YouSaid · the spoken record

Theodore Schwartz

lines on the record: 74
first: 2025-05-21
most recent: 2025-05-21
sittings or episodes: 1
sources: podcast

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“Into the operating room and he did the full operation that he was set to do, and then he went and claimed his son's body when the operation was done. And that just tells you something about what kind of a human being he was, what sort of focus, dedication, self-restraint, and discipline was required of Harvey Cushing to move the field forward the way he did.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Present at home, you're not fully present at home. It's just a very demanding career, and it's an unforgiving career. And I write about in the book, you know, there's some stories of some famous neurosurgeons like Harvey Cushing or Ghazi Yashurgill, who people don't necessarily know all those names. But there's a famous story about Cushing, who was really the founding forefather of neurosurgery. In the turn of the century, 1905, you know, he really was the first surgeon to dedicate his career to neurosurgery, which at the beginning of the century had a mortality of about 50%. And at the end of his career, it was down to about 8%, really remarkable what he had done to make neurosurgery safe. But he went into operate on a Saturday morning on a patient. And he got the news that his second son, who had just graduated or finished his third year at Yale, was in a car crash and died. He got the news in the morning and he walked.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“I think it's the same thing. When you have a career where not only are you out of the house for a long time and you get called out of the house at awkward times, so that could be on Valentine's Day, right? That could be at 2 in the morning. But even when you're there, even when you're at home, there's part of you that's always absent. You know, one thing that I realized is no matter where I am, there's always part of me that's thinking about the patients that are in the hospital that I operated on last week and how they're doing. And maybe one of them is struggling a little bit and I have to be aware of that. And I'm thinking about the patients I'm going to operate on next week and the challenging cases coming up and how those are going to go. And I'm visualizing them in advance constantly. So the past and the future of what you do is weighing on you all the time so that even when you're”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“So the numbers are going up. Women are actually doing better. They're now at maybe 10%. I think we expect them to be at about 30% in a few years. But it's a very demanding career. And as you know, women often are focused on childbirth and being having the freedom to raise their children in the way they want to raise them. And neurosurgery doesn't always allow a woman to do that. But if depending on how you want to run your life and what you want to do, obviously I know many women who are neurosurgeons and have children and they're wonderful mothers to their children. They may not have four or five children. They may have one or two children just to have the time. But I think that is a limitation to know that you're not going to be there as much as you may want to be for your children.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“I love Ron Carter, but I have to say Jocko Pastorius. He was an electric bass player. I don't know if you're familiar with him. No, it's”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“I think I've always been pretty good at concentrating. You know, I think, you know, we do have to take a lot of tests along the way. And you have to sit in your room and study and memorize an enormous amount of information. And that takes the ability to sort of sit and focus for long periods of time. I'm also a musician, which I found very helpful because the ability of sitting in a room and practicing an instrument, which I would do for hours and hours and hours if you want to become very proficient at it, is something that lends itself to neurosurgery”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“See again, they may never wake up from that operation. And you don't want to take that lightly. It's an enormous responsibility. And so you want to make sure you choose people who are going to be completely dedicated to the task.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“I don't think raw IQ matters that much. You know, the end of the book, I quote this, there's an article that came out in the British Medical Journal that looked at the IQs of neurosurgeons, rocket scientists, and average professionals and essentially found that they were all about the same. And I don't think that raw IQ is what makes a great neurosurgeon. You know, it is psychologically very demanding because you are taking care of people at a moment in their lives that is the most critical where they're in most of need of help. And they basically hand over to you their most prized possession for four hours, six hours. And you have to be on your A game. Every time you're under the microscope doing neurosurgery, because, you know, one false move, one damaged blood vessel, one damaged nerve. And that individual that you're taking care of may never walk again.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“You know, we choose at the top programs surgeons often based on research criteria. A lot of the top programs want someone who have worked in labs and proven that they have a research brain and that they're going to contribute to the field. And that is one aspect of neurosurgery for sure. We want people who are going to improve what we do because medicine is constantly evolving and we need to get better. But on the other hand, surgery is very much a tactile physical sport that requires judgment and coordination and stamina and sacrifice and grit. And some of the best neurosurgeons combine all of those qualities. And we interview the residents for 20 minutes when they come in. And it's very hard to evaluate them on all of those.