In this installment of the Frictionless Medicine mini-series, host Geeta Patel interviews Dr. Nels Carroll, a board-certified cardiothoracic surgeon at Los Robles Health System. 

Dr. Carroll discusses his journey from educator to pioneer in robotic thoracic surgery, the role of marketing in engaging doctors, and how he uses technology, data, and collaboration to provide patient-first healthcare. He shares insights on bridging educational skills with medical practice, handling patient concerns regarding advanced surgical procedures, and his groundbreaking work in Southern California, including the first-ever robotic chest wall reconstruction and single anesthetic robotic lung cancer resection in Ventura County. 

The episode provides a deep dive into the evolving landscape of robotic surgery and the future of med-tech and AI in the medical field.

00:00 Introduction to Frictionless Medicine

00:13 Meet Dr. Nels Carroll

01:31 Dr. Carroll's Journey into Medicine

02:43 The Role of Education in Medicine

04:11 Patient Concerns and Communication

06:22 Adoption of Advanced Surgical Techniques

07:33 Marketing and Communication in Medicine

10:25 Innovative Surgical Milestones

19:58 Future of Med Tech and AI

25:15 Conclusion and Final Thoughts

Frictionless Medicine is a production from /prompt, the leading earned first creative marketing and communications agency. Grounded in the present, yet attuned to the future. 

Produced and distributed by Simpler Media Productions.

>> Speaker A: Welcome to Frictionless Marketing, the podcast that dives

deep into the stories of the most innovative brands and the people

moving them forward.

Our mini series, Frictionless Medicine explores the

HCP perspective on today's trends throughout the

industry. Today we're joined by Dr.

Nels Carroll, a board certified cardiothoracic

surgeon at uh, Los Robles Health System. Join host

Geeta Patel as Dr. Carol shares insights on staying ahead

of trends, the role of marketing and engaging

doctors, and his journey from educator to a

pioneer in robotic thoracic surgery. Discover how

he leverages technology, data and collaboration to

strive for seamless patient First Healthcare.

>> Geeta Patel: Dr. Carol, thank you so much for joining us.

We're excited to have you here, especially as someone

who's at the forefront of tech and AI and

medicine. So we'd love to kick things off by just

having you share a little bit about yourself and your background and

what you're doing right now.

>> Dr. Nels Carroll: Yeah, thank you so much for having me here. I'm, um,

excited to speak with you guys. I'm a

cardiothoracic surgeon. I work for Los Robles

Medical System in Thousand Oaks, California, right

outside of la. Did my surgical training in

Texas, worked in Washington for a few years

before coming here to California. Uh,

big part of my practice is robotic

surgery, so certainly a big slant towards

technology and pushing some boundaries and

some barriers to what has been done towards

what we can do. So really

excited to be here.

>> Geeta Patel: Amazing. What inspired you to get

into medicine and specifically into

the robotic and tech side of things?

>> Dr. Nels Carroll: Well, I had kind of a circuitous route into

medicine. Actually coming out of school, I was

in Teach for America, which is, I

think of it, kind of like a domestic Peace Corps.

I was really enthralled with the mission

of serving underserved

people, kind of giving them some of the opportunities that I had

had through that process

of learning how to be an educator. I really

became fascinated with the concept of

pursuing education in a different arena and that

being medicine. So that's where I kind of made the

big jump into wanting to pursue medicine.

And then really, it was just a process of trial

and error. Real interest in science and a real interest

in surgery and refining

processes and through interactions with

some particularly excellent

teachers and surgeons, realized what we

were capable of doing by harnessing some of these

resources to improve our

processes.

>> Geeta Patel: That's amazing. How do you feel like Teach for

America has shaped you as a

physician in terms of just being able to explain some of the

most complex medical issues, but also some of

these complex tech procedures with your

patients? How do you feel like that's kind of given you the skills you need

to speak with them? Them?

