Exploring the Intersection of Humanity and Technology in Healthcare with Dr. Rafael Grossmann

Ever wondered how the seemingly impersonal world of technology can enhance humanity in healthcare? Join us as we navigate this paradox with Dr. Rafael Grossmann, a trailblazing surgeon and technology enthusiast hailing from Caracas, Venezuela. Dr. Grossman's unique journey into the heart of healthcare innovation began with his role as the first surgeon to use Google Glass in a live surgery, and extends to his ongoing efforts to marry technology and medicine in ways that privilege the human element of healthcare.

Get ready to tackle the pressing issues that stand between today's healthcare practices and the broad adoption of potentially transformational technologies. Together with Dr. Grossmann, we'll unravel the complexities of HIPAA regulations, explore the educational gaps that exist, and offer invaluable advice to healthcare professionals on the fence about integrating cutting-edge technologies. It's not just about digitizing healthcare - it's about leveraging technology to create more humane medical care.

In the ever-evolving landscape of healthcare, adaptability isn't just key - it's the difference between obsolescence and revolution. Discover the potential of generative AI in healthcare, get a sneak peek into the power of innovative devices like the Apple Vision Pro, and be inspired by Dr. Grossmann's insights on his dual roles as a clinician and innovator. Learn how this marriage of roles allows him to create healthcare products that positively impact patients' lives. This isn't just a tech talk - it's an exploration of how humanity and technology can coexist in harmony in the realm of healthcare. Don't miss out!

Transcript

Speaker 1: 0:02

Hey everyone, evan and Irma, here from Avira Health today with Dr Rafael Grossman, an amazing friend of Avira Health and surgeon, innovator, physician, entrepreneur, xr. Magician Rafael, how are you?

Speaker 2: 0:21

I'm good, my friend. Thank you very much for letting me be here and the invitation and it's got to see you and Irma there.

Speaker 3: 0:29

So good to see you, rafael.

Speaker 1: 0:31

So good to see you and we appreciate you and even from the hospital, taking a few minutes out to chat with us. Maybe we can share your website. I'm actually an amazing site and video for the folks that get a context of who you are and the amazing work you do. Let's take a look.

Speaker 2: 0:54

What defines possibility? The bright light in an endless space. For more than three decades, my job has been centered around certainty, the certainty of hope, of saving or improving the lives of those who trust me through surgery. Once you chase the ability to strive for certainty, the mind becomes restless, and that is the seed of possibility. Welcome to the world of extended reality.

Speaker 2: 1:37

Through XR, we can understand the glory of our past, the pulse of our present and the potential of our future. However, there's a greater possibility that XR presents. It can give us the ability to revolutionize the fabric of humanity, medicine and education. Through technology. You can harness the potential and efficiency of your practice by enhancing your world through augmented reality. You can become a better learner through virtual reality by opening the doors to innovative simulations and research, or interacting with the hybrid world through mixed reality, where the possibilities are endless. There's never been a better day than today to change our world for the better. My goal is to bridge the gaps in healthcare and education by instilling humanity and technology into the lives I touch. Join me in building a new world of possibility and certainty through passion, passion and collaboration Wow that was something.

Speaker 3: 2:59

That was very intriguing. You definitely piqued our interest and it seems like possibilities are endless. But I want to go back to maybe the beginning and ask you about your immigrant experience. I'm curious about your journey from Caracas, venezuela, to becoming a practicing surgeon here in the US, and how has your immigrant background and experience influenced your whole perspective on healthcare.

Speaker 2: 3:33

Yes, absolutely. You know that's the core of everything. I think I am from Venezuela, from Caracas, and that's where I grew up, that's where my family is, and I'm sixth generation of Germans in Venezuela. You know German, spanish. You know it's all a mix. But yeah, in 1800s is my first relative, my father's side got there, my mother's is probably even before that, and I went to med school in Venezuela, my whole life in Venezuela.

Speaker 2: 4:02

Then med school, after med school, I worked for a year as a rural physician, which is what you do in most countries, actually, and also in Venezuela, because education is mostly free. So you go to med school for free and then you have to pay your social debt by being a general provider, a general practitioner, for a year in a rural or underserved area. So I did that. In the meantime I was learning English and studying for my boards, in my USM and Lee boards, and then the second year I kept working in an emergency room and also I was assisting in surgeries. You know, here the system is a little bit different. My father is a surgeon, so I was helping him and in fact I was helping him since the very first days of med school as an assistant, and surgery was really, really my passion. Out of eight kids I was the only one in medicine.

