Amanda: How my Mother’s Love Propelled Me to Become a Surgeon!

1 00:00:00,480 --> 00:00:02,404 Speaker 1: Welcome to the Healthy, Wealthy and Wise 2 00:00:02,524 --> 00:00:08,064 podcast with Dr William Chokta, MDJD. Our mission is to empower 3 00:00:08,125 --> 00:00:11,897 you with the knowledge and the tools you need to thrive in all 4 00:00:12,099 --> 00:00:16,184 aspects of your lives. Join us now as we discuss everything 5 00:00:16,285 --> 00:00:19,823 from nutrition and exercise to money management and personal 6 00:00:19,862 --> 00:00:24,733 growth. Dr Chokta will provide insightful advice on how to 7 00:00:24,774 --> 00:00:28,064 improve your physical and financial health, as well as 8 00:00:28,103 --> 00:00:31,460 your emotional and mental well-being. Whether you're 9 00:00:31,481 --> 00:00:35,930 looking to boost your energy levels, unlock financial freedom 10 00:00:35,930 --> 00:00:40,228 or cultivate a more positive mindset, we've got you covered. 11 00:00:41,880 --> 00:00:45,901 Get ready to become the best version of yourself? So let's 12 00:00:45,941 --> 00:00:50,329 get started. Here's Dr William Chokta, MDJD. 13 00:00:51,240 --> 00:00:55,308 Speaker 2: Good morning, welcome to our Healthy, wealthy and 14 00:00:55,389 --> 00:01:00,469 Wise podcast. This is part of our Leadership Masterclass 15 00:01:00,509 --> 00:01:05,426 series and it is designed to help you live long and thrive. 16 00:01:05,799 --> 00:01:09,388 We're delighted to have you with us today, and I am Dr William T 17 00:01:09,388 --> 00:01:13,481 Chokta. I will be your facilitator this morning. So 18 00:01:13,542 --> 00:01:16,882 welcome, and let's get started. Today, we're going to talk about 19 00:01:16,882 --> 00:01:24,165 artificial intelligent robots in surgery. That's true, 20 00:01:24,700 --> 00:01:30,804 artificial intelligent robots in surgery. I believe life is 21 00:01:30,843 --> 00:01:35,106 about being of service to others . I believe knowledge is power. 22 00:01:35,620 --> 00:01:39,102 I believe leaders can change the world. One of the things I've 23 00:01:39,162 --> 00:01:43,798 learned in my 50 years of surgical practice is that it is 24 00:01:43,897 --> 00:01:48,046 important to have beliefs, because our beliefs affect our 25 00:01:48,126 --> 00:01:52,382 thoughts, our thoughts affect our feelings and our feelings 26 00:01:52,563 --> 00:01:58,268 affect our actions. So if you are not feeling well or you are 27 00:01:58,308 --> 00:02:01,882 not acting the way you think you should act, go back to your 28 00:02:01,923 --> 00:02:05,275 beliefs and make sure your belief systems are where they 29 00:02:05,355 --> 00:02:10,883 should be at the present time. With the Masterclass and with 30 00:02:11,062 --> 00:02:15,539 our podcast, i always like to have you think as doctors, think 31 00:02:15,539 --> 00:02:20,693 as physicians. Put yourself in the shoes of that physician as 32 00:02:20,753 --> 00:02:24,665 we go through this particular topic, and then it will make 33 00:02:24,747 --> 00:02:28,781 much more. It will be much more relevant and be much closer to 34 00:02:28,800 --> 00:02:33,411 what we're talking about. I always like to put up an outline 35 00:02:33,411 --> 00:02:36,221 , and the purpose of the outline is to tell you what we're going 36 00:02:36,221 --> 00:02:40,771 to talk about and to let you know when we're just about done. 37 00:02:40,771 --> 00:02:44,174 I realize that you're very, very busy people and you have a 38 00:02:44,254 --> 00:02:48,352 lot on your plate and you have a lot to do, and I appreciate you 39 00:02:48,352 --> 00:02:53,367 sharing parts of your valuable time with us, and so we will 40 00:02:53,508 --> 00:02:56,462 certainly keep that in mind. We're going to talk about the 41 00:02:56,502 --> 00:02:59,200 definition of artificial intelligence. We'll then go to 42 00:02:59,222 --> 00:03:04,181 the benefits of AI in medicine in general. We'll talk about the 43 00:03:04,181 --> 00:03:08,800 benefits of AI robot assisted surgery applications. We'll talk 44 00:03:08,800 --> 00:03:12,490 about what those benefits are for physicians and we'll end up 45 00:03:12,691 --> 00:03:16,181 talking about what those benefits are for hospitals. When 46 00:03:16,181 --> 00:03:20,049 I start talking about the benefits of artificial 47 00:03:20,128 --> 00:03:24,044 intelligent robots for hospitals , then you know that I'm just 48 00:03:24,084 --> 00:03:29,259 about done. Well, what is artificial intelligence? One of 49 00:03:29,280 --> 00:03:33,149 the basic definitions is the simulation of approximation of 50 00:03:33,248 --> 00:03:39,325 human intelligence in