David Khosrowzadeh thought he wanted to be a doctor from a young age, thanks to time spent around his physician grandfather, and gentle–or maybe not so gentle–pressure from his parents. Although most people don’t end up in the profession they imagined when they were children, David actually did. Find out how David confronted academic insecurities and managed family pressure to establish his career in medicine.

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Highlights from this episode include:

Inspiration to be a Doctor

• David’s personal inspiration for becoming a doctor. [00:06:54]
• What it was like for David as a kid shadowing his grandfather as he treated his patients. [00:08:30]
• How David dealt with family pressure to become a doctor. [00:10:01]
• How his grandfather’s funeral impacted David’s plan to go into medicine. [00:11:15]
• “It helped me realize, hey, this is what I should be doing.” [00:12:20]
• How a family illness affected David’s brother’s decision to pursue a career in medicine. [00:15:17]

Early Education

• David discusses the high academic expectations his parents had for him from an early age–and what happened in second grade when he stopped taking education so seriously. [00:50:17]
• “If there was a B, it was, “What happened?”” [00:50:47]
• “I remember feeling really overwhelmed that first year [of high school]. I just felt like I was drowning, and there’s kids that I thought were a lot smarter than me.” [00:52:19]
• “You have to look at yourself and realize what your limitations are; what is your learning style and capabilities and figure out what’s gonna get the job done.” [00:53:02]
• How David’s parents insisted that he go to a more challenging high school, which he didn’t want to do–and how he feels about that moment now. [00:55:29]
• David’s consistent insecurities in school that other kids were smarter than him and that he was out of place or didn’t belong–right up through medical school. [00:57:07]
• How social media and the internet can contribute to the feeling that many other people are special or talented, but you aren’t. [00:58:52]
• How David figured out the best way for him to learn, and developed the specific skills he needed to succeed academically at a high level, even when he wasn’t really sure he could do it. [01:01:58]
• The way most high school students perceive the value of a “prestigious” education compared to the way people in their 30s or 40s view that same education. [01:38:18]

Medical School

• “They throw a lot of courses at you that have nothing to do with being a doctor, truthfully. Organic chemistry I hated; I hated biochem, physics three, and four. It just is not things that you’re using.” [00:18:45]
• The financial implications of paying for medical school. [01:03:44]
• “The cost is getting higher and higher every year.” [01:04:10]
• The personal situation that made David have to take the MCAT twice. [01:12:16]
• David discusses the role that your MCAT score plays in the med school admissions process. [01:14:01]
• “I was really surprised to find that med school, for me, was even more fun than undergrad was.” [01:16:52]
• The important conversation David had with his father that made him feel good about his decision to go to med school. [01:32:34]
• “I would tell someone [applying to college]], if you have the opportunity to go somewhere where it’s all paid for versus somewhere where you’re taking on a few hundred thousand dollars of debt, take the scholarship, and then save that debt for the med school part because you’re likely not gonna get a scholarship for medical school.” [01:37:40]

Life as a Doctor

• What it’s like to spend a lot of your time around people experiencing illness and death. [00:17:32]
• “The job is never done. You get someone well, there’s three more with worse conditions.” [00:20:18]
• “There’s a point where you have to be able to leave the room, and move on, and keep going.” [00:21:19]
• David discusses the challenges of being empathetic with patients without being too emotionally affected to do his job properly. [00:21:45]
• How David uses his father’s illness to inform his interactions with families in difficult medical situations. [00:22:28]
• “You’re still gonna get those moments where you close the door, you leave the room, and you’ve got the tears in your eyes… There’s those moments, where you feel really great. Just one of those every 20 can fill your tank.” [00:29:40]
• How being a good doctor sometimes means helping families make difficult decisions, in addition to offering medical care. [00:30:50]
• What “defensive medicine” is. [00:37:59]
• The very real risks and concerns associated with doctors getting sued by their patients. [00:39:20]
• “He started viewing patients as potential plaintiffs.” [00:40:09]
• How to look into an opportunity to shadow a doctor you may know. [01:20:59]
• The logistics of David’s 7 days on, 7 days off work schedule. [01:22:53]
• The importance of being conscientious and considerate in any workplace. [01:24:23]
• The difference between working in a hospital and opening a private practice. [01:25:55]
• The career options David is considering pursuing in the future. [01:28:29]
• How much time David spends on documentation on a computer compared to the time he spends with actual patients. [01:40:44]

How Practicing Medicine is Changing Today

• The changing roles of primary care doctors. [00:07:32]
• How residency has changed so there aren’t as many new doctors working unreasonable hours. [00:26:32]
• The connection between increased medical malpractice litigation and the rise of specialized medicine. [00:35:46]
• How technology affects–and potentially threatens–careers in medicine. [00:42:41]
• The roles that nurse practitioners and physician assistants play in many modern hospitals. [00:46:51]
• The difference in earning potential and legal liability between doctors today and doctors 20 or 30 years ago. [01:06:41]
• “Every month, we’re hearing about new titles that didn’t exist before, from an administration aspect.” [01:07:32]
• “Now, it’s more about delivering efficient care and getting people in and out of the hospital as fast and safe as possible.” [01:07:55]
• How metrics on each doctor in a hospital impact the way those doctors practice medicine. [01:08:46]
• “There are fields of medicine where you can still make more than a million dollars a year, but those fields are getting smaller and smaller.” [01:09:05]

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Morphine, Ice Cream, and Tears by Joseph Sacco

Transcript

[00:00:00] [Musical Interlude]

Mike Barrett: [00:00:01] Job interviews: career and life advice from just about everybody.

[00:00:05] [Musical Interlude]

Mike Barrett: [00:00:09] Hello again, and welcome to the second episode of the Job Interviews Podcast. I think a lot of people are going to be very interested in our guest today, who is a doctor and who is one of those people who knew from a very early age that he wanted to be a doctor and then went out and became one.

Patrick Barrett: [00:00:23] Yeah.

Mike Barrett: [00:00:23] When you sum it up in one sentence like that, it doesn’t sound such an accomplishment, but it’s actually pretty hard —

Patrick Barrett: [00:00:28] It sounds straightforward, but it’s not that common.

Mike Barrett: [00:00:31] And he has a lot of real-world experience, of course, which should be interesting to anyone who is considering going into the medical field. But even if you aren’t considering going into that field, I think it’s super useful to understand how it works, in general, and maybe listening to him, you’ll realize it is actually something that you would be interested in pursuing.

Patrick Barrett: [00:00:49] Yeah, absolutely. We get into a lot of the reality of the day-to-day life that he has, and that’s not going to be exactly the same for every doctor, but I think there’s definitely some common themes that probably are not what you would expect, if you didn’t have experience doing that.

Mike Barrett: [00:01:04] Sure. I would imagine, for a lot of people, doctor is one of those professions where your idea of what it’s like to be one — if you don’t closely know a doctor, your idea of what it’s like to be a doctor is probably heavily shaped by TV shows, movies —

Patrick Barrett: [00:01:17] Yeah, it’s one of those—there’s certain jobs you don’t see all the time in TV, and movies, and media, and everything, but this is definitely one that’s glamorized —

Mike Barrett: [00:01:23] You’re right. This doctor is not one of those jobs, right.

Patrick Barrett: [00:01:25] Yeah, and you have a certain perception that may not be accurate. If you watch “Grey’s Anatomy” and think that going to med school means you’re gonna be one of those people, then that’s probably not necessarily true.

Mike Barrett: [00:01:35] Sure. I read something a long time ago that suggested that—it was a talk with a bunch of doctors, and it mentioned that the TV show “Scrubs” was the closest that any show had ever gotten to it, actually.

Patrick Barrett: [00:01:44] Interesting.

Mike Barrett: [00:01:45] That’s not an endorsement of the show “Scrubs.” I’ve only watched a few episodes, but it was an interesting … It was a comedy take on things, and it shows the —

Patrick Barrett: [00:01:54] Yeah, sort of like a tragicomic kind of [crosstalk]

Mike Barrett: [00:01:56] Yeah, the ups, and the downs; the emotional aspects of everything.

Patrick Barrett: [00:02:00] The voiceover at the end of every day, which is super accurate.

Mike Barrett: [00:02:03] The voiceover [laughter]

Patrick Barrett: [00:02:04] They have the intercom in the hospital. Somebody comes in, “Do you know what we learned today?”

Mike Barrett: [00:02:07] Right, exactly.

Patrick Barrett: [00:02:09] Yeah, so, anyway … And then, another interesting aspect of this interview was, outside of the entire med-school/doctor aspect, to hear from David about his personal academic experience was very interesting because I think most of us see someone who is able to get through med school, and get hired, and be a doctor, and then help people—that must be a super genius, academic whiz kind of person, and I would’ve thought of David like that. But to hear him say it, it was more about insecurity, and really hard work, and him being convinced that he wasn’t gonna hack it unless he really pushed himself, and that was really interesting —

Mike Barrett: [00:02:53] I mean, I think it’s also reflective … We’ll let him get into the details, obviously, in the interview, but it’s reflective of what I’ve heard from a lot of doctors, who’ve gone on to become —

Patrick Barrett: [00:03:00] Yeah, from the outside, we might see them as, “Oh, wow, this person can handle any academic challenge, or practical challenge, or whatever,” and if you’re in the middle of that, then you might feel a lot less confident in your abilities and concerned that you’re not gonna make it through and all of that.

Mike Barrett: [00:03:15] Yeah. I was also very interested in David’s view of his own family, and the way that his family experience, in a variety of ways, shaped his medical practice.

Patrick Barrett: [00:03:26] Absolutely.

Mike Barrett: [00:03:27] And I think that that is something that can be broadly applied to a whole bunch of different careers, not only to him, in this career.

Patrick Barrett: [00:03:36] Yeah.

Mike Barrett: [00:03:37] So, without further ado, why don’t we stop talking about the interview and actually have the interview?

Patrick Barrett: [00:03:42] I think that sounds like a good idea.

Mike Barrett: [00:03:44] Okay.

Patrick Barrett: [00:03:45] Hello. We are here with Dr. David Khosrowzadeh. Get it right because he gets real fussy if you don’t call him that [laughter]

David Khosrowzadeh: [00:03:53] You can still pronounce it. I’m very proud.

Patrick Barrett: [00:03:54] Of course I can! I actually went to high school with David. Mike went the same high school but not at the same time, as he is aged.

Mike Barrett: [00:04:03] Yes.

Patrick Barrett: [00:04:04] But, yeah, we have not spoken or caught up in a while, so I’m quite eager to hear all about your journey. So, you want to just introduce yourself, give your name, and just a brief description [crosstalk]

David Khosrowzadeh: [00:04:18] Again, if you weren’t listening, David Khosrowzadeh —

Patrick Barrett: [00:04:21] Doctor! [crosstalk]

David Khosrowzadeh: [00:04:22] Dr. David Khosrowzadeh. Still—I go by Dr. David around the hospital because I’ve gotten tired of correcting people so many times.

Patrick Barrett: [00:04:29] What’s the point? Yeah. Not Dr. K?

David Khosrowzadeh: [00:04:31] No, there’s another Dr. K.

Mike Barrett: [00:04:33] There is?

Patrick Barrett: [00:04:33] Dr. K2? [crosstalk]

David Khosrowzadeh: [00:04:34] Yeah, there’s actually two Dr. Ks.

Patrick Barrett: [00:04:35] Dr. K3.

David Khosrowzadeh: [00:04:36] [Laughter] Yeah, they got it. Dr. David seemed easier.

Patrick Barrett: [00:04:40] Yeah. Are they also Khosrowzadehs, or are they —

David Khosrowzadeh: [00:04:43] You know, close —

Patrick Barrett: [00:04:44]—because that would be really something [crosstalk]

David Khosrowzadeh: [00:04:46] Not quite. Not as many syllables.

Patrick Barrett: [00:04:47] Okay.

Mike Barrett: [00:04:47] Huh. Are there no other Drs. David …?

David Khosrowzadeh: [00:04:51] Not that have claimed that. They usually have more manageable last names, so they went with those [laughter]

Patrick Barrett: [00:04:56] Okay, so —

Mike Barrett: [00:04:58] Does anyone ever think that David is your last name; that you’re Sam David, like that’s …?

David Khosrowzadeh: [00:05:01] No, that’s never actually come up.

Mike Barrett: [00:05:03] Huh.

David Khosrowzadeh: [00:05:03] I think most people see what I’m dealing with and just [laughter] with Dr. David.

Patrick Barrett: [00:05:10] Got it.

David Khosrowzadeh: [00:05:11] Yes.

Patrick Barrett: [00:05:11] All right, so … We’ve interrupted you several times. So, just, I guess, a brief overview of your current occupation, and —

David Khosrowzadeh: [00:05:21] So, I’m a, I’m a physician; an internal medicine physician. With that, it’s a wide net, but I’m a hospitalist. So, I work as a primary care doctor for patients in the hospital setting. Anybody that goes to the E.R., the E.R. doctor’s job, they’re the gatekeepers of the hospital. If they can get someone well and send them home, they will. If they need to admit them, keep them in the hospital, then they’ll call me, and I take over as their primary doctor during their hospitalization. I prefer it to being in the outpatient setting because things happen much faster, a lot less red tape. And I like inpatient acute care. People are a little bit more sick, and [crosstalk]

Patrick Barrett: [00:06:04] That’s so weird [laughter]

David Khosrowzadeh: [00:06:08] I know, I know, it sounds weird. They’re a little more sick [crosstalk]

Mike Barrett: [00:06:12] No, but it’s more … you can have a more direct impact. You can —

David Khosrowzadeh: [00:06:15] Right.

Mike Barrett: [00:06:16]—more use your training and everything, I assumed is what you meant [laughter]

David Khosrowzadeh: [00:06:19] You got it

Patrick Barrett: [00:06:20] Or maybe that’s [laughter]

David Khosrowzadeh: [00:06:22] We’ll go with that.

Patrick Barrett: [00:06:28] So, is that what you anticipated you’d be doing when you were starting med school? At what point did you say, “Oh, this is the field I’d like to go into,” or was it more that it just made sense [crosstalk]

David Khosrowzadeh: [00:06:42] Sure. I knew I wanted to be in primary care. I didn’t know inpatient or outpatient —

Mike Barrett: [00:06:48] Sorry, can you explain — not just for our audience, but also for me — what is primary care, and how does it contrast with other—

David Khosrowzadeh: [00:06:54] Yeah. I guess going back to why I wanted to become a doctor and who inspired me, my grandfather was a general practitioner. So, he graduated University of Louisville med school, and practiced — he was the first doctor in Fort Myers, and —

Patrick Barrett: [00:07:12] In Fort Myers?

David Khosrowzadeh: [00:07:13] Yeah, when Fort Myers was being [crosstalk] when the city was really up and coming, he was the guy.

Patrick Barrett: [00:07:21] Wow. That’s really cool [crosstalk] Was he, I guess, like a small-town doctor [crosstalk]

David Khosrowzadeh: [00:07:26] Small town — rural, at the time — doctor as the city was coming up.

Patrick Barrett: [00:07:31] That’s really interesting. Okay, so —

David Khosrowzadeh: [00:07:32] So, he was a general practitioner, or a primary care doctor, at the time, and back then — ’70s, ’80s, ’90s — primary care doctors did it all. They did surgeries, small surgeries; they delivered babies; procedures in the office. He did colonoscopies. He was kind of a Jack of all trades.

Mike Barrett: [00:07:52] Sure.

David Khosrowzadeh: [00:07:54] So, growing up, my mom was always really proud of him, and we had a joke in the family, like we couldn’t go anywhere without my mom somehow mentioning her dad was a doctor somewhere in the conversation. Her love for that, and then, my dad being Iranian, Persians, they really value basically three professions [laughter] — physicians, lawyers, and engineers — if you’re not that, or a landowner, then you’re really [crosstalk] really, you’re a failure as a son. So, I had a good amount of —

Patrick Barrett: [00:08:30] Land?

David Khosrowzadeh: [00:08:30] Gentle encouragement towards becoming a physician from an early age. I shadowed my grandfather a couple summers, and he was kind of a grump —

Patrick Barrett: [00:08:44] Still working in Fort Myers?

David Khosrowzadeh: [00:08:45] Yeah, still working in Fort Myers. He was a grump around family and so forth, but in the office, he was a different person; put on the coat, and he just had so much more energy and charisma.

Mike Barrett: [00:08:58] That’s really interesting.

David Khosrowzadeh: [00:08:59] So, it was —

Mike Barrett: [00:09:00] Do you think — if I could interrupt your for a second — was that … I don’t want to call it an act, but was that something he consciously did for the patients —

Patrick Barrett: [00:09:05] Like intentionally —

Mike Barrett: [00:09:06] —or do you think he just internally liked it so much that it …?

David Khosrowzadeh: [00:09:09] I’d like to tell myself that it was something that he just really enjoyed doing.

Patrick Barrett: [00:09:13] Organic, kind of.

David Khosrowzadeh: [00:09:14] Yeah. I don’t know, he just came alive.

Mike Barrett: [00:09:18] Sure.