Speaker 2: 4:51

And so after the second year I ended up finding a position in Chicago, the University of Chicago, doing research, for a couple of months initially, and then they extended it for a year. That was an unpaid position, as many most IMGs or international medical graduates who come to this country to seek for the train, you know, trying to be the first to arrive and the last to leave the place, to impress, to be not as good as, but try to be better than in the status quo, so that then you can be seen and you have a chance to make it. And my goal was to train in surgery. And after that year in Chicago I went to an Arbor, michigan, to do my surgery training and I did for seven years and then went back home, which was the goal, but unfortunately home was, you know, not an idea.

Speaker 2: 5:44

The country had changed a lot, a lot of political and social, economic, moral issues, so decided to come back and I settled in Maine for almost 18 years, up until a couple of years ago when I started migrating south to Portsmouth, new Hampshire now, and a full-time clinician, full-time general and trauma surgeon. I do mostly trauma and acute care surgery, but the goal is to go back to what I was doing in Maine and what I helped set in Maine, which was a trauma program that also does a part elective surgery. So I do a minimally invasive and laparoscopic robotic surgery as well, and that's what we want to do here. I'm here helping create that program in a great community close to Boston, where you guys live, and to New England, and at the same time juggling you know, being an advocate, a technophile, trying to innovate and trying to use technology in a smart way to improve what we do, how we teach, how we learn, how we really envision the healthcare that we would want for us and our families.

Speaker 1: 6:53

Oh, what a wonderful journey. And on that note of physician innovator, tell us about your first experience as the first surgeon, I believe, to use Google Glass during a live surgery. I mean, that was really early. In this whole world of mixed reality, extended reality, what was it like?

Speaker 2: 7:16

Yeah, it's, you know it's a lot of times I get asked that question. I've always liked technology. I've always been, you know, driven to connect and communicate better using technology. I've done a few TED talks and one of my first TED talk was about using an iPod Touch device in rural Maine to connect and do a consults emergency trauma consults at a distance using telemedicine. This is back in 2010, 11. And iPod Touch device. So that landed me doing TEDx talk, and then I started thinking more about becoming a communicator, about the power of technology to improve what we do.

Speaker 2: 7:56

And then that drove me to Silicon Valley area, dan Kraft, which is a common friend. He had the sort of the embryo of exponential medicine which is now next in MedHealth, and that was. It was in a big conference, a small conference, not even a conference. It was like a training session of seven, eight days. And one of the incredible things I saw there at that FutureMed event, or FutureMed training, was a Babac Parvis, the inventor of Google Glass, you know, and when I saw what Google Glass could do, you know basically accessing the all human knowledge, the internet from a frame in your head connected to the web, able to stream and take pictures or videos. I said, wow, we got to use this to communicate and connect better. So I got a device very early and I just had to use it in surgery, really without thinking too much, just as it came out of the box, to improve the experience that my students had. Rather than watching what I was doing, they were just sitting sipping you know, sipping a little coffee in a conference room and they were basically having my perspective of an operation, and I wrote a little post on that and my good friend John Nostra put it in Forbes and within hours it became viral and next day I was getting calls from Argentina and Italy and you know, everywhere. You know what you know Glass was very sexy back then, and so I thought this is a great way to use technology in a different way probably a better way than a non or as meaningful way, in order to improve for what we do. The video that you saw at the beginning has some shots that I haven't that's not very public because of HIPAA reasoning and my hospital's regulations back the other hospital where I was, but you know it really drove, I think, my my entrance, I think a little bit into into the, the being a sort of an influencer, I guess of source or opinion leader, of how technology, used differently, can improve.

Speaker 2: 10:06

And you know, I always call Google Glass as the, the, so the model key of AR. In a way, you know, it's a. It's not a commenter reality per se, but it's a way to use a head mounted display, and now we are all the way to devices like, like the, the view six, you know, which is, you know, regular set of glasses, but with all the power of XR within them. So it's a. We've gone far, a evolving very quickly. I call it an R evolution. This is a revolution. Really. It's a very few years. We've gone from nothing to everything, and now Magic vision pro is coming out and and many other devices out there that are unbelievable, magical almost, and many of them now with the power of a genitive AI. The world is is becoming really, really, what we have dreamed of, and we have to use all that power with a lot of responsibility, I think to improve what we do.

Speaker 3: 11:01

Yes, so tell us more. What is your vision for how all this technology and augmented reality and virtual reality can change the landscape of medical education in particular?

