Richard J. Chung, MD: Hello, and welcome to Pediatric Voices, expert insights about timely topics in children's health, brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center. My name is Dr. Richard Chung, a Physician at Duke Children's and a co-host of this show. On today's episode, I'm joined by my friend, colleague, and esteemed co-host of this podcast, Dr. Angelo Milazzo. Angelo, how are you?

Angelo Milazzo, MD: I'm doing well, Richard. It's so nice to speak with you today.

Richard J. Chung, MD: Yeah, this is super fun, Angelo. Now, typically you and I are like two ships passing in the night, hosting separate episodes of this podcast with wonderful members of our Duke Children's community, but you and I rarely have the chance to actually be on an episode together. And so I've been really looking forward to this.

I think this is going to be a lot of fun.

Angelo Milazzo, MD: I've been looking forward to it as well. We did have an opportunity to recap the first season, so to speak, of the show. I thought that was a fun conversation. We had a chance to reflect on some of the guests that have been on, some of the topics we've covered. And I really enjoyed that opportunity to share collective thoughts with the audience. I'm looking forward to doing that again today.

Richard J. Chung, MD: That's right. And I think for today's conversation, as you and I have discussed a little beforehand, we'll start with the podcast, but then sort of zoom the lens a little wider to the broader ecosystem around how health information is communicated. How our patients, families, their loved ones, and even we, ourselves as clinicians and community members access trustable healthcare information.

It's not as easy as it might sound. You know, Angelo, in thinking about the conversation, I was looking online and Googling, actually, which I guess is one mechanism for finding health information. And I noticed that there was actually a survey last year put out by what's called the Kaiser Family Foundation.

And what they did was they actually surveyed several adults around the country, around 10 different health related false claims and asked them to rate each of them as definitely true, definitely false, probably true, or probably false. And that middle zone where people were leaning in one direction or the other, but weren't entirely true about whether something was true or false was the large proportion of responses, what they called in the survey, the muddled middle.

Right. Which kind of demonstrates that at least in this survey, about half to three quarters of adults in our communities for some of these health related topics just aren't entirely sure. They sort of think they know what's true, but they aren't a hundred percent certain. And so that's kind of where some of that vulnerability to misinformation and confusion comes from.

And so I thought this would be a really good focus of conversation because fundamentally that's what we're after with this podcast is certainly we want to have good conversations. We want to shed light on wonderful things that are happening here at Duke and beyond, but fundamentally we want good, high quality, trustworthy information in the hands of people who need it to make positive decisions for themselves and their loved ones.

And so, let's kind of launch in here. Does that sound okay, Angelo?

Angelo Milazzo, MD: It does sound okay. It sounds like a great place to start the conversation. I think the research you cited is fascinating. It makes me wonder to what extent that lesson is exclusive to healthcare information? I don't believe it is. I think it's reflective in general of this large people in this middle position, whether it's respect, whether it's in respect to information about healthcare, information about what's happening in the world, information about finance, information about science in general.

I think that folks have found themselves in this really unenviable middle space where they're not quite sure. They feel as though most of their sources are somewhat trustworthy, but they don't feel as though any of their single sources are completely trustworthy.

So again, I look forward to using that as a way to springboard into other ideas today.

Richard J. Chung, MD: That's such a good point that getting information is hard in general, and it's not specific to health or healthcare. For example, a couple of weeks ago, one of my patients came into their appointment excited telling me that Taylor Swift had dropped a surprise album overnight. And part of me was like, okay, that's probably true.

I mean, why would this patient make it up? But, can I entirely trust a word of mouth in that way? And I use that example in jest, of course, but many people are talking about Taylor Swift and other celebrities and such and all the gossip that surrounds them. But it's a good point, right? That how do you get information these days in a way that's usable, particularly when you have to make decisions that have real consequences?

And the only other thing I'll point out about this particular Kaiser survey was when they asked what are the remaining sources of trustable information in your life? Doctors, healthcare providers, we're at the top of the list. And so I know we, in our clinical practice, may not always feel like that seems true, just because there is a lot of uncertainty and questioning that happens.

But that remains the case that healthcare providers are at the top of the list. Second were federal agencies which have been called into question, particularly in the midst of the confusion of COVID-19, but remain really near the top of the list of trustworthy sources of information. And so let's kind of riff off of that, Angelo.

