Justin Baker 2

Transcript

00:09 --> 00:11Hello and welcome to the Science et
00:11 --> 00:12al podcast about everything science
00:12 --> 00:15sponsored by the Yale School of Medicine.
00:15 --> 00:16I'm your host, Daniel Barron,
00:16 --> 00:19and in this episode I'm speaking
00:19 --> 00:20with Doctor Justin Baker.
00:20 --> 00:22Justin is the Co founding scientific
00:22 --> 00:24director of the McClain Institute
00:24 --> 00:26for Technology in Psychiatry and
00:26 --> 00:27he also directs the Laboratory
00:27 --> 00:29for Functional nor Image Ingane
00:29 --> 00:31by Informatics at McLean Hospital.
00:31 --> 00:34He is an assistant professor of
00:34 --> 00:36psychiatry at Harvard Medical School
00:36 --> 00:38and in all of these capacities he has
00:38 --> 00:41the time to do research when it tries
00:41 --> 00:43to combine his expertise in Bremen, Jane.
00:43 --> 00:45With his expertise in deep
00:45 --> 00:46multi level phenotyping,
00:46 --> 00:49something that will discuss in the podcast.
00:49 --> 00:51He's a clinical psychiatrist
00:51 --> 00:53with expertise in schizophrenia,
00:53 --> 00:56bipolar spectrum disorders and
00:56 --> 00:57other disorders.
00:57 --> 00:59Ann, I first learned to Justin and
00:59 --> 01:01his work through a colleague at NYU.
01:01 --> 01:02You the beginning of my residency training.
01:03 --> 01:04It was like the very beginning
01:04 --> 01:06of my intern year.
01:06 --> 01:08So I read an article and actually
01:08 --> 01:10written an article for Scientific
01:10 --> 01:12American about this nascent
01:12 --> 01:14field of digital diagnostics,
01:14 --> 01:16something I thought was really cool,
01:16 --> 01:18but I didn't know much about yet an
01:18 --> 01:21my NYU you friend told me to check
01:21 --> 01:24out Justin's research and at the time
01:24 --> 01:27Justin was using digital devices like
01:27 --> 01:29smartwatches or Fitbits to monitor
01:29 --> 01:31and trace patients symptoms and try
01:31 --> 01:33to combine that with biological
01:33 --> 01:35measures like brain imaging.
01:35 --> 01:37I invited myself to Justin's annual
01:37 --> 01:40technology in Psychiatry Summit in Boston.
01:40 --> 01:41Which was really cool.
01:41 --> 01:43He had adjusted and been able to invite
01:43 --> 01:45out speakers from Apple and Google,
01:45 --> 01:47and he had Tom Insel give.
01:47 --> 01:50What are the key notes is really
01:50 --> 01:52exciting and later that winter I was
01:52 --> 01:54invited to give a talk in McLean.
01:54 --> 01:56Anne asked to meet with Justin
01:56 --> 01:57during the day.
01:57 --> 01:58I remember us walking
01:58 --> 02:00around at Mcleans campus,
02:00 --> 02:02which even in the dead of Winter
02:02 --> 02:04was still quite lovely and he
02:04 --> 02:06and I just kind of patrolled the
02:06 --> 02:08perimeter and tell her fingers got
02:08 --> 02:10cold and we had to go inside.
02:10 --> 02:12And during this time I really got
02:12 --> 02:14to know Justin and he was able
02:14 --> 02:17to give me a lot of really useful
02:17 --> 02:18advice to get through residency,
02:18 --> 02:21and since that time's I found him to be
02:21 --> 02:24a very kind and generous mentor and friend.
02:24 --> 02:27I'm really grateful to Justin for
02:27 --> 02:29participating in this podcast and.
02:29 --> 02:30Also,
02:30 --> 02:32and and all the help that he's given
02:32 --> 02:34me over the last few months when I was
02:34 --> 02:37writing a book about digital psychiatry,
02:37 --> 02:40which Justin's a big big expert.
02:40 --> 02:42This podcast was filmed at the end
02:42 --> 02:45of a very busy day for Justin.
02:45 --> 02:47I had invited him out to yell to
02:47 --> 02:49give this psychiatry grand rounds
02:49 --> 02:51and really enjoyed watching the
02:51 --> 02:53audience and seeing how impressed
02:53 --> 02:56and kind of awakened they seem.
02:56 --> 02:58Looking at all this research that
02:58 --> 03:01Justin was doing and how he could
03:01 --> 03:04use these digital devices to create
03:04 --> 03:06clinically useful tools and so.
03:06 --> 03:08Really excited to present this
03:08 --> 03:09episode with Justin
03:20 --> 03:23What was your residency program like? Like?
03:23 --> 03:25What was your experience there like?
03:25 --> 03:29Were they? It sounds like they were trying
03:29 --> 03:32to expose you to different researchers,
03:32 --> 03:35and I'm curious how your desire to
03:35 --> 03:38do research was received by anymore.
03:38 --> 03:41Dynamically minded clinicians.
03:42 --> 03:44Well, you know. I mean, I had
03:44 --> 03:46really been recruited to the program
03:46 --> 03:47because of my research background.
03:47 --> 03:49The reason my board scores?
03:51 --> 03:53And it wasn't like I like the
03:53 --> 03:55clinical, but you know, I think
03:55 --> 03:57it was understood that you know.
03:59 --> 04:02I was going to be doing some
04:02 --> 04:03research at throughout it,
04:03 --> 04:06but I think I tried to, you know nonetheless,
04:06 --> 04:09like really immerse myself in
04:09 --> 04:13the clinical programs and I. So.
04:13 --> 04:17You know, I think people were supportive
04:17 --> 04:23in general of the research. And.
04:23 --> 04:25You know, I think you you try to be a
04:25 --> 04:28good citizen and do all the clinical
04:28 --> 04:31work and really kind of try to learn from it.
04:31 --> 04:33While also not letting that other
04:33 --> 04:35part of your brain totally turn off
04:35 --> 04:37and trying to make sure that you
04:37 --> 04:39take it seriously enough to wear,
04:39 --> 04:41like if something really important,
04:41 --> 04:43then you're going to prioritize it
04:43 --> 04:45an even if it causes you know people
04:45 --> 04:48to give you like some feedback like
04:48 --> 04:50**** you know you kind of have to
04:50 --> 04:52learn how to make those decisions
04:52 --> 04:54for yourself and work with your
04:54 --> 04:57allies and your program to get the
04:57 --> 04:59support 'cause it's you don't want
04:59 --> 05:01to be a situation where it's just
05:01 --> 05:03you arguing against everybody else.
