Between Heartbeats and Algorithms: Reclaiming What Matters in Healthcare with Dr. Devjit Roy

Mike Tsakopoulos: Welcome to SoundPractice, the business podcast for physicians and healthcare leaders, hosted by Mike Tsakopoulos and produced by the American association for Physician Leadership.

Host: Generative AI isn't just another technology shift. It is a fundamental transformation in how sectors operate. One such sector is healthcare. But unlike other sectors, health care's success is evaluated by metrics beyond dollars. At a time when technology and science garner the headlines, my guest calls for a dose of humanity, a profession that is improved by better human interactions. Next on Sound Pract. My guest today is Devjit Roy. Dr. Roy serves as chief medical officer at Nathan Latauer Hospital in upstate New York. He is the author of Between Heartbeats and Algorithms Reclaiming what matters in healthcare. Dr. Roy, welcome to SoundPractice.

Dr. Devjit Roy: No, thank you for having me. I'm really excited to, uh, be able to do this with you.

Host: Well, I'm excited as well. And before we get to the book, which is really our subject matter today, I would like to, um, hear more about your path as a physician leader. Can you tell me?

Dr. Devjit Roy: Oh, yeah, absolutely. Um, actually, currently I'm the cmo, CMIO and VPMA here at Nate Littower Hospital. So I wear a lot of hats. Uh, we're a rural nonprofit, ah, as rural as can be. Um, uh, and I'm also the medical director at the nursing home here. So we're a hospital nursing home and 11 primary care practices kind of speckled in the Adirondacks. Um, I also serve as a board member for Mountain, uh, Valley Hospice, and I'm also the co president of a joint venture between our hospital and another hospital, uh, that's about, ah, an hour away, uh, to try and preserve specialty practices here. Um, now it's interesting, I think in rural you always have to wear multiple hats. So I still practice as a hospitalist and as a palliative care doc. And um, I also practice, uh, in the, in the nursing home too. Um, how did I get here, though? I think, um, so I was a medical director for hospital medicine for scp. Uh, and SCP is the hospitalist group that we have here. Um, I first came here, uh, prior to being the medical director for hospital medicine here. Um, in my last hospital I was a hospitalist and I was also, um, a director of palliative care. I was trying to actually grow palliative, um, care in my last hospital. That was actually during COVID Um, and then prior to that I was, ah, a lot into informatics. I was helping out hospital systems too. Um, and this was a part of Sound when I was out In Wyoming. Uh, I was, ah, a wellness director there for their wellness program. Um, I saw patients that had addiction and wellness medicine and lifestyle medicine. Um, and I was also helping with their EHR rollout for Cerner. And so I kind of was always wearing those two hats in the IT space, um, and kind of the clinical space, um, whether it's inpatient, outpatient, just a little bit of everything. So. But, uh, yeah, I got into this role in 2023 and it's been pretty amazing.

Host: Excellent. Well, your book is Heartbeats and Algorithms, and it opens with these two sentences. Quote. I didn't set out to write a book. I was just trying to make sense of it all. Close quote. Can you tell me about that?