>> Dr. Nels Carroll: Oh, I think it's huge. Aside from the technical

responsibilities of a surgeon and what you're actually doing at the time of

surgery, at least

50% of the job is

educating and communicating with patients and with their

families. There's really no more vulnerable

or scary time than being a patient

undergoing open heart surgery or undergoing

surgery for cancer. So it's incumbent

upon me, it's incumbent upon us as the

medical community, to the way I communicate it. Pull

up a chair to the table. Working as

a consultant for them, the patient is the

chairman of the board. There's a lot of different people that

pull up a chair to the table. So it's my job to

really explain myself, give

background, give context, and make sure

that they feel comfortable and confident with what we're

doing moving forward so that they can

really just focus on

healing and not be worried about

things that are out of their control or that they don't understand

that we can help them understand that background in

education has been pivotal in helping

me do my job.

>> Geeta Patel: What would you say are some of the

biggest hesitations or concerns among

patients when you are discussing some

of the more advanced surgical procedures using

AI and tech?

>> Dr. Nels Carroll: Oh, yeah, there's a whole

spectrum. You hear these catchphrases

and patients will say, listen, I don't

want a robot operating on me, right?

I'm coming to you as a surgeon. I don't know this

robot, right? So it's just about communicating

that. I think for everyone,

it's just intuitive. The fears of the

unknown. What's really important is just

explaining that these are tools

that allow us to. Allow me to do my job

better. For example, within the field

of lung cancer resection, standard

approach in literature 50, 60 years ago

was a thoracotomy. A big incision between the

ribs, spread the ribs apart, looking

directly at the lung, operate on the lung.

There was a total seat change when that transitioned

to thoracoscopic surgery. So we put in a

camera, make smaller incisions,

much less painful for the patient, much less time

in the hospital. But then there's really now this

total paradigm shift where it's not just

a camera, um, but when we say we're doing

it robotically, that camera is actually

two cameras adjacent to each other,

creates a stereoscopic visual

input. So it's three dimensional.

The degrees of freedom, the range of

motion of the instruments is

infinitely better than what we can do with

standard, we say vats or

videoscopic thoracic surgery.

So those things are fascinating. They're very

interesting. But what matters to the

patient is it hurts

less, the surgery is more accurate,

the surgery is safer, they

recover more quickly. Those are the things that

matter. So I think keeping

things in context and making it relatable

is hugely important.

>> Geeta Patel: No, that's really interesting when you talk about these

advancements and, uh, it seems like since you're on

the forefront of a lot of this, thinking about

the peers in this field, are they

as open to adopting these new methods?

Do you feel like there are certain groups of

physicians that are a little bit more open than others? And how

does literature and how things are being

communicated to them, um, impacting their

adoption of these practices?

>> Dr. Nels Carroll: Well, I think that's a really good question.

Within any practice, any

profession, when you're trying

to move things forward,

at times there's resistance. It

has to do not so much

with focusing on that

as it does with being true to the

process. In that if you're

offering a, uh, safer,

more effective

process, it speaks for

itself. I think

communicating and building

within the medical community to

bring people on board, to make them aware.

Part of what I really appreciate about the opportunity

to talk to you guys in the context of

marketing, you know, from my perspective within

medicine, nothing that I do has to do with

sales. So marketing, for me

isn't about sales, but it's about

communicating, it's about sharing.

Within our medical community,

people are so

overwhelmed with information, especially our

primary care physicians. They're being

inundated from all these different

specialists. And I'm one of those specialists, you

know, so when I meet a, uh, primary care physician, a

family medicine doc, for the first time, I'm coming

to the office and I'm saying, hey, I'm Dr. Carol. You know, I'm a

cardiothoracic surgeon. Initially, they

might just gloss over, like, okay, I just met with a

urologist yesterday. I'm going to meet with a

neurosurgeon tomorrow. There's

a new, uh, radiation oncologist that's

coming to my office this afternoon. Like, how do I

put all this into context? It's an

ongoing pursuit, but to share that

information. You know, I had a pivotal

lesson in that as a medical student.

Worked with a really fantastic surgeon,

T. Sloan guy, that's his name. Really

phenomenal robotic cardiac

surgeon. Taught me so much, has

continues to be a mentor. But we actually

published his experience

with building or

recruiting into what he was doing.