David Khosrowzadeh: [00:09:18] And maybe used all of his energy, and by the time he got home, there wasn’t much left [laughter] [crosstalk]. Should’ve become a hospitalist.

Patrick Barrett: [00:09:27] Yeah, he’d love that …

Mike Barrett: [00:09:33] I didn’t mean to interrupt, sorry. So, you shadowed him —

Patrick Barrett: [00:09:38] How old were you when —

Mike Barrett: [00:09:38] You saw —

Patrick Barrett: [00:09:39] —in those summers you were saying when you went to go shadow him?

David Khosrowzadeh: [00:09:41] It was probably middle school approaching high school.

Patrick Barrett: [00:09:45] So, you’d just be in the office all day, and see what [crosstalk]

Mike Barrett: [00:09:48] In the shadows. That’s what it comes from, right? [crosstalk]

David Khosrowzadeh: [00:09:51] For a week, we’d go down and visit him, and he’d take me to the office.

Patrick Barrett: [00:09:55] Was this, your mom was like, “Guess what? You’re shadowing grandpa!” or was it — you know what I mean? Was this an assignment, or did you ask —

David Khosrowzadeh: [00:10:01] So, when your parents want you to do anything, there’s resistance, I think. Internally, you feel this pressure, and it makes you want to resist and rebel. But I saw how much he enjoyed what he was doing, and it seemed like a noble profession, so I—they weren’t dragging me kicking and screaming. I’m also a pleaser for my parents, so I went to keep them happy. I really enjoyed it. It seemed like a good field, and so went through high school with that notion in mind that I was going to be a doctor. There was a lot of people in our high school that were gonna be doctors.

Patrick Barrett: [00:10:40] Yeah.

David Khosrowzadeh: [00:10:40] I remember getting through high school, starting undergrad. There was probably—I mean, I want to say, at least 20 people at UF that were gonna be doctors. And by the end of undergrad, the weed-out process had occurred, and people went different routes, and there was maybe two of us, two, three of us left.

Patrick Barrett: [00:10:57] Yeah, wow.

Mike Barrett: [00:10:59] So, was it wanting to follow in your grandfather’s footsteps, or something along those lines that was in the back of your mind all throughout that process? So, even in med school, you were like, “Well, I wanna go do …” essentially, what he was doing? Kind of the Jack of all trades route?

David Khosrowzadeh: [00:11:15] Really, where it really ironed things for me was his funeral. We went—he passed away when I was just about to start … I was in the application process for med schools, and we went to his funeral.

Mike Barrett: [00:11:28] Wow.

David Khosrowzadeh: [00:11:30] I knew he had made an impact there, but I didn’t realize, until being at his funeral, there was just probably 300 people there, and people shaking our hands as they were leaving and just telling my mom stories, and me stories about what he … What he did for them, or their dad, or their sister, or brother. And so, that was like, man … There’s not many—unless you’re a politician, or movie star, or whatever, you don’t have that kind of—[crosstalk] At least 300 [laughter]

Mike Barrett: [00:12:04] No, but that must have been very —

Patrick Barrett: [00:12:15] Yeah, there’s not many professions where you can —

Mike Barrett: [00:12:19] Clearly, that impacted you heavily.

Patrick Barrett: [00:12:20] Yeah.

David Khosrowzadeh: [00:12:20] Yeah, it did. It helped me realize, hey, this is what I should be doing.

Mike Barrett: [00:12:27] And were there times … I’m under the impression that med school’s kind of hard [laughter] so, were there times during that process, when you thought back to that, or did you need to use it to motivate yourself sometimes, or not really? Was that not really how it worked?

David Khosrowzadeh: [00:12:40] I think it wasn’t something that was constantly on my mind, but it was something that, when they were —

Patrick Barrett: [00:12:47] Kind of understood this is …

David Khosrowzadeh: [00:12:49] Yeah. Once I was on that track, it was gonna happen. And when I say “weed out” in undergrad, I don’t mean that people weren’t good enough. It’s just a matter of how committed —

Mike Barrett: [00:13:00] It’s kind of a gut-check thing because I see people go through it —

Patrick Barrett: [00:13:03] Yeah.

Mike Barrett: [00:13:03] I have a lot of friends who’ve wanted to be doctors and they didn’t all decide that. It’s like you say, it’s not just that you can’t necessarily, it’s more that you realize, “This isn’t quite what I thought it was.”

David Khosrowzadeh: [00:13:13] Right.

Mike Barrett: [00:13:13] “I like this other field more,” maybe, or …

David Khosrowzadeh: [00:13:15] Absolutely —

Mike Barrett: [00:13:17] I’m sorry. Does that weeding out, so to speak, still happen in med school, itself?

David Khosrowzadeh: [00:13:22] There were a few people that … There was maybe 200 people in my class, and we graduated with 180. So, I mean, there’s some weeding out that occurs, and social situations arise in someone’s life, or —

Mike Barrett: [00:13:34] Sure.

David Khosrowzadeh: [00:13:36] —realizing it’s just not for them, or family crises. Something like that can derail the plan. But for the most part, everybody that was there in the beginning made it to —

Mike Barrett: [00:13:46] Made it through.

David Khosrowzadeh: [00:13:47] Yeah.

Mike Barrett: [00:13:47] I was just trying to think why the phrase “weed out” has such a negative connotation. It’s because if the word “weed.” [laughter]

Patrick Barrett: [00:13:54] The least desirable versions of something [crosstalk]

David Khosrowzadeh: [00:14:02] The worst plant in the garden.

Patrick Barrett: [00:14:04] You’re right, the worst [laughter]

David Khosrowzadeh: [00:14:06] Yeah.

Patrick Barrett: [00:14:09] So, do you—you described this early impact of your grandfather and everything. Is that something that affected your brothers? Are you brothers following that path? I don’t know —

David Khosrowzadeh: [00:14:22] So, the youngest … There’s four brothers. The two in the middle, the heat was off of them [laughter] They had fulfilled their quota [crosstalk] Yeah, you understand. They stopped caring about the last one.

Patrick Barrett: [00:14:38] Yeah, “Do whatever you want. We got what we need.”

David Khosrowzadeh: [00:14:41] Yeah. But it’s funny, the second is an attorney now. He just passed the bar.

Mike Barrett: [00:14:45] There you go.

Patrick Barrett: [00:14:46] The other acceptable profession, or one of the other ones.

David Khosrowzadeh: [00:14:48] Yep, the other acceptable one. The third one [crosstalk]

Mike Barrett: [00:14:50] Does he feel like being on a podcast? [laughter]

David Khosrowzadeh: [00:14:51] We’ll talk. We’ll talk after, yeah. The third one was the artist of the family. He’s making video games.

Patrick Barrett: [00:14:58] Oh, awesome.

David Khosrowzadeh: [00:14:58] Which was something my dad couldn’t fathom and didn’t understand.

Mike Barrett: [00:15:01] It’s a type of engineering … I mean, you’re creating a thing to solve a problem.

David Khosrowzadeh: [00:15:05] It’s really cool.

Patrick Barrett: [00:15:06] It’s awesome. It sounds really cool.

David Khosrowzadeh: [00:15:07] He wants to work for Nintendo, and he’s kind of —

Patrick Barrett: [00:15:10] Who doesn’t, man? [laughter] Maybe he’ll meet Mario.

Mike Barrett: [00:15:15] Who’s the fourth brother we didn’t hear about?

Patrick Barrett: [00:15:16] The fourth brother.

David Khosrowzadeh: [00:15:17] Yeah, the youngest. So, he was going to be the engineer. He actually had did an intern year, intern summer, with an engineering company and … Well, I guess I’ll rewind a little bit. He wanted to be a doctor, and then my father got sick. He got cancer, when I was in med—when I was in residency, and my youngest brother was there throughout everything — all the cancer treatments, and the rehospitalizations, and so forth, and was there in hospice. And I think it scared him. He got cold feet about medicine. He didn’t wanna be in a hospital anymore. So, he went to the other field —engineering [laughter]. He’s really good at math, and he just figured that’d be a good fit. And then, he worked at an engineering office for a full summer, and he hated it. It was just—he said what he was doing was just dry —

Mike Barrett: [00:16:16] Was he in college at this point?

David Khosrowzadeh: [00:16:18] Yeah, UNF. So, then he called me, and he’s like, “I think I wanna be a doctor again.” So, now he’s doing premed, and he’s [crosstalk]

Mike Barrett: [00:16:25] That’s kinda cool. I respect a lot when someone, first of all, is willing to actually investigate, what it is that they think they wanna do because that’s the best way to find out, obviously, if you actually like it; but then, also, to be willing to say, “I was committed to this thing. Gave it a decent shot; had some decent exposure to it. Don’t really like it. Let me try this …” Just to keep moving forward like that is something that a lot of people—a lot of people would just feel trapped in whatever thing that [crosstalk]

Patrick Barrett: [00:16:51] Yeah, like, “I started doing this —

Mike Barrett: [00:16:52] —and then they just [crosstalk] That’s impressive for him.

[00:16:56] [Musical Interlude]

Patrick Barrett: [00:16:59] The number-one reason most students struggle with tests like the SAT and the ACT is that they try to attack those tests using skills that would work in a classroom setting. But the SAT and ACT are very different from tests you normally take in school. In fact, the single most important skill across all sections of both tests is careful reading. If you’re interested in learning more about the most effective way to prepare for the SAT and the ACT, search for the “SAT Prep Black Book, Second Edition,” and the “ACT Prep Black Book, Second Edition” on Amazon.com.

Mike Barrett: [00:17:32] You kind of touched on something that is, I think, extremely uncomfortable, at least for non-doctors, maybe also for doctors; I don’t know. But it’s something that, in my experience with tutoring clients, and their families, obviously a lot of the kids that you work with want to go on to be doctors. It’s a pretty prestigious field. I don’t know if they all recognize the extent to which, frankly, human misery, and death, and that kind of thing is around the profession —

Patrick Barrett: [00:18:06] Like you’re around sick people, and worried families —

Mike Barrett: [00:18:08] Yeah, and it’s—I don’t mean that in … You know what I mean? It’s a thing in our society; we don’t really talk about —

Patrick Barrett: [00:18:12] Yeah.

Mike Barrett: [00:18:13] —that process as a thing, and I imagine it’s something that you must have seen many, many times. Any doctor probably has seen it a lot of times.

David Khosrowzadeh: [00:18:19] Yeah.

Mike Barrett: [00:18:20] Do you think—could you speak a little bit, if you’re okay with it, to how that has been for you, and if you think that it has played any role in possibly weeding people out, or diverting people into other professions? Or, if you think, or disagree with me, that maybe people should be made more aware of it, when they’re younger and considering the profession? I didn’t mean to get so heavy [crosstalk] You brought it up and it’s on my mind.

David Khosrowzadeh: [00:18:45] It’s important. I think that in the weeding out process in undergrad, the reason that it happens is because they throw a lot of courses at you that have nothing to do with being a doctor, truthfully. Organic chemistry, I hated; I hated biochem; physics three, and four, it just is not things that you’re using. You’re not ever having to —

Patrick Barrett: [00:19:07] You’re not building catapults, and stuff?

David Khosrowzadeh: [00:19:10] Right. [laughter] Not yet [crosstalk]

Patrick Barrett: [00:19:17] We gotta hit that guy right in the mouth. It’s gonna be hard! Thank God for this physics class! [laughter]

David Khosrowzadeh: [00:19:20] Good thing I have my books [crosstalk] I mean, they throw these classes at you, and the purpose is to just see how much you want it. And nothing I really enjoyed; really, the first—the only patient interactions I was having was through my grandfather and volunteering at the V.A. in Gainesville. But in terms of that, I think the later on—the weeding out that you’re talking about, when it comes to death, and suffering, and seeing misery, that would occur more, perhaps, in medical school. Now, you’re being entrenched in the hospital setting —

Patrick Barrett: [00:20:03] Like in residency or [crosstalk]

David Khosrowzadeh: [00:20:05] Well, med school, you’re gonna be doing rotations; third and fourth year, you’re gonna be rotating out of different specialties, and seeing what you like, and making, hopefully, relationships with program directors to get in a residency somewhere.

[00:20:18] But I do remember when I started residency in Chicago, internal medicine residency, that first few months, I was just … It’s like this barrage of sick, and you’re trying to stamp out disease, and it just keeps coming. The job is never done. You get someone well, there’s three more with worse conditions. I remember telling my program director—I was coming up three months straight of difficult rotations to start residency, and I was like—there was a vacation coming up. And I remember telling him, I was like, “I’m exhausted. It’s kind of overwhelming, this—dealing with sick people. It’s gonna be nice to be away from sick people for a while,” and taking that time off, seeing if I —

Patrick Barrett: [00:21:03] Recharging.

David Khosrowzadeh: [00:21:03] Yeah. I mean, that could have been a weed-out point for me, truthfully.

Patrick Barrett: [00:21:05] Yeah. It sounds you were [laughter] on the brink a little bit.

David Khosrowzadeh: [00:21:09] I haven’t really thought of that since it happened, but I remember that conversation. He wasn’t necessarily very pleased that I was having those thoughts.

Patrick Barrett: [00:21:18] Yeah.

David Khosrowzadeh: [00:21:19] But, coming back, there’s a point where you have to be able to leave the room, and move on, and keep going.

Mike Barrett: [00:21:34] I don’t think that that means … I think, to a lot of younger people hearing this, that might seem cold, or detached, but it’s actually—you have to do that so that you can help the other people. Right, or no?

David Khosrowzadeh: [00:21:45] Yeah, absolutely. You don’t wanna be cold, and detached in the room, but you have to be [crosstalk] Empathy is so important.

Patrick Barrett: [00:21:54] Otherwise, you get overwhelmed.

David Khosrowzadeh: [00:21:55] You have to share that with them, but you have to be able to let it go and not bring it with you to the next case, or the next day.

Patrick Barrett: [00:22:01] Are you trained in that? Did they … When you become a doctor somewhere, is that part of your training at any point, or is it just kind of on the job that you just, through repetition, or something?

David Khosrowzadeh: [00:22:10] I think it’s an on-the-job situation. Hopefully, you’re learning under attendings that have that skill, and you’re —

Patrick Barrett: [00:22:16] Okay, yeah, like the individual that you’re working with might offer advice related to that.

David Khosrowzadeh: [00:22:20] Yeah.

Patrick Barrett: [00:22:20] But it’s not like everybody gets in the auditorium, and “Here’s how to carry on” kinda thing.

David Khosrowzadeh: [00:22:24] And it’s funny because it should be.

Patrick Barrett: [00:22:27] Yeah.

David Khosrowzadeh: [00:22:28] I think it’s important, and it’s brushed over in med school. It’s an important skill to have—develop empathy and dealing with end-of-life situations are challenging. A lot of times, you’re thrown in your first family meeting, and you’ve never done it before. The grandfather that’s on their last days, and you’re deciding between hospice, and PEG tube, and which route … But I think, for me, I tried to take a bad situation —my dad’s illness — and use it to my advantage.

[00:23:03] When you’re on the other side of the door, and you’re waiting for the answers, and you’re waiting for someone to come tell you what’s the plan, you really —

Patrick Barrett: [00:23:14] Sure, yeah.

David Khosrowzadeh: [00:23:15] —that’s really the only true way to develop that empathy. I keep using the word … Going through that experience, actually being in hospice, and seeing what it’s like, and seeing what a good doctor looks like, and what a bad doctor looks like, and waiting all day for answers … That is a skill, or experience that I am trying to use in my practice, and it’s important.

Patrick Barrett: [00:23:42] Sure. Wow.

Mike Barrett: [00:23:44] Thank you for discussing that.

David Khosrowzadeh: [00:23:46] Yeah.

Mike Barrett: [00:23:48] You mentioned something, too, when you were differentiating between the academic weeding out versus the experiential weeding out that comes later. One thing—I briefly entertained — briefly, as in maybe for a day — the possibility of going into medicine, when I was in high school, and I read a book called “Morphine, Ice Cream, and Tears.” I don’t know if you’ve ever heard of it? It was —

Patrick Barrett: [00:24:14] Oh, man.

Mike Barrett: [00:24:15] It’s really something

Patrick Barrett: [00:24:18] Quite something. It’s just really fascinating —

Mike Barrett: [00:24:22] It was written …

Patrick Barrett: [00:24:24] The ’80s, I think.

Mike Barrett: [00:24:24] I think the ’70s, or ’80s [crosstalk]

Patrick Barrett: [00:24:27] It sounds like it’s Morphine Ice Cream, but it’s Morphine-comma-Ice Cream [crosstalk] It was the ’70s, man. It was a crazy time [laughter]

Mike Barrett: [00:24:41] It’s actually “Morphine, Ice Cream and Tears.” [Laughter]

Patrick Barrett: [00:24:46] Yeah.

Mike Barrett: [00:24:46] It was the memoir or something of a guy who worked in an E.R.; I wanna say in New York City; a major city —

Patrick Barrett: [00:24:55] Yeah, it was in Manhattan, I think.

