Emergency Medicine w/ Dr. Til Jolly

Episode Information

January 27, 2021

Emergency Medicine Physician Dr. Til Jolly talks about treating COVID patients and the adrenaline and routine of practicing emergency medicine.

Topics Include:

• How his pediatrician was his first source of inspiration in his decision to become a doctor
• The way that the emergency medicine staff deal with the stress and trauma they encounter
• The importance of listening to the patient without interrupting
• That patients might not always get the exact answer they were looking for when they come to the Emergency department
• The importance of wearing masks to help protect against COVID spread
• How they treat COVID patients differently than they did at the beginning of the pandemic
• How wearing masks stops the spread of COVID and a bit about the COVID vaccine
• His plans and goals for the Doctorpedia emergency medicine channel

Highlights

• “When I was a kid, I was interested in math and science and all sorts of things and I had some mentors. I remember one in particular, my pediatrician, in a relatively small town, Greenville, North Carolina. My pediatrician Dr. Trevathan always took an interest and took time to talk with me and explained things to me in a way that I understood. So he wasn’t just doing things, he was trying to have me understand and that made an impression on me.”
• “A typical emergency physician on a shift may see one or two real emergency type things, or even less frequently than that, that he or she really needs to act on very, very quickly and those happen, but happily you’re part of a team. And you’re part of a team that all knows their roles in those things. So it’s not like orders are being shouted out every 10 seconds. Everybody knows what to do when that happens, everybody does their job and manages the patient.”
• “It’s like a lot of jobs. People think of police work or firefighting as adrenaline rush type jobs too, but most police, firefighters and paramedics will tell you that a lot of what they do is pretty routine. And then every once in a while, they have to jump in and do something a little more dramatic.”
• “You learn not to keep everything to yourself. You learn to make sure that when you have to have a difficult conversation with somebody, you’re not going to get interrupted. If you have a phone on you, you give it to somebody else so that you’re not distracted. And so you can put your entire attention on the family you are dealing with at that time.”
• “Both we and the younger trainees have to remember that people are coming to us with a problem and they’ve never met us. And we’re asking them to trust us with sometimes their most personal information, and help to solve a problem that they’re worried about enough to come to the emergency department.”
• “It’s important to listen to people. This is true in every human interaction, but it’s really true in a medical interaction, and gain their trust. And then, when they have a question, to answer it.”
• “Now with hospitals now under significant stress, it’s beyond the emergency department, we work very closely with people all over the hospital. It’s not just the ER and everybody else. We’re part of a team with people inside the hospital who are also in difficult situations that we’re all trying to work together and manage this as best as possible.”
• “We learned over time that patients with COVID can tolerate much lower oxygen levels than normal before they get put on those ventilators. And in fact, putting them on those ventilators might be the wrong thing to do. And if you all recall early on, we were worried we were going to run out of ventilators, right? Well, now we aren’t really running out of them, partly because we’ve learned that we don’t need to use them as much.”
• “All you have to do is look at some of these videos that mechanical engineers have created of what happens to somebody who coughs or sneezes with and without a mask and it becomes obvious. Like I said, it’s not a hundred percent solution, but it’s up there.”
• “I think one thing the government and others need to do, and will start to do, is to be very open about the data, very open about what we know and we don’t know, very open about side-effects, and provide that information on a regular basis.”
• “Doctorpedia is a great concept and it’s already made some great gains. Like lots of things in life – it’s going to be built on growth relationships. And then answering the needs of everybody.”

Relevant Links

• Doctor Profile
• LinkedIn

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:24)
Hello, this is Daniel Lobell with the Doctorpedia podcast. Today I’m honored to have Dr. Till Jolly. How are you, Dr. Jolly?

Dr. Til Jolly: (00:35)
I’m doing great. How are you?

Daniel Lobell: (00:36)
I’m well, thank you so much for doing the show.

Dr. Til Jolly: (00:40)
I’m happy to be here.

Daniel Lobell: (00:41)
I’m happy to have you. I like to get to the beginning and understand why people became doctors, to start these interviews off. What inspired you to go into medicine?

