The modern patient experience is more complex than ever, and while health systems focus on measurable metrics like satisfaction scores, the true patient experience involves much more. Creating memorable and personalized touchpoints with patients, especially within cost constraints, is a growing challenge for healthcare leaders. The reduction of physician agency, driven by the industrialization of healthcare, has played a significant role in both physician and patient dissatisfaction. Addressing these problems requires a systemic rethinking of the role and identity of physicians in today’s healthcare landscape.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Bryan Vartabedian, MD, chief medical officer at Texas Children’s Hospital. They discuss his beginnings in pediatrics, the current state of physician burnout, and why the rise of technology and algorithmic care has created a disconnect between doctors and patients. They also talk about the future of telehealth, what key performance metrics don’t capture, and the power of suboptimization in healthcare.
Listen here:
To learn more about Dr. Vartabedian, follow him on LinkedIn here.
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Want to learn more from Dr. Joseph? Order a copy of his book, Designing for Health.
Show Notes:
[00:00] Intros
[01:30] Dr. Vartabedian’s background
[06:20] Evolving medicine towards empathy
[10:04] Addressing physician burnout
[14:59] The power of suboptimization
[20:56] The people margin
[24:10] What key metrics don’t show
[28:38] Combatting pajama time for physicians
[32:35] The future of telehealth appointments
[35:07] Well-designed things that bring Dr. Vartabedian joy
[37:04] Outros
Transcript:
Dr. Craig Joseph: Dr Bryan Vartabedian, where do we find you today?
Dr. Bryan Vartabedian: I'm dialing in from Texas Children's Hospital in Austin.
Dr. Craig Joseph: Well, that is excellent. I have some experience with Texas Children's Hospital, but it's mostly in a smaller city called Houston. Have you heard of that one or are they related?
Dr. Bryan Vartabedian: I have heard of Houston. I cut my teeth as a leader in Houston, so I'm familiar with it. I think we probably passed each other at some point during our tenure.
Dr. Craig Joseph: I think you're right. So far, we’ve established that Austin and Houston are different cities. But they both have hospitals that are called Texas Children's. Excellent. So why don't we get a little introduction of how you became a leader. Now, you're the chief medical officer at Texas Children's in Austin. You're a pediatric gastroenterologist. You cannot deny any of that information. How does one kind of get to where you are? So, you did you always want to go to medical school and become a doctor? Give us that story.
Dr. Bryan Vartabedian: Yeah, I think I'm getting to the point where I almost forget what those decisions were back then, but, yeah, I think I enjoyed science and people and thought I'd take a shot at it when I was in college and landed in medical school. And of course, things have changed and evolved over the course of my career. So, all my original intentions for wanting to be here have kind of evolved and changed. But I love where I'm at, as both a leader and a physician.
Dr. Craig Joseph: Excellent. So, when you graduated from medical school, you went and did a pediatric residency. Was it always your intention to become a sub-specialist, or did you think you were just going to be a primary care pediatrician?
Dr. Bryan Vartabedian: Yeah, I wasn't sure. You know, I think I deliberated between psychiatry and pediatrics, and wound up as a pediatric gastroenterologist, which is kind of interesting because there's a lot of mind body stuff there. So, I think I liked the technical aspect of gastroenterology. Flirted with being a cardiologist but landed here.
Dr. Craig Joseph: Okay. All right. And are you still practicing now?
Dr. Bryan Vartabedian: Yeah, I do clinic one, about one day a week here in Austin. Beyond that, I'm wrapped up with my administrative responsibilities of, opening the hospital and all the things that go along with that.
Dr. Craig Joseph: So how does one become a Chief Medical Officer? Certainly, that was not your intention. Starting out, the typical story I hear is, I foolishly volunteered for something, many decades ago, and it's been a slippery slope since that. Did that happen to you, or was it a thoughtful, methodical process?
