Augmenting Medicine with AI: Hassan Tetteh, MD, on Innovation in Healthcare

living a life in full is a conversation you always wanted to have with that person who gave an amazing ted talk or the author of one of your favorite books or that inspirational olympian you always wanted to know more about it's graduate level conversations with those making a difference in the world and in the lives of others this show brings you new ideas and approaches so that you can live a life in full i'm your host doctor chris stout and i hope you enjoy this episode

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great to have you on chris thank you very much for the kind introduction i really appreciate it absolutely it's very

impressive and i'm excited as well to have you on for those that may not have seen it there was a recent piece in the wall street journal and it noted that you had one of the coolest sounding jobs in medicine so i have to reprise it here and it's war fighter health mission chief for the department of def defense joint artificial intelligence center or jake can you tell us more about what you do there and what the center is about

oh sure well that that is you know was a great compliment paid to me by alan rip who wrote that wonderful article in the wall street journal so certainly one of the highlights of my career to be recognized by that great periodical but that came about you know like many things in my life through serendipity divine intervention and maybe a bit good luck and so you know many people ask how did i get that job and how did i wind up where i am i think a lot of it goes back to what i do in healthcare and my clinical sort of background is really the genesis for much of what i think i do today and the pursuits and interests that i've had so as a cardiac surgeon and those of us that have been in cardiac surgery for many years know that you can imagine this is a very high pressure type of intense specialty subspecialty i should say in surgery we take our outcomes very seriously there is something that was created by my colleagues decades ago called the society of thoracic surgeons database if you can imagine cardiac surgeons tend to be a profile in the quintessential type a personality and we love data unfortunately in cardiac surgery the stakes are high or fortunately the stakes are high and so when they are high our outcomes matter and if we have a bad day in the operating room our patients are going to have a bad day in life and so because of that many decades ago as i mentioned my colleagues started to report their outcome data and so those that were doing really good obviously would share what they were doing to have good outcomes meaning low mortality more morbidity and do something that's very hard stopping the heart putting patients on bypass fixing their hearts and then getting them to recovery and as we started to collect all this data we started to realize that there were certain things that the good programs and those that had really great outcomes were doing and it wasn't that the patients or the i'm sorry the surgeons that were having poor outcomes or worse outcomes were not doing anything better it's just that they were not doing things the same way and as we started to look at that data and analyze things we established this database over decades all cardiac surgeons started to do much better because we were sharing this information and data that's really the beginning of where i started to see that information especially a lot of data on a lot of patients could lead to really good outcomes because when you started to follow the things that the patients that were doing well and the programs that were having good outcomes did like giving less blood giving antibiotics for certain cases before you started just different techniques in the operating room you start to see that how you could learn from this data and you can improve outcomes and so when i learned about clinical informatics as a subspecialty years ago i was all in it made perfect sense to me i said well yeah absolutely taking information looking at data and applying technology to make our work better and there's a subspecialty for this this is just an extension of what i've been doing all my life in cardiac surgery and i saw the outcomes and i saw what it did for cardiac surgery i mean if you think about what we've been able to achieve in cardiac surgery heart transplants notwithstanding lung transplants notwithstanding to stop someone's heart routinely fix it and then bring them back to not only health but better health than they were before i mean that's one of the modern miracles of modern medicine and yet we take it for granted but that came about through due diligence data analysis and rigorous and dedicated work from a cadre of surgeons that were really focused on getting better and they got better by looking at what worked and what didn't work and so informatics to me is an extension of that so fast forward you said how did i get this job well i dedicated a lot of study and focus and time to becoming board certified in informatics because again it just seemed to me to be a natural extension of what i was doing in cardiac surgery and i said wow you could apply this across all of medicine there's absolutely room for improvement in every area of medicine when you look at data when you look at when you look at what you you know you can gather from information and outcomes for patients and then see what worked and didn't work and make it better and improve it and so that led to an opportunity to become believe it or not the chief clinical informatics officer for navy medicine the chief medical informatics officer for navy medicine the entire medicine enterprise and because i had this great opportunity to go to the war college and had an opportunity to focus on writing a thesis and artificial intelligence when the jaip was established to join artificial intelligence center at the department of defense at the sort of national level at the epitome of our national defense apparatus the recognition that artificial intelligence was one of these technologies that we needed to continue to lead in and we needed to lead in in the future to ensure not only our national security but also to make sure that we were going to provide the policies and sort of the roadmap for how we would apply this technology across the world they recognized that in health there was an opportunity to have a mission within that construct within the joint artificial intelligence center military medicine would benefit from having a dedicated mission that was going to be able to use leverage and apply artificial intelligence to improve the health of our service members and give us an edge in national security and to make sure we had a ready force that was always able to be successful in missions i was recruited into that position it was a long winded way of answering your question but it came about principally speaking as a result of just following my passion and doing what i knew had always worked at least in my experience in cardiac surgery which is looking at data taking that data learning from that data getting insight from it and improving your practice not only personally but professionally and sort of throughout the community of cardiac surgeons wow

