Innovation in today’s healthcare landscape is evolving rapidly, with new technologies frequently introduced to enhance clinical workflows and improve patient care. However, it’s critical to pause and reevaluate what meaningful innovation truly looks like. Often, reducing complexity, streamlining processes, eliminating redundancies, and focusing on human-centered design can be more impactful than layering on additional tools. In many cases, the most effective solutions that truly help and connect to patients are not the flashiest, but the simplest and most intuitive.
On today’s episode of In Network's Designing for Health podcast, Nordic Chief Medical Officer Craig Joseph, MD, talks with Kai Romero, MD, head of clinical success at Evidently. They discuss her journey from emergency medicine to hospice care, and how curiosity can fuel bold career pivots. They also discuss the importance of rethinking innovation in hospice and health technology, emphasizing that streamlining workflows and prioritizing human-centered design often delivers greater impact than adopting complex technological solutions.
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Show Notes:
[00:00] Intros
[01:14] Rethinking end-of-life care
[04:10] Using curiosity to drive career choices
[10:26] Innovation in hospice
[22:16] Blood bank story
[24:05] Communication gaps in the professional setting
[25:03] About Evidently
[29:08] The human aspect of medical records
[35:56] Kai’s favorite well-designed thing
[37:20] Outros
Transcript:
Dr. Craig Joseph: Doctor Kai Romero. Where do we find you this morning?
Dr. Kai Romero: We are in my garage in San Francisco, California.
Dr. Craig Joseph: How many start-ups have gotten their start in your garage? I'm assuming, like, every garage has 2 or 3 startups that have started in it in the San Francisco area. Is that not accurate? I don't know.
Dr. Kai Romero: Yeah. If by startup, you mean children, then yes. Three. We'll call them startups.
Dr. Craig Joseph: These are not startups. I've heard of that before, I don't think.
Dr. Kai Romero: No. Probably not. I'm trying to remember. I think my husband might have started. No, it wasn't in this garage. It was in a different garage. But yeah, you're right. In general, there's, like, many ghosts of startup past in every San Francisco garage.
Dr. Craig Joseph: All right, well, that is good to know. I'm glad that you have, clarified that because I was, I thought you were going to be like, oh, Xerox. Yeah, that's what started here. Let's take a step back from startups. We'll get to startups. But let's take a step back first talk about your clinical arc.
So, you went to medical school, became an emergency medicine doctor and then pivoted to hospice and palliative care and then ultimately still do that a little bit, but also do kind of startup stuff. So talk us through all of that. How did you go from those two? How do you go from I think it makes more sense to me. If you were internal medicine doctor and then became a palliative care doctor or gerontologist or something like that. So, yeah. How did that work out?
Dr. Kai Romero: Yeah. I mean, I think people often underestimate how much death, dying, and serious illness management happens in the emergency room, especially for most. You know, most people are kind of getting their care towards the end of their life in an urgent or emergent fashion. They're also getting it in outpatient visits. But often the emergency room actually is where a lot of these issues are being seen and managed. And as a resident, I realized, something I think that a lot of emergency medicine doctors do, which is that we, the way we manage end of life care in the ED is with a default. And this is changing a little, but in general, a default, the kind of maximal aggressiveness. And it didn't feel aligned with what I imagined many people might want.
And so one example I like to rely on is like if you go into a car dealership, most people want a pre-owned Honda. The occasional person wants a semi-truck. Our standard of care in American health care is a semi-truck for everyone. Unless you've made it very clear that you don't want the semi-truck. The semi-truck being the full CPR, ICU, or Pressors dialysis. And so I think what I realized you run so many codes, you do so much urgent medical care on very sick people who seem like they don't have much time. And then also if you follow up, you find out how they do after these big codes. And I just realized that I didn't always feel like we were having as many of the conversations as I might have wanted prior to kind of going down this very aggressive route. And that's what really led me to hospice and palliative medicine. Really the question was whether there was a different way than maximal intervention. And then once I completed that fellowship, I realized that one really lovely time in my career was when I was working two days a week doing hospice medicine and two days a week in the ED, and I had small kids.
