What Makes for a Good Doctor? Part 2

Dr. David Joseph rejoins Dr. Michael Koren for part 2 of his journey from reluctant med student to medical consultant, inventor, and artist. In this section, Dr. Joseph talks about the difficulties in navigating our current, disjointed, and often impersonal medical system. He recounts having to go through seven different consultations with physicians before anyone physically examined him and how persistence is key in our medical system. They finish up by talking about the doctor's artwork, which can be found at https://www.davidjosephart.com/ and on Instagram at @artbydavidjoseph

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Music: Storyblocks - Corporate Inspired

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Chapters

• 0:00 From Training to Inventor
• 2:04 Building Labs, Clinics, and Hospitals
• 4:35 Pivot to Bariatrics and Imaging Devices
• 5:58 The Pain Mystery Begins
• 8:20 Missed MRIs and the Far Lateral Clue
• 11:20 Three Surgeons, Three Conflicting Plans
• 13:11 The Missing Test and Second Opinions
• 15:15 Vail’s Four‑Hour Exam and a Slot
• 17:00 Surgery, Relief, and Lessons Learned
• 18:10 From OR to Art Studio
• 20:05 Found Objects, Gallery Wins, and Where to See

Transcript

Announcement: 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! And I'm having an absolutely fascinating conversation with my former classmate, Dr. David Joseph. And he's had just this spectacular career. So interesting. And he's been walking through some of these many adventures that he's had from the time of his childhood through his graduation from Harvard Medical School to becoming a serial entrepreneur. So again, Dave, thanks for being part of the MedEvidence family. And we you just got to keep on going. You know, this stuff has been amazing. And uh I've heard your stories before, but every time I listen, I hear something new, and there's always a little bit of nuance. So you were just telling us when we dropped off about an unfortunate situation that you made the most of. So you you fell, you injured your own nerve, which prevented you from doing your routine work as an anesthesiologist, but you used it as an opportunity to learn mediation and to learn how to get much more involved in corporate affairs, and you kind of ran with that as a career. So that's what we were just talking about when we left off. So uh just give us a little bit more information about that. And then I'm really fascinated to hear about your personal story with the healthcare system, because that to me is so insightful in terms of how complex our healthcare system is and what you need to do to succeed when you negotiate it, when you negotiate with that healthcare system. So, Dave, go ahead, just give us uh a little bit more flavor on your post-accident career that led you from uh going from anesthesiology to more administrative elements of medicine and ultimately consulting.

Dr. David Joseph: 1:48

Uh well, and then what I really spent most of my career on was um inventing medical devices. So I was working as this as the CEO of that company, um, but also working with another uh you know other groups as you know a medical device inventor. Um I had banded with uh some other physician engineers uh physician inventors, and you know, we started a rapid prototyping lab. Um, and you know, our first product was sold to Johnson & Johnson, who also purchased a uh minority interest in the lab. Um we then transitioned into building a multi-specialty clinic that gave uh tremendous advantage to the various um solo practitioners in the community by joining and and opening up the ability to have revenues from MRI and labs and things that they couldn't do as solo practitioners. Um and then we we purchased a hospital out of bankruptcy, renovated it, um, and put that into you know into a system so that we could bill better um with the hospital as being part of our system. Um we then ended up uh building uh another hospital. We sold the land under the um the clinic um and the hospital to Ariot um and then did a 1091 exchange um purchasing the largest uh VA clinic in the southeast uh side of Atlanta, um, giving us a you know a great income stream on that uh on that what was otherwise just the land we were sitting on.

Dr. Michael Koren: 3:34

Nice. When you say we, uh can you say the name of the company, who the we is?

Dr. David Joseph: 3:39

Yeah, it was Scott Laboratories.

Dr. Michael Koren: 3:41

Okay.

Dr. David Joseph: 3:43

Um and so uh and then Grace Grace Clinic and Grace Hospital were the names of the of what we had built.

Dr. Michael Koren: 3:52

Um and so then we ended up And where where was that located for the people listening in? Where's Grace Hospital?

Dr. David Joseph: 3:58

In Texas.

