What Makes for a Good Doctor?

Transcript Generated by AI.

Announcer: 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Michael Koren: 0:11

Hello, I'm Dr. Michael Koren, the executive editor of MedEvidence! I have to say that one of the fun things about my job is I get to talk to old friends and chat about things that amuse us, hopefully entertain the audience, and hopefully are something that will create some value for the people that are listening into our conversation. And I have such an opportunity today with my old buddy, Dr. David Joseph, who's going to join us from Martha's Vineyard, where he's spending this summer. But while he's spending his summer in Martha's Vineyard, believe it or not, he's doing some incredibly productive things. So, Dave, welcome to MedEvidence!, and I can't wait to share your story with our audience.

Dr. David Joseph: 0:51

Great. I'm glad to be here.

Dr. Michael Koren: 0:53

So you Dave and I go back to medical school, and we're actually part of he's part of a series of these discussions with some of my old medical school classmates, who, by the way, are these incredibly creative and productive and wonderful people that have really fascinating stories. And Dave and I were at our medical school reunion recently, and we found that a lot of people had some neat stories to tell. And part of what we're going to discuss today is what Dave disclosed to me at our recent 40th medical school reunion for Harvard Medical School. So, Dave, um just to start, tell people a little bit about how you ended up at Harvard Medical School and a little bit about your background in in um uh as a child in medical school and ultimately how we got into medical school, and then uh we'll talk a little bit more about some of our experiences at Harvard.

Dr. David Joseph: 1:45

So I've been entrepreneurial ever since I was a little kid. Um when I was nine, I managed to convince the local newspaper distributorship to give me a paper root. Um and then over the next three years, I took on four more paper routes. So I had five paper routes, I divided it up into four routes that made more sense, and hired four friends to each take one of those paper routes, which was now, you know, a 1.25 paper route. And so I would get five salaries, give them each one, and I would keep one. And then, you know, I would fill in for somebody that was sick or out of town. And so the distributorship just absolutely loved this. And then by the time I was 16, I had expanded it to eight routes, divided up between six employees, and then I would keep two salaries. Well that I was doing a lot of a lot of other things as well. Um uh I uh worked as a consultant in computational linguistics at the University of Illinois while I was in high school. Um, and that led to a number of publications in international peer-reviewed journals and patents um on the uh basically the lexicon of medical language and uh basically creating a very crude predecessor to autocorrect. Um so that may not make me too popular, but uh but it we it was good for what it was designed for. I was also named as a witness, expert witness in federal court, um, and a technical consultant to the Federal Aviation Administration while I was in high school. Um, and that was in a lawsuit um about the impact of the fluoroscopic inspection devices at airports on photographic film. And it turned out that you know, that was what I did my, you know, uh junior year, sophomore year science fair project on. And it turned out that this was the only um research that anyone had done that was not sponsored by either a film company or the um the machine manufacturers. So given that it was the only non-biased research out there, the federal court you know stipulated me as an expert witness.

Dr. Michael Koren: 4:12

This was to show that the the machines that were looking in your uh luggage were actually affecting your film and other possessions with within the luggage, is that correct?

Speaker 01: 4:24

Yeah, just the film, but yes. And you know, so I you know it looked at the differences between um uh film that was already exposed and film that had not yet been exposed, and different, you know, different speeds of film, whether it was a 25 or uh 1600, etc., different types of film. Well, and interestingly enough, that research that was sponsored by a major pharma company that just happened to have their headquarters in my high school's district. So to do this, I needed, you know, several pieces of equipment that the high school obviously didn't have. And so I went to this pharma company and they agreed to fund these pieces of equipment as well as the several hundred rolls of film that I needed to do the experiment.

Dr. Michael Koren: 5:13

Wow, fascinating. So cool. So so you you went to college at MIT. I'll start finishing up your story, but go ahead.