So as a physician yourself, as a podcast host and also as an individual consumer of healthcare, a parent of young people, you wear a lot of different hats. And so as you think about accessing trustworthy health information for you, yourself, your loved ones, and for your patients and their families, how do you think about that at this point?

Angelo Milazzo, MD: Yeah, great question. I'm going to answer it, but I want to take one step back and reflect on a couple of things that you said, because you made some really amazing points. To the point about your story with the patient and the information about Taylor Swift's new album, it reminds me that these issues existed long before digital media. So I've dated myself many times in the course of recording these podcast episodes, but I'll date myself again by reflecting on something I was told as a child, and that is believe none of what you hear and half of what you see or the other version is none of what you hear and half of what you read.

And I think that lesson about being skeptical, about being discriminating about information that you bring in, that's a lesson that I learned very early in life. I think many people who became physicians or scientists or people who deal with information and data on a daily basis take that somewhat skeptical approach.

The other interesting point you made, was this idea that there are still some people, some professions, some groups in our society that people recognize as authorities or experts, although we could reflect that some of that expert, that faith and expertise has eroded in the last few years. But it is interesting, I can clearly remember, again, I'm going to date myself, when I was a medical student, I went on house calls with one of the last true house call keeping family physicians in the five boroughs in New York.

And he would go into patients homes and not only did he provide health care, but he would provide life advice. I clearly remember people asking him questions about a loan they had just taken out from the bank or something that was happening in the news. So I think it's really interesting that physicians have always occupied to some extent, this position in society as learned individuals, as people who, could bring a fair and sort of poignant analysis to any kind of problem.

So I hope, we've retained some of that despite, you know what we've seen go on in the last few years. Now, to answer your question, in terms of evaluating sources, this has become increasingly complicated. As these sources have multiplied, have proliferated; we have to be much more, I think, discerning in terms of how we're addressing these sources, how we're consuming the information and how we're sharing it, both in our personal lives and our professional lives.

When I am talking to patients and families and they are saying, or they're asking where can I turn to for additional information? When it comes to medical information, to be very practical about this, I try to steer patients and families to sources that I might go to if I was putting together educational information for a patient.

And that means sources that are generally connected to a health system or a university system or a similar organization. So to give you a very specific example, in my work as a Cardiologist, I often refer patients and families to the website of the Mayo Clinic. The Mayo Clinic has a fantastic online repository of very good health information related to cardiovascular illness, both for children and adults, wonderful illustrations.

Wonderful descriptions of diseases, of procedures, of things related to cardiovascular health. It's written in a way that it's easily consumable by lay people, but it's actually quite useful for professionals as well. So they've actually struck a really nice balance between providing something that's easily digestible, but also packs a lot of there's a lot of signal amongst very little noise, relatively speaking.

So I, again, to sum that up, I try to steer people toward those sources that have sort of that imprimatur of academia or health systems sheen on it, that kind of thing. The final thing I'll say here is, and this is a lesson that I think applies to air other areas in life when it comes to consuming media, something I've tried to teach my children to do, and something I taught to my other family members about, and that is try to approach all these sources with an inquisitive mind. Don't simply take everything at face value. Ask, from where did this information come? So if you go to a source like the Mayo Clinic's website, look and see where they're sourcing their information from, and lo and behold, most of these reliable sites will tell you where that information has come from.

So if you want to do additional research or if you want your physician to help you do additional research, you have a starting point.

Richard J. Chung, MD: I think you made such great points, Angelo, and I agree with you. I think entities like the Mayo Clinic and others have really put out high quality information that threads that needle between having sufficient detail and scientific rigor, but then also making it usable for people who may not have healthcare backgrounds so that they can read it on their own time and really take control so that they're not always beholden to their doctor or other healthcare provider to interpret that information, right?

And that's not an easy thing to do, particularly when you're dealing with complex health conditions. I guess one other aspect, you know, the Kaiser survey, back to that, you know, the federal agencies they described, the CDC, for example, or state departments of health and human services, like our wonderful North Carolina DHHS, were still high on that list of trustable sources.

And, and I think there was a lot of complexity during COVID-19 just because they were saddled with interpreting what really nobody understood at the time, and then making that easy to communicate and disseminate to a broad swath of a diverse community, particularly when the information was constantly changing.

