>> Speaker A: Welcome to Frictionless Marketing, the podcast that dives
deep into the stories of the most innovative brands and the people
moving them forward.
Our mini series, Frictionless Medicine explores the
HCP perspective on today's trends throughout the
industry. Today we're joined by Dr.
Nels Carroll, a board certified cardiothoracic
surgeon at uh, Los Robles Health System. Join host
Geeta Patel as Dr. Carol shares insights on staying ahead
of trends, the role of marketing and engaging
doctors, and his journey from educator to a
pioneer in robotic thoracic surgery. Discover how
he leverages technology, data and collaboration to
strive for seamless patient First Healthcare.
>> Geeta Patel: Dr. Carol, thank you so much for joining us.
We're excited to have you here, especially as someone
who's at the forefront of tech and AI and
medicine. So we'd love to kick things off by just
having you share a little bit about yourself and your background and
what you're doing right now.
>> Dr. Nels Carroll: Yeah, thank you so much for having me here. I'm, um,
excited to speak with you guys. I'm a
cardiothoracic surgeon. I work for Los Robles
Medical System in Thousand Oaks, California, right
outside of la. Did my surgical training in
Texas, worked in Washington for a few years
before coming here to California. Uh,
big part of my practice is robotic
surgery, so certainly a big slant towards
technology and pushing some boundaries and
some barriers to what has been done towards
what we can do. So really
excited to be here.
>> Geeta Patel: Amazing. What inspired you to get
into medicine and specifically into
the robotic and tech side of things?
>> Dr. Nels Carroll: Well, I had kind of a circuitous route into
medicine. Actually coming out of school, I was
in Teach for America, which is, I
think of it, kind of like a domestic Peace Corps.
I was really enthralled with the mission
of serving underserved
people, kind of giving them some of the opportunities that I had
had through that process
of learning how to be an educator. I really
became fascinated with the concept of
pursuing education in a different arena and that
being medicine. So that's where I kind of made the
big jump into wanting to pursue medicine.
And then really, it was just a process of trial
and error. Real interest in science and a real interest
in surgery and refining
processes and through interactions with
some particularly excellent
teachers and surgeons, realized what we
were capable of doing by harnessing some of these
resources to improve our
processes.
>> Geeta Patel: That's amazing. How do you feel like Teach for
America has shaped you as a
physician in terms of just being able to explain some of the
most complex medical issues, but also some of
these complex tech procedures with your
patients? How do you feel like that's kind of given you the skills you need
to speak with them? Them?
>> Dr. Nels Carroll: Oh, I think it's huge. Aside from the technical
responsibilities of a surgeon and what you're actually doing at the time of
surgery, at least
50% of the job is
educating and communicating with patients and with their
families. There's really no more vulnerable
or scary time than being a patient
undergoing open heart surgery or undergoing
surgery for cancer. So it's incumbent
upon me, it's incumbent upon us as the
medical community, to the way I communicate it. Pull
up a chair to the table. Working as
a consultant for them, the patient is the
chairman of the board. There's a lot of different people that
pull up a chair to the table. So it's my job to
really explain myself, give
background, give context, and make sure
that they feel comfortable and confident with what we're
doing moving forward so that they can
really just focus on
healing and not be worried about
things that are out of their control or that they don't understand
that we can help them understand that background in
education has been pivotal in helping
me do my job.
>> Geeta Patel: What would you say are some of the
biggest hesitations or concerns among
patients when you are discussing some
of the more advanced surgical procedures using
AI and tech?
>> Dr. Nels Carroll: Oh, yeah, there's a whole
spectrum. You hear these catchphrases
and patients will say, listen, I don't
want a robot operating on me, right?
I'm coming to you as a surgeon. I don't know this
robot, right? So it's just about communicating
that. I think for everyone,
it's just intuitive. The fears of the
unknown. What's really important is just
explaining that these are tools
that allow us to. Allow me to do my job
better. For example, within the field
of lung cancer resection, standard
approach in literature 50, 60 years ago
was a thoracotomy. A big incision between the
ribs, spread the ribs apart, looking
directly at the lung, operate on the lung.
There was a total seat change when that transitioned
to thoracoscopic surgery. So we put in a
camera, make smaller incisions,
much less painful for the patient, much less time
in the hospital. But then there's really now this
total paradigm shift where it's not just
a camera, um, but when we say we're doing
it robotically, that camera is actually
two cameras adjacent to each other,
creates a stereoscopic visual
input. So it's three dimensional.
The degrees of freedom, the range of
motion of the instruments is
infinitely better than what we can do with
standard, we say vats or
videoscopic thoracic surgery.
So those things are fascinating. They're very
interesting. But what matters to the
patient is it hurts
less, the surgery is more accurate,
the surgery is safer, they
recover more quickly. Those are the things that
matter. So I think keeping
things in context and making it relatable
is hugely important.
