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47:59
>> Steve: BEHAVIORAL ECONOMICS IS A FIELD OF STUDY THAT MELDS PSYCHOLOGY WITH ECONOMICS. ALTHOUGH IT'S BEEN AROUND SINCE THE 1970s, IT'S ONLY IN THE PAST 15 YEARS THAT ITS CONCEPTS HAVE BEEN POPULARIZED, THANKS IN PART TO A BOOK BY MICHAEL LEWIS CALLED "MONEYBALL," AS WELL AS HIS LATEST, "THE UNDOING PROJECT - A FRIENDSHIP THAT CHANGED OUR MINDS." THAT RECENT BOOK PROFILES THE SO-CALLED FATHERS OF THE DISCIPLINE, ISRAELI
48:21
PSYCHOLOGISTS AMOS TVERSKY AND DANIEL KAHNEMAN, WHOSE WORK EVENTUALLY WON A NOBEL PRIZE FOR ECONOMICS. IT ALSO TALKED ABOUT THE WORK OF OUR NEXT GUEST, DONALD REDELMEIER. HE IS A STAFF PHYSICIAN AND SENIOR SCIENTIST AT THE SUNNYBROOK HEALTH SCIENCES CENTRE. HE SPENT THE EARLY DAYS OF HIS CAREER WORKING WITH TVERSKY AND KAHNEMAN, AND HE JOINS US NOW ON THAT AND TO EXPLAIN HIS WORK IN MEDICAL DECISION SCIENCE. SO NICE TO HAVE YOU HERE. >> Donald Redelmeier: IT'S NICE TO BE HERE, STEVE.
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>> Steve: WE HAVE TO POINT OUT YOU'RE NOT THE FIRST FROM YOUR HOUSEHOLD WHO HAS BEEN ON THIS PROGRAM. >> MY WIFE IS MARIAM SHUCKMAN AND MUCH MORE PHOTOGENIC THAN I HAVE. >> Steve: SHE HAS BEEN ON THE PROGRAM A COUPLE OF TIMES IN THE PAST, WRITTEN AN IMPORTANT BOOK THAT WON AN AWARD ABOUT YOUR FIELD OF WORK. WE'RE HAPPY TO HAVE THE OTHER HALF OF THE FAMILY ON THE PROGRAM TODAY TOO. HOW DID YOU END UP IN A CHAPTER IN MICHAEL LEWIS' BOOK? LET'S START THERE.
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>> IT'S A LONG STORY, BUT MICHAEL LEWIS' EARLIER BOOK "MONEYBALL" CONTAINED ONE BIG MISTAKE WHICH WAS CALLED OUT BY RICHARD THAYLER YEARS LATER. RICHARD WOULD GO ON TO WIN A NOBEL PRIZE. AND MICHAEL LEWIS, TO HIS CREDIT, THEN WENT BACK AND IDENTIFIED THE MISTAKE IN "MONEYBALL" SO THIS ENTIRE NEW BOOK HERE IS SORT OF TO ADDRESS THAT -- >> Steve: "MONEYBALL" WE ALL REMEMBER IS THE BOOK FOCUSING ON BILLY BEAN, THE GENERAL MANAGER
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OF THE OAKLAND A'S WHO CAME UP WITH DEVISING WHO WOULD BE A GREAT BASEBALL PLAYER. HE TOOK A TEAM WITH ALMOST NO PAYROLL MUCH FURTHER THAN IT OUGHT TO HAVE GONE. WHAT WAS THE MISTAKE THEY FOUND? >> THAT BILLY BEAN WAS NOT WORKING IN ISOLATION. I MEAN, BILLY BEAN WAS A SMART GUY, NO DOUBT ABOUT THAT, REVOLUTIONALIZED BASEBALL. BUT BILLY BEAN GOT HIS OWN IDEAS FROM A MUCH MORE DISTANT SOURCE, A SOURCE THAT WAS INFORMING
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POLITICS, FINANCE, AND BASEBALL AS WELL AS MEDICINE, AND THAT WOULD HAVE BEEN TVERSKY AND KAHNEMAN. >> Steve: SO BILLY MEAN WAS CHANNELING THOSE TWO IN THE WAY HE THOUGHT ABOUT NEW METRICS AROUND BASEBALL? >> AND THE FALLIBILITY ABOUT HUMAN INTUITION. HE COULD BE SERIOUSLY MISTAKEN AND APPEALING TO STATISTICS WOULD SOMETIMES GIVE A MUCH MORE INFORMED JUDGMENT. >> Steve: SO MICHAEL LEWIS, HAVING WRITTEN THAT BOOK AND HAVING DONE SO WELL WITH THAT
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BOOK AND HAD IT TURNED INTO A MOVIE WITH BRAD PITT, HE DECIDED TO DO THIS NEW BOOK AND YOU KNOW THE GUYS AT THE CENTRE OF THIS NEW BOOK. HOW DID YOU GET TO MEET THEM, ORIGINALLY? >> AMOS TVERSKY I FIRST MET AT TORONTO, I WAS TAKING A CLASS IN STATS AND PROBABILITY THEORY AND HOW COUNTERINTUITIVE SO MANY OF THE FINDINGS WERE. ONE OF THE ARTICLES WE WERE SUPPOSED TO READ AND ESSAY ABOUT WAS AN EARLIER ARTICLE BY TVERSKY AND KAHNEMAN.
