EP. 26: A PHYSICIAN-ENGINEER AND HIS PATIENT STORIES

WITH BRYANT LIN

Aug 30

WITH BRYANT LIN, MD, M.ENG

A medical device engineer and The director of Stanford’s medical humanities program shares the importance of storytelling in patient-centered innovation.

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Episode Summary

Technological advancements have enabled us to accomplish medical miracles through novel medical devices, algorithms, and digital tools. At the same time, the exponential entanglement of tech with health care has led many clinicians to feel disconnected from the human element of medicine. Here to discuss this conundrum is Dr. Bryant Lin, the director of Medicine and the Muse, the medical humanities program at Stanford Medical School, and a mechanical engineer by training who focuses on medical device development. Dr. Lin also conducts research in Asian population health and is the cofounder of Stanford’s Consultative Medicine Clinic, which evaluates patients with medical mysteries. In today’s episode, Dr. Lin shares his unique perspective at the crossroads of technology and the humanities, and discusses how storytelling can be a powerful instrument to keep physicians grounded in what truly matters for their patients.

Bryant Lin, MD, MEng is a primary care physician, educator and researcher. The cornerstone of Dr. Lin's work is keeping medicine focused on humans - patients, providers, families and trainees - and not lost in technology and algorithms. His research and educational interests span (1) Developing and testing novel medical technologies, (2) Improving the health of Asian populations with Precision and Population Health, and (3) Increasing expression and interconnections in the Health Community with the Humanities and Arts.
After receiving his undergraduate and master's degrees in Electrical Engineering and Computer Science from MIT, he completed his MD and internal Medicine training at Tufts University School of Medicine and Tufts Medical Center. He came to Stanford to serve as a Research Fellow in Cardiac Electrophysiology and Biodesign Fellow where he learned to identify unmet human-centered needs. After completing his post-graduate training, he stayed at Stanford as clinical faculty in Primary Care and Population Health in the Department of Medicine and started the Consultative Medicine Clinic, which evaluates patients with medical mysteries. He currently directs Medicine and the Muse, Stanford’s medical humanities program. Finally, he co-founded and co-directs, with Dr. Latha Palaniappan, the Center for Asian Health Research and Education (CARE) which aims to improve the health of Asians everywhere.
In this episode, you will hear about:
• How an early interest in engineering led Dr. Lin to medicine - 1:42
• A poignant letter Dr. Lin received from one of his long-term aging patients that reaffirms why his medical career is meaningful - 4:10
• A discussion of how medical bureaucratization has stolen away much of the human connection that underpins fulfilling medical work - 7:39
• How Medicine and the Muse, the medical humanities program at Stanford, helps clinicians connect with the meaning in medicine - 12:40
• What Dr. Lin hopes to achieve through teaching medical humanities to future clinicians - 25:45
• How storytelling helps healthcare providers better connect with their patients - 27:28
• How Dr. Lin integrates storytelling into medical device design, and why it is imperative to not allow technology to distance physicians from their patients - 31:24
Henry Bair: [00:00:01] Hi. I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are, by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] Our guest today is Dr. Bryant Lin, who is not only the director of the Medical Humanities Program at Stanford Medical School, but is an engineer by training who is involved in medical device development. In addition, he does research in Asian population health and founded Stanford's Consultative Medicine Clinic, which evaluates patients with medical mysteries. In today's episode, he joins us to discuss his journey in medicine and share touching stories that illustrate his deep interest in the human connections that underlie all of his diverse areas of interest. Bryant, Welcome to the show and thanks for being here.
Bryant Lin: [00:01:38] Great. Thanks for having me. It's really fantastic to be on your podcast.
Henry Bair: [00:01:42] As we mentioned in your introduction, your resume is packed with all sorts of different kinds of activities. Can you take us all the way back to the start and tell us what first drew you to a medical career?
Bryant Lin: [00:01:56] I studied engineering, electrical engineering, computer science. I stayed on for a kind of a fifth year master's at MIT. I was interested in medicine, did all my pre-med requirements. It was a bit painful because I had to do, I think, four lab classes. I wasn't sure I wanted to go into medicine, so I went and actually worked in management consulting for a year. I really hated it. It was a soul sucking experience. And so rather than do pure engineering, I felt like I enjoyed engineering. I felt like if I did engineering, it would be I'd be working with five people, ten people in the same people all the time, which is great. But I really wanted more exposure to a diversity of people, and I thought medicine could get that for me, and I'm living a fairly sheltered life. I think it was really beneficial in retrospect that I made that decision. Definitely. I've gotten exposed and been able to help and have been helped by people from from all backgrounds and all walks of life.
