Technology has transformed the healthcare landscape by making information more accessible, however, this shift also brings challenges in managing huge volumes of data effectively. EHRs offer significant benefits for data sharing yet can result in an overload of unintelligible notes due to the ease of entry. As healthcare systems continue to evolve and face demands for urgency and time management, it is crucial to prioritize space and flexibility in care delivery and promote a thoughtful, patient-centered approach rather than focusing solely on efficiency at the cost of quality.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Spencer Dorn, MD, Vice Chair and Professor of Medicine at UNC. They discuss Spencer’s career path, changes in medical note writing, and the value of slowing down to create better decision-making and deeper patient connections. They also talk about AI, its growing involvement in medicine and how AI could present opportunities to rethink and innovate in clinical documentation and workflow.
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READ THE TRANSCRIPT
Show Notes:
[00:00] Intros
[00:55] Spencer’s background
[02:44] Technology’s role in healthcare
[07:04] Benefits and challenges of electronic health records
[10:04] Importance of concise notes
[16:12] Thinking fast and slow
[19:22] Balancing efficiency with creating space in healthcare systems
[22:04] AI in medicine
[29:12] How AI could change clinical documentation
[33:17] Spencer’s favorite well-designed thing
[35:02] Outros
Transcript:
Dr. Craig Joseph: Doctor Dorn, welcome to the podcast. Where do we find you today?
Dr. Spencer Dorn: I'm in my office in Chapel Hill, North Carolina.
Dr. Craig Joseph: Awesome. That's a good place to be. How's the weather?
Dr. Spencer Dorn: Surprisingly cold. Yeah. It snows. It snows here about once every couple of years. It happened to snow this weekend. So exciting for kids. A little cold for their parents, but, yeah. Beautiful sunny day.
Dr. Craig Joseph: Otherwise, that's. And how long will the snow stick around for?
Dr. Spencer Dorn: Oh, just usually a day or two before it warms. In fact, most of it's gone already.
Dr. Craig Joseph: Yeah, that's the best kind of snow in my opinion. Snow that comes down and then two days later is no longer there. All right. Well, you are. I've gone through a list of the things that you do. You're a gastroenterologist, practicing gastroenterologist, or you're a vice chair and a professor of medicine at UNC. And so, my first question to you is, what have you done wrong? Why? Why have you been punished with all those jobs? And how can you fix some of the mistakes that you've made so that you can get rid of some of those jobs? Or do you like those jobs?
Dr. Spencer Dorn: Yeah, actually, I consider myself quite lucky to have a bunch of different jobs. It's a privilege to be able to do different things. And while I love clinical medicine, I also like working with other people outside of clinical encounters. I like writing, I like learning, I like building new products. And for me, not a punishment. It's actually a privilege. To be able to practice gastroenterology, which I'm biased, but I think is a specialty that really gives a broad view of health care because we do so many different things. We take care of people in the hospital and the emergency department outside of the hospital and clinic. We do procedures and a lot of cognitive work, acute and chronic care. So, so gastroenterology for me has always been a great vantage point for considering what American health care looks like. And the academic work is great as well. Working as a vice chair of a large departments you realize that regardless of the specialty or the discipline, there are actually very common challenges and opportunities in medicine. So that's been wonderful. Being a professor is fun. Get to write and present and work with a lot of young people who are in training. And then I do some informatics work as well. So, it's yeah, I'm privileged to have a few different responsibilities for sure.
Dr. Craig Joseph: Well, that's great. And I'm assuming they all kind of overlap and help you, especially kind of your operations and technology backgrounds.
Dr. Spencer Dorn: Yeah, definitely. I mean, I actually always say I'm not a technophile, per se. I don't wear an Apple Watch. I'm never, you know, waiting online at midnight to get a new release of some product. It was really through clinical operations that I got interested in technology, healthcare technology. And it was really through clinical practice that I got interested in healthcare operations. So, through practicing medicine, I started wondering, why do we do things the way we do and how can we do them better? And then through getting involved in trying to make things better, start to recognize the central role that technology, most notably the EHR, but various other types of software, influence how we organize ourselves, how we practice care. So, yeah, so coming from that perspective, just, you know, technology, it's not that it's something magical. It's just something I see as quite interesting, but as an enabler to hopefully, do things better.
