't often think
8:02
- of that as for a doctor, but, you
8:03
- know, doctors, we're we're constantly covering for each
8:06
- other. If we're out sick, we're out for
8:08
- other reasons.
8:09
- Mhmm. I have transportation
8:11
- that can get to and from
8:13
- my appointments, you know, even though they may
8:15
- be at different locations.
8:17
- I can even get somebody you know, I
8:18
- have a great care support network. I can
8:20
- my wife's here with me. My older son
8:23
- drives. Well, he's back from college for the
8:26
- summer. So when he's here, he can drive
8:28
- me. But, you know, my sister and her
8:30
- her husband live nearby, and they drive. And
8:33
- they can take me to my appointments if
8:34
- if if I don't feel well or I
8:36
- can't drive myself.
8:38
- You know, so and then, you know, health
8:40
- literacy. Right? I'm a doctor. I
8:42
- theoretically know you know, have enough knowledge to
8:45
- understand my care.
8:47
- So all of these things and there are
8:48
- many, many, many other aspects of access that
8:51
- your listeners are honestly probably more expert than
8:53
- me about, but, you know, I experienced these
8:56
- firsthand,
8:58
- about how things could go right for me.
9:00
- I also know, of course, have connections. I
9:02
- can call up somebody in my in my
9:04
- hospital and say, hey. You know, can I
9:06
- get an appointment?
9:08
- So all of these things work worked for
9:10
- me. They should be able to work for
9:13
- everyone this way. And and I think we're
9:15
- trying. Right? Patient navigation,
9:17
- especially in oncology, is very common.
9:19
- But, you know, I think we can do
9:21
- better. I think we can definitely do better
9:22
- across the board. Mhmm.
9:25
- Doctor Lind, did the six day turnaround, did
9:27
- it have a measurable difference in in your
9:30
- treatment,
9:31
- in in I I imagine the personal stress
9:33
- that you must have felt or anxiety to
9:35
- I think waiting is such a difficult part
9:37
- of any health care journey. But can you
9:39
- speak to what what was different about having
9:41
- that turned around in six days versus the
9:42
- baseline, which would be much longer?
9:45
- Absolutely. It did. I think,
9:48
- you know, even though my overall long term
9:51
- prognosis
9:52
- is number one, poor and number two, uncertain,
9:56
- I would say that short term anxiety
9:59
- of not having a plan
10:02
- is very, very stressful, very emotional,
10:05
- you know, especially at the beginning when you're
10:07
- being diagnosed. And, you know, I went through
10:09
- kind of all the five stages of grief
10:11
- in different order rapidly several times.
10:14
- And, you know, having that diagnosis enables you
10:18
- to get a plan. But once you have
10:20
- the plan,
10:21
- at least in my case, and and I
10:23
- know just from experience as a primary care
10:25
- doc,
10:26
- that does settle people down, and that did
10:29
- in my case, you know, it settles you
10:31
- down. Hey. I have a plan. I know
10:32
- what to do. I have my appointments to
10:35
- go to. I have a follow-up scan. You
10:38
- know, that really enables you
10:40
- to live your life again. And I think
10:42
- that to me is the kind of one
10:44
- of the basic principles
10:47
- of health care should be
10:49
- how do we help people live their lives,
10:52
- not live medical lives, but live the lives
10:55
- of what they're doing.
10:56
- You know, in in our class, the lung
10:58
- cancer class, I structured it so
11:01
- that actually most of the sessions, most of
11:04
- the lectures
11:05
- were about what the patient experiences and not
11:08
- so much we had a few sessions on
11:10
- few lectures on the science and treatment and
11:12
- so forth. But, you know, we talked about
11:14
- nutrition, spirituality,
11:15
- caregiving,
11:17
- access, you know, all of these things that
11:19
- really the patient experiences most of the time.
11:22
- You know? But, you know, as doctors in
11:24
- the health care system, you know, we're we're
11:26
- there for them. You know? Again, I'm just
11:29
- arbitrarily putting a number,
11:31
- you know, a single digit percentage of their
11:33
- life. Right? They're in the clinic, a tiny
11:35
- part of their life. They're in the infusion
11:37
- center, in the scanner, a tiny part of
11:39
- their life. Even in the hospital. Right? I
11:41
- mean, hopefully, they're not in the hospital 80%
11:44
- of their life. They're in the hospital, you
11:45
- know, a single digits percent of their time.
11:48
- And, you know, what we should be doing
11:50
- is enabling, empowering
11:52
- patients like myself
11:53
- to live their lives, you know, as best
11:56
- they can outside of the medical system.
11:59
- And, you know, I I think that's that's
12:02
- that's the goal and really,
12:04
- you know, being a patient myself open that
12:07
- lens to me. You know, again, I knew.