Speaker 01: 5:23

Uh yeah, so I went to went to MIT. And what was interesting was that I had a I'd been an artist during that time as well. I was offered a position at the um Art Institute of Chicago's school, but ended up deciding to go to MIT, figuring it was easier to be an a scientist and do art on the side than the other way around. So at MIT, I um I the bioengineering unit at Mass General was looking for a senior to do their thesis in their lab. And so I went to them as a freshman and told them why that was a really bad idea, because this person would, you know, take a while to get acclimated to their lab, and then they would do their project, they have senioritis, and they just wouldn't get much out of them. Whereas as a freshman, I could, you know, potentially work there for four years. And you know, they said, Well, you don't have the engineering classes yet. And I'm like, Well, but you know, what are you looking for? And they're like, Well, here's one project that you know that we would like somebody to take on, and described it. And I looked at them like they were crazy and just said, Well, why couldn't you do this? And they looked at each other and they're like, Okay, and what what else are you looking for? And they described something else. And I'm like, Well, couldn't you just do XYZ? And they're like, Okay, you're hired. Um so uh, so during while I was at MIT, I had a number of um of inventions, um uh one of which was a piezoelectric sorption detector for anesthetic gases. So, you know, while you know nowadays most ORs have you know gas chromatography that separates out each component of the gas, what what we wanted to do was get a portable, rugged, inexpensive monitor that would tell you uh what's called the MAC, the um maximal alveolar concentration of anesthetic. So whatever um whatever gases they were using, it would uh it would detect the total amount of anesthetic that they were getting. Aand I played around with you know different ways to achieve this for probably a few weeks and thought I had hit on something that actually would work, but it worked for everything except nitrous oxide. But then when I dug deeper, the value for nitrous oxides MAC had only been measured once before in 1890 and had never been repeated.

Dr. Michael Koren: 8:18

Really?

Dr. David Joseph: 8:19

So I repeated that those experiments and discovered oh, now it falls right on the line where it should. So, you know, I published a correction to the value of the MAC for nitrous oxide, and then that device worked perfectly well with everything, you know, everything being right on the line and totaling up the total amount of anesthesia exposure. And so that was sold to a um a Swedish company. It never really caught on in the States because you know these expensive systems were already in place in a lot of places, but it was used extensively throughout Europe and Africa um and parts of Asia. So that was the first product that I worked on with them. Um, and then worked on uh if you remember, you know, the old um IVEX and IMEDs, the um the infusion pumps, you know, they would only alarm once uh an IV had infiltrated. And so, you know, there would no pressure and uh you know, but by then the the vein the vein was blown and you'd have to start a new IV. So I invented an inline pressure sensor that could detect this before it became infiltrated. So just as the pressure was rising, indicating an impending an impending uh

Dr. Michael Koren: 9:53

Problem, with an occlusion.

Dr. David Joseph: 9:56

Yeah. Um and therefore the IV could just be adjusted and the IV, you know, and you wouldn't have to replace the IV. Um so that was something that was originally sold to um IVAC, but you know, and is you know well off patent now, so it's in you know all of the infusion pumps now. And then there was a valve that I invented for um ventilators that uh essentially what is now known as pressure support ventilation was what that valve was doing, even though I had a different name for it. Um uh and that was sold to Puritan Bennett. And then and this was all during college. This was all during college. Uh basically after solving that first problem that they had had somebody working on for quite some time, they basically said, you know, we'll give you um, you know, free access to the lab and we'll pay you a 40-hour week salary. You just have to, you know, agree that um that the royalties are split according to the normal thing, which was three 33% to the hospital, 33% to the department, and 33% to me or whoever else was involved in the device. And then another one that I um that I developed was a combined adult pediatric ventilator for anesthesia machines. So that you know, normally you would have a uh, you know, ventilator with a large capacity for adults. And if you had a child, you'd have to switch out the ventilator to one with a very small bellows, etc. And so I designed a bellows that was basically a large bellow with a small bellow on top of it, and you could just switch back and forth without having to change the ventilator. Um I don't remember who that one was sold to, but one of the you know, one of the companies in in that market.

Dr. Michael Koren: 12:01

Wow, well, amazing stuff.

