Intro (00:01):
Welcome to Health Law Talk, presented by Chehardy Sherman Williams health Law. Broken down through expert discussion, real client issues and real life experiences, breaking barriers to understanding complex healthcare issues is our job.

Conrad Meyer (00:23):
And good morning. Good afternoon whenever you’re listening. This is another addition of health law talk here at Chehardy Sherman Williams. Conrad Meyer, Rory Bellina, healthcare attorneys bringing you the latest and greatest in healthcare law policies, social issues. Right? Is that right, Rory?

Rory Bellina (00:42):
That’s right. Good Description.

Conrad Meyer (00:43):
And today we have a guest in the studio, the wonderful Dr. Christakis – Ares Christakis. How are you?

Dr. Ares Christakis (00:53):
Good. Good morning. Thank you for having me here. Yeah, thanks

Rory Bellina (00:55):
For coming.

Conrad Meyer (00:56):
We really appreciate that. Now I knew you listened to the show. You told me you listened to the show and we’re very appreciative of that. So now that you’re in the studio, you’re sitting here, what do you think?

Dr. Ares Christakis (01:11):
I think it’s very nice setup. I think it kind of all makes sense cuz your audio sounds really good on the podcast.

Conrad Meyer (01:19):
We appreciate that.

Dr. Ares Christakis (01:21):
And do you have a real professional and legitimate setup here?

Conrad Meyer (01:24):
Well we tried. Thank you. Yeah, we tried now a labor

Rory Bellina (01:27):
Of love, but we’ve got

Conrad Meyer (01:28):
It set up. Lori did all the building. I mean he was the one that put all the stuff up.

Rory Bellina (01:32):
It took a little bit of time, but we’ve got it now and we’re happy with the results.

Conrad Meyer (01:37):
So I think the results’ good. I think mean. Look, we thank you for coming in. So general surgeon, tell me about you. I know we know you’re a physician, I know you’re a surgeon. I don’t know much I, I’d like to know more about you. So how did this start for you? How did your journey start med school and to where you are now? How did it all begin?

Dr. Ares Christakis (02:01):
So I wouldn’t say it was by design, but sort of a New Orleans person. I’ve done high school, college, med school, residency and now work all within a few miles radius.

Conrad Meyer (02:19):
All here in Louisiana, in

Dr. Ares Christakis (02:21):
New Orleans. Wow.

Conrad Meyer (02:22):
Oh wow.

Dr. Ares Christakis (02:24):
Which is a little bit unusual with a brief hiatus where I was in Alexandria after residency doing some trauma surgery. But medical school is one of those things. You’re in college the sciences. Mm-hmm feel like you interacting with people, hearing people’s stories, working with people and of course helping them and medical school becomes sort of a natural attraction. Then I have a memory in medical school enjoying the emergency room, which is what I thought I wanted to do. And then I saw people getting wheeled out of the emergency room to go to the operating room and I felt like that’s where the real fund

Conrad Meyer (03:07):
Was. Where they’re going going somewhere

Dr. Ares Christakis (03:09):
Else. And there’s really some fantastic things that happen in operating rooms, whether by general surgeons or other surgeons. And sometimes the collaborations that work over there are really the collaborations that work are really fantastic.

Conrad Meyer (03:25):
Well how does that work mean? Let me ask you that. So I mean we always hear cardiac surgeons, neurosurgeon, orthopedic surgeons where general surgery fit into the, I guess the layers of specialties. How does that work in the surgery area?

Dr. Ares Christakis (03:42):
So traditionally they were just surgeons back in the day that was sort where they started and it was just a surgeon and they did everything and they slowly started to subspecialize. And you’ve reached a point where there are for residency training, there’s multiple different training tracks. There are a fair number of them that start with general surgery and then they will complete the rest of their training elsewhere. Maybe they’ll just do one year of general surgery, maybe they’ll do two or three years and they’ll complete their training in

Conrad Meyer (04:21):
Whatever subspecialty they decide.

Dr. Ares Christakis (04:24):
Oftentimes they have to complete an entire surgery residency to go and do that. But that’s one of those things that’s train that’s changing. Is it

Conrad Meyer (04:32):
Four year, six year? What’s the common for general? General

Dr. Ares Christakis (04:36):
Surgery is five years.

Conrad Meyer (04:37):
Five

Dr. Ares Christakis (04:38):
And just to use say vascular surgery as an example, there are many programs that are three years after a five year general surgery residency. But there are also what they call zero five programs, which are vascular surgery from the beginning. And they don’t do a full general surgery residency before going on to do vascular.

Conrad Meyer (04:59):
So on match day you could literally match in a three or a vascular surgery residency from the beginning? Yes. Wow, okay. I did not know that.