Because as a robotic mitral valve surgeon,

it's a real niche. Oftentimes

he had to get the word out to patients

to let them know, hey, here's an alternative. You know,

rather than a sternotomy, we can do this minimally,

invasively. We can offer you a really tremendous

surgery. So

that continues to be in my mind

about the importance of not just going one

foot in front of the other, but

sharing what we're doing and working and

building and growing. And just one other thought

to go along with that. It's. I'm not under

any illusions that as I

step into a new medical community, I'm, um,

bringing a whole wealth of knowledge and nobody gets

it. You know, the guys who've been doing thoracic

surgery for 20 years, 30

years, 40 years, have seen so

much and have so much

tremendous information and wisdom

that they can help me with.

So I think it's about bringing a little bit different experience,

bringing it to the table, working together,

and then moving forward.

>> Geeta Patel: I mean, that's really great insight. I heard you

say sharing is really important, so I kind of want to

take a second to also just share and,

um, talk a little bit about your recent accomplishments. You

recently completed the first ever robotic

chest wall reconstruction in all of Southern

California. I just want to make sure I get this right. And the first

ever single anesthetic robotic lung cancer

resection in Ventura County. Is that correct?

Correct. Okay, first of all,

let's take a moment to say that is

incredible. Um, just to be first ever and to

be on the cutting edge and to do this is wonderful.

I heard you say it's important to communicate and share a lot

of this. And a lot of times what we do from a marketing

standpoint is figure out how we can empower our patients

to also get educated on these topics so that

they're coming to their surgeons, that they're coming to their physicians

and discussing some of these options. I'd love to hear from

you on how you're sharing some of those great

milestones with potential patients and

trying to market it outside, or communicate it,

if you will, outside of the physician world.

>> Dr. Nels Carroll: Well, that's. Thank you. Yeah, I mean, these are really

exciting. Uh, I think as a clinician, you're just kind of

confronted with the situation, and you

think about, what's the best way I can do this? And

then when you come up with a creative

strategy and it works,

that's really exciting. And then you want to build from

that. Just to be totally frank,

how do we share that is something that

we're very much grappling with. You know, the chest

wall reconstruction. So a Little bit of context

had a gentleman riding a motorcycle

collided with a deer, fractured 10

ribs. So he had 10 rib fractures, multiple

displaced rib fractures. The consequence of

that is he was dependent on a lot of oxygen, a lot of pain

medicine. He was able to get up and breathe deeply

and walk around. So the traditional

approach to reconstructing that is to make

a big incision all the way along the

back towards the side,

and to actually divide a lot of muscles

and screw titanium plates into the

ribs. That works, but it's

painful and you want to be better. So

the next step is to do that thoracoscopically. We

talked about vat surgery, and so what we did is we took

it the next step and did it robotically. The

biggest incision that we made on this Jose, 2

inches. We plated from the

inside. We also did a cryonerve

ablation the morning after surgery.

He's breathing room air, he's walking, he's taking

Tylenol. For that patient,

it's phenomenal. It's exciting because you

see the potential to improve the process.

We didn't divide any muscle. We spread the

muscle fibers. We do these little finite

things to really improve the process. But

how do you share that? I don't really have an answer for

that because it's just an area of growth, I guess, for

me. And I shared that with

our hospital. And they still

are grappling with that a month later and

haven't come up with anything to

share that. Maybe because it seems a little

esoteric or they're not familiar with it.

The single anesthetic lung cancer

is really a paradigm shift too.

Just thinking patient first. So a

patient might have a screening CT scan,

a suspicious nodule. They're referred

to a doctor, they're referred to another to get a

biopsy, they're referred to another to get some

testing done. They go get some other imaging

done. They're referred to a surgeon

in our community. On average, then it

takes between 60 and 90 days

from the time of initial suspicion to

treatment. So with a single

anesthetic event, what we're now doing,

patient gets a suspicious CT scan.

I'll see them within a week and get some

other imaging done. We'll have a

discussion within another week.

We go to surgery, patient goes to

sleep. I'll do a robotic navigational

bronchoscopy and mediastinal staging.

The pathologist is in the room with me, can

tell me right away if it's cancer.

If it's cancer while the patient's

asleep. Proceed directly to complete

Anatomic resection. So I'll take out the

cancer, take out the lymph nodes, do

nerve blocks, put in a drain.

Two hours later, patient wakes up.

90% of the time, they go home the following morning.