Speaker 2: 11:13

Well, I think that the, the possibilities are only limited by how clever our, our imagination is really. I we have seen it in the last few years for sure, and there is a lot of not Talk about potential anymore, but validation with multiple studies, for example, in VR, not just for education only, but for for diagnostics and even treatment in VR. In VR, but extends to to XR, right VR, ar, mixed reality called XR, so extends to XR. I think that education, you know nowadays, if you're not using XR for education, you are not in the 21st century. I think there's no way. It's like not using computers for, for, for education, it's not like not using, you know, you know smartphones to, to, to, to communicate.

Speaker 2: 12:03

I think that it's not a substitute to traditional means of, of, of work, in this case of educating, of learning or teaching, but it's certainly another tool to bring the experience a notch up and, in some circumstances, a substitute, what we traditionally did and the pandemic really Showed us that that we've been preaching for years. You know, the power of remote connectivity, the power of telemedicine or teleeducation. He became a necessity, right. So Necessity being the mother of invention, I guess, and you see a lot of Platforms out there for educating people, bringing them an immersive computer generated Environments to, from from healthcare, you know, from from medical Schools to tech and nursing schools. Everyone should be using and some are using Virtual reality, for example, to educate and and improve. It is more efficient, is more comfortable, decreases cost increases, engagement, a retention. There are many validated facts in those statements.

Speaker 1: 13:15

Wonderful. So, as a practitioner, you've seen firsthand. The barriers, though, to widespread adoption of these technologies in healthcare, given our system today. What are they, and how are you managing to overcome those, those barriers?

Speaker 2: 13:31

Well, you know, I think that as we evolve right, as the technology of often, our mind Evolves and our regulation evolves, all those tend to Minimize and we find other areas of difficulty or other hurdles. Initially we talked about HIPAA and your privacy laws and that is now really not an issue anymore, because anyone knows that any system that is going to be used in healthcare and if you're gonna deal with the private health information or a PHI, you must have a secure server, you know may to be, and all of that is intuitive is I mean you can't even Get into the market or mentioned Getting into market without having a HIPAA compliant system right. So that is really not a barrier, but for years was a big barrier and stopped many incredible innovations, like where I was in the other system, where I was, you know, the. The concern of HIPAA Prevented them from being the first hospital in the world to announce the Google Glass surgery or to do surgery with a or to do a Outpatient visits with Google Glass. Because of the lack of vision, but also because of the HIPAA, you know, hurdle.

Speaker 2: 14:39

I think that nowadays the biggest hurdle is probably related to to a regulation and to education. It's a regulation and education, education, because this that you are doing, both of you preaching and helping us preach and advocate and talk about this to people now, and I think that when the players know what's available, they question why are we doing it this other way, which is not as good as efficient, when we can do it this way? If I'm a patient and I see I saw this guy doing this outpatient visit with a glass and he was not looking at the computer when he was talking to me, he was actually looking at my eyes and interacted empathetic connection with me, so why are you guys not using that? So as we educate, I think those barriers tend to disappear. But that's probably the biggest barrier right now and I think that in the recent past I think even regulation has become less of a hurdle because now we have leaders in those areas, at least in the US and many places in Europe and other parts of the world, but especially in the US and the FDA, for example, which was in a way the gatekeeper for all this incredible, magical innovation.

Speaker 2: 15:46

The FDA has become for many years now, even before the pandemic, more open-minded and more up to the times and you see how things get into market faster still safer, but faster in the market and less expensive. So you have incredible solutions out there that are not relying on luck or money to get in, but the gatekeepers now are really becoming more up to the times, and that's still a barrier, I think. And if you think about things like generative AI, for example, chat, gpt-like systems, that's a big barrier still, and a scary one, because we have to make sure that we regulate technology. But I think that all those barriers evolve as the technology evolves and I think that more and more things are going to be more natural and intuitive and things that we saw as barriers and hurdles and impossibilities are going to become the past.

Speaker 3: 16:48

This is a great segue to my next question. You've mentioned the paradoxical power of technology to coexist with better, more humane medical care. Please elaborate on. How do you see this? How do you see technology enhancing the human aspect of health care, which is, of course? As I know, all physicians want to get back to spending more time with patients and showing the empathy that got them to be in the profession in the first place.

