TRANSCRIPT 🔗
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Hi, this is Tom George.
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I'm the CEO at the Michigan State Medical Society, and welcome to our podcast, Protecting Physicians, Preserving Medicine.
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And in this podcast, we'll be talking to some of our members who are leaders in their fields to find out how they're navigating changing times, the changing times that we're all experiencing in healthcare.
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Today, my guest is Dr.
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Guaram Sharma.
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Guaram, welcome to my program.
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Thank you so much, Dr.
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Dr.
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Sharma is a pathologist, a clinical and molecular pathologist at Henry Ford Health Systems.
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He's the immediate past president of the Wayne County Medical Society and one of the leaders in healthcare innovation in our state.
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Welcome to my program.
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It's a delight to have you here.
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And I wanted to start by asking you about your journey from Delhi to Michigan and Henry Ford.
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Thank you so much, first of all, for inviting me.
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I'm so lucky to sit in this historical building and read about MSMS and its illustrious history in this state.
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My journey is like many of us.
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A journey started with great intentions and with a series of detours and landing up in a spot where you find yourself to be very lucky.
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I was born in India.
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I grew up in Delhi.
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And my father is a pathologist in India.
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He runs his own community-based practice of pathology.
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He's an owner and operator.
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And when I was a kid, I used to observe him.
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I used to observe that he would see over a hundred patients a day.
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Did he invite you to follow him around?
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Maybe a day or two.
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But I think as a pathologist, you always observe, and as a kid too.
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So yes, yeah, you know, I would I would go and uh visit his clinic and then observe these people coming up to him and giving them their or showing their medical notes to him, and he would actually help them identify the right test.
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We would perform the testing right uh in the premises and give them the report the same day.
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And what was fascinating for me was the incredible reach that he had in the community because he used to see these families again and again.
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So I resemble my father a lot.
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So I would go to a shop to buy something, and they would recognize me and they would give me a discount.
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And I said, wow.
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The other thing was I noticed that as a pathologist, there was a lot of emphasis in his life about data, about clarity of what he's going to say or write.
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And I appreciated that.
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So once I was done with my medical school, uh I was looking at avenues of where I want to do.
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And you know what?
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I realized that my father was incredibly lucky because when he trained in India as a pathologist, pathology and microbiology and biochemistry was in his syllabus.
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However, by the time I graduated, you could only train in either pathology or a microbiology or a biochemistry track.
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So my father would joke with me that I was always going to be one-third a good as a pathologist, as him, and that's in good spirits.
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I realized that the United States still had the anatomical pathology, clinical pathology track, which covers all these disciplines.
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And of course, the United States is and was at the forefront of genetics.
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So I made the decision to pursue my training here.
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So that brought me to Detroit, and I was very lucky to get a spot at Henry Ford Health and I did my residency there.
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And in my residency, I understood something very basic, which is the electronic health record holds all the data and the insights.
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And because it does that, if you really want to be a good physician, you have to understand the electronic health record.
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And the labs, in fact, are 70% of data in anybody's electronic health record.
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So that prompted me to go to the University of Pittsburgh and do an informatics fellowship.
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And then came back to Michigan because I was missing Michigan, I'll be honest, my wife and I, and uh did my training here in molecular genetic pathology.
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Uh, and uh with that skill set, I always tell my friends I'm a pathologist whose skill set is a mile wide but an inch deep.
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Why do I say that?
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Because these fields move forward a lot every year, and it's impossible to know everything about everyone and every field, but I have the pleasure of working with a great team of clinical chemists, microbiologists, and pathologists at Henry Ford.
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So delighted to be in this state, delighted to be a part of uh the profession of medicine in Michigan, and delighted to be part of Henry Ford.
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Load full transcript
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So it was in your blood?
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In a way, you can say, yeah, I was uh born into it.
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Um did you know you were gonna go into pathology when you started medical school then?
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It sounds like it it was a likely possibility.
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Well, you're absolutely right.
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You know, in fact, when I graduated, uh my medical school offered me uh a resident spot in dermatology.
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And somehow, after much uh thinking, I chose a different path to come back to pathology.
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So to answer your question, yes, I had a strong inclination of going towards that.
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Now you describe like your father actually seeing patients.
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Yes.
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The patients would come to the to the lab, they'd be referred for studies, and he he would actually know the patients.