05:03 --> 05:05But I was fortunate at the time to have
05:05 --> 05:08been recruited by a program director
05:08 --> 05:11who wanted to make research more of a
05:11 --> 05:13conspicuous part of the training program.
05:13 --> 05:15And so even though I faced some
05:15 --> 05:17obstacles like I had my own initiative,
05:17 --> 05:20I was able to create the projects.
05:20 --> 05:22But then as I got through residency
05:22 --> 05:24because I, like many right,
05:24 --> 05:26like I had a really hard time
05:26 --> 05:28getting much done during residency.
05:28 --> 05:29Yeah, sure,
05:29 --> 05:31you know the stuff that I was
05:31 --> 05:33sort of collecting by just.
05:33 --> 05:36You know, leveraging those lab resources,
05:36 --> 05:38but.
05:38 --> 05:41So after the residency was over,
05:41 --> 05:44I helped them to compete for another 25,
05:44 --> 05:48which at the time the program.
05:48 --> 05:50Didn't know about that mechanism,
05:50 --> 05:53so you know over the course of participating
05:53 --> 05:56in some of those opportunities
05:56 --> 05:59like the NIH is brain camp and.
05:59 --> 06:01Some of their programs I I learned
06:01 --> 06:02about that mechanism and then.
06:04 --> 06:07I think for me it was appealing
06:07 --> 06:10to take on a role like that so
06:10 --> 06:12that in addition to the research.
06:12 --> 06:14You know, coming out of residency,
06:14 --> 06:16you knew you were going to have to
06:16 --> 06:18piece things together with sort
06:18 --> 06:20of additional responsibilities.
06:20 --> 06:22But if for me I could take my
06:22 --> 06:24experience having kind of navigated
06:24 --> 06:26this complex landscape and sort of
06:26 --> 06:28quantify that in a program that would
06:28 --> 06:31be both like enjoyable for me and I
06:31 --> 06:33could begin using that to both to
06:33 --> 06:36find students and also just kind of
06:36 --> 06:38continue learning as I was trying
06:38 --> 06:40to now compete for my own award.
06:40 --> 06:42And things like that so.
06:44 --> 06:46So I helped him to get that and
06:46 --> 06:48they were successful at it.
06:48 --> 06:50And then I used to run the
06:50 --> 06:53program for a few years and.
06:53 --> 06:55You know, I think.
06:55 --> 06:57One of those things where it's
06:57 --> 06:59it's nice to see your programs
06:59 --> 07:01continue to kind of take off on
07:01 --> 07:04their own and then was able to kind
07:04 --> 07:06of as I was getting other funding
07:06 --> 07:07or other projects came along.
07:07 --> 07:10I was able to sort of.
07:10 --> 07:12Take a less directly involved
07:12 --> 07:15role and then kind of gradually.
07:15 --> 07:18I'm still involved with the program today,
07:18 --> 07:19but.
07:20 --> 07:23I guess something else that I've
07:23 --> 07:25been skeptical of during my
07:25 --> 07:27training and you mentioned this.
07:27 --> 07:30Like how do we know you know, right?
07:30 --> 07:33So I can terms of symptom assessment.
07:33 --> 07:36A lot of your work now is
07:36 --> 07:37measuring different symptoms,
07:37 --> 07:40like getting back to like the
07:40 --> 07:42kernel behavior or whatever and.
07:42 --> 07:45At what point in your training did
07:45 --> 07:47you start to wonder like whether
07:47 --> 07:50even the words that we were using to
07:50 --> 07:51describe conditions or like those
07:51 --> 07:54sorts of dependencies that may or
07:54 --> 07:58may not add up to bipolar disorder?
07:58 --> 08:00What was your like journey through that?
08:01 --> 08:05Yeah, I mean I think. You know,
08:05 --> 08:07I guess my experience of that was sort of.
08:10 --> 08:11It didn't really make much
08:11 --> 08:13sense that that was how we were
08:13 --> 08:16doing the evaluations, but.
08:16 --> 08:17You know when you're training to
08:17 --> 08:19become a doctor or psychiatrist,
08:19 --> 08:21big part of that is just,
08:21 --> 08:23you know what's the protocol?
08:23 --> 08:25What do you need me to do?
08:25 --> 08:28Should you need me to ask these questions?
08:28 --> 08:30OK, you know, write down what they say.
08:30 --> 08:31OK, like, OK,
08:31 --> 08:33you're calling that pressured speech,
08:33 --> 08:35OK, you're calling this low mood or
08:35 --> 08:36you're calling this constricted affect.
08:39 --> 08:42So I just saw it as a.
08:42 --> 08:44We're just being trained to follow protocol.
08:44 --> 08:46I'm not going to question,
08:46 --> 08:49you know like on the one hand,
08:49 --> 08:52like it's seemed really arbitrary and.
08:52 --> 08:54Probably not biologically based,
08:54 --> 08:56but at the same time it's.
08:56 --> 08:59It's it's allows first kind of reliability
08:59 --> 09:01that had a pragmatic utilities,
09:01 --> 09:06so I really try to do separate in my mind,
09:06 --> 09:09the pragmatic utility piece from.
09:09 --> 09:11From but you know,
09:11 --> 09:14but at the same time each.
09:14 --> 09:15Experience of this of, like you know,
09:15 --> 09:16why are we doing this again?
09:16 --> 09:18OK, just that's fine,
09:18 --> 09:20but just tell me you know.
09:20 --> 09:21Through each clinical experience,
09:21 --> 09:24just kind of noticing the places where
09:24 --> 09:25something could be more objective.
09:27 --> 09:30And kind of filing that away a little bit,
09:30 --> 09:32you know, just to say like I can't possibly
09:32 --> 09:35study everything right now, but like here,
09:35 --> 09:38here's a way for me to say like.
09:38 --> 09:41You know this one is really kind of fuzzy,
09:41 --> 09:43and none of the clinicians know what this is,
09:43 --> 09:45but they're constantly
09:45 --> 09:47having to put it on paper.
09:47 --> 09:50And it's causing a lot of confusion or
09:50 --> 09:52like something like why are we documenting
09:52 --> 09:54endzeit exactly like what does that mean?
09:54 --> 09:56When I show a patient my note
09:56 --> 09:58that says he has poor insight,
09:58 --> 10:00he gets really upset.
10:00 --> 10:02So like, should we be using a
10:02 --> 10:03different word than insight?
10:03 --> 10:05You know, I know what we mean,
10:05 --> 10:07but like you know, just.
10:07 --> 10:09Starts you thinking along the lines of.
10:09 --> 10:11Like are these assessments
10:11 --> 10:12were doing truly optimal?
