Episode 10 - Understanding the Science of Practice in Neurosurgery and Medicine
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Dr. Tony Asher, who specializes in brain and spine surgery, talks about the science of practice in this episode of Back Talk Doc. He introduces this concept, that’s being done on a national level, in order to accomplish three goals: boosting healthcare, cost efficiency, and patient satisfaction. These outcome science programs aim to collect quantitative data based on studies and experience, and analyze that information, leading to better care for patients.
He also shares how physicians can be involved in this initiative, without sacrificing the heart of medicine. There is a risk of devaluing the patient-physician relationship, especially if you only treat their case as part of a data set. This relationship should not be sacrificed for the sake of data.
Dr. Asher stresses the importance of medical practitioners staying up-to-date with the latest knowledge and drawing up from their own experiences to determine the best course of action for them.
Key Moments In The Episode
- Evolution of clinical care in neurosurgery - 05:48
- Practical aspects of the neurosurgery practice - 08:35
- How healthcare groups are being measured in terms of performance, quality and outcomes - 14:08
- How the processes benefit patients - 18:30
- Efforts done on a national scale - 21:23
- How to reconcile the art and science of medicine - 23:18
- Clarifications - 28:36
- Additional resources for patients who want to be more involved in their care - 30:42
- Tips to improve your own personal health and wellness - 33:14
Links Mentioned In The Episode
- “The Science of Practice”, Neurosurgical Focus Journal
- American Association of Neurological Surgeons
- NeuroPoint Alliance
- American Academy of Orthopedic Surgery
- American Spine Registry
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery & Spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75 years.
And now, it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 00:34
Thank you for tuning in to Episode 10 of Back Talk Doc. I really appreciate you taking the time today to hear a message that is not talked about very often amongst the public. Up until now, on our first nine episodes, we focused predominantly on clinical aspects of spine care, and I've tried to educate and help teach you, the listener, on how to take care of your back and how to get evaluated in a way that makes sense, and just arm you with some information so you can make better decisions.
Sanjiv Lakhia: 01:08
Today, we're going to shift gears a little bit from the clinical side of the equation, to more of a what I would term a behind-the-scenes effort that has been going on across the country and really being led by today's guest, and that is Dr. Tony Asher. I am honored to have him on the show today. Dr. Asher has been a practicing neurosurgeon with Carolina Neurosurgery & Spine Associates for about 25 years, and Tony is a internationally renowned scholar, teacher, clinician in the field of brain and spine surgery. And that's really not an understatement. His bio is extensive.
Sanjiv Lakhia: 01:44
And just a few brief highlights: he's currently the President of the Neuroscience Institute at Atrium Health. He's the Director of Adult Brain and Spinal Cord Tumor Programs at Levine Cancer Institute. He's been a residency program director, and he sits on the boards of many of the major foundations across the country as it pertains to the field of neurosurgery. And he's really spearheaded the effort to bring, as he calls it, the science of practice to the forefront in the field of neurosurgery. And that is, helping to demonstrate and support our clinical decision making process that can ultimately lead to better outcomes for you, the listener, as it pertains to your back pain.
Sanjiv Lakhia: 02:25
So Tony, thank you for coming, and really, welcome to the show today.
Dr. Tony Asher: 02:28
Sanjiv Lakhia: 02:30
Tony, take us back to the early part of your career and just kind of help the listeners understand your path to the field of neurosurgery. And for someone who really doesn't know you or know what you're about, I'm going to just open up the floor to you. Share your thoughts and help people get to know you better.
Dr. Tony Asher: 02:45
Well, thanks. I really appreciate the opportunity to participate in this today. This is a... really been looking forward to it. And I'd say that I was not one of those individuals who always knew they wanted to do neurosurgery. There's a lot of people I know who, at a very early age, understood that this was going to be their calling, and I can't say I'm in that crowd. I knew I wanted to be in medicine because I felt that I could make a difference in that field.
Dr. Tony Asher: 03:11
I originally started in general surgery, actually. I was very interested in the field of immunotherapy and spent about four years at the National Cancer Institute doing research with a gentleman named Steve Rosenberg, a fantastic individual, great mentor, incredible mind, and really one of the pioneers in cancer therapy in the United States. Steve was a general surgeon, had been recruiting general surgeons to his lab. I spent a lot of time talking to him about career paths and after, again, spending almost four years doing bench research, matched into a general surgery program and quickly realized that there was a disconnect between my clinical interest in scientific interest. And if there's anybody who aspires to go into medicine, particularly in academic career, I would advise them that it's really important early on to make sure those things match up.
