AI, Chatbots, and the New Age of Men’s Health: The Future of the Exam Room

25:26What is informatics? I mean, just back up that a little. It sounds like a made-up word. There's information and there's automatics. Infographics. Yes. Infotainment. Exactly right. Yeah, exactly. So edutainment. I think that's what this is, is edutainment. Yes, edutainment. Edutain is, Dr. Denise. Edutain is about informatics. I, I, I, is that sort of the entire field or is that, you know, walk me through what, what, I mean, again, that's where I get to like, what do you, what are you thinking about? You know, when you're not taking care of patients and when you're not operating on guys and you're not doing everything else that you're doing, what are you thinking about?

26:09You know, what are you working on in this space that you're going to define for me here? Yeah. Well, you know me, I'm thinking about just changing the world and, you know. Always for the better. Always for the better and how we can leverage systems already in place to do that. Informatics is just how it sounds. It's like the science of information. So it's a science around storing, obtaining information, sorting information. And when you think about it in a health system setting, it's thinking about all this data that we are taking in. And it's not just patient level information, right? It's looking at like policies that govern these systems that we work in.

26:46It's the policies that govern what hospitals are able to do. So there's a lot of different levels of information that we are constantly storing and organizing. But I think what most people think about first is, oh, it's all patient information. There's so much information coming into us on a patient level, but on a system level. And the beauty of informatics is thinking about how are we integrating these systems to actually work better together. So when you think about information systems for, let's say, patient information, that still has to talk to another system that's also giving the health system information.

27:25Nowadays, and really for as long as informatics has really been a field, this also requires interdisciplinary work, right? So when you think about information, every hospital will have their IT team. And I think most people think informatics people are just like information technology, but that's actually just one aspect of it, right? in terms of how we are organizing, storing, and staying within policy. But it's literally the science of information. But in the health system, it's how we are leveraging these different information systems to actually keep the machine going. Does that make sense?

27:59It makes perfect sense. Yeah. So then how do you harness that? How are you going to change the world? Talk to me about some research, some things you're working on that people can look forward to? Because I guess what I want to know is, you know, it's such a rapidly evolving field. Where do you see your practice, not your practice, I guess, a practice of medicine, because you're obviously at the forefront, you know, two years from now and five years from now in terms of the patient experience and, you know, what's your role in that? Yeah. So I think even thinking on first, like the health system level, right, I still think back to access, like we don't do globally good enough of a job of figuring out like the optimal ways for people to still engage and get into the health system.

28:42And now with so many more people needing to get into the health system, we just have to make that more efficient. So whether it's the chatbot that can help someone triage, even what doctor to go and see, right? Like how oftentimes do people just get to us and it's like, I'm meant to see a neurologist or, you know, or just all of these things. And so even just helping people to figure out where to go. And then once they are in the system. I don't know about you, but even when I have a basic medical issue, I literally think about like, I'm a whole physician and it still is so much work to, you know, the teams I have to work with, the follow-ups, the phone calls.

29:19How can we make parts of the, even making an appointment easier for a patient, the right appointment, the right doctor, the right time. And so I think because I care about access, as I know you do, I'm constantly thinking about why aren't these systems optimized to just make it easier for people. And when we get information like patient experience polls and things like that, what are we actually, how are we tapping into that data to actually then pour into enhancing, you know, the experience. So I think on a hospital level, I really envision continuing to work in that space where we can optimize access.

29:54And even though I'm starting in the lens of urology, I think globally, there's a lot of issues with just getting patients to the right people at the right time. And we now have the ability, the capability of empowering patients to utilize these systems to actually, you know, get there. So is that an app? I mean, so the deliverable would be somebody that has maybe less access to care, maybe on public health insurance, that's somewhere in, you know, a lower socioeconomic part of Los Angeles or Chicago has an app on their phone where they say, I have a sore throat, or they click. And then not only do they get, okay, well, you know, do you have a fever?

