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Bob Wachter, MD and Andy Slavitt, MBA, on the Past, Present, and Future of COVID-19i think we're rea

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Updated on Jan 18,2023

Bob Wachter, MD and Andy Slavitt, MBA, on the Past, Present, and Future of COVID-19

i think we're really early on our path,toward transformation and disruption and,so the hope of the day is you get a,sense from really some world leading,speakers what's happening why it's,happening where life is going to take us,and leave with a sense of a little bit,of disquiet because there's going to be,a lot of change but also some optimism,that that we can actually reach a better,place and that's the goal,so um,with andy i thought we would best uh,divide our time half,covid,and half sort of non-coveted and the,system beyonce is that all right half,monkey box,no no,very little monkey pucks and by the way,andy you had coven a couple of weeks ago,yes it is i assume your rapid test is,negative because here i'm sitting next,to you without a mask i'm all good good,okay terrific never better all right so,welcome thank you for thank you for,coming great to be here and you know,like i came here,uh a big admirer of bob's i think bob's,what i call,a health care citizen meaning he doesn't,think you don't just think for your,institution or for yourself,you do a great job thinking they have,everybody but now i'm a big fan of,richards because i think the um for,anybody had to do what he did this,morning,this sort of um,almost renaissance person's,perspective,on healthcare from high to low,with data,with truth with objectivity,um,is a really good grounding and i think,you know,at its basis,you know the the biggest pandemic we,have going right now is probably,misinformation distrust disinformation,and so,i'm attracted and i think we all should,be to reliable,high integrity,people in conversations like i think you,guys started so hopefully we'll continue,it yeah good good i think you called,that right i've learned a lot about,leadership from working with richard for,now close to a decade so you got to see,a slice of it today,uh,once you so you had covid you you dodged,it for two and a half years you had it a,couple of weeks ago what'd you learn,from the experience of having it that,you didn't know i think a couple things,one is that,you know ba 5 can find a hole in all of,our stories,so there's the the variants that are,getting,increasingly more clever if you could,put human terms on these variants um it,makes it,incredibly hard unless you're going to,live a completely risk-free existence,which you know except in the most,extreme cases i don't recommend i don't,think any of us recommend um,the second thing is that with all of the,biotechnology that's occurred over the,last couple of years it is very,different,to have coveted today than it is two,years ago it's extremely different uh,you know we're talking about things like,bounce backs we're talking about very um,narrow optimization fields as opposed to,a couple years ago when we're talking,about overcrowded hospitals and and the,like and i think we are on a path,where,where it will get it will get,increasingly like that um,still i think and i wrote a piece in the,atlantic last week um that we are in a,rut,uh this is like relates a little less to,me than to everybody where where we,don't we don't see,how the egg how the path improves,dramatically from here and there's a,couple of ways that that could happen,and then i learned,as you as you know,that the practice of medicine on this is,still very early,and there's a huge variation and,um the i went to a wonderfully wonder,wonderful doctor who sees lots and lots,of covert patients,who prescribed me about five things of,which um i think i needed one of them,and the other four,were either,and i called i called bob actually and,said bob hey what do you think i'm,getting,these things prescribed to me i don't,know whether they make sense and you,said in the kindest possible way you,know they don't make sense don't take,them,and that was a bit of a surprise uh at,this stage and in fact you and i just,did an episode which we released,yesterday with a checklist on,you know what actually the evidence says,to do,when you get coveted and it's amazing,how many people out there just don't,know,where to go and what to do yeah,you mentioned that it's increasingly,hard to hide you're still being pretty,careful at least you were until you got,it,do you think that's a waste of time and,energy at this point and it's it's it's,you know because a lot of people are,fatalistic about this a lot of people,maybe,maybe most of you,without the requirement are going in,indoor places without mass and sort of,like maybe not even worth trying to,dodge it what do you think about that,now maybe one of the best things we can,do,is to adopt a posture there's no wrong,answers,for individuals i mean look if you're,putting someone else at risk and you're,being reckless i think that's wrong,that's my own value judgment but,but other than that i think we ought to,take a step back,and stop saying,you know we gotta stop with the sneering,stop with the dirty look stop the she's,wearing a mask he's not wearing a mask,and and and,arriving at value judgments,um let it

