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Medical Education, Medical Schools, Stanford Medicine Unplugged

Considering premed? Some things to think about…

Considering premed? Some things to think about...

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

MatchDay14-Ever since I was little, people asked me if I would become a doctor like my dad. I wasn’t sure until I shadowed a doctor my freshman year of college. As soon as that happened, I started looking for guidance on how to choose between my many interests so that I could both be true to myself and become the best candidate for medical school that I could be.

I was lucky to have many great mentors who took the time to thoughtfully answer my questions, and now I’d like to pay it forward. For anyone in the early stages of premed that wants advice, here are my thoughts on certain areas.


  • Medical schools will likely want to see evidence that you’ll be able to keep up with the academic rigor of their program. This sounds obvious, but the way that you can demonstrate this is to do well in your classes as an undergraduate.
  • Don’t take more classes than you can master. There are many interesting courses available in college but you need to be strategic about giving yourself the time to excel in your classes and giving yourself time to just be.


  • Give yourself time to see what extracurriculars you gravitate towards naturally. When you find them, pick one or two and invest time and energy in them. Take them in interesting, unique directions:
    • If research is your thing, then ask interesting questions. Schedule time every few months to actually speak with the faculty overseeing your research.
    • If volunteering is your thing, then be a leader in your field. Identify a need that has not been filled or an organization that inspires you and work hard on that.
    • If you’re an athlete, then be a leader on the field and off. Be a mentor to younger teammates.
  • At the end of the day, medical schools want to see your leadership and legacy as an undergrad.

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Global Health, Medical Education, Patient Care, Stanford Medicine Unplugged

From medicine to the mat: Learning self defense

From medicine to the mat: Learning self defense

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

cute karate girl“You hit me!” My sparring partner accused me from behind his hands. We were in a self-defense studio practicing what to do in a mugging situation.

At first I was supposed to mug my six-foot tall, athletically built male partner. He had no problem fending me off safely.

The trouble started when it was his turn to mug me. He stepped past my socially acceptable 3-foot bubble. I panicked. My legs crouched and I lunged forward. My palm drove into his nose.

The mugger stumbled back and suddenly he was my partner again, holding his face.

“Sorry, sorry,” I didn’t know what else to say.

He squared his shoulders and offered to try again. As long as I didn’t hit him.

I nodded, trying to get focused. I was here for a reason. Many reasons actually. It had been a goal of mine to gain some level of proficiency in martial arts since I was little. When I grew up to be five feet three inches and too small to donate blood, I gave up on that particular goal.

Then this summer I spent a month volunteering in a hospital in Uganda. I saw more there than I have had time to process. There were real-life miracles, like when a patient survived after arriving with a blown pupil and an epidural hematoma. There were tragedies that I don’t know if I will ever shake off, such as the small child who died during rounds. There were also preventable snafus, like when one of my fellow volunteers was mugged walking home.

I had decided there were some tragedies I could protect myself from. Additionally, I had taken a year off from medical school to write a novel. The protagonist in my novel is highly trained in martial arts and I wanted to do some field research. When I returned from Uganda, I decided to throw my weight into self-defense classes every Monday and Wednesday evening.

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Medical Education, Patient Care, Rural Health, Stanford Medicine Unplugged

Two weeks in Humboldt County, Calif.: Insight into rural medicine

Two weeks in Humboldt County, Calif.: Insight into rural medicine

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Hamsika among trees

As part of the family medicine clinical rotation here at Stanford, students have the option of spending two weeks doing a “rural medicine” track in Humboldt, a small 150,000-person county that is about a 5- to 6-hour drive north of Palo Alto. Each month, up to two medical students can volunteer to be in Humboldt, and Stanford takes care of arranging for hosts, clinic preceptors, and pretty much everything else. I had heard from upperclassmen that this track was “amazing” and “unique” and that I should “do it!!!” And so, three weeks ago, I found myself downloading an audiobook version of Aziz Ansari’s Modern Romance to keep me company as I made the long drive to Fortuna, California.

