1 00:00:11,280 --> 00:00:14,136 >> Speaker A: Welcome to Frictionless Marketing, the podcast that dives 2 00:00:14,168 --> 00:00:16,968 deep into the stories of the most innovative brands and the people 3 00:00:17,024 --> 00:00:18,100 moving them forward. 4 00:00:20,560 --> 00:00:23,352 Our mini series, Frictionless Medicine explores the 5 00:00:23,376 --> 00:00:25,832 HCP perspective on today's trends throughout the 6 00:00:25,856 --> 00:00:28,504 industry. Today we're joined by Dr. 7 00:00:28,552 --> 00:00:31,416 Nels Carroll, a board certified cardiothoracic 8 00:00:31,448 --> 00:00:34,340 surgeon at uh, Los Robles Health System. Join host 9 00:00:34,380 --> 00:00:37,332 Geeta Patel as Dr. Carol shares insights on staying ahead 10 00:00:37,356 --> 00:00:39,892 of trends, the role of marketing and engaging 11 00:00:39,956 --> 00:00:42,564 doctors, and his journey from educator to a 12 00:00:42,572 --> 00:00:45,572 pioneer in robotic thoracic surgery. Discover how 13 00:00:45,596 --> 00:00:48,452 he leverages technology, data and collaboration to 14 00:00:48,476 --> 00:00:51,000 strive for seamless patient First Healthcare. 15 00:00:57,910 --> 00:01:00,766 >> Geeta Patel: Dr. Carol, thank you so much for joining us. 16 00:01:00,838 --> 00:01:03,838 We're excited to have you here, especially as someone 17 00:01:03,894 --> 00:01:06,302 who's at the forefront of tech and AI and 18 00:01:06,326 --> 00:01:09,166 medicine. So we'd love to kick things off by just 19 00:01:09,238 --> 00:01:12,174 having you share a little bit about yourself and your background and 20 00:01:12,182 --> 00:01:13,530 what you're doing right now. 21 00:01:13,990 --> 00:01:16,680 >> Dr. Nels Carroll: Yeah, thank you so much for having me here. I'm, um, 22 00:01:16,718 --> 00:01:19,278 excited to speak with you guys. I'm a 23 00:01:19,334 --> 00:01:22,174 cardiothoracic surgeon. I work for Los Robles 24 00:01:22,222 --> 00:01:25,080 Medical System in Thousand Oaks, California, right 25 00:01:25,120 --> 00:01:27,880 outside of la. Did my surgical training in 26 00:01:27,920 --> 00:01:30,648 Texas, worked in Washington for a few years 27 00:01:30,704 --> 00:01:33,580 before coming here to California. Uh, 28 00:01:33,580 --> 00:01:36,456 big part of my practice is robotic 29 00:01:36,488 --> 00:01:39,448 surgery, so certainly a big slant towards 30 00:01:39,624 --> 00:01:42,408 technology and pushing some boundaries and 31 00:01:42,464 --> 00:01:45,464 some barriers to what has been done towards 32 00:01:45,512 --> 00:01:48,216 what we can do. So really 33 00:01:48,368 --> 00:01:49,684 excited to be here. 34 00:01:49,872 --> 00:01:52,588 >> Geeta Patel: Amazing. What inspired you to get 35 00:01:52,644 --> 00:01:55,596 into medicine and specifically into 36 00:01:55,668 --> 00:01:57,640 the robotic and tech side of things? 37 00:01:57,940 --> 00:02:00,428 >> Dr. Nels Carroll: Well, I had kind of a circuitous route into 38 00:02:00,484 --> 00:02:03,292 medicine. Actually coming out of school, I was 39 00:02:03,316 --> 00:02:06,252 in Teach for America, which is, I 40 00:02:06,276 --> 00:02:09,132 think of it, kind of like a domestic Peace Corps. 41 00:02:09,276 --> 00:02:12,188 I was really enthralled with the mission 42 00:02:12,284 --> 00:02:15,164 of serving underserved 43 00:02:15,212 --> 00:02:18,060 people, kind of giving them some of the opportunities that I had 44 00:02:18,100 --> 00:02:20,770 had through that process 45 00:02:21,230 --> 00:02:24,070 of learning how to be an educator. I really 46 00:02:24,110 --> 00:02:26,918 became fascinated with the concept of 47 00:02:26,974 --> 00:02:29,830 pursuing education in a different arena and that 48 00:02:29,870 --> 00:02:32,742 being medicine. So that's where I kind of made the 49 00:02:32,766 --> 00:02:35,530 big jump into wanting to pursue medicine. 50 00:02:36,030 --> 00:02:38,886 And then really, it was just a process of trial 51 00:02:38,918 --> 00:02:41,814 and error. Real interest in science and a real interest 52 00:02:41,902 --> 00:02:44,662 in surgery and refining 53 00:02:44,726 --> 00:02:47,670 processes and through interactions with 54 00:02:47,710 --> 00:02:50,566 some particularly excellent 55 00:02:50,678 --> 00:02:53,654 teachers and surgeons, realized what we 56 00:02:53,662 --> 00:02:56,646 were capable of doing by harnessing some of these 57 00:02:56,718 --> 00:02:58,790 resources to improve our 58 00:02:58,830 --> 00:02:59,770 processes. 59 00:03:00,110 --> 00:03:02,630 >> Geeta Patel: That's amazing. How do you feel like Teach for 60 00:03:02,670 --> 00:03:05,542 America has shaped you as a 61 00:03:05,566 --> 00:03:08,534 physician in terms of just being able to explain some of the 62 00:03:08,542 --> 00:03:11,414 most complex medical issues, but also some of 63 00:03:11,422 --> 00:03:14,102 these complex tech procedures with your 64 00:03:14,126 --> 00:03:17,062 patients? How do you feel like that's kind of given you the skills you need 65 00:03:17,086 --> 00:03:18,258 to speak with them? Them? 66 00:03:18,394 --> 00:03:21,202 >> Dr. Nels Carroll: Oh, I think it's huge. Aside from the technical 67 00:03:21,266 --> 00:03:24,242 responsibilities of a surgeon and what you're actually doing at the time of 68 00:03:24,266 --> 00:03:26,350 surgery, at least 69 00:03:26,810 --> 00:03:29,618 