The AI Revolution That Could Save Healthcare with Dr. Robert Pearl

The AI Revolution That Could Save Healthcare with Dr. Robert Pearl

Kelly Kennedy: Welcome to episode 228 of the Business Development Podcast, and today I'm joined by Dr. Robert Pearl, former CEO of the Permanente Medical Group, and author of Chat, GBT md. This isn't just a conversation about healthcare, it's a front row seat to a historic moment and turning point. Dr. Pearl believes we are standing at the edge of a transformation, so massive.

The world will never be the same. If you are hearing this, if your heart is beating this moment matters to you, stick with us. You don't wanna miss this episode.

Intro: The Great Mark Cuban once said, business happens over years and years. Value is measured in the total upside of a business relationship, not by how much you squeezed out in any one deal, and we couldn't agree more.

This is the Business Development podcast based in Edmonton, Alberta, Canada, and broadcasting to the world. You'll get expert business development advice, tips, and experiences, and you'll hear interviews with business owners, CEOs, and business development reps. You'll get actionable advice on how to grow business, brought to you by Capital Business Development Capitalbd.ca.

Let's. Do it. Welcome to the Business Development Podcast, and now your expert host, Kelly Kennedy.

Kelly Kennedy: Hello, welcome to episode 228 of the Business Development Podcast, and on today's expert guest interview. I bring you an absolute trailblazing leader. Dr. Robert Pearl is a leader in healthcare whose transformative work has reshaped the industry's landscape.

As the former CEO of the Permanente Medical Group and president of the Mid-Atlantic Permanente Medical Group, he directed the care of millions of patients and led thousands of physicians to deliver outstanding medical services. His leadership has been pivotal in establishing Kaiser Permanente as a benchmark for quality in healthcare.

Earning accolades for excellence from JD Power Associates and the Centers for Medicare and Medicaid Services, a respected author, educator, and thought leader, Dr. Pearl's. Impactful books including Mistreated and Uncaring Challenge, conventional Wisdom, and his latest book Chat GPT, MD explores how AI can revolutionize healthcare.

His commitment to leveraging technology and innovation promises to redefine patient care and set new standards for the industry. Proving that with visionary leadership, the future of healthcare is not just within reach, but ripe for transformation. Dr. Pearl, an honor to have you on the show today.

Robert Pearl M.D.: Thank you so much, Kelly.

It's great to be with you today.

Kelly Kennedy: I have to say I thoroughly enjoyed your book and I was surprised because obviously I'm not from a medical profession, I'm also just living this crazy world of AI introduction. But I. Honestly, it was very insightful. Like I said before the show, it was very insightful.

As someone who has lived my entire life outside of the medical, just been a re a receiver of medical services to really get an insight as to what doctors are facing. You know, in North America this time.

Robert Pearl M.D.: Every one of us is a medical expert because we all are patients. We all have to get care. We see the challenges of the current healthcare system.

We see the problem with affordability. Over half of Americans can't afford American healthcare today, we're seeing growing problems with access, and for many of us, even if we've been in medical school, we find ourselves not feeling like we really control our own destiny, that we can control our own healthcare, that we even know what's going on.

As things getting more and more complicated, of course, that's becoming more problematic. So yeah, I think we're all. Expert in some way, even if prior to generative ai, we were not experts actually in providing the care, making the diagnosis, recommending the treatments.

Kelly Kennedy: Yeah. Yeah. No chat. GBT like we said before the show, I, I got the feeling while reading chat, GBT md, that this is gonna be a historical book for a historical moment.

And I know we chatted before and I'm like, did you feel that way? And you're like, yeah, totally.

Robert Pearl M.D.: This, this is going to be the equivalent that I talk about in the book. And by the way, all prophets from the book are the Doctors Without Borders, a great charity. This is like the Gutenberg Bible that now made access to books possible because prior to that time, they were so expensive, handwritten, taking a year of a person's time that only the very, very wealthy could do it.

Or the internet that brought knowledge to our homes, to our fingertips, brought it to parts of the world that otherwise could never had it. Or the iPhone, a tool that all of a sudden untethered us from our wind on wired telephones and allowed us to take information, access information everywhere. But as I mentioned earlier, before we started, what's so different about this is that the technology does not provide, not just knowledge, but expertise.

Do you have a medical condition, a medical problem? You can go to Google today and click on a variety of links and get information, but you can't actually apply it. Certainly not effectively. You know, I was on a, a different podcast recently and at the end of the show I was talking to the Ho Host as I talked to you before we started today, and she said to me Dr. Pearl, you're a skier and you're an expert in medicine. My husband fell about two months ago. His arm was over his head. He slid about a hundred feet and his shoulder still hurts and he can't use that arm as well as the other side. What's going on? She had never used Chachi. Bt I said to her, you know, I think I know what's happening, but let's do the following experiment.

Let's have some fun. Why don't you go to Chat GPT just get the free version and put all of the information you can think of about your husband into it and see what it says and then call me back and we'll talk about what I think's going on. Five days later, she contacted me. She said, thank you so much.

I did exactly what you said. And Chat GPT said He probably tore a rotator cuff. He needs an MRI to establish a diagnosis and you should see an orthopedic surgeon because he most likely needs to have a procedure done, not just to protect itself, but because he needs to have procedure done. That is expertise.

She said, I did exactly that. The doctor said he probably had a rotator cuff tear, got an MRI to confirm it and did the surgery and said at the end, had you not come in for a couple more months. I probably couldn't have returned the muscle to the right place 'cause it would've Wow. Contracted. That is expertise and why the generative AI technology is so much different than all prior forms of ai.

Kelly Kennedy: Wow. Wow. You know, and I want to get into that with you. Before we do, I wanna get to the bottom, you know, who is Dr. Pearl? How did you end up on this journey? I know you spent some time in my backyard. I was literally in Calgary yesterday on business, and I know that you spent some residency there, but, you know, take us back to the beginning.

How did you end up on this path?

Robert Pearl M.D.: Oh as I say in the last part of the book, serendipity and serendipity is very different than luck, but serendipity was definitely a major factor. You know, I went to college to become a university professor. I had graduated high school at 17 and only spent three years of college.