so that's great it makes so much sense hearing you you know kind of describe it with the interest that you have in data and outcomes and you know my background is a little parallel track i mean one of the things way back when dinosaurs walked the earth and you know my background is more so psychology and psychiatry no really looked at outcomes in those areas and it was just sort of everybody sort of had their theoretical canon you know you were a psychoanalyst or you were a jungian or you were a whatever and you kind of just you know you like if you had a bad outcome whatever that might be it was the patient's fault you know it wasn't because of a variation in therapeutic or therapist's ability it wasn't because you know my therapeutic approach can beat up your therapeutic approach or anything and it you know it was sort of finally really early seventies eighties and and then starting into the nineties that people actually started looking at outcomes and measuring outcomes and i think for you perhaps so correct me if i'm mistaken but it seems like in the more cardiac and cardiothoracic kinds of areas one of the things like you're not going to do a randomized controlled trial on a patient someone's there they're in need you're going to help them as best you can and you kind of have to take all comers you can't say well i'm going to i've got exclusionary criteria i'm sorry sir you have diabetes so i'm not going to be to have you be part of my subject so can you speak to that because i think that's one of the amazing things where ai can kind of come in and help us sort through some of those kinds of things and it's not these super clean n of one hundreds these are in the thousands but also with a boatload of comorbidities and other kind of complicating factors how do you sort through for that and your specialty with clinical data

and informatics oh chris that's an excellent question i mean it gives me goosebumps thinking about the question and my answer in response to that because you're absolutely right you know i can see absolutely incredible and powerful application of ai and you know and data analysis to exactly the same question that you just posed so you just said you know a scenario you just highlighted a scenario that happens know every day in our practice like you said when you are individually taking care of a patient that patient is in front of you and they are looking for your help right and they have a cardiac condition but invariably because they have a cardiac condition they probably have some comorbidities they may have some diabetes they may have hypertension they have a family history they have you know poor exercise habits potentially or just poor genetics you know and so now they're faced with this challenge and they're coming to you for help and assistance and in their mind because i've been in the patient's shoes so to speak you don't care about the statistics and all you're worried about is how are you going to help me with my problem but as the clinician is at the provider and especially as a cardiac surgeon you have to take into account this myriad of all of these other factors in addition to their underlying condition and problem with their heart to sort of come up with a good treatment plan for them and this is where you know we pay a lot of you know platitudes to this thing called informed consent right but i can tell you it's because of this database right and this years decades rather of collecting information that we can now actually with almost almost almost precision accuracy tell a patient that is undergoing a a pretty significant cardiac condition what their risk of mortality and morbidity is going to be based on a lot of data that we've gathered over the years and so we can come up with something called an sts risk classification and a score and it can go down to pretty high fidelity numbers in terms of saying well if you were to have this procedure and given all your comorbidities you have a five percent or a ten percent chance of having a complication you have a one percent or two percent chance of death and we can share this information with patients and you obviously do this in a very careful and a very thoughtful way in a compassionate way but what it does i think is it helps to put in context and characterization what this patient is about to undergo both for the physician the provider and the family so that they know what to expect and i think it's been invaluable for us because it starts to set expectations for patients and their families so what they can expect right and most people i'll tell you when you're straight with them about that they're like most people going to be optimistic about what their chances are but at least they'll be realistic as well going in and i think it does an incredible amount of building trust and also engendering a lot of confidence in patient doctor relationship so that's what the data has done for us and now you can imagine you overlie the power of artificial intelligence which is taking a lot of data finding patterns and being able to give you insight into those patterns how incredibly invaluable that could be as we sort of advance and mature this technology and this application of this really powerful tool and i call it a tool it's not going to be a panacea it's not going to save or make everything better but it's going to help enhance the way that we deliver care so we can start applying the right kinds of therapies technologies and therapeutics to the right patient at the right time and i think that's where ai is going to really play a big and so you know i think you know alan ripp and the editors at wall street journal aptly called the article that they highlighted there as how ai can make your doctor smarter that's what i think it has the potential to do not replace your doctor but make your doctor smarter and i'll give you another very practical example of this you know maybe outside of the realm of cardiac surgery but just as a doctor and being posed with the question like many of my colleagues are often done you know often faced with you know on a daily basis so while i was at the war college it was a two year stint there so the first year i was actually the doctor on campus i was called the command surgeon and sort of as a reward or punishment depending on how you look at it you get to go to school then the following year so this is an appropriate story because it actually highlights for me in my mind and reminds me of why it was that i decided to dedicate that year while i was a student to artificial intelligence so i had a colleague of mine who you would get you appreciate this he was the clinical psychologist on our campus and he was leading a lot of our behavioral health initiatives on our campus and doing really great work super fit guy i mean the guy looked like a boston marathoner i mean strong fit healthy guy but he had a family history of heart disease and i remember one day i was in my office and like we often did sort of late afternoon we would just have this sort of banter talking about all kinds of topics and he came in one day and he was very concerned because one of his family members had a heart condition and he said you know he was having what he wouldn't call symptoms but just some discomfort and you know it was very vague kind of things like he said you know when i do certain things i have this chest pain and i also have you know this sort of feeling and then i kind of feel like a flutter and so does this a constellation of a bunch of different things but in an otherwise very healthy seemingly fit looking individual and he posed a very simple question to me and he said what do you think that all means hassan and i'm thinking to myself like that's a damn good question and i don't have a damn good answer for you and i feel bad that i don't because you're quite concerned about it you're a very healthy person and i would be concerned if i were in your shoes too and i felt chris i felt inadequate that i didn't have the answer for him because i'm like he's describing symptoms that if you took individually and in a different kind of clinical picture and presentation you would say well that's clearly a heart problem or that's clearly a musculoskeletal problem or that's probably nothing at all but here he was very anxious about it family history and a constellation of things that you know individually didn't mean a lot but maybe collectively meant something and in that particular presentation with that family history probably meant a lot and i didn't have i didn't have the knowledge in my mind in my little peanut brain to figure out what it was that was what was causing all of this right and i thought to myself and this could be incorrect obviously but i thought to myself i bet there's some case study somewhere someone over the history of medicine probably wrote about some symptom set of symptoms that this person is presenting with almost exact same picture of what he's presenting with the family history and said you should consider this as a possibility for this condition and perhaps not maybe it doesn't exist but i don't know if it does right and i can't go through the entire pubmed library and go over petabytes of data and figure out to find that one needle in the haystack and say hey i know what's wrong with you doctor so and so wrote about this very condition back in eighteen twenty something and i didn't have that information and that's when it dawned on me that the power of ai is that it can help me be a little bit more effective at answering that question and that's really i think chris for that it was that afternoon i remember vividly because i have notes written down about it that i decided when i had the opportunity i said you know what i'm going to look into how ai could be applied to help you know a physician like myself have a better answer for my friend instead of saying dude i have no idea what's going on