Dr. Til Jolly: (00:54)
My path is not that unusual. When I was a kid, I was interested in math and science and all sorts of things and I had some mentors. I remember one in particular, my pediatrician, in a relatively small town, Greenville, North Carolina. My pediatrician Dr. Trevathan always took an interest and took time to talk with me and explained things to me in a way that I understood. So he wasn’t just doing things, he was trying to have me understand and that made an impression on me. From then, I took courses and did things that were medical and confirmed my initial thoughts, but it was really from an early age.

Daniel Lobell: (01:44)
You know, something about that resonates with me because my pediatrician, Dr. Steven Goldstein was one of the most sophisticated guys that I ever knew as a kid. I’d go in there and he’d rap with me like I was an adult, and there’s something really cool about that. He would tell me stuff and it’s a bit smarter than everything else people were telling me.

Dr. Til Jolly: (02:07)
It’s an important skill that pediatricians have. As children grow up, they’re becoming adults and it’s really important to be able to relate to them more as adults than as children, as they get older.

Daniel Lobell: (02:23)
I liked my pediatrician so much that I kept going to him into my teenage years till I was this older guy with all these little kids in the waiting room. And he finally said, “You know, you have to find an adult doctor”, [Laughs] but I really liked going there.

Dr. Til Jolly: (02:41)
Yeah, lots of people have that experience. I don’t remember how long I went to him, but I’m sure it was longer than I probably should have.

Daniel Lobell: (02:51)
[Laughs]. So you grew up in North Carolina and your folks, they weren’t in medicine?

Dr. Til Jolly: (03:00)
Not really. My dad was a farmer and my mom was a psychologist – she was an educator. She taught in schools and then in the local university, but not really in medicine. I had some cousins who were in the medical field, but not anybody directly.

Daniel Lobell: (03:22)
It’s interesting because both of your parents’ professions in a way are health related. Farmers – because I always think of food as medicine. If you’re doing it right, you’re on good drugs and if you’re not, you’re not, but especially stuff that’s grown out of the ground – would you agree that that’s some of the best medicine you can take in some respects?

Dr. Til Jolly: (03:45)
That’s very true. We really tend to take for granted where our food come from and who creates it and it really is an important part of health.

Daniel Lobell: (03:59)
What kind of farming did your dad do?

Dr. Til Jolly: (04:04)
He was in Eastern North Carolina, so there was some tobacco being grown, which was common at the time, not so common now, and then corn and soybeans and peanuts. And it’s sort of a mix of things. Like a lot of people with small farms, he rotated the crops and managed things and was an important part of the small community.

Daniel Lobell: (04:21)
Did you get your hands dirty too, doing some gardening?

Dr. Til Jolly: (04:25)
Not that dirty. I can’t claim to have gotten my hands all that dirty, but the lessons I learned from them and from their parents, both of them grew up on farms. It’s an important part of one’s legacy.

Daniel Lobell: (04:41)
Yeah. And I said, gardening, I meant to say farming, but I think they’re both pretty related. You said your mom is a psychologist or was a psychologist.

Dr. Til Jolly: (04:53)
Yeah. So she taught psychology. She spent time in schools as a school psychologist and then eventually taught psychology in the university, mostly child and educational psychology. So she didn’t practice as a psychologist, but she did teach it to a lot of people who eventually probably did practice.

Daniel Lobell: (05:14)
So it’s like nutritional health and mental health. And those two people got together and made a doctor.

Dr. Til Jolly: (05:21)
[Laughs]. You could put it that way. Yes.

Daniel Lobell: (05:24)
[Laughs]. So what field of medicine did you specialize in when you went to school?

Dr. Til Jolly: (05:30)
Well, eventually I ended up in emergency medicine. So, being in emergency departments in various places I’ve worked in my career. I started out with a larger interest in surgery and intended to be a surgeon, very much influenced by some mentors I had in surgery when I was in medical school. And then, through a number of things became more attracted to emergency medicine, the variety of practice. I had some mentors in emergency medicine who really drove me in that direction. And that was a choice I was happy I made.

Daniel Lobell: (06:08)
Is it an adrenaline rush type of thing going into emergency medicine? You just really like the immediacy of it, or what do you think it is?