Dr. Michael Koren: 3:59

Got it. Okay.

Dr. David Joseph: 4:00

So um we then transitioned, and our latest uh venture has been in bariatrics um and looking for solutions there and have a product that you know we're that we're working on right now. Um we've you know transitioned and moved the lab to um to Puerto Rico. Um and our you know, and that that research is still underway under a um under a subsidiary. And then there was another company that had a uh revolutionary device for um doing cardiac spec, which allowed it to be done in two minutes and in an upright position, um, some somewhat like a dental chair, uh rather than laying flat on your back, et cetera. Um, and a number of other uh various uh devices and things that I worked on with varying groups of people, you know, over the years.

Dr. Michael Koren: 4:56

Beautiful. Absolutely beautiful. So let's transition to your recent personal journey through the US healthcare system. I found that so fascinating. And um I think there'll be important insights for the people who are listening in to our conversation.

Dr. David Joseph: 5:13

Sure. Um so uh I had a situation. I um first I tore my uh my meniscus in my right knee. Um and while I was uh you know using a cane and in a brace and having to sort of twist my way off the couch by you know pushing on the cane to get up, um apparently uh that you know pressure caused me to hurriate uh um a disc. So I woke up one morning and I was at the Liberty Hotel, which is you know in Boston, basically, you know, in the parking lot of Mass General. And I woke up and I couldn't move. I mean, the pain was so intense that I literally had to get an ambulance to go from the Liberty Hotel in the parking lot of Mass General to the emergency room. Oh my god. And uh one thing that happened while I was there is that uh I never saw the attending physician. I had a um uh, I forget whether it was a PA or a nurse practitioner, but who claimed to be the attending physician, despite wearing a badge that showed what their position was. Um and you know, I was despite having trained there, etc., I really was not treated very well there. Um eventually I, you know, they put me on some meds, I I left. Um, and then uh the pain, you know, essentially was not resolving. Um I had an MRI, and the MRI was read as being, you know, normal, um, other than some, you know, old congenital uh spinal stenosis. Um and you know, I had an and a you know, after a few months, it was the pain was still terrible. Um, I had another MRI. It was also read as being normal.

Dr. Michael Koren: 7:17

And the also at Mass General or at a different place, the second MRI.

