A Decade Of ZDoggMD: The Unfiltered Story

– [Tom] When did you upload your first video to YouTube?

– The first video I put on YouTube was my graduation speech from UCSF. So my buddy, this guy Ellie, he’s a surgeon now, we were med school buddies, he recorded the whole thing on like one of those VHS handi-cams in 1999 and I was voted like the classic UCSF. You got to vote for two speakers and one of them was this very earnest young lady who was like we’re going to overthrow the system and single payer and all this stuff, and the other one was me. Because they just wanted to like give a stiff middle finger to the whole experience because they knew I’d do that. So I, he recorded it, and I had it on a VHS and I played it back and I was like, oh man, this thing, this was the highlight of my life. I got laughs out my colleagues. Like, it felt like I was finally accepted, right? Like my whole life and career in medical school I’m trying to, because the first day of medical school, I’ll never forget it, it was like being back in high school. Like, nobody accepts you, immediately there’s clicks, you’re trying to find, okay am I with the, and you’re like am I with the nerds in medical school? Everybody is some variant of nerd but like there’s the jock nerds and there’s the stoner nerds and there’s this. So you’ve got to find your thing so you’re not accepted. So finally I was like, oh, I got laughter from my peers and my mentors who are sitting behind me in this, in this, this talk that I did. And so I was like, YouTube was a new thing. I figured out like how to upload it on my PC and I put it on YouTube and immediately it got like 30,000 views. And I was like what? Like 30,000 views of this like speech that I did. And that was when I started thinking, oh, what if I did this consciously and I actually started creating content? I don’t think there are doctors doing this.

– [Tom] Why do think that one got 30,000 views?

– I, well, you could say it was the early days of YouTube. There wasn’t a lot of medical content. I think because.

– [Tom] No, that’s too self-effacing. What do you think it, what was the chord it struck?

– What people tell me, and I have trouble seeing this in myself, is that I saw something as it was and I presented it as it was using humor but it was all true. So none of the jokes I made in that speech were actually based on untruth. They were all true and nobody, apparently, in medicine had the courage, especially in those days, to actually say that publicly.

– [Tom] It’s interesting that nobody had the courage to say the truth.

– No, because, first of all, I think a lot of people are in denial of the truth because the truth is very hurtful. Like when you figure it out you go, ugh, I don’t want to know that! So you pull up the defenses. And I think the second thing is people are conditioned. Like you’re really conditioned by fear. Oh my gosh, I’m going to hurt someone if I do the wrong thing in medicine, or I’m going to offend a patient or my mentors and I’m going to not have a job or I’m not going to get patients or people aren’t going to trust me. Because remember, most doctors, anyone worth their salt has imposter syndrome. They think they don’t even belong there because they know what they don’t know and they’re like this is really hard. And they’re always afraid that someone’s going to get onto them. So if you go up in front of all your classmates and your mentors and Nobel Prize winner, Michael Bishop, sitting behind me, and Dean Highly Deboss and all these luminaries and you go, this is what I think of medical school. You are making yourself vulnerable in a way that is unthinkable. Now, of course, because I was also desperate for acceptance, I knew deep down this is the only way my own peers will accept me is if I go up there, because I don’t have something special in terms of intellect, I’m not going to like blow them away with my knowledge of the force, you know, I’m not some Jedi medical person. I’m like an average doc but what I do have is the ability to stand up and to say things in a funny way that’s true.

– [Tom] It’s interesting because the truth does hurt, right? But like lies compound and hurt so much worse.

– Well, so lies compound and hurting worse is a truth that you only realize as you get older and those lies come to roost in your life and you go, oh, man, I’ve been lying to myself, I’ve been lying to everyone else, other people have been lying to me, we’re all lying to ourselves, too, we’re really good at self-deception. And then why am I unhappy, why is the consistent acquisition of material goods not, and success.

– [Tom] Yeah.

– I, everything, click it off, click it off, unhappy, unhappy, unhappy, maybe if I just get this, unhappy still. And so you do have to start to cut through the deception and that’s hard. It’s an ongoing process.

– [Tom] Do you think the culture of medicine is built on lies?

– Is the culture of medicine built on lies? I think the culture of medicine thrives on putting up a front and and a kind of a deception the same way an actor puts up a front. But in acting, it’s clear the person is acting. In medicine, it’s not. So in the room, you’re a certain persona. Online, you’re a certain persona. With your colleagues, you’re a certain persona. Heaven forbid you’re yourself. That’s just the one persona that’s probably not acceptable. Right? So, yeah, I think it is based on a kind of a fabricated icon that you present to the world, for sure.

– [Tom] I know what I’m thinking and it’s hard to be concise about this so I’ll just ramble a little bit. It’s like when you show up and you’re bright-eyed and bushy-tailed, right, on day one and you think you’re going to save the world and that things are one way and then you find out they’re the opposite way and you’re forced to swallow the black pill, basically, that like this is not going to go how you think it’s going to go and no, really, you’re not here to help, you’re here to bill. It can of like you have to then accept the lie and live the lie at that point because you’re in too deep.