Dr. Ares Christakis (05:10):
That’s relatively new And I have, this is all current as of the last time I was a resident and had these conversations. So Gotcha. If it’s no longer zero five, but I believe that’s what it

Conrad Meyer (05:22):
Is. So you can go. So some programs like meaning another professional boards like vascular or cardiac or whatever. So you can go to a general surgery residency for X number of years and then of apply, is it considered a residency or is that considered a fellowship? A fellowship. So it’s a fellowship. Yes. And it’s dictated the years by whatever that professional board is or is it some other way, some other governing body that says hey, this is what you do for this?

Dr. Ares Christakis (05:48):
Yes, there are some trauma surgery for example has a one year fellowship, which in some locations is a two year fellowship. And so there is some variability amongst the fellowships but there are a lot that have a minimum requirement.

Conrad Meyer (06:06):
Interesting, Interesting. So you went straight into general surgery five year residency and then what happened that year? You just go straight to practicing. So

Dr. Ares Christakis (06:15):
I had spent five years doing my residency here at LSU in New Orleans after residency. There was a plan for me to stay with one of the local universities as staff and for various budget reasons they weren’t able to make that happen in the end to make their vision happen. And so I ended up at that point going to Alexandria, Louisiana to do trauma surgery. Trauma surgery is one of those things that doesn’t necessarily require a fellowship if you’ve had the experience and know what you’re doing. and I worked three years up there at repeats Regional Medical Center, which is a very good level two trauma center. Really a fantastic place. Gives people great care and we did a lot of good things up there.

Conrad Meyer (07:10):
Now were you a group up there? You worked for the hospital itself?

Dr. Ares Christakis (07:14):
We were a hospital employed.

Conrad Meyer (07:15):
Gotcha, okay.

Dr. Ares Christakis (07:16):
And I was there for three years and came down here and I’m currently hospital employed over at Touro where I’m a part of their general surgery program.

Conrad Meyer (07:26):
Gotcha. So you straight from raped back home and at Touro and had been at Touro ever since.

Dr. Ares Christakis (07:32):
Yes. And so here of course not doing trauma surgery at Touro, doing more general surgery and acute care surgery.

Conrad Meyer (07:40):
Very interesting, very interesting. So let me ask you this, what’s it, It’s gotta be, it’s a lot of pressure to be a surgeon I would think. I mean you’re talking, I mean to do surgery on someone patient comes in. I mean I know lawyers have pressure but I don’t think Laura have pressure Rory the way surgeons would have pressure.

Rory Bellina (08:01):
No, I think had mentioned, I’m sure that the pressure that you have is life or death. Ours is not. And then obviously we

Conrad Meyer (08:09):
Lose a case so we don’t do a deal. I mean

Rory Bellina (08:12):
There’s a time component, it’s doing it proper. If COND or I mess up on amending bylaws, we could amend them. But if you mess up on a surgery, there’s a lot more significant repercussions for the patient. So I guess if you could talk about, you said that you know, thought you wanted to do ER work, but then seeing the patients leave the ER and come in or go off to surgery led you to surgery. Was that what kind of drove you to go that path? Is the excitement of getting in there and fixing it as opposed to just treating and referring out or was it something else?

Dr. Ares Christakis (08:51):
I think there was, for me, a part of the attraction was being able to see through the entire issue from start to finish. And that was something that the emergency room does a lot of fantastic things and they know enough about everything to manage all of the acute things. But I think not being able to be there for the definitive management and see how it turns out was not something that I was crazy about. And I think they do fantastic work and they’re a huge asset to us. But spending time in the operating room, fixing the problem, seeing it through is something that I found attractive in surgery is somewhat unique cuz you more often have an opportunity to definitively fix a problem. Obviously it’s not always that way but it’s not, for example, blood pressure where you will treat someone’s blood pressure and you’ll probably treat that for their entire life and you’ll sort of manage it. There’s more opportunity to definitively excise a tumor or remove an inflamed appendix or definitively fix something. And a lot of our patients are not our lifelong patients for that reason.

Conrad Meyer (10:14):
So when you get in, you can actually see, Now let me ask you, that’s a good question. So when you ever gotten into a surgery before and you are like, oh I know what I’m going after and then you went in, you’re like, wait a minute, I found something else I need to fix that is that. And then likes an aha moment, you know, thought one thing and you got in, Oh well this is really the issue. Has that ever happened before?

Dr. Ares Christakis (10:37):
It’s pretty unusual. I think that with imaging these days and our aversion to surprises in the operating

Conrad Meyer (10:46):
Room, that would not be good.

Dr. Ares Christakis (10:48):
When I have a case scheduled, for example tomorrow I have five cases scheduled tomorrow and oh wow, I can sit down and of run through every case in my head and I can visualize the entire case. And that’s sort of the tendency. And you have all of the imaging and you really leave no stone unturned before you go to the operating room.

Conrad Meyer (11:10):
So you’ve already done it. In other words, in your mind you have gone from prep to close in your mind of that case before. Wow.