30:35Do you get the chatbot starting? At the end of that, there's like, hey, there's a doctor, you know, two blocks away that has a 615 appointment. I mean, is that kind of the holy grail of, because even in my busy practice, where we have a wait list of sometimes months to at least eight months sometimes to see me, I still have pockets in the day, you know, where I'm telling jokes and boring my staff with my stories, right? That, that if somebody was walking two blocks away and said, huh, gosh, it sure'd be nice if I could get my erectile dysfunction taken care of and all of a sudden, you know, snap.

31:10Is that, is that a reasonable thing that could happen in the next couple of years? Absolutely. And you hit it right on the head. You know, I think we're thinking about the system of efficiency. How oftentimes do we have blocks of time that are like, you know, underutilized. And, you know, we could actually be getting that patient who otherwise is waiting eight months, but even better. So the patient who actually should be seeing you is getting to you, you know, at the right time. And so I think now, and this is actually a place where our system is working toward, but now there are even embedded chatbots within the EMR.

31:42And where we're trying to get to is that patients can actually have these conversations in the EMR to accelerate systems like, okay, I can make my appointment and I can find this specific person. We are already there. And it's funny, it's a catch-22 because like you said, we sometimes do like having maybe an extra 15 minutes there where we can have a breather. So I think some of the adoption issues, even with our own colleagues, is around, well, is now this system going to make sure every minute of my day on the clock is accounted for as a hospital head. Like, yes, that's what they want, right?

32:18They want to make sure that you are being used as efficiently as possible. But then does that contribute to burnout? If now these pockets that we've been used to leveraging to build in our own rest are now being tapped into to do even more work. And so it's still this push pull I find within the system, but on the patient side, it is actually going to really enhance patient care and access. Okay, so I told you this years ago when we met that I have a feeling that you're going to be my boss someday. You're already on more advisory boards and more national boards than I am in my career from the AUA through SMS and ASRM.

32:56So someday you're going to be, I'm going to make up your job title, say seven, eight, ten years from now, you're going to be chief informaticist for HHS. So what is your blueprint? Like how do we get from where we are now? What structural changes do we need? Where do we need to spend the money to save money? Because a lot of what you're saying is if we do this more efficiently, you know, just like we say in the OR that time is money, because every minute in an operating room in the United States is somewhere around 300 to$400 a minute. So if we can figure out how to turn a room over faster, we can see more people take care of more people and become efficient.

33:30And I feel like there's so much, I hate to say the terms these days, waste, fraud and abuse, but at least waste and abuse in the health system that we could get better, right? And so what do you need when I nominate you for chief informaticist of HHS? Tell me what that looks like. Well, that's so kind of you, Dr. Mills. I think that, you know, the first thing really simply enough is actually education. You know, I think even though there's all these awesome systems and things in place even now that we could leverage even more, the fact is most people still do not trust the system. And I think that when, and this is not even just physicians, even just patients, right?

34:08And so I still think there's a lot of education that needs to happen. Interestingly, even though a lot of people now are using like, you know, AI in their daily lives, right, to come to my office and give me their own diagnosis and other things, when you then contextualize it around like their, you know, like healthcare, like you using it, it takes on a different tone. You know, now with medical legal issues around like, was that really like your, you know, diagnosis and synthesis or was that an AI chatbots? Like those are things that are getting tricky. But I think the first part of this foundation is I think widespread education and reassurance around privacy.

34:45We are still not where most other parts of the world are around just protecting people's privacy and data. If you go to Europe right now, Europe, China, they've been ahead of the curve when it comes to setting up these privacy practices in place. And I would say our government now is actually, I'd say, quite supportive of AI. You know, I think that this kind of ebbs and flows for people, but I do think that people just need education reassurance. And I think after that, we also have to think about just organizing our data, right? So back to informatics, we have a lot of information out there. But how useful is it if we can't actually tap into it and do anything with it?