I’m not sure what I expected to see when I got there. For some reason, I had this dramatic idea that I would be spending two weeks with no cell phone service, spotty access to Internet, no Starbucks visible in a 10-mile radius, and paper medical records instead of an EMR. The reality wasn’t quite so bleak (in fact, the very first sign I saw in Fortuna pointed toward a Starbucks, and I had zero trouble with cell phone service and Internet access), but it was still a jarringly different experience from my first three months of rotations, spent in Palo Alto and Santa Clara.

First and most noticeable was the shortage of physicians. Everyone talks about the physician shortage and the need for primary care physicians, but it wasn’t until I got to Humboldt that I first saw this need manifest. In the clinic where I was working, there was one family medicine physician – total. Each day, he saw 25 or more patients and did everything from diabetes care to trigger point injections to skin cancer. There were poignant moments in clinic, when it was clear that a patient needed specialist care, but there simply wasn’t anyone to refer the patient to. The nearest specialist care center was UCSF, five hours away. Moreover, it was sometimes difficult to access patients’ past medical records, or records from other clinics. The EMR in Fortuna was just a few years old, and in fact, there was one day of clinic when my preceptor and I explicitly dedicated time to transferring patients’ past medical history from paper records into the EMR.

Contrast this to the second half of my family medicine rotation, which I spent at a Stanford-affiliated clinic. Over the course of 1 week in this clinic, I worked with five different family medicine preceptors, and there were still more physicians at the clinic with whom I had not worked with directly. We saw between 12 and 15 patients a day and had the luxury of scheduling in 40-minute time blocks whenever a patient needed the extra time. I had no trouble accessing patient’s medical records, not only within Stanford but from outside institutions they had been seen in in the past. Test results popped up in Epic (Stanford’s EMR) in a timely manner, with lovely color-coded labels and notifications whenever a patient was due for a vaccine. And when we needed specialist care, it was just a click away.

If I’m honest with myself (and I hope I don’t regret saying this publicly), I felt much more at ease in the latter clinic environment, where I was able to pend orders for any test I thought a patient needed, trend patients’ lab values, and declare confidently that I thought a patient could benefit from such-and-such specialist care, knowing that it was a viable option rather than a hopeful suggestion. My first two years of medical school trained me to think about what diagnoses were possible, then immediately what labs and imaging studies were needed to work these diagnoses up. I was lost in the world of rural medicine when sometimes the test to work something up was not an option. My time in Humboldt gave me much-needed perspective – not only into how far medicine has come but also what medicine was once like, and where I stand in the middle of it all.

Hamsika Chandrasekar is a third-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo of Hamsika Chandrasekar by John and Jean Montgomery

Medical Education, Medical Schools, Medicine and Society, Stanford Medicine Unplugged

Does medical school unfairly glamorize the medical profession?

Does medical school unfairly glamorize the medical profession?

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

discovery walkAny Stanford student knows all too well that the immense campus, with its seemingly eternal sunshine and endless rows of palm trees, can make it difficult to want to get outside and experience the real world. When it comes to medical education, this creates a very real concern: Is it possible to experience the full diversity of our health-care system when you are living in the so-called “Stanford bubble” – an idyllic college campus in one of the wealthiest counties in the United States?

I’ve certainly felt the effects of the Stanford bubble, but interestingly, working with a diverse population of patients has not been my primary challenge. Stanford has a wide net of connections with the Peninsula region and larger Bay Area – from clinics serving the urban underserved in East Palo Alto to flu vaccination programs reaching a rural population in the Central Valley farmlands. Those experiences are widely accessible to anybody who seeks them out.

No, my problem with the Stanford bubble is not about the patients – but rather the doctors. Doctors are known for being overworked and stressed, right? It certainly doesn’t seem that way in our bubble, where speaking with our outstanding pre-clinical faculty about their careers brings inspiring stories of cutting-edge research achievements, clinics filled with fulfilling cases and grateful patients and many years of training bright up-and-coming doctors. On the contrary, my faculty mentors speak highly of the balance they’ve found in their professional lives – clinic one day, research the next and teaching in between.