It was like I was beholden to no one. I just kind of showed up when I showed up and I left. When I left. But the nature, I don't know, maybe you've found this too. It's hard to be partially in anything. And so invariably you end up kind of putting more time and energy because you get excited about something and it starts kind of growing and growing. And that's what happened to me with the hospice work and what had been this, like, really lovely, kind of contained boundary career, turned into chief medical officer position at a hospice and palliative care organization, which was amazing. And it was I came into that role in February of 2020. So a month later, I was kind of helping to coordinate all of the pandemic response and then ultimately kind of this last pivot, I guess what I would say, the thing that and again, I think this is true for a lot of people, what ultimately fueled a lot of my passion, and pivoting into hospice from emergency medicine allowed for that. Pivoting into leadership from a frontline clinical role allowed for that. And after 4 or 5 years in that leadership role, I was kind of just looking, again, to be a novice at something. I find that so energizing and so interesting. And so when a former colleague of mine asked me whether I would consider joining her at Evidently, I jumped at the opportunity because I knew it was something I knew nothing about.
And I've always said I really like the very sharpest part of the learning curve where I can barely keep it together day to day. And it was an opportunity for that again. And it really has been that I've learned so much, in the short time that I've been there. I just love knowing that my brain is elastic enough to accommodate new thoughts, new motivations. And I also love finding the things that are kind of universally true as you move through these different spaces, as we look through a lot of patient records. And one of the things that struck me early on at Evidently, which is so focused on obviously, the technology of that chart summarization, using data to inform that really focused on the technical aspects of that. But I would read through these charts and I was like, wow, this is a memoir of suffering and loss.
When you look at an entire patient's life kind of right there in front of you, and you actually read all of it, and you actually look through the whole narrative arc of their life. I was so struck by the fact that we think of medical records as these kind of cold, detached chronicles of like numbers and measurements. And in fact, like this is the story of their life sometimes and often is a very sad story that we're reading. And I do think that one of the things that I recognized moving into this space was how rarely that perspective gets brought up. Like, what does it mean to be optimizing data in a medical record? Well, like there's the technical reality of what that means. And then there's like the emotional reality of having summed up a life. And I think that even people for whom it is not instinctual to go to that place really appreciate being reminded of that fact.
Dr. Craig Joseph: So, you've just said a lot and that it's well, I'm fascinated by something that you said, which I now am analyzing myself and going, yeah, I guess that makes sense. The fact that you like to be a learner and that you like, and the less you know about a new topic that you're getting into, the more fascinating it is to you. At first, my first thought was, well, that's the opposite of pretty much every physician I know, right? Most of us, and not just physicians, but I think professionals in general, like we want to get to the point where we think we know it all or most of it and/or at least act like we know it all. I've seen physicians who were afraid to ask me. They needed help logging into the electronic health record, and they didn't want to look dumb in front of the nurse. And so they would just kind of fake it. And it was clear to me, like, you don't even know how to get in here. Let alone use this tool, but you're different.
Dr. Kai Romero: Yeah. I do think the culture of medicine is in direct opposition to my instincts. In that way, there's a real sense of luck. And I think that applies really broadly. It's actually one of the things I've loved about hospice medicine. It's so low ego. People show up with their issues, sometimes someone's extremely experienced and they're like, I still don't know if this is the right thing, that I love. But I'll also say that I think that remaining in touch with my curiosity about things and about other people is like the source of my satisfaction with life. Period. Like, what's one of the things I love about emergency medicine? Like, literally the fact that you get to meet new people all day and find out who they are in the context of their life, like give them an opportunity to present themselves to you. It's just endlessly fascinating the way that human beings kind of decide to. This is going to sound like terrible tech rolling, which but the way that human beings decide to, like, brand themselves on their first interaction, like what you decide to lead with. I could listen to that all day long because it it's just such insight into how they got here, who they are, what experiences have shaped them.