Dr. Devjit Roy: Yeah. Um, so actually when I started writing this book, um, it was actually during COVID um, now, you know, I had mentioned this earlier. I, uh, so I was one of the hospitalists, uh, at a Covid surged hospital. And we were actually in ground zero then. And so, um, the first case was actually a couple of blocks from my apartment, mine and my wife's apartment. And there was so much uncertainty then. Uh, we didn't really know, uh, much about the illness. We couldn't test for it. Um, we didn't really know the disease. Course sometimes we would discharge patients home on room air, and then they would come back two days later, um, near death, dying. Right. And then we started figuring out the blood clots. And so there was just a lot of uncertainty. And I remember, so even at times I was sleeping out of my car because I didn't know how this would affect my wife. Right. And. And I remember I actually started to write down, um, thoughts, um, in the past, of lessons that I had learned from patients, actually. So that was the inception. I was just kind of journaling, and I think it was just helping me to cope with so much trauma. And so. So literally I was trying to make sense of it all is what it started. And then I actually hadn't found a journal. Um, so, you know, since then we had moved multiple times and, you know, I was just kind of cleaning out my office and I found, you know, this journal that had, you know, 10, 15 patient stories that I had just kind of written down. And I'm like, you know, I never really made anything of it. And so much in healthcare has changed where the humanity of healthcare has been almost. And I. I don't want to say the word standardized, but it's. It's becoming very algorithmic. Right. Um, in the er, you follow sepsis protocol or you Know you want to, uh, oh, blood transfusions, well, you have to follow this algorithm. But then, uh, moving forward, right? When, when you're having a conversation with an insurance company, did they meet inpatient criteria or observation criteria? Uh, did they stay for the three days to be discharged to a nursing home? Like, there's all these little algorithms that we kind of, that have been inserted into our lives that have been quietly changing the way that we practice as clinicians. And they don't teach you that in med school, they don't teach you that in residency or fellowship. Right? Like you're just, you know, you're taught the, the medicine you're taught to take, um, a history and physical, which is also almost algorithmic if you think about it. And so all these algorithms that, that started to change the way we practice. And, and now, um, and this became, I guess, more contemporary. You have now AI and systems now again changing the way we practice. First it was the EHR, and now AI and insurance. So you have all these algorithms that are changing the way we practice. And I think, I think the, to take, I guess the passion and the journaling that part and um, and then convert it into something that was contemporary. That's where the inception of this. Well, so much of medicine is changing now. It's becoming algorithmic. How do we maintain the humanity in the day to day clinical care? So then, and my thought was we need to get clinicians, doctors more involved into leadership. And so, and so that's where, you know, that's kind of how I took the book in that, that angle. It's kind of a call to physicians.

Host: Your book in large part speaks to the art of medicine. Do you believe that that art is being neglected?

Dr. Devjit Roy: Yeah, um, I think quickly, the quick answer is yes, but with that said, I think when you're trying to learn something new, right? And so I'm thinking about medical school and residency. We do need a roadmap, right? We do need a textbook. We need that checklist just to be able to learn it. And then I've noticed after you see patient after patient, after we go through all the different experiences of practicing, where it's like, hey, is this really heart failure or is this really pneumonia or is this really this. Or hey, I remember, uh, this case with this patient where I thought it was this, but it really was that. Let me just keep that in the back of my mind, right? And so what I've realized is that art actually happens with experience and, and we're able to compile a person's story and really get to the root causes of the issue, if you have that experience. But it starts with the blueprint of medicine. Right. And. Right. And so I think what's interesting though is as we become more algorithmic, it's kind of some things you can put into an algorithm, but then you also have to know when to color outside the box or outside the lines, if you will. Um, I think where that gets tough is, well, you can't always code that, you can't always build that, you can't always structure it in a way. Um, and I think that's, uh, the art is starting to go away. I think it's important for us to remind ourselves that people are messy and you can't put every person into a bucket or a box. You have to be able to think outside that box.

Host: Very interesting. As medical technology grows ever larger in the practice of medicine, do you believe it alters the composition of medical school classes? In other words, are we self selecting for different types of individuals to become physicians based upon technological advancements?