machines. The simulation or approximation 51 00:03:39,545 --> 00:03:44,082 of human intelligence in machines. I like to simplify 52 00:03:44,122 --> 00:03:48,360 that and just say teaching machines to think. Artificial 53 00:03:48,381 --> 00:03:53,479 intelligence is basically teaching machines to think. Some 54 00:03:53,479 --> 00:03:58,308 of the goals of that is to have a computer enhanced learning, 55 00:03:58,930 --> 00:04:03,765 reasoning and perception. There are two basic categories of 56 00:04:03,846 --> 00:04:08,223 artificial intelligence. Technically, one category has to 57 00:04:08,223 --> 00:04:12,538 do with basic pattern recognition, where the machine 58 00:04:12,617 --> 00:04:16,487 is taught how to recognize a certain pattern of data or 59 00:04:16,627 --> 00:04:23,209 pictures or images, etc. The other basic type is complex 60 00:04:23,329 --> 00:04:29,512 human emotion. Indeed, when you get into emotion and computers, 61 00:04:30,254 --> 00:04:35,180 that gets you into some of the controversial areas. For the 62 00:04:35,199 --> 00:04:39,910 most part, we will not get into that today, but that is an issue 63 00:04:39,910 --> 00:04:47,439 with computers, particularly with AI and with chatbots. We 64 00:04:47,459 --> 00:04:51,762 will talk about that a bit later , at another time. Basically, 65 00:04:52,021 --> 00:04:56,091 computers follow algorithms and these are patterns of data or 66 00:04:56,310 --> 00:05:01,341 rules of data that data has to follow. This is part and parcel 67 00:05:01,382 --> 00:05:06,211 to the process of how artificial intelligence is able to occur, 68 00:05:07,279 --> 00:05:09,625 if you just keep in mind that when we say artificial 69 00:05:09,685 --> 00:05:15,286 intelligence, we are talking about teaching machines to think 70 00:05:15,286 --> 00:05:18,211 . One of the ways that artificial intelligence has been 71 00:05:18,211 --> 00:05:22,911 very helpful in hospitals and in medicine in general is it 72 00:05:22,971 --> 00:05:27,281 helps all of us in healthcare to improve in our accuracy of 73 00:05:27,341 --> 00:05:33,177 diagnosis. It helps us to improve in our ability to 74 00:05:33,257 --> 00:05:36,865 evaluate medical images, particularly with x-rays, mris, 75 00:05:37,026 --> 00:05:41,846 ultrasounds and CAT scans. It improves our medical decision 76 00:05:41,886 --> 00:05:45,656 making, and this is mainly with a process called clinical 77 00:05:45,716 --> 00:05:49,850 decision support. Whereas a physician, if I have a plan of 78 00:05:50,009 --> 00:05:54,463 action or therapy for a certain patient, and as I have to put 79 00:05:54,504 --> 00:05:58,194 that data into the computer, because all hospitals now are 80 00:05:58,233 --> 00:06:02,360 computer rise based on the Affordable Care Act, obamacare 81 00:06:02,821 --> 00:06:09,235 from 2010. And now what I put into that computer has to be 82 00:06:09,317 --> 00:06:13,444 correct or in alignment, if you will, with what that computer 83 00:06:13,485 --> 00:06:18,360 perceives as quality care. Otherwise it will not allow me 84 00:06:18,459 --> 00:06:23,509 to do that, and that's an extra protective layer, in my judgment 85 00:06:23,509 --> 00:06:29,310 , for quality patient care. And the other part of artificial 86 00:06:29,329 --> 00:06:32,678 intelligence and medicine is predictive analysis, and this 87 00:06:32,899 --> 00:06:38,374 gets a lot into executive management and staffing, nursing 88 00:06:38,374 --> 00:06:42,103 , staffing, position staffing, et cetera, et cetera. But all of 89 00:06:42,103 --> 00:06:46,757 this goes to quality patient care And this, indeed, is what 90 00:06:46,776 --> 00:06:49,584 we're most concerned about. So what are some of the benefits 91 00:06:49,625 --> 00:06:53,884 for patients in surgery? And let me say that when I say 92 00:06:54,386 --> 00:06:57,596 artificial intelligence, robot in surgery, i'm talking about 93 00:06:58,697 --> 00:07:05,728 robots in robot assisted surgery for patients. In other words, 94 00:07:06,129 --> 00:07:10,125 this is surgery that's robot assisted, so it's not just 95 00:07:10,406 --> 00:07:12,935 that's the robot running around in surgery. There are no humans 96 00:07:13,035 --> 00:07:15,100 there. No, no, no, no, no. That's not what I'm talking 97 00:07:15,141 --> 00:07:20,122 about. I'm talking about surgery that is robot assisted or AI 98 00:07:20,223 --> 00:07:23,692 robot assisted, and there's some particular benefits to the 99 00:07:23,733 --> 00:07:27,663 patient, and one of the very obvious benefits to the patient 100 00:07:28,805 --> 00:07:34,839 is that patients have a shorter hospital stay And part of the 101 00:07:34,899 --> 00:07:39,153 reason for that is that the incision in general for these 102 00:07:39,192 --> 00:07:44,603 types of surgeries tend to be smaller And because of the small 103 00:07:44,603 --> 00:07:49,317 incision that decreases the risk of surgical site infection. 