with me

and that's when i started to realize it you know what ai can do is it can take a lot of information it can automate the collection of data it can optimize the analysis of data and it can highlight patterns and those patterns can give you insight when you talk about developing algorithms and things like that that's just another level of giving you that kind of insight that can help you to make a better decision and i know there is lots to talk about and there's lots of controversy and there's lots to be concerned about when you talk about applying that kind of technology and that kind of tool to something that's very personal something that's very important something that's so critical as healthcare but i think people should look at the upside of that right i think a lot of people actually are very pleased that netflix can give you a suggestion for a movie you may like based on a bunch of patterns that they recognize from their viewing hack and wouldn't it be nice too if at my disposal when my friend asked me that very important question to him that i had in my hands there in my fingertips a number of different possibilities that could explain what was going on with him and then i could take that information and i could apply that knowledge that new knowledge now with asking some more probing questions and maybe even ordering some more diagnostics that maybe you know would bring me closer to the giving him a better answer than dude i have no idea what's going on you know and so that's at its core that's to me where i think ai can have a very you know important role in helping us to deliver better health care and that's what excites yeah absolutely it

sort of reminds me of kind of like thinking about the you know there used to be the little books that you could like fit into the pocket of a lab coat of like you know neurology for the house officer or whatever you know like when you're doing whatever rotation and all of a sudden you got something that seems like neurology then you whip that one out and you kind of look at it and you see the pearls here's an interesting case study or whatever but to take the power of one hundred xing times clinical studies and case studies to be able to have that at your fingertips because like you said you can't just go to hop onto pubmed and ten minutes later have the definitive answer and i think one of the promising things because there's a lot of overlap you read about when you're looking at ai and medicine with predictive analytics and with personalized medicine and it seems to me i mean my simple minded way to think about it is to say we've got this trove of searchable data that a machine can go through and scrub for looking for certain kinds of patterns as you've noted and then take that and look at it maybe at the end of one quantified self to the patient that's sitting in front of you and say okay we're going to take all this that we know from the literature and studies and now we're going to scrub this against your family history your current lab tests your fitbit data from the last year whatever it is that someone brings or doesn't bring to the clinical waiting or the exam room

so to speak your genetic makeup even

yeah yeah and the other thing that kind of drives me crazy with this is that it's just like with COVID which is wouldn't it be great if we already had this database that we could just easily get all the answers to our questions with a ninety five percent certainty and it's sort of like i have done some stuff with genetics and smps and whatnot and there's a great database called snpedia i don't know if you've ever heard of it we can put it in the show notes for folks that are interested in the audience but it's basically kind of this periodically updated database like a wikipedia but the fact that there's going to be studies published tomorrow that have not been published today that are going to have add to the data add to the knowledge bring in x thousand more patients in and we'll know more tomorrow than what we knew today and the fact that a lot of these either they're free or they're very inexpensive to access i think will also be one of the key places that i hope people smarter than me can then go to as they're developing these algorithms to be able to trawl or to scrape or to search to be able to start to get those kinds of things out there so you talk about you start off with the cardiology and big data and i had it's been fascinating in my evolution to kind of go from almost a hubris of randomized controlled trials and remarkably small ends to kind of what we go to today and i moved from being primarily in behavioral health to then also getting into sports medicine and orthopedics and stuff and worked as a running a department there looking at data analytics and we went from i went from like being tickled to have an n of one hundred over a course of a year to having twenty three thousand patient visits a day through this orthopedic practice a national practice and you know then i developed i went to clinicaltrials dot gov we developed two patient registries can you talk a little bit more about either from or both the military side of patient registries because i know that there's a treasure trove of data there in the defense department and then anything anything else like with other patient registries that you're familiar with or you know with clinicaltrials dot gov and what promise you think that those might hold for the ai colleagues of

