Why AI Gives You Average Work (And How to Get A-Plus Instead)

Melanie Barr: What happens when a physician stops thinking only like a doctor and starts building an entrepreneur? >> [music] >> Dr. Jessica Wu is a Harvard-trained Beverly Hills dermatologist, best-selling author, educator, and founder who has built across skincare, health tech, and physician-led care. She's now launching a new platform connecting dermatology, hormones, and metabolic health to create a more integrated [music] approach to women's care. Welcome to She Built It. I'm Melanie Barr. Thank you for joining us, Dr. Wu.

Speaker 2: >> Thanks for having me, Melanie. >> Share with us what you're building and

Melanie Barr: the problem that it's designed to solve. >> I'm so excited to be building something

Speaker 2: at this stage of my life. My background is as a medical doctor, a physician. And what I'm building now is a medical practice called Woom, which brings together dermatology and women's health in one physician-delivered practice. Your doctors actually talk to each other, coordinate your care so that you don't have to go from practice to practice trying to connect the dots and and repeating yourself over and over again. Where that comes from is over the past 25 years of taking care of patients who are largely women. And now as as we've grown up together and reached midlife and beyond together, many patients asked me for help that went beyond the initial reason that they came to see me as a dermatologist. And they asked me questions about hormones and sleep, metabolism, and all of these things that they were not able to get help with at other doctors. And so I found that I'm spending so much of my time coordinating care for them even though as a dermatologist, that is not traditionally how we are seen. [clears throat] I took it upon myself to connect patients with the best specialists that I knew and often would walk them to their appointments or accompany them to their appointments.

Speaker 2: Eventually, more and more patients asked me, "Why can we see our doc here in your office?" And so I thought, "That's a great idea." Assembled wonderful physicians who are dermatologists and gynecologists and specialists in women's health in my practice, which is now called Woom.

Melanie Barr: >> I'm having this conversation so often now and there's so many of us in the world and how has it taken us this long to get here? And you're right, you go to several different doctors and then you get a bit of fragmented information and it would be so much easier if all of those answers were more in one place instead of having to go and hearing all the different advice.

Speaker 2: >> That's right. And and I found that many of my patients were literally in tears being overwhelmed by getting a little bit of information here about metabolism, a little bit over there about hormones and then they would come to see me for something that was seemingly unrelated. For example, hair thinning which is quite common at at midlife or changes in their metabolism, how how their body looks and felt or changes in their skin. And so often times the skin their skin was the first sign of something happening internally.

Speaker 2: It's not expected and and I don't know of any other doctors doing this. I'm certainly not a hormone specialist, but I have learned a lot from helping

Melanie Barr: patients navigate through their hormone issues. I agree, it's very fragmented.

Speaker 2: Doctors have a certain amount of limited time to give to patients at each visit. That's the way our broken health care system works. It's not often not enough time to answer those questions or to dig deeper and to find the underlying cause.

Speaker 2: Yes, come in for hair thinning. Many times they'll be sent home with either a topical or an oral medication. Which could work to an extent, but what is really causing the problem? In my case personally, I struggled as well because I had issues with fibroids, I had issues with bleeding, I also noticed my hair thinning and I thought, "Oh, I'm just getting older." My doctor at the time told me that's normal, "You're just getting older, you're you're reaching menopause." Come to find out I just became tired, my hair fell out in clumps and I had a very dangerously low ferritin which is a type of iron in your body. Dangerously low. Normal is 20 to 150, mine was eight. And so I ended up getting infusions and slowly started to feel better. The hair slowly started to grow back, but it would have been so easy if If did not have my medical training. Would have been easy for me to be dismissed by a doctor saying, "You're fine. It's just It's normal. It's It's normal. Normal part of aging." I am building a place where patients have the time, doctors have the time. It's with physicians who I have vetted myself, who have the same level of curiosity and care. And I recognize that not everybody can come to Beverly Hills and see me in my practice, but the other part of what I'm building is working on ways to change medical education so that we get the doctors at an early age and encourage them to ask those questions. So, medical education is a big part of my advocacy and also changing how changing how these medical visits are are paid and reimbursed by insurance companies. That's a That's a bigger question for for another podcast, but it shouldn't be limited. It shouldn't only be just women who can come to my office in Beverly Hills who have this level of care. This type of empathetic care and deep thoughtful connected care should be available to all.

