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Episode #148. The Human Algorithm: How Clinicians Can Code Compassion into AI, with Dr. Alessio Morley-Fletcher, Co-Chair of the Department of Pediatrics’ Effective AI Implementation Committee at Boston Children’s Hospital
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Foreign.
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Welcome to Risk Never Sleeps, where we meet and get to know the people delivering patient care and protecting patient safety. I'm your host, Ed Gaudet. Welcome to the Risk Never Sleeps podcast in which we learn about the people that are protecting patient safety and delivering patient care. I'm Ed Gaudette, the host of the program. I'm here live at Health in Vegas and. And I am here with Alessio Morley Fletcher. Dr. Fletcher from Boston Children's. Welcome to the show. Welcome to the program.
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Thank you so much, Ed.
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B
Now, you spoke here. You were. You were on a panel.
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A
Yeah. So I was leading a session on the clinician entrepreneur role, which I think it's really a fascinating new field that's booming, where at the same time, there's a lot of need for supporting clinicians who are trying to navigate this new, like, you know, see change of technology, how we can harness technology in a way that really makes us be more connected with patients and drive innovation from within the hospital setting.
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B
Got it. So share a little bit about your background, your current role in your organization.
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A
Sure, absolutely. So I'm originally from Italy, Alessia. It's like Alex in Italian. My last name is British. My grandpa, paternal grandpa was from London, but my dad was born and raised in Italy. And you can imagine the challenges in spelling my long affinity last name as a kid at school.
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B
Folks, I'm looking at an Italian Tom Brady. Okay, this guy is handsome.
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A
Oh, that's so sweet of you. And so basically born and raised in Rome, where I did my md we have slightly different academic system in Europe, so it was like a six years of, like, training. At that time. I also had the chance to do some rotations internationally, especially in New York. We ended up spending lots of time in Mount Sinai Hospital. Mount Sinai. And this is where I started really getting really in tune and fascinated with like, American nano clinical system. And then I did additional training in Italy, a master's in pediatric gastroenterology. So I came to United States initially scholarship with training in pediatric gastroenterology. I was fortunate enough to go to immediately to Boston, to the Harvard University setting, such as, like a Mass General Hospital, where I did there I had to go through a quite a pesky journey as a foreign doctor, namely that you have two options. One is to just do research, which is super important. But in that case, everything is recognized in terms of credentials. And otherwise, if you need or you want to be like, more in close contact with your patients. Being really a clinician, you basically have to start from scratch. Again, so I had to take all the board exams, do residency and fellowship gastroenterology. But then when I was in the hospital, during my training there, Mass General, I realized I was getting very passionate in different sectors of medicine that I really wanted to connect one to another one was certainly the importance of doctors be better at listening to themselves, becoming more resilient. I felt that the system as many strengths, but at the same time, as we know, it's quite challenging to be a doctor and a lot of issues. Right. And so I started getting trained in mind body medicine, which was at that time like a field of medicine that was not as popular as today, as you can imagine, but really was extremely helpful for me to learn some tools that it would really be practical for my own sake, but also for patients be better listeners. And also with my colleagues. It also was noticing that I was really constantly passionate about all the problems that could happen in the patient journey. And I was like, you know what, while I do love pediatric gastroenterology, I actually want to have a broader impact. And so there I chose another subspecialty pediatric hospital medicine, which is relatively new subspecialty which would allow me to work in different settings. And so once I became an attending, I moved to Boston Children's. And there I've been working both about the children's and also at the major partner hospital, which is a South Shore hospital, as a pediatric hospitalist and urgent care attending. And so I get to work depending on the day in different sectors of the hospitals, the emergency department, the newborn nursery and the inpatient unit. So I deal with 1 hour old babies to up to 21 years of age depending on the setting. So my conversation could be about diapers to sex, drugs and rock and roll and risky behavior for teenagers. So it's great because it keeps me on my toes, clinically speaking, but also gives me opportunity to see all what's working and what's not working, how to fix it.