ours yeah i think it's all wonderful actually i mean i think you had in your own experience what i think many of us are going to experience in future generations and they'll probably look back at us and i used to joke around i still do with my residents and my colleagues in cardiac surgery and i say you know someday for you know many years from now maybe not even many years from now they'll look back and say you guys were doing what you were ripping veins out of people's legs and cracking their chest

open

what were you thinking man that was craziness you know barbaric

i mean

it's functioning and it's working now but maybe people years from now will discover that oh you know what because of these registries because of different kinds of experiences we may find that oh you know perhaps there's and we do know this to some extent obviously that there's some dietary modifications you can make that can actually reverse some cardiovascular disease that you might have and maybe that's a better way maybe someone will create a wonder drug that can you know melt the plaque away who knows but the point is these registries and even more importantly some of the crowd sourcing and some of these sort of platforms and i'll highlight one because i got to meet the developers as well as some of the leadership in this organization patients like me for example right right yeah where you have an entire community right of individuals all across the world who have a condition and not only that chris they're living with this condition every single day so unlike us in healthcare or even in a clinical trial even in a randomized clinical trial where you're seeing that patient episodically right over a course of like five six maybe twelve months and you're seeing them for visits that last maybe an hour maybe two hours these people on these platforms are sharing information and data and observations about their condition twenty four hours a day seven days a week and they're sharing things with the community of like minded folks that unfortunately are suffering from the same experience that they are and they're telling each other hey this has worked for me you know i tried this i tried that and that i think is a rich and i think often overlooked source of information that could actually help contribute a lot to the body of knowledge that we have for treating patients with different conditions and that's why i think you see and i know patients that have had chronic conditions and i know my own patients that have had chronic conditions that will place a lot more confidence in those kinds of forums than they will with things that i'm telling them and why it makes sense right because they're like well you know what doctor you only see maybe one or two of me in your career i'm on a chat or i'm in a forum with hundreds of people that have the same condition that i have they've been told to try this and it didn't work for them but yet they discovered this or they discovered that and it's working for them and you know what i tried and it's working for me and i applaud that when that happens i try and support them and i try and give them information to help their journeys to health and i don't discount those things because i think they're very important so when you talk about the randomized clinical trial they're great right but they're also not without flaw because sometimes they don't have a very diverse patient population so even though you may lean an insight or may say yes this is the right path for this condition or this therapeutic is the right way to treat this population you may be missing a whole swath of the population just because in that clinical trial they didn't have a a particular social demographic they didn't have the right genetic composition all of those patients happen to be from the northeast and not in the pacific northwest or whatever it is exactly so there are some limitations with even that mode of data gathering but i think that if you look on the horizon in the future what's to come i think we're going to get insight a lot more rapidly because people are walking around with supercomputers in their pockets and those supercomputers are collecting a lot of data whether we want it sometimes or not to collect that data it is collecting the data and when it comes to trials and to gleaning insight for what may work or may not work with patients i think you'll find that these platforms like a patient like me or in your practice in your experience have seen twenty three thousand patients over a short period of time that are all having very similar kinds of therapeutic interventions performed on them and then being able to have the ability to follow up with them very dynamic dynamically you'll start to see what works and don't work and doesn't work you'll say hey wait a minute you know what these people do very well with the six week course of rehabilitation as opposed to what i thought they needed which was nine months or whatever it was exactly you know what we need to apply these techniques as opposed to others and we may get better outcomes here or we know that this absolutely doesn't work and in fact may cause more harm for patients that are undergoing these sort of therapies so i think the future is very exciting in that regard because i think it's only going to be better in terms of how we gather how we synthesize and analyze and gain insight from this information that before we largely didn't have access to and again i'm not being pollyannish about some of the potential hazards with gathering all of this information and gaining sometimes the wrong insights from it but i do believe that the good in these cases will far outweigh the bad and i think what we'll hopefully get at the end are more and better ways of treating and caring for patients and hopefully doing it in a way that's more affordable that's a little bit more effective and hopefully more

efficient yeah well put what you say makes me think about we would all love to have the magic bullet the easy button and to say okay if we just throw some ai at this and an algorithm or two then we'll have the the magical answers and you know light will be rainbows and butterflies and i think you know there's sort of the meta aspect of what you're saying too about you know patients like me is that there's also you know a nice here's my psychology coming out but it's also nice support you know it's a nice kind of way to get you know feel not alone with whatever you know the disease or illness or issue is that the one's dealing with and i was at a stanford medicine x conference years ago where i first learned about them and some of the speakers there you know like one one guy was a data scientist he wasn't an md and he was a data scientist talking about what you were saying by virtue of the fact that his daughter had a terminal or a poor prognosis kind of illness and stitching together those kinds of things i think are hugely important i've just recently been working on a project in digital therapeutics getting an fda approval for a project and it's interesting to me and again it makes me feel like i'm a luddite or something but you think of fda and you think of randomized clinical trials et cetera et cetera et cetera and now there's at least in this space that i'm specifically focused in in terms of more so digital therapeutics and behavioral health care is looking at what the you know real world data that you can submit for approval from the fda for clearance using real world data as opposed to you know having a controlled group and doing kind of the traditional you know specific orthodoxy of of pharmacotherapies and drug development so i think we'll excuse me learn a great deal from looking at those kind of patient organically organized and like you said carrying around their own little microcomputers with them to be able to look at data and then if a couple of apps here and there and getting those data back to their healthcare providers and and whoever else they're involved with i think will be a big boon to what happens i want to circle back again and keep my psychology hat on one of the things you talked about in that article that's involved with jake's is the project orion can you share a little bit about that for people in the audience that may not have heard