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The legacy of COVID-19 in healthcare improvement and research | Bob Wachter | THIS Space 2020
2018 Virtual Medicine Conference: Bob Wachter
One-On-One With Dr. Bob Wachter, Head of Department of Medicine at UCSF
Bob Wachter's 69 step guide to ripping your mask off
The omicron boosters are here. What you should know about them | Life Kit
Twitter Suspends The World’s Leading LGBT Children’s Author | Ep. 869
Dr. Bob Wachter and Dr. Howard Krein on Achieving Health Moonshots in a COVID World

The legacy of COVID-19 in healthcare improvement and research | Bob Wachter | THIS Space 2020

we're going to go straight now to,uh an interview with professor bob,wachter who of the university of,california,who is a bit of a legend in many ways,not only,because of his chair of department of,medicine at the university of california,at san francisco,but also because he chaired the vector,report on itv nhs,which was published in 2016 which had a,major influence on,nhs digital strategy uh most important,position of all he's chair of this,institute scientific advisory board,and throughout the pandemic he's accrued,an extraordinary social,media following and the one thing the,other thing you need to know about him,and he just told me this now he is,possibly,the biggest fan of bruce springsteen,there is,or at least as he said in the top ten,and i'm going to,pass you over now to jenny burt who is,going to interview him,i'm jenny burt senior social scientist,at this institute and i'm absolutely,delighted today,to be talking to professor bob wachter,so bob is professor and chair of the,department of medicine at university of,california san francisco ucsf,he's very much regarded as a leading,thinker in the role of hospitalist,medicine,having coined the term hospitalist,actually in a,new england journal of medicine paper,back in 1996.,bob's written extensively on patient,safety and digital health technologies,including a new york times science,best-selling book the digital doctor,which is very much worth a read,and of great relevance as well for us,here today,bob is currently chair of the scientific,advisory board at this,institute bob welcome to this space,thank you jenny it's a great pleasure to,be here so in,2016 bob uh at the request of the uk,government,you led a review of digitising secondary,care and using it to improve the nhs,and that culminated in a report called,making it work,and during that review you were looking,at what worked and why in it and,healthcare and also where improvements,were needed,so thinking back about what you learned,about the nhs,during that time what could you predict,would have worked and what wouldn't as,the nhs was suddenly faced with,responding to the covert pandemic,well first of all i learned how,impressive the nhs is and how many,spectacular people there are,working in it i also learned that it's,pretty bureaucratic,and one of my concerns would have been,how nimble it is in in that there are,massive advantages to having your health,system,largely run by the government but also,real challenges and,particularly in areas that are rapidly,moving and and are,depend on innovation the uh the,the core advantage i think of having the,nhs as a essentially single system and i,know every time i say that people,say well yes i know but it feels a,little bit siloed and,of course it does but but at least the,potential and aspiration that it acts as,a single system,is the ability to disseminate,information out there,quickly to organize studies across the,entire,the entire ecosystem and in fact that,has played out,if you think about the the literature,base that we use,to make decisions in covid uh a,disproportionate amount of it comes from,uk,uk clinical research uh and if you think,about the number of patients and people,in the uk,uh it's clearly punching above its,weight as,we would say in the states i'm not sure,if that translates uh in terms of its,impact on clinical research,and if you think about the work in,vaccines for example there's,the uk has done very impressive,impressive work,uh throughout coven but in terms of,the digital background you have a real,advantage having in,having a single system that is uh that,at least theoretically,is woven together digitally where you,can collect data across the entire,uh system analyze it look for real world,evidence and then,implement uh either intentional,uh trials of uh doing doing this versus,doing that or,look at natural experiments see what,what happens to have changed for a,variety of reasons,and look i think uh much more easily,than we can in the u.s where we really,have a patchwork,system uh at whether something worked,so thinking about that u.s experience,what kind of resilience do you think,there was,any is in the us system again to be,responding to these major challenges,the us at this point at least has failed,in its coveted response and and,really at a massive and almost,unprecedented scale,um and and much of that just happens to,have to do with our politics of the,moment which is extraordinarily,fragmented and uh and partisanized,and covet is a societal stress test i,mean it really,is uh uh you know it entered,into the society uh probably not true,it's not just covenant any pandemic,comes in,and tests the resiliency of all of your,institutions,it tests the relationship between the,people and the government,uh the between the government and and,industry and requires,uh all sorts of things that are just,turned out to be hard,rapid mobilization of the health care,system,of the public health system of the,scientific community,rapi