Mike Barrett: [00:24:56] —in the ’70s, or ’80s. Can’t remember. It was about his experience, like how he started out very idealistically — and this is obviously pre-internet. There’s a lot more openness now, in terms of every profession, I think. And he had an idea of what it was to be a doctor, and in the memoir, it didn’t exactly work out that way. In many instances, his experience, and the help that he was able to give, and the positivity of it was overwhelming. I mean, it’s not that it was always bad, but some of the bad stuff, he was like, “No one told me anything like this was ever going to be possible.” And I’m not saying that it’s like that now; obviously, I have no idea. He might also have made it up for the memoir. I have no way to know. But one thing that he mentioned that I do have other confirmation is a thing is the idea that when you’re a first-year person out of med school and working in the hospital, that everybody’s mean to you, and they make you stay up like —

Patrick Barrett: [00:25:53] Like hazing-ish —

Mike Barrett: [00:25:54] It is. It sounds a lot like hazing. And the best explanation I’ve ever been able to find for why you would do that is just that someone did it to you —

Patrick Barrett: [00:26:02] Yeah.

Mike Barrett: [00:26:02] —and this is just how it works. And there’s apparently been a lot of studies showing, statistically, that it’s bad for patients that doctors … I don’t know if they even are still put through it, but that they were put through it. The patients suffered because sleep-deprived doctors are making bad decisions, and all that kind of stuff. So, A) is that still a thing in any kind of capacity, and B) do you … I have this impression that it’s gradually getting better, but I don’t know …? As someone who actually knows, could you tell us what was going on with that?

David Khosrowzadeh: [00:26:32] It’s funny you bring that up. I was sitting in the doctor’s lounge last week, and I was at a table with a bunch of surgeons, different kinds of surgeons — a urologist, cardiac — and they were all … I was the only medicine guy there, but they were all exchanging war stories of residency. One of them is probably in his 70s now. One of them’s in his probably 40s.

Patrick Barrett: [00:26:55] Oh, wow.

David Khosrowzadeh: [00:26:56] And they were all telling me about the—surgeons typically are known to have it worse in residency than we do. They were all sharing these experiences of being up for three days, and that kind of thing, and just the amounts of patients they’d have to see. Just sounded pretty tough for all of them. There was a case, I believe, and I’d need to verify and look it up, but I believe it was in New York, where a resident or an intern fell asleep during an operation and there was a bad outcome.

Mike Barrett: [00:27:34] Sure.

David Khosrowzadeh: [00:27:34] I wanna say it was in the ’90s, or early 2000s, but that news went out to all the residency programs, and they realized they needed to re-evaluate. And I’m sure they’ve looked at data, like you’re expressing, about it being bad for patients. These days, fortunately, there’s a lot more policing that goes on, in terms of hours you’re allowed to work straight, and so forth. Just like the rest of society, medicine is getting softer. Medical training is getting softer. And some of the older docs don’t like it, and they think that leads to worse doctors, but I disagree. I think there’s a way to learn and to get conditioned for what’s coming without it being over the line and dangerous.

Mike Barrett: [00:28:23] Well, also, what we know … “we.” I don’t know it. What people say they know about sleep deprivation shows it’s not a thing that you can condition yourself to, beyond a certain point. There’s not an infinite capacity for just working sleep-deprived [laughter]

Patrick Barrett: [00:28:37] To get better at operating—

Mike Barrett: [00:28:38] At some point, this poor person, and the poor patient that was being worked on … At some point, you just have to hit the limit, just like truck drivers can’t drive 100 hours in a row. There’s a limit to what you can do, or high school students can’t pull all-nighters three nights a week forever.

Patrick Barrett: [00:28:56] You tried, but …

Mike Barrett: [00:29:00] I did try [laughter]. That’s one of the ways I know that you can’t. Thank you again for talking about that. So, now that we’ve talked about all the negative things, which is not—wasn’t my goal. It just sort of happened … Could you touch on maybe some of the most positive experiences? I mean, obviously, you seem like a very positive person. You chose this career. You’re committed to it. I’m assuming you’re quite good at it. You’re good at everything else I know about with you. So, what are the —

David Khosrowzadeh: [00:29:30] The good.

Mike Barrett: [00:29:32] Yeah.

David Khosrowzadeh: [00:29:34] I talked to my youngest brother, who decided to go back in to medicine [crosstalk].

Mike Barrett: [00:29:38] Yeah, what did you say to him [crosstalk]?

David Khosrowzadeh: [00:29:40] When he told me that—because I’ve kind of become a father figure now, since dad’s gone. He came to me, kind of like I would go to my dad, to say, “Hey, I wanna change majors,” and that kind of thing. Not sure how I’d react to that, him changing course, and it’d be extra time in college, and that kind of thing. But I was so happy for him because, I mean, I don’t think there’s another field that can give you that fulfillment. And it’s not every time. It’s not like every case, you’re going in, and it’s just, “You’re wonderful, doctor. Thank you. You saved mom,” that kind of thing. There’s maybe one of those out of 10, and some weeks, one of those out of 20, but you’re still gonna get those moments where you close the door, you leave the room, and you’ve got the tears in your eyes, kind of like “The Office,” the show … There’s those moments, where you feel really great. Just one of those every 20 can fill your tank for a few more … Hundreds. However, many, maybe …

[00:30:50] So, being a part of those situations—and it’s not always like, “You saved my mom.” Some of those situations, it’s helping a family decide … I had a case; this elderly guy who’s 95, and he suffered a massive stroke, and wiped out his whole right side. The outlook was pretty grim, and he wasn’t able to make decisions for himself. So, having a family meeting — this was a few weeks ago — we had a family meeting with the care manager there, myself, and the GI doctor, who would be putting—he couldn’t swallow for himself, so there was a procedure that he was gonna need—a feeding tube surgically inserted into his stomach to keep him alive because he couldn’t eat on his own. The fork in the road was to put that feeding tube and send him to a nursing home for “rehab,” or to allow hospice to intervene, and to make sure he was comfortable, and offer him pleasure feedings, and that kind of thing.

Mike Barrett: [00:31:54] Sorry, just for members of the audience who may not know because it’s come up a couple times, hospice is medical care, where the goal is just to comfort them and physically —

Patrick Barrett: [00:32:08] End-of-life care, like making the person comfortable.

Mike Barrett: [00:32:11] Yeah, like avoiding pain. But correct me if I’m wrong, when you go into hospice, you’re not coming out. The idea is —

Patrick Barrett: [00:32:16] You’re no longer trying to resolve the medical issue [crosstalk]

David Khosrowzadeh: [00:32:19] You’re limiting the aggressive interventions; anything painful. You’re not doing blood work. You’re not doing any needles or anything that necessarily is gonna cause them any pain or suffering. It’s when you … Typically, a patient has likely less than six months, or has a terminal condition of some sort. Not being able to swallow could be a terminal condition if you’re not able to eat and drink. They would be involved. There’s a lot of misconceptions about hospice. The reason I bring up that family meeting is because, sometimes, it’s making sure you’re acting in the best —

Mike Barrett: [00:32:57] Of course.

David Khosrowzadeh: [00:32:57] —making sure the family is navigating through these difficult decisions —

Patrick Barrett: [00:33:00] They feel like they have the right information, and they’re making the best decision they can make [crosstalk]

David Khosrowzadeh: [00:33:03] Right, and the goal has always gotta be to do what the patient would want, if he could wake up and tell you. Helping them through that … They ultimately decided to go with hospice. I received an email from our medical director, who had heard from the family, and that he had passed, and just wanted to thank me for taking the time for the conversation, and for doing what ultimately, he would have wanted. So, even in cases like that, there can be a sense of fulfillment because you’re helping people through a tough thing.

Patrick Barrett: [00:33:39] And that’s, again, the sort of thing that—you never had a class about that, right? That’s just an on-the-job … You’re in that moment [crosstalk]

Mike Barrett: [00:33:46] That reminds me, a friend of Patrick’s gave a TED Talk. Actually, he’s an M.D., as well, and he used the phrase … He said something like being a doctor, or working in a hospital, or something like that was like a backstage pass to the human condition. That you just see everything, and you see it —

Patrick Barrett: [00:34:08] Playing out in different rooms, all the time kind of [crosstalk]

Mike Barrett: [00:34:11] Yeah, up front, and … And it’s real—I mean, I hate to say it, we live in a world where so many things are on TV, or they’re faked for Instagram, or whatever, but this is actually real. These are real people.

David Khosrowzadeh: [00:34:19] Yeah, that’s well put. I like that. I might take that [laughter]

Mike Barrett: [00:34:26] Yeah, I stole it from him [crosstalk] you steal it from me.

David Khosrowzadeh: [00:34:29] I want a tagline [crosstalk]

Mike Barrett: [00:34:31] I wonder who he stole it from [laughter] But yeah, that’s really something. Sorry, I just glanced over at the note you wrote, and it is the stereotypical doctor [crosstalk]

Patrick Barrett: [00:34:42] Oh, doctor scrawl, yeah —

Mike Barrett: [00:34:43] Oh, wait, no … It’s not as bad as I thought.

Patrick Barrett: [00:34:44] No, it’s not too bad. I can read it.

Mike Barrett: [00:34:47] Okay, sorry [crosstalk]

Patrick Barrett: [00:34:48] It’s better than my handwriting.

Mike Barrett: [00:34:49] Yeah, never mind. Take it back. Take it back. So, you mentioned something else earlier, too. You referred to the idea that your grandfather did everything. And I think you used the phrase “back then.” I wrote it down as something that you said. You said, “Back then, they did it all …” My impression, from speaking to doctors and just as an outside observer is that, over time, the field has become way more specialized. Softer, you said. In a sense, I think this goes with that and also not more regulated — I think that’s the wrong term — but there seems to be a much bigger reliance now on what the guidelines say you have to do —

Patrick Barrett: [00:35:27] Like processes and [crosstalk] all these steps and thing —

Mike Barrett: [00:35:29] —being concerned about insurance issues and legalities, which I think maybe three generations ago, it seems that doctors —

Patrick Barrett: [00:35:36] Like his experience probably did not include nearly so much [crosstalk]

Mike Barrett: [00:35:38] Right. Is that an accurate reflection? Can you address your thoughts on that?

David Khosrowzadeh: [00:35:46] I do remember towards the tail end of his practice in the late ’90s, he was getting disgruntled with the way medicine was going. He was being forced to take on a lot of medical malpractice coverage and it was exorbitant. And it was to the point where he decided to go uncovered because it was — it wasn’t financially feasible for him [crosstalk]

Mike Barrett: [00:36:11] So, it would have been cheaper to get sued, lose the lawsuit —

David Khosrowzadeh: [00:36:14] Yes.

Mike Barrett: [00:36:14] That was a better prospect than continuing?

David Khosrowzadeh: [00:36:17] Right, than paying for this coverage. That was one of the things that frustrated him; the fact that things were becoming more electronic rather than paper charts. As an older physician, it was tough for him to adapt to the technology. That part of it I love. I think that it’s important paper charts had to go away because it was time.

Mike Barrett: [00:36:39] Well, think how much information must have been lost or whatever, and that won’t happen, right?

David Khosrowzadeh: [00:36:46] Right. Ideally. Maybe this is too advanced for this, but having the different hospital systems, electronic medical records talk is the current frustration —

Patrick Barrett: [00:36:57] Within the hospital, it’s got a system that works, but it can’t …

David Khosrowzadeh: [00:37:00] Yeah, and that’s, I think, by design of the companies that make the [crosstalk] software. Hopefully, one day, we can get to that point. But he was able to do it all because he wasn’t dealing with … You go down the street and look at the billboards, and it’s all about people holding checks with how much money they made suing a doctor. So, we’re in a different environment than he practiced in.

[00:37:28] And that’s why things are more specialized because, God forbid, if you’re a primary care doctor and you’re delivering a baby and something goes wrong, you can hear the attorney’s voice: “Well, Doctor, how many babies do you deliver a year?” [crosstalk] “This isn’t your thing.” That’s why, as primaries, we’re kind of forced a lot of times, and it does rack up costs … The more consultants you have in the case, the more expensive the case is. You have to, unfortunately, protect —

Patrick Barrett: [00:37:57] Send people to specialists, and that kind of thing?

David Khosrowzadeh: [00:37:59] Yeah. It’s defensive medicine.

Patrick Barrett: [00:38:02] Is that an established term?

David Khosrowzadeh: [00:38:03] Mm-hmm.

Patrick Barrett: [00:38:04] That’s interesting [crosstalk]

Mike Barrett: [00:38:04] The other day, I took my child — I don’t wish to say the name of my child [laughter] but I took the child to the doctor. And I thought that the child might have an issue, like a lazy eye. I guess a lot of babies are born with something like that, and it resolves itself eventually. And I said to the doctor, “Do you think that this is a thing?” He’s a very nice guy; very relaxed. He goes, “Well, it doesn’t matter what I think. We have to send her to …” [laughter]

Patrick Barrett: [00:38:45] Well, that could be like a ruse, though. You could have, “I’ll say her, and act like …”

Mike Barrett: [00:38:49] That’s true. That’s what it was. Anyway, we have to send the child —

Patrick Barrett: [00:38:50] Call the baby “Larry.”

Mike Barrett: [00:38:51] —to a specialist, like whatever the word is —

David Khosrowzadeh: [00:38:56] Ophthalmologist?

Mike Barrett: [00:38:56] Yeah, but for babies. I guess it’s a thing? I don’t know.

Patrick Barrett: [00:38:59] Micro-ophthalmologist? [laughter]

Mike Barrett: [00:39:03] And my mother-in-law was with us and afterwards, she was like, “Well, why couldn’t he just say if he thinks it’s a problem or not?” And I didn’t know, but I was like, “My guess is he can’t be the one who wrote down that it is or isn’t a problem.” Someone who is qualified to [crosstalk] that kind of thing has to be the person who says —

David Khosrowzadeh: [00:39:20] God forbid, if your child’s eye didn’t get better —

Patrick Barrett: [00:39:23] Little Larry.

David Khosrowzadeh: [00:39:25] Yeah, little Larry, he continued to have that problem, then down the road [crosstalk] that doctor would be exposed.

Mike Barrett: [00:39:32] Do you get training in that aspect of things — in the legalities, and liabilities, and that sort of stuff?

David Khosrowzadeh: [00:39:40] Not really, no. And it’s something that would also be great to have. And it’s surprising, in doctor’s lounge lunches, how much of it goes on. As a general rule, if you’re personable, and your patients like you, you’re much less likely to get to sued. However, personable, likeable doctors [crosstalk] colleagues of mine have gone through it, and it’s a tough thing to swallow.

[00:40:09] I know an E.R. physician that I work with, he said he was sued; named in a lawsuit. It was kind of a ridiculous case. But he said that it affected the way he practiced. He started viewing patients as potential plaintiffs [crosstalk]. Obviously, that’s not why you get into this [crosstalk]. Hopefully not turning a bunch of people off medicine, but it’s one of the things that you have to be aware of [crosstalk]. And I think any field you’re in … I mean, my father-in-law is an engineer, and he tell me they’re always dealing with lawsuits and that kind of thing, too; no matter what you’re in —

Mike Barrett: [00:40:49] Sure, and I … As a law school dropout [laughter] I would like to say maybe — I don’t know if you agree or not — but there are times when a doctor is just flatly negligent, and someone suffers because the doctor does something they shouldn’t have done.

David Khosrowzadeh: [00:41:03] Right.

Mike Barrett: [00:41:03] Or an engineer builds a thing knowing that—or says a thing ought be built knowing that it’s not actually done correctly. It’s not that these things should never exist, to me, but it’s that there are so many times when a case does exist that it really ought not to. Is that —

David Khosrowzadeh: [00:41:18] That’s absolutely correct, yes. There are cases when wrong was done, and a patient suffers harm. And in those cases, absolutely. We should have the system in place, but it does—it gets abused.

Mike Barrett: [00:41:30] Sure. Yeah. Well …

[00:41:35] [Musical Interlude]

Mike Barrett: [00:41:36] Did you know that every math question on the SAT or the ACT can be answered in under 30 seconds if you find the fastest possible solution? Now, you don’t have to answer each math question in under 30 seconds, of course. You can still get questions right by using longer solutions. In fact, that’s what most people do when they get a question right on those tests. But approaching standardized math questions in that way takes a lot more time, causes a lot more frustration, and greatly increases the likelihood of making a mistake that will cost you the question. In short, it’s harder overall and it usually results in lower scores.

[00:42:06] And it’s absolutely true that if you find the shortest solution for any math question on an official SAT or ACT, that solution will take less than 30 seconds; sometimes as little as 10 seconds, or even less than that. Those kinds of faster solutions are much easier to implement and generally lead to significantly higher scores with less overall mental effort once you know how to do them. If you’d like to learn more about this idea, keep listening for the special segment at the end of this episode. And for more on the SAT and the ACT, head over to QuestPrep.com, or search for the “SAT Prep Black Book, Second Edition,” or the “ACT Prep Black Book, Second Edition,” on Amazon.com. Thanks.

Mike Barrett: [00:42:41] There were a couple of other things. Basically, every time you talk, I think of things I wanna ask you. One of them—you mentioned the technology, things going digital, and so on. Have you seen any expansion of artificial intelligence, or virtual reality, or any of those kinds of things in maybe the way data’s analyzed, or the way patients are given therapy, or any kind of thing like that?