Dr. Bryan Vartabedian: Well, I guess not exactly that I, I kind of began. I left, Texas Children's Hospital after training and went into competition against Texas Children's Hospital and built up a successful hospital, practice rather. A doctor who was a physician in chief at the time, picked up my practice in 2003 and put it in The Woodlands, and I was the first full time subspecialist outside of the Texas Medical Center for Texas Children’s Hospital. So, with him I kind of shaped, this, this kind of blueprint for what community care might look like. And so, when West opened, I helped with that and certainly helped design and opened Texas Children's The Woodlands. And so, when the time came to, build Austin, I had a lot of experience with how Texas Children's integrates with communities. And so it was sort of a, I think, an easy decision for them. And I thought it would be a great cap on my career to do that.
Dr. Craig Joseph: Awesome. Okay, well, that makes sense. One of the reasons I'm so excited to talk to you is that you are tech-adjacent. Often, I talk to chief medical information officers and CHIOs. And you seem super knowledgeable about many of those things, but you're kind of more in just general leadership and management. But you understand how tech enables or also causes problems. The other reason I'm excited to talk to you is that you've written pretty extensively and spoken pretty extensively. How many books do you have out now? Is it, at least one?
Dr. Bryan Vartabedian: I have a couple out. My latest one is called Looking Out for Number Two. It's for parents. It's not tech related, but it's on bowel movements and the microbiome, and it's a lot of fun.
Dr. Craig Joseph: And how long did it take you to come up with that title? Which is amazing.
Dr. Bryan Vartabedian: I kind of started with the title and wrote the book around it.
Dr. Craig Joseph: Yeah, well, I mean, you can lie, but I'll take that. One of your, one of your blog posts really kind of hit home for me because you mentioned you talk about technology and how it's kind of bringing everyone up, maybe even the, the playing field. So, that, you know, in your work, simple transactions, or doctor offices kind of become commodities and health systems can't compete when it goes down to kind of zero in terms of the cost and so really what you can compete on are scarce resources such as, experiences and empathy and trust. I'd love to kind of get your view on that. How close are we to kind of everyone being technologically equivalent? And then, how are we going to compete if we're not competing based on that?
Dr. Bryan Vartabedian: Yeah, I know, so it's interesting to see how medicine has evolved. Back when we were younger and in medicine, the physical exam and touch and all that sort of thing were important for diagnosis. And now we've become very reductionist with the way we make diagnoses. We're now evaluating patients and preventing and preempting disease based upon molecular markers. And genes and other things like that. And I think is where I was getting with that commodity issue is that as we all begin to use the same technology, the same CT scanner, the same EHR, I think what's going to define health systems or how we're going to be positioned, is going to be based upon the experiences that we offer for patients in between those transactional diagnostic procedures and routine things that we've kind of, gotten into the habit of doing the kind of industrialized, part of healthcare. So, I think it really represents a great opportunity for health systems to rethink how we look at the patient experience, which is a whole other discussion. But the way we interact with patients in and around these kind of commodity technologies and diagnostic tests, I think is going to define us as systems.
Dr. Craig Joseph: Well. So, you're a health system leader. How do you kind of do some of that patient experiences, how do you even kind of start to identify priorities and so that you can compete if everyone's using the same technology? What are some of those differentiators and how do you actually say, okay, well, trust is important. How do you just assign trust to, your physicians and grade them on their trustworthiness? I suspect not.
Dr. Bryan Vartabedian: I think it's, you know, the challenges. We're all beholden to the sort of the measures of patient satisfaction, it's a metric that we have to chase. And I think it's noble for us to be thinking about patient experience in that way. But the problem is, we've kind of become so accustomed to sort of studying to the test. And so, I think that we have to rethink patient experience, truly the kind of experience that parents are having. When they interact with their data and when before they come to see us and, what's that experience like? The true experience, not just sort of the, the checkbox. So, I don't think we're there yet in terms of this commodity idea that I have, but I think that a system can be creative, and proactive in the way we really create a stellar experience for families.
Dr. Craig Joseph: Kind of making it easy to do the right thing. And the right thing is to be trustworthy and transparent and all of those other kinds of adjectives or nouns that you kind of are calling out.