10:12 --> 10:13You know I didn't.
10:13 --> 10:15It's like and you kind of
10:15 --> 10:16know that they're not.
10:16 --> 10:19But you know that they're sort of time
10:19 --> 10:21honored and there's not a lot of evidence.
10:21 --> 10:23Do something different,
10:23 --> 10:26and so you know it's question is like.
10:26 --> 10:28If we are going to change things,
10:28 --> 10:30how would we know that we're changing
10:30 --> 10:33them for the better and stuff so?
10:33 --> 10:33But
10:33 --> 10:35the question I think
10:35 --> 10:36it's interesting 'cause not
10:36 --> 10:38everyone thinks along those lines.
10:38 --> 10:39Alright, so I'm wondering if.
10:39 --> 10:43I mean, I I I've noticed many residents
10:43 --> 10:46don't don't think along those lines.
10:46 --> 10:48Many attendings you know people have
10:48 --> 10:51been practicing for their entire career.
10:51 --> 10:53Don't really question that. So.
10:53 --> 10:55So there's a difference between becoming
10:55 --> 10:57proficient at detecting pressured speech,
10:57 --> 10:59say and wondering what exactly
10:59 --> 11:01is pressured speech like.
11:01 --> 11:04At what frequency of words does it
11:04 --> 11:06become pressured from normal or rapid?
11:06 --> 11:09Or like where is the line? Yeah,
11:09 --> 11:11yeah, and I wasn't.
11:11 --> 11:14I mean, I wasn't necessarily
11:14 --> 11:18preoccupied with that like in terms of.
11:18 --> 11:22Defining the words, but I think.
11:22 --> 11:24I guess it was more about
11:24 --> 11:26when you go from the.
11:26 --> 11:28Stage of training where you're
11:28 --> 11:30really just filling out the forms
11:30 --> 11:32the way you know to fill them out
11:32 --> 11:34can work done to get the work done
11:34 --> 11:36to really trying to get to be better
11:36 --> 11:39at it to be more efficient at it.
11:39 --> 11:40To kind of have a more intuition
11:40 --> 11:42around you know these kind of master
11:42 --> 11:45clinicians who could come into a room
11:45 --> 11:46and then within a few seconds have
11:46 --> 11:48zeroed in on some core pathology to
11:48 --> 11:50me that was really fascinating, right?
11:50 --> 11:52Like you know we spend so much
11:52 --> 11:54time getting these notes documented
11:54 --> 11:57for billing and all these things.
11:57 --> 11:59But you know you have the clinicians
11:59 --> 12:00who are not doing that,
12:00 --> 12:03but they're able to kind of come in
12:03 --> 12:04and ask these incisive questions
12:04 --> 12:05and get
12:05 --> 12:07to the heart of the matter.
12:07 --> 12:09Something I remember observing
12:09 --> 12:10in intern year was there's a.
12:10 --> 12:13There's a clinician, Tom Duffy.
12:13 --> 12:14Here, who is a hematologist.
12:14 --> 12:16I've ever one morning was like
12:16 --> 12:187 in the morning we've been
12:18 --> 12:20this is a medicine rotation,
12:20 --> 12:23even fretting over this one patient for it.
12:23 --> 12:26Half an hour you know the whole team
12:26 --> 12:29standing around and he came in and.
12:29 --> 12:30Within 30 seconds it couldn't
12:30 --> 12:33have been more than 30 seconds.
12:33 --> 12:34He knew what was wrong.
12:34 --> 12:36He ordered the tests and
12:36 --> 12:38the test came back exactly.
12:38 --> 12:40See predicted and I remember thinking like.
12:40 --> 12:44So here's a guy who was detecting some
12:44 --> 12:48signal which none of us were able to detect.
12:48 --> 12:50But then there was another step
12:50 --> 12:52where he was able to demonstrate
12:52 --> 12:54that what he had detected is
12:54 --> 12:56accurate and his prediction.
12:56 --> 12:59He had made a quantifiable prediction
12:59 --> 13:01with Mary Unquantified an I've had
13:01 --> 13:03the same experience in psychiatry,
13:03 --> 13:06where people with equal vigor can
13:06 --> 13:08conviction state a formulation for case.
13:08 --> 13:11But then there's no way to.
13:11 --> 13:14Really test whether that's accurate.
13:15 --> 13:18Well, right? I mean sometimes it is.
13:18 --> 13:20You know you can ask them,
13:20 --> 13:21and that's like if you have a
13:21 --> 13:23sense that like I bet this is
13:23 --> 13:24somebody with trauma history.
13:24 --> 13:25I'm just getting that vibe or there's
13:25 --> 13:27something I'm picking up, sure. Yeah yeah.
13:27 --> 13:30Then you can ask for you start to use your.
13:30 --> 13:31Hypothesis generation to basically
13:31 --> 13:37gradually zero in on that, so I think.
13:37 --> 13:40So I think we we still, as you know,
13:40 --> 13:42good clinicians still do that which is
13:42 --> 13:45like within a very short amount of time.
13:45 --> 13:48They use the gestalts, sort of.
13:48 --> 13:49Where you're looking,
13:49 --> 13:52how you're moving to generate some
13:52 --> 13:54hypothesis and then the questions
13:54 --> 13:56are really kind of designed to zero
13:56 --> 13:58in on that mythology and then.
14:01 --> 14:05You know? Is there like a lab
14:05 --> 14:08test you can then run to be 100%?
14:08 --> 14:10Generally no, but.
14:10 --> 14:12Our tactic is usually like,
14:12 --> 14:13well, if I'm right,
14:13 --> 14:15then I should be able to use this
14:15 --> 14:17medication and then it will get better.
14:17 --> 14:22So yeah, it's it's a gap that
14:22 --> 14:24needs to be filled. Well.
14:24 --> 14:26Occurs to me now that a lot of your
14:26 --> 14:29research in the digital phenotyping is more
14:29 --> 14:31precisely defining the problem. Set right?
14:31 --> 14:33So like you work with accelerometers,
14:33 --> 14:35speech analysis, facial expression like
14:35 --> 14:38these are all things that you can do.
14:38 --> 14:39Like yeah, I mean,
14:39 --> 14:41well obviously not the accelerator.
14:41 --> 14:43Maybe your Geo location,
14:43 --> 14:46but certainly you can look at a patient.
14:46 --> 14:47Analyze their face,
14:47 --> 14:49see where their eyes are gazing.
14:49 --> 14:51Don't tell something about their
14:51 --> 14:53body language or affect and you
14:53 --> 14:57don't need a number for that, but.