Henry Bair: [00:03:00] So after you completed your medical training, you went on to do a research fellowship in cardiac electrophysiology. Can you tell us more about what drew you to that in particular?
Bryant Lin: [00:03:12] What was a natural intersection between engineering and medicine? Right. Cardiology. There's kind of two areas that people think of and that come up automatically where you tend to see more engineers. One is orthopedics, obviously, because of the mechanical aspect and implants. And the other one is cardiology because of physiologic signal processing and get devices involved. I did research in physiologic signal processing when I was an undergrad. However, I also for my master's, I did orthopedic research, so I kind of got both. I explored all the engineering heavy areas of research in medicine. Kind of got a good mix of both. I was I like working with my hands. I like doing kind of manual things. So I thought I was going to be a surgeon once I entered medical school. Being in the EPI lab didn't float my boat. That wasn't for me. So that's why I didn't decided not to enter those subspecialties.
Henry Bair: [00:04:10] Despite all the engineering work that you did. You mentioned that the reason you chose medicine was because of the human element, the human interaction element of it. Tell us more about that. Like, was there a particular moment in your training or career particular patient you cared for that really solidified your conviction that this was the most meaningful work that you could do, this combination of the engineering, but also the human centered part of it.
Bryant Lin: [00:04:38] I had this experience was about 2013. So several years after being an attending and I had this patient. Knew him well, had known him for a few years. Got to know him and his wife and his children. And for many years he had chronic kidney disease. And he for many years had said, I don't want to have dialysis. He was in his eighties, approaching 90 at the time. I don't want to have dialysis. If the time comes, just let me go. So the time came and the family and especially his wife, they weren't really ready to let him go. He was very much a family man, a gentleman, too. He would always come in pressed shirt, tie, hair, impeccably, always in place, and very polite, very respectful, very, very kind of a traditional, old fashioned gentleman. Chinese American spoke English really fluently. I can't remember if he's first generation or second generation, but he said, "Okay, I, you know, I hear my family and we talked about this before, but I'm willing to try a dialysis because obviously my family is not they're not ready to let me go." We had a big family meeting, so I said, "okay, let's send you to nephrology and get you started in dialysis." And you know, that lasted for a few months. He was having a lot of trouble, had infections and kind of all the usual challenges.
Bryant Lin: [00:06:05] I think he even got hospitalized. And so at some point I had another family meeting and I said, Hey, this doesn't seem like it's going that well for him. You know, he had expressed his wishes previously that he'd never wanted to do dialysis. So now is the time to really think about whether we should continue this or not. Family was all together. Him all on the same page after a few meetings and said, okay, let's let's remove dialysis. A few weeks later, I got this letter in the mail. He said,
Bryant Lin: [00:06:38] "Dearest Dr. Lin, I wanted to thank you so much for taking such good care of me in my old age. You treated me as you would treat your own father with humor and care and great professional skill. I feel so honored to have been under your care." And he died two weeks prior. So this is a letter he wrote before he died. And he took the time in his last days and hours to send me this letter. So ever since then when people ask, Why did you own the medicine? This is why I went to medicine. You know, it's that personal relationship, that connection you have. We're really privileged, privileged to be there at people's high points and low points in their life throughout the span of their life.
Tyler Johnson: [00:07:26] So I feel like when you finish that letter, we should just drop the mic and the podcast and I'll go home. That was the answer we found out. Henry, we're done.
Bryant Lin: [00:07:37] This is the answer. Yeah.
Tyler Johnson: [00:07:39] Let me ask you a question. I hate to turn that beautiful story into a process question, but at some point we have to talk about process, right, to enable those kinds of experiences. Because what I think Henry and I have heard on the podcast and what I know you know this, but what everybody hears from everyone in medicine, right, is that in a really sad and paradoxical way, medicine is sabotaging doctors ability to have that exact kind of experience. Right. Because there's such an overwhelming burden of bureaucratic box checking and the electronic medical record and dings and pings from a thousand different places and administrative requirements and.
Bryant Lin: [00:08:21] Death by a thousand cuts, right?
