AI Revolution: Robot-Assisted Surgery and Empowering Patient-Centered Healthcare

100:00:00,480 --> 00:00:02,404Speaker 1: Welcome to the Healthy, Wealthy and Wise 200:00:02,524 --> 00:00:08,064podcast with Dr William Chokta, MDJD. Our mission is to empower 300:00:08,125 --> 00:00:11,897you with the knowledge and the tools you need to thrive in all 400:00:12,099 --> 00:00:16,184aspects of your lives. Join us now as we discuss everything 500:00:16,285 --> 00:00:19,823from nutrition and exercise to money management and personal 600:00:19,862 --> 00:00:24,733growth. Dr Chokta will provide insightful advice on how to 700:00:24,774 --> 00:00:28,064improve your physical and financial health, as well as 800:00:28,103 --> 00:00:31,460your emotional and mental well-being. Whether you're 900:00:31,481 --> 00:00:35,930looking to boost your energy levels, unlock financial freedom1000:00:35,930 --> 00:00:40,228or cultivate a more positive mindset, we've got you covered. 1100:00:41,880 --> 00:00:45,901Get ready to become the best version of yourself? So let's 1200:00:45,941 --> 00:00:50,329get started. Here's Dr William Chokta, MDJD. 1300:00:51,240 --> 00:00:55,308Speaker 2: Good morning, welcometo our Healthy, wealthy and 1400:00:55,389 --> 00:01:00,469Wise podcast. This is part of our Leadership Masterclass 1500:01:00,509 --> 00:01:05,426series and it is designed to help you live long and thrive. 1600:01:05,799 --> 00:01:09,388We're delighted to have you withus today, and I am Dr William T1700:01:09,388 --> 00:01:13,481Chokta. I will be your facilitator this morning. So 1800:01:13,542 --> 00:01:16,882welcome, and let's get started. Today, we're going to talk about1900:01:16,882 --> 00:01:24,165artificial intelligent robots in surgery. That's true, 2000:01:24,700 --> 00:01:30,804artificial intelligent robots insurgery. I believe life is 2100:01:30,843 --> 00:01:35,106about being of service to others. I believe knowledge is power. 2200:01:35,620 --> 00:01:39,102I believe leaders can change theworld. One of the things I've 2300:01:39,162 --> 00:01:43,798learned in my 50 years of surgical practice is that it is 2400:01:43,897 --> 00:01:48,046important to have beliefs, because our beliefs affect our 2500:01:48,126 --> 00:01:52,382thoughts, our thoughts affect our feelings and our feelings 2600:01:52,563 --> 00:01:58,268affect our actions. So if you are not feeling well or you are 2700:01:58,308 --> 00:02:01,882not acting the way you think youshould act, go back to your 2800:02:01,923 --> 00:02:05,275beliefs and make sure your belief systems are where they 2900:02:05,355 --> 00:02:10,883should be at the present time. With the Masterclass and with 3000:02:11,062 --> 00:02:15,539our podcast, i always like to have you think as doctors, think3100:02:15,539 --> 00:02:20,693as physicians. Put yourself in the shoes of that physician as 3200:02:20,753 --> 00:02:24,665we go through this particular topic, and then it will make 3300:02:24,747 --> 00:02:28,781much more. It will be much more relevant and be much closer to 3400:02:28,800 --> 00:02:33,411what we're talking about. I always like to put up an outline3500:02:33,411 --> 00:02:36,221, and the purpose of the outlineis to tell you what we're going3600:02:36,221 --> 00:02:40,771to talk about and to let you know when we're just about done.3700:02:40,771 --> 00:02:44,174I realize that you're very, very busy people and you have a 3800:02:44,254 --> 00:02:48,352lot on your plate and you have alot to do, and I appreciate you3900:02:48,352 --> 00:02:53,367sharing parts of your valuable time with us, and so we will 4000:02:53,508 --> 00:02:56,462certainly keep that in mind. We're going to talk about the 4100:02:56,502 --> 00:02:59,200definition of artificial intelligence. We'll then go to 4200:02:59,222 --> 00:03:04,181the benefits of AI in medicine in general. We'll talk about the4300:03:04,181 --> 00:03:08,800benefits of AI robot assisted surgery applications. We'll talk4400:03:08,800 --> 00:03:12,490about what those benefits are for physicians and we'll end up 4500:03:12,691 --> 00:03:16,181talking about what those benefits are for hospitals. When4600:03:16,181 --> 00:03:20,049I start talking about the benefits of artificial 4700:03:20,128 --> 00:03:24,044intelligent robots for hospitals, then you know that I'm just 4800:03:24,084 --> 00:03:29,259about done. Well, what is artificial intelligence? One of 4900:03:29,280 --> 00:03:33,149the basic definitions is the simulation of approximation of 5000:03:33,248 --> 00:03:39,325human