Dr. Bryan Vartabedian: Truly creating memorable experiences for families is central. How do we do that is a bigger challenge given the cost constraints that we all face? It's easy for us to sit here and say we need to do X, Y, and Z when we look at the shrinking margins and, all the, the financial headwinds that we face as, health system leaders.
Dr. Craig Joseph: Okay. All right. Well, so let's kind of pivot a little from patient experience to clinician experience. Physician burnout is a major problem that everyone's kind of dealing with. And one of your thoughts was that focusing on fixing burnout is like trying to eliminate fever during an infection. You say we're focusing on the sign, which is the burnout, but not the cause, the disease. And so, what are some of the things that are underlying causes of, of physician burnout and, and how do we fix it? Because Motrin is not working.
Dr. Bryan Vartabedian: It's a good question. You know, burnout, it’s challenging, we even have a hard time defining what it really is. You know, if you Google it, you'll get a dozen different, definitions. But it kind of fits into what I call a wicked problem. And a wicked problem is a problem that doesn't respond to the traditional measures of intervention. It's like a ball of string. You pull one, you pull one thread, and it just makes it worse. So, you try to do one solution, and it just makes the whole thing worse. So, it's, it's a very complicated problem to fix. And it's representative of, I think, a number of things that are happening in medicine that doctors are facing. One is our changing identity as physicians and as providers. A lot of what we used to do with our eyes and ears and our hands has now been replaced by technology. We talked about the industrialization of healthcare. We're beholden to higher volumes of care and algorithmic care. And a lot of these things leave us wanting for something bigger than just moving patients through clinics. EHRs. We love to blame the EHR for the burnout epidemic, but it's really well beyond, what Epic has done. So, I think it's complicated, Craig. And I think that, we can't just come up with one solution of yoga mats and wellness officers just to kind of fix the situation. I think it's emblematic of a lot of broad issues that have conspired to sort of make us feel, like we have a real lack of agency. Lack of agency kind of defines the modern American physician. Right?
Dr. Craig Joseph: Yeah. Well, it's, the word, the phrase that I've kind of latched on to is that moral injury, right. Like, I know what the right thing to do is. And I'm unable to do that because of because of cost constraint, because of the payer, because of regulation, because of laws. And no one wants to kind of go around trying to help people and knowing how to help people and then not be able to do it. So yeah, I'm glad to hear that. You think it's not just the electronic health record. I love to blame the electronic health record for some aspects of burnout, but clearly, the same EHRs are being used across the world. And they're not having the same effect. And why is that?
Dr. Bryan Vartabedian: You know, I think it's remarkable when I was really active on Twitter before it all kind of fell apart. The EHR anti-sentiment was just crazy. Just everyone was beating up on Epic and you really got the sense that all the problems we’re facing were due to Judy Faulkner's software and it's well beyond that, right?
Dr. Craig Joseph: Yeah. It's funny, I used to be on that, very much more active than I am now on that Twitter thing. And there was one physician who was, it was an anonymous account, but very aggressively anti-EHR. And that specific vendor was Epic, as you mentioned. And I reached out to him, and I said, hey, you know, some of the things that you're complaining about, you're absolutely right. Like, it shouldn't be like that. Did you know that it's like that at your hospital, but it's not like that everywhere that uses the same software. So do you know that? Hey, you know, your hospital is making some decisions that are affecting you and you're thinking that it's the technology requiring it. It's not. And it's very similar to me to a joint Commission as well. I don't know if you, do you have joint commission out there in Texas? Have you heard of joint commissions? Yeah, learning more oftentimes people are like, oh, a joint commission requires us to do this or that. And, often, not always, but often. No, it's actually the joint commission requires your hospital to follow the policies and procedures that your hospital has outlined. So you’ve got to blame the right group. All right, let's move on to one of my favorite words, because I like to focus on me, Dr. Vartabedian, and, I may not have told you that. Yeah. You're figuring out pretty quickly. Suboptimal. Suboptimal. One of my favorite words. And I'm going to quote you now, the real money may be in sub-optimization. So, you were talking about, well, how about I just let you give context to that, that sentence, how is sub-optimization helpful? I thought you're always supposed to optimize and be as efficient as possible. It doesn't make any sense.
