Dr. Julie Wood Spills the Tea on Brain Health Advancements

[00:00:04] Welcome to HITea With Grace, where we spill the tea on HIT. Today I'm honored to welcome to the pod Dr. Julie Wood, Senior Medical Director at Linus Health. Thanks for joining me today, Dr. Wood. Thanks, I'm glad to be here. So you have spent nearly 30 years as a practicing family physician and held senior leadership at the Academy of Family Physicians. Amazing. What was the moment or experience that made you realize brain health needed a fundamentally different approach in primary care?

[00:00:32] I worked a lot on clinical strategy and various types of resources and education for clinicians at my last role. And it was becoming increasingly aware. It wasn't like a one point in time, aha moment, but it was becoming really aware that we were doing a good job of taking care of patients that already had dementia and getting the information out. But it was very current state. And I said, we're going to have to start working and started working with our team to look to the future state and what was needed for that front line of primary care that's so important.

[00:01:01] So it was more of a coming together of several things. Wow. Did you have any personal experiences that kind of informed that as well? I do from my practice years and some of it also is from my own relatives. So sadly, as most of us would have some experience with a patient with dementia or a family member with dementia. So I had my mother-in-law and my own grandma. So seeing that from the family side, I think is really important as well on how you integrate that because the caregivers are important.

[00:01:30] The clinicians are important. And there's so many things that have to occur. And we're learning more and more that the workflows as far as practicality is what we really need to be working on to make this viable. So sorry to hear that, but it's so true. It does seem that the caregiving aspect people do overlook often and it is critical in this area. Primary care already does a great job framing heart disease, diabetes and cancer risk around prevention, whole person health.

[00:01:55] Why does brain health historically, why has it lagged behind that model and what needs to change there? I think there's a lot there. I think a lot of it's stigma, honestly. And we don't always think about the brain except for disease. We have a disease model in our health care non-system, I like to call it. But I think because it's not thought of as a preventive thing. There's a stigma about having the diagnosis or about having some brain health problems, but there's more brain health than dementia.

[00:02:24] So there's a lot of things we can do to keep our brains healthy. But I don't think we've put it in that context. And like you said, it's just exactly that way. We've learned a lot about heart health, about diabetes prevention and treatment. But we don't think about our brains, which is kind of an ironic statement. So I think that's where we really need to start. So it's between reframing it within health care and including it. So putting the brain back in the body. And I love the whole person health initiatives. And I think that's really important.

[00:02:53] And so that's a great place for us to start doing that. But I also think thinking about it before somebody turns 65. Thinking about it when they're in their 30s or earlier. So it's a part of the physical exam that have that discussion. Because so much of it is interrelated. I love that idea of putting the brain back into the body. And it really, truly is the way to see this topic of brain health. And how critical it is to really see it more as preventative and whole person care.

[00:03:19] In addition to diagnosis and all the other things that are involved right in brain health, generally speaking. I have been following your work for a while. You and Linus. You are an amazing human being. And Linus is an amazing company. Everybody should take a look at them. And you've talked about in the past tension between wanting to address cognitive concerns in that busy primary care visit. Right? But really having limited time and tools to do that well and properly.

[00:03:44] Can you paint a picture of what it actually looks like day to day for a family physician? Who's kind of turned into a neuroscientist many times when you think about it. When it comes to brain health and trying to assess that. I think one of the tensions is we have to turn into a lot of different things to do a good job if we're taking care of a person throughout their life. So there's chronic disease management. There's wellness and prevention are two big parts of it. And those things all take time to do well.

[00:04:12] And I know when I've been out of clinical practice a while. But one of the reasons I actually left is because I felt like I couldn't do a good job and do what I was trained to do and knew to do. But I had pressures and so many of our other clinicians do that we work with to see somebody every 15 minutes or less. Sometimes it's eight minutes. And you can't do a good job. And that really wears on your soul when you can't do that. I mean, that's hard.

[00:04:40] And clinicians want to do a good job. Family physicians want to do a good job. And the way our payment system is set up, I think, is part of the tension because there's a lot of productivity most of the time. So day-to-day is a little bit hard because if you've seen one family physician, you've seen one family physician. They all do different kinds of things. They adapt to their communities on what's needed. But it's a time factor is the hard thing. Because even if you're in your own practice, which is less common these days, most are employed.