>> Geeta Patel: No, that's really interesting when you talk about these
advancements and, uh, it seems like since you're on
the forefront of a lot of this, thinking about
the peers in this field, are they
as open to adopting these new methods?
Do you feel like there are certain groups of
physicians that are a little bit more open than others? And how
does literature and how things are being
communicated to them, um, impacting their
adoption of these practices?
>> Dr. Nels Carroll: Well, I think that's a really good question.
Within any practice, any
profession, when you're trying
to move things forward,
at times there's resistance. It
has to do not so much
with focusing on that
as it does with being true to the
process. In that if you're
offering a, uh, safer,
more effective
process, it speaks for
itself. I think
communicating and building
within the medical community to
bring people on board, to make them aware.
Part of what I really appreciate about the opportunity
to talk to you guys in the context of
marketing, you know, from my perspective within
medicine, nothing that I do has to do with
sales. So marketing, for me
isn't about sales, but it's about
communicating, it's about sharing.
Within our medical community,
people are so
overwhelmed with information, especially our
primary care physicians. They're being
inundated from all these different
specialists. And I'm one of those specialists, you
know, so when I meet a, uh, primary care physician, a
family medicine doc, for the first time, I'm coming
to the office and I'm saying, hey, I'm Dr. Carol. You know, I'm a
cardiothoracic surgeon. Initially, they
might just gloss over, like, okay, I just met with a
urologist yesterday. I'm going to meet with a
neurosurgeon tomorrow. There's
a new, uh, radiation oncologist that's
coming to my office this afternoon. Like, how do I
put all this into context? It's an
ongoing pursuit, but to share that
information. You know, I had a pivotal
lesson in that as a medical student.
Worked with a really fantastic surgeon,
T. Sloan guy, that's his name. Really
phenomenal robotic cardiac
surgeon. Taught me so much, has
continues to be a mentor. But we actually
published his experience
with building or
recruiting into what he was doing.
Because as a robotic mitral valve surgeon,
it's a real niche. Oftentimes
he had to get the word out to patients
to let them know, hey, here's an alternative. You know,
rather than a sternotomy, we can do this minimally,
invasively. We can offer you a really tremendous
surgery. So
that continues to be in my mind
about the importance of not just going one
foot in front of the other, but
sharing what we're doing and working and
building and growing. And just one other thought
to go along with that. It's. I'm not under
any illusions that as I
step into a new medical community, I'm, um,
bringing a whole wealth of knowledge and nobody gets
it. You know, the guys who've been doing thoracic
surgery for 20 years, 30
years, 40 years, have seen so
much and have so much
tremendous information and wisdom
that they can help me with.
So I think it's about bringing a little bit different experience,
bringing it to the table, working together,
and then moving forward.
>> Geeta Patel: I mean, that's really great insight. I heard you
say sharing is really important, so I kind of want to
take a second to also just share and,
um, talk a little bit about your recent accomplishments. You
recently completed the first ever robotic
chest wall reconstruction in all of Southern
California. I just want to make sure I get this right. And the first
ever single anesthetic robotic lung cancer
resection in Ventura County. Is that correct?
Correct. Okay, first of all,
let's take a moment to say that is
incredible. Um, just to be first ever and to
be on the cutting edge and to do this is wonderful.
I heard you say it's important to communicate and share a lot
of this. And a lot of times what we do from a marketing
standpoint is figure out how we can empower our patients
to also get educated on these topics so that
they're coming to their surgeons, that they're coming to their physicians
and discussing some of these options. I'd love to hear from
you on how you're sharing some of those great
milestones with potential patients and
trying to market it outside, or communicate it,
if you will, outside of the physician world.
>> Dr. Nels Carroll: Well, that's. Thank you. Yeah, I mean, these are really
exciting. Uh, I think as a clinician, you're just kind of
confronted with the situation, and you
think about, what's the best way I can do this? And
then when you come up with a creative
strategy and it works,
that's really exciting. And then you want to build from
that. Just to be totally frank,
how do we share that is something that
we're very much grappling with. You know, the chest
wall reconstruction. So a Little bit of context
had a gentleman riding a motorcycle
collided with a deer, fractured 10
ribs. So he had 10 rib fractures, multiple
displaced rib fractures. The consequence of
that is he was dependent on a lot of oxygen, a lot of pain
medicine. He was able to get up and breathe deeply
and walk around. So the traditional
approach to reconstructing that is to make
a big incision all the way along the
back towards the side,
and to actually divide a lot of muscles
and screw titanium plates into the
ribs. That works, but it's
painful and you want to be better. So
the next step is to do that thoracoscopically. We
talked about vat surgery, and so what we did is we took
it the next step and did it robotically. The
biggest incision that we made on this Jose, 2
inches. We plated from the
inside. We also did a cryonerve
ablation the morning after surgery.