14:57 --> 14:59That maybe maybe you're trying to pin
14:59 --> 15:01yourself down to a number like cannot?
15:01 --> 15:03Could I understand it like that or is?
15:03 --> 15:04Yeah,
15:04 --> 15:06I guess the way I would think about
15:06 --> 15:08it is like my experience of being
15:08 --> 15:10a psychiatry resident was like.
15:10 --> 15:12You're not very good at everything.
15:12 --> 15:14You're being trained to do 'cause
15:14 --> 15:16you're just learning, and so you get.
15:16 --> 15:18But you get exposed to people
15:18 --> 15:20who are really good at it.
15:20 --> 15:23And then you're trying to see if you can
15:23 --> 15:26figure out how to get good like that,
15:26 --> 15:28and what exactly is it that they're doing.
15:28 --> 15:33That's different than what I can do, and so.
15:33 --> 15:35The ability of really good
15:35 --> 15:38psychiatrists to enter ologist to
15:38 --> 15:40pick up on these subtle things.
15:40 --> 15:43And like be able to tell that this
15:43 --> 15:45particular type of movement is a
15:45 --> 15:47lithium trimmer because it's in this
15:47 --> 15:49frequency or that this particular
15:49 --> 15:51kind of head nod is Parkinson's
15:51 --> 15:53versus essential tremors because of
15:53 --> 15:55sort of like the precise dynamics
15:55 --> 15:57or the way that it's moving.
15:59 --> 16:01Or that this person speech is
16:01 --> 16:04manic and this other persons is
16:04 --> 16:06psychotic because of very subtle
16:06 --> 16:09dysarthria is that they're hearing?
16:09 --> 16:12It was that being able to map between these
16:12 --> 16:14sort of subtle constellation of features
16:14 --> 16:16into sort of a much more coherent formula.
16:16 --> 16:19That to me was what was really
16:19 --> 16:21cool about it, which is like.
16:21 --> 16:24I can kind of see that they're doing this,
16:24 --> 16:27but like I am not good at it and this idea
16:27 --> 16:30that I'm just going to like see a million
16:30 --> 16:33patients and eventually get good at it.
16:33 --> 16:37Seems to me kind of crazy, because then.
16:37 --> 16:39Like no one will get good until
16:39 --> 16:41they've seen people for 10 years.
16:41 --> 16:42Yeah, what about the half
16:42 --> 16:44a million they see before
16:44 --> 16:44their angry and
16:44 --> 16:46so and so? How is it that you know
16:46 --> 16:49going to school in a teaching hospital?
16:49 --> 16:51You know you're not providing great care,
16:51 --> 16:52but you're kind of like wow,
16:52 --> 16:55they're letting me see people even though
16:55 --> 16:58my skill set is so mature at this point.
16:58 --> 17:00And just kind of feeling uncomfortable about
17:00 --> 17:03that and thinking like, gosh, you know,
17:03 --> 17:06if there was at least some ways of.
17:06 --> 17:08Having some assistance in terms of some of
17:08 --> 17:10these features which should be quantifiable.
17:10 --> 17:12Like, shouldn't we be investing
17:12 --> 17:13in that kind of thing?
17:13 --> 17:15Even so that like somebody like me
17:15 --> 17:17could learn to do it way faster or
17:17 --> 17:19there wouldn't be as much liability
17:19 --> 17:22when I'm not trained up and stuff
17:22 --> 17:24or something as basic as like I'm
17:24 --> 17:27going to have to go to my supervisor
17:27 --> 17:30later and tell them how it went?
17:30 --> 17:32And if I feel like dodging it,
17:32 --> 17:35I could just talk about neuroscience.
17:35 --> 17:37Alright baby.
17:37 --> 17:39Or if I really want to learn that day,
17:39 --> 17:41I could record the session and then
17:41 --> 17:43play it from my supervisor and we
17:43 --> 17:44could go through it in great detail
17:44 --> 17:46and I'll feel really embarrassed.
17:46 --> 17:49And yet, like I will learn way more that day,
17:49 --> 17:50could they let you
17:50 --> 17:51do that? Sure? Oh,
17:51 --> 17:52they did not let us record.
17:52 --> 17:54I would have loved to have done
17:54 --> 17:56that. I mean, I think in most programs
17:56 --> 17:57it's considered standard of care.
17:57 --> 17:58If you're learning psychotherapy
17:58 --> 18:02to record your sessions, not a lot.
18:02 --> 18:03Yes, that's unusual. I think.
18:03 --> 18:06I mean, it's a it's definitely part of
18:06 --> 18:08almost every psychological training.
18:08 --> 18:10And then yeah, no. We were.
18:10 --> 18:11We were strongly encouraged.
18:11 --> 18:13You know, with patient permission,
18:13 --> 18:14you gotta get them signed.
18:14 --> 18:16Yes, to get audio recordings
18:16 --> 18:18and in some cases like video
18:18 --> 18:20recordings of your sessions,
18:20 --> 18:22because unlike the old days where
18:22 --> 18:25you would have a one way mirror
18:25 --> 18:27an you get somebody like really
18:27 --> 18:30like watching you and Nikki notes.
18:30 --> 18:32So here was a way to use technology
18:32 --> 18:34in a very simple way,
18:34 --> 18:35which is just don't worry bout
18:35 --> 18:37scribbling down your process notes.
18:37 --> 18:40I mean there may be a reason to do that,
18:40 --> 18:41but let's let's have you actually
18:41 --> 18:43record verbatim what was said and
18:43 --> 18:45your posture and all the things?
18:45 --> 18:47And and let's just look at it
18:47 --> 18:49and see what you might be doing
18:49 --> 18:50differently and stuff.
18:50 --> 18:51And to me like those were
18:51 --> 18:53the moments that were both.
18:53 --> 18:55Again like you feel yourself being
18:55 --> 18:56sculpted out of out of stone.
18:56 --> 18:58'cause it's like kind of painful.
18:58 --> 19:00But at the same time you're like.
19:00 --> 19:01Oh,
19:01 --> 19:03that's what you mean by this and you
19:03 --> 19:06kind of have somebody's not in the room,
19:06 --> 19:09but it kind of in the room to train you.
19:09 --> 19:11So it was all sorts of variances
19:11 --> 19:13that to me it was like this.
19:13 --> 19:14OK,
19:14 --> 19:15obviously it would be way more
19:15 --> 19:17efficient if everyone had to
19:17 --> 19:19record every single session, right?
19:19 --> 19:20Because I you know,
19:20 --> 19:22like and I get that there there are
19:22 --> 19:24technical and privacy issues with that.