Dr. Til Jolly: (06:18)
You know, it’s interesting, we all could ask a version of that question over time. And every once in a while, something happens that does require that, like the things you see on TV, but most of the time it’s pretty routine. It’s the ability to manage a variety of things coming at you, some of which include an adrenaline rush, but most of which are actually pretty routine. And over time, even the things that others consider adrenaline causing, are more routine after you’ve seen a number of them. And then the ability to try to solve immediate problems and then sometimes work through some pretty complex problems that show up in the emergency department, because that’s the only place that people can go. So there’s a certain reward to it.

Daniel Lobell: (07:09)
So there becomes a point where if everything is an emergency, nothing is an emergency. And then I guess on very rare occasions, what you’re saying is that there’s an “emergency emergency”.

Dr. Til Jolly: (07:20)
Yeah. A typical emergency physician on a shift may see one or two things, or even less frequently than that, that he or she really needs to act on very, very quickly and those happen, but happily you’re part of a team. And you’re part of a team that all knows their roles in those things. So it’s not like orders are being shouted out every 10 seconds. Everybody knows what to do when that happens, everybody does their job and manages the patient, but the vast majority of things are more routine, take a little more time to figure out, take some tests to figure out and then take figuring out what the right thing is to do for the patient, that may not be an immediate answer. It’s like a lot of jobs. People think of police work or firefighting as adrenaline rush type jobs too, but most police, firefighters and paramedics will tell you that a lot of what they do is pretty routine. And then every once in a while, they have to jump in and do something a little more dramatic.

Daniel Lobell: (08:24)
Right. My uncle David ran an emergency room in the Hamptons for years and I would talk to him a little bit about it. I thought being the head of the ER was pretty exciting and he had a similar attitude of “You get used to it”. And the thing that I always found a little tough as a kid was that he seemed very jaded about the loss of life. Does that happen to everyone or is that just my uncle David?

Dr. Til Jolly: (08:56)
I don’t know about jaded about the loss of life. You do see some things that most people don’t see and don’t really have to deal with and you do deal with death sometimes. And you learn how to deal with that and you learn how to process it and learn how to get people through it. I don’t know about being jaded about it. But everybody learns their own way of dealing with the bad things that they see and that they have to manage as part of their professional life and keep it compartmentalized so they can do all the rest of the things they need to do.

Daniel Lobell: (09:42)
I’m curious, you say, “You learn how to deal with it and you learn how to compartmentalize it”. Is there anything that you can share with me and with the listeners about how you deal with it? What are some of your coping mechanisms and strategies that have worked for you over the years?

Dr. Til Jolly: (10:01)
Some of these things are things you’re taught over time. You learn not to keep everything to yourself. You learn to make sure that when you have to have a difficult conversation with somebody, you’re not going to get interrupted. If you have a phone on you, you give it to somebody else so that you’re not distracted. And so you can put your entire attention on the family you are dealing with at the time. And then you’re going to realize that if you’ve been in a difficult situation that can be fairly emotional for the nursing staff, the physicians and for the other people that have to be in the room – sometimes you do kind of a debriefing and you take everybody aside afterwards and talk it out and you talk it out amongst yourselves, you talk about what went right and what went wrong and, and how everybody feels about it. Everybody’s got their own coping mechanisms, but you have to realize that you’re not alone in those situations, and that the service you’re delivering to people who are getting through perhaps the worst moment of their lives, as far as family is concerned, is very important. And you have to keep your wits about you and, and manage that professionally.

Daniel Lobell: (11:15)
What are some of the challenges that are unique to working as an emergency doctor, that someone like me would never think of?

Dr. Til Jolly: (11:25)
Well, I think when people go to the emergency department, they all want an answer, no matter how, whether it’s a broken bone or a heart attack or even a vague pain they can’t figure out, they want an answer. And they come with a set of information, which in our eyes is frequently very incomplete. Usually when I see a patient, it’s the first time I’ve ever seen that person and it’s probably the only time I’m ever going to seen them – there are people that I’ve seen multiple times, but most of the time, it’s my only shot at them. And I have incomplete information and the patients sometimes assume that we know more about them than we do and also assume that we’re probably going to give them a definitive answer when in some cases we’re not – either we’ll get them admitted to the hospital where it may take a few days to sort out their problem, or we send them home and have another physician figure it out, perhaps at a later date. So I think people need to realize that they’re not going to get the complete answer every time and that we’re dealing with lots of other things around us in a sometimes difficult environment. But we really want to do the best for them with the information we have.