104 00:07:49,317 --> 00:07:54,596 It also decreases postoperative pain And many times allows 105 00:07:54,637 --> 00:07:59,951 these patients to recover much faster, and that's just ideal 106 00:07:59,992 --> 00:08:02,437 for a patient And if you've ever been a patient who's had 107 00:08:02,478 --> 00:08:06,466 surgery or had a family or friend or loved, one who had 108 00:08:06,507 --> 00:08:09,800 surgery, then you understand exactly what I'm talking about 109 00:08:10,262 --> 00:08:15,110 And you can appreciate how important it is to have the 110 00:08:15,228 --> 00:08:19,204 procedure done properly but have the patient not stay in the 111 00:08:19,322 --> 00:08:22,946 hospital any longer than they absolutely have to. One of the 112 00:08:22,985 --> 00:08:25,915 things that's important about robotic surgery is that it 113 00:08:25,956 --> 00:08:30,309 completely revolutionized the way operations are done in 114 00:08:30,408 --> 00:08:33,740 general in the operating room. As I mentioned before, i 115 00:08:33,760 --> 00:08:36,934 graduated from Yale Medical School 50 years ago. Matter of 116 00:08:36,955 --> 00:08:42,868 fact, we're celebrating our 50 year anniversary this year, 1973 117 00:08:42,868 --> 00:08:47,701 . And what the traditional surgery is? the surgeon would 118 00:08:47,721 --> 00:08:51,897 stand at the bedside, do the operation and then leave. Well, 119 00:08:51,977 --> 00:08:55,904 with robotic surgery, basically, you do not stand at the bedside 120 00:08:55,904 --> 00:09:02,822 , you sit at a console, computer console, and you do the surgery 121 00:09:02,822 --> 00:09:08,759 indirectly, moving the arms of the computer itself, which is in 122 00:09:08,759 --> 00:09:11,470 direct contact with the patient . I know that might seem a 123 00:09:11,490 --> 00:09:16,365 little confusing, but basically the physician is sitting and not 124 00:09:16,365 --> 00:09:20,357 standing. Now that may not seem like a very big deal, but I can 125 00:09:20,357 --> 00:09:24,091 assure you, during those early days of surgery, certainly in my 126 00:09:24,091 --> 00:09:29,325 career, we used to stand hours in the operating room, and so 127 00:09:29,365 --> 00:09:33,755 that physicality became a significant issue. So now to 128 00:09:33,816 --> 00:09:38,090 have surgery, particularly large operations or long operations, 129 00:09:38,171 --> 00:09:43,020 theoretically, where the physician can sit and merely 130 00:09:43,140 --> 00:09:47,629 work. A console makes it much easier physically for the 131 00:09:47,668 --> 00:09:51,922 surgeon and, in my judgment, provides better quality care for 132 00:09:51,922 --> 00:09:56,298 the patient. What are some other ways that the surgeon is 133 00:09:56,359 --> 00:10:01,072 benefited by this robotic cystic apparatus in the operating room 134 00:10:01,072 --> 00:10:05,322 ? Well, as I mentioned before, it allows a surgeon to do what 135 00:10:05,341 --> 00:10:10,017 we call a minimally invasive surgery instead of making the 136 00:10:10,096 --> 00:10:13,905 long incisions. And all of this takes time The long incision, 137 00:10:13,926 --> 00:10:20,004 more blood loss, more OR time because you have to close that 138 00:10:20,063 --> 00:10:26,323 long incision and clearly makes it much easier for the patient 139 00:10:26,364 --> 00:10:30,759 not to have that long incision. Number one Secondly, as I 140 00:10:30,820 --> 00:10:33,928 mentioned, the surgeon is sitting as compared to standing 141 00:10:34,009 --> 00:10:37,839 long hours in the operating room A huge change in the 142 00:10:37,879 --> 00:10:41,004 traditional way that surgery is being done. Now, every single 143 00:10:41,085 --> 00:10:44,678 operation one does not use the robot, but I think it's fair to 144 00:10:44,739 --> 00:10:50,399 say that the robot-assisted surgery is probably used in most 145 00:10:50,399 --> 00:10:55,413 operations and the usage of the robots in surgery is continuing 146 00:10:55,413 --> 00:11:01,404 to grow. And thirdly, one of the benefits is the robot itself 147 00:11:01,404 --> 00:11:05,999 has a certain type of mechanical dexterity that allows 148 00:11:05,999 --> 00:11:11,495 the surgeon to manipulate the robot in ways that it would be 149 00:11:11,629 --> 00:11:15,701 very difficult for the surgeon to physically use their hand. I 150 00:11:15,740 --> 