David Khosrowzadeh: [00:43:07] So, I think just like every field, we’re facing that. And I think doctors are a little more protected than if you’re a banker, or something else, but certainly, it’s something that we have to be aware of. And it’s helpful, but it can also take your job one day. I know that radiologists, for example, every hospital used to have a few radiologists onsite to look at X-rays and that kinda thing. Now, you’re able to outsource that, so there’s —

Mike Barrett: [00:43:40] That’s a good point. It’s not only AI, and things like that, like a machine doing it, but it’s also —

Patrick Barrett: [00:43:44] Being done remotely, or —

Mike Barrett: [00:43:45] —that you can send that digitally to somebody else.

David Khosrowzadeh: [00:43:47] Absolutely. Somebody in Australia, I heard, was reading an X-ray for us recently. Anywhere that they can have a computer, and a radiologist [crosstalk] can be doing those. So, it’s something to be mindful of when you’re choosing your field.

Mike Barrett: [00:44:01] What about remote surgery? Is that [crosstalk]

David Khosrowzadeh: [00:44:06] It’s not something that I see very often in my cases here, but I know it exists. Remote surgery is where a surgeon is thousands of miles away on a robot, and the patient’s getting operated on. I’m sure that—it’s not imminent that that’s gonna be happening in every hospital, but in 20 years, could be. Another aspect of technology that we see is we’re seeing doctors on iPads wheeled into the room. For example, if we have a patient that’s having a stroke —

Patrick Barrett: [00:44:44] Like FaceTime kind of thing?

David Khosrowzadeh: [00:44:45] Yeah.

Patrick Barrett: [00:44:46] Oh, wow. Okay. I was like doctors on iPads …?

David Khosrowzadeh: [00:44:48] Sometimes, for feasibility’s sake, and time’s sake, and also, I’m sure, the hospital’s bottom line, if a patient’s having something emergent and needs a doctor right then, they can wheel in the iPad, and the neurologist can make an assessment, if someone’s having a stroke. The neurologist will do the interview by iPad, FaceTime, and [crosstalk]

Mike Barrett: [00:45:13] Is there someone else in the room for the neurologist to say, “Hey, so-and-so, can you please try to move his arm?” [crosstalk]

David Khosrowzadeh: [00:45:17] Yes, there’s always a nurse present that’s trained in that [crosstalk] There is someone there helping conduct the exam portion of things because at the end of the day, you’ve gotta touch the patient, but that’s another aspect. And for good and bad. There’s a lot of doctors that are able to practice at home in their pajamas, and they like it, and it works out for them. But it’s something to be mindful of. If they can do that, then they can perhaps do what I do.

Mike Barrett: [00:46:03] You mentioned, also, nurses. To what extent—there’s a phrase that I’ve heard my doctor friends use, which is a “physician extender.” In the way that the … Again, please tell me where I’m wrong on this, but my understanding is that in the way that a hospital is run, or any kind of center like that is run, you have the doctor, and then increasingly, you have nurse practitioners, and other highly trained nurses, pharmacists, those kind of people who are able to take on more and more of the decision-making capacity so that if one doctor before could do X patients in an amount of time, now, with these physician extenders around the doctor, they could do 10–20X. Is that a thing? Could you just discuss that?

David Khosrowzadeh: [00:46:51] Nurse practitioners, and physician assistants, they are physician extenders, and they—a lot of times, I’m … As the primary doctor, I have a physician extender at night, a P.A. that covers my night shifts, and she calls me if there’s any issues. She does admissions and takes care of my patients at night. She does a fantastic job. I trust her wholeheartedly. That, obviously, is less expensive for the hospital than hiring a nocturnist — a nighttime version of myself. It obviously helps the doctors out quite a bit. They’re able to cover more ground, see more patients that way.

[00:47:32] And I have experiences with cardiologists who have ARNPs, and now, a lot of the surgeons, they’ll have a P.A. that’s onsite doing the notes and seeing patients, so they can do more surgeries and not have to necessarily do so much note-writing and documenting. They’re getting more and more responsibilities. I think that coming … One of the things that separate physicians from them is the ability to prescribe narcotics, which may be an advantage for them because they don’t get—they don’t have to deal with —

Mike Barrett: [00:48:02] Liability wise, they don’t have to [crosstalk]

David Khosrowzadeh: [00:48:04] —and drug-seeking type behaviors, and so forth. But there’s word that that could be coming, where they have the ability to do that, as well.

Mike Barrett: [00:48:11] That’s interesting. When you mentioned that there’s word coming, is that from professional groups, or just [crosstalk]

David Khosrowzadeh: [00:48:19] —yeah, locker-room talk.

Patrick Barrett: [00:48:24] We just—before this, David, took us into this secret doctor lounge area that I never knew existed, where there was unlimited peanut M&Ms. [laughter] I was going to ask, changing topics a little bit to less what you’re doing right now and more getting back to when you were in elementary school, middle school, high school. You mentioned that you had a lot of, as you said, positive pressure in the direction of doctorhood. So, do you remember, growing up, being aware that education was important in your family; that your parents were telling you to do the best you can do …? What is your general sense about early in life?

Mike Barrett: [00:49:15] Sorry, and … The only other podcast that we’ve done, I also interrupted Patrick at this point [laughter] just because we are maybe thought of as people who represent the idea that high school, and college, and testing, and all this stuff is super important — please don’t sugarcoat, or water down [crosstalk]

Patrick Barrett: [00:49:40] —give us the unvarnished truth —

Mike Barrett: [00:49:41] Yeah. If you didn’t feel it was that important, or if particularly … Please just be—the goal here is to be honest, and transparent about the high school and college experience because, frankly, there’s not a lot of honesty, and transparency around it —

Patrick Barrett: [00:49:58] Everybody feels like, “Well, this is what I think, but …”

Mike Barrett: [00:50:00] Yeah, “This is what I probably should’ve done …” [crosstalk]

Patrick Barrett: [00:50:02] “It’s better for me to say this, so I’ll say that …”

Mike Barrett: [00:50:04] We would like to know—you’re obviously a successful professional person. We would like to hear your specific … Just as you’ve been for the rest of the discussion, what you actually really think about that. So, please don’t feel you need to …

David Khosrowzadeh: [00:50:17] I’ll first say that the SAT is not important at all [laughter]. Any preparation for that is a waste of time [laughter] and I gotta go [crosstalk]. No, no. My dad, and mom, but less so, had very high expectations on grades. It was all As —

Patrick Barrett: [00:50:45] As far back as you remember [crosstalk]?

David Khosrowzadeh: [00:50:47] —elementary school, first grade. Yeah, and I remember second grade, I was starting to veer off, and getting in trouble, and becoming a class clown type figure. I was lying about my grades to my parents, and not realizing that the report card was gonna come [laughter] and it came, and it wasn’t good. And there was some life-changing intervention for [laughter] Yeah, but it was important. It was a fork in the road for me, and it got me back on the right track, and always was the expectation. If there was a B, it was, “What happened?”

Mike Barrett: [00:51:34] This is something I’m always curious about. You are clearly a very intelligent person. Do you think that you’re lucky, and it was coincidental that you are inherently intelligent and then you were able to get all these As, or do you think that there was a role where the family pressure/encouragement directed you to up your intelligence? You know what I mean? Or is there necessarily even a connection in second grade between intelligence and grades? Who knows, necessarily? But what are your thoughts on that?

David Khosrowzadeh: [00:52:02] Are you saying like a nature versus nurture of intelligence?

Mike Barrett: [00:52:05] Kinda. Yeah. Let’s say, for example, you just had tried really, really hard, and just never got straight As. What do you think would have been the outcome there …?

Patrick Barrett: [00:52:13] Like with his parents, how [crosstalk]

Mike Barrett: [00:52:16] I’m just hypothesizing [crosstalk]

David Khosrowzadeh: [00:52:19] I think, in general, to a degree, it helps to have smart parents and hopefully get some of those genes. But for me, it was more roll up your sleeves and work hard. In high school, I wasn’t in some of the prep schools, like Darnell or James Weldon. So, going this—to Stanton, which was a pretty tough school and an IB program, I remember feeling really overwhelmed that first year. I just felt like I was drowning, and there’s kids that I thought were a lot smarter than me, present company included, that it just came so natural; it was just so easy.

[00:53:02] I had to … For me to learn, I have to write things down. In med school, I was traveling around with a bunch of pens and drawing out anatomy to understand it. Other people would—I remember one kid, he just cruised into the tests. It was his first time going through the material, that night. He was finishing up the last page right as we were walking into the test, and we got the same grade, even though I had gone through it four times and written it down to the point of calluses. And so, if you—you have to look at yourself and realize what your limitations are; what is your learning style and capabilities and figure out what’s gonna get the job done.

Patrick Barrett: [00:53:43] Figure out what works for you, and then just embrace it.

David Khosrowzadeh: [00:53:46] Yeah.

Patrick Barrett: [00:53:46] That makes a ton of sense.

Mike Barrett: [00:53:48] So that started then, like you said, elementary school; got to high school, which was apparently a bit of a shock to the system given that the school was so rigorous. At what point—I guess we’ve already established you knew you wanted to be a doctor. That was just in the back of your mind. At what points in that progression did you start thinking specifically about college and applications [crosstalk] and all that kind of stuff, or were you just like, “Well, it doesn’t matter. I’ll eventually go to law school …” That was me. [laughter] Medical school, whatever school … How did you weigh those priorities, and what did you think about at that time?

David Khosrowzadeh: [00:54:27] We were lucky where we went to school in that it was something that was at the forefront of the discussion from beginning of freshman year —

Patrick Barrett: [00:54:36] For context, we went to a magnet school that was just — magnet is a good visual. Just sucking all the nerd kids all around town into one area.

Mike Barrett: [00:54:47] Nerd magnet.

Patrick Barrett: [00:54:49] Nerd magnet. As you said, the expectation for everybody was, of course, you’re working toward going to college and whatever …

David Khosrowzadeh: [00:54:57] It was the culture. Everybody was talking about where they wanted to go. It was something that you got sucked into and —

Patrick Barrett: [00:55:05] Yeah, for better or for worse. Sometimes, a lot of people feel –

David Khosrowzadeh: [00:55:07] Not a bad thing. And I had friends that went to public schools that I would have gone to, had I just continued on. I fought my parents about going to that school —

Mike Barrett: [00:55:15] Our school was also public, it should be added, as well, just for —

David Khosrowzadeh: [00:55:17] That’s true. The local school [crosstalk]

Patrick Barrett: [00:55:20] The non-magnet versus magnet schools …

David Khosrowzadeh: [00:55:22] Me and my parents had an argument about whether I was gonna — I got an acceptance letter to —

Patrick Barrett: [00:55:28] Going to Stanton or not?

David Khosrowzadeh: [00:55:29] —that school, the magnet school. Out of the blue, I guess I had done well on a test in middle school, and they reached out to me, and my parents were like, “You’re absolutely going to this school.” It was number one in the country at the time on some ranking.

Patrick Barrett: [00:55:46] Newsweek or something [laughter]

Mike Barrett: [00:55:49] Believe it or not, people used to pay to have paper delivered to their house, and the paper had pictures of people —

Patrick Barrett: [00:56:02] Now we know that paper is just garbage [crosstalk] Yeah, so it was number one in the [crosstalk]

Mike Barrett: [00:56:09] —and they really wanted you to go, and you, it sounds like, were not super —

David Khosrowzadeh: [00:56:12] All my friends were gonna be going to the local school and that’s where I wanted to go.

Mike Barrett: [00:56:18] Sounds like some second-grade class-clownery coming back [crosstalk]

David Khosrowzadeh: [00:56:21] And they won the debate [crosstalk] I think it was rigged, but they [laughter] looking back, a lot of those friends that I had are not really doing much anymore or got in trouble somewhere along the line. It’s really a godsend and a blessing that that happened because I don’t know that I’d have got this far.

Patrick Barrett: [00:56:50] Did your parents convince you at all, at that point, or was it just [crosstalk] Was there a little bit in your mind, like maybe they’re right, or was it just, you’re doing this, and you’ll see later that it’s right?

David Khosrowzadeh: [00:57:01] I saw where they were coming from, about the school and stuff —

Patrick Barrett: [00:57:04] Yeah, you got their argument. You just … You were more thinking about …

David Khosrowzadeh: [00:57:07] Right. It was just more — for me, at the time, it was more about my friends. And going to a place where I didn’t know anyone, and this intimidation factor of everyone being smarter than me, and at a different level than me, and that kinda thing. I think, honestly, that humility has helped me every stage. Even when I got accepted to med school, I kept—I remember telling my parents this: I kept waiting. The first day, orientation week, I kept waiting for the dean to walk in the room, and be like, “Oh, you … [laughter] You’re outta here.” [crosstalk] There’s obviously some anxiety that comes with that, but I think it also compels you to work harder.

Patrick Barrett: [00:58:02] It’s an interesting point being in a community like that, because I often think that that was the most important education, more than college or anything, that community of people. And it was great teachers, but a lot of it was the kids you were around and the mentality. Like you said, you could stand out in some ways and still see that there’s other kids, and other stuff that are way better than … You know what I mean? It’s a good thing to see and not be freaked out by it, or intimidated, or not feel like that means you can’t try, or whatever. It doesn’t matter. There was a kid, I remember, in one of my—in a French class, and he was almost always asleep. He got Fs. He did terribly, and he was an international-level robotics whiz. He was always asleep because he was up till 6:00 in the morning, in his lab or whatever, and he’s designing robots [crosstalk].

Mike Barrett: [00:58:52] Well, and I think that’s an interesting thing now, too, because one thing that the internet has done, for better or worse — a lot of ways that it’s not for better — it has made you aware that no matter how good you at something, there is someone —

Patrick Barrett: [00:59:11] I feel like that’s a good thing. If you can realize —

Mike Barrett: [00:59:12] If you realize it, absolutely.

Patrick Barrett: [00:59:14] It depends on how you take it, but if you let it intimidate you [crosstalk]

Mike Barrett: [00:59:17] I think at that younger age, maybe I’m projecting, but I think for a lot of people, the idea that “I am uniquely … I am the best football player in my school; I’m the best this; I’m the first chair in the orchestra,” or whatever [crosstalk] I think you could have that feeling and believe that you were pretty good at something, a long time go [laughter] but now, whatever you think you’re good at —

Patrick Barrett: [00:59:39] No matter what you do or how good you are …

Mike Barrett: [00:59:40] There is someone who is at least as good as you who’s out there.

Patrick Barrett: [00:59:43] But then, with the internet, too, there are all these weirdly specific little skills that people develop on their own.

Mike Barrett: [00:59:47] That’s true.

Patrick Barrett: [00:59:48] I saw a video of a guy doing flute beatboxing [laughter] playing a flute, and beatboxing simultaneously [crosstalk] However many before YouTube, or whatever … I started to say the internet, and then I said YouTube, and I said before the YouTube [crosstalk] I don’t say “The YouTube …” [laughter] I was just changing what I’m saying. Yeah, there wouldn’t have been beatboxing flautists but now there are. And so, it’s interesting, like you said [crosstalk] thank you very much … If you want to be the best at something, you better make up a new thing [laughter] and then also get good at it because somebody else is gonna do it, too.

Mike Barrett: [01:00:25] But that also … Like you said, it is good. And as you both said, good to have that humility and to be aware that life is still worth living even though I’m not the [crosstalk] best person —

Patrick Barrett: [01:00:38] If you can recognize that everybody else is also intimidated — that’s so comforting to me because I feel like I can come off very confident. I’ve been told that, but for me, it’s less that I’m confident; it’s more that I know everybody else is freaking out [laughter] I’m secure in that knowledge that I have those feelings, and I’m like … A lot of people walk into a room the first time, they go, “Everybody’s looking at me here, and I don’t know what I’m doing …”

Mike Barrett: [01:00:57] They also don’t know what they’re doing.

Patrick Barrett: [01:00:59] Yeah, exactly, but that’s a pretty universal feeling —

Mike Barrett: [01:01:03] Something that you touched on briefly, as well, was this idea of limitations and knowing your own learning style … I think that that’s such a critical thing just to even be aware of. I think a lot of people, especially people who are driven by their families to pursue a particular career or whatever, they’re given the idea that they don’t have any limitations. The limitations are for other people —

Patrick Barrett: [01:01:30] Or they shouldn’t have them [crosstalk]

Mike Barrett: [01:01:31] That’s a better way to put it.

Patrick Barrett: [01:01:33] Figure out a way not to have [crosstalk] Get back to me later about that.

Mike Barrett: [01:01:36] Right, which is, I think, not possible or at least I’ve never met a person who was fully unlimited in every way … How did you …? Was it trial and error? Or how did you come to have an idea of what you think your limitations are, and how do you decide which ones are things that ought to be worked on and which ones are things that like, “no, it’s just the way it is, and I gotta deal with that?”