But is this really representative of the real world? When you step outside the realm of “academic medicine,” the picture seems to change considerably. It’s not a secret that, among physicians nationwide, burnout is widespread and pervasive – afflicting 46 percent of doctors in a recent study. Burnout was defined as “emotional exhaustion, depersonalization and low personal accomplishment.” To be honest, I can’t say that I’ve ever observed anything like that in my pre-clinical years, let alone in 46 percent of our faculty. As pre-clinical medical students, burnout is something that we hear about constantly, but witness never, allowing us to convince ourselves that it’s just some abstract idea that doesn’t apply to us.

I’m constantly inspired by my teachers and mentors here at Stanford. I will consider myself incredibly fortunate if I manage to step into their shoes at some point in my career. But part of me that wonders if we’re really seeing the full picture as pre-clinical students. We’re being shielded from the “front lines” – the thousands and thousands of primary care doctors who work tirelessly under the strains that our health-care system imposes on private practice physicians. Are we being set up for an unpleasant surprise later on? How can we possibly avoid being part of the 46 percent if we don’t have a good awareness that it exists? Perhaps it’s time to start bringing these questions into the medical school bubble.

Nathaniel Fleming is a second-year medical student and a native Oregonian. His interests include health policy and clinical research. 

Photo by Norbert von der Groeben

Medical Education, Medical Schools, Medicine and Literature, Stanford News

Tiger mother, tiger cub: A Stanford doctor reflects on his upbringing

Tiger mother, tiger cub: A Stanford doctor reflects on his upbringing

Tiger Child Pic JAMA PedsWhen Amy Chua’s book, “Battle Hymn of the Tiger Mother” was published in 2011, Jason Nagata, MD, was in medical school at the University of California, San Francisco. He caught on to the humor (which escaped some of the book’s reviewers), and the anecdotes resonated with him – reminding him of his own strict and intense upbringing. “It was very funny and very controversial,” he said. “A lot of that book stuck with me from the child’s perspective.” He started to share some of those memories with people around him and found that his fellow med school students had similar stories, too. He wrote about his experiences as a “tiger child” in a funny and touching essay (subscription required) published online today in JAMA Pediatrics.

When I connected with Nagata, we spoke over Skype because he was working in Ecuador as part of his global health residency. He noted that despite the negative press Chua’s book received, he believes that strict childhood training helped prepare him for medical school. “The tiger mentality is prevalent throughout medicine,” he said. “It was intense as a child, but it prepared me well for medical training – the hours and the intensity.”

But Nagata had to learn the hard way to make room in his schedule for rest. After a particularly intense time during medical school, he developed an ulcer that landed him in the hospital. His recovery took more than a month. He explored writing as a way to reflect and think through his experiences as a student and later as a doctor. When he came to Stanford, he attended the Medicine and the Muse writing workshops to hone his writing chops. His current essay is just the latest in a series.

Although he makes time for rest, he still has plenty of drive and intensity. He mentioned that he was planning a trip to the Galápagos Islands and to hike Mount Chimborazo, the highest mountain in Ecuador, the weekend after we spoke. After he completes his residency at Stanford, he’ll start a three year fellowship in adolescent and young adult health in July 2016.

Nagata describes his own mother’s unusual path from NICU nurse to graduate student in chaplaincy. “She exemplified the tiger mom and probably works even harder than I do,” he said. “I got a lot of my habits from her.” She doesn’t demand as much from Nagata these days, but her Tiger mom spark isn’t completely gone. When he told his mother about the upcoming essay, she quipped that she was planning to write a rebuttal to JAMA Pediatrics “in her own tiger mother vein,” he said.

Previously: For group of Stanford doctors, writing helps them “make sense” of their experiences
Photo of Jason Nagata as child, courtesy of Jason Nagata

Medical Education, Medicine and Society, Stanford Medicine Unplugged

Learning how to learn medicine

Learning how to learn medicine

Stanford Medicine Unplugged (formerly SMS Unplugged) is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

A few weekends ago, I saw a patient with bloated shins at our school’s free clinic, and I marked in my notes that she exhibited “peripheral edema,” an esoteric phrase that means little to those outside of the medical community. That experience only highlighted the tendency in medicine to inflate common bodily functions into opaque medical jargon. Its use can be frustrating for patients who are trying to understand their illness — and at times even for the uninformed medical student who is trying to learn about his patient.