Dr. David Joseph: 12:03

So that was what was going on, you know, that was what I was doing, and then um, you know, I had planned to uh to go into you know bioengineering, thought a little bit about medical school, then um one of the guys that was working in the lab on his PhD thesis at a dissertation, um had spent like six years working on this project because someone told him that this would be a really you know much needed and great you know product to design. Spent six years developing this, and then he found out that the guy who suggested it to him was the only one who really cared about this. And he had pretty much wasted six years of his life because he didn't have the ability to judge what was clinically significant or not. Um, and so that had me thinking about going to medical school, but I wasn't sure about that. And then um there was someone who was also a mechanical engineering student a year ahead of me, and she and I used to um study together, do problem sets together, etc. And so she was applying to medical school, and she was bummed about you know, um, about not having done as well on her MCATS as she thought she should. And so uh I was looking through the um the little booklet that Harvard Medical School puts out you know with your application, and I looked through it and I said, Well, you know, don't worry about your MCATs, you don't have to give it to them. And she said, Well, of course I do. I'm like, No, it's not a requirement. And she's like, Yes, it is, and I said, Well, it's not a requirement for admission. And yeah, she said, Yes, it's right there in the booklet. And I'm like, Well, I think you're talking about the the section at the bottom of page 26 where it says the MCATs are an entrance requirement for Harvard Medical School. And she's like, Yeah, I'm like, does doesn't mean you can't apply without them. And she's like, you're crazy. And said, Well, why don't you why don't you apply to that? I'm like, Well, I I won't have a degree, I'm just a junior. And she's like, Well, does it say that in there? And I'm flipping through the booklet. And I'm like, No, it doesn't. So I'm like, and so she's like, Well, then you apply. I'm like, okay. So yeah, well, I went to the medical school, and if you remember at that time you had to purchase your application instead of sending in a fee with the application, you like actually paid in advance.

Dr. Michael Koren: 14:39

Right.

Dr. David Joseph: 14:40

Uh, so I got my application and threw it on my desk and kind of forgot about it. And then, you know, five, six weeks later, we're studying for you know two exams and doing a problem set due the next day. It's like four in the morning. And she's like, Did you turn your application in? And I'm like, What application? She said, the one from Harvard Medical School. I'm like, Oh shoot, no. She's like, Okay, go back to your room and get it out. It's new today. I'm like, okay. So I went back to my room and pulled up the, you know, pulled out the application and started, you know, reading through it after I filled in the demographic stuff. And, you know, the first question, if you remember, was why you wanted to be a doctor or something along those lines. And I'm like, God, this is not a good time to decide why I want to be a doctor. It's 3:30 in the morning. I'm getting kind of, you know, uh antsy. And, you know, we've got this final coming up. So I looked through my box of essays that I had, and I found an essay that was just the right length and had gotten an A plus from the teacher. And it was all about coaching little league baseball. Um, I coached my brother's little league baseball team, and so um I just retyped that into the space, didn't say anything about medicine, physician, healthcare, anything whatsoever. Went on to the next question was why you wanted to go to Harvard. And I took their their little paragraph from the um the booklet and made it all into alliteration. So it sounded really silly, but said basically the same thing. If you know, hard Harvard has hardcover handbooks, you know, blah, blah, blah. Uh and then and then sent it off. And then uh, you know, a few weeks later, I get a letter from the admissions office saying, you know, we have no record of your having taken the MCATs, since the MCATs are a requirement for Harvard Medical School. You know, please let us know as soon as possible when you took the MCATS. Otherwise, we'll have to withdraw your application. So I call up and, you know, I badger the secretary until she lets me through to um Oglesby Paul, the dean of admissions. And he's used to dealing with calls from frantic applicants. And so, you know, I explained to him, Oh, I got this letter, you know, blah, blah, blah. He's like, Yes, yes. Well, just all you need to do is tell us when you took the the MCAT. So I said to him, you know, um, the the um MCAT is not an admission requirement for Harvard Medical School. And he said, Well, yes, it is. And I said, No, it's not. He was like, You're telling me, the director of admissions, what the admissions requirements are, and I said, Well, respect, sir. I think you're referring to the paragraph at the bottom of page 26 where it says the MCATs are an entrance requirement for Harvard Medical School. He said, Yes. Said, Well, that's a significant difference. The MCATs are an entrance requirement, not an admissions requirement. So if you admit me without them, I'll gladly take them for you over the summer and have them by the time I enter in September. He's like, that's not what it means. I'm like, oh, that's exactly what it means. I've talked to two of my linguistic pre uh two of my linguistics professors, and and they both say that's exactly what it means. And he's like, Well, that's certainly not what we meant. He said, I'll talk to another members of the committee and I'll get back to you. Yeah. Okay. So a couple days later I get a call from him and he says, you know, well, we discussed it on the committee. It's not what we meant, but it it but it is what it says. So, you know, we won't withdraw your application. You know, good luck. So um, anyway, I uh without getting into too much detail on the tangents involved with it, but um had a great interview, uh, I believe with the same guy that interviewed you, yeah, and uh and also the person in our class who was the rodeo clown and um person in our class who you know when answered, you know, why are you applying to medical school, said, because if I have I don't have perfect pitch. So he had you know interviewed a number of of the m more

Dr. Michael Koren: 18:56

Non-standard candidates has that.