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B
Where do you live?
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A
I live in Boston, in downtown, in Back Bay.
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B
Okay, Okay. I live in Andover.
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Oh, cool.
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My hospital, South Shore.
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That's it. We close the circle. I love that.
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And my daughter just had her first baby.
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Oh, cool.
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B
I wonder if you delivered him. Do you deliver?
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No, I don't. I used to, but you know, but we take care of babies. So we work very closely with the OB team.
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B
Yeah.
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And the nicu. So we're like really like, you know, just a well oiled machine to take care of all the babies who come to us or if they are now getting secret and secret, we have to send them to like the otp. We work as like another.
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B
Oh, excellent. Cool.
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Nice.
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B
How many days you do in South Shore?
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So it depends on like, you know, on the week. I have a relatively flexible schedule because that is my clinical hat. And then I wear other hats. One is in healthcare simulation, which was something one of the other interests I had that I developed over time. This time as an attending, even though I got exposed to healthcare simulation already during training at mgh. And as an attending, I just started realizing that that was the best way for us to identify problems, promote psychological safety, especially for some categories such as nurses who have a lot of experience, a lot of insight, but, you know, hierarchically speaking, sometimes they can feel intimidated by these old school, like, no mentality of physicians. And also the opportunity to connect the other dogs, such as the mindfulness, the burnout. Because the more we trained, the more we practice, the better prepared we are when we're really real life hits. And I find fascinating and also very sad in medicine, which is the field that is highest risk. I know you are passionate about patient safety. Highest risk in terms of safety. And we never get to practice. For us, it's always Sunday, it's always game day, and we have to change this. And simulation, which was initially borrowed from the aviation industry, it's been booming in many two decades or so. So I had the chance to be training simulation with the great people at Boston Children's and then now become a facilitator, then train the facilitators. And so I was really fortunate to learn from like, a people like who. The founder of the International Society for Pediatric Simulation, Peter Weinstock at Boston Children's. And then I was teaching with him also internationally, lucky enough. And then I've been like directing the pediatric simulation program at South Shore Hospital for DD and the inpatient.
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B
Oh, interesting.
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Yeah. And so. And this thing.
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So you're busy.
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I'm busy, but in a very good way. I have to say I'm extremely grateful that I have such a supportive leadership at the hospital at Boston Children's Hospital and also through the network.
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Yeah.
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We have the chief of the Department of Pediatrics, Wendy Chang, or the director of the network operations, Dr. Graskin, Karen Graskin, who have been extremely supportive of doing different things because they see that everything is kind of connected.
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Yeah.
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And these things, all these things eventually led me to AI, which is the newest hat I've been wearing. I'm sure you're curious to learn more about it.
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B
You're on the chair. You're on the chair, right?
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A
Yeah. So basically, our Chief of pediatrics, Wencheng, such an innovative thinker, she realized that, you know, Boston has been doing amazing work in terms of innovation. We're lucky to have our Chief Innovation Officer who's really like a star in the field, John Brownstein, who is also speaking here, who have been doing great work in like, in terms of innovation detecting things. We were one of the first hospitals to implement our internal chatgpt. Oh, wow.
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Yeah.
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Which is great. And do so many other things really, like in terms of really empowering clinicians and patients. But at the same time, we see that the people in the front lines may not be aware of all the wealth of tools that we have, or we may not have enough data from them. Who are the ones who are experiencing the pain points. And there's, as you know, a lot of skepticism or fear about technology because some people may fear that they may lose their jobs or they will become dehumanized. And so the Chief of Pediatrics, Wendy Chunk, wanted to create a working group about. More than a year ago, I was fortunate enough to be a co lead of this working group. And then eventually that led to more work and really realizing that we need to become more like an institutionalized entity. So we created the Effective AI Committee. And for us, the most important word is not AI is not a committee. I could not care less. Not the fact that my co chair is the word effective. Because I feel that today you and I were talking earlier about it, that there is so much hype around AI and everybody talks about AI. Sometimes we don't even need an AI solution.
