Unlocking the Potential of AI in Medicine

April 10, 2024 | Podcast: Future-Ready Business

AI holds immense promise in revolutionizing medicine, from improving diagnostic accuracy to streamlining administrative tasks. However, its integration must be carefully managed to ensure patient privacy, regulatory compliance, and preservation of the doctor-patient relationship. As with any technological advancement, the key is finding the right balance.

In this episode of FRB, Art Cavazos and Courtney White discuss with family medicine physician Dr. Lane Aiena the benefits of value-based healthcare, the potential of AI in medicine, and the importance of sustaining the human touch that is at the heart of healthcare.

Featured This Episode

Our Hosts:
Art Cavazos

Art Cavazos
Partner, San Antonio
Twitter “X”: @FinanceLawyer
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Courtney White
Research Attorney, Dallas & Houston
Instagram: @courthousecouture
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Episode Guest:

Dr. Lane Aiena
Family Medicine Physician
Host of Doc To The Future Podcast
Twitter “X”: @DrLaneAiena

Episode Transcription

Art Cavazos: Hi, I’m Art Cavazos, a finance and corporate lawyer with Jackson Walker, and this is Future-Ready Business. I’m joined today by my co-host, Courtney White, and we’re excited to be talking with our special guest, Dr. Lane Aiena, about the future of healthcare. Dr. Aiena is a returning guest—and you should go check out our previous episode if you haven’t listened to it already. But before we jump in, as always I’d like to remind our listeners that the opinions expressed today do not necessarily reflect the views of Jackson Walker, its clients, or any of their respective affiliates. This podcast is for informational and entertainment purposes only, and does not constitute legal advice. So, Lane? Dr. Aiena? I forget what you prefer.

Dr. Lane Aiena: Lane is fine.

Art Cavazos: I know you’re not one to stand on formal titles. For those listeners who may not have heard the podcast we did previously, why don’t you tell us a little bit about yourself and your background?

Dr. Lane Aiena: Sure. Art, Courtney, thank y’all for having me back. I was so excited when you reached out and excited to be back. This is a great podcast, and I’ve listened to all the episodes since and all the episodes before, so keep up the great work.

Art Cavazos: Thank you.

Dr. Lane Aiena: Yeah, absolutely, man. My name is Lane Aiena. I’m a family medicine doctor in Huntsville, Texas. I work for a small private practice, Huntsville Family Medicine. I am the host of my own podcast that I will occasionally upload a new episode for but not near frequently enough, called Doc to the Future. I serve on the Texas Academy of Family Physicians Board of Directors, and I’m the current president of my County Medical Society. Here locally, I am on the Walker County Hospital District Board and serve as one of the board members for that. And, most importantly, father to four incredible kiddos, and we stay busy, my wife and I over here in Huntsville. It’s great to be back.

Art Cavazos: Excellent. And Courtney, obviously a valued member of the Future-Ready Business team, but for those who this might be their first episode, why don’t you tell us a little bit about yourself, as well?

Courtney White: Hi, Art. Thank you. I am a research attorney in the Houston office of Jackson Walker by day, and by night I am Courthouse Couture on Instagram, TikTok, YouTube, Pinterest, and my own blog, because I’m a lawyer who also happens to love fashion.

Art Cavazos: Awesome. So, we’re going to be talking today about a few different topics. We’re definitely getting into AI in medicine, which is like in every industry a very hot topic right now, but before we do that I did want to check in with you, Lane, on what we talked about in last year’s episode, which was the transition from fee-for-service to value-based care and kind of the wide-reaching effects that that was going to have on the healthcare industry. I just wanted to see what’s changed, what hasn’t, since last year? Maybe can you start with a reminder for us, you know, what exactly is fee-for-service and value-based care?

Dr. Lane Aiena: Sure. So, fee-for-service is the system we’re in currently. I provide a service, I charge a fee. So, you come in from a visit, there’s a fee you pay, you go in for a heart cath, you get an MRI, whatever that service is, you get a fee. And that’s the current system we have. The system is very expensive in current medicine, as we all know (it takes up by a third of the economy), and the fear is – and the fact is, frankly – it’s just not sustainable. So, there’s been – and I don’t want to rehash everything we talked about in the last episode, but just briefly – there’s been a big push to find something that we can continue into the future and not bankrupt the system. One of the ways that we’re looking into that would be to move away from the fee-for-service and find a different way to pay for these systems.

What we had kind of talked about last time was this transition to value-based care. Now, what is value-based care? That goes away from you pay me for everything I do to what is the patient getting out of it, how are my results, what is the value of the care I’m providing? There is a continued transition to this, as in most things in medicine, nothing is happening quickly (most things in any field, right?). The Medicare Advantage plans are still growing. Those are the things you see advertised when it’s open enrollment. You see all of the – so, I joke with my patients, all those celebrities from the ’60s and ’70s that were really popular come back and tell you why you should pick the one that is sponsoring them, and William Shatner comes on and tells you why his is going to be the best one and it’s very confusing and convoluted, but that’s a lot of where it’s going. In the private sector, you see HMOs, the managed care plans, and they are pushing as well to shift a large percentage of their patient base to these plans.