But after my first year, my hero. A individual who was very talented. He went on to become the chairman of Reed College. He didn't get tenure, not 'cause he wasn't brilliant or his writing wasn't well respected, but because of his political views as a naive 17-year-old, I said to myself, I wanna be in something where politics doesn't exist.

Medicine, it's life and death. How could there be politics in medicine? Boy was I foolish in my 17-year-old mind politics, dominate healthcare today as my other books talk about. But that was a serendipitous direction. I went to the Yale Medical School after that, decided to do heart surgery. Came out to Stanford for my residency, and I was disillusioned again because I could see all the politics and then serendipity strikes again.

I get a chance to be on a rotation. Plastic surgery, go to Mexico to fix kids with cleft lip and cleft palate. And I am enthralled here in a mere hour and a half. We change a human life and I decide to become a reconstructive plastic surgeon, and I'm ready to head back to South America to again do some more volunteer work.

When all of a sudden, serendipity strikes the plastic surgeon in Kaiser Santa Clara has a tragic plane crash and dies. They call me up, they say, Dr. Pearl, you're not doing anything. You know that you're committed to come the end of your residency. Will you come here and help us out for a few months?

Why not? You know what, you know what, what else would I do that had to be done that I couldn't do? Soon after, I think, and I go there. I've never heard of Kaiser Permanente before that time, and I love it. I love the culture. I love everything about it. I love the people. I love the commitment to prevention.

It's just the collaboration, the cooperation, the integration. And I'm there. And then all of a sudden after the first year during my clinical medicine and I get a phone call from the head of the medical staff and he says, would you like to be the chairman of the operating room committee? This is a big job.

You're responsible for all the surgery being done. Again, am I foolish naivete? I assume it's because I'm coming from Yale and from Stanford. No, it's 'cause every other person turned down the job. But that takes me into administration and I start to learn how it feels to be able to solve problems. I create a course to train new nurses.

I find a way to get traveling nurses at the time that was not being done by anyone. I. Else, and all of a sudden things are successful. When you're successful, you start getting more opportunities. Again, serendipity opening itself up. I have a chance to be at the Stanford Business School and then I become the head of the facility there and I'm loving that job, full-time surgeon, head of the facility and Kaiser Permanente gets into big trouble.

It's 1998. The organization loses hundreds of millions of dollars for two years in a row. So the verge of bankruptcy, it only has two days of cash as the borrower day of cash in order to be able to meet the state regulatory insurance requirements. The CEO steps down, they're looking for someone, I call a couple of people I know this is inside the medical group, inside the CEO role of, in the Permanente half of Kaiser Permanente, and.

I ask them, you know, are you interested in the job? I'll support you. I'll help you in any way you want. And they'll say, are you already in mind? I don't want that job at all. And I realize that if I don't step forward, that the people who are likely to do so are not ones that I wanna follow.

Kelly Kennedy: Mm-hmm.

Robert Pearl M.D.: And again, serendipity comes into play and I become the CEO in Kaiser Permanente.

And so that's my path along the way. Every point in turn, just opportunity shows us up. And what's different than I pointed out in the book is luck is just chance. Serendipity is positioning yourself to be open for opportunities when they arise. And as one of my mentors said to me, windows open and windows close, you better be repaired to jump through them.

Once they open for, they will not stay open forever.

Kelly Kennedy: Yeah. Yeah. Wow. Wow. Like, what an unreal opportunity. And honestly like, like you said, an insight into the medical industry because you would think. You would think so many people would be absolutely thrilled to be offered, you know, a prestigious position like the CEO of Kaiser Permanente.

And the fact that we have physicians that are turning that down speaks volumes, I think, to the pressure that is on physicians right now in the current system. And like I said, we're speaking to a lot of people right now who have been in the system, who have used many medical services, right? Like by, by the time you're in your forties, you've, you've used some medical services very likely in your lifetime.

You've, you've done some stuff and you know, there's a lot of people who envy Canada. You know, we have, we have a pretty good healthcare system, but my gosh, do we have our challenges? I'll tell you the wait times to get into a doctor or into, into a hospital here in Canada or astronomical sometimes it's very challenging to navigate the system here.

I imagine it's very similar in the United States. You know Dr. Pearl, can you just give us an insight? What is it like to be in the system to work within the medical system?

Robert Pearl M.D.: The idea of the medical system is a very heterogeneous set of systems. There's no single system, as you know, the Canadian system is a governed, financed one.

Predominantly. You have the US system that is, I'd say more private than it is public. Although increasingly the public side is growing both as the population ages and with the growing reliance, what's called Medicaid, the system for the people who don't earn enough money to qualify for a different type of insurance through their employer.

And I, I separated 'em into two different parts. There are those systems that are paid on a. Pay for volume, fee for service. And there are those systems that are paid on a capitated, a single payment to a group of clinicians to provide care to a population of patients. So the Kaiser Permanente experience, and what I love so much about it is that it's a pay for value system.

And just step back and think about this, the difference if it's a, if it's a pay for for volume, the way you increase your income is you do more and more and more. Yeah. And at some point you starting to do things that may not add very much value, or in many cases diminish it. There are a lot of evidence of that, of people doing procedures.

Have been shown. In fact, actually the interesting part is how much of the research comes outta Canada on knee arthroscopy, showing that a year later there's no difference in outcome in people who have knee arthroscopy versus ones that are treated with physical therapy and more conservative measures.

And yet in the United States and orthopedics, that's the number one operation being done across the United States on a volume perspective. So you have the FIFA for volume that drives increasing services. And I think what's happening right now, and you point to it, is that clinicians feel like they're on a treadmill.

They're ever running ever faster. Mm-hmm. They're having to see patients every 17 minutes. At the end of the day, they go home knowing they cut corners. And when you cut corners, you know you're gonna make errors. And when that happens, you experience what's called moral injury. We're seeing burnout rising.

And by the way, burnout in the United States is very, very high. And I focused on it for a long time. It's just as high in Canada, just as high in Great Britain. It's just as high in many nations for the exact same reason. Clinicians are having to do more and more. And they don't have the resources to do so, and they feel as though they are not able to provide the care.

And you alluded to it, the, the waits and time and the dissatisfaction. You don't feel good as a clinician telling a patient, you know, you should see today or tomorrow saying, I'll see you in a couple of weeks or a couple of months. Yeah. Depending upon what the intervention is going to be. But I wanna differentiate that for the viewers and listeners from capitation, this pay for value.

