February 5, 2026 • 36 mins
If you're an engineer trying to figure out where you can create value, this episode shows you where to look: where values themselves are shifting.
In this episode of The Engineering Passion Express, I take you on a 100-year journey from open surgery to surgical robots through three lenses: First, a sick man in 1910 traveling to New York to pick the right surgeon. Second, Dr. John Wickham, who coined 'Minimally Invasive Surgery.' And finally, Fred Moll, who founded Intuitive Surgical, who along with a team of engineers brought surgical robots to the forefront.
Join me and learn how many times before an invention comes along, the values of an industry need to shift to make it the right time for the adoption of the technology to be a benefit.
The Engineering Passion Express is about growing knowledge and the passion for engineering.
If you are a conference organizer and are looking for an engineering or scientific speaker to inspire or educate in a keynote presentation, please reach out to me on LinkedIn. You can find my profile below.
Thanks for listening,
Brandon Donnelly
Please connect with me on linkedin @ linkedin.com/in/brandondonnelly
Listen
Watch
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:18):
You're on the train to find a surgeon.
Like those guys who use theengineered robots invented to
cut you open and fix stuffinside you?
You don't know what a robot is.
What year is this?
1910?
Yikes! We must have reallyswitched to the wrong track
somewhere along the line.
(00:40):
Oh well, we'll let you out here.
We'll catch up with the propertimeline and the invention of
those robots later.
See you in the future, and enjoythe New York of 1910.
I step off the train and I lookat my watch.
It's been ten days since I lefton the journey from Texas to New
(01:02):
York to the minute.
I was seeking a surgeon, and thejourney was long and arduous.
I've had the fear of sinking ina riverboat, being robbed on a
train, and I've spent a fortuneof time and money all while
being sick to get here.
Surgeons of the 1910s havereputations built from newspaper
and radio, but that's notnecessarily the same as surgical
(01:24):
skill.
I braved all that on the journeyto New York because that's where
people say the best surgeonsare.
On its surface, that could beentirely false.
There are a few things thatindicate there must be good
surgeons here.
One, there's a big population.
Lots of people means lots ofsources of talent.
(01:45):
Two, there's money.
And if you're skilled and youlike money, you're seeking that.
And three, there's a reputation.
And that reputation draws inthose looking for talent, and
those customers draw in thetalent.
A virtuous cycle culminating insomething that started as a
possible fiction, becoming atruth if the reputation persists
(02:06):
long enough.
Now that I'm here, New York Cityfeels louder than it needs to
be.
Carriages, horns, voices layeredon top of one another.
Brick buildings rise too closetogether, as if even the streets
are competing for space.
Everyone seems to be in a hurry,including the men in white
coats, indifferent to the sickold man trying to find a
(02:27):
hospital in a crowded city he'snever been to.
Of course this city is loud.
Everyone is selling something.
Being louder than the other guyis the way some people, like the
newsies, for example, survive.
(02:50):
Inside the hospital, the smellhits first.
Chloroform, antiseptic,something sweet and chemical
that makes it hard to tellwhether this place exists to
heal or to harm.
I sit on a wooden bench, hat inmy hands, watching names move
through the building before Iever meet them.
Names whispered by porters,names printed in newspapers,
(03:13):
names repeated with confidenceby people who sound like they
know what they're talking about.
One surgeon, Lawrence Ashford,is famous.
His reputation even arrivesbefore he does.
I hear about his confidence, hisdecisiveness, the speed with
which he works.
While another surgeon, SamuelSmith, blends in.
Dr.
(03:34):
Samuel Smith.
A name that doesn't announceitself.
No stories trail behind him.
No one lowers their voice whenthey speak his name.
Dr.
Ashford and Dr.
Smith, they both seem capable,they both seem calm.
They both wear the same coat.
But I don't really know how totell which one is better.
(03:55):
How does someone make a life ordeath decision?
Based on reputation, when skillis what matters.
No charts line the walls.
No numbers are offered.
There is no ledger of outcomes,no public record of who lived
cleaner lives afterward and whodid not.
There is only reputation.
And reputation is unevenlydistributed.
(04:19):
I notice how people standstraighter around Dr.
Ashford, the famous one.
How his answers to questions areshorter, and how doubt seems
unwelcome in his presence.
With Dr.
Samuel Smith, the questionslinger longer.
He listens more.
He answers carefully.
Seemingly competent, seeminglythoughtful, but seemingly isn't
(04:41):
certainty.
And my life is on the line.
I make my guess.
It's not a decision.
Those require weighing outfacts.
There are none of those here.
(05:04):
As they prepare me for surgery,I wonder if I've chosen wisely.
As the mass lowers, the smell ofchloroform thickens, and who
knows what happens next.
(05:33):
I have no idea how we've arrivedin London.
In this place, in this time, youcan feel that the values of
people are in plus.
I'm sure the ships will in thehistory.
(05:54):
We'll see it when we get fullyback to the correct timeline,
I'm sure.
All you've done is get off thetree.
The hospital's just around thecorner, and it's time you see
your patients.
No more waiting.
Gibble, gibble, gibble, gibble.
(06:32):
It's the kind of smell thatgrows on a man after thirty
years.
The smell of familiarity.
After being paged, I enter theroom.
A patient rests quietly.
Sheets pulled to the chin, JohnWickham hovers nearby, checking
the chart, murmuring notes tohimself.
My eyes are scanning the patientand the chart.
(06:54):
Dr.
Wickham points to a column ofdata that I haven't seen before.
What is this?
I ask.
I've never tracked these numbersbefore.
Wickham glances at me.
Recovery times.
Complications that don't appearon mortality stats.
Measures of trauma we canminimize.
(07:16):
I've spent decades optimizingfor outcomes.
The ones the industry rewarded.
Mortality.
Obvious complications.
Textbook recoveries.
SPEAKER_00 (07:27):
What was Wickham trying to do?
SPEAKER_01 (07:30):
So I ask him, and you care to measure these
things?
Why?
Wickham smiles faintly.
Because patients care.
If we can shorten the time ittakes to return to their life,
isn't that what matters too?
I look at the numbers again.
Unsure.
(07:52):
I don't have these numberstracked for my patients.
Do I need them?