Tyler Johnson: [00:08:23] Yeah. Yes. Or 1000 clicks, as it were. So when, you know, if you are at Stanford or most places, you get to write up your Stanford faculty profile, it strikes me that yours says the first thing it says is the cornerstone of Dr. Lin's work is keeping medicine focused on humans and not lost in technology and algorithms. So I guess that my question then is how have you thought about trying to actively work on that? Right, that kind of experience. No one can feel burnout on the day they get that letter. If you felt burnout, it'll like dissolve like the mist in front of the sun. Like the rising sun. Right? Like it just it just they're sort of incompatible. But on the other hand, that letter can only come if you're given the physical and temporal and emotional and whatever support that you need to be able to build the kind of relationship with that patient over months or years that allow him to sincerely write that kind of letter. So how do we make sure that that kind of thing remains possible amidst all of the bureaucratic change that's come over medicine in the last couple of decades?
Bryant Lin: [00:09:35] That is a great question, something I've struggled with. We're trying a little bit to address some of this in medical humanities medicine, the muse. Our program here is called Medicine the Muse. You know, it's complicated, right? Just like you said, there's there's so many aspects, right? There's the. Workflow of your clinic day, right? How does that add to your burnout? What are you doing that is is really unpleasant and something that honestly you were not trained to do is the doctor. Why is that your job? To fill out the paperwork and sign things. Right. Why is it your job to fight with the insurance company? Right. All of those things are a death by 1000 clicks or faxes. This is where this kind of bucket. Term of wellness is a challenge, right? You know, I always cringe a little bit when I hear wellness. Right. Because people think about, well, it's, you know, you get free lunch or we gave you cheap, dry cleaning.
Tyler Johnson: [00:10:34] This is the the Dr. Glaucomflecken and Dr. Appreciation Day, right where you like get your free donut in the morning or something.
Bryant Lin: [00:10:41] Yeah, exactly. Yeah.
Tyler Johnson: [00:10:43] Great. Because you're so tired.
Bryant Lin: [00:10:44] Yeah. And it's funny, you know, my wife works at Google, right? So they get all this free stuff, right? And it's great. And it's it's it's good. Better than not having it, I guess. But I think we need to focus on what really provides joy and medicine for all of us. Right. And and we obviously in medicine, we don't focus on the process workflow side, but we focus on how do you reflect about that? How do you write about that? Right. How do you think about that? But also, one thing I learned we talk about medical communities is about writing and reflection and observation and empathy. But really, it's still mostly about enrichment for most people, right? It's just leading a richer life. Right. So I sort of take that view of how can I live my richest life as a doctor? Right. You know, as opposed to, oh, this is painful, right? That's kind of a negative view. How do I increase the richness of my patient doctor experience? Right. And sometimes it's time, right? Like you sort of you were implying, well, we don't have enough time or are we going to have this you know, and it's hard we it's terrible thing. Henry medical student you know we we counsel medicines well you have to kind of take the time that you have allotted right. You know you'll learn there are tricks right there tricks. But on the other end, former colleague Justin Lotfy. So he was in primary care. He went to Stanford concierge and now he's part of a very kind of higher end concierge practice. But he you know, he has infinite time per patient, right? I mean, he gets well compensated. But, you know, he has I mean, essentially almost infinite time per patient. It's the time is limited by the patient, not by the doctor. Right. So it's interesting. I don't know if I have an answer for your excellent question, Tyler, but we need to focus on what enriches the doctor, you know, the experience of being a doctor for all of us.
Henry Bair: [00:12:40] So, Brian, you mentioned earlier that you try to help clinicians through the Medical Humanities Program at Stanford Medicine in the Muse. You try to help physicians through through writing and other activities. Can you tell us more about those activities? How do you help clinicians reflect on why they do what they do?
Bryant Lin: [00:12:59] So it's not me personally just to make that clear. I'm like the last person to be hired as a director of medical humanities from the perspective of I'm not I don't I'm not a writer. I enjoy writing, I enjoy reading, I enjoy film and so forth. But I definitely have no expertise in those areas. But I like to run programs, I like to start programs. I'm fairly innovative about starting programs. So I think that's why I was chosen to be the director of medical humanities and we've started all sorts of new programs. So but just to be clear, it's not me, it's it's everyone else except for me. So I can give you several examples. So Laurel Brightman, excellent writer. She's been running programs at Medicine to muse on writing for years. Very popular writing programs on reflective writing, writing and medicine writing retreats for med students. We have new programs. So, for example, it seems like, well, why would this necessarily fit with medicine? We have a Stanford Medicine Orchestra now. We have a Stanford Medicine Chorus, and it's incredible. I will run into people who are like, Oh, I joined the chorus. I have such joy. This brings me such joy in my life. Is it directly have to do with them being a doctor? I don't know. I was I temporarily moved to this apartment near on campus, Stanford West, and then I ran into a new colleague who joined Stanford. And she was telling me, oh, you've got a great voice, you should join the chorus. And she had no idea that that was part of the program that I had helped start, and that was great to hear. I loved that. Right. She was so enthusiastic about that. This again, this joy of of living. And it doesn't necessarily have to be directly related. Longwood Medical Orchestra's famous write, why is it a medical orchestra? Well, a lot of say a lot of doctors are very accomplished and skilled in many areas. But it's not a 1 to 1 relationship with practice of medicine. Right. It's more of an experience about being a human.