Dr. Craig Joseph: I feel, though, that at the beginning you were talking about not wearing an Apple Watch or staying up late. I feel like you were looking directly into my soul, and I feel seen and, and also, disrespected. Although I'm an Apple fanboy, I do not stay up late for new releases, but I do have an Apple Watch, so that's so interesting. Your varied from where I think most physicians just say it. Why are we doing it this way? And then they're done. They ask the question, but they don't start pursuing it. They don't see that. They don't feel like they have the ability to change the system. You've kind of adopted a different attitude. So it was just a did you have an intention to do that when you were kind of in training that you were going to do this, or did it just kind of stumbled into from one thing to another, ask questions people like, well, that's a great question. Why don't you help us answer that question?
Dr. Spencer Dorn: I think a combination, I think I'm wired, I'm innately curious. And, although I'm actually an introvert, I really love working with people and speaking to people and understanding their perspective. So, I think I'm somewhat inclined towards it, but no, I did not go through medical school and residency and fellowship saying, oh, I'm really interested in operations. And as you know, you get relatively little exposure when you're going through training. It was more after I completed training. I became a health services researcher doing kind of health services research, and I really like doing it. I wondered a lot, is anyone reading my stuff? I'm making a difference. So, I said, let me at least hedge my bets and do something a little more practical so that I can see a little more closely the impact I'm having. You know, I saw some challenges with how we were doing things in our clinic. So, I kind of volunteered to help change things a little bit. And as you know, usually the reward work is more work if you do it well. So yeah, for about a decade, I helped run our clinical GI program, which is incredibly proud of amazing people working here.
And, you know, just one thing led to another. So, I can't say it was necessarily intentional. It just kind of happened organically. But I do think I'm the type of person who likes to kind of get nerdy about some of these operation things. And I do like to work with people and hear about their ideas and how we can make things better. So, combination nature and nurture, like most things.
Dr. Craig Joseph: That's great. All right. We've come to the questioning part. You're good at test taking. I'm assuming been taking tests for a long time. Is a true or false question true or false? Electronic health records are the root of all evil. True or.
Dr. Spencer Dorn: False? Yeah, I'd say a hard false. They're, Hard false. Okay. All right. Yeah. You know, I mean, everyone wants a boogeyman, right? We all want to have a simple answer for why things aren't going so well. And as you know, from some of the writing I've done in our prior discussions, the author has emerged as this convenient scapegoat. For all the problems in medicine, certainly are not perfect. And then we certainly can use them much, much better than we do. But it's a bit foolish and silly, I think, to suggest that the reason why we're all burned out and unhappy with health care, is just too overly simplistic. You know, I practice before I was in medical school and residency and training before EHR, so I saw the analog world, and it's clear to anyone who's practiced on both sides of the kind of digital of the digital implementation that there's been, some things are much better today than they used to be.
Right? Yeah, it's actually it brought a lot of benefits. And then some things are worse. And it's just that we have challenge, I think, as human beings to take this kind of broader view and not try and zero in on a really simple explanation for our problem. So no, you're not the root of all evil. We could talk about why some things are much better with the EHRs. Some things are likely to be worse with EHRs. Let's avoid those simple, binary distinctions.
Dr. Craig Joseph: Well, so let's talk about some of the things that are good. I think data sharing is, well, even if we can argue about it. But, you know, information is no longer tied to a piece of paper in the medical records department that you'd have to go down. I remember as a resident literally going through vaults looking for an old record. All of that information is widely available. Everything's available, which is good news. And the bad news is everything's available.
Dr. Spencer Dorn: Yeah, totally. I mean, I also have terrible penmanship. I don't know if I had to become a doctor to justify it, but write notes were hard to access and they were often illegible. Right. So it was, you'd have to trudge down to your medical records department, or you'd have to wait for a fax from another hospital to send something over. And then even once you got it, it was often hard to make sense of. So now, as you mentioned, crack, easy to get information, certainly within your own practice or health system and often in adjacent systems as well. It's quite easy to get medical records of, you know, notes, labs, test results, etc. The challenge, as you mentioned, is that it's so easy to get information and it's also so easy to collect information.