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AND THEN LATER ON IN MY LIFE I SPENT SEVEN YEARS AT STANFORD UNIVERSITY AND I GOT TO MEET THE MEN. IT WAS ABSOLUTELY INSPIRING. >> Steve: IT WAS TVERSKY WE'RE TALKING ABOUT. >> TVERSKY FIRST. WHO WAS A MAJOR HERO. THEY SAY YOU SHOULD NEVER MEET YOUR HEROES. AU CONTRAIRE. THERE HE WAS IN REAL LIFE AND HE WAS FANTASTIC. >> Steve: I GATHER YOU WERE VERY SURPRISED WHEN YOU MET AMOS BECAUSE HE HAD VERY LITTLE MEDICAL KNOWLEDGE AND YET HIS PRINCIPLES WERE BEING APPLIED IN THE FIELD OF MEDICINE QUITE
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SIGNIFICANTLY. HOW DID THAT ALL WORK ITSELF OUT? >> HE WAS SO MANY STEPS REMOVED FROM IT. THESE FUNDAMENTAL INSIGHTS EVENTUALLY WOULD PLAY OUT IN MULTIPLE DOMAINS IN WHICH HE KNEW NOTHING. BUT IT WAS ONE OF THE MOST -- GREATEST PART OF OUR RELATIONSHIP. OF COURSE, HE DID 90% OF THE TALKING, BUT 10% OF THE TIME HE WOULD ASK ME A QUESTION, AND IT WAS JUST GREAT TO ACTUALLY HAVE THE WISE MAN LISTEN TO, YOU KNOW WHAT I MIGHT HAVE TO SAY AND
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AMOS WAS SO SMART, HE KNEW EXACTLY THE RIGHT TYPE OF QUESTION WHERE I WOULD KNOW THE ANSWER AND THAT ANSWER WOULD BE WORTH LISTENING TO. >> Steve: CAN YOU GIVE US A FOR INSTANCE? >> OH, ABOUT, YOU KNOW, SOMETIMES THE LANGUAGE OF MEDICINE AND THE COMMON PITFALLS THAT ARE GOING ON RIGHT NOW ON THE WARDS OF A HOSPITAL, HE WOULD KNOW ALL THE ABSTRACT THEORIES AND YET I WAS PRETTY GOOD WITH SPECIFIC INSTANCES.
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>> Steve: NOW, IT'S ALMOST -- I THINK IT'S MORE THAN 25 YEARS AGO THAT YOU TWO COLLABORATED ON A PAPER TOGETHER, AND I GATHER IT WAS ABOUT HOW DOCTORS BEHAVE DIFFERENTLY WHEN DESIGNING TREATMENTS FOR GROUPS OF PATIENTS VERSUS INDIVIDUAL PATIENTS. WHY IS THAT SOMETHING -- WHY WAS THAT GROUND IMPORTANT TO TROD ON, AS IT WERE? >> WELL, I MEAN, I THINK IT'S AN ETERNAL TENSION BETWEEN MEDICAL PRACTICE, WHICH DEALS WITH ONE
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PATIENT AT A TIME, AND MEDICAL POLICY, WHICH DEALS WITH ENTIRE POPULATIONS OF PATIENTS. AND THERE ARE A LOT OF DECISIONS THAT YOU WOULD REJECT IF YOU ONLY HAD TO DO IT ONCE, AND YET YOU WOULD SAY YES IF YOU GOT TO DO IT A HUNDRED TIMES. AND SO THAT'S SORT OF A FUNDAMENTAL CONFLICT THAT MUST DRIVE THE MINISTER OF HEALTH CRAZY IN ONTARIO. >> Steve: AGAIN, DO YOU WANT TO GIVE US AN EXAMPLE? >> I'LL GIVE YOU A FINANCIAL EXAMPLE.