12:09
- Right? Of course, patients are not in the
12:12
- hospital, not in my clinic,
12:13
- but that's not how you see them because,
12:15
- you know, you're seeing them in the clinic.
12:16
- You're seeing them in the hospital. So this
12:19
- is kind of the I knew, but I
12:20
- didn't really know.
12:22
- I I I'm fascinated by that distinction. It's
12:24
- like you you see things on paper. You
12:26
- see things in the textbook, and they make
12:27
- sense intellectually. But until you've lived it, it's
12:30
- a different level of resonance. And you you've
12:32
- mentioned your class. Let's let's talk more about
12:34
- your class. I mean,
12:36
- when I introduced you as having resolve, you
12:38
- you after your diagnosis, you built a course
12:41
- around your own diagnosis and you teach it
12:43
- to medical students,
12:45
- of everything in this curriculum, maybe to underscore
12:48
- the point we just made, but what's one
12:50
- lesson
12:51
- that you really want the next generation of
12:52
- physicians to carry forward, not just theoretically,
12:56
- but to really embrace maybe with a different
12:58
- level of
12:59
- intensity than they otherwise would if they had
13:01
- a professor who was teaching them purely from
13:04
- textbook?
13:05
- Yeah. I I I mean, it's a great
13:07
- question. I I thought about that a lot.
13:09
- I mean, my initial goals for the class
13:11
- were
13:12
- really,
13:13
- you know, seeing how we could encourage
13:15
- students to go into some aspect of cancer
13:17
- care, which which I think we achieved. And,
13:20
- obviously, that's a little bit self self fulfilling
13:22
- because you're not gonna sign up for the
13:24
- class unless you're interested in something about cancer,
13:27
- whether it's a researcher or a primary care
13:29
- doc. But to me, it really
13:32
- became about
13:33
- seeing patients,
13:35
- which, you know, that we do in education,
13:37
- but, again, adding
13:39
- emphasis to how patients are not patients. They're
13:42
- human beings. Right?
13:44
- They are out there living their lives. They're
13:47
- trying to find
13:49
- their happiness every day. Right?
13:52
- So, you know, I really wanted to put
13:54
- a face to that. In medical school so
13:57
- we had undergrads and medical students and different
13:59
- other graduate students as well, who's mostly medical
14:02
- students in our class.
14:04
- And, you know, you don't get much continuity
14:07
- in training. Right? It's just
14:09
- difficult to do. Right? You see one patient
14:11
- and then maybe for a few days, and
14:12
- then you see another patient.
14:14
- But, you know, I thought this was a
14:15
- unique opportunity for me to share my experience
14:19
- over,
14:19
- you know, ten weeks of a class, really
14:22
- a little bit more than ten weeks of
14:23
- the class,
14:24
- and from somebody who could speak to it
14:26
- as a patient and a physician.
14:28
- And, you know, really, to me, it was
14:30
- the emphasis that
14:32
- it's the holistic care we should be providing,
14:35
- not in the kind of, you know, I
14:37
- hate to say, kumbaya
14:39
- kind of way of holistic care. You know,
14:41
- I think that word has this stigma to
14:44
- it. Right? For some reason,
14:45
- you know, we should be providing
14:47
- holistic care, but maybe, you know, I I
14:49
- know semantics are important, so I would call
14:51
- it human care. And and, of course, in
14:53
- this day of AI,
14:56
- to me, that's just more important, you know,
14:58
- than ever
14:59
- to really emphasize
15:01
- to to our future doctors or future generations
15:03
- of not just clinicians, but researchers and health
15:07
- care administrators
15:09
- and, you know, all all the other clinicians,
15:11
- you know, not just physicians
15:13
- and, you know, all the staff, all the
15:15
- wonderful people providing the care
15:17
- that, you know, it's it's really
15:20
- about taking care of people as as human
15:22
- beings.
15:23
- Mhmm. Not as you know, You know, we
15:26
- have to do numbers. Right? Of course. You
15:28
- know, it's all about quality and efficiency and
15:31
- so forth. But, you know, there are humans
15:33
- behind every number, and it should be there
15:36
- are humans first, and then there are numbers
15:37
- second.
15:38
- So I think it is easy to lose,
15:40
- and I've been guilty of this.
15:42
- It's easy to lose sight of that when
15:45
- you're so busy and you're trying to, you
15:46
- know, get health care systems run efficiently
15:49
- and not lose money.
15:51
- You know, the human should come first and
15:54
- the number second.
