Harnessing the Tsunami of New Medical Information - Dr. Sievert Weiss, Co-Founder of AMBOSS

Shiv Gaglani: Hi, I'm Shiv Gaglani, today we're going to tackle a question that's of keen interest to the learners in our audience, but it matters to the general public as well. As the rate of new medical knowledge continues to accelerate, how can medical students and practitioners keep up with it all and make sure they are providing the most up-to-date care to their patients? Well, we have an excellent guide with us today to help sort through that issue. Dr. Sievert Weiss is the co-founder of AMBOSS, a medical technology company whose platform has greatly improved the way medical knowledge is acquired and utilized at the point of care. Since starting in 2012, the company's international team has grown to over four hundred physicians, scientists and software engineers, serving more than two million healthcare professionals in over 180 countries. I've gotten to know Sievert over the last few years as well as his co-founder Madjid, who we met up with in New York City a couple of months back, and I'm just really impressed with everything they've achieved. So, Sievert, thanks for taking the time to be with us today.

Dr. Sievert Weiss: Thank you so much, it's a pleasure and an honor for me to be here.

Shiv Gaglani: Thank you and obviously, I know a lot about your background and your founding story. It’s very similar to what motivated us to create Osmosis. But for our audience -- who definitely has heard of AMBOSS, but may not have heard the founding story or you yet -- what can you tell them about your background and what got you interested in medicine, and then ultimately, spawning AMBOSS?

Dr. Sievert Weiss: So, what got me interested in medicine…I was, let's say, a good student, but I had no extraordinary skills in school. I likes sciences overall, and I liked more the application of the sciences and so essentially, I wanted to study something that is very close to a human need, and above all, not a luxury. This is what I found in medicine and in the health of human beings and that fascinated me and motivated me to study medicine. 

Now onto the founding story of AMBOSS. Roughly six years later, we were studying in a group of three friends for the final exam and that is very similar to how it looks in the U.S. In our case, that was in 2010 and we found the preparation was super frustrating. It was a lot of details that you had to remember, and it took a lot of time, it was not very efficiently made, and so there were actually -- and I won't tell you who it was -- but there were two of us in the group of three, who taught the other one a lot of the topics by explaining them. That worked super well for us because, as you know, explaining topics helps you retain a lot of the information and really understand them and the other person was just a super auditory learner, and he would remember most of the things that you would tell him. So that worked super well and at some point, we were wondering, “Why isn't there a software that would basically teach the concepts and everything that is needed for the exam?”

This is basically kind of like the starting point of AMBOSS, where the idea came up.  What would efficient and effective preparation and sustainable preparation look like where you really understand what this is about? So essentially, it's basically about solving our own pain point at the time that brought us to work on AMBOSS. 

Shiv Gaglani: Yes, it's obviously incredibly relatable. The product has gone through many iterations over the past decade or so since you started the company. Can you tell us what's the current iteration and what gets you most excited? You obviously have a very robust offering for medical students, but a lot of practicing providers use AMBOSS -- especially in Germany – at the point-of-care. So, can you tell us a bit more about the user experience today? 

Dr. Sievert Weiss: First of all, maybe you can imagine AMBOSS kind of like Wikipedia by physicians, for physicians, with education and add-ons. We aim for AMBOSS to be this lifelong companion for the medical professional. In Germany, it already starts day one of med school and accompanies the physician on to becoming a specialist, and this works super well as we believe in kind of this continuum of medical knowledge. You start with basics, and then everything builds on top of that. You learn about the diseases and then how to treat the diseases and then specializing in how to do this treatment. This is kind of like the blueprint that we that we follow for both our German and English versions, only that the English version is a bit behind.

Shiv Gaglani: I remember still when I was at an AMSA (American Medical Student Association) meeting probably 2016 or 2017 in DC and you guys had just set foot in the U.S. market. Again, very impressed with everything you've accomplished expanding outside of Germany, where you have a really solid market penetration there. 

So, you're in the business of medical knowledge and you're a physician yourself. One of the biggest things we've learned over the last several years because of the pandemic -- and just general societal turmoil, social media, etc. -- is the rise of medical misinformation and disinformation. Can you talk to us a bit about how we should change medical education to reflect the tsunami of medical knowledge and ideally combat this issue of misinformation and disinformation?

