YouSaid · the spoken record

Ezekiel Emanuel

lines on the record: 82
first: 2019-05-22
most recent: 2019-05-22
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“Ah yes, when I was in the White House, one of the things I did was we had regulations governing research, biomedical research. They had not been revised in decades, and they were certainly antiquated and out of date. And I initiated and led a process of revising the regulations.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“One of our problems at the moment is we're way over on, let's give people information and they'll decide. No, it doesn't work that way. Information overload, lots of us have inertia and we have a hard time. I will tell you, I read financial information about my stocks or my bank account or my credit cards and my eyes glaze over. I'm very bad at it. I'm not protecting myself. I need someone else to protect me.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I think that's an excellent observation, and we way overemphasize informed consent as a protection of people. I think that's very common in American society. Just give people information and they'll decide. Well, I don't have enough time to get information on everything I have to do. I have to trust lots of institutions. I have to trust the regulatory oversight bodies that are making sure the airplanes are working. I can't go out and inspect the plane every time I take off and things like that. And I agree with you in low trust societies or societies where there aren't good institutions relying on individuals is no substitute for relying on institutions to protect us. And I have often said that, you know, it's very hard for an individual to figure out the risk-benefit ratio of, say, a research experiment or any medical procedure, and that you need to rely on others with expertise. And I think”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“an organ means someone else won't get an organ and we need to take that into account so part of what I have I think a lot of what my work has been is the values that we emphasize tend to be exaggerated and probably inadequate to describe the situation and we typically need to put in more values so once we have lots of values in the pot as it were we tend to be really bad about prioritizing them and I think I tend to be one person who says you know here are the constellation of values and here's how you should prioritize them. Not everyone agrees with me a lot of the time, but I do think I'm trying to bring in more subtle values and widen the way we think about issues.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Other values that are important. And I'll give you an example. For I think most of our discussions, we have overemphasized individual autonomy, certainly since I've been working in this area since the mid-80s. It's autonomy, autonomy, autonomy. And that sort of disengages people in two ways. One, it sort of removes people from their social network, whether it's family, community, religious orientation. And I think that just wrong, emphasizing the individual has consequences for other people. And the second thing is it sort of ignores the economic political realities that some choices for individuals will have big economic consequences, political consequences for other people that we need to take account of. Spending a lot of money on one person definitely means we're not spending it on other people. And we have to take that into giving one person.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“No, it isn't an accident. And I did actually read all those people. I read a lot of John Rawls and contemporary ethicists. I read a lot of sort of biomedical ethicists like Norm Daniels and Dan Callahan. I would say that in general, what I try to do is intuitively figure out what the right answer is to a situation and then figure out what are the principles that got me to that right answer and what are we trying to do. I would say that so this is a biographical statement about the way I do it. In general, when there's a conventional wisdom about a problem, I usually find that wrong. And I spent most of my career as like, oh, that's the conventional wisdom. It must be wrong. Here's the right answer. And here's why it's the right answer. And the conventional wisdom is wrong. And typically one of the problems I think with the conventional wisdom is that they overemphasize one set of values and tend to underemphasize.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Whoa, I don't know that anyone's actually asked me that question. And I think it's pretty complicated. I don't think it's a linear process. But it's no accident.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I did a lot of philosophy. I did a lot of political theory in the government at Harvard's political science department's called government. Yeah, those are the two things. I also did some law training.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Get your expectations right. You shouldn't expect the medical establishment to have that big an impact on life expectancy. So it is a reasonable metric, but if you really want to affect life expectancy, and by the way, I'm not a big proponent of using that as a metric for all sorts of reasons. We should invest in education, better housing, more equal incomes for people, not invest $3.5 trillion in the healthcare system. The healthcare system by and large has come at the end. People already have diabetes. That's not the best place, most cost-effective place to invest. And we know that probably the opportunity cost of overinvesting in healthcare come at the cost of education, housing, and other things in society. And so it's not a surprise that we're spending a lot of money and the returns are down. It's not because Japan spends a lot of money that they have an average life expectancy of.