Right. And so I don't know that our broader public really understood just how challenging that was. And so that if there was any wrinkle in the information that needed to be ironed out subsequently as the science came out, they were in tune for that but sort of in an unfair way. And so. How do you talk to families about the CDC or these broader public health entities that are governmental in nature when we're kind of in the wake of the COVID-19 pandemic and some of those questions have been raised?

Angelo Milazzo, MD: Well, I'm reassured by the findings of that study. It seemed, based on what we saw in the popular press, as you say, that a lot of our public institutions took a beating during the pandemic. And we know that there were secretaries of state departments of health and human services and related professionals who left public health directly because of what went on.

The mistrust, the pushback, the voices of non experts becoming louder and louder and louder to the point where these people felt professionally, and in some cases, personally threatened. So, despite those headlines, it's kind of nice to hear that people still do have faith in these state, regional, federal experts.

And, knowing some of these people personally, people who've done that work here in our state of North Carolina, some of whom are now working, friends of yours and mine who are working at the federal level including some very close colleagues who are doing this work; we know that these folks are so well intentioned.

We know that these folks have a passion for delivering accurate, usable, actionable information, and they truly want to create healthy populations. I'll also say I have a personal stake in this. My daughter is a graduate student in public health right now, and I see that same drive, that same mission, that same passion.

I hear it when I talk to her about her studies and the work she wants to do. So I'm encouraged about the present and even more encouraged about the future. I think, as I alluded to before, expertise as a concept has been challenged and will continue to be challenged. And it's not just going to be in healthcare.

It's going to be in other areas too. The whole role of federal agencies is actually, this is being adjudicated in the courts right now. There is this idea that one part of law has always been administrative law, and administrative law has been one of the pillars of the way we think about regulations and, related legislation in this country; that may be changing and that's going to be a very interesting change to negotiate the role of experts and the application of expertise. The rules of engagement may be modified in the coming years. So we're going to have to be really, deliberate, really cautious, really focused on our relationship to experts and our relationship to the information that they provide. The final thing I'll say in this piece is that when we're looking at the information coming from experts and expert agencies, what I find really refreshing, at least in the information that I've had the opportunity to consume, is that in most cases, it's not presented as dogma.

It's presented as here's the best that we know today. I think we saw a lot of that during the pandemic and the response. And I think that threw some people for a loop. The idea that an expert could think one thing at one point in time and then using information, using data, revise that opinion, change that opinion.

I think that in some senses, shook people's confidence, but to me and probably to most people like us, that actually reinforced our faith because we know that they're constantly looking at changing information and adapting their policies, their procedures, their principles to that new information.

Richard J. Chung, MD: That's such a good point. That idea that flexibility in the face of new information coming, being willing to quote correct yourself when new information comes to light is actually a marker of somebody who's trustworthy versus the opposite. And, you know, I was thinking about kind of what are the red flags?

So we've talked about what types of sources should you gravitate towards? But I guess the other piece is what should you shy away from? Like what are the red flags that a particular source of information might actually not be worth your time and might actually be harmful in some form or fashion? And among those red flags might be a source that is not open to new ideas, not receptive to questioning who a source that is too black and white and too staunch. And is so clearly trying to push forward a particular conclusion or agenda. I think others that come to mind would be a source of information or a story that is very emotionally charged, one that draws out either positive or negative emotions in a strong way and demands action on the face or in view of those emotions rather than the facts.

And then one that really seems too good to be true. Or too bad to be true, right? Something that is extreme in nature, that really, as you alluded to before, really needs to be verified. You know, I think back to one of my favorite shows back in the day, this was maybe 10 years ago, a show called The Newsroom, right?

Where it was broadcast news and it it was a fictional story, of course, but showed how the reporters kind of went about putting together stories, and I remember always that there would be this really alluring headline, but that they would have to hold things back until they got confirmation, right?

Until they got at least a second source of reputable information before they actually took it to the bank. And I think that's a good example for us, right? So you hear something someplace, but you need confirmation. You need a second source at least before you make a health decision or do something specific in view of that information uh, does that resonate with you, Angelo?