15:55
- So, you know, we were talking about kind
15:57
- of this old bio I had and, you
15:59
- know, how I described myself. And, you know,
16:02
- I really believe
16:04
- even when I wrote it years ago and
16:06
- and now that, you know, my focus is
16:08
- on, like, keeping,
16:09
- you know, technology, all of these great things
16:11
- we have, they're secondary to support of medicine,
16:15
- which is humans taking care of other human
16:17
- beings.
16:18
- Mhmm.
16:20
- I I think that is such a powerful
16:21
- message, and it sounds it it can sound
16:23
- trite or obvious, but I think to your
16:25
- point, unless you are really believing in it
16:28
- in the day to day, it is easy
16:29
- to get distracted by KPIs and all these
16:32
- other metrics, dashboards,
16:34
- efficiencies.
16:36
- But if if you lose sight of that,
16:37
- it it's it's you're really losing, I imagine,
16:40
- quite a lot in the world of medicine.
16:41
- So Absolutely
16:43
- insidious. You know? My even my 14 year
16:45
- old son has heard KPI before, which is
16:47
- funny. Right? Even a 14 year old kid
16:50
- would have heard that term. Right? You know
16:52
- what? That sort of filtered out through society,
16:55
- not just health care, like the idea that
16:57
- we gotta measure everything.
16:59
- I mean, we should measure things, but we
17:00
- should remember there there's there there are many
17:03
- other things more important than numbers.
17:05
- Completely
17:06
- agreed.
17:07
- Also, as you were
17:09
- did you receive
17:10
- care at Stanford? Were you kind of holding
17:12
- up a mirror with this course to your
17:14
- own institution?
17:16
- All my care has been at Stanford, and
17:18
- I have to say it's been amazing.
17:21
- You know, they have done an amazing job.
17:23
- You know, part of this, again, is my
17:25
- privilege. Right? I'm an insider. I've been there
17:27
- for twenty years.
17:29
- So, you know, but I I think,
17:31
- you know, I I
17:32
- am so grateful for the high level of
17:34
- care I've gotten.
17:36
- I think it's interesting.
17:38
- You know, the people I've spent most time
17:40
- with are actually the infusion nurses because you're
17:42
- sitting there for an hour
17:44
- kinda getting an IV. Originally, in my case,
17:46
- when I switched meds, I was there for,
17:48
- like, two nine hour days getting an IV
17:50
- infusion.
17:51
- And, you know, those would be that's the
17:53
- human face
17:54
- of your health care system.
17:56
- And, you know, I'm really grateful that you
17:59
- know, I'm grateful to all my doctors and,
18:01
- you know, my primary care doctor, my oncologist,
18:03
- doctor Heather Wakeley.
18:04
- But, you know, really, the people who are
18:06
- putting in,
18:08
- you know, the the face to face time
18:10
- because they can, but, also, they're they're so
18:13
- empathetic. I think that's where, you know, nurses
18:17
- appropriately get
18:18
- many of the kudos for,
18:21
- you know, being caring and and really supporting
18:23
- patients because, you know, that's really their job.
18:26
- Their job is the face, and that's why
18:28
- I think most of them go into the
18:30
- profession.
18:32
- You know, honestly,
18:33
- probably better than doctors at doing that. I
18:36
- think there have been there's been studies. There's
18:38
- evidence to show that. But,
18:41
- so, like, no. I'm really grateful for all
18:42
- the care, the amazing care I've gotten at
18:44
- Stanford. And this is this is not an
18:46
- advertisement. Nobody's paying me Of course. Of course.
18:48
- Salary, but not they're not paying me to
18:51
- say this.
18:52
- Of course. I think it's an important distinction.
18:54
- It's like you using the term you're holding
18:56
- a mirror up. It's it's this is this
18:58
- is your home in many more ways than
18:59
- one.
19:00
- What's maybe if you can recall as a
19:02
- patient, what's what's one of the more
19:04
- uncomfortable,
19:05
- I suppose,
19:06
- things that you learned, something that
19:08
- really looked pretty different as a patient than
19:11
- it does from the faculty level, from the
19:13
- c suite, and then something that our listeners
19:15
- just might be at risk of of underestimating.
19:18
- I think I think the whole prior authorization
19:22
- mess
19:23
- is really
19:24
- again, I knew it because I was on
19:26
- the doctor's side. You know? I filled out,
19:28
- you know, forms and provided
19:30
- letters
19:31
- to try to get things approved, you know,
19:33
- either imaging or medications for my patients.
19:37
- And, you know, it was kind of, you
19:39
- know, everybody hates doing all the doctors, of
19:41
- course, hate doing it. And Mhmm. It's a
19:43
- big burden on our system.
19:45
- But, you know, from the patient perspective, it's
19:47
- incredibly,
19:48
- incredibly,
19:50
- I would say, stressful and and even damaging.