Dr. David Joseph: 7:21

The second MRI was at uh Martha's Vineyard Hospital. Um and so uh, you know, the pain was just classic for a herniated disc. I mean, it, you know, textbook. Uh so I couldn't believe that there was nothing there. And so one of our um medical school classmates, uh, you know, who was good friends of both of us, um, had you know, his practice was uh reading spine MRIs. So, you know, I sent him a disc of it, and he came back, you know, within minutes saying, Oh, you've got a uh you've got a far lateral uh herniated disc, an L34. Um and he's like, you know, I said, Well, how could they miss that? And he said, Well, actually the far lateral herniations are are missed fairly often. Um he's like, because this is all I do, I look for it, you know, on every on every film. Um and so now at least I had a a diagnosis, um, and I would start to get better, and then it would suddenly get worse again. Start to get better, suddenly worse. Well, so I went through a year of conservative treatment, um, which basically was medications. Um they put me on gabapentin, and I had a um a language issue as a result of that. I would sort of I would have um pause vocalizations, I would be talking, and without even realizing I was doing it, I would go silent for you know three seconds, a minute. And um and it was you know something that just did not work well when you're in the boardroom of you know Fortune 500 companies and things like that. Just you know, freeze. Um they switched me to um uh Lyrica. Same thing, kept on, you know, it didn't didn't go away, went off of that, and then it went away within you know a short period of time. Um and so finally after a year of this terrible pain syndrome, um, I decided, okay, it's it's time to to have surgery. And so I went to someone uh at the Brigham, uh neurosurgeon there, who uh you know I met with, and he went over the MRI with me and said, okay, well, we could do this um in a you know minimally invasive procedure, and you know, you'd be out the next day and you know, very little recovery, etc. And I was like, okay, great. And then I called a few people that I knew at at uh at the Brigham who told me that that that neurosurgeon was known as Dr. Blood. So I decided that, you know, that that was probably not a good place to have this procedure, you know, uh a good surgeon for me. Um, and so I decided, you know, I should have three consults. I should, you know, so I went to another um uh I went and saw somebody at uh at Mass General who basically told me, you know, you have no surgical disease. There's nothing we can do for you. You just need to learn to live with the pain. Um and so then I went to the Mayo Clinic and saw someone who said, Well, yes, you know, you have surgical disease for sure. Um, but this is gonna need an open procedure that's gonna, you know, that's you know, it can't be this can't be done with minimal minerally invasive procedure. Yeah, you're gonna need to, you know, plan on you know months of of recovery, etc. So with three different answers from three different neurosurgeons, I'm like, okay, well, you know, this is ridiculous. And so I made three more appointments. Um and I met with a uh a neurosurgeon that I knew in um in Tucson that I had worked with, you know, back when I was practicing. And, you know, he looked at my MRIs and, you know, and said, Well, you know, did you have this test? And I'm like, no. And he's like, Well, there's no way to know whether you need a minimally invasive procedure or a big open procedure unless you've had this test. So let's go over to the, you know, the radiology office and have them do this test, see if, you know, if there's spondal lithiasis. And so had the test. And he's like, okay, good. You know, you don't have spondal lithiasis. So we could do this with a minimally invasive procedure. So I was like, okay, great. Um, then I went to one up at Barrows Neurosurgical in Phoenix, um, who confirmed that it could be done in a minimum minimally invasive nature, but you know, had terrible bedside manner and um just you know wasn't a good fit. And then I figured, well, I've already got this appointment set up at the Stedman Clinic in Vail. I may as well go through with that as well. And when I made the appointment, they said, you know, okay, well, you know, your appointment is uh, you know, at 8:30, plan to be there until about 12: 30. I'm like, wow, does he run that late? And she's like, Oh, you the appointment will be you know three to four hours long.

Dr. Michael Koren: 12:59

Wow.

Dr. David Joseph: 12:59

I'm like, wow, okay. So, you know, I went there and first a PA student came in um and did her exam, etc. And then a sports medicine PA uh came in and did his exam. And then a fellow came in and did a you know full exam, testing all kinds of things that I'd totally forgotten about since medical school in terms of you know uh of a neuro uh exam. Um and uh and then finally the attending came in, and interestingly, none of them had looked at the MRI yet. And I asked about that, and he's like, Oh, we all we always do this, we go through our exams first, then we all get together and talk about what we think clinically from the exam, and then we look at the MRI together and see if that fits. Interesting. Yeah, okay. So this was I realized the first time anybody had actually looked at my back, let alone touched my back, in six consoles.

Dr. Michael Koren: 14:09

Oh my god. Isn't that interesting? Wow.

Dr. David Joseph: 14:12

And so, you know, they came back. He said, Okay, you know, we agree this is something that could be treated with a um with a uh minimally invasive microdyskectomy. Um, I had already watched a video that he had on his website of doing it, so I see how careful he was, etc. And so I said, Oh, I, you know, um, you know, uh okay, I I want you to do it. I definitely, you know, want you to do this procedure. And this was in September. And he said, Well, I, you know, I have some openings the week after Thanksgiving. And I'm like, Oh, I can't wait that long. You know, I need relief. And like, well, you know, I don't know what to tell you. That's, you know, that's when our next opening is. And I said, Well, you know what? I'm just gonna stay here in Vail, and I'm gonna be NPO (nothing by mouth) after midnight every day and check every morning to see if you've had a cancellation. And he laughed and I said, No, no, I'm serious. And he's like, Let me go check on something and went away. And he came back and he's like, I'll tell you what, I can do you tomorrow as the last patient of the day. I'll do it at you know, seven o'clock in the evening. Um, he said, if you can get, you know, uh uh get cleared by uh by medicine um and get all your you know labs, et cetera, done. And you know, I pulled out of my blazer jacket, all the labs, uh, the you know, the work up by my primary care position, etc., and said, here you go. Was like, okay, well, I'll see you at seven o'clock tomorrow night.