The biggest problem right now in healthcare is chronic disease. Now, chronic disease is hypertension, it's diabetes, it's heart failure. And to understand the significance of that the complications from chronic diseases are the heart attacks, the strokes, kidney failure, major issues. In fact, according to what's called the Centers for Disease Control, the CDC in the United States, if chronic disease were effectively managed.

We could reduce heart attack, strokes, kidney failure, cancer by 30 to 50%. Now imagine what that would do to a healthcare system. Yeah. Now I know that your listeners are entrepreneurs. I teach the Stanford Graduate School of Business. I'm very familiar with entrepreneurs and train a lot of them to compete against the Canadian ones, the ones in the United States, although we have a lot of international students.

But in a system of incentives where you are gonna be rewarded for being able to provide care more efficiently when you have a single payment that you're gonna be receiving for which you have to provide that care. Now, that incentives, there's a line to prevent chronic disease, to help patients, to eat better, to exercise more, to be able to get the preventive services that they need and to better manage chronic diseases.

And if you look at how well we do, and this is not just the US number, it's more global. In the United States, only 55% of patients with hypertension, the leading cause of strokes, 40% of strokes caused by hypertension. We control that only 55% of the time. Diabetes is a epidemic in the United States. A third of Americans are either diabetic or pre diabetic.

We control that 30% of the time. So here you have a problem for which we have a great solution, a solution that will improve the health of people, that will preserve lives, extend longevity, improve people, how people feel, how well they're able to work. We have the tools to accomplish it, and yet we don't do it.

We don't do it in the United States. We don't do it globally. And why don't we, we do it. 'cause clinicians are rushed. You can't focus on these very important areas. If you only have 17 minutes per patient, you gotta take care of the acute problem that brought them there that day. So I think that that's the frustration.

That exists. I think it's far less. When I was the CEO in Kaiser Permanente, physician satisfaction was 20% higher than doctors in the community practicing in the volume-based pay for volume type approach. So that's where we are today. So I think you can feel differently. I think when you're able to invest in people's health, you're able to feel good when they come in and tell you how much better they are doing.

Yeah. And when you're able to do well financially, not by doing more to them, but by keeping them healthier, I think that can lead to a lot of satisfaction. Unfortunately, 90% of the world's healthcare does not follow that model.

Kelly Kennedy: No, no, no. And you know, one of the questions that it leads me to is how did we end up here, right?

Like, how did we end up from physicians that used to give time and house calls and real attention to a system where we gotta rush people in and out in 17 minutes and I go to the hospital and I have to wait for eight hours to see a physician in Canada. Like that is the, wait, it's eight to 10 hours if you need to go to the emergency room for anything.

And unless you're dying, you ain't getting in. And there's a lot of people who say, well, Canada, you guys have free healthcare. It's like, it's not free. We get taxed heavily for our healthcare system. And I'll tell you I, I'm incredibly thankful for it. However, I hate using it. And I think many, many, many Canadians feel the same way.

It's funny because obviously in in America there's a lot of private healthcare systems and I have heard, you know, many, many people I've talked to here say. As amazing as it is to not have to pay for our healthcare system. I think I'd rather pay to have better service than what we get today.

Robert Pearl M.D.: This is why I mentioned earlier about chronic disease because I think that we've gotten there not out of bad intent, neither bad intent.

By the way, the problems the United States with access are getting just as bad or almost as bad as in Canada. So I don't, but I don't think, you know, if, if you're in the United States, people will say it's the for-profit corporate side of medicine. You go to England, they'll say it's the government. You go to Canada, they say it's the provinces.

Everyone has someone to blame.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: But I think the fundamental problem. I dunno if you've ever heard of a guy named Hamm's Razor. Yes, Hamm was a fryer. He said, you know, when there's a lot of explanations of something or a simple explanation, always pick the simple explanation. What's the common factor of the United States and Canada and Great Britain and these other nations of which burnout are so high and weights are growing and costs are having difficulty to contain.

It's this epidemic of chronic disease. We're seeing it worldwide over the past 20 to 30 years. We can spend a lot of time talking about whether it's the bad food and the fast food or the lack of exercise or all the other changes, but it's global and worldwide, and it's these chronic diseases that I think have driven the problems of today.

I don't think anyone is specifically to blame. Everyone's trying to do something about it. So in the United States what happens? You have insurance companies that put what's called prior authorization. Sure, you can get to seek care for some things, but as soon as you need something that costs a lot of money, they're gonna drive you through a lot of hoops to get the authorization and the approval.

You go up to Canada, as you say. Yeah, you can certainly go into the er, but there's a long wait that before you're gonna get your care. You got a Great Britain and you have a national health service that's failed. You have all these different places with different reasons, and I think it's just that the demand is too great to be able to be met by the resources of any country that's there.

I mean, think about it, you know, you go back and, you know, maybe your parents or your grandparents. What was the medical care they needed? They broke a bone. They had to have it fixed. They had appendicitis. They got pneumonia and had to get an antibiotic. They were very sick sometimes for a short amount of time, but then it was over.

They might not see a doctor again, except for maybe a routine checkup once a year for five years. As soon as you have diabetes, you're gonna see, you're gonna be in the clinician's office three to four times a year. The third of your patients are coming in four times a year instead of one time a year.

What is that gonna mean upon the volume of people? You're gonna be seeing the demand on your services, and if that volume goes up, you can't just keep staying later and later and later. There's a limited amount of time. You know, I, I read somewhere that if the primary care physician did everything that was currently recommended for the totality of needs of the patients, they see it would take 27 hours a day.

It's just wow. Not possible. So that's what I think to be the major challenge, and it's actually a major part of why I wrote Chachi BTMD, how AI empowered patients and doctors can take back control in that case of American medicine. It's probably true just as much for Canadian and for every other country that's listening into your podcast today and looking in on the podcast today.

Yeah. Thi this is a massive opportunity to be able to take care of the problem that I think is the fundamental cause of the challenges that people experience in every healthcare system. And I'm actually quite optimistic that if we use it well, we can improve the health, not just of our nations, but of the world entirely.

Kelly Kennedy: Wow. Wow. You know, Dr. Pearl, like, so what you're saying is the big difference between say the modern generation and say two generations back is essentially chronic disease. That's the thing that's increased substantially.