50% of the job is 70 00:03:29,754 --> 00:03:32,658 educating and communicating with patients and with their 71 00:03:32,714 --> 00:03:35,270 families. There's really no more vulnerable 72 00:03:35,610 --> 00:03:38,310 or scary time than being a patient 73 00:03:38,730 --> 00:03:41,314 undergoing open heart surgery or undergoing 74 00:03:41,362 --> 00:03:44,186 surgery for cancer. So it's incumbent 75 00:03:44,218 --> 00:03:47,050 upon me, it's incumbent upon us as the 76 00:03:47,090 --> 00:03:50,058 medical community, to the way I communicate it. Pull 77 00:03:50,074 --> 00:03:52,842 up a chair to the table. Working as 78 00:03:52,866 --> 00:03:55,674 a consultant for them, the patient is the 79 00:03:55,682 --> 00:03:58,602 chairman of the board. There's a lot of different people that 80 00:03:58,626 --> 00:04:01,562 pull up a chair to the table. So it's my job to 81 00:04:01,586 --> 00:04:04,314 really explain myself, give 82 00:04:04,402 --> 00:04:07,402 background, give context, and make sure 83 00:04:07,426 --> 00:04:10,116 that they feel comfortable and confident with what we're 84 00:04:10,148 --> 00:04:12,660 doing moving forward so that they can 85 00:04:12,700 --> 00:04:14,916 really just focus on 86 00:04:15,068 --> 00:04:18,036 healing and not be worried about 87 00:04:18,188 --> 00:04:21,156 things that are out of their control or that they don't understand 88 00:04:21,228 --> 00:04:23,972 that we can help them understand that background in 89 00:04:23,996 --> 00:04:26,532 education has been pivotal in helping 90 00:04:26,596 --> 00:04:28,480 me do my job. 91 00:04:29,100 --> 00:04:31,492 >> Geeta Patel: What would you say are some of the 92 00:04:31,516 --> 00:04:34,356 biggest hesitations or concerns among 93 00:04:34,428 --> 00:04:37,332 patients when you are discussing some 94 00:04:37,356 --> 00:04:40,082 of the more advanced surgical procedures using 95 00:04:40,186 --> 00:04:41,590 AI and tech? 96 00:04:42,010 --> 00:04:44,754 >> Dr. Nels Carroll: Oh, yeah, there's a whole 97 00:04:44,802 --> 00:04:47,186 spectrum. You hear these catchphrases 98 00:04:47,298 --> 00:04:50,178 and patients will say, listen, I don't 99 00:04:50,194 --> 00:04:52,910 want a robot operating on me, right? 100 00:04:53,450 --> 00:04:56,066 I'm coming to you as a surgeon. I don't know this 101 00:04:56,138 --> 00:04:59,122 robot, right? So it's just about communicating 102 00:04:59,186 --> 00:05:01,954 that. I think for everyone, 103 00:05:02,042 --> 00:05:04,482 it's just intuitive. The fears of the 104 00:05:04,506 --> 00:05:07,150 unknown. What's really important is just 105 00:05:07,190 --> 00:05:09,570 explaining that these are tools 106 00:05:10,230 --> 00:05:12,638 that allow us to. Allow me to do my job 107 00:05:12,694 --> 00:05:15,678 better. For example, within the field 108 00:05:15,734 --> 00:05:18,526 of lung cancer resection, standard 109 00:05:18,558 --> 00:05:21,262 approach in literature 50, 60 years ago 110 00:05:21,446 --> 00:05:24,222 was a thoracotomy. A big incision between the 111 00:05:24,246 --> 00:05:27,118 ribs, spread the ribs apart, looking 112 00:05:27,174 --> 00:05:30,126 directly at the lung, operate on the lung. 113 00:05:30,318 --> 00:05:33,198 There was a total seat change when that transitioned 114 00:05:33,214 --> 00:05:35,662 to thoracoscopic surgery. So we put in a 115 00:05:35,686 --> 00:05:38,260 camera, make smaller incisions, 116 00:05:38,840 --> 00:05:41,840 much less painful for the patient, much less time 117 00:05:41,880 --> 00:05:44,848 in the hospital. But then there's really now this 118 00:05:44,904 --> 00:05:47,792 total paradigm shift where it's not just 119 00:05:47,816 --> 00:05:50,672 a camera, um, but when we say we're doing 120 00:05:50,696 --> 00:05:53,616 it robotically, that camera is actually 121 00:05:53,688 --> 00:05:56,220 two cameras adjacent to each other, 122 00:05:56,520 --> 00:05:59,072 creates a stereoscopic visual 123 00:05:59,136 --> 00:06:01,300 input. So it's three dimensional. 124 00:06:01,720 --> 00:06:04,432 The degrees of freedom, the range of 125 00:06:04,456 --> 00:06:06,670 motion of the instruments is 126 00:06:06,970 --> 00:06:09,378 infinitely better than what we can do with 127 00:06:09,434 --> 00:06:11,890 standard, we say vats or 128 00:06:11,930 --> 00:06:13,990 videoscopic thoracic surgery. 129 00:06:14,810 --> 00:06:17,682 So those things are fascinating. They're very 130 00:06:17,706 --> 00:06:20,402 interesting. But what matters to the 131 00:06:20,426 --> 00:06:22,770 patient is it hurts 132 00:06:22,850 --> 00:06:25,778 less, the surgery is more accurate, 133 00:06:25,954 --> 00:06:28,450 the surgery is safer, they 134 00:06:28,490 --> 00:06:31,170 recover more quickly. Those are the things that 135 00:06:31,210 --> 00:06:34,074 matter. So I think keeping 136 00:06:34,122 --> 00:06:36,842 things in context and making it relatable 137 00:06:36,906 --> 00:06:38,470 is hugely important. 138 00:06:38,930 --> 00:06:41,850 >> Geeta Patel: No, that's really interesting when you talk about these 139 00:06:41,890 --> 00:06:44,762 advancements and, uh, it seems like since you're on 140 00:06:44,786 --> 00:06:47,770 the forefront of a lot of this, thinking about 141 00:06:47,810 --> 00:06:50,470 the peers in this field, are they 142 00:06:50,850 --> 00:06:53,658 as open to adopting these new methods? 