35:23And I think this is where health systems and these entities have to talk to each other, because right now, the way I'm collecting information may be different than the way you're collecting information. and we can't actually figure out patterns and other ways to tap into it if we're collecting it differently. So I think the next step is that level of, that high level of cooperation just around the way we are doing things, our processes and our data collection, because if we don't study that, we actually can't make things better. So I would say education and then that cooperation really is not where we want to be.

35:56And I think that's going to be key if we're really going to change the world, as I say. I love it. I love it. Yeah, actually, you brought up another point that one of the frustrating things for a consultant such as us, you know, we're not primary care, we're specialists is that say you get an ER note, somebody is in the emergency room, the emergency room notes at 12 pages long, right? And they talk about every vital sign that since they come in. And to get to the salient information, I'm using my non AI brain to go line by line, and I'm a fast reader, and I can process pretty quickly. but is there software now that can look at an ER note or look at a long note, get rid of all of the stuff that, you know, they have to document so that we know exactly.

36:41I mean, talk to me about that. Cause yeah, our medical records now are just, you know, if they were pages, they would be trees worth of information that would be plopped on our desk. Every time somebody gets out of the ER. Exactly. And cut the fat as we say, no, totally agree. You know, our notes probably a fourth of what those other ones are. Yeah. Yes, there is software. A lot of several health systems, maybe not a lot, but several health systems now have their own kind of internal AI systems so that you're not using a public one that could potentially put patient data out there. We're using like Phoenix AI, for example, but you can actually then summarize it.

37:21Now, unfortunately, now it's that extra step where you may have to just upload that document to get those salient points. But I think certainly in the next few years, we are going to get to that point where we're going to have a chatbot in our EMR to just say, summarize this, or, you know, let's pare it down to those salient points because this just contributes to our fatigue and then just a cognitive decline that we face as, you know, physicians, because we're spending time doing things that we don't need to be doing. We need to be thinking about, you know, patients and really optimizing their care, not sifting through someone else's nose.

37:56So I just think, unfortunately, the way that EMRs have been set up, it's again, it hasn't put us first. And I think more of these systems are really thinking about that a little bit better. So yes, I think that's also something coming down the pipeline, but you can do this like manually now for yourself, as long as it's a HIPAA, you know, kind of protected system to summarize that. Okay, well, you're getting me excited. I I think I can get beyond learning how to take screenshots. We can get you there. I'm positive. I'm positive. You'll be getting a lot of texts from me saying, Dr. Denise, I'm stuck in some dark web.

38:34I don't know what happened.

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42:57We do a segment on every show that is loosely titled, Am I Going to be OK? And it's always about a patient journey, you know, sort of like, you know, a guy you and I see all the time in our clinic. He's on anabolic steroids. He wants to be a dad. Is he going to be OK? Is there a way to treat that guy so that he's going to recover sperm? And, you know, you hear the story and, of course, you say, well, yeah, he's probably going to be OK. We can do this. But for this episode, because we're really focusing on informatics and AI, I want to ask about our physician colleagues in a couple of different fields, because we hear things about machine learning that can either help or replace radiology, pathology, dermatology.

43:40So walk through some of those advances and are colleagues going to be okay? Are there still going to be radiologists in five years, 10 years and see what, you know, see how those guys are doing? Yeah. Well, I think short answer is absolutely. You know, all of the systems that we train, you know, in the space of the AI machine learning is still reliant on that human aspect of helping with the training. I think what we have done, which has been smart, has been using policy to continue to protect our specialists. So, for example, if you are a radiologist and they all very openly use these systems to kind of sift through all of the images that they get.

44:20But you can't bill for it unless, you know, there's like a human part of that. So I think at least here in the United States, there has been systems in place. And this is where specialty societies have been key and, you know, protecting themselves. But I think this is where you leverage policy, right? And this is where you partner. And I think as we've seen in radiology and pathology, they have been early leaders actually in the AI and informatics space just by virtue of what they do. It's kind of these fields that lend themselves better to lots of information to then train and do all these things.