19:24 --> 19:27And like not every patient may want to do it,
19:27 --> 19:31but. It just seemed like a natural thing.
19:31 --> 19:33If you're going to be in a training
19:33 --> 19:35hospital that for the types of
19:35 --> 19:36encounters where they really
19:36 --> 19:38couldn't be someone in the room
19:38 --> 19:40for various reasons that you needed
19:40 --> 19:42systems to be able to objectify,
19:42 --> 19:43like what was going on.
19:43 --> 19:46If only the if the only reason to do
19:46 --> 19:48it was to get more useful supervision
19:48 --> 19:51and not be able to like Dodge,
19:51 --> 19:52sure your blind spots
19:52 --> 19:54stuff. I'm wondering so it sounds like
19:54 --> 19:55there's a different orientation towards
19:55 --> 19:58technology then, at least in the.
19:58 --> 20:00The long term care.
20:00 --> 20:03Training some aspect of the residency
20:03 --> 20:06training between our programs and I've
20:06 --> 20:08wondered sometimes if the culture
20:08 --> 20:11of an institution is such that.
20:11 --> 20:13People don't want measurement
20:13 --> 20:16because then they could be disproven.
20:16 --> 20:18And so I wonder,
20:18 --> 20:20so some some attendings that one of the
20:20 --> 20:22reasons I really respected Doctor Duffy.
20:22 --> 20:25It was he would tell you what his
20:25 --> 20:27prediction was and that way you
20:27 --> 20:29know it and he knew it and he
20:29 --> 20:31was testing himself and holding
20:31 --> 20:33himself accountable to prediction.
20:33 --> 20:34I haven't found it.
20:34 --> 20:36That's the case as much in psychiatry
20:36 --> 20:39and I've been curious whether that's
20:39 --> 20:40a cultural thing that's pervasive
20:40 --> 20:43or maybe just my way of eliciting
20:43 --> 20:46bad reaction from people, yeah?
20:46 --> 20:48Yeah, I mean, I think the culture of
20:48 --> 20:49measurement and like psychiatry's
20:49 --> 20:51is an interesting one I mean.
20:54 --> 20:56Even something as basic as.
20:56 --> 20:58When you have a complex
20:58 --> 21:00patient being willing to get a
21:00 --> 21:02neuro psych evaluation where,
21:02 --> 21:03like the neuropsychologist could
21:03 --> 21:06come in with their battery of tests
21:06 --> 21:08and provide you like a system by
21:08 --> 21:10system breakdown of their capacities.
21:13 --> 21:15Which. Psychiatrist Azharul didn't
21:15 --> 21:19didn't do, and part of that was.
21:19 --> 21:21Well, is it really going to change
21:21 --> 21:23my management or you know it's
21:23 --> 21:25a lot of additional valuation?
21:25 --> 21:26I'm not sure it's
21:26 --> 21:28well so that so that question
21:28 --> 21:30there is interesting, right?
21:30 --> 21:32Because will it change my management and?
21:32 --> 21:35I have had the experience that
21:35 --> 21:37there isn't much that would change
21:37 --> 21:39some people's management right now,
21:39 --> 21:41and no amount of data
21:41 --> 21:42will move amount right, so
21:42 --> 21:45I think I think rather than
21:45 --> 21:46being prescriptive of like woman,
21:46 --> 21:48of course you should measure
21:48 --> 21:50because this medicine and come on
21:50 --> 21:52guys like let's measure the brain.
21:52 --> 21:53Let's measure behavior.
21:53 --> 21:55You know it's a no brainer,
21:55 --> 22:00so to speak. But I think.
22:00 --> 22:02One of the other really important
22:02 --> 22:05skillsets I think of becoming a
22:05 --> 22:08psychiatrist is sort of working with.
22:08 --> 22:09Resistance when someone doesn't
22:09 --> 22:11want to change their behavior?
22:11 --> 22:12Sure, yeah.
22:12 --> 22:14And then understanding that in terms
22:14 --> 22:16of like not just being like will
22:16 --> 22:18come on like why won't you change?
22:18 --> 22:20You know, but to say like that's interesting.
22:20 --> 22:22So what exactly is it about
22:22 --> 22:24this that you would think is
22:24 --> 22:26not worth doing this really to?
22:28 --> 22:31To roll with the resistance right and
22:31 --> 22:34to try to understand what is it about
22:34 --> 22:36that additional thing that if you
22:36 --> 22:39ordered that tasks and you got it back.
22:39 --> 22:41You wouldn't want to necessarily use
22:41 --> 22:44the data, so I think I learned a
22:44 --> 22:47lot around just trying to, you know.
22:47 --> 22:50Just accept that resistance as a valid
22:50 --> 22:52thing and they do think it exists and
22:52 --> 22:54it's valid and we can't dismiss it.
22:54 --> 22:57And to think back around well, what?
22:57 --> 22:59Why is that?
22:59 --> 23:02You know, is it still worth measuring?
23:02 --> 23:04How do we address the the places
23:04 --> 23:07where there is a particular concern,
23:07 --> 23:09whether it's a privacy concern or
23:09 --> 23:12I don't want to be have my judgment
23:12 --> 23:14usurped by this test kind of concern.
23:17 --> 23:18'cause then it's sculps.
23:18 --> 23:21Sort of how you think about incorporating
23:21 --> 23:24the measurement and like where in
23:24 --> 23:27the clinical decision making process
23:27 --> 23:30there maybe is a role for a tasks
23:30 --> 23:34that help somebody reduced there.
23:34 --> 23:36There you know.
23:36 --> 23:40That the uncertainty in situations where.
23:40 --> 23:42I really don't know what to do
23:42 --> 23:43and there might be a place that
23:43 --> 23:44something like that would be helpful,
23:44 --> 23:47but. Soon
23:47 --> 23:50very effective at doing that,
23:50 --> 23:52approaching people.
23:52 --> 23:54Psychiatrist of understand.
23:54 --> 23:55Recognizing the resistance and
23:55 --> 23:59then being able to navigate it.
23:59 --> 24:02You even successful at implementing
24:02 --> 24:04these digital phenotyping
24:04 --> 24:06procedures on different units,
24:06 --> 24:09which seems. Like a real
24:09 --> 24:11cool well I don't know how
24:11 --> 24:13successful you necessarily bent.
24:13 --> 24:15I would say that my experience of of
24:15 --> 24:18trying to get these kinds of measures
24:18 --> 24:20into clinical services has been
24:20 --> 24:22very different from my experience.
24:22 --> 24:26Is trying to get a neuroscience perspective
24:26 --> 24:29into those same clinical services.