Dr. Tony Asher: 04:06
When I went back to residency training and realized that the clinical applications of general surgery weren't quite as interesting to me as the scientific ones, I was able to and was very fortunate to be exposed to neurosurgery at the University of Michigan, which was, at the time, and really still is, a phenomenal training program. Well, my mentor became... nickname is Buzz, but it's Julian Hoff, one of the giants in our field. Dr. Hoff influenced me to go into neurosurgery, and I realized that my clinical interest all of a sudden became aligned with something I was very excited about.
Dr. Tony Asher: 04:39
I had always been interested in neuroscience, but I realized in direct patient encounters just how exciting neurosurgery was. So, I made a career change at that point, and then found some ways to adopt my scientific interest to neuroscience and never looked back. I did do my training at University of Michigan, and then I've been in Charlotte now for 25 years. It's been a really fantastic ride.
Sanjiv Lakhia: 05:02
I appreciate you sharing that. I've worked with you now for almost six years, and you've always struck me as someone who has a diverse set of talents. And to hear how your interests kind of blended together with the clinical side of things, it really makes a lot of sense. It's to everyone's benefit, for sure.
Sanjiv Lakhia: 05:20
Today, the topic here we're going to talk about is an area you've put a lot of blood, sweat, and tears into over the last probably decade or so, and that is the whole idea of developing datasets, tracking our clinical outcomes to ultimately lead to better care for our patients in the field of neurosurgery and spine surgery, to be specific. Over the course of your career, how have you seen clinical care evolve? What are some of the key kind of tipping points you've seen in the field of neurosurgery?
Dr. Tony Asher: 05:48
The main tipping point in spine surgery from my standpoint is that I'd say about two decades ago, maybe a little more than two decades ago, spine surgery went from being something that was practiced by a relatively small number of individuals at the highest end... So, most neurosurgeons performed some spine surgery, but by modern standards it was relatively rudimentary. Basic decompression surgery instrumentation was something that we often did in conjunction with orthopedic surgeons because that was just kind of what they were doing. What really was the game changer was the development of technologies that made fusions in particular more accessible to more people. It took a bit of the art out of it, but it made it easier for individuals who perhaps weren't as mechanically minded as others to apply these technologies in a variety of clinical settings.
Dr. Tony Asher: 06:43
That resulted in two things. One, more patients who needed advanced spine surgery were able to access those techniques. But on the other hand, it also resulted in an explosion of spine surgeries. And I think for the most part, that explosion was appropriate because there were a lot of people who were just not receiving appropriate therapy. On the other hand, I think that most individuals would agree, if we did a sober analysis of what's happened over the last two decades in particular, there's been an increase in the application of these techniques that probably goes beyond the need of the population. To what extent is something that we can debate, but I would say that in terms of procedural care in general, there probably is too much therapy.
Dr. Tony Asher: 07:29
That doesn't mean that patients are necessarily receiving procedures when they didn't need a procedure at all. It may mean that the procedure that they receive is more surgery than they need, and that has to do with some conflict factors that I think we'll touch on later about incentives in medicine. But unquestionably, the advanced state of technologies and the fact they are more accessible to more individuals, they are easier to apply, and safer to apply means that there's been an explosion in surgeries, mostly for the good, but in some circumstances, maybe in ways that are putting stresses on our healthcare system that we really need to start looking at very critically.
Sanjiv Lakhia: 08:07
Yeah, no, I think that's very well said. And that ties into my next question for you. As we were preparing for today's discussion, I did have a chance to review your 2013 article in the journal, the Neurosurg Focus Journal, which you titled, The Science of Practice. And elaborate for our listeners the practical aspects of this in the daily life of a neurosurgeon and how it can be beneficial to the neurosurgeon and the patients. And I think you're really getting at, how do we make ourselves better and more accountable?
Dr. Tony Asher: 08:35
Right. So in that paper, and this has been something that I've been interested in for a long time, we tried to address not just narrow technical issues, but also philosophical issues as they related to why we need to be doing what we're doing. So philosophical, intellectual, practical issues. And so, in that regard, I took a step back and I said, "Let's look at information flows in general, particularly in adult learners." And we made the following points.