Dr. Michael Koren: 15:53

I love it. Persistence, my friend, persistence, yes.

Dr. David Joseph: 15:56

Yes. And then um, you know, the second I woke up from the anesthesia, I knew the pain was gone, completely gone. And he said that the reason that I kept getting better and then getting worse was that I had bone spurs and there was a lot of fragment in there as well. So there's no way I was ever going to get better with conservative treatment because those fragments and bone spurs were there. Yeah.

Dr. Michael Koren: 16:22

Irritate the the nerves, yeah. Wow. Incredible story. Well, it's such it's such an incredible story because one, unless you were so incredibly persistent at each step along the way, you would have never gotten to the solution. And two, it shows you that there is in modern medicine a loss of connecting with people in the way that's really time modern and effective with actual exams and actually digging into what's going on with the person rather than just looking at an x-ray and deciding that something or can or cannot be done based on that x-ray. So to me, that's such a fascinating story and really attribute to your persistence and creativity to actually get to the place where you one found the right diagnosis, two, found the right surgeon, and then ultimately got relief. So great story. I love that.

Dr. David Joseph: 17:15

Yeah, it we it was remarkable. And you know, and then this is someone as a you know, a physician, not you know any, you know, someone else might have just accepted the doc at Mass General who said, Oh, you have no surgical disease, you'll have to learn to live with the pain.

Dr. Michael Koren: 17:31

Absolutely crazy. Unbelievable. So let's transition to our last topic of conversation, which is your super interesting career as an artist. And I hope hopefully you'll have a few samples of your really terrific work that I've reviewed on your website, and you can share that with our podcast audience. But you're obviously a super creative guy. You've you have this engineering background and management background, and you kind of put it all together and created some fabulous works of art. So tell us a little bit about this story.

Dr. David Joseph: 18:00

Sure. Well, um, so during uh so I've always been a travel photographer. I mean, as as a hobby, I've done that for years. I've been to 133 countries on all seven continents and you know, have photographed all over the world. During COVID, it was driving me crazy that I had to cancel trip after trip after trip and had felt like I had no outlet for my creativity. So I decided, okay, well, at least I'll get something you know productive done and I'll clean out the garage. So I started cleaning out the garage, and everything that I picked up, I would, you know, see what it could be that, oh, you know, if you turn this upside down, it looks like the head of a giraffe. And, you know, all these different you know things were jumping out at me. So I started putting things together and and building things, which, you know, as a mechanical engineer, I love working with my hands. I love, you know, my power tools and building things. So it was a perfect, you know, combination. And I started um I started creating this this art. Um, and uh it I found that there was a definite um audience for it. And so I you know it was I applied for a membership in you know the oldest uh gallery on Martha's Vineyard that you know started in 1954, which has a very competitive jury process. And I um I was you know, I felt I was like too early in my career to apply there, but I was encouraged to go ahead and apply, and sure enough, I was accepted. And so now I've had uh you know, I've had several galleries that I uh that I um exhibit at. And I just can't wait to get up in the morning and go out to my uh garage studio. Of course, now the garage is too full to ever fit a car in, uh, let alone you know clean out the garage, but um uh and start building things. Um so I've got a number of things here that I can show you.

Dr. Michael Koren: 20:10

Yeah, yeah, we'd love to see it. Show us a couple of things and the inspiration behind them.

Dr. David Joseph: 20:14

Okay.

Dr. Michael Koren: 20:15

So this one is Okay, so I can see it's an old microscope.

Dr. David Joseph: 20:19

Yes, it's an old microscope. Um, and the part from here has been moved up to here to be the head. And with those eyes, it it looks like an alien, and it's holding, you know, a blue chemical, which is actually colored salt, and a piece of chalk, and it's got a uh slide of a leaf on it, and its name is you know, is our science teacher an alien?

Dr. Michael Koren: 20:48

I love it.

Dr. David Joseph: 20:49

So that's one.

Dr. Michael Koren: 20:52

And that that was just an old microscope that was sitting around your garage that you repurposed?