Angelo Milazzo, MD: Yeah it resonates. And I also enjoyed that show. Jeff Daniels was amazing. The writing. I think that was an Aaron Sorkin show, an Aaron Sorkin, Penn show. And like most of his work, just really gripping and really fascinating. Yeah. You've raised a really interesting point. What I have thought in recent times is with the proliferation of news sources in the digital world, what I have seen is a blurring of the lines between traditional news reporting and what we would call op ed reporting.

And in some cases, I think, what we're getting is a fusion of both. When anyone can publish, when anyone can put up a website or a blog or go to a place where they can offer information to the world, there is that risk that we lose that definition between what is reportage and what is opinion.

I think the best writers, the best writers of fact and the best reporters of the news can inject a little bit of personality into the way that they write without crossing the line. And again, not to blame everything on what's happened in the last few years, but what we have seen in recent times, what we've dealt with a lot as physicians in terms of helping our patients and families understand information is we have seen what would otherwise have been traditional sources of news and information may be contaminated by some of this tendency to offer an opinion or to reflect on something without simply describing it.

So let me turn that question to you, in respect or with respect to these sources potentially not being pure, potentially being contaminated, what has been your approach to sifting through this information? How have you helped patients and families try to navigate that?

Richard J. Chung, MD: I think it's a great question and I'll think about my clinical practice first and foremost. So as you know, Angelo, I work mostly with teens and young adults and developmentally, they're in a stage where they are in between, right? Depending on their parents or guardians or other caring adults, to wade through the information and bring it to bear on particular health decisions.

But they're also naturally and appropriately gravitating towards more autonomous decision making, right? Where maybe for the first time, they're actually trying to connect the dots between a variety of different sources of information. And a lot of that is not the Mayo Clinic website or straight from Dr. Angelo Milazzo's mouth, you know?

It is also my friend and social media. And my older sibling and a variety of sources. And I think those are all relevant and reasonable places to bring your curiosity and uncertainty when you're trying to come to some sort of decision. And it's not always, you know, Hey, should I take this medicine or not?

Or should I do this medical test or not? It's should I eat this way? Or should I try this particular health behavior? Or should I exercise in this way? You know, all these sorts of day to day decisions that oftentimes we as healthcare providers are oblivious to, right? Because it happens continuously and not just in the context of healthcare.

And so I think it, it really draws to fore just how important this conversation is. And I think, again, I come back to kind of those red flags, when you feel like there's a pressured sale, right? Somebody's trying to get you to close the deal on a particular health decision. You know, I do a lot of work around vaping and smoking, and that's a very concrete example.

And I talk to young people all the time as to kind of how did they start in on that particular health behavior? And it's always very complicated, right, in terms of that conversation and that situation and the social pressures and the emotional valence of that particular moment. And so, it can be challenging.

And so I think helping young people really develop their skill set around navigating those moments and discerning what's true and untrue, helpful and unhelpful in a particular moment. But again, not undermining the value of a peer, even, right? A same age peer, a kid who may actually have in hand, useful health information because they themselves have received it from somewhere else, a trustable source.

Like that could be even more impactful in the decision making of a teenager than it coming straight from me as their doctor. And so, I'm not sure I answered your question, Angelo, entirely, but just to kind of, maybe I just kind of added more confusion to the mix. But I, I think it's a really great question and one that I wrestle with constantly as I work with young people.

Angelo Milazzo, MD: I want to dive into your example a little bit more deeply if we can. So with your adolescent, teen, young adult patients where you're doing cessation counseling or you're talking to them about the use of nicotine containing products or tobacco containing products, in a very specific way, in a very specific sense, where are they getting most of their information?

Is it from TikTok? Is it from kids at school? Is it from mom and dad? Is it a combination of all those things? But are there certain sources that they're more frequently talking to you about and asking you, and part two, are they asking you to help them evaluate those sources?

Richard J. Chung, MD: Yeah, I think it's all of the above. I think for a lot of these issues, let's take vaping as the concrete example, because it's such a prevalent issue and ubiquitous in terms of the different influences that make up the broader ecosystem of, let's say, an individual teen's life, they're glimpsing pieces of information in a variety of different sources.

And so, when they come to the point of for themselves making a decision around whether they want to do it or not, they've really accrued a lot of different perspective from peers, from the internet, from social media, TikTok in particular, but others as well. Maybe they've heard about it from parents or other caring adults, maybe not.