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Absolutely.
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So it's important that whatever we deliver is effective. And as I said, I'm lucky to be a co chair for this. I work with an amazing group of people and we're really trying to tackle the problems in different ways. One is around education, which is the one the initiative I'm leading about really how to increase the AI literacy. Because I do think that even in hospital, as great as Children's Hospital, one of the best in the world, where there are so many people know a lot about AI, there are also a lot of people who don't know much about AI. And we have to close this divide. I'm really interested in closing divides and breaking down silos. And so there is a lot we can do in terms of helping people better understand what they need about AI. What AI is how to ask for help or even share their great ideas with others who are doing the same. So that we don't reinvent the wheel.
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I love that. Yeah.
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And then we help really kind of filter and wet and vets proposals so that we can bring them to John Brownson's team. With them, we work closely. They've been really super supportive and really, like, you know, giving us a lot of help in this. Really try to come up with some internal solutions, because I think the hospitals have many innovators who don't. They know themselves are innovators.
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Yeah.
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Or the hospital doesn't encourage them to be innovators. And this has to change.
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Yeah, No, I love that and I love the point you made earlier that it's not always AI. We don't always need AI to solve every problem. And so coming with the use case and really the understanding of why, why AI, and maybe we don't need AI for this solution. I love that point. How did you get into health care?
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What's your origin story? You know, I always say provocatively that I chose medicine because of my love for philosophy and history. Oh, no doctors in my family in, like, an immediate generation. So I had no clue about what medicine was about, except for the fact that Bean exposed his child to surgeries when I was young, like 5 and 7. And at that time, how the experience, you know, it's hard when you are young to verbalize it, to understand, but it did not feel cool. I felt many times alone in the hospital. And also it was striking to me that the two most important people in my life, my parents and those moments, were almost useless. Namely, they were the first one to be scared, concerned, and they were trying their best to encourage me, but you could see they were scared. And therefore I felt like, huh, These superheroes are not superheroes when it comes to health.
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B
Yeah.
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And complete strangers are the ones who are running the show, and they don't take much care about myself. So I did a situation where first I had an eye surgery, and at some point they had to remove the covers. They had, like, on my eyes after two days, and that was done when I was alone without my parents. And imagine, like, two days in complete darkness, and suddenly you are asked to open your eyes in front of a doctor in front of, like, a trainees, and nobody's there.
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B
Five years old.
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A
Yeah. Yeah. That time I actually was seven. And. And they were. I was seven years old. And so somehow I think subconsciously stayed with me to say, I want to help most vulnerable ones, kids. Yeah. I want to help them feel encouraged in moments when they feel very unfamiliar with the setting. So I think that stayed with me for a long time.
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Yeah.
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And then I was supposed actually to go into business school because I want. I'm very interested in foreign affairs, politics, the good side of politics. And so I got accepted into a prestigious business school. But the summer before I would start business school, somehow I felt like, you know what? There is something here. I'm. I'm in search for meaning. And I don't think that even though I find business very interesting, politics interesting, but side of me is not maybe the calling. Exactly. Yeah. And I think also that I think was interesting in like on a family level. I come from very different parents. I'm very lucky. They are divorced, but they get along super well. But my mom is a dancer from Sweden, living in Italy and teaching dancing flamenco, Spanish dance. Speaking of like the. The sky is the limit. She really taught me that if you have a passion, it doesn't matter. Incredible what your origin is.
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Yeah.