Robert Pearl M.D.: Chronic disease and to somewhat some extent our ability to take care of it. So that two generations back, and I write in the book of my grandfather who died from a heart attack, that today would've been reversed by our ability to do an interventional cardiac procedure.

But most people of his time didn't have diabetes or hypertension. They didn't have as great incidences of heart failure. You know, asthma was much less, we, all the mental health issues, the obesity, we can go to the list of chronic problems that exist in society today. And they just were not there at the time.

It was mainly infectious disease, trauma cancer, for which there were things that could be done, but then there was a limit to how much could be done. So it's the, it's the massive aggregate of demand and we haven't really evolved the American healthcare, the world healthcare system until now.

Regenerative ai really across most of its, hi, most of its modern history.

Kelly Kennedy: Yeah. You know, obviously you've talked with a lot of medical professionals. I'm sure there's plenty of them that have reached out to you regarding this book. What is the feel in the medical industry with regards to generative ai?

And I know, like, it was funny 'cause reading the book you talked about how a hospital is such a weird, it's almost like a, a technology wormhole where you, on one hand you have fax machines from 1990, and on the other hand you have the most advanced robotics in the world operating maybe in the same area.

And it kind of blew my mind a little bit. Why is it that, that a hospital is still kind of operating that way when it's obviously it would be faster to send an email or something along those lines. Can you run me through why it's still being done like that?

Robert Pearl M.D.: Well, I can't say why it's being done. I mean, again, when I was CEOI put in a comprehensive electronic health record.

For our 12,000 physicians taking care of 12 million patients. So I can't, I can't justify why it's there, but you're absolutely right. That is the culture of medicine. The, I like to correct something you said. The fax machine is an 1834 invention. Wow. And it's still the most common way that doctors exchange information so that It absolutely is there.

I think a lot of it is the culture that I wrote about in my previous books, but to answer your question about generative ai, every physician that I speak with, every clinician that I speak with is excited about it. They're using it now. There's a lot of different ways it can be used. It can be used administratively.

In fact, the big shift that we're seeing these days is electronic health records generation out of voice recognition through a generative AI software tool. Lots of different co companies across the world are creating these applications. It's interesting maybe up to three years ago or two years ago I do a lot of consulting for businesses teaching the medical school at Stanford, the, and the business school at Stanford.

I do a lot of consulting for companies, and the most common call I got was often from an AI company that said, we have the greatest product in the whole world. It saves two and a half hours per day per physician, and no one's buying it. What, what, what's the problem? And I said, if you have a tool that really saves two and a half hours per clinician, you have a line out your door.

This is not a problem. The problem is your tool is not nearly as good as you think and I'd be happy to look at it and work with you and try to figure out what you can do to make it that much better.

Kelly Kennedy: Mm-hmm.

Robert Pearl M.D.: Now with generative ai, the tools are there. They're actually working. I was the critic in the past.

I'm now a major supporter. I think that within five years every clinician will be using a generative AI tool to create electronic health records. 'cause they've been the bait of a lot of doctors' existences. They have to stare at the screen, not look at the patient. It's often added many, many hours a day.

And the systems that can effectively do it are ones that are time saving and clinicians will value that. And maybe to get back to some of the question you asked before, why are these outdated technology? It's just faster. Mm-hmm. Why they still use so many paper charts, it's just faster to write. A few sentences in a paper record that they spent 10 minutes entering a electronic health record.

Electronic health records will be better. But what doctors have not had is time. Yeah. So the, that opportunity is definitely gonna be there with the degenerative AI tools that are there. A second areas is the clinicians themselves using it to make diagnoses. And increasingly physicians are doing that when they're stumped, when they want second opinions.

The third area though, I really think in terms of this tool is gonna be in terms of patient empowerment. I can't find very many clinicians who are not gonna say, this is a great opportunity. Where they may disagree is going to be how much they should empower the patient. And in my book chat, GPT md, but also in what I'm talking about these days, specific to chronic disease, this to me is the big opportunity.

It's really interesting, and again, you have a lot of entrepreneurs listening in and I teach the Stanford School the business school, but the engineering school is next door and they have developed a huge number of wearable devices that can measure blood pressure, blood glucose, blood oxygen. They can even do EKGs.

We're talking about band-aid size devices that are relatively inexpensive, highly reliable, not just, I want you people to pause and think. You have highly reliable, inexpensive tools able to ma measure major parameters of human physiology. You would expect they'd be ubiquitous. Yeah. I can't find a single doctor using them.

How do we explain this? Why? Because the information coming from them can't be managed. It's not that it's not valuable. Mm-hmm.

Kelly Kennedy: Can't be

Robert Pearl M.D.: managed. Let's just say you get diagnosed with hypertension, you get prescribed the medication and three times a day your device measures your blood pressure. After a month, you have a a hundred, basically a hundred measurements.

92 are normal, eight are abnormal. How are you doing? You're doing great. 'cause 92 are normal. You're doing terribly. 'cause eight are abnormal. How are you doing? You have no idea.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: Alright. Now I'm your doctor. Do I want you to send me a hundred blood pressure measurements? No. No. I electronic. No. We have this data and we can't use it.

That's where generative AI comes in.

Kelly Kennedy: Mm mm-hmm.

Robert Pearl M.D.: Generative AI can look at it. It can look at first derivatives, second derivatives. You can look at trends. You actually can use what's called a plugin. I love plugin 'cause it sounds so visible. It's really Bluetooth, but you plug in the clinician recommendations.

What do they expect after a month of the new medication? Should you be normal or not normal? Hopefully normal. And if it's supposed to be normal, you're not normal. Why wait four more months to see your clinician? Yeah. And by the way, when you go back there, when the blood pressure's elevated, what's the doctor gonna say?

It's so white coat syndrome. You're just afraid come back in four more months. It's gonna be a year before the first set of changes is done. We could be doing it every month. We could be changing glucose measurements every month. We could be predicting which patients are likely to be in the ER tomorrow with heart failure.

Good on the list of things that the combination of the monitors, along with degenerative AI tools could accomplish. Remember what I said? Management of chronic disease, 30 to 50% fewer heart attack, strokes, cancer, kidney failure. By the way, 80% fewer lower limb amputations. So we have a massive tool, massive potential of which we're not using it today.