Dr. David Joseph: 18:57

Right, right. So he's looking at at the my application and he's like, Oh, I'm so you know, excited to meet you. You know, everybody has their own theory on what the meaning was of your essay, because it's a great essay, but it doesn't say anything about healthcare, medicine, uh anything related. So everybody has their own theory on what it is. So I'm really excited to hear what's the true story. They said, Well, the truth is it was 4:30 in the morning on the day that it was due. I had a final coming up at 8 a.m. I knew I didn't really have time to write another good essay, so I just typed that one in. And his jaw drops and is like, seriously? I'm like, Yeah. And it's like, oh, I'm like, but feel free to go with whatever your theory was. And you know, I'll confirm that that was the right one. And you know, he laughs and he looks at my um at my uh transcript and he's like, So this is really unusual because you know, you've got a D in organic chemistry, a D in inorganic chemistry, a C minus in physical chemistry. He's like, you know, do you have an explanation for this? I'm like, Oh yeah, absolutely. You know, I knew that somebody in those classes had to get the D, and I just felt I was much more emotionally prepared to handle that trauma than other people. And he cracked up. And yeah, he was like, So really, why do you want to go to medical school? And I said, Oh, so I can marry a nurse. And he, you know, he he cracked up, and you know, anyway, we ended up having a three-hour discussion that went, you know, great. And then at the end, he said, you know, I'm totally behind you. I'm gonna be so supportive of your application. He said, But there's a bunch of old foogies on there that think you're just making a mockery of this. What can you what can I tell them on your behalf? And I thought for a minute and I said, Well, why don't you ask them whether the purpose of the admissions committee is to admit people that are gonna be good medical students or admit people that are gonna be good doctors? Because I probably won't be that good a medical student, but I'll be a hell of a doctor. He's like, ooh, I like that.

Dr. Michael Koren: 21:16

That's a good one. Yeah.

Dr. David Joseph: 21:18

And then I got the ticket envelope in in April. Um, so you know, as I said before, I was a junior at that time. So that meant my last year of my engineering degree at MIT and my first year of medical school um were the same year. So I was going back and forth between the two campuses. Um, and often in order to be fair to both, just skip both classes. Uh and that certainly, you know, uh, you know, goes along with what you mentioned, you know, prior to you know this podcast about, you know, yeah

Dr. Michael Koren: 21:55

Yeah, I'll mention that in a second. But that that's so fascinating. Um but I I love one of the take-home messages, Dave, which is that you have to read the protocol. That's why I tell our people here in in the research world is that the nuances of the protocol are extremely important, and you clearly understood that. You were able to articulate your point of view and actually make a successful case for yourself at Harvard Medical School. So that's brilliant. I just have to say that. Absolutely brilliant. So getting back to the to our experience, we we got to know each other because we were anatomy lab partners. And the traditional good medical student would be very prepared going into each dissection. They would read the manual, they know exactly what they're looking for. And Dave and I were not the best at that, I think it's fair to say. And so we would go there and sort of wing it a little bit and just kind of look at the book while we're there and not particularly well prepared. And uh, I guess um the professor kind of picked up on that a little bit um during the course of our our our time in the anatomy lab. But you know, we you know we still got something out of it, of course, and we and uh at the end of the day we we learn what we need to learn. But one of the funny things about this is that um I mentioned to Dave uh uh you know as a little bit of a as a joke, quite frankly, that maybe we're not cut out to be real medical students, maybe we should be medical student emeritus status. And uh uh the funny thing was that the next dissecting class, Dave had a little pin that we put on a lab coach that said, you know, Dave Joseph and Mike Koren, uh medical student emeritus. And I I thought that was great. I knew we'd be lifelong friends at that point because uh we had the same sense of humor. And uh, you know, I I can say that although I didn't love anatomy lab, it did help convince me that I would be better suited to be a cardiologist rather than a surgeon. And that was a decision I was making, and I know that you have a spin on that as well.

Dr. David Joseph: 23:53

Yes, I I certainly did not like uh anatomy at all. I'm sure I disliked it more than you did. But um, you know, I I had a conversation with our anatomy instructor. The name of our uh of our class was Functional Anatomy. And so, you know, having come from MIT, the where the professors were very open to you know out-of-the-box thinking and um things like that, uh I asked him, why, you know, why do we have Latin names? Why are we using Latin names? Why don't we use, you know, long bone of a leg or you know, uh fingerbone number one, number two, you know, et cetera. And he was just he he turned bright red and was furious that I would even suggest this.