[00:05:08] But there are a lot of pressures from a lot of different ways to go. And we do want to see all the people we need to see. But for things like what we're talking about today, looking at brain health, mental health, those kind of things just can't be rushed. And you don't want to rush the wellness either. So that's that tension that I feel. And I've been to meetings where they've said to me or others in the room, as some of the only primary care docs sometimes, you guys just don't care.

[00:05:34] That really upset me when I was at a meeting and they had already created the solution for primary care without asking us. So I think that's challenging when you, it's not that people don't care. It's the pressures of the time that makes it really hard. That makes so much sense. And you really help paint the picture there of what you're going through. And you want to be able to do the best job possible in the amount of time that you're allotted. And I think this is a good segue into AI, right? We just got to kind of dive right in.

[00:06:03] And we've been hearing about this. Can I share one other thing with you? Oh, sure. I'm going to interrupt your question. There's one thing that really helped me understand. And it's helped others understand when I get that you don't care. Not me personally, but as a primary care doc. And you're not paying attention to what you need to pay attention to. There was a study that came out in, I believe it was 2022. It was in the Journal of the Society of General Internal Medicine. And they wanted to look at some of these time pressures, especially on preventive things. And they found out that to do all the things that are recommended in the literature that

[00:06:33] are accepted as standard of care, it would take a primary care doctor 27 hours a day to do the, not to do the illness, but to do all the screen. My jaw is literally dropped for those of you that want to know. I interrupted you because I really think that's important. So I'm sorry I interrupted your AI question because I think that's a great segue. But that was without documentation. So there's still, and that's without all the other things that happen during the day and the chronic disease management. That's the preventive things.

[00:06:59] If you did all the accepted recommendations, working it through with the patient and taking care of that, and you need to do that. Right. And so like, how do you do that? Right. And I guess that is the perfect segue. And I'm so glad you, cool, unquote interrupted. You're not interrupted. This is your time, right? I want to hear from you, but like, you're right. Like, if you have to be working 27 hours a day to do what you know the patients and caregivers need you to do the job you want to get done right, obviously, what are we going to do with

[00:07:29] staffing pressures the way they are, with reimbursement the way it is? It is, you have to utilize AI to get smart, right? And work smart and try to figure out how to do these tests and get the information that you need from the patient and caregiver to help them the best way you can. And I think it's part of a team too. It's really important. How do you explain the importance of some AI-enabled cognitive assessment tests now when it comes to Alzheimer's? What are they? One.

[00:07:58] And then how are you explaining that to clinicians who are used to relying on paper-based screening and other kind of screening tools that take a lot longer? So they're really great to have. What I've been working a lot with are AI-based tools that help look at potentially risks of dementia or other cognitive impairment? And you mentioned the paper and pen issue or paper and pencil. And I get that question a lot, especially from the clinicians or the MAs or whomever's

[00:08:27] administering the test. They don't take very long, which is great. But why can't I just keep using my pen and paper? And that's a question I get probably at least, if not daily, definitely several times a week from clinicians. And especially when you're used to a workflow of using that pen and paper. The great thing about the AI components and what I work with is on an iPad. And the patient draws different things that we ask. And there's a process to that. So there's time it takes.

[00:08:56] And one of the common ones is drawing a clock. And if you draw a pen and paper clock, you might do a pretty darn good job. And this is what the clinicians are always asking me. Well, that clock looks pretty good. And our test will grade. I'm using grade kind of loosely. It grades several different things. And it looks at hundreds of metrics, actually. But it includes the time that it takes you to draw the circle. Does the circle look correct? And so there's different things that have happened within a cognitive assessment to give you more data.

[00:09:26] And that AI is fantastic about looking at those latencies, the tilt of the pencil. It could pick up trimmer. A lot of different things that can really give us some idea. And they may say, the results may say, that we do a red, yellow, green system. So green means not currently having a problem. Yellow is kind of borderline, if you will. And then red means we really got to work this up. The yellows are the hard ones, I think, often. And it's what do we do with that? And the nice thing about the AI is it gives some input on here's what you can do.