Not because it doesn't work. Because we just haven't done it. And that really leads, at some point we should talk about how do you shift the reimbursement methodology we talked about earlier in this program? Because if I am reimbursed on a fee for volume basis, pay for volume basis, how anxious am I to have 30 to 50% fewer patients in my office?

Kelly Kennedy: Not that anxious.

Robert Pearl M.D.: Exactly. It's not that I don't want good things to happen, I just can't afford on a capitated basis now. Now I am very interested in being able to address the health needs of people. And if I can lower these by 30 to 50%, I do really well financially. And you as a patient, you do great first of.

Second of all, you're not spending your time in a doctor's office. Third of all, you're alive. And fourth of all, your healthcare costs are likely to go down, and yet we have not yet made that transition.

Kelly Kennedy: Mm.

Robert Pearl M.D.: If I could add one piece right now for, for viewers, what I want them to think about, again, these are entrepreneurs.

I love entrepreneurs, and how they think about things about the future. If I told you today that your car could go as fast as an airplane five years from now and as fast as a rocket ship 10 years from now, would you be doing anything differently as you think about business would be building roads differently?

Kelly Kennedy: Mm-hmm.

Robert Pearl M.D.: Ho restaurants, hotels, that's what's about to happen with generative ai. It's doubling in power every year. Wow. That means that five years from now, it's gonna be 32 times more powerful. 10 years from now, a th a thousand times more powerful. And if I can make another point about that, we really are, you and brain can't understand that pace of change, exponential growth.

Kelly Kennedy: No.

Robert Pearl M.D.: And we fail to see all of the applications, you know, I think back to 2007 when the iPhone was introduced.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: I've been interested in technology ever since I was in high school, but my dad, I don't, he was not a ludite, but it just, you know, it wasn't his generation, if you wanna call it that. Sure.

Yeah. And my dad called me and he said, Robbie, I gotta tell you, I bought an iPhone. I said, dad, that's amazing. Whatcha gonna do with it? He said, I'm gonna lock it in my trunk. If I get into an accident, I can call for help.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: That was only use he could see.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: You know, but in fairness to my dad, that's the use almost anyone could see.

It took a decade. Yes. Was to realize we can't drive anywhere anymore without an iPhone, you know? Yeah. We can't know what's happening in the world without our iPhone. We can't, we can't do so many fun. We can't stay in contact with people. We can't order food, you know, go down the whole list of things that we can't do now without an iPhone.

It just wasn't visible then.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: And that, again, part of why I wrote Chat GPT, MD to help people to see all the ways it could be done. You know, one of the big challenges right now with generative AI is that people are afraid they're gonna, it's gonna run outta data because it's already taken all the information off of the internet.

It's already encode all the books and journal articles and things like that, that sit in play. I don't know if you've ever been in a hospital, but if you were, you probably had a monitor at your bedside or a couple of monitors at your bedside. Yeah. Those monitors generate a petabyte of data that's 10 with 14 zeros after it.

Wow. And 97% of that is thrown away, lost, and never looked at again. Healthcare, we have so much information that we could use to capture, and now we could know what's gonna happen in the hospital tomorrow. We could be able to predict, based upon the data that your machines are showing now, what's gonna happen in six hours, 12 hours, 24 hours.

Again, I don't know how much viewers and listeners understand about medical practice today, but increasingly we don't touch patients. We actually use robotics to do it. We sit in a chair several feet away and we watch a set of eight arms go inside a patient, or we go to a cath lab where we advance and pull back a catheter that's in the groin going up to the heart two feet away.

We look at monitors to go to figure things out. I've just described the perfect large language model. That's exactly what machines do. It looks at a monitor, gets it as data, and then it has a physical response. It moves levers or pushes a catheter. We have so many opportunities in the healthcare sphere with generative AI that this 32 times 1,002 times increase is probably an understatement of about what's to happen, not a wishful hope.

Kelly Kennedy: So in the book, we obviously, we get to the challenge that the medical industry doesn't necessarily advance quickly, right? Like we talked, essentially what you're talking about is going to be Healthcare 4.0. Correct? Yes. How do we get from the current healthcare system 3.0 to Healthcare 4.0? And I know you mentioned potentially.

Potentially non-healthcare companies like Walmart, Amazon CVS, walk us through that. How does this happen?

Robert Pearl M.D.: Well, this is why I was so excited to come on your show today. 'cause I think the likelihood is it's gonna come out of the business world, not out of the medical world. The medical world, first of all, it's doing very well today.

So it's doesn't have to, you know, it thinks it doesn't have to make any changes. Of course, it doesn't recognize the process of disruption that is so ubiquitous inside a business world, a business industry mentality. So I think that someone's gonna come up with this. I was hoping that it would be bigger when I wrote the book, you know, it's fast.

I just think how fast things move. Many of these companies are not as aggressive as they appear to be at first getting into the healthcare. What called the healthcare pond. And the reason is because I. It's really large. It's the massive size. I mean, these businesses are big. We're talking about Amazon, we're talking about Walmart.

These are the largest and second largest companies in the world in terms of retail volume. But healthcare in the United States alone is a $4 trillion entity, and that's a big number as well. And as they start to look at all the various opportunities in healthcare versus alternatives in retail, I think some of them are deciding to stay more focused on the retail side than the healthcare mm-hmm.

Side. So I think someone else, the entrepreneurial world is very likely to be able to accomplish it. I think they're gonna start by creating pockets, opportunities maybe in Canada, they'll find provinces or parts of provinces they can contract with on a capitated basis to be able to provide care.

They'll be able to create medical groups and bring in hospitals and hospital systems, able to support it. And they're gonna have a major focus in generative ai. Every patient will own their own electronic health record. It won't be owned by some corporate entity or some business venture. It's gonna be owned actually by the patient themselves.

And that will be linked into everything they do, to what they eat, to the, to the exercise they get to the relaxation that they have. It'll be a constant reminder of ways to improve their health. It will allow them to be an empowered patient. To already having preloaded the entire medical history family history, all the genomics, it will allow them to be able to put in place their symptoms and be able to understand what's going on.

The diseases are likely to happen. The wait for a diagnosis won't be as you described in Canada several months. It's gonna be several seconds, maybe a minute if it takes a while for them to type. Although even typing isn't gonna happen because the new gener of AI tools, the the chat, GPT-4 oh is verbal as well as typing.

