Welcome to Open Heart Surgery with Boots, where we explore the journey of heart health through the eyes of those who live it every day.

I'm your host, Boots Knighton, and in season five, we're focusing on what it truly means to thrive.

We'll dive into cutting edge medical advances, share powerful stories from both sides of the stethoscope, and learn how to be better advocates for our own health.

From candid conversations with cardiac patients to insights from dedicated healthcare professionals, each episode brings you closer to understanding the complex world of heart health.

Whether you're navigating your own cardiac journey or supporting someone who is, you're in the right place.

So let's get to today's story.

Hello, welcome to another episode of Open Heart Surgery with Boots.

I am your host, Boots Knighton coming at you from Victor, Idaho, where it is snowing today.

I'm recording this in early January and I am so excited for this season.

This is the fifth season of Open Heart Surgery with Boots and I am bringing you my A plus game this season, bringing the most distinguished guests yet.

And today I am so thrilled that Dr.

Marshall Runge, who wants to be called Marshall, has agreed to come on and share his expertise and wisdom with us.

And let me just talk about Dr.

Marshall Runge for a second.

He's a distinguished physician scientist, considered a leader in academic medicine, and an advocate for the integration of AI into healthcare systems.

He currently serves as dean of the medical school at the University of Michigan.

Wow.

Aren't we lucky to have him today?

With numerous accolades and awards, Dr.

Range has earned a reputation as one of the foremost experts in healthcare innovation.

His work is bridging technology and medicine and has been pivotal in reshaping the modern healthcare landscape.

Dr.

Runge, aka Marshall, thank you so much for saying yes in your busy schedule.

It really is an honor.

Well, thank you, Boots, and thank you so much for that very kind introduction.

My entire career has been focused on cardiovascular disease, although I have other responsibilities, both in seeing patients, trying to help patients understand their disease, and in both doing research in my own research area, as well as being able to help interpret some of the research that we see and we see quick headlines in the press and trying to help people, and we're all people, after all, understand what they can do for their heart.

And I think the opportunities we look at in the future with AI and large language models are just so intriguing.

Say more about that because I was just reading an article recently, I think maybe it was in the Washington Post about just the journey of even chat GPT and GPT5 and how hard it is to get that I had no idea how expensive it is and then how cutthroat it is and, and so it made me think about our upcoming conversation.

It just sounds like it's not as easy and straightforward as I thought it was.

Well, I'll make a couple of comments.

So the first is that in terms of just day to day use of AI, I now use it all the time and platform I use is offered for free at our university at the University of Michigan.

It's chat GPT4 and you have to get comfortable with it a little bit.

But once you understand what kinds of questions to ask and that you're really having a conversation as weird as that might be with a computer, you can find out so much that is meaningful information.

I always double check it.

But to give you an example, part of what I do, and most physicians do is I have to do continuing medical education and maintenance of certification.

And in doing that I every quarter I have to answer a bunch of questions and I find that I can get really outstanding data and interpretations from ChatGPT in a much more rapid manner than if I use any traditional medical resource.

So I've come to really find it to be invaluable.

And if for you or you probably know this, but for any, any of your listeners or viewers, I think what they'll find is you have to give, you have to kind of train yourself to use it, but then it is, it is invaluable.

So I'm a big fan of, of that part of AI.

I also, what I find so amazing and intriguing is that AI works.

This sounds a little corny, but AI works in mysterious ways and it gathers all this information and it integrates it.

And in so many instances in medicine, and I'll talk about some in heart health, it'll come up with answers that we just would never have thought of asking, questions that we never thought of asking, that can be extremely helpful.

And there's some great examples out there, some in cardiovascular disease, some in prevention, some in therapeutic areas.

And so I think we're facing a moment in which things are going to really change dramatically in healthcare and in health and all of us thinking about our own health, it's been called this AI movement's been called a Promethean moment.

I had to look up that.

So pro Prometheus was a Greek God who, you know, caused lightning and fire and all kinds of things.

And after these moments everything was different going forward.

And I almost.