44:55But I think they protected themselves around billing. I think they've also recognized that this thorough put of information, they can actually do more, but I think they're still in the driver's seat. So dermatology path, you know, we get these, you know, you get all these articles now, are they going to be surgeons? I'm like, we're always going to be here. I think people just have to recognize that we are still steering the shift when it comes to training. The fine-tuning is going to be what do we still need to be in the driver's seat for, right? And I think this is where the better we get at good data and good information in and getting in good information out, we still have to make sure we have those checkpoints in place with humans behind that.

45:40And I don't think that's ever going to go away. Yeah. I mean, I'm super excited in our field. But I guess we can talk a little bit about what are the advances in the men's health field. And one thing that I came across recently that I'm sort of blown away by is the sperm selection and sorting technique in either using ejaculated sperm or testicular sperm extraction techniques for in vitro fertilization. So just for like a two-minute sidebar, if there are any couples out there listening and struggling with fertility and a guy has very low to no sperm counts, we now spend hours under the microscope.

46:16I mean, I'll give you an example from just yesterday where I was performing a surgery on a man that has no sperm in the ejaculate. And the surgeries, you know, Dr. Denise, takes sometimes two hours, sometimes four hours of looking in the testicle for all these little pockets where we might find sperm. And then it takes hours upon hours. In fact, our embryologist worked for about three hours yesterday and three hours this morning. And they found one sperm, one modal sperm in all of that. Right? I know. So, wow. I mean, you know how that is. It's just, you know, you just never give up until you find it.

46:50But now I'm understanding that there are not only embryologists who are trained to look under a microscope through slides after slides of tissue that can take hours. But there's some sort of oversight with machine learning where there's software, there are companies coming in that they can look through that a lot faster and have maybe even improved accuracy. Have you worked or seen any of this technique and technologies coming down your way? Because I know that there's, I mean, your old alma mater, Columbia, I know has looked into this and has actually implemented AI in assisted reproduction. So give us something to look forward to there for our couples that are struggling with fertility out there.

47:31Absolutely. And I think this is one of the most exciting aspects when we really personalize it to our field. You know, as you mentioned, for those couples where maybe you don't have, you know, sperm in your jaculate and you're doing more of the sperm sample. But I think in these cases, this is really where I think we're going to see these game changers, because the more information, again, getting back to data, right? And this is why data sharing is so important. But these systems are being trained to recognize, even down to like a pixel level, you know, what are the patterns around where we're finding things like sperm cells that are moving as we try to still better define those cases where we spend hours and hours.

48:10But we're going to get to a point where we're slowly getting there to a point where it can actually capture what part of your sample actually has like the sperm, you know, that you need. And so I think that that is something that is already here. It's also stemming to radiology as well. And so when you look at images, even though we don't really, for most of what we do, like require a lot of, you know, like ultrasound and things, but people are actually also using like ultrasound to figure out patterns around people that may actually have like viable sperm, which is like crazy. really getting down to, again, defining that pixel to the way, you know, so I mean, people are already doing this.

48:48But I think in short, you know, this is, and again, to emphasize, this is why we all have to talk to each other, we all have to use, you know, leverage our data with the research. Because if we're not sharing this information, we need enough of these samples to then figure out what part of the sample actually has a sperm and to be able to replicate that with other patients. And so I think, yeah, our REI colleagues already doing this for assisted reproduction, they're already using this to select out the best embryos and other things. But I think for sperm samples, this is already here. And I think this is going to revolutionize couples that previously we may not have been able to find sperm, but doing it in a high level, more efficient way, just because of all the training that these systems have had to really hone in on those samples.