Melanie Barr: >> And I love that you say curiosity because I think every woman has gone into to see a doctor at some point and thought, "I'm not sure if this information is correct. I wish you would go a bit deeper and find out what's

Speaker 2: really going on beneath the surface." >> Yes, and and unfortunately, it's There are time limitations. It is a symptom that type of brief care, incomplete care, is often a symptom of the way a medical practice is set up. And I think a a lot of people don't realize that large corporations, many of which are funded by private equity groups, are getting into medicine. Over 15% of dermatology practices, oncology practices, ophthalmology, orthopedic surgery practices are owned by these corporate groups look at the numbers. And I have had colleagues who've been told that you have X number of minutes per patient. Front desk staff, receptionists are told you have literally 4 minutes per patient. That's how much time you can spend. It's hard to deliver care and nurses and doctors do their very best, but when you have that limitation, it's it's hard to dig deep and get those questions answered and get to know patients longitudinally over time. I have some patients that literally I've taken care of for 25 years. You get to know people, you get to know their context over that period of time that is hard to get in one 15-minute appointment.

Melanie Barr: >> My next question is, what's the greatest friction in scaling it? Do you think what you just mentioned as far as ability to see patients long enough and the way insurance is set up is that biggest friction?

Speaker 2: >> For me, the biggest friction is and I'm in a growth phase hiring doctors. I went from one to four doctors in the last 3 months, is finding the doctors. It's the people. It's always the people, right? Finding the doctors and the support staff to support the doctors. This goes back to medical education and my work in medical education. What I see is that even as a student, the young medical students, I was 21 when I went to Harvard Medical School, med students are usually 22 or early to mid-20s. They're indoctrinated to think that factory medicine, to believe that factory medicine is the only way to practice. This is the way it is. You're going to work for a big corporation or hospital or big group and they're going to tell you what to do, when to show up, how much time you're permitted with each patient, then you'll get your paycheck and that's the way it is. And I try to show them by example that I've had a practice for 25 years, it's thriving, it's growing, I have a long waiting list, I've hired three doctors and hiring more to come. There is a different way to practice. You you take a risk by practicing this way. It's private practice or independent practice. You take a risk because you are turning down that guaranteed paycheck, but in exchange, you can deliver a different kind of care. Patients, I think and I've seen, increasingly value that. If they have to pay more out of pocket, I'm I'm not charging thousands of dollars per visit. If they have to pay more for per visit, they see the value in that. Many people spend over a thousand, some older folks are spending a few thousand dollars per month in insurance premiums, but they keep denying visits. So, they deny what your doctor is doing and you have to end up paying for it anyway. So, so there there needs to be a change, obviously, in in that part of the reimbursement, but but I think changing the mindset of doctors, as well, and getting getting to them early.

Melanie Barr: >> Yeah, and if we go to the doctor, we're in search of help, and how much can

Speaker 2: really be done in 4 minutes? >> Right. It's It can't. Good care is not done in in 4-minute visits. Sometimes it takes 10 minutes just to I walk in and we talk about how are the kids? I love your shoes. And that is all part of the relationship building and putting people at ease. These in-between times that sometimes you can elicit the real problem. Yes, I'm here for my leg, but I'm wearing my baggy jeans because I've gained 20 lb in the past 6 weeks and I don't know what's going on. Well, let's talk about that issue before we get to your laser. So, uh so I think more time needs to be allotted and the talking needs to be valued as much as the doing. Right now, um a lot of young medical students are going into surgery specialties because the way our health care system is now, it pays more for a doctor to do something with their hands.

Speaker 2: Cut something out, cut something off, burn something off, than it does the talking part of it. And the talking part of it, connecting the pieces, is so important and is what is missing, especially bringing it back to women's health. Especially when it comes to women's health, is the connecting your gut over here with your sleep over there, with your skin changes over here.

Melanie Barr: >> Cuz you go in and you don't always know what to articulate to get to how to get

Speaker 2: the care you need. >> No, you don't. It's because how how would you know? That's the role of a thoughtful physician is to ask the questions. Asking the questions, that is the hard part. And if we talk about AI, I I see so many similarities because you can get okay care if you tell a doctor, I have a rash, and the doctor takes a look at you, or may maybe go to to a telemedicine consultation, or or you you take a picture of your rash and you put it into Google and you'll get an okay answer. You'll get a C+ answer. Maybe it might work or it might not, whatever the recommendation is. Step back and you bring in experience and thought and context into that question. Just like you bring in that thought and experience into the prompt, then the output, the advice is going to be so much better and more accurate.