Back in my own office, Jack, mynext surgical consult, is asking
(08:12):
me questions.
Your mortality rates?
He asks.
I present my record.
Decades of experience, a steadyhand, results that have stood
the test of time.
The patient nods, appreciatingthe history and data.
I do nothing without multipleopinions, Jack says.
(08:34):
That's wise, I tell him.
Many patients return after otherconsultations because my
experience carries weight.
Later, as I walk past Wickham'soffice, I notice that he's
speaking with Jack.
Wickham's voice is calm,precise, careful.
(08:56):
He's talking about his ownmortality statistics.
Slightly higher than mine, butstill within safe ranges.
Then he moves on to what no oneelse has measured.
My focus is recovery, Wickhamsays.
On average, patients return tonormal life two months faster.
(09:16):
Less pain, fewer complicationsthat linger beyond the hospital.
This is what matters to you,isn't it?
The patient listens, eyeswidening.
You can tell for the first timehe imagines life after surgery.
Not just survival.
His questions about mortalityfade into the background.
(09:37):
He is drawn to the life he couldregain.
Not just the life he could keep.
Down the hallway, I continueeavesdropping.
My chest tightening slightly forsome reason.
I've been in the upper echelonsof surgical prestige, yet here a
younger surgeon, lessexperienced in years, is
(09:58):
teaching the patient aboutthings I hadn't considered.
(10:24):
Ignoring most of the hellos andDr.
Hawthorne attempts at myattention, my mind is fixated on
these new metrics.
They don't seem right to me, andI can't seem to focus on
anything else at the moment.
I reach the hospitaladministrator.
I'm not sure what came over me,but I forgot to even knock.
Instead saying, Do you know Dr.
(10:46):
Wickham is tracking statisticsno one else in the industry
measures?
And he's sharing them withpatients to draw them here.
The administrator raises aneyebrow, the kind of look you
often see from administratorsand bureaucrats who don't
understand your technicalconcerns.
Yes, and it's wrong.
(11:07):
We've tracked mortality ratesfor decades.
If optimizing these new metricsstarts to affect those rates, or
even just appears to, what willhappen to the hospital, to our
doctors, to our reputation?
The administrator leans back.
Dr.
Wakeham is trending in the rightdirection.
(11:27):
His mortality rates aren'trising.
In fact, he's improvingoutcomes.
Why is this panic necessary?
I slammed the desk.
Because it's uncontrolled.
We built a hospital withprestige on mortality rates, and
now he's rewriting the rules.
(11:48):
The administrator remains calm,unconvinced by my fear.
Most administrators are fed doomand gloom reports all day long.
So they're like an impenetrablewall when it comes to emotional
pleas.
Perhaps it's time the rulesreflected what patients actually
care about, the administratorexclaims.
Since mortality rates started asa measure, everyone has worked
(12:10):
hard at making theirsexceptional.
It's now hard to stand out as ahospital on that alone.
We need something else to bringpatients here.
Rather than choosing to just goto their nearest hospital.
In my opinion, Dr.
Wickham is on to something goodhere, and his work is leading to
lower costs for the hospitaltoo.
Less readmittance, less bloodtransfusion cost.
(12:34):
I leave flustered, my chesttight, my mind racing.
Am I a relic of the past?
Is Wickham the future?
Is my career hanging in thetension?
(12:56):
It's been ten years since thatday in the administrator's
office.
My career has reached terminalvelocities since that day, and
I've become a dinosaur.
Dr.
Wickham, on the other hand, is astar.
He coined the term minimallyinvasive surgery.
He's opened an institute totrain others, creating culture
(13:19):
where patient-centered measuresdrive practice by tracking data
that matter to patients, notjust what the industry measured.
He has reshaped surgicalpriorities.
And following that shift invalue, he's reshaped the
techniques that are used.
(13:40):
Laparoscopic surgeries guided bycameras are now the norm rather
than open surgeries.
Training programs integratethese new methods.
Mortality rates remainexcellent, but recovery time,
patient comfort, and long-termquality of life have become
metrics surgeons cannot ignore.
The field itself has bent.
(14:01):
Most experienced practitionersare following reluctantly
towards the values Dr.
Wickham has championed.
In fact, I'm stepping on a stageto present to a medical
conference.
Fifty surgeons seated in amedical theater designed for
knowledge share.
I've reached the tail end of mycareer and I have some lessons
(14:22):
for those with decades left togo.
Up on the stage, I begin mytalk, opening up the conference
where Dr.
Wickham will speak later.
While I'm a bit envious of Dr.
Wickham, I'm also humbled thateven though he was my junior and
relied on my expertise at thebeginning of his career, I had a
privilege of working with a manwho changed the entire industry.
(14:45):
The lights dim and mypresentation begins.
I'm Dr.
Reginald Hawthorne, 40 years asa surgeon.
I should have seen this coming.
I've been a doctor for decades.
I've seen the evolution ofsurgical practice, recovery
care, anesthesiologicaldevelopments, diagnostic tooling
(15:07):
developments.
Nothing stays the same in thisfield forever.
It's likely I should have beenthe one who saw what Dr.
Wickham saw, and perhaps I didit one time.
I just didn't care enough toexperiment, to be a champion for
the patients, and then once Ihad my data, campaign it across
the industry.
Dr.
Wickham did.
(15:30):
In fact, it's likely because Iwas focused in the wrong place.
I was spending most of myavailable time honing my hands
further, trying to make themlegendary.
Unfortunately, due to mybullheadedness and not realizing
there is a plateau on themortality metric beyond which
hands have no further influence,I spent decades focused on the
(15:52):
wrong problem.
Rather than my hands going downin the history book as a
surgeon, Dr.
Wickham will be known as the manwho changed surgery.
Focusing on getting us all tounderstand, for two doctors with
the same mortality rates, theone who has patients recovering
the fastest is the most skilled.
(16:14):
He's an admirable man, Dr.
Wickham.
You all are in attendance tohear from him, and it's my great
honor to open for him.
But before that, I want to sharesomething honest with you.
Years ago, before all of thiscaught on, Dr.
Wickham was working on thisalone.
When I found out about thesemetrics he tracked, I was
(16:35):
distracted and I was upset.
My mind wouldn't get off of why.
My frustration all those yearsback is gone.