– Yeah and that, you know, this idea that how we’re paid is all antithetical to our idealism is one piece of it. But then even go even deeper. Your day on the wards, you know, third year medical school I remember these cases were like, we had, you know, the team had misdiagnosed an endometrial cancer as something benign and had told this woman and her partner that everything was okay. And then the pathology re-report came back and we had to go and tell this woman, no, actually everything’s not okay, the endometrial biopsy shows you have cancer. And seeing how we had to present that and handle that and it was this big production and all this prep going into the room. And in reality, what was required was a human being to go in there and go, I am so sorry, we made this mistake for these reasons. We will never make this mistake again because we’ve learned from this. But this is what’s going on and I’m so sorry. That’s what needed to happen, right?

– [Tom] Do you feel, did you feel 10 years ago as a doctor when you were like in the thick of it, did you feel like you were walking around passively through sort of a labyrinth that was created by malevolent actors? It feels like, it feels like that sometimes but at the same time it’s intermixed instantly with this joy of, oh my gosh, I got to be with this guy today when he, you know, he had his amputation. And you got to be with him post-op and tell him everything went okay and you got to be with the fam-. So you have that magical shamanic thing and then you have absolute garbage where you go, you know what, we can’t even dot our Is and cross our Ts and keep our act together. None of these records connect. This guy was seen here but now were duplicating all the tests because of all the system failure. And then you see people failures where it’s like egos clashing and bad conditioning. You know, these are, these, I like to believe these are all really good people in a very bad system. And you know like Marty Makary and I were talking and, you know, he’s written books about how bad the money games are in medicine and he said, every time I sit down with these people though, I’ll go with the CEO of a company that’s been suing their own patients and these are real, you know it, you feel it, these are good people. They just, sometimes they don’t even know what’s going on. They can’t see the full system that’s involved. But the thing is, we’re still responsible for that.

– [Tom] It reminds me of Murray Rothbard wrote a book called Bureaucracy and basically like in it he says that you can’t change bureaucracy, that bureaucracy will change you.

– Ah!

– [Tom] That once you go into it, it’s going to grind you down and make you part of the machine.

– Bureaucracy will change you is the bumper sticker that they should give you before you start medical school.

– [Tom] Yeah.

– And look it every day and go, is that happening to me? Is that happening to me? And believe me, every day you’ll find one little thing that has happened to you that bureaucracy has changed you. It’s absolutely true. And I think this is where, so if you look at the effect we’ve had over 10 years, the reason doctors and nurses and health care people and patients who care about this stuff actually watch us is they go, oh, that’s funny because it’s true. I’ve felt that. You know what, no one’s ever said that that’s got any credentials behind their name. Like people, people whisper about it and they say this but they won’t go out publicly and say, you know what, this thing’s built on a house of cards that’s going to crumble unless we, who have built it, actually do something about it.

– [Tom] People like that about you. Like, A, when you did the moral injury video, right, they liked it because you were saying we’re not burned out, like there’s not something wrong with us, like you people hurt us.

– Yeah, that moral injury video is interesting because that was a, I had no idea that video was going to get that kind of response. And, in fact, you and I were talking when we were making it and I’m like, well, here’s a thought, let’s do this thing about moral injury. I’ve talked about it briefly before and I feel strongly about it. No one’s going to care about it but let me just get this off my chest. And you were like, yeah, whatever, and we were both like whatever. And we did it, I just did that rant, and I started getting angry during the rant. Put it out and it went crazy and for doctors that was like a rallying cry, like you know what, it isn’t just us, we’re not crazy. The system is crazy but the problem is, it feels like they’re blaming us. It feels like the system is saying it’s your fault, you’re not resilient, you’re not tough enough, you don’t meditate enough, you’re not woke enough, so you can’t adapt to this because everyone else is adapting, right? Wrong. Because in medicine we don’t communalize our pain. We isolate into silos. So you don’t know that the guy in the office next to you who’s working in the big corporate medicine world that you’re in is considering, contemplating suicide. You have no idea. You think that this is a super-accomplished surgeon who does this and this and this. You have no idea because we don’t share our pain. Moral injury video probably was one of the seminal moments where we go, guess what, my pain is like this, is yours like this? And everybody stands up and goes that’s it, that’s what it is. And it doesn’t even have to be 100% correct. And a lot of people gave me crap for it and they’re like, you know what, you’re letting individuals off the hook, there is some responsibility for resilience and all that. And I’m like, well, just read the comments. See how people have been treated, see how they feel and then invalidate that. Tell me you can invalidate that. You can’t. This is a groundswell, right? The question then is what do you do with that? Right? What do you do with that righteous anger and that awakening where you’re like, man, we’re getting fucked.

– [Tom] One of the revolutionaries during the Scottish Revolution, can’t remember his name, but he said, you know, I care not who makes the laws of the land, but I care who writes its songs. And what he’s really saying there is like I care about the culture because we’re always going to be trampled underfoot but I care about how we’re interacting with power, you know? And what I’m saying to you is like do you think you’ve changed the culture since you started speaking out 10 years ago? Because that’s, that’s the goal, right?

– If you want to unveil an imposter syndrome in me, ask me if anything has changed because of what I’ve done.

– [Tom] Tell me the answer.

– And I’ll tell you if it has, I’m going to deny that it was because of me. I’m going to say it was the inevitable progress of people waking up. But honestly.

– [Tom] Take yourself out of it.