Dr. David Joseph: 20:56

Yes. Um and then this one, I'm sure you can tell. Um

Dr. Michael Koren: 21:06

It looks like a heart with hands.

Dr. David Joseph: 21:08

With hands holding it.

Dr. Michael Koren: 21:10

Uh okay, there you go.

Dr. David Joseph: 21:12

It can either be wall mounted or sitting on a shelf like such. This one is, you know, your heart's in good hands.

Dr. Michael Koren: 21:24

I love it.

Dr. David Joseph: 21:25

Um this one is my is my first uh double-sided one. So this is Dr. Jekyll and Mr. Hyde. So a paintbrush. With the handle up, it's Dr. Jekyll. And with the handle down, it's Mr. Hyde.

Dr. Michael Koren: 21:50

That's so funny.

Dr. David Joseph: 21:54

Um I've done a number a number of medical, medically related ones. I don't know if this is viewable or not, but you can see the um single manometer as the body.

Dr. Michael Koren: 22:13

Okay. And then it looks like a spatula. That's part of that?

Dr. David Joseph: 22:18

Yeah, a spatula is the um is sort of the the fish's uh uh fin. Uh-huh. And then the

Dr. Michael Koren: 22:26

Oh, that's so cool. Yeah, I can see it. Yeah, yeah, interesting.

Dr. David Joseph: 22:30

Uh shoe trees.

Dr. Michael Koren: 22:31

Uh-huh.

Dr. David Joseph: 22:32

And then of course golf clubs and tail fin.

Dr. Michael Koren: 22:38

Um what do you call that one?

Dr. David Joseph: 22:42

Uh this is just called Metafish.

Dr. Michael Koren: 22:45

Okay.

Dr. David Joseph: 22:45

Then this one.

Dr. Michael Koren: 22:56

Uh let's see. Well it's hard for me to see exactly, okay.

Dr. David Joseph: 23:03

So this one is named Mike.

Dr. Michael Koren: 23:06

Okay.

Dr. David Joseph: 23:07

And his uh his introduction is

Dr. Michael Koren: 23:10

0I can see why he's named Mike now, okay.

Dr. David Joseph: 23:13

Yeah. So begging people not to drop the mic and upset about how that came into play.

Dr. Michael Koren: 23:22

Oh, that's funny. Okay. Now yeah, I can see a little bit better. That's hysterical

Dr. David Joseph: 23:25

And then this one. Uh-huh. It's a shoe. It's a shoe, but if you look at the face here and the and these um, I don't know if you can see the curl at the bottom. This one is Sophia, the spotted seahorse shoe fish.

Dr. Michael Koren: 23:47

Ah, now I can see it. Yeah, yeah. Yeah, at first the the little swirl at the bottom is hard to see, but now you can see it. Uh that's hysterical. There you go. That's helpful. Yeah.

Dr. David Joseph: 23:58

And then there's a whole lot more. Um, most of them are in the gallery, uh, in one of the galleries right now. But um, but your viewers can see a whole lot of them at my website, which is www.davidjosephart.com, um, or on my Instagram, which is at Artby DavidJoseph.

Dr. Michael Koren: 24:19

I love it. David, this has been an absolutely joy for me, a fascinating conversation. Thank you for sharing a lot of experiences, including personal experiences, with our audience. And again, um uh check out his artistic endeavors. They're really absolutely fascinating. Uh, he sold a lot of them, and I'm I'm sure that some of these items uh are gonna go fast. They're all one of a kind. Am I not mistaken about that?

Dr. David Joseph: 24:46

Correct. They're all one of a kind.

Dr. Michael Koren: 24:48

So, you know, once somebody uh gets the mic or somebody gets the uh the seahorse, that's it. You have to wait uh for the next generation to get another one.

Dr. David Joseph: 24:57

That's right. Um,

Dr. Michael Koren: 25:00

Dave, again, this has been a lot of fun for me. Thank you for being part of our MedEvidence family, and uh, we'll definitely circle back with you for another podcast sometime in the near future.

Dr. David Joseph: 25:09

Sounds good. I've had fun too.

Announcement: 25:12

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