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“When I started out, I had horrible back pain standing in the operating room, excruciating. I couldn't stand for more than half an hour and my low back would go into spasm. And I realized very early on that neurosurgery is a physical activity. You not only have to stand for long periods of time. You know, you can't have a significant tremor. You have to be able to focus for long periods of time. And you have to be able to work on very little sleep because sometimes you're getting woken up at two in the morning to do emergency surgeries and then you have to go back in the next morning and keep operating. What helped me in the end was learning how to do a lot of core exercises that strengthen your core planks and things like that. And then just practice and experience like anything. The more you do it, the more you strengthen those muscles and the better you can tolerate it. But for many years, I had excruciating back pain and I was constantly stretching the operating. And I think a lot of surgeons go through that until those particular”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“The day they graduate, they're fully competent to practice on their own. And that's one of the difficulties involved in training someone to do neurosurgery, where we really don't have good practice facilities where we can have them practice on cadavers that are really not the same or have models that they can use. They're really not the same, or simulations are not quite as good. You know, I don't at this point, we don't label physicians as early in their training, but I think if you do a little bit of research when you see your surgeon, you know, there's a CV there, right? So it'll say, this is when he graduated or she graduated from medical school, and you can do the calculation on your own and say, wow, they just graduated from their training two years ago. Maybe I want someone who has five years under their belt or 10 years under development. It's not that hard to find that information.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“You raise a great point, and I've thought about this. I talk about this quite a bit. The general public, when they come to see me, for example, I'm at a training hospital and I practice most of my career where I was training residents. And they'll come in to see me and they'll say, you know, I want to make sure that you're doing my operation. I want to make sure that you're not letting a resident or do the operation. And we'll have that conversation and I'll tell them that I'm doing their operation, but that I oversee residents and I have assistants in the operating room. But at the same time that they don't want the resident touching them in training, we are obliged to produce neurosurgeons who graduate from the residency capable of doing neurosurgery. What they want neurosurgeons to graduate fully competent because on day one you're out there taking care of people, but yet they don't want those trainees touching them when they're training. And that's obviously an impossible task to not allow a trainee to do anything.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Unfortunately, I've tried that, and you get some oddball answers. Some of them are correct, some of them are incorrect. I think the best thing to do is try to find someone that you know, a friend of yours, who's in the healthcare profession, and have them call around and ask their friends because they'll know someone who is a neurosurgeon. And it's really the neurosurgeons know who are the top neurosurgeons doing a particular operation because those are the people who write the most articles, give the most lectures, do the most volume. They're people that are known to be very, very good. It can be very hard for a consumer to know that. And what I found is most consumers are so awed by the fact that you are a brain surgeon, you know, that you've gone through this training, that they sort of take what most surgeons tell them at face value. I happen to practice in New York City where everyone gets second, third, fourth opinions. So, you know, people are a little more critical about their physicians and do more research. But I think it is very important to get second, third opinions and speak to people in the medical profession.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“And you're going to get a much better product. I get paid exactly the same amount as the resident who was the first day out of their training. There is no accounting for experience and expertise in reimbursement for physicians for what they do. I may have a bigger volume, right? So I may do more cases because more patients come to me because I have more experience and more of a reputation. But for every widget I produce, I get paid exactly the same. And the quality of the product can be dramatically different.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, the economics of medicine are quite different than other things because most doctors will take most insurance plans. So if you have a private insurance, whether it's United, Blue Cross, or Etna, you can see an incredibly good neurosurgeon who is likely to take your insurance. There are some pockets of places in the country where some physicians may not take insurance plans, but for the most part, most of them do because the insurance companies have such a powerful control over the patients and the patient volume. But if you think about it, and I know economics is really what you are all about, if you think about it, it's somewhat unfair to the physician because the insurance company fixes the rate that they'll pay a surgeon. So if I am day one out of my neurosurgery training and I take out a brain tumor and you have United Healthcare, whatever your insurance is, I'll get paid X dollars. If I'm 30 years older and I have 30 years more of experience and I take United Healthcare and you come to me 30 years later,”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Sophie's choice of saying should I leave some tumor behind to make sure that the patient can walk after surgery or should I be more aggressive and try to take it out and try to cure them and put them at risk of some sort of a postoperative deficit? None of that is tracked by hospitals. Hospitals are not really concerned with whether you get the whole tumor out or not. They're concerned with whether you get an infection or not, whether you get a clot in your leg or not. There's certain very specific things that they track because that's how the government judges them and determines their reimbursement. And so unfortunately the things we measure are the things that are easier to measure and the things that the government wants us to measure, but they're not necessarily the most important things to be measured in a neurosurgical operation. And the same would be true of a cardiac surgery or urology, I presume.