And I think that extends into my career as well. But essentially for me being in touch with my curiosity is a counter measure to judgment bias. And like early anchoring, which are all things that I kind of try to avoid clinically anyway. And it's just a much easier space for me to operate from both when I'm making clinical decisions or having patient interactions and career wise. I just am happier there. And I do wonder whether the culture of medicine sometimes makes it so that you feel like a Rube or something. If you acknowledge that you don't know the whole story, actually I had this interaction the other night when I was on call, I was talking to someone, the granddaughter of a patient who was actively dying, and I was explaining to her that turning up the oxygen at this point might just kind of irritate her nerves and be more uncomfortable. And that actually titrating morphine or other medications would be probably more beneficial if the goal was comfort.
Sometimes people think that we use morphine just to kind of make patients unaware that they're having trouble breathing. But I wonder if I could talk to a little bit about the kind of physiology behind it. And she said, oh, I already know. And I said, oh, okay. And she said, yeah, video dilates. And I was like, well, that is one thing, there can be cardiac vessel dilation. But I wanted to talk to you a little bit more about stretch receptors on the alveoli and cutting feedback loops there. Something that I know that I only learned in fellowship, actually, not even in fellowship. I only learned after fellowship as a hospice attending quick reactive nurse to say, oh, I already know that. Like you don't, I don't need to learn anything from you. Despite the fact that like end of life care was not her specialty. And when I explained to her, she was like, oh, that's really helpful to know. But I just thought to myself, it is so hard to move through the world feeling like you can't learn something new, or you can't acquire new information in the face of someone being an expert.
Also, everybody loves to share their expertise. If you don't give them that opportunity, I don't know. But yeah, it is a core motivating principle of my life. And I think brings me tremendous joy in all aspects of my life. And I've never regretted pausing and asking, why? Tell me more about that to anyone, including my husband, including my kids. And when I'm not curious, I know something's amiss.
Dr. Craig Joseph: I love that, and as I mentioned earlier, my first instinct was, well, this lady, no way. I don't know what she's talking about. And then, as I, as you continue talking, I'm like, oh, she's describing me. Okay. She's describing me. And I get it, through some of my work from a consulting standpoint where I love walking into a hospital and not knowing anyone, and I don't know what the culture of the organization is. And I don't know who this person. Five years ago, this guy screwed over that guy. And hence now, these two departments hate each other and don't work together. And finding all of that out is so much fun.
Dr. Kai Romero: It's so fun. People are endlessly complicated and have such complex backstories to things, and their lives are interesting and they're interested in telling you, I don't know, it's the best. Like, sometimes I'll be in a big city and look up at one of those huge apartment buildings and I'm like, oh my God, every single room in that building has a whole universe in there, and I'm not going to know any of them. But like, it does feel like a really motivating thought to collect as many as I can, like Pokémon cards, as long as I've got time. I never get tired of it. Which makes me hopeful because I think of like, all of the things that can be more challenging as you age. You know, your mobility gets harder and blah blah. But like, if stories are the thing that's interesting to me like that I can keep doing if I'm completely bedbound, I'm planning and planning long term.
Dr. Craig Joseph: Yeah. No, that's good. It's never too early to start planning. Let's pivot a little and talk about kind of innovation and design. And one of the things that I learned when we were preparing for this talk was that you think your specialty, and I have to be clear, when I talk about that, of hospice and palliative care isn't at the cutting edge of technology. And in fact, that often is, from your perspective, kind of resists innovation and change more so than other specialties. Tell us more.
Dr. Kai Romero: Yeah. I mean, I think that the rootedness of hospice and palliative medicine in one-on-one personal interactions between a care provider and a patient or a care provider and a family, that is the core of what hospice and palliative care bring to the table.
Interestingly, I do think palliative care, just due to a shortage of clinicians in the pandemic, has pivoted to telemedicine much more quickly and much more permanently than hospice was able to. So, I still volunteer clinical faculties at UCSF, and I know that in their palliative medicine department, because their catchment area is so large, so many of their patients are coming from hundreds of miles away. It actually is a way to create access that would not otherwise exist. Telemedicine is the issue there is that the alternative to telemedicine is someone driving hundreds of miles to clinic.