intelligence in machines. The simulation or approximation 5100:03:39,545 --> 00:03:44,082of human intelligence in machines. I like to simplify 5200:03:44,122 --> 00:03:48,360that and just say teaching machines to think. Artificial 5300:03:48,381 --> 00:03:53,479intelligence is basically teaching machines to think. Some5400:03:53,479 --> 00:03:58,308of the goals of that is to havea computer enhanced learning, 5500:03:58,930 --> 00:04:03,765reasoning and perception. There are two basic categories of 5600:04:03,846 --> 00:04:08,223artificial intelligence. Technically, one category has to5700:04:08,223 --> 00:04:12,538do with basic pattern recognition, where the machine 5800:04:12,617 --> 00:04:16,487is taught how to recognize a certain pattern of data or 5900:04:16,627 --> 00:04:23,209pictures or images, etc. The other basic type is complex 6000:04:23,329 --> 00:04:29,512human emotion. Indeed, when you get into emotion and computers, 6100:04:30,254 --> 00:04:35,180that gets you into some of the controversial areas. For the 6200:04:35,199 --> 00:04:39,910most part, we will not get into that today, but that is an issue6300:04:39,910 --> 00:04:47,439with computers, particularly with AI and with chatbots. We 6400:04:47,459 --> 00:04:51,762will talk about that a bit later, at another time. Basically, 6500:04:52,021 --> 00:04:56,091computers follow algorithms and these are patterns of data or 6600:04:56,310 --> 00:05:01,341rules of data that data has to follow. This is part and parcel 6700:05:01,382 --> 00:05:06,211to the process of how artificialintelligence is able to occur, 6800:05:07,279 --> 00:05:09,625if you just keep in mind that when we say artificial 6900:05:09,685 --> 00:05:15,286intelligence, we are talking about teaching machines to think7000:05:15,286 --> 00:05:18,211. One of the ways that artificial intelligence has been7100:05:18,211 --> 00:05:22,911very helpful in hospitals and in medicine in general is it 7200:05:22,971 --> 00:05:27,281helps all of us in healthcare toimprove in our accuracy of 7300:05:27,341 --> 00:05:33,177diagnosis. It helps us to improve in our ability to 7400:05:33,257 --> 00:05:36,865evaluate medical images, particularly with x-rays, mris, 7500:05:37,026 --> 00:05:41,846ultrasounds and CAT scans. It improves our medical decision 7600:05:41,886 --> 00:05:45,656making, and this is mainly with a process called clinical 7700:05:45,716 --> 00:05:49,850decision support. Whereas a physician, if I have a plan of 7800:05:50,009 --> 00:05:54,463action or therapy for a certain patient, and as I have to put 7900:05:54,504 --> 00:05:58,194that data into the computer, because all hospitals now are 8000:05:58,233 --> 00:06:02,360computer rise based on the Affordable Care Act, obamacare 8100:06:02,821 --> 00:06:09,235from 2010. And now what I put into that computer has to be 8200:06:09,317 --> 00:06:13,444correct or in alignment, if you will, with what that computer 8300:06:13,485 --> 00:06:18,360perceives as quality care. Otherwise it will not allow me 8400:06:18,459 --> 00:06:23,509to do that, and that's an extra protective layer, in my judgment8500:06:23,509 --> 00:06:29,310, for quality patient care. And the other part of artificial 8600:06:29,329 --> 00:06:32,678intelligence and medicine is predictive analysis, and this 8700:06:32,899 --> 00:06:38,374gets a lot into executive management and staffing, nursing8800:06:38,374 --> 00:06:42,103, staffing, position staffing, et cetera, et cetera. But all of8900:06:42,103 --> 00:06:46,757this goes to quality patient care And this, indeed, is what 9000:06:46,776 --> 00:06:49,584we're most concerned about. So what are some of the benefits 9100:06:49,625 --> 00:06:53,884for patients in surgery? And letme say that when I say 9200:06:54,386 --> 00:06:57,596artificial intelligence, robot in surgery, i'm talking about 9300:06:58,697 --> 00:07:05,728robots in robot assisted surgeryfor patients. In other words, 9400:07:06,129 --> 00:07:10,125this is surgery that's robot assisted, so it's not just 9500:07:10,406 --> 00:07:12,935that's the robot running around in surgery. There are no humans 9600:07:13,035 --> 00:07:15,100there. No, no, no, no, no. That's not what I'm talking 9700:07:15,141 --> 00:07:20,122about. I'm talking about surgerythat is robot assisted or AI 9800:07:20,223 --> 00:07:23,692robot assisted, and there's someparticular benefits to the 9900:07:23,733 --> 00:07:27,663patient, and one of the very obvious benefits to the patient 10000:07:28,805 --> 00:07:34,839is that patients have a shorter