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“That's what I was about to say. We know now with prostate cancer. We're taking out a lot of prostates. People are getting side effects, impotence, incontinence, and yet we're not actually having a big impact on mortality. So you need to look at the impact on mortality overall and the five-year mortality ranking the percent of people who have a five-year mortality controlled four stage of disease. That's a hard metric to come by for a non-oncologist to see. So we've done, for example, a remarkably good job of early diagnosis of breast cancer, five-year survival of breast cancer in the United States is the highest in the world, but a lot of that probably is due to early diagnosis of small cancers that wouldn't have made any difference to the woman anyway. We have actually not had that big an impact on larger cancers. And so what you see is the overall mortality from breast cancer hasn't really changed. So you need to look at the overall mortality in the population”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“You are good with Google. I know that. So I would say that actually what you want to look at is the relationship between, you want to look at five-year mortalities and the percent of people who have five-year mortality, but you also need to measure that by not having”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Priced tremendously. But that is one example. We now have immunotherapies that are making dramatic changes, curing kids with incurable ALL or curing people with B cell lymphomas in the next year or so. They're going to be treating people with myeloma with it and probably curing them. So there's been a lot, a lot of changes in the chemotherapy world.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Gotten fewer side effects. We have real cures for illnesses. I'll just give you one example, but it's sort of characteristic. When I started out in practice learning in 1990, I became an oncology fellow at the Dana Fiber Cancer Institute, CML, chronic myelogenous leukemia, a disease of older people around 60 years old. There's a chronic disease sort of smoldered along, as we said, and then blasted off, transformed into acute leukemia. And within six months people died regardless of what you did. You threw a lot of chemotherapy at them and they died. Now, actually a colleague of mine from the Dana Farber developed a drug called Gleevak, basically made it a chronic illness. People don't die of CML anymore. They die of some other condition. It is really a miracle cure, and it's a very easy drug to take. It's very expensive, or was very expensive when it was on patent. Novartis jacked up the...”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“This is a super exciting time when lots of things are changing and you can have a real positive impact in shaping the future, probably for at least half a century. We're going to put in place the structure over the next decade that's going to be in place for the next half century of American delivery.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I've just said it, which is learn a lot of the other stuff about life and, you know, the preclinical stuff is not that important. We put a lot of emphasis on that microbiology, that pathophysiology. Learning it is important, but don't overemphasize it. There's a lot of other life that you need to really understand to understand American medicine and to understand your patients and provide optimal care. I also would say to medical students coming up, I do think that this is probably the most exciting time in American medicine in a century since really about 1910, 1920. And it causes a lot of anxiety for people. So I want to be sympathetic to that, you know, change is, we all talk about change in America. We're all for change except we don't like change. We're all conservative. We would prefer no change. But I do think if you can go with the change, this...”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, well, I think you might learn something about your relationship to dead bodies and your relationship to death and your relationship to using a body and simply manipulating it, that would be important.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I don't probably not, but I'm not 100% sure about that because there are probably areas where you don't need the clinical side or even the insights into the clinical side. One of the things you might say that's gone wrong with electronic health records is that they were designed by people who didn't understand the clinical interaction. And I think one of the things that totally frustrates current doctors is, you know, these things were written and damn it. They don't integrate well into my clinical experience into seeing a patient in the office. I'm on the screen too much. I'm not interacting eye to eye with patients. And I think that's a result of people who really didn't understand the clinical world.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I think more philosophy, more American history, more English literature, more psychology, more behavioral economics and political science, all those things would be better.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“But I don't think that is the major issue here. I do think that there's a lot that you learn about yourself that is very important for being a good doctor and being able to relate to patients. And again, this is where we overemphasize IQ as opposed to EQ. I mean, one of the problems I think of American medical training is the pre-med requirements. They are ridiculous. Absolutely ridiculous. I'm in the literature saying they're ridiculous. Organic chemistry. Irrelevant.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Every test you throw at me. Absolutely. It's not about, again, this goes back to the EQIQ thing. It's not about the IQ. You keep thinking IQ here, Tyler.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Yes, absolutely, and because an undergraduate degree is not about skill building. It's about finding and understanding yourself deeper and understanding your place in the world, understanding your place in history, understanding your place in the economy. So you're saying...”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“No, I think it will make it better. So we have a lot. Really irrelevant to medical practice, totally irrelevant why we teach it I have no idea. Similarly, the Krebs cycle I learned I count it six times, never use it once in practice. What are we doing? So just think about the future. In the future, all these preclinical courses are going to be online. You're going to have great teachers who are teaching online. Well, what's a medical school doing other than showing you videos? And we already know today A third of students show up to class. Two-thirds of them look at the videos of their class already. So I think increasingly we're going to go to, you know, you'll do the preclinical work before you get to med school, and then med school is really the clinical work. And then, by the way, in med school, spending your time in a hospital is not the future, the future of American medicine is out of the hospital. So we need more rotations, more experiences for students out of the hospital. No med school has made that big shift. And those are the”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, there are a lot of ways of doing it. I don't think you actually need vouchers. You need to make doctors fiscally responsible or at risk, as we say, in the business for their patient's health, for the total cost of care of their patients. And then they really are going to focus their attention on more sick people. And yeah, the rich will always buy out. And we need to recognize that one or two or three percent of the population can afford Cordon's medicine, but 97% of us, first of all, can't afford it. And for many of us, it's just not the highest priority in our life. And so we won't pay that extra money to get those docs.