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2018 Virtual Medicine Conference: Bob Wachter

okay well we're gonna finish today with,the real honor of having Bob Walker with,us as our second keynote speaker and and,dr. Walker comes to us from UC San,Francisco and he's known for many many,things I think it was in 1996 when you,coined the term the hospitalist I think,he wrote about it in the New England,Journal of Medicine and at the time,recognized that there was this problem,where there was an unmet need in the,healthcare system,for a specialist who takes care of,patients in the hospital and at the time,the model was that doctors would work in,their clinic or our office then run,across the street to the hospital and,then run back again and it was,inefficient it wasn't a good use of,their time and it made more sense to,have somebody stationed in the hospital,whose job it is to take care of,hospitalized patients and thus was born,the hospitalists which we all now know,as an entire area of medicine since that,time sort of fast forward now twenty-two,years or maybe twenty years when you,wrote the digital doctor sort of,recognize that we have a new unmet need,now that we have remote patient,monitoring and wearable biosensors and,all sorts of other opportunities to,reach beyond the four walls of this,hospital the new unmet need is how do we,manage patients in the community where,they actually live work and play,people spend 99.9 percent of their lives,far away from a hospital like this there,are the senior centers and they're at as,we've seen they're at home they're at,work they're at the park but they're not,here in a hospital like this so whose,job is it to monitor those patients when,they're in the community using all these,different devices and sensors and remote,monitoring and that is sort of becoming,a new to the doctor the digital Estella,Stu's job it is to understand how to,monitor these patients in the community,so that was the subject largely of a,fantastic book that I have all my own,students I recommend that they read the,digital doctor and in that book,dr. Walker really goes through where are,we with digital health broadly and it,brings that it brings a very clinical,approach to it he's the chairman of,medicine at UCSF really one of the top,medical medicine departments internal,medicine departments in the country and,he has a virtually no background in,virtual reality which is exactly why,he's here to talk with us because I,somebody from the outside so that we,don't you know drink the kool-aid and,get too excited about one another's work,somebody from the outside who has been,through the as he says here the bumpy,road of implementing health information,technologies and has seen what works and,really what does not work which he,writes about in a very compelling way in,in his book which has now been studied,extensively for you know the work that,you've done so I can sit here of course,and talk forever about you so I'll stop,there and welcome you and thank you for,being with us today,is it is it clicked on at a power on,check that let's try that testing one,two three there we go great so it's,great to be here end of a long day I'm,I'll try to go go quickly and I'm,keeping you from from dinner and,refreshments but it is an honor to be,here and I've been here the entire day,and I've learned a ton as Brendan said I,when he asked me to come and speak I,said are you sure because I this is,something I know very little bit about,but I first of all I learned a lot and,second of all I do think the context,that I've spent a lot of time thinking,about is actually quite important let me,tell you I came to digital I I've been,interested in thinking about patient,safety for a very long time really for,the last 15 to 20 years and I live in,the Bay Area and those two things you,couldn't help but think that digital is,going to cure all the ills of healthcare,and that's what I was thinking when,digital entered my world largely in the,form of an electronic health record and,I saw that digital made things better,certainly and I fully believe that my,hospital is safer now than it was before,we had before we had technology but I,saw all kinds of unanticipated,consequences that were just surprising,to me it wasn't as easy as any of any as,much thought and we saw all sorts of,bumps along the way and then one day at,my hospital which is a fantastic,hospital we gave a kid a 39 fold,overdose a common antibiotic the correct,dose was one pill we gave the kid 39,pills this was in a fully electronic,system with computerized order entry bar,coding the works and it's an error that,could not have happened when we were on,paper it happened of course because,there was a little glitch in terms of,the original prescription but then the,alerts fired and people ignored them,because they get hundreds of alerts a,day and the pharmacists who normally,would have had to pour out the the the,antibiotic had been replaced by a robot,and then a nurse so on order for 39,pills this is an absurd absolutely,absurd order this would be like driving