Tyler Johnson: [00:14:59] I have to say, when I finally became faculty, just for reference, right after I graduated from college, I think I had 11 further years of medical training before I joined the faculty. So when I finally became faculty, in effect, a first generation doctor in my family, I recognized that I had no idea. Back when I was in college, thinking about medical school, I had zero idea of what I was getting myself into. Right. I just because how would you know if you don't have family members there? Since then, I've started going back to my alma mater every semester to give a talk to the pre-med class. They're called Counting the Cost, where I just take them through what the progression from being an undergrad, interested in medicine to becoming an actual doctor, it looks like. And one of the things that I have to tell them is that in particular, if you have a significant other and even more to the point, if you have children when you are in medicine, at least when you're in training, I should say, to go into medicine, at least in my experience, if you are lucky, you can do your medical training and you can nourish the relationships that are most important to you. Full stop. Like there is, at least in my experience, and I have a number of other things like I love to write and I love to sing. I used to be in choirs all the time and I still remember as an undergrad there was a semester where it was a little more complicated than this, but in effect it came down to choosing between being in one of the student courses and having the time that I needed to devote to biochem and organic chemistry and physics and whatever to prepare for medical school.
Tyler Johnson: [00:16:38] And I made the choice. I mean, it's almost like I physically put that other stuff down and then I didn't pick it back up again until that would have been in 2003 that I made that decision. And I didn't pick that stuff back up until 2016 when I finished my fellowship, which is just to say that again, to the same point that we were talking about a minute ago in terms of that there's so much bureaucratic stuff that I think a lot of doctors feel divorced from the very reason that they went into medicine in the first place. It's also true that a lot of this other stuff that I totally agree with you makes us feel fully human, whether it's singing or writing or running or playing basketball or hiking or whatever it is. There is an element of sacrifice, and we have structured medical training in such a way that it's almost entirely consuming. I don't even know that there's a question in here so much as just an observation that there is a challenge and there are trade offs.
Bryant Lin: [00:17:33] I mean, I can't agree with you more. It's a joke around that I'm not a humanities person because I trained in engineering and I made the exact same tradeoffs. You write, I basically had no elective time. I couldn't take any. I see all these students. Undergrads have the privilege of teaching a couple of undergrad classes and I see them and they have great opportunity to explore. And the quarter system is great, but I had to do the same thing. I had to make a choice, well, jeez, I could take this class or I could fulfill my requirements and get things done with. Some of us are very skilled and they can somehow do a lot of things and not make these trade offs. But I think those people are far and few between. And then some of us like me are kind of making up for it later, right? You know, I'm making up for it by like two years. I need to set aside some time to write, you know, at least once a week, maybe not every day. This is where I'm going to show my new Substack newsletter. So we identified an issue. You know, a lot of people in the health community don't have a place to publish their work. And we decided, let's try. And this is a total experiment to start a medical humanities substack newsletter. So it's called PanaceaHealth.Substack.com. It's not- we're going to start publishing it in a week or two and you're invited to submit, you can email. I think it's panaceahealth@gmail.com. Send us your submission. And our goal is to really publish these things for the people like yourself and for me who may have made trade offs years ago. And now we're getting back into writing or getting back into music or whatever. So yeah, we're hopefully opening up an ecosystem where people in the health community can really explore different areas and enrich their lives. And by doing so, maybe not directly, but indirectly, we'll become better doctors and be happier people.
Henry Bair: [00:19:26] Bryant will be sure to link panacea in the show notes to this episode.