[00:09:56] And here's what this is looking like it could be. Or this person is just a bit at risk. Let's screen them more often. That's a long answer to your question. And I could talk about that for hours because the science behind it is really cool and really helpful. It's truly incredible. And that's what AI should be doing, right? AI should be doing all the things that AI does well so that the clinicians can be doing what they do well and be giving that time to the patient and caregiver the way that they'd like to. I'd like to talk a little bit, too, about access.

[00:10:25] Now, access to brain health specialists, it's a huge bottleneck. My grandfather actually had dementia. And it was just such a nightmare to find a brain health specialist where he lived and get him the diagnosis he needed to get the support he needed. And it just took forever. But this is true, especially in rural and underserved communities. How do you see AI-supported tools in primary care changing that referral dynamic between generalists and specialists?

[00:10:54] It's a great question. A lot of times, I think, as you're trying to get in maybe to a memory care type of situation, a clinic or a brain health specialist, it's that there's not a lot that's been done already or not as much as could be helpful. And what's helping with these AI tools is it's helping streamline, here's a person that has some concerns. And then we can provide some clinical decision support along with that and see, is this person eligible for a biomarker based on what we know?

[00:11:22] Is this person eligible for other testing? And one of the keys, I think, to this, too, is looking at reversible causes, particularly in primary care. Not only can we do preventive things, we can look at reversible causes and we can address those before they even get to that brain health specialist. And so I think that helps. And sometimes, even if there's a lag, we can be working on those other lifestyle modifications, changes in medications that can make a big difference, address vitamin deficiencies, things like that. All of those are really important.

[00:11:51] So we can be doing that concurrently. But if we also know, and particularly in systems where they're working well with neurology and other brain health specialists, is having a plan when we have that testing done in the office with the AI and it says red flag or yellow flag, that we've already worked with our colleagues in the specialty arena to say, here's a pathway we'll take and make sure that we're all on the same page. This is the hard part because computers don't talk to each other within the EMRs.

[00:12:21] And so there's things that are challenging and it's not as simple. I'm kind of talking ideal state. But there's some exemplars, I would say, that their systems have worked that all out already. So if all this can occur in primary care, you're optimizing the patient, you're optimizing the workup, then the neurologist is like, yeah, send them on. And some people have really decreased their time to getting to because they know they don't have to do all those things as a start. They know that they're already done. They know what they want.

[00:12:45] And we have done the upfront work to help the patient get as well as they can and then have all the information to send right away or have available in their EMR when they go see the memory care person. So I think that's two front, twofold. It's having the ability to do all that ahead of time. So it's not starting. And then the neurology team understanding that when we get a patient that's had all this done, we can really get going and decide what's going on. So fascinating.

[00:13:11] Now, it seems like every single day there's a new disease modifying Alzheimer's treatment and it's a shock to the system. Like everyone's like, what? This is crazy. And it seems like it's every day, maybe once a month. I mean, it's often. Do you feel that there are pressure that's putting pressure on health systems to identify patients earlier? And do you think that patients are calling for that too? And how does that shift the urgency around the work that you're doing and doing more AI

[00:13:39] based assessments when it comes to Alzheimer's and having that be more involved in the primary care and within the health systems themselves? Oh, I think it definitely is a pressure and a push, but I don't think it's the only one. There's select people at the right time that are eligible for those treatments, which is great, but it's not everybody. So the point is, I think that we can catch those earlier before. Oftentimes, that's the nice thing about the AI too, is that it helps pick up pre-symptomatic, if you will.

[00:14:08] So maybe a person, when they come in for their annual Medicare wellness visit, and that is literally for wellness and prevention in my mind. And part of that is supposed to be a cognitive evaluation, but doing one that is more precise and gives you more data from the AI and doing that each year and longitudinally and tracking progress and seeing, oh, this person has got some changes that show that we might need to track this a little bit more. And then going down that path of that workup.

[00:14:35] So it does accelerate things, I think, and having a systematic way to address it within the primary care practice can be really helpful. So I do think there is some pressure, but I also think the pressure is we have the opportunity now for people to hear that they may have some concern before they're actually noticing the symptoms or their families noticing the symptoms. And you can intervene more. It might be a medicine. It might be a trial. It might be just optimizing their meds or the other things like we talked about earlier. So there's a lot of things that can happen. What excites you the most about where brain health is headed?

