My excellent Conversation with Theodore Schwartz

Here is the audio, video, and transcript.  Here is part of the episode summary:

Tyler and Ted discuss how the training for a neurosurgeon could be shortened, the institutional factors preventing AI from helping more in neurosurgery, how to pick a good neurosurgeon, the physical and mental demands of the job, why so few women are currently in the field, whether the brain presents the ultimate bottleneck to radical life extension, why he thinks free will is an illusion, the success of deep brain stimulation as a treatment for neurological conditions,  the promise of brain-computer interfaces, what studying epilepsy taught him about human behavior, the biggest bottleneck limiting progress in brain surgery, why he thinks Lee Harvey Oswald acted alone, the Ted Schwartz production function, the new company he’s starting, and much more.

And an excerpt:

COWEN: I know what economists are like, so I’d be very worried, no matter what my algorithm was for selecting someone. Say the people who’ve only been doing operations for three years — should there be a governmental warning label on them the way we put one on cigarettes: “dangerous for your health”? If so, how is it they ever learn?

SCHWARTZ: You raise a great point. I’ve thought about this. I talk about this quite a bit. The general public — when they come to see me, for example, I’m at a training hospital, and I practiced most of my career where I was training residents. They’ll come in to see me, and they’ll say, “I want to make sure that you’re doing my operation. I want to make sure that you’re not letting a resident do the operation.” We’ll have that conversation, and I’ll tell them that I’m doing their operation, but that I oversee residents, and I have assistants in the operating room.

But at the same time that they don’t want the resident touching them, in training, we are obliged to produce neurosurgeons who graduate from the residency capable of doing neurosurgery. They want neurosurgeons to graduate fully competent because on day one, you’re out there taking care of people, but yet they don’t want those trainees touching them when they’re training. That’s obviously an impossible task, to not allow a trainee to do anything, and yet the day they graduate, they’re fully competent to practice on their own.

That’s one of the difficulties involved in training someone to do neurosurgery, where we really don’t have good practice facilities where we can have them practice on cadavers — they’re really not the same. Or have models that they can use — they’re really not the same, or simulations just are not quite as good. At this point, we don’t label physicians as early in their training.

I think if you do a little bit of research when you see your surgeon, there’s a CV there. It’ll say, this is when he graduated, or she graduated from medical school. You can do the calculation on your own and say, “Wow, they just graduated from their training two years ago. Maybe I want someone who has five years under their belt or ten years under their belt.” It’s not that hard to find that information.

COWEN: How do you manage all the standing?

And:

COWEN: Putting yourself aside, do you think you’re a happy group of people overall? How would you assess that?

SCHWARTZ: I think we’re as happy as our last operation went, honestly. Yes, if you go to a neurosurgery meeting, people have smiles on their faces, and they’re going out and shaking hands and telling funny stories and enjoying each other’s company. It is a way that we deal with the enormous pressure that we face.

Not all surgeons are happy-go-lucky. Some are very cold and mechanical in their personalities, and that can be an advantage, to be emotionally isolated from what you’re doing so that you can perform at a high level and not think about the significance of what you’re doing, but just think about the task that you’re doing.

On the whole, yes, we’re happy, but the minute you have a complication or a problem, you become very unhappy, and it weighs on you tremendously. It’s something that we deal with and think about all the time. The complications we have, the patients that we’ve unfortunately hurt and not helped — although they’re few and far between, if you’re a busy neurosurgeon doing complex neurosurgery, that will happen one or two times a year, and you carry those patients with you constantly.

Fun and interesting throughout, definitely recommended.  And I will again recommend Schwartz’s book Gray Matters: A Biography of Brain Surgery.