24:29 --> 24:31Well, in other words, like you know,
24:31 --> 24:33going to the psychosis unit and
24:33 --> 24:35saying like you know we should be
24:35 --> 24:36scanning everyone who comes here
24:36 --> 24:38with a functional scan because I
24:38 --> 24:40bet we can find that there's this
24:40 --> 24:42difference in their brain that we
24:42 --> 24:44should then use and part of our
24:44 --> 24:46evaluation and people are like, OK,
24:46 --> 24:49we like the idea of the brain thing,
24:49 --> 24:51but like what exactly is it that you
24:51 --> 24:54need to do and how is that going to
24:54 --> 24:56change what I'm doing for this person?
24:58 --> 25:02And having to kind of really be.
25:02 --> 25:03Humbler, Alec would have,
25:03 --> 25:05like you know, that's a good point.
25:05 --> 25:08I'm not sure it would change anything in my,
25:08 --> 25:10you know, I would love the data
25:10 --> 25:12you know from a researcher,
25:12 --> 25:14but you know, you're right.
25:14 --> 25:16Like I guess I can't tell you exactly
25:16 --> 25:19how you would use it in a way that you
25:19 --> 25:23know you might not be able to kind of get
25:23 --> 25:24that information from their behavior.
25:24 --> 25:27So the idea of sort of getting psychiatrists,
25:27 --> 25:29whether it's residents or attendings
25:29 --> 25:31wherever to like really care about the
25:31 --> 25:33underlying biology of what they're seeing.
25:33 --> 25:37Um, you know, I taught some of the clinical
25:37 --> 25:40neuroscience curriculum for many years and.
25:40 --> 25:41You know it's really variable.
25:41 --> 25:43Some some people are really
25:43 --> 25:44interested in it somewhere,
25:44 --> 25:47just like totally glaze over.
25:47 --> 25:48And initially, you're you perceive
25:48 --> 25:50that as sort of threatening,
25:50 --> 25:52like why can't these people care
25:52 --> 25:54about their organ of interest?
25:54 --> 25:55It's so irresponsible,
25:55 --> 25:56you know as things,
25:56 --> 25:58but then you realize you know as
25:58 --> 26:00you go through the training program.
26:00 --> 26:03Like psychiatry is really hard to do well.
26:03 --> 26:06Just with the tool you know the tools
26:06 --> 26:08that we have and if I'm providing a tool
26:08 --> 26:10that provides no additional information
26:10 --> 26:13or or help that person's day go smoother,
26:13 --> 26:14or you know,
26:14 --> 26:16or you're asking him to learn a
26:16 --> 26:18whole new field of information.
26:18 --> 26:21Like of course they should be sceptical,
26:21 --> 26:21right so?
26:21 --> 26:25The other experience I had done that for many
26:25 --> 26:28years and tried to get you know neuroscience.
26:28 --> 26:30You know into the minds of the
26:30 --> 26:34did you make playdough brands?
26:34 --> 26:36But like you know I,
26:36 --> 26:38I did try to help teach.
26:38 --> 26:40You know what I considered?
26:40 --> 26:42Neuroscience 101 that every
26:42 --> 26:45psychiatrist should sort of know.
26:45 --> 26:48And I think I still do that to some extent,
26:48 --> 26:50although my approach has changed quite a bit,
26:50 --> 26:52but.
26:52 --> 26:55When we started getting more into the.
26:55 --> 26:59The digital phenotyping where we were
26:59 --> 27:02taking people's behaviors and really
27:02 --> 27:06trying to study them more precisely.
27:06 --> 27:07The approach was quite different,
27:07 --> 27:10which was more of that.
27:10 --> 27:12You could go to the clinicians and say
27:12 --> 27:14look you're an expert at reading the
27:14 --> 27:16behavior I need your help to design a
27:16 --> 27:18system that can do as well as you can,
27:18 --> 27:21or even just pick up on some
27:21 --> 27:23of what you're picking up on.
27:23 --> 27:25And like I had already trained with
27:25 --> 27:28many of these people, so I like,
27:28 --> 27:29I knew, OK,
27:29 --> 27:31this person's got an amazing ability
27:31 --> 27:34to pick up on those subtle trimmers,
27:34 --> 27:34right?
27:34 --> 27:36Or those subtle dysarthria's,
27:36 --> 27:38or those little movements of the face
27:38 --> 27:41that in the context of an interview they
27:41 --> 27:44could infer was a sign of paranoia right?
27:44 --> 27:46And so to me that was fascinating
27:46 --> 27:48that they had this ability,
27:48 --> 27:51but I wasn't sure how much of it was
27:51 --> 27:55real and how much of it was superstition.
27:55 --> 27:57But what was great about it was I
27:57 --> 27:59could go to them and not say, like,
27:59 --> 28:00hey, I've got this technology.
28:00 --> 28:01I'd like you to start using it.
28:01 --> 28:03I went to them to say, hey.
28:03 --> 28:06I really need to find ways of measuring this.
28:06 --> 28:09Can you help me design a system?
28:09 --> 28:12Mission as you are? Yeah yeah.
28:12 --> 28:14And so the clinicians loved it because
28:14 --> 28:17they were like this is really cool.
28:17 --> 28:19I've always wondered if
28:19 --> 28:21what I'm hearing is real.
28:21 --> 28:24And we could begin connecting
28:24 --> 28:26them with computer scientists who
28:26 --> 28:28were expert at decoding audio,
28:28 --> 28:30audio, or speech signals
28:30 --> 28:32from audio and and decoding.
28:32 --> 28:33You know,
28:33 --> 28:36facial movements from video and
28:36 --> 28:39linking those people who were really
28:39 --> 28:41interested in the mental health
28:41 --> 28:44aspects but had a hard time gaining
28:44 --> 28:47access to the data with the clinicians
28:47 --> 28:49who were really fascinated by the
28:49 --> 28:52nuts and bolts of behavior which.
28:52 --> 28:54Which was not everyone but the certain
28:54 --> 28:55clinicians had that inclination.
28:55 --> 28:57And and then just getting those
28:57 --> 28:59two groups to be able to talk to
28:59 --> 29:00one another basically and being
29:00 --> 29:02the translation element of saying,
29:02 --> 29:05you know, I consider myself like a
29:05 --> 29:06mediocre psychiatrist, but I can,
29:06 --> 29:08at least I know what she's pulling out.
29:08 --> 29:10And I know that.
29:10 --> 29:12Here's how we were taught to think about it,
29:12 --> 29:15and so let's design some systems
29:15 --> 29:17that can pick up on it.
29:17 --> 29:18Hydrus loved it.
