The Forefront of Surgical Innovation
Episode 410

Carla Pugh, Professor of Surgery at Stanford University School of Medicine

The Forefront of Surgical Innovation

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The Forefront of Surgical Innovation

Episode 410

Recommended Book:

Siddhartha

Best Way to Contact Carla:

cpugh@stanford.edu

Mentioned Link:

Oura

The Forefront of Surgical Innovation with Carla Pugh, Professor of Surgery at Stanford University School of Medicine transcript powered by Sonix—the best audio to text transcription service

The Forefront of Surgical Innovation with Carla Pugh, Professor of Surgery at Stanford University School of Medicine was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.

Saul Marquez:
Welcome back to the podcast that I have the privilege of hosting Dr. Carla Pugh. She’s a Professor of Surgery at Stanford University School of Medicine. She’s also director of the Technology Enabled Clinical Improvement Center. Her clinical area of expertise is acute care surgery, and her research involves the use of simulation and advanced engineering technologies to develop new approaches for assessing and defining competency in clinical procedural skills. Dr. Pugh holds three patents on the use of sensor and data acquisition technology to measure and characterize hands on clinical skills. Currently, over 200 medical and nursing schools are using one of her sensor enabled training tools for their students and trainees. Her work has received numerous awards from medical and engineering organizations. In 2011, Dr. Pugh received the Presidential Early Career Award for scientists and engineers from President Barack Obama at the White House. She is considered to be a leading international expert on their use of sensors and motion tracking technologies for performance measurement. In 2014, she was invited to give a TED med talk on the potential uses of technology to transform how we measure clinical skills in medicine. Recently, Dr. Pugh was introduced into the American Institute for Medical and Biological Engineering, as well as the American College of Surgeons Academy of Master Surgeon Educators. So it is a true privilege to hear her thoughts on today’s podcast. We’re going to be focusing in on what she believes is most important in healthcare and hearing some of her ideas and beliefs on where health care is going today. So without further ado, just want to give you a warm welcome. Dr. Pugh.

Carla Pugh:
Thank you so much, Saul. I look forward to our minutes and time together that we have this morning. So excited to be here. Thank you.

Saul Marquez:
It’s a privilege. Now, I’d love to ask you, what is it that got you into the medical sector?

Carla Pugh:
That happened when I was five. I went under sort of straight and focused person who I’m after hearing a number of family stories about my great aunt and great grandmother, one on my mom’s side, one of my dad’s side of the family. They were actually midwives and veterinarians, both of them, you know, on the farm in the rural south. And as a five year old, my interpretation of what they did and the stories I heard about them, I assume they were doctors. And so that was my plan going to be like those two amazing women and that, you know, that was my interpretation and never gave up.

Saul Marquez:
That is wonderful. I love that story. And it’s so neat that you just got fixated on it and said, this is what they’re doing. I’m inspired and I’m going for it. And you haven’t looked back since?

Carla Pugh:
No.

Saul Marquez:
That’s so neat. And, you know, one of the things that I find really interesting about your work, Carla, is, is your focus on sensors and measuring, you know, today where we’re in this value based care world where we’re trying to get there. And so measurements have never been more important. I’d love to hear from you what you believe needs to be on health leaders agendas and how you’re approaching that.

Carla Pugh:
Well, I… it’s two areas. I mean, everything to me centers around data and creating new data streams that actually quantify things that were previously are currently only qualitative. And, you know, I think when you look at what guides some of our health care decisions, treatments and policies today, it’s based on years of what I would say good data, but there’s still a fair amount of subjectivity and different ways of interpreting that data. And I think we’ve learned a lot, but I think that now, instead of trying to improve upon some of those areas, patient surveys and things like that, for example, there’s different data, there’s different technology that enables us to collect data that kind of takes out the human and irritation, emotion part of it. And I I don’t see mean to be one of the young persons who totally believes in data in the world. Take over new data and get rid of the old. I think there is I think you have to pay attention to history. I think that there is some truth, definitely truth in qualitative survey and interview data and policies that were handed down. But I think if you take a look at the decisions we’ve made based on that data and combine it with new data, we could get a lot further.

Saul Marquez:
That’s such an interesting thought. And so I’d love to hear some examples of what you’re thinking here.