On the more physician side of things, since you and I last talked, we actually partner with an ACO, Main Street Health, and it’s gone very well. This is not me in any way pushing any one or the other. This is just kind of my personal story of how we joined it. It’s getting more and more difficult for a small practice like ours to continue to be a small independent practice. So, we wanted to partner with an ACO to make sure we could continue to do that with our patients. Main Street has been great. They placed two navigators in our office, which are there to help start kind of a high touch model for patient care. The navigator comes in after the visit for some of the patients we have and talk to them about are their medicines they are having trouble affording, how are you doing getting to the clinic, is there anything that’s keeping you, between you and the doctor, some of those social determinants of health, the more recent phrase being non-medical drivers of health? And they help us to bridge that gap on the more technical and insurance side. Main Street, obviously, works with the contracts we have with the managed care plans. I personally don’t see as much of that. They will give me a form to make sure that we have all of the correct diagnoses that these forms also include. Have you done their mammogram? Are they up to date on their eye exams? If they’re diabetic? Are they up to date on colon screenings? So, it’s very helpful stuff and stuff that you think, you know, you do this every day, 30 times a day. But you’d be shocked at how many times I did not ask that guy, but his eye exam and he’s diabetic. It’s been very helpful. I think that medicine is going to continue moving this way, we have got to get more value out of the care we’re giving. I think that doctors understand this.

And we also understand that what we do for the patient only goes so far in the office, right? It’s not going to end these four walls of the clinic. It’s great to have a partner, since I have a small clinic and limited staff time, it’s great to have these people in the office now that are able to do things like call them and ask them which medicine are you having trouble affording? Hey, could you help them find a contractor that may be able to work with insurance to get a shower bar for them so that they don’t fall? Think of the medicine that saves the system in the long run. And that’s the case they make for this is that it’s saving money in the long run, and you’re getting more value for the money spent in medicine. So that’s kind of where it’s going. And that’s personally our little anecdote, if you will, as to what we’ve done the change and how we’re headed that direction since we last spoke.

Art Cavazos: And do you see anything changing as far as the timeframe that this is all occurring on? Or has any of that solidified a little bit more as to when the transition will be complete?

Dr. Lane Aiena: No, and I’m not sure what that would be, what that would look like. I know that there were bills in, at least in the state of Texas, I know there were bills, one in particular about can PPOs engage in these types of plans voluntarily. And it’s hard to get the house of medicine to agree on how to go forward in this because that’s the issue with once this change is enacted, we want to make sure that the patient’s first and foremost benefit. But we don’t want to leave any physicians behind. Right. And it’s tricky. With where does each individual specialty fit into this new payment model. We want to make sure that everyone is well represented everyone feels like they’re getting the right thing for them. And they feel like they can continue to serve their patients in the way that would be the most beneficial. There’s a lot of discussion there. I’m very active in the Texas Medical Association, as well as the Texas Academy of Family Physicians. And I’m on the Texas Medical Association’s workforce for alternative payment models. We’re still working on a sleeker name, but that’s what we are so far. And this is a discussion we have frequently of how can we make sure everyone in the house medicine feels representative? Because until we can come to an agreement, how can we go to the legislature and push a certain idea? It’s hard enough to get good ideas past right? It’s hard enough to enact change. But it’s that much more difficult. If we don’t agree with our partners, and it’s never anything vitriolic is we understand we all want to take care of the patient. So there’s ongoing discussions. I know that there’s a lot of people that are a lot smarter than I am working on some of these answers. It is moving forward. We certainly don’t have any kind of a concrete deadline. But we’ll see next year which bills come up and we’ll see how the house of medicine decides to go about that.

Courtney White: Lane, I know my question for you kind of stems from the fact that I’m not a doctor. But I used to be on the national policy board for the American Heart Association really because of both of my grandparents having strokes. And my father’s dementia we found out was caused because he was likely having silent strokes that we weren’t aware of. And one of the things that I thought was so interesting in the process of me even understanding my own father’s health was that as a lawyer, I’m taught to think critically and analyze everything. And even I was like, there’s so much for me to learn and understand and questions I need to ask when I’m going to the doctor and trying to piece together the puzzle of my dad’s health. So what I was really wondering, are there any efforts to try to combine the experiences of individuals from diverse backgrounds, all of those social determinants of health, individuals who actually have different socio economic backgrounds, individuals who are in rural communities, who may not have doctors near them, to try to use them as a part of the piece to the puzzle in providing this value managed care? Because I really, I personally think that value managed care ends up being better for the patient and for the doctor.

Dr. Lane Aiena: Absolutely. And one of the big things you kind of hit on there is one of the Texas getting the family physicians biggest push, which is access to care. It’s and that was a question that comes up often is what is the most important issue facing us, and the one that the doctors continue to say, is access to care. What’s the point of everything we do if people don’t have access to this care? So that’s critical. And I mean, we could do so many episodes on that one question alone of the different populations that are unfortunately underrepresented. Rural is one near and dear to my heart, I’m in a rural community. And when it comes down to it, logistically, it’s just hard to get care in a rural community. And during COVID, we saw that everyone wants to help a rural community. But logistically, Look, man, you’re at the end of the stop, you know, I mean, we’ve already passed out all the masks we’ve already passed out all of the PPE, as we were talking about back in the bad old days during COVID. It’s difficult and it’s expensive, and it’s time consuming to get care to rural areas. So how do we make that happen, and minority communities that are underrepresented? How do we get them there too? We want to give all of these people voices at the table, and the non-medical drivers of health, this recognition that, you know, 80% of patients health doesn’t happen in my office. Right? And the recognition is starting to bubble up to the surface of physicians, and it’s still new, it’s still not something that a lot of, it’s a lot of physicians, but I don’t know that it’s even the majority yet, but it’s getting there. Right?

