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Rami Saydjari: A General Surgeon’s Perspective on Healthcare

Rami Saydjari gives a general surgeon’s perspective on healthcare on this episode of the Perspectives on Healthcare Podcast with Rob Oliver. He is a retired general surgeon and healthcare executive. He is a member of the baby Boomer generation and joined the podcast from Houston, Texas.

Here are 3 points that stood out as Rami Saydjari shared a general surgeon’s perspective on healthcare:

· Life is all about making a positive impact on the world around you.
· Quality healthcare is first and foremost about safety. It should also be effective, timely, efficient, equitable and patient centered.
· Good surgeons do not believe that surgery is the best treatment for every single presenting issue.

You can learn more about Rami Saydjari through the links below:


Here is the transcript of Rami Saydjari: A General Surgeon’s Perspective on Healthcare:

Rob Oliver: Thank you and welcome to another episode of Perspectives on Healthcare. Today’s perspective comes from Rami Saydjari. He is a retired general surgeon and healthcare executive. He is from Houston, Texas. He is a member of the Baby Boomer generation. Rami, welcome to the podcast.

Rami Saydjari: Thank you, Rob. Thanks for inviting me.

Rob Oliver: Absolutely. So tell me a little bit about yourself and your role in health care, please.

Rami Saydjari: Okay. As you noted, I’m a retired general surgeon. That’s not necessarily voluntary. I have some health issues that force that my hand. I practiced for 20 years after the initial career in research and cancer. University of Texas Medical Branch at Galveston is where I did both my medical school and my cancer research. And I spent about 20 years in private practice in the Midwest. And after that, I kind of saw the writing on the wall as far as my health was concerned. And I transitioned to health care administration after getting an MBA at the University of Tennessee. And after a few years of that, the health issues caught up with me, and retirement and spending more time with my family in writing became my focus.

Rob Oliver: Okay. It sounds like a progression that was there, yet at every bend, it sounds like you were looking for, okay, this is where I am. How do I make the most of what I’m able to do? So I applaud you for that, and I appreciate that.

Rami Saydjari: I’m sure that’s something you’re very familiar with. And I spent a little bit of time fighting the disease processes, but after a time, I realized I had only limited energy, and I wanted to focus that energy on positive things.

Rob Oliver: A very powerful statement. And to me, it’s all about making a positive impact on the world around you. And it sounds like you and I are on the same page with that.

Rami Saydjari: Absolutely.

Rob Oliver: Tell me, what does quality health care mean to you?

Rami Saydjari: It’s a great question, and it does mean different things to different people. But for me, quality health care is first and foremost about safety. We take a Hippocratic oath when we graduate medical school, and the first precept of that is first, do no harm. And I’ve tried to live my life using that precept as my guide. Quality health care should be effective. Effective health care means knowing when and not when to use certain treatments. And for example, somebody who comes in with a cough and a cold from a virus doesn’t need antibiotics, even if the patient is demanding it or the physician paves into those pressures. So effective care is very important. Just because your hospital has a Cat scanner doesn’t mean you have to have a Cat scan every time you have a headache or a belly ache. So effective care is very important. Kindly care is also a very important concept. To me, it’s a little like justice. Healthcare delayed too long is healthcare denied. And I’m afraid that all too often that happens because of various barriers that we face to obtain healthcare in this country. It should be efficient. Quality healthcare should be efficient in terms of understanding that just because you throw money at a problem doesn’t necessarily mean that you’re getting better results. And so one has to look at studies that demonstrate the most effective and efficient means of rendering care and not simply throw money at the problem. Equitable right. That’s very important to me, the sense of social justice. That is to say, if you’re rich in this country, you should get the same quality health care as you are if you’re socioeconomically disadvantaged. That also, unfortunately, is a problem we face in this country and a barrier we must overcome. And ultimately, I think, healthcare should be patient centered. That is to say, it’s been shown, I think, quite effectively in a number of studies, that intelligent patients, when presented with treatment options and varieties of care plans, are actually in a great position to choose some of the most effective and efficient care themselves. They don’t need to be driven in any one particular direction. They simply need to be informed. And my job as a physician is to help guide them to that decision by giving them the information they need and request. And I’ve tried to live my life by that as well.

Rob Oliver: Yeah, I would say that what you just said there at the end, it is intelligent patients who are informed. And so that’s so much. In the past, it’s been doctors and medical professionals making recommendations and telling people what they’re supposed to do as opposed to giving them the information and then working together. It’s got to be a collaborative effort.

Rami Saydjari: Absolutely.