Dr. Ares Christakis (11:20):
Yes. And I don’t know if everybody does it that way, but in my mind

Conrad Meyer (11:25):
That’s how you do it. And that’s right and that’s very methodical. Cause you have to be perfect the whole time. I mean it’s hard. And that’s what I saying with Rory. I mean we can mess up and we can kind of fix it. We can do things, change things, amend things. And I tell this to students cause I mean I teach the law students and I try telling them the mentality of physicians. I mean you have to be perfect a hundred percent of the time. That’s a hard bar, Rory. I mean that’s a high bar. Yeah.

Rory Bellina (11:55):
I had a question for you cuz Connor and I were talking before the show, but a future episode we’re gonna do with reps, device reps or whoever it may be. I want to get your perspective on how you’ve seen in your years of surgery, how you’ve seen reps evolve. Do you have a lot of experience with them? Are they in surgery with you just sitting there guiding, assisting, and what’s your overall opinion of them? Because there’s been a lot of controversy regarding reps, reps in the surgery room, obviously how they’re paid and how they can and can’t be paid. And then just overall what your relationship is with reps in the OR suite.

Dr. Ares Christakis (12:38):
So reps work pretty closely with us. pretty often. I think that in my practice I don’t see a lot of reps on a daily basis. They will occasionally pop their head into a case of mine and check that everything’s okay and I don’t have any issues. For example, there’s a rep who provides one of the mesh products that I like and I’ve been using that same mesh product since some time in the middle of residency. And he is the same rep that’s been coming around. And so there’s not necessarily anything new to show me with those products. Every now and then there’s a new product that comes out and they have something to show you but they’ll poke their head in and make sure that everything’s situated. I do think that in some of the subspecialties where they’re using, sometimes they might be using some fancier equipment, there is close collaboration that I think is important. I think the big thing that I had spent some time with reps was with the DaVinci robotics system when I first started doing robotics. I’ve lost count but it’s probably a few years ago now they have a whole onboarding process to make sure that everybody’s getting the appropriate skills and that sort of thing.

Conrad Meyer (14:06):
Do we Vinci does that?

Dr. Ares Christakis (14:08):
Yes, yes. They have a program.

Conrad Meyer (14:12):
I was gonna talk about that by the way. I was gonna get but you already got to it before I did. So I’d like to hear a little bit about what’s that process and the

Rory Bellina (14:20):
Onboarding.

Dr. Ares Christakis (14:21):
So in for general surgery, DaVinci has a huge piece of the market share. I know that other robots exist, but just to give you an idea, I’ve never seen them. I’ve read about them, I know of at least one in town that they’ve sort of experimented with, but they really have the vast majority of the market share for general surgery. And so what they will do is this is all for procedures that you already are familiar with and you’re already presumably doing them open a lot of them, you’ve been doing them laparoscopically for a long time. So you’ve been doing them minimally invasive already. And the robotics is adding a different instrument, at least in this case for the general surgeons. And so they have a program where they will take you to one of their facilities. I know there’s one in Atlanta, maybe there’s one in Houston. And they’ll take you there for an intensive course. They’ll have a cadaver lab or a lab that uses that will use pigs as the subject and teaching skills. And once that is done they will assist in getting you a proctor at the facility that you work at. So somebody will come to your facility and make sure that you don’t have any questions as you’re getting acclimated with the robot.

Rory Bellina (15:53):
I have a basic question about robotics. So if I come see you at Touro or if I’m referred to you for surgery and you say Rory, I want to do x surgery does the patient have any choice in whether it’s gonna be done through robotic or not? And what, are there any advantages, disadvantages? And then obviously from a reimbursement standpoint, if you could talk about that on the differences between I guess doing it the old school way versus robotic.

Dr. Ares Christakis (16:22):
So taking reimbursement first. The open procedures get reimbursed different than the laparoscopic procedures. So laparoscopic being the minimally invasive and the robotic procedures. I think that the term they often prefer, if you’re looking for a more precise term is robot assisted laparoscopic surgery. Okay. And so for those procedures, at least in general surgery, they almost universally reimburse the same as the laparoscopic. So once you’re minimally invasive those reimburse the same. Okay well there

Rory Bellina (17:04):
Has to be a huge cost to getting these robots to the hospital. So can you talk about some of the benefits or some of the reasons why you choose not to do one for a patient?

Dr. Ares Christakis (17:13):
So in my practice I think that there are certain procedures that have significant advantages in doing them robotically for me, I think there are advantages for hernias, for colon surgery. Those are the two big ones and there are a lot of different permutations of that. I get a little less excited about it For gallbladder surgery I think that there are a lot of people out there that will do with them robotically and I think that that’s a very reasonable way to do it and there are some advantages but for me the cost benefits not entirely there in my hands. And so for that reason I don’t necessarily recommend it for that. I do think patients do get some choice. If a patient comes to me for example and they want an inguinal hernia repair I can talk to them about doing it open, doing it laparoscopically or doing it robotically. Usually when we have that conversation, I think that the benefits for and robotic assisted inguinal hernia repair are stark enough that they will usually choose that.