– If it take myself out of it, I would say, well, people are using terminology, even, like health 3.0, whatever that is, right, this ethos of rehumanizing medicine. People are talking about moral injury, which wasn’t invented by me. It was Wendy Dean and Simon Talbot who took it from a book about Vietnam. And so this idea that everything builds on these sort of series of cause and effects of every player in a network effect. So, yes, I’m a node in this network, and a pretty decent sized node, I mean, a couple of million people. And I get recognized everywhere I go now. It’s crazy, it’s unsettling, and yet at the same time, when it happens and someone says, hey, the reason I follow you is your moral injury piece or what you said about nurse violence or what you did. I go, ah, you get this feeling of elevation, like, my little part of the network had some effect. And so that’s how I think about it. Did we have an effect? It’s this additive effect of all these things starting to, you know, perturbate. And that’s why I tell people, oh, what can I do? I’m powerless, I’m a CNA, or I’m a nurse, or I’m a primary care physician at Kaiser and I feel sometimes like I’m a pat of a big system that doesn’t move. Move your ass. Stop complaining and just do one thing and watch what happens because the network starts to vibrate. The next thing you know, you have a dramatic shift in perception which then changes action, which changes everything. So that’s a long answer to the question of did we have an effect? Now that I think about it actually, yeah, fuck yeah, we had a big effect. And we continue to have effect. And the next 10 years is going to be even more insane because we’re getting more self-aware as to how to make this effect even more pronounced, right?

– [Tom] Yeah. It’s almost like we’re stuck on a like a cruise liner that’s like barreling towards disaster, right, and we’re all just locked in the cargo hold and we have to, everyday we have to hear sort of propaganda-type announcements, you know, from the loudspeaker. And what you’re doing is changing the way that people interact with the announcements coming over the loudspeaker. So you could say like, okay, you haven’t stopped the ship from barreling ahead to certain disaster but it’s like it can’t be stopped, right?

– Yeah.

– [Tom] What we need to change is ourselves.

– Yeah and that’s the thing. So I think the criticism of the moral injury piece was but you’re letting people off the hook for changing themselves and the answer is no. The answer is that’s not what we’re doing. The answer is people are starting to become aware of what it is that’s hurting them.

– [Tom] Yeah.

– So you’re listening to this voice that’s telling you it’s me, it’s me, it’s all me, it’s my, I’m a failure, or I’m an imposter, I can’t do it. And then suddenly there’s another voice that’s telling you that he’s suffering, too, that’s saying, hey, guess what? Actually, it’s not just you, it’s all this. If we all realize that, I bet we could change all this. Then it is our responsibility, right? And even then, I talk about things like meditation and transcending this illusion of self and these other things that cause human suffering. That’s also necessary, that’s also part of it. If everybody suddenly got awakened to this, the whole system would transform, right? But you can’t expect that. It has to be, you have to hit it at all angles, I think.

– [Tom] It changes slow because it has to happen at an individual level, right? One person at a time?

– One person at a time. There was a point, you and I were having a discussion, how do we transform medicine? And the answer we came up with was it has to happen one person at a time. Every message we get on Facebook, everything, we have to respond and say, hey, take, have hope. This, it’s little things you can do. And it involves you also reframing your power in the world. You’re much more powerful than you think because you affect everybody around you.

– [Tom] Think about the way that you started the decade versus how you’re ending the decade. Yeah, you put up some videos on YouTube in the beginning but they were, they were clownish because you were so scared to take the step off the plank.

– So it’s interesting, it’s good to go back to those videos. So starting out with like the first real video I did at ZDoggMD was called Colon Wars. And it’s funny because now Star Wars, the saga has wrapped up, right, and for better or for worse, I haven’t seen the new one yet, and I started with this idea that, oh, isn’t it funny that a colonoscopy is just like flying down the trench in Star Wars. And I made a bunch of jokes and it turned out it went viral among GI docs, right? But it’s pure comedy. Like, I mean, it’s not even that funny. It’s just clownish, me in a room with a camera, I didn’t know what I was doing. I got a Mac so I was able to edit for the first time, get it on YouTube. And I put it out and I felt, I remember, even with that video, I was like, oh shit, like I can do so much damage in the world. Like, there’s so much stuff in my head that I want to get out and the early stuff was terrible. But it’s funny, there’s still people who come up to me, usually doctors who are like dude, you’ve fallen off, man. It’s those early videos. And they’re off their rocker in my mind but at the same time, I’m kind of like, that’s right man, that was me in the heart of medicine when I was full-time practicing. That came from that place, right?

– [Tom] Well, you were making yourself into a joke, I think, because you were scared of anybody actually taking you seriously. Because if somebody took you seriously, then it was real. And then you had really stepped out and you were alone, right?

– You know, the only, the first time I had to be taken seriously was for TEDMED in 2013. And they told me specifically, like, this is not a joke. You can use humor but there has to be a gift, a message you’re giving the audience and it has to be serious. And I wasn’t having any of that because part of my, I think my conditioning, is you use humor to keep people at a bit of a distance to break down sort of the fear of people not accepting you. So if you make a joke and they laugh, you’ve been accepted. If you say something serious and they don’t agree or they’re not feeling it or you haven’t given it the gravity that it needs, you’ve been rejected. And so I think that’s a deep conditioning. So, yes, I think my early videos were a lot of clownery to try to push off, even if they had a serious topic. Like we did some stupid video called Pull and Pray about STDs, right? Horrible. But the idea was, hey, use a condom, coitus interruptus is a bad way to keep safe from things like STD and pregnancy, so let’s make this stupid song about it that’s clownery and me putting on a kangal and, you know, yo yo yo. And so burying the lead, right, in all this comedic nonsense I guess was a way to get me to feel, it was only after I met you guys actually that I started going, because you would tell me, no, you actually have to, there’s a message here that you’re burying so stop being an asshole and just give the message, right?