As medical students, we feel as if we’re training to become glorified breathing-and-walking medical dictionaries

It doesn’t help that the list of jargon is endless. Itchiness becomes pruritus. Listening to the body’s internal noises condenses into auscultation. When you urinate, you’re really micturating, and if you have trouble doing so, you also have dysuria. Having a rash turns into having erythema. An abnormally large liver translates to hepatomegaly. An unhealthy level of cholesterol is labeled as hyperlipidemia. Chest pain is referred to as angina. Even the simple act of sweating is termed hidrosis. For vast majority of the first two years of medical school, we spend our time learning this vast and complex language that seems to have a word or phrase for every single bodily event — health and unhealthy, normal and abnormal.

But that is what medical training and much of medicine are — making observations of the human body and noting them with memorized jargon. And once we have acknowledged all the relevant observations, we connect the dots to form a story. If we’re astute and lucky enough, that story will end with the name of the disease along with its possible treatments and cures.

One would think that in order to provide adequate treatment to our patients, our education would possess more depth into the mechanisms behind drugs and diseases. But we only graze their physiological and molecular basis. It isn’t a reflection on our lack of curiosity. Rather, unfortunately, medicine is still limited by our dearth of knowledge. Despite the trillions of dollars poured into research, our advances in human genomics, and the fancy gadgetry, the human body remains a stubborn black box. Most of the time, all we can do is look at the inputs and outputs. Take aspirin, for example. Cardiologists recommend patients with a history of cardiovascular disease to take a baby aspirin every day to reduce their chances of a heart attack. But how this drug — first discovered by the ancient Egyptians — leads to decreased risk of death still remains a mystery.

These days, patients can sequence their entire genomes at a speed and price that was unimaginable a decade ago. They can scan their entire bodies to produce images with unprecedented detail. But in a unexpected twist, in order to confirm a diagnosis, physicians may still resort to the primitive practice of taking a gross piece of tissue from the patient and viewing it under a compound microscope, a contraption invented nearly half a century ago. Our expensive technology has been only able to expand our ability to observe and has done little peel back the veil covering the underlying mechanisms of human diseases.

But that is not to say that we should lose faith in medicine and underestimate the importance of labeling our observations. For the patient, putting a name on an abnormality, even if there may be no treatment available, can be comforting and give hope for recovery. For the caretaker, being able to identify an important physical finding can point to a set of suspect diseases. For my patient, leg swelling strongly suggested that he might be suffering from congestive heart failure.

As medical students, we must feel as if we’re training to become glorified breathing-and-walking medical dictionaries. Make no mistake — we are. We’re learning to make observations, note them down, and make sense of them down the road. And we shouldn’t underestimate the power of this process. It is at the core of the scientific process, and it’ll be how we ultimately serve our patients.

Steven Zhang is a second-year medical student at Stanford. When he’s not cramming for his next exam, you can find him on a run around campus or exploring a new hiking trail.

Photo in featured entry box by Patrick

Medical Apps, Medical Education, Medicine X, Patient Care, Technology

A look at using smartphone apps for patient-centered research

A look at using smartphone apps for patient-centered research

The usefulness and power of mobile apps in research was one of the last topics at Medicine X yesterday. One of the panelists in the late-afternoon “Clinical research in the palm of your hand” session was Stephen Friend, MD, PhD, who told attendees how willing most patients are to share their health data for science. “If you give someone a choice and ask them, ‘Do you want your data to be looked at by qualified researchers around the world?'” people usually say yes, reported Friend, president of the nonprofit biomedical research organization Sage Bionetworks.

Panelist Michael McConnell, MD, professor of cardiovascular medicine at Stanford, can certainly attest to this: He’s principle investigator of a study, MyHeart Counts, that has seen tens of thousands of users offer up their heart-related data for study.