Daniel Lobell: (12:45)
Yeah. I think that in the times that I’ve been to an emergency room, you certainly want to go in feeling like you can share something or feel competent in some way. And as soon as you start talking to whoever the doctor in triage is, just let them figure it out because you tell them what the symptoms are, but ultimately I think I specifically have a tendency to try and self-diagnose, which is always or often incorrect. And I imagine, as you kind of hinted to there, you run into that a lot.

Dr. Til Jolly: (13:21)
People do that and everybody manages it differently, but both we and the younger trainees have to remember that people are coming to us with a problem and they’ve never met us. And we’re asking them to trust us with sometimes their most personal information, and help to solve a problem that they’re worried about enough to come to the emergency department. Very few people really want to come there. We all work in a place that most people don’t want to go to and so we also realize that as we’re taking care of patients.

Daniel Lobell: (13:56)
Yeah, I was talking to this other doctor on the podcast about this recently, where you never think that the person who you’re going to put your life into their hands is someone you’ve never met. And we build trust in so much of our life in these relationships with people. And ultimately they’re not the people that you really need to be able to trust, right? They’re not the ones who are going to cut you open. They’re not the ones who are going to potentially stop you from bleeding or whatever it is – it’s a stranger. And there’s something really weird about that. And I suppose, like a big part of your job is, is taking away that weirdness, making it comfortable.

Dr. Til Jolly: (14:42)
Yeah. We talk about customer service, although it’s really more than that. But you really have to learn very quickly and you learn this from your first days in patient care and medical school, how to introduce yourself, how to try to make this person, who’s a stranger, comfortable with you, and ask them questions in a way that gets the answers you need, not interrupt them, let them speak. There’s data, I don’t remember the exact numbers, but it’s a ridiculously short period of time that most physicians give patients to talk before they interrupt. And it’s important to listen to people. This is true in every human interaction, but it’s really true in a medical interaction, and gain their trust. And then, when they have a question, to answer it.

Daniel Lobell: (15:40)
My comedic instincts, the entire time, were to try and interrupt you, as you said, don’t interrupt. [Laughs]. I resisted on your advice.

Dr. Til Jolly: (15:48)
[Laughs]. I figured that might be coming.

Daniel Lobell: (15:52)
So what do you wish your patients knew? Like if there was one thing you could have them come in knowing, what would you advise them?

Dr. Til Jolly: (16:02)
I think specific to the emergency department, I think they need to realize that everybody’s job there is to help them in one way or another, whether it’s the person who registers them or the nurse who triages them or the nurse in the back who’s taking care of them or their physician or their residents and physician assistants, anybody that’s going to take care of them is there with a goal of helping them. But they may not get exactly what they expect or what they’re asking for, or what somebody told them they might need. And that really speaks to where they get information. Whether it’s their friends or the internet, or Dr. Google as we call it, or other sources or the latest article they read in the newspaper. So I think they need to be willing to listen and willing to understand, but also realize that everybody there really has their best interests at heart.

Daniel Lobell: (17:02)
Yeah. I think that’s good advice. I know that right now, people are more on edge than ever because of COVID 19. Does that translate over to the medical staff as well? How has it changed the way you guys interact with patients these days?

Dr. Til Jolly: (17:20)
It’s had remarkable effects on the medical system. When you go to work a shift now in the emergency department, there’s always a little bit of danger from either infections or occasional violence or other things that we all accept as part of the job. But this is a unique threat. And so now when you come to the emergency department, which we still want you to do, we don’t want you to put off things you really need, but the entire staff is always wearing protective equipment. We all know of physicians and nurses who have gotten sick from COVID, and some physicians, nurses, paramedics, and others have died, unfortunately from COVID. We all are aware of that. I know a few who have gotten sick, I don’t know anyone who has passed away, but it’s a risk that we’re taking to do our jobs, as opposed to the usual infectious risks, which are the occasional patient, this is now anybody.