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Yes.
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That that you know seems uncommon today that the pathologist actually has a face-to-face interaction with patients.
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Yes, you you're absolutely right.
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And it's a different way of practice.
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So, like you have a primary care physician that you go with every problem, big or small.
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Um, in that model, if you needed a blood test, you or or any kind of test, you would go to a pathology clinic and get seen by a pathologist, and the pathologist would make sure that the test that was ordered was the right one for the disease.
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Uh, and call the doctor and say, hey, maybe you want to change this.
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Um now, 20 years later, I say on the spot utilization management, if you think about it, making sure that the right patient is getting the right test.
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Um, but that is how pathology is practiced in other parts of the world.
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With your um informatics background, I think this is a fascinating kind of marriage of, you know, you talked about the data being held in the labs and the the transition to electronic medical records.
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So you you live through that transition.
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Oh, yes.
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When you started, the rec records were paper.
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Absolutely.
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You're right.
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When I started off uh during President Obama's term, there was a great incentive to transition to electronic health record, and we went from 14% to I think more than 90% in a few years.
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While that was mandated as part of that legislation, I think what it led to is this great adaptation.
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Uh, and I lived through it.
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Not only that, I also saw the difference in the data that not all healthcare data is the same.
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For example, a lot of it is qualitative data.
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So when you write a clinic note, you are describing, you are a human being describing what you saw, what you observed, compared to billing data, which is very objective and very factual, compared to lab data, which is an intersection of both.
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So, yes, I lived through it.
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And now we actually see the power of data with all the new companies coming in and you know, trying to find on mine insights of this data that has accumulated over the last decade or so.
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Tell me a little bit about where AI is going to fit in all this and where you see things going, and how maybe you're using AI today.
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So I would describe myself as a realist, neither an optimist nor a pessimist.
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Because I think we have to understand the fact that AI is a technological tool which is augmenting human intelligence.
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People always frame this as well, AI take over medical work, the physician's work.
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I would say most probably not.
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I would say that a physician with AI would definitely outperform a physician with no AI.
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So that's the paradigm.
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I think what AI does is it has tremendous ability to do repetitive work with high fidelity, which we were previously using humans for.
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A clinician's time was spent flipping through the records, trying to get the last imaging study or the last clinic note.
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And I think AI can automate much of that.
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Having said that, I'm also a realist because AI is intelligence.
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It's not contextualization.
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So sometimes AI misses the mark on that.
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And I think we have to be careful.
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So President Reagan used to say, trust but verify.
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And I think AI is a partner that you can trust, but you need to verify.
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Yeah, I think that makes sense.
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And I'm wondering if there's an analogy, and maybe this is isn't quite fair, but I'm sure there was a time when pathologists, you know, read blood smears with a microscope by hand and they counted the cells in the field to determine whatever a count of a certain kind of cell.
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And then a machine came along that could do it.
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And I'm sure there was some anxiety over, you know, should we can we trust the result from the machine?
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You know, there was a transition period.
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And, you know, I see this in my own specialty, anesthesiology, you know, uh, too.
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I mean, we have automatic blood pressure cuffs, we take them for granted now.
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But when they first came out, it was like, I don't know, I better, you know, I'm gonna check that by hand just to make sure.
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Now we've become accustomed to it and we don't really question it.
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Um, so I'm I'm I mean, I'm sure that you know that this this is a a repeating theme where new technology comes out, we're suspicious of it.
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There are some issues, you know, but over time you you know, we we we make improvements and um uh then you know then then we adopt it and we recognize its limitations and we use it, you know, hopefully appropriately.
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But it seems like there are analogies, there would be other analogies, you know, that have occurred from time to time, you know, in the field of pathology before.
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Um my brother-in-law is a radiologist, and we often joke that 30 years back it was said that we won't need any radiologist and we won't see need any cars because everybody will be driving an electric car.
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And now we joke that he is a radiologist who goes to work every day driving a car.
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So I I think what you are pointing to is the way we as a society think.
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We always buy into a very optimist, hyped up future, but then we actually when get to it and we adapt it, we know its pros as well as its cons.
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And sometimes unexpected and powerful capabilities.
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And as we go through it, we sort of titrate down to a level that is realistic and reproducible, and most importantly, safe for patients.
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Don't you think that is very important?