It'll have all that information and it'll be able to provide you with the information that you need. And by being able to do that and be able to solve so many problems, it creates the time and the opening for those people who actually need to come into care to receive that care. And it's gonna figure out a way to use telemedicine so that the medication changes that need to happen because your chronic diseases are not responding as expected, don't require an office visit, don't require you to miss a day of a work or school.

And so we're gonna create a system that's not only gonna be higher quality with better clinical outcomes, but far lower cost, far greater convenience. And as the entrepreneurs figure out how to create those systems, whether they're gonna be in local communities or in provinces or supporting specific businesses, it could have happened in a lot of different ways.

Other people are gonna see it and wanna see it. And I think that that's the way that it's going to. Happen. You know, as we think about well, let me offer a second alternative. There's actually two ways it could happen. It also could happen because we're gonna be frustrated by the inability to provide care to the poorest in society as difficult as it is.

And in the United States, remember we have tiers of services. Not everyone has the same government insurance that you have in Canada. And so people who have either have Medicaid, the service for the poor, or those who have no coverage at all, or those who live in just poor communities, often have can't get access to care 'cause there's no one there to provide it to them.

This would be a perfect opportunity to use the same tools to create community health centers where maybe one clinician can support five or 10 different community workers using generative AI to be able to now provide care to thousands of people. I wanna give you one thought. If we could save one heart attack, one cancer, one kidney failure, one stroke.

We could hire for a year, 10 community healthcare workers, train them up, give them generative ai, and they could see every patient in that geography. Monthly. 5,000 people. Wow. 5,000 people could receive healthcare on a preventive basis. One heart attack, one stroke, one cancer, one kidney failure. So I think it's gonna happen, I'm hoping, I'm hoping it's gonna happen actually by clinicians inside medicine.

Kelly Kennedy: Mm-hmm.

Robert Pearl M.D.: But I'm worried that they are so over wrought right now, overworked right now that they're not gonna do it. I thought it might happen by the big entrepreneur, by the big companies. I'm actually thinking now the entrepreneurs are gonna come in and find the opportunity to be able to provide this care.

Yeah. And when we see what's there, I think of this as top down disruption rather than bottom up. The traditional Clay Christensen model was that the people who don't have access to care, they're very poor. Would be the ones who would first receive the service, and then with that it would build up up from it.

I can see it the other way where people will say, I have the best insurance, but I still can't get care in Canada. Yeah. How do I get this care? I don't wanna come to the United States for it, but I can go to this place that's able to provide that with cutting edge technology, particularly generative AI tools.

Kelly Kennedy: I think the question that we have to ask is who stands to gain the most? And I, I really think it's the end user, right? Like it is the patient who stands to gain the most from this transition.

Robert Pearl M.D.: I agree with you completely. Sure. Because you're gonna be healthier, you're gonna be alive. Yeah. You're gonna have lower costs, you are gonna be more functional.

It's not just living, it's living a life where you can do the things that you want to do. The problem is in the monetization of that, if your insurance and your coverage is paid by the government. Then you don't have that level of control. That's right. If this was a retail product, sure you could decide to go to the company providing it rather than to the ones that don't.

But you don't have that option. That's why I see the entrepreneur being the first mover. And it's gonna be hard to figure out who to, you know, maybe it's a business you could contract with. Maybe it's gonna be a community, maybe it's gonna be a province. That's why I say they're gonna have to find the right payer.

And as you pointed out before, it's gonna have to align. So the, the care provider is gonna have to be lower in cost, not necessarily in year one. 'cause year one is always gonna be a startup cost, but by year five. Finding a business willing to make that kind of investment with the return coming five years from now, as you know, is not easy to do.

It's actually the bane of the entrepreneur's existence that first few years. Yeah. Monetizing growth. Once, once you're successful it becomes easier. But early years are often the hardest. But I think that that's where it's gonna happen. I you know, a few years ago I spoke to people down at Disney and I said, you know, if you give me all of your employees because I had about 150,000, I will provide healthcare for you.

That is hiring quality at 20% lower cost. Wow. And at the time, they didn't do it and they didn't do it. I think, you know, they said is they didn't wanna disrupt people's relationships and a bunch of other things. And I can understand it 'cause I'm not sure that, that I had the tools to accomplish what I was hoping to be able to do, or at least be able to do it in the most cost effective way, which now I, I could do it and it could become the mark of Disney.

And what Disney does it that you can see other companies jumping on board.

Kelly Kennedy: Yeah. Yeah. No, I, I think, I think you're right. I think people are gonna look back to this moment, to this book and they're gonna say, this was the moment. Like that was the feeling. And I hope the listeners are getting that today. I really enjoyed your book and at the end of the day, that is what you're doing with Chat GPT, MD.

You are literally marking a moment and I actually, I had to ask you a question because I feel like the choice to write this book couldn't have been an easy one. Walk me through, you know, the moment you realized, holy cow, we are onto something huge here. And I imagine you're not the only person who came to that conclusion, but like, walk me through the moment.

Because it's one thing to recognize that this is gonna change everything. It's a whole nother thing to write the book on it.

Robert Pearl M.D.: I would like to expand a little bit. You're absolutely right. We're marking a time. That's a moment, a major change. But what I also want to do through this book is let people look into the future because.

Part of the motivation was everything I read about generative AI was all about its shortcomings today. And I said, you know, that's absurd to worry about the shortcomings of today in a product that's exponentially growing, that's gonna be 32 times more powerful five years from now. Open your eyes. What exists right now is 1% of what's gonna be here.

Yeah. You know, I don't know if you remember back to the COVID pandemic, we talked about exponential growth. We said if there's a lake, a pond with a single lily pod and that lily pod doubles every night and it takes 50 days to fully cover the lake. What does the lake look like on day 43?

Kelly Kennedy: Yeah, right full.

Robert Pearl M.D.: On day 43, less than 1% of the lake is covered. Yeah. You say it's never gonna happen. In fact, even the day before, only half of the lake is covered. You know, you wanna be able to see what's gonna happen in the near future, and yet you can't see it because our brains have trouble seeing that. So I think it's also my hope to open people's eyes and let them embrace the future before it arrives.

