Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop and welcome to my podcast and videocast station. Today, I have the privilege of interviewing a colleague from the other side of the world. I've got Dr. Michael Zima, a cardiologist, a man of my own heart who's joined me. Welcome, Michael. Thanks so much for making the time to speak with me today. Thank you for having me, Warrick. Just by way of a little bit of background, obviously you're in cardiovascular medicine, but a potted summary of where your career is. And then we'll actually talk about your most recent undertaking, which was writing a book. And I'm really very keen to tease out some of the important issues around that. But first, a little bit about you. My background in clinical medicine is cardiovascular disease. During my 40-plus years in medicine, I've been in a number of different silos, from physician in training to practitioner to chief of cardiology at a community hospital, chief of cardiology at an academic medical center, vice president of an independent practice association. board member of the physician holding company, professor of medicine at two state universities, and finally as a physician clinical reviewer of a large national radiology benefits manager. So I've worn a number of different hats, sometimes concomitantly, and so I felt that I was more than qualified. to give the reading audience a glimpse at healthcare delivery from the inside out. Well, there's no question that your clinical and I guess administration expertise is deep and significant. So I'm impressed by that CV without question. And obviously it leads into the book that you've written, Mike, which is modern healthcare delivery. Is it deliverance or a debacle? And sort of really what prompted you to write this story? Why did you feel motivated to write a book? Because I know from my own experience, it's not easy to start to write a book. It takes a bit of work and a bit of time. I was struck by the overall naivety, not just of the lay public, but of... individuals involved with health care delivery at all levels, providers, insurers, administrators, technologists, technicians, about a subject of such importance to everyone, because sooner or later, everyone on the face of this earth will be involved in the delivery of their health care. And I felt that Considering the misinformation that was out there being propagated by the so-called pundits, who often don't know the difference between Medicare and Medicaid, that I felt charged to finally sit down, spend the hours, years actually, doing the appropriate research, educating myself first, and then putting that down on paper so that others could finally get a proper understanding. of the dilemma that we face today as a nation in healthcare delivery. So just obviously we're at the opposite sides of the world and obviously our healthcare systems are a little bit different. For those listening on my side of the world and for those who need a refresher on your side of the world, you alluded to Medicare and Medicaid. Just can you explain the difference of those in one line for the people listening? Right. Well, they have one similarity, and that is they were both put forth by President Lyndon B. Johnson in the mid-1960s. Medicare was the health insurance, traditional Medicare, provided by the government after people would retire at age 65 or who were on dialysis. That was added later at a younger age. But it basically was the security network, if you will, in health care for individuals who would pay in over their working years to pay their Medicare insurance premium, if you will, to finally have that benefit at the time of retirement. Medicaid, on the other hand, was President Johnson's response to trying to get health care out there. for everyone in the country, particularly those under poverty conditions. So Medicaid, Medicaid was our poverty program to bring people into Lyndon Baines Johnson's Great American Dream. So the book, Modern Healthcare Delivery, really what was your focus of bringing that book deliverance? deliverance or debacle about this modern healthcare, where were you seeing the main rubs? What were the main issues that really you wanted to bring forth to the people who read your book? Well, let's use the title as a segue to attempt to answer that question. In the Bible, deliverance is God rescuing his people from bondage. Whether it's in the Old Testament, in the book of Samuels, where he rescues his people from peril, or in the New Testament, Colossus, where Christ triumphs over the greatest peril of mankind, sin, and rescues people from Satan. Deliverance is always rescuing someone from bondage or danger. You know, I think in today in medicine, with the technology that is now available, coupled now with artificial intelligence, we finally have the potential on this earth to conquer illnesses that have plagued mankind for decades, if not centuries. The problem with that is... at least in our country here, the costs of delivering that care have now exceeded 18% of our gross domestic product, our GDP, and it's not sustainable. So the debacle is the financial debacle. The potential for deliverance is there, but there are a number of hurdles which must be overcome lest we face a financial debacle and a collapse. at least in this country, of the healthcare system as we know it. When you started to formulate your ideas about this, Mike, I'm guessing that because of your own experience in cardiovascular