143 00:06:53,754 --> 00:06:56,522 Do you feel like there are certain groups of 144 00:06:56,546 --> 00:06:59,482 physicians that are a little bit more open than others? And how 145 00:06:59,506 --> 00:07:02,220 does literature and how things are being 146 00:07:02,260 --> 00:07:04,920 communicated to them, um, impacting their 147 00:07:05,620 --> 00:07:07,440 adoption of these practices? 148 00:07:07,940 --> 00:07:10,412 >> Dr. Nels Carroll: Well, I think that's a really good question. 149 00:07:10,596 --> 00:07:13,228 Within any practice, any 150 00:07:13,284 --> 00:07:15,756 profession, when you're trying 151 00:07:15,828 --> 00:07:18,360 to move things forward, 152 00:07:18,820 --> 00:07:21,692 at times there's resistance. It 153 00:07:21,716 --> 00:07:24,268 has to do not so much 154 00:07:24,324 --> 00:07:27,084 with focusing on that 155 00:07:27,172 --> 00:07:29,948 as it does with being true to the 156 00:07:30,004 --> 00:07:32,524 process. In that if you're 157 00:07:32,572 --> 00:07:35,548 offering a, uh, safer, 158 00:07:35,724 --> 00:07:37,120 more effective 159 00:07:38,020 --> 00:07:40,332 process, it speaks for 160 00:07:40,356 --> 00:07:42,280 itself. I think 161 00:07:42,580 --> 00:07:44,440 communicating and building 162 00:07:45,140 --> 00:07:48,092 within the medical community to 163 00:07:48,116 --> 00:07:50,560 bring people on board, to make them aware. 164 00:07:51,060 --> 00:07:53,916 Part of what I really appreciate about the opportunity 165 00:07:53,948 --> 00:07:56,188 to talk to you guys in the context of 166 00:07:56,244 --> 00:07:59,146 marketing, you know, from my perspective within 167 00:07:59,218 --> 00:08:02,218 medicine, nothing that I do has to do with 168 00:08:02,274 --> 00:08:04,630 sales. So marketing, for me 169 00:08:05,010 --> 00:08:07,178 isn't about sales, but it's about 170 00:08:07,314 --> 00:08:09,470 communicating, it's about sharing. 171 00:08:10,370 --> 00:08:12,630 Within our medical community, 172 00:08:13,250 --> 00:08:15,546 people are so 173 00:08:15,698 --> 00:08:18,362 overwhelmed with information, especially our 174 00:08:18,386 --> 00:08:20,778 primary care physicians. They're being 175 00:08:20,834 --> 00:08:23,690 inundated from all these different 176 00:08:23,810 --> 00:08:26,662 specialists. And I'm one of those specialists, you 177 00:08:26,686 --> 00:08:29,494 know, so when I meet a, uh, primary care physician, a 178 00:08:29,502 --> 00:08:32,470 family medicine doc, for the first time, I'm coming 179 00:08:32,510 --> 00:08:35,382 to the office and I'm saying, hey, I'm Dr. Carol. You know, I'm a 180 00:08:35,406 --> 00:08:38,310 cardiothoracic surgeon. Initially, they 181 00:08:38,350 --> 00:08:41,334 might just gloss over, like, okay, I just met with a 182 00:08:41,342 --> 00:08:43,782 urologist yesterday. I'm going to meet with a 183 00:08:43,806 --> 00:08:46,246 neurosurgeon tomorrow. There's 184 00:08:46,278 --> 00:08:49,238 a new, uh, radiation oncologist that's 185 00:08:49,254 --> 00:08:52,070 coming to my office this afternoon. Like, how do I 186 00:08:52,110 --> 00:08:54,672 put all this into context? It's an 187 00:08:54,696 --> 00:08:57,600 ongoing pursuit, but to share that 188 00:08:57,640 --> 00:09:00,336 information. You know, I had a pivotal 189 00:09:00,368 --> 00:09:03,140 lesson in that as a medical student. 190 00:09:03,880 --> 00:09:06,576 Worked with a really fantastic surgeon, 191 00:09:06,768 --> 00:09:09,248 T. Sloan guy, that's his name. Really 192 00:09:09,304 --> 00:09:11,664 phenomenal robotic cardiac 193 00:09:11,712 --> 00:09:14,384 surgeon. Taught me so much, has 194 00:09:14,472 --> 00:09:17,248 continues to be a mentor. But we actually 195 00:09:17,384 --> 00:09:19,820 published his experience 196 00:09:20,760 --> 00:09:23,568 with building or 197 00:09:23,624 --> 00:09:26,380 recruiting into what he was doing. 198 00:09:26,840 --> 00:09:29,776 Because as a robotic mitral valve surgeon, 199 00:09:29,808 --> 00:09:32,260 it's a real niche. Oftentimes 200 00:09:32,840 --> 00:09:35,808 he had to get the word out to patients 201 00:09:35,904 --> 00:09:38,832 to let them know, hey, here's an alternative. You know, 202 00:09:38,856 --> 00:09:41,104 rather than a sternotomy, we can do this minimally, 203 00:09:41,152 --> 00:09:43,776 invasively. We can offer you a really tremendous 204 00:09:43,888 --> 00:09:46,272 surgery. So 205 00:09:46,456 --> 00:09:49,020 that continues to be in my mind 206 00:09:49,400 --> 00:09:52,272 about the importance of not just going one 207 00:09:52,296 --> 00:09:54,944 foot in front of the other, but 208 00:09:55,112 --> 00:09:57,760 sharing what we're doing and working and 209 00:09:57,800 --> 00:10:00,800 building and growing. And just one other thought 210 00:10:00,840 --> 00:10:03,408 to go along with that. It's. I'm not under 211 00:10:03,464 --> 00:10:06,272 any illusions that as I 212 00:10:06,296 --> 00:10:08,630 step into a new medical community, I'm, um, 213 00:10:08,928 --> 00:10:11,776 bringing a whole wealth of knowledge and nobody gets 214 00:10:11,808 --> 00:10:14,654 it. You know, the guys who've been doing thoracic 215 00:10:14,702 --> 00:10:17,598 surgery for 20 years, 30 216 00:10:17,654 --> 00:10:20,238 years, 40 years, have seen so 217 00:10:20,294 --> 00:10:22,490 much and have so much 218 00:10:22,950 --> 00:10:25,890 tremendous information and wisdom 219 00:10:26,230 --> 00:10:28,810 that they can help me with. 220 00:10:29,430 --> 00:10:32,410 So I think it's about bringing a little bit different experience, 221 00:10:32,870 --> 00:10:35,850 bringing it to the table, working together, 222 00:10:36,310 --> 00:10:38,234 and then moving forward. 