Dr. Devjit Roy: Oh, absolutely. And I think it's a very interesting concept. So we're in a rural place, right? We're in a rural hospital setting. So our recruiting pool is already very limited. So let's say. And why is it limited? Well, we won't have all the bells and whistles, right? We won't have the newest robot, let's say we won't have, well, any robot for that matter. Um, yet if a medical student or if a surgical resident is training on that robot, and as a rural hospital, we're unable to have that robot here, then how is that, uh, medical resident or that surgeon going to be able to practice here? If they can't do an open coley, they can only do lab coleys, right? Now that same concept goes with AI. If a medical student is being trained on AI or is learning through AI yet we don't have AI in our systems then, and they're not used to clunky workflows, they're going to burn out quickly because they're going to have to learn a whole new system. So that's where it's interesting, um, how medical technology, if it's not standardized throughout, it's harder to recruit for a smaller system. Um, but I've noticed actually, and in my medical school, they're actually being very deliberate in not having AI be something that they're able to use, although because it kind of stunts, uh, the growth ability, I think. Um, I remember. So I used to be an engineer and in Order for us to use a calculator, we actually needed to program it. We needed to first write the code of a calculator back in. That was the language that we had to use. And it's just miles and miles of code. Uh, but if you didn't do that to really respect what a calculator did, you weren't allowed to use it. I think we have to do something similar when it comes to AI almost where that the medical student or the resident has to first learn how to think like a clinician before they start relying on a tool.

Host: Very interesting times to be practicing medicine. I'm sure in heartbeat and algorithms you write about 15 patients who have influenced how you practice medicine. Can you please tell me about one of them?

Dr. Devjit Roy: Sure. Uh, absolutely. I think, um, and this is one that really kind of is close to the heart. So it was during COVID times. Um, there is a patient that was actually, um, was intubated. They were intubated for like 60 days and. Sorry, they were ventilated and they were intubated for 14 days or 15 days and then converted to a long term ventilator, but they just weren't waking up. And I remember, um, the patient's, uh, loved one worked at the hospital with us. An amazing person. Um, uh, and so, you know, I was on the case not only as hospitalist, but also as a palliative care provider. Uh, and I remember when I would see this patient, it would always remind me as if they were locked in like a Parkinson's patient. And so I had um, so thinking about a Parkinson's patient, it's like, hey, if you give them some Sinemet, they'll start to unlock, right? They'll start to move. And then of course, your sleep wake cycles are off. So we trialed two different medications, Modafinil and Sinemet, on this patient. And within two days out of, again 60 days of being almost comatose that like, not they woke up and then they started eating again. They, they ended up discharging to, to an acute rehab, um, about two weeks later. Now this was a patient that most of the medical staff had already just kind of, well, you know, it's going to go to hospice. Da da da, da da. And so what I took from that case was staying humble that, hey, we don't know. There's so much in medicine that we still don't know, right? And, and I practice with humility every day, whether it's as a leader or as a clinician, um, to be curious, meaning to ask hey, something is not, you know, how did. Let's learn more about it. And grit, um, just, you know, that discipline to stick with it. So I kind of take those three things every day when I'm a clinical, when I'm working as a doc or as an administrator, I guess, uh, to be curious, be humble and just be gritty. Keep to the path. Um, yeah, no, that case always kind of sticks with me. Um, yeah, sorry.

Host: No. Um, so the foreword to your book was written by Peter Angood. Dr. Angood, as you know, is the CEO and, uh, President of the American association for Physician Leadership. Why did you think Dr. Angood was, um, the person to write the forward?

Dr. Devjit Roy: Yeah, no, actually, I was just so grateful that he could. So he has had so much experience. Right. So he was an ICU physician, and now, uh, similarly, he has been able to, I would say, mobilize the physicians or clinicians to get into leadership. And I love that. Right. The fact that you have an ICU doctor who learned how to become a leader. And, uh, you know, I've seen, uh, Peter talk and he, like, Dr. Am good talk, and he's just so polished. I mean, he is just awesome. Uh, he's got an amazing story. I've read his book. He's done so much. And so that's where, you know, and, uh, when. When that was offered, I'm like, absolutely. Because he gets it. He's what I want to be. I would say he's just an amazing person. So.

Host: How very, uh, very nice. Over your career, the practice of medicine has. Has changed, but so have patients. How are patients different today than when you started practicing?