Dr. Til Jolly: (18:26)
So you’re constantly wearing protection and constantly trying to take care of yourself and each other in a completely changed environment. And now with hospitals now under significant stress, it’s beyond the emergency department, we work very closely with people all over the hospital. It’s not just the ER and everybody else. We’re part of a team with people inside the hospital who are also in difficult situations that we’re all trying to work together and manage this as best possible.

Daniel Lobell: (18:56)
What does that look like? What is the managing that’s going on?

Dr. Til Jolly: (18:59)
There’s a collection of things. So first we’re all making sure we all have the right protective equipment on, whether it be masks or respirators and goggles and things like that. And this has been an odd disease in many ways. One of the things that’s very interesting about COVID is the fact that the way we’re managing it now is different from the way we managed at the beginning, because we’ve learned. So we exchange information with our doctors who work in the ICU and with our doctors who work outside in clinics to figure out what’s the best thing to do for patients who are particularly sick, whose oxygen levels are low, who need to go to the hospital. What’s the best way to manage people who you can send home? And now we send them home sometimes with those pulse oximeters that measure the oxygen level in your blood, from your finger. We’re even now developing therapies for what are called monoclonal antibodies to send people to clinics to get those, to try to keep them from coming to the hospital. So really it speaks to how the system works together.

Daniel Lobell: (20:08)
How has it changed in terms of what you guys are doing? You mentioned briefly at the onset of what you were saying that you’ve changed the way you handle it, as you’ve learned, what you tell the patients to do differently, but what have you guys been doing differently on your end?

Dr. Til Jolly: (20:28)
It’s interesting. We need to get a little bit clinical here. When patients come in and are very sick and have significantly low oxygen levels because of pneumonia, because of infections in their lungs, they frequently need to be put on ventilators on breathing machines and have tubes put down their throat to help to protect them. But we learned over time that patients with COVID can tolerate much lower oxygen levels than normal before they get put on those ventilators. And in fact, putting them on those ventilators might be the wrong thing to do. And if you all recall early on, we were worried we were going to run out of ventilators, right? Well, now we aren’t really running out of them, partly because we’ve learned that we don’t need to use them as much.

Dr. Til Jolly: (21:20)
And then another fascinating thing that patients, when they get admitted and they’re sick, they have done to them what is called proning, which means that instead of lying on their back, they get put on a bed, usually a specially designed bed on their belly, in the prone position. And that position, for fairly complicated reasons, improves their dynamics of breathing. And so they end up spending most of the time face down because that improves their breathing mechanics. And we’ve seen some very good results, but nobody would have thought that was going to happen early on. I don’t even know how that was discovered, but now it’s pretty common.

Daniel Lobell: (22:01)
Wow. I never heard of that before. The face masks – I hear conflicting things, obviously the mainstream narrative is to wear them but I saw an article put out by the CDC a month or two ago that said that maybe they don’t work. What’s your opinion?

Dr. Til Jolly: (22:23)
They work. I’ll give you a slightly longer answer than just that they work, but they do work. And the problem with reading the occasional article is that, taken in isolation, you miss the pattern. And it’s true that some of the messaging about this has changed, but they do work and they work in two ways. The first is they keep anybody who might be infected from transmitting as much infection outside, even with normal breathing or speaking or a cough or something like that, they’re not perfect. They’re not a hundred percent seal, but they’re a lot better than not having a mask. And all you have to do is look at some of these videos that mechanical engineers have created of what happens to somebody who coughs or sneezes with and without a mask and it becomes obvious. Like I said, it’s not a hundred percent solution, but it’s up there. And we don’t have great data on how much a regular cloth mask protects you, but just logically it does. We have a little bit of data and logic would tell you that if you’ve got a mask on, it protects you from splashes and probably keeps some particles away from you. So it is quite true. If everybody would just wear a mask, we would be a lot better off.

Daniel Lobell: (23:44)
What about goggles? I know you mentioned that you guys wear goggles – should the general population also be wearing goggles and if not, then why not?