This is a big topic that I think is important. I’m excited to see it being recognized. And like I said, like with these navigators here in our clinic, just use starting to use them over the past seven, eight months for non-medical drivers of Health has been a big, big difference maker for us, which we are so excited about. And you can see the differences in the health of these patients, you really can. Now, is my small clinic going to move the needle nationally? No, I can’t give you any data. We’re not big enough to generate it. But hopefully as more places sign on and we get more voices like the ones you referenced, that change can be enacted and we can start to get access to everyone that needs it.

Art Cavazos: Would you mind giving us just a little more kind of examples? Or how those navigators are helping with the non-medical determinants of health?

Dr. Lane Aiena: Sure. One good one is medicine prices. So let’s say aren’t you come to me? And I think I’m just going to, well, I mean, let me not use any medicine names. They didn’t pay us to mention them on here. So we won’t mention them. Right. But let’s say there’s a really expensive diabetic drug that has also been used for weight loss recently that I think would be really good for you. But insurance won’t cover it. Right? People can Google what I’m talking about if they haven’t heard it, right. So let’s say they want you to do that. But the insurance just flat out won’t cover it. You’re not diabetic, you’re pre diabetic, you’re on your way to diabetes, and you’re overweight. You know, the patient here is overweight. I can talk to the navigators and say, can you help them find an assistance plan? Can you help them find a way to afford this medication? It’s hard for me with such a small staff to go that extra mile, right, because my nurse is busy rooming my patients all day, the float we have is busy calling all the results and following up with results and talking to patients all day. We’re not even getting into prior authorizations, which we could do an entire episode of me just being angry about, which I’d love to do if you’ve got the time. But now I have people that can do that. And think of the health benefits of these patients getting a medicine with a program that was out there, they just weren’t available they didn’t know was available. Now they know what’s available, the navigators help them through it. Now they can get that medicine, which they wouldn’t had before they’ve lost the weight, they’re healthier, they’re fasting blood sugars gone down, their risk of diabetes has gone down. If your risk of diabetes and hypertension goes down with your obesity, your risk of heart disease has gone down. It takes 20 years to prove that’s going to help but that’s probably going to help right so that’s a big one right there.

The other one like I’ve kind of referenced earlier is if a patient needs, say a ramp built for their house, like I don’t know who to call for that. They don’t teach me that in medical school. But if the patient can’t get into their house, that’s not going to do much good if they just had knee surgery or god forbid an accident that’s affected their ambulation, they can help do things like that. And that’s where they really come into play. They can help them with other simple questions like, well, simple for them, not for me about insurance coverage, and maybe which Advantage plan would be best for me? Or do I even need an Advantage plan with traditional Medicare be better for me, that’s all well within their wheelhouse. So those are some of the things that they help us with. And, like I said, anytime that we can take our reach, and move it outside of these four walls, a clinic for the patients, you really start to see those benefits.

Art Cavazos: Awesome.

Courtney White: It sounds like to me, Lane, is that what they’re able to provide is kind of a bridge between medicine and social work. So actually being able to do some of the analysis that you just literally don’t have time for, in the amount of I think minutes, I was told that doctors have to kind of see their patients.

Dr. Lane Aiena: Right, I have 15 minutes. And there’s a lot, and I yelled references. I think two episodes ago, there’s a lot that people don’t see goes into law. And medicine, I thought it’s very similar. You see your doctor in the room, right, you don’t see the tutor one time we spend actually on the charting on the paperwork, doing the prior authorizations, et cetera, going over the lab results, the imaging results. It’s just a matter of how many hours are in the day. And at the end of the day, and I’m very open with my patients about this, I tell them, look, I got four kids at home, I cannot spend all day with you here I have 26 other patients to see today. And I have four kids that I would like to see grow up. So I can only dedicate so much time to you. Otherwise, I’m taking time away from the other patients. I’m taking time away from my kids taking time away from my wife, these are all things that all of us are juggling. On the other side of that coin. They’re here to see me. When I go to the doctor, look, it’s all about me right now. Right? I’m sick make me better. So it’s, it is a very complex issue, that does not have a simple answer, we’d have come up with it by now. But anytime that we could get help with some of these issues that I frankly just could not have ever tackled before. It has been, you know, exceptional. And hopefully more organizations can come around to help small clinics, rural clinics like mine that just don’t have the staff. If you’re a gigantic health system, you probably have several social workers, you have people that can do these things. This is part of the reason why clinics like ours, tend to be struggling right now, just part of it. There’s a lot of things that go into that, right. But they’d referenced a couple episodes ago about the smaller practices have the smaller staff, it’s the exact same in medicine, right? We have the smaller staffs, we can’t afford to throw in a social worker be nice, but it’s just not in the cards. But to have someone to help bridge that gap has been very nice.