Dr. Tony Asher: 09:07
One, there had been extensive studies performed over the course of the last few decades looking at experts in a variety of domains; professionals at the highest levels of their fields who are really making a difference in what they do. And universally, those studies showed that those individuals had a quality called metacognition, which is to say that they were constantly aware of deficits in their own knowledge base and trying to fill those deficits, and oftentimes doing that on the basis of their experiences. They were telling them that in this particular circumstance, I did not know how to handle this in the appropriate way. And so, I had to obtain the information to allow me to do it. So, it was based on their experience in their daily lives and in their professions.
Dr. Tony Asher: 09:59
If we fast forward to another form of research that was going on around the same time that people are looking at, if you will, expert experience, adult learning was really being looked at differently than learning in elementary school, in college. And it was being determined that adults really had to learn through experience in order for it to stick, in order for it to have meaning, and in order for it to have a greater impact going forward. And then, finally, it was observed that not only was that form of learning in experience important in terms of making you better able to assimilate the knowledge, you're actually creating new knowledge by pulling various elements out of experience, understanding your experience, and then creating new insights.
Dr. Tony Asher: 10:54
That was really a revolution when people started thinking about it. And it sounds almost matter of fact. Most of us would say, "Look, I understand that. Every day, I'm going about my life, and I'm experiencing these different things, and I learn through my experience." But trying to make that a regular thing, first of all, and then making it a scientific thing as opposed to just something that's casual is really where this outcome science started coming in. So again, the observations that experts routinely were engaged and learning from experience; that experience is a great way for adults to have a meaningful educational experience. And we can derive new knowledge from analyzing experience, where the core observations and philosophical underpinnings for what we ended up developing our outcome science programs around, which is the idea that we can and should, in a regular way, collect information from experience; in this circumstance, our professional experiences as physicians. Analyze that and use that to improve patient care on a daily basis.
Dr. Tony Asher: 11:55
That was really the revolutionary part. And so, this idea, the science of practice, is the idea that as we practice, it literally can become a scientific enterprise. It is not just our interactions with patients in a traditional sense. It is looking at our relationship with patients and perhaps being even more responsible by saying, "In this encounter, we are going to, in a regular way, record patient experience." They're going to tell us what their baseline experience is. They're going to tell us how they experienced their care. They're going to tell us whether or not they had a good care experience. We are going to objectify that information. And then, down the road, we'll compare that patient experience to other patient experiences to understand how we can improve care going forward.
Dr. Tony Asher: 12:37
That is, to me, what we're trying to accomplish with all of our outcome science programs going forward. It was really the philosophy and, I would say, blueprint that we outlined in this paper and, as you mentioned, general neurosurgery focus.
Sanjiv Lakhia: 12:53
Yeah, I really enjoyed that article. Most patients, if you're listening out there, you understand that. You expect your doctors to do continued education through their career. Most are aware that we're required by the state medical boards and our professional societies. But your article, it really talks about going well beyond that, and I felt like it blended the idea of personal growth that's really out there in the business world. I have a lot of friends who are in the business world, and they are constantly looking at self-improvement, self-reflection, and it really takes that kind of corporate mindset and blends it with the healthcare field. And something really special can be created from that type of process.
Sanjiv Lakhia: 13:28
And then, on a micro level, I feel like I ask my patients to kind of do that for themselves on a day-to-day basis as we treat their back pain. We want them to collect their data, report their experiences. We have collaborative discussions about what the best plan of care would be. So, it makes total sense for it to be infiltrated through our clinical care pathways and lead to better care for our patients.
Sanjiv Lakhia: 13:50
Talk to the listeners about... You mentioned this a little bit, but talk to the listeners about the different ways healthcare groups now are being measured in terms of performance, quality, and outcomes. Just for an individual who really has no idea that this is going on, talk to them about how this is being done and maybe perhaps how a patient could benefit from that.
Dr. Tony Asher: 14:08
I guess I'm going to answer that in two different ways. First of all, everyone is aware that we are being externally evaluated, primarily by individuals who are paying the bill for care. And that's appropriate because they can and should derive value from what we end up doing with and for our patients. My concern about most of those external methods right now, even though they're described as value-based, is that in general they're much more apt to emphasize the cost of care as opposed to what I think clinicians and their patients would describe as the quality of care. And I'm not saying that we shouldn't be looking at cost of care. Healthcare is a $3 trillion industry in the United States. It'd be the sixth largest economy in the world if it were standalone, and there are estimates that up to 20% of diagnostic and procedural care are not yielding value.