Right? So, the old days I get, I'm not one of these old days were so much better, but it took a little more effort to record information, so we were a bit more parsimonious with what we recorded. And now it's just so easy to grab a whole bunch of information and throw it in your note automatically. So, we have these loaded notes that we can read but often can't make sense of. They're unintelligible. So yeah, I think the most obvious benefit of the year is information is widely available and easily accessible. But as you mentioned, the downside is it's so easy to grab information and to create to document things that sometimes that information is really low quality.
Dr. Craig Joseph: Yeah, I mean, I recall being a fourth-year medical student and I was rotating in the ICU, and my note was awesome, I thought, and it was a page and a half, the attending’s note was maybe four or five lines. What felt bad for me was that the attending’s note with four lines said so much more than my one and a half pages of medical school. You know, like, here's a list of the medicine the patient’s taking, and here's a list of the labs. I don't know what's important. So, I'll put it all in here. And, you know, you could see as the training went on, people became much more sophisticated about what they wrote down, and they only wrote the things that were important. And we've lost a lot of those skills with, with, the electronic health record, with the advent of the EHR, there's really nothing you could do about that. I don't think the how do you teach residents and, and medical students how to write a note, or is that a part of academic training? It at UNC, I'm putting you on the spot as if you know about it all training for all.
Dr. Spencer Dorn: Yeah. I can't speak to all training, I think. Well, to go back to your point, it's like the Pascal quote, right? I would have written a shorter letter if only I had the time. It takes more energy and discipline to write a shorter note. Your ICU attending was right. Well, he or she was far more experienced than you were. So, they were able to shift signal from noise and they had a little more discipline to only put on paper what was necessary as compared to as an eager medical student. Right. You think everything's important, and you want to make everyone happy. So, you think more is better. So, I think a lot of the challenge, of digitizing notes is that it's so easy to create them that why put in a discipline into what actually is going in there?
I think there's a value to writing notes. It's not just a useless exercise that many of us have come to see as, but it's actually an exercise in reasoning and information synthesis and the like. I can't see what is happening to all of you. NC the medical training, I can tell you what happens when I attend on service with fellows is I always implore them to write shorter notes and not to load up their assessment. And with, you know, there's a lot of mixing, right? You write an assessment. Oh, this is a very sweet 82-year-old woman who has a history of X, Y, and Z, who, you know, ate a pumpkin pie last week and this week she's coming in with GI, but like, how do we shrink the amount of it? Like how do you critically synthesize and pick out what's important for your assessment and keep it really short and brief and your plan as well. So, that's what I encourage. Some of the trainees I work with, I'm also a bit of a, I probably annoy them that I tell them there sign out notes. You know, the column in Epic, if you use Epic or other medical records that like for inpatients, it is a brief capsule of who the patient is in case someone else has to quickly learn who they are if they get called to the bedside.
I'm a big stickler for at the end of each day, go over that and condense it to one or two sentences. One, it will help your colleagues out, but more importantly, it will help you make sense of who the patient is and what's going on. If you have a busy team, it's sometimes hard to remember who everyone is, so a lot of it is like, we need to avoid some of these shortcuts that give us and I think a bit harder about, what we're doing and put a little more effort into some of these activities.
Dr. Craig Joseph: There are not a lot of voices in medicine that are kind of proposing or at least emphasizing the importance of note writing as part of patient care, but you've been writing about it. KT Lynne from University of Colorado has been very loudly stating that he's concerned that automating that process, you know, just having some AI write the note.
Well, it might accurately reflect what's happened. It doesn't give the clinician the opportunity to think back, think through. When I was writing a note, I always thought about what do I need to know six months from now when I've totally forgotten this encounter that helped me figure out what was what was most important?
Dr. Spencer Dorn: Yeah. No, I think you're right. I think note writing and I like KT, I am completely aligned with his views on this, and I've spoken to him about this and read some of his thoughts on this. We too easily think it's just busy work, right? It's just like, yeah, right. Like all this pointing and clicking and typing as if we're doing it just to satisfy some administrator or pay or somewhere. But that's actually not. Yes, there is an element of that. And I understand why physicians recoil at feeling like they must do some of these activities. But there's a lot more value to writing notes and a lot of the other activities we do. And I believe a lot of this is intrinsic to clinical medicine. Right? We're not forgetting about the billing requirements and the coding and all the other things.