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She became extremely successful. She then became president of the Italian chapter for the Spanish Dance Society. But from Sweden, you know, blonde, blue eyed women dancing flamenco, Spanish dance. And not only flamenco. And my dad is an intellectual. So somehow I think I had this. The mind and the body. The body through my mom, honoring these beautiful machines that we were given in life. And then the intellect from my dad. And I think that medicine was the way to connect these two interests. And then I closed the circle by saying that the thing that really led me to medicine was I had a very good relationship with a pediatrician when I was like, you know, teenager. I will be the one will be calling him, just asking him about, you know, how to manage my asthma. Somehow I felt probably the need to feel empowered because of that experience when I was much younger. Yeah. And I called this guy one day, I said, Massimo, that was his name, Max. I said, I'm so sorry to disturb you. I know you're seeing patients, but I think I want to go into medicine. My only fear is that I want to go to medicine primarily to heal myself. And I think that's very selfish. And the guy told me if that is the reason that's exactly why you should go into medicine. Namely that it's very humbling to some extent. Yes, we help people, we save people's lives. But in the end is also a journey, humbling journey to understand how you manage your energy, how you become a better listener.
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B
It's also empathetic.
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Absolutely. And it's. I mean, something. Some people are more tuned than others. But it's A muscle that you have to learn over and over and over to nurture. And is how why I'm so passionate about fixing burnout. Because even the most empathetic people, when they're burned out, one of the first symptoms that they stop carrying.
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Absolutely. Yeah. It's so easy to get cold, isn't it? As humans. Yeah. We have to always be in touch with the empathetic side of our hearts and our minds and our souls.
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Yeah. You can't say any better. I love that.
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B
So if you could go back in time, what would you tell your 20 year old self?
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I will tell my 10 year old self to worry less. It's something I keep hearing from people and I'm realizing that, you know, there's a reason why many people keep saying this. Yeah, we tend to worry a lot. It reminds me of like the great quote, I think it was Mark Twain and it had it on his tomb saying that here lies a man who worried a lot about things. Most of the which never occurred. And I, you know, I think also as doctors we tend to always think of the worst case scenario. It's very important in pediatrics, even more so because if you are in an emergency department, you are discharging somebody, you have to tell yourself this, like, you know, maybe an appendicitis, I'm missing and then it goes into rupture and then in septic or it's. So we deal with really difficult decisions but at the same time we tend to have this tunnel vision of, you know, it's me against the world. The world is like not helping me or we have to fix it all. Whereas it's where it's a family and this is where like you know, meetings like this, conferences, venues like health even like you and I and Mark really interacting. It's such a reminder that it takes a village.
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B
Yeah.
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To live together and we can help one another, we can learn from each other. Yeah.
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We have to remember and remind ourselves of that because the robots are coming.
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Oh yeah, yeah, absolutely. Absolutely.
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Do you think we'll see robots as doctors and nurses in our lifetime?
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Well, in many ways I think it's already happening for terms of, you know, of tools that we're doing in terms of predicting like no risk for being admitted to the hospital or not. She'll just been doing phenomenal work in this regard with some colleagues mine and define and again John Brownstein's team, like really like how to really do it. Be not only a diagnostic medicine, but predictive and then prescriptive medicine. I think will happen, but they will still be. They need for the human touch.
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B
Yeah.
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When you're really like, you know, suffering, you want, you know, a human hand touching you.
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Empathetic human.
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Exactly.
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B
Yeah.
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But there is a lot we can do in order to free up people's minds, lift up their pressure from mundane tasks. My cio, John Branson keeps talking about, you know, this is the first goal of AI, really trying to really address those needs of three automation, reducing like no bias, so that then we can do better things. We can all work at the top of our licenses, including the patient and I think the patients as a license, we have really to really uncover that, encourage that.
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B
Yeah, we always talk about bringing patient into the care plan, but now I think it's reality with AI, right?
