A lifetime of insights - patient care, philosophy, history, and grappling with how evidence based medicine (EBM) should impact the practice of medicine. Find us on Twitter: @RichardLehman1 @raj_mehta
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Clinicians have trained in the art and science of medicine, and yet feel powerless to make a meaningful impact on the healthcare system. Clinical Changemakers is the podcast looking to bridge this gap by exploring inspiring stories of leadership, innovation and so much more. To learn more and join the conversation, visit: www.clinicalchangemakers.com www.clinicalchangemakers.com
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The Rise, Fall, and AI-Powered Rebirth of Evidence-Based Medicine | Dr. Richard Lehman & Dr. Raj Mehta
1:02:47
1:02:47
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1:02:47“You know, what if they were to actually put it’s [AI] mind to a science of practical compassion for everybody?… if the right machines were to come along and help us do it, that's going to be a fabulous thing.” Dr Richard Lehman is a retired GP from Oxfordshire who had a "ringside seat" to the birth of evidence-based medicine, previously held acade…
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Scaling Evidence-Based Medicine Across 630,000 sq Miles | Dr Raj Srivastava (Chief Clinical Programs Officer, Intermountain Health)
43:48
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43:48"When the frontline feels we're actually offering, 'what do you need? What are the resources we can help?' We'll co-create. Of course, they don't have the control of the resources or some decisions, but that's what executives can do." Dr. Raj Srivastava is a pediatrician, health system leader, and implementation science researcher, serving as Chief…
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How One Doctor's Career Pivot Inspired 25,000 Others to Rethink Medicine | Dr. Amandeep Hansra (Founder, Investor & Chief Clinical Adviser)
48:57
48:57
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48:57"At the end of the day, we don't really invest as much into products as we do into people. It's the people behind the products that are going to make the product successful" Dr. Amandeep Hansra is a general practitioner turned health tech entrepreneur, advisor, and investor, founder of the Creative Careers in Medicine community (with over 25,000 me…
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A Philosopher-Physician's Fight To Reclaim Medicine's Soul | Dr. Vikas Saini (President of Lown Institute)
49:26
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49:26"The enterprise of medicine has both scientific and moral dimensions, and they're inextricably balanced" Dr Vikas Saini is a Cardiologist and President of the Lown Institute, where he leads a non-partisan think tank advocating bold ideas for a just and caring system for health. With a unique background combining philosophy and medicine, Dr. Saini h…
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Goal-Oriented Healthcare: Breaking Free from the Problem-Focused Paradigm | Dr. James Mold (University of Oklahoma)
44:25
44:25
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44:25"The way to prevent cascades is to keep your eye on the goal, to understand what you're trying to accomplish and not to go down rabbit holes chasing abnormalities, but rather to be focused on the outcome that you're looking for." Dr James W. Mold is a family medicine physician, geriatrician, researcher and academic with a Master of Public Health de…
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Networks, Culture & Safety: How to Build Effective Healthcare Organizations | Prof. Ingrid Nembhard (Wharton School)
45:48
45:48
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45:48"We need to pay more attention to the networks that operate between people and the networks that operate between organisations.” Professor Ingrid Nembhard is an Organisational Behaviour expert in healthcare systems, based at the Wharton School of the University of Pennsylvania. Her research focuses on how characteristics of health care organisation…
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Liberate Health Data and Escape the EHR Trap | Dr Sidharth Ramesh (Medblocks Founder)
45:20
45:20
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45:20"Epic charges researchers to access the data that the same Institute has spent thousands of hours storing. They're not a good custodian of data... they're literally locking your data away and holding it for ransom." — Dr. Sidharth Ramesh Listen now on Apple, Spotify, YouTube or wherever you get your podcasts. Dr Sidharth Ramesh is a medical doctor,…
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From Evidence to Exit: Building Credible Health Tech | Dr Saira Ghafur (Co-Founder of Provea Health & Lead for Digital Health at Imperial College)
40:56
40:56
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40:56“The market was flooded with all these new tools and technologies that people were using, but no real evidence base behind them. Now we’re in this space where we need evidence. — Dr Saira Ghafur Listen now on Apple, Spotify, YouTube or wherever you get your podcasts. Dr Saira Ghafur is a medical doctor specialising in respiratory medicine, an acade…
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Customer Obsession in Healthcare: Primary Care Redefined | Dr Raj Behal (Amazon One Medical)
47:40
47:40