hospital stay And part of the 10100:07:34,899 --> 00:07:39,153reason for that is that the incision in general for these 10200:07:39,192 --> 00:07:44,603types of surgeries tend to be smaller And because of the small10300:07:44,603 --> 00:07:49,317incision that decreases the risk of surgical site infection.10400:07:49,317 --> 00:07:54,596It also decreases postoperativepain And many times allows 10500:07:54,637 --> 00:07:59,951these patients to recover much faster, and that's just ideal 10600:07:59,992 --> 00:08:02,437for a patient And if you've everbeen a patient who's had 10700:08:02,478 --> 00:08:06,466surgery or had a family or friend or loved, one who had 10800:08:06,507 --> 00:08:09,800surgery, then you understand exactly what I'm talking about 10900:08:10,262 --> 00:08:15,110And you can appreciate how important it is to have the 11000:08:15,228 --> 00:08:19,204procedure done properly but havethe patient not stay in the 11100:08:19,322 --> 00:08:22,946hospital any longer than they absolutely have to. One of the 11200:08:22,985 --> 00:08:25,915things that's important about robotic surgery is that it 11300:08:25,956 --> 00:08:30,309completely revolutionized the way operations are done in 11400:08:30,408 --> 00:08:33,740general in the operating room. As I mentioned before, i 11500:08:33,760 --> 00:08:36,934graduated from Yale Medical School 50 years ago. Matter of 11600:08:36,955 --> 00:08:42,868fact, we're celebrating our 50 year anniversary this year, 197311700:08:42,868 --> 00:08:47,701. And what the traditional surgery is? the surgeon would 11800:08:47,721 --> 00:08:51,897stand at the bedside, do the operation and then leave. Well, 11900:08:51,977 --> 00:08:55,904with robotic surgery, basically,you do not stand at the bedside12000:08:55,904 --> 00:09:02,822, you sit at a console, computerconsole, and you do the surgery12100:09:02,822 --> 00:09:08,759indirectly, moving the arms of the computer itself, which is in12200:09:08,759 --> 00:09:11,470direct contact with the patient. I know that might seem a 12300:09:11,490 --> 00:09:16,365little confusing, but basically the physician is sitting and not12400:09:16,365 --> 00:09:20,357standing. Now that may not seemlike a very big deal, but I can12500:09:20,357 --> 00:09:24,091assure you, during those early days of surgery, certainly in my12600:09:24,091 --> 00:09:29,325career, we used to stand hours in the operating room, and so 12700:09:29,365 --> 00:09:33,755that physicality became a significant issue. So now to 12800:09:33,816 --> 00:09:38,090have surgery, particularly largeoperations or long operations, 12900:09:38,171 --> 00:09:43,020theoretically, where the physician can sit and merely 13000:09:43,140 --> 00:09:47,629work. A console makes it much easier physically for the 13100:09:47,668 --> 00:09:51,922surgeon and, in my judgment, provides better quality care for13200:09:51,922 --> 00:09:56,298the patient. What are some other ways that the surgeon is 13300:09:56,359 --> 00:10:01,072benefited by this robotic cysticapparatus in the operating room13400:10:01,072 --> 00:10:05,322? Well, as I mentioned before, it allows a surgeon to do what 13500:10:05,341 --> 00:10:10,017we call a minimally invasive surgery instead of making the 13600:10:10,096 --> 00:10:13,905long incisions. And all of this takes time The long incision, 13700:10:13,926 --> 00:10:20,004more blood loss, more OR time because you have to close that 13800:10:20,063 --> 00:10:26,323long incision and clearly makes it much easier for the patient 13900:10:26,364 --> 00:10:30,759not to have that long incision. Number one Secondly, as I 14000:10:30,820 --> 00:10:33,928mentioned, the surgeon is sitting as compared to standing 14100:10:34,009 --> 00:10:37,839long hours in the operating roomA huge change in the 14200:10:37,879 --> 00:10:41,004traditional way that surgery is being done. Now, every single 14300:10:41,085 --> 00:10:44,678operation one does not use the robot, but I think it's fair to 14400:10:44,739 --> 00:10:50,399say that the robot-assisted surgery is probably used in most14500:10:50,399 --> 00:10:55,413operations and the usage of therobots in surgery is continuing14600:10:55,413 --> 00:11:01,404to grow. And thirdly, one of the benefits is the robot itself14700:11:01,404 --> 00:11:05,999has a certain type of mechanical dexterity that allows14800:11:05,999 --> 00:11:11,495the surgeon to manipulate the robot in ways that it would be 14900:11:11,629 --> 00:11:15,701very difficult for the surgeon to physically use their hand. I 15000:11:15,740 --> 00:11:18,505know that sounds a little complicated, but the bottom line15100:11:18,505 --> 00:11:22,975is the robot is more flexible in many more different ways, 15200:11:23,515 --> 00:11:28,615which ends up making the surgerymore efficient and safer. So 15300:11:28,655 --> 00:11:32,785another huge benefit for the robots in robot-assisted surgery15400:11:32,785 --> 00:11:36,159in our operating rooms. What are some of the types of surgery15500:11:36,159 --> 00:11:40,758that robots are used on? Well, pretty much most major types of 15600:11:40,817 --> 00:11:44,677surgery prostate surgery, general surgery, gynecological 15700:11:44,736 --> 00:11:48,730surgery, heart surgery and again, the usage is continuing to 15800:11:48,830 --> 00:11:52,966increase over time. What are some of the main advantages to 15900:11:52,985 --> 00:11:56,619the hospital for the robot? Remember what I said when I get 16000:11:56,698 --> 00:12:01,655to advantages for the hospital. We're just about done. One of 16100:12:01,676 --> 00:12:07,356the huge advantages for the hospital is financial. Because 16200:12:07,418 --> 00:12:12,293of robots in the hospital or artificial intelligent robots in16300:12:12,293 --> 00:12:15,761the hospital, hospitals have been able to increase their 16400:12:15,822 --> 00:12:20,019revenue stream over $100 billion, and at the very top of that 16500:12:20,099 --> 00:12:24,177list is robot-assisted surgery. Basically, most hospitals 16600:12:24,278 --> 00:12:27,825increase revenue based on procedures as compared to 16700:12:27,926 --> 00:12:32,443medication or number of days patients stay in the hospital. 16800:12:32,875 --> 00:12:38,163So anything that increases the efficiency and volume of 16900:12:38,222 --> 00:12:42,875procedures tends to increase revenue for the hospitals, and 17000:12:42,894 --> 00:12:47,538this is exactly what robot-assisted surgery does, and17100:12:47,538 --> 00:12:51,576so it ends up being win-win theoretically. In summary, 17200:12:52,197 --> 00:12:56,197artificial intelligence is not the future, it is now, and this 17300:12:56,277 --> 00:12:59,317is certainly true in healthcare.Artificial intelligence is 17400:12:59,357 --> 00:13:03,868defined as computer learning or non-human learning, if you will.17500:13:03,868 --> 00:13:08,844Doctors like robots in surgery because surgery, physically and 17600:13:08,923 --> 00:13:13,980technically, is easier. Patientslike robots in surgery or in 17700:13:15,563 --> 00:13:19,836robot-assisted surgery because it decreases pain, it decreases 17800:13:19,937 --> 00:13:25,878recovery time and it decreases hospital stay. Hospitals like 17900:13:25,998 --> 00:13:29,988robots assisting in surgery because it increases revenue. 18000:13:30,554 --> 00:13:35,164And remember, robots have been in surgery for 15 years, not 18100:13:35,205 --> 00:13:40,120just this year or last year, buttheir usage is growing and the 18200:13:40,220 --> 00:13:43,826number of types of surgery that they're being used on and the 18300:13:43,905 --> 00:13:49,859volume is significantly increasing. My basic principles 18400:13:50,581 --> 00:13:54,519God is in charge. I am a physician of faith and it is, 18500:13:54,600 --> 00:13:59,028indeed has been, my faith in Godthat has sustained me over the 18600:13:59,107 --> 00:14:03,446years. I have no bad days. I'm one of those people who believes18700:14:03,446 --> 00:14:05,857that they've had enough bad days, so I decided a number of 18800:14:05,918 --> 00:14:09,366years ago that I would not have any more bad days, and so I do 18900:14:09,427 --> 00:14:14,457not. I have good days and I havegreat days. I have learned that19000:14:14,457 --> 00:14:17,966don't sweat the small stuff, and most stuff is small. 19100:14:18,975 --> 00:14:21,984Consequently, i don't worry about little things at least I 19200:14:22,024 --> 00:14:27,078try not to And I found that thatkeeps me stress free, or at 19300:14:27,139 --> 00:14:30,782least minimally stressed, and allows me to have a more 19400:14:30,822 --> 00:14:35,928fruitful and a more happy and happier day. Forgiveness is 19500:14:36,210 --> 00:14:39,211therapy. If there are things that individuals and 19600:14:39,272 --> 00:14:44,547circumstances have done to you, forgive them And you would be 19700:14:44,607 --> 00:14:48,270amazed how therapeutic it is, regardless of who's right or 19800:14:48,291 --> 00:14:53,326wrong or regardless of what the issues are just forgive, and 19900:14:53,346 --> 00:14:56,809that, indeed, is therapeutic. And finally, my