A lot of clinical medicine involves writing. Why? Because writing is part of how we think. There's this great quote, that I stumbled on that is along the lines of if you think you're thinking without writing, you're just thinking. You just think you're thinking, right? Like writing is so intrinsic to just how we frame things and how we make sense of information and how we form our thoughts. And we shouldn't just look to get rid of that. Some of it, yes, some of it's annoying. Some of the things we write may be rubbish, but at least in my mind, the assessment and plan portion and the note are just so critically important, I believe, to clear to clinical reasoning that we have to be careful not to give it up.
Dr. Craig Joseph: I mean, are you a soap note kind of guy, or an episode note kind of guy?
Dr. Spencer Dorn: I actually type my notes. With patients sitting in front of me, I type quickly, and I can look at them in the eye. And typing is probably the best class I took in middle school or high school. I don't remember when I took it, but probably the most valuable one I actually got. So, a lot of my notes I write before I see a patient is a specialist. Another thing we don't talk about enough is a lot of the note we, especially for specialists, but also for hospitals and sometimes primary care physicians is created before we see the patient, because who is this person I'm seeing for the first time and what relevant tests have they had? What relevant treatments have they had? What was their weight their having? They have gastroparesis and they have difficulty eating. What was their weight when they were seen in clinic a year ago, etc... So, a lot of my notes actually, right before I see patients, I kind of like do my homework in advance. And then I write a lot of the notes I write during the encounter. And then afterwards, you know, either in between patients or at the end of the day or at lunch, working through lunch, I kind of polish them off, and arguably, I spend maybe too much time on notes, but for me, it's just part of how I practice.
Dr. Craig Joseph: Well, this would be a good time to talk about a post I saw that you wrote where you were interrupted in terms of seeing a patient and you had to say, oh, I got to get out of here right now. Left the room and said, you know, I'll get back to you later to finish this encounter and to tell you my thoughts and, and you wrote a piece, quoting, Daniel Kahneman’s book Thinking Fast and Slow. Can you tell us a little bit about this? You know, what did you learn and how can we all leverage that kind of information?
Dr. Spencer Dorn: And full disclosure, I'm a big Daniel Kahneman fan. Just passed recently. Actually, I think his work was just, oh, you don't need me to judge it. Or if you want a Nobel Prize. He's world famous for a reason. But I was in clinic, with a really sweet older woman and her husband. They had waited several months to see me, and they drove several hours to see me. We were hitting it off. You know, they're just some people that you just have a really good chemistry naturally with. And, things were flowing really smoothly and felt like, you know, we were starting to uncover some things that were important. And I think I had just examined her and was coming back into the room to discuss with her and her husband what I thought was going on and some options for moving forward. And I got interrupted with a personal emergency, and I had to stop the visit like, on the spot. And I was terribly embarrassed. So, yeah, I explained, you know, they were really nice, and they were apologizing to me.
Sorry to deal with this, but I said, I'm going to call you tomorrow. We'll do a video visit to wrap up. And I dealt with the emergency. And that night I was thinking about her because I was like, this was the first time in my career this had happened. I had a really good idea for what time I thought she needed in terms of therapy, and it wasn't an obvious idea. And the next day we did this video visit to kind of wrap up what we had started the day before. I proposed this to her, and I just felt like I understood her problem so much better than I would have if I, you know, the day before. And I think it was just time and space, and it was almost like subconscious. I was subconsciously thinking about her in reasoning, and it just really made a deep impression on me that so much of what we do in medicine, right, where time pressure and I get a lot of time to see, especially compared to most physicians, I spend an hour with new patients. I'm very lucky to have that privilege, because I work in an academic system, and I see people have really generally complicated problems. But even that's not enough time sometimes to really consider what's going on. And it just reminded me of Daniel Kahneman, how, you know, the whole thinking fast, thinking slow. So much of what we do in medicine is thinking fast by necessity. Because, right, if we slow down, we're going to keep someone waiting. Someone's going to be angry with us.