Melanie Barr: >> Speaking of AI, how do you see it in leveraging your business?

Speaker 2: >> I use AI every day every day in my different businesses. I could not move as quickly as I am now AI. One way that I'm using AI in a very interesting way, unexpected way, is through diagnosis. Nowadays, a lot of patients come in, they've already had blood work done. They get blood work at Function Health, a number of these organizations that will order blood work for you. But what do you do with that? People also have a lot of wearables data. I have an Oura Ring. So a lot of people wear Whoops, Oura Ring and they're on medications, they're on supplements, they have scans. So there's all this data, but who is looking through the data and making sense of it? What we do for our patients at Willow is with their written permission, for those who wish us to do this, is that we can access their blood work, as long as they have blood work, we can access their medication history, we know their scans, we can access medical records in some cases, and we can put together a story of their health and compare to where they are now and we can help to diagnose what is happening.

Speaker 2: Of course, this is this is all very um very uh privacy compliant. Our models are our own. Patient's medical information is not shared through chat or cloud or any any of these other systems, other models, but we can we can plot what's happened over time to, let's say, your your hormone levels or your iron levels or your inflammatory markers and we can ask, "Why is this patient having hair loss now? What was happening? We know that there's a lag time, for example, if you talk about hair, a lag time of 3 to 4 months from when something happens internally to when it is visible in your hair. Let's go back and look at what was happening in your health, in your blood work, in your medications, supplements, etc. 3 to 4 months ago and see if we can identify what's a maybe the cause. That is much more powerful and more accurate than asking a patient what was happening 3 months ago. Because we I have a hard time I have to think what would have been October. Now September, 3 months ago was June. What was I doing? I don't remember. Did I start my supplement in May or June or July? The more data we have, the more accurate it can be, the more helpful it can be. So diagnostically, we use AI a lot. Also for teaching, I do do a lot of teaching and mentorship. For example, one of my UCLA research assistants and I wrote a paper that was just submitted a couple weeks ago to a scientific dermatologic journal. And we asked the question of does your nutrient micronutrient status affect the results of collagen stimulating treatments like Sculptra? To design that study would have taken months to do. A literature search would have taken many months. And it took us a number of weeks to do a literature search, but we used AI to look back at the published scientific literature, to look at different types of nutrients, wound responses, how your skin's collagen responds to different types of vitamins, minerals, and supplementation. And we came up with a very interesting conclusion, which hopefully will be published soon. But that's an example of using AI for education to speed up the the research. Ultimately, will change how we practice in the office. Because new products are showing up. How do we know which one is better than the next one? And how do we know how we should be using these types of treatments? For education and advancing scientific research, it will be very very useful for me personally and also for giving lectures and creating content. Most of us use AI to help us create content.

Speaker 2: It's more a rough draft is how I think of it, a starting point. You think about someone trying to create dermatology content or women's health content. You can say, "Write me 10 posts about women's health and 10 posts about dermatology and anti-aging." Easy. Spit out 10 posts and they'll be fine.

Speaker 2: They'll be fine, they'll be accurate, but it will sound like everybody else and there there won't be your specific point of view. I talk to my team a lot about are we trying to say that is unique to to us, unique to me, that only I could say? And AI cannot come up with that. It can it can help guide you and give you a framework of, "Okay, well, you need to have a hook and then these three beats and maybe make it this point." But unless you put in your context of 25 years of treating patients and hearing what they say, the output's going to be very generic and and that's AI gives you averages. So, it it gives you That's why I consider AI C+ work. But I'm only interested in giving my patients and giving my followers A+ material.

Melanie Barr: >> Yeah, you still need that human element and it's interesting to think about patients bringing in their own data and being able to analyze that from the rings or anything that they're able to share and that can get, it seems it could get medicine closer to those 4 minutes because the more data you have, I assume, the better you can advise patients.

Speaker 2: >> Yes, but that that also assumes that and requires that the doctor's willing to do it and that the doctor is educated and experienced in interpreting that data. A lot of the data on my Oura Ring, we didn't learn about medical school or training. What are my patients about deep sleep? Deep sleep is so important when it comes to tissue repair, bones and muscle, and its skin. I didn't learn that in medical school. It requires more and continual education and finding those doctors who, again, we talked about curiosity, having that curiosity to educate themselves.