223 00:10:38,422 --> 00:10:41,138 >> Geeta Patel: I mean, that's really great insight. I heard you 224 00:10:41,194 --> 00:10:44,162 say sharing is really important, so I kind of want to 225 00:10:44,186 --> 00:10:47,120 take a second to also just share and, 226 00:10:47,120 --> 00:10:49,810 um, talk a little bit about your recent accomplishments. You 227 00:10:49,850 --> 00:10:52,594 recently completed the first ever robotic 228 00:10:52,642 --> 00:10:54,946 chest wall reconstruction in all of Southern 229 00:10:54,978 --> 00:10:57,938 California. I just want to make sure I get this right. And the first 230 00:10:57,994 --> 00:11:00,914 ever single anesthetic robotic lung cancer 231 00:11:00,962 --> 00:11:03,912 resection in Ventura County. Is that correct? 232 00:11:03,946 --> 00:11:06,940 Correct. Okay, first of all, 233 00:11:06,980 --> 00:11:09,420 let's take a moment to say that is 234 00:11:09,460 --> 00:11:12,412 incredible. Um, just to be first ever and to 235 00:11:12,436 --> 00:11:15,356 be on the cutting edge and to do this is wonderful. 236 00:11:15,468 --> 00:11:18,412 I heard you say it's important to communicate and share a lot 237 00:11:18,436 --> 00:11:21,116 of this. And a lot of times what we do from a marketing 238 00:11:21,148 --> 00:11:23,788 standpoint is figure out how we can empower our patients 239 00:11:23,884 --> 00:11:26,812 to also get educated on these topics so that 240 00:11:26,836 --> 00:11:29,740 they're coming to their surgeons, that they're coming to their physicians 241 00:11:29,820 --> 00:11:32,672 and discussing some of these options. I'd love to hear from 242 00:11:32,696 --> 00:11:34,864 you on how you're sharing some of those great 243 00:11:34,952 --> 00:11:37,920 milestones with potential patients and 244 00:11:38,040 --> 00:11:40,944 trying to market it outside, or communicate it, 245 00:11:41,032 --> 00:11:43,580 if you will, outside of the physician world. 246 00:11:44,280 --> 00:11:46,800 >> Dr. Nels Carroll: Well, that's. Thank you. Yeah, I mean, these are really 247 00:11:46,840 --> 00:11:49,472 exciting. Uh, I think as a clinician, you're just kind of 248 00:11:49,496 --> 00:11:52,432 confronted with the situation, and you 249 00:11:52,456 --> 00:11:55,072 think about, what's the best way I can do this? And 250 00:11:55,096 --> 00:11:57,216 then when you come up with a creative 251 00:11:57,248 --> 00:11:59,836 strategy and it works, 252 00:11:59,948 --> 00:12:02,492 that's really exciting. And then you want to build from 253 00:12:02,516 --> 00:12:05,280 that. Just to be totally frank, 254 00:12:05,940 --> 00:12:08,876 how do we share that is something that 255 00:12:08,948 --> 00:12:11,916 we're very much grappling with. You know, the chest 256 00:12:11,948 --> 00:12:14,320 wall reconstruction. So a Little bit of context 257 00:12:15,060 --> 00:12:17,996 had a gentleman riding a motorcycle 258 00:12:18,108 --> 00:12:20,540 collided with a deer, fractured 10 259 00:12:20,580 --> 00:12:23,436 ribs. So he had 10 rib fractures, multiple 260 00:12:23,468 --> 00:12:26,332 displaced rib fractures. The consequence of 261 00:12:26,356 --> 00:12:29,116 that is he was dependent on a lot of oxygen, a lot of pain 262 00:12:29,148 --> 00:12:32,136 medicine. He was able to get up and breathe deeply 263 00:12:32,168 --> 00:12:35,064 and walk around. So the traditional 264 00:12:35,112 --> 00:12:37,960 approach to reconstructing that is to make 265 00:12:38,000 --> 00:12:40,632 a big incision all the way along the 266 00:12:40,656 --> 00:12:43,220 back towards the side, 267 00:12:43,920 --> 00:12:46,792 and to actually divide a lot of muscles 268 00:12:46,936 --> 00:12:49,512 and screw titanium plates into the 269 00:12:49,536 --> 00:12:52,504 ribs. That works, but it's 270 00:12:52,552 --> 00:12:55,528 painful and you want to be better. So 271 00:12:55,584 --> 00:12:58,570 the next step is to do that thoracoscopically. We 272 00:12:58,610 --> 00:13:01,610 talked about vat surgery, and so what we did is we took 273 00:13:01,650 --> 00:13:04,362 it the next step and did it robotically. The 274 00:13:04,386 --> 00:13:06,970 biggest incision that we made on this Jose, 2 275 00:13:07,010 --> 00:13:09,562 inches. We plated from the 276 00:13:09,586 --> 00:13:11,818 inside. We also did a cryonerve 277 00:13:11,834 --> 00:13:14,778 ablation the morning after surgery. 278 00:13:14,874 --> 00:13:17,450 He's breathing room air, he's walking, he's taking 279 00:13:17,490 --> 00:13:20,138 Tylenol. For that patient, 280 00:13:20,234 --> 00:13:23,162 it's phenomenal. It's exciting because you 281 00:13:23,186 --> 00:13:25,880 see the potential to improve the process. 