That's somewhat of an exaggeration, but I think things are going to be very different in our coming years with AI and what it can bring us.

So I'm hearing excitement, lots of excitement.

Okay.

For me, I feel a sense of trepidation because I, admittedly, because I, I believe in like heart connection.

Right.

I'm, I'm thinking hard all the time and having this, this connection with you and in community.

And so as a patient, when I hear you say that, part of me is like, oh cool.

It's kind of like double checking your thinking when you're working with a patient and helping them find like the, the proper way to treat whatever needs to be treated.

But then also part of me is like, well, then we take out that soul connection with our providers and our community.

And so I realize that's more of an existential question or thought, but part of me has a little bit of trepidation because I don't want to lose that, that, that connection with fellow humans.

Boots, that is a great point.

And you'll hear different people talk about AI and how maybe an AI bot could replace a healthcare provider, replace a doctor or a nutritionist or a therapist.

And I don't think that's going to happen.

And the reason I don't think that's going to happen is because you miss that human connection.

And that is so important.

As people connect with each other, as they connect with their care providers, as their care providers connect with them, there's subtleties in the way that all of us interact that cannot really be replicated by AI.

The best I've heard is that explanation, and I don't know when, if ever this will be overcome, is that AI can mimic, that it feels you, that it has emotional responses, but it does not have emotional responses.

That's based on what you're telling it and what it thinks you want to hear.

And so, and in some cases that's turned out to be somewhat dangerous because a person can get so connected to an AI bot that becomes their friend.

And that's just not realistic.

No.

Well, there's just not a soul there.

There is no soul.

Yes, it's soulless.

Right, Right.

Taking a step back, you mentioned you could go and ask a question.

Could you give us some examples of when, of what that would be?

What.

What is a recent question you've asked of maybe regarding a patient or.

I don't know what you can share, but I'm just really curious.

Well, I'll give you both my personal experience and also what is out there in the medical Literature.

Now I think I'll start with what's out there in the medical literature.

So AI turns out to have a predictive value for heart disease from examining retinal scans.

So if you go to the doctor, and particularly if you have diabetes, you'll have a retinal scan, a photograph of your retina, sort of the back part of the eye where the business part of seeing occurs.

And what's been found recently, which is just amazing, is that based on those retinal scans, AI is picking up cues that can help it predict if your likelihood of having heart disease and even your five year mortality.

And so how does it do that?

Well, that's part of the unknown about AI.

It's taking together these huge amounts of data that we don't really, we can't assimilate.

I mean, I can't assimilate everything in the world at the same time.

And it's looking for patterns.

Now sometimes those patterns turn out to be spurious and they're not really.

It may be a pattern kind of like, well, I feel like every time I'm humming a certain tune, I get a green light instead of a red light.

So, you know, it can be as spurious as that.

But many of these findings have turned out to be true and have turned out because it's picking up a pattern that we wouldn't be looking for.

So I think that's where AI can really have an impact.

It picks up patterns that we're maybe not used to.

So to give you a common everyday question that I get, let's think about people who have a elevated LDL cholesterol.

So LDL cholesterol is the bad cholesterol.

It's associated with buildup of plaque in the coronary arteries, associated with a increased risk of heart attack and stroke and cardiac death.

And what we have known for a long time is that statins drugs like Atorvastatin or Lipitor or Rovastatin or Crestor have a protective effect.

And if you take all the big studies that have been done, they show that that protective effect against heart problem, heart related problems, including cardiac death, can be up to 22%.

Now that's a big, that's a big impact.

And I personally am a big fan of statins.

I take a statin, my LDL cholesterol is somewhat elevated.

My brother, who has basically the same LDL pattern I do, chooses not to take a statin.

We're both still alive and well.

And so it begs the question, well, what are these studies showing?

Us and when you really look at those in detail, it's that not all the 20,000 patients who were studied on or not on a statin, they didn't all get a 20% benefit.

It's a small number who get a big benefit and then a whole bunch of people who don't get any benefit.

And as you know, I'm sure you're viewers and listeners know statins do cause myalgias, muscle pains, or other kinds of side effects that for some people make it virtually impossible to take a statin.