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A
Yeah, absolutely. So first, and I can share an example, I recently completed a study we're now submitting for publication with some colleagues. It took a lot of time to get it approved through, as you can imagine. We started thinking about it right after ChatGPT was released and, you know, it took so much time. So these are one of the problems of innovation. We have to make it much faster and nimble. But the content was around the ed, the waiting area, the triage, when you're waiting to be seen. And if you are not super sick, you don't get seen right away. Yes, rightly so, but most patients don't understand that. Most parents don't understand that. They feel like, well, why am I waiting? So I always tell them, you know, I know you've been waiting here for a long time. Take it as a compliment. It means that your child is not as sick.
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B
Yeah.
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But at the same time, there's a lot of time that gets wasted and they perceive that. And that is actually a perception has been directly correlated with satisfaction of care received or not and compliance. So I came up with this idea. How about we leverage AI ChatGPT while they are waiting to be seen, for them to become better storyteller of their problem. Because when I see patients, the one factor that frustrates us the most as physicians, especially in the ed, but also inpatient and so many subspecialties and other specialty. No, lymph, pediatric. Is that if you and I are. Even if you are my patient and I talk to you, usually it takes me about 80% in the ballpark to try to get the story from. Yeah, and it's not because you don't want to give it to me, because maybe you lack a certain, like, skills that will never enable you for experience.
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B
So you don't know how to talk about it.
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Yeah, yeah. But also because it takes time for you to think about it, what really matters to you. So we've done interesting studies that really what matters to the patient may be very different from what led the patient to the ED or to the doctor. And often doctor has no clue that that thing really matters to them. Maybe they come from a knee pain, but actually they are worried about something else because their family member has a chronic disease and they worried that this is the same thing. Right. So if we have ChatGPT, that helps them to say, hey, what's the story? Why are you here? What are your most concerned? Tell me more about what happened the other day. And then they have this summary and the patient can say, you know what, I agree with this. This is my summary. I generated it. And then the doctor comes and they share the same notes. Then you're not spending 80% of the encounter trying to get a story. You are actually working on top of your lives and say, okay, let me examine you. Let's start spend more time on the real problem. That's your education. And so that was really. We.
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B
When is that out?
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A
Yeah, so hopefully soon. We did this pilot study, was very well received. I had the kind of. The thought, okay, I'm sure people will be interested in this. At the same time, I was like, you know, let's see what happens, how much they like it or not. And it was fascinating to see that their comments were like, ChatGPT couldn't say any better than this. Help me be a better storyteller. And then also it was nice to see those summaries because they were very accurate. We saw some flaws. Of course, sometimes it'll be like lacking of maybe prior visits, two days prior, some details, but on average, extremely accurate, well received, very readable, helping the clinician. And you can imagine also how healthy it is in terms of health equity. Imagine those who are not proficient in English. Yeah, you can do that in their own language, their own story.
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B
I can't wait to see it when it comes out. If you weren't doing this job, what would you be doing? If you weren't doing medicine, what would you be doing?
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A
I think my mom says an actor, I don't know whether she means that, you know, I'll be good or not. But, you know, she always says the story that, you know, when I'll be a kid climbing down the stairs and rolling down and screaming, she'll be coming thinking I got injured, and it'll be like, standing up, like, no, you ruined the scene. How to start all over again. And so to some extent, I like, Like a stuntman. Yeah. That would have been my career. Like, for sure. Not like a movie star, maybe. Stuntman. Yeah.
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B
But John Wick movies.
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A
Yeah, exactly.
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B
Oh, nice.
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But it's more like, to me, what's interesting, like how you put yourself in other people's shoes or at least how you. How'd you try doing that? Yeah, I find that very interesting.
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B
Good tie in. Good way to end the program. Edgar Death from the Risk Never Sleeps podcast. If you're on the front lines protecting patient safety and delivering patient care, remember to stay vigilant because Risk never sleeps. Thanks for listening to Risk Never Sleeps. For the show, notes, resources and more information and how to transform the protection of patient safety, Visit us@SenseInet.com that's C-E N S I N-E-T.com I'm your host, Ed Gaudet. And until next time, stay vigilant because Risk never sleeps.