282 00:13:26,180 --> 00:13:29,052 We didn't divide any muscle. We spread the 283 00:13:29,076 --> 00:13:31,884 muscle fibers. We do these little finite 284 00:13:31,932 --> 00:13:34,812 things to really improve the process. But 285 00:13:34,836 --> 00:13:37,772 how do you share that? I don't really have an answer for 286 00:13:37,796 --> 00:13:40,780 that because it's just an area of growth, I guess, for 287 00:13:40,820 --> 00:13:43,740 me. And I shared that with 288 00:13:43,780 --> 00:13:46,780 our hospital. And they still 289 00:13:46,820 --> 00:13:49,340 are grappling with that a month later and 290 00:13:49,380 --> 00:13:52,182 haven't come up with anything to 291 00:13:52,206 --> 00:13:54,950 share that. Maybe because it seems a little 292 00:13:54,990 --> 00:13:57,570 esoteric or they're not familiar with it. 293 00:13:58,110 --> 00:14:00,890 The single anesthetic lung cancer 294 00:14:01,470 --> 00:14:03,970 is really a paradigm shift too. 295 00:14:04,270 --> 00:14:06,822 Just thinking patient first. So a 296 00:14:06,846 --> 00:14:09,574 patient might have a screening CT scan, 297 00:14:09,702 --> 00:14:12,598 a suspicious nodule. They're referred 298 00:14:12,614 --> 00:14:15,254 to a doctor, they're referred to another to get a 299 00:14:15,262 --> 00:14:18,152 biopsy, they're referred to another to get some 300 00:14:18,176 --> 00:14:20,952 testing done. They go get some other imaging 301 00:14:21,016 --> 00:14:23,420 done. They're referred to a surgeon 302 00:14:23,760 --> 00:14:26,552 in our community. On average, then it 303 00:14:26,576 --> 00:14:28,820 takes between 60 and 90 days 304 00:14:29,520 --> 00:14:31,800 from the time of initial suspicion to 305 00:14:31,840 --> 00:14:34,424 treatment. So with a single 306 00:14:34,472 --> 00:14:37,380 anesthetic event, what we're now doing, 307 00:14:37,760 --> 00:14:40,380 patient gets a suspicious CT scan. 308 00:14:40,800 --> 00:14:43,642 I'll see them within a week and get some 309 00:14:43,666 --> 00:14:46,122 other imaging done. We'll have a 310 00:14:46,146 --> 00:14:48,906 discussion within another week. 311 00:14:49,058 --> 00:14:51,722 We go to surgery, patient goes to 312 00:14:51,746 --> 00:14:54,410 sleep. I'll do a robotic navigational 313 00:14:54,490 --> 00:14:57,130 bronchoscopy and mediastinal staging. 314 00:14:57,290 --> 00:15:00,218 The pathologist is in the room with me, can 315 00:15:00,274 --> 00:15:02,986 tell me right away if it's cancer. 316 00:15:03,178 --> 00:15:05,786 If it's cancer while the patient's 317 00:15:05,818 --> 00:15:08,746 asleep. Proceed directly to complete 318 00:15:08,778 --> 00:15:11,652 Anatomic resection. So I'll take out the 319 00:15:11,676 --> 00:15:14,500 cancer, take out the lymph nodes, do 320 00:15:14,540 --> 00:15:17,236 nerve blocks, put in a drain. 321 00:15:17,428 --> 00:15:19,760 Two hours later, patient wakes up. 322 00:15:20,460 --> 00:15:23,396 90% of the time, they go home the following morning. 323 00:15:23,548 --> 00:15:26,500 When they go home the next day, we answer two 324 00:15:26,540 --> 00:15:29,492 questions. Was it cancer? Yes. What 325 00:15:29,516 --> 00:15:32,500 do we do about it? It's done. And 326 00:15:32,540 --> 00:15:35,080 especially with these early stage lung cancers, 327 00:15:35,590 --> 00:15:38,494 totally revolutionizes that experience 328 00:15:38,582 --> 00:15:41,278 for the patient. So rather than having three 329 00:15:41,334 --> 00:15:43,566 months of first 330 00:15:43,638 --> 00:15:46,290 wondering, then knowing 331 00:15:46,630 --> 00:15:49,550 that you have cancer, but not knowing the 332 00:15:49,590 --> 00:15:52,330 implication, and then 333 00:15:52,870 --> 00:15:55,870 worrying and waiting and worrying 334 00:15:55,950 --> 00:15:58,590 and going on WebMD and getting more 335 00:15:58,630 --> 00:16:01,502 worried, here, we're truncating that whole experience. 336 00:16:01,686 --> 00:16:04,540 So within two weeks, you find out what it is, 337 00:16:04,580 --> 00:16:07,340 you're treated, you go home and you take 338 00:16:07,380 --> 00:16:10,060 Tylenol for a week. And at the end of that 339 00:16:10,100 --> 00:16:12,844 experience, you can put in the rearview 340 00:16:12,892 --> 00:16:15,676 mirror. You know, that's what we talk about, that single 341 00:16:15,708 --> 00:16:17,980 anesthetic event. It's really 342 00:16:18,020 --> 00:16:20,924 exciting. But I think we're still grappling 343 00:16:20,972 --> 00:16:23,080 with how do you even take all that information 344 00:16:23,620 --> 00:16:26,492 and share it, uh, share that with 345 00:16:26,516 --> 00:16:28,880 our community doctors, share it with our patients. 346 00:16:29,530 --> 00:16:32,402 So even the hospital, still not 347 00:16:32,426 --> 00:16:34,802 really sure how they're going to share that. It's a work in 348 00:16:34,826 --> 00:16:35,510 progress. 349 00:16:35,930 --> 00:16:38,498 >> Geeta Patel: Well, just hearing both those patient 350 00:16:38,594 --> 00:16:41,186 experiences and stories immediately helped 351 00:16:41,218 --> 00:16:44,162 me truly understand the power of what 352 00:16:44,186 --> 00:16:46,994 you're doing. And, um, I'm blown away. It's 353 00:16:47,042 --> 00:16:50,018 really incredible. I do think that there's something 354 00:16:50,074 --> 00:16:52,994 within the patient testimonials and those patient stories, 355 00:16:53,122 --> 00:16:56,092 especially as someone who does focus groups 356 00:16:56,156 --> 00:16:58,940 with patients. Often you hear about the process. 