'cause once it arrives, it's always too late. But going back to the question that you posed, you know, I, you know, it is strange. I, and so in some ways, I, I continue to see myself as naive, the same way that I was back in college and medical school and in residency training. You know, I, I could see the shortcomings of the healthcare system, and I wrote the book in 2015 called Mistreated.

While we think we're getting good healthcare, we're usually wrong, begins with the story of my dad and his untimely death for a preventable medical error. And I wrote about the shifts that had to happen moving from fee for service to capitation, the shifts from fragmented care to integrated care, the shifts from outdated technology to modern technology, the shift from lack of leadership to strong leadership.

And I thought with these four pillars in place to change what happened very quickly. And a couple of years later, nothing was different. I couldn't find any evidence that I had made an impact, and that was disappointing. Mm-hmm. And so I said, there's gotta be something else going on. And that's, that's what professors do at business schools.

They say, what else is, what are we missing? That's, I said, well, we're missing the culture. Had to be the culture. Mm-hmm. So I spent some time researching that. I wrote Mistreated, while we think we're getting good healthcare, I'm sorry, mistreated how the, how the culture of medicine kills doctors and patients.

And I pointed out a lot of different ways that as clinicians, we we work hard, we have high values, we're very committed, but we have so many blind spots and things that we do that. Don't add value that we continue to do. 'cause we've always done it that way. Maybe the fax machine is another great example of the culture that we tolerate.

A technology that is so out of date and yet other things that don't add as much value. We use a lot. And I looked at the question of why and the changes that were there. And again, I thought that having pointed out the culture, that now change would happen. Although a couple years later nothing happened.

Yeah. And then all of a sudden, as you said, 2022, we see the introduction of chat T and now I said, okay, I finally understand why little progress has happened. It's not that the system that no one sees, how the system is broken, they've seen it just as I've seen it. We've seen it actually for a hundred years.

It's not just the culture of medicine standing in the way. It's the fact that we haven't had a tool capable of making the changes necessary. If you look at what are the two reasons why. Technology does not get implemented in medicine. It's always one of two things, either. Number one, it slows doctors down.

It may have a great outcome, but if it slows doctors down, they do not want that technology. Or number two, it cuts into their income. What do Upton Sinclair say? You can't convince someone to see and embrace the change when doing so will negatively impact their income. Yeah. That's the reality that existed.

All the tools that we've had so far, electronic health record is a great example of that. It's a tool that essentially has slowed down doctors and because of the insurance companies, how it is used, that required documentation, it's actually cut into their income as well. And now we have a tool, amazing tool.

It's almost free. I mean, the original version is still free.

Kelly Kennedy: Yep, yep.

Robert Pearl M.D.: Even the one, the subscription is $20 a month. That's like a, A latte a week.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: You know, it's very affordable if it's not free to people. It has this opportunity to be able to make these changes in a positive way, improving health, preventing disease, helping people live a more fulfilling lives.

And in doing so, it could actually reduce the burnout that is so prevalent in medicine today. I said, now we have something that is there. Yeah. So I was not planning to write the book actually. I was actually deciding that I'd written all the books I wanted to write and now I said, I gotta write this book.

I, I gotta write it. Because people have to see what's there. 'cause if they don't see what's there and actually take the steps to try to make it be a reality, then it's not going to happen. It's not gonna happen as quickly as it needs to occur. And then I said to myself, wait a second. This is growing by exponential leaps and bounds.

If I use the standard approach, my two books previously, which by the way, were Washington Post bestsellers it ticked two years. Between the writing and the publication. Wow. Takes about a year to write it. Then you gotta work with your editor, then you gotta print it, you gotta distribute it. It's a two year pro.

By two years from now, anything I writes gonna be wrong.

Kelly Kennedy: Yeah.

Robert Pearl M.D.: How can I get out fast? How do I get out fast? Why don't I use the tool? Why don't I experiment with the tool to see what it can accomplish?

Kelly Kennedy: Yeah.

Robert Pearl M.D.: And I approach it the way I do with a medical student or a resident who comes to me and says, Dr. Pearl, I'd like to write a paper with you. I said, okay, that's a great idea. You know, let's talk about what we might wanna be writing about and the research we wanna be doing and you know, send me your findings and your ideas and I'll send you mine. And we'd go back and forth. And that's what I did with this tool.

Kelly Kennedy: Yes.

Robert Pearl M.D.: Interesting. Is a 30 page bibliography, as you know at the very end. And the reason it's there is I fact checked everything that the technology came up with. 'cause one of the problems is hallucinations. And there were not very many, but I found one that came up with an expedition to the North Pole that I could find no evidence ever actually happened.

The leadership lessons that were learned. And so in the book itself, I talk about one that I know did happen, which is Shackleton at the South Pole. Yes. But everything else fact checked out and I think the back and forth writing, it got better. Yeah. I'm not sure in the end that it saved time, but it moved.

Well, it saved time 'cause it made me work more sooner 'cause it got things back to me faster. Yes. But I don't think it saved a total number of hours. It just compressed them more. And in about six months I was able to include that. As you mentioned to me before the show, I do have two parts where I very clearly spell out.

These were written by Chat GPT. Yes. They're not very long, but I wanna give the reader a sense of what the technology alone can do. Then compare that and contrast that to the rest of the book that were written in a combined fashion. You know, I take responsibility for everything about it. In fact, the way the book started is I took everything I had written, which was over 1.2 million words and I downloaded it into chat, GPT.

So I pre-trained it so it know how it knew, how it knew what I thought, it knew how I wrote it, knew my thinking, my verbal style, my written style. And so it was able to replicate that as all language, large language models were able to accomplish.

Kelly Kennedy: The thing that surprised me about your co-authorship with cha GPT was the way that it spoke to you in the book.

Like it was like another protagonist, like it really did personify itself. And I was like, holy cow. Like, what are we in for in 10 or 15 years from now?

Robert Pearl M.D.: Not 10 or 15, it's five. Wow. Maybe 10, but it's much sooner than that. It's, it's gonna be an entity. I mean, again, I don't know if you saw the movie her about a decade ago, where Scarlet Johanssen, where essentially Scarlet Johansen is inside a phone as a AI tool that can have a relationship with the Joaquin who is the protagonist and the story of what happens in his relationship with her, how he relates to it, how he comes to see it.