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One-On-One With Dr. Bob Wachter, Head of Department of Medicine at UCSF

as we go through this pandemic one of,the guiding voices here in the bay area,and really across the country is dr,bob walter the head of the department of,medicine at ucsf his twitter account,has exploded in size as he tweets,regular updates tonight,we get him in real time dr watcher joins,us now from san francisco doctor,nice to have you back on the program i,just want to be clear here as you,probably know the president says we're,rounding the corner,when it comes to this pandemic are we,it's not the corner that we want to be,rounding the corner is one that's going,up like that,and uh we have to turn this around,quickly or we're going to see hundreds,of thousands of more,more deaths no i don't know what corner,he's talking about could we go back into,a lockdown is there a scenario that you,see,from your medical point of view that,maybe two or three months from now we,could go backwards into that business,lockdown,it's possible if things continue,exploding uh certainly i don't know that,it'll be a nationwide lockdown it will,probably be uh,based on local prevalence and,hospitalization rates and death rates,but there are certainly parts of the,country,that are looking like they may need to,almost reboot from the beginning in,order to get things under control,at least so far things are not at that,level at the bay area but we've got to,be vigilant,hey doctor i think i speak for a lot of,people i get confused dealing with all,this you and your colleagues have told,us that europe is a bellwether what,happens there,will soon come to us well if those,european countries are diligent when it,comes to wearing masks and social,distancing,yet there's still a surge over there,what's the answer,well they they're seeing variations the,way we're seeing in the united states,france is exploding,spain is not doing very well italy is is,going back to,where it was in the beginning germany is,still doing fairly well so it varies,according to the country,but i think you know we're now eight to,ten months into this and a lot of places,have begun to let their guards down,and unfortunately is nothing about the,virus that has changed in 10 months and,for the vast majority of us who have not,had the infection,there's nothing about us that's changed,so if you let your guard down and you,stop,wearing mass and start getting together,uh,in in groups that are too big i think,we're starting to see what that looks,like,both in in parts of europe and now most,of the united states now if you don't,mind if i can ask you a personal,question your plans family plans or,friends plans for for the holidays what,are you thinking,i'm staying put san francisco right now,is about the safest place,in the country i may have a couple of uh,my children who live in the bay area who,have been very safe over to the house,but beyond that that's as far as we're,going to go,doctor you've got to scare yourself,there at ucsf two,non-coveted patients i believe have been,infected with covid also three medical,workers there,a total of five people uh how's the,hospital dealing with it,we are we're kind of redoubling our,efforts uh we have been extraordinarily,safe all through this and the number of,covet patients we've had in the hospital,has been very low,we test every patient who comes in the,hospital whether they're coming in for,covet,symptoms or coming in for a heart,procedure or a gi procedure,and we have universal masking and all of,the healthcare providers wear goggles,and at least so far it's been very safe,this is one where a patient had tested,negative,when they came in and then at the time,we were discharging them we tested them,again and it turned out that they had,turned positive,which doesn't happen very often that led,to a investigation,contact tracing all the things we're,supposed to do and we're just going to,continue to redouble our efforts to make,sure all of our patients and our,caregivers remain safe,and final question is it disheartening,for you to see the political narrative,uh not aligning at all with the medical,narrative,yeah it's it's disheartening it's,it's pretty terrible i mean many of us,in the medical profession and the,scientific professions,wanted to stay away from politics we,that's not what we do,but unfortunately the politics have,gotten so intertwined with the,with the pandemic it's it's impossible,to stay away it,you know we have to do the right things,and it's so sad,that people have chosen their teams,there's just no question that the the,guidance around mass,and distancing avoiding large crowds it,will work and it will save thousands of,thousands of lives and i don't care who,you're voting for,that has to be the thing that you do in,order to keep yourself safe,and keep the people around you safe dr,walker we appreciate and value your time,thanks a lot for your medical insight,thank you so much