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Patient safety comes first, and we only get to know it after we have adopted technology.
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What um what do you advise your medical students and residents, you know, when they ask about the future of your field and about medicine in general?
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I would say, first of all, medicine was and is a noble profession.
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Um the reason why they should, and I hope they will continue to come into this profession, is to help the fellow human being.
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And I think that need for empathy and understanding will never go away, whether you have AI, either as artificial intelligence or augmented intelligence in your clinic or not.
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I think they should always have an open mind and adapt, learn the new systems, and then process it.
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What I caution most of them is know your niche.
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Not everybody can be everything.
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You know, I I read Indic philosophy, and there is a quote in that, and it says, it is better for a person to be the best in what they are supposed to do compared to be better at what somebody else is supposed to do, right?
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So I'm a pathologist, my first job is to be a great pathologist.
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Can I be more knowledgeable than somebody in family medicine or radiology or allergy?
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Maybe yes, maybe no, but that's not my job.
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So knowing our niche is really important because then once you know what you are good at and what you are being asked to know about, you can really drill down.
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And I think in this world where everything is a big distraction, people sort of dilute their focus.
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So they're doing this now, but then they move on to something else, then they move on to something else.
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So I think knowing your natural home is important.
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That's the third piece of advice I give them.
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I know you must be a good teacher, and I know that because one of your residents uh won the Joseph Weiss Essay Award.
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Yes.
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And I saw it in the Wayne County Medical Society's um magazine, uh the Detroit Medical News, um, and and his essay touches on some of these themes, you know, uh the human touch versus technology.
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And I I couldn't help but wonder if you had inspired part of that.
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So Dr.
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Baba is an incredibly talented physician.
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Uh before he did residency, he in fact did uh two years of informatics training.
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And you know, it might look as a paradox that here are two informatics people talking about empathy, but that's what we really understood after the end of the training that informatics is understanding, it is the tool to get to what you really need to do, which is help the human have a better life.
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So I I just I think that's fascinating.
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So the two of you have this informatics background, but really it leads you to uh an appreciation of the human touch that's required in medicine.
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Exactly.
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You you're absolutely right, because you know, at the end, what is to be a physician uh it's less about our degree, it's more our more about our ability.
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So my grandmother used to teach me a very simple fact of life, which is what should a person pursue and it boils down to three pursuits that must run in parallel.
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The
first pursuit that every person should do is the pursuit of knowledge or saraswati, which means to learn about things that better us and help us better others.
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So, for example, a doctor goes to a medical school to gain the knowledge, then does a residency or a fellowship to gain the skills to be a good physician.
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The second pursuit is the pursuit of prosperity or luxury.
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That is a pursuit that once you have the skills that can help society, hopefully society will give you the resources and means to have a prosperous and comfortable living.
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There is a third pursuit, which is pursuit of security and wellness, that is durga, which means once you are knowledgeable, once you have a comfortable living, you should still feel secure that whatever you have accumulated in terms of your knowledge is still useful, and in terms of with your means is still secure.
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So that comes with the power of influence.
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And if you think back, don't you agree that as a physician, when you become a doctor, you automatically put yourself on a pursuit that hits all the three ideas that I gave you.
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We have knowledge that can help patients.
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Nobody else has that.
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We have the means, or we are respected in society that most of us have a comfortable living.
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And lastly, our profession with AI, without AI, without anything, the world will still be needed.
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So we'll have a security.
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So I think medicine is a profession that fulfills this natural human need for knowledge, prosperity, and security.
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And to me, that's the best profession still.
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That's a kind of a wonderful way to um to consolidate it.
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I hadn't thought of that, but it seems to be a fundamental truth.
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So, yeah, so if you're sharing that with your students and residents, I think they would they would find that very inspiring.
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And can I can I can I share a very core idea that comes out of it?
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By all means.
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Once you're trained as an anesthesiologist, that is the saraswati you have, no one in this world can take that knowledge from you.
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Agreed?
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Once you have built your reputation and your influence, that's your durga.
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Unless you do something bad, nobody else can take it away, right?
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And finally, prosperity, right?
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Prosperity is a waxing and waning cycle, right?
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But that is an outcome that comes from the year that you have invested.
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What I see in today's generation is this oh, we want to get the return on investment fast.
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And sometimes, you know, we want it too fast.