I'm too old to change what Ifocused on.
However, I would let this be alesson to all those pursuing
fields like medicine.
Values shift.
Keep your eyes open on ways todo things better rather than
(16:57):
following the same metrics aseveryone else.
If you hear of a doctor doingsomething that gets you fixated,
angry, or otherwise emotional,sit with it longer, calm down,
rationalize, try to understandwhether they are correct.
I didn't do enough of that.
Dr.
(17:18):
Wickham is an anomaly, a man sofocused on how to do things
right, to track things thatmatter to patients, yet also a
risk taker and a change maker.
This industry needs less Dr.
Reginald Hawthorns, and it needsmore Dr.
John Wickham's.
And that was it.
(17:39):
I stepped off the stage,considering it an honor to even
be in the same event with myprotege, my colleague, my
friend, John Wickham.
Dr.
John Wickham.
And that was the last bit I evercontributed to the medical
field.
I couldn't help but wonder whoout there is the next Dr.
(18:02):
Wickham.
And how could they possiblychange this field in the same
way?
Well, we've arrived inCalifornia in the 1990s.
I'm not sure how we keepbouncing around like this.
We need to get all these trainlines fixed.
Anyway, we're drawing we're inthe top of the digital age now.
(18:23):
Computers, robots, it's changingeverything.
Every business magazine is fullof this stuff.
Oh look, we've arrived nearanother hospital.
Anyone heading there for work?
Please head out now.
The hospital looks differentthan it used to.
I used to work here as asurgeon.
(18:43):
Dr.
Mole, the patient is ready tosee you.
That used to ring a familiarsound here.
The walls are smoother now, lesscolor, less ornament.
Technology hums everywhere.
Monitors, carts, elevators.
But the place still smells thesame.
Clean, sharp, faintly metallic.
I've been here before.
(19:06):
Excuse me, Fred.
Yes, I respond.
They're ready for you now.
I'm nervous.
These people used to be mypeers, but now we feel opposed.
I take the stage and start thepresentation not loudly, not
forcefully, but carefully.
These are smart, educated,dedicated professionals who have
(19:27):
spent decades honing theircraft.
They won't take likely to changewithout reason.
I'm here to describe the work ofmy company, Intuitive Surgical.
We're working on buildingsurgical robots that help
surgeons become superhuman intheir hands abilities.
This presentation is to give astate of technology.
(19:47):
It feels like there are 50 ofthem in the room, all peering
into my soul, and I feel a bitweak, but I continue anyway.
My name is Fred Mole, thefounder of Intuitive Surgical.
I'm a former surgeon who saw anopportunity for technology to
augment surgical abilities.
I left my role as a surgeon andbecame an entrepreneur.
(20:08):
I raised funding, hiredengineers, and guided by my
experience as a surgeon, webuilt robots to help surgeons
make cleaner incisions, havesafer operations, and provide
quicker recovery for theirpatients.
Here's how the robots work aculmination of multiple
different technologies.
First, our engineers worked ontremor filtering.
(20:31):
Every involuntary movement isdetected and removed.
Only intentional motion passesthrough.
Next, they built micro motionscaling.
Large hand movements becomesub-millimeter actions inside
the body, granting precisionbeyond what normal hands can do.
(20:53):
Then we worked on havingarticulated instruments, ones
that can operate at angles thehuman wrist can't reach without
massive strain.
And then, of course, we've beenworried about redundancy and
fail-safes.
If something goes wrong, thesystem stops before damage
occurs.
Surgeons all listen, but thenthen they resist.
(21:15):
One surgeon doesn't raise hishand to his voice.
He doesn't need to.
His reputation fills the roombefore he speaks.
He says, My outcomes areexcellent.
What he doesn't say, I don'twant to relearn my craft.
(21:37):
I don't want my advantagediluted.
I don't want a machine standingbetween me and my identity.
What he says instead?
SPEAKER_00 (21:47):
What happens if it fails inside a patient?
SPEAKER_01 (21:51):
I again describe the fail safes that I had just
mentioned moments earlier, butit doesn't seem to be getting
through.
Perhaps because they don't careto hear it.
The surgeon nods and then says,I don't see the problem that
you're solving.
And that's the end of it.
They are all busy and theydecide to go back to their
planned operations, officehours, and normal day-to-day
(22:13):
stuff.
How could they not see theproblem?
Patients want small incisions,quick recovery, few
complications.
None of them see that?
I was them.
Am I really so different?
(22:36):
I leave the meeting and go backto my teammate at the intuitive
surgical headquarters.
We refine the pitch, clarify themessage, and adjust the
language.
Weeks pass.
I meet another group of 50 or sosurgeons.
Same objections, differentphrasing, exactly the same
outcome.
A committee wants more data, anadministrator wants liability
frameworks, marketing reframesthe pitch, engineering iterates
(22:58):
the system, money goes out,nothing comes in.
Two months later, my financialinvestors ask, How are we doing?
I have no answers that theywant.
Only that understanding of themarket has improved.
Which it has.
But unfortunately, actualinterest in the product has not.
(23:21):
I asked for more time.
They're obviously frustrated,but creation enough to provide
more funding to continue.
I go home that night, thelooming failure weighing on my
soul.
At these conferences, it seemslike the largest egos speak for
the entire group, and I'm notcertain whether their words are
(23:42):
representative.
I decide to meet with somesurgeons one-on-one.
(24:05):
And some ones which haven'theard about the technology yet.
The initial meetings with theconference attendees aren't
fruitful.
It appears the opinions havebeen painted by the group
already, aligning with what wasalready stated at the conference
by the singular most vocalsurgeons who resist the robots.
But then there's Dr.
Alvarez.
(24:26):
My team had called his officeand he was interested in talking
because he likes to keep up withthe technology.
I do some research on him.
His hands are steady, reliable,not legendary.
I give him the same explanationas the conferences.
Word for word, I talk abouttremor filtering, micromotion
(24:47):
scaling, articulatedinstruments, redundancy, and
fail-safes.
At each technology introduction,Dr.
Alvarez leans forward and asksquestions.
How does it distinguish betweena tremor and a small movement?
Can the scaling be changed, oris it a set number?
What sort of range do thesearticulated instruments have and
(25:08):
what are their applications?