00:11:18,505 know that sounds a little complicated, but the bottom line 151 00:11:18,505 --> 00:11:22,975 is the robot is more flexible in many more different ways, 152 00:11:23,515 --> 00:11:28,615 which ends up making the surgery more efficient and safer. So 153 00:11:28,655 --> 00:11:32,785 another huge benefit for the robots in robot-assisted surgery 154 00:11:32,785 --> 00:11:36,159 in our operating rooms. What are some of the types of surgery 155 00:11:36,159 --> 00:11:40,758 that robots are used on? Well, pretty much most major types of 156 00:11:40,817 --> 00:11:44,677 surgery prostate surgery, general surgery, gynecological 157 00:11:44,736 --> 00:11:48,730 surgery, heart surgery and again , the usage is continuing to 158 00:11:48,830 --> 00:11:52,966 increase over time. What are some of the main advantages to 159 00:11:52,985 --> 00:11:56,619 the hospital for the robot? Remember what I said when I get 160 00:11:56,698 --> 00:12:01,655 to advantages for the hospital. We're just about done. One of 161 00:12:01,676 --> 00:12:07,356 the huge advantages for the hospital is financial. Because 162 00:12:07,418 --> 00:12:12,293 of robots in the hospital or artificial intelligent robots in 163 00:12:12,293 --> 00:12:15,761 the hospital, hospitals have been able to increase their 164 00:12:15,822 --> 00:12:20,019 revenue stream over $100 billion , and at the very top of that 165 00:12:20,099 --> 00:12:24,177 list is robot-assisted surgery. Basically, most hospitals 166 00:12:24,278 --> 00:12:27,825 increase revenue based on procedures as compared to 167 00:12:27,926 --> 00:12:32,443 medication or number of days patients stay in the hospital. 168 00:12:32,875 --> 00:12:38,163 So anything that increases the efficiency and volume of 169 00:12:38,222 --> 00:12:42,875 procedures tends to increase revenue for the hospitals, and 170 00:12:42,894 --> 00:12:47,538 this is exactly what robot-assisted surgery does, and 171 00:12:47,538 --> 00:12:51,576 so it ends up being win-win theoretically. In summary, 172 00:12:52,197 --> 00:12:56,197 artificial intelligence is not the future, it is now, and this 173 00:12:56,277 --> 00:12:59,317 is certainly true in healthcare. Artificial intelligence is 174 00:12:59,357 --> 00:13:03,868 defined as computer learning or non-human learning, if you will. 175 00:13:03,868 --> 00:13:08,844 Doctors like robots in surgery because surgery, physically and 176 00:13:08,923 --> 00:13:13,980 technically, is easier. Patients like robots in surgery or in 177 00:13:15,563 --> 00:13:19,836 robot-assisted surgery because it decreases pain, it decreases 178 00:13:19,937 --> 00:13:25,878 recovery time and it decreases hospital stay. Hospitals like 179 00:13:25,998 --> 00:13:29,988 robots assisting in surgery because it increases revenue. 180 00:13:30,554 --> 00:13:35,164 And remember, robots have been in surgery for 15 years, not 181 00:13:35,205 --> 00:13:40,120 just this year or last year, but their usage is growing and the 182 00:13:40,220 --> 00:13:43,826 number of types of surgery that they're being used on and the 183 00:13:43,905 --> 00:13:49,859 volume is significantly increasing. My basic principles 184 00:13:50,581 --> 00:13:54,519 God is in charge. I am a physician of faith and it is, 185 00:13:54,600 --> 00:13:59,028 indeed has been, my faith in God that has sustained me over the 186 00:13:59,107 --> 00:14:03,446 years. I have no bad days. I'm one of those people who believes 187 00:14:03,446 --> 00:14:05,857 that they've had enough bad days, so I decided a number of 188 00:14:05,918 --> 00:14:09,366 years ago that I would not have any more bad days, and so I do 189 00:14:09,427 --> 00:14:14,457 not. I have good days and I have great days. I have learned that 190 00:14:14,457 --> 00:14:17,966 don't sweat the small stuff, and most stuff is small. 191 00:14:18,975 --> 00:14:21,984 Consequently, i don't worry about little things at least I 192 00:14:22,024 --> 00:14:27,078 try not to And I found that that keeps me stress free, or at 193 00:14:27,139 --> 00:14:30,782 least minimally stressed, and allows me to have a more 194 00:14:30,822 --> 00:14:35,928 fruitful and a more happy and happier day. Forgiveness is 195 00:14:36,210 --> 00:14:39,211 therapy. If there are things that individuals and 196 00:14:39,272 --> 00:14:44,547 circumstances have done to you, forgive them And you would be 197 00:14:44,607 --> 00:14:48,270 amazed how therapeutic it is, regardless of who's right or 198 00:14:48,291 --> 00:14:53,326 wrong or regardless of what the issues are just forgive, and 199 00:14:53,346 --> 00:14:56,809 that, indeed, is therapeutic. And finally, my final