– [Tom] Yeah, because you know, the first time I met you was like in 2015, like midway through the decade and I watched your videos beforehand and I was like, oh, these are like cute and funny and like I get what he’s doing. Like, they’re actually pretty good. Like, he might not even need me to come in and help out. But we had a meeting and then we talked for the first time and I was like, you know what, there’s just something about Zubin. Like I liked you immediately, you were super inspiring in what you were doing and I could tell that you were divorced from the character that was ZDoggMD, like that there was a real, significant person behind this shtick. And so when we had our first meeting it was all I like wanted to do was be like say the shit you’re saying to me now to everybody. You know? And maybe it’s because I have a millennial authenticity or something but I was like just say it! Fuck these old men who want everybody to shut the fuck up and let them continue to print money, you know?

– It’s, it’s really kind of true, actually. I hate to say it because I have trouble seeing myself clearly but you actually always did have that kind of figured out that like just say the shit that we talk about, right? Which is why I started working with you because I’m like, hey, this guy actually gets it. And the quality of the work suddenly went blrrrt. And with the, you know, I think, with the elevation in the quality of the videos and the audios with Devon as the audio engineer, suddenly you couldn’t hide behind bad production. So you couldn’t say, oh, you know what, it’s just me with a handi-cam like doing some shit, it looks terrible. And it’s me with Garage Man and it sounds awful. And I’m not a singer. Oh no, now I have an audio producer who’s a world-class audio engineer, I have world-class cinematographers in you guys, and, you know, he made me take vocal lessons so I could at least approximate in a studio the sound of the some of the parodies we were trying to do. Now you can’t hide behind bad production anymore which means you can’t hide behind dumb comedy, it has to be, even the character ZDoggMD was a joke, it was like a throwaway. Okay, what’s the Twitter handle that wasn’t taken? What did they used to call me in the ’90s when I was in college? They called me ZDogg because I used to like Snoop Dogg because that was just a dumb, hey, ZDogg! I’ll just use that. Ten years later, I’m still stuck with that fucking name. But that was what it was, it was this kind of thing, right? A character.

– [Tom] Let me tell you something though, it goes deeper than all that because 10 years ago you’re a doctor who’s making a high six-figure salary, you’re Stanford-trained, like you have respect, you have money coming in, and you decided to take this crazy, brave step and step out on your own, right? And in doing so, you pull everybody along in the way. There’s no reason why I should be in this hotel room speaking to you right now. You manifested that into reality and I was inspired and I got pulled along and became a Z-packer also. So like as somebody who is a fan of you, I can tell you like, it is meaningful what you’ve been doing the last 10 years, in a deep way. And like, it’s not just me. Millions of people feel the same way about you. You know?

– You know, in those rare periods where I can accept that connection, I sit here and go, wow! What amazing amounts of gratitude I have, right? Like how did we all connect? Like how do you guys like drop everything and come work with me? Like how do I get a team, like how do I get Devon to do these songs? Like he, he’s way too good for what I do, right, and yet, here he does it. And I think it’s, I think it is because we all kind of align and we actually manifest each other. We go, you know what, we can actually do some good in the world. Even if we joke about, nah, he’s fucking, this is never going to work. We wouldn’t do it, I think, if we didn’t truly believe and I think people wouldn’t follow. They really wouldn’t. They would stop me in airports to take selfies. I’m not a famous person, dude. Like I’m not famous in the way that like Leonardo DiCaprio walks around and he’s famous. The way that I get recognized is really fucking weird. Like it’s a nurse or it’s a medical student or it’s a doctor or it’s a respiratory ther-. And they come up and they go, you’re ZDogg. They don’t even, it’s not even a question, are you ZDogg? You’re ZDogg, here’s what I think about what you’re doing, here’s why you inspire me, can we have a selfie? It’s a formula. And it’s, I never get tired of it, you know? My wife gets tired of it because we’ll be in a, at dinner and someone will just come up like they’ve known me forever and that to me says, okay, we’re doing something right. It means they know me as an authentic person, they trust me enough to come up, and they care enough about the message something’s resonating so something we’re doing right that we can’t stop. And we’ve tried, we’ve experimented with all kinds of shit. Oh, will we get more views if we do this? And then if we do, you’ve seen sometimes I just get really sad when we get a lot of views doing something that I don’t believe is

– [Tom] Right. helping the world.

– [Tom] Yeah, but you know, the views and stuff is, that’s surface, you know, I think, I think what people are here for is it’s so, like especially in your field, is so fucking rare that somebody would step out like that. You know? Like, what were the conditions, we talk about changing the individual, like what were the, and don’t tell the same road story you tell all the time, what were the conditions of the origin that truly like made you take the first step?