Art Cavazos: So speaking of all of that administrative burden and paperwork, another topic we wanted to talk about today is AI in medicine, which is really something that even as recently as when we did the last episode kind of late 2022 wasn’t even really on the radar. And you know, here we are just a little over a year later. And it’s probably the number one topic on a lot of industries, but definitely also in medicine. Why don’t we start out, tell us a little bit about the importance of AI in medicine? And, you know, is this all kind of overblown and kind of a fad? Or is this something you think is going to have more of a lasting and real impact on the way that medicine is practiced?

Dr. Lane Aiena: It’s a fad. We can move on. No.

Art Cavazos: All right, we wrapped up.

Dr. Lane Aiena: Thanks. Great episode guys, join us next time. No, this is big. And this is where medicine is going to go. And I can say that with more confidence than most things that I have tried to predict in the future. The trick is, how does medicine, get in front of it and make sure that we’re utilizing it correctly, in a way that benefits patients first and foremost, and in a way that benefits physicians. And I want to really harp on that point, because back when we introduced electronic medical records, it really didn’t do any of those things. And what electronic medical records kind of turned into was glorified receipt generators. But that’s what they are. They don’t make patient care more efficient. They don’t make it better. There’s no interoperability, they don’t talk to each other. Each one slows me down and it takes away time that I should be spending with the patient. It’s a huge cause of burnout. If it’s not number one, it’s number two, right? When it comes to physician burnout, it just wasn’t implemented well. It should be a great idea. And there is every now and then I’ll still get handwritten charts from other small clinics and I can’t read a word of it because it’s in doctor scratch and doctor scratch is just as bad as the jokes say. I’m grateful for electronic records and that they make it easy to read. But these notes they produce are so big and so bloated from all the regulations and just trying to check boxes for proper billing. All I really need is just, a lot of times what they said at the physical exam and your assessment and plan. But that’s five, six pages that I have to sift through to find that stuff. And a lot of it’s auto generated so that the doctor that generated that note could also see 30 patients that day, and eventually get home to their family and eat and sleep and do those other normal human things that we all strive to do. So we need to make sure that AI in medicine is implemented smarter, and in a way that benefits patients. And if it benefits the doctor, and making medicine more efficient, both time and money wise, and more accurate than it will inherently benefit the patient.

Art Cavazos: What are some specific ways that AI is actually being used in medicine already? Or that you see it being used, you know, in the near future, just to kind of give some, kind of flesh out what it is exactly we’re talking about here?

Dr. Lane Aiena: Sure. I want to get out in front and say it straight up, I do not think it’s going to take our jobs. And I’ll kind of get into that as to why here in just a moment. There’s two big reasons I think why it won’t take our jobs. I’m hoping, maybe I’m hoping, but let’s just say I think it won’t take our jobs. One of the big areas that currently AI is pretty good at and we’re starting to see that field open up is radiology. And I was reading up that there is a company and I don’t remember their name, but they have developed an AI that can read chest X rays. Now, the vast majority of chest X rays I ordered are turnout normal, which is good, right? It’s good that the majority of people I see don’t have pneumonia. So what they’ve done is basically a screening technology test for gosh, I want to say like 75 different abnormalities that tend to come with chest X rays, and it kind of separates them into normal/abnormal, so it screens it for the radiologist. And then if there’s an abnormal one that flags what it thinks is abnormal, the radiologist checks it and goes from there, thus saving that radiologist a ton of time. That would be awesome.

In my practice, if I could integrate that with my EMR. Since we’re a small clinic, I do a lot of my own X rays now I still will often send to a radiologist and get a read back. But that’s not till a day or two later. So the patient wants an answer at the bedside and I want to give them an answer at the bedside. So oftentimes, I’m reading my own X rays. I would love to have something that could screen it and just say normal, abnormal, normal, abnormal. Now, the question is, well, Lane, what if the AI misses something? I miss something sometimes to, right. No human being is perfect. That’s why I rely on the radiologist, we will have to make sure there are checks and balances in these we will have to make sure these are studied in the same manner and rigor, the double blinded placebo controlled studies, that medicines are screened in right, we need to make sure that these are as accurate as they can be. I doubt that will ever be 100% accurate, but neither is the system we have right now. So can we develop it to be a more efficient and still better system, but still enact those same checks and balances? And they’re using them for other imaging as well I’d I think I’d read it. Maybe this was a YouTube video I caught about retina scanning. And I thought that was pretty fascinating. I don’t know, you show me. I’ll have patients bring in pictures of their retinas. And I’ll tell him, I have no idea what I’m looking at. I’m really glad that your ophthalmologist does because I, in med school, they don’t teach me what’s between the eyelids. They just told me to refer it out. So I’m very thankful for optometrist and ophthalmologist.