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We just don't want to invest that much in getting that core knowledge base in place, getting those frameworks in place or qualifications in place.
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So sometimes that's an interesting philosophical discussion that I have, like the one we are having.
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Uh but uh I think there are many other ways to look at what you want in life, and I think being a physician opens your mind to a lot of probabilities.
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So your grandmother was one of your mentors, you know.
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Are there were there any other people that were really influential in guiding your pathology career?
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You mentioned your father and your grandmother.
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Yes.
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So my father was uh the one who set me on the path.
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Um, I would like to give a lot of credit to Dr.
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Richard Zarbu.
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He's the chairman of the Department of Pathology at Henry Ford.
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He was the one who hired me as a first-year resident in pathology.
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Uh wow, about 20 years back.
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And now I serve uh with him as his vice chair.
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Uh, he's been incredibly supportive.
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Uh we work in a medical group, and the medical group invests a lot in the physicians at Henry Ford, and uh we have great CEOs, uh including Dr.
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Steve Palcanis, who invests a lot of resources in making sure that everybody, including pathologists, are able to grow in their field.
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And I would give a lot of credit to College of American Pathologists.
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Why?
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Because it is organized medicine and pathology.
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That is one organization in the last 20 years has supported and trained me with the skills that are not traditionally taught in medical schools.
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For example, going and meeting a senator.
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I'm sure as a former senator yourself, you You would agree that it's a skill and an art that we must inculcate, and it's incredibly influential.
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Yeah, that's a good segue into your work in organized medicine.
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Yes, we do.
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And so it started with the College of American Pathologists, and you've served on at least one of their committees.
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Yes.
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But then you also became
involved in the Wayne County Medical Society.
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You served as the president-elect, the president, you're cycling through.
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So I want I want to tell me a little bit about your involvement with Wayne County Medical Society, how you got started.
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You know, you you you had this introduction, apparently, through the pathology uh uh uh society, um, but how you transitioned or how you moved from that and and and became so involved in your county medical society.
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So you will find it interesting.
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It all started with me opening an email.
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You know, we get a hundred emails every day.
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Many of them are from state societies, many of them are from county medical society from our respective colleges.
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So one fine day I opened an email from Wayne County Medical Society that our medical group uh sponsors us for, and it had an invitation called Young Physician Essay Competition in the honor of Dr.
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Wise.
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I'm sure you're familiar with it.
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Here is the thing: you know, because of my early upbringing, I have this philosophy friend of mind.
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And if you remember those dark days of 2020 when COVID was everywhere, I asked myself, this isn't the first time that there has been a calamity of this scale in human history in terms of disruption of society.
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So let's find out uh how did people react, how did leaders react?
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And I came across the story of Marcus Aurelius.
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So Marcus Aurelius was the last of the good Roman emperors, and he was a stoic, and he was known to be extremely capable, but extremely balanced, because he was taught and practiced Stoicism, and he kept the Roman Empire through a plague, through an economic uh ruin, and numerous rebellions.
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So I thought he had something that I need to learn about, and that was Stoicism.
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So I started writing about Stoicism, and that's why I ended up becoming an essayist on the weekends.
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So I wrote an essay for Wayne County Medical Society, Wayne County Medical Society accepted it, published it, and I thought, so they are not talking about pathology, but they're talking about things that relate to medicine.
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And that's when I started writing more and more about their newsletter.
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I got an editorial board and eventually made it through the board and was elected the president.
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So, as I said in the beginning, life is a series of detours, never planned, but you're delighted to reach where you are.
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You know, it's interesting, and um I just make the observation that in the journal of the American Medical Association, Ojama, which AMA members get, there's a regular feature, a piece of my mind.
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Yeah.
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And it is a usually a story written by a physician, uh, you know, maybe about a patient or experience, or it's often very philosophical.
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But I know for many years that was the most commonly read piece in JAMA.
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And so I think you've, you know, you've hit on something interesting.
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And I'm wondering, did your writing and your involvement in the Wayne County Medical Society, is that, I mean, I know it's important to you, but do you see that as maybe a way to avoid burnout or a way to you know enhance your your professional uh satisfaction, you know, by reaching out and being involved with other physicians?
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I think you have the answer in your question.
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So let's look at the term society.
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So medical society is a society, but what is society?
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So society is a collection of people who have something in common.