And you know, we've got to get through our day. We want to get home to our families for dinner on time, all those types of things. It just made a big impression on me that, you know, I like slowing down and not feeling pressure to have the answer on the spot. Sometimes it's really valuable. And, you know, we have to remind ourselves that we don't need to know this answer today. We can get back to people. That was a really nice teaching moment for me.
Dr. Craig Joseph: Even with you with your informatics and your operational and clinical leadership responsibilities, knowing that efficiency is not always the goal for physicians to be ultimately efficient. You're reminding me of, a brain fart. Obedient who? I think you know, he was on the pod last year, and he talked about sub optimized workflows where basically adding friction to workflows to slow people down because efficiency is not always good. And I think you we don't want you to stop your clinic in the middle of the day, routinely for personal or clinical emergencies. That's not the goal.
But how do we kind of, I don't know if you have any thoughts about how do we kind of build in some of these, friction, some friction or some trip points where we're just like, yeah, you're going to have to sit and think about this because the dictation is not available for 30 minutes, or that's not a real answer, but there's, you know, there's something in there. Is there some way of leveraging how forcing us to do that slow thinking. And I don't know if it's possible.
Dr. Spencer Dorn: There probably are ways to engineer it. I don't know if we need to engineer so much as we need a little more space and we need a little more compassion towards ourselves, humility. You know, we need to ease up on ourselves, I think, a little bit and create a little more space to slow down in our thinking, or to take more time to chat with our patients about things that are completely unrelated to their clinical condition, right? To hear about their pets or their grandkids or write the things that most of us go into medicine for. We can over engineer. Our interactions with these like really discreet, predictable, you know, time pressed encounters.
I think we need to create a little more space to have more flexibility, to think more slowly or to connect interpersonally, more deeply, or just to have more time to catch up on things. Because if, you know, for operations like health care, never it's not like trains running on time, all the little delays throughout the day build up. And then, you know, you're apologizing to a 3:00 patient. You're starting that procedure at 4:00 because you had a really difficult polyp to remove two hours earlier. I think engineering is important in health care.
And we need to be efficient because there are limited resources. And there are a lot of people who need us, and there are lights to keep on and bills to pay and all those types of things, but they're very real. At the same time, I think we can over engineer because, right, things don't always run as planned. And we need time. We need space to connect.
Dr. Craig Joseph: Yeah, I love the concept of friction in design, designing friction into workflows and procedures and people's days to slow them down, even subconsciously, you know, some things should be difficult. And we're specifically not going to put default defaults here in this technology or in this part of the year, because we want you to think about it.
If that slows you down or if you sometimes pick the wrong answer, that's okay. Well, let me pivot to one of the required topics, on a podcast, which is our artificial intelligence AI, we were required by state and federal law to talk about that. There was a recent article in JAMA that showed that physicians who had access to ChatGPT actually did not enhance their diagnostic reasoning, accuracy, or speed. And then there was another study that showed that labs outperform doctors in diagnostic reasoning and accuracy. So, my question to you, Doctor Dorn, is, what are you and your physician colleagues planning to do when you're out of a job, probably next year? And I take over, like, what's the, what are your other plans? Do you have artwork? Are you a woodworker? Like, what are you going to do?
Dr. Spencer Dorn: I was hoping to become a podcast host, but there's stiff competition.
Dr. Craig Joseph: I feel like that's also going to be taken over.
Dr. Spencer Dorn: The first thing I'll say is there's a great quote by a pioneering, informative system named Warren Slack, who was an internist at Harvard. And I think you said this in either the 80s or maybe the early 90s. And he said, if a physician can be replaced by a computer, then he or she deserves to be replaced by a computer. So, if the computers can do things better than we can, fine. Right. Fine. But let the computers do it.
I think the computer certainly can do many things better than we can, and I think it's fine for us to acknowledge that. But I think there's a gross oversimplification of what physicians do, and there's this public perception of physicians as what do we do? We intake data, we output diagnoses and diagnoses, and we prescribe things like that. You know, like where are these little automatons that walk around input, output, input output. And as you know, as a physician, and I think as many non-physicians realize, that's a relatively small part of our jobs, we do so much more than, you know, input, output than is appreciated.