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IF I WERE TO BET YOU A 50/50 CHANCE OF WINNING $5,000 VERSUS LOSING $4,000, YOU PROBABLY WOULD DECLINE BECAUSE THE FACT OF GOING BACK TO DISCUSS IT WITH YOUR WIFE, HEY, I LOST $4,000, HONEY, WOULDN'T GO OVER WELL, RIGHT? BUT IF YOU ONLY GOT TO PLAY THAT GAMBLE ONCE, YOU WOULD TURN IT DOWN. WHEREAS IF I OFFERED YOU A HUNDRED TIMES THAT, WITH THE GAINS AND THE LOSS OF CANCELLING OUT, YOU'D OF COURSE SAY YES BECAUSE IN THE LONG RUN, IT'S GOT A VERY LARGE EXPECTED VALUE, RIGHT?
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SO IF YOU ONLY GOT TO DO THINGS ONCE, YOU WOULD REJECT THE OPPORTUNITY. WHEREAS IF YOU COULD PLAY IT A HUNDRED TIMES, YOU WOULD SAY YES TO THE OPPORTUNITY. >> Steve: AND IT'S IMPORTANT TO UNDERSTAND THE THINKING BEHIND THAT DISTINCTION BECAUSE, WHY? >> BECAUSE IN MEDICAL CARE, I ONLY DEAL WITH PATIENTS ONE AT A TIME. THEY ARE ALL UNIQUE INDIVIDUALS. NONE OF THE GAINS AND LOSSES WOULD EVER BE ABLE TO CANCEL OUT.
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WHEREAS IF YOU'RE A MINISTER OF HEALTH, YOU HAVE TO LOOK AT HOW TO MAXIMIZE THE WELL-BEING OF THE OPTION. YOU'RE LOOKING AT POLICIES THAT WILL AFFECT THOUSANDS OF PATIENTS. >> Steve: DOES THAT THEREFORE, THE KNOWLEDGE OF THAT, DOES IT CHANGE THE WAY DOCTORS DO WHAT THEY DO? >> I THINK IT CERTAINLY -- YOU KNOW, THE LANGUAGE OF PROBABILITY PROVIDES YOU BOTH THE WORDS AND THE LOGIC TO AT LEAST UNDERSTAND THE CONFLICTS THAT ARE GOING ON INSIDE SORT OF
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EVERYBODY'S MIND, WHY SORT OF OTHER POLICIES ARE GOING TO BE IN DISAGREEMENT SOMETIMES. >> Steve: LET'S TALK ABOUT THE OTHER GUY, DANIEL KAHNEMAN. HE ENDED UP AT THE UNIVERSITY OF BRITISH COLUMBIA, DID HE NOT? >> YES. >> Steve: WAS HE THERE WHEN YOU MET HIM? >> NO, HE WAS BACK AT BERKELEY THEN AND NOW CURRENTLY AFFILIATED WITH PRINCETON. >> Steve: AND WHAT WAS YOUR INTERACTION WITH HIM LIKE? >> OH, I MEAN, TWO VERY DIFFERENT PEOPLE, RIGHT?
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LIKE, DANNY WAS -- STILL IS THE WORRIER, WHEREAS WITH AMOS, EVERYTHING IS PERFECTLY FINE. DON IS JUST A BLESSING IN DISGUISE. EVERY STORY HAD AN ULTIMATE HAPPY ENDING. DANNY ALWAYS WORKED HARDER, WHEREAS AMOS JUST SLACKED OFF ON SATURDAYS AND SUNDAYS, SPENT HOURS WASTED WATCHING BASKETBALL, IN MY OPINION. DANNY WAS ALWAYS A LITTLE BIT SPREAD TOO THIN. NOT SO PERFECT AT SAYING NO TO THINGS. WHEREAS AMOS WAS THE MOST IMPRESSIVE PERSON I'VE EVER SEEN AT SAYING NO.
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HE WOULD SAY NO QUICKLY, DIPLOMATICALLY AND EXTREMELY ACCURATELY. >> Steve: WASN'T DANIEL'S TAKE ON LIFE TO BE A PESSIMIST SO THAT WHEN BAD THINGS HAPPENED, YOU'D NEVER BE DISAPPOINTED BECAUSE YOU KNEW IT WAS GOING TO WORK OUT THAT WAY ANYWAY? >> BECAUSE OF THE PAYOFF MATRIX. THEY BOTH HAD SEEN REAL SUFFERING, NO DOUBT ABOUT THAT. COULD APPRECIATE THEIR LIVES AS SORT OF LIKE, YOU KNOW, TOP TIER ACADEMICS. THAT WAS TRUE AS WELL. >> Steve: AMOS WAS A WAR HERO, WAS HE NOT?