Speaker 2: 17:17

You know, that is sort of my I want to say my mantra, almost, I think, because it's so frustrating to see how we have, for the last 20, 25, 30 years, gotten a hold of incredible, almost magical technology to communicate and connect better, and you figure, well, that's important because, obviously, digital health and electronic medical records, electronic health records, ehrs, emrs oh they're going to be an incredible solution to improve medicine. But then what happened is that we started looking away from the patient and, yes, we have more data, we have better documentation maybe, but we have lost the patient provider, patient physician relationship that we had in the past. So I think that a way to rescue that, to resuscitate that, is to bring technology to humanize us and to, in a way, take away those tasks that we don't need to focus on and then focus on the tasks that we can really, as humans, really really do connect, empathize, be compassionate, cry, laugh, hug, touch our patients. Now we can do that if we apply the technology in a better way, because you can have an ambient intelligence clinical system that is watching everything and documenting for you, or you can have a camera in your glasses and there is an AI scribe or a human scribe, like for Agmetics, the company that those outpatient human scribes documenting for you, and you are talking to your patient and looking at them and the eyes, rather than back on the.

Speaker 2: 19:04

And still, unfortunately, most of the health care is done that way, with big computers where you document and you spend 80% of the time on that computer and then 5% of the time with your human in front of you, and that's one of the biggest, if not the biggest, cause of burnout. We talk about burnout in health care. It is because of that. We want to help patients, we want to work with humans, we don't want to work with keyboards, and that's what we unfortunately still do.

Speaker 1: 19:31

Yeah, well, what advice would you give to health care professionals who are hesitant, or maybe reluctant or too busy to integrate all of these leading edge technologies into their practice, which you've done so magnificently?

Speaker 2: 19:45

Well, I think that the first thing is that I think to seek to learn to be curious, to engage in network and whatever social media channel or whatever network you are in physically or virtually, and learn about what's out there that can help you be a better medical provider. As a provider because this is from text to to subspecialty physicians, you know, nurses, pas, tags everyone you know has sort of the same role to, to, to be a human, helping other humans and, and you know, you got to seek out what's out there. Look at people like you too who are communicators and and bring content that is Validated. That it's that it's important, that it's going to improve health care. Attend events and conferences. You know there's vast amount of knowledge everywhere, everywhere. It's just a matter of of start tasting it. Because you got to do that, because if you want to be a health care of the future the near future, not the future in 20 years, the future like in three years I think that you need to engage a you probably heard the question, or ask that question or do you think that computers are going to replace doctors or nurses?

Speaker 2: 21:05

And the answer very commonly now is yes, but not really all doctors or nurses. The only ones that are going to be replaced are the ones that don't engage with these Technologies. So why would you go to a doctor that still does x-rays and I in a in a, in a on a on an acetate plates you know what I mean? Or or a doctor that that you know a, when operating on your gallbladder to remove it, makes a big incision rather than for little incision is the same. Why would you go? So? The only ones that are going to be replaced are the ones that don't engage with a Technologies in a smart fashion. They only a once that don't do a maybe Genitive AI to do the registration or the post-op instructions. So those are the ones that are gonna go. So humans, a Human providers, are going to evolve to embrace technology, and you have to do that because if you don't, you're gonna be out.

Speaker 3: 22:00

So let's go a little bit further into the future. As a health care futurist, what curious to know what you see as some trends and technologies that will have significant impact in healthcare in five or ten years. And what about this brand new technologies that come in yeah, come into market like the apples? New virtual reality headset.

Speaker 2: 22:28

Yeah, that's a pretty big question, right? I think that you know five years, that there's no question about mine that most education and diagnostics and and and even therapeutics, in five years for sure, especially in procedural a, a feels like like surgery, any type of surgery, is going to be very much based on a some type of extended reality and haptic a type, a platform with a very, very high a content of a Some type of generative or large language model AI. There's no question, it's happening already now. The system has gone from. I recently tweeted a little post, a little tweet about Tweet and a threat as well. We got to go both sides now. So, if AI is a monkey, generative AI is a bright, smart, human, and I think that's really we have leaped into, into really the future of what AI can, can, can do and the potential of AI, and I think that there's no question that in the, in the, in the very near future, within three years, we're gonna have all of that used in healthcare quite a bit, from education to diagnostics, to therapeutics, and you mentioned the vision pro I I mean talks to, you know, with Apple, to to really a Help in a way drive how that is integrated into healthcare, like it will be integrated in many others, a human endeavors.