The fail-safes are the mostimportant.
Make me feel good about them.
Dread and fear race over mybody.
It seems like more of the same.
I explain the fail-safes again,but then Dr.
Alvarez says that's great.
I realize these are notobjections.
(25:29):
They're invitations to say more.
Dr.
Alvarez asks about where he cantest out the machines and get
some initial training.
I tell him we can set somethingup at the intuitive surgical
headquarters for him to try itout and get trained.
It's small, but it's something.
Finally, 1% interest and 99%resistance.
And that's enough to keep megoing through all the fear.
(26:06):
But I'm busy and there isn'tmuch point in doing so if the
hospital won't bring on one ofyour robots.
I'd like to introduce you to thehospital administrator.
Her name is Margaret Caldwell,and I can get you 15 minutes on
her calendar.
I appreciated that message fromDr.
Alvarez.
So I show up to the meetingearly and I get my presentation
ready.
(26:26):
But Margaret isn't interested insurgical hands and the
comparison to robots.
She asks, What happens if themachine fails?
Who carries the liability?
What problem are we actuallysolving?
I explain about fail safes.
I don't have an answer aboutliability, but I'm happy to put
in a legal framework thatprotects us both, as well as
(26:49):
provide training to ensure staffuse it properly.
As for the problem, I tell herpatients value, quick recovery
times, small incisions, andprecise work.
She listens, raising an eyebrowlike administrators often do.
Then she delays.
She says she liked to run itagainst committees, reviews, and
budgets.
(27:09):
I leave.
Getting in my car, I stare atthe wheel and droop my head.
I've blown it.
I didn't give that administratoranything to make a decision on.
So they deferred again tosurgeons, and we're back in the
same loop.
More months pass, more moneyburns.
(27:29):
I have no idea what to tell myinvestors at this point.
I certainly didn't reach out tothem proactively to deliver any
news.
(28:00):
The vinyl chairs are dull green.
One has a crack down the middle.
Taped over so many times it's nolonger clear what color it was
originally.
The lights hum.
A cleaning cart rolls past.
I used to walk these halls withcertainty.
Dr.
Mole, the surgeon.
(28:22):
Now I wait in them.
Feeling the same uncertainty asthe people waiting for the news
of loved ones' operations.
The stakes are different forthem and me, but the butterflies
in my stomach feel the same.
Across the room, families sitthe way families always sit,
folded inward, eyes fixed ondoors that won't open.
(28:44):
No matter how hard you stare.
I know this posture.
I've seen it from the otherside.
And the thought races through mymind.
I could stop.
I could go back.
Operate.
Be certain again.
No one would blame me.
(29:05):
This entrepreneurial path wasalways fraught with peril.
But then I think about thosefamilies and why they're here.
Those people over there don'tlook happy.
When Papa comes out of surgery,even if successful, he's not
gonna be himself for a while.
That's why waiting feelsendless.
That's why outcomes matter.
(29:28):
And Dr.
Alvarez suddenly pops into mymind.
His questions, his curiosity.
He's a like-minded doctor whowanted to surpass his physical
limits for the benefit of hispatients.
He was my 1% hope.
If he hadn't shown something tome that day, this would be the
(29:50):
end.
But hope never arrives ascertainty.
It arrives as interest in apossibility.
And that interest sparksrefusal.
A refusal to quit.
SPEAKER_00 (30:05):
So I'll stay at it.
But I need a boost.
SPEAKER_01 (30:11):
I'm gonna call Dr.
Alvarez again.
So I type in his digits, buthe's unavailable.
Though he returns my calls acouple hours later.
He says, Margaret told me thehospital can't justify the cost
of your surgical robots.
I think she doesn't know how tovalue the technology correctly.
(30:33):
I tell Dr.
Alvarez, there's no doubt I letyou down there.
I was talking surgical in thatmeeting.
If I could get another 15minutes with her, I'd talk about
shorter stays, less bloodtransfusions, lower 30-day
readmissions, lesscomplications, and mortality
rate improvements.
That would be better.
(30:54):
I'll get you 15 more minutes,Dr.
Alvarez tells me.
(31:15):
I say, trying to keep it casualto help my brain remember, not
to get technical, but to talkmore about benefits to the
hospital.
What has changed since the lasttime?
She asked me.
Last time I was in here, I madea mistake.
I told you about the things thatmatter to surgeons.
Of course, you deferred me tothem for further review.
Today I'd like to quickly runyou through why you should value
(31:38):
these robots through the lens ofthe hospital as a business.
That would be great.
I know we have to betechnologically forward here at
the hospital, but I get pitchesthat I don't know what to do
with on the daily.
Please go ahead.
There are really five thingsthese robots will improve for
the hospital.
Shorter stays after surgery,less blood transfusions due to
(32:01):
smaller incisions that causeless blood leakage, lower 30-day
readmissions, less complicationsdue to the precision offered by
the robot and the minimalexposure of the patient, and as
always, the important mortalityrate improvement.
Those are certainly items we'reinterested in.
Each of these increase our costof patient care.
(32:22):
If you can provide some numbersof expected changes in these
categories, we can run itagainst our expected savings and
see if it makes sense.
I'd be happy to.
I'll send them to you tomorrow.
Can we meet again next week toreview those numbers and see if
they make any sense?
I'd be happy to.
Thank you.
Looking forward to talking againin the future.
(32:43):
Me too.
Have a great day.
(33:14):
We agreed that while thehospital may have some
uncertainty in the numbers, theycould also do a massive press
release and get some positiveexposure for the hospital by
being forward-thinking abouttechnology.
And that was enough to persuadeMiss Caldwell to take a leap.
Obviously, due to his interestand support, Dr.
Alvarez adopts first.
(33:35):
His incisions shrink, hisrecovery times shorten, his
patients go home earlier thanexpected.
Those patients tell the othersthey know who are seeking
surgery about their experience.
Other hospital administratorsnotice this.
Hospitals start marketing it asa service.
Demand appears where resistanceonce lived.
(33:55):
The legendary surgical handsdon't vanish, but they're no
longer the ceiling to a greatcareer for people like Dr.
Alvarez.
The robot doesn't replacesurgeons, it changes what skill
means.
The floor rises, the ceilingstretches, and the industry
can't ever go back.