about it yet yeah sure so that i must say it's a collaboration

from

multiple different agencies within the department of defense and quite frankly other interagency interagency intergovernmental agencies getting after and addressing as you say putting on your behavioral health hat a problem a challenge and an issue that's been a big problem for us here in the country and certainly within the military and that's suicide and of course behavioral health depression and all of those things that come with it and so you know regrettably and you know certainly the pandemic has probably exacerbated things with isolation and loneliness and also just the other stress that comes with just living in this time of a global pandemic you know more behavioral health issues and challenges that people are faced with you know and what we have tried to do in the department and what we've tried to do in healthcare writ large is to prevent suicide i think everybody you know knows and understands the tragedy that suicide is not only obviously for the individual but those family members and friends that they leave behind and there are always these questions that are asked well why and could we have could we have avoided this could we have prevented this right and so suicide prevention is something that i think many people have dedicated their lives to addressing i've had my own colleagues you know friends that throughout my medical career at different levels medical school residency fellowship that have committed suicide and when i reflect on those lives that are lost i've done the same thing i've asked why how could that have happened and i didn't see it coming and so when you think about everything we just talked about we're looking at data and looking at patterns and trying to gain insight project orion and many of the initiatives within the department and with healthcare in general are looking at ways to take information information on individuals information on populations and see if we can find triggers or patterns or recognize things that may be hints if you will to provide a path to intervene on one's behalf to hopefully prevent a tragedy or prevent someone going down a path of a destructive behavior that may lead to suicide or worse and so that's at its core what it's all about and we have a lot of information on folks that we have just by way of medical records by way of service records and with care and security and privacy all in mind and taking things in aggregate we are looking for patterns that for us are even the ones that beyond the things that are usual suspects relationship problems financial problems problems at work to see if there are other triggers that could potentially give us some insight into saying hey if you identify an individual that has one two three or several of these factors that we know have been identified as things that these people that have committed suicide all share in common we may want to intervene on that person's behalf ask them how things are going maybe get them to the appropriate help and buy them the resources that they may need so that they can prevent a tragedy from falling down one thing that i will just share with the audience which is which is something unique to the military which i think gives us perhaps an edge in this sort of endeavor if you think about it is the fact that in the military and this is unique to the military it's not like something that the civilian sector does and i only learned about it somewhat recently actually is that in the military if one commits suicide depending on which service they're in there is a complete and very comprehensive investigation that occurs on that individual and it's almost like a forensic analysis of one's life tragically unfortunately triggered by the fact that this person committed suicide and so we look at a person's record they look at their social connections and and you know service records where did they deploy where did they get assigned health you know and things like that and you know it's done obviously because you know in the military for someone to commit suicide it's a big deal and we want to try and learn from this experience to prevent it from happening again but as a result of this investigation what comes of that is a report it's a very comprehensive report in some cases depending on the individual and the circumstances it could be several hundreds of pages wow and if you think about it right that's unique to the military because most times in the civilian sector someone committed suicide the investigation will just go so far as to make sure it wasn't a homicide or foul play or something other than what it seemed to be which was a suicide and that's pretty much it and the report will be filed and it may be just a few lines but when you think about having a comprehensive record on a number of patients in this case it's a lot of patients unfortunately where we're looking at a lot of different aspects of one's life for people that have actually committed the act they haven't attempted they were not people that were unsuccessful in the act regrettably they were all successful so you think about this as a resource of information at least for this particular population in the military that can be used to help us identify patterns and recognize trends that we may see among this population of individuals that have regrettably committed suicide perhaps give us some insight into helping our commanders our leaders our healthcare providers our behavioral health professionals to say hey when we identify you know triggers that we notice are sort of shared in common for this group financial trouble sometimes relationship issues moves deployments you know all of the things that are you know very well identified as triggers for causing stress we can be a little bit more in tune to being receptive and of course proactive and helping individuals to give them resources provide them with some tools and hopefully help prevent them going down a path where there's destructive habits that are that are sort of adopted and worse suicide that's committed

it'd be interesting to see the you know of those that were intervened with to see you know if that you know did help you know mitigate the

i think it would be yeah no i think that's a good question i think it's it's important to note here too that this is a very difficult and challenging problem and certainly we don't have the panacea but what we're trying to do is address a very serious problem that many people have not been successful at addressing not only military i mean the world almost every society and almost every community is faced with these tragic events and what we're trying to do is again use information and what i would argue is a fairly unique kind of resource to help you know give us an insight into some of the things and some of the maybe identify some patterns that you know could help us to be more aware yeah hopefully a bit more active at addressing you know the challenges that people may be going going through that may lead down the path of suicide that's fascinating