Tyler Johnson: [00:19:31] You know, I was struck when Henry asked you why you went into medicine and you said, oh, well, I don't you know, for a long time I didn't think I had that story until I realized that this story that happened later in my career was that story. But one thing that I think if I can just sort of make a plug for doctors, I think that we maybe sometimes fail to recognize how unusual the experiences that we have are for 99% of the population. Right. Whatever your niche is in medicine, you are present in the most vulnerable moments of people's lives. And in large part, you know, part of the driving force behind this podcast is that very idea, right? It's the idea that doctors have these experiences that are distinctive and that have something really important to say about who people are and why we're here and what matters most in life. And I think that we could do a better job than we do right now of sharing the insights that we are privy to that most people just don't have access to.
Bryant Lin: [00:20:37] I mean, I couldn't agree with you more. Starting to sound like a broken record. You know, I think that's why, for example, Henry was saying that you guys have a great audience beyond health care providers. And I found the case to be true for a lot of the medical humanities work that we're doing. We have this service called Story that's an extension of the story initiative at Stanford, and we're doing a story lab with a health library, and people are coming in and they want to tell their stories. And of course, we don't restrict it to anybody. Could be a patient, a caregiver. Lots of stories out there. But I agree, you know, it's such a unique experience. Sometimes I think back and I because as I said, I lived a pretty I live I still live a fairly sheltered life. And I would have been a totally different person if I had not had this experience of being a doctor and being there at 2 a.m. when somebody is dying or being there when you're talking to somebody who's crying because they're worried they can't afford their medicine, it's just this incredible privilege that we have or being there. I saw a patient today. They thought he had a pancreatic cancer years ago and he had a Whipple. And he's every year he invites his doctors out to dinner because he's still alive.
Henry Bair: [00:21:56] For the listeners who may not be aware, can you tell us what a Whipple is?
Bryant Lin: [00:22:00] Whipple has a massive surgery where basically you're taking out your pancreas. And it's this crazy surgery that when you're a student, you're like, Oh, I want to be in that way. If you want to be a surgeon, I want to be in the Whipple, right? Because there's like uncommon surgeries. And and they only do the surgery because most of the time it's obviously Tyler's the oncologist, most of its spread already right by the time. And they have pancreatic cancer. So they're not really candidates for the Whipple. So it's really reserved for palliative to reduce pain or some other issue or if it's thought to be potentially curative. So this patient just celebrates every year COVID. We've been having trouble getting together, but he's always tells us, you know, let's take you. And I think it was Dr. Paul's kids who did the operation. You know, I want to take you out because I'm still alive. These are these great experiences to write. It's not all doom and gloom.
Tyler Johnson: [00:22:53] No. And I think that's precisely part of the point. I mean, I one of my favorite movies, there's a very old movie that's based on an essay and experience written by Oliver Sacks, where he took care of this group of people who had been interned at a Brooklyn psychiatric hospital who were part of what they called the garden. Because as one of the attendants there said, all they did was feed and water them because they had been catatonic for decades. Then they go back through and figure out that they were probably all suffering from this rare neurologic complication of the Spanish influenza epidemic in the early 1900s. And so, anyway, through this long list of happenings, he ends up giving them a medicine that had been developed for Parkinson's disease, and they all wake up after having been catatonic for like 30 years. Right. So in the movie, Robert De Niro plays the primary protagonist who'd been asleep for 30 years, and Robin Williams is the plays Oliver Sacks, although he goes by different name in the movie. But anyway, but there's this scene where Robert De Niro, who has just sort of come back to life. It just is like grabbing Robin Williams by the lapels and shaking him and saying, like, you have to tell them, you have to tell everyone what a miracle it is to be alive, to be able to go outside and choose.
Tyler Johnson: [00:24:10] Are you going to go right or you're going to go left? You have to go and tell them. Right. And I remember one time I had been working in the cardiac critical care unit at Stanford. And then just by happenstance, my next month was in the Baden Student Health Clinic, where almost which is the Stanford Student Health Clinic, where almost everybody is coming in because they, like, stubbed their toe or they have a cold or something. The majority of the patients, I just wanted to grab them and be like, go away. Like go be a college student, do anything but being in the doctor's office. What are you doing here? You are healthy and young and alive. Go play in a fountain or something. Right. And but that's the thing, is that if you haven't been a doctor or if you haven't had one of those experiences yourself, you just can't know that. Right? I mean, it almost feels like a covenantal responsibility or something. Like if you're let into this private, super well guarded order that only certain people can go into and then you get these certain insights, I feel like it's like we're responsible for telling everybody else about them because most people just never get to never know that.