(34:24):
As I sit waiting, now I realizesomething.
Every era thinks it's reachedthe end of replacement, that
nothing else could possiblymatter more.
We had reputations, then we hadoutcomes, now we have precision.
Then somebody asks a differentquestion.
So now I wonder who's sittingalone right now in a waiting
(34:45):
room somewhere, refusing toquit, measuring something that
no one else is ready to careabout yet, and thinking about
the new tools and innovationsthat will matter, and we'll be
(35:54):
able to get the body.
You're on the train to find a surgeon.
Like those guys who use theengineered robots invented to
cut you open and fix stuffinside you?
You don't know what a robot is.
What year is this?
1910?
Yikes! We must have reallyswitched to the wrong track
somewhere along the line.
(00:40):
Oh well, we'll let you out here.
We'll catch up with the propertimeline and the invention of
those robots later.
See you in the future, and enjoythe New York of 1910.
I step off the train and I lookat my watch.
It's been ten days since I lefton the journey from Texas to New
(01:02):
York to the minute.
I was seeking a surgeon, and thejourney was long and arduous.
I've had the fear of sinking ina riverboat, being robbed on a
train, and I've spent a fortuneof time and money all while
being sick to get here.
Surgeons of the 1910s havereputations built from newspaper
and radio, but that's notnecessarily the same as surgical
(01:24):
skill.
I braved all that on the journeyto New York because that's where
people say the best surgeonsare.
On its surface, that could beentirely false.
There are a few things thatindicate there must be good
surgeons here.
One, there's a big population.
Lots of people means lots ofsources of talent.
(01:45):
Two, there's money.
And if you're skilled and youlike money, you're seeking that.
And three, there's a reputation.
And that reputation draws inthose looking for talent, and
those customers draw in thetalent.
A virtuous cycle culminating insomething that started as a
possible fiction, becoming atruth if the reputation persists
(02:06):
long enough.
Now that I'm here, New York Cityfeels louder than it needs to
be.
Carriages, horns, voices layeredon top of one another.
Brick buildings rise too closetogether, as if even the streets
are competing for space.
Everyone seems to be in a hurry,including the men in white
coats, indifferent to the sickold man trying to find a
(02:27):
hospital in a crowded city he'snever been to.
Of course this city is loud.
Everyone is selling something.
Being louder than the other guyis the way some people, like the
newsies, for example, survive.
(02:50):
Inside the hospital, the smellhits first.
Chloroform, antiseptic,something sweet and chemical
that makes it hard to tellwhether this place exists to
heal or to harm.
I sit on a wooden bench, hat inmy hands, watching names move
through the building before Iever meet them.
Names whispered by porters,names printed in newspapers,
(03:13):
names repeated with confidenceby people who sound like they
know what they're talking about.
One surgeon, Lawrence Ashford,is famous.
His reputation even arrivesbefore he does.
I hear about his confidence, hisdecisiveness, the speed with
which he works.
While another surgeon, SamuelSmith, blends in.
Dr.
(03:34):
Samuel Smith.
A name that doesn't announceitself.
No stories trail behind him.
No one lowers their voice whenthey speak his name.
Dr.
Ashford and Dr.
Smith, they both seem capable,they both seem calm.
They both wear the same coat.
But I don't really know how totell which one is better.
(03:55):
How does someone make a life ordeath decision?
Based on reputation, when skillis what matters.
No charts line the walls.
No numbers are offered.
There is no ledger of outcomes,no public record of who lived
cleaner lives afterward and whodid not.
There is only reputation.
And reputation is unevenlydistributed.
(04:19):
I notice how people standstraighter around Dr.
Ashford, the famous one.
How his answers to questions areshorter, and how doubt seems
unwelcome in his presence.
With Dr.
Samuel Smith, the questionslinger longer.
He listens more.
He answers carefully.
Seemingly competent, seeminglythoughtful, but seemingly isn't
(04:41):
certainty.
And my life is on the line.
I make my guess.
It's not a decision.
Those require weighing outfacts.
There are none of those here.
(05:04):
As they prepare me for surgery,I wonder if I've chosen wisely.
As the mass lowers, the smell ofchloroform thickens, and who
knows what happens next.
(05:33):
I have no idea how we've arrivedin London.
In this place, in this time, youcan feel that the values of
people are in plus.
I'm sure the ships will in thehistory.
(05:54):
We'll see it when we get fullyback to the correct timeline,
I'm sure.
All you've done is get off thetree.
The hospital's just around thecorner, and it's time you see
your patients.
No more waiting.
Gibble, gibble, gibble, gibble.
(06:32):
It's the kind of smell thatgrows on a man after thirty
years.
The smell of familiarity.
After being paged, I enter theroom.
A patient rests quietly.
Sheets pulled to the chin, JohnWickham hovers nearby, checking
the chart, murmuring notes tohimself.
My eyes are scanning the patientand the chart.
(06:54):
Dr.
Wickham points to a column ofdata that I haven't seen before.
What is this?
I ask.
I've never tracked these numbersbefore.
Wickham glances at me.
Recovery times.
Complications that don't appearon mortality stats.
Measures of trauma we canminimize.
(07:16):
I've spent decades optimizingfor outcomes.
The ones the industry rewarded.
Mortality.
Obvious complications.
Textbook recoveries.
SPEAKER_00 (07:27):
What was Wickham trying to do?
SPEAKER_01 (07:30):
So I ask him, and you care to measure these
things?
Why?
Wickham smiles faintly.
Because patients care.
If we can shorten the time ittakes to return to their life,
isn't that what matters too?
I look at the numbers again.
Unsure.
(07:52):
I don't have these numberstracked for my patients.
Do I need them?
Back in my own office, Jack, mynext surgical consult, is asking
(08:12):
me questions.
Your mortality rates?
He asks.
I present my record.
Decades of experience, a steadyhand, results that have stood
the test of time.
The patient nods, appreciatingthe history and data.
I do nothing without multipleopinions, Jack says.
(08:34):
That's wise, I tell him.
Many patients return after otherconsultations because my
experience carries weight.
Later, as I walk past Wickham'soffice, I notice that he's
speaking with Jack.
Wickham's voice is calm,precise, careful.
(08:56):
He's talking about his ownmortality statistics.