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So physician society is a medical society, but it is a deeper concept of fellowship.
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So if a group of people believe in something and their interests are to get somewhere, they form a fellowship, and that is a society in the modern context.
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So when you do that, you have conversations like you and I are having, and I learn from you, and you learn from me, and we also correct each other, right?
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So that dialogue is the basic thing that separates humans, that ability to dialogue with another person is what separates us from everybody else on this planet, right?
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And that helps has helped us become better and better with every generation.
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What we have often lost, I think, in the last 20 years with the rise of social media, is we are connected more, but we are more isolated.
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Because we are speaking at each other, but not with each other, right?
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So if you think about it, won't you agree that state medical societies, county medical society, and national medical society is your professional home, your fellowship, your society where you can go and speak to like-minded people, discuss your problems.
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Just discussing the problem is, I think, getting a relief of 50%, right?
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And then maybe you get solutions.
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So I think you have it right.
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The society is not just about a subscription, the society is about fellowship, about some common goal that we all
want to attain.
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What um what comes next as you pass through the presidential cycle at Wayne County?
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And if you want to say a few words about what the Wayne County Medical Society is up to, this would be a good time, but especially like what what what you see coming next.
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So I was uh very fortunate to serve as the president of Wayne County Medical Society, and I say fortunate because I follow in the footsteps of people who were invested in the health of Southeast Michigan, and that is one of the oldest counties in the United States.
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So there is a weight of history there.
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Um let's talk about history.
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Heraclitus, he was a Greek writer, and 2,500 years ago he wrote a line that is so profound that change is the only constant in the world.
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Nothing else.
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So I did my term, we adapted new ways of communicating, new aims to pursue, but then change is the only constant.
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So I finished my term, and we now have Dr.
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Fletcher who has taken over, a very capable leader.
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What I hope is there are a few things that we started, such as podcasts, that will help a newer generation of clinicians connect with us.
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And I'm so incredibly impressed that MSMS is starting this podcast series.
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Because guess what?
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People now consume digital media.
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And that is, if we have to have a future of fellowship, much of it would be digital.
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Doesn't mean that AI will replace this, it'll just mean that we'll be reaching out to far more people with better electronic means.
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That works for them.
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And your podcast through the Wayne County Medical Society is Clinical Connections, right?
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Yes, yeah, absolutely.
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That can be found on their website and on YouTube, right?
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Yes.
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So we decided to host our long-form podcast on the on our YouTube channel, WCMSSM, or you can just Google Wayne County Medical Society podcast, and you will have the opportunity to hear from leaders in Wayne County and talk about their different journeys.
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So we have someone who became a CEO, we have someone who is a chair of radiology, different paths, right?
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You know, and and you know what, as I said, life is detours, right?
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So if someone has walked that path before you, why not learn from them?
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Um well, thanks so much, Guara, for joining me, you know, on our podcast.
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It's been a delight.
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And I want to give a quick MSMS update, you know, to our viewers on some things that are happening uh within our organization.
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I know our members, uh, if they followed things, they know we've done some restructuring within the last year.
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And it it has led to a more important role that our committees are playing.
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So if you're an MSMS member and you want to be more involved in our processes and our decision making, then I would encourage you to consider joining one of our committees.
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We have several, they can be found on our website.
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We have a committee, for example, that reviews legislation a policy committee, a public health committee, a CME committee.
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We need help from our membership with driving, though.
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So please consider uh joining one of our committees.
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I wanted to give an update too on an issue that we have that's pending in the legislature that I think is important to our members.
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It's one we've been working on.
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Kind of relates to you know what we talked about a little bit with um uh some of the you know burdens that physicians face.
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And it has to do with the relicensure process in Michigan.
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If you've been here for a while, you might have noticed that Michigan has one of the higher bars for relicensure requiring 150 CME credits in a three-year cycle.
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That's at the extreme end.
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The national average is about 25 credits per year.
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That's 75 in a three-year cycle.
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So we have a bill that's in the legislature to do that.
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It's House Bill 5313.
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So if you're meeting with your legislator, tell them to support this bill, which would which would put our standard uh you know with the other states and would help reduce a little of the burden from relicensure.
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Well, thanks for viewing.
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Thank you, Dr.
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Scheimer, for joining me.
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And um, you can catch us next time on protecting physicians and preserving medicine.