Well, think about if we could be much more precise in who would really benefit from those statins and prevention.

I think speaking broadly for American healthcare and the costs of healthcare, and in the case of cardiac disease, the number of procedures or bypass surgery or whatever, when you think about those things and the cost of those things, the way out of our conundrum is prevention.

So in the United States, obesity is now well over 50% of the population, and that carries with it a risk of diabetes, a very high risk of diabetes.

And so if we could prevent this really tsunami of obesity that's hitting the United States or lessen it, that's how we save money in healthcare.

It's not by.

I mean, we do need all the advanced procedures, and I'm a great fan of advanced procedures, but what we need to do is lessen the entry into that inevitable pipeline.

So I gave the cholesterol example.

I'll give you another one that is really intriguing to me that I don't understand very well at all.

But AI has turned out to be really valuable in both wearable devices.

I have a not advertising for Apple, but I have an Apple Watch and in other types of wearable devices and picking up patterns that we wouldn't ordinarily associate with increased risk.

So, for example, the amount of variability you have in your heart rate when you are not exercising or exercising is quite a predictor.

And AI can analyze that in a way that's difficult to do in anything less than a wearable, as another example, and this has been shown mainly in Alzheimer's disease, but very subtle changes in phraseology using social media, for example, or your intonation when you're speaking on a phone can be analyzed by AI and predict memory decline.

Alzheimer's maybe five years before any other known tests, including cat scans and MRIs, et cetera.

So what is it picking up out of all that?

I don't know.

People are studying what it.

What is it that is picking up.

But what's clear is it's picking up these patterns that are very difficult for us as, you know, thinking, interacting human beings to pick up in each other.

You know, it's not like someone says, oh, I feel awful, I'm so depressed.

It's very subtle changes that can be picked up by AI.

And I want to say one last thing.

One of the.

And then I'll stop talking.

One of the great unknowns in heart disease that I've studied in our own research, but also is a big topic is when are you at risk?

If you have a plaque in one of your coronary arteries, you have a blockage, when are you at risk of that plaque cracking or causing that artery to be blocked off?

And you don't want to.

If you think that if you had data that you're at high risk in the next few weeks, you'd absolutely want to get something done.

On the other hand, if you have data that shows you're not at risk and you need to continue your exercise, you need to continue your dietary measures, your statin or whatever medications, then you wouldn't have to rush off and have a cardiac catheterization.

Well, AI is proving in early studies to be able to detect what those subtle differences are between what's called a vulnerable plaque, one that might rupture, and a stable plaque.

That's been something that's been studied for decades, including invasive studies looking at putting a catheter in and examining that plaque and seeing how much fat or calcium or whatever is in that plaque.

But it appears to be the case that AI may be able to detect the difference between a dangerous and a not dangerous plaque based on imaging like a CAT scan or an mri, non invasive imaging.

So I just give this as a few examples of where I see the future going there.

We're not there yet.

And with with the caveat, the important caveat that you mentioned, we need to have healthcare providers be able to have a conversation with their concerned patients about this.

It can't just all pop up from a search of ChatGPT, but I think those tools will be very valuable.

Mind blowing and relieving because it's.

Heart catheterizations are not fun.

Absolutely not fun for anyone.

I've actually literally said I'd rather have an open heart surgery than a heart cath.

So that says it all.

Yeah, my therapist was like, why on earth would you say that?

And I was like, well, because you're asleep for your open heart surgery.

Yeah, it's terrible.

But anyway, I so much hope in everything you just shared as a As a heart patient, and I so appreciate it and I would love to add a little something to the heart rate variability.

I have a Garmin watch that I'm actually taking a vacation from right now because I noticed this can be like a two part discussion.

I noticed it was causing health anxiety.

And that's like an delicate line you walk, right?

Like, okay, I'm watching my data, but I noticed that my data was stealing my joy and my sense of peace.

And since I've stopped wearing it, I feel so much better.

And I was just reading another article, I'm forgetting where now I read a lot.