David Khosrowzadeh: [01:01:58] I think from the beginning, you’ve been processing information and studying for tests. You know what you can do, and you know what comes easy. You know what works and what doesn’t. There are some people that are visual learners. There are some people that have to write it down. And that was the case for me. I needed a lot of repetition to really hammer it home. So, I think that self-awareness comes early.

[01:02:31] I remember, every time a new school year would start, the end of summer, the blues of summer ending, and the dread of going back to school … And every year, I would have that feeling and talk to my parents, like, “Oh, gosh, I don’t know if I can handle eighth grade. They’re gonna be doing this, and this, and this …” I remember third grade, “They’re gonna be doing cursive and all this stuff.” My parents, my dad especially, would just tell me, “It’s gonna be the same. You’re a better version of you …”

Patrick Barrett: [01:02:57] Yeah, you have also grown [crosstalk]

David Khosrowzadeh: [01:03:00] Yeah, so don’t let it overwhelm you, and all the way through med school, just carried that [crosstalk]

Mike Barrett: [01:03:05] That’s such an interesting point.

David Khosrowzadeh: [01:03:07] Because you’re changing, too; otherwise, we’d start at eighth grade from the womb [laughter]

Patrick Barrett: [01:03:14] Yeah, next year, we’ll be in eighth grade [laughter] And that’s the origin of first grade [laughter]

Mike Barrett: [01:03:26] Did you ever—in your practice, were you ever aware of other types of limitations? I don’t know enough about medicine to suggest what some of them might have been, but were you ever aware of those kinds of things, and how do you address that?

David Khosrowzadeh: [01:03:44] I think that something we should definitely cover that can be a limitation for a lot of people, unfortunately, and it’s only getting worse, is finances.

Mike Barrett: [01:03:53] Please, yeah.

Patrick Barrett: [01:03:54] Of going to school [crosstalk]

Mike Barrett: [01:04:00] I feel more at ease talking about people dying [laughter] but that’s how it’s gotten. That is absolutely … You’re totally right, so yes, please, by all means address that.

David Khosrowzadeh: [01:04:10] I don’t have the exact data offhand, but just friends of mine that that have gone through it that took loans out from the beginning are in several hundred thousand dollars of debt. The most I’ve ever heard is in the 400s. That was someone that had took out loans for undergrad — a private school. And then med school. And the cost is getting higher and higher every year. I remember my med school tuition would go up, it seemed like, $5,000 every semester, and it was the same education. It wasn’t like we were getting [crosstalk] it was just getting higher because that’s what it is [crosstalk]

Patrick Barrett: [01:04:50] Let’s see if they pay it this semester! [laughter] They did! Oh, my God! [laughter]

David Khosrowzadeh: [01:04:56] I really honestly felt like, yeah, these guys are idiots!

Mike Barrett: [01:05:00] Do they know what dollars are? [crosstalk] They just keep giving them to us …

David Khosrowzadeh: [01:05:04] That’s its own discussion, but I think the schools bear a lot of the responsibility for that.

Mike Barrett: [01:05:11] Well, I think, also, when I was younger, I remember there was this idea that being a doctor was a very lucrative position. And I don’t know, and I don’t wanna pry into your personal situation, but my understanding now is that either because it’s now carrying so much debt, which it didn’t really carry before, or because of so much malpractice insurance, or because a million other things, that it is not as lucrative as it was [crosstalk]

Patrick Barrett: [01:05:39] —might’ve been made out to be, especially for us when we were in elementary school, and everybody’s like … [crosstalk] That was a golden option. If you do this, then you’re good to go [crosstalk]

Mike Barrett: [01:05:48] Which I think also—and this is something that the guy in “Morphine, Ice Cream, and Tears” mentioned, I believe—he mentioned that most people who went into the field really did love humanity, and they wanted to make sick people better —

Patrick Barrett: [01:06:01] Like that was a part of the motivation, at least —

Mike Barrett: [01:06:02] —but there was a percentage of people who just wanted a way to make a lot of money and get a lot of respect from their communities [crosstalk] and he talked about how about that didn’t always turn out great.

David Khosrowzadeh: [01:06:11] Right.

Mike Barrett: [01:06:13] I don’t know—when I speak to people now who are in their teens and early 20s, especially if they don’t have a lot of doctors in the family, or a lot of friends who are doctors in their orbit, their idea about the financial aspects of going to med school and then practicing, choosing a specialty, all that stuff, it doesn’t seem to match up with what I hear from people like you, who actually have done it recently. It just seems a little bit different.

David Khosrowzadeh: [01:06:41] Watching my grandfather, he went through what he would call — a lot of doctors now, older doctors — will call the golden era, where they were making a lot more money. Pharmaceutical company relationships with the doctors, they could take them on lavish vacations for weeks at a time and encourage them to prescribe certain medications. There’s so many rules that we can’t even get a pen, at this point, anymore because it’s [crosstalk]

Patrick Barrett: [01:07:10] Yeah, you can’t have this pen, either [laughter]

David Khosrowzadeh: [01:07:16] Right, you can’t take any of it [crosstalk] So, there’s that aspect, and then just the overhead — the malpractice that he was having to deal with, and then from a hospital setting —

Mike Barrett: [01:07:27] Well, there’s so much more technology now, and that in itself is so much more expensive, and everything is just more, more, more.

David Khosrowzadeh: [01:07:32] Then, administrators. There’s two to three administrators per doctor now [crosstalk] and so many layers of making sure you’re keeping up with compliance and changes in insurance companies, and there’s roles developing every month, we’re hearing about new titles that didn’t exist before, from an administration aspect.

[01:07:55] When you have all that and then, you also have to keep in mind that, during that golden era, it was a fee-for-service model, meaning — and not necessarily that that was a good thing — but you could have a patient in the hospital. You could consult all your friends and keep them in the hospital. The longer you kept them in the hospital, the more money you would make. And now, insurance companies have gotten wise to that [laughter]. So, now, it’s more about delivering efficient care and getting people in and out of the hospital as fast and safe as possible. Sometimes that’s a stressor for us [crosstalk]

Mike Barrett: [01:08:42] Does it ever swing too far the other way —

David Khosrowzadeh: [01:08:43] It does.

Mike Barrett: [01:08:43] —where you’re pressured to let a person out, and you don’t think it’s time?

David Khosrowzadeh: [01:08:46] You’re never told, “Hey, you’ve gotta discharge this person.” Ultimately, we’re making the decisions, but we’re judged on metrics [crosstalk] You’re judged next to your peers on how expensive your cases are, and how many consultants you bring on your cases, and how long they’re in the hospital.

Mike Barrett: [01:09:01] If you’re too far outside of whatever is the norm —

David Khosrowzadeh: [01:09:05] You’re a bad doctor. So, the metrics are a thing that physicians are dealing with now that they weren’t before. They were autonomous to do what they needed to do and not really worried about anyone looking over their shoulder. But in terms of how much money you can make, there are fields of medicine where you can still make more than a million dollars a year, but those fields are getting smaller and smaller.

[01:09:36] They always said in med school, it was the ROAD to success. So, radiology, but more so interventional radiology; guys that are doing procedures, like you’ve got a tumor in your kidney, they’ll do a biopsy [crosstalk] a targeted biopsy with a CAT scan or ultrasound. That’s the R. The O, ophthalmologists; A, anesthesia; D, dermatology. There’s a few others [crosstalk] Yeah, they didn’t make the cut [crosstalk] It’s a fairly safe field, where you don’t have to necessarily worry about job security. Our population is getting older. We’re always gonna need doctors. But if you’re going into it to make millions a year, there are less opportunities and types of doctors —

Mike Barrett: [01:10:26] Than there were.

David Khosrowzadeh: [01:10:26] —you can be than there were.

Mike Barrett: [01:10:27] Do people in med school, in your experience, did they openly discuss this? Because you mentioned the ROAD to success thing. Did people talk about finance and that?

David Khosrowzadeh: [01:10:36] Yeah, of course, in every field, every class, there’s people that are there that that’s probably on their mind, and there were discussions like that. I wouldn’t say it was everybody talking about how much they were gonna make, or what field they were gonna go into for that reason, but certainly, there were people that that’s what their mind was on, and they were going for that certain field, whatever it may be, from day one.

Mike Barrett: [01:11:00] Wow. Interesting.

Patrick Barrett: [01:11:05] Jumping back, still to the earlier thing, your high school experience, and like Mike asked earlier, when you shifted to thinking about getting into schools, and scores, and everything. Do you remember being stressed out about getting a certain test score, to get to a certain school? Did you have a “I’m gonna go to this school, and it’s gonna go this way?” Did you have a path that you were counting on, and was it stressful to get there, or did you not …? What was that like?

David Khosrowzadeh: [01:11:39] So, my goal was always to go to a med school relatively close to home. Persian culture, it’s—you’ve got to be available. I would get a hard time from my more Americanized friends because I would go home every other weekend from Gainesville to Jacksonville, a two-hour drive.

Mike Barrett: [01:11:58] Wow. Really?

David Khosrowzadeh: [01:12:00] I would still get heat from my dad that I wasn’t home enough [crosstalk].

Mike Barrett: [01:12:06] He’s forcing you to be a doctor, but while you’re going to be a doctor [crosstalk]

David Khosrowzadeh: [01:12:12] My friends would ask me —

Mike Barrett: [01:12:12] Because he loves you. Obviously, that’s why [crosstalk] Yeah, go ahead.

David Khosrowzadeh: [01:12:16] They would ask me, “What are you doing?” [crosstalk] it was important for me to go to school somewhere in Florida. I took the MCAT the first time, and there was two times. And I was going through a social situation, where I went through a breakup a week before my MCAT, and it just totally messed up my headspace. I remember sitting halfway through the test, rereading the first paragraph again and again. Just nothing was clicking. I just knew—I walked out [crosstalk] have to retake it.

[01:12:56] After that experience, the pressure was much higher in the preparation, the second time around, to, number one, make sure I was learning this material. Number two, making sure absolutely nothing went wrong, which was even harder. I just put blinders on. Absolutely, I think for me, especially, like I was saying, every step of the way not knowing if I was gonna make it and not knowing if I was good enough. The testing was another aspect of that. And I wish I would have heard that quote from you before about knowing that everyone else was freaking out because that would have been helpful [laughter] You go in the testing room, and you feel like everybody’s [crosstalk]

Patrick Barrett: [01:13:32] —because also, the more people that are freaking out internally, they’re just trying to stand there, and be normal [laughter] everybody else is looking at everybody else making the same placid face of … [crosstalk] Is it MCAT time already?

Mike Barrett: [01:13:47] Was there a specific score that you were shooting for? Were there specific tiers of programs you knew you wanted to get into? How much pressure—or was it more like, “As long as I do my best, I think I’ll get in somewhere.” What was the …?

David Khosrowzadeh: [01:14:01] Generally, in terms of scores for schools, what I think the audience should be aware of is certain scores — every program has a score that’s gonna get your resumé on the desk. And if you don’t get on that score … And they have different levels of what they’re willing to tolerate and so forth. That’s number one, and that’s why I think the testing is important, and the grades are important, because that’ll get you at least in the door for a potential interview. Then, you’ve just got to not be a major weirdo [laughter] at least just 30 minutes [crosstalk] In terms of what score I wanted, I had a score in mind. I wanted, for the MCAT, a 30 was what I wanted. First time around, wasn’t close; second time around, I got there.

Patrick Barrett: [01:15:11] Earlier, when you were in high school looking toward college, for that testing/admissions situation, was that similar in that you had a certain SAT score, or a certain school that was the school to go to? What was that whole situation like for you?

David Khosrowzadeh: [01:15:26] For me, there wasn’t as much pressure with the SAT; I just wanted to do well. I don’t remember what “well” would’ve been, or if I had a number in mind, but my goal was to go to UF. It was close to home, and it had a med school, and it was one of the better schools in the state [crosstalk]

Mike Barrett: [01:15:43] Did you go to med school at UF? After?

David Khosrowzadeh: [01:15:47] No.

Mike Barrett: [01:15:47] Sorry, did you know at the time … I think now, looking back, a lot of people who’ve been through all of their schooling recognize that it’s normal to go to undergrad one place and somewhere else for whatever you do afterwards. But did you know, as a teenager—because you mentioned UF had a med school. Really, strictly speaking, that shouldn’t have played any role in your decision making because you weren’t gonna necessarily go to that med school, or you could have gone after going somewhere else, but did you know that at the time, or …?

David Khosrowzadeh: [01:16:13] It would have been nice. At the time, that was the goal was to just stay there. We had a condo [crosstalk]

Mike Barrett: [01:16:19] Okay, so that was the plan.

David Khosrowzadeh: [01:16:21] That was the plan, yeah. That would be pretty rare for someone to go to graduate school where they’re going for undergrad, at least from the experiences of colleagues of mine. Most people travel. And I think, looking back, I’m glad that I had experiences outside of just one place for eight years because I think it helps broaden your horizons a little bit, and just have a clean slate, and meet new people, and so forth —

Patrick Barrett: [01:16:50] Like a mind-expanding experience, kind of …

David Khosrowzadeh: [01:16:52] Yeah, exactly. I went to med school at Nova, which is in Fort Lauderdale. That was never in my thinking, growing up, that I was gonna live in South Florida. I always had a negative connotation of South Florida, for whatever reason. But I really enjoyed my time there. I had a great time. Met great friends. One thing I wanna say is I thought that, as undergrad was winding down, the fun was over, and that it was time to get serious. I was serious, but I had a fun undergrad experience. But I was really surprised to find that med school, for me, was even more fun than undergrad was —

Mike Barrett: [01:17:35] That’s really interesting.

Patrick Barrett: [01:17:36] Yeah, that’s surprising.

David Khosrowzadeh: [01:17:38] The first year, not so much, but after you get through that first year and you’re not so much in the books, and you’re out in the hospitals; you’re with like-minded people that have similar goals as you, and so forth. Most of the people in my wedding were from my med school class.

Patrick Barrett: [01:17:55] It almost sounds like being on an athletic team together. You’re going through this experience, and you’re physically working hard to do your rounds, and stay up late, and all that kind of stuff.

David Khosrowzadeh: [01:18:07] Exactly. That experience or being in the military. That’s how I thought; we were doing our time together. It was more fun because —

Mike Barrett: [01:18:17] When you say fun, was it the socializing, the same kind of socializing that you were doing as an undergrad, or was it more of that it actually … You found the fun in the training [crosstalk]

David Khosrowzadeh: [01:18:34] Both. [laughter]

Mike Barrett: [01:18:38] —just holistic fun. [laughter] Well that’s good.

David Khosrowzadeh: [01:18:46] It confirmed for me that I was doing the thing that I wanted [crosstalk] I didn’t have that [crosstalk] sense of uncertainty of, “Oh my God. I’m doing all this stuff. What if I hate it?” Now, I was actually working in the hospital. I was realizing, okay, this is what I’m gonna do [crosstalk]

Mike Barrett: [01:19:03] That gets back to when you mentioned the shadowing. I didn’t appreciate when I was younger, and at the age that I might have been shadowing—not just for if I wanted to go to medical school, but just any profession—that that’s a thing that you could do. I didn’t realize that that existed. I think, now, when I look at the people that we’ve worked with who have or have not done those types of shadowing experiences, it’s a great … Depending on the person that you’re shadowing, how transparent they are, and how accessible they are—it’s a great way to actually see, “oh, this is the day-to-day life in this type of thing.” Do you look for opportunities to let other people shadow with you or is that really a thing you can do in your current role?

David Khosrowzadeh: [01:19:45] It’s funny you bring that up because the youngest brother that I talked about who had the engineering veer in his path and now is interested in medicine again, he’s shadowing me next weekend [crosstalk]. I’m super excited about it. I’ve been talking to HR to get his badge, and so forth. I’m excited for him because I really—I know after his experience with my dad, and so forth, I really feel strongly that after a couple of days of getting in it, he’ll be fired up to finish strong in undergrad, and get the testing scores he needs to get in the door because I think that his personality—he’ll be a good fit.

Mike Barrett: [01:20:28] Is there a way, if someone is listening to this … Hopefully, someone might [laughter]—if anyone listening to this doesn’t know how they could try to shadow a physician, or some other professional, is there some kind of — I should know this but I don’t — is there some kind of body that they can go to, like someone who matches you up with people who would let you shadow them, or is it more of a personal network kind of thing; going on LinkedIn? How do you find those people?

David Khosrowzadeh: [01:20:53] There may be something out there [crosstalk]

Mike Barrett: [01:20:56] I’ll make a note to myself that I should find out about that [laughter]

David Khosrowzadeh: [01:20:59] I’m not sure of it. Usually, it’s personal networking, personal relationships. You have an uncle, or you have a family friend, a neighbor, and anybody can shadow any physician. It’s a pretty straightforward process, especially if they have their own practice, but if they’re in the hospital setting, it’s a matter of a just working it out with HR and getting a badge. I would say it’s more rare for a physician not to have been shadowed than being shadowed. When I’m walking around the hospital seeing physicians, very, very frequently, you’re seeing somebody who’s following them around, and observing, and so forth.