Carla Pugh:
Well, I mean, I think just for example, wow, if there’s one thing that maybe it’s just funny because it does happen sort of serendipitously. But what a week in my life there was just a preponderance of comments, questioned a news. Articles and things that have come up regarding blood pressure and simply me as a physician who uses sensors for everything. I came in for my physical exam and had a nurse practitioner take my blood pressure. And it was just such an interesting experience for me to be aware of how she placed the blood pressure cuff on my arm. I thought it was loose, but I didn’t say anything. Yeah, I didn’t say anything I like rather than standard. Seems a little more on the loose than the previous 10 years. You know, going in with a year to get an exam and a team where you might lose it. And other times that too. I just let it go because I was curious, like what blood pressure she would come up with when it was loose. I don’t remember what it was because it’s not a big deal. But all I know is that when I got home, because I have a home blood pressure cuff, I did the miniature experiment of one. I put it on tight and looked at the blood pressure and I put it on loosely and looked at the blood pressure. And there was a 30 point difference in…

Saul Marquez:
Was it really?

Carla Pugh:
30 points. I was blown away. That’s a big difference. So then I go back to work. Great. There are a whole lot of companies that have it is the mainstay for people that have high blood pressure or want to know they buy these cuff from Walgreens and, you know, CBS and all these places. And there are millions of people who are taking their blood pressure at home.

Saul Marquez:
Yeah, that’s interesting. So is their…

Carla Pugh:
Our whole system is based is based on. Yes. Take the blood pressure. But we haven’t gone back and look at are we actually getting accurate data? And now we’re I mean, we’re giving medications for years based on a protocol. You take the blood pressure three times. If it’s elevated, then that means you actually have high blood pressure and then you start your medications.

Saul Marquez:
That is really interesting. So this this gap Right. and this very variability right? A lot of folks are saying, hey, take the variability out and you’ll improve outcomes. I mean, how do we do that in this particular instance? There’s so many devices out there.

Carla Pugh:
Yeah. I mean, and so. So there are what I was excited to see is that the ACMA again, that same week, like I said, it was the serendipity and I was inundated with all of these things. But the ACMA American Medical Association that same week put out this call for proposals in terms of local health systems, making it their focus to try and get accurate blood pressure. And it was just interesting that you know this.

Saul Marquez:
And this is after you saw the article after.

Carla Pugh:
I saw that article after I had just come from there and then did my own personal experience. But anyway, I say all that to say is that the conversation has come back to surface and people are looking at what we’ve done in the past. And, you know, I think there was an article that came out that said there’s two parts of it. One, people who take their blood pressure medicine at night time actually have lower blood pressure during the day. And that was one of the recommendations. And then there was some arguments about what is considered hypertension and revisiting all of that data. And should it be know, should we be shooting for 120 over 80 or should we actually be shooting for 1 10? And then others said it should be when 30 we should be more loose. What’s so amazing to me is that all of those recommendations and this is the example, all of those recommendations are based on manual blood pressure cuffs or even the computer blood pressure cuffs. But there’s still a human in the loop in terms of applying that cuff. Right. And so then I’m looking at all of these companies that are trying to get in the space of using sensor technology to actually capture a blood pressure. So forget the cuff. But some of them, as I looked more deeply, they’re actually just miniaturizing the blood pressure cuff and putting it on your wrist. I think there’s a company, Omran, that has and it looks like it looks like a watch. It’s really cool. But then when you get down into the specs of it, it actually still a blood pressure cuff. But even in that instance, because it’s a watch and because it’s standardized, that means that you’re actually not you know, once you decide, you know, what loophole that the watch fits your wrist, then at least it’s consistent data. Yeah, if that makes sense. So that just kind of is an example where all of our research for the past 30 years on blood pressure is based on using a blood pressure cuff. And with this story that I told you that we know that it’s inconsistent, but if you think about a wearable blood pressure sensor, that can actually change the whole game.

Saul Marquez:
Right.

Carla Pugh:
Because now we don’t really know what could only only data that we have of continuous blood pressure monitoring is invasive monitoring within the hospital system when we actually put catheters inside your artery.

Saul Marquez:
Yeah.

Carla Pugh:
But those are usually under it’s usually when you’re in the intensive care unit and you’re very sick. Obviously, we can’t do that invasive study on a healthy person. But now I think this whole week I was like, oh, you know, I wonder what my blood pressure is over… or over a month period. How is it different when I’m exercising it on my game and really getting, you know, my five days a week of exercise did or what is it like when I writing a grant for NIH for four weeks in a row and not sleeping well? Exactly like wake. And then I believe that we actually have to challenge our system like our I mean, our health, our body. And so some of those challenges to your body probably actually makes it better. So when is high blood pressure for a certain number of hours? Okay. We have no idea because we don’t have the data. So anyway, I’ll get off your high horse on that. But that was expect to go down that route. But.