Dr. Til Jolly: (23:51)
Eye protection is potentially helpful. It’s probably not as helpful as masks. There’s no reason not to, so there’s no danger, just like there’s no reason not to wear a mask. I mean many of us have worn masks for eight or ten hours at a time long before COVID in the hospital and it’s not a problem. Goggles and masks are certainly not going to hurt you. There’s no harm done. There probably is some protection to your eyes and they certainly protect from splashes. So we wear them because we’re in significant danger of getting splashed from various procedures. The general public certainly can wear them. If nothing else, what they do is they help remind you to keep your hands away from your face. They’re just an extra protection. They are not a replacement for masks and shouldn’t be seen as a decent substitute for that.

Daniel Lobell: (24:53)
This is probably just silly, but I was thinking about it and I have no problem being silly. It’s what I do. But I was thinking about it the other day. People will protect their eyes from this disease. Those are, you know, openings in the face. You protect your nose and mouth, nothing with the ears. Is it impossible for infection to travel because isn’t the ear, ear, nose and throat all connected?

Dr. Til Jolly: (25:17)
I suppose anything’s possible, but the ear doesn’t really have the kind of mucus membranes that the nose and the mouth do, in order to absorb it. Because if you think about what’s inside your ear canal, which you’ve probably never looked, there’s really skin, there’s not really a mucus membrane. So there’s no good opening for viruses to get in that way.

Daniel Lobell: (25:40)
So you could have a COVID patient potentially cough in your ear. You should be okay. [Laughs].

Dr. Til Jolly: (25:48)
You’d want to avoid that of course, but if they did, then the particles would get on you and then you could pretty easily spread them to your mouth and nose if you wanted to.

Daniel Lobell: (25:59)
Right. I know there’s lots of new therapeutics. You talked a little bit about some of the new things and procedures you guys are doing. How optimistic are you for this being a thing of the past in the near future?

Dr. Til Jolly: (26:14)
Well, like lots of things, it kind of depends on your definition of the near future. We’re going to be at this through the winter and spring easily. I think some of the treatments we’ve come up with are helpful. You’ve heard of a drug called Remdesivir, which is an antiviral drug. There are things called monoclonal antibodies that are very promising to try to keep keep patients out of the hospital. I think those are helpful, but they’re certainly not cures. The vaccine at this point is quite promising. We don’t have the final data on it yet, but it’s quite promising. Truly it’s a great scientific achievement to have been developed as fast as it was. We have a lot of work to do to manufacture enough and to get the public to accept it. But if the vaccine is reasonably close to what we think it’s going to be, and we can get the population to accept it, then into 2021, things should start to ease gradually over time.

Daniel Lobell: (27:20)
Yeah. I am hearing from some people that there’s a hesitancy to take the vaccine. One person made a point to me that I thought was kind of interesting, a female friend of mine. She said, “Well, we don’t know the effects of it on fertility. And because it’s so new, how could anybody know, how could it have been tested?” What would you say to someone like that?

Dr. Til Jolly: (27:47)
Well, it is true that we don’t know everything there is to know about this vaccine. And I, however, certainly trust the independent scientists, the FDA and the independent scientists on other countries’ scientific advisory boards, Dr. Fauci and other clinical leaders. The data that’s going to be gathered on this vaccine is going to be remarkable in scope. The folks that receive it will be followed. The people that are in the experimental groups will be followed for a long period of time. I don’t know that there’s any particular reason to believe that it would have specific effects on fertility or otherwise. There are all kinds of things you read on the internet. I think one thing the government and others need to do, and will start to do, is to be very open about the data, very open about what we know and we don’t know, very open about side-effects, and provide that information on a regular basis. And hopefully we’ll start to see that more and more.

Daniel Lobell: (28:53)
Yeah. I want to shift gears a little bit away from COVID now and onto the internet, the worldwide web, the exciting worldwide web. I will congratulate you. I understand that you have recently joined Doctorpedia as a founding medical partner and as our chief medical officer of the emergency medical channel – what are your hopes and dreams for that channel?