19:53
- So I I I can share two examples.
19:56
- One was early on. I had my X-ray,
19:58
- and and for some reason, the,
20:01
- I think the prioritization
20:03
- wasn't submitted in time. But, you know, I
20:05
- signed off to say, hey. I'd pay for
20:07
- it if it wasn't covered.
20:09
- But so, you know, the CT scan that
20:11
- diagnosed my lung cancer,
20:13
- just because the system didn't work, you know,
20:16
- I got a bill for that because the
20:17
- insurance just kept rejecting it and rejecting it
20:19
- because things weren't done in exactly the right
20:22
- checkbox order. Right? Even though it was Yeah.
20:25
- So I got a big bill for that.
20:27
- Right? I mean, for me, I could do
20:29
- it, but, I mean, luckily, we took care
20:30
- of it. But it's stressful to have to
20:32
- call and call and email and email
20:35
- to try to take care of this huge
20:36
- bill when you're dealing with, you know, a
20:39
- new diagnosis of
20:41
- terminal cancer. Right? So Mhmm. That was one
20:43
- where I I realized, and and I'm like,
20:45
- god. I'm never gonna sign that patient,
20:48
- you know, whatever they call it, patient agreement
20:49
- for financial responsibility form again. I'm never gonna
20:52
- do that because it was I mean, it
20:54
- got taken care of, but it's such a,
20:55
- you know, hassle and painful to do that.
20:58
- Right. So the other thing was, you know,
21:00
- for my medication. So,
21:03
- I in in last fall in 2025,
21:06
- I had progression of my cancer,
21:08
- and so I had to change treatments. My
21:10
- oncologist, doctor Heather Wakeley,
21:12
- good friend of mine, chief of oncology,
21:15
- one of the literally the most famous
21:18
- lung cancer, thoracic oncology
21:21
- oncologists in the world. Like, she was the
21:23
- president of one of the societies. And Mhmm.
21:25
- And so she's, you know, she's, like, you
21:28
- know, the expert,
21:30
- in lung cancer care. And in particular, my
21:32
- type of cancer,
21:34
- she's even more expert,
21:36
- if if one could say that. So, you
21:38
- know, she, of course, prescribed the medication,
21:42
- which so I was on
21:44
- evidence based treatment before a chemotherapy in Tagrisso.
21:47
- And then it was changed to
21:50
- Rybrevant
21:51
- and losertin in last clues,
21:53
- which is a antibody and a targeted therapy.
21:56
- And
21:57
- it was rejected by insurance. You know? So
22:00
- the oral therapy,
22:01
- the the last dose was rejected twice, and
22:04
- the IVU was rejected once. I still remember
22:07
- this is a Friday.
22:08
- And to start this medication, it's, you know,
22:10
- it's a lot, two nine hour days of
22:12
- infusion. So it was a infusion. So it
22:13
- was a Friday, and I got a message
22:15
- from the nurse saying,
22:16
- hey. Don't go because we haven't heard from
22:18
- your insurance. And then on the Monday,
22:22
- I, you know, they I I was on
22:25
- a video appointment with, my oncologist, and she's
22:27
- like, why aren't you at the infusion?
22:29
- And I said, you know, I because it
22:31
- was eight 8AM, so she hadn't seen her
22:33
- messages. And the the message was sent, like,
22:35
- late Friday. And I was like, jeez. I,
22:37
- you know, I heard insurance hadn't covered it.
22:39
- And she said, let me let me see
22:40
- what's going on. And it was rejected. So
22:43
- the IV treatment was rejected, and and I
22:45
- was so upset. I mean, so stressful.
22:48
- My, you know, my symptoms were getting worse.
22:50
- I had a horrible cough,
22:51
- and my my right lung was filling up
22:54
- with fluid. I had a pleural effusion.
22:57
- And,
22:57
- I was so mad, so I posted on
22:59
- LinkedIn. And and, you know, it went viral.
23:02
- I got you know, for LinkedIn, I had,
23:03
- like, a 100,000, 200,000, 300,000,
23:06
- I think, 500, 600,000,
23:08
- impressions by the next
23:10
- morning.
23:11
- And then, of course, once that went viral,
23:14
- it got approved, like, within two hours. Wow.
23:17
- So, you know, I have that again, I
23:19
- have this privilege because I have this platform
23:21
- to do that. But Yeah. You could imagine.
23:23
- Right? There's a delay. It takes time, and
23:26
- and, you know, I hear this number all
23:27
- the time. I don't know where it comes
23:29
- from. You know, these prior authorizations, once they
23:32
- go to external review,
23:34
- 80% of them are approved. So, you know,
23:36
- that doesn't speak well to how we're
23:39
- looking. And I I'm not blaming
23:41
- any particular insurance. I think it's just the
23:43
- whole
23:44
- system and the idea
23:46
- of prior authorizations.