Dr. Sievert Weiss: There is this urban legend or a statistic of a certain basis that says medical knowledge is currently doubling every seventy-three days or so. Not all of that knowledge that is comprised in this is probably clinically relevant knowledge. But still, it's hard to sift through and get an overview of this and medical studies are basically still taught in the same way they were a hundred years ago: basically, students being presented with facts that they are expected to memorize, and half of which is outdated by the time they leave university, probably. We're really, I guess, reaching a cognitive boundary here. If we look at this exponential growth of the knowledge, and on the other side, the kind of aptitude of the human brain, there's a systemic problem and the answer cannot be just cramming more facts, right? So, we need a different answer, we need a fundamentally different answer to this. 

I think one core component of future medical education will be that we will need to teach students techniques to navigate these floods of information. That will be a crucial component of every physician's life in the future, and we do have the chance with those technical advancements -- digitization and all of that -- to offload parts of this cognitive burden into these tools. As physicians, we think medical knowledge is what the physician is, but maybe accepting that there is this cognitive burden, we will be ready to accept tools. I do think that really opens up opportunities to put focus on more innate human abilities that have been neglected before. 

I think additionally, future medical education should also focus more on basic medical principles to build foundations, where you can build on top of that. It should focus on data literacy to understand and add future research insights to this. And I think another very core human skill is the human interaction, and, essentially, empathy. That's something we always assumed you would understand along the way in medical school, but that's not the case. It's not really taught and we're losing a lot of potential here. 

So, I'm convinced that theoretical knowledge will shift to the digital space and also with that movement become more accessible. As I think you also outlined in one of your great articles, I think in Forbes, I also believe that there will be collaborations between digital universities, partner hospitalists, and so on. You're just increasing capacity levels for educating physicians all over the world. That's mostly my kind of framework of where medical education should head in the near future and at least think about where to move because the current system will not meet those demands in the future.

Shiv Gaglani: That very much aligned. What you just said there reminds me of something I heard Vinod Khosla say at a conference called Future Med, which if you haven't been, I know you'd love it, as well. By the way, we had the curator of Future Med, Dan Kraft, on this podcast. Vinod Khosla said something very provocative, which was cited in many news articles: that 80% of what doctors do by 2025 will be obviated, not necessary. A lot of people at face value thought he was saying, ‘we don't need 80% of doctors by 2025.’ Obviously, that’s not what he was saying. He was saying 80% of what they do, which is hopefully a lot of the documentation, some of the medical knowledge recall, and they can focus more on the actual practice of medicine and soft skills and patient shared decision making and those kinds of things. It sounds very aligned with how you as a physician, and a successful medical education entrepreneur, have seen it. 

So, the role of the physician is changing, as we talked about. Traditionally, they've enjoyed a very high status, and have been seen as demigods in white coats. But now we have physician assistants, a very fast-growing field, nurse practitioners, the scope of practice is changing, and in many cases, there are models that sort of disintermediate the physician and put the patient first. We have Amazon and CVS going big in healthcare, and we have digital health companies. What is your view of what doctors should be focused on for the next ten years? I know we talked a bit about medical knowledge and soft skills, but how do you see the profession evolving?

Dr. Sievert Weiss: Just to be super clear, I love, respect, and admire this profession very deeply. I think it's super important for society. But the one concept that I like to touch on here, is this: the demigods in white coats notion it is not good for us. It's not good -- neither for the physicians nor for the patients -- and I think this is because it creates false expectations on both sides. 

On the physician side, it creates this pressure to live up to this expectation and that means they will hide their insecurities, they always want to try to project their confidence and know everything. As we said earlier, there will be things that they don't know, and so I think it's important to confront this insecurity more openly because they should be open about it. They should be able to say, "I don't know, but I will look it up for you,” or “I will send you to my colleague, or I will ask my colleague.” 

I think what we also learned from COVID times is we should be more vulnerable, right? We do not have endless energy. We do suffer from the circumstances, emotionally and psychologically. So, I think it's super important to get away from this patriarchal model to a model that is more on eye level and that will also greatly influence our communication with patients with colleagues, and then have repeated effects on adherence and effectiveness of treatment, and so on and so forth. Overall, I think we will turn more into this kind of manager of the patient's path, but be less like this father figure that knows everything and will just tell someone to do it and have them not really understand what it's about.