Dr. Bryan Vartabedian: I'm going to have to delete some of these posts because I'm now a physician leader and I can't say these things.
Dr. Craig Joseph: It's out there. It's out there.
Dr. Bryan Vartabedian: I can run, but I can't hide, apparently. I think, you know, when we look at everything that happens in the healthcare space, we're really fixated on optimization and processes and, you know, PDSA cycles and so on and so forth. And that makes perfect sense. And thank God we do, because we want, you know, we want zero error with our sterilization of our equipment and so on. I do think, and this kind of stems back, you know, kind of roots back to this experience issue that we were talking about. There are some things that we probably don't want to measure or want to leave unmeasured. I think we're getting into this habit of wanting to quantify everything. And, you know what? What do we want to leave unmeasured? End of life discussions? Things like that probably we can't quantify. I'm sure someone's trying to quantify them, but it's something that we probably need to leave between of the doctor and the patient.
Dr. Craig Joseph: Yeah. You had mentioned in that blog post that listeners will not be able to find once we drop this episode, I found it, and you mentioned it's kind of like elbow room, elbow room in the healthcare system, you also kind of refer to it as, slow medicine, kind of baked in. Right. And I it really kind of resonated with me that oftentimes being super-efficient is, is very important. But at other times it's just what you need to do is stop and when dealing with these messy things called humans, you know, stop and not be efficient and, and slow down a little bit for this one patient or this one problem, because it really does require your attention. Efficiency is great when you're sterilizing instruments in the operating room 100%. But there are times where you kind of got to bake in that and acknowledge and accept and encourage people to say, hey, if you've got an emergency, yeah, or some other kind of need to slow down and you should do it almost like this slow food movement.
Dr. Bryan Vartabedian: The slow food movement. Yeah.
Dr. Craig Joseph: Yeah. You know, when I was contemplating this quote, it kind of reminded me. One of the things that I like to do, which is not efficient, which is I like to read a newspaper or at least browse through the newspaper. I look at the print version of the newspaper. I know this is crazy. Hear me out, hear me out. Because I think.
Dr. Bryan Vartabedian: You're an IT guy.
Dr. Craig Joseph: I know it's bad, but I love it when I am looking through, a big newspaper like, you know, Washington Post or the Wall Street Journal. It's going to be constantly, there's always going to be an algorithm there. It's always going to be pointing me at certain articles that I probably do want to read, but that necessarily means they're going to be articles that I'll never see that I might have been interested in seeing and, you know, I'm an adult. I can look through, newspaper, what we used to call a newspaper. The print version of that newspaper. I regularly, almost daily find articles that are super interesting, oftentimes, important for work that we do just, you know, it may not be about healthcare, but it's healthcare, or customer service in general. And I can kind of leverage that in some of my work. I never would have seen those articles because the algorithm would never think, oh, wait, why do you care about how to run a FM radio station? Well, I don't, but there was something interesting in there that kind of caught my eye in the first couple of paragraphs. And to me, that's suboptimal. That is not efficient.
Dr. Bryan Vartabedian: I think that's called serendipity, Craig. It's when we sort of stumble on things and it's kind of critical to the creative process and even in leadership, we have to really try to connect things that are unconnected sometimes, and we get these ideas from other, other places. It's great. I think a lot of our biggest problems in healthcare have been solved outside, you know, in other verticals. And I think when we nose around the way you're talking about, I think it's, it's really important. I will say that I think, I've termed it selective sub-optimization. That's when we choose certain things in the healthcare space that we want to just leave untouched. Right.
Dr. Craig Joseph: I love it. And that's why it's important to have leaders like you who acknowledge that, hey, it's not all going to be about, how our metrics doing that are going to be times where this is a metric. I don't want to be optimized. I want to, you know, make sure that you have time and that you can do the right thing. Because to your point about a patient experience making memories and, you know, that one time that physician slowed down her afternoon and, required some reorganization of the schedule, but really made a difference in someone's life, so, yeah. Love it.