basic 200 00:14:56,850 --> 00:14:59,927 principle is that everything is relationship. Relationships are 201 00:14:59,967 --> 00:15:03,431 based on three things Mutual respect, mutual trust, good 202 00:15:03,471 --> 00:15:06,966 communication. If you have all three of those things, you have 203 00:15:07,006 --> 00:15:10,288 a very good relationship, whether it is a work 204 00:15:10,328 --> 00:15:14,827 relationship, a family relationship, a good friend 205 00:15:14,868 --> 00:15:19,908 relationship. And if you have a good relationship, then chances 206 00:15:20,048 --> 00:15:24,210 are you are happier in your life . In spite of issues always 207 00:15:24,269 --> 00:15:27,909 associated with surgery, and regardless of the operation and 208 00:15:27,970 --> 00:15:34,395 regardless of how new the technique is or the associated 209 00:15:34,456 --> 00:15:38,385 equipment, be it a robot or something else, surgery is still 210 00:15:38,385 --> 00:15:45,330 a very, very dangerous area And I think it's important to 211 00:15:45,389 --> 00:15:50,347 understand that, as patients, you have rights, and we've gone 212 00:15:50,388 --> 00:15:55,211 over this before, but let me go over them again that, regardless 213 00:15:55,211 --> 00:15:59,610 of what type of technique is used, so who the position is or 214 00:15:59,750 --> 00:16:05,905 is not, all patients who are to have any type of operation need 215 00:16:05,926 --> 00:16:10,427 to have been given what we call informed consent. Those two 216 00:16:10,506 --> 00:16:13,908 words informed means that you should be given sufficient 217 00:16:13,989 --> 00:16:19,714 information in a way that you understand it, so that the 218 00:16:19,774 --> 00:16:24,293 second word consent you can consent or agree to the 219 00:16:24,332 --> 00:16:29,554 procedure, and this is particularly true with invasive 220 00:16:29,595 --> 00:16:35,208 procedures or the larger the procedure is. And the informed 221 00:16:35,229 --> 00:16:38,330 consent is very specific, regardless of what state you're 222 00:16:38,471 --> 00:16:42,894 in. It's very specific and it has to cover three particular 223 00:16:43,014 --> 00:16:49,807 elements, and those elements are risk benefits and alternative 224 00:16:49,847 --> 00:16:55,625 treatment. Risk benefits and alternative treatment What are 225 00:16:55,645 --> 00:17:00,370 the risks of the procedure? And the physician and or the 226 00:17:00,410 --> 00:17:05,498 proceduralist be it the surgeon or the anesthesiologist or nurse 227 00:17:05,498 --> 00:17:10,990 anesthetist should give you specifics about what those risks 228 00:17:10,990 --> 00:17:15,546 are, because, again, you want to be informed enough so that 229 00:17:15,605 --> 00:17:18,905 you can then make a decision about whether this is an 230 00:17:18,925 --> 00:17:22,108 appropriate operation for you. I would encourage you to have 231 00:17:22,190 --> 00:17:24,928 family and or close friends with you. If you don't feel 232 00:17:24,988 --> 00:17:29,570 comfortable making these decisions completely by yourself 233 00:17:29,570 --> 00:17:33,728 , there's absolutely nothing wrong with that. But you want to 234 00:17:33,728 --> 00:17:37,309 be sure before you agree, because at the end of this 235 00:17:37,410 --> 00:17:42,013 process they're going to have you sign a form that says that 236 00:17:42,094 --> 00:17:45,645 you agree, that you've got sufficient information so that 237 00:17:45,686 --> 00:17:50,666 you can agree If English is not your first language, and even 238 00:17:50,727 --> 00:17:54,169 though the doctor or the nurse or whoever was the physician or 239 00:17:54,189 --> 00:17:57,028 whoever's going to do the procedure is talking to you and 240 00:17:57,087 --> 00:18:02,049 you think you don't understand everything. It's OK to say that. 241 00:18:02,049 --> 00:18:05,244 It's OK to say well, you know, my English is the best And I 242 00:18:05,286 --> 00:18:08,145 think I understand, but I don't understand. Blah, blah, blah, 243 00:18:08,165 --> 00:18:12,625 blah, blah, blah. A lot of times , because informed consensus are 244 00:18:12,625 --> 00:18:16,527 done on every single day, many times a day. The individuals 245 00:18:16,607 --> 00:18:22,832 given them tend to go very fast And it's important, because this 246 00:18:22,832 --> 00:18:27,612 is new for you as a patient, to slow them down and to say no, 247 00:18:27,652 --> 00:18:32,207 you need to go over that again. Explain it to me. If, again, 248 00:18:32,769 --> 00:18:35,367 english is not your first language, but you speak English 249 00:18:35,409 --> 00:18:39,632 and you speak it very