Dr. Devjit Roy: Yeah, so. And so luckily I'm in a, In a rural, uh, place and in a rural hospital or in a rural nursing home or patients are just grateful here. That's not always the case. Right. I think they're just grateful to have somebody that's trying to help, you know, help them. I think what's good now is patients are. And I used to struggle with this with Dr. Google, quote unquote. Right. Um, what I am actually happy about is that patients are taking more accountability for their care. And, and that's a good thing. Meaning if. If we're trying to help patients in a hospital or in a clinic, or if they're not bought into trying to get better. It's hard, I think, having all of this information at their fingertips, whether it's the new up to date AI Doximity, AI Google, Gemini, to be able to ask health questions too. We as clinicians, as Docs need to make sure that we can help our patients to unpack all of this information that they have so it makes sense to them in their clinical story. And so, um, I think initially I was worried that, hey, patients are just getting bad information. Well, maybe I just haven't been able to communicate effectively with them, and maybe I have to change the way I teach, uh, them or learn, you know, um, am trying to help them and kind of meet them where they're at. Right. So I think, uh, it's also holding me more accountable as a physician. I would say so, because I got to be on top of my game.

Host: So, in a way, you would feel that it helps you with clinical skills. Is that fair?

Dr. Devjit Roy: Yeah. And not only clinical skills, but in communicating. Right. So if I'm, um, uh, speaking with a patient and I'm trying to, let's say, educate them on heart failure, and then the next time they come, they're like, well, you know, you're telling me that this is heart failure, but I went to Gemini or I went to, uh, Doximity, and my symptoms are, you know, similar to this rickettsial disease that they talk about. I'm like, oh, okay, so let's talk it through. So, all right. Um, da, da, da, da, da, da. So it allows that conversation and to remember how rickettsial disease and heart failure. So it definitely keeps me on my toes, but it also shows me my gaps in communication. Right. Did I take too much of a paternal or an authoritarian way to communicate heart failure to a patient? Is that why they didn't take their medication? Well, let's talk through it. Right.

Host: Very interesting.

Mike Tsakopoulos: Yeah.

Dr. Devjit Roy: It kind of shows my gaps.

Host: Well, I know we started off this interview discussing how it was not your original intent to. To write a book, but now that you have written the book, describe to me, um, who you hope reads it.

Dr. Devjit Roy: Sure. Um, so initially, I was like. I said it was kind of like my own personal journal just to kind of cope with what I was going through. Then it became lessons that I've learned that I wanted to make sure that medical students and residents would actually read it, because some of the lessons, like, hey, if your nurse brings you up, you know, says something, listen to the nurse. Right. Because be humble to listening to that nurse, or be humble to listening to that patient who's scattered across 10 different specialists. Take the time, unpack it, because you'll do them more justice right then. But then, you know, when it comes to physician burnout, so I've had, you know, I've written, um, about, you know, in the book about a friend of mine who actually had committed suicide. And, and it goes into physician burnout. So how do we actually develop resilience? Okay. How do we actually cope with the day to day? How do we maintain, um, clinical practice and still maintain our relationships in our, in our lives that matter? So these are all little points that are kind of in there. So, so now. And it's funny because, uh, as I discussed the book, a lot of nurses loved reading it. They're like, oh my God, I love this. So initially it was supposed to be for medical students and residents, then it was for the new physician. But now, honestly, nurses, it could be anybody in healthcare. Anyone that's interested in leadership and burnout in implementing, uh, new technology. It kind of touches everything.

Host: Well, it's very well written. Now the subtitle to your book seems hopeful to me. That subtitle is, ah, Reclaiming what Matters in Health Care. Um, am I correct? Are you hopeful?