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I MEAN, I THINK I RECALL READING IN THE STORY SOMEWHERE WHERE SOMEBODY WAS ABOUT TO THROW A GRENADE AND MISTHREW IT OR SOMETHING LIKE THAT AND IT WAS GOING TO BLOW UP AND HE PULLED THE GUY AWAY FROM THE GRENADE, SAVED HIM, TOOK SHRAPNEL HIMSELF. >> YEAH. THEY BOTH ARE WAR HEROS, NO DOUBT ABOUT THAT. BUT AS MOST WAR HEROS, THEY DON'T WANT TO TALK ABOUT IT. BECAUSE ALTHOUGH THEY MIGHT HAVE DONE A WHOLE BUNCH OF THINGS ABSOLUTELY CORRECT, THEY MIGHT
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HAVE DONE ONE OR TWO THINGS THAT THEY REGRET, THAT THEY SHOULD HAVE DONE EVEN BETTER, AND THOSE LOSSES HAUNT PEOPLE TO THE END OF THEIR DAYS. THAT'S SORT OF A UNIVERSAL AMONGST MOST VETERANS EVEN HERE TODAY IN CANADA. THEY JUST DON'T WANT TO TALK ABOUT IT. >> Steve: DO YOU WANT TO AMPLIFY ON THAT AT ALL? WERE THEY SPECIFIC AT ALL WITH YOU ABOUT THOSE KINDS OF LOSSES? >> NO. THEY WOULDN'T TALK ABOUT IT. >> Steve: NOT EVEN WITH YOU? >> NO. BUT THEY WOULD TALK ABOUT THE HERE AND NOW.
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OH, BY SORT OF READING THE BOOK BY MICHAEL LEWIS, I LEARNED A LOT BECAUSE REALLY, WITH BOTH OF THEM, WE TALK ABOUT TODAY'S AGENDA RIGHT NOW. >> Steve: WHAT WAS IT ABOUT YOUR RELATIONSHIP WITH THESE TWO MEN THAT MICHAEL LEWIS WANTED TO EXPLORE WITH HIS BOOK? >> THAT'S A TRICK QUESTION SIMPLY BECAUSE, YOU KNOW, MICHAEL LEWIS DOESN'T INTERVIEW YOU FOR 30 MINUTES. HE COMES UP FOR THREE DAYS AND IT'S SORT OF, YOU KNOW, ON AND ON AND ON, AND THEN HE FLIES
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BACK FOR ANOTHER THREE DAYS, AND THEN HE FLIES BACK FOR ANOTHER THREE DAYS. HE COMES AT YOU FOR DAYS AFTER DAYS AND THERE'S EMAILS BEFORE AND AFTER. >> Steve: DID HE DO THAT WITH YOU? >> OH, YEAH. HE'S EXTREMELY THOROUGH. YOU KNOW, THERE'S LOTS OF EMAILS BEFORE, AND AFTER THERE ARE SO MANY QUESTIONS YOU HAVE NO IDEA WHAT THE THREAD IS GOING TO BE. >> Steve: DID YOU EVER ASK HIM, LEAVE ME ALONE ALREADY. I'VE SPENT ENOUGH TIME WITH YOU. >> HE'S LIKE YOU, STEVE. HE CONTROLS THE AGENDA PRETTY WELL.
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>> Steve: I SEE. CAN I ASK YOU A REALLY OFF-BEAT QUESTION HERE, I THINK -- I HAVE READ ANYWAY, I NEVER MET THE GUY, OBVIOUSLY, BUT I READ THAT AMOS TVERSKY HAD A LISP. IS THAT RIGHT? >> YEAH. A VERY SMALL LISP. I THINK IT WAS ABSOLUTELY THERE AND SOMEWHAT ENDEARING. >> Steve: AND YOU HAVE, LET'S -- YOU HAVE A STUTTER. >> THAT'S CORRECT. >> Steve: DID YOU TWO EVER DISCUSS THAT? >> NEVER. >> Steve: REALLY? >> NEVER. SIMPLY BECAUSE -- AND -- BUT THERE WERE OTHER PITFALLS WE JUST DIDN'T DISCUSS.
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IT'S NOT AS IF HE WAS SECRETIVE. AMOS WOULD TAKE ALL SORTS OF PERSONAL PHONE CALLS RIGHT IN FRONT OF ME IN THE OFFICE. HIS WIFE PHONES HIM UP, THE PRESIDENT OF THE UNIVERSITY PHONES HIM UP. THE AUTOMOBILE REPAIR GUY PHONES HIM UP. HE WAS PERFECTLY TRANSPARENT ABOUT THAT. AND THERE WAS ALWAYS ONE OR TWO SENTENCES OF DEBRIEFING AFTERWARDS AS WELL. SO IT'S NOT THAT HE WAS SECRETIVE, IT'S JUST THAT WE DIDN'T TALK ABOUT THAT. >> Steve: OKAY.