Dr. Bryan Vartabedian: Or to choose the right proxies, Craig. In other words, what we're measuring or what we're trying to look at, right?
Dr. Craig Joseph: Yep. Absolutely. All right. Let's go on to something else I found that you had talked about. I'm giving us a selective view of all the stuff that you kind of consider because we don't have enough time to talk about everything, for sure. You had quoted, the automatic engineer, Mike Shelton, and he talked about something called the people margin. And you had mentioned that. Hey, you really need to take the people margin into account when talking about healthcare, when designing workflows and health system processes. Understanding that people are messy, and that they’re not always going to do what's in their best interest to do. Is this something that you work with, every day?
Dr. Bryan Vartabedian: Absolutely. You know, increasingly what we do in a hospital is based upon processes, and everything seems to be clearly defined. And the wild card in all this is the fact that we're dealing with humans, as you said, that are messy and complex and unpredictable. And so the humans always kind of confound everything that happens. Who's the guy that runs IT at Mayo now?
Dr. Craig Joseph: I do know who you're talking about. The Mayo System platform. John Halamka.
Dr. Bryan Vartabedian: Yeah. That's right. He always said that computers are easy and humans are difficult. And that’s kind of that point. We can design all the best software in the world, but you get humans using it. Same thing with movement of patients or our pre-op area, which we try to optimize, or a couple of these amazing processes. But every mom that comes in with a baby, holding a baby is going to have an operation, brings their own baggage along, and it's really hard to control for that. So, controlling for people margins is really challenging. And it's something I don't think we'll ever be able to sort of overcome as informatics or physician leaders trying to really optimize everything.
Dr. Craig Joseph: Yeah. Your pre-op, experience reminds me of travel. You know, people who know how to travel or who do it a lot. They are no smarter, but they’re just more experienced, can get through very quickly. And other people, struggle and, and even folks who are experienced, if they're flying across the country for someone, you know, a loved one who's having a problem. They are also not thinking clearly. And, yeah, I think having to try to consider that and kind of, how do you have kind of two lanes, in pre-op. Right. For those experienced, those frequent fliers we used to call them, taking that into account that everyone's not going to be the same and putting some, some leeway in there. Yeah, it makes a lot of sense.
Dr. Bryan Vartabedian: Yeah. And even users with the, you know, training doctors, you’ve got the senior doctor that wants to print out all of his visits on a piece of paper. And then you get the young 25-year-old resident who flies through Epic in ways that I can't even understand.
Dr. Craig Joseph: So, yeah, it is kind of funny. When I was at Texas Children's as the interim CMIO many years ago, this is about the time where Epic could come out with this ability to kind of, score physicians on their efficiency of using the electronic health record. Not to say you're good or you’re bad, but to say you're struggling in this area. Even though you may not know it, you're not efficient. And, compared to your peers, we can make you much more efficient. And so ultimately, though, everyone kind of came with a number and you could rank them from one to the to the bottom, which just was for fun. I said, well, I love to see who's at the top and the, the most efficient user according to the technology of the electronic health record vendor was the surgeon in chief, a pediatric cardiothoracic surgeon, who I'm sure you're well aware of, now, I found that humorous, laugh out loud humorous because this is not a guy that uses the electronic health record, and I think what probably happened is that he logged into Epic 2 or 3 times in his life, and, had a cadre of fellows and residents and PAs around him who said click here, click here, click there. Then the three times he did it, he was incredibly efficient and so got a very high score. But to your point, that, you know, we need some context there with that technology because, just looking at the numbers, you're not going to get an accurate understanding of what's really happening. There are docs who don't interact as much, and that's okay. Yeah. All right. Goodhart’s law. And I'm not sure it's a law, but it's an idea that says that when you when you take a metric or a measure and it becomes a target, it ceases to be a good measure, because people play to the test. Right. If you're good, you're going to pay your teachers based on how well the kids do on the state assessment. They are going to get a lot of instruction on doing well on the state assessment and not necessarily instruction on other things. Have you seen this happen in in healthcare? Are there particular metrics where someone says, hey, you told me you wanted me to do well in this metric, so that's what you got.