Conrad Meyer (18:27):
Okay. It’s interesting because I think just people not like Dr. Kak is here or just even you and I Roy cuz we do this a lot every day, but the general public here’s robotics and they’re like I want to get that. So if you just literally put the word robotic or robotic surgery, they’re gonna come and say well if I had the surgery I want the robot. Cuz they think in their mind it’s like oh it’s better.

Dr. Ares Christakis (18:57):
And I will say that this is not something that’s limited to lay people. I’ve had a physician that came and saw me in clinic last week, , he had an umbilical hernia that needs repairing. It’s not very big of a size that doesn’t require mesh. And really doing it robotically on the whole will give him in aggregate, longer incision potentially a little bit more pain And it really no benefit.

Conrad Meyer (19:27):
There’s no benefit. And

Dr. Ares Christakis (19:28):
That’s a case where even a physician will come in and say, I I’d like this to get done robotically. And you, it’s our job to educate the patient to where they are thinking about the same things we’re thinking about. They’re worried about the same things we’re worried about and looking at the same benefits that we’re looking at. And they usually will follow the recommendation.

Conrad Meyer (19:50):
But I mean do you have patients that come in and say, You know what, I heard you did robots and I really want you to do the robots cuz I want to get robotic surgery. Cuz that’s the best, I mean do you have patients that do that and say, Oh god I have the robot.

Dr. Ares Christakis (20:04):
We do. And to be honest with you, most of the time they’re right.

Conrad Meyer (20:09):
At least they’re right. That’s good. I

Dr. Ares Christakis (20:10):
Mean think that

Conrad Meyer (20:11):
I’m just, I’m a surgeon, I’m like, you know what, I’m just gonna put the sign robotic and then people are gonna wanna come see me. I think that might work

Dr. Ares Christakis (20:18):
For one example is that any, anytime I’m placing mesh, I prefer to place it robotically. I think that mesh has of been a hot topic in the legal world and so enough to where they have these advertisements on TV and so it’s in patient’s minds and they have concerns about it. And really whenever we’re doing a hernia, there’s two things that we’re looking for. One is to make sure that it doesn’t recur and two, to make sure that we don’t get an infection. And I think that there was a very big jump in decreasing infection rates when we went from open surgery to laparoscopic. And I think that there’s some further improvement going from laparoscopic to robotic in addition to some of the other benefits of the actual repair and being a bone repair. So to be honest with you, most of the time patients have that. Right. I do think that there are distinct advantages.

Rory Bellina (21:18):
You mentioned pain and we have a episode scheduled with a pain physician. So I won’t go too deep into this but I’d love to get your history on how your practice has changed for pain management post-surgery because you mentioned mesh and now we’re talking pain. If you could just talk about what you learned in med school and residency regarding pain and pain management and opioids and then just in practicality issues you’ve run into issues with patients and then how you handle it now because it’s a very controversial topic and I know the CDC is, or FDA recently, as recent as this week I think has revised some guidance on how pain management should be done. So this

Conrad Meyer (22:04):
Is a very interesting topic. I mean we’re waiting in some waters here but I understand where you’re going with this. It’s like a mosaic picture

Dr. Ares Christakis (22:13):
So it’s

Rory Bellina (22:14):
Fluid.

Dr. Ares Christakis (22:15):
So I’m kind of forcing me to use the tired metaphor of the pendulum. Sure, yes. So when I was a resident, I have a distinct memory. So we were a trauma center and I have a distinct memory of there was a nurse that would come around that was involved with pain and they would come around and critique the amount of pain medication we were prescribing and they are of following the data that’s there at the time a lot of this data and how this data came about has of been in news a good bit lately but it was very common for them to tell us that we were not prescribing enough pain medication and they would sort push you to prescribe more. And some of us were a little bit more stubborn than others and kind of holding our ground and saying, well that’s what I feel comfortable prescribing.

(23:21):
We’re not gonna do more. And then I have a memory at some point after residency when they started telling us that we were prescribing too much pain medication all the while when I was prescribing too little and when I was prescribing too much I was always prescribing the same. And I think that now they’re starting to come back the other direction and realize that maybe that it was a little bit of an overreaction the way they handled they cast a little too y of a net and trying to rein in some of the opioid usage and it was sort of affecting some of the surgical patients and that sort of thing. Sure. Because

Rory Bellina (23:59):
It’s needed for a lot of your surgeries. I mean I’m sure I’ve undergone a couple of surgeries and been prescribed them. I’m sure most of us have it’s needed for real pain for a lot of surgical procedures. But then you have the issue of addiction or abuse and then chronic pain, which is a totally separate topic, but I think for you and for surgery it is needed for some. And if you could just talk on on your experiences with that.