– So I’m, it’s 2009 and I’m, you know, like nearly a decade into what was, in my mind at that point in my life, this is what I am. I’m a hospital doctor at Stanford working for a big multi-specialty group, I teach, I do this, identity, identity, this is my thing. I was so bored in my time off because I was on shifts, basically, when I wasn’t charting in Epic, that I was so bored that I was picking up stupid hobbies like audio gear, like high end stereo gear and just becoming neurotic about it. All this energy going into this stupid, useless hobby that brought me no joy, it just brought me anxiety. And then at work I was watching everything fall apart, like more and more computer, less and less teaching, less and less mentorship and shamanism and more of just click, click, click, click algorithm. But, I think I had deceived myself enough that that was how it is. Like, oh I do this for another 15, 20 years, then I retire, then I’ll be happy. Or, you know, that’s just what you do. This is just life. You work and the harder you work the happier you are, right? But none of that was really falling into place and I had my kids and that changed everything a little bit. But, I found myself like reading books about string theory in my spare time because I was like what’s the meaning of everything? Like, everything seems empty, like I’m doing all of this but I don’t even understand what all this is. So when that starts happening you start to wonder like what’s going on in general? Then I made the mistake, and this was the thing. So, I don’t often tell this story publicly. So Tony Hsieh, the guy who runs Zappos, had just written a book called Delivering Happiness about his experience with building a culture at Zappos. And he had gone to school, to Harvard, with my wife so they knew each other and I knew him and so on. And we were in Las Vegas one Thanksgiving, Las Vegas of all places, we lived in the Bay area, and he invited us over for Thanksgiving dinner or something like that. So we went with our one-year-old daughter, Nina, at the time, or two years old, and said. And he was, he was radiating this kind of joy about all the things that were going to happen. Like I’ve made a billion dollars, I have this amazing company, we’re going to transform Las Vegas, we’re going to do all this, this is my calling, this is my path, this is what I do. And I remember he looked at me as like, so how’s everything at Stanford, it must be cool, your parents must be really proud of you, and this and that, and you must be really happy. And I remember that was the first time someone asked me, you must be really happy. And I’m like, I had to sit there and go. And I remember it just came out, I was like, no, I’m not happy at all. I’ve never really even been asked that. I’m doing what I’m supposed to do. I’m not happy at all. This is feels so wrong, like this profession that I thought was my calling has falling into this chaos and I, myself, am not the person that they think that I’m supposed to be. So what, and I remember, I just thought, like what do I do? You know, I’m looking at this guy, he’s like a billionaire, I don’t know him that well, I’m just like, sitting at a table, what do I do? And he’s like, what do you want to do? And I’m like if I’m being honest, I am really good at teaching and making people laugh and I don’t know, I would probably put videos on YouTube or do something stupid like that. And he said, then why don’t you just do that? And I remember going, okay, that’s just dumb. You don’t make money doing that, I have all these expectations, I can’t be a doctor and do that. I went and we flew back to the Bay area. For the next three months I went into a depression. Like it was, because it had been held off by years of self-deception. Like, oh, you know, if I just get a bigger, nicer car, we get the house, I have kids, I’ll be happy. Maybe if I become partner I’ll be happy. Okay, now I’m making a lot of money, I’m happy now, right? No. Okay, I’ll get better speakers and then I’ll have beautiful music in my life. No. Fuck! Three months of just suicidal depression. Like, my wife was so worried about me because I would just come to bed at like, like two in the morning just like dragging and just detached and miserable. And I think she suspected it was because of the visit with Tony where I was like I’m not happy at all and it all just unraveled. And that, I remember the night it was like right before my birthday 2010, beginning of the decade, I was like fuck it. I went online, I created a Twitter account. What names are available? ZDoggMD? No one has that. I went through a bunch of different. Placebo, this, that. Nothing. ZDoggMD was available, I now have the Twitter account. I now have the Facebook account. I now have the YouTube account. Okay. Let me upload a video. Graduation speech, colon video. The graduation speech has been up under a different name, I re-uploaded it. And the next thing I know, I was like, you knew it right away, I was like, even if it got 200 views or something, like this is the end of this phase of my life. Like I don’t know what’s going to happen, and I was deluded. To be honest, that was delusional thinking. How can that be? Some idiot Stanford doctor like puts a dumb-ass video on YouTube and says to himself, clearly, I’ll never forget what I told myself, I was like this is the beginning of something transformative and I don’t know where it ends but I know this is it. I know it, I know it. And it turned out to be true. And ever since then, it’s been nonstop, like doing generally what I feel called to do. And when I don’t, I feel it, I feel it. I start to really get depressed or burned out and then I have to adjust course. But being in, having the awareness now to go, oh, this is not me, I’m not doing this anymore. I’ve had phone calls, dude, with people that want something from me and I’ve told them to fuck themselves on a phone call because it felt like I’m being pulled back into this world. Now, maybe that’s an overreaction but that’s where I’ve gotten now. And it took me a decade after unplugging from that matrix to be able to do that. And people are like, oh, you’re, you know, you’re lucky you were able to do it because you have this talent and that talent. I don’t have shit. All I had was the ability to stand up and say, you know what, I’m not afraid. Sorry, I’m terrified, I’m not going to let the terror stop me from doing what I know, I feel intuitively is right. And so that’s all it is. That’s what I tell people, too. Just, you know the right answer, why are you asking me for advice? You know what the answer is, you’re just afraid of it. And even now if you ask me, oh, what are next 10 years, right? I’m probably terrified of what the answer is, right? Because maybe it’s something crazy, right? But that’s, that’s how it has to be.