But how, you know, healthcare anxiety actually does have adverse effects on our health.

So here's AI informing me on my wrist of, you know, lack of sleep, lack of health, heart rate variability.

And I'm starting to panic, which becomes like this, this snowball effect.

But as you're saying, you know, it's also very beneficial to know when something is amiss because I was able to go to my cardiologist over a year ago and be like, something's not right.

And we were able to make some changes because of my watch.

Right.

So it's this fine line and I think that's where like having a cardiac psychiatrist or a really good therapist, like, I have people who can help manage the emotional and mental stress of having a heart issue, but also, and at the same time harness the power of AI to improve our lives.

You know, boots, that's interesting because I haven't had anybody personally tell me a story like yours, but I absolutely believe it.

It's sort of an extension of what we have called for years white coat syndrome.

So I've been a doctor for over 40 years.

White coat syndrome.

Oh, white coat.

Yep.

White coat syndrome is when you go in to get your blood pressure measured.

Doesn't matter if the doctor's actually wearing a white coat or not, but your blood pressure goes up because of this anticipatory stress, just like you're talking about with your watch.

And I've been a doctor for over 40 years.

I have white coat syndrome.

I have to like, just Zen out, you know, when I go for my annual physical because my blood pressure, you know, bounces up over what it normally is.

Just thinking, well, golly, what could be going wrong?

I'm having my annual evaluation.

So what you're talking about is taking that to a whole new level where it's bothering you all the time, not just when you go get your blood pressure checked.

Yeah, and I totally can believe that, you know, the Interesting thing about heart rate variability to me is it has different components, how much your heart rate varies when you do different things.

But I'm finding myself using it with my watch is when I'm doing some episodic exercise.

So the other day I was playing tennis with one of my kids and, and I was running all, all over the place and I thought, well, let me see what my heart rate is.

So it had gotten up to like, after a long point had gotten up to 135.

And so, you know, that's not terribly high, but it's not, you know, my normal is about in the 60s.

And so I wanted to see how long it took for it to start dropping down.

And it took a minute or two, didn't ever get back down to the 60s.

And then we kept playing.

But it's that one part of heart rate variability that I think people can monitor for themselves has to do with your conditioning level.

And so the better conditioning you are, the faster your heart rate drops.

If you do something and it gets your heart rate way up and it just is kind of staying up there very slowly dropping, what does that tell you?

Well, it tells you you could be better conditioned.

And so that's not quite the same as looking at your, your wearable and thinking, oh my gosh, what's happening now?

So, so there's some good things that you can get out of that.

And again, these are all things that just work.

Weren't present when I started practicing medicine, when, when I started practicing cardiology.

In fact, it was before the earliest of these drugs, called thrombolytic drugs that would dissolve a heart clot in one of your coronary arteries, those were just being test studied.

It was in the mid-80s.

Now, when you think about all the tools that we have, you know, one other thing I forgot to mention having to do with heart surgery is I think that our ability and heart disease and in other areas to use robotics has been limited.

And it's partly because of expense, because you buy that robot for I don't know how much, millions of dollars.

And all the proprietary supplies that are used with the robot are expensive.

And to date, the outcomes haven't been shown to be better than a highly skilled surgeon.

But I could, I could foresee a way that those could be used as they are in other instances with a minimally invasive approach.

So not having to crack your sternum, your breastbone, and the recovery time for that is much, much faster.

There's, there is minimally evasive cardiac surgery now where the Recovery time can be in days rather than in the month or more that it takes for your breastbone to heal, your sternum to heal.

So I think all these things are things we can look for in the future when we're not there yet.

Well, you know, it's interesting.

I've had a couple of conversations with surgeons about that, because with one of my defects, myocardial bridging, I'm part of a Facebook support group for that.

And there's more and more people on, in that forum that are going to a couple of different places in the United States for robotic unroofing.

And it's been mixed results.

A lot of them have had issues with their lungs afterwards.

A lot of collapsed lungs, a lot of pericarditis that I normally haven't been hearing about through, like, the more traditional open heart surgery route.