Dr. Ares Christakis (24:27):
Well I will say that one thing that has come out of all of this is that there is a lot of healthy conversation around the usage of pain medication and it’s not something that’s just done lightly and taken for granted. And so when in surgery we don’t expect patients to have chronic pain, it’s very rare for us to have a patient who postoperatively has chronic pain and when get, if they get an area where they’re having chronic pain, that’s not something that’s really best managed by a general surgeon. And so that’s a patient that you would refer out to a pain clinic or someone who does,

Conrad Meyer (25:11):
If he can find one one now.

Dr. Ares Christakis (25:13):
But that’s something that’s very unusual for us. Usually the pain is a conversation with the patient for after surgery. And to be honest with you, what I’ll tell the patient is that I don’t want you to be uncomfortable , I don’t want this experience to be miserable for you. But do know that your pain is, to a certain extent, it’s temporary and it’s kind of secondary to the primary goal, which is to have your problem fixed definitively without other complications And the pain we can manage in the short seven to 10 days that that’s an issue.

Conrad Meyer (25:51):
If you had to me, I’m gonna pivot for one second. So if you had to, I’m sure you get this family comes up to you maybe one of your friends and they say, my son or my daughter wants to be a surgeon, can they come talk to you mean we get it too sometimes with lawyers sometimes and they ask if you wanna go to law school, I say no, don’t go. But I wanted to ask you from certain, when you get people that ask you, my son, my daughter wants to go to med school and they really wanna do this and they wanna come talk to you, What do you think about that in today’s climate, in today’s provider, client culture, client payer, all the regulations, all the stuff you deal with every day, the schooling, the work, What would you tell someone in terms of if they wanted to be a physician, how would you respond to that when man you don’t wanna crush a kid’s dreams and all, you might wanna go to that, but I’m curious, how do you respond today if someone says, Hey, I wanna be a doctor, what do you tell?

Dr. Ares Christakis (26:53):
So

Conrad Meyer (26:54):
Did I throw a curve ball at you? Huh?

Dr. Ares Christakis (26:56):
No, no, no, no, no, no. I think that no it’s, its a good question cuz it’s true. There’s a

Conrad Meyer (27:01):
Lot going on

Dr. Ares Christakis (27:02):
Today. Cost of education going up, reimbursements going down. There’s a regulatory climate that has different regulatory agencies, even for surgeons starting to creep into the way we document an operative case for example. Some of that there’s good reasons to do it. Some of it is, it’s some of it’s artificial problems in our mind. For us it’s

Conrad Meyer (27:33):
More work,

Dr. Ares Christakis (27:35):
Yes, hoops to jump through, things like that. But if you were to get me on that side, I could probably spend the rest of the podcast talking about that kind of thing, . But there’s really not something else that I would rather do. And I think that it’s not for me to tell that person. And I think it’s unfortunate. I think that some physicians will focus on that negative side . I think that what we do is fun. Well

Conrad Meyer (28:18):
You clearly enjoy it, you love it.

Dr. Ares Christakis (28:19):
Sometimes it’s tough. I’d love for us to be able to have this podcast in the operating room. You could see what I do. We love to show people what we do.

Conrad Meyer (28:27):
I think that’s amazing. I really do. And then you clearly love what you do. I mean

Dr. Ares Christakis (28:32):
I have students all the time that people that will get in touch with me, either they’re a family friend something like that, and that they’ll get in touch with me and ask the shadow. And depending upon their age and what they’re working on, sometimes they’re allowed into the operating room. That’s nice. I think it gives them a good idea of what’s going on. And our job I think is to have frank conversations with them. And sometimes that includes some of the things that are less fun about what we do. But those are, we don’t like talking about numbers and don’t talking about the the law and things like that, but they’re sort of a necessary part of making those things work.

Conrad Meyer (29:16):
So if you were telling someone that you would say, look, if you really love it, if you love science, if you love the human body, the anatomy, if you like that, then by all means go.

Dr. Ares Christakis (29:25):
Yes, absolutely.

Conrad Meyer (29:27):
Regardless of all the other cloud, there’s a bright spot there somewhere.

Dr. Ares Christakis (29:33):
So I will tell you that when we are in the operating room, and I think a lot of surgeons feel this way,

Conrad Meyer (29:40):
Let me ask you if there’s like, is there TVs in the operating room and they’re watching movies? I mean you hear all these crazy things. I mean they got like van hailing playing in the background where everyone’s cutting and dancing mean. Is it really like that or is that a little bit overplayed?

Dr. Ares Christakis (29:55):
So much, but certainly there’s certainly music in the operating room.

Conrad Meyer (29:59):
I mean you playing Metallica like Inner Sandman or you or is it more classical calm music?

Dr. Ares Christakis (30:08):
So for me it’s choice. So whoever’s operating the music device

Conrad Meyer (30:13):
You have a DJ has to pick. I’m kidding, I don’t think you have a dj.

Dr. Ares Christakis (30:15):
So yeah, they have a circulating nurse in the room’s usually in charge of the music.

Conrad Meyer (30:20):
But I can see how that would help if you’re in there for hours, it would be nice to have something to break that and allow for mental focus.