– [Tom] The power of the mind is not a joke, right, like it’s not delusional that you set your intention and you hit your target, you know? And the reason you were able to do it, like why you were inspired to do it is because you were with somebody who inspired you who had done it, who had manifested it into reality, Tony. And you inspire the same thing in others. That’s why it’s inspiring to watch you. Because I get the same feeling, the story you told about Tony, I get the same feeling hanging out with you.

– That’s nuts.

– [Tom] I’m like, this is a guy that shouldn’t be here. He shouldn’t be doing this and yet he is and he made this happen just by having the audacity to try.

– It’s really funny though and we can’t, we can’t lessen the influence that people have in the world. So Tony had no business being as successful as he was. He was the introverted kid who was really awkward. I mean, my wife knew him at Harvard and, you know, he, nobody predicted that he was going to do what he did. And when he did it, he brought so many people along with him and inspired so many people and I was one of them. And continue to be inspired by him, actually. And the truth is, if we can do that, if every single person who walks into a hospital has the ability to inspire at least one other person in the hospital, whether it’s a patient that day, whether it’s someone, and it’s just by being present and being them and showing that intention does matter. Intention matters. That’s why one of my missions in this next decade is to fight tooth and nail this idea that people get vilified online when they make a mistake or when they say something and they’re misunder-, their intentions are misunderstood. Look at the intention behind the action and respect that intention. And if the action’s wrong, give the feedback but don’t assume somebody is a bad person.

– [Tom] Think about, man, just think about how powerful that ripple effect really is and it’s almost like you being in the position that you’re in as like the lone person of the last, like you really are like the maverick of the last 10 years in health care, okay? I’m just going to tell you that you can own it because I just said it to you. It’s almost like you’re going to fucking set fire to the kindling that is underneath the entire substrate because where do more ripple effects, where could they ever possibly happen than in the nation’s hospitals, clinics, you know, urgent cares. Like where could it ever, that’s where the fucking ripple comes from, people going there and having a positive experience it could change society.

– I’m a, I think that it’s these individual things. And this is the other thing. So the other thing I do, I, here I am in a hotel in Vegas, I travel all the time. You know, before 2010, I never traveled. I had never gone on a plane. It was a huge deal. Like print the ticket out, worry about, oh my gosh, I’ve got to get there three. Now I’m going all around the country speaking and performing and connecting with people and the crazy thing is I see it on the ground level. It’s like you go to like Stormont Vail in Kansas and you listen, people fill a theater to come and see you. And they all have stories of like, oh, this is what I do in the hospital. Every day I do this thing. And people are affected by it and they’re and they have enough awareness to see that. And then you magnify that. You redirect and go look at the influence that you have. You think you’re powerless, you’re stressed, you’re depressed, it’s okay to have those feelings and to be that way, but look at also what you’re doing and then the more you set your intention, I’m going to come into the hospital today and I’m going to influence at least one other person for the better, that’s actually going to happen.

– [Tom] Well, I’ll do my best to anonymize this story but like think about, you know, all the times you’ve had your preconceptions rocked in so far as I remember one time we were going out to a rural area and I won’t say where because it’ll dox who the person is but your preconception was that this doctor that we were going to meet was sort of a piece of shit and that they were probably doing unnecessary procedures and billing and then we got to go inside their clinic and we got to hang out with them for a few days and I think you had a total change of heart where you were like, oh shit, this guy is like a pillar of this, he’s like propping up this community. He’s a foreign medical grad who came, you know, here to rural America to like actually do it. So I think it’s more often that you find positive things when you.

– You know, I’ve got to say this, I have a lot of preconceptions and biases as does everyone and when I find them destroyed, like not just disillusioned, just absolutely destroyed, it’s an awakening experience. You go, wow, everybody is trying their best. Some are trying a little harder than others but everyone’s doing the best they can. And then you want to encourage it when people are doing good. That’s why I say things like incentives matter, a fee-for-service incentive system means you do more stuff to people. You know, this disintermediating patients from the cost of care is tough because then costs escalate, especially when doctors are getting paid. If, one of the hardest things to get people to do is to look at their own incentives and how they’re affecting what they’re doing. These are good people with bad incentives. What happens? The behaviors are then bad. It’s really hard because these are my people. I was incentivized the same way and I did the same bad things. It’s much easier to bring someone in the hospital unnecessarily if you’re getting paid to do it. It’s so much work to discharge someone from the Emergency Department. And risk? What if I get sued? What if I miss something? Bring them in and then what happens? They end up getting a hospital-acquired pneumonia, end up having complications, and may end up dying. So you’ve made a fatal decision based on your financial incentives. And then you have to live with yourself.

– [Tom] It’s sort of a story that’s familiar across, you know, human history which is like the young, naive farm boy gets conscripted and then finds himself in a war in the machinery of war doing horrible things that they,

– Horrible things.

– [Tom] that go against their moral code.