1:00:18
MICHAEL LEWIS DESCRIBES YOU AS, BY NATURE, A GENERALIST, BY TRAINING AN INTERNIST, AND YOUR JOB IS IN PART TO CHECK THE UNDERSTANDING OF SPECIALISTS FOR MEDICAL ERROR. HOW WELL DOES HE DO DESCRIBING YOU THAT WAY? >> IT IS ACCURATE BUT I WOULD PUT A NUANCE THERE IN THAT NOBODY EVER PHONES ME UP BECAUSE THEY'RE WORRIED THEY MAY BE MAKING A MISTAKE. WHO HAS THAT AMOUNT OF SELF REFLECTION? INSTEAD MOST PEOPLE PHONE ME UP BECAUSE SOMETHING IS GOING SERIOUSLY WRONG WITH THEIR
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PATIENT, EITHER A LOT OF COMPLEXITY OR SOME STUFF THAT IS TRULY UNUSUAL. SO I GET INVOLVED MOSTLY TO HELP IMPROVE THE SITUATION, TO HELP SET THE RECORD STRAIGHT WITHOUT BEING TOO ANTAGONIZING. >> Steve: SO BY THE TIME YOU'RE ON THE CASE, SOMETHING'S GONE WRONG; FAIR TO SAY? >> FAIR ENOUGH. I ONLY DEAL WITH PATIENTS THAT ARE VERY, VERY SICK. >> Steve: ALL RIGHT. >> PEOPLE WHO HAVE BROKEN A BONE AND ALSO HAVE PNEUMONIA OR PEOPLE WHO HAVE A BRAIN TUMOUR AND ALSO A HEART ATTACK AT THE SAME TIME.
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>> Steve: HOW CAN THIS BE A HAPPY JOB FOR YOU? >> WELL, IT'S IMPORTANT. IT'S VALUABLE. AND IT'S GRATIFYING, ALL RIGHT? A LOT OF THE PATIENTS REALLY DO IMPROVE, AND YOU CAN ALSO -- EVEN IF YOU CAN'T ALWAYS CURE THE SITUATION, YOU CAN MINIMIZE CHAOS AND SORT OF IMPROVE PEOPLE'S UNDERSTANDING, EXPECTATIONS, DISPEL A LOT OF THE MYSTERY OF WHAT'S GOING ON. >> Steve: AND WHAT DO YOU THINK YOU LEARNED FROM AMOS AND DANNY THAT YOU HAVE BEEN ABLE TO APPLY DIRECTLY TO THE WORK YOU DO AT SUNNYBROOK?
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>> THAT MISTAKES OUGHT NOT TO BE DEMONIZED OR DENIED BUT THEY'RE ACTUALLY BUILT INTO THE VERY WAY THE BRAIN WORKS. AND SOME OF THE MISTAKES ARE SO SYSTEMIC, SO PREDICTABLE, ALL RIGHT, THAT THEY CAN ACTUALLY BE ANTICIPATED IN ADVANCE AND PREVENTED. >> Steve: NOW, YOU REFERRED EARLIER TO THE MINISTER OF HEALTH, AND I HAVE IT ON PRETTY GOOD AUTHORITY THAT WHEN THE AUDITOR GENERAL STARTS LOOKING INTO THE MINISTRY OF HEALTH, YOU KNOW, SHE'S NOT EXACTLY THE MOST WELCOMED PERSON AT THE PARTY.
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AND I'M GUESSING IT'S THE SAME WITH YOU TOO. WHEN YOU START SNIFFING AROUND, DOCTORS THINK YOU'RE THE LAST GUY THEY WANT TO SEE LOOKING OVER THEIR SHOULDER? >> NOT EXACTLY. IT DEPENDS ON THE DIVISION OF LABOUR. THE BEST CONSULTS ARE FOR OBSTETRICS BECAUSE OBSTETRICIANS MOSTLY CARE ABOUT WHAT'S GOING ON INSIDE THE UTERUS. AND FOR ALL THE STUFF ELSEWHERE, LIKE HIGH BLOOD PRESSURE OR LOW MAGNESIUM, THEY ARE HAPPY TO RELEGATE IT TO SOMEBODY ELSE, SUCH AS ME. EVEN ORTHOPEDIC SURGEONS.