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I actually think the sick people ought to get concierge medicine. That's the real future people who are at risk for serious complications, serious exacerbations of the illness. They're the people who need concierge medicine. And again, if you go around the country and you look at places that are really performing well, super high quality, low cost, they almost all give concierge medicine to the sick people, not just to the people who can afford it. And I think that's actually much more relevant to what we want.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I'm stuck with Google. Wow, that, I think, is, again, we need to distinguish the workforce problem from the problem of the way it's structured and the way it's organized. Do we actually need more bodies or could we more efficiently organize the system? The latter is the problem, more efficiently organize the system. And if you look at places that actually do a great job, do a very good job with fewer doctors and more of other people who do respond in a timely manner to emails. And most of those questions can readily be answered without doctors knowledge.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, no, I think they would drive up the cost. You know, medicine is a classic case of supply-induced demand. Doctors write orders, and they have a certain income in mind, and they will do things to get to a certain income, and especially on the margins where we don't, you know, what's called unnecessary care or low value care. And that's a bad thing if you have too many doctors who need to get to a certain income. the demand just not there.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Actually, give them adequate care. You can do over the phone. You can do text. You could have someone else, a nurse practitioner, even a medical assistant, the front office desk person can do it. And I think getting that, what we're the highfalutin language of task shifting under our belt, we're not going to need more doctors. And I fear that once you train a doctor, it's basically a million dollars or more, depending on what kind of doctor you have, of billings that you have to do to care and feed for them. And that's a lot of money.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, if you listen to the Association of American Medical Colleges, the AAMC, the official body, as it were, there's a shortage. And interestingly, if you go to almost every other country, they say there's a shortage. The fact is there's no shortage at all. If you calculate out, and we did this crazy calculation, someone said, no higher math required, just lots of division. If you look at the number of office visits that we have, you look at the number of primary care doctors we have, you actually are quite generous, half an hour of visit, not 12 visits a day. You can easily accommodate all the primary care visits we have and also all the primary care visits we need with the current existing doctors. It's really about how we allocate their time and it's also about using, not using the office as much. There are lots of things we've brought patients in for that we don't have to bring them in for to.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I'm not sure. So I think there are professions that tend to have high. I would say actually one profession that has a very high that I've seen is when you properly select community healthcare workers, not everyone has encountered a community healthcare worker, but they tend to be people who want to do good, are good listeners to other people, good problem solvers for other people. And I do think that's a group when I've met them tend to be really high in EQ.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“So, Doc, I think increasingly doctors are just one part of a team. They are typically the captain of the team because they have some knowledge and insights that others don't. But they have to be one part of a team. We recognize a lot. You need chronic care coordinators. You need mental health specialists. You need dieticians. You need pharmacists. All of them have to be components of a team. And the doctor is typically the captain of the team, but not the only member of a team. And I do think we tend to overrate the importance of a doctor and underrate the importance of a system around the doctor.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“I'm not sure actually what the best predictor is. I'm not a person I would say I've had to cultivate my emotional intelligence. It doesn't come natively to me the way it does to one of my brothers or both of my brothers actually. But I do think the ability to understand what's going on in someone's person and the ability to tell fake from real smiles is probably really important. And we talk about a lot about empathy and empathy is one component of emotional intelligence, but only one component of it. But there are some games that you can play in collaborative, looking at collaboration.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source
“We think that smarts is what counts, but I think a lot more of it is emotional intelligence, judgment under pressure, much more important. So just think about what the big challenge is for medicine today. The big challenge is the fact that 86 cents of every dollar goes for people with chronic illness. That's an illness that can have every day for the rest of their lives or every day for the foreseeable future. The main thing is to get them to change their behaviors related to that. And that is not about intelligence. That is about relating to them and emotional intelligence and getting them and persuading them to change their behavior.”
2019-05-22 · Conversations with Tyler · Ezekiel Emanuel on the Practice of Medicine, Policy, and Life · IDENTIFIED FROM THE TRANSCRIPT · source