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47:40"I think of quality as what is the patient's ‘job to be done’. What are they trying to get out of this encounter or from their help? What are they trying to achieve? Making quality about that." — Dr Raj Behal. Listen now on Apple, Spotify, YouTube or wherever you get your podcasts. Dr. Raj Behal is a medical doctor and Chief Quality Officer at Amaz…
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The Economic Imperative: Why Health Equity Matters for Everyone | Prof. Bola Owolabi (NHS England Director)
48:34
48:34
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48:34"The greatest legacy we can leave as this generation of leaders is to make meaningful progress in narrowing those health inequalities between communities." — Prof Bola Owolabi. Episode Overview In this episode, Professor Bola Owolabi, GP and National Director for Healthcare Inequalities at NHS England, shares her insights on health inequalities in …
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Money, Power, Health: How Corporations Shape Our Health | Dr. Nason Maani (Commercial Determinants Researcher)
50:01
50:01
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50:01"The health impact of corporate power isn't just about products—it's about how commercial interests shape the entire landscape of health policy and research." — Dr Nason Maani Listen now on Apple, Spotify, YouTube or wherever you get your podcasts. Dr Nason Maani, lecturer in Inequalities and Global Health Policy at the University of Edinburgh, aut…
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Science Communication: Why the Basics Matter in an Age of Sound Bites | Dr Aaron Carroll (CEO of Academy Health)
45:15
45:15
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45:15"I'd rather have people understand why they should believe something, not just that they should." — Dr Aaron Carroll Listen now on Apple, Spotify, YouTube and or wherever you get your podcasts. Dr Aaron Carroll, pediatrician, professor, president and CEO of Academy Health, and renowned science communicator, discusses the art and science of effectiv…
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Leading New York State & Bridging the Private Sector | Dr Nirav R. Shah (Senior Scholar at Stanford)
47:19
47:19
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47:19"There is a lot of mistrust between the two, the private sector thinks about government bureaucrats who've done the same way for 20 years...the public sector talks about the private sector... who just want to make money at any cost... and they're both wrong." - Dr Nirav Shah, Senior Scholar at Stanford. In this episode, Dr Nirav Shah reflects on hi…
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The Intersection of Invention, Innovation & Business | Dr Josh Makower (Serial Entrepreneur, Investor, Leader of Bio-design)
37:13
37:13
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37:13“You can be successful as an innovator, even as a physician or any other background you have, as long as you follow the process and really focus on the needs. That's the key.” — Dr Josh Makower, Director and Co-Founder of the Stanford Byers Center for Biodesign. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode, Dr Joshua…
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Moral Injury & the Musical Chairs of Housing | Dr Margot Kushel (Director of the UCSF Benioff Homelessness and Housing Initiative)
43:51
43:51
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43:51"There is a very evidence-based way to house people for people who are experiencing homelessness, it has been around a long time, it's been testing empirically, it's called housing first" — Dr Margot Kushel, Director of the UCSF Benioff Homelessness and Housing Initiative. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode…
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Exploring AI, ChatGPT and Clinical Informatics | Professor Nigam Shah (Founder, Chief Data Scientist for Stanford Health Care)
40:38
40:38
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40:38"Even though you trained them for something silly, like to predict the new word, new capabilities emerged, as in, now they can answer, which is something they weren't trained for" — Professor Nigam Shah, Chief Data Scientist for Stanford Health Care. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode, Professor Nigam Shah …
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Leading a Nation through a Global Pandemic | Sir Ashley Bloomfield (Former Director General Of Health)
43:47
43:47
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43:47"One of the conclusions I've drawn from COVID...in a sense, was that our communications approach was our most important public health intervention" — Sir Ashley Bloomfield, Former Director General Of Health, New Zealand. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode, Sir Ashley Bloomfield reflects on his humble upbrin…
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Power, Managers & the Science of Teams | Professor Sara Singer (Director of the HELIO Labs at Stanford Medicine)
38:40
38:40
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38:40"You have to be somewhat more strategic, you have to identify your sources of power and use those sources of power to influence the people you want to enact whatever it is you are asking of them" — Professor Sara Singer, Director of the HELIO Labs at Stanford Medicine. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode, Pr…