well, it is within your right to say I 250 00:18:40,012 --> 00:18:45,115 want someone who speaks Tagalog to come and explain this to me, 251 00:18:46,847 --> 00:18:50,066 or this form that you've asked me to sign is in English And I 252 00:18:50,086 --> 00:18:53,749 don't understand all these words . And I want someone who speaks 253 00:18:54,230 --> 00:19:00,250 Mandarin or Cantonese or Spanish to come and explain this to me, 254 00:19:00,250 --> 00:19:03,866 because I don't really understand. Most hospitals and 255 00:19:03,946 --> 00:19:10,172 organizations will not allow patients to use extensively 256 00:19:10,251 --> 00:19:14,413 their family members to interpret medical information, 257 00:19:15,765 --> 00:19:20,405 and if that indeed is the case, you have a right to say I want 258 00:19:20,425 --> 00:19:24,387 to have someone who can talk to me in my language. If I am 259 00:19:24,468 --> 00:19:28,107 Russian or Ukrainian, i want someone who can talk to me in my 260 00:19:28,107 --> 00:19:31,989 language so that I can make sure that I fully understand 261 00:19:32,431 --> 00:19:37,008 what it is that you're going to do to me. Another thing that's 262 00:19:37,067 --> 00:19:40,509 important to understand about informed consent that when you 263 00:19:40,569 --> 00:19:44,873 have surgery, there are basically two different areas of 264 00:19:44,873 --> 00:19:48,525 medicine or health care that are taking care of you. I'm 265 00:19:48,545 --> 00:19:51,892 talking about physician. Now There's a surgeon, obviously, 266 00:19:51,951 --> 00:19:53,229 who's going to do the operation. 267 00:19:53,650 --> 00:19:54,794 Speaker 1: Whoever, he or she is . 268 00:19:55,224 --> 00:19:57,612 Speaker 2: But there's also another department called 269 00:19:57,772 --> 00:20:01,853 anesthesiologist. So there's an anesthesiologist, whoever he or 270 00:20:01,913 --> 00:20:06,634 she is, both of them are required to give you written 271 00:20:07,155 --> 00:20:12,497 information verbal and written information about what you're 272 00:20:12,545 --> 00:20:16,027 going to have to go through to have this operation. The surgeon 273 00:20:16,027 --> 00:20:21,348 is required to explain the human details, risk benefits, an 274 00:20:21,348 --> 00:20:25,385 alternative treatment about the surgery. The anesthesiologist 275 00:20:25,846 --> 00:20:30,553 is required to explain the human detail, risk benefits and 276 00:20:30,613 --> 00:20:34,748 alternative treatment before you have anesthesia. Now, if you're 277 00:20:34,748 --> 00:20:38,415 having a local anesthesia, then those risks may very well be 278 00:20:38,477 --> 00:20:43,814 small, but regardless, both are required to get consent from you 279 00:20:43,814 --> 00:20:49,387 or informed consent from you. And again, the informed part 280 00:20:49,468 --> 00:20:54,021 means that they need to give you information sufficient from 281 00:20:54,102 --> 00:20:56,470 your perspective not their perspective from your 282 00:20:56,490 --> 00:21:01,453 perspective that you can indeed consent and say okay, i 283 00:21:01,647 --> 00:21:06,093 understand and I agree to go ahead and let you put me to 284 00:21:06,133 --> 00:21:09,684 sleep for an hour or two hours or five hours or whatever the 285 00:21:09,724 --> 00:21:14,799 time may be. And the reason for that is, i like to say, that 286 00:21:14,840 --> 00:21:18,611 there's always a possibility of complications, there are always 287 00:21:18,671 --> 00:21:25,300 a possibility of issues, and it's not 100%, 100% of the time. 288 00:21:25,300 --> 00:21:29,997 And so you need to be aware so that you can make decisions and 289 00:21:30,057 --> 00:21:34,490 have family or friends advise us , help you make decisions about 290 00:21:34,630 --> 00:21:38,896 whether you really want to have this procedure done at this time 291 00:21:38,896 --> 00:21:45,333 . Most of the times, patients will have those procedures done 292 00:21:45,393 --> 00:21:50,182 because the whole thing that brought you to the physician is 293 00:21:50,262 --> 00:21:55,499 something significant enough that you want to be healed or 294 00:21:55,538 --> 00:22:00,232 have this whole issue resolved. But don't feel rushed, and I 295 00:22:00,292 --> 00:22:08,003 know that's hard to fathom but you have rights and feel good 296 00:22:08,044 --> 00:22:11,839 and feel free to exercise your rights, because those rights are 297 00:22:11,839 --> 00:22:15,712 designed to protect you and to make sure that you get the very 298 00:22:15,792 --> 00:22:20,008 best care possible. So remember that there are two elements of 299 00:22:20,087 --> 00:22:23,656 an operation. There's a surgical element physician there's the 300 00:22:23,757 --> 00:22:29,499 anesthesia element physician and or nurse practitioner Okay, and 301 00:22:29,499 --> 00:22:32,709 so make sure, feel comfortable asking questions, i guess is 302 00:22:32,729 --> 00:22:35,339 what I'm trying to say Now. I understand that's a challenge. 