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THEY DON'T MIND SEEING ME AT ALL BECAUSE THEY WANT TO PAY ATTENTION TO THE OPERATIVE FIELD AND IGNORE ALL THE OTHER ELEMENTS IN THE BODY. THE WORST ANTAGONISM USUALLY COMES WITH ANAESTHESIOLOGY BECAUSE THEY OFTEN WANT TO INCREASE THE DOSE AND FREQUENCY OF THE PAINKILLERS. I THINK THAT'S A FEATURE CONTRIBUTING TO A PATIENT'S DELIRIUM, SO I WANT TO DECREASE THOSE MEDICATIONS. >> Steve: HOW DO YOU RESOLVE THOSE CONFLICTS? >> OH, IT TAKES A LOT OF DIPLOMACY AND I'M NOT AS GOOD AT THAT AS YOU ARE.
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>> Steve: YOU'RE NOT JUST A PRETTY FACE, YOU'RE A DIPLOMAT AS WELL? >> OH, YEAH, YEAH. ALSO BEING ABLE TO BITE YOUR TONGUE AT THE RIGHT TIME AND ALSO BEING ABLE TO SEQUENCE YOURSELF RIGHT? WHAT NEEDS TO BE SAID WHEN? >> Steve: HMM. OKAY. I NEED TO PROBE THAT A LITTLE BIT. GIVE ME AN EXAMPLE OF SAYING THE RIGHT THING AT THE RIGHT TIME AS OPPOSED TO THE WRONG THING AT THE WRONG TIME. >> SOMETIMES, YOU KNOW, YOU'VE GOT A PATIENT, SAY, WITH A BROKEN BONE, AND THEY WANT TO
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KNOW IF IT'S SAFE TO TAKE THE INDIVIDUAL TO SURGERY AND ALL OF A SUDDEN YOU NOTICE SOMETHING VERY STRANGE IN THEIR EYE, RIGHT, WHICH MAY BE AN UNDIAGNOSED DISEASE. IT'S NOT GOING TO INTERFERE WITH SURGERY. ERGO, WHAT YOU WANT TO DO IS GREEN LIGHT THE OPERATION AND MUZZLE YOURSELF, NOT EVEN WHISPER THE NAME WILSON SYNDROME ON THE CHART. IT'S JUST GOING TO CONFUSE PEOPLE, ALL RIGHT? THEN WHEN THE OPERATION IS OVER AND THE PATIENT IS RECOVERING, THAT'S WHEN YOU CAN PROCEED WITH
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A LOT OF THESE SECONDARY ISSUES. >> Steve: DO A LOT OF HOSPITALS HAVE A GUY LIKE YOU IN THEM? >> ALL LARGE HOSPITALS WOULD DEAL WITH SORT OF MEDICINE CONSULTS FOR PATIENTS ADMITTED TO NON-MEDICINE SERVICES, LIKE OBSTETRICS OR PSYCHIATRY. I'M A LITTLE SPECIAL IN TERMS OF MY TRAINING IN COGNITIVE PSYCHOLOGY AND THE PITFALLS OF PEOPLE'S REASONING. MOST PEOPLE, THEY JUST DEAL WITH THE STRAIGHT BIOLOGY OF THE SITUATION, WHERE I'M A LITTLE
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BIT MORE LEANING TO THE ADDITIONAL QUESTIONS OF WHY DID THIS OCCUR AND WHAT ALSO MAY BE LURKING IN THE BACKGROUND. >> Steve: LET ME UNDERSTAND YOUR TRAINING A LITTLE BETTER. YOU OBVIOUSLY WENT TO MED SCHOOL, GOT A G.P., WENT THROUGH THAT PROCESS LIKE EVERYBODY ELSE, RESIDENT ALONG THE WAY. DOING THE 35-HOUR STRAIGHT SHIFTS OR WHOEVER LONG THEY MAKE YOU DO. HOW LONG IS IT? >> I DID LIKE SEVEN YEARS OF TRAINING AT STANFORD UNIVERSITY, INTERNSHIP, RESIDENCY, AND
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FELLOWSHIP TRAINING AND ALL OF THAT WAS AFTER MEDICAL SCHOOL AT THE UNIVERSITY OF TORONTO. >> Steve: SO YOU GRADUATED WITH WHAT? >> GRADUATED WITH AN MD DEGREE AND BEFORE THAT ONLY TWO YEARS OF UNDERGRADUATE WORK. SO I STARTED MEDICAL SCHOOL AT AGE 19. I WAS VERY YOUNG. >> Steve: AND GOT OUT WHEN YOU WERE ... >> WHEN I WAS LIKE 23, 24, YEAH. >> Steve: SPECIALIZED IN ANYTHING? >> GENERAL INTERNAL MEDICINE. >> Steve: DO YOU STILL CUT? >> I DON'T DO SURGERY ANYMORE.