final basic 20000:14:56,850 --> 00:14:59,927principle is that everything is relationship. Relationships are 20100:14:59,967 --> 00:15:03,431based on three things Mutual respect, mutual trust, good 20200:15:03,471 --> 00:15:06,966communication. If you have all three of those things, you have 20300:15:07,006 --> 00:15:10,288a very good relationship, whether it is a work 20400:15:10,328 --> 00:15:14,827relationship, a family relationship, a good friend 20500:15:14,868 --> 00:15:19,908relationship. And if you have a good relationship, then chances 20600:15:20,048 --> 00:15:24,210are you are happier in your life. In spite of issues always 20700:15:24,269 --> 00:15:27,909associated with surgery, and regardless of the operation and 20800:15:27,970 --> 00:15:34,395regardless of how new the technique is or the associated 20900:15:34,456 --> 00:15:38,385equipment, be it a robot or something else, surgery is still21000:15:38,385 --> 00:15:45,330a very, very dangerous area AndI think it's important to 21100:15:45,389 --> 00:15:50,347understand that, as patients, you have rights, and we've gone 21200:15:50,388 --> 00:15:55,211over this before, but let me go over them again that, regardless21300:15:55,211 --> 00:15:59,610of what type of technique is used, so who the position is or 21400:15:59,750 --> 00:16:05,905is not, all patients who are to have any type of operation need 21500:16:05,926 --> 00:16:10,427to have been given what we call informed consent. Those two 21600:16:10,506 --> 00:16:13,908words informed means that you should be given sufficient 21700:16:13,989 --> 00:16:19,714information in a way that you understand it, so that the 21800:16:19,774 --> 00:16:24,293second word consent you can consent or agree to the 21900:16:24,332 --> 00:16:29,554procedure, and this is particularly true with invasive 22000:16:29,595 --> 00:16:35,208procedures or the larger the procedure is. And the informed 22100:16:35,229 --> 00:16:38,330consent is very specific, regardless of what state you're 22200:16:38,471 --> 00:16:42,894in. It's very specific and it has to cover three particular 22300:16:43,014 --> 00:16:49,807elements, and those elements arerisk benefits and alternative 22400:16:49,847 --> 00:16:55,625treatment. Risk benefits and alternative treatment What are 22500:16:55,645 --> 00:17:00,370the risks of the procedure? And the physician and or the 22600:17:00,410 --> 00:17:05,498proceduralist be it the surgeon or the anesthesiologist or nurse22700:17:05,498 --> 00:17:10,990anesthetist should give you specifics about what those risks22800:17:10,990 --> 00:17:15,546are, because, again, you want to be informed enough so that 22900:17:15,605 --> 00:17:18,905you can then make a decision about whether this is an 23000:17:18,925 --> 00:17:22,108appropriate operation for you. Iwould encourage you to have 23100:17:22,190 --> 00:17:24,928family and or close friends withyou. If you don't feel 23200:17:24,988 --> 00:17:29,570comfortable making these decisions completely by yourself23300:17:29,570 --> 00:17:33,728, there's absolutely nothing wrong with that. But you want to23400:17:33,728 --> 00:17:37,309be sure before you agree, because at the end of this 23500:17:37,410 --> 00:17:42,013process they're going to have you sign a form that says that 23600:17:42,094 --> 00:17:45,645you agree, that you've got sufficient information so that 23700:17:45,686 --> 00:17:50,666you can agree If English is not your first language, and even 23800:17:50,727 --> 00:17:54,169though the doctor or the nurse or whoever was the physician or 23900:17:54,189 --> 00:17:57,028whoever's going to do the procedure is talking to you and 24000:17:57,087 --> 00:18:02,049you think you don't understand everything. It's OK to say that.24100:18:02,049 --> 00:18:05,244It's OK to say well, you know, my English is the best And I 24200:18:05,286 --> 00:18:08,145think I understand, but I don't understand. Blah, blah, blah, 24300:18:08,165 --> 00:18:12,625blah, blah, blah. A lot of times, because informed consensus are24400:18:12,625 --> 00:18:16,527done on every single day, many times a day. The individuals 24500:18:16,607 --> 00:18:22,832given them tend to go very fast And it's important, because this24600:18:22,832 --> 00:18:27,612is new for you as a patient, toslow them down and to say no, 24700:18:27,652 --> 00:18:32,207you need to go over that again. Explain it to me. If, again, 24800:18:32,769 --> 00:18:35,367english is not your first language, but you speak English 24900:18:35,409 --> 00:18:39,632and you speak