Dr. Til Jolly: (29:14)
I think there is a tremendous amount of information available to patients from all sorts of sources and what I hope to do with this channel is to identify a priority list of the important things that patients ask about related to emergency medicine, whether that be for adults or for children and for injuries or illnesses, things that are sudden, things that are more chronic, and try to provide them with a credible review of that condition, and something that they can trust and also give them something they can refer to. If, for instance, they’re discharged from the emergency department and they didn’t quite understand what they were told, or they didn’t quite understand exactly the ramifications of whatever their problem was, they can come to Doctorpedia and see, “Oh, that’s what that doctor meant”.

Daniel Lobell: (30:20)
Ah, so it can be very specialized in other words for whatever the person is dealing with.

Dr. Til Jolly: (30:26)
As it grows. I think within Doctorpedia’s model, which is quite impressive, really a very physician focused way of reviewing specific conditions, so that either through a video and audio file, a brief video of a review of a condition or written information really written or described in a way that patients can understand, but really also focused on what we believe are the most common concerns of patients who go to the emergency department, which really can run the gamut from one specialty to another.

Daniel Lobell: (31:04)
Can you specify a little bit about what some of those concerns that you’ve seen are?

Dr. Til Jolly: (31:09)
As we look through this, we talked about COVID earlier, and I think that’s a current one – hopefully that’s going to become a thing of the past at some point, but simple things like allergic reactions or anaphylaxis, something that many people potentially suffer from and need better information on, or sepsis, which we know is a major cause of severe illness presenting to an emergency department and providing patients with an understanding of what that is. And then as we look forward to the future, it will likely include segments about what to do if you have chest pain or what to do if you have a minor burn or what to do if you think you might’ve broken your ankle or what to do if you think somebody is having a stroke and how to assess them. And then even some things more administratively, like “What does it mean to be in the emergency department, who’s taking care of me and what does the billing mean? And how does this interact with my normal doctor?” – All sorts of administrative things that people don’t understand and don’t think about until later.

Daniel Lobell: (32:22)
Yeah. Fantastic. I didn’t even of asking you that, but I think that will be a very valuable resource to people. I don’t even know what it means whenever I’ve been to the ER and the billing or anything, you kind of look at it and it’s like another language you don’t know. You’re like, “I guess it’s right. I hope, I think”, and also your mind is on so many other things.

Dr. Til Jolly: (32:46)
And most people remember only a small percentage of what they’re told on a good day and when they’re under stress and in pain or sick or worried about their family member, they remember even less. And so providing them with a resource to understand that a bit better is a good service.

Daniel Lobell: (33:11)
Yeah. I don’t remember anything. I don’t even remember who I’m talking to. [Laughs].

Dr. Til Jolly: (33:17)
[Laughs].

Daniel Lobell: (33:17)
No, it’s true. It is. And when you think about the incredible amount of information you take in on any given day and how little of it you retained. In fact, I was talking to my wife about this recently. I said, “You know how many days I’ve just totally forgotten.” Even this year, so many days go by and you don’t even realize that day happened. Isn’t that crazy? You lived on earth for a day. You have no recollection of it.

Dr. Til Jolly: (33:42)
Yeah. The whole thing kind of went by and you wondered what you did. Well, you know, let’s think about that in a stressful situation.

Daniel Lobell: (33:50)
And everybody talks about how they want more time in the world, but the time that we have here, a lot of us don’t even know we had it.

Dr. Til Jolly: (33:58)
That’s a good point.

Daniel Lobell: (34:01)
Technology is changing constantly. And specifically with regards to apps and internet technologies, how do you see this changing what you do?

Dr. Til Jolly: (34:11)
Technology is a major part of what we do. And I remember early on my career, this will date me a bit, but early in my career, one of my colleagues being very proud that he convinced my chairman to purchase a fax machine to put into our emergency department. And the chairman said, “Oh, we’ll never use that.” So that was really early placement of technology in our ER, that we use all the time amazingly, but you know, technology is changing pretty fast. Medicine tends to be a little behind the rest of society sometimes in adopting technology. I think medicine or healthcare just tends to move slowly in lots of ways. It’s very tradition bound, and also heavily regulated. And there’s a fair amount of risk in the practice of medicine.