Hopefully, they've heard about it from healthcare providers in the past. Now, what are the relative sizes or proportions of their brain that each of those pieces take up? It's hard to say, right? And that can vary. Maybe my words take a very small part of their brain in terms of their decision making at the end of the day.

And, and then there's the recency of the TikTok video they viewed just this morning that may have an outsized impact on their decision that night. And so, I think it's just a really complicated environment and we can and should always try to bring highest quality, positive sources of information into the lives of young people and their families.

Like that's definitely one task. The other task that I thought I would raise here actually is this idea of helping young people and their families become increasingly media literate. You know, we as pediatricians are developmental experts, right? And one thing we can and should be thinking about for kids and youth is particularly in this kind of digital environment.

How do we raise them up to be productive, savvy, healthy consumers of health information in their own right. We can't always spoon feed highest quality information to them, particularly as they launch into the world independently. So part of our job is to raise them up to be effective so that, when they're an adult, when they're off at college, when they're independently navigating these things, they are well equipped to discern fact from fiction and to figure out what they want to, based on their own values, apply to their own life and, I don't know that we always pay heed to that. You know, as parents or clinicians, really raising them up to do this on their own versus just kind of doing it for them, which is often our instinct.

Angelo Milazzo, MD: Yeah, it's fantastic question, Richard. I see it, I and say this from the perspective of someone who is not a general pediatrician, but I'm going to lean heavily here on what I've learned from people like you and the work, you know, of our colleagues in primary care who are really focusing on these issues. I see it as the modern version of reading to your child at night.

I think the way we create an environment where young people can safely adjudicate these sources is by participating with them directly. Again, I didn't create this idea. There's some very good guidelines published by the American Academy of Pediatrics. We can potentially link to those in the notes for this show.

I would encourage patients and families to seek them out because it's, it's really been well specked out. But what I will say is that parents should dedicate some time in the day to sit with the child and look at social media with them, understand the sources, or sample the sources that their children are evaluating in their private time.

Now, there are going to be some negotiations that are going to have to go on depending on the age of the child and all sorts of complexities around sensitivity and around devices and security and you know, we could talk all week about the intricacies of that. But I do think you need to start early. There have been some very specific guidelines about how early in life children should be exposed to social media. Again, people can go reference them. But when we talk about those earliest stages of exposure beyond just the FaceTime calls and things of that sort, when they're really interacting with the technology.

So they're going on the sites and they're reading posts and they're looking at influencers and they're consuming all these amazing media sources. That's when I think mom and dad or guardian or grandparents or whomever is primary in that child's life, needs to get personally involved with how these children are interacting with these tools.

You know, it's so easy to blame the tools. It's such a convenient boogeyman. It's such a convenient scapegoat. And I can remember the same, you know, I'm a child of the late 70s, early 80s, and I can remember the same conversations around video games, the same conversation around hip hop music and, putting warning labels on things.

So it's really that type of conversation translated to a different time, a different context. But I think the themes are the same. I don't think we should just say these media tools are bad. I think we should say they are tools and we either use them responsibly or we don't. We either help and guide our children to use them responsibly or we don't.

So I think we have a very active role to play as pediatricians, as clinicians, as healthcare providers, working with families and children, coming up with a digital media plan. And the last thing I'll say here is I'm going to lean a little bit on the work of a specific colleague that you and I both know.

I recently had a chance to hear him speak in person and was fascinated. Dr. David Hill, who is well known in our community and has led this work nationally for the American Academy of Pediatrics. And you and I were at a conference where you also spoke and gave, by the way, an amazing presentation on we were talking about vaping, tobacco and nicotine containing products.

You absolutely gave a fascinating talk about that, but David gave the keynote and in his keynote, he did a really nice survey of the available literature on social media, the impact on children on their mental behavioral health, on their development, et cetera, and so on. And what I learned that day is that the jury is out. There are studies and there are data on both sides of the argument. For every study that you can find that suggests that there may be harm, we can find other studies that suggest there may be benefit. There are some children, and, you know this better than I do, who find themselves on islands. They find themselves without a community with which to engage. Whether it's because of an emotional issue or a psychological problem or a medical concern or even just a an issue related to school or to social behavior or to their interactions with the world.