it very well, it is within your right to say I 25000:18:40,012 --> 00:18:45,115want someone who speaks Tagalog to come and explain this to me, 25100:18:46,847 --> 00:18:50,066or this form that you've asked me to sign is in English And I 25200:18:50,086 --> 00:18:53,749don't understand all these words. And I want someone who speaks 25300:18:54,230 --> 00:19:00,250Mandarin or Cantonese or Spanishto come and explain this to me,25400:19:00,250 --> 00:19:03,866because I don't really understand. Most hospitals and 25500:19:03,946 --> 00:19:10,172organizations will not allow patients to use extensively 25600:19:10,251 --> 00:19:14,413their family members to interpret medical information, 25700:19:15,765 --> 00:19:20,405and if that indeed is the case, you have a right to say I want 25800:19:20,425 --> 00:19:24,387to have someone who can talk to me in my language. If I am 25900:19:24,468 --> 00:19:28,107Russian or Ukrainian, i want someone who can talk to me in my26000:19:28,107 --> 00:19:31,989language so that I can make sure that I fully understand 26100:19:32,431 --> 00:19:37,008what it is that you're going to do to me. Another thing that's 26200:19:37,067 --> 00:19:40,509important to understand about informed consent that when you 26300:19:40,569 --> 00:19:44,873have surgery, there are basically two different areas of26400:19:44,873 --> 00:19:48,525medicine or health care that are taking care of you. I'm 26500:19:48,545 --> 00:19:51,892talking about physician. Now There's a surgeon, obviously, 26600:19:51,951 --> 00:19:53,229who's going to do the operation.26700:19:53,650 --> 00:19:54,794Speaker 1: Whoever, he or she is. 26800:19:55,224 --> 00:19:57,612Speaker 2: But there's also another department called 26900:19:57,772 --> 00:20:01,853anesthesiologist. So there's an anesthesiologist, whoever he or 27000:20:01,913 --> 00:20:06,634she is, both of them are required to give you written 27100:20:07,155 --> 00:20:12,497information verbal and written information about what you're 27200:20:12,545 --> 00:20:16,027going to have to go through to have this operation. The surgeon27300:20:16,027 --> 00:20:21,348is required to explain the human details, risk benefits, an27400:20:21,348 --> 00:20:25,385alternative treatment about thesurgery. The anesthesiologist 27500:20:25,846 --> 00:20:30,553is required to explain the humandetail, risk benefits and 27600:20:30,613 --> 00:20:34,748alternative treatment before youhave anesthesia. Now, if you're27700:20:34,748 --> 00:20:38,415having a local anesthesia, thenthose risks may very well be 27800:20:38,477 --> 00:20:43,814small, but regardless, both are required to get consent from you27900:20:43,814 --> 00:20:49,387or informed consent from you. And again, the informed part 28000:20:49,468 --> 00:20:54,021means that they need to give youinformation sufficient from 28100:20:54,102 --> 00:20:56,470your perspective not their perspective from your 28200:20:56,490 --> 00:21:01,453perspective that you can indeed consent and say okay, i 28300:21:01,647 --> 00:21:06,093understand and I agree to go ahead and let you put me to 28400:21:06,133 --> 00:21:09,684sleep for an hour or two hours or five hours or whatever the 28500:21:09,724 --> 00:21:14,799time may be. And the reason for that is, i like to say, that 28600:21:14,840 --> 00:21:18,611there's always a possibility of complications, there are always 28700:21:18,671 --> 00:21:25,300a possibility of issues, and it's not 100%, 100% of the time.28800:21:25,300 --> 00:21:29,997And so you need to be aware so that you can make decisions and 28900:21:30,057 --> 00:21:34,490have family or friends advise us, help you make decisions about 29000:21:34,630 --> 00:21:38,896whether you really want to have this procedure done at this time29100:21:38,896 --> 00:21:45,333. Most of the times, patients will have those procedures done 29200:21:45,393 --> 00:21:50,182because the whole thing that brought you to the physician is 29300:21:50,262 --> 00:21:55,499something significant enough that you want to be healed or 29400:21:55,538 --> 00:22:00,232have this whole issue resolved. But don't feel rushed, and I 29500:22:00,292 --> 00:22:08,003know that's hard to fathom but you have rights and feel good 29600:22:08,044 --> 00:22:11,839and feel free to exercise your rights, because those rights are29700:22:11,839 --> 00:22:15,712designed to protect you and to make sure that you get the very 29800:22:15,792 --> 00:22:20,008best care possible. So remember that there are two elements of 29900:22:20,087 --> 00:22:23,656an operation. There's a surgicalelement physician there's the 30000:22:23,757 --> 00:22:29,499anesthesia element physician andor nurse practitioner Okay, and30100:22:29,499 --> 00:22:32,709so make sure, feel comfortable asking questions, i guess is 30200:22:32,729 --> 00:22:35,339what I'm trying to say Now. I understand that's a challenge. 