Bryant Lin: [00:25:15] Well, I think that it's a little bit of the power of the the humanities to get people a glimpse of that right. I think the stories. Abraham Verghese novel and one breath becomes air still have people who are come out of the woodwork and just like these are amazing books you know the movies right. But yeah, hopefully those stories that like your podcast and the other ways to communicate stories are ways people can get a glimpse of those, the privilege we have.
Henry Bair: [00:25:45] Bryant, as the director of the Medical Humanities Program at Stanford. You teach the introduction to medical humanities class for medical students. Can you tell us what you try to impart on your students? Is it specific media of medical humanities or approaches to listening to a patient's stories? Or is it engagement in creative work like writing? Or is it something else?
Bryant Lin: [00:26:10] Stanford med students. I always joke around, you know, it used to be you'd go to Stanford Medical School to cure cancer. Now you have to cure cancer to get into Stanford Medical School. So you guys are already pretty smart and savvy. And people who are taking this class and focusing in medical humanities are fairly sophisticated already. So for us, it's mainly giving them the experience and a different view and definitely different media. So I also teach this class called Storytelling in Medicine. It's an undergraduate interest for sophomores at Stanford. One thing we found that is introducing different media, different ways of storytelling. It's been really impactful for most people because you kind of get stuck in the same way of telling stories. I think getting these different media shows how you can bring a richness to to relaying these stories and in some stories are really more amenable to certain types of media. I think the experience itself, I just mainly encourage people to really keep a notebook, be aware of what Tyler said is like an amazing experience you're having and recording it. So that kind of daily reflective journaling or just keeping a notebook and saying, Geez, this is the impactful thing that happened today, I think that's a way to really gain appreciation and empathy.
Henry Bair: [00:27:28] I've always been interested in the humanities. I studied humanities in college. I read medieval literatures. That was what I dedicated my four years to. And when I talk about my interest in music and art and literature and history, I feel like I always have to remind myself and also express the caveat that, no, I genuinely don't believe that you need to appreciate Bach or Beethoven or read Tolstoy to be a good physician. That's not a prerequisite for being a good physician. Right. And so when I think about the medical humanities and medical humanities coursework in medical school, I always think about is this something that I want all medical students to experience? Is this going to benefit all medical students or are there more general principles that we can impart on all future doctors that is separate from actually engaging in works of the humanities and the arts? What are your thoughts about that?
Bryant Lin: [00:28:30] I mean, just having the framework of Storytelling. So I didn't come up with this. Cynthia Nguyen, who is a psychiatrist who worked with our program, she has said this is a model of knowing your own story, knowing the other person's story and telling a story. So that's kind of the three aspects, right? So as a health care provider, right, you need to know where you're coming from, right? Knowing your own stories are very important and it's obviously very complex and rich knowing the other person's story. Very important. Listening, right. Observing. But also you're telling a story, right? No matter how good the evidence we have, we still have to shape it into a story. Right. Stories are impactful and so telling stories as opposed to just spewing data. People tend to remember that better, obviously both or even better. So if you have a mix of facts and story, I think there was a research done showing that it's something that's very unequivocal. Then just giving the facts very persuasive, probably good enough, but things are like where there's some plasticity there, there's a borderline, there's a lot of subjectivity. Telling the story is helpful. I mean, I can tell you an example of struggle with my weight my whole life. I'm actually on my mother's side. I'm a fourth generation doctor, believe it or not. So that side, of course, has diabetes and they're like some of them smoked and had cancer. And they're the bad doctors that didn't listen to themselves. So when you get down to that point telling the story, people will understand better. So when I tell people, hey, I'm a fourth generation doctor and I've struggled with my weight my whole life, that's more impactful to them right then.
Bryant Lin: [00:30:16] Oh, geez, here's the data. Here's the data. And nothing about you, right? Because I can empathize with them on that. I can empathize with and everything. I have patients who say, geez, I have chronic pain. You have no idea what it's like. And I'm like, You're right, I have no idea what that's like. I can try to empathize, but I'm never going to have that experience. It's not have to have for me to be a doctor, to have experienced everything my patients have. But if I've had that experience, if I can tell a story, sometimes that's very impactful. So I would tell them it's funny. So five years ago, six years ago, I lost a ton of weight. My blood pressure was high, you know, I lost like £35. I tracked my diet and everything and patients came in who'd known me for years, ten years, say, Oh my God, how did you do it? You lost so much weight. And then they believed me, right? All that evidence, everything they gave me. So. So it's really kind of interesting. And then actually even second hand, my colleague told me, jeez, I told my patient what you did, and they're doing that. So it's very interesting how impactful stories are over evidence, even though I, of course, provided them all the evidence based medicine about how to lose weight and why it's good for them. But the stories were really impactful. So it's very interesting that side.