Slightly higher than mine, butstill within safe ranges.
Then he moves on to what no oneelse has measured.
My focus is recovery, Wickhamsays.
On average, patients return tonormal life two months faster.
(09:16):
Less pain, fewer complicationsthat linger beyond the hospital.
This is what matters to you,isn't it?
The patient listens, eyeswidening.
You can tell for the first timehe imagines life after surgery.
Not just survival.
His questions about mortalityfade into the background.
(09:37):
He is drawn to the life he couldregain.
Not just the life he could keep.
Down the hallway, I continueeavesdropping.
My chest tightening slightly forsome reason.
I've been in the upper echelonsof surgical prestige, yet here a
younger surgeon, lessexperienced in years, is
(09:58):
teaching the patient aboutthings I hadn't considered.
(10:24):
Ignoring most of the hellos andDr.
Hawthorne attempts at myattention, my mind is fixated on
these new metrics.
They don't seem right to me, andI can't seem to focus on
anything else at the moment.
I reach the hospitaladministrator.
I'm not sure what came over me,but I forgot to even knock.
Instead saying, Do you know Dr.
(10:46):
Wickham is tracking statisticsno one else in the industry
measures?
And he's sharing them withpatients to draw them here.
The administrator raises aneyebrow, the kind of look you
often see from administratorsand bureaucrats who don't
understand your technicalconcerns.
Yes, and it's wrong.
(11:07):
We've tracked mortality ratesfor decades.
If optimizing these new metricsstarts to affect those rates, or
even just appears to, what willhappen to the hospital, to our
doctors, to our reputation?
The administrator leans back.
Dr.
Wakeham is trending in the rightdirection.
(11:27):
His mortality rates aren'trising.
In fact, he's improvingoutcomes.
Why is this panic necessary?
I slammed the desk.
Because it's uncontrolled.
We built a hospital withprestige on mortality rates, and
now he's rewriting the rules.
(11:48):
The administrator remains calm,unconvinced by my fear.
Most administrators are fed doomand gloom reports all day long.
So they're like an impenetrablewall when it comes to emotional
pleas.
Perhaps it's time the rulesreflected what patients actually
care about, the administratorexclaims.
Since mortality rates started asa measure, everyone has worked
(12:10):
hard at making theirsexceptional.
It's now hard to stand out as ahospital on that alone.
We need something else to bringpatients here.
Rather than choosing to just goto their nearest hospital.
In my opinion, Dr.
Wickham is on to something goodhere, and his work is leading to
lower costs for the hospitaltoo.
Less readmittance, less bloodtransfusion cost.
(12:34):
I leave flustered, my chesttight, my mind racing.
Am I a relic of the past?
Is Wickham the future?
Is my career hanging in thetension?
(12:56):
It's been ten years since thatday in the administrator's
office.
My career has reached terminalvelocities since that day, and
I've become a dinosaur.
Dr.
Wickham, on the other hand, is astar.
He coined the term minimallyinvasive surgery.
He's opened an institute totrain others, creating culture
(13:19):
where patient-centered measuresdrive practice by tracking data
that matter to patients, notjust what the industry measured.
He has reshaped surgicalpriorities.
And following that shift invalue, he's reshaped the
techniques that are used.
(13:40):
Laparoscopic surgeries guided bycameras are now the norm rather
than open surgeries.
Training programs integratethese new methods.
Mortality rates remainexcellent, but recovery time,
patient comfort, and long-termquality of life have become
metrics surgeons cannot ignore.
The field itself has bent.
(14:01):
Most experienced practitionersare following reluctantly
towards the values Dr.
Wickham has championed.
In fact, I'm stepping on a stageto present to a medical
conference.
Fifty surgeons seated in amedical theater designed for
knowledge share.
I've reached the tail end of mycareer and I have some lessons
(14:22):
for those with decades left togo.
Up on the stage, I begin mytalk, opening up the conference
where Dr.
Wickham will speak later.
While I'm a bit envious of Dr.
Wickham, I'm also humbled thateven though he was my junior and
relied on my expertise at thebeginning of his career, I had a
privilege of working with a manwho changed the entire industry.
(14:45):
The lights dim and mypresentation begins.
I'm Dr.
Reginald Hawthorne, 40 years asa surgeon.
I should have seen this coming.
I've been a doctor for decades.
I've seen the evolution ofsurgical practice, recovery
care, anesthesiologicaldevelopments, diagnostic tooling
(15:07):
developments.
Nothing stays the same in thisfield forever.
It's likely I should have beenthe one who saw what Dr.
Wickham saw, and perhaps I didit one time.
I just didn't care enough toexperiment, to be a champion for
the patients, and then once Ihad my data, campaign it across
the industry.
Dr.
Wickham did.
(15:30):
In fact, it's likely because Iwas focused in the wrong place.
I was spending most of myavailable time honing my hands
further, trying to make themlegendary.
Unfortunately, due to mybullheadedness and not realizing
there is a plateau on themortality metric beyond which
hands have no further influence,I spent decades focused on the
(15:52):
wrong problem.
Rather than my hands going downin the history book as a
surgeon, Dr.
Wickham will be known as the manwho changed surgery.
Focusing on getting us all tounderstand, for two doctors with
the same mortality rates, theone who has patients recovering
the fastest is the most skilled.
(16:14):
He's an admirable man, Dr.
Wickham.
You all are in attendance tohear from him, and it's my great
honor to open for him.
But before that, I want to sharesomething honest with you.
Years ago, before all of thiscaught on, Dr.
Wickham was working on thisalone.
When I found out about thesemetrics he tracked, I was
(16:35):
distracted and I was upset.
My mind wouldn't get off of why.
My frustration all those yearsback is gone.
I'm too old to change what Ifocused on.
However, I would let this be alesson to all those pursuing
fields like medicine.
Values shift.
Keep your eyes open on ways todo things better rather than
(16:57):
following the same metrics aseveryone else.
If you hear of a doctor doingsomething that gets you fixated,
angry, or otherwise emotional,sit with it longer, calm down,
rationalize, try to understandwhether they are correct.
I didn't do enough of that.
Dr.
(17:18):
Wickham is an anomaly, a man sofocused on how to do things
right, to track things thatmatter to patients, yet also a
risk taker and a change maker.