There are thousands of things we do. And the very basic simple everyone has this view of just input, output, or they either think that's all we're doing or all we're doing is writing notes. Right? So, let's just automate all this. And I think it's just an overly simplistic view of physicians in terms of the JAMA paper that you cited.
One thing I've been thinking about a lot about recently. I've thought a lot about that JAMA paper, really brilliant study. And as you mentioned, what it showed is that large language models can outperform physicians on these, you know, diagnostic, and clinical reasoning on these vignettes. And what's really interesting also is that when physicians were given these language models, they didn't perform any better than they did without them. And, speaking to, you know, the author, one of the lead authors of the study, what's really interesting is that physicians use these tools like a traditional like Google or search engine. Right? So, they actually didn't really know how to use the line. They didn't know how to use the AI. So, I think, one thing to me that's really interesting about that study is as physicians, we probably need to avoid these fears, like AI is going to take over our jobs because that's just silly.
And instead recognize that AI is a clash, right? It's not one thing. It's a clash of powerful tools. And we should spend a little bit of time and effort learning about these tools, not necessarily learning about, you know, foundation models and, you know the deep science behind it. But what are these tools, how do they generally work and how am I supposed to use them? So, these are just a few thoughts. I probably ramble a bit. So, bring me back to your line of questioning.
Dr. Craig Joseph: Well, I you know, I think that was really the main gist is that, hey, just giving these doctors this tool and saying, God, it's almost as if you gave me an endoscope and said, well, you're a physician. Go, you know, put this thing somewhere. That it would have a bad outcome because I'm not trained on that tool. And I think what we're seeing is a lot of research where, yeah, we didn't train anyone on these tools. And then we are shockingly finding that they don't know how to use them.
Dr. Spencer Dorn: Yeah. And the good news is it's not I mean, it's not super hard to learn the like. So, they say in training you probably need to at least 150 colonoscopies before you're like, feel like you even know what you're doing. And in truth, you probably need to do a thousand before you're relatively confident. You don't need to spend, you know, a year playing with ChatGPT to understand these tools. I think some basic education of understanding these are probabilistic models and, you know, just the basis of basics of how they work. Or if it's a predictive algorithm, right? The language models are not all there is an AI, of course, but then. Right, I don't know of some a lot of people are like ten hours is probably enough. Ten hours of playing with these things is probably enough to develop enough understanding of these tools. So, it's not this, you know, like if they learn how to do cardiac catheterization or how to, you know, oblate atrial fibrillation, orienting we with the basics of these not being afraid, not fearing will be replaced because, I mean, maybe one day.
But as you know, Kane said, in the long run, we're all dead anyway. So, in the short term, we're not being replaced. These are tools that can do some things really well. Let's just learn how to use them. And that doesn't mean going off and getting a master's degree in computer science.
Dr. Craig Joseph: One thing I saw that you wrote, I think you wrote, about, Henry Ford's quote that if you ask people what they wanted, will again, when he was developing a car, he would have they would have said faster horses and, oftentimes we use technology as we are now to automate what we already do now, the way we understand it and now. And so, we're using an AI to write a note, maybe not be the best note, but it's faster. It's more efficient. I think you've been talking about hey, maybe it's time to rethink clinical documentation. Why are we why being we using this very advanced and expensive technology to write old-fashioned notes? Maybe we need something new that's not even a note at all. So, what is five, ten years from now? What are we doing? How are we communicating? What happens in medicine?
Dr. Spencer Dorn: I think we're likely doing the same thing we are now. It doesn't mean we should be right. Change is very hard in medicine. There are a lot of regulatory requirements that many blame for the length of our notes. If you compare, American physician notes to notes, from doctors in Europe, our notes are much, much larger. Or I should say longer. And what's interesting is a lot of the requirements, the documentation requirements changed a couple years ago, as you know. But our notes lengthen and change. So, a lot of us are writing much longer notes than we would like, you know, than what players require. But it's just this hard to change behavior.