Dr. Devjit Roy: Um, definitely hopeful. Um, and we should be, I think so. If, if I could say one of the major causes of, um, of burnout for me, uh, has been, uh, any EHR that I've had to use. Right. Because we've become documentation, special specialists. Right. We're just recording now. I didn't go to medical school or residency or fellowship just to become

Host: a

Dr. Devjit Roy: record keeper, I guess. Right. So where I'm hopeful is. So, uh, so actually I'll take it back. Why has EHR been such a struggle for so many of us clinicians? Well, we weren't a part of the build on any ehr, be it epic, Meditech, Cerner. How many doctors were a part of the coding team to create an emr, right? How many clicks does it take to order something? How many clicks does it take to document something? If I'm talking to a patient, how am I going to remember all that stuff and get it in? So the workflows of a doc is very messy. And because EMRs were kind of inserted into that workflow, rather than building the workflow, um, uh, building the workflow from the bottom up, that's where the burnout came in. We actually had to come up with band aids to work around an ehr. AI actually helps because what I'm seeing is a lot of the AI companies are actually bringing in docs to help create the workflow from the bottom up. So our systems now we are definitely, um, AI powering them, but we're starting from the ground up again. We're trying to make it so, hey, how do we make a doctor be a doctor, focus on the patient and allow the AI to do all the documentation, the billing, the coding? Sure, it can help with communicating and this and that, but how do we, uh, how do we bring back that conversation to the doctor and patients so they can just focus on that and allow AI to do everything else? Right. And so that's where I am hopeful, to be honest. Um, but only if we get enough docs. Being a part of this conversation is

Host: our time together grows to a close. I'm interested in what's next for you, any projects or activities that you're working on. It seems like you are a wildly busy, um, physician later. So I'm just curious because you've, um, accomplished so much.

Dr. Devjit Roy: Yeah, no, uh, so, yeah, so right now, like, you know, we have our day to day projects and then, you know, we have career goals and all that stuff. Right. So I think for me, you know, as I'm learning, uh, to see how AI can really help physicians and apps and nursing and just health care, as that develops, I kind of see myself growing, um, in that space. Meaning I want to be able to make delivering care to patients easier. And how do we maintain access for all patients? How do we make sure that the right care is being done? And how do we unhijack patients, lives that have been hijacked by illness? So those are my three main things. Um, and so as I kind of figure out where my career is going, um, that's why, uh, in my current role, that's why I love it so much. Because when a patient comes into the hospital, to the nursing home, to our clinic, their lives are hijacked by illness. Right. If somebody gets a cancer diagnosis, a heart failure diagnosis, uh, their lives just get hijacked. And how do we unhijack that life and get them back to what matters to them? And, and so I want to be able to keep doing that at the population, the public level. And so I think we need more docs getting involved like that.

Host: So I, I definitely agree you have very, uh, worthy goals. Uh, there. My, my guest has been, ah, Devjit Roy. Dr. Uh, Roy's book is Between Heartbeats and Algorithms Reclaiming what matters in healthcare. Dr. Roy, thank you so much for being on soundpractice.

Dr. Devjit Roy: Thank you again for having me. Um, uh, this was awesome and it was great meeting you, Mike.

Host: Been my pleasure. My thanks to Devjit Roy. Dr. Roy's book is Between Heartbeats and Algorithms Reclaiming what Matters in Health Care. I highly recommend Dr. Roy's fine book. My thanks also to the American association for Physician Leadership for making this podcast possible. Please join me next time on Soundpractice. We release a new episode every other Wednesday.

Mike Tsakopoulos: You've been listening to Soundpractice, the business podcast where physicians and healthcare leaders check out the show notes for this episode@soundpractice.com if you have any suggestions for future episodes, we'd love to hear them. Email us uh@infoooundpractice.com subscribe to SoundPractice wherever you listen to podcasts, so you can automatically receive our episodes. And please rate us and comment on the podcast in itunes and Google Play. Soundpractice is presented and produced by the team at American association for Physician Leadership. We are the world's premier organization for all aspects of physician leadership in every sector of healthcare. Learn more at uh physicianleaders. Org.

Dr. Devjit Roy: Robin whitwood kapow.