When they go home the next day, we answer two

questions. Was it cancer? Yes. What

do we do about it? It's done. And

especially with these early stage lung cancers,

totally revolutionizes that experience

for the patient. So rather than having three

months of first

wondering, then knowing

that you have cancer, but not knowing the

implication, and then

worrying and waiting and worrying

and going on WebMD and getting more

worried, here, we're truncating that whole experience.

So within two weeks, you find out what it is,

you're treated, you go home and you take

Tylenol for a week. And at the end of that

experience, you can put in the rearview

mirror. You know, that's what we talk about, that single

anesthetic event. It's really

exciting. But I think we're still grappling

with how do you even take all that information

and share it, uh, share that with

our community doctors, share it with our patients.

So even the hospital, still not

really sure how they're going to share that. It's a work in

progress.

>> Geeta Patel: Well, just hearing both those patient

experiences and stories immediately helped

me truly understand the power of what

you're doing. And, um, I'm blown away. It's

really incredible. I do think that there's something

within the patient testimonials and those patient stories,

especially as someone who does focus groups

with patients. Often you hear about the process.

They worry about recovery, they worry about pain.

Those are oftentimes the biggest concerns that they have

is what's going to happen after. And it

seems like that could be an interesting starting

point. I do want to switch gears a

little bit about just how you're learning about

what's new and what's possible. How are

you getting your information about, uh, the latest in

medtech and AI when it comes to your

field?

>> Dr. Nels Carroll: Yeah, that's a great question. It's very much

a, uh, ongoing changing dynamic. There's

so many things happening in the field. For me

personally, it's relying on

mentors and friends and anecdotal information.

There's a gentleman by the name of Yui Nguyen,

who is a really fantastic thoracic

surgeon, works in Portland, Oregon,

taught me everything I know about robotic thoracic

surgery. And he continues to be a source of

information. But conferences,

professional societies, for us in our world,

the sts, the aats,

those are very much where People

are pushing those boundaries, but a lot of it has to do

with a million things get published.

Which things do you trust? You have to

dig a little deeper to the person behind the article.

That just comes from communication and

relationships. I'm a young guy and I

certainly am still very much learning how to

navigate all of that and growing in that process.

But I think having an ear to the ground

on the thoracic side or the

cancer world, we very

much are multidisciplinary. We have a

tumor board discussion. So every patient with lung

cancer that needs to be discussed or worked through.

I'm meeting with medical oncology, radiation

oncology, pathology,

radiology, diagnostic

radiology. We have a tumor navigator. We have

these meetings, and there's so much

robust information coming from all these

different disciplines. Again, it comes

down to being open, to

participating and to asking more

questions so that I can be responsible

as an advocate for the patient. Uh, especially

because I'm, um, as all of us taking on a lot of

responsibility. If I'm going to make an incision, I

owe it to the patient to be entirely

prepared for the consequences of those

actions. Kind of a muddy answer to a

fairly clear question, but I think it

just has to do with keeping my eyes and ears open

and communicating and admitting that there's

a lot that I don't know so that I can

find answers to those questions.

>> Geeta Patel: It sounds like, um, we hear a lot about how

valuable conferences are because it gives you all a

moment to just stop and really focus on

what's new, the new data, and to your point, who's

publishing it and what that study looks like. We've heard that

quite a bit. It sounds like for this field in particular,

what's unique that we haven't heard as much

is advocating for it and having other

physicians advocating for it, for the future of the

program and for the spread of that data.

I think that's very interesting and unique to the

MedTech and AI space. I'm

curious to know what your thoughts are

on the future. I say that with

10 years from now, do you see this

being the common practice, or

do you still see that because there's so much advancement

happening that it's still going to be a slower adoption?

>> Dr. Nels Carroll: So great question. It's something that we all kind of wonder

about. What's. Where are we going forward?

My practice really is one foot in two

worlds because there's a thoracic side of things.

Lung cancer. Absolutely.

Robotic thoracic surgery is

more and more common. In training,

trainees are coming out with that experience,

they're sharing that and they're building from that, and

it's growing. And the benefits are just

irrefutable. In the cardiac side of things,

too, there's going to be a tremendous amount of change.