29:18 --> 29:20The patients loved it.
29:20 --> 29:22Unlike, you know a brain imaging experiment.
29:22 --> 29:23You know,
29:23 --> 29:24we pay them.
29:24 --> 29:28But like we're making them sit in this really
29:28 --> 29:31loud tube and play these boring video games.
29:31 --> 29:33Whereas like the experiments to study
29:33 --> 29:36patients in these interactions with the
29:36 --> 29:38doctor was for them really easy and fun.
29:38 --> 29:42You got to talk to somebody and
29:42 --> 29:44talked about your problems.
29:44 --> 29:46We're lining up to do the studies
29:46 --> 29:48and so just created are different.
29:48 --> 29:49Kind of you know,
29:49 --> 29:52right there on the ground on the unit.
29:52 --> 29:54We didn't have to leave the unit,
29:54 --> 29:56we could just bring people into
29:56 --> 29:58these rooms where it felt like,
29:58 --> 30:00hey, this actually is like.
30:00 --> 30:02A sustainable way of digging
30:02 --> 30:03into the pathology which no one
30:03 --> 30:05else seems to be really doing.
30:05 --> 30:07So taking that thing where you just
30:07 --> 30:09sort of go to a clinician and say,
30:09 --> 30:11alright, you've got a lot of pearls.
30:11 --> 30:13You know you taught a bunch of
30:13 --> 30:15them to me during residency,
30:15 --> 30:17but let's see if we can like build a
30:17 --> 30:18computer that operationalize pearls,
30:18 --> 30:21and then in my in the back of my mind.
30:21 --> 30:23I'm thinking like what we really
30:23 --> 30:25want to do is design something
30:25 --> 30:27that if we could scale that up,
30:27 --> 30:28we would be able to know,
30:28 --> 30:31like which of these things are true pearls.
30:31 --> 30:33Yeah, and which of them are just,
30:33 --> 30:34you know,
30:34 --> 30:36like rocks or what's right like that
30:36 --> 30:39kind of they look good but they're not,
30:39 --> 30:41but they're not actually correlated with
30:41 --> 30:43the outcomes that we think they are so.
30:46 --> 30:48And I think that including the clinicians
30:48 --> 30:49in that process to say, like, hey,
30:49 --> 30:51look, you know we're all fallible.
30:51 --> 30:52This is, you know,
30:52 --> 30:54this is what you were taught,
30:54 --> 30:58so we want to get back to sort of.
30:58 --> 31:00You know you've honed your interview
31:00 --> 31:03to be efficient, but let's see if
31:03 --> 31:06we can make it even more efficient.
31:06 --> 31:08Let's see if we can help you
31:08 --> 31:11to train residents or the next
31:11 --> 31:13generation with these videos as well.
31:13 --> 31:14As you know,
31:14 --> 31:17your kind of classroom didactic style.
31:18 --> 31:20Well, it seems like it's a very
31:20 --> 31:22effective way of doing it.
31:22 --> 31:23I think it could be it.
31:23 --> 31:25I think it's still evolving and I
31:25 --> 31:27think it would be great if there
31:27 --> 31:28were a whole platform around.
31:28 --> 31:30Sort of when you come into
31:30 --> 31:31a training environment.
31:31 --> 31:32This is just the expectation,
31:32 --> 31:34which is that like you're going to be
31:34 --> 31:36learning from a lot of pre existing video,
31:36 --> 31:38you're going to be learning from
31:38 --> 31:40a lot of encounters from your
31:40 --> 31:41mentors that are being recorded.
31:41 --> 31:43You're going to learn from your
31:43 --> 31:45own encounters that are being
31:45 --> 31:46recorded and then whether or not
31:46 --> 31:48the mentors in the room with you.
31:48 --> 31:50There will be all sorts of
31:50 --> 31:52statistics about your interview
31:52 --> 31:53that they can look at and be like.
31:53 --> 31:54Oh yeah,
31:54 --> 31:56now you really don't want to smile
31:56 --> 31:58the whole time like that's going to
31:58 --> 31:59or not small.
32:01 --> 32:04And it's been fascinating in the labs.
32:04 --> 32:07Now we record the dyads where the
32:07 --> 32:09research assistants and stuff are.
32:09 --> 32:11Interviewing the patients so we can
32:11 --> 32:13see what somebody looks like when
32:13 --> 32:15they're fresh off the training,
32:15 --> 32:18you know. Just start talking
32:18 --> 32:21to patients like fresh off the
32:21 --> 32:23medicine wards or just coming. You
32:23 --> 32:26know, new research assistant joining the lab.
32:26 --> 32:30No clinical experience and like how do they?
32:30 --> 32:32Conduct themselves in encounter
32:32 --> 32:34where the you know what are the
32:34 --> 32:36kind of intrinsic skills that some
32:36 --> 32:39people bring to that that there is,
32:39 --> 32:41you know they can build report quickly,
32:41 --> 32:45let's say. Or where you know
32:45 --> 32:47where does that get in the way?
32:47 --> 32:49Like if you're trying to create too
32:49 --> 32:51much for poor and therefore like
32:51 --> 32:53people don't ever quite exposed
32:53 --> 32:55their pathology in some ways.
32:55 --> 32:57So it's yeah, it's just interesting to.
32:57 --> 33:00In that context I can require all the
33:00 --> 33:02research assistants to do it this way,
33:02 --> 33:04and then we can see as someone
33:04 --> 33:06who gets better at it,
33:06 --> 33:08like what are they doing differently?
33:08 --> 33:09And I
33:09 --> 33:11just had this idea that you have a
33:11 --> 33:13lab or and you are experimenting on
33:13 --> 33:16how best to train a psychiatrist.
33:16 --> 33:18For your research assistance,
33:18 --> 33:19so they're like your.
33:19 --> 33:21I don't know just Guinea pigs,
33:21 --> 33:23but like her subjects and
33:23 --> 33:24you're changing the experimental
33:24 --> 33:27conditions and then are you, are you
33:27 --> 33:29still involved in the residency program?
33:29 --> 33:32So you're translating that straight into the.
33:32 --> 33:33Training of like MD physician? Yeah
33:33 --> 33:36no. I mean that that would be cool.
33:36 --> 33:39I mean I guess my.
33:39 --> 33:40You know, if they were to ever
33:40 --> 33:42come to me to say like hey Justin,
33:42 --> 33:44here you have this great training
33:44 --> 33:45thing, can we use it?
33:45 --> 33:48I would be like sure, let's try it.