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Bob Wachter's 69 step guide to ripping your mask off

my name is Bob Watcher from UCSF,Department of Medicine,and now let me show you,how to calculate,if you need to put your mask on,I'm guessing you like me are struggling,with whether it's time to get back to,normal,I'm gonna join him in a few weeks yep,I'm gonna risk I'm gonna rip my mask off,I was in Florida,at a party outdoors and it began to rain,and here's what I did I immediately got,out a napkin and started writing down,probabilities so we gotta decide should,we go in and rip our mask off,um let's do context I'm still fairly,healthy whatever that means that could,mean any number of things I'm vaccinated,so that's good,because we really need to focus on my,personal risk here that's the most,important thing,Florida 100 cases per 100K per day,it's basically huge as big as a,Delta search there's many home tests so,this could be off it could be off,it could be off,so let's start that as a starting point,of where it could be off mind you I'm,thinking about all this as I'm preparing,to ride on my napkin right as it's,raining I'm running towards the door,but then I I dashed to the side my visor,shots reduce my risk of getting covered,by 50 more importantly three shots have,reduced my case by 95 what about long,covet nobody knows let's just,assume something there okay,okay what about long-term organ,dysfunction,what about my old mom,I finally thought about someone besides,myself,it's a miracle,there's 40 people in there,everybody is says they're vaccinated and,Rapid tested and I'm sure that's no,problem,getting one of those rapid tests were,all Rich that's fine most of,them are in the blue States great last,girlfriend right,so in Florida at 17,so I'm about to run out of the napkin I,just work oh we're gonna get there but,baseball experience it UCSF asymptomatic,test positivity right tends to be half,the overall test positivity right so,what that means is you know after that,maybe probably could be in Florida,symptomatic and we don't have to worry,about symptomatic people,because,obviously they would not come to a sweet,sick party with oysters,okay but even eight percent is too high,it's too high you know the reason why is,because all these people are,amazing,ah,they're just really great,I know I don't know I just assume that,they're all really safe,even though they're going inside,middle of the overcrowd search,but they're really safe I promise so,we're gonna go with one to three percent,you know,could have been 17. could have been less,but we're gonna go with two percent,one in 15.,excellent,b c k for background,this is easy that ball and a group of 40,people that's five percent chance at,least one person was positive and,potentially infectious if you're,confused about how I got from one in,fifty to 55 chance want a more puzzle,that body is don't worry about it I did,it in my head it's easy I was right,about to go into the party it did it in,my head don't worry about it,now we have 33 chance attack rate in the,house okay let's write that down to,2.33,and that's the the attack right,yeah house,so let's say five percent let's say,let's say five percent chance of getting,infected remember there's only a 55,chance that such a person is there,that chance would also drop with good,ventilation,which is why we kept two doors open so,you follow me it's clear how this,modifies the probabilities we have in,mind right,right you guys are following me right,okay we're gonna get there,that's what I was thinking when the rain,began to fall,I went through all of this,with my mind,now here's my math,all right here we go,we did that we did that,we did that,okay ten percent I don't well where does,ten come from,odds,wait so oh we decided that it was one in,fifty,wait,exposure times risk,it's one in fifty,okay it's one in fifty guys trust me,the odds of coming in close contact one,in ten wait how do you erase this erase,it,no,okay eraser,oh it's so tiny,okay we're racing no I've erased the,graphs okay,okay pencil one in ten,and that was times,that equals 150.,excellent,right one in fifty and this is a sure,thing this one in 50 is for sure that,was at no point any ambiguity or,uncertainty about any of these terms so,this is solid,there's no way it's like five and fifty,maybe or 10 and 50. I there's just no,possible way I could be off in multiple,components of this calculation,and there's no way that uncertainty,wouldn't multiply together in the end,I wrote all this on a nap in and I was,like I'm going in,and then I tell my mom that 33 attack,rate Mom 1 in 50 times 30 Mom Mom it's,fine foreign,thank you