Dr. Tony Asher: 15:08
So, we have to look at cost. But looking at costs in isolation or suggesting the cost is effectively a surrogate for quality more generally is not where we need to go. So, being our patients' advocates and also looking at things in a much more comprehensive context means that we as clinicians need to look at quality and ask what quality means. And so, to me, what clinicians are doing in addition to looking at the economic efficiency of care are also looking at things like patient experience.
Dr. Tony Asher: 15:39
So, we have things called patient reported outcomes, which are these validated measures that you're very familiar with and you've incorporated into your practice. Or, we ask them about where they are right now. You're in my office, you're probably here because you have a problem. Let's see if we can quantify that problem. What's your level of disability? What's your level of pain? What's your quality of life? And establishing a baseline, and then evaluating the patient experience as they go on through the treatment course is critically important in defining what they're doing and as part of the systems that we're using to evaluate quality going forward.
Dr. Tony Asher: 16:12
On the physician side, we have to be very self-critical. We need to be asking questions of ourselves regarding how often we're applying different strategies, whether we are doing the least invasive thing, at least as surgeons, that we need to achieve a particular outcome. What are our complication rates? What are our own successes? So the patients are reporting their experience of care. I'm applying a particular therapy. In a way, they're rating us when they're talking about these various experiences. And finally, patient satisfaction, again, not as an isolated thing. A lot of folks have been talking about patient satisfaction, again, as a surrogate for all types of quality. I really don't see it that way. I think it's an element, a very important element, but not the only part of this equation.
Dr. Tony Asher: 16:54
Yet, as somebody who's been a patient too many times for musculoskeletal issues over the last several years myself, I do think satisfaction is important. And I think that our patients telling us whether they were satisfied, i.e., whether we had achieved a mutually agreed upon goal at the end of this care pathway, is critically important. Those, to me, are the important ways that we as clinicians can get to this. And hopefully, Sanjiv, if we combine the economic portion of this with these clinical aspects that we've just discussed, we can get closer to not only appropriately measuring whether or not we're achieving what we want to, but also moving the ball forwards from the societal perspective, because we all need to be part of improving healthcare.
Sanjiv Lakhia: 17:37
So the end game with this approach, if I hear you correctly, is number one, improving the quality of care we're providing our patients. Number two, keeping our eye on the ball with cost and cost efficiencies and how we provide that care. Number three, really being focused on how satisfied is the patient experience. And it makes sense. I mean, you can't fly, you can't have an automotive experience without being asked to respond to how your experience was. I think these processes are throughout the economic environment. And for us to get that going through the healthcare setting makes total sense.
Sanjiv Lakhia: 18:16
So, you spoke a lot about the importance of clinical data collection registries and demonstrating positive outcomes. And you may have just answered this, but do you have anything else to add in terms of how you view that these processes ultimately benefit our patients?
Dr. Tony Asher: 18:30
Well, if we rely on anecdote, then I don't think that we're ever going to get where we need to be. The idea that any individual would say, "I recognize quality when I see it," which is frankly what the attitude was many, many years ago, and in some circumstances, fortunately in smaller quarters still today, we won't make progress. We have to objectify this. Data is driving improvement in every domain. You mentioned it earlier on. In the corporate world, and particularly manufacturing, going back many decades is way in advance of medicine in terms of its daily commitment to understanding things in a very quantitative way and taking very regular approaches to understanding what's happening in front of us and how we can improve it. I think that adopting those philosophies and those methods is going to be important for us and our patients and making it a very regular thing.
Dr. Tony Asher: 19:35
I will say... I want to make sure everybody understands that I'm not comparing medicine to a manufacturing process per se. And we have unique challenges, not the least of which we're dealing with human systems that folks in various industries do not face. We, in particular, have a hard time developing ideas about what constitutes a quality outcome in certain circumstances. What I mean by that is that quality is really something that's defined by individuals and groups. I can tell you that, excuse me, as a patient, I bet I had a different perspective about what my outcome should be than my employer or my insurance company. We all have different objectives in this game. I think that the payer wanted me to achieve a good outcome, but they wanted that to be achieved at the lowest possible cost. My employer wanted me to get back to work as soon as possible. I wanted my pain to go away. Those things were complementary, but frankly, they're different outcomes.