Saul Marquez:
Now that’s interesting.

Carla Pugh:
I said it just it’s a perfect example to me of how we’ve done things historically. We have years and years of just excellent research, but it’s based on a specific way of capturing information that does have some human in the loop potential. And now there’s new technology and new data that actually could completely revamp some of that research, but also further the research that we could do.

Saul Marquez:
So what’s the potential of having a sensor that does measure blood pressure?

Again, I think that we don’t even have a picture of a 24 hour period in the life of a healthy person. What is their blood pressure? In fact, actually, I’ve spoken to a few companies. Again, it just kind of really crazy. I just got inundated with a thing when that happened. That means I need to get in this space and do the work that I did meet a company. I did meet a company that has a wearable sensor that’s actually not a cuff, but it’s really it’s I can’t disclose all the details, but it’s a sensor that can actually detect blood pressure and do it continuously without you actually having to press a button.

Saul Marquez:
Is that right? That’s fascinating.

Carla Pugh:
And they it’s a startup and they actually got over 100 adults to wear it. And they were shocked.

Saul Marquez:
They compare it…

Carla Pugh:
None of them have been diagnosed. Exactly. But none of them have been diagnosed with high blood pressure. But there were times during the day when their blood pressure was high.

Saul Marquez:
Interesting.

Carla Pugh:
I think that it gives us the potential to have a better understanding of human physiology and how the environment impacts our bodies. And I think it’ll spark research in other areas. You know, how does your, how do your lungs respond when you’re spending a week in downtown New York or in a, you know, an area that has car exhaust versus middle of Wisconsin in the woods? Like, how does your body adjust? I mean, I think our body does work. You know, Right. lungs clean up dirty particles and then we’re fine afterwards. But I think it’s different for someone who’s visiting versus someone who lives there.

Saul Marquez:
It’s the situational factors. And, you know, I think about. Have you ever seen the movie Emily?

Carla Pugh:
Emily?

Saul Marquez:
Emily. Yes. French movie, it’s so good. It’s one of our favorites.

Carla Pugh:
I have to add that,.

Saul Marquez:
Yeah, it’s a quirky film and it’s to scale that back sort of grows up in France and in Paris. And it’s her story. It’s a really neat story. But the thing that came to mind is her. Her father, a physician, would examine her. And because he never touched her like he never would like, showed her love or anything like that. The only time she would touch her was during her examinations. And her heart would just like pound very rapidly. And because of that, he felt like she had a heart condition.

Carla Pugh:
Oh, my goodness. Like know, dad, you’re like freaking me the hell out because, like, everyone has some anxiety because you actually want to know you want confirmation immediately that you’re actually doing okay.

Saul Marquez:
Yeah. So to your point. Right..

Carla Pugh:
That’s interesting.

Saul Marquez:
Yeah.

Carla Pugh:
I have to watch that one. And I love both of these stories.

Saul Marquez:
I think you’ll enjoy it. It’s it’s one of our favorites. It’s a really good one. But regardless. Yeah, I mean, you you’re bringing up some really great points. Right. And so we’re gonna have to really examine some of the basic assumptions that have been made for to use. Like you said, you know, quantitative over the qualitative that we’ve been using for a while, this data. So maybe you can share with us a project or research that you’ve done that’s helped improve the way that we do things in healthcare.

Carla Pugh:
Wow. I think that I liked that you feel that I’ve done something and I… I see myself as very much a researcher. And despite all of the amazing opportunities, awards and high accolades, I am I feel like I was still just beginning seriously.

Saul Marquez:
How about a project that sticks out as like this is wonderful. Like this is something that you felt proud of.

Carla Pugh:
Oh, I have a lot of those and I’m so I could get. I will. I mean, I. Because it’s just so exciting. I’m kind of, you know, med scientist type. And then, you know, we go out there with our sensors and do things and learn and every single time we go out, we find something that we are truly excited about. So sticking with cardiovascular health. We had a project where we in a simulated environment, a heart simulator we partnered with. There’s a company called a Kind Heart, and they make really sort of like hybrid simulations. And I think I’ll just be clear, I mean, so similar to airline pilots where they have flight simulators to learn, you know, rare and unusual circumstances in case you have to land on the Hudson River. Right. They practice those things. And so they’ve been doing that since the 19th. I think the link system came out like the 1930s, 1940s. But healthcare and medicine, we’ve only really started getting into simulation probably around the 1980s. So this got a 50 year lead on that. But this one company called Kind Heart and has a hybrid.