health, as I know my own journey, I view everything through a cardiovascular prism to a large degree, at least from a starting point. Was it really the space of cardiovascular disease that brought your... focus to this potential deliverance and debacle situation? Or were you looking at a different part of medicine? I think I was calling upon all my experience, certainly the anecdotes that I pepper throughout the book. And I make no apology for it, even in the preface of the book, that I may show my bias now and then. But those anecdotes come from my... clinical years in the trenches, if you will, doing cardiovascular medicine. And the experiences that I had dealing with other types of healthcare providers, insurance companies, pre-approval, pre-authorization, all of that served as an excellent background work in putting together on print the concepts and the problems that I attempted to elucidate in the book for the readers. Look, I love a story and I know people who listen to podcasts love a story. So would it be, would I be okay to tease you out on sharing one of those stories with us? And what I might do is because I think there's such a lot to this concept of what we're able to do and how we're able to deliver it. What I'd like to do is maybe share the story if you'd be kind enough. Maybe we touch on it a little bit more, but then I might wrap this up as a, part one, and then maybe we could continue with part two in more depth about the book. Sure, sure. Well, a story might be from, I guess it's chapter three, entitled What the Heck Ever Happened to Marcus Welby, M.D.? Now, Marcus Welby, for those who may not be familiar, M.D., was a show broadcast on ABC Network. in the 1970s here, starred Robert Young as that avuncular family physician who was not only a healer of body, but a confidant, a healer of mind, if you will, spirit also, who knew all his patients by name, their families, etc. And when we look at today's physicians. And again, I have hands-on experience in dealing with our trainees, both in New York and in Tennessee. I just did not see that type of level of connection. And when I would ask the trainees, why not? They would give me an answer. We just don't have the time like you did in your generation. Of course, that made me feel good, Warrick, in my generation. You know, we're on the clock now, and we have an average in our country of a 12-minute visit, 90 seconds of which is utilized in relating the diagnosis, the treatment options, and the recommendation to the patient. We just don't have the time to have those relationships. You know, I thought about that and I said, how did we get to that point? And I discussed that in detail with the book, how we evolved that through the insurance reimbursement system, through the escalating costs of delivering that medical care from the provider's perspective, et cetera. But I realized that doctor-patient and doctor-doctor communication was deteriorating right in front of my eyes over decades. But it was happening ever so slowly until it finally has eroded. You know, it's a concern. I think that story really is concerning, particularly the residents talking about different generations just not doing what's critical in medicine, which is connecting with patients. I have some dealing with medical students. I get them to sit with me during a consulting day. There's really only three things I want them to get out of that day. I ask them to put their notebooks away because I'm sick to death of people writing notebooks and missing the major picture, if you know what I mean. And I say, look, there's three points I want you to get. The first is people don't care how much you know until they know. Until they know how much you care. Number one. And this is exactly what you're talking about. Number two is the job as a privilege. And that's across the range. We get the chance really to make a real and meaningful difference in people's lives. And we get paid for that, which is extraordinary. And the other is really an obligation to do what's required for every patient. But that number one is exactly what you're talking about. And one of my own frustrations as well. which I work on, actually. We all have to do that. In this country, that was the birth of concierge medicine. When physicians and patients who had the wherewithal, at least, finally got fed up enough with being treated, with being punctuated after an average of 12 seconds of their conversation before they'd be punctuated by the provider who had to stay on the clock to get to the next patient. And, you know, that was the birth of a whole different type of medical field. Well, I'm absolutely sure we've got a lot of stuff in common around the way we think patients, patient care, the journey through a disease process should be covered, I'm sure. that we will find more to talk about in part two of this, because I'm going to wrap it up now. We've gone more than I thought we were going to go, but we'll wrap it up and we'll come back for a part two. So thank you for those listening. I hope you've enjoyed this first stage. I'm going to say goodbye to Mike for now. He'll say goodbye as well. Yes, goodbye. And Warrick, thank you again so much for having me on. It's a pleasure. We'll be back with a part two. Thank you so much for joining me. Take care. Bye for now and please don't die from a heart attack. Take care. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. 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