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The omicron boosters are here. What you should know about them | Life Kit

this is npr's life kit i'm marielle,segarra there's a new coveted booster,that targets the variants that are,circulating around the country and still,causing tens of thousands of infections,a day pharmacy chains and doctor's,offices have started giving this shot on,this episode of life kit we're going to,talk about who's eligible and whether,the booster is something you really need,hey life kit listeners andy tegel here,to spread the word about our new special,series dear life kit,it's an advice column for your ears,and we're getting personal,every episode will enlist expert advice,for one of your most pressing and,intimate anonymous questions about life,love and how to keep it together,all in about 10 minutes,new episodes every saturday until,october 8th,listen to dear life kit from npr,with me is npr health correspondent,allison aubry hey allison hey marielle,great to be here yeah great to have you,so who's eligible for the new booster,well the cdc is now recommending these,new boosters for people 12 years and up,there are two boosters authorized a,pfizer shot recommended for people 12,and older and a moderna shot for those,18 and up people are eligible as long as,it's been at least two months since,their last booster or coveted vaccine,got it and is this booster different,from previous ones,yeah the big difference is that the new,boosters are designed to fend off ba-4,and ba-5 these are the sub-variants of,omicron that are now dominant in the u.s,i spoke to infectious disease expert,judy guzman-cottrell she says there's a,lot of hope that these new boosters will,offer improved immunity we finally have,a booster that matches the currently,circulating covid variant in the united,states this virus has been mutating so,quickly over the past two years,that i feel like we've been playing,catch-up and finally we have caught up,you know a lot of the infectious disease,experts i talked to say that though the,booster is now open to most of the us,population the people who can benefit,the most are older people so beginning,around age 60 people with compromised,immune systems and people with chronic,conditions that put them at higher risk,is that because in general older folks,are at higher risk from covid or,is it also because their immunity wanes,more quickly,i think it's a combination but,definitely yes,older folks are at higher risk and if,you look at death some people who are,most likely to die from covid are,over age 70 right well so what about,healthier or younger people i think,there's a little less urgency to go out,and get the booster right now if you're,young and healthy but the consensus i'd,say is that there's still a benefit i,mean studies show that protection wanes,over time even though at this point most,people are getting only mildly sick from,covet sick for a few days,there are still risks and inconveniences,you have to miss work you may have to,interrupt travel stay away from other,people and you could get symptoms of,long covet,of course the big risk is there's a,chance of passing it on to really,vulnerable people at a time when there's,still about 400 cova deaths a day um i,spoke to a doctor bob walked or at uc,san francisco he says he's getting this,booster as soon as possible he says he,got his last booster shot about eight,months ago my immunity has waned,significantly my immunity against,getting infected is wayne almost,completely so,there's no question that getting a,booster of some sort increases the,likelihood that you'll have a benign,case if you get one and we'll lower the,probability you'll get a case of covid,so he says to him it's pretty clear that,the benefits of getting this booster,shot outweigh any risks and he's also,advising his adult children they're in,their late 20s early 30s to get boosted,too all right so what about if you've,already had covet especially recently if,you've had covet over the last several,months it's pretty certain that you've,been infected with ba4 or ba5 so you've,got some time before you need a booster,generally three months after an,infection is when you should start to,think about getting the new booster shot,judy guzman cottrell told me that she,and her two teenagers are just getting,over covered now our natural antibody,response will protect us against covid,for another few months,so i do think it makes sense to wait and,get the updated booster about three,months after our positive coded test we,had covered in august so getting a,booster in november will then protect us,from covid this winter so we can avoid,sick days from work and from school,that's at a time when the virus is very,likely to be on the uptick it won't,surprise any infectious disease experts,to see another surge this coming winter,what's the advice for people who have,not had covid recently,but want to wait until maybe late fall,or early winter to get a booster,when the risk as as you say is likely to,be much higher well i think that many,people will wait i mean given that the,full pr