it's like a digital phenotyping you know i mean it's like being able to have those markers and so to speak and kind of through a process of like a psychological autopsy as opposed to

a physical it's fascinating that it's because of your background so that is one thing that i will say has been a breakthrough i would call it a breakthrough because again and it's something that we identified our team our very talented team of many professionals working on this identified as a unique attribute that we have in the military which is this sort of repository and so one of the things that we came up with was a bit of a way of quantifying or maybe presenting this data in a meaningful way that can be helpful so you talked about an autopsy tool so taking all of this information one of the things that's being developed now and it's certainly not complete at this point but what's being done is they're taking these reports and looking at patterns and they're developing kind of like a psychological autopsy tool and i don't want to use the word inappropriately but if you think about why we perform autopsies in healthcare right we do that because there may have been a cause of death that was not clear right and so use our pathologists to perform what's called an autopsy which is they'll look at the deceased and they'll not only do a gross anatomical survey but they'll do a microscopic one and sort of examine organ by organ what could have contributed to this person's demise and from a psychological standpoint right it would be hard to do that you know physically but from a behavioral health standpoint especially if you have information that we do have in some of these reports you kind of go through just like you would in an autopsy and look at some of these aspects of one's

social

circumstance professional circumstance and see if there are things that could have given you some insight into why this person unfortunately committed suicide and so i think it's an area where there's some novelty and of course the audience may be thinking well where does ai come into that well think about hundreds and hundreds of pages per individual unfortunately thousands of people that have committed suicide that's a lot and you can apply ai like natural language processing which has been in part responsible for us to be able to just google things right and figure out negatives how we get to you know all of the knowledge that's been digitized it's because there's a computer that has been trained and algorithms that have been developed to be able to find keywords out of a myriad of text and that same kind of of technology can be applied in this circumstance to look through those you know those reports and do so and i think a more efficient and sometimes a bit more effective way than any one individual even team

of individuals sure yeah i was first introduced to a software program called atlas ti and it was looking at refugees into the united states from kosovo and it was in psychiatry department of psychiatry at university of illinois college of medicine and it was fascinating to me i mean i was very naive to this this is some years ago so i'm sure it's much more robust than what it was back then but it was just this whole idea of taking patient narratives and looking for similar choices of words and this is after going through proper translations and whatnot with their native tongue et cetera and it was fascinating like you said i mean we keep circling back to pattern recognition and to be able to see these things but you're absolutely right to have these kinds of statistical analytical kinds of tools to be able to do that there'd be no way a human could do it there'd be no way a therapist even with a thousand patients it's just beyond human capacity well i want to circle back if you don't mind we'll get back to ai and the audience doesn't need to worry but also i can't let you go without talking a little bit about your early years in doing my research i found that you were a aspiring graffiti artist is that correct that's correct okay okay banksy

yeah well i grew up in brooklyn i always like to tout where i come from because i think you can appreciate this as a behavioral health person you know where you sort of you know indoctrinated into early life i think has some some influence over how you live your life moving forward my wife and i were talking about that you know and for good bad or indifferent depending on how one you know i guess reacts to the environments in which they grew up in so and you know i grew up in a brooklyn that's a lot different than the gentrified version of the brooklyn that people know today sure yeah for me it was not only a test of mettle but also one of survival and also prevention vision of great survival skills yeah but from that experience there were some really great highlights of my early childhood and teenage years in the city and one of those was this very creative very dynamic art form called graffiti which maybe depending on how you look at it nowadays especially i think being an adult now myself probably didn't see that as much of an artistic expression more than just vandalism and probably a bunch of nuisance but back then graffiti art was very ubiquitous i would say all over the city and for me it was not only just the actual art form and the coolness of doing it with the spray paint and the markers and all that went along with that but it was this social connection of knowing other artists and learning about them and knowing about them and learning about them through their art but then you know in my case sometimes meeting them and being like oh my gosh that's so and so and oh my gosh know i saw that mural that you did i saw that work that you did and and and so there was this like there was this kind of like community that i belong to and you know as a teenager i really embraced it and it was like a sense of belonging and i was part of something and and i wanted to go to art school and in fact i got accepted to art and design high school which is in new york which is competitive art school very good art school you had to you know actually have a portfolio you had to go there and actually have a drawing test and an exam where they sat you down and gave you different objects to draw and they would look at it and grade it so i got accepted and i was very enthusiastic because this was going to bring me even closer because a lot of graffiti artists went to art and design at that time that's what actually graduated from there and i was like now i'm going to be a part of it and i was going to take a train from brooklyn to manhattan every day go to school so it was very exciting and all of that enthusiasm quickly got you know curtailed when i shared with my west african immigrant dad that i wanted to be an artist

i can't imagine

he said he said nope that's not gonna happen you're not gonna make any money as an artist and i fortunately i also got accepted to to a technical science school brooklyn tech he said you're gonna go to science and engineering school instead i think you'll have a much better job prospect now he was partially right right because we both know artists that are doing much better than many scientists