Mike Barrett: [01:21:36] If somebody wanted to shadow you — not that I’m suggesting people approach you specifically but just for your —

Patrick Barrett: [01:21:42] What’s your email address? [laughter]

Mike Barrett: [01:21:46] Is there a way that that request should be framed? Are there things that you would find out about someone, and say, “No, you can’t shadow me because I don’t trust you to be around patients …” or is there some kind of thing like that? Is there any kind of filter there?

David Khosrowzadeh: [01:21:57] I think that just generally being an approachable, nice person is generally gonna get you in the door. We’re just like everybody else. It’s no different than a lawyer, or someone in a grocery store, or whatever. You wanna be around people that are pleasant to be around, that are on time. That’s really the thing [crosstalk] not wearing shorts, then you’re gonna be totally fine. [laughter]

Patrick Barrett: [01:22:28] You take it seriously, I’ll take it seriously. That’s all I’m saying. [laughter]

Mike Barrett: [01:22:36] Showed up late; am currently wearing shorts. [laughter] No, but that’s fair. That’s a really good point [crosstalk]

David Khosrowzadeh: [01:22:42] No, I don’t think there’s any secret sauce to it, it’s just [crosstalk]

Patrick Barrett: [01:22:45] It’s stuff everybody should know. [laughter]

David Khosrowzadeh: [01:22:49] When you have your own podcast, you live by different rules [crosstalk]

Patrick Barrett: [01:22:53] You’ve mentioned, we talked about this earlier, that your normal schedule is—just to get in [crosstalk] day-to-day life of a person in your position. You have seven straight days on, and then off, all the time. That’s your normal [crosstalk]

Mike Barrett: [01:23:10] That’s not necessarily everyone’s normal thing. That’s your normal arrangement.

Patrick Barrett: [01:23:13] What’s the hours like for those days?

David Khosrowzadeh: [01:23:16] Generally, 10-hour, 12-hour days. They’re long days [crosstalk] but you get a week off, every other week. 26 weeks off a year, built in.

Mike Barrett: [01:23:28] That’s not bad at all. You mentioned, is it a P.A., that you have over night?

David Khosrowzadeh: [01:23:33] A nurse practitioner.

Mike Barrett: [01:23:34] Nurse practitioner, sorry. Is that person also working on your schedule? [crosstalk]

David Khosrowzadeh: [01:23:38] Yes, on my week, she’s working those nights, about 12 hours each night. There’s kind of a [crosstalk]

Patrick Barrett: [01:23:44] Does she have a week off, then, as well?

David Khosrowzadeh: [01:23:48] Yeah.

Mike Barrett: [01:23:48] You’re always working with the same [crosstalk] person overnight. You learn each other’s habits, and things like that. You don’t have to constantly be …

Patrick Barrett: [01:23:58] It’s weird. It’s like a coworker that you don’t actually — you’re not in the same building at the same time [laughter] you tag out on the way out —

Mike Barrett: [01:24:05] It’s kind of funny because I’m thinking, like when I used to work in restaurants, whoever opened the restaurant would always complain about whoever closed the restaurant [laughter] just doing a horrible job. Is there any of that, or are you guys more professional than that? Do you ever come in in the morning, and go, “Oh my God, I can’t believe she didn’t do blah-blah-blah …” [crosstalk]

David Khosrowzadeh: [01:24:23] I’m lucky that there are really no instances where that’s happening. Sure, colleagues, just like any workplace, if somebody’s not pulling their weight, and making your job harder, people will notice. Something the students going forward take with them is if you are on time, and make other people’s lives easier, and you’re not the liability of the room, then you’ll go far.

Patrick Barrett: [01:24:51] That’s a huge basic skill in any job, any situation where you’re interacting with even one other person.

David Khosrowzadeh: [01:24:56] Yes.

Patrick Barrett: [01:24:57] Being on time. [laughter] Those little basic things, and there is no class for it, and there’s not … It’s just this simple thing, like, other people depend on you, and vice versa, and it matters if you show up when and where you’re supposed to, or you’re not causing little problems for other people.

David Khosrowzadeh: [01:25:13] In terms of lifestyle, there was an administrator who made a joking comment about how doctors wanna have the boats of their ancestors, or the boats of the old golden era doctors, but they don’t wanna work as hard —

Patrick Barrett: [01:25:31] Those hours, or something.

David Khosrowzadeh: [01:25:33] Yeah. My grandfather was putting in major hours —

Mike Barrett: [01:25:35] That’s an interesting take. Yeah, he must’ve [crosstalk]

David Khosrowzadeh: [01:25:37] When you’re the guy, your phone [crosstalk] There’s no nurse practitioner covering you at night. He was running his own practice. Somebody had chest pain at night, they’re calling [crosstalk] he’s going to the hospital. Someone’s gotta deliver a baby. He’s gotta go.

Mike Barrett: [01:25:54] That’s a very good point.

David Khosrowzadeh: [01:25:55] The financial aspect of that was he was doing really well, but there’s pros and cons, and you have to decide. There are still ways to do both, and as a physician now, getting out of training, you can go and try and start up your own practice. It’s becoming less and less frequent, though. The private practices are getting gobbled up by the hospitals, and more and more people like myself are choosing to be employed because they don’t want to necessarily deal with the overhead, and the headaches of running an office, and hiring and firing nurses [crosstalk] Keeping up with what —

Patrick Barrett: [01:26:31] Because being a doctor and running a business are two separate things, and you’re deciding to embark on both together. Yeah.

David Khosrowzadeh: [01:26:37] Absolutely. There are opportunities to be both. You can probably make a little bit more money, or maybe even a lot more money if you choose to go that route, but for me, lifestyle was very important to me, and family, and so forth. Those things were more important to me than making more money.

Patrick Barrett: [01:26:54] So, the seven-and-seven framework is something that you’re happy with? You feel really good about it [crosstalk]

David Khosrowzadeh: [01:27:01] I wasn’t sure in the beginning. I had to kinda sell it to my wife —

Patrick Barrett: [01:27:03] Yeah, it’s kinda hard to imagine what that’s like [laughter]

David Khosrowzadeh: [01:27:07] I have to say, I was told this morning before I left work that I had to give a shout out to my wife and son. So, hey guys [crosstalk] I had to pitch it because the idea seemed cool to me, but you have to—your spouse [crosstalk] has to realize that every other weekend, you’re gone. It sounded great, seven on, seven off, great, but every other weekend, you’re working, so a lot of weddings —

Patrick Barrett: [01:27:37] And like 12-hour days and stuff [crosstalk]

David Khosrowzadeh: [01:27:40] Weddings, and [crosstalk] family things, and holidays — if Christmas falls on that seven on, then you’re working. That’s happened. Happened half the times. [laughter]

Patrick Barrett: [01:27:54] There’s not vacation days, or working out your schedule with somebody else to [crosstalk]

David Khosrowzadeh: [01:28:00] I have a counterpart who works opposite weeks to me [crosstalk].

Patrick Barrett: [01:28:03] So, you would have to just try do [crosstalk]

David Khosrowzadeh: [01:28:04] —we would just come up with a trade. Come to the trading table, which we do.

Mike Barrett: [01:28:09] You could, in theory, do 14 on, 14 off, if the other people are okay with covering that.

David Khosrowzadeh: [01:28:13] Yep, taking those days. Absolutely [crosstalk]

Mike Barrett: [01:28:15] That’s very interesting.

Patrick Barrett: [01:28:19] Do you ever think about, at another point in your career, having your own practice, or working in a different environment or anything?

David Khosrowzadeh: [01:28:29] Yeah, I think that there aren’t many people in my position that are in their 60s and keep doing it because, at a point, you have kids, and they have soccer practices, and the weekends become more valuable than the seven off, per se. If they’re at school all day … I’m not in that position yet, but there will be a time, eventually, where I’ll wanna transition to something else. I don’t know what that is yet. Having my own practice, we’ve talked about that, and my wife running the administration side because she’s pretty business oriented.

[01:29:03] I’ve recently got involved in more administrative duties to see what that’s like. There is really a lack of leadership amongst physicians. There’s a need for it, and when you have the CEOs of hospitals that are coming from business school, rather than med school, there’s — it can be a problem. Learning that kind stuff … In terms of going back to school one day, I’ve thought about getting my MBA at some point, and there’s programs for gaining that knowledge, and running hospitals, and hospital systems. That’s something down the road, it would be a possibility.

Patrick Barrett: [01:29:50] Hospital administration—is that the term for that? What would you call that? [crosstalk]

David Khosrowzadeh: [01:29:55] There’s a medical MBA, and there’s a hospital administration position. I don’t remember the exact terminology, but there’s schools for that.

Patrick Barrett: [01:30:05] You’d be in the business side of running a hospital is what you’re describing basically? As a potential later career move kinda thing?

David Khosrowzadeh: [01:30:13] Yeah, more of the traditional Monday to Friday —

Patrick Barrett: [01:30:15] Did you ever at any point have just some totally unrelated not medical like “Oh I’d like to open a sports bar or be a …”? Any other dream or anything that was just a totally unrelated path or was it just—you’re gonna be a doctor [laughter]

David Khosrowzadeh: [01:30:32] I had a lawn business in high school briefly over a summer but never really … Nothing serious no. It was always gonna be this. I think there’s pros and cons to that. I think the pros are that if you start undergrad training knowing what you wanna be you can develop an advantage and a head start rather than showing up and enlisting in multiple different classes and trying to figure out as you go and then figuring it out. I mean it’s good to be open minded, but it’s also helpful if you know what you wanna do and you can plan your schedule accordingly.

Patrick Barrett: [01:31:11] That makes sense. It’s interesting because I feel like you hear a lot about there’s just certain situations where a child is expected to do a certain thing. And a lot of times it doesn’t go so well because the kid doesn’t really wanna do it; doesn’t take to it. It’s like an expectation you don’t wanna have. For you it seems like it worked out really well, because you really from everything you’ve described—like being at your grandfather’s funeral and being moved by that, that felt so right. It seems like it’s fit you very well.

David Khosrowzadeh: [01:31:44] I think going through high school with that expectation, even elementary and middle school, of what you should be and what you’re gonna be, there was always a little tiny piece of me that was semi-resentful, maybe, about that.

Patrick Barrett: [01:32:00] Yeah, this is sort of laid out for you.

David Khosrowzadeh: [01:32:00] And what if this doesn’t work out and then my life’s ruined? Fortunately, I had those experiences with my grandfather that helped me realize okay maybe they’re right.

Patrick Barrett: [01:32:11] Was there any fallback when you thought that, of what if this doesn’t work out? Then, I’m gonna have to be — what is it? Engineer, lawyer, or landowner?

David Khosrowzadeh: [01:32:17] It would probably be something in sports. I enjoy it so much. Something business side of sports [crosstalk] But once I got accepted to med school and I had to make the decision, now, it’s real.

Patrick Barrett: [01:32:33] It’s happening.

David Khosrowzadeh: [01:32:34] And I remember there was a very important conversation with my dad in Jacksonville, where we were talking on it. We were on a drive, and now, I was gonna be moving … I wasn’t gonna be an hour away. I was gonna be five hours away, and my life was gonna be consumed. There wasn’t gonna be coming home every weekend anymore. Those days were gonna end.

[01:32:53] So, I remember talking to him about it, and he told me, he’s like, “If you wanted to do anything here, I totally support you. You don’t have to do this. I want you to do it because you wanna do it.” So, that was a very important conversation for me because then that pressure —

Patrick Barrett: [01:33:09] It was your choice now.

David Khosrowzadeh: [01:33:10] —was off, and it was my choice, and I think that was important for me going into starting med school that I was the one signing the paper. Someone wasn’t holding my hand [crosstalk].

Mike Barrett: [01:33:21] Do you think now, as a father, do you anticipate how much of that nurturing/guidance/pressure, whatever you wanna call it, do you anticipate doing on your own, or have you thought that far ahead?

David Khosrowzadeh: [01:33:40] Not in-depth, but sometimes, I have thought about it, and I think it’ll be a similar approach to, as my younger brother. I’m gonna tell him—I’m gonna be like my grandfather was to me. I’ll certainly bring him around. I’m not gonna keep my business life, or my professional life separate from him. I want him to be immersed in it and see how happy it makes me. I would like him to see some of those experiences that I get to have with patients and so forth. And hopefully, that will inspire him to wanna do it, but if it doesn’t, I’m not gonna pitch a fit.

Mike Barrett: [01:34:18] That’s so great that you — I mean, I know that you’re a sincere person, obviously, but it’s so great that your love for this is so sincere that — you know what I mean? You’re not just saying, “Oh, I really like being a doctor.” You clearly love it so much that it’s a part of you, and you wanna share it with your child. That’s really something, and I think it’s worth noting.

[01:34:40] For all the negative things I was mentioning before, and the financial aspects, and those kinds of things, there are not a lot of professions where a lot of people who are in the profession say, “This is who I am. This is the reason I’m on Earth,” but I think a lot of doctors—a significantly higher percentage of doctors feel that way than in other professions, and that’s no small thing. And it’s really incredible that you’ve cultivated that and arrived here through all this hard work, and everything.

David Khosrowzadeh: [01:35:07] I think that, in general, if you’re a happy person and can find the bright side of whatever you’re doing, you’re gonna be a happy person no matter what. If you are a negative person, and pessimistic, and cynical, you’re gonna find reasons not to like whatever you’re doing. So, a lot of it starts with yourself.

Patrick Barrett: [01:35:29] Do you have any —

Mike Barrett: [01:35:31] We have a camera on. People can see me doing that [crosstalk]

Patrick Barrett: [01:35:38] For people in the audience, which hopefully exists again, thinking of getting into med school or finding out if that’s for them, or whatever, do you have any general advice? Are you aware, talking to doctors coming in — younger, newer doctors — that they’re having a different experience from what you had?

Mike Barrett: [01:36:06] Are there gaps? Like things that you think they should have addressed or thought about in some cases, enough that you’ve seen — to say it’s a generational issue, or —

David Khosrowzadeh: [01:36:15] Somebody coming in from undergrad to medical school, is there something that —

Mike Barrett: [01:36:18] That kinda thing, yeah.

Patrick Barrett: [01:36:20] I guess I was saying through meeting those people, are you aware of anything that’s going on differently now for, say, a 15-year-old who thinks, “I wanna be a doctor someday,” that they should be thinking of, having in mind? You were saying, for example, that the premed stuff didn’t actually come into play once you were actually a doctor. It was more just like, “Deal with these classes …” It seems like a good piece of advice to be —

Mike Barrett: [01:36:44] Aware of.

Patrick Barrett: [01:36:45] Yeah, that this is not the doctor experience, what you’re going through now. This is just — in the sense, that it’s a hard thing to get through, but not that it’s not a skill you’re gonna be using. What are the important skills? You covered it with the—you’re a regular nice person and trying to be considerate, and everything, but is there something that you can think of that a kid who’s a junior in high school or something should be thinking about right now, or is it just go to undergrad, pick the school that seems like the best fit, and it’ll be more of an issue once you’re really applying for med school?

David Khosrowzadeh: [01:37:15] If I’m talking to 15-year-old me, if there’s anything I would tell him differently, I think it’s just to be aware of what’s out there, in terms of the finance, and financial implications of the debt you’re taking on. Make sure that if you have the opportunity to go to an undergrad with a scholarship, like we were lucky enough to do, that’s a big advantage.

[01:37:40] I would tell someone, if you have the opportunity to go somewhere where it’s all paid for versus somewhere where you’re taking on a few hundred thousand dollars of debt, take the scholarship, and then save that debt for the med school part because you’re likely not gonna get a scholarship for medical school [crosstalk]. That’s something to be—I know physicians now out of practice a few years that are only just paying off their debt, and everything they were making was going towards paying that off. And they’re the responsible ones. Then, there’s others that just let it build up —

Patrick Barrett: [01:38:10] And defer it, and worry about it later …

David Khosrowzadeh: [01:38:13] So, that would be a big piece of advice —

Patrick Barrett: [01:38:16] Plan ahead a little bit for the financial impact [crosstalk]

Mike Barrett: [01:38:18] Something else, too, I think — when you are in high school, and finishing up, and about to go to undergrad, it feels like such a—just a huge change. It is this huge change, but it feels like your whole life has been leading up to this choice, and you get to now pick, and be an adult, and go wherever you want. And I think people don’t recognize that there’s gonna be a time when that’s over, and you actually have to go be an adult [laughter] [01:38:47] Whatever pleasure, or notoriety, or whatever you might have thought you were going to have from this undergrad degree is less meaningful, when you’re 30, or 40, or 50 than it seems like it’s gonna be, when you’re a 15 making that decision. And if you can get out of that situation with as little debt as possible … I don’t think there’s anybody in their 30s, or older, who would say that that’s a bad idea. I think we would all say “do the one where you don’t have to pay money for decades on that.” That’s an interesting age distinction kind of a thing.