23:47
- I know no one with cancer who's getting
23:50
- unnecessary
23:51
- cancer treatment.
23:53
- Nobody.
23:54
- I mean, I I don't see how you
23:55
- could argue that in, you know, an oncologist
23:58
- and the patient are doing things because these
24:00
- are unpleasant treatments. I mean, these are not
24:03
- fun to do.
24:04
- And if the oncologist thinks it's appropriate,
24:07
- you know, it should be covered, and the
24:09
- onus should be on the insurance company
24:12
- to really rather than not right now, the
24:14
- onus is on the patient and physician. And
24:17
- and, you know, we spent hours
24:19
- writing letters and things,
24:21
- you know, to get these these treatments approved.
24:24
- So, you know, to me, again, I knew,
24:26
- but I didn't really know
24:28
- how damaging,
24:30
- this idea of prior auths. And, again, I'm
24:33
- not blaming one because every insurance does this.
24:36
- Right.
24:36
- And and it's very much, you know,
24:39
- very nitpicky. Right? I happen to follow not
24:41
- exactly
24:42
- because my treatment was cutting edge. It was
24:45
- approved FDA approved,
24:47
- but because I had already had chemotherapy,
24:50
- the the the guidelines, the NCCN guidelines, which
24:53
- are the standard
24:54
- cancer guidelines for treatment,
24:56
- didn't take that to account
24:58
- that, oh, you all would have already had
25:00
- it because they required
25:01
- approval. They would say, oh, you have to
25:03
- do chemo in addition. But it made no
25:05
- sense to me because I already had you
25:07
- know, for me, I already had chemo because
25:09
- that that standard of care had changed
25:11
- that for people like me, you would do
25:13
- Tagrisso plus chemo.
25:15
- So I I mean, I don't wanna get
25:16
- in the weeds of that. But, yeah, it's
25:18
- just very to me,
25:20
- you know, it's incredible, like, how many people
25:22
- may have just given up
25:24
- and not got treatment. I I mean, I
25:25
- give you an example. Later that week, because
25:28
- the treatment was delayed a week, I had
25:29
- to get one point three liters
25:31
- of fluid drained from my lung.
25:34
- Wow. Because I couldn't I was coughing and
25:36
- felt terrible. I couldn't sleep.
25:39
- And, you know, maybe. I don't know. Maybe
25:41
- that would not have been necessary
25:43
- had I started treatment when it was supposed
25:45
- to start.
25:47
- So, you know, it's it's it's upsetting
25:49
- to me as a doctor
25:51
- and even more upsetting to me as a
25:52
- patient
25:53
- that I had to do that.
25:56
- And it's challenging. And, you know, this happens
25:58
- all the time. It happens every day.
25:59
- Yeah. No.
26:01
- The the billions that prior auth cost in
26:04
- terms of, like, the administrative burden of it,
26:06
- the inefficiencies,
26:07
- but then I think beyond those big numbers
26:09
- that sometimes are a little numbing when you
26:11
- get to these stories about
26:13
- it it's not as though you were,
26:16
- for a nine hour, right, nine hour IV
26:19
- treatment session to be Two days. Two two
26:21
- nine hour days. Yeah. Yeah. It's not something
26:24
- I'm getting unnecessarily.
26:25
- You know? It's like Exactly. Oh, this is
26:27
- unnecessary. I mean, it's it's kind of amazing
26:30
- that Yeah. I mean, I can understand maybe
26:32
- for very specific things, but, you know, again,
26:35
- I've never met anybody who's gotten unnecessary
26:38
- cancer treatment.
26:39
- You know, we're we're again, this is the
26:41
- human insurances here
26:44
- supposedly to serve us. Right?
26:46
- Because we are mixing you know,
26:49
- I'm happy to pay in the system,
26:51
- you know, as a healthy person. I was
26:53
- healthy for many years, and I paid into
26:54
- the system. And that helped other people get
26:57
- their care. Right? That's the whole purpose of
26:59
- insurance. You've got healthy people, and you unfortunately,
27:02
- in my case, now I'm in the kind
27:04
- of unhealthy
27:05
- group that's eating up money, but that's why
27:08
- you have a, you know, a large pool
27:09
- of people so you can reduce that overall
27:12
- risk. Right? You shouldn't be nitpicking
27:14
- every detail of individuals
27:17
- because then it's I mean, that's not the
27:19
- point. The point is you have a pool
27:21
- of people and, you know, it's a subsidy.
27:23
- It's kind of a almost a Robinhood model.