49:35Yeah, no, it's truly spectacular. When I saw one of those demoed and just how fast, you know, I think I'm fast. You've seen me work under a microscope. And I think when I saw what this computer was doing on just a normal slide and how quickly these little halos were appearing every, you know, little sperm here, little sperm here. I mean, it was just like, not even, I can't remember what he was saying. It's like a hundredth of a second it takes to recognize sperm. And when you're doing that over grams and grams of tissue in a large microtessia, just it'll accelerate as well as you know hope improve the accuracy but as you said you still need some person there at the end of the day to to kind of go to the next step and and use that sperm so so it sounds like you and i are going to be okay there you can't you can't do a vasectomy from home and you can't uh you can't put a penile prosthesis in from home and so not yet not yet well that's it so i'm heading off to the the ces consumer electronics show in vegas in a couple of weeks, what should I be looking out for there?

50:33What is, what do you know about what's in the pipeline that, that is exciting you, you know, for the next couple of years? Yeah. So I think, when we think about medical decision-making and how that's really going to aid providers overall, I mean, I think not so much for physicians, but quite honestly, our system, you know, now we have different levels, our PAs and MPs. And I think because of the different levels of training, I do think that some of these medical decision tools are going to actually be quite helpful, especially if you think about places, rural areas, underserved areas that may not have super specialists.

51:08I think that these chatbots and I think that these aids that are AI driven are really going to help people who are in places that don't have access to UChicago, UCLA, and some of these other big places. Paring down even to our surgical field, I think when we think about kind of surgery across the way, right? And so far, robotics has really been a space where they've been able to train and kind of do surgeries from afar. I think it's going to be really exciting for us to do the same with, you know, our microsurgeries and getting to a point where we can also assist people that are not in our, you know, domain necessarily, our geographical area in some of these cases around the world.

51:49You know, I mean, fertility is alive and present throughout the world, but not everyone has the technologies that we may have and other places may have. So I think what I would look for are certainly what's coming down the pipeline with medical decision making, patient education, which we haven't really talked about. You know, I know something I've picked up from you, I have like handouts and summaries for everything. But nowadays, you can really fine tune and personalize patient education, you know, pamphlets, handouts, you know, for individuals. And so I think that aspect is inciting where maybe someone is not just getting your generic, you know, everything to know about like Cialis or something, but they're getting something that's pivoting from the visit you had with them and really giving them what they need and really kind of that, you know, aspect of precision medicine.

52:35I think those are kind of in short, the low hanging fruit of what's out there. Everyone is going to just be trying to find ways to make our lives a little easier and lure us in, but physician buy-in with this stuff is not easy. So if it's not things that make our lives easier, I think it's going to be, you know, a hard sell. Yeah, inertia is tough, especially for doctors. We're kind of stubborn and conservative, and we find one way to do it, and it's hard for us to change. And so that's why we need people like you. I used to call you a rising star. Now you just are a star in urology and health policy.

53:10There's another part of this segment that I always like to ask my guests, especially somebody that is a men's health specialist and therefore a health specialist, is that what do you do, Dr. Denise, every day to make you? What grounds you? What is your thing where you wake up and say, I have to do this to make sure I have a good day, to make sure I can be the best me and take care of the hundreds of guys that are relying on you every week? Yeah, great question. And I think this is also something that as we take care of more people, we have to be consistent with this to ground us. for anyone that knows me, honestly, I think kind of my spiritual base has always been a really important part of me.

53:50I pray every day. You know, I wake up and, you know, I listen to whether it's kind of, you know, just some music that kind of calms me. But I just really pray about the day ahead. You know, I pray that I come home. I pray that it just goes well. And I think that's something that my whole life has really, you know, been able to ground me and just kind of see the bigger picture, you know, what I do. I think outside of that, the physical piece that also connects to your mental and spiritual, I have to stay active. It's so hard to, you know, be still and want to be still when you have so much to do.

54:28But I'm like, you have to get your blood flow going, you got to get those endorphins going. And so that's something that I still keep as an important aspect of my life. Could be better with sleep as we maybe all could be. But I listen to the podcast. We just had a sleep specialist on. So you have to learn from Dr. Kishani. Oh, yeah, I've been working on that for a long time. But I do think that that is one thing that every day, I just wake up with some quiet time. And I think that bridges well to kind of the rest of my day. Yeah, I think this may be the first time in our history and friendship where I've actually seen you sit down.