And my surgeon, before I had my surgery, I had my surgery by a trained Mayo surgeon who is down at Intermountain Hospital in Marie, Utah.

And I asked him about the pros and cons because at the time I was still like, should I travel to Chicago?

Should I come to you?

And, you know, he was saying, it's just too dangerous.

Like, it really is good to have eyes on the heart.

And I can't remember exactly.

It was four years ago now, but, you know, he, he said it just is almost safer to still have actual hands in there.

Getting the lay of the land.

This is my own way of explaining it.

Getting the lay of the land of the heart and seeing what needs to happen.

But that was four years ago, maybe.

And, and maybe you can speak to that a little more eloquently than I just did, but it just, it doesn't seem foolproof to me yet.

You were pretty eloquent there, I'd say.

And you hit the nail on the head.

And there are these concerns.

So, for example, removing that thin piece of tissue that's lying on top of your coronary artery, causing a bridge, it means different things if you're, if you're, if the surgeon's looking at it and can expose your entire heart versus if the surgeon's looking through a little scope at what the robot is doing.

And I, and I can.

I.

I had never heard before that there's an increased incidence of pericarditis, but I can believe it because the pericardium, you can treat very gently if the surgeon.

I'm not a surgeon.

The surgeon can treat very gently if the chest is open, whereas that may be more difficult to do and more irritating to the pericardium, if it's done by this robot that's being instrumented.

What I have heard is, although it's not common, there are certainly cases where there's a problem with the robotic approach nicking the wrong artery or causing bleeding or something like that, that it converts to an open heart procedure, so an open chest procedure.

And so honestly, Boots, I don't see that there's been a huge step forward in robotic heart surgery at present.

It's not used very many places, as you know.

Yeah, I think that's, as I mentioned before, partly expense, partly lack of better outcomes, but I think also they're like everything.

There are a lot of things that need to be worked out.

Maybe it'll turn out that it's never a great approach, but the only way we'll know is when we learn more about it.

Right.

Here's an example where maybe AI is not necessarily the route.

And this is where we have the human to human connection in the operating room.

Right, right.

Yeah.

And I, you know, with all my excitement about, about AI, and I am excited about AI, I think all of this needs to be looked at very carefully because it's very doubtful, even to me as an enthusiast, that AI is the cure all.

It's just not a cure all.

I think of it more in terms of being able to look at information, patterns from vast, vast stores of information that would be impossible to look at otherwise.

Yeah, one, one example I saw recently had to do with rare, what are called orphan or rare genetic diseases where they don't occur commonly, but they do occur, and they're thought to be some of these.

I think the definition is fewer than 4,000 a year in the United States.

So a pretty small number of conditions.

And what AI has found is that although there may be a gene, a specific gene that's thought to be the problem, there are other contributing genes that may affect the, that do affect, seemingly affect the severity of that gene defect, such that in one person it's not a big problem, in another person it's quite lethal.

And so trying to understand all those parameters, because as advanced as geneticists are these days, and as large as the databases they look at, it's just not currently possible to analyze all the genes in the genome.

30 over 30,000 genes, and they're over 3 billion base pairs.

And so how do you analyze that?

Well, I'm hopeful, not proven, but I'm hopeful that AI can help us look at these things.

For example, I'll take two other examples.

Lots of people have A high cholesterol, it never bothers them.

So my mother had a LDL cholesterol of 250.

I mean, that's sky high.

But she had an HDL cholesterol of her HDL cholesterol was like 100, which is also sky high.

And so she lived to be 94.

She never took a statin.

She never, I mean, she walked, but she wasn't like a major exerciser.

And so that what might have been fatal for somebody else wasn't at all for her.

And it's all around these surrounding genes, I think that we just don't understand.

But that gets back to this question about even something as seemingly simple as cholesterol management.

If we knew more about who would benefit from cholesterol lowering drugs and in whom there is no benefit, you could say the same thing about drugs that help with remodeling the heart.

So after a person's had a heart attack, there are, we have sort of the guideline driven five drugs that are supposed to help in remodeling.