Saul Marquez:
I mean, it’s a standard…

Carla Pugh:
Not everyone… Exactly. There are some standards that are coming in, you know, in different areas. But it’s definitely not a holistic standard across healthcare, in medicine. So that’s why I mean, once that happens, then I feel I will achieve my goals. So I that’s the answer to that question. Why? I don’t believe that I’ve arrived yet, because it’s not it’s not a standard across all of health care to use simulation training before we interact or to complement our healthcare training. It’s not a standard. So the example kind heart, those hybrid simulations where the 3D print body cavities out of various silicon techs and in hard plastic materials and then they actually use some bovine organs that they get from the butcher. So talk about tool use, they’re eating beef or bacon or whatever. We actually go and get some of the other parts that people don’t eat so that we can actually practice procedures on. So they found a way to actually profuse a bovine heart and actually give it electrical signals that make to make it eat like a heart. So you’re looking at the heart that’s sitting in the fabricated human chest. And they have done a great job of being able to train and assess heart surgeons that are in their early stages of their career, cardiothoracic fellows. And so what we did was put motion sensors on the fellows as well as the assistants when they’re putting a simulated patient on cardiopulmonary bypass. And we did it for three early heart surgeons and three very experienced senior heart surgeons with 15 years of experience under their belt.

Saul Marquez:
And what were you measuring for?

Carla Pugh:
We were looking we were just looking at their movement, OK, you know how they use the right hand, how they use their left hand, what is it that they’re doing digitizing all of the steps and maneuvers that they make when they are placing a patient on cardiopulmonary bypass? Wow. It confirmed for us, as it has using sensors and motion tracking data that there is a signature. It almost is like a beautiful painting. There is a specific signature that’s created for each medical procedure that we do. When you’re doing it correctly, it looks a certain way.

Saul Marquez:
Every time?

Carla Pugh:
If it’s. Yeah.

Saul Marquez:
Wow.

Carla Pugh:
Every time. What’s really amazing about that is that if you ask the surgeons what they do, they always think that they do things differently than others because they were trained differently. They were trained to do this or do that, use this type of instrument. Start on the left and progressed to the right. And then others say, oh, we always start on the right and progressed to the left. And, you know, we use the right angle. We use a tonsil clamp. And so when the surgeons describe what they do, they tend to use descriptors that focus on their tools and their steps, whereas the motion data actually is more pure data and that it just shows the direction and the velocity of their movement. And what’s really cool is the direction and the velocity of their movements ironically, has nothing to do with the surgeon itself, but it has to do with the anatomy and the heart’s always in the same place, mostly unless you have a disease where your heart’s on the wrong side. But what that means is that doesn’t matter if you start on the left, doesn’t matter if you start on the right foot because you’re still doing a sequence of maneuvers around the heart, the final painting or picture is the same.

Saul Marquez:
Is there a picture? Is there a painting?

Carla Pugh:
There… Is that what I call them painting because it’s the easiest way to explain it, because you have to see the data. So when.

Saul Marquez:
I get that. But is there a..

Carla Pugh:
There’s a painting that’s created? It’s like great. It’s like two paintings, two painters, two artists talking about painting the Mona Lisa Right..

Saul Marquez:
I wonder what that looks like.

Carla Pugh:
All yellow. OK. Good for you. And I’m going to use this sized brush and all variations of yellow yellow tones will create. I’m going to use orange tones, but in the end, if it all looks like the Mona Lisa who cares about the color.

Saul Marquez:
Right. Right.

Carla Pugh:
Until that has been you talked about data. The data that exist in health care regarding hands on procedures and medicine. When is verbal data that physicians dictate and they use their own descriptors because there’s no standard.

Saul Marquez:
That’s interesting. Well, you know, what would be interesting to hear from you, Carla is is now that you have this dataset, is there a way to say do a test to determine aptitude and potential capability of a student that’s to take a career down a certain path.

Carla Pugh:
Yes, definitely.

Saul Marquez:
Nice.