Stanley Shaw, MD, assistant professor of medicine at Harvard, shared thoughts on how having an ongoing data connection with patients can feel for a physician-researcher: “I had a surprising sense of immediacy when I started looking at… data. We had people upload information such as their blood glucose levels. You can see people cranking the level down day by day over weeks or months. It really does remind you of that pact between an individual and their physician and that it’s a privilege to take care of patients. It’s very exciting.”

Also exciting is when apps are shown to have a direct impact on a patient’s care or quality of life. Friend gave the example of a program that reduced emergency room visits and hospitalizations by allowing providers to keep track of patients via an app. “If someone has been holed up in their house for four days, we can send someone to find out why,” he said. And if a patient stops taking a daily walk, that provides the medical team with clues as well.

Of course, not every patient— especially one with a chronic illness — is going to bother logging onto an app to share data every day, said Yvonne Chan, MD, PhD, assistant professor of emergency medicine at Mount Sinai Hospital. “We talk about access and engagement,” she said, but different types of users are going to engage with an app differently. For example, asthma patients with severe, poorly-controlled baseline disease are easy to engage and keep — especially if they happen to own a smart phone. Such patients are highly motivated to better control their disease and stay out of the emergency room.

“But people with minor disease that’s well controlled, maybe they have better things to do,” she said. Apps could be designed to engage different patient populations; maybe that asthma app could have a mode that included more entertainment for patients who are less sick and less motivated.

More news about the conference is available in the Medicine X category

Medical Apps, Medical Education, Medicine X, Patient Care

Engaging and empowering patients to strive for better health

Engaging and empowering patients to strive for better health
Nancy M-D on stageMedicine X yesterday featured a series of talks on a topic that is near and dear to the heart of many conference attendees: Empowering and engaging patients. Marty Tenenbaum, PhD, a former consulting professor of computer science at Stanford, began the session with a moving talk on how difficult and frustrating it was to find the right therapy after he was diagnosed with metastatic melanoma 17 years ago.

“I spent a lot of time in the stacks of Stanford reading medical journals. They all agreed on one thing, which was my dire prognosis. I thought, there’s gotta be something better than this,” he said. Tenenbaum’s ordeal prompted him to create a nonprofit, called Cancer Commons, which helps connect cancer patients to the therapies that have the best chance of curing them.

Howard Look, president and CEO of the app Tidepool, said it “was like crawling through broken glass” to get access to his daughter’s blood glucose data when she was diagnosed with type 1 diabetes in 2011. “We quickly discovered how hard it is to calculate the right dose of insulin,” Look said, driving the point home by showing a series of texts he once received from his daughter, Katie:

Katie: “Dad, I’m low. I’m 52 and dropping.”
Howard: “That’s okay, you have your juice boxes right?”
Katie: “I can’t find my juice boxes.”
Howard: “I’ll come get you.”
Katie: “I don’t know where I am.”

“This is a scary moment if you are a parent,” he said. “You might think that when the stakes are this high there must be a way to manage your diabetes with some sort of software or app. At the time, there wasn’t one.” This motivated Look to design an app that helps diabetic patients get and use to their blood glucose data effectively. “When you liberate the data, you empower the patient and enable them to engage however they want to engage,” Look said.

Next, Brian Loew, founder and CEO of Inspire, talked about the online community of patients and medical professionals in that social network. Many patients have reporting feeling more able to discuss certain issues with their doctors after first talking with their peers in Inspire, he said. “How do I travel with a wheelchair? How can tell my kids I have cancer?  These are questions that are often easier to ask of a person who has done or experienced it,” Loew explained.

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Events, Medical Education, Medicine X, Stanford News

Learning from patients by walking in their shoes

Learning from patients by walking in their shoes

digital storytelling workshopWhere else but at a medical conference in Silicon Valley would you hear the term “empathy hack”? The concept of the empathy hack unites the acknowledged need for education geared toward fostering empathy in health-care providers with the innovative, disruptive mentality of the valley. The result is “One Day,” a pilot project led by Rice University’s Kristen Ostherr, PhD, and Roni Zeiger, MD and CEO of, who shared their hacking concept with attendees at a Stanford Medicine X | ED workshop yesterday.