Dr. Tony Asher: 20:32
So, I think it's important for us as we have this data dialogue to recognize the fact that we have different objectives here, and that's fine, but the perspective of all stakeholders in the equation needs to be taken into account. I will mention one other challenge that we have, interestingly, particularly in spine care, which is obviously a huge focus of your practice, is that we can't always agree what the problem is. So, I would contend that a clinical problem in any musculoskeletal disorder involves a symptom, involves a structural issue, and probably other factors. And that combination is really what we have to agree to. So if you and I as folks, we're data experts, can't even agree what we're treating, we're going to have a problem doing comparisons down the road from an economic and clinical outcome standpoint.
Dr. Tony Asher: 21:23
So what we're working with on the national level, trying to develop a more regular way of categorizing diagnoses in a musculoskeletal context. And at least in the largest categories, having universally accepted and then ultimately universally applied standards for...Here's an apple, here's an apple, here's a pear, here's a pear. If we can't make those types of comparisons and do it in a regular way, i.e. there has to be fidelity associated with it so that a clinician in Buffalo is seeing it and a clinician in Ann Arbor is seeing it, and they're both agreeing that it's the same thing. Unless and until we can get to that point, and we're working hard on the national level to create those definitions, we won't be able to move the ball forward. And I would say that that's a major emphasis right now in developing our data systems to get to that fidelity in clinical definitions.
Sanjiv Lakhia: 22:19
Okay, so here's my concern with that. As I've kept my eye on the ball in terms of the data dialogue, as you term it, and I would even lump that in a little bit with the evidence-based medicine movement that came kind of before is, how do we as clinicians reconcile that, which on some degrees speaks to putting things on autopilot a little bit or having people put down the same clinical care pathways based upon diagnoses? How do we reconcile that with maintaining the art of medicine, which I would say is a primary reason why patients come to see their doctor, is because they want to be felt like they're being treated as an individual and not feel like, as you said before, like manufacturing where there could be on an assembly line. So, how do we reconcile as practicing doctors, maintaining our autonomy and our decision making process while still keeping our eye on the ball and asking those tough questions? Is what we're doing the right thing?
Dr. Tony Asher: 23:18
That is a fantastic question. And I think it really gets to the heart of what we're trying to accomplish, and the heart of why we went into this pursuit in the first place. So, I would say that the clients and the other folks who are out there who are looking at this in those traditional systems, i.e., let's look at a traditional manufacturing process are assuming that someday we're just going to put all this into a big equation and AI is going to be determining what every patient coming in can and should get in terms of care, and we're just not going to need to have clinical decision makers because computers are going to be doing it for us. And I reject that, not just because I'm a physician and I think that I need to declare, that obviously there is a self-interest and a collective interest in medicine that we need to look at and acknowledge that maybe some of those things could be biasing our opinions towards having physicians more meaningfully involved.
Dr. Tony Asher: 24:15
But I would say that independent of those self-interests, there are good reasons why we need to keep the physician in the equation, not the least of which is the care is rapidly evolving. In fact, it is evolving so quickly that I would maintain that these traditional paradigms of developing information and applying them just can't even keep up. So in that regard, clinicians need to be aware of newer methods and be able to apply them in a meaningful way. We can't wait years for randomized trials to tell us what to do, particularly in some of the other diseases we take care of like cancer. We just don't have decades to figure things out. I would say that that one of the advantages of these quality systems is that a number of folks are promoting them as ways of more rapidly getting to a collective idea about what is more likely going to work.
Dr. Tony Asher: 25:09
So what I would say, Sanjiv, is what I've envisioned going forward is a combination of methods that allow clinicians to have information at their fingertips that are based, not only on our collective experience, but also telling me... Look, I understand in general how patients do with this procedure, but I have information that tells me and I can tell my patient what my experience is applying this therapy in this particular setting, and I can use it to inform our dialogue about what we need to do. That, to me, is going to be important as we move forward because I think the idea that the physician/patient relationship is not only sacred, it is valuable and is something that we need to understand how we can make better going forward. It is going to be critically important, not just to maintain autonomy because autonomy in and of itself I think is important only if it improves an outcome.
Dr. Tony Asher: 26:00
So the last thing I would say in that regard is that what we are beginning to develop are these peer networks that are looking at care more broadly. And peers, particularly in areas where the evidence isn't guiding us in a specific way, are providing their collective wisdom to help advise individuals and groups about the best form of therapy. If we combine that with the information that does exist out there in terms of clinical trials, in terms of our national registries, and then use that to inform patient decision making, that's where we need to be. But abstracting the physician from it and reducing it to equation is something I think that we're never going to be able to achieve. And if we do institute that, I suspect it would be more on the basis of just cost savings as opposed to really providing a quality outcome.
