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David Crawford: Hi, everyone. Welcome to Crawford's Corner. This is E. David Crawford. About three or four weeks ago, on the front page of The Wall Street Journal was an article entitled, "Young Doctors Want Work-Life Balance. Older Docs Say That That Is Not the Job."

And there's a discussion about the hook to pagers and now the question of balance in life and culture and so forth. Joining us to discuss this topic is a very good friend of mine, Jay Shah. He is a renowned urologic oncologist and associate professor at Stanford University School of Medicine.

He specializes in bladder cancer, robotic surgery, and focusing on improving outcomes. Dr. Shah went to undergrad at Harvard, did his medical training at Columbia and residency, and then pursued a fellowship at M.D. Anderson in Houston, Texas.He's really recognized for his excellence in teaching and patient care. And he also serves as chief of the medical staff at Stanford Health Care. What an achievement! Beyond his clinical work, Dr. Shah is passionate about leadership development, quality improvement, team building, and he's a certified executive coach.

He and I have been friends, seeing each other in the gym, working out. We both try to stay in shape. And so Jay, thanks a lot for joining us. This is a pretty interesting topic that's generating a lot of different points of view on both sides. So in the next few minutes, if you could just share your thoughts about this and use your certified executive coach training, what they do.

Jay Shah: Yeah. Thanks for having me, Dave. Really appreciate it. It's been a pleasure having conversations with you around this topic and other topics at the gym and at meetings, et cetera, and I'm glad that we're having this conversation in this larger format.I think there are no physicians, no urologists or physicians of any specialty, who would disagree that medicine is hard. And it's been getting harder. And I think we're all just trying to figure out how do we make it all work for us.

I see these kinds of conversations where—in that article you mentioned—it sort of drew a line saying that older physicians feel like it was a calling to go into medicine. And it seems to a lot of folks who are on the back 9, so to speak, of their career, the latter half of their career, that younger physicians seem to see it more as a job than a calling or a vocation of sorts.

I don't see it quite along generational lines. I think we're all trying to have the same conversation, and I think everyone's just trying to figure out, how do I make this work for me? What I mean by that is we agree medicine is more complex today than it used to be.

Just the simple pace of medical innovation today relative to even 20 years ago is so different. And I think the new folks coming out just feel like it is nearly impossible to be able to do everything. So they have a more, “OK, I'm going to work my shift, and then I'm going to go home and do my thing. I'm going to turn my pager off.” It seems to us older folk like they're tuning out, they don't care as much about the patient. And having talked to a lot of younger folks, I don't think that's actually true. I think they care deeply about the patient. I think everybody does.

David Crawford: Very good point. Yes.

Jay Shah: And I think if we keep having this argument of “they think differently, and I am right,” I think we're never going to get anywhere. I think what we all want to do is take phenomenal care of patients, and we want to guard ourselves from burning out.You and I both know people personally, close friends of ours who over the years—because of, we don't have to get into specific reasons—but they've either done things that have sabotaged their own careers, or have had horrible things happen to them, or have had things that have kept them from being able to contribute to medicine and to their personal lives in the ways that we know they were capable of.

And I think nobody wants to go through that. I think everyone just wants to feel like, “I'm working really hard, I'm taking good care of people, and I feel happy about what I do.” Being in that space where you're working and don't feel happy about it—because medicine is such a, people say this all the time and it's so true, it's a noble, noble profession. You never have to convince anyone that being a doctor is valuable. But then when I see people that just don't get the joy that you can have from it, it's heartbreaking. So I think everyone wants to work hard. Everyone wants to have free time. Everyone wants to have a lot of money. Those are not unique to one group or another.

David Crawford: Some of the things that take the joy away are you're feeling like you're always charting, you're a slave to Epic or whatever is out there. You're always clicking something. I think that has a lot to do with what's going on here, too.

Jay Shah: 100%. Well, the way I see it, and the way that I've spoken to other colleagues about it, there are system-level issues like what you're describing. The fact that we used to be able to just write stuff in a paper chart, but now we have to use this very complex electronic medical record.

While it makes certain things easier, it makes a lot of other things harder. Patients can now reach out to you all the time. They're wondering a quick thing, and they send you a message. And if you don't get back to them in a certain amount of time, you get dinged by your health system's metrics for your responsiveness or lack thereof.

So there are system-level things that I think folks in leadership like you, me, the folks that we work with, have to be very thoughtful about—what are the things we can do to lower these system-level burdens? I'm very fortunate to be at Stanford, where we have a chief wellness officer who is phenomenal, and we have an informatics group that actively thinks about how we can make Epic—which is the system we use—work for our providers better.

