119. Daniel Brotman, Academic Hospitalist

Show Notes:

Daniel Brotman shares his journey from undergrad to medical school. After finishing a year of research in Boston, he decided to work for a year before applying for medical school. He had already taken the MCATs and taught Stanley Kaplan during his year off. He also worked in the lab at Brigham and Women's Hospital.

Music and Circadian Rhythm 

Daniel talks about his love of music. He considered himself a better musician than singer, and he loved playing piano. He has a 1930 Steinway piano and plays piano karaoke for fun. He has been participating in a music group at Harvard and has heard about other Harvard alums joining similar groups. From music the conversation turns to circadian rhythms, which are rhythms that cycle through the body based on the action of the circadian pacemaker. Circadian rhythms are synchronized to the 24-hour day based on visual stimuli, such as light coming into the suprachiasmatic nucleus of the hypothalamus.

Internal Medicine and Finding Work/Life Balance 

Daniel was accepted to medical school after his year of research. He started at the University of Virginia and found it to be a beautiful, traditional place. He initially didn't want to do internal medicine but discovered his passion for it at the end of his third year. He married his first wife, Edith, while in medical school. Daniel graduated from medical school and went on to become a hospitalist at the Cleveland Clinic. He chose to practice inpatient medicine due to his love for it and the intense work required for his family. Hospital medicine was a new field at the time, and Daniel's career began there.

Working as a Hospitalist

Daniel explains that being a hospitalist means practicing in the hospital rather than having an outpatient practice. Patients often come in through the emergency room and need an inpatient doctor to help them through their acute illness. Daniel's role is also as a consultant to help surgeons care for their patients who have medical issues or help other disciplines help care for their patients who have medical issues. Hospital Medicine is defined by the site of practice being in the hospital, similar to an emergency room medicine doctor practicing in the emergency department. After leaving the Cleveland Clinic, Daniel returned to Hopkins, where he started the Hospitalist program.  He learned that humility is essential in healthcare, as taking care of patients alone doesn't make for a good team. He also learned that medicine quickly gets out of date, with many concepts still valid but some completely turned on their heads. Overall, his experiences and lessons learned over the years have helped him become a more effective and compassionate healthcare professional.

The Goldilocks Phenomenon

Daniel Brotman discusses the importance of humility in healthcare, particularly in the context of medical knowledge and practices changing. He gives the example of beta blockers and heart failure treatment. He explains that beta blockers can drive patients into congestive heart failure by reducing their heart pumping activity, which is crucial for patients with weak heart muscles. However, studies have shown that beta blockers can be beneficial for those with weaker heart muscles. Daniel discusses the Goldilocks phenomenon, where doctors should not just jump on the latest research from journals but also not gravitate towards every new strategy published in medical literature. This can lead to side effects or challenges with the effectiveness of new drugs. He suggests that doctors should not rely solely on society's guidelines, as they may not always be updated over time. Instead, they should look for guidelines synthesized by knowledgeable professionals who have considered all issues and come up with a synthesis that makes sense. He also discusses the importance of humility in healthcare, stating that it is essential to rely on the expertise of colleagues and the entire team rather than oneself.

AI in Healthcare

The conversation turns to AI in healthcare such as Bridge, which listens to doctor conversations and creates notes based on them. While Bridge is effective in some cases, it struggles to put things fully in context. For example, it might report that the patient denies edema, which is not what it intended to convey. Despite this, it can create a note without looking at anything. However, there are potential areas where AI can make errors, which doctors should be aware of.  And it cannot provide a diagnosis. Doctors should be cautious when using AI tools, as the consequences of not double-checking their work can be significant. AI is expected to be beneficial in making recommendations for treatment strategies, but it should not replace doctors' work. 

Directing the Hospitalists Program at John Hopkins

Daniel has been directing the Hospitalist program for almost 20 years. He has since become a full professor and has an endowed chair named after John Flynn, a mentor and resident. He enjoys helping junior hospitalists navigate their career paths, which can be diverse and include research, quality improvement, or patient care. He has a great team of doctors to work with and mentor. One of the biggest challenges of leading a group of 50 hospitalists is delegation. Brotman has worked on developing ways to trust junior leaders and structure supervision in a way that maintains quality control. He has also learned to provide feedback to junior leaders, as they are high-performing and smart. Another challenge in leadership is trying to harmonize the economics of their work with clinical outcomes or academic outcomes. Many doctors feel pressure to be productive, which can negatively impact patient care. 

Influential Harvard Professors and Courses

Daniel discusses his experiences at Harvard, including his involvement in research and coursework in circadian rhythms with professors, which he found to be a significant part of his junior and senior year. He also mentions his passion for science and his focus on mastering content to pass tests. His interests have expanded since then, and he still enjoys reading non-fiction books and entertaining activities. He also enjoys skiing, although he was not very good on the ski team in his freshman year.

Timestamps:

00:02: Dan's Journey from Harvard to Medical School 

03:36: Understanding Circadian Rhythms 

06:00: Medical School and Early Career 

08:40: Hospitalist Career and Lessons Learned

22:26: AI in Medicine and Leadership Challenges

32:43: Personal Reflections and Broader Interests 

37:19: Final Thoughts and Contact Information 

Links:

John Hopkins website: https://www.hopkinsmedicine.org/som/

Email: [email protected]

Featured Non-profit

This episode’s featured non-profit is Innovations for Poverty Action (IPA) recommended by Colin Teichholtz who reports:

“Hi. I'm Colin Teichholtz, class of 1992 the featured nonprofit of this episode of The 92 report is Innovations for Poverty Action, or IPA. IPA discovers and advances what works to improve the lives of people living in poverty around the world. IPA has country offices throughout Africa, Asia, Latin America and the Caribbean. IPA is all about more evidence and less poverty. I've personally been a supporter of IPA for over a decade, and as of earlier this year, I'm honored to have the opportunity to serve as a member of the board. You can learn more about IPAs work at poverty, dash, action.org, and now here is Will Bachman with this week's episode.”

To learn more about their work visit: https://poverty-action.org/