Of course, telemedicine is superior to that. The problem for hospice is that the alternative is a wonderful, sweet hospice nurse coming to your house. Why would you ever choose the telemedicine visit, if that's the alternative? And so that's one challenge. And I would say in general, hospice kind of suffers from its own success in a lot of ways. It's done an incredible job of driving down the cost of end-of-life care for people that enroll with enough time for it to show benefit. And the response broadly of the federal government and other entities that are paying for it is, well, then let's drive down your reimbursement. And it kind of feels like if that's the reaction, it's hard for people to feel like any innovation or any improvement in efficiency is going to do anything other than take more resources away. It's not kind of, an environment that is ripe for innovation. And at the same time, there is an absolute need for it. So the organization I work with By the Bay Health began as hospice of Marin, and I think 1975, that was the second hospice in the country. The founder, Mary Taverna, actually helped write the Medicare Hospice Benefit and back then the original hospice care was almost entirely cancer patients.
So, the way that you treated them was different, the way that you had to kind of plan for resources around them. Now, many of our patients are patients with advanced neurological disease or advanced heart disease, both of which are far more challenging to prognosticate. The patients with advanced neurological disease for many years before they are hospice-eligible have just a bottomless chasm of need that hospice would perfectly manage a home-based visit.
So, I say all of this, in order to say that, I think that there are opportunities for innovation within hospice and palliative medicine. But to me, what feels really important is laying the groundwork for hospice clinicians to know that the goal is not to replace that patient interaction or to shift that patient interaction per se, but more to make improvements around things like, you know, we'll get a lot of phone calls of people calling and asking what time their medication is going to arrive, creating an app where you can track your medication delivery so that we're not getting five phone calls about the medication delivery, would be a very non-threatening innovation for a hospice clinicians, but I think those are the types of innovations that probably make sense, as opposed to innovations that are intending to reduce or modify clinician interaction with patients. I think that feels like kind of a nonstarter.
Dr. Craig Joseph: It's a story told over and over and over where in fact, what will really help them is an app that locates the meds that are being transferred from the hospital to their home so that they and their caregivers know where that is. So, they don't worry about calling the hospice nurse and asking.
Dr. Kai Romero: Absolutely. And I think to me, one of the things that's been really interesting about doing this work in tech is when you meet someone that can identify a care gap and come up with the lowest by most obvious solution. Any time that's happened, I'm like, who are you? I will follow you to the ends of the earth because you're right. Putting in a consultation five minutes after admission on this debilitated patient so that you can determine where they're going makes a lot more sense than doing it five minutes before you discharge them. Those types of solutions. I'm like this is it, all the answers are here. And then of course you use technology to support them. But I think when people have thought deeply about the human experience of being a patient or workflows or kind of design within a hospital system, that feels magical. And there's a handful of people that think about it in a very clear way and can execute on it in a very clear way, but it's amazing how rare that is. Most of the time, people are trying to overlay technology on top of a personal problem and you're like this isn't going to work.
Dr. Craig Joseph: I'll see you and raise you. Sometimes it's not just the low-tech solution, it's the no-tech solution or our actually, the solution is, there's a book that I keep behind me to kind of remind me called Subtract. It's all about how as humans, we are not good at looking at a solution that is not additive. Meaning, oh, I want to make this thing safer, or I want to make this thing clearer or whatever. Most of us don't start with, well, what can we take away? What can we take away from what's already there? We mostly start with what can we build on top of?
Dr. Kai Romero: Well, not to quote your own book to you, but one of the things that I remembered in chapter eight was this specific comment that we often think about kind of automating or replicating paperwork management in an E.R. without asking, should it exist in the first place? I thought that was such a great point that very rarely are we asking ourselves, like my husband works in government HR. What's fascinating, and it previously worked in San Francisco. Oftentimes people will, when you're trying to kind of bring in technology, they'll say, if my job is to process form 160, what is the technological equivalent of processing form 160. And he'll often have to be like, no, your job is to get a client or is to get an employee through the onboarding process, not to process form 160, this is the bigger picture of your job. And we're going to, and this is how technology will help. But it often involves like backing up and looking at the kind of being structure and saying, where do you fit into this large process and what is your end goal? Because otherwise people are inclined to really narrowly focus on kind of the singular task. And if that task doesn't continue to exist, everything is a failure. It's interesting and very hard work to pull people away from their kind of tightly held workflows.