27:26
- You could call it. Right? The healthy people
27:28
- subsidize the poor people because the the not
27:30
- the poor people. Subsidize the sick people because,
27:34
- that's the way the system works. That's how
27:36
- it can work. Mhmm.
27:38
- Something needs to change there. I know there's
27:40
- different initiatives in place to make it less
27:42
- burdensome, but it is what you just outlined
27:44
- is so highly intrusive.
27:46
- It's so,
27:47
- tightly wound at the front end. And then
27:49
- to your point about LinkedIn posts,
27:51
- it's it's, you know, it's addressed. So So
27:53
- it's amazing how these things do get resolved,
27:55
- but the time lost
27:57
- to to figuring this out while you're dealing
27:59
- with a new diagnosis and trying to update
28:01
- your your care, it's,
28:03
- it's intrusive to say the least. And it's
28:05
- not just the patient. It's the whole family.
28:07
- Right? Yeah. Very much so. The whole family's
28:09
- gotta put their lives on hold. They're stressed.
28:12
- You know?
28:13
- You know? What are you do you know,
28:14
- you're like, jeez. What do I do? Just
28:16
- like what I said earlier, when you have
28:17
- a plan,
28:18
- things calm down. When there's uncertainty,
28:21
- you know, that's really when the anxiety kicks
28:23
- in.
28:25
- Yeah. Doctor Lin, I wanna end on a
28:28
- note that I think is hopefully a hopeful
28:30
- and optimistic one.
28:32
- There is I talked to talked to numerous
28:35
- clinical leaders, clinicians,
28:37
- and there's a good amount of of worry
28:40
- as of late, probably a little bit more
28:42
- pronounced in the past two two to three
28:43
- years about the clinicians and the doctors coming
28:46
- up right now who are
28:48
- have Gen AI available to them, the instant
28:51
- answers fast instant
28:53
- like, so instant now more than ever that
28:56
- a lot of people worry will leave them
28:57
- lacking traits that the generation before them had.
29:01
- As as physicians,
29:03
- can you
29:04
- you you actually teach these students. You interact
29:06
- with them regularly.
29:08
- Is that fear right? And if you can,
29:11
- can you just tell us about a student
29:12
- or a moment in your classroom
29:14
- that has really left an impression on you
29:16
- and shown you that the people who'll be
29:17
- caring for us down the road are are
29:19
- gonna be just fine?
29:22
- So it's a great question. You know? I
29:24
- think this is not just a question question
29:27
- medicine.
29:28
- It's a question in across all of education.
29:30
- Right?
29:31
- What do we need to teach? What what
29:34
- do we need to encourage
29:36
- students, learners
29:37
- to to understand,
29:39
- you know, in this age of AI?
29:41
- You know, I don't have the answer to
29:43
- that because, you know, I it's interesting. I
29:45
- went to my son's in terms of what
29:46
- we need to learn, I went to my
29:48
- son's undergraduate
29:50
- school. He goes to Chapman. He just finished
29:52
- his freshman year. And, you know, they made
29:55
- a point. There's a faculty panel. Well, you
29:58
- know, we used to all need to learn
29:59
- how to spell. Right? Yeah. You know? But
30:01
- now nobody needs to know how to spell.
30:02
- I mean, of course, there's the wizard spellers
30:05
- in the spelling bee, but, you know, nobody
30:07
- needs to know how to spell, and nobody
30:09
- cares about that, honestly. I mean, very few
30:11
- people are, you know, saying, jeez. That's a
30:14
- that's a skill
30:15
- that we've lost and that was important. And,
30:18
- you know, same thing with handwriting and so
30:20
- forth.
30:21
- You know, in medicine, we've already seen this
30:22
- to a certain degree with the physical physical
30:25
- exam.
30:26
- So it used to be even when I
30:28
- was training, you know, whatever, almost thirty years
30:30
- ago,
30:31
- you know, the physical exam was really emphasized.
30:33
- You know, listening using
30:35
- the stethoscope, listening to the heart and lungs,
30:38
- you know,
30:39
- the neurologic exam, the eye exam, you know,
30:42
- all of these
30:43
- exam features.
30:45
- But now,
30:47
- you know, it seemed it's less emphasized because
30:49
- we have all these amazing tests. Right? You
30:52
- know, why you know, if if you're kind
30:54
- of
30:55
- you know, if you're not a cardiologist,
30:57
- you know, do you need to be a
30:59
- super expert to identify every little heart murmur
31:02
- when you have an echocardiogram, which is probably
31:06
- no matter how good you get at it,
31:08
- probably gonna better be better than you are.
31:10
- Right? Just period. Right? Because it's the gold
31:12
- standard. Right?