Shiv Gaglani: It's almost like the Reformation. Martin Luther questioned whether you need a priest to communicate to God, or can the priests more be a spiritual guide, as opposed to the one intermediary to reach spiritual care. You know, we've had a lot of guests on this podcast, talk about digital solutions in healthcare, and how it can be difficult to gain adoption of new technology. I'm sure you've read the book Crossing the Chasm by Geoffrey Moore. Elsevier itself released a report called Clinicians of the Future, and something like 75% of surveyed physicians believe that technology should be taught in medical schools in the curriculum. I'm curious, what are your thoughts around how do we get more of the digital health technologies across the chasm? Should we be teaching these in med school or through platforms like AMBOSS and Osmosis?

Dr. Sievert Weiss: That's a very good question. I think similar to data literacy, there should be something like digital literacy, or digital health literacy. I think it'd be super important for physicians to understand what are these digitalized solutions really doing? Where do I need to put my focus on, and what is mature enough and what is not? I think that will both be beneficial for obviously the physicians and patients, but it will also drive adoption of those solutions. Today, as you said, there are companies saying, "we do not really get traction in the market.”  I think that can have multiple reasons. 

One reason is definitely that physicians are skeptical, and they have always been skeptical towards new tools. There's this article that I once read where they say when they introduced the thermometer 300 years ago, there was an outcry in the physician population because they were like, "Yeah, but it's not capturing all of the aspects of a fever, it's just measuring the temperature." And yes, that's right, but there's a standardized way to measure the temperature now. It has taken some years to be adopted. You find a similar adoption curve for X-rays, and so on. 

Today, there's all this talk about AI. Will AI replace the physician and so on. What will help any company in the healthcare system is to maybe not think about replacing, be it physicians or nurses. I'm pretty convinced that there will always be this human factor that we need. A human wants to talk to a human. But the two worlds can augment their powers and skills and do something where those tools are just intrinsically better in. But again, when the humans focus on the innate human skills, then it'd be a win-win situation. 

Finally, in my experience what helps any healthcare or digital health company to break into this space is thinking from the user's perspective, and asking yourself, "What is the problem? How big is it? And how much better would the experience be when I introduce my solution?" Then I think you can find adoption. It usually takes a bit longer than in other markets, but it might also be more defensible.

Shiv Gaglani: Yes, that makes a lot of sense. I think that's really wise advice for anyone looking to start or embracing new technology. There's the saying about if you're a hammer, everything looks like a nail. And especially during the hype of 2021 with crypto and blockchain -- some of which have legitimate applications, others do not -- I was encouraged and actually bought the domain osmosisblockchain.com - just in case there was something to that technology for Osmosis. Maybe there will be eventually. But it makes me think about some the Gartner Hype Cycle of technology adoption. 

So, going back to COVID, we launched this podcast because of COVID. It's called Raise the Line, because -- in addition to flattening the curve -- we wanted to strengthen our healthcare system by training more doctors and nurses like AMBOSS does, and Osmosis does, and Elsevier does, etc. What are some of the kinds of other things in our health systems -- and maybe this is also where you can, if you'd like, compare and contrast the German and U.S. health system -- that are not going well? What are some of the things we should be doing to fix it or to Raise the Line, as we say?

Dr. Sievert Weiss: I think something that you are doing here, for example, is a really a great addition to the portfolio of solutions. I mean, in the end, science is super complex, and there's a need to explain science. I think what we saw in COVID times is that it's really important to make people understand and also understand what they understand. I think this is also something that we can take away for medicine as a whole. 

For example, when I studied medicine the books that I read were not written in a way that I could understand. I would have to reread every sentence because it was so complex, and they would use so many complex terms that it's not made for understanding. I don't want to blame anyone here, but it felt more like someone wants to show off that he or she has studied so many years and become a professor or whatever, and the goal of teaching should be that as many students, or as many persons, understand as much as possible. I think that's the same for medical students, or patients or the general population. It should be about understanding. 

So, I think we really need to rethink how we communicate with each other and understand that this is not a one-way street. It's not someone is saying something, and then this would have any effect. No. We need to make sure, is this understood or not, or what is understood of this? We could go deeper down that route, but I think on the topic of science communication, that would be one important topic.

Shiv Gaglani: Definitely. I totally agree with that and the way we communicate science, oftentimes, is over our patients’ heads. And if they don't understand something, they aren't going to take the full antibiotic regimen, for example, which can contribute to antibiotic resistance. So, I agree. That's an important point. One of the things I think our health system needs to do better is get doctors and nurses and others to be better communicators, and you're describing these battles. What are some of the other things you're thinking about for improving our healthcare system?