357 00:16:59,060 --> 00:17:01,932 They worry about recovery, they worry about pain. 358 00:17:02,076 --> 00:17:04,828 Those are oftentimes the biggest concerns that they have 359 00:17:04,884 --> 00:17:07,788 is what's going to happen after. And it 360 00:17:07,844 --> 00:17:10,732 seems like that could be an interesting starting 361 00:17:10,796 --> 00:17:13,772 point. I do want to switch gears a 362 00:17:13,796 --> 00:17:16,716 little bit about just how you're learning about 363 00:17:16,788 --> 00:17:19,772 what's new and what's possible. How are 364 00:17:19,796 --> 00:17:22,750 you getting your information about, uh, the latest in 365 00:17:22,790 --> 00:17:25,758 medtech and AI when it comes to your 366 00:17:25,814 --> 00:17:26,410 field? 367 00:17:26,950 --> 00:17:29,918 >> Dr. Nels Carroll: Yeah, that's a great question. It's very much 368 00:17:29,974 --> 00:17:32,846 a, uh, ongoing changing dynamic. There's 369 00:17:32,878 --> 00:17:35,518 so many things happening in the field. For me 370 00:17:35,574 --> 00:17:38,318 personally, it's relying on 371 00:17:38,374 --> 00:17:40,974 mentors and friends and anecdotal information. 372 00:17:41,142 --> 00:17:43,422 There's a gentleman by the name of Yui Nguyen, 373 00:17:43,566 --> 00:17:46,254 who is a really fantastic thoracic 374 00:17:46,302 --> 00:17:48,370 surgeon, works in Portland, Oregon, 375 00:17:48,990 --> 00:17:51,446 taught me everything I know about robotic thoracic 376 00:17:51,478 --> 00:17:54,342 surgery. And he continues to be a source of 377 00:17:54,366 --> 00:17:56,918 information. But conferences, 378 00:17:57,014 --> 00:17:59,846 professional societies, for us in our world, 379 00:17:59,918 --> 00:18:01,930 the sts, the aats, 380 00:18:02,590 --> 00:18:05,430 those are very much where People 381 00:18:05,470 --> 00:18:08,198 are pushing those boundaries, but a lot of it has to do 382 00:18:08,254 --> 00:18:10,650 with a million things get published. 383 00:18:11,070 --> 00:18:13,990 Which things do you trust? You have to 384 00:18:14,030 --> 00:18:16,800 dig a little deeper to the person behind the article. 385 00:18:16,950 --> 00:18:19,660 That just comes from communication and 386 00:18:19,700 --> 00:18:22,268 relationships. I'm a young guy and I 387 00:18:22,324 --> 00:18:25,244 certainly am still very much learning how to 388 00:18:25,252 --> 00:18:28,012 navigate all of that and growing in that process. 389 00:18:28,116 --> 00:18:30,280 But I think having an ear to the ground 390 00:18:30,740 --> 00:18:33,644 on the thoracic side or the 391 00:18:33,732 --> 00:18:36,636 cancer world, we very 392 00:18:36,708 --> 00:18:39,692 much are multidisciplinary. We have a 393 00:18:39,716 --> 00:18:42,716 tumor board discussion. So every patient with lung 394 00:18:42,748 --> 00:18:45,632 cancer that needs to be discussed or worked through. 395 00:18:45,796 --> 00:18:48,584 I'm meeting with medical oncology, radiation 396 00:18:48,632 --> 00:18:50,220 oncology, pathology, 397 00:18:50,640 --> 00:18:52,776 radiology, diagnostic 398 00:18:52,808 --> 00:18:55,752 radiology. We have a tumor navigator. We have 399 00:18:55,776 --> 00:18:58,424 these meetings, and there's so much 400 00:18:58,592 --> 00:19:01,352 robust information coming from all these 401 00:19:01,376 --> 00:19:04,200 different disciplines. Again, it comes 402 00:19:04,240 --> 00:19:06,280 down to being open, to 403 00:19:06,320 --> 00:19:08,920 participating and to asking more 404 00:19:08,960 --> 00:19:11,874 questions so that I can be responsible 405 00:19:11,922 --> 00:19:14,626 as an advocate for the patient. Uh, especially 406 00:19:14,698 --> 00:19:17,442 because I'm, um, as all of us taking on a lot of 407 00:19:17,466 --> 00:19:20,402 responsibility. If I'm going to make an incision, I 408 00:19:20,426 --> 00:19:23,394 owe it to the patient to be entirely 409 00:19:23,442 --> 00:19:25,730 prepared for the consequences of those 410 00:19:25,770 --> 00:19:28,722 actions. Kind of a muddy answer to a 411 00:19:28,746 --> 00:19:31,730 fairly clear question, but I think it 412 00:19:31,770 --> 00:19:34,434 just has to do with keeping my eyes and ears open 413 00:19:34,602 --> 00:19:37,596 and communicating and admitting that there's 414 00:19:37,628 --> 00:19:40,540 a lot that I don't know so that I can 415 00:19:40,660 --> 00:19:42,668 find answers to those questions. 416 00:19:42,844 --> 00:19:45,516 >> Geeta Patel: It sounds like, um, we hear a lot about how 417 00:19:45,588 --> 00:19:48,492 valuable conferences are because it gives you all a 418 00:19:48,516 --> 00:19:51,244 moment to just stop and really focus on 419 00:19:51,412 --> 00:19:54,348 what's new, the new data, and to your point, who's 420 00:19:54,364 --> 00:19:57,180 publishing it and what that study looks like. We've heard that 421 00:19:57,220 --> 00:19:59,900 quite a bit. It sounds like for this field in particular, 422 00:20:00,020 --> 00:20:02,316 what's unique that we haven't heard as much 423 00:20:02,388 --> 00:20:05,320 is advocating for it and having other 424 00:20:05,360 --> 00:20:07,992 physicians advocating for it, for the future of the 425 00:20:08,016 --> 00:20:10,952 program and for the spread of that data. 426 00:20:11,136 --> 00:20:13,832 I think that's very interesting and unique to the 427 00:20:13,856 --> 00:20:16,616 MedTech and AI space. I'm 428 00:20:16,648 --> 00:20:19,560 curious to know what your thoughts are 429 00:20:19,600 --> 00:20:21,940 on the future. I say that with 430 00:20:22,480 --> 00:20:25,016 10 years from now, do you see this 431 00:20:25,088 --> 00:20:27,848 being the common practice, or 432 00:20:27,984 --> 00:20:30,984 do you still see that because there's so much advancement 433 00:20:31,112 --> 00:20:33,864 happening that it's still going to be a slower adoption? 