This is gonna be the real future of this type of generative ai because it can know you. It can personalize things about you. In fact, it can do it in very positive ways. It can incorporate your DNA information into the medical advice that it provides. It can incorporate your specific family history into the medical information it provides.

You know, it's let's say it's late at night, it's 11 o'clock at night, and the it's 11 o'clock at night and your child has 103 fever. What do you do?

Kelly Kennedy: Yeah.

Robert Pearl M.D.: Do you take the child to the emergency room and you know, you'll have an hour wait. They'll be surrounded by people coughing with infectious disease or you stay home, but you go to Google and you click on a link, it says, could be meningitis.

They'll be dead in the morning. What do you do? You have no idea what to do today. You call your doctor's office. What does it say? Go to the local er. Why does it say that it's not about you? They don't know anything about you and your child. It's to protect themselves in case something should go wrong.

What you need is you need to have specific information that will help you. Chachi bt accomplishes that. You put all the information in there. The, the application asks you, how's your child doing? And they limp in bed, or they ride in their bicycle around the living room floor. With that information, it can give you a recommendation about what you should do.

Will that recommendation be perfect? No. But if you called a nurse in a call center, would it be perfect? No.

Kelly Kennedy: No.

Robert Pearl M.D.: What's the best estimate of what is going on? And it's far better than today. When you're simply having two guests. We go to the ER too often and we don't go there often enough. Both things happen 'cause we have a mismatch between the likelihood of a problem.

This is the kind of opportunity that a generative AI tool creates for you as an empowered patient. You can now decide about your medical care, and I'm optimistic in doing so, that you will get better care. That you will take better care of yourself. 'cause now you'll have the ability to do so. I think that we are on the verge, not just of a technological event that will be equivalent to the Gutenberg.

Printing press or the internet or the iPhone one, that will be a major leap forward in the health of people, particularly for populations that are struggling right now, who can't get the access, who can't afford the care in other countries that don't have a fully funded governmental system, that people who have chronic diseases that are making them pro have difficulties, have complications like heart attacks and strokes that are having them be challenged every single day of their life, will now have opportunities to have improved health.

We're gonna actually see it, I'm hoping to be able to improve our diets to start to address some of the challenges of obesity. Some of the shortcomings in lack of exercise, the lifestyle medicine improvements that have been shown. To be equally effective to modern medicine and improving people's health.

I think we're on the verge, not just of technological breakthrough, but of a health breakthrough. We need to have the technological tool to do it, but that's only half of the problem or half of the solution. We also need the leadership, and that's gonna take people. And as you know, I spend quite a bit of the time in the book talking about a new leadership model.

One that will allow leaders to inspire others, to align them in the direction that needs to go and to motivate them to be able and willing to move forward. And I think if we can do that in all countries of the world, we're gonna restore the professional pride. We're gonna restore the higher purpose that I think, unfortunately all too often has less left medicine as the demands on doctors and other workers has become too great.

We can once again restore health to all the people of the world.

Kelly Kennedy: Wow. Wow. What a way to end the show, Dr. Pearl that is, that is a great way to end today's show. Amazing. Amazing. I hope you're right. I really do. I hope that this is the, the point of massive change that leads us to an an incredible future. I really do.

Robert Pearl M.D.: If it's not, it won't be the technology. It's gonna be the people, because it will take humans to lead other humans into being able to use this technology Well. For any of the viewers who want more information to go to my website, Robertpearlmd.com, where they can find a significant amount of data, both in technology and in medicine in general.

I really encourage the entrepreneurs of the world to step forward. This is a great opportunity when Windows open, they don't stay open forever. They ultimately close. This is your chance to move forward. I look forward to seeing the advances in success that you will achieve.

Kelly Kennedy: Thank you, Dr. Pearl. Before we stop though, I just wanna move into, I know you have a monthly newsletter and you also have an amazing podcast Fixing Healthcare.

Can you chat about that really quick before we close?

Robert Pearl M.D.: Happy to do so. My newsletter is the monthly Musings on Medicine. It's a free, no subscription, no advertisers. Everything I do, by the way, has no advertisers and there's no cost to accessing it or to being able to receive it. It has a huge summary of all the events of the past month and links to all the various articles and all the various.

Podcasts that are available. I have a weekly podcast called Fixing Healthcare. It. Each week is a slightly different version. There's one where I bring in an external guest. My last season I just finished was on the end of life issues. The one I'm about to start next month is gonna be on technology.

Eric Topel from the University of San San Diego is my first guest talking about the, the three likely advances that we're gonna see. They're gonna radically change people's life and people's health. I also have one called Diving Deep, where I go deep into a particular subject of interest that month.

I have one called Medicine of the Truth, which summarizes all the advances in research and in medical findings over the previous 30 days that are there. And then I have one called Unfiltered I do with Jonathan Fisher, which is focusing very much on burnout ing very much. On the psychosocial advances and opportunities in medicine.

They're all available starting Tuesday night, each week on Amazon or wherever you get your listening pleasure. So those are the opportunities. There's lot of, there's a lot of ways people can come educated, but if they go to the monthly musings that can get all that information or just simply go to the website, robert Pearl md.com and you can find ways to access all of that and more at no cost and no subscription requirements.

Kelly Kennedy: Amazing. Well, thank you, Dr. Pearl. I appreciated that immensely. I would highly recommend Chat GPT, MD. You can get it on Amazon or anywhere else you get your books. It's amazing. Highly recommend.

Robert Pearl M.D.: I would love to hear from folks if they read the book what they, what their thoughts are, particularly if they have thoughts that disagree because this is an area of new opportunity and we're all in this together.

All trying to learn tomorrow will be better than today. If today, we can align and move forward as one. Best wishes to all on their future and generative ai, a new world is upon us. Thank you so much for having me again today, Kelly.

Kelly Kennedy: Thank you, Dr. Pearl. Until next time, this has been the Business Development Podcast and we will catch you on the flip side.

Outro: This has been the Business Development Podcast with Kelly Kennedy. Kelly has 15 years in sales and business development experience within the Alberta oil and gas industry, and founded his own business development firm in 2020. His passion and his specialization is in customer relationship generation and business development.

The show is brought to you by Capital Business Development, your Business Development Specialists. For more, we invite you to the website @ www.capitalbd.ca. See you next time on the Business Development Podcast.