Henry Bair: [00:31:24] Over the last 30 minutes or so, we've spoken so much about the human side of medicine that I've momentarily forgotten. You are an engineer with multiple patents on medical devices and who advises companies on product development. And yet, as Tyler mentioned on your Stanford faculty page, the opening sentence specifies that while you are interested in algorithms and data and technology, you want to make sure that the human element is not lost. Can you tell us how you bring that element, the storytelling and the patient values to your medical innovation work?
Bryant Lin: [00:32:04] With with medical device design, you're really as opposed to, geez, I've got this innovation, I want to figure out what the problem is, right? You're really figuring out what the human based problem is and then addressing that and figuring out what the solution is. Because there's so much of that in Silicon Valley about, geez, I have a solution. Where's the problem? I is the solution to everything, right? And I still remember we had a couple of students are like, well, you're a primary care doctor. You won't need primary care doctors, especially because I will just get rid of that. And I'm like, I don't think you understand what primary care is all about. I can't speak to other specialties, but I said I was mentioned that these are tools, right? But it doesn't. At its core, medicine's a human interaction business. Right. So I think that's true for medical device design. Medical technology design. You know, we always grouse about epic write epic. Everybody hates epic, right. Because it doesn't seem like they were really human centered. Right. They'll randomly change features and like, jeez, I just learned how to do it. I know how to use it. And you change your feature and it doesn't seem to improve my life, right? So this is what we want to hopefully try to get away from.
Bryant Lin: [00:33:12] So that to me is the common thread, right? How do you make things more human centered? Obviously medical humanities are naturally human centered. I also co-direct and co-founded the Center for Asian Health Research in Education. And again, it's of course, all about improving research and education and training and community health. But again, that also is at the center of Asians as a group. How do we communicate with them? How do we research them, research? What's going on with them from a human centered standpoint? Not necessarily from a purely scientific standpoint. Right. We want to know what's important to them. Right? We want to know, geez, you know, they sometimes want advice about their diet. So we want to know where they're coming from, right. Culturally, but what are they eating? Right. They're not eating sandwiches. They're not eating bread. You know, they're eating noodles and rice. Right. So how do we give them advice? So that's what I meant by that to me. Is that really core is how does it affect the person? How do we make the life better for them?
Tyler Johnson: [00:34:12] You know, it's so interesting to me. I just finished a week working in the hospital. And one of the things that I was talking about with my team is so when someone comes into the emergency room, if the emergency room decides that the person is sick enough that they need to be admitted to the hospital, then the emergency room calls whatever team is supposed to be admitting them to go down and see them and bring them into the hospital. And one of the things that was so interesting was that my team was sort of admitting to me that they'll often get the call from the emergency room and scroll through the information about the person on the electronic medical record and look at their vital signs and their problem list and whatever. And then having never left the comfort of their seat in the team room, they'll call the emergency room doctor back and say, Oh, I just looked through everything in the electronic medical record and this person doesn't need to come into the hospital. They're fine. And then they were the group that I was working with was reflective enough to say. Something doesn't seem quite right there. And then the one the senior most of the residents there was like, Yeah, I did that a few times, except that then after I did that, I had an F experiences when I would then actually go to the emergency room and actually see the person and find out that in fact the person was really sick, regardless of what their numbers and history and whatever look like in the electronic medical record to figure out that that wasn't a good idea.
Tyler Johnson: [00:35:28] But the thing that's so striking to me about it is that it is actually true in that example that the digital avatar of the patient had come to matter more than the patient. They thought they could get all the information that they needed to get about the patient from the electronic medical record, which you don't have to be in medicine very long to know that. The most informative thing about seeing a patient is the information you get in the first 30 seconds of actually seeing them. Right. And so anyway, but it's just to say that I think there really is a tide that all doctors are having to swim against where we can't let those electronic avatars or whatever you want to think of them. We just can't let those come to matter more than the actual people.
Bryant Lin: [00:36:18] I used to joke around that that's like the the when you're on the other side, right. You realize that you want to be seen, right? You're demand. You want this kind of care. And as we said earlier, if you don't have that experience, maybe hard to have that view. I think it's because the view also of doctors and residents, especially because the burnout is a big serious problem, is that that that's not a person anymore. That's one unit of work, right? You know, it's one unit of work on my already overloaded. I mean, I have the same problem as an outpatient when I refer patients. Right. For for for for a specialist. Right. You know, in primary care, we I mean, we're full. We can say we don't want to see we can't take new patients. But if I have a patient and they want to get in, I'm like, I got to I've got to see them. Right? I can't say, oh, geez, you don't need to be seen. But many specialists, they say that, right? Oh, I reviewed the chart and it doesn't seem like that person needs to be seen or, you know, another favorite is like, I don't treat that kind of problem.