Those help in many people, they don't help in all people.

And maybe it's a contribution of one drug more than another.

But when, when a person is asked to take five drugs up to three times a day, you know, that's very difficult to do.

And, and talk about raising your stress level.

Did I miss my noon dose?

It's, we can do better.

And I think AI will be a tool that will help us do better.

And that's the key.

It's a tool and I think that it's important how we frame it.

To me as a patient, it's like, okay, take the human aspect of my provider, my healthcare, my team.

I have a whole team and consider AI as part of the team.

Yeah, that's exactly it.

And, and I tell, yeah.

And you're still CEO.

The CEO of your healthcare.

We are CEOs and we hire you.

We hire all of y'all heart healthcare providers and AI.

Right.

So yeah, I think that's a great way to look at it.

And, and obviously you've embraced this, but I think for those who listen and view your, your podcast, I think it's important for people to be the CEO of their own healthcare.

And I think I strongly feel like the more information they have, the better.

I will tell you that when the Internet got going and people could look up stuff, could get information, even before Google, people would come in sometimes to see me highly motivated, sometimes highly educated people would have a stack of papers this thick and they wanted me to read it, I'm like, oh, come on.

But as is true with the Internet, in so many circumstances, what you get from Internet responses is more or less like social media.

It's opinions.

And so having something that helps weed out those opinions, whether it's a medical reference, like up to date, or whether it's AI or whether it's whatever it is, I think can really help people simplify how they think of being their own health care CEO.

I love that term.

Yeah.

And can we unpack that a little more?

Because where I'm now going in my brain is, should I show up in your office today as a patient, how would I.

And I want to get an A plus from you is like, rock star patient.

You know, what would that look like to you as a provider?

And let me give you an example.

One thing I make up that would look, you know, be A plus rock star would be I show up with, like, my list of medications I'm on.

I can give you maybe I have a heart rate or, excuse me, a blood pressure monitor at home, so I can maybe show up with some data.

I can show up with maybe a food log of what I've eaten in the past week.

Like, I.

I always come at.

I always approach it as, how can I help?

You have the best picture of me because I only get, like, a certain amount of minutes with you.

Right.

But add to that or subtract from it.

Like, what.

What is a rock star patient that helps you perform your best care for the patient?

Well, you've got a lot of components there in what you do, and I think meaningful information is extremely valuable.

In some cases, your healthcare provider may want to get that in advance so they can look at it.

Other times, you can just bring it forward.

I think, from the provider standpoint, from the physician standpoint, having that distilled in a way that if I'm seeing you, I can take a look at what you've brought in, and in two or three or four minutes, I can understand it is incredibly much more valuable than hearing about each single episode that you've had that you think might be important to your health.

And so I think that will be.

That is an advantage of having some quantifiable information that you'll have from your.

From your watch, from whatever.

And so.

But rather than showing, Bringing every tracing in, showing it, say, well, here's what the summary is, and they may want to dive into it more.

So I think that I think food logs are great.

I think exercise logs are great.

I think exercise logs along with if you have a wearable, what's going on with your wearable when you're exercising?

If you say, well I'm, I'm walking, you know, three miles a day and it turns out you're walking one mile an hour and your heart rate never varies, that's not the same thing as a brisk three mile a day walk.

So I think those things are all very valuable and I think having them, you're being able to produce them which takes a little bit of work on your, on your side in a way that's pretty easily understandable and digestible.

It's is invaluable to your healthcare provider.

Some of these things.

If I could interrupt and to yourself, because think about it, I mean it's so interesting the conversations I have with people who, and you know, I'm pretty well known in my community.

A lot of people know I had heart surgery and I ended up speaking on the TEDx stage about it.

So then you know, that made friends.

Congratulations.

Thank you.

It was really neat.

So I find that I'm like the heart confessional.

So people are like the health confessional.

People just come up to me and just start talking, talking to me about like their life which I'm happy to hold space for.

But it's so interesting to me.

I'll ask questions and how people hadn't thought to even raise awareness around that aspect of their bodies or their health or that perspective.