David Khosrowzadeh: [01:39:21] And I think being aware of the scholarships that are out there … I knew kids in undergrad that they — there’s phone books out there full of the different scholarship opportunities that [crosstalk]

Mike Barrett: [01:39:33] Phone books were a thing, back when people had phone numbers [laughter] It was a huge mound of paper —

Patrick Barrett: [01:39:39] It’s like a magazine, a big magazine —

Mike Barrett: [01:39:41] Right, and it would come to your front door periodically, even though you didn’t want it, and it had everyone’s name in it [crosstalk]

David Khosrowzadeh: [01:39:48] These things are just full of scholarship opportunities, I remember. They’re out there, and no one knows about them, and I imagine they go unfulfilled. If you’re having—if you’re not fortunate from a financial standpoint to have support of your parents and so forth, then go out there and do your research and see what you can do —

Mike Barrett: [01:40:12] What possibilities exist, yeah.

Patrick Barrett: [01:40:14] I do wanna ask, also, because I don’t think we covered this, is there — what is the most surprising thing to you? What has been the most surprising, since you’ve become a doctor and have seen what the life is like, I guess. Is there any particular aspect of that, that was not what you expected or that you had to adjust to, or anything like that? It seems like you, more than most people … You’ve shadowed your grandfather; you were more—had a little sneak preview into that world already, I guess. Is there any particular thing that was not what you expected?

David Khosrowzadeh: [01:40:44] I can’t think of anything offhand that’s been surprising. I guess one thing I could say is the documentation, is—how important it is. One of the biggest complaints of physicians that I know is that we spend — and it’s getting worse — we spend so much time at the computer, documenting, and less and less time with the patients because it’s just so much clicking you have to do and so forth because that is the record. And from a medical-legal standpoint, and so forth, the orders that we’re placing … There’s a lot of benefits to having an electronic medical record, but we are also spending [crosstalk] That’s something that’s been surprising, and it’s kinda universal. We all agree, and it’s one of the problems in medicine that we’re hopeful some Steve Jobs type person can help us fix [crosstalk]

Patrick Barrett: [01:41:46] —say, like a 12-hour day, on average, how many hours would you say you’re in a patient’s room versus on computer, versus whatever else you’re doing [inaudible]?

David Khosrowzadeh: [01:41:57] I would say it’s 70–30 computer.

Patrick Barrett: [01:41:58] 70–30 computer. So, those are the two primary things you do, either with the person, or with the computer mostly?

David Khosrowzadeh: [01:42:03] You’re doing you’re walking from the floors, and you meet in the doctor’s lounge for lunch, and so forth. But in terms of doing our clinical responsibilities, it’s 70–30 computer, which is … You imagine, when you’re getting out of undergrad, and med school, you’re just gonna deal with patients, and it’s becoming less and less so, where you have the time to do it because you have to document [crosstalk]

Patrick Barrett: [01:42:30] When you were in med school doing the rotations, were you … Were those rotations the patient side of things? Like you weren’t sitting in the room watching doctors fill out forms on computers, I assume?

David Khosrowzadeh: [01:42:41] A lot of times, they’re sending you home. You’re doing your rounds; you’re seeing the patients, and they don’t necessarily want you hovering around while they’re doing documentation [crosstalk]

Patrick Barrett: [01:42:49] Yeah, so you’re exposed to that side of it, but not so much [crosstalk] the other one.

David Khosrowzadeh: [01:42:54] Not necessarily —

Mike Barrett: [01:42:54] Would that be something—when your brother shadows you, will he see you doing the documentation stuff, as well?

David Khosrowzadeh: [01:43:00] When I’ve had people shadow me before, I’m usually saying, ‘Ahh, you don’t have to watch this …”

Mike Barrett: [01:43:06] This is just two-thirds of what I do [laughter]

David Khosrowzadeh: [01:43:10] Probably, now that I’m saying this out loud, I probably will make him sit around [crosstalk]

Mike Barrett: [01:43:18] So, it is noon.

Patrick Barrett: [01:43:20] It is. Is there any question that we didn’t ask that we should have? Anything you think we might’ve left out, or didn’t cover, or anything?

David Khosrowzadeh: [01:43:27] I can’t think of it. I think we …

Mike Barrett: [01:43:30] I can’t thank you enough. You were super-transparent, and open, and helpful.

Patrick Barrett: [01:43:36] Yes, very eye-opening —

Mike Barrett: [01:43:37] I can’t guarantee that anyone will see this or hear it, but if they do [crosstalk] they will find it helpful, I’m very sure.

David Khosrowzadeh: [01:43:43] This is a life goal, being on a podcast. [crosstalk]

Mike Barrett: [01:43:48] So glad I could help with that.

David Khosrowzadeh: [01:43:57] As a fan of podcasts, myself [crosstalk]

Patrick Barrett: [01:44:01] You are now part of podcast canon. How exciting. How exciting for you! [laughter]

Mike Barrett: [01:44:07] Once more, I’d like to thank David for sharing his time with us. And I think whether you are considering going into a career in the medical field or not, there’s really a lot that you can learn from what he just said. I’d like to point out a couple of things.

Patrick Barrett: [01:44:20] All right. Let’s hear them.

Mike Barrett: [01:44:21] Okay, here they come. For me, one thing that I’ve heard, most of the people that I know who are doctors, who are my age or older, a lot of them, as we mentioned just now in the interview, have talked about how the profession has evolved, involving, now, more paperwork, more software that you have to use, more legal issues, and thinking about insurance, and all that kind of stuff. And for a lot of people that I’ve heard feedback from, that has not been a thing that they really love, necessarily, about the profession. But I really was interested and very happy to hear David say that, yeah, okay, all that stuff’s going on, but it’s not that bad, and I still love what I do.

Patrick Barrett: [01:44:59] Yeah, you’re still helping people, if that’s your driving …

Mike Barrett: [01:45:02] Sure, and It’s such a beautiful thing to hear a doctor say that, and it really helps drive home — to do this in this profession, you should feel that way —

Patrick Barrett: [01:45:09] Yeah.

Mike Barrett: [01:45:09] —and the vast majority of doctors do it —

Patrick Barrett: [01:45:11] Absolutely.

Mike Barrett: [01:45:11] —and I think it’s just a very, very important thing to keep in mind. Like I said whether you’re considering this profession or not, at some point, we’re all either going to be a doctor or go to a doctor [laughter]

Patrick Barrett: [01:45:20] Interact with a doctor, yeah.

Mike Barrett: [01:45:20] Some people will do both.

Patrick Barrett: [01:45:22] Yes. A chosen few.

Mike Barrett: [01:45:23] Yeah, so it’s just very, very useful, I think, and extremely beneficial to hear what an actual doctor thinks about the profession and especially one who loves it and is apparently so dedicated to it.

Patrick Barrett: [01:45:34] Yeah, it was very unusual to talk to somebody who just, it seemed like, from a young, young age, he was gonna be a doctor —

Mike Barrett: [01:45:41] Sure.

Patrick Barrett: [01:45:42] —and it happened [laughter]

Mike Barrett: [01:45:43] Right, and he loves it. Yeah.

Patrick Barrett: [01:45:44] He actually followed through with it. Not that people don’t follow through with it, but a lot of times —

Mike Barrett: [01:45:48] Sure.

Patrick Barrett: [01:45:48] You get pointed in another direction or whatever.

Mike Barrett: [01:45:51] Yeah.

Patrick Barrett: [01:45:51] But to want that from so early in life and obviously, he was very influenced by his grandfather and the time that he spent around his grandfather.

Mike Barrett: [01:45:57] Another thing, too, to grind away at it the way that he did.,. He mentioned that there are a lot of classes you have to take that are challenging classes and don’t actually directly touch on what you go on to do.

Patrick Barrett: [01:46:07] Yeah, it’s almost like, “Oh, you wanna be a doctor? Get through this.” [laughter] “It’s not really gonna help you doct anyone.” [crosstalk]

Mike Barrett: [01:46:15] But also, as someone who’s known David off and on for a while, I was very surprised to hear him say that he doesn’t think of himself as being extremely intelligent or gifted.

Patrick Barrett: [01:46:24] Absolutely. Yeah, as someone who went to high school with David and has known him for a while, there’s nobody who knows David who would think that [laughter]

Mike Barrett: [01:46:30] That was interesting —

Patrick Barrett: [01:46:32] That is a huge lesson —

Mike Barrett: [01:46:33] —from the standpoint of —

Patrick Barrett: [01:46:34] Absolutely.

Mike Barrett: [01:46:35] The way that you see yourself is not necessarily the way that other people see yourself.

Patrick Barrett: [01:46:38] He’s like, “Aww, I’m so bad at this,” or “I have to work so hard to do that.”

Mike Barrett: [01:46:41] Right.

Patrick Barrett: [01:46:42] Maybe you do, but most people do.

Mike Barrett: [01:46:44] Sure.

Patrick Barrett: [01:46:44] If you walk around and you don’t notice other people trying that hard, it doesn’t mean they’re not trying that hard —

Mike Barrett: [01:46:49] Yeah, exactly.

Patrick Barrett: [01:46:49] People try super-hard to look they’re not trying hard, and they’re good at it. You’re probably better at it than you realize —

Mike Barrett: [01:46:56] Right? Yeah, I would never have guessed that he felt like it was that [crosstalk]

Patrick Barrett: [01:46:58] I would not have either.

Mike Barrett: [01:46:58] I mean, obviously, medical school is not easy for anyone. No one ever said that was a breeze, but I would never have guessed that the entire trajectory of his academic career was as big of a challenge for him as he seems to have felt that it was.

Patrick Barrett: [01:47:11] Yeah, when he started going to the magnet schools and felt like he was in that environment with a lot of other “smart kids,” as though he was not one of the smart kids, which —

Mike Barrett: [01:47:19] Yeah, that was very surprising to hear.

Patrick Barrett: [01:47:20] —as far as everybody else is concerned, he certainly was … I never noticed that in him. I never would have guessed it, being around him, but it was very interesting to hear that, and, in retrospect, understand the effort that he put in and the way that he described feeling he had to work extra hard, and he did it. He was motivated, and he got it done, and it’s awesome. Yeah.

Mike Barrett: [01:47:41] Another thing that was interesting for me to hear him talk about it — it’s something that I’ve heard other people talk about, especially clients in the past whose families were physicians or in this kind of field and maybe they were considering going into it — this idea of shadowing. I didn’t know that was a thing. When I was at the age when you might consider shadowing someone in the medical fields, I didn’t know that —

Patrick Barrett: [01:48:02] It seems like, for whatever reason, particularly in the medical field, as opposed to … I mean, there’s other people you could probably shadow, if you wanna do it, but it seemed like it’s —

Mike Barrett: [01:48:11] Well, we did that one interview with the policeman who did the ride along when he was younger —

Patrick Barrett: [01:48:14] Yes, the ride along.

Mike Barrett: [01:48:14] Same kind of a thing.

Patrick Barrett: [01:48:15] Yeah, but it seems … Didn’t David say pretty much every doctor he knows has had that at some point? I mean, that’s —

Mike Barrett: [01:48:20] Yep, every doctor that I know has done it. When I was at the age where I might have been considering doing it myself, I didn’t know that that was a thing —

Patrick Barrett: [01:48:26] You’re not aware that’s a thing you could just try to make happen.

Mike Barrett: [01:48:28] Sure, and it’s a great example of how, if you are interested in a profession, you should try to read up on it and see “how does someone get into this?”

Patrick Barrett: [01:48:36] Maybe this is a way to learn more about it.

Mike Barrett: [01:48:37] Right. We have the internet now. You can find out about those things more easily. Don’t wait for someone to tell you.

Patrick Barrett: [01:48:41] Absolutely. Go on whatever social media channel you use and just say, “Hey, does anybody know somebody who does this job or that job? I’d to talk to them and maybe even see them.”

Mike Barrett: [01:48:49] Sure.

Patrick Barrett: [01:48:49] If you show interest in somebody’s job, they’re probably gonna like that, and feel important, and want you to be there.

Mike Barrett: [01:48:57] Absolutely.

Patrick Barrett: [01:48:58] Shadowing seems like a really important experience.

Mike Barrett: [01:49:02] Another thing that he mentioned in connection with that was the importance — if you are going to shadow someone or do any kind of thing along those lines—the importance of showing up on time [laughter] being polite, and approachable —

Patrick Barrett: [01:49:09] Exactly. Those little simple things make such a difference.

Mike Barrett: [01:49:13] Absolutely.

Patrick Barrett: [01:49:14] You can make a horrible impression right off the bat by being late and not communicating, or you can do what you said you were gonna do, and show up, and be polite, and nice, and everything. It’s a world of difference.

Mike Barrett: [01:49:23] And if you’re out there listening to this, and you are the kind of person who habitually shows up on time and does that kind of thing, you might be thinking, “Are there really that many people who don’t do it?”

Patrick Barrett: [01:49:30] Oh, man!

Mike Barrett: [01:49:30] The answer is yes.

Patrick Barrett: [01:49:32] Yes!

Mike Barrett: [01:49:32] And conversely, if you are the person who doesn’t really make a habit out of doing that, and you’re thinking, “Well, no one notices or cares if I …” That is not true in a professional context.

Patrick Barrett: [01:49:41] Yeah, people notice, and they care.

Mike Barrett: [01:49:42] Right. People are showing up to do the best job that they can do, ideally, and they wanna be surrounded by people who are also showing up to do the best job that they —

Patrick Barrett: [01:49:50] Yeah, they very much value their time, and their energy, and everything like that, and if they feel like they’re putting into something and you are not, then they are not gonna wanna spend time with you —

Mike Barrett: [01:49:58] That’s a natural way to feel. Right. Especially if there is someone else, they could be mentoring —

Patrick Barrett: [01:50:02] Exactly!

Mike Barrett: [01:50:02] —who is gonna bother to do those things and show they respect the —

Patrick Barrett: [01:50:05] Yeah, and a lot of these things are fairly simple. And if there’s some cataclysmic thing, and you are super-late, and you have a really good reason —

Mike Barrett: [01:50:11] Of course, things happen.

Patrick Barrett: [01:50:12] Yeah. Communicate about that and let them know. If you can text them on your way and say, “Oh, I’m gonna be late because …” As we were late to meet David [laughter] but we let him know. It was a long drive. Obviously, I mean, we are being hilarious about it, but it’s a very sincere, very real—it makes a huge difference, if you’re late, and you never said a word about it, or if you’re late, and you text as soon as you know you’re gonna be late, and say, “This is the situation. I’m sorry about it. I’m gonna get there as soon as I can. A lot of people, I think, don’t do that, just thinking, “Aww, what does it matter? I’m late either way.”

Mike Barrett: [01:50:45] Yeah.

Patrick Barrett: [01:50:46] But it’s a huge difference. It shows respect to the other person and lets them know that you’re valuing the time that you’re giving them. Yes, if you’re gonna shadow somebody, try —

Mike Barrett: [01:50:56] Sure.

Patrick Barrett: [01:50:56] Make a huge effort to be considerate and then present, and —

Mike Barrett: [01:51:01] Be the kind of person that you would want shadowing you, if you had worked hard to get into a profession, and took your time very seriously, and did your best to help people. Who would you want shadowing you? Try to be that person.

Patrick Barrett: [01:51:12] Yeah, and don’t be … The point of being there is to ask questions, and you don’t wanna get in the way of the doctor dealing with a patient, but if there’s a —

Mike Barrett: [01:51:18] Well, we assume … We’ve never shadowed anyone.

Patrick Barrett: [01:51:20] We assume that, yeah.

Mike Barrett: [01:51:20] It seems like how it oughta go.

Patrick Barrett: [01:51:21] Exactly. Intuitively, we’re gonna give that advice, you know, but if there’s a lull or something, and you say, “Hey, can I ask you some questions about what just happened?” or “Do you mind if I …?”

Mike Barrett: [01:51:30] Sure.

Patrick Barrett: [01:51:30] Get in there. I’m sure the person is expecting that you’re gonna have questions, and they wanna help you with them.

Mike Barrett: [01:51:36] Another interesting thing, to me, that came out of this talk is being able to peek behind the scenes and see a little bit into how a hospital is run, or at least how this this particular part of this particular hospital seems to be run, and all of this shifting, in some ways, towards things like increasing use of various types of softwares, both to track patients and to do maybe some basic diagnostic stuff. David mentioned having a doctor —

Patrick Barrett: [01:52:06] The FaceTime thing.

Mike Barrett: [01:52:07] Yeah, on the iPad, or whatever —

Patrick Barrett: [01:52:08] Dr. FaceTime. Yeah.

Mike Barrett: [01:52:09] Is coming in—Dr. FaceTime [laughter]

Patrick Barrett: [01:52:10] Somebody just brings a floating doctor head into your room, and then —

Mike Barrett: [01:52:14] Yeah, exactly.

Patrick Barrett: [01:52:15] It seems kind of obvious in retrospect, but I didn’t know we were there already.

Mike Barrett: [01:52:18] Right, and obviously, if you are … To me, it’s obvious, if you’re considering going into one of these health professions, you would wanna be just aware of where those trends might be going —

Patrick Barrett: [01:52:28] Yeah, this is kind of the way it’s going, and —

Mike Barrett: [01:52:29] Right, how that might impact your decisions, if you’re still in the phase of doing your education, or doing your own shadowing, how can you expose yourself to those kinds of trends just so you can have your own ideas about where that’s likely to go in the future?