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I'LL OCCASIONALLY PUT IN SUTURES BUT MOSTLY I ADD MEDICATIONS AND TAKE AWAY MEDICATIONS, IN PARTICULAR MEDICATIONS THAT ARE SAFE UNDER NORMAL CIRCUMSTANCES AND NOT NECESSARILY SO SAFE WHEN YOU'RE TRYING TO RECOVER FROM AN OPERATION. >> Steve: SO YOU HAVE A SPECIALTY AS AN INTERNAL SURGEON. >> INTERNAL MEDICINE, NOT INTERNAL SURGERY. I DON'T PICK UP A SCALPEL ANYMORE. >> Steve: BUT YOU'VE HAD TO BECOME I GUESS A JACK OF ALL TRADES IN SOME RESPECTS. YES?
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>> I MOSTLY DEAL WITH ALL THE COMPLICATIONS THAT OCCUR OUTSIDE OF THE OPERATING ROOM, OF WHICH THERE ARE PLENTY. >> Steve: AND WE'RE NOT EVEN TALKING ABOUT THE ONTARIO MEDICAL ASSOCIATION RIGHT NOW. >> OH, I DON'T KNOW VERY MUCH ABOUT POLITICS AT ALL. >> Steve: I BET YOU DO. DO YOU GET INVOLVED IN ANY OF THAT STUFF? >> NO, I'VE GOT ENORMOUS DEFICITS ABOUT POLITICS, AUTOMOBILE REPAIR, YOU KNOW, SPORTS, CURRENT AFFAIRS. I REALLY AM A VERY -- I AM FOCUSED ON MEDICINE AND REALLY NOT MUCH ELSE.
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>> Steve: IN WHICH CASE, IF YOU COULD CHANGE ONE THING ABOUT THE WAY MEDICINE IS PRACTISED IN THIS PROVINCE TODAY, WHAT WOULD IT BE? >> I'D RATHER HAVE TWO OR THREE WISHES. BUT IF I'VE ONLY GOT ONE WISH. >> Steve: LET'S START WITH ONE. >> ONE WISH, MORE MEDICAL SCIENCE. WHAT REALLY SORT OF DROVE THAT HOME IS THAT EVERY ONE OF MY INTERNS NOW ARE A HUNDRED TIMES SMARTER THAN SIR WILLIAM OSLER ONLY BY VIRTUE OF THE FACT THAT THEY GET TO PRACTISE MEDICINE A CENTURY LATER.
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MEDICAL SCIENCE IS WHAT REALLY MOVES THE WORLD FORWARD. IF YOU WANT TO DIAGNOSE PREGNANCY IN A WOMAN, THAT'S EASY. IT'S A URINE TEST. OSLER HAD TO DO PHYSICAL EXAMS AND ALL THESE SUBTLE FINDINGS. HEALTH CARE IN THE FUTURE WOULD BE EVEN BETTER THAN TODAY. THAT'S MY WISH. >> Steve: WAS THE GREATEST DOCTOR IN CANADIAN HISTORY, OSLER? >> FOR HIS TIME. LIKE I SAY, NOWADAYS, ANY OF MY INTERNS COULD BEAT THE PANTS OFF THE GUY.
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>> Steve: AGAIN, A COUPLE OF ODD QUESTIONS HERE: HAVE YOU READ THE FINAL WORK, AS IN MICHAEL LEWIS' UNDOING PROJECT? >> WELL, I GOT AN ADVANCE COPY OF IT, YOU KNOW, ONE WEEK IN ADVANCE. IT COMES IN THE MAIL, EXPRESS COURIER, AND IT'S ABSOLUTELY TERRIFYING. YOU OPEN IT UP AND YOU WONDER WHAT DAMAGE IS GOING TO BE DONE, WHAT SKELETONS ARE THERE IN THE CLOSET -- >> Steve: YOU CAME OFF OKAY. >> OH, IN RETROSPECT, ALL RIGHT, IT'S SORT OF OKAY.
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BUT, YOU KNOW, THAT FIRST DAY, IT'S ABSOLUTELY JUST NERVE-WRACKING. IN RETROSPECT, YOU KNOW, THERE ARE CERTAINLY SOME VERY PAINFUL PARTS OF IT, BUT THAT'S WHAT AUTHENTICITY IS ALL ABOUT. AND THERE ARE STILL A FEW GLITCHES IN IT THAT AREN'T EXACTLY RIGHT THAT MIGHT GET CHANGED IN THE SECOND EDITION. >> Steve: DID YOU GO BACK TO HIM ON THOSE? >> OH, YEAH. ALL SORTS OF SUGGESTIONS. HE'S VERY OPEN TO SUGGESTIONS. >> Steve: HE IS. YOU MENTIONED THERE WAS SOMETHING PAINFUL THAT YOU READ. >> OH, YEAH.