And they are turning increasingly to social media as a haven, as a refuge. And Dr. Hill brought that out in his conversation, in his keynote address. And it was a really, really fascinating topic to hear more about. And again, this is backed by data. This isn't just theoretical. I say all this, again, to emphasize that it's much too convenient, it's much too easy to indict the technology. We need to be responsible shepherds of the technology. We need to help children and help families navigate the controversies, the complications, the pitfalls. To borrow from another great thinker, with great power comes great responsibility, right? That's exactly what we have to be here is we have to be responsible.

Richard J. Chung, MD: Well said, Angelo. I think you hit on so many critical points and I agree with you wholeheartedly that social media or other technological tools are just tools, right? And like with any tool, it can be used well and productively, or it can be used poorly in a way that might be harmful. And I think the other point that I want to kind of double click on is this idea that what we're going through as caring adults, helping young people navigate the current ecosystem has a lot of parallels to things that you and I dealt with when we were teens and our parents were also wrestling with these same sort of dynamics.

Now, it's different, but it's also fundamentally the same in some way. That's what we talk to parents about all the time when they feel kind of overwhelmed or bewildered by the TikToks and the Instagrams and the technological tools. Truthfully, they don't feel as comfortable and they don't feel like they can kind of wade into those conversations because they don't understand the tools, but they understand broader principles, right?

Around what's harmful versus helpful and how to help young people take pieces of information, put them together and come to decisions. And that isn't fundamentally different than it was back in the 1980s or the 1990s. The overlay is different, right? The decisions are different, but the fundamental principles and the values and the concepts around shepherding young people forward in a positive way is largely the same.

And so my hope is that that helps parents and guardians, even if they feel bewildered by the tools still feel confident in their wisdom and capacity as parents and guardians to really move things forward for their young people. And so, uh, so that they don't kind of check out and wash their hands of the process, but really stay engaged. I think that's really critical as you highlighted.

Angelo Milazzo, MD: Yeah, that's as usual, perfectly said, perfectly articulated, Richard. And, you talk about these tools. I think we would be remiss if we didn't cover this new generation of tools, the next iteration of technology. You and I are beginning to see our institution apply some of these new electronic tools to our work as physicians, but I'm really curious and would love to get your perspective on where you think we're headed.

And, AI has become a buzzword in virtually every industry, virtually every conversation, you know, all the media headlines we hear today are about how AI is going to revolutionize everything from finance to science, to the legal profession, you name it. No end to the possibilities here.

And many conversations about, you know, we talk about power and responsibility. How do we harness the power of artificial intelligence in a responsible way? Well, what about the ramifications that may extend to personal health information? To not only the way you and I manage patients, but the way patients are engaging with these tools to get answers about information.

So it was one thing for our patients to get a consult with Dr. Google. It's a whole other thing for our patients to get a consult with Dr. ChatGPT. And I'm not trying to indict any particular search engine or AI interface. I'm just using the popular examples. So I'd love to hear your take on this issue. Obviously a complicated issue and we're still learning, but where are you in your thinking on this today?

Richard J. Chung, MD: I think it's a great question and on point in terms of this conversation, because that is the new frontier, certainly. I think all of the things we've talked about in terms of the rapidity of technological change and the evolution of different tools that people are using for different purposes, it's just even more accelerated, right, with AI. It feels like we're not even on an annual cadence with new updates. It's monthly even, and it's hard to keep up. And I think the first thing for me as a clinician, and for me as a parent as well, of young people, is to try to stay abreast of what's going on, but to have a deep sense of humility, right?

Because I know for a fact that I cannot and will not ever be at the vanguard of all of the AI advancements. And so at some level, I think with our patients and families, we're kind of learning together, right? And so that's where that relationship comes into play. I don't know that anybody would make an appointment to see me, to ask me about AI questions, right?

That isn't my zone of expertise, but it's relevant to my zone of expertise. And so I need to at least be in the game. I need to be in the conversation and have sufficient familiarity and also have deep reverence for the fact that many of my patients, even teenagers, are experts, have more expertise, have more knowledge than I do, and so I need to be learning from them as well as a means of understanding their own personal experience and then also building myself up as a useful adult in their life.