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Twitter Suspends The World’s Leading LGBT Children’s Author | Ep. 869

today on the matt walsh show the leading,lgbt children's author in the world was,suspended from twitter over the weekend,it was an appalling act of homophobia,but there's something even deeper and,more important going on which we'll talk,about today also the cdc has finally,started admitting some basic truths,about the covet virus just in time for,the midterm elections but you know,that's a coincidence i'm sure and the,teacher stuffs her son in the trunk of,her car so that she doesn't give her so,that he doesn't give her covid,interesting parenting strategy plus navy,boot camp goes woke and we must cancel a,prominent doctor who posted a dramatic,25 tweet thread about his son's battle,with a cold all of that and more today,on the matte wall show,well as you all know and have seen true,masculinity is constantly under attack,in our culture and we need core pillars,to keep us grounded,in true masculinity one such pillar is,steak and not just any steak though you,need 100,american steak on your dinner table,fortunately for you good ranchers is the,exclusive meat company of the daily wire,they help you get american meat,delivered to your door they've got 100,american steakhouse quality uh meat and,it's it's all for an affordable price,over 85 percent of the grass-fed beef in,stores and online is imported from,overseas and that means you're getting,less quality also means that you're,undermining american farms and ranches,and often that causes them to close down,ultimately shop good ranchers today to,support american-made and put the small,farm back on top support american farms,and ranches and get delicious t-bones,gourmet burgers rib eyes and many more,mouth-watering cuts in the process i,mean the the big headline for me with,this is that this is just really good,stuff i've had i've tried the product,myself,and um it is this is this is one of,those easy,spots to do because i actually really,enjoy it not that i don't enjoy the,other sponsors anyway visit,goodranchers.com walsh and use codewall,should check out to get 30 off any one,of their many boxes everything they sell,is truly top notch and you really have,to try it so visit goodranchers.com,walsh today to save 30 on your new,favorite steak start the year with good,ranchers american meat delivered,so tragedy struck my family on friday,when i got the news which came,completely out of nowhere hitting like a,bolt of lightning from the clear blue,sky,that i had been suspended from twitter,these are truly the times that try men's,souls i was informed of the suspension,mere moments after posting a video of me,defeating my wife in a plastic sled race,in our front yard now at first i thought,that i was being suspended because of,that video perhaps on a bullying charge,or something either way you know that's,the kind of indispensable content that,the internet was deprived of in my,absence then i received the email from,our twitter overlords they informed me,that the suspension was for two,offensive posts that i had recently,authored,one said this,trigger warning get ready for this this,is what it says,the greatest female jeopardy champion of,all time is a man the top female college,swimmer is a man the first female,four-star admiral in the public health,service is a man men have dominated,female high school track and the female,mma circuit the patriarchy wins in the,end the other was a tweet from a few,months ago i think was a few months ago,and i was responding i believe to the,news that demi lovato had come out as a,they them she had come out as multiple,people,where i said in my trademark diplomatic,and gentle style i am not referring to,an individual person as if she is two,people everyone else can run around,sounding like maniacs if they want to,but i will not be participating no thank,you,well i did say no thank you so i think i,was pretty polite about it,what rules did these two posts violate,well the company said that i'd run a,foul of their policy prohibiting hateful,conduct,what is hateful conduct,that's this is the only explanation they,offer for that they say,you may not promote violence against,threaten or harass other people on the,basis of race ethnicity national origin,sexual orientation gender gender,identity religious affiliation age,disability or serious disease,now it should be noted that you can,still promote violence against them if,you just disagree with their opinions,because people do that to me every,single day i mean every day someone is,telling me they're going to kill me or,wishing death on my entire family but,that's okay because they just hate me,for everything i stand for and believe,that's totally fine,hate somebody for their race or gender,on the other hand well that is,unacceptable,but did i promote violence i mean did i,make any threats against anybody,i said the patriarchy wins but that was,simply an observation not a threat,i didn't say the patriarchy will win you,fools you're all gonna pay,that's the kind of thing i might say,but