Dr. Bryan Vartabedian: You know, I hate to pick on Press Ganey, it's important that we focus on patient experience. But when we do get to the point when we can sort of game the system by studying to the test, you know, it stops being a valid measure, I think. And so, I think we have to look at patient experience a little broader than we than we have so far. Because again, we're I think we're so focused on the, the end metric that we're retrofitting ourselves to the tool rather than, than patient experience. But, again, I think I Press Ganey has done a wonderful job for advancing the concept of patient experience. But given that it's now linked to reimbursement and so on and so forth, it creates some challenges.
Dr. Craig Joseph: Yeah. Well, I mean, I don't practice now, but as a primary care pediatrician, half my day seemed to be spent socially with new, new parents, convincing them that antibiotics are not helpful for a viral infection. You know, so what kind of score would I get if you came into the office, and I thought you were going to get an antibiotic for a cold. And here I am spending extra time with you. Actually, it's much easier just to write you the prescription faster. Efficient, right? Throughput is better. But yeah, you know, you have to spend a lot of time with someone so as not to get that negative score, because the doctor was not, did not help me because I wanted this prescription. I didn't get this prescription. So, no easy way around that, I don't think.
Dr. Bryan Vartabedian: No, as long as we’re measuring things, I think we're all going to want to do better. And so, it creates a challenge for us. Right.
Dr. Craig Joseph: All right. Well yeah okay I'll buy it, I was hoping that you were just going to tell me exactly what to do to fix all of the problems of healthcare in the United States.
Dr. Bryan Vartabedian: I’ll get you a little closer.
Dr. Craig Joseph: Alright. Yeah, I think I think you're right there. One of the things that, has been a big deal along with clinician burnout has been, pajama time. And pajama time is, physicians specifically spending time after their day, usually in the clinic, filling out charts, responding to patients, after hours. Is this chiefly, a problem for the CIO and the chief medical information officer to kind of deal with. But I think as the chief medical officer, you're the one that has to deal with, physicians, looking to go somewhere else if they're having a lot of pajama time. How has this been kind of identified as a problem, particularly with your physicians? And what are you doing to help with that?
Dr. Bryan Vartabedian: Yeah, I know it's a great question, Craig, because I think it is a issue for select physicians, I think, who have a hard time kind of defining the technology that they're using. I've worked with a provider previously who was up at night, till ten, eleven at night responding to MyChart messages and was engaging in this back and forth, these extensive back and forth discussions.
Dr. Bryan Vartabedian: Quite frankly, that were not really that appropriate, created a real problem for us as a call group because when we had to cover his inbox, the standard had been set that we were beholden to this, getting into this conversation with these families. And so, I think some of this is a failure on the part of, leaders, CMIOs, or even myself to help the doctors on our medical staff define how that technology should be used. I've always wondered whether Epic should help with that, but I think the user base is so diverse that it's really hard for them to do it. But I think as a group of pediatric gastroenterologists or oncologists, we have to collectively, talk about how we're going to use MyChart messaging. What are the limits to it? Where does it begin or where does it end? And I think if we just talk about MyChart messaging, once we fix that, it takes care of a lot of things. I think a lot of the pajama time that I see with some of my colleagues is, quite frankly, it's inefficient. And it's, not knowing how to use, the right phrases and what not and Epic. And I think it's something that training can help with.