434 00:20:33,992 --> 00:20:36,872 >> Dr. Nels Carroll: So great question. It's something that we all kind of wonder 435 00:20:36,936 --> 00:20:39,780 about. What's. Where are we going forward? 436 00:20:40,320 --> 00:20:43,320 My practice really is one foot in two 437 00:20:43,360 --> 00:20:46,056 worlds because there's a thoracic side of things. 438 00:20:46,208 --> 00:20:48,936 Lung cancer. Absolutely. 439 00:20:49,128 --> 00:20:51,460 Robotic thoracic surgery is 440 00:20:51,920 --> 00:20:54,376 more and more common. In training, 441 00:20:54,568 --> 00:20:56,980 trainees are coming out with that experience, 442 00:20:57,840 --> 00:21:00,632 they're sharing that and they're building from that, and 443 00:21:00,656 --> 00:21:03,128 it's growing. And the benefits are just 444 00:21:03,264 --> 00:21:06,248 irrefutable. In the cardiac side of things, 445 00:21:06,304 --> 00:21:08,900 too, there's going to be a tremendous amount of change. 446 00:21:09,280 --> 00:21:11,140 One of the things that we 447 00:21:11,920 --> 00:21:14,792 continue to wonder about is the 448 00:21:14,816 --> 00:21:17,544 transition from open cardiac surgery 449 00:21:17,672 --> 00:21:20,220 to these transcatheter processes. 450 00:21:20,880 --> 00:21:23,000 So as a patient, the concept of a 451 00:21:23,040 --> 00:21:25,992 transcatheter, meaning, for example, 452 00:21:26,136 --> 00:21:28,888 the aortic valve in the heart is 453 00:21:28,944 --> 00:21:31,448 very prone to aging because it's in the high 454 00:21:31,504 --> 00:21:34,472 pressure area of the heart. The 455 00:21:34,496 --> 00:21:36,984 aortic valve tends to calcify, becomes 456 00:21:37,032 --> 00:21:39,960 stenotic. And the natural history of that 457 00:21:40,000 --> 00:21:42,888 is that, uh, valve needs to be replaced or else 458 00:21:42,904 --> 00:21:45,096 the life expectancy declines 459 00:21:45,128 --> 00:21:46,380 precipitously. 460 00:21:47,040 --> 00:21:49,992 Historically, to replace that valve, we had 461 00:21:50,016 --> 00:21:52,814 to open the chest, arrest the heart, 462 00:21:52,982 --> 00:21:55,982 take that valve out, and sew in a new one. And 463 00:21:56,006 --> 00:21:58,770 that's still a really good surgery. 464 00:21:59,110 --> 00:22:01,050 But what 465 00:22:01,670 --> 00:22:04,494 we have developed as a medical community 466 00:22:04,582 --> 00:22:07,550 is the ability to replace that valve through 467 00:22:07,590 --> 00:22:10,142 a catheter. So much like, you know, I 468 00:22:10,166 --> 00:22:12,542 described to a patient, you know, you've seen a ship in a 469 00:22:12,566 --> 00:22:15,486 bottle and you look at that and you say, how the heck 470 00:22:15,518 --> 00:22:17,950 did they get that into that bottle, through that narrow little 471 00:22:17,990 --> 00:22:20,794 neck? Well, it was folded delicately 472 00:22:20,842 --> 00:22:23,738 in a way that allowed it to fit through there. We now have 473 00:22:23,794 --> 00:22:26,682 engineered these valves in a way that we 474 00:22:26,706 --> 00:22:29,338 can fold them down, put them into a very 475 00:22:29,394 --> 00:22:32,234 narrow catheter, introduce it to an artery 476 00:22:32,282 --> 00:22:35,114 in the hip, slide it up into position, 477 00:22:35,202 --> 00:22:38,202 release it, pushes the old valve out of the way and the 478 00:22:38,226 --> 00:22:40,682 new valve is functional in its place. We call that 479 00:22:40,706 --> 00:22:42,986 TAVR Transcatheter Aortic Valve 480 00:22:43,018 --> 00:22:45,318 Replacements. TAVR initially 481 00:22:45,414 --> 00:22:47,878 was just for really high risk 482 00:22:47,934 --> 00:22:50,198 folks who couldn't tolerate open 483 00:22:50,254 --> 00:22:53,170 surgery. And then we've seen where 484 00:22:53,550 --> 00:22:56,070 with more experience and more refinement of 485 00:22:56,110 --> 00:22:57,810 technique and technology, 486 00:22:58,910 --> 00:23:01,730 these valves work very well. 487 00:23:02,030 --> 00:23:04,918 So we've gone from offering them just to high risk 488 00:23:04,974 --> 00:23:07,206 patients to intermediate risk 489 00:23:07,278 --> 00:23:10,150 patients. And now we're looking at more and more 490 00:23:10,190 --> 00:23:13,180 applications, younger patients, healthier 491 00:23:13,260 --> 00:23:15,900 patients. The implications of 492 00:23:15,940 --> 00:23:18,876 that are really, uh, a burgeoning topic 493 00:23:18,908 --> 00:23:21,868 of discussion. For example, 494 00:23:22,044 --> 00:23:24,988 Medtronic is a company that makes a really terrific 495 00:23:25,084 --> 00:23:27,868 valve, and we've seen through recent 496 00:23:27,924 --> 00:23:30,364 the SMART trial data that 497 00:23:30,452 --> 00:23:33,212 particularly for a small annulus, 498 00:23:33,356 --> 00:23:36,220 which it's a narrow space and 499 00:23:36,260 --> 00:23:38,990 you're replacing it with this valve, the 500 00:23:39,030 --> 00:23:41,982 Medtronic valve works great. So 501 00:23:42,006 --> 00:23:44,830 we've got this excellent data that really 502 00:23:44,870 --> 00:23:47,630 is kind of pushing our thinking to 503 00:23:47,670 --> 00:23:50,574 when is the right time for surgery and when is the 504 00:23:50,582 --> 00:23:53,422 right time for a transcatheter option. We 505 00:23:53,446 --> 00:23:56,238 always want to offer the patient the least 506 00:23:56,294 --> 00:23:59,262 morbid, least painful procedure, but 507 00:23:59,286 --> 00:24:01,710 at the same time, we want to offer the most 508 00:24:01,750 --> 00:24:04,290 durable, most effective treatment. 