ever will that's true yeah that's true

but maybe from a statistical standpoint you know the odds of doing okay as a scientist and an engineer is probably a little bit better than the one

your dad was just predicating this off the data and looking probabilistically right exactly

right exactly right he was like well chances of you being a world famous while you're living yeah right yeah critical point probably a lot less than you going to science and engineering school and becoming a scientist or an engineer and truth be told chris at that time i still like many kids and especially if you're a child of west african immigrant parents two of them you'd already been indoctrinated into you're gonna be a doctor or a lawyer so yeah yeah i sort of vaguely had that interest anyway so it made sense and i you know i didn't protest too much so but i never gave up my affinity to art and that's why you know many years later fast forward not only was i able to go into a specialty which i think you know involves quite a bit of creativity and that is being a surgeon and of course you hear a lot about the art and the science of medicine and there truly is an art to it especially when you deal with individuals who are unique in their own way and then of course i had recently the opportunity to start a book series around the genre of art and call it the art of human care way to bring all of these things full circle and bring them all together i know

and i want to this is a wonderful natural segue to that one other thing before we get into that is that you had another very well i guess let me just circle back even to the graffiti i mean thankfully to your parents and to whatever other kinds of events transpired in between but the blessing that it is that you've taken the career path that you have and the lives that you've saved and the lives that you've changed and continue to do so so i just want to not blow by that but i mean that's something really to make a highlight and to take credit for and it's wonderful and not an easy path that you've chosen but you also if i can maybe kind of play psychologist again here one of the tipping points or turning points rather for you was an undergrad where you nearly died do you feel comfortable sharing that story and was that kind of one of the springboards

into medicine that was absolutely not only a springboard but definitely a springboard that led to at least me in my analysis the type of medicine or type of doctor that i believe i am and had it not been for that experience in undergrad which you just highlighted which for the audience what happened to me in undergrad was pretty consequential you know your podcast is aptly called living your life before i would say you know that many years ago in my tween age years as a junior and undergraduate i was not going to have a full life for sure because i contracted bacterial meningitis ironically after coming back from an interview for medical school oh

my gosh

so here i was in my proverbial deathbed because for the audience even now with all we have in modern medicine if you have bacterial meningitis and you get it severe enough as i did it could definitely be a death sentence right and there's not uncommon for many young people and very old people and everyone in between to die from bacterial meningitis every year and so i had it you know i was even incorrectly diagnosed initially but fortunately given you know the right therapy albeit in much smaller doses than i needed i was diagnosed with a stomach flu when in fact i had bacteria and it had not been for some some friends and fraternity brothers of mine that found me sort of almost you know on death's on death's doorstep to the hospital i would not be here having this conversation with you but the good news is that i survived obviously and the good news is that experience i will tell you for anybody that has ever been on the other side of our healthcare system not the delivery part but the receiving part it will be an experience that changes you and i'm not talking about the going to visit the doctor or going to the er or you know for going get you know because you had a sprained ankle or something i'm talking about like knocking on death's door one one foot one foot in the grave another on a banana peel you know tenuous you know two binary orifice that kind of of experience under the receiving end you quickly realize how vulnerable you are you're vulnerable you're anxious and even as an invincible you know teenager i was i was like i was very nervous i was scared for my life i was going to survive i wasn't even aware of what was happening to me half the time because i spent several weeks in the hospital and much of that summer after recovering but what it did engender for me was this deep sense and appreciation and i think gave me an empathy which i would have never had for my own patients once i became the doctor and when i started around patients on the other side so to speak in the bed in the icu intubated with their family members around understand what it felt like in that situation i know it's it's given me an incredible sensitivity and i said as i said an empathy that you can't learn in a textbook right right right everyone is supposed to be nice in medicine but you know there's one thing about being nice in medicine because you read about it is another thing about being nice in medicine because you remember being in that predicament and knowing and remembering how those people that were really nice and compassionate to you made you feel and they made you feel great they made you feel feel good they made you feel hopeful yeah well they made you feel like oh and i'm going to get through this and i want to make my patients feel like that and that that's been that's been a it's been a very you know important part of the kind of physician that i am today even so many years after you know that event i mean that happened decades ago but i can remember like it was yesterday every time sure

of course yeah trauma's like that so

i can i can realistically say i

know how you feel yeah yeah no no placating so were you pre med then

well i was i mean i was an undergrad i was a biochem major okay and it was my junior year i actually like i said went for an early decision look at hopkins so i got an interview i ultimately did not get accepted but i like to always say i got my poetic justice back from hopkins cause i went back to got my business school degree from hopkins and i've been on faculty and work with their staff there now but yeah they in their infinite wisdom decided to reject me after my meningitis bowel great i'll be back

oh yeah

yeah but it all worked out good

good yeah to the benefit of us all especially you so so i have a few more questions are you good for time sure yeah okay awesome i do want to circle back now to the art of human care series what spurred that i mean we've talked a little bit about your artistic abilities and beginnings and stuff but i also heard you subcontracted out the illustrations to somebody else for some of your books with this can you tell us about that and tell us about the whole idea