303 00:22:35,421 --> 00:22:37,730 I've been again, i've been in a position over 50 years and I 304 00:22:37,810 --> 00:22:40,838 know that most of you will basically do whatever we 305 00:22:40,878 --> 00:22:44,960 physicians ask you to do because you trust us and you respect us 306 00:22:44,960 --> 00:22:47,210 , et cetera, et cetera. Nothing wrong with that, that's 307 00:22:47,289 --> 00:22:51,182 completely appropriate. But you can also ask questions. Or it's 308 00:22:51,383 --> 00:22:55,453 also okay to say I do not understand, and there's nothing 309 00:22:55,534 --> 00:22:59,903 wrong with that. Just say I do not understand, i need more 310 00:22:59,942 --> 00:23:04,381 information, i need more time. Whatever those words are, i do 311 00:23:04,442 --> 00:23:08,112 not feel, rushed, unless it's a life-threatening operation and 312 00:23:08,132 --> 00:23:10,939 the decision has been made immediately. But if it's an 313 00:23:11,019 --> 00:23:15,336 elective operation, meaning that it is not life-threatening and 314 00:23:15,356 --> 00:23:19,813 it does not have to be done immediately, then feel free to. 315 00:23:19,973 --> 00:23:23,040 And even if it is an enema risk operation, you still ask the 316 00:23:23,080 --> 00:23:26,635 questions. But certainly if it's an elective operation, feel 317 00:23:26,655 --> 00:23:29,971 free to ask those questions. What are the risks of this 318 00:23:30,112 --> 00:23:34,606 operation, what are the benefits of this operation And what are 319 00:23:34,626 --> 00:23:38,917 the alternatives of me not having this operation? And those 320 00:23:38,917 --> 00:23:41,892 three elements have to be discussed with you. They have to 321 00:23:41,892 --> 00:23:46,787 be in writing and you have to sign it to say that you have an 322 00:23:46,807 --> 00:23:51,218 agreement. So before you sign anything, make sure that you're 323 00:23:51,258 --> 00:23:57,009 comfortable as best as you can be and you have received that 324 00:23:57,130 --> 00:24:00,958 information. Well, what are some of the risks for, say, robotic 325 00:24:00,998 --> 00:24:05,855 assisted surgery? Basically, most of the literature suggests 326 00:24:05,875 --> 00:24:10,009 that robotic assisted surgery does not add a great deal to the 327 00:24:10,009 --> 00:24:13,321 basic risks of any type of operation, and surgery is risky 328 00:24:14,104 --> 00:24:17,395 and usually depends on the operation you're having, what 329 00:24:17,455 --> 00:24:21,048 your condition is prior to the surgery. But there are some 330 00:24:21,087 --> 00:24:24,355 things that may be relatively unique with using the robot, 331 00:24:24,936 --> 00:24:28,471 patients in very unique positions, sometimes during the 332 00:24:28,510 --> 00:24:37,002 time of the robotic surgery they may be turned certain ways, and 333 00:24:37,002 --> 00:24:41,201 so that can be issues that have to do with peripheral nerve 334 00:24:41,643 --> 00:24:44,491 damage, and so you want to make sure that appropriate patients 335 00:24:44,571 --> 00:24:47,278 all know this, as you're an anesthesiologist. But again, 336 00:24:47,940 --> 00:24:50,615 there's nothing wrong with you knowing that information, also 337 00:24:51,376 --> 00:24:54,929 that there has to be appropriate padding to make sure that 338 00:24:54,969 --> 00:25:01,282 there's no nerve discomfort or damage after the operation. 339 00:25:01,884 --> 00:25:04,711 Sometimes you may be in a certain position doing surgery 340 00:25:04,751 --> 00:25:09,247 for a long period of time, and so you want to make sure that's 341 00:25:09,287 --> 00:25:12,865 the case. Anesthesiologists particularly make sure that the 342 00:25:13,047 --> 00:25:16,842 eyes are closed, unless it's an eye surgery, obviously And 343 00:25:17,022 --> 00:25:20,682 frequently they will change the eyes, because a lot of times 344 00:25:20,722 --> 00:25:23,394 when we close our eyes, even when we're asleep, we may not 345 00:25:23,434 --> 00:25:26,824 close the lid completely, And so if you can see any part of the 346 00:25:28,247 --> 00:25:35,162 eye that's open between the lids , that area could be damaged in 347 00:25:35,201 --> 00:25:40,402 terms of having it scratched or injured somehow. So usually good 348 00:25:40,402 --> 00:25:45,039 anesthesiologists and