Carla Pugh:
There are some people that are gifted in terms of their haptic ability, sense of touch, perception and situation awareness. There’s some people that are gifted. We’ve seen it, a medical student. You can’t tell by looking at them, but, you know, when they’re coming in, what comes out of their mouth. But when you see their touch data, it’s amazing.

Saul Marquez:
Yeah, that’s fascinating. Well, I appreciate you taking us down that road. And and folks here sitting in your car and maybe you’re running, listening to this, working out and you’re like, wow, wonder what would happen if you put some sensors on me right now, my ear. And that’s what Dr. Pugh does. You know, she she dives into the things that later become technologies that change health care for the better. And so give us an example, Carla, of a time when you had a setback and what you learned from that.

Carla Pugh:
Wow. I had that all planned out. You know, I’m like failure is the key to success. And like, I’ve made a whole bunch of mistakes. I mean, I’m human, right. And and I’ve learned a lot along the way. And I kind of, you know, think about failures, if you will. For me, it’s setbacks in terms of achieving my dream in an efficient manner. So most of my failures for me are actually self defined because I’m impatient.If you wanted to you know what? You have some level of success. You say we’ve found this, let’s go team and folks are look at you like, okay, that’s cute. So for me, I look at I love them, you know, failures of communication. I think that’s the biggest thing. Like, so that’s just been my you know, how do I learn how to communicate? How do I learn to tell the story in different ways, such that the engineers see that this is really cool and that this is something that they can actually thrive in a career in making a huge discovery and partnering with us. Same thing with the data scientists and those that are doing artificial intelligence. So I think that when you are passionate in an area that’s not quite mainstream, you have to slow down and find ways of communicating that such that you can then build the team and the interest and the support to carry it across the finish line.

Saul Marquez:
Love it. Yeah. That communication is key. So if you had to say out of all the neat things that you’re working on, Dr. Pugh, if you had to say decide on one, which one would you say is the most interesting and exciting project right now?

Carla Pugh:
Yes. There are some things I can’t tell because I have a piece that is pending and it’s very tempting because they’re great for the community. I think that people are starting to get it regarding the use of sensors to assess human performance broadly. So whether it’s human physiology or whether it’s actually surgeons performing complex procedures in the operating room, I think that what’s been most exciting is that there are a number of people who have looked at motion tracking data and I find it interesting Right., because that’s the golf swing data. It’s the same thing. Right. Right. But to apply that process to health care, which is what we’re doing and we’ve done it for a number of different procedures, the one that’s been newly exciting for us is to apply it in the field of optimal allergy. And the reason being is that all of the other procedures we have done to date have large gross motor movements moving your hand, putting in sutures, grabbing instruments from a table, using a variety of instruments for a variety of different movements. And so when we had an ophthalmologist express interest, we’re like, oh, my goodness, what am I going to do? Things that I read because they’re under the microscope and they have these instruments in their field. Is this so much smaller? Even their operative field is smaller. The eyeball Right.. I’m in the abdomen. Swimming around. Oh, my holy. There with the eyeball. Like such a spotless field. That’s one thing. Smaller instrument and then really fine motor movements. So we were a little intimidated and weren’t sure we were wanting a failure. But then we were so curious. So, yeah, I didn’t take long. We thought about it for like five nanoseconds. Okay, great. Let’s do it. Yeah, I know. Five days. No, no. We’re kind of compulsive now. I mean it. I mean, it doesn’t exist. I mean, we thought about it for five nanoseconds. It took five days of schedule. Yeah. So to get across campus with our equipment, we went to. And you know this ophthalmologist just already had a cataract surgery simulator. Like it’s perfect.

Saul Marquez:
So very forward thinking partner that you found.

Carla Pugh:
Yes. And already kind of thinking about data and using artificial intelligence to analyze his operative data. And so we went in. We went to his lab. We’d looked at what he had. We instrumented him. We instrumented his instruments and we instrumented the cataract surgery simulator. And we’re smiling to this day. So. Yeah. Yeah.

Saul Marquez:
So what did you guys find out.

Carla Pugh:
It’s the same. It’s the same. They have. I wish I could. I need a partner with an artist so that I could name all of these standard pitchers that come up with motion data from surgical procedures. Because it all they all look different, but they’re meeting the heart surgery, cardiopulmonary bypass beta, create a pattern that looks different than a cataract surgery. But I need I need a partner with some artists to help me name these things because they’re just amazing. Yeah. But we’ll have to be able to capture that data. And obviously, we had to increase the game so that we can actually see all the interesting idiosyncrasies and nuances within the data that actually represented what he was doing. It’s beautiful. So that was really exciting because that was a far end extreme of different vertical movements.