No one likes to change my point with the Henry Ford quote. That gets used a lot because it's such a good quote, but probably overused, is that maybe AI creates a new window, a new opportunity that instead of writing our long, bloated, mostly crappy notes faster, maybe we could rethink clinical documentation altogether. Now, maybe it sounds like I'm talking to both sides of my mouth because earlier I said note writing is really important. But what you know, I dream of sometimes is maybe we could just write our impression, and really high level what we're thinking and passively collect all the other data. And then when Doctor Joseph needs to see the patient, I saw a week from now, the AI can instantly synthesize and assemble and pull together the right piece of information that he needs at that point in time. So instead of writing these long, static documents, maybe we can just create little packets of information that we think are important for someone else to know and file that away, and then later on allow more dynamic recreation and of the information necessary at that point in time.
Dr. Craig Joseph: What about bringing in patients into the note writing process? Where do you where do my thoughts go as the patient?
Dr. Spencer Dorn: I think that's important. I think the patient's concerns can and should and certainly do have a say. And now that we're increasingly using ambient to record conversations, that's being passively collected as well, I think we'd have to be careful not to create even more burden, write more effort to towards doing this. But I would love a world where we use, passive data collection and blend it with some active, thoughtful information capture, and then later, depending on the need at a given point in time and what you know, who is seeing the patient, what their need is, reassemble dynamically the right information rather than having to look back at notes. As you know, notes are just part of this old paradigm. In fact, we have tabs in our ears because it recreates the old tabs in a filing cab. Right? Note our filing cabinets. I don't need to tell you this. As someone who is a design thinker, those are. That's the faster horse, right? And now we're speeding the horse up. We're giving the horse steroids by not only having us digitize these notes into these, you know, hypothetical file and cabinets, but now we're just automating a lot of that note writing process. And I think we could do better, but I'm also realistic, and I think change will take a long time.
Dr. Craig Joseph: You know, we're getting to the point where the regulations and laws are kind of catching up, maybe, or at least contemplating catching up. And so, it used to be the physician note was the end all be all of what happened at that office visit or, that progress note on that hospital day, or the procedure note. That was it. There was no other information that could be that could be leveraged to understand what happened. And now we, as you so eloquently point out, there's so much other information out there. Well, this has been this has been a great conversation. As with all of our conversations, great or not, we always end with the same question if there's a product or a tool or a process in your life that is so well designed, it brings you joy. What are there 1 or 2 things that epitomize of design for you?
Dr. Spencer Dorn: One that came to mind, which maybe someone's shared on your podcast before? Probably not. Is I use this great little meditation timer. It's a digital timer with almost no features. It's called the NSO. NSO, which is a Japanese, word, that relates to Zen. It's essentially a circle without a beginning or an end. And this timer is designed in the spirit of that. And it has, you know, you could set the time, and you could set the sound of the chime and the volume, and that's pretty much it. And what I love about it is its simplicity. It's not like you're meditating with your phone next to you, because the last thing you want to do after you meditate is, you know, get on Twitter or, The Wall Street Journal, whatever you read. So, it's just like, highly functional does exactly what you need, but it's super simple and does not draw you into things you don't need to be doing.
Dr. Craig Joseph: So no, no, that's a new one. That's great. That's great. It's an it's a specific tool and it does what it does well and it doesn't do anything else I love it, I it kind of reminds me I've seen these what we used to call word processing, I think we call it typing or writing now, but these, tools that are essentially just, typewriters, they're, they're like a computer, but they don't they don't connect to the internet or they do, but they're only for storage and, to try to get rid of all the distractions so that you just focus on what you're supposed to be doing. This was great. I really appreciated the conversation. Thank you so much. You're forward thinking. And I would encourage everyone to listen to you on, to read your, your writing, which is, I think mostly on LinkedIn. I at anywhere else.
Dr. Spencer Dorn: Yeah, right. I've been writing for Forbes recently as well. So, something a little bit longer form, still relatively short, but a little more than a LinkedIn post. Yeah. And people could check out the work we're doing at UNC. I am very proud of our department and our health and our health system here. But yeah, it was great speaking to you. Craig, I really enjoyed this conversation.
Dr. Craig Joseph: Thank you so much, Doctor Spencer Dorn.