Sanjiv Lakhia: 26:50
Now, that's a great answer to that question. I'll share with you an experience. I had a patient earlier in the week, a Hispanic-origin female. And she has a pretty significant pain syndrome in her leg from a herniated disc. We had done a couple injections, epidural injections. Only about 30% relief with those. So in that scenario, the outcome was poor. The patient was very happy with me, very satisfied with the care of our team, but functionally wasn't improving. So, my recommendation at that point was to send her to one of my colleagues and have you guys look at her for surgery, and she didn't like that. And she felt like I was abandoning her a little bit, and she wanted to bring her family in and talk about it. So, in that setting, we've set up another appointment because you have to take into consideration, I think, patients' fears, their cultural background, their connection with the clinical care team.
Sanjiv Lakhia: 27:51
I'm happy to hear you share those thoughts because, for me, sometimes I think it's okay to pause as we're going through the treatment recommendations and the clinical care decision making with our patients because we don't want to lose the heart of medicine. We want to improve the outcomes, for sure, maintain the quality, but it's the heart of medicine, it's that patient/doctor relationship. In my opinion, people come to see you, Tony, not because they know of your extensive career accomplishments, but because they know you're going to look them in the eye. You're going to treat them like you would a family member. And that's where we have to continue to reconcile it and keep our eye on the ball. In my opinion, that's what sets apart the exceptional physicians from maybe the lesser ones.
Dr. Tony Asher: 28:36
I think that's extremely well-stated, and I guess the only thing I would add to that is that this might be a more convenient way for the listeners to think about the clinical conditions that we do see. There's a whole category of items that I think that, if you lined up 100 doctors, 99 would agree, "This is the way this needs to be taken care of."
Dr. Tony Asher: 28:57
Let's say that maybe that constitutes 60% of what we do. This is a fairly clear-cut thing. There's evidence out there a peer group would likely universally recommend virtually the same thing, minor variations. But 40% of what we do, particularly in musculoskeletal disorders, it's really hard to sort out. Maybe it's something that would manifest itself differently, and the same thing would produce different symptoms in a variety of different patients, or we simply have not come to a consensus how to deal with this. In those circumstances in particular, I think it's important for responsible physicians to be very involved in that decision making.
Dr. Tony Asher: 29:39
To me, that's never going to be the area of medicine that's going to be reduced to an easy equation. But I don't believe that even though there's some uncertainty, it needs to be random. In that 40%, that's where I think our data systems can help inform it, and maybe even... I'm thinking in terms of a continuously connected peer network where we can almost instantaneously reach out to a group that could help us as individuals come to some broader understanding of what a larger group would do in this slightly ambiguous setting. That, to me, is where I think these systems can evolve and help us improve care in those areas where we just don't yet have enough evidence to provide a uniform set of recommendations.
Sanjiv Lakhia: 30:25
That's very well stated and I appreciate that clarification there. Are there any resources that patients can look to if they want to learn more about what's being done to ensure they're getting the best quality of care or level of care as they seek care for their back and spine conditions?
Dr. Tony Asher: 30:42
There's certainly a lot of information out in the universe in terms of back and spine care. I don't know that... There regrettably aren't as many resources related to some of these outcome science-based approaches that we've discussed earlier. But I would say in terms of our methods, because these are evolving systems, individuals could go to the American Association of Neurological Surgeons website and specifically look under the NeuroPoint Alliance and learn about what we're trying to accomplish and some of our early successes.
Dr. Tony Asher: 31:13
For the more sophisticated consumer, you could access any one of dozens of papers we've written looking at how we're applying this information to improve patient care, specifically the different things that patients can do to improve their outcomes: stopping smoking, improving your diabetes control, in some instances, losing weight. Those have been demonstrated time and time again to be things that improve outcomes. And I think that if patients see the objective information out there about how they can help influence their outcomes, they might be very influenced to be more involved in their care.
Dr. Tony Asher: 31:53
Carolina Neurosurgery & Spine Associates has some information on their website, and we need to improve that. And I would also say that if you went to the American Association... I'm sorry, the American Academy of Orthopedic Surgery, you can read about the American Spine Registry that we've just developed in collaboration with Orthopedic Surgery. I should mention that we are inclined for all these things to be cooperative programs.