Patrick Barrett: [01:52:42] Yeah, something else to ask a doctor that you might be shadowing. And another, I think, really interesting part of that, going along with what you said, was I think David said that, in a normal day, he guesses that he spends about 70 percent of his time on a computer, which is more than I would’ve thought [laughter] I’m sure it’s more than his grandfather spent because he might not have even had a computer for—when he started.

Mike Barrett: [01:53:03] Yes. Pre-computer, right.

Patrick Barrett: [01:53:05] Obviously, I assume when you’re on the computer, you’re doing doctor-y things.

Mike Barrett: [01:53:09] Sure.

Patrick Barrett: [01:53:10] It’s still medicine, but it’s not talking to people; it’s not maybe what you would imagine when you’re thinking, “Oh, I’d like to be a doctor when I grow up.”

Mike Barrett: [01:53:17] Right, exactly. I would bet that most people who are considering going into the profession, if they haven’t … David even said when he shadowed people, they just told them to go home, so they didn’t have to watch him do that part.

Patrick Barrett: [01:53:26] Yeah because you think, “Uh, this is boring. Why would I …” Then, he mentioned—

Mike Barrett: [01:53:28] Right, but it actually turns out to be —

Patrick Barrett: [01:53:29] —then, he mentioned that, when his brother shadows him, he said, “Ooh, I should actually make him watch me do that because —

Mike Barrett: [01:53:32] —more than half your time.

Patrick Barrett: [01:53:33] —if you wanna give an accurate —

Mike Barrett: [01:53:34] And again, this is not to discourage anyone who’s interested in professions, as David said —

Patrick Barrett: [01:53:38] Yeah, here’s the information we have, and you should probably know —

Mike Barrett: [01:53:41] Right. He loves it. He wants his own child to do it, so obviously, he —

Patrick Barrett: [01:53:43] But this is part of the experience —

Mike Barrett: [01:53:45] Right, part of it.

Patrick Barrett: [01:53:46] —at least for this doctor that we just spoke to, and he seems to think that that’s pretty standard; some version of that. Another interesting thing was his schedule — the whole seven days on, seven days off. I actually heard about that from another doctor friend. So, he’s not the only one [laughter] I don’t know if that’s standard, but it’s definitely out there. I didn’t know that was —

Mike Barrett: [01:54:06] Sure. There’s a variety of schedules, in my own limited experience with friends who do this kind of thing.

Patrick Barrett: [01:54:10] Yeah, I have a friend who’s in E.R. medicine and that, apparently, is much more predictable than a lot of fields —

Mike Barrett: [01:54:17] In terms of the numbers of hours —

Patrick Barrett: [01:54:18] In terms of your schedule. There’s a whole range of quality of life kinds of issues, as a doctor, for your hours, and your predictability of your schedule, balanced off with the money that you make, or where you might live … There’s so many so many variables there that are certainly worth …

Mike Barrett: [01:54:37] Along those lines, also, when David mentioned different types of specialties, how some specialties have a reputation among other doctors for being like, this one, you make a lot of money, but it’s very stressful; this one is relatively easy. All of those kinds of things are very important, I think, to take into consideration, if you are considering moving in that direction.

Patrick Barrett: [01:54:56] Yeah, going down that path.

Mike Barrett: [01:54:57] You would wanna know what’s the difference between being this kind of surgeon versus a dermatologist versus an ophthalmologist versus whatever.

Patrick Barrett: [01:55:03] I think a ton of our perception of different career paths, especially earlier in life, when you’re making those decisions more, when you’re in high school, or college, or even earlier, it’s similar to … I was gonna mention Oregon Trail. I don’t know if anybody listening to this knows what that is, but it’s an old video game where you would set out on the Oregon Trail, and you make some decisions in the beginning, and you’re like … Do you wanna be a banker or do you wanna be a carpenter? If you’re a carpenter, you make less money, but you can fix your wagon as you go along. If you’re a banker, you have more money, but you can’t do those skills.

Mike Barrett: [01:55:34] Sure.

Patrick Barrett: [01:55:34] It’s almost like this box you check; that you have this job … That’s your life. That’s what you do every day for a long time —

Mike Barrett: [01:55:41] Right, not in the Oregon Trail [laughter]

Patrick Barrett: [01:55:42] No, it was an immersive game—no, yeah, in real life, if you choose to be this kind of doctor, or that kind of doctor, it’s not just the salary difference, it’s a lot of stuff, and that’s true of any job, but it’s really hard to appreciate what that means for anybody, until you actually start doing it —

Mike Barrett: [01:55:57] Which again, is also the value of shadowing, right? Unless you see some of that —

Patrick Barrett: [01:56:00] Yeah, until you’ve committed a ton of time and money to it, and then you find out, “Oh, I didn’t realize I’d be working late nights six nights a week all the time forever,” or whatever it is.

Mike Barrett: [01:56:10] Along those lines, too, for me, one of the most interesting things and very uplifting, and positive — I’m glad I got to hear this — was David talking about how he really likes being able to connect with people and care for them, and actually make their lives —

Patrick Barrett: [01:56:23] Yeah, in difficult times.

Mike Barrett: [01:56:24] —noticeably better, and in difficult times, it’s a special kind of person to want to confront those times.

Patrick Barrett: [01:56:28] Yeah, absolutely. And the aspect of, of talking with a family about a loved one, getting bad news, or passing away. That’s intense. That’s real, and that, again, goes along with this is part of the experience.

Mike Barrett: [01:56:40] Although, something kind of interesting, too, when he mentioned that they don’t really give you classes on how to do this —

Patrick Barrett: [01:56:45] Yeah, they just kind of throw you in there.

Mike Barrett: [01:56:46] I don’t mean to laugh because it’s a very serious thing, but —

Patrick Barrett: [01:56:48] Yeah, but it’s … Wow. Yeah.

Mike Barrett: [01:56:49] —it feels like something I would want to have a class on, if I were gonna be a person doing it —

Patrick Barrett: [01:56:52] Yeah, have somebody tell me. I think he said they just kind of hope that the doctors that you are, not shadowing, but you’re going along in med school, in your residency, that you kind of pick it up along the way from them, but that’s —

Mike Barrett: [01:57:02] Well, then, also, I think the assumption, at least again from things that I’ve heard and read, the assumption is if you’re entering this profession, this is what you want—not that you want to have people being sick or whatever, but you —

Patrick Barrett: [01:57:13] You’re gonna be in this environment.

Mike Barrett: [01:57:14] Right. You know, then you’re sort of drawn towards helping people in that kind of scenario —

Patrick Barrett: [01:57:17] And some people do not feel comfortable in that, and some people do. Actually, now that I think of it, I had a doctor give me much less bad news, but bad news when I was in high school about being able to wrestle, and the bad news was that I couldn’t anymore [laughter]

Mike Barrett: [01:57:29] The bad news is you have to wrestle three times a day, forever.

Patrick Barrett: [01:57:32] Yeah, medically, you have to wrestle. But, yeah, he did a terrible job, and it was really upsetting! I didn’t really think about it until just now and make the connection. And that’s not nearly as bad news as it is for some people.

Mike Barrett: [01:57:44] Yeah, I had … I’ll never forget this. I had a doctor … I don’t even know what the proper term is, but just a general all-purpose doctor, like the guy that you just go see periodically.

Patrick Barrett: [01:57:55] What is that?

Mike Barrett: [01:57:56] Whatever that’s called … A doctor? [laughter] I should really know.

Patrick Barrett: [01:58:00] Why is it … General Practitioner. GP. There we go. Okay! [laughter]

Mike Barrett: [01:58:03] There you go. That seems like a thing. That’s a phrase I’ve heard. But I mentioned to him that I was worried about a blood condition or something because my grandfather had died of it, and he goes, “Ehh, people die.” [laughter]

Patrick Barrett: [01:58:12] Whoa!

Mike Barrett: [01:58:12] And he caught himself after [crosstalk]

Patrick Barrett: [01:58:15] Which you can hear him saying that in his head, because he’s a doctor, but to say it out loud to you?

Mike Barrett: [01:58:19] Right.

Patrick Barrett: [01:58:19] When I was … The guy was—I was there with my mom, who is also Mike’s mom … Our mom. Our mom. Our mom, me, and Mike, not you listeners … [laughter] Yeah, probably not. And the doc—and my mom said something about, you know, “Oh, well, he’s a wrestler,” and the guy goes, “Oh, his wrestling days are over,” which is the first time anybody’d mentioned … And he said it as though I already knew that; like, “Oh, of course, his wrestling days are over.” And I remember not reacting at all in the moment, and then, as we left, I went to the bathroom to cry. [laughter]

Mike Barrett: [01:58:52] Sure.

Patrick Barrett: [01:58:53] And it wasn’t—some people are like, they’re counting on it for a scholarship. It’s a part … It wasn’t like that for me.  It wasn’t that kind of—like I was gonna head for the NFL, and I wrecked my knee, and I couldn’t play —

Mike Barrett: [01:59:02] And he didn’t say, “You can’t walk …” There’s things that are much more dramatic —

Patrick Barrett: [01:59:05] Yeah, it wasn’t even that bad, realistically, but it was just so abrupt, and I didn’t know that that was the situation. And my friends were on the wrestling team, and I really enjoyed it, and I—it was a big deal for me at that moment, and the guy handled it badly. And he had wrestled in high school, too, that guy!

Mike Barrett: [01:59:22] Really?

Patrick Barrett: [01:59:22] He should’ve known that it mattered, anyway. But, yeah, whatever. I’m sure the guy has delivered much worse news in his life. Hopefully, he did that a little better.

Mike Barrett: [01:59:29] Well, that’s another thing to keep in mind, I would imagine —

Patrick Barrett: [01:59:30] For him, the perspective —

Mike Barrett: [01:59:31] —if you’re an older doctor, listening to this conversation right now, you’re like, “Having your wrestling days be over is not that big a deal compared to other things.” Sure, absolutely, but for you as a patient, that was —

Patrick Barrett: [01:59:40] Yeah, and it’s awesome that David seems to clearly have an ability to perform well in those situations, and the matter of being sensitive and understanding. For you, it might feel like it’s just another patient, but for them, it’s a huge day in their lives, and a really bad day, probably, for most people, unfortunately.

Mike Barrett: [02:00:00] Sure.

Patrick Barrett: [02:00:02] That’s another one of those things, like this is part of the reality. If you’re gonna go down this career path, every specialty, I guess, probably doesn’t deal with the same number—if you wanna go into one specialty as opposed to another, some of them might deal more with end-of-life type situations and some of them might not, but there’s gonna be some mix of … There’s gonna be some bad news mixed in there, and —

Mike Barrett: [02:00:21] Sure, the types of challenges you’ll face; the types of patients you’ll deal with —

Patrick Barrett: [02:00:23] —and you’re gonna need to need to stand face to face with people and maybe be in an uncomfortable situation, and that’s part of the skillset you’re gonna hopefully have, if this is a path you wanna go down.

[02:00:36] Another much more practical thing that I think was really important that David mentioned was when you’re going into undergrad, you’re gonna have options that are more affordable. You’re probably gonna have some kind of scholarship so you can try to go for —

Mike Barrett: [02:00:49] That’s a very interesting point.

Patrick Barrett: [02:00:50] —at the point of med school, that pretty much goes away. For most people, the assumption is —

Mike Barrett: [02:00:54] Yeah, most scenarios.

Patrick Barrett: [02:00:55] —well you’re gonna be a doctor, so you’re gonna pay these tuition fees, and then you’re gonna have the debt because you can afford it because you’re gonna be a doctor. So, you want to try to plan for that ahead of time. I mean, it’s honestly … For almost anybody, it’s great advice, anyway, even if you’re not gonna be a doctor, to try to minimize the cost of your undergraduate education [crosstalk]

Mike Barrett: [02:01:16] Sure, because the graduate degree … Generally, for most fields where a degree or some kind of academic certification matters, for a lot of those fields, you’re gonna have to go beyond undergraduate, anyway. You’re gonna have to go for a master’s, or a Ph.D., or an M.D., or something. On the other hand, if you have a field where those things don’t matter so much, having a bachelor’s degree or having any academic thing doesn’t really matter that much, then it also doesn’t really matter [crosstalk] where it comes from —

Patrick Barrett: [02:01:42] They’re mostly interchangeable—yeah, if you have a degree and it’s —

Mike Barrett: [02:01:44] And this speaking very broadly —

Patrick Barrett: [02:01:46] Very broadly —

Mike Barrett: [02:01:46] —obviously not saying it’s [crosstalk] apply to every single person’s —

Patrick Barrett: [02:01:48] —but for most people in most situations, that’s generally gonna be accurate.

Mike Barrett: [02:01:50] Right. In most cases, to go into significant debt for an undergraduate degree generally doesn’t make a ton of sense for most, and it was good to have him point that out.

Patrick Barrett: [02:01:58] Yeah, absolutely. Yeah, and it’s extra important in medical school because you are gonna go into debt for med school in almost any situation, so you might as well not pile on by going to an undergraduate school that costs a ton of money if you can avoid it. Most people have some kind of an in-state option, or they can [crosstalk]

Mike Barret: [02:02:15] —whatever your options are

Patrick Barrett: [02:02:16] Try for any number of scholarships available —

Mike Barrett: [02:02:18] Try to find the less expensive ones.

Patrick Barrett: [02:02:19] —just bear in mind that those options probably will not be out there for med school. I thought that was really—it made a ton of sense once he pointed it out.

Patrick Barrett: [02:02:27] So, yeah, that’s all for now. If you like this show, please take a moment to rate and review us on iTunes, or the podcast player of your choice. And, of course, if you wanna hear more episodes, remember to subscribe, as well. You can find our “SAT Prep Black Book,” and “ACT Prep Black Book” on Amazon.com, and you can find our online video courses on QuestPrep.com. Please tune in for our next episode coming up in a couple of weeks. And in the meantime, feel free to reach out to us on our QuestPrep Facebook page, or the QuestPrep YouTube channel.

[02:02:58] [Musical Interlude]

Patrick Barrett: [02:02:59] This episode was hosted by myself, Patrick Barrett, and my brother Mike Barret. Our guest was Dr. David Khosrowzadeh. Dr. K. to his patients. Every musical element was created and performed by Parker Hale Hastings. A newborn blue whale is about as long as a school bus, drinks 50 gallons of milk per day, and gains 10 pounds per hour.

Mike Barrett: [02:03:27] And here’s that special segment on math in standardized tests that we promised you earlier in the episode. Most-test-takers don’t realize that the math sections of the SAT and the ACT are specifically designed by the test-makers to be different from the kind of math that you would see on a normal high school math test. This causes most test-takers to make two fundamental mistakes, and both mistakes make the math sections of these standardized tests seem much harder than they actually are.

[02:03:54] First, most people try to approach math on the ACT, and the SAT the same way they would attack questions in math class. In other words, they use a slow, methodical approach based on formulas and repetition. So, these test-takers look at each question and hope that it sparks some kind of mental connection to a formula they once learned in school. And then they try to remember all the steps they learned for applying that formula.

[02:04:15] The second mistake comes up when the test-taker realizes they don’t actually know a formula for the question they’re looking at, which is something that happens pretty often, actually. So, this second mistake is that people assume that if they don’t know a formula for a question, then the question must be impossible for them to answer. Again, this goes back to the way math is usually taught in school, which involves drilling formulaic responses into your head until those responses become habit.

[02:04:39] Math class doesn’t reward you for coming up with new approaches to strange questions, so you naturally assume that if you can’t answer a math question, it must be because nobody ever showed you exactly how to do that kind of math question, and you won’t be able to come up with the right approach on your own. But when you understand how these standardized tests are designed, you’ll see that there are simpler, quicker ways to approach math questions on them, and these approaches would often literally be punished in a high school math class because they don’t involve formulas.

[02:05:05] These kinds of shorter, more effective solutions often require you to take advantage of the unwritten rules of the standardized test. They may also reward you for doing things thinking in abstract ways or noticing patterns in the set of answer choices, or reading extremely carefully, or even using your calculator to avoid actually doing the math question in the way that a normal high school teacher would think of doing a math question.

[02:05:27] And by the way, while I have you here, all of this is just one more reason why it’s so critical to practice with real official test questions. The problem here is that fake practice questions written by companies besides the College Board, or ACT, Inc., don’t always follow the same rules of questions design that the real test has to follow, which means that the fake math questions you might see from those other companies may not offer these kinds of faster solutions. So practicing with fake questions can sometimes prevent you from developing the same good test-taking instincts that you might be able to develop when working with real official test questions from the companies that actually make the test.

[02:06:02] Anyway, our test prep Black Books, and online video courses for the SAT and the ACT contain all the training that you’ll need to start noticing these faster solutions that are available on official math questions from those tests and start applying those solutions with confidence. In both our Black Books, and our online courses, the whole goal of our training is to turn you into the kind of test-taker who routinely notices these efficient solutions and then does them accurately, and consistently because that kind of thinking is the key to beating a standardized test. For more information on our books, and video courses, head over to QuestPrep.com. You can also find our Black Books for the SAT and the ACT on Amazon.com.

[02:06:44] [Instrumental Music]