Dr. Craig Joseph: The reference to the paperwork, it resonates. And, I think that my first exposure to that was a gazillion years ago, when I worked for an EHR vendor and we had a go live and there was a situation I was told I needed to go down to blood bank. There's a situation. That's what I was told. And that's I don't I don't whatever that is. I don't want to go there.
Dr. Kai Romero: No, I mean unless you're. Yeah. Who needs you to carry bags of fluid?
Dr. Craig Joseph: I don't want to go to blood bank under the best of circumstances. And I don't want to go there when there's a situation. But I went and the situation was that the blood bank didn't want to give out the blood, because the form that they needed that was signed by the physician was not translated into the new year. And we had some physicians down there and they're saying, I don't even know what form you're talking about. And there was a back and forth between, of course you do, you sign for these forms. You know, we've never released blood without this form. And, and they've said they've died. And so, someone's clearly not there before it went to fisticuffs. But, I don't know if it was me or one of my colleagues, but we were just like, okay, let's start from the beginning. Like, where do you order? It was being signed by the unit clerk, which is like a secretary for the hospital floor. And, I know, you know, but for some of our listeners.
So clearly it was like, well, I guess this form really isn't that necessary after all? Because the unit clerks were kind of signing it. I don't remember how it got that way, but it was one of those things where like, yeah, the forms really necessary. But it's clearly not necessary at all because there have been no harms come, no one has noticed this. And so that was a good sign that we probably could do without that form.
Dr. Kai Romero: Well, it's also a good reminder of like, we're all living in our own universe and thinking like, what does this form mean to me versus someone else? The unit clerk was signing whatever and sending it off because he or she knew that they had to do it. And on the receiving end, the blood bank was like, here is this very important form we've just received from this other person. And you just realize, like, gosh, it makes me wonder how many things are like that in my life where I am offhanded and do whatever, and the person receiving my input is taking it a really different way, positively or negatively. I think there's probably so and the same in reverse. Somebody says something or does something offhand, and I'm kind of in my own head about it one way or the other, and they have no idea what impact it's had.
Dr. Craig Joseph: Well, let's talk about Evidently and Evidently is the startup that that you joined and when I first heard about Evidently I said, well, why have I not started a company called Evidently.
Dr. Kai Romero: You can start one called “Obviously”.
Dr. Craig Joseph: I know it's too late now. You have Evidently. And I'll just be accused of copying, which will be true, and it'll hurt my feelings. Tell us about Evidently. What do you do?
Dr. Kai Romero: Yeah. So really, the goal of Evidently is to kind of create clarity in the medical record. So to facilitate everything from clinical care on the front end to billing on the back end, and the way that we do that is by using machine learning to read the entirety of the medical record, create summarization for clinicians and one of the key things about the summarization, so that is true is that they're all fully clickable. So, any concept that we identify, you can click on and get all of the information and the primary source document within a click or two.
But also, we'll do things like associate that concept with other related concepts. So, if you click on the concept of CHF, for example, it'll bring up, a little a screen kind of a dashboard about CHF, but it'll bring up the creatinine, their renal function if they've been on dialysis. It'll bring up their last echo, their last chest X-ray, basically all the associated concepts that you as a clinician would be looking for. And that's all customizable. So what's interesting sometimes is there's obviously, we can't anticipate what a transplant surgeon is going to want to see and the types of subtlety that they'll be looking into the record for.