But an AI could help identify some of that stuff and maybe screening as well. Another way that AI is currently being used is with charting. And I’m really excited about that my wife asked if I was scared about AI and medicine, I would love, love, love for AI to do my notes. I would, just tell me where to sign and how much it costs because that would just take so much of the burden off. I could spend more time with my patients. It would be fantastic. And I actually got to have dinner, it was a group of doctors with a gentleman named Puneet Soni. And I apologize to him if he hears this and I mispronounce it with Suki. Suki AI. It’s one of the big players in AI right now. And you see the patient and it’s in your phone and you just basically say, alright, I’ve got a 28 year old male here with chest pain palpitations, he reported he was riding his bike and you just go through the whole note and it can do the note for you. And then I can tell it, here’s the prescriptions I want to send. Here are the orders I want to send. And it’s, their goal is for it to be able to generate it like I have a scribe there that can send my medicines for me write my note for me, do the orders for me. Pull up I could say, you know, Lane Aiena is here and it’ll pull up my labs from last time and the ones that it has learned are, you know, important to pull up when I’m there. Boy, I would love that.

So I’m really rooting for Suki and the people in that space and hoping that they can find a way to make it good and efficient and smart and integrate it, and that’s the tricky part is the integration. Because none of that really matters. I can’t integrate it with the EMR that we have. So there’s a lot of things in the way, if you will to make that happen. But these are, I talked to the guy, he’s a lot smarter than I am. So I think that there are people out there that can figure this out. And I’m very excited about that. Because again, if something like Suki can succeed, it kind of checks those boxes for us, right? It’s good for the patient. And it’s good for the doctor. And then it makes it efficient and makes it cheaper, and I can spend more time with the patient, which is what I was trained to do in the first place.

Art Cavazos: Yeah, and it definitely sounds like that scribing ability could really help with that burnout issue that you’re talking about. And you know, you mentioned how much you would love for AI to kind of takeover that piece of the job. And you mentioned, you know, right now physicians are kind of on average, spending two hours on electronic paperwork for every one hour that they’re actually spending with patients. And it just seems like that’s definitely backward ratio. And you mentioned accuracy. And obviously, that’s going to need to be addressed. What about privacy? Do you worry at all about your patient’s privacy using these applications?

Dr. Lane Aiena: Sure. No, I think that’s a great question. And I think that I’m worried about it. But I think that HIPAA is such a big deal here in America, I think that they will know that they have to adhere to those standards, because HIPAA has teeth. And HIPAA can cost you an enormous amount of money very, very, very, very quickly. So I’m always worried about the privacy for my patients. But unlike AI itself, which is kind of the Wild West, and we don’t know who’s going to regulate it, or how, I know how privacy is regulated in medicine, and they remind me of how it’s regulated all the time. So I’m not too worried that it will be regulated. So at least privacy is a pretty black and white answer of be private, or will charge you like 10 grand per patient that you let an information out of and if you have 5000 patients on your panel that got out, you can see how quickly that adds up.

Courtney White: You know, TeleDoc has become a really huge resource, especially during COVID. Because it kind of helps that gap that we were talking about that doctors deal with, especially in rural or other communities. Or if you have issues that are smaller in nature, and maybe you don’t need to go to the doctor, do you think there’s a possible way that AI could kind of be used to even screen patients initially, to kind of deal with their symptoms? And I didn’t know if there was any research or thoughts about that yet. Just curious.

Dr. Lane Aiena: Maybe. But that’s tricky. So if you look at what physicians do, and I’m just kind of thinking back to residency as far as triage goes, and this goes for nurse practitioners, it goes for nurses, it goes for physician assistants, as well. It’s not just the numbers we’re treating, it’s not just the reported symptoms, right? I can have two patients. A matter of fact, today, as a matter of fact, I had two different patients tell me chest pain, right. One of them was chest wall pain, which was musculoskeletal, which was absolutely no big deal. I told him to take some Advil and go on with his life. And he accepted that answer. He was thrilled that it wasn’t important, I could reproduce it on palpation, it was worse with moving that one arm didn’t fit any of the cardiac things. The other patient I spoke to recently had very classic cardiac symptoms. So I sent that patient to the hospital. Now, it’s going to take an AI that is very, very confident to be able to do that, right. And that’s when you start to get into legal issues, because some patients and this is one of the reasons why I don’t think AI will take our jobs, and we’ll get to the other one in a second.

It’s the art of medicine. And it is difficult, from a patient to patient, to patient to determine just from what they are saying, who is sick and who isn’t. It’s something that you take in as the whole patient, you take a look at the patient, right? Does this patient look sick? And that’s one thing Dr. Abraham taught me early in my training that I’ll never forget. He said I you know, when you walk in the room within the first 10 seconds, you should know if this patient sick or not just right, then you should be able to look at that patient and tell how important it is you should triage this patient right then. And that’s completely true. And patients will say things that are important to them that may not be important for this current diagnosis, they may leave things out that are very important to this diagnosis. But will the AI think to ask that, there is a certain human element to this that is going to be very difficult for AI to replicate? I don’t know that I would say impossible because two years ago, I’d have said what’s going on right now is impossible. And four years ago, I’d have said COVID was impossible. So who knows. But I do think that that human element, the art of medicine, even when you’re looking at a multimodal AI, which we could get into here in a moment, even if you feed it everything including a picture of the patient, is there a company that’s going to be willing to open themselves up legally, so saying that this patient is this, our AI is so good that it will never miss a patient that should have been sent to the ER, what would end up happening is they would turn up the sensitivity for that. And it would send way too many people to the ER and care would get way too expensive for legal reasons, and y’all are better at legal reasons than I am. So I’ll defer to y’all my question.