Right.

And so I guess that's where like your role comes in as provider.

Being able to ask the right questions to boil down to what needs to be addressed that day.

But I just find with the wearable, just the food log, I bring that up because like when the more I look at a food log, the wearable, yes I'm taking a vacation from it right now.

But it, what it did do on a positive level is raise my awareness and it helped me make the changes I needed to make for my health because therefore, because then I was aware and I was getting the real time input data input day to day.

So that's another good thing about AI is that it can raise your awareness.

And I know there's like apps on the phone now for even food logs.

I did like the standard like pencil and paper but there are, there are so many tools and tricks that we have at our palm on our, on our iPhones that like can help us raise our awareness to be better patients for healthcare providers like you.

Yeah, those are great comments Boots.

The food log reminds me so I've off and on had trouble with my weight and particularly as your metabolism starts slowing down in your 30s and 40s.

And so I remember my internist at the time said, one, just go see this nutritionist.

I'm like, I know about nutrition.

And they said, no, just go see him.

And so one of the things they did was we sort of talked for a while and they said, well, why don't you do a food log?

And I said, why?

They said, well, maybe you're, you have some eating habits that you could think about.

And they said, for example, do you eat at night?

And I was like, yeah, but not that much.

So when I kept that food log, it was just, it was, I don't know what.

It was astoundingly terrible.

So, you know, I was, I was, I was getting in an extra, you know, 6 or 800 calories after dinner.

So.

And that, that was a habit I'd had for a while.

And I, I just thought, well, you know, how bad can like, some chips and dip be?

Well, it can be bad.

And you're like, oh, yeah.

So I think, I think your comment, I'm kind of circling back to your comment about self awareness.

It, it is, when you do things like that, it is very helpful.

I also want to make one comment about interaction with healthcare providers and AI.

So you may well be aware of this or you may not be.

There's, there are programs now or they're products that use what's called ambient AI to record your interaction with your healthcare provider.

We, we use one here.

The one we use is called Nuance.

Dax.

Dax.

But there's several of these, and they don't just record your conversation.

They put it into a, into a note.

So you and I are talking.

And if this were, if we had nuance on at the end of this, I'd say summarize my conversation with Brooks and it would have it all summarized, or in the case of a medical visit, it'll have it all summarized into what your present illness is, what your past medical history is, what your review systems are.

And what that does is it frees your doctor, nurse, healthcare provider from having to take notes.

Or many of us have both personally on the provider side, but also on the patient side, met with our primary care physician or our physician, and seeing them, they're just typing away, you know, furiously during our interaction.

This frees them to really have a much more meaningful conversation.

And that, that is again another example of benefit from AI.

Now since we use that, I know that I need to read that because it may be Full of errors or may have misinterpreted something.

But it still is so much faster than my starting from scratch to dictate or type in a medical.

A note from our medical interaction.

Well, and how many patients do you see in a day?

Right.

And you have to keep all those people straight.

That's right, yeah.

My cardiologist uses.

I don't know what the program is, but yeah, she.

She is sold on it.

She said it has saved her so much time.

Yeah, I think it's saved many people.

And electronic medical records, or electronic health records, I think have many positive to them, but from the provider side, they have been an enormous time sink.

So I think these new approaches will be helpful.

In fact, it's a little bit of an aside.

I have a hobby of writing medical fiction, so I.

I wrote a.

I wrote a novel about electronic medical records and things that could go bad with electronic medical records.

It's a novel.

It's not factual.

I'm glad you brought that up.

What is the title of it?

I was just reading the summary of it.

Oh, the title of that is Coded To Kill.

And the.

The premise is that there's a group of ne'er do wells who are hacking into the unified medical records of a big hospital and using it to dig up dirt.

But also, have you heard the term Internet of things?

No.

So IoT or Internet of things is a term that's used to describe how everything's connected to everything.

And a lot of what we do, you know, for example, we don't have a system like this in our home.

But if you.

If it's a really hot day and you want to crank down the air conditioner on your way home, on your drive home, you can do that through your Internet of things.