Speaker 2: 24:07

The fact that the, the vision pro, is out there, you know, literally very soon for developers and next year for for for the rest of the Consumers, is very exciting because, yes, the device apparently is much better in many ways than other devices. And you know device, you know you have the meta pro, you have the, the magic lead to, you have the HoloLens to, you have the, the view six set of glasses, you have the vario, you have the Pico there, many at all. Yes, the A3 from Lenovo, all of them are phenomenal, right, some have their own little idiosyncrasy, but better or not, but when it's Apple, everyone is gonna get that, no matter you know what. So is it like it? When you have an iPhone 14 and the 15 comes out, you know you almost oh, this is not working though, I gotta get the 15. So there is an excuse.

Speaker 2: 25:00

And I think the, the social, the power, I think that Apple Brand or Apple devices and the trustability of Apple you know for, for electronics and for use case, I think that is gonna drive the industry to, to heights that we have been dreaming of in the last five to ten years. So I think that a virtual reality, augmented and mixed reality are going to have a very, very solid presence, a Almost standard of care. You know, the status quo is going to be to use these tools, not a substitution 100%, but as another tool, a compliment to everything we do in the digital world. There's a bridge between humans and Technology of humans and and digital. So it's going to be very exciting very soon three to five years most, I think.

Speaker 1: 25:51

Well, very exciting indeed. And if folks are watching this, either individuals, maybe organizations or brands how can they work with you, either on a consulting basis or an advisory basis or Project basis? I mean, or do you even have time for that these days? You're super busy.

Speaker 2: 26:09

Well, yeah, I'm a full-time clinician, but somehow I've juggled the time and I think, using technology in a far way to be able to to really become an advisor, a consultant, a keynote speaker you know, an advocate, a, officially or unofficially, a Several companies out there and and I love to engage, I love to teach, I love to learn, I but I love to be part of Something that is going to help patients at the end. So if I can help drive, you know, the development, the strategy or the design of a healthcare related product, I'm on it. And if I see that the product that is going to have impact on my patients, we all do it because of the patients, right? I'm a full-time clinician, so my goal is really a Participate in that, in that in the journey, and I don't think the journey can be done without the help of clinicians. I'm not the only one, obviously, but, but I'm out there and I want to be used as a research.

Speaker 2: 27:05

I have a website that you have that you have Shown in there, just Raphael grows one dot com. But I'm very active in Twitter, starting to be active in thread, and Very active in LinkedIn, really, and I'm trying to to to use that as a platform to connect and communicate better, to get Knowledge and to give knowledge and advice. So I'm always open to conversations and and you know trying to every couple months I try to go to some impactful conference or event to speak it somewhere, because I think that we have the responsibility. If we clinicians don't go out there and tell everyone a Clinicians or non-clinicians, different types of industries that this is what needs to happen, because we know, because last night I was in the ED suffering from the staff shortages or the EMR not working is, I know they, you know, I feel it in my, in my skin.

Speaker 2: 28:01

So if we are not involved, then you know we are. Actually it's our fault. We need to be responsible enough to engage as much as we can and To help drive the solutions that we need for the problems that we know. So I think that that's really one of my goals for the last 10 years. 15 years has been so love to engage and Try to help anyone who is willing to to seek.

Speaker 3: 28:28

Powerful message to to end our conversation yeah and thanks so much.

Speaker 1: 28:32

And on that note of shortages of staff and and burnout, I mean you know what do you do to manage those, those challenges? I hope you're taking some time off in the summer. Some are not much Deserved here in New England. Is our time to thrive in the summer? What do you have to?

Speaker 2: 28:51

Yeah, I really think that it's about balance and you need to, you know, do what you love right and and make sure that what you Are doing is something that you love and and if you are deviating from loving it, you got to find ways to start loving it again.

Speaker 2: 29:06

And that's the key to not burning out. And I think you know having a support network of friends and family you know it's invaluable and and happy people. You know that that support you and you support people. And you know being close to nature and you know being in New England has been always a blessing because you're very close to you know you can be at the top of the world in regards to development and progress, but you know you can try very quickly to to the middle of nowhere right, especially in Maine, where I was and and not even have signal right. So I think that going back to nature, it's really important. I think that you know doing things that relate to, to the basics of our world and forget about Technology and other things, really, really Refuel the brain and the soul with a lot of good energy.

Speaker 1: 29:57

So Good energy for all. Thanks so much for joining us, taking time out of your busy practice. Thanks viewers for watching and please reach out. Follow Rafi on social media. All the other channels are here in the video. He's so fun and interesting to engage with.

Speaker 3: 30:17

Thank you so much and the beautiful Thank you, rafael, my pleasure.