So we're doing a lot of things, trying to integrate AI into our electronic medical record, where hopefully very soon, for any provider—we've already started rolling this out in pilots—but hopefully any provider at Stanford very soon will be able to walk into a room with a patient, just have a regular conversation like you and I are having. An ambient AI technology will listen to that whole conversation, and the moment you leave the room, you turn on your Epic at your desktop, and boom, the note is there.

It's actually phenomenal. If you haven't had a chance to see this, you have to check it out. It's so good at filtering out all the stuff that's not really part of the medical record but is integral to establishing rapport: “Oh, how'd your son's baseball tournament turn out? Did you ever end up going to Kathmandu like you mentioned last time?” All the things that patients really say help them feel connected to the doctor. Those don't make it into the note, but all the valuable medical stuff gets put in there, and it's really fantastic.

So that's just one small example at a systems level—things that we can do to make our providers' lives better so they're not charting for six hours after a busy nine-hour clinic.

David Crawford: I think that is very important. It used to be we walked into the room and we looked at the patient, and we talked with them. Now we're sitting in front of the computer and we're banging away. And I'm not a very good typist, quite honestly. I look at our residents, and they're like, wow.

So yeah, I'm looking forward to the integration of that. I guess some of us have had scribes that have gone into the rooms with us, but that's helpful. That's not always covered. And at least in our place, if you want it, it comes out of your own pocket.

What do you think this is going to look like in the next five years, and what's going to be the outcome? Are we going to be doctors of the past and proud of what we're doing and things like that, or what's going to happen?

Jay Shah: Yeah. No, I think that's not going to happen. I think we are going to figure out as a group how to make medicine work for us better. And I think we are on the crux of an entire revolution beyond just medical documentation, beyond just health care, but I think as a society as a whole.

This specific meeting that you and I are having right now—it is going to have notes transcribed by AI. Similarly, we're going to figure out how we can make AI work for us. I know there's a lot of concern in terms of, will it replace humans? Will it get rid of doctors altogether? And there's a lot of dystopian movies out there painting pictures of how bad that could be. But I actually think collectively, as a society, humans are pretty dang smart, and we're going to figure out how to make our own lives easier with all of this.

And I think in parallel with that, as we figure out how to make our systems work for us, I think the other piece that's important is the cultural piece. I think you can have the EMR burden or not, but right now, even that article that you started our conversation with kind of divides things along a generational line. There's an us-versus-them aspect to it, and there is no them. We are all part of the same team. We are part of the problem, and we are part of the solution—all of us. And I think creating the kind of culture where people can speak honestly and openly about these things without making assumptions like, well, the young folks are lazy or the old folks are outdated, they're dinosaurs. We're never going to get anywhere like that.

Everyone's going to be old eventually, and we're constantly going to have new young folks. So I think that conversations like this one we're having is an opportunity for us to try to shift the dialogue a little bit.

In my role as chief of staff, I say this all the time: my guiding principle is that everyone I come across—if you're lucky enough to have a job at Stanford—you're smart, talented, you come to work every single day wanting to do the right things, and you enjoy working hard. That's where I start. Give everybody the benefit of the doubt.

And I would say the same thing for people in medicine. If you are a doctor, if you are an APP, if you're a nurse, if you're in health care today, you are a good person who wants to do good things for other people, and you come to work being willing to work hard and do the right things. But we don't often start the conversation there. Where we start is, “Well, you're a little bit different than me in some way. Therefore, you're lazy, or you're outdated, you're not as smart,” whatever. And that doesn't help things.

David Crawford: Well, listening to you, I see why you're in the leadership position you're in—team building and focusing on it. And I think that's true. When all those things are present, you like what you do and you're happy, and that's true. Jay, any closing comments? We really appreciate having you.

And as I mentioned before we started, one of the other things that you're really good at dealing with is this whole thing with physician burnout. And again, a lot of us have thought in the past, well, these guys are all weaklings, they're not with it, this is an excuse. So we're saving that for another time. But any parting comments you want to make?

Jay Shah: No. I'll say thank you. Thank you for having this conversation. Thank you for getting us in front of other people's ears, because I think people forget a lot of times, we're so busy as doctors, we're so busy working hard, that we sometimes forget there are other people who get it. And we kind of just—our super-egos are so developed, we'll put our heads down and we'll just grind. And I just want to remind everyone that you're not alone. Everyone's working really hard. You've got good people around you wherever you are, and sometimes reaching out to remind yourself of that can be very therapeutic.

David Crawford: Jay, thanks very much, and we look forward to—I hope we can get your commitment to do something in a month or so on those other things.

Jay Shah: Yeah. I am passionate about these topics, so anyone that I can talk to about this, I'm always happy to engage. And I would offer that to your listeners as well: if anyone wants to reach out, I'm happy to chat.

David Crawford: Thank you, and have a great day. Appreciate it.

Jay Shah: Thanks. You too.