He's breathing room air, he's walking, he's taking
Tylenol. For that patient,
it's phenomenal. It's exciting because you
see the potential to improve the process.
We didn't divide any muscle. We spread the
muscle fibers. We do these little finite
things to really improve the process. But
how do you share that? I don't really have an answer for
that because it's just an area of growth, I guess, for
me. And I shared that with
our hospital. And they still
are grappling with that a month later and
haven't come up with anything to
share that. Maybe because it seems a little
esoteric or they're not familiar with it.
The single anesthetic lung cancer
is really a paradigm shift too.
Just thinking patient first. So a
patient might have a screening CT scan,
a suspicious nodule. They're referred
to a doctor, they're referred to another to get a
biopsy, they're referred to another to get some
testing done. They go get some other imaging
done. They're referred to a surgeon
in our community. On average, then it
takes between 60 and 90 days
from the time of initial suspicion to
treatment. So with a single
anesthetic event, what we're now doing,
patient gets a suspicious CT scan.
I'll see them within a week and get some
other imaging done. We'll have a
discussion within another week.
We go to surgery, patient goes to
sleep. I'll do a robotic navigational
bronchoscopy and mediastinal staging.
The pathologist is in the room with me, can
tell me right away if it's cancer.
If it's cancer while the patient's
asleep. Proceed directly to complete
Anatomic resection. So I'll take out the
cancer, take out the lymph nodes, do
nerve blocks, put in a drain.
Two hours later, patient wakes up.
90% of the time, they go home the following morning.
When they go home the next day, we answer two
questions. Was it cancer? Yes. What
do we do about it? It's done. And
especially with these early stage lung cancers,
totally revolutionizes that experience
for the patient. So rather than having three
months of first
wondering, then knowing
that you have cancer, but not knowing the
implication, and then
worrying and waiting and worrying
and going on WebMD and getting more
worried, here, we're truncating that whole experience.
So within two weeks, you find out what it is,
you're treated, you go home and you take
Tylenol for a week. And at the end of that
experience, you can put in the rearview
mirror. You know, that's what we talk about, that single
anesthetic event. It's really
exciting. But I think we're still grappling
with how do you even take all that information
and share it, uh, share that with
our community doctors, share it with our patients.
So even the hospital, still not
really sure how they're going to share that. It's a work in
progress.
>> Geeta Patel: Well, just hearing both those patient
experiences and stories immediately helped
me truly understand the power of what
you're doing. And, um, I'm blown away. It's
really incredible. I do think that there's something
within the patient testimonials and those patient stories,
especially as someone who does focus groups
with patients. Often you hear about the process.
They worry about recovery, they worry about pain.
Those are oftentimes the biggest concerns that they have
is what's going to happen after. And it
seems like that could be an interesting starting
point. I do want to switch gears a
little bit about just how you're learning about
what's new and what's possible. How are
you getting your information about, uh, the latest in
medtech and AI when it comes to your
field?
>> Dr. Nels Carroll: Yeah, that's a great question. It's very much
a, uh, ongoing changing dynamic. There's
so many things happening in the field. For me
personally, it's relying on
mentors and friends and anecdotal information.
There's a gentleman by the name of Yui Nguyen,
who is a really fantastic thoracic
surgeon, works in Portland, Oregon,
taught me everything I know about robotic thoracic
surgery. And he continues to be a source of
information. But conferences,
professional societies, for us in our world,
the sts, the aats,
those are very much where People
are pushing those boundaries, but a lot of it has to do
with a million things get published.
Which things do you trust? You have to
dig a little deeper to the person behind the article.
That just comes from communication and
relationships. I'm a young guy and I
certainly am still very much learning how to
navigate all of that and growing in that process.
But I think having an ear to the ground
on the thoracic side or the
cancer world, we very
much are multidisciplinary. We have a
tumor board discussion. So every patient with lung
cancer that needs to be discussed or worked through.
I'm meeting with medical oncology, radiation
oncology, pathology,
radiology, diagnostic
radiology. We have a tumor navigator. We have
these meetings, and there's so much
robust information coming from all these
different disciplines. Again, it comes
down to being open, to
participating and to asking more
questions so that I can be responsible
as an advocate for the patient. Uh, especially
because I'm, um, as all of us taking on a lot of
responsibility. If I'm going to make an incision, I
owe it to the patient to be entirely
prepared for the consequences of those
actions. Kind of a muddy answer to a
fairly clear question, but I think it
just has to do with keeping my eyes and ears open
and communicating and admitting that there's
a lot that I don't know so that I can
find answers to those questions.