Dr. Ares Christakis (30:28):
So I think that if it’s a case where everybody knows what they’re doing, it is an elective case. It’s not something that’s distracting in that setting. But you know, can imagine that in trauma maybe we did it a little less or if there’s a difficult portion of the case, sometimes there’s a part of the case where music gets turned down or off and you know, make sure everybody’s paying attention and sure.

Conrad Meyer (30:57):
And the fact that you like to bring in people and show them around and really give them a chance to see what it’s like giving again, if it’s appropriate to see what it’s like being a surgeon. I mean what a tremendous opportunity.

Dr. Ares Christakis (31:13):
I think that most surgeons at the end of the day, despite any complaints anyone might have, they will tell you that when they’re in the operating room, even if the case is not a fun one maybe it’s a tough case or maybe there’s a patient who you just know going in is not going to have a good outcome, but surgery is of your

Conrad Meyer (31:33):
Least

Dr. Ares Christakis (31:34):
Bad option regardless. I think that when they’re in the operating room, I don’t think they’re thinking about much else and there’s a certain piece about that.

Conrad Meyer (31:44):
That’s really good.

Rory Bellina (31:45):
So we have a rule in the show that every physician that comes on, we have to ask them their covid story and how they did professionally, how things changed for the better or the worse. So if you could just tell us a little bit of how your practice changed, anything you went through that you’d like to share and just anything you’d like to talk on that. Cause I think I’m tired of talking about it particularly, but I think some people still like to hear different areas how practices changed and things you had to go through and that kind of thing.

Dr. Ares Christakis (32:19):
I kind of agree that it’s an interesting question in as much as it sort put its hands, it affected everyone. It touched everything, it touched every specialty and every specialty in a different way. And it’s interesting to see how people addressed the same problem from their vantage point. For us it was kind of interesting. There was a period where they shut down elective surgeries. There was some conversations about how to manage these patients. Especially in that first wave in March of 2020. We went from no covid cases to this huge jump the day that the tests became available. And it seemed like an endless line of patients coming in. And for us, everybody was asking for dialysis access, right? Cuz everybody’s kidneys were failing and everybody, And the other one that was a common question was tracheostomies for patients who couldn’t get off the ventilator but had been stabilized and they had made it through that acute inflammatory phase and there was all kinds of conversations about when’s the right time to do it. And sometimes operating on people that had covid and a setting that it of limits your ability to really protect everyone in the room.

Conrad Meyer (33:49):
That must have been really hard. Mean that mean going from universal precautions, right? On a surgery you would do now or before C, to having to do surgery with covid of a covid positive patient. I mean that must have been tenfold.

Dr. Ares Christakis (34:07):
It was interesting I think that

Conrad Meyer (34:11):
You had the space suit on. Did you have the helmet and all that?

Dr. Ares Christakis (34:14):
There was a period where we had done that for some of the tracheostomies that were bedside tracheostomies. Oh wow. We had done that. The facility had to, they converted one of the cardiology floors into a second ICU because they didn’t have enough ICU beds at the time. I had a wife at home who was pregnant and that’s scary. And those were actually the patients that were hit pretty hard with. It was, especially in that first wave, was ruthless

Conrad Meyer (34:51):
To patient from our standpoint, cuz my wife’s a physician too, we had a total infection protocol at our house where we were literally came in totally undressed in the garage, put it in bags, immediately go to the shower and throw ’em in the wash and hot water only. I mean we did that for months.

Dr. Ares Christakis (35:13):
We definitely had a version of that. Yes.

Conrad Meyer (35:15):
And my wife would come home and I would see her, I said, Did you get the clothes in the bag? And then the washer you get, did you shower yet? And I felt I was a little, little high look laughing. I was high. It was a little high drama in our house. I mean I can’t even imagine in surgery. It must have been 10 times worse.

Dr. Ares Christakis (35:34):
Well and one of the things is in the beginning some of the ways to approach Covid beat were pretty clear. They started becoming less clear as Covid started to drag on and , maybe you had fewer sicker sick patients in the hospital and at what point did you resume normalize that was not as obvious a transition on when to resume normal operations and things like that. And so it was a period where the CMOs of the hospitals really earned their keep cuz they had a lot of tough decisions to make. I think that in our world, there were definitely some bad outcomes that I can think of that were sort tied to that. I think that there were patients who maybe had abdominal pain but wouldn’t come to an ER cuz they were scared that the ER was just full of covid patients, which was often true. And so maybe they ended up coming a few days after that with a perforated appendicitis and so they were much sicker than they would’ve been previously. Oh no. So it definitely affected patients in other ways.

Rory Bellina (36:51):
Is there anything that you or your hospital has put into place or kept in place I guess, that when went into place for Covid that you’ve kept or that you, as far as procedures, are you still asking patients to wear masks? What does that look like? Has it changed your practice, I guess is a better way to put it.