Bryant Lin: [00:37:21] Right. Right. I have a fairly narrow view and yeah, I agree. I mean, it's kind of we lose sight of what's important. And this is where it's funny. One of my current patients, he was in the cohort of House of God. So House of God for the audience is this famous book that is somewhat generational about Beth Israel. Beth Israel House of God. So is a residency program and the experience of the doctors at the time. And thankfully things have drastically changed in residency training. But that book at its core is really all about what was the human experience, not just from the trainees, but also as patients, about how you you get dehumanized. You stop treating these patients as people and you treat them as some dehumanized in present day would be a digital avatar. Right. But in the old days, it was a stereotype, right? So yeah, I don't know if it's going to get worse or better. It's interesting because we also now have e consults, right, as an outpatient. And so those literally they only treat the digital avatar. Right. It's very fascinating.
Henry Bair: [00:38:26] What are e conflicts?
Bryant Lin: [00:38:28] So E consoles are electronic consoles. So for example, dermatology, it's very hard for someone to dermatology. It takes months to get them in to be seen. And then if you e consult them and you have a photograph, they could give an opinion based on the photograph and some clinical information that's there. And sometimes that's great because they are very good and they're willing to see them. So if if they say, hey, this is not enough information, we'll try to get them in. So it actually serves a reasonable purpose as a triage. Another service that does this a lot is psychiatry because again, it's hard. It's usually the service is that the specialists that are really backed up and have a hard time getting people in. But it's challenging, right? Imagine doing an E consult for psychiatric issue without talking to the patient. So I don't know how they do it. It's tough, you know, it's a lot of medication review and so forth. So treating the digital avatar is a reality that we we face, in a way, a very human specialty like psychiatry. Right. It's become really kind of main practice here, at least at Stanford.
Tyler Johnson: [00:39:35] Well, you've been so generous with your time. Just to wrap up, let us ask you this final question. And this builds on some of the things Henry asked about earlier, but you're among the many things you do. One thing is that you're a teacher. When you're teaching up and coming doctors. What are sort of your key take home points or your pearls that you like to share with them about how to keep the person at the center of what they do in medicine as they come into these years, where they're going to be very busy as trainees and then let it later as as full fledged doctors.
Bryant Lin: [00:40:06] Yeah. You know, I encourage students, trainees to learn about the patient. This is kind of this old story. Everyone's heard this. Well, the attendings want to know about the social history, right? Whereas the students and residents always want to tell you a patient here with a history of ABCD fghijklmn0pqrst You know, they literally load up all this history because they're worried that they're going to miss something. And then they tell us about the history. The social history, of course, is important medically, but it's important because you know them as a person. So I think that's one I think maybe simple way to really make sure you really maintain that humanity because you know them as a person. They're they're a father, they're a mother. They're a brother or sister. Right. So you know the context, right? Maybe. No, don't know their whole story, but, you know, part of their story. So I think it relates to that model of know your own story, but know their story as well. That, I think is is a maybe a simpler way to center yourself on who they are. You know, like when you talk to somebody normally, right, you don't immediately start asking them about, oh, does your neck hurt? Right. What's that rash? When did you start having it right? You ask them. Oh, hi. Nice to meet you. Tyler, where are you from? Right. You know, maybe. What do you do? Right. You. We're just this weird profession where we start out. I don't think even lawyers or any other profession does that. Right. They, you know, everybody else, accountants, so forth. They want to know you as a person before they get down to brass tacks. Maybe that's a factor. We don't have very much time, but I think that should be the case in medicine as well. Maybe before you get to the chief complaint, before you get to the HPI, you start with, hey, let me introduce myself to you as a person and then I want to learn about you as a person first.
Henry Bair: [00:41:55] On that encouraging note and advice, thank you very much, Bryant, for taking the time to speak with us today and share your story.
Bryant Lin: [00:42:02] Great. Thanks so much for having me. Appreciate it.
Henry Bair: [00:42:07] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctors Art. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:42:25] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.
Henry Bair: [00:42:39] I'm Henry Bair.
Tyler Johnson: [00:42:40] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.