But ultimately the goal is to do some of the summarization so that you have a better kind of quick sense of who the patient is, but also for things like EHR docs who are seeing undifferentiated chest pain, create a little dashboard around chest pain so that when a patient comes in, you can say, this is their history. These are the related items. Here's all of their lab results, their EKG, etc. It kind of just allows you to create that, that mental model that you have in your mind for evaluating that symptom, to put it down on paper and immediately have the results in the information that you need to manage it. And then on the back end, all of that clarity in documentation and in capturing kind of the totality of the patient complexity allows us to help systems bill appropriately for those patients. And I think the thing that I really love about this organization is that we have extremely talented machine learning PhDs that help create it. And then we have a lot of doctors that are part of the product team, helping to mold it and make it make sense for clinicians. And I really feel like that tension is so important for software development, specifically in this space for two reasons.
One is you want to know that the people who are developing it are people that understand the depth and breadth and true limitations of machine learning, which I think sometimes people who have less experience in that field don't appreciate enough. And then you need clinicians who can say, like this makes sense or doesn't make sense. Somebody said the other day that I can't remember who it was. The only thing that I will never tell you is if it's being ridiculous and, like. That's very true. There's no gut check in AI. And I think the clinicians are so important for kind of creating that and being able to say, like, look, I understand the logic behind why this ended up here. This cannot end up here because it's ridiculous. So, I think, yeah, really the goal is to kind of create some clarity in an overall very murky space, save people time and energy. We have one transplant team who reviews records from all over their Midwestern state, and it cut down their biopsy time by 90% because instead of having to click on 50 different things from, I think it was from over two hours per chart down to 15 minutes. Instead of having to click on 50 different things to collect all the information they needed, they could. They just had a dashboard, could look through it. It was pre-populated by the software.
Dr. Craig Joseph: So, the key thing to me there or one you said many different things is this concept of transparency, what I would call transparency when most people think of it as the ability to click on it and see the source right. And it's something that I think most people outside of clinical medicine, maybe they don't understand why every when they get admitted to the hospital, even for a minor outpatient procedure, 42 people have asked them what their allergies are.
Dr. Kai Romero: If they change their answer 41 times.
Dr. Craig Joseph: Most people don't get that. And I think I've written a blog post once about one of my experiences in my third year, very beginning of my third year, that was back in the day when you didn't really get any clinical experience in the first two years of medical school. And boy, the story that I got, at least I thought I'd got from the patient, was very different than the story that the attending got two doctors later, right? First, the third-year medical student, then the intern, then the resident, then the attending. I just remember the look that the attending gave me because I was the lowest person on the totem pole. So, I'd given the well, this patient comes in for this and that and no, she didn't have that. And no, this was the presenting side. And then the opposite turned out to be true. Some of that was my fault of not interpreting or not asking the right questions in the right order, for sure. But some of it was just like you said, oh, the patient has actually changed remembering things now because they've been prompted. And then they had five minutes between the intern and the met and the third-year resident to come in.
Dr. Kai Romero: Well, there's also this like back and forth where you realize, like, patients are humans. So, if they get interest or positive regard for something they've said, they'll emphasize that to the next person. Like the story actually does change based on feedback. And like, I don't do that if I'm talking, you know, when I was pregnant you talked to the OB and I was an elder while pregnant. So, I was 38. I love the term geriatric for a 38-year-old. And so, I talked to the high-risk OB, and like, I knew what my OB thought was cool. So, I was like, I'm going to lead with that. Like, I'm going to make this OB like me with my cool story I'm telling her now, like, this is just how humans are, you know?
And so it is interesting, there is a piece of like chart summarization that's fascinating because it often strips away a lot of that, like kind of up and down, that you get because it's just focused on like, all right, if this was mentioned 30 times, obviously it's something that has more evidence behind it than something that was mentioned twice, which is generally true. It takes out that piece of like human beings innovating for their audience, which is a little bit the patient physician interaction.
Dr. Craig Joseph: It's true. I don't know, I think the advice I would give you, which you don't need, my advice, was similar. I had some parents who would bring their children to me. And they were kind of talking about signs and symptoms that I was pretty confident that weren't there. And I remember I said, listen, the last thing you want to do is impress me. You don't want to impress me because if I'm impressed, it's bad.