One of the things that we

continue to wonder about is the

transition from open cardiac surgery

to these transcatheter processes.

So as a patient, the concept of a

transcatheter, meaning, for example,

the aortic valve in the heart is

very prone to aging because it's in the high

pressure area of the heart. The

aortic valve tends to calcify, becomes

stenotic. And the natural history of that

is that, uh, valve needs to be replaced or else

the life expectancy declines

precipitously.

Historically, to replace that valve, we had

to open the chest, arrest the heart,

take that valve out, and sew in a new one. And

that's still a really good surgery.

But what

we have developed as a medical community

is the ability to replace that valve through

a catheter. So much like, you know, I

described to a patient, you know, you've seen a ship in a

bottle and you look at that and you say, how the heck

did they get that into that bottle, through that narrow little

neck? Well, it was folded delicately

in a way that allowed it to fit through there. We now have

engineered these valves in a way that we

can fold them down, put them into a very

narrow catheter, introduce it to an artery

in the hip, slide it up into position,

release it, pushes the old valve out of the way and the

new valve is functional in its place. We call that

TAVR Transcatheter Aortic Valve

Replacements. TAVR initially

was just for really high risk

folks who couldn't tolerate open

surgery. And then we've seen where

with more experience and more refinement of

technique and technology,

these valves work very well.

So we've gone from offering them just to high risk

patients to intermediate risk

patients. And now we're looking at more and more

applications, younger patients, healthier

patients. The implications of

that are really, uh, a burgeoning topic

of discussion. For example,

Medtronic is a company that makes a really terrific

valve, and we've seen through recent

the SMART trial data that

particularly for a small annulus,

which it's a narrow space and

you're replacing it with this valve, the

Medtronic valve works great. So

we've got this excellent data that really

is kind of pushing our thinking to

when is the right time for surgery and when is the

right time for a transcatheter option. We

always want to offer the patient the least

morbid, least painful procedure, but

at the same time, we want to offer the most

durable, most effective treatment.

So it really takes a lot of

longitudinal data and a lot of

thoughtful collaboration to find the

sweet spot for that. Where that will go

in the future is really interesting,

especially as we branch out into other

valves. I have, uh, a tremendous

good fortune of working with Dr. Cybul

Carr, who's a

absolute international expert in structural

heart or transcatheter interventions for

valvular disease. We're pushing the

boundaries on some tricuspid valve

interventions, mitral valve interventions,

things that we once thought we could only do

surgically. And I think

seeing that progress

and seeing the experience and courage of guys like

Dr. Carr to help us try

things and push forward really brings a

lot of confidence that that

area of medicine is only going to continue to grow.

Certainly there's still always going to be a role for

surgery. And the more thoughtful and collaborative we

are, the more effectively we can

utilize surgery and transcatheter

interventions together. So, uh, lots

to be discussed, lots to see, but

really exciting.

>> Geeta Patel: Yeah, it sounds like we're a lot closer in

some fields than others than we think. So

it is very exciting. Well, I just want to

close by thanking you so much for your

time and just sharing

all these advancements with us. It's very exciting

to see where we're headed in the medical

world and how much innovation has

happened over the last 10 to 15 years to get us

to a place of less pain, less

invasiveness. And I think your work has a

lot and is contributing a lot to this and we're

all very grateful for it. So thank you.

>> Dr. Nels Carroll: Well, thank you. Thank you so much for having me. Honestly, I

learned a lot from you guys and so

I appreciate you giving me an opportunity to speak. I love

to connect and learn more from other folks as we're all

trying to do the same thing. We're trying to

improve our patients lives. So thank you so much.

>> Speaker A: Thank you for listening to this episode of the Frictionless Marketing

podcast. For a complete transcript of

this conversation or more information on Prompt,

please Visit us at ahmeetprompt.co.

if you found this episode insightful, share it with your connections

on LinkedIn. To learn

more about how to make marketing frictionless. Purchase Friction

Fatigue by Prompt CEO Paul Dyer

online and at booksellers worldwide.

Frictionless Marketing is a production from Prompt, the leading

earned first creative marketing and communications agency.

Grounded in the present, yet attuned to the future.

Produced and distributed by simpler media productions.