Dr. Ares Christakis (37:15):
I can’t think of anything other than I think that it’s been sort of a mass education event and everybody in the hospital that maybe didn’t know how to wear an N 95 mask knows how to wear it now. But I can’t think of a lot that stayed with us as a result. And I’m sure that when I walk out here I’ll think of something. But

Conrad Meyer (37:37):
You going, Aha. Well let me ask you this. So I watched the Jetsons, now I admit it when I was a kid and I heard you talked about a few years ago where DaVinci started coming in. So I’m, I’m gonna ask you this as a general surgeon, you’re talking to other surgeons all over the place. Where do you see surgery in five years from now, 10 years from now? Is it all robotics? Is there new robots? Is there new techniques? Is there, in other words, am I gonna be like Captain Kirk on Star Trek and I’m gonna go see Bones and he’s gonna scan me with some little tri-quarter and gimme a pill and I’m gonna solely be fine. I mean that’s not realistic, but I’m asking you, do you see anything in the future for surgery or what’s it gonna be like in five years with advanced things and are you seeing anything that like that now?

Dr. Ares Christakis (38:31):
So talking about general surgeons specifically, I would say that I think that there will be improvements on the current robotics platforms. So instruments that can get in through tighter spaces. Currently the robot system we use we generally use three or four eight millimeter ports. . So you have eight millimeter incision sites that you access the abdomen through. I’m fairly certain that they have in the works a single site robot, which will allow you to get all those instruments through the same port.

Conrad Meyer (39:16):
But one port.

Dr. Ares Christakis (39:17):
Yes. And through a smaller port. That’s amazing. And I mean it’s possible that I’ve missed something here and that’s already out, but I don’t think it is. And I think that that might change a little bit of what we do as they improve that. I think that in a more broadly speaking, really the sky’s the limit. They’re really a lot of things. If I’m not mistaken, the first use of robotic instruments was maybe in the eighties. I wanna say that they used a robot to assist with a brain biopsy. Wow. It might have been into the nineties, but don’t quote me on that. And they find uses for it. A lot of times they’ll have the technology and they’ll kind of know that it can be used somewhere. And when I was a resident and they had the robot, I was a little bit skeptical of it because I don’t think the technology was really there for it. And I think that they were trying to apply it maybe to the wrong surgeries. And eventually through that collaboration that we sort touched on earlier between industry and the rep and the physicians, they sort find a better way between the two of ’em and how to apply that technology. And there’s really a lot of things out there now they’re doing the robotic joints. I know they do a lot of those over at Touro

Conrad Meyer (40:42):
And I saw one where they fed this cable, I don’t know if it was from the cath lab or not, but it was some way that they don’t do stents. In other words, this little device would be fed up through your leg and it would go up to where your heart was and it would had a little scoop. So as you’re a little shovel and as it would move forward, it would scoop up the plaque and it would suck it down the wire. And I’m like, and it was no stent. And I’m like, man, that looks, I don’t know if it was real or not. I don’t know if I saw it. It was one of these device ads. And I’m like, that’s really cool. And that’s just one thing. And I’m thinking to myself, there’s gotta be hundreds of things these people are doing and I can’t even imagine what it’s gonna look like five years from now, 10 years from now.

Dr. Ares Christakis (41:30):
No, I think that, and this is why I think that collaboration’s important because there’s a lot of technology out there and there’s really no other way to deploy it that I can fathom that doesn’t involve reps from the company that are around to make sure that questions are answered and you know, really don’t want your surgeon or whatever the specialty may be, trying to figure out a hardware while they’re in the operating room.

Conrad Meyer (42:00):
Well I hope you’re gonna be around for quite some time. I mean, you’re gonna get, hopefully in 10 years I might need surgery, gonna call you up and you’re gonna have some device, you could cure everything. And with knowing a little incision, maybe it’s two millimeter, I don’t know. I don’t know. Well that’s good, that’s good. I mean, Roy, I mean I think I got a really good picture. This is really, you know, do a lot of tough work, Aries, I mean you got a lot of stress, but you seem beloved. I mean you’re on top of things. I mean every time I see you, you’re always happy, you’re always smiling. He is always happy and I’m like, man, I wish I want to be. I have, I know how, just get rid of the stress. Just go back to med school I guess. Yeah, sure.

(42:43):
I’m gonna go to med school and go for a five year general surgery residency. Gee, wow. I’ll be 70 when I get out. Right. . Well I wanna tell you thank you mean, let me ask you this. We never ask Jess this. Do you have any questions for the healthcare? We can give legal advice but is on the other side. When you listen to the healthcare side, when you listen to us, are there any things that you as a surgeon or you as the physician walk out and say? Sometimes I wish I would’ve asked the lawyers this. Is there anything that comes to mind aside from our fees? Cuz we know you, y’all love to pay legal fees.