And so I think a lot of the, and that's uncomfortable as a clinician, right? We love to be in a position of expertise where we are unidirectionally informing a decision, but more and more nowadays, we're sort of at level with our patients and families in terms of the amount of knowledge or expertise we might have and ChatGPT is a good example and in preparation for today's conversation, I actually asked I asked ChatGPT I asked them is ChatGPT a good source of trustworthy health information?

And I was actually impressed with ChatGPT's self awareness. So what ChatGPT said was, while I can provide general information and guidance on a wide range of topics, including health, it's essential to understand that I am an AI language model and not a substitute for professional medical advice, and it goes on to say that, my responses are based on the inputs, right, the data that it was trained on as of a particular point in time, and so it's limited by the quality of the input data, right? And so, I'm glad to know that at least ChatGPT among the different AI interfaces is not purporting to replace Angelo Milazzo or Richard Chung or the other healthcare professional. And, I'm glad that at the end of the day, it is pointing people back to these trusted human relationships, right, that can really navigate information, but do it in a way that's truly personalized to the human lived experience of an individual patient and family, which I think is the enduring value of that healthcare relationship as compared to technological tools. And so, Angelo, you know more about AI than I do. So I'm curious what you're going to say.

Angelo Milazzo, MD: I don't think that's true. We have fulfilled the criteria of the Turing test. We now have machines that can convincingly articulate themselves as if they were human or, semi human. The response you got from ChatGPT sounds relatively fair minded to me, like it might have been spoken by a professional colleague.

So I think we've checked that box. Turing test passed. No, I agree wholeheartedly and fully with what you said. And in a way it sort of summarizes what we've been talking about today. And that is, it, at the center of all these conversations, at the center of all of these interactions, is the relationship that we have with our patients and their families. And once that is built on a solid foundation, then we are in a position to be able to help them navigate these sources, whether those sources are their local public health official, whether it's ChatGPT, whether it's a colleague here at Duke, whether it's an influencer on TikTok, we can't begin to have any credibility in that exchange if we don't already have that pre-existing human relationship. So that is where it starts. That's our privilege as physicians that we get to enter into that kind of bilateral exchange, that bilateral confederacy, so to speak, with our patients and their families. From that position, we can then help them understand all this information that's coming at them at, you know, increasingly larger velocities.

I think AI, again, as I said before, it's going to sound like I'm repeating myself; it is a tool. And we are all learning as we are applying it today. So we are all of us, engaged in this conversation about the responsible use of artificial intelligence. And, so that our listeners understand, we're beginning to apply that here at Duke and at many other health centers across the country in the care of patients, whether it's doing a first pass response to an incoming patient message.

Whether it's helping us summarize medical literature, which is actually something AI turns out to be very, very good at doing, or whether it's helping us prepare educational information for patients. Those are three of the most common usages that we're engaged in today in partnership with the developers.

So, again, so that people know, our institution has a very vigorous partnership with Microsoft. Other institutions have those relationships with other developers. So, it's good to see that the people who are literally programming these models want to engage with us directly to help us apply their models so that they continue, they can continue to learn what the strengths and weaknesses of those models are. I'll summarize this by saying it all comes back to that human to human interaction, regardless of the tool, whether it's social media, whether it's an app on your phone, whether it's artificial intelligence, natural language engine, whatever it is, it's all predicated upon the way you and I interact with the patients who we are fortunate to be able to take care of.

Richard J. Chung, MD: Well said Angelo. I'd like to kind of bring us home in this conversation by taking a step back and reflecting on the podcast itself. You know, podcast is a mechanism for disseminating health information and just the privileged opportunity that you and I have had to partner in this effort.

And, one common question we ask of our guests, not all episodes, but many episodes, is what inspires you most day to day? And I guess my question to you, Angelo, in all of the episodes you recorded, all the conversations you've had, if you had to distill it down, what about those conversations has inspired you most at this point?

Angelo Milazzo, MD: I think we talked a little bit about this the first time we collaborated on an episode and did a sort of a mini review of our first season. And I'm going to restate what I said at that time, or at least try to capture the spirit of what I said. What really has energized me in doing this podcast, and it came at a perfect time, again, to use the pandemic as a mile marker in our professional and personal lives, it sort of came as we were entering the dying days of the most significant part of the public health emergency.