Dr. Michael Koren: 24:38

Really? Wow.

Dr. David Joseph: 24:40

Um and then there was another time where he overheard me making a comment, you know, to you or one of our other partners, um about you know, that this anatomy class was like memorizing a phone book and not at all functional. And he, you know, really got mad at that. But uh, but yeah, so anatomy was not at all of interest to me. Um, and I ended up deciding to go into anesthesia for a number of reasons, but um, one being the real-time physiology. You see something, you do something, you see the effect on it. If that didn't work, you try something else. No starting somebody on you know, on hyper antihypertensive treatment and then waiting a month to see if it's working, et cetera, just the instant gratification of, oh, if I change this, this will work, um, as well as the the technology involved, um, and the you know, kind of that ability to work with technology and continue you know, inventing things as well.

Dr. Michael Koren: 25:43

So interesting. So to segue a little bit, um, during our recent medical school reunion, you told me a story about your interaction with the healthcare system that turned out to be very, very complex that I thought was really enlightening to me, and it and you're kindly sharing it with others now that I think would be extremely helpful for for people to know that it's hard sometimes for a physician, a very knowledgeable physician, to navigate the the healthcare system, and maybe little tidbits that will be helpful for the people that are listening to this particular podcast. And I'll also ask you to comment on one of the other things that affected your career when you had an injury when you uh were relatively early on in your practice, as I recall, that really had a huge impact on how your career developed over the course of you know the next decades. So uh enlighten us a little bit about those two scenarios, if you would.

Dr. David Joseph: 26:40

Okay, sure. So in terms of the injury, um it was a total ulnar uh nerve injury at the elbow in my left hand. So I could not uh I couldn't use a laryngoscope. I couldn't.

Dr. Michael Koren: 26:54

And you you fell, what happened? Uh something like you fell at the beach if I remember correctly, or what what happened that caused the injury in the first place?

Dr. David Joseph: 27:00

Oh, I I slipped on wet rocks. Um uh, you know, large wet uh rocks. It was during the winter, and I had, you know, leather shoes on, and we were walking along the the lake in Chicago and slipped, ended, you know, fell and hit my um my funny bone and you know got that intense paresthesia. Um and then uh uh a few weeks later, I was on a different small island in the Atlantic, and I went and tried to take the milk carton out of the refrigerator, and it just slipped through my hands. I couldn't hold it. And then I started doing other tests and realizing that my ulnar nerve was shot. Um, and so flew back to Arizona, had um uh EMGs done, which showed a total block at the um at the elbow, had surgery, had an exploratory um epineurectomy that released the sheath, and there was uh you know a lot of clotted blood in the in the in the sheath of the nerve. So essentially pressure built up and it was an anoxic injury to the nerve. Um so you know, at first I, you know, they said this may recover, it may take up to a year to recover, it may not recover. Um, so during that phase, I actually um studied mediation and negotiation and started up a company that was doing um healthcare mediation and negotiation. Um and it became successful very quickly. Um, and so I uh I was mediating um healthcare disputes, some of them being um uh turf wars between, say, the orthopedic spine surgeons and the uh neurosurgical spine surgeons and things like that in hospitals, um, as well as helping groups not uh navigate the managed care world that was just sort of coming into play then and helping them uh negotiate those contracts, ended up um selling that company to um an international, very large international mediation negotiation firm that had no healthcare presence and stayed on as their director of their healthcare division uh for two years. And then at that time, the company that I had been working for in Arizona as a as a clinician, um you know, had let their CEO go and they brought me back to be their CEO, you know, armed with all this new knowledge and skill in negotiation. So um, you know, since then, you know, I've been the their CEO for three years while also pursuing a lot of other careers in um yeah, in medicine and other uh and other functions as well, serving on you know boards of about 50 companies ranging from startups to uh nonprofits to Fortune 500 companies and doing consulting work, et cetera, founding some companies, et cetera.

Dr. Michael Koren: 30:12

Yeah, incredible. Absolutely incredible. So, Dave, we're gonna take a quick break here. And um just it's gonna take me a few minutes to process these incredible stories. So thank you for sharing them. But we're gonna get right back to our second session with Dr. David Joseph in just a moment.

Announcer: 30:30

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