Dr. Til Jolly: (35:08)
For medicine to adopt something new, it has to be proven probably to a higher degree of certainty than perhaps in other industries. It’s not really a knock on either one. It’s just the truth. But there are lots of technologies, the availability of information in an instant has changed both patients’ perceptions and the way physicians practice medicine. We can now bring up information on patients and on conditions instantly, much differently than the way we used to, by looking through paper charts and things like that. That’s just a simple thing that people don’t even really remember how to do anymore. And then if you look toward the future, our communications methods are much better than it used to be between email and faxes, but then there’s some of the risks of social media.

Dr. Til Jolly: (36:03)
Some of the information can flow quickly and it can be bad information, or it can be good information. And then if you look forward to the way that certain technologies will apply, already seeing the application of artificial intelligence, in certain parts of medicine, and that is going to get bigger and bigger, partly because there’s a lot of money in it. But there’s also a lot of benefit to be had by essentially putting more and more brain power, whether it’s human brain power or technical brain power into decision-making, an analysis of things like x-rays and cat scans and pathology slides and things like that. But we also have to remember to maintain the human touch because at some point people want a human helping them through whatever it is.

Daniel Lobell: (36:53)
Yeah. Or at least something that seems like a human as the robots get more advanced, if it can pass for a human. [Laughs].

Dr. Til Jolly: (37:02)
[Laughs].

Daniel Lobell: (37:02)
And probably faster than we’d like to think. Are there any apps that you personally engage with to monitor your health?

Dr. Til Jolly: (37:11)
It’s interesting – I’m a bit of a traditionalist. I have an analog watch that I like. So I have not really adapted to that. I run and exercise regularly, and I know how to take my heart rate manually if I need to. I keep up with things that way, but I certainly have friends and colleagues who really have gained great benefit from these sorts of things. In fact, the practice of medicine with the ability to do what’s called remote patient monitoring and to monitor these things in patients with heart conditions or with diabetes or with congestive heart failure or with sleep apnea to get data to the physician, on a regular basis, provides monitoring that’s better and better all the time.

Daniel Lobell: (38:08)
I have sleep apnea and I have a machine that’s supposed to be sending data and for the last year or so, I thought it was, only to find out that no one’s been collecting this data for all this time. I just spoke to my doctor. He goes, “Where’s it going?” I said, “I don’t know.” I think there’s a danger in that too, when you think you’re being watched and you’re not.

Dr. Til Jolly: (38:30)
Yeah, if we’re generating data, then we have to figure out what to do with it.

Daniel Lobell: (38:36)
And I thought, “How egocentric am I that I think somebody’s sitting there and watching the way I sleep every day.” Like maybe people have better things to do.

Dr. Til Jolly: (38:46)
[Laughs].

Daniel Lobell: (38:46)
[Laughs]. But it gave me some kind of sense of false comfort just knowing.

Dr. Til Jolly: (38:53)
It gave you a sense of comfort, but somebody needed to explain to you how much comfort you should feel from that.

Daniel Lobell: (39:00)
Very little. So wrapping up here. It’s exciting to have you as part of Doctorpedia. I’ve really enjoyed talking to you. What do you think Doctorpedia can do to better serve the online health space?

Dr. Til Jolly: (39:19)
I think as Doctorpedia comes along and grows, it’s a great concept and and it’s already made some great gains, but I think as we grow the concept and the format and the content, I think growing your relationships with the more organized healthcare community, whether it be health systems or practices, to really help to figure out what they need and what’s going to help them, and also engaging with specific patient groups to help figure out what they need and what’s going to help them. So it’s like lots of things in life – it’s going to be built on growth relationships. And then answering the needs of everybody.

Daniel Lobell: (40:00)
Yeah. I think hopefully we’re doing that and it’s just going to grow and grow. And I look forward to watching your channel grow and grow and all that that you shared, to me sounds like very valuable information and the prospect for even more valuable information to come. So thank you very much. I appreciate you giving me this time and I hope you enjoyed the interview.

Dr. Til Jolly: (40:24)
Thank you. Thank you. I did enjoy it.

Daniel Lobell: (40:29)
Thank you so much, Dr. Jolly. This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.