anesthesiologists know this They 349 00:25:45,039 --> 00:25:49,723 will cover the eyes and tape them. But again, just like the 350 00:25:49,763 --> 00:25:53,835 surgeon, the anesthesiologist has to give you informed consent 351 00:25:53,835 --> 00:25:58,480 . Informed consent, they have to say hi, i'm Dr So-and-so, i'm 352 00:25:58,500 --> 00:26:02,105 going to be providing anesthesia for you. Dr Blah-blah-blah is 353 00:26:02,125 --> 00:26:05,099 going to do the surgery, i'm going to do the anesthesia. Do 354 00:26:05,140 --> 00:26:09,229 you have any questions after they go through the litany of 355 00:26:09,308 --> 00:26:13,969 information to talk to you about ? And it's important again for 356 00:26:13,989 --> 00:26:17,059 you to be aware of that and for you to ask the appropriate 357 00:26:17,160 --> 00:26:22,269 questions that you may need to ask to make sure that everything 358 00:26:22,269 --> 00:26:28,248 goes well with your operation. Now, again, the procedure itself 359 00:26:28,248 --> 00:26:32,326 is going to have brisk And the surgeon should go over those 360 00:26:32,386 --> 00:26:36,279 risks with you. But anesthesia will also have brisk And so the 361 00:26:36,361 --> 00:26:42,550 anesthesiologist is required by law and by ethics to go over 362 00:26:42,590 --> 00:26:47,527 those risks with you. And if you are in any way uncomfortable, 363 00:26:48,348 --> 00:26:52,306 it is OK to get second opinions, say, well, you know, i need to 364 00:26:52,346 --> 00:26:56,387 talk to So-and-so, that's OK, unless it's a life-threatening 365 00:26:56,428 --> 00:26:59,865 situation. And again, you still have the right to consent if you 366 00:26:59,865 --> 00:27:05,582 are alert, awake and can give consent to that being done. So 367 00:27:05,602 --> 00:27:09,544 please keep that in mind. So most of the complications 368 00:27:09,564 --> 00:27:15,201 associated with robotic-assisted surgery tend to be those things 369 00:27:15,201 --> 00:27:17,644 that are associated with positioning of the patient 370 00:27:18,406 --> 00:27:24,746 during the time of the operation And they tend to fall into the 371 00:27:24,846 --> 00:27:28,163 area of the anesthesiologist And again, depending on the surgery 372 00:27:28,163 --> 00:27:31,291 , because the surgeons themselves position patients, 373 00:27:31,941 --> 00:27:36,460 certainly in orthopedics and other types of procedures, and 374 00:27:36,480 --> 00:27:40,587 so both have a dual responsibility there to make 375 00:27:40,628 --> 00:27:46,866 sure that everything occurs. Ok, again, there's no question that 376 00:27:46,866 --> 00:27:53,359 there are benefits to robotic-assisted surgery, but, 377 00:27:53,460 --> 00:27:57,222 like with any type of surgery, there are always risks, 378 00:27:57,242 --> 00:28:01,342 certainly if you're going to be asleep, and it's important that 379 00:28:01,942 --> 00:28:07,472 those risks be explained to you in the form of verbally and in 380 00:28:07,553 --> 00:28:12,548 writing, and in a language and in a way using words that you 381 00:28:12,608 --> 00:28:16,746 can understand. They cannot be using big words that make no 382 00:28:16,786 --> 00:28:19,102 sense to you, because you're not a physician and may not be 383 00:28:19,162 --> 00:28:23,561 medically inclined. That is not your responsibility. That is the 384 00:28:23,561 --> 00:28:27,500 physicians and the healthcare team's responsibility. So feel 385 00:28:27,561 --> 00:28:31,583 free to search your rights And, if you're uncomfortable, bring a 386 00:28:31,583 --> 00:28:35,854 friend or somebody with you who will do that for you. That's OK 387 00:28:35,854 --> 00:28:39,391 , because one of the things that has occurred in the area of 388 00:28:39,751 --> 00:28:44,286 Obamacare 2010 Affordable Care Act is that healthcare is now 389 00:28:44,365 --> 00:28:48,622 patient-centered. It is patient-centered And that means 390 00:28:48,642 --> 00:28:51,890 that you're the patient, the most important person in the 391 00:28:51,931 --> 00:28:57,150 room, and so you're well within your rights to a searcher of 392 00:28:57,250 --> 00:29:01,450 rights And if there's any pushback, small or large, 393 00:29:02,251 --> 00:29:05,201 rethink whether you want to have these individuals take care of 394 00:29:05,281 --> 00:29:09,461 you, if indeed you have that option at the time. And my final 395 00:29:09,461 --> 00:29:13,540 thought be the change you want to see in the world. Be the 396 00:29:13,580 --> 00:29:17,083 change you want to see in the world. Thank you so much for 397 00:29:17,123 --> 00:29:20,340 spending your valuable time with us. Have a great day.