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Venture Capital in Silicon Valley - From Clinician to Investor | Dr Oliver Keown (Director at Intuitive Ventures)
43:39
43:39
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43:39"In times of hesitancy in the market, leaders lean in, they assert themselves, they flex and they find an opportunity” — Dr Oliver Keown, managing director of Intuitive Ventures. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode, Dr. Oliver Keown discusses his career journey from a doctor in the UK's National Health Servi…
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Trust, Strategy and Resilience & Moving Healthcare Forward | Dr Thomas H. Lee (Harvard Professor, Chief Medical Officer at Press Ganey)
41:43
41:43
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41:43"There's good news, we're actually seeing signs of a virtuous cycle, we're seeing [workforce] pride in organizations and that leads to people working together better, making the care better, which means the patients are more grateful, which makes people feel even more pride". — Dr. Thomas H. Lee, Professor of Medicine at Harvard Medical School and …
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Upstream Doctors & Social Interventions Research | Dr Laura Gottlieb (Director of Social Interventions Research & Evaluation Network)
39:51
39:51
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39:51"We think as healthcare institutions as just healthcare institutions...actually healthcare institutions are just big businesses that happen to do healthcare, this idea is that there is a whole array of other activities besides healthcare, that have an enormous impact on our local communities" — Dr. Laura Gottlieb, Family Physician and Director of S…
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Digital Health and Career Reflections at Microsoft | Dr. Simon Kos (Former Chief Medical Officer)
50:29
50:29
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50:29"If we had a multitiered, multilayered approach to clinical leadership where we don't just provide about patient care, but we think about improving the processes and tools...and leave a legacy over time then I think we'd have greater success in driving digital change in health" — Dr Simon Kos, Healthcare Executive at Microsoft. In this episode, Dr …
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Journey to Zero - How to Lead the Climate Revolution in Healthcare | Dr Nick Watts (Chief Sustainability Officer, NHS)
48:12
48:12
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48:12"Don't let the fact that you don't know the last step, stop you from acting today.” — Dr Nick Watts, Chief Sustainability Officer, NHS. Listen on Apple, Spotify, or wherever you get your podcasts. In this episode, Dr Nick Watts discusses what it takes to be part of a world-leading race to zero carbon emissions in healthcare. Dr Watt reflects on his…
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Leadership by Design at the Mayo Clinic | Dr. Stephen Swensen (Former Director for Leadership and Organization Development)
44:28
44:28
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44:28“Culture is absolutely the mortar between the bricks and the primary value of Mayo Clinic that everyone knows. From the environmental services folks to the accountants, to the nurses and doctors and social workers, the needs of the patient come first.” — Dr. Stephen Swensen, Former Director for Leadership and Organization Development at Mayo Clinic…
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Demystifying Organizational Behavior in Healthcare | Professor Amy Edmondson (Harvard Professor of Leadership and Management)
46:37
46:37
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46:37"Psychological safety is at the very heart of this discussion... a belief that it is safe for interpersonal risk...in my research I have found this not to be the norm, but it is a very powerful thing when it's there." — Professor Amy Edmondson, Novartis Professor of Leadership and Management at Harvard Business School. In this episode, Novartis Pro…
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Complex Systems & the Quality Improvement Toolbox | Dr Kedar Mate (President & CEO of the Institute for Healthcare Improvement)
50:30
50:30
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50:30"When you face those problems, you have a couple of choices, right? You can say, these problems are too big for me and I can't solve them. Or you can say, these problems are going to persist unless I do something about them" — Dr Kedar Mate, President and CEO of the Institue for Healthcare Improvement Listen on Apple, Spotify, or wherever you get y…
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Introduction Episode - A Call To Action For Transforming Healthcare
5:23
5:23
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5:23Listen now on Substack, Apple, Spotify, or where ever you get your podcasts. So it sounds to me like we have 21st-century problems with 20th-century approaches. So what do we do? Well, I believe that clinicians given the right skills and opportunity can be at the heart of solving many of these very complex issues. — Dr Jono Hoogebrug, Family Medici…
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Richard and Raj discuss Palliative care
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Richard and Raj discuss some of the History of Statistics, and how it informs the practice of EBM today.