This industry needs less Dr.
Reginald Hawthorns, and it needsmore Dr.
John Wickham's.
And that was it.
(17:39):
I stepped off the stage,considering it an honor to even
be in the same event with myprotege, my colleague, my
friend, John Wickham.
Dr.
John Wickham.
And that was the last bit I evercontributed to the medical
field.
I couldn't help but wonder whoout there is the next Dr.
(18:02):
Wickham.
And how could they possiblychange this field in the same
way?
Well, we've arrived inCalifornia in the 1990s.
I'm not sure how we keepbouncing around like this.
We need to get all these trainlines fixed.
Anyway, we're drawing we're inthe top of the digital age now.
(18:23):
Computers, robots, it's changingeverything.
Every business magazine is fullof this stuff.
Oh look, we've arrived nearanother hospital.
Anyone heading there for work?
Please head out now.
The hospital looks differentthan it used to.
I used to work here as asurgeon.
(18:43):
Dr.
Mole, the patient is ready tosee you.
That used to ring a familiarsound here.
The walls are smoother now, lesscolor, less ornament.
Technology hums everywhere.
Monitors, carts, elevators.
But the place still smells thesame.
Clean, sharp, faintly metallic.
I've been here before.
(19:06):
Excuse me, Fred.
Yes, I respond.
They're ready for you now.
I'm nervous.
These people used to be mypeers, but now we feel opposed.
I take the stage and start thepresentation not loudly, not
forcefully, but carefully.
These are smart, educated,dedicated professionals who have
(19:27):
spent decades honing theircraft.
They won't take likely to changewithout reason.
I'm here to describe the work ofmy company, Intuitive Surgical.
We're working on buildingsurgical robots that help
surgeons become superhuman intheir hands abilities.
This presentation is to give astate of technology.
(19:47):
It feels like there are 50 ofthem in the room, all peering
into my soul, and I feel a bitweak, but I continue anyway.
My name is Fred Mole, thefounder of Intuitive Surgical.
I'm a former surgeon who saw anopportunity for technology to
augment surgical abilities.
I left my role as a surgeon andbecame an entrepreneur.
(20:08):
I raised funding, hiredengineers, and guided by my
experience as a surgeon, webuilt robots to help surgeons
make cleaner incisions, havesafer operations, and provide
quicker recovery for theirpatients.
Here's how the robots work aculmination of multiple
different technologies.
First, our engineers worked ontremor filtering.
(20:31):
Every involuntary movement isdetected and removed.
Only intentional motion passesthrough.
Next, they built micro motionscaling.
Large hand movements becomesub-millimeter actions inside
the body, granting precisionbeyond what normal hands can do.
(20:53):
Then we worked on havingarticulated instruments, ones
that can operate at angles thehuman wrist can't reach without
massive strain.
And then, of course, we've beenworried about redundancy and
fail-safes.
If something goes wrong, thesystem stops before damage
occurs.
Surgeons all listen, but thenthen they resist.
(21:15):
One surgeon doesn't raise hishand to his voice.
He doesn't need to.
His reputation fills the roombefore he speaks.
He says, My outcomes areexcellent.
What he doesn't say, I don'twant to relearn my craft.
(21:37):
I don't want my advantagediluted.
I don't want a machine standingbetween me and my identity.
What he says instead?
SPEAKER_00 (21:47):
What happens if it fails inside a patient?
SPEAKER_01 (21:51):
I again describe the fail safes that I had just
mentioned moments earlier, butit doesn't seem to be getting
through.
Perhaps because they don't careto hear it.
The surgeon nods and then says,I don't see the problem that
you're solving.
And that's the end of it.
They are all busy and theydecide to go back to their
planned operations, officehours, and normal day-to-day
(22:13):
stuff.
How could they not see theproblem?
Patients want small incisions,quick recovery, few
complications.
None of them see that?
I was them.
Am I really so different?
(22:36):
I leave the meeting and go backto my teammate at the intuitive
surgical headquarters.
We refine the pitch, clarify themessage, and adjust the
language.
Weeks pass.
I meet another group of 50 or sosurgeons.
Same objections, differentphrasing, exactly the same
outcome.
A committee wants more data, anadministrator wants liability
frameworks, marketing reframesthe pitch, engineering iterates
(22:58):
the system, money goes out,nothing comes in.
Two months later, my financialinvestors ask, How are we doing?
I have no answers that theywant.
Only that understanding of themarket has improved.
Which it has.
But unfortunately, actualinterest in the product has not.
(23:21):
I asked for more time.
They're obviously frustrated,but creation enough to provide
more funding to continue.
I go home that night, thelooming failure weighing on my
soul.
At these conferences, it seemslike the largest egos speak for
the entire group, and I'm notcertain whether their words are
(23:42):
representative.
I decide to meet with somesurgeons one-on-one.
(24:05):
And some ones which haven'theard about the technology yet.
The initial meetings with theconference attendees aren't
fruitful.
It appears the opinions havebeen painted by the group
already, aligning with what wasalready stated at the conference
by the singular most vocalsurgeons who resist the robots.
But then there's Dr.
Alvarez.
(24:26):
My team had called his officeand he was interested in talking
because he likes to keep up withthe technology.
I do some research on him.
His hands are steady, reliable,not legendary.
I give him the same explanationas the conferences.
Word for word, I talk abouttremor filtering, micromotion
(24:47):
scaling, articulatedinstruments, redundancy, and
fail-safes.
At each technology introduction,Dr.
Alvarez leans forward and asksquestions.
How does it distinguish betweena tremor and a small movement?
Can the scaling be changed, oris it a set number?
What sort of range do thesearticulated instruments have and
(25:08):
what are their applications?
The fail-safes are the mostimportant.
Make me feel good about them.
Dread and fear race over mybody.
It seems like more of the same.
I explain the fail-safes again,but then Dr.
Alvarez says that's great.
I realize these are notobjections.
(25:29):
They're invitations to say more.
Dr.
Alvarez asks about where he cantest out the machines and get
some initial training.
I tell him we can set somethingup at the intuitive surgical
headquarters for him to try itout and get trained.
It's small, but it's something.
Finally, 1% interest and 99%resistance.
And that's enough to keep megoing through all the fear.