>> Geeta Patel: It sounds like, um, we hear a lot about how
valuable conferences are because it gives you all a
moment to just stop and really focus on
what's new, the new data, and to your point, who's
publishing it and what that study looks like. We've heard that
quite a bit. It sounds like for this field in particular,
what's unique that we haven't heard as much
is advocating for it and having other
physicians advocating for it, for the future of the
program and for the spread of that data.
I think that's very interesting and unique to the
MedTech and AI space. I'm
curious to know what your thoughts are
on the future. I say that with
10 years from now, do you see this
being the common practice, or
do you still see that because there's so much advancement
happening that it's still going to be a slower adoption?
>> Dr. Nels Carroll: So great question. It's something that we all kind of wonder
about. What's. Where are we going forward?
My practice really is one foot in two
worlds because there's a thoracic side of things.
Lung cancer. Absolutely.
Robotic thoracic surgery is
more and more common. In training,
trainees are coming out with that experience,
they're sharing that and they're building from that, and
it's growing. And the benefits are just
irrefutable. In the cardiac side of things,
too, there's going to be a tremendous amount of change.
One of the things that we
continue to wonder about is the
transition from open cardiac surgery
to these transcatheter processes.
So as a patient, the concept of a
transcatheter, meaning, for example,
the aortic valve in the heart is
very prone to aging because it's in the high
pressure area of the heart. The
aortic valve tends to calcify, becomes
stenotic. And the natural history of that
is that, uh, valve needs to be replaced or else
the life expectancy declines
precipitously.
Historically, to replace that valve, we had
to open the chest, arrest the heart,
take that valve out, and sew in a new one. And
that's still a really good surgery.
But what
we have developed as a medical community
is the ability to replace that valve through
a catheter. So much like, you know, I
described to a patient, you know, you've seen a ship in a
bottle and you look at that and you say, how the heck
did they get that into that bottle, through that narrow little
neck? Well, it was folded delicately
in a way that allowed it to fit through there. We now have
engineered these valves in a way that we
can fold them down, put them into a very
narrow catheter, introduce it to an artery
in the hip, slide it up into position,
release it, pushes the old valve out of the way and the
new valve is functional in its place. We call that
TAVR Transcatheter Aortic Valve
Replacements. TAVR initially
was just for really high risk
folks who couldn't tolerate open
surgery. And then we've seen where
with more experience and more refinement of
technique and technology,
these valves work very well.
So we've gone from offering them just to high risk
patients to intermediate risk
patients. And now we're looking at more and more
applications, younger patients, healthier
patients. The implications of
that are really, uh, a burgeoning topic
of discussion. For example,
Medtronic is a company that makes a really terrific
valve, and we've seen through recent
the SMART trial data that
particularly for a small annulus,
which it's a narrow space and
you're replacing it with this valve, the
Medtronic valve works great. So
we've got this excellent data that really
is kind of pushing our thinking to
when is the right time for surgery and when is the
right time for a transcatheter option. We
always want to offer the patient the least
morbid, least painful procedure, but
at the same time, we want to offer the most
durable, most effective treatment.
So it really takes a lot of
longitudinal data and a lot of
thoughtful collaboration to find the
sweet spot for that. Where that will go
in the future is really interesting,
especially as we branch out into other
valves. I have, uh, a tremendous
good fortune of working with Dr. Cybul
Carr, who's a
absolute international expert in structural
heart or transcatheter interventions for
valvular disease. We're pushing the
boundaries on some tricuspid valve
interventions, mitral valve interventions,
things that we once thought we could only do
surgically. And I think
seeing that progress
and seeing the experience and courage of guys like
Dr. Carr to help us try
things and push forward really brings a
lot of confidence that that
area of medicine is only going to continue to grow.
Certainly there's still always going to be a role for
surgery. And the more thoughtful and collaborative we
are, the more effectively we can
utilize surgery and transcatheter
interventions together. So, uh, lots
to be discussed, lots to see, but
really exciting.
>> Geeta Patel: Yeah, it sounds like we're a lot closer in
some fields than others than we think. So
it is very exciting. Well, I just want to
close by thanking you so much for your
time and just sharing
all these advancements with us. It's very exciting
to see where we're headed in the medical
world and how much innovation has
happened over the last 10 to 15 years to get us
to a place of less pain, less
invasiveness. And I think your work has a
lot and is contributing a lot to this and we're
all very grateful for it. So thank you.
>> Dr. Nels Carroll: Well, thank you. Thank you so much for having me. Honestly, I
learned a lot from you guys and so
I appreciate you giving me an opportunity to speak. I love
to connect and learn more from other folks as we're all
trying to do the same thing. We're trying to
improve our patients lives. So thank you so much.
>> Speaker A: Thank you for listening to this episode of the Frictionless Marketing
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