Art Cavazos: What you’re saying makes a lot of sense. And, you know, as far as multimodal AI, why don’t you tell us a little bit more about that?

Dr. Lane Aiena: Sure. So a lot of what people think about when they think of AI currently is ChatGPT, where I type in a question or a prompt, and it spits out something for me. And then it’s more of a single modal unit modal. I’m not sure what the exact phrase for that is. But that’s not medicine, right. And I was trying to think of an example of a single modal diagnosis I could use and the only thing I could think of is a completely otherwise healthy patient whose blood pressure runs high. That is single modal, right? This is a person with no other past medical history. 36 year old female, but due to some genetic bad luck, she has high blood pressure, nothing else is wrong. So I put in the high blood pressure, and it spits out the medicine that she should take but even then, does she has a family history of kidney diseases or any heart disease going on? Is she swelling in her legs? Could a diuretic benefit or more than something that would be you know, work elsewhere? Even then it’s iffy, right? Same with like a UTI. You think that’s pretty simple? Is the patient having burning with urination, right? Well, does that patient have kidney disease? Is that patient feverish? Are they having flank pain? What does the patient look like? Are they Is there a chance they’re going septic? I’ve had in seven years, I’ve had a handful of patients with UTIs that I sent to the hospital because once I saw them was like, no, or we’re not handling this with bills. So even then, you’re looking more at multimodal, now what a multimodal AI would be as I would submit the data for the patient. Here’s a patient 36 year old female presents with high blood pressure. Here is a picture currently of the patient here are her recent labs, hey, here’s an EKG that I just had done for her. Here’s a chest X ray she had three months ago. So that AI is looking at a whole bunch of different things, and compiling it down to one idea to spit back out to me. That’s the way it’s going to have to be in medicine, medicine will absolutely have to be multimodal, because medicine is inherently a multimodal field. As physicians, we use multimodal intelligence. Hopefully, every time we speak to a patient, there’s very few things, it’s just one thing I’m thinking about. Now, just like you guys with law, you don’t spit out every thought you’re having when you give a recommendation. So a lot of people don’t think about this, and that’s fine. I don’t when I have something fixed at my house. I don’t know how they’re fixing it. I’m just happy it works. But at the end of the day, even though we’re not saying these things, we’re thinking these things, and AI will have to be able to replicate that as well.

Courtney White: Well, I don’t know if AI is at the point where it will be able to, but I definitely see the benefit in that if we can get to that point, I think it will hopefully help accuracy and diagnosis. And not to talk about my dad. But just the idea that we went so long with so many doctors going to one of the best neurologist and for us to then find out that my dad had this other cardiovascular issue that had never really been identified was just mind boggling to me. And if we could have been asked some questions earlier, maybe we would have gotten to that point sooner. So that was kind of my only real comment on multimodal medicine is that I think it will hopefully help with more accurate diagnosis.

Dr. Lane Aiena: Absolutely. And first of all, I’m sorry to hear about your dad. And I hope the best for you guys. Dementia and memory issues are a, just a horrible, horrible diagnosis for the family to go through. And they are so difficult to pin down, because so many different starting points have the same endpoint. And it makes it so tricky to figure it out. And a lot of them have a lot of overlap. A lot of patients with Alzheimer’s dementia also have vascular disease. So it’s very difficult to pinpoint Well, what is the reason this patient’s having this dementia? One place that AI could hopefully contribute to that in the future is pattern recognition. Now AI is very good at pattern recognition. We feed in a whole, whole, whole bunch of data, and it starts to learn. Okay, well I can start to recognize these patterns. One example I’d read about was sepsis. Sepsis is deadly in the hospitals. That’s when you have an infection that gets into your bloodstream and you get very, very sick your blood pressure generally tanks you start to have in organ damage, which is called septic shock. Once you get to septic shock, the mortality rate is astronomical, right? Could AI be programmed to recognize that earlier than a physician because as easy as that sounds with all of us talking to each other. It is not as easy to recognize on the floor. It can be very subtle with the changes especially if, what if a patient’s blood pressure just runs low? What if their white blood cell count just happens to always run high? What if they’ve had a fever the whole time they’ve been here? If all these things we look at for sepsis can make it kind of tricky to identify quickly, especially when you’re managing x other number of patients that are also equally sick. Could an AI help to catch those patterns earlier?

Another way that AI may be able to help and this is, it’s not there right now. But let’s use dementia as an example. Because I think that’s a great example, right? It’s a very complex, very complicated disease, that we are still really in the trenches of studying what is dementia? You can look up amyloid plaque theory, for example, we’re still trying to figure out if that’s the chicken or the egg. So could AI be fed all the data we have and come up with a new idea? Now that’s well into the future. But could we have AI help us in IDEA hypothesis generation, and that’s exciting. They’re trying to do it right now, with proteins. So whenever you get sick, there’s an antigen in your body and your body makes antibodies to it to fight it. We’re trying to make medicine we’re trying to figure out, okay, well, what is going to be able to attack this bacteria in a certain spot or this virus on a certain protein, but I have to make something really complex to attack that there, right? Could AI take a look at it, and come up with that much more quickly than we do? That’d be incredible. So there’s work in that field, it is an exciting thing to think about that AI could help us with some of this hypothesis generation, we would still have to test it, we would still have to have the human side of it.