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Dr. Bob Wachter and Dr. Howard Krein on Achieving Health Moonshots in a COVID World

actually the biggest thing that happened,in terms of technology obviously was,telemedicine was one that was clear that,clearly hit its tipping point but the,second was dashboards,with covid i think we learned that we,need to have real time,up to the minute,you know dashboards information that,doesn't make us look at some humongous,spreadsheet but actually takes it and,presents it to us in forms that are,beautifully visualized actionable,whether it's for a clinician or whether,it's for a healthcare system leader and,i think was the first time that we kind,of understood the power of the data that,we have sloshing through our digital,tubes it is the duty of leaders to lead,of the creative to create the daring to,do the free world expects leadership of,us its fate and our faith depends upon,our leadership,well i say that nothing is,welcome everybody and i'm so excited to,be here for those of you who don't know,me i'm howard crine,a uh practicing uh head neck surgeon in,philadelphia and chief medical officer,of startup health and i'm so excited to,have a special guest with us today for,our uh fireside chat achieving mood,shots um with the one and the only,bob wachter bob welcome,thank you harrod it's a joy to be here,i'm inspired watching those videos,oh thank you you know what every time i,see that video i get a little inspired,to it gives me a little bit of,goosebumps of where we are in medicine,and in healthcare and what the,possibilities are,um so i want to take a moment just for,those of you who have most likely heard,of bob but don't know all of his,accolades i just wanted to just give a,brief introduction let everybody know he,is a best-selling author he is a,renowned clinician leader and researcher,out at uh us i'm sorry ucsf uh in,california and as we were talking it is,a little bubble and a little wonderful,place in this world um to to to to be,able to be uh consistently bob also was,the uh host of uh pod the podcast in the,bubble from the front lines and bob has,really been at the forefront of uh,healthcare healthcare innovation,um and reimagining where we are going,and uh once again it's bob it's just,such a pleasure to to have a little time,to talk with you we've we've spoken,before but i'm really excited to to to,hear what your thoughts are on where we,are and where we're going thank you,probably my biggest contribution was i,coined the term hospitalist 25 years ago,two days ago so just to show how old i,am a quarter of a century ago was when,that all started so let me ask you just,to touch base on that did you ever think,when you coined it i always i always am,curious when people make such such,monumental contributions when you coined,that when you start first thought,thought of that that term did you ever,think that it was actually going to be,as big and as important in healthcare um,when you when you invented it,not quite as big i i thought that the,the model for care at the time for,inpatient care which was your primary,care doctor is responsible for taking,care of you in the hospital that just,struck me as undoable there's a physics,problem you can't be in two places at,the same time what i saw in academia was,a different model where people sometimes,came out of their research lab for a,couple weeks a year,to get cme from their residency it's,just neither one of those seem like the,best way to deliver the best care and do,it at the lowest cost and have,physicians involved in making systems,work better,so i thought it would grow i mean i i,kind of had in my mind the growth of,emergency medicine and the growth of,critical care medicine,two fields that had emerged a decade or,a couple decades earlier,where you had generalists become,specialists in the site of care so what,seemed odd was the hospital didn't have,a specialist who was a specialist in,hospital care but i didn't think it,would be the fastest growing specialty,in history there are now 60 000 of these,people and at ucsf i've i run the,department of medicine i have 900,faculty that work in my department and,about 150 of them are hospitals now so,it's now far bigger than cardiology or,gi or pulmonary uh and that i didn't,quite envision,yeah it's amazing i mean and as you as,you mentioned uh hospitalist,every every academic center that i know,and actually most even private private,uh um uh hospital systems,the hospitalists are who run everything,it's who we as uh sub-specialists and,specialty uh physicians count on um and,and certainly need to uh to be able to,run the hospital so yeah certainly the,major players during covet i think you,know that that was i think the things,that turbo charged over the last 10 or,20 years how steph work hour limitations,all of a sudden,you you didn't have this infinitely,expansive group of young doctors being,paid below minimum wage and so you had,to figure out who's actually going to,take care of sick people and teaching,hospitals and then covet you know has,turbo charges as well you know hospitals,got ver

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