Dr. Sievert Weiss: You also said that maybe there's a comparison between the U.S. and Germany to be made. I've looked at this before, and I've seen it here and there. Just from the outside facts, life expectancy in Germany is higher and still going up. In the U.S., it's declining. Germany is covering everyone with health insurance, and it's mandatory. At the same time, Germany is spending less on a per capita basis. This is not to say, "Hey, Germany is the best system in the world," and I'm pretty sure this is a complex topic of costs, delivery, insurance, structure, incentives, and so on. But just from these facts, something seems to be off here.

If we look, for example, into the education system…in Germany, if you go to university or school, most of that is public. You don't pay for that and it's not as simple as that, I guess, but in both topics, you'll find this fundamentally different approach of the state takes care of its population vs. the population has to take care of itself. This is a philosophical question of what kind of model do we want? We talked about the patriarch before. In this case, you could say, the German state is like the patriarch. I think that there might be something to be learned here.

I am definitely super far away from seeing how anything of that could be turned around. But all the evidence and all the trends point in the direction that medical care will only grow, right? We have a growing population basis, the patients become older and older and usually we find more ways to treat them. So, we need to find a way to address these problems in a somewhat practical fashion and in my opinion, that we do not lose too many people on the way. That at least from an ethical point of view, we should change our minds on this.

Shiv Gaglani: I think that makes sense, and that's one reason I'm a big supporter of this internationalization of companies. AMBOSS operates successfully in 178 countries. Same with Elsevier, and Osmosis…we’re in many, many countries. We’re hiring many physicians and nurses in all these countries who can kind of come into these forums and share how they do in their system versus the other system and, ultimately, turn that into education. 

My final question is just related to general career advice. You've had a very successful career as a physician, as a healthcare educator, and an entrepreneur. What advice would you give to people listening right now about meeting the challenges of the COVID pandemic and beyond?

Dr. Sievert Weiss: As you know, giving advice to someone you don't know and without the context is always, I think, super hard and now limiting it to COVID, I don't know if it would change my advice. But my advice would be, from all the experiences that I had, is basically follow your heart. That might sound super trivial. But for me, that has changed a lot and it takes quite some courage to do so. Essentially, think about the time that you're in. That this is your life. Do something that you like in that time. Pursuing that can be super hard, especially if it's not a well-trodden path as it was in all cases -- yours and mine -- but there is no need to adhere to what society expects from you. That is not what will make you happy. If this is not what you like, try to find out what it is that you like, and then try to do it and you won't regret that.

Shiv Gaglani: Totally. That's also some very good, general advice for people to take, and I agree with you. It's very contextual. Actually, that reminds me of one last question I had for you that I really wanted to get across. When we were on a podcast together, I think we were both asked about our book recommendations. You recommended William Irvine's The Art of Living a Good Life. A very good book. I'm sure you've seen Sam Harris had him on the Waking Up podcast, and there's a whole William Irvine stoics series, which is great, in addition to Ryan Holiday stoic content. His new book Discipline is Destiny is coming out in a couple of weeks. What are you reading right now? Any other book recommendations? Because you're one-for-one in my book in terms of how good that one was…

Dr. Sievert Weiss: Yes, I just finished Four Thousand Weeks, so that, I think, goes in line with the stoics. It's coming from a different angle, though. It's coming from this productivity angle, and how can you productivitize your life and things like that. But it's really fascinating to think about your life in these four thousand weeks, and that's that it makes it very tangible. That this is a limited time. So yeah, I would highly, highly recommend that.

Shiv Gaglani: That's awesome. Oliver Burkeman, I think is the author's name. He also is on Sam Harris's Waking Up podcast which is a great series. Well, Sievert, thanks so much for taking the time to be with us today and, more importantly, for the work that you and your team at AMBOSS have done to Raise the Line and strengthen our healthcare system by educating so many millions of current and future healthcare professionals.

Dr. Sievert Weiss: Thank you Shiv. Thank you also for your work.  It was a pleasure to be here and talking with you. It was a great chat.

Shiv Gaglani: Likewise. I really enjoyed it, and with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to Raise the Line and strengthen our healthcare system. We're in this together. Take care.