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YOU KNOW, SOME OF THE TENSION BETWEEN AMOS AND DANNY, I WAS COMPLETELY OBLIVIOUS TO AT THE TIME RIGHT? >> Steve: WELL, THEY WENT THROUGH A DIVORCE. >> WHEN MOMMY AND DADDY ARE FIGHTING, OFTEN THE CHILDREN DO NOT KNOW. AND THESE PEOPLE WERE EXTREMELY CLASSY. >> Steve: THEY WERE ... >> THEY WERE JUST SORT OF WELL-POISED. I REALLY HAD NO IDEA EVEN THOUGH I WOULD HAVE -- IF YOU HAD INTERVIEWED ME AT THE TIME, I WOULD HAVE SAID THAT ABSOLUTELY EVERYTHING IS FINE. >> Steve: REALLY?
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FIRST OF ALL, YOU KNEW THEM BOTH. YOU KNEW THEM BOTH WELL. >> I KNEW THEM BOTH EXTREMELY WELL. >> Steve: DID YOU KNOW THEY HAD STOPPED TALKING FOR YEARS? >> I DID NOT. I STILL WONDER WHETHER THAT'S AN EXAGGERATION INSIDE THE BOOK. >> Steve: THAT'S WHERE I GOT IT FROM, OBVIOUSLY. >> OKAY, YEAH. >> Steve: DID YOU KNOW THAT THERE WAS AN INTENSE PROFESSIONAL JEALOUSY BETWEEN THE TWO OF THEM? >> I READ THAT IN THE BOOK. I NEVER SAW IT FACE TO FACE. >> Steve: YOU NEVER SAW IT. YOU KNOW WHAT?
1:10:05
ON THE FACE OF IT, IT KIND OF MAKES SENSE, RIGHT? ONE GUY GOT THIS GENIUS GRANT FROM THE McARTHUR FOUNDATION, TVERSKY, AND THE OTHER GUY, DANNY, DID NOT. >> WELL, THAT'S WHY ONE OF THE REASONS THAT AMOS WAS ALWAYS QUITE DISMISSIVE OF AWARDS. HE THOUGHT THAT THEY EXAGGERATED SMALL DIFFERENCES, THEY BRED A LOT OF ANIMOSITY, AND THAT NUMBER TWO AND NUMBER THREE WERE ALMOST EVERY BIT AS GOOD. SO HE WOULD ACTUALLY VERY, VERY MUCH DOWNPLAY HIS AWARDS. >> Steve: GOTCHA. ALL RIGHT.
1:10:37
SO YOU READ THE CHAPTER ABOUT YOURSELF. THERE WERE SOME PAINFUL PARTS. THERE WAS SOME STUFF YOU WISH WAS CHANGED. YOU MADE YOUR SUGGESTIONS. ON BALANCE, THOUGH, WHAT IT'S LIKE TO READ -- I MEAN, MICHAEL LEWIS IS A BIG DEAL AND HE WROTE ABOUT YOU. HOW IS THAT? >> IT -- WELL, IT SORT OF REMINDS ME OF A GOOD GREEK TRAGEDY WHO THE GODS WOULD DESTROY. THEY WOULD FIRST RAISE TO PROMINENCE AND WE DO NOT KNOW WHAT'S IN STORE FOR ANY OF US,
1:11:03
ALL RIGHT, INCLUDING THE TERRIFYING ASPECT OF THIS INTERVIEW HERE TODAY. BUT THE BOOK ITSELF IS I THINK ABSOLUTELY TERRIFIC. THERE'S AN ENORMOUS AMOUNT OF CONSUMER SURPLUS THERE. >> Steve: SO YOU WOULD RECOMMEND IT? >> ABSOLUTELY. THE AMOUNT OF HOURS AND HOURS OF PAINSTAKING WORK FOR A PURCHASE PRICE OF ONLY $20 OR $30, YOU'RE GETTING AN EXTREMELY GOOD DEAL FROM THAT. >> I WANT TO THANK YOU VERY MUCH FOR COMING INTO TVO TO TELL US NOT ONLY ABOUT YOUR WORK BUT
1:11:33
THESE TWO GENIUSES YOU HAD THE PLEASURE OF KNOWING AND WORKING WITH. >> THANK YOU, STEVE. IT'S BEEN VERY EXCITING. >> Steve: DONALD REDELMEIER, SENIOR MD, SUNNYBROOK MEDICAL SCIENCES CENTRE.
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