The concept behind “One Day” is to pair a patient and a learner (a medical student, doctor, researcher, hospital administrator, or educator) and have the learner experience a day in the life of that patient, with everything that entails, including self-treatments and physical challenges caused by the patient’s illness.

The learner receives a “kit” containing materials that simulate the condition of the patient for the learner, i.e.  a thin straw and air pack to simulate a nebulizer used by patients with cystic fibrosis, or leg weights to be worn to simulate the drag caused on limbs by Parkinson’s disease.

Once patient and learner are matched, they agree on a form of communication for the day, with modalities including SMS Text, Facebook chat or texting with video, audio and photographs. The learner then follows the actions of the patients during the day, whether administrating nebulizer treatments or trying to negotiate crossing a street quickly with limbs that are weighed down.

After describing the project, Ostherr and Zieger asked attendees to brainstorm ideas for expanding this model to be used for other patient illnesses and experiences. Participants in the outdoor workshop were doctors, patients and medical educators, and their responses included chronic pain, diabetes, homelessness patients, and palliative care and end of life treatment. Caroline Okorie, MD, a Stanford pediatric pulmonologist, said she would like to see an exercise like this for teenagers dealing with CF: “They really have a unique issues, even in comparison to adults.”

A patient who has been dealing with chronic pain for years suggested that learners should deal with multiple challenges, as many patients do. “It may not just be that the pain is your back, that can lead to shoulder pain, or headaches, and all this happens at once.”

Zieger and Ostherr, who hope to bring the project to medical schools, emphasized the simplicity of the model: The kits cost approximately $30, and HIPPA concerns are handled by informed consent filled out by the patient participants. It’s small investment for the potentially-eye opening and revelatory experience of health-care providers walking in the shoes of a patient, even just for a day.

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics.

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Kristen Ostherr and Roni Zeiger (both standing) courtesy of Stanford Medicine X

Events, Medical Education, Medicine X, Patient Care, Precision health, Technology

“No ordinary conference”: The magic that is Medicine X returns to the stage

"No ordinary conference": The magic that is Medicine X returns to the stage

Larry Chu welcoming attendeesMedicine X, Stanford’s popular conference on emerging technologies and medicine, returned to the stage today.

The conference, which was proceeded by the first-ever Medicine X | Ed, is now in its fourth year, and the momentum and magnitude of the event has steadily increased since it began.

Last year, more than 4,000 participants in 69 countries took part in the Medicine X experience via Twitter, making it the most-discussed academic conference in the world. Its past successes were reflected in the theme for Medicine X 2015: “Great Xpectations.”

After executive director Larry Chu, MD, welcomed attendees with a reminder that they “all belong here,” Lloyd B. Minor, MD, dean of the medical school, officially opened the conference with remarks that encouraged this engaged audience to take action and seize opportunities to improve health care. “This is no ordinary time in our history, and Medicine X is no ordinary conference,” he said. “We are here today to have discussions and generate ideas about how to leverage the power of information and the latest technology to improve health for people in our own communities and across the globe. Health care is truly the opportunity of our lifetime.”

Minor talking“Since last year’s Medicine X conference, Stanford Medicine has launched a bold new initiative — our vision to lead the biomedical revolution in precision health,” he said. “Precision health as the next generation of precision medicine: Precision medicine is about sick care, precision health is about health care.” Everyone participating in this event is an important part of moving this conversation forward, he explained.

Eric Topol, MD, chief academic officer at Scripps Research Institute and bestselling author, went on to give an opening keynote on ways we can use new technologies to democratize medicine and involve the patient in his or her own care. “We have views of the human being that we never had before,” Topol said, referencing smartphones and other technologies that people use to monitor their health metrics.

These new technologies are important because they’re interactive and easy for patients to use, and they allow patients to become more involved in their health care, Topol explained. He showed an image of the iconic black doctor’s bag. “These are vintage tools,” he said. “This is my bag,” he explained, pointing to an image of a several digital tools.

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