55:06I'm trying to remember. I don't think I ever have ever seen you sit. Whenever we're at a meeting or conference, you're literally running across the room. You always have time for me, which I'm grateful for. But by the same token, you have three other meetings you're getting to at warp speed. Somehow in the nicest Chanel shoes possible, you still manage to walk a straight, almost a run line to get to where you go because you are always the best dressed person at any conference that I see on top of it all. So it's - I was just trying to keep up with you, you know, you're talking well, just keeping it going.

55:39I can't get into those Chanel shoes as well. But I'm going to try. Those are 26 goals. Dr. Denise Asafwajay, my dear friend, a true just hero to healthcare and guys everywhere. It's just so awesome you spent some time with us and you delivered on the mailroom. with Dr. Jesse Mills. You delivered. Thanks so much, Jordan. What another cool little time to hang out and learn. I am full of hope for the future and for my medical practice. Yeah, well, our part two will be hopefully me coming to tell you more about how we're going to help people find better sperm and egg donors. That will be a part two of what we're doing.

56:25I think that it's, and being in the data space, of course, as if I don't have a million things to do, I've also have actively thought about ways to solve some of the issues on the fertility side. So I'm really looking forward to that. And if I'll drop a shameless plug for people as they continue to follow me, but this will be rolling out soon. My platform just helping people to find egg and sperm donors a little easier and leveraging data. It's not a shameless plug at all. That's a public service. How do people find you? How do we, and we'll put these in the show notes too, obviously, but how do people find the brilliant mind of Dr.

57:03Denise's self-worth? Well, on Instagram, which is, I think, where most of my patients do find me, I'm Dr. Denise Official. That's my official tag. On Twitter, I'm Dr. Denise underscore, and I also have a website, DrDeniseOfficial.com. So usually on my Instagram, patient information there, and I think as I'm getting more things out here with this other platform. You'll see more information there, but I'm happy to connect. And certainly anyone who is in Chicago who needs anything for male infertility to sexual health needs, I'm your gal. Oh man, we knew you when we got you before your star, just supernova.

57:43Thank God. Thanks so much, Dr. Denise. I hope you have a wonderful rest of your day and I appreciate you coming on the mail room with me and Jordan. Have a great time. I can't wait to see you in D.C., if not sooner. Yes. Thank you so much. It was such an honor being here. An absolute honor. So happy. So excited. Follow the podcast. Follow the podcast. If you're listening, you should be. Bam. Look at you. Dr. Denise.

58:23Let's talk about it. Let's talk about it in the mailroom. Let's talk about it. Let's talk about it in the mailroom. The Mailroom with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier. And the theme was provided by Long Transit. If you liked what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.

59:13Consult your health care provider for any medical or other related questions or concerns. The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

59:47or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off. ZepBound is approved as a 2.5, 5, 7.5, 10, 12.5, or 15 milligram injection. ZepBound contains terzepatide and should not be used with other terzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if ZepBound is safe and effective for use in children. Don't share needles or pens or reuse needles. Don't take if allergic to it, or if you or someone in your family had medullary thyroid cancer, or if you've had multiple endocrine neoplasia syndrome type 2.

1:00:24Tell your doctor if you get a lump or swelling in your neck. Stop ZepBound and call your doctor if you have severe stomach pain or a serious allergic reaction. Severe side effects may include inflamed pancreas or gallbladder problems. Tell your doctor if you experience vision changes before scheduled procedures with anesthesia. If you're nursing, pregnant, plan to be, or taking birth control pills. Taking ZepBound with a sulfonylurea or insulin may cause low blood sugar. Side effects include nausea, diarrhea, and vomiting, which can cause dehydration and worsen kidney problems. Talk to your doctor.

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