Rob Oliver: And I will also say, I will admit surgeons have gotten a bad rap on the podcast occasionally because they’re the easiest example to say, when you’re a hammer, everything looks like a nail. And when you’re a surgeon, you can see surgical interventions for most of the problems that come into your office. And I would imagine, though, because I’ve had a surgeon correct me on this, that when you are a surgeon, cutting someone open is usually the treatment of last resort. You’re looking to see what else can be done before you actually get to that point. Is that a proper characterization?

Rami Saydjari: Absolutely. I couldn’t agree with that more. And in fact. I hate to use the word pride. But I did pride myself on being the surgeon primary care physicians would refer their patients to when they knew in their hearts that surgery was the high risk option and maybe not the best treatment option. But the patients were somewhat consistent or perhaps the physicians themselves needed to understand that they were covering that base. If you will. And they would send them to me. And I was the guy that would often say, you know, I don’t think surgery is the best option here. We should try something else first. And often I didn’t have to see those patients back. So yes, I couldn’t agree more just because the hammer nail analogy is good. My mentor, when I was in residency used to say, son, if you walk into a brown shoe store, don’t be surprised if they try to sell you a brown pair of shoes. And so just because I’m a surgeon doesn’t mean that I’m going to cut on every patient who walks in the door. And people, both doctors and patients, were pleasantly surprised at that approach.

Rob Oliver: Yeah, fantastic. Can you give me an example of quality health care?

Rami Saydjari: The best example I can think of is a healthcare system physician, an office who follows evidence based guidelines. I’m a big fan of that notion. We have access to some of the amazing research on how best to diagnose and treat complex medical problems. But often physicians simply follow the algorithm that they were taught 20 years ago in medical school of residency, and they failed to see or keep up with or embrace evidence based guidelines. In the latter part of my career as a healthcare administrator, I was overseeing a rather large multi specialty physician group. And I found a lot of resistance by otherwise very intelligent men and women to embracing evidence based care. And it never made sense to me. It’s science. That’s what they were trained in. And somehow they strayed from that principle thinking that science was somehow a set of tenants and principles set in stone rather than a malleable living thing that evolves over time. And unfortunately, that can lead to patient harm not only inefficient care, but dangerous care. And so I ended up having to be the crusader for that sort of reform and change. Didn’t always make me the most popular doctor on the block, but that was the job.

Rob Oliver: Okay, I think just to take what you’re saying, human beings are not cars, we’re not machines. And so with the car, you have a manual and you know exactly this thing does this. Human beings are complex biological systems as well as emotional beings and psychological beings, and there’s an entirety of that. And so sometimes the medical community will look at humans and have that machine like approach in which this presenting issue has this resulting treatment every single time, in every single circumstance. And what I’m hearing you say is we can’t be in that model. Is that correct?

Rami Saydjari: Absolutely. Evidence based guidelines are just that. They are guidelines. They put you in the right point, you in the right direction, and put you in the ballpark for treatment, care, and options that are proven to be safe and effective. But in each individual patient’s. Case 1 may encounter circumstances and factors that clearly point you in a slightly different direction, but at least you’re in the right ballpark and therefore less likely to cause harm to the patient or spend money unnecessarily running a bunch of silly tests that aren’t going to change the outcomes or the treatment plan.

Rob Oliver: Okay. What do you wish people understood about your role in healthcare?

Rami Saydjari: I alluded to this earlier, and I think the thing to understand is, especially among specialists, that just because I’m a surgeon doesn’t mean that I’m going to operate on you every time you get referred to me. The idea is, as you pointed out earlier, to develop a collaborative relationship with the patient, identify the underlying problem and say, well, yes, surgery may be an option, but we should also try these things first, or before we assume that surgery is necessary, perhaps we need to run one or two more tests to confirm that that’s appropriate for taking on that risk, if you will.

Rob Oliver: Okay. What excites you about the future of health care?

Rami Saydjari: I will say that at the time of my retirement, I was really pushing for this, and I still do to this day. I’m really excited about artificial intelligence and technology as it can be applied to health care so that we can standardize care at the highest possible levels of quality and efficiency. For example, you think about all of the interactions with overworked primary care physicians who are basically doing something that a nurse can do, a nurse practitioner could do, or frankly, in the future, I suspect the computer will be able to do that is to say, make a simple diagnosis and perhaps even prescribe basic treatments under the supervision of human physicians. But I think AI is going to be the way of getting at a more efficient way of delivering health care under the supervision of people doctors, nurses, nurse practitioners, because we have a terrible shortage of physicians, especially in rural areas in this country. And again, that shortage and lack of access to healthcare can have really negative outcomes if we don’t pay attention to that, and this is one way of getting around it, we can standardize healthcare at the highest levels and give improved access to health care for the millions who have limited access down.