This, fell into our laps, this opportunity to engage with our patients and families in this brand new way. So it really recharged my batteries in terms of reminding me how important my professional relationships are. I mean, the guests that I've had on the show have taught me something in every single conversation, not just about the science and the research and the healthcare that they provide, but also about themselves as individuals.

I think that's really, really important. I think each of them in their professional work, I would dare say, each of them bring a little bit of that into their engagement with their patients and their families. And that really came out in the conversations. These folks are committed. They are passionate about what they do.

They love talking about what they do and they love engaging. They want that engagement. I think you and I are the same. I think you and I crave that communication. And, you know, I'll summarize this by saying that the most important thing we do as healthcare professionals is communicate. When potential future doctors ask me, what's the most important course I'm going to take in college?

I say it's your reading and writing courses, it's your English literature, it's your you know, romance novel survey course, it's your Shakespeare survey course, it's your history classes. Those courses where we learn to communicate, where we learn to talk to one another, where we learn to, as, we said today, evaluate primary sources.

Those are the skills that to me translate so much more effectively than your score in your organic chemistry class in your sophomore year in college. Sorry, a long winded and complicated and discursive answer to your question, but I felt like it deserved it. So let me, turn that on you. What have you drawn most out of this experience sharing hosting duties for Pediatric Voices over the last year or so?

Richard J. Chung, MD: Yeah, Angelo, I resonate with everything you've said, and it really is the same as my response to that question. It's kind of the common humanity that I see in all of the people that we've had conversation with, and also how that humanity connects back to individual patients and their families. Whether you are mostly in a lab pipetting things, whether you are behind the screen of a computer programming things, whether you are at the state capitol negotiating with decision makers around health policy, whether you are at the bedside caring for somebody in a clinic, whether you're in the ER or the hospital, all of these different vantage points within an academic health center like Duke.

It feels like everybody is doing very different things, but at a core level, we're all doing the same. It's human beings driven by a passion for the well being of children and their families, finding ways to express that passion and have impact in a variety of different places. And it all rolls up into the power of an entity like Duke or similar entities, where we are trying to advance the science, but also taking care of patients today and impacting lives today, all of the above.

And I think that's hugely inspiring to have these conversations and to know that these amazing brilliant colleagues at the end of the day, are all driven by kind of that same core motivation. I think the other thing I will say, which I think we also mentioned in the past is just the beauty of conversation, long form conversation and how despite reels and TikToks and short form bursts of information and stimulation, how useful they can be, frankly, and how satisfying they are for most, if not all of us.

These long form conversations will always have a substantial place in terms of how we communicate information, how we cultivate relationship, and how we live, frankly, as members of our community. And I think podcasting is just so much fun because of that. You don't often get the chance to have a free ranging, long form conversation with somebody to explore their lives and their work in this kind of way. And I think that's why podcasting has really taken off and I think will be here to stay. And so, thank you, Angelo, for indulging me in this conversation today, for being a co-host of the show. It's been a real privilege for me.

Angelo Milazzo, MD: I'm pausing to let your words hang in the ether here for a moment, Richard, because it's just the perfect way to summarize today's conversation. I don't want to be that sportscaster who talks over the walk off home run. I want to let people savor it because it's worth savoring. So hopefully folks will rewind, press that 15 second or that 30 second rewind key on your device and listen to Richard again.

But likewise, my friend, it has been an honor and a privilege and I would do it all over again in a heartbeat. It's, been so much fun co-hosting these first two seasons with you. So with that, I am going to say goodbye to our audience. Pediatric Voices is brought to you by Duke Children's Hospital and the Department of Pediatrics at the Duke University Medical Center here in sunny Durham, North Carolina.

The show was created by Dr. Richard Chung, and by me. Courtney Sparrow keeps us on track and she organizes our work. Thank you, Courtney. Special thanks to Debbie Taylor and to our Chair of Pediatrics, Dr. Anne Reed for her support. And also, of course, thanks to the wonderful people at DoctorPodcasting. You can find our show and hit the subscribe button wherever you find your favorite podcasts.

You can connect with us on social media, including our website, which is pediatrics.duke.edu/podcats. You can also connect with us at dukechildrens.org. We would love to hear from you. We would love your feedback. So please leave us a review at your favorite podcast aggregator or application. Thank you all so much for being the most important part of the show. We'll see you next time.