And then that also leads me to the second reason, I think that AI will never replace doctors that we can segue into. And that is compassion. And I actually think that’s the more important of the two is the compassion. Let’s say, I put all of that information in to my doctor ChatGPT. And it spits back you have dementia, that is not how I want to be told I have dementia or you have cancer, that nobody wants to see that pop up in a screen. And even if I could ask it, what’s next, I don’t want it to just coldly spit out you have a 36% chance to live if you do the following, you know, treatment. I need a human being there, I need a human being with compassion, I need a human being that will work with me with my social determinants non-medical drivers of health, sure, there may be a treatment that’s available in the middle of the Medical Center in Houston. But can I get there, maybe the second best treatments in The Woodlands and closer to me, and that would be much more feasible for me and my family who can’t take off work for six months to go be a part of that study, right? So I think that compassion is another big, big part that they will never be able to replicate with an AI. And it’s going to be why doctors will remain important. And it’s going to be that human to human interaction that hopefully AI strengthens, it gives me more time to build that relationship. So that’s where I hope it goes.

Art Cavazos: Yep, definitely sounds like a dystopian future if you get your news like that. And maybe a an emoji instead of real compassion, right.

Dr. Lane Aiena: So it’s a real 1984 stuff right there.

Art Cavazos: But when you were talking about potentially using AI to study kind of on a population level and determining, you know, hypotheses for why things arise and things like that, it did make me think of something we mentioned earlier, which was the training of the AI model. And, you know, what is the data being used for that training? And is it sufficiently diverse? And you know, does it pull from a diverse population that is going to be representative enough so that the model can make accurate predictions and accurate hypotheses? What are your thoughts on those challenges?

Dr. Lane Aiena: This is a really great question. And I hate using that phrase when people ask me questions, but it’s, it really is.

Art Cavazos: All the other questions have been terrible to this open to this point.

Dr. Lane Aiena: Which is why I hate the implication that question, but it’s a great question, because it doesn’t have a good answer right now. Right? And it’s very complicated. And I heard a great example of, of one of the many, many complications that would come with this, and it’s skin cancer. So let’s say I feed an AI robot, you know, or AI program, excuse me, whatever. Thousands and thousands of images, mostly Caucasian skin cancers? Well, it’s going to be better inherently, of identifying skin cancers for Caucasians. And it’s not going to be as accurate if an African American sends a picture of their skin cancer, and it may miss the diagnosis. But Caucasians are far more likely to get skin cancer. So there are far more examples that I could feed the AI of skin cancer from a white person’s skin than otherwise, we have to be able to counterbalance that somehow. And I don’t know what the answer is because you don’t withhold the data, right? It’s still important to give it as much data as possible. What we need to do is make sure that the AI, if we can’t fix a bias and something like that, right if the data is going to be inherently biased when we put it in the with our example, being more Caucasian skin cancers than not, then the AI needs to be able to recognize that and it needs to be able to say that when it gives its answer. And that is complicated. I mean, we as humans can’t even recognize our own implicit biases. And now we’re going to ask an AI. How do you program an AI to recognize something that you can’t even recognize yourself? Right? And that’s just one example. It’s, it’s going to be one of those things that we’re always going to have to be fighting for and fighting towards, and inequality push for AI, kind of like an asymptotic relationship, right?

I hope that we get closer and closer to that line of a completely unbiased AI that I don’t know that we could ever truly reach. But it’s up to us both as physicians and as programmers to make sure we are continuing that push and recognizing, hey, I don’t know if this answer is correct. Could it be because of an implicit bias in AI? Which opens up a whole nother world of, well, why did the AI spit this out? And they have entire episodes of podcasts over, why did the AI spit this episode? Or spit this answer out? It, it’s not as easy as me just looking under the hood and seeing it and the AI isn’t really great at telling me why it said it. It’s like, well, because that’s the answer on the AI right. And ChatGPT is notorious for that, right? Just tell you what, because I’m right. So it’s a very difficult subject, that is a very important subject, that we need to continue to make sure that we focus on it. And it can’t just be one person’s job. And it can’t just be one organization’s job, it has to be a push from all of us, for the betterment of all of us, right to make sure again, to go back to our first topic that all of us have equal access to this care, I think that’s what’s going to be important in the end, and why it’s gonna be so important to make sure we push this correctly and get it right early. It’s like getting the patient diagnosis wrong the first day of the hospital, you screwed up the whole trajectory, man. So we got to get this right early.

Art Cavazos: I’m glad you said that about it being kind of all of our responsibilities, because that was going to be my follow up question is, you know, whose responsibility should it be that this data is diverse? And I love that answer. I think it’s all of our responsibilities, probably, you know, the companies producing the AI, the doctors using it, the patients, you know, kind of demanding it. And the regulators, I think all of us are responsible love that answer.