33:48 --> 33:49When we've tried to explore
33:49 --> 33:51even using the pre recorded
33:51 --> 33:53videos for educational purposes,
33:53 --> 33:55the IRB is basically said like Nope
33:55 --> 33:58and I think that has to do with like
33:58 --> 34:01a lot of the ethics of sort of when
34:01 --> 34:03you're engaging in research studies.
34:03 --> 34:06Who's going to use that data in one of
34:06 --> 34:10the context that are considered appropriate?
34:10 --> 34:13I think down the line that may happen, but.
34:13 --> 34:14You know, I'm not trying to
34:14 --> 34:16foist it on them at this stage.
34:16 --> 34:18There's a lot of other legitimate reasons
34:18 --> 34:21why they may not want to go that route.
34:21 --> 34:24But just back to your kind of other
34:24 --> 34:27earlier comment like you know now it
34:27 --> 34:30has sort of evolved into thinking about
34:30 --> 34:33the lab as a little sandbox of you know,
34:33 --> 34:35different health care,
34:35 --> 34:36delivery and training.
34:38 --> 34:41You know systems where you know what if
34:41 --> 34:44it were possible to train somebody up to
34:44 --> 34:47be really competent at doing interviews,
34:47 --> 34:49both for information extraction
34:49 --> 34:51like just doing some valuation,
34:51 --> 34:53but also potentially providing therapy,
34:53 --> 34:56like if there were ways to short circuit
34:56 --> 34:59this apprentice based system by having a
34:59 --> 35:01much more tech enabled feedback system
35:01 --> 35:04where your supervisor didn't have to watch,
35:04 --> 35:07like every hour of every video but like.
35:07 --> 35:11It could identify features that you
35:11 --> 35:15know start to gain some some trust
35:15 --> 35:19around those features that helps a.
35:19 --> 35:20More experienced clinician.
35:20 --> 35:22Really read the report,
35:22 --> 35:24kind of what you did and then
35:24 --> 35:26give you more rapid feedback.
35:26 --> 35:29And then you're trying again
35:29 --> 35:31and you can gradually.
35:31 --> 35:33And maybe even rapidly improved.
35:33 --> 35:38So yeah, I would have loved that.
35:38 --> 35:39Is really cool.
35:39 --> 35:42What is this one of these like?
35:42 --> 35:44You kind of are amazed at how
35:44 --> 35:46inefficient you know the training
35:46 --> 35:48process is right and it's like as
35:48 --> 35:50somebody who is concerned about the
35:50 --> 35:53overall cost of health care and
35:53 --> 35:55mental health in particular and
35:55 --> 35:58and all of those kind of high level
35:58 --> 36:01policy things like it seemed to me.
36:01 --> 36:05Pretty egregious how inefficient
36:05 --> 36:09our training was considering.
36:09 --> 36:12That that basically bakes in a lot of costs,
36:12 --> 36:14right? And that like it's not,
36:14 --> 36:18it's not really up to us whether that's.
36:18 --> 36:20That's just the way we do it,
36:20 --> 36:20you know.
36:20 --> 36:22I think you know you kind of have
36:22 --> 36:24to sort of see the way things are
36:24 --> 36:26moving in terms of value based care,
36:26 --> 36:27measurement based care.
36:27 --> 36:29If like you're not going to get
36:29 --> 36:30to spend every hour of,
36:30 --> 36:32we can let you know doing evaluations
36:32 --> 36:34like it has to get more efficient.
36:34 --> 36:36You have to be able to demonstrate.
36:36 --> 36:39Why each question you ask is actually?
36:39 --> 36:41A good use of your time,
36:41 --> 36:44because if it were a lab test or something,
36:44 --> 36:45right?
36:45 --> 36:46Because if you don't,
36:46 --> 36:48if you're not able to at least
36:48 --> 36:50demonstrate that value other people
36:50 --> 36:52are going to come in and do you
36:52 --> 36:54know more mediocre valuations,
36:54 --> 36:56but the outcomes will be fuzzy
36:56 --> 36:58and insurance companies or payers?
36:58 --> 37:00We're going to ultimately say well,
37:00 --> 37:02we're only going to pay for that
37:02 --> 37:04thing because this much more detailed,
37:04 --> 37:06nuanced valuation costs way more and
37:06 --> 37:08doesn't seem to be that more effective,
37:08 --> 37:10so.
37:10 --> 37:12I think the same for training
37:12 --> 37:16like if we can't figure out how to
37:16 --> 37:18train people more efficiently than.
37:18 --> 37:22It could end up actually being
37:22 --> 37:24problematic for the.
37:24 --> 37:27Yeah, for the field you know so.
37:27 --> 37:28Well,
37:28 --> 37:31I wish you all the best doing that and
37:31 --> 37:33maybe I'll go through residency again
37:33 --> 37:35if you roll out your tech based open
37:35 --> 37:38course on how to be a psychiatrist.
37:38 --> 37:39Or you can
37:39 --> 37:42help you know. Disseminate it.
37:42 --> 37:43Once it's out there.
37:43 --> 37:44Very happy. Yeah, I'd be
37:44 --> 37:46very happy to thank you. Thank
37:46 --> 37:48you so much for taking the time to
37:48 --> 37:49talk, that's great, thanks.
38:01 --> 38:03Well, I hope you enjoyed that episode.
38:03 --> 38:05Thanks again to Justin for being
38:05 --> 38:08on the podcast and you can find
38:08 --> 38:10Justin on Twitter at Justin Baker,
38:10 --> 38:11MD's in medical Doctor.
38:11 --> 38:13Again, that's at Justin Baker MD.
38:13 --> 38:15You can also find him on his
38:15 --> 38:16partners.org faculty profile
38:16 --> 38:18page or on Google Scholar.
38:18 --> 38:20Just look up Justin Baker thanks
38:20 --> 38:22to the Yale School of Medicine for
38:22 --> 38:24sponsoring the podcast and especially
38:24 --> 38:26to Adrian Bonding Burger for.
38:26 --> 38:27Producing the podcast and Ryan
38:27 --> 38:29McEvoy for his help sound editing.
38:29 --> 38:31A special thanks to you for
38:31 --> 38:32listening and again,
38:32 --> 38:34my name is Daniel Barron and I've
38:34 --> 38:36been your host and I'll see you
38:36 --> 38:38next time here on science at all.

Information

The co-founder of the McLean Institute for Technology in Psychiatry and director of the Laboratory for Functional Neuroimaging and Bioinformatics at McLean Hospital and an assistant professor of psychiatry at Harvard Medical School, Justin Baker joins Daniel on Science et al. to talk about how he came to be so passionate about and interested in the human brain, and the two discuss some of his more innovative work posing questions about conditions like schizophrenia.

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