In this case, in the.

In the novel, because so many things are connected in a hospital setting, these ne'er do wells are leveraging this Internet of things.

So, for example, I didn't have any idea until I started working on this.

When you're in the hospital and you get a bag of IV fluids, I figured there was a pharmacist or a pharmacy tech who put together those bags.

Well, in big hospitals these days, it's done by robots, which are incredibly accurate and they don't make mistakes, except for if they're programmed wrong.

And so you can imagine how somebody who's trying to kill somebody in the hospital could reprogram that pharmacy robot to give the wrong medicines or give a lethal dose of something.

So anyway, the novel's about things like that.

And.

Oh, wow.

Great thing about.

Thing about fiction is you can just make up whatever you want and there's no fact checking.

Exactly.

Well, I was gonna.

Whoops, I just hit my mic.

I was just gonna ask.

I hope it wasn't based on any true stories that you know of.

The novel is not based on any true novel stories.

What.

What stimulated me to write it, though, was when I was at the University of North Carolina, there was an incident there that a famous athlete, that all kinds of people had looked at their medical record.

They weren't supposed to be looking.

I mean, those are supposed to be private.

But they'd looked because we had electronic medical records.

So I had the dubious charge of having to speak to about 50 faculty members who'd inappropriately accessed this athlete's record.

And, you know, I know I don't know about you, but about me, I worry that that happens.

And so we actually have, at the University of Michigan, as do many places, we have a AI driven scanner of electronic medical records that looks at every single electronic medical record every day and figures out whether if you looked at.

If I looked at your record, was that because I'm your cardiologist or just because I'd heard you were in the hospital?

And if I was doing that for my own reasons at the University of Michigan, I get fired.

And I think that's the way it should be.

But you know, that that also is something that's benefited from the advent of AI Even before we were hearing about.

AI Wow, you are a treasure.

And I either blabbermouth.

I'm not sure which one.

Before we part, I have two questions that you can answer very succinctly.

Number one, what is the medical advice or advice you wish you could give to all heart patients?

If there's just something you want to scream from the mountaintops that you don't get to say enough, that you just don't feel said enough to we heart patients.

What is it?

Well, it's very much akin to what you were talking about.

And I always learn from people.

You can and you should be the CEO of your health.

And there are things that you can do to improve your health to prevent having more heart problems that aren't as terrible as you think they are.

So be the CEO of your health.

Love it.

And then number two, and I think we already have an idea just based on our whole conversation today.

But like, when you get up in the morning and you go to work at University of Michigan, what are you the most excited about?

Well, I'm excited.

We talked a lot about AI.

I'm excited because I think there's a future in health care that's going to accelerate more than at any time during my 40 years in health care.

And I think that's exciting because I think we'll get the tools and have the ways that we can control our own health and that our patients can control their own health in a manner that really was unimaginable 15 or 20 years ago.

So I'm excited about that.

So being proactive instead of reactive.

Right.

I'm less excited about the fact that one of the two elevators from the parking lot I park in is being worked on, and it's seven flights of stairs.

So at the end of that, I feel.

At the end of that, I feel good about it.

Otherwise, I'd never be walking those seven flights of stairs when I come in.

I hope you get your own parking space, by the way.

Well, I sort of have a parking place.

Okay.

I think you've earned it.

I think it's okay.

You can own the fact that you have your own.

Your own parking space.

Well, I will.

I will.

Then, yes, I have my own parking space.

Oh, good.

Well, Dr.

Marshall Ranghi, thank you so much for your time today.

I speak for all heart patients.

We all benefit from your work, and I can hardly wait to see what comes next from you and your team at the University of Michigan.

And for everyone listening today, be sure to check out the show notes.

I'll have a bio in there of Dr.

Range and a way to find him and buy his book, support his work and just keep taking care of you, like he said.

Like I said, you are the CEO of your own health.

And remember, in case no one has told you today, I love you.

You matter, and your heart is your best friend.

Thanks, Dr.

Runge.

Thanks, Boots.

A privilege to be on your show.