– There are many times when I think that’s why moral injury resonates so much is it does feel like that. It feels like that kind of environment. Now, I’ve had military people reach out and say you don’t understand what moral injury is and I agree, I agree. It’s impossible to fathom that. At the same time, I think it’s on a spectrum and I think this spectrum is similar. But see this is the thing, this is where, okay, now we have a burgeoning explosion of amazing doctors on YouTube. There’s really funny people like MedLife Crisis, this British guy, he’s genuinely funny, smart, educational, and is rewarded with lots of subscribers and lots of engagement. And this is amazing. This is what we want to see happen is people expressing themselves. What I think we do that’s quite unique is we have people themselves wake up. So part of our message is you watching have much more power than you know. Like, once we recognize the problems, you can actually change it through intention, through these little things. If it’s just taking the EHR and spinning it around so that the patient can see what you’re typing, you’ve now broken down a bit of the barrier that this garbage technology created, right? Did anyone intend the garbage technology to be garbage technology? No. They were the product of incentives.

– [Tom] Yeah.

– So it’s just like that.

– [Tom] I think it’s interesting because it’s like the cynical people that are out there, you know, and I’m, myself, always cynical and skeptical.

– Oh, me, too.

– [Tom] And they’re going to to look at you and they’re going to be like, you know, fuck this guy. This guy is, he’s rich, and you know, he’s sitting in some fancy hotel room, you know, he, everybody loves him and he’s telling me like the lowly clerk to, you know, I’m supposed to speak up. No, I’m just going to like live for the weekend and, you know, just keep clocking in and then die. That’s what I’m going to do. Right?

– I, there’s a huge undercurrent of that and I used to take it very personally because I know who I am, right? That’s the other thing.

– [Tom] Well, you know the fucking power. You know the power of like if you believed in it then you could bring it into reality. You know, like everyone can. There’s not, it’s not scarce.

– These are excuses and when I call them that, people get very angry. I go stop complaining, or continue to complain, I did. It’s not like I stopped complaining, dude. I bitch and moan constantly. I just stand up and go and do something. Even if it’s a little thing. But the thing is, these guys, I think it’s another layer to protect them from the underlying fear of who and what they are. Who and what they are is vastly greater than what they think and they’re terrified of that because with it comes the responsibility to live a little bit unstably for a while. Like when I started doing this thing, man, when I finally left Stanford, that was, dude, like. I’m sure I’ve shaved a few years off my life just from stress. Like I have little lacunae in my brain from hypertension probably from just being like I am, what am I doing?

– [Tom] Oh man, it’s scary to be out there.

– Terrifying.

– [Tom] Yeah.

– And then, you know, like, after the TEDMED thing then there was all this expectation, oh, he’s going to build a clinic that’s going to transform health care. And I was like, dude, nobody can live up to that. All right? All you can do is set an example and try to set some kind of intention that this thing is going to perturbate the system in a way that more things happen. And now look what’s happening. You have people up in Vancouver, Washington that are doing very similar models and have made it better. And they’re going to conferences like AMGA and they’re telling people about it and I’m like, this is it, this is what we want. We want this to ripple out. If it transforms even a part of primary care, so, but everybody can do that. Even the smallest role in the hospital, even just showing up that day and doing your thing. This is the other thing I don’t let people off the hook for, do your job like you fucking care about it. Like, I, you don’t have to be the best whatever, right, but you have to come with all your energy, everything brought to it like you care about it. And people who do that, even if they’re not good at what they do, man, I love them. People who, you can tell they’re phoning it in or they don’t care, you know right away. You’re like, you’re in the wrong thing. And now you’re making my life hard, right, and you’re making the patient’s life hard. And whether you’re an administrator or a doctor, it doesn’t matter, the effect is the same, it’s negative.

– [Tom] Okay, we’re going to do a blood oath right here, except we’re not going to swap blood because it’s gross, but 10 years from now no matter what we’re doing, even if we’re not working together, we’re going to come back and finish this part of the video. So give me your predictions for the next 10 years.

– Oh man. Well, my prediction is I’m going to still be bald. Number next.

– [Tom] For health care! Give me your predictions for health care.

– Predictions for health care, okay.

– [Tom] What do you think is going to change? I mean, what do you see on the horizon?

– I think we’re in a situation now where the current system is not ever going to stay stable. We’re going to get instability in the system which is either going to emerge a better system, better payment models, better incentives, better care patterns, or it’s going to codify a shift to something worse that we’re seeing now, which is algorithms and cookbooks. What I think, if I had my way, what would happen is we would figure out that most of medicine, the most effective parts of a lot of modern medicine, is the shamanic connection between the health care giver and the patient. It’s a relationship between two people and it’s not just that. It’s empowered by a network relationship for all the other people that contribute to that. It’s a human dynamic so let’s make sure that we respect and honor that that explains the mind/body connection, that explains the placebo effect, and then really optimize the science where it can be optimized. So figure out that most of the stuff we do doesn’t work. We’re just paid to do it. There’s inertia, the medicine culture is gar-, it’s a fucking garbage culture, Tom! It’s a garbage indefensible in the 21st century. It is garbage.

– [Tom] Look, can we get to the beautiful dream? If the relationship’s taking place in this central bureaucracy. You know, I have to go into this soulless hospital to talk to the doctor, right, and he just treats me like I took a number at the counter and I’m here for a fucking sandwich at the deli.

– No, it can 1000% it can change. Yeah, because we saw.

– [Tom] Within that? Within that?

– Within that, no, you have, well.

– [Tom] Can you decentralize it?