Dr. Ares Christakis (43:21):
I think so. I don’t have any specific questions at the moment, but I will say that I do listen to your podcast and I think that it, it’s really an asset for physicians to really understand the legal framework that they’re working in. I think that for physicians, from our perspective we understand the medical framework very well but the, it’s worthwhile understanding the legal framework because if you’re not involved in it like Dr. Quo who was two podcasts ago, if you’re not involved in it, there are other people out there that are creating that legal framework for you. And that legal framework will affect the medical framework. It will affect, it’ll affect what you’ll be able to do and what you’ll be able to accomplish. And so this really is an asset. This really is an asset to us. And I think that physicians really need to get more comfortable with their attorney friends.

Conrad Meyer (44:29):
I would totally agree with that. I mean I think a lot of them see us as well. I said the enemy or just sort a, how would you describe it? Word? I dunno the enemy, but it would be a necessary evil.

Rory Bellina (44:40):
Yeah, I don’t think it’s the enemy. I think that what I hear more of is that we’re slowing things down for doctors that, and I wanna say we mean attorneys or legislators or the government as a broad phrase. We hear a lot that you’re slowing down medicine, you’re making all these rules and regulations on how we have to document and we can’t do this, but we can do that and you’re gonna pay us less, but you want to see more patients. And that’s the feedback that I think I hear a lot is why is medicine so regulated? Why can’t I send a patient to a surgery center that I own? I would tell them that I own it. Why can’t I pay this person for referring somebody? To me? That’s what I hear a lot is explaining to them why we have these regulations because it’s the most heavily regulated industry, maybe above finance, maybe a bunch above the financial sector. If not it, it’s one or two. So I think that’s what I hear the most and it’s just kind of educating, Well, here’s where these came into place and here was the thought back then when

Conrad Meyer (45:45):
We’re here to help.

Rory Bellina (45:46):
When Stark became a thing, there were issues. Now it’s totally evolved into something that Peter Stark did not want this to be, but it is. So I think it’s just talking about where,

Conrad Meyer (45:59):
Well, I think is to, Dr. Kak is his point. Reimbursements are going down, tuition’s going up, mean physicians are looking for ancillary revenue service resources that can help maintain or grow just their current standard of revenue. And there’s a lot of regulatory oversight with respect to how that is structured properly to be able to do that. And I know that there’s a lot of confusion out there. Sometimes we hear, well the other guy’s doing it, so why can’t we do it? How many times have you heard that? Right.

Rory Bellina (46:34):
So

Dr. Ares Christakis (46:35):
One thing I’ll say about that is that I think physician burnout is a big topic. And I mean if

Conrad Meyer (46:42):
You’ll a big

Dr. Ares Christakis (46:43):
Deal, if you did a Google search, you’d find a couple dozen newspaper articles where they’re talking about that. And in my experience, the burnout is not because of the medicine it’s because of everything else. I don’t know a lot of physicians who are just burnt out just for the treating patients and doing that. I think that what burns them out is everything else that goes along with it. And so I think that when physicians of put that section outta mind and they put the legal framework out of mind, they end up being bystanders and they don’t get to affect the environment that they operate in. So they really kind of need to listen.

Conrad Meyer (47:34):
Well, we hope they do. I mean, don’t you worry. Yeah,

Dr. Ares Christakis (47:36):
Absolutely. . Absolutely.

Conrad Meyer (47:38):
Well, Dr. Christakis, thank you so much for coming on the show today. We really appreciate that. It’s been fun. I mean, I thought I knew you before, but it’s nice to be able to delve in and really see what goes on in your world. I, I don’t know how you do it, frankly. I mean, it’s tough being a surgeon, the pressure, but you carry it like a sword. I mean you, you’re doing great. I mean, calm, cool, and collective. I mean, if I ever need surgery, I definitely wanna come to see you. Right? I would feel so much better when he walked out the door. I’m like, man, I’m in good hands.

Dr. Ares Christakis (48:14):
So I will just say that I think that this is something, I think that this is something typical of physicians out there. Physicians are, there’s a lot of physicians out there that’re just comfortable with what they do. And so it’s common.

Conrad Meyer (48:29):
But you’re definitely one of them. You’re definitely one of

Dr. Ares Christakis (48:32):
Those. Thank you guys for having me. It was a lot of fun. Yeah.

Conrad Meyer (48:34):
Thank you. We really appreciate that. Well that’s gonna wrap it up for us here at Health Law Talk. We really appreciate Dr. Christakis and it was very, very nice and we’re gonna get this out and everybody can listen to it really soon. We look forward to the next episode of Health Law Talk. Everybody have a great weekend. See soon.

Intro (48:50):
Thanks for listening to this episode of Health Law Talk, presented by Chehardy Sherman Williams. Please be sure to subscribe to our channel. Make sure to give us that five star rating and share with your friends, Chehardy Sherman Williams is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does this podcast establish an attorney client relationship. Reference to any specific product or entity does not count as an endorsement or recommendation by Chehardy Sherman Williams. The views expressed by guests on the show are their own and their appearance does not imply an endorsement of them or their entity that they represent. Remember, please consult an attorney for your specific legal issues.