30300:22:35,421 --> 00:22:37,730I've been again, i've been in a position over 50 years and I 30400:22:37,810 --> 00:22:40,838know that most of you will basically do whatever we 30500:22:40,878 --> 00:22:44,960physicians ask you to do becauseyou trust us and you respect us30600:22:44,960 --> 00:22:47,210, et cetera, et cetera. Nothing wrong with that, that's 30700:22:47,289 --> 00:22:51,182completely appropriate. But you can also ask questions. Or it's 30800:22:51,383 --> 00:22:55,453also okay to say I do not understand, and there's nothing 30900:22:55,534 --> 00:22:59,903wrong with that. Just say I do not understand, i need more 31000:22:59,942 --> 00:23:04,381information, i need more time. Whatever those words are, i do 31100:23:04,442 --> 00:23:08,112not feel, rushed, unless it's a life-threatening operation and 31200:23:08,132 --> 00:23:10,939the decision has been made immediately. But if it's an 31300:23:11,019 --> 00:23:15,336elective operation, meaning thatit is not life-threatening and 31400:23:15,356 --> 00:23:19,813it does not have to be done immediately, then feel free to. 31500:23:19,973 --> 00:23:23,040And even if it is an enema risk operation, you still ask the 31600:23:23,080 --> 00:23:26,635questions. But certainly if it'san elective operation, feel 31700:23:26,655 --> 00:23:29,971free to ask those questions. What are the risks of this 31800:23:30,112 --> 00:23:34,606operation, what are the benefitsof this operation And what are 31900:23:34,626 --> 00:23:38,917the alternatives of me not having this operation? And those32000:23:38,917 --> 00:23:41,892three elements have to be discussed with you. They have to32100:23:41,892 --> 00:23:46,787be in writing and you have to sign it to say that you have an 32200:23:46,807 --> 00:23:51,218agreement. So before you sign anything, make sure that you're 32300:23:51,258 --> 00:23:57,009comfortable as best as you can be and you have received that 32400:23:57,130 --> 00:24:00,958information. Well, what are someof the risks for, say, robotic 32500:24:00,998 --> 00:24:05,855assisted surgery? Basically, most of the literature suggests 32600:24:05,875 --> 00:24:10,009that robotic assisted surgery does not add a great deal to the32700:24:10,009 --> 00:24:13,321basic risks of any type of operation, and surgery is risky 32800:24:14,104 --> 00:24:17,395and usually depends on the operation you're having, what 32900:24:17,455 --> 00:24:21,048your condition is prior to the surgery. But there are some 33000:24:21,087 --> 00:24:24,355things that may be relatively unique with using the robot, 33100:24:24,936 --> 00:24:28,471patients in very unique positions, sometimes during the 33200:24:28,510 --> 00:24:37,002time of the robotic surgery theymay be turned certain ways, and33300:24:37,002 --> 00:24:41,201so that can be issues that haveto do with peripheral nerve 33400:24:41,643 --> 00:24:44,491damage, and so you want to make sure that appropriate patients 33500:24:44,571 --> 00:24:47,278all know this, as you're an anesthesiologist. But again, 33600:24:47,940 --> 00:24:50,615there's nothing wrong with you knowing that information, also 33700:24:51,376 --> 00:24:54,929that there has to be appropriatepadding to make sure that 33800:24:54,969 --> 00:25:01,282there's no nerve discomfort or damage after the operation. 33900:25:01,884 --> 00:25:04,711Sometimes you may be in a certain position doing surgery 34000:25:04,751 --> 00:25:09,247for a long period of time, and so you want to make sure that's 34100:25:09,287 --> 00:25:12,865the case. Anesthesiologists particularly make sure that the 34200:25:13,047 --> 00:25:16,842eyes are closed, unless it's an eye surgery, obviously And 34300:25:17,022 --> 00:25:20,682frequently they will change the eyes, because a lot of times 34400:25:20,722 --> 00:25:23,394when we close our eyes, even when we're asleep, we may not 34500:25:23,434 --> 00:25:26,824close the lid completely, And soif you can see any part of the 34600:25:28,247 --> 00:25:35,162eye that's open between the lids, that area could be damaged in 34700:25:35,201 --> 00:25:40,402terms of having it scratched or injured somehow. So usually good34800:25:40,402 --> 00:25:45,039anesthesiologists and