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E21: Patients' Role in Generating Evidence
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33:50Richard and Raj discuss how patients can be involved in the process of generating evidence, from determining patient centered outcomes to prioritizing types and goals of research.
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Richard & Raj discuss decision making in EBM, and the tipping points that change clinical practice.
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Richard & Raj discuss Overdiagnosis, starting with the difficulty of defining the term to the practical challenges in every day clinical practice. Links on Overdiagnosis: https://www.bmj.com/content/344/bmj.e3502 https://academic.oup.com/jnci/article/102/9/605/894608
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References: 1. Wilson JM, Jungner YG. [Principles and practice of mass screening for disease]. Bol Oficina Sanit Panam. 1968;65(4):281-393. 2. Mant D, Fowler G. Mass screening: theory and ethics. BMJ. 1990;300(6729):916-918. doi:10.1136/bmj.300.6729.916 Discussion Timestamps: 0:15 Population Health and Screening History 6:44 Population Health Math …
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Richard and Raj discuss the potential future role of AI in EBM and medicine
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E16: James Mccormack on Applying Evidence and the "One Agent at a Time" approach
38:27
38:27
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38:27James Mccormack, from https://therapeuticseducation.org/ , discusses personalized, one-agent-at-a-time approach to medication management. He also has helped to create several decision based websites: Overall CVD cvdcalculator.com Heart failure https://hfmedchoice.com/ Diabetes https://decisionaid.ca/diabetes/…
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Richard and Raj discuss the history of Hypertension and how it lead up to modern day challenges of managing high blood pressure.
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The NNT
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E13: GP Evidence & Web-based Aids for Shared Decision Making
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32:51
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32:51Reference: https://gpevidence.org/
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richard and raj discuss the changing approach to managing diabetes over the years.
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E11: EBM’s over-reliance on meta-analysis
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39:06Richard and Raj discuss the role of meta-analysis in EBM, in light of the recent controversial cochrane report on masks (physical interventions) in respiratory infections.
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E10: What works for the Individual Patient?
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42:14Richard and Raj discuss personalized medicine in primary care
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Richard and Raj discuss common challenges and errors that may occur in diagnostic reasoning. Reference: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2009.03507.x
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Richard and Raj discuss the cognitive process of diagnosis, and reflect on the different ways physicians make diagnosis beyond the standard approaches taught in EBM.
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Raj and Richard continue their discussion on Diagnosis
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References: Diagnostic strategies used in primary care. BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b946 (Published 20 April 2009)Cite this as: BMJ 2009;338:b946
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E5: 10 Commandments for patient-centered treatment
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41:271. Lehman R, Tejani AM, McCormack J, Perry T, Yudkin JS. Ten Commandments for patient-centred treatment. Br J Gen Pract. 2015;65(639):532-533. doi:10.3399/bjgp15X687001 https://bjgp.org/content/65/639/532 2. Yudkin JS, Lipska KJ, Montori VM. The idolatry of the surrogate. BMJ. 2011;343(dec28 1):d7995-d7995. doi:10.1136/bmj.d7995 https://www.bmj.com…
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E4. CHF: Optimizing Drug Combinations vs Risks of Polypharmacy
42:39
42:39
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42:39A discussion on Heart Failure, polypharmacy, and optimizing therapy with multiple medications.
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Is EBM dead? This was a common claim the 2010's, but the response to the Covid pandemic lends some optimism that EBM is has some life yet! Join us as RIchard discusses the rise of EBM from 90's to the 2020s.
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Richard discussed the concept and complexity of making shared decisions with patients. Or as he prefers to describe it, a "shared understanding of medicine".
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Richard Lehman discusses the practice of primary care before EBM, and why EBM was necessary for medical practice to progress into a new era.
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