Dr. Tony Asher: 32:14
I tried to spend most of my career developing collaborative, synergistic environments where individuals from multiple backgrounds can help move the ball forward, and our partnership with orthopedic surgery is going to be critically important as we move forward to make sure that we can disseminate these techniques and allow as many people to access them as is possible.
Sanjiv Lakhia: 32:36
All right. Thank you for that. And I can piggyback off of that with our closing questions. As you know, on this podcast, I really like to add a little health and wellness spin to most of the episodes because that's near and dear to my heart. And I can't imagine your schedule on a day-to-day, hour-by-hour basis. I know you're on too many committees to count, but you're also very focused on your own personal health and wellness. Do you have any tips or insights you want to share with our listeners? What systems for living do you maintain to keep yourself in optimal performance and healthy condition?
Dr. Tony Asher: 33:14
I'd say in general, I think that we have a healthy spiritual life and call ourselves spiritual people. That doesn't necessarily always translate into strictly religious, but we are aware of our environment, aware of how sacred life is, and I think that that's an important philosophy to guide life in general. I would say with respect to health specifically, as I've gotten a little older, I've done less impact-related sports. But working out, sometimes vigorously, has always been very important to me. And I think it's really helped get through some very demanding situations in a professional context, and I think keeps me sharp.
Dr. Tony Asher: 33:50
In the last year, I've really changed my nutrition quite a bit. I always thought I ate well. I've been much more conscious of things, particularly refined foods. And I can't say I've completely eliminated them, but sugar containing foods and most refined foods are now not part of my diet. Whether or not that's improved my energy level, my energy level's definitely improved. I would like to think there's been some association there. But a number of folks had been trying to lead me down that path for the last couple of years, and I must say, I've noticed a fairly significant improvement in daily energy levels.
Dr. Tony Asher: 34:24
And the last thing I'll say about timing is that I think people, if you want to be more active, if you want fitness to help improve your overall energy levels, but you just don't think you have time, early in the day tends to work for me. So, if I can get up a little earlier, squeeze in a workout, I'm not worrying about trying to do it when I'm dragging myself home at night and very tired. That's been a very effective way to make sure that I get it in regularly. It's worked so far, and I'll probably continue in that pattern.
Sanjiv Lakhia: 34:53
What about stress relief?
Dr. Tony Asher: 34:54
Stress release for me is pretty much related, again, to physical activity. When I'm not doing that, I do read quite a bit. I like to read widely. I read... periodical kick, but nonfiction, particularly history. And that, to me, is just a great way to relax. I like to write, and in particular, put down my thoughts about some of the things that I've read and what those mean to me, and I share some of those reflections with friends. It tends to be in some ways a stress reliever, but also a way of maintaining connectedness to a lot of great and interesting things that are well outside of what I do on a daily basis. I think it's important for us to really immerse ourselves in all the wonderful, intellectual things out there and art that other people are involved in.
Sanjiv Lakhia: 35:42
That's great to hear you say that. Going through medical school, it almost felt like I was part of a Navy Seals group where, as physicians, we're really not allowed to do some of these self-nurturing endeavors. I, myself, do meditation, at times, a little bit of journaling, certainly a lot of prayer, and interviewing Mark Smith, Andrew Sumich. It's been great to hear that my partners also are aware of this and taking the steps because I think our patients deserve it. And for us to be functioning at a high, high level, it starts with our own self-care.
Sanjiv Lakhia: 36:18
Tony, thanks for sharing those tips to our listeners. I really appreciate you taking the time today to go over somewhat of a complex topic. And if you're listening to this podcast, my goal today was really just to introduce you to the idea that a lot of work is going on behind the scenes to improve how we deliver spine care in this country, and in particular, through our group.
Sanjiv Lakhia: 36:39
So, this is not necessarily a podcast where I expect you to go down and look at some YouTube videos and learn some new exercises, but A, to give you a little bit of peace of mind, and B, arm you with some good information so that when you talk with your spine physician, you can ask, "Hey, what's been done to make sure that your recommendations are on par with what I should be looking at?"
Sanjiv Lakhia: 36:59
So, I hope you guys enjoy this episode today. Tony, really, thank you for taking the time. Keep up the good work, and I look forward to hearing about, and reading about, and being side-by-side with you as your accomplishments continue to come on through the door.
Dr. Tony Asher: 37:13
Sanjiv, thanks for this opportunity. It's been great.
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com