Melanie Barr: >> I have 13-year-old twins, and I'm always saying, "Get your hormones so you can grow as tall as you're supposed to grow." So, I understand. It's interesting. I have that conversation about sleep a lot these days.

Speaker 2: >> How much are they sleeping? >> for and for myself, too. I try to get them 8 to 9 hours during the week, and then let them sleep as much as possible on the weekends. >> How much do you sleep?

Speaker 2: >> About 8 hours. Most at least 7. >> [laughter] >> If I can get 7, you know, I'm really trying. I wasn't always that good, but I'm trying to be a little bit better. So, I just feel better during the day when I get that get that rest.

The brain’s glymphatic system

Speaker 2: >> I learned about the lymphatic system. Do you know about the glymphatic system in your brain? I think everyone knows about your lymphatic system, which is the lymph vessels flushing toxins from the rest of your body. Your brain has its own system called a glymphatic system that flushes toxins that are built up from brain metabolism. Throughout the day, your brain is the most metabolically active tissue in your body. It just think of everything that it is responsible for doing, and so there are a lot of byproducts that are produced, and when that happens, it can accumulate. That's one of the reasons you start to feel tired, you start to feel groggy toward the end of the day, toward the later evening. And if you don't have enough deep sleep, there is not enough of that flushing that happens, and there is some research suggesting that if you don't have enough of that flushing that happens, that could uh predispose you to dementia and Alzheimer's because of the accumulation

Melanie Barr: of of those proteins. >> Interesting. I'm going to be thinking about that tonight as I go to sleep, and now I can add that to the layer of reasons for my twins why why they should get additional sleep. What do founders in health care most often underestimate?

Speaker 2: >> Yeah. >> A place that has amazing hospitality, you think of Four Seasons Hotel. I can spend all day I want to I just want to live there. And yet, most people do not want to set foot in a hospital. Healthcare leaders and leaders in general need to spend more time thinking about hospitality, not just for the benefit of patients, but also for the benefit of themselves and their staff. Because when I think about hospitality, I think of an environment that is welcoming. If you think about what it means to be hospitable is to welcome someone, for example, into your home.

Speaker 2: And I talked to my staff about this a lot, which is every day we're trying to think about how can we make the office and the the entire patient experience more hospitable, more welcoming. And it's not just pretty flowers in the reception area. It's how are patients greeted when they walk in? How is the phone answered? How do staff talk to each other, not just to patients, but to each other? I think that hospitality is missing component and could lead to patient customer loyalty, but also staff loyalty as well.

Melanie Barr: >> I love the intentionality that you're putting into it, because we are humans, and as we get more and more towards technology, having that human element is so important and appreciated by by patients and people.

Speaker 2: >> Hard to be human when you have 4 minutes, though.

Melanie Barr: >> We have talked a lot about business today and how you're growing your business. What do you do to make sure that you're finding and living your joy

Speaker 2: outside of work? >> Scheduling. Scheduling the non-business time. And it used to be that I and I still do often work 7 days a week, but every month my husband and I go somewhere. And well, not this month because we're launching. Other than when we're launching a new business, every month we take a long weekend somewhere. And that is scheduled throughout the course of the year. And there are certain times that are just they're not negotiable. Doesn't matter what else is going on, but those weeks we we are away. And I find that scheduling ahead of time makes a big difference. Otherwise, you look up and you've been working 7 days straight for 5 months.

Speaker 2: That's very easy to do. Yes. I I can do it. Yes.

Speaker 2: Scheduling is important and fitting in a time for family. For example, my parents are in their 80s and 90s. My dad's 93. Learned so much about business from him. It all comes down to being 6 years old, 8 years old and and hearing the things that he told me. So, I'm very very blessed and grateful that he's still with us. At 93, he schedules. He He has a full schedule. He does his ballroom dancing and his piano playing and he's taking singing lessons right now. And so, all of these things are scheduled and if you don't schedule them, I find I don't do them. You would tend to, but then they never happens.

Melanie Barr: >> Mhm. So true. Thank you for everything that you're doing for our health and for women's health and for joining us today. Please [music] share with us how and

Speaker 2: where we can find you. >> You can find me online at woom.com and on social media at drjessicawoom. [music]