Courtney White: Because I think we already know, Art, that just to kind of respond to that as well, that unfortunately, with research, we know that medical research in and of itself, leaving out AI does not tend to be very diverse, we know that certain populations are afraid of or unwilling or whatever the reason may be are not ready participants in a lot of medical studies, which means that we don’t always get the accurate results. And there are organizations that work diligently on that. But I don’t know if we have an answer to even that. So let alone AI. My curiosity is really are there any doctors that are anti AI, I know my doctor has really strong feelings about doctors not making the money that people think they’re making. She says doctors are not rich, especially if they are family doctors. She wants her daughter to go to law school instead of medical school. So I was wondering what your thoughts are, are there any doctors that feel like AI may destroy their earning potential, opportunities or, or anything in that realm.

Dr. Lane Aiena: Doctors, like lawyers and every other group are a very diverse bunch. And you can give me any topic, and I will find a doctor that doesn’t agree with you. Trust me, we just went through COVID. And I fielded quite a few emails about that, as a matter of fact, about COVID and the vaccine, etc. Most doctors are willing to have a discussion. It’s kind of why you get into a field like this, right? It’s an inquisitive field by nature. So it lends itself to people that want to talk that want to hear the evidence, but there’s just as many folks that dig their heels in for any number of topics, and AI is going to be one of them. And anytime there’s something new, know there’s going to be people that don’t want to do it. And to those physicians, I want to make sure that I impress upon them how important I think it is that we actually do get ahead of this. We can’t just wring our hands and sit in our offices and talk about the way things should be. And that is one thing that us Doc’s are just terrible about, we don’t vote that, well, we don’t get involved politically. And it’s because we’re busy. It’s because we do a lot and everybody’s busy and everyone stays busy. But nothing changes by me sitting in my office and telling you guys what would be better right or telling my patients what should have been done.

We need to make sure that the House of medicine is taking a leadership role in this space. We can’t sit back and let the computer programmers with all the good intentions in the world, dictate where this goes. We have to make sure that medicine not only has a loud voice in this but is the leader in where this goes, because we have a, frankly, we have a responsibility to our patients to make sure that this doesn’t turn into another electronic medical records. So for the doctors that are staunchly against it, I invite them the most of all, to be a part of the conversation. It’s, I don’t need a fanboy in here telling me how great AI is going to be I need someone out there complaining about it to say what needs to change that’s far more valuable for the patients, right. But those are the ones who don’t want to get involved. So and if they do, they don’t get involved enough. So we need those people that are staunchly opposed to be staunchly involved. And we need them to be voicing their concerns. So that we think about that. And we addressed that early, not later, early.

Art Cavazos: Well, I think that is a perfect note to end on. We’re pretty much out of time here. Thank you so much Lane for joining us again, always a pleasure. And thank you to all of our listeners for joining us on this episode of Future Ready Business. We definitely touched on a lot of things today regarding the future of healthcare, particularly value based care, and AI and medicine. And Lane, I hope you’ll join us again next year or maybe even sooner for another update. Always a great time. In the meantime, you mentioned your podcast earlier. But why don’t you tell us about that again, and where folks can find you on the internet?

Dr. Lane Aiena: Absolutely. And first of all, before I do, thank you all for having me. It is, once again, it’s been an incredible honor. And it’s been a pleasure, I would love to be on again. So, you just say the word and we’ll make the time. So I’d be happy to be back. My podcast is Doc to the Future, your podcast place for pertinent picks of what’s coming to affect you, the physician, or really anybody. I mean to ad that extra tagline at the end of there. We just finished a phenomenal three-part series on burnout that I think everybody could find value in not just physicians. So, if you search Doc to the Future, you can find that. And I think that everyone should give it a listen. I was very fortunate to have three incredible guests that just knocked it out of the park. You can find me on Facebook, I’m not on there often. But if you like pictures of kids, you can come find me on Facebook and see the pictures of my four great kiddos on Facebook just Lane Aiena, it’s easy to find. Yeah, if you want to give Doc to the Future, listen that be great. I’m trying to do more episodes. And I certainly enjoyed doing it. So, thank you all for having me on. I really appreciate it. And again, anytime you all would like to have me back. I’d love to be a guest.

Courtney White: I thought this was an amazing episode. Thank you so much for coming on Lane. I really enjoyed it.

Dr. Lane Aiena: Thank you. Yeah, absolutely. Thank you.

Art Cavazos: And where can folks find you on the internet Courtney?

Courtney White: People can find me @courthousecouture or at www.courthousecouture.com. Where again, I talk about fashion but I also talk about emerging legal issues and so much more.

Art Cavazos: Yeah, fashion for professionals, which is kind of a whole other deep topic in itself. We actually did an episode on it, but we’ll have to revisit that as well. If you liked the show, please rate and review us wherever you listen to your favorite podcasts and share FRB with your friends and colleagues. You can find the show on Instagram @FutureReadyBusiness, and you can find me on Twitter and TikTok at @FinanceLawyer. As mentioned at the top of the show. The opinions expressed today do not necessarily reflect the views of Jackson Walker, its clients, or any of their respective affiliates. This podcast is for informational and entertainment purposes only and does not constitute legal advice. We hope you enjoyed it. Thanks for listening.

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