(26:06):
But I'm busy and there isn'tmuch point in doing so if the
hospital won't bring on one ofyour robots.
I'd like to introduce you to thehospital administrator.
Her name is Margaret Caldwell,and I can get you 15 minutes on
her calendar.
I appreciated that message fromDr.
Alvarez.
So I show up to the meetingearly and I get my presentation
ready.
(26:26):
But Margaret isn't interested insurgical hands and the
comparison to robots.
She asks, What happens if themachine fails?
Who carries the liability?
What problem are we actuallysolving?
I explain about fail safes.
I don't have an answer aboutliability, but I'm happy to put
in a legal framework thatprotects us both, as well as
(26:49):
provide training to ensure staffuse it properly.
As for the problem, I tell herpatients value, quick recovery
times, small incisions, andprecise work.
She listens, raising an eyebrowlike administrators often do.
Then she delays.
She says she liked to run itagainst committees, reviews, and
budgets.
(27:09):
I leave.
Getting in my car, I stare atthe wheel and droop my head.
I've blown it.
I didn't give that administratoranything to make a decision on.
So they deferred again tosurgeons, and we're back in the
same loop.
More months pass, more moneyburns.
(27:29):
I have no idea what to tell myinvestors at this point.
I certainly didn't reach out tothem proactively to deliver any
news.
(28:00):
The vinyl chairs are dull green.
One has a crack down the middle.
Taped over so many times it's nolonger clear what color it was
originally.
The lights hum.
A cleaning cart rolls past.
I used to walk these halls withcertainty.
Dr.
Mole, the surgeon.
(28:22):
Now I wait in them.
Feeling the same uncertainty asthe people waiting for the news
of loved ones' operations.
The stakes are different forthem and me, but the butterflies
in my stomach feel the same.
Across the room, families sitthe way families always sit,
folded inward, eyes fixed ondoors that won't open.
(28:44):
No matter how hard you stare.
I know this posture.
I've seen it from the otherside.
And the thought races through mymind.
I could stop.
I could go back.
Operate.
Be certain again.
No one would blame me.
(29:05):
This entrepreneurial path wasalways fraught with peril.
But then I think about thosefamilies and why they're here.
Those people over there don'tlook happy.
When Papa comes out of surgery,even if successful, he's not
gonna be himself for a while.
That's why waiting feelsendless.
That's why outcomes matter.
(29:28):
And Dr.
Alvarez suddenly pops into mymind.
His questions, his curiosity.
He's a like-minded doctor whowanted to surpass his physical
limits for the benefit of hispatients.
He was my 1% hope.
If he hadn't shown something tome that day, this would be the
(29:50):
end.
But hope never arrives ascertainty.
It arrives as interest in apossibility.
And that interest sparksrefusal.
A refusal to quit.
SPEAKER_00 (30:05):
So I'll stay at it.
But I need a boost.
SPEAKER_01 (30:11):
I'm gonna call Dr.
Alvarez again.
So I type in his digits, buthe's unavailable.
Though he returns my calls acouple hours later.
He says, Margaret told me thehospital can't justify the cost
of your surgical robots.
I think she doesn't know how tovalue the technology correctly.
(30:33):
I tell Dr.
Alvarez, there's no doubt I letyou down there.
I was talking surgical in thatmeeting.
If I could get another 15minutes with her, I'd talk about
shorter stays, less bloodtransfusions, lower 30-day
readmissions, lesscomplications, and mortality
rate improvements.
That would be better.
(30:54):
I'll get you 15 more minutes,Dr.
Alvarez tells me.
(31:15):
I say, trying to keep it casualto help my brain remember, not
to get technical, but to talkmore about benefits to the
hospital.
What has changed since the lasttime?
She asked me.
Last time I was in here, I madea mistake.
I told you about the things thatmatter to surgeons.
Of course, you deferred me tothem for further review.
Today I'd like to quickly runyou through why you should value
(31:38):
these robots through the lens ofthe hospital as a business.
That would be great.
I know we have to betechnologically forward here at
the hospital, but I get pitchesthat I don't know what to do
with on the daily.
Please go ahead.
There are really five thingsthese robots will improve for
the hospital.
Shorter stays after surgery,less blood transfusions due to
(32:01):
smaller incisions that causeless blood leakage, lower 30-day
readmissions, less complicationsdue to the precision offered by
the robot and the minimalexposure of the patient, and as
always, the important mortalityrate improvement.
Those are certainly items we'reinterested in.
Each of these increase our costof patient care.
(32:22):
If you can provide some numbersof expected changes in these
categories, we can run itagainst our expected savings and
see if it makes sense.
I'd be happy to.
I'll send them to you tomorrow.
Can we meet again next week toreview those numbers and see if
they make any sense?
I'd be happy to.
Thank you.
Looking forward to talking againin the future.
(32:43):
Me too.
Have a great day.
(33:14):
We agreed that while thehospital may have some
uncertainty in the numbers, theycould also do a massive press
release and get some positiveexposure for the hospital by
being forward-thinking abouttechnology.
And that was enough to persuadeMiss Caldwell to take a leap.
Obviously, due to his interestand support, Dr.
Alvarez adopts first.
(33:35):
His incisions shrink, hisrecovery times shorten, his
patients go home earlier thanexpected.
Those patients tell the othersthey know who are seeking
surgery about their experience.
Other hospital administratorsnotice this.
Hospitals start marketing it asa service.
Demand appears where resistanceonce lived.
(33:55):
The legendary surgical handsdon't vanish, but they're no
longer the ceiling to a greatcareer for people like Dr.
Alvarez.
The robot doesn't replacesurgeons, it changes what skill
means.
The floor rises, the ceilingstretches, and the industry
can't ever go back.
(34:24):
As I sit waiting, now I realizesomething.
Every era thinks it's reachedthe end of replacement, that
nothing else could possiblymatter more.
We had reputations, then we hadoutcomes, now we have precision.
Then somebody asks a differentquestion.
So now I wonder who's sittingalone right now in a waiting
(34:45):
room somewhere, refusing toquit, measuring something that
no one else is ready to careabout yet, and thinking about
the new tools and innovationsthat will matter, and we'll be
(35:54):
able to get the body.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by Audiochuck Media Company.