31:14
- So,
31:15
- you know, so that's very interesting. I mean,
31:17
- there's many arguments for
31:19
- continuing to be very good at the physical
31:22
- exam, but it's definitely something that I think
31:24
- we've all perceived that's been, you know, lot
31:28
- somewhat lost over the years of
31:30
- medical training,
31:31
- that emphasis and that that skill of the
31:33
- physical exam.
31:35
- But on the other side, it's like we
31:36
- have technology. Right? I still remember
31:39
- and sorry for the long winded answer. I
31:41
- was I I'm from Tennessee. We were during
31:44
- COVID,
31:45
- we took a road trip to the Smoky
31:46
- Mountains
31:47
- in Gatlinburg, Tennessee.
31:49
- And I'm a woodworker, and there was, like,
31:51
- this little, like, woodworking shop. And I'm like,
31:53
- oh, we gotta stop and talk to the
31:55
- guy.
31:55
- And the guy's, like,
31:57
- died, like, a to true Tennessee, and, you
32:00
- know, he's got his you know, he's got,
32:02
- like, sawdust all over himself. And and I
32:05
- saw he had some guitars, not just his
32:07
- furniture, but he had some guitars. And I
32:08
- said, hey. Did you did you make these
32:10
- guitars? He's like, yeah. I made these guitars.
32:12
- And I said, hey. Did you, you know,
32:14
- did you did you, like, hand plane everything?
32:16
- Did you you know? Because, you know, we're
32:18
- kind of obsessed nowadays with making things by
32:21
- hand. And he's like he just looked at
32:23
- me strange, and he looked at me and
32:24
- he said, I have electricity.
32:29
- So he's like, you know, why would I
32:31
- hand plane it when I've got these tools,
32:33
- like, these machines to do it? I'm sure
32:35
- he could do it. Right? But, you know,
32:37
- he was quite skilled. The the guitars looked
32:39
- beautiful.
32:40
- So that's the thing. It's like, yeah, we
32:42
- have electricity. We have technology. Why not use
32:44
- them?
32:45
- Mhmm. So so so, yeah, I don't know
32:47
- in terms of and it's hard to predict
32:49
- because
32:50
- we don't know what skills
32:53
- will be missing, what we needed. I think
32:56
- we need to continue to monitor. So this
32:58
- is the thing. I think what the way
33:00
- we can adapt to this AI
33:03
- world is really monitoring outcomes to make sure
33:06
- things don't get worse. Right? And and like
33:09
- we do with everything, you know, making sure
33:10
- we're improving quality. But on the positive side
33:13
- so, again, sorry for long winded answer.
33:16
- I've asked this question to a couple of
33:17
- different groups.
33:19
- And one group,
33:22
- was a group of,
33:23
- you know, kind of AI for this is
33:25
- a medical education conference at Stanford on AI.
33:28
- And
33:29
- and I asked them, I said, how many
33:30
- of you raise your hand
33:32
- if you
33:34
- are comfortable having an AI doctor.
33:36
- And, you know, a lot of people this
33:38
- is the AI, like, enthusiast audience. A lot
33:40
- of people raise their hand. And then I
33:42
- asked them,
33:43
- hey. How many of you would be comfortable
33:45
- having an AI doctor if you were diagnosed
33:48
- with stage four lung cancer?
33:50
- Fewer people raise their hand. And then I
33:52
- asked them the third question. I said, hey.
33:54
- How many of you
33:56
- would wanna have an AI doctor at the
33:58
- end of life? And
34:00
- still a couple of people raise their hand,
34:01
- but even fewer.
34:03
- When I asked this question,
34:05
- you know, to physicians
34:07
- and students
34:09
- I mean, the older physicians got nobody even
34:11
- for the first question, nobody raises their hand.
34:13
- Like, they don't even wanna Right. But even
34:15
- with younger, you know, students' positions,
34:18
- you know, that's a much less they they
34:20
- wouldn't even for themselves,
34:22
- they recognize the importance
34:24
- of that humanity. So, you know, I've had
34:27
- almost nobody
34:28
- raise their hands for the second or third
34:30
- question when it's a physician or a student
34:33
- audience. So, you know, I I think that
34:35
- because they're talking about themselves. Right? So Right.
34:38
- You know, that's what they want for themselves.
34:40
- You know, that's hopefully what they're gonna be
34:42
- looking for, providing for their patients. So,
34:46
- you know, I do think they recognize that
34:48
- it's the humanity
34:49
- in medicine that's important,
34:51
- and AI is just a tool. It's just
34:53
- a tool.