absolutely so that that idea came about as a result of i think you know you can't hide the inner artist once you have one so i had the inner artist and you know i have a daughter and i have a son and my daughter you know more so than my son had always expressed this you know artistic affinity and you know i loved her drawings and and i know most parents say oh i love my child's drawings i really love my drawings she was just like really just gifted at it and i told my wife i remember early on i said well you know if she ever wants to go into art i'm not going to dissuade her even if she has to stay on our payroll for the rest of her life i remember what my dad did to me that's

great oh i love it i don't

want to do that so i so crystal i actually she was eight years old at the time i remember this very very well because i told i said hey ella you know at this point i had already wrote i already wrote one book i had wrote my first novel at that time gifts of the heart which i wrote after i got back from my deployment and i was thinking about you know like many artists do like what can i do next what do i do next and so i was thinking about thinking about and i came up with this art of human care concept and i was like how neat would it be to have art in the book because art is so healing and so therapeutic and i start thinking about how art is like in every aspect the hospitals you know there's music there's like there's sculptures there's paintings on the wall and it's this universal thing that you know people just feel good with art and i mean i think about it people like have their favorite song they have their favorite poem or they have it so i just thought to myself there must be a good way to fuse this and as i started looking to it i was like wow there really is a lot a body of work on art and healing and so i told my daughter who was eight at the time i said you know you're wouldn't it be neat her name is ella blue and i said wouldn't it be neat ella if we wrote a book together and you drew the pictures and as an eight year old you know she's you know i don't know what kind of answer she gave at the time to me was a yes so i was like good we're gonna work on this and so four years later oh the first one came out and and ella drew all the hearts in the book i love that yeah so that's what started it so and of course i was like wow we gotta do this again it was good reception from it and i said let's work on another one and so i had these ideas for these series of books and because covid occurred you know the timeline and sort of the order of the books got a little bit upended like you know like i'm sure nothing like that happened to anyone else yeah covid threw a little monkey in my plans and so i found myself you know sort of sequestered and hunkered down but also impacted tremendously by covid both personally professionally and thinking to myself well you know if there's ever going to be a time where an incredible body of art is going to be produced it's going to be during COVID at least for our generation and so let me contribute to that by writing another book and then also you know infusing great art again into this work and so yeah i found a number of artists i told them what i was trying to do and i mean beautiful art i think came out of it and so that's incorporated into the art of human care for covid and then i also follow that up with the art of human care with artificial intelligence and i found an incredible digital artist that you know really sort of i think saw my vision and manifested in some really cool pictures that sort of juxtapose the words in that book so yeah there you have it that's how

that came about that is so awesome i love the you know kind of the integration of these different kinds of things into your work and how you've described how whatever kinds of experiences if they're traumatic with you know being sick at age twenty and having greater empathy and bedside manner than maybe what would have been without that and again thank goodness for surviving it and then the whole aspect of art i loved your point if she's going to be on the payroll let her be an artist i love that it speaks to not only your humanity but also being a great dad so i think that's wonderful that might be a great way to wrap up our show but before i let you go for people that are interested in getting a hold of your books learning more about your work et cetera what are some of the ways that people can go about doing that

yeah great question chris so i definitely invite and love interacting and learning from other people whatever their work is and happy to answer questions on my journey so to speak so two places you know being digital people nowadays that would that would sort of give insight into what i'm doing and the work that i have is art of human care website it's just art of human care all one word okay and there you see all of our books and then of course i have my own personal website which is drteva dot com and that's doctor it's spelled out d o c t o r t e dash t dash t e h dot com and of course as i mentioned artofhumancare dot com great yeah we have and from those you can launch into our social media and instagram and all those kinds of other platforms but those are like the two great starting points so to speak into the into the world of doctor tedda excellent good well i

encourage people to go exploring around in there i certainly have and and you're also you know you appear in a variety of other places as well too so so that's that's good it's good to be connected this way but anybody interested in this you know please check out our show notes we'll have that in there as well too and again hasan i just want to thank you for making the time today my gosh you have like the most incredibly busy schedule of anyone i can imagine with all the different responsibilities and things that you're involved with and you still have time to be able to share yourself with us and with the audience and i very much am indebted to you for doing that it's great and great to be in touch with you and get to know a little bit more about you and your background well thank

you chris for giving me the opportunity to be on such a great platform and to contribute in any way to your audience's inspiration and inspiring them hopefully to live their full life and live their life in full so i really appreciate the opportunity thank you my pleasure

you're quite the inspiration living a life in full is a production of stout media a subsidiary of gordian knot llc assistant producer gracie wong music dan o' brien executive producer and host doctor chris stout to learn more stop by our website at lifeinfull for show notes and please recommend us to your friends and subscribe on your favorite platform and as for the obligatory disclaimer this podcast is for general information uses only and does not constitute the practice of psychiatrist medicine nutrition or other professional health care services including the giving of medical or psychological advice no doctor patient relationship is formed lastly and perhaps most importantly i take conflicts of interest seriously for all of my disclosures as well as show notes please see livingalifeinfull dot org podcast and my linkedin profile thanks and until next time