Dr. Kai Romero: There was an article I read once about Law and Order, and about how Law and Order shaped the way that people talk to cops, because now people are like, oh, let me report out the way that someone on Law and Order would just tell me what happened. I think a lot of people have had this experience of like, you want your doctor to like you. There's still a part of you that wants to please or entertain or interest the person standing in front of you and like you think that that's not going to shape the story.
Dr. Craig Joseph: Well, it's I mean, it's kind of part of design that we've been talking about that you have to have a mental model for how the system is going to work. And I get it, if I'm interesting, if I think I'm interesting to you, I will get better care. The book that you referenced, my book that I coauthored, we started off with a little section called Painted Shoes. And this was an adolescent who's in and out of the hospital noticed that she was often treated as just another admission. Not anyone's fault, just the reality of life. And for some reason, I don't remember exactly why, but she painted her shoes in a decorative way. And people noticed that, and they're like, oh, wait, I remember you. You were here two months ago. You had those great red shoes. Now they're green. And so she became known as that girl with the painted shoes. And then they remembered her. And that was actually quite good for her because she didn't have to repeat her story as much, and she had more authenticity. And so we're all kind of leveraging some of these design principles without realizing that we're leveraging design principles.
Dr. Kai Romero: Well, and as doctors who, when we are patient, we essentially have painted shoes, right? Nobody forgets me. Nobody forgets what I've done, what work I'm doing, who I am. When I'm in a medical interaction position, pay and regard broadly has fallen precipitously in the last, let's say 50 years. But aggressively in the last ten. The hospital's the one place where everyone's like, Doctor Romero, how are you? And I actually remember one interaction I had with a labor and delivery nurse, but I overheard her signing out to her fellow nurse and she said, she's an ER doc, but she's really nice, but she's really nice. And I was like, oh. What? What presupposes shouldn't you have about every physician you've interacted with before?
Dr. Craig Joseph: Oh no, I would expect the but part.
Dr. Kai Romero: The but was there when it comes to thinking about how do you take this big, complex mess of humanity that the medical record captures to a greater and lesser degree? Right. There was nothing in that kid's medical record, probably about her shoes. And that was a core experience of the medical system for her. And so, recognizing that the medical record actually doesn't capture a huge percentage of someone's experience of the health care system. Still trying to give the kind of overarching narrative of who they are and what has happened to them and how they've responded to treatment. That's why it's so hard. And if you're trying to increase efficiency for a physician or for a clinician, you pull out the medical concepts and you link them all together. But it's actually all of the stuff in between. No one has time to read all of that. But there is a part of me that's like, that's actually where a lot of the cool stuff is.
Dr. Craig Joseph: We have come to the end of the time that we have, one of the questions that we always like to ask, since we talk about health care and design, is there something in your life that's so well designed that it brings you joy when you use it?
Dr. Kai Romero: Yeah, I thought a lot about this. And the thing I landed on is my Birkenstock clogs. I have been wearing Birkenstock clogs since I was 12, and I've had various pairs there, slip on there, comfortable there, see me. They seemingly exist outside of fashion trends. I mean, there's a store in Marin that has been there since 1975, and they last forever, and you can resole them. And literally I've had some pairs for 25 years. They have adapted to kind of all these different phases of my life, like when I'm holding kids and can't tie shoelaces, when I need to run down to the garage because I'm holding laundry. I don't know, it just feels like they've accommodated all of the ways that my life has ebbed and flowed, and they never go out of style. They, like, exist outside of that. Yeah.
Dr. Craig Joseph: That's awesome. And are they free because you live in San Francisco?
Dr. Kai Romero: You get one when you move here. Yeah. You get a CBD gummy and Birkenstock clogs. And those are the two main things I'm trying to think of. What else would be on that list? A composting bin.
Dr. Craig Joseph: Okay, that's probably one thing you actually do get. Doctor Romero, it has been a pleasure talking to you and learning from you. Thank you so much for talking with us today.
Dr. Kai Romero: Thank you so much for having me. This has really been a lovely way to spend my morning.