34:54
- Again, I don't know. I I I I'm
34:57
- I don't think anybody knows kind of what
34:59
- are the skills we need, what are the
35:00
- skills we don't,
35:02
- and that's gonna shake itself out. I think
35:04
- we need to monitor and make sure, you
35:06
- know, we don't have descaling. Right? There was
35:07
- a study about
35:09
- people,
35:10
- gastroenterologists
35:11
- doing colonoscopies
35:12
- and, you know, people getting deskilled about identifying
35:15
- certain things.
35:17
- But, you know, we can measure that and
35:18
- we can adapt,
35:20
- to that.
35:22
- You know, and certain things AI is probably
35:24
- gonna be better than us. And it's like,
35:25
- well, if it's better than us,
35:27
- why do we need humans? Right? It's sort
35:29
- of like, jeez. If it was a Waymo
35:32
- world,
35:33
- you know, and there are no no card
35:34
- s, you know, maybe that's just a better
35:37
- world to live in. So, yeah, that part
35:39
- I don't know. But I'm very hopeful about
35:42
- the future of students and residents because,
35:44
- you know, I I think they're all even
35:47
- with all these tools,
35:48
- you know, they're all very aware that they're
35:50
- taking care of people and they're trying to
35:52
- help other people.
35:54
- Mhmm.
35:55
- I really like that three part question that
35:57
- you asked.
35:58
- And I think that to your point, it's
36:00
- I love the story too about I have
36:02
- electricity. I mean, that's that's so true. There
36:04
- is a lot of mixed feelings at times
36:06
- about AI in different fields, particularly in medicine
36:09
- and health care, but,
36:11
- I think you really in your front part
36:12
- of that answer helped explain the nuance of
36:14
- this, why
36:16
- medical students gravitating toward it or being more
36:18
- open to it than maybe others are is
36:20
- not a bad thing. But,
36:21
- to hear the hand raising ratios in those
36:24
- different groups, I think, really does sum it
36:26
- all up.
36:28
- Yeah. Doctor Lin Yeah. I I I just
36:30
- wanna thank you. Were you gonna add something
36:32
- there?
36:33
- No. No. No. I mean, yeah,
36:34
- I'm a positive guy. You know? Yeah. I
36:36
- tend to be I mean, obviously,
36:38
- if I weren't, I wouldn't be with I
36:40
- wouldn't be on the air with I wouldn't
36:41
- be on the podcast with you. You know,
36:43
- I'm generally very optimistic. I mean, this is
36:46
- why I teach. Right? Yeah. Teaching is so
36:48
- like, you see the next generation
36:51
- and, you know, of course, you see the
36:52
- things that always happen. Right? Oh, I remember
36:55
- when I was a student exploring and, you
36:57
- know, some things don't change. Like this question
36:59
- about technology. Right? You know, they ask these
37:01
- same questions a generation ago, two generations ago.
37:04
- Right? Such and such is ruining our profession.
37:06
- And and,
37:08
- you know, but, you know, I think students
37:11
- working with
37:12
- students and trainees always gives me hope. Always
37:15
- gives me hope. Both for my own case,
37:17
- you know. You know, I I it gives
37:20
- me hope that, you know, if I if
37:21
- I live long enough to the next treatment
37:24
- that these students will be taking care of
37:26
- me. Right? And coming up with the next
37:28
- wonder drug for me,
37:30
- you know, I I I think these these
37:32
- students give me hope, and it's part of
37:34
- why that's actually probably the main reason
37:37
- I teach.
37:38
- And, you know, I'm I write about my
37:40
- experience and, you know, come on podcasts.
37:43
- You know, I I I could do other
37:45
- things,
37:46
- you know, could be traveling the world. I
37:48
- could be on the beach right now.
37:50
- But, you know, I I think doing things
37:52
- that are hopeful is is really great, and
37:54
- these students
37:55
- and trainees, you know, they give me hope,
37:57
- and,
37:58
- it's fun. Give me a little bit of
38:00
- sunshine in my life every day.
38:03
- I I I can't thank you enough for
38:04
- sharing that with us,
38:06
- on this podcast with our audience today. To
38:08
- your point, you could be on the beach.
38:09
- You could be doing a lot of different
38:10
- things with your time, but your perspective is
38:13
- remarkable.
38:14
- Your students are quite lucky, and so are
38:16
- we to have the chance to get to
38:17
- visit with you like this and hear from
38:19
- you firsthand, doctor Lin. So thank you so
38:21
- much. Again, listeners, this is doctor Bryant Lin,
38:24
- primary care physician, educator, researcher, and as you
38:27
- just heard so much more at Stanford Medicine.
38:30
- Doctor Lin, I just wanna thank you again
38:31
- for being my guest today. Great to visit,
38:33
- and I hope we can do this again.
38:34
- Great. Thanks, Molly. Thanks for having me.