509 00:24:04,980 --> 00:24:07,692 So it really takes a lot of 510 00:24:07,716 --> 00:24:10,332 longitudinal data and a lot of 511 00:24:10,436 --> 00:24:13,372 thoughtful collaboration to find the 512 00:24:13,396 --> 00:24:16,348 sweet spot for that. Where that will go 513 00:24:16,404 --> 00:24:18,796 in the future is really interesting, 514 00:24:18,988 --> 00:24:21,468 especially as we branch out into other 515 00:24:21,524 --> 00:24:24,476 valves. I have, uh, a tremendous 516 00:24:24,668 --> 00:24:27,276 good fortune of working with Dr. Cybul 517 00:24:27,308 --> 00:24:29,400 Carr, who's a 518 00:24:30,100 --> 00:24:33,062 absolute international expert in structural 519 00:24:33,126 --> 00:24:35,702 heart or transcatheter interventions for 520 00:24:35,726 --> 00:24:38,502 valvular disease. We're pushing the 521 00:24:38,526 --> 00:24:41,286 boundaries on some tricuspid valve 522 00:24:41,318 --> 00:24:44,170 interventions, mitral valve interventions, 523 00:24:44,750 --> 00:24:47,190 things that we once thought we could only do 524 00:24:47,230 --> 00:24:49,330 surgically. And I think 525 00:24:50,190 --> 00:24:52,726 seeing that progress 526 00:24:52,918 --> 00:24:55,830 and seeing the experience and courage of guys like 527 00:24:55,870 --> 00:24:58,806 Dr. Carr to help us try 528 00:24:58,878 --> 00:25:01,862 things and push forward really brings a 529 00:25:01,886 --> 00:25:04,370 lot of confidence that that 530 00:25:04,910 --> 00:25:07,730 area of medicine is only going to continue to grow. 531 00:25:08,030 --> 00:25:10,790 Certainly there's still always going to be a role for 532 00:25:10,830 --> 00:25:13,830 surgery. And the more thoughtful and collaborative we 533 00:25:13,870 --> 00:25:16,502 are, the more effectively we can 534 00:25:16,526 --> 00:25:18,966 utilize surgery and transcatheter 535 00:25:18,998 --> 00:25:21,894 interventions together. So, uh, lots 536 00:25:21,942 --> 00:25:24,870 to be discussed, lots to see, but 537 00:25:24,910 --> 00:25:25,782 really exciting. 538 00:25:25,926 --> 00:25:28,790 >> Geeta Patel: Yeah, it sounds like we're a lot closer in 539 00:25:28,830 --> 00:25:31,480 some fields than others than we think. So 540 00:25:31,670 --> 00:25:34,372 it is very exciting. Well, I just want to 541 00:25:34,396 --> 00:25:37,140 close by thanking you so much for your 542 00:25:37,180 --> 00:25:39,320 time and just sharing 543 00:25:39,900 --> 00:25:42,724 all these advancements with us. It's very exciting 544 00:25:42,772 --> 00:25:45,444 to see where we're headed in the medical 545 00:25:45,532 --> 00:25:48,420 world and how much innovation has 546 00:25:48,460 --> 00:25:51,332 happened over the last 10 to 15 years to get us 547 00:25:51,356 --> 00:25:54,180 to a place of less pain, less 548 00:25:54,220 --> 00:25:56,964 invasiveness. And I think your work has a 549 00:25:56,972 --> 00:25:59,908 lot and is contributing a lot to this and we're 550 00:25:59,924 --> 00:26:01,768 all very grateful for it. So thank you. 551 00:26:01,884 --> 00:26:04,752 >> Dr. Nels Carroll: Well, thank you. Thank you so much for having me. Honestly, I 552 00:26:04,776 --> 00:26:07,712 learned a lot from you guys and so 553 00:26:07,736 --> 00:26:10,640 I appreciate you giving me an opportunity to speak. I love 554 00:26:10,680 --> 00:26:13,312 to connect and learn more from other folks as we're all 555 00:26:13,336 --> 00:26:16,224 trying to do the same thing. We're trying to 556 00:26:16,392 --> 00:26:19,180 improve our patients lives. So thank you so much. 557 00:26:23,800 --> 00:26:26,656 >> Speaker A: Thank you for listening to this episode of the Frictionless Marketing 558 00:26:26,688 --> 00:26:29,562 podcast. For a complete transcript of 559 00:26:29,586 --> 00:26:32,362 this conversation or more information on Prompt, 560 00:26:32,506 --> 00:26:35,270 please Visit us at ahmeetprompt.co. 561 00:26:36,450 --> 00:26:39,306 if you found this episode insightful, share it with your connections 562 00:26:39,338 --> 00:26:42,218 on LinkedIn. To learn 563 00:26:42,234 --> 00:26:45,114 more about how to make marketing frictionless. Purchase Friction 564 00:26:45,162 --> 00:26:47,658 Fatigue by Prompt CEO Paul Dyer 565 00:26:47,754 --> 00:26:50,110 online and at booksellers worldwide. 566 00:26:51,970 --> 00:26:54,806 Frictionless Marketing is a production from Prompt, the leading 567 00:26:54,838 --> 00:26:57,766 earned first creative marketing and communications agency. 568 00:26:57,878 --> 00:27:00,454 Grounded in the present, yet attuned to the future. 569 00:27:00,622 --> 00:27:03,190 Produced and distributed by simpler media productions.