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“What's interesting is what's collected now and tracked by hospitals is what they care about. And what you learn when you're in the practice of medicine is that the priorities of a hospital and the priorities of an individual physician are not completely aligned. They're partially aligned. So for example, one of the things that we measure now that hospitals are very concerned with is whether your patient comes back into the hospital after a certain period of time and whether they get an infection or not. Till Gawande, you mentioned before in his checklist, his checklist is wonderful for reducing infections and certain frequent complications. But when I'm in the operating room, I'm concerned about whether I'm going to be able to get this whole tumor out or not. I'm concerned about whether my patient is going to be able to see when they wake up after surgery, whether they're going to be able to walk when they wake up after surgery. And often there's a push-pull decision making.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Theory you could measure their outcomes and have them enter their outcomes into a database for every surgery that they do. Right now we are so far from doing that. We have no idea what goes on once that OR door is closed and a surgeon is on their own, there's really nobody looking over their shoulder for the most part. So yes, I think that data could be accumulated, but we're not even close to accumulating any of that right now.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Surgeon that you're seeing is doing that surgery. And not all surgeons are created equal. So the AI will not necessarily be able to take into account the skill level of the particular surgeon that you're seeing because that's unique to that one surgeon and that one surgeon alone.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Think that in the interpretation of MRI scans, a patient comes into your office with conglomerative symptoms and you've got to figure out what they have, those things in AI are very good at. But often neurosurgery is different than internal medicine. We're usually not presented with diagnostic dilemmas or radiographic dilemmas. The dilemmas that we face are decision-making, physical decision making in the operating room. That's really what neurosurgery is all about. Remember, a patient will come to us. They already have an MRI scan in their hand, right? So they're coming and they're saying, I know I have a tumor. I know where it's located. What should I do about it? And the other thing that's tricky about having an AI make a decision, let's say you have a tumor that could be observed. It could be radiated. It could be operated upon. So you have three options. But what's going to factor into whether to do the surgery or not is how good the”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Yeah, I don't disagree with you. So, again, I'm not arguing with the training part. I think we could do it much more quickly for sure. But as I mentioned, there's a certain amount of maturity involved in making the decisions that we make that plays in. It's not just years that you've been doing it, but it's also wisdom. And wisdom comes with age as it does with experience.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“Possession, you want them to have a little bit of experience. You want them to have some age and some wisdom when they're taking care of you. And if we condense everything, then that person could be 26, 27 years old. So I think we have to balance education with the wisdom that's required to be a great neurosurgeon.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“I do agree with you. I think that the undergraduate education, a liberal arts, I was a philosophy and English major, right? Which was wonderful. And I loved the expanding universe that I explored. But to be a neurosurgeon, I did not need to read Nietzsche and Kierkegaard. And even in medical school, there's a lot of things that are done that could be condensed. We rotate through the hospital for two years, choosing what we want to do. And if you know what you'd want to do, you could condense it. So I do think that undergraduate education and medical school could probably be condensed into six years instead of eight. But I'm not sure that the neurosurgery training, that could be condensed as well. Obviously, you don't have to do research, right? If you're not interested in research, you don't need to do it. You probably could learn how to be a nurse surgeon in four years. But if you think about you being on the table, right, rolling into a hospital and looking up at the person who's about to open your brain and take care of your most precious place.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source
“So, med school is actually four years for everybody. It's universal. And then neurosurgical training is anywhere from six to eight years. The average is usually seven years. You do one year of internship. And then I did two years of a junior residency. You often do research. It could be one in two years folded into your residency training. And then you would do additional two more years of senior and chief residency. So I was not done with my training till I was 33 years old.”
2025-05-21 · Conversations with Tyler · Theodore Schwartz on Neurosurgery, Consciousness, and Brain-Computer Interfaces · IDENTIFIED FROM THE TRANSCRIPT · source