– You can, you can destabilize that pattern. You can say, you know what, the incentives have changed. You’re now paid that both caregivers and patients have a certain type of experience and certain types of outcomes. It’s hard to measure those, right? But it’s a doable thing. It’s an asymptote we can strive to reach. We may never get there. But the thing is, I saw, in our clinic I saw it, I’ve seen it in other clinics where it is really about this relationship. It’s not a transaction anymore and it, you know, you and I joke like, oh, is this, am I just bullshitting? No, dude, I saw it work. The days that I saw it work where it really gives you this sense that, oh, if we can do it here in Las Vegas, in some of the shittiest health care in the country here, like this place is the wild west, it can happen in the hearts of our big institutions. It just, and when and I go and talk, these leaders are inspired. I, that’s one thing I will give myself. I’ll sit at the table with them and they’re wiping tears after the talk and they’re saying this has been so hard leading this organization. People don’t realize I’m the bad guy, then I have to save everybody, I have to pay for everything, I’m a doctor, too, so there’s that. But thank you for making me feel like this can be done, right, and will be done. So if that’s all we do, Tom, in 10 years, is start to inspire that change and it happens even 30%, that’s a huge accomplishment in such a massive system that causes so much human suffering.

– [Tom] Let me tell you something. I’ve now been doing this for five years.

– That’s nuts. Half a decade.

– [Tom] From age 25 to 30. So I have now ceded the change of health care with part of my youth. And if you fuck this up. If you fuck this up, ZDoggMD, I’ll be so pissed.

– No pressure, Tom Hinueber. No pressure. You know what though, honestly, that is enough reason, that’s a good enough reason as any. That all of us have ceded a lot of our lives. And think about, when you think about, when you hear about a patient who just got fucking screwed, right, because the system, you know, like your dad or anybody who’s just been through this ringer. Or your mom, right, or my parents. They’ve had terrible health care, too, occasionally, and you’re just like, this is not just about, oh, I’m a doctor and I need to have a better life. It’s about really fixing it.

– [Tom] Let me do, legitimately, like I was telling my wife the other day, like, I was like I know too much about health care, like I shouldn’t know this much. And, you know, honestly, now it’s like shaken my faith and confidence in the system and I’m, I want to be put back into the matrix where I thought that doctors were, you know, really smart, great people, who were going to help me. And not that they were handcuffed by all this bullshit. You know and I was going to be treated like an automaton.

– You know what’s weird? When I become a patient or when my family becomes patients, I let go of everything I know and I place a shamanic trust in the person who’s there. Whether it’s the nurse or the doctor. It’s happened a few times now and I’m always shocked because I know better, right? I’m like, ah. But the truth is I also know better. I know that they actually do want me to get better, they do care, the actually do. And that, yes, they’ve got all kinds of systems problems and you can make jokes about it in real time, right, to try to diffuse some of this stress. But the truth is they’re there, they’re with you, and we have to give them that part of us as patients. Otherwise, we can’t expect them to give what they give. That’s, I think part of the problem is we do need to hold ourselves, as patients, accountable. It’s hard because you know a lot now and it’s easy to get cynical. I know enough now that I’ve actually pushed beyond cynicism and I’ve transcended into like actual hope. I’m like, ah, these are, we’re all humans, man. We’re doing the best we can. I think we actually have something here that could work. So, in 10 years, I think we might see it manifest. If I had, if I had my way, I would talk about nothing but meditation, self-actualization, and transcending our material world world view but I know that that’s not actually going to move the needle as much as what we do so we going, it’s going to infuse what we do a little bit. You know, the way that Deepak Chopra has become famous and annoying for in the bad side, like he’s trying. It’s interesting because, you know, I’ve really got to think about that.

– [Tom] Just say it, just blurt it out.

– Because if I’m being honest, you know, like the interview I did with Donald Hoffman. If we’re talking about the next 10 years.

– [Tom] Yeah.

– You know, a two-hour interview. Go read the comments on that interview. It’s got two hundred and some odd thousand views on YouTube and it was me in a flow state with an individual that I thought is onto something about understanding who we are. And I thought it would power, it would actually power a health care transformation if we actually saw the world that way. So for two hours, I interviewed the guy thinking no one would watch it. Not only did a bunch of people watch it, but the comments are insane, dude. And so when you look at someone like Deepak Chopra who’s been talking this kind of woo woo nonsense for how many decades, right? But then you have to go, well, he’s actually not entirely wrong. The heart of what he’s saying is not wrong. He’s just framing it into pseudo-scientific gibberish. Maybe our role in the next 10 years is to science the fuck out that and actually bring to the world in way that actually, okay, now that is the next emergent paradigm is something that transcends this reductionist approach that has, that has, I think, fucked medicine up. And we’ve ceded that to people that are in the alternative medicine world that speak ill of science and slander what actually works. Why?

– [Tom] Well and scientists hate them, too.

– And scientists.

– [Tom] It goes both ways, right?

– It goes both ways. They’re all dogmatic but the truth is the scientists are right, these guys are spewing pseudo-scientific gibberish. But the alternative medicine guys are right because there’s something that science is not able, in its current incarnation, to quantify and that is this.

– [Tom] Yeah.

– And that’s with, you know, acupuncture, what is that? Is that magical chi? No. It’s somebody there looking you in the eye, touching you, sham acupuncture works like regular acupuncture, it’s, that’s what we need to be understanding. And there’s precious little research in it. So maybe we can inspire people to do that.