[00:15:05] I know you're a leader in family medicine and in public health. And where are you seeing, could you imagine this technology would have existed five or 10 years ago? Not to this practical extent. When I was thinking about AI and doing policy work and things like that, it was more around how do we use this safely? How do we use this? And so it doesn't take over all the things that you hear and read about. That's more what I was thinking about five years ago. And I am very happy to see where we're heading with some practical tools and things that

[00:15:33] can really make a difference in outcomes and help people and their families to have a better quality of life. Well, thank you for the work that you're doing. We are inspired by you. And we're just excited to see where you and Linus Health go and soar to. Now, while my listeners love to hear about what trends in the space, they also love to learn from women leaders like yourself about what drives you. So what are things that you do in your daily life that help you work your best and make a difference?

[00:16:01] I've learned, unfortunately, over time that I have to take care of myself first. And I didn't do that for a long time the way I should have. So I do try to make sure that sleep is really important to me. I'm much better about nutrition. So caring for oneself, that sounds kind of trite, I guess, but it really does make a difference to present your best self and your most healthy self. Absolutely. What are some, obviously, leaders like yourself have to be resilient. So what are some strategies that you've put in place when challenges and obstacles come your way that just keep you going?

[00:16:31] For me, you can probably figure out pretty quickly, I like to talk. And I also find that I have to make myself listen a little bit better. I like listening, but I have to focus on listening because I get very excited and I want to jump in. But collaboration to me is very inspiring and networking and getting the right people together to do something meaningful and actionable. And action is really important to me. I've been in positions where you have good work to do and you have good people around you, but nothing seems to happen. And that's a pet tea of mine.

[00:17:01] It's trying to find things that we can take action on. That might be a small step. And I've learned that over time to take a small step and get it completed instead of trying to eat the whole elephant, as they say. But that's helpful to me is the communication, both the talking and listening, getting the right people together and then collaborating on getting something done and taking action. If you could give your younger self a piece of advice, what would you tell her? Oh, that's a good one. Well, I'll go back to the healthy thing. Take care of yourself. I didn't do that.

[00:17:30] It was very hard to do as a resident. They kept crappy food around for us for free, which was well-meaning. So I would eat that stuff. And so I just did not do well in taking care of myself. So that would be one thing I would tell my younger self. And the other one was to be confident. Go forward with confidence. You got this. And it's very helpful to just kind of look back and think that I don't think I was underconfident, but I don't think I was overly confident. So I need to hit that just right. But be confident in yourself and you'll do well. So inspiring.

[00:17:59] Now to finish this conversation off right, where can our listeners find you online? I am mostly on LinkedIn. It's probably the best place to find me. I do a little Facebook of family stuff, but I don't do that as much as I used to. So I'll check in on people. But for finding me, I would go to LinkedIn, please. Terrific. And I'd be glad to chat with you. Oh, wonderful. Now, before I forget, did you happen to bring tea with you today? I did. Tell me about your mug. So I had a hard time picking because I have some kind of fun, sarcastic ones.

[00:18:27] And I decided maybe since this is our first meeting, that was not the time to bring that one out yet. So I brought a relaxing one. And this is from Big Cedar Lodge, which is one of my favorite places on earth in South Missouri. And it's beautiful. It's relaxing. It smells good. And so when I have my mug here, it reminds me to relax and take deep breaths and enjoy what's going on. I love Big Cedar Lodge. And I think I've been to that one. Is that in Branson? It's south of Branson. It's not in Branson proper because a lot of people say, oh, I don't want to go to Branson.

[00:18:56] Well, it's south of there. And you can go to Branson and do Branson things if you want. But you could go. It's technically in Ridgedale, Missouri. I'm not an emissary for them, I promise. But I just love that place. It's just restoring. Truly. Well, thank you so much for joining us today. We loved learning from you. Thank you. I really enjoyed being here. And thanks to you folks for joining us too. Check out the High Tea with Grace podcast for more interviews with great guests like Dr. Julie Wood today. Cheers. Like a Girl Media is more than a media network. It's a community.

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