Rob Oliver: Okay. And again, I want to keep on something that you said there, because our conversation was humans are not machines, and therefore each need to be handled individually. At the same time, physicians are not machines. When we take machine learning and we take artificial intelligence and bring it in, if we leave that strictly to itself, we’re missing something. Your prescription to say and prescription, I’m sorry, poor pun in the midst of what we’re talking about. But to say it has to be overseen by a human to give it the human quality and the human understanding, because computers don’t necessarily see all of the indicators can you talk a little bit more about that?

Rami Saydjari: Yeah, I guess I would see a computer or an AI in this situation as being a little bit of a first line. I won’t say gatekeeper. That’s a terrible word, but it allows patients to get timely access to simple care when they need it and not have to wait on a physician who might be booked out weeks or even months in the case of some specialist. But you must have the human component, the physician component, to maintain the human connection, the empathy that is required to deliver effective care. Effective care is not always just about efficiency and when to operate and when not to operate. It’s about that human connection and making sure the patient understands that we see them as a human being and not just as a statistic, and that they feel as if they’re being cared for properly in that regard. And the machine, while effective and efficient, may not be able to do those things and never will be able to do those things. That’s why humans will always keep part of the equation.

Rob Oliver: Okay, work with me on this. Please be patient. So here’s where I’m going. I’m thinking that artificial intelligence can be helpful in coming to a diagnosis, but humans are not diagnoses. I am not a spinal cord injury. I don’t know what your diagnosis is, but that’s not who you are. We are complete and full, well rounded individuals. We’re human. That’s what makes us human. To me, that’s what keeps us in this, where the artificial intelligence can be helpful in coming to a diagnosis, but there needs to be the human part of it that has empathy and that recognizes the larger aspect of our humanity and what’s going on. What’s your reaction to that?

Rami Saydjari: I think that’s spot on. You couldn’t have put it better. My primary diagnosis, of course, my retirement was Parkinson’s disease. And like spinal cord injuries, no two patients are alike when it comes to how that manifests and how they live their lives with that diagnosis. And so assuming that you can simply follow an algorithm chart and figure out how to take care of Rob Oliver or Randy Sage, you’ll never get adequate care doing that. You have to have people who understand the impact it has on the patient, not just the treatment, but the diagnosis itself. What portion of their life is being affected? How can I help this patient lead a happy, fulfilled life despite the diagnosis? And again, you’re not going to find that in a pill bottle somewhere or in a cat scanner. That’s the human relationship part of it that I don’t think a machine is ever going to build a completely substitute for or even adequately substitute for.

Rob Oliver: Yeah. Very early on, I had Nicholas Smith, who is a psychology fellow down in Tampa, and he deals with kids who have a diabetes diagnosis and talks about the impact that that has on them as an individual, on their family, on their parents, all of. And diabetes is not a psychological issue, but it has a psychological component to it that has a high importance, as well as the physical side of maintaining your insulin and doing all of those things. So very interesting. Okay, last question for you. What is one thing medical professionals can start doing today to improve the quality of health care?

Rami Saydjari: I think they can give up the notion of medicine as a cottage industry where you practice it ten different ways in ten different towns because you had ten different medical schools teaching it to you. I think they need to embrace science. They need to embrace the evidence based guidelines, bring their practices up to a standard of care that is something we can all be proud of and that is safe. There are thousands upon thousands, perhaps millions of unnecessary injuries and deaths every year in this country because of how medical care is delivered. And I think that that’s something we can address immediately by changing the culture. Physicians need to not be afraid of opening a book or reading a journal every once in a while and making sure they’re up to speed on this and using computers to assist them. And that is to say, I may have considered myself an expert in a number of fields, but I cannot remember a time when I looked at my patient list for the next day and didn’t decide to brush up on the most recent articles on that particular disease. That’s not always the case. Some physicians simply do it this way because that’s the way they’ve always done it, and that’s the way they were taught. And it may have been fine 20 years ago, but it may not be in the modern arena. So I would say the one thing they can do today is to give up the kind of high bound, I’ve always done it this way attitude and begin to embrace science as it was meant to be embraced.

Rob Oliver: Okay, so you had given us a number of components of quality health care at the beginning. One of them it sounds like we’re going to add, is consistency, where you’re getting the same type of care no matter who you see, no matter what school they went to, no matter where you are in the country or possibly even in the world is one. And then having the most up to date understanding of the conditions that you’re facing. Right? Yeah. Excellent. All right, listen, thank you so much for being here. I really appreciate you joining me. Sharing your perspective, both as a surgeon, as a healthcare executive, and as a patient. It’s all a very valuable thing. I appreciate you, and I respect your perspective on healthcare.

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Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.

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