anesthesiologists know this They34900:25:45,039 --> 00:25:49,723will cover the eyes and tape them. But again, just like the 35000:25:49,763 --> 00:25:53,835surgeon, the anesthesiologist has to give you informed consent35100:25:53,835 --> 00:25:58,480. Informed consent, they have tosay hi, i'm Dr So-and-so, i'm 35200:25:58,500 --> 00:26:02,105going to be providing anesthesiafor you. Dr Blah-blah-blah is 35300:26:02,125 --> 00:26:05,099going to do the surgery, i'm going to do the anesthesia. Do 35400:26:05,140 --> 00:26:09,229you have any questions after they go through the litany of 35500:26:09,308 --> 00:26:13,969information to talk to you about? And it's important again for 35600:26:13,989 --> 00:26:17,059you to be aware of that and for you to ask the appropriate 35700:26:17,160 --> 00:26:22,269questions that you may need to ask to make sure that everything35800:26:22,269 --> 00:26:28,248goes well with your operation. Now, again, the procedure itself35900:26:28,248 --> 00:26:32,326is going to have brisk And the surgeon should go over those 36000:26:32,386 --> 00:26:36,279risks with you. But anesthesia will also have brisk And so the 36100:26:36,361 --> 00:26:42,550anesthesiologist is required by law and by ethics to go over 36200:26:42,590 --> 00:26:47,527those risks with you. And if youare in any way uncomfortable, 36300:26:48,348 --> 00:26:52,306it is OK to get second opinions,say, well, you know, i need to 36400:26:52,346 --> 00:26:56,387talk to So-and-so, that's OK, unless it's a life-threatening 36500:26:56,428 --> 00:26:59,865situation. And again, you still have the right to consent if you36600:26:59,865 --> 00:27:05,582are alert, awake and can give consent to that being done. So 36700:27:05,602 --> 00:27:09,544please keep that in mind. So most of the complications 36800:27:09,564 --> 00:27:15,201associated with robotic-assistedsurgery tend to be those things36900:27:15,201 --> 00:27:17,644that are associated with positioning of the patient 37000:27:18,406 --> 00:27:24,746during the time of the operationAnd they tend to fall into the 37100:27:24,846 --> 00:27:28,163area of the anesthesiologist Andagain, depending on the surgery37200:27:28,163 --> 00:27:31,291, because the surgeons themselves position patients, 37300:27:31,941 --> 00:27:36,460certainly in orthopedics and other types of procedures, and 37400:27:36,480 --> 00:27:40,587so both have a dual responsibility there to make 37500:27:40,628 --> 00:27:46,866sure that everything occurs. Ok,again, there's no question that37600:27:46,866 --> 00:27:53,359there are benefits to robotic-assisted surgery, but, 37700:27:53,460 --> 00:27:57,222like with any type of surgery, there are always risks, 37800:27:57,242 --> 00:28:01,342certainly if you're going to be asleep, and it's important that 37900:28:01,942 --> 00:28:07,472those risks be explained to you in the form of verbally and in 38000:28:07,553 --> 00:28:12,548writing, and in a language and in a way using words that you 38100:28:12,608 --> 00:28:16,746can understand. They cannot be using big words that make no 38200:28:16,786 --> 00:28:19,102sense to you, because you're nota physician and may not be 38300:28:19,162 --> 00:28:23,561medically inclined. That is not your responsibility. That is the38400:28:23,561 --> 00:28:27,500physicians and the healthcare team's responsibility. So feel 38500:28:27,561 --> 00:28:31,583free to search your rights And, if you're uncomfortable, bring a38600:28:31,583 --> 00:28:35,854friend or somebody with you whowill do that for you. That's OK38700:28:35,854 --> 00:28:39,391, because one of the things thathas occurred in the area of 38800:28:39,751 --> 00:28:44,286Obamacare 2010 Affordable Care Act is that healthcare is now 38900:28:44,365 --> 00:28:48,622patient-centered. It is patient-centered And that means 39000:28:48,642 --> 00:28:51,890that you're the patient, the most important person in the 39100:28:51,931 --> 00:28:57,150room, and so you're well within your rights to a searcher of 39200:28:57,250 --> 00:29:01,450rights And if there's any pushback, small or large, 39300:29:02,251 --> 00:29:05,201rethink whether you want to havethese individuals take care of 39400:29:05,281 --> 00:29:09,461you, if indeed you have that option at the time. And my final39500:29:09,461 --> 00:29:13,540thought be the change you want to see in the world. Be the 39600:29:13,580 --> 00:29:17,083change you want to see in the world. Thank you so much for 39700:29:17,123 --> 00:29:20,340spending your valuable time withus. Have a great day.