Dr. Craig Joseph: Yeah. And, you know, in my experience, expectation setting is a big deal. And I think that's what you're saying with that one physician who was, happy to spend to set expectations very high, that lots of things can be done online, going back and forth and back and forth. I think the yeah, one of the big things that I've seen, just from what I practice, people used to say all the time, I'm calling my doctor, and I now know when I have these conversations with people, like, they actually never called me. During the day, they called my office, and they dealt with a team of people and sometimes, oftentimes, the question, could be resolved or the problem could be resolved. Question could be answered before it got to me. And so, I think there's also like an expectation setting, hey, this is not something that I have to deal with. I shouldn't even see this. This should go to someone else to try to answer it beforehand. And they generally, if you have an experienced group around you, they know what they can do and they know what you're comfortable with and they know when to say nope, this is a good question for the good doctor. We’ll let them go. All right. Well, let me ask you about telehealth. This will be my last difficult question for you, so, you're going to be ready. You're going to be off the hook. Bedside manner is something that's very important, especially for pediatricians, but for all physicians, how do you over a video conferencing system, provide some sort of confidence, or even differentiation? When you're dealing with patients or their parents, are there any easy any tricks that you have found or ideas that you've heard?
Dr. Bryan Vartabedian: You know, I think it for me, the challenge with telemedicine, and I remember during Covid, when I first started doing these like six-hour telemedicine sessions, I was so exhausted at the end of the 3- or 4-hour sessions, and I couldn't figure out why. And I finally figured out that it was. I was always searching for like these physical cues that I would get from mothers and in children when they were in the exam room with me. And so I felt like I was always like, straining to see what mother's eyebrows were doing or things like that. So, I think it creates a challenge because we lose a certain element of connection with telemedicine. It's a tradeoff, right? Because that mother down in the South Valley of Texas, can access us for a follow up visit for their liver transplant without making the six-hour trip. The downside is we sort of we lack some of this ability to read these cues. And so how we make that connection is really difficult. I think we've got to remember the basics. I'm always shocked at the number of providers that still don't have themselves framed properly within the, within the screen. They've got poor lighting, or they've got the camera on their desk. So you're looking up their nose and all this sort of thing. And so, I think creating a really well-framed experience, I think acknowledging like I'm doing now and using my eyebrows and nodding and recognizing, I think is important. And you sometimes have to exaggerate that a little bit via a visit in order for it to be perceived on the other side. I always think it's hard to have connection with the to look at you, to see what's happening, but also connection with the camera, which creates the notion of eye contact.
Dr. Craig Joseph: Yeah. Oh, yeah. I can't wait till that gets solved. At least easily. All right, we have we have come to the point of the podcast interview where I like to ask the same question to of all of our guests. And the question is this, we've talked about design of systems and workflows and ideas along those lines. Are there 1 or 2 things in your in your life that are so well-designed that they bring you joy and happiness?
Dr. Bryan Vartabedian: Yeah. No. I think design is so critical to healthcare because avoiding good design in healthcare has been avoided for years. So, I think, it's relevant to our discussion, Craig, I think one of the things that brings me joy that I use most days is a writing application called Bear. It's a note taking app that, is designed around the Mac operating system and just the subtleties of movement between documents that is so smooth to me. And it makes it feel very easy when I'm using it. Everything from the typography to the spacing of the words, I just love it. And so, it helps when I have that kind of milieu. It's conducive to writing or getting my ideas down on the screen.
Dr. Craig Joseph: And is that one of the tools that you used in writing your books?
Dr. Bryan Vartabedian: Yes. I used to use an application called Ulysses, which is very good. I've recently transitioned over to Bear, and it was really based on the design and the subtleties of moving between documents. So, design is really important to the way we interface with technology.
Dr. Craig Joseph: I love it, and I don't think I knew that you were an Apple guy. You've just identified yourself as an Apple guy. So that's great. I am also, I’ll call myself a frustrated Apple guy. So awesome. Well, thank you. This has been a great conversation. Really appreciate it. I look forward to the next book. When's the next book coming out?
Dr. Bryan Vartabedian: I don't have anything coming out. I've been dreaming of something with technology and healthcare, but I haven't got it nailed down yet.
Dr. Craig Joseph: All right, well, I can't wait till you actually get time to do it, and then, get access to it. Appreciate your time. And this has been a great conversation. Thank you so much.
Dr. Bryan Vartabedian: All right. Thank you very much for your time today.