Saul Marquez:
That’s really, really interesting. Yeah. Now, that’s the other end of the spectrum as far as movement space where the surgeon is working and you get a similar output that obviously looks different because of the particular type of surgery. But fascinating, fascinating motion data, people. This is a fascinating place to be working today. So this interview. Wow. I mean, I’m looking at the time and it’s already flown. So let’s sun dive into the lightning round. I’ve got to get a few questions for you in a lightning round fashion. And then we’ll we’ll finish that with the favorite book that you recommend to the listeners. You ready?

Carla Pugh:
Sure.

Saul Marquez:
OK. What’s the best way to improve health care outcomes?

Carla Pugh:
Get better outcomes definition, outcome metrics redefined the outcome metrics.

Saul Marquez:
What is the biggest mistake or pitfall to avoid?

Carla Pugh:
Blanket application of results from qualitative or mixed data. That’s not validated.

Saul Marquez:
Love that one. How do you stay relevant as an organization despite constant change?

Carla Pugh:
Listen, collaborate and create a culture of innovation.

Saul Marquez:
What’s one area of focus that drives everything in your work?

Carla Pugh:
The data.

Saul Marquez:
It’s all about the data.

Carla Pugh:
All about the data.

Saul Marquez:
Dr. Pugh, these next two are more on a personal note. What’s your number one health habit?

Carla Pugh:
My number one health habit. Yeah, interesting. So I am currently hacking my sleep habits.

Saul Marquez:
Nice.

Carla Pugh:
Using the oura ring.

Saul Marquez:
Oh, which one’s the oura ring.

Carla Pugh:
Oura.

Saul Marquez:
OK. And it measures…

Carla Pugh:
Unfortunately I have. No. No. I was gonna say, unfortunately I haven’t invested in the company. I have no ties with it, but it has the best sleep data ever. And I’ve had colleagues who compare this data. They wear both that oura ring and flip it a little less on the exercise because it does have an accelerometer, but it’s only on your finger.

Saul Marquez:
Ok.

Carla Pugh:
So if you’re using the Stairmaster or not moving your arms or something, you know less. But temperature, heart rate, movement, the five phases of sleep, it’s amazing. And I can tell how my sleep is affected by what I eat after 6 p.m..

Saul Marquez:
Wow.

Carla Pugh:
They don’t know that I know it. Right. They don’t have they don’t have a association, but they don’t have the food data. Right. But I’m a foodie and believe that food is like from a health perspective, the definite base intake of food affects your health in so many ways. And it definitely affects sleep.

Saul Marquez:
Fascinating. The oura ring, something and look up. I’ll definitely put it on my list. And what’s your number one success habit.

Carla Pugh:
Number one success habit. Oh, try. Try again. Reflect. Forgive yourself. Forgive others. Do it again and do it better.

Saul Marquez:
That’s a great message. And what book would you recommend to the listeners, Carla?

Carla Pugh:
Oh, my goodness. I have one that I had from childhood. I know people like new new books all the time, but my all time favorite is Siddharta by Herman Hesse.

Saul Marquez:
Love that. I think that’s been recommended once other times.

Carla Pugh:
Really?

Saul Marquez:
It’s poetry, right?

Carla Pugh:
Oh, it’s a story.

Maybe I’m thinking of a different book then.

Carla Pugh:
Yeah. Siddhartha is kind of a life journey story and just amazing. Yeah Oh yeah. Yeah. It’s a short read too. And so I think you can read it in a weekend. But I think what’s interesting is, you know, that book was probably written over 40 years ago and it’s still the life lessons and the story is still applicable today.

Saul Marquez:
Is that right?

Carla Pugh:
Yes.

Saul Marquez:
That’s a great recommendation, folks, for all of the show notes from today’s meeting with Dr. Carla Pugh, go to outcomesrocket.health and type in Carla in the search bar. You’ll see a full transcript as well as links to Siddhartha and also the work that Dr. Pugh is up to. So make sure you check that out at outcomesrocket.health search bar type in Carla and Carla. Wow. This has been a really fun conversation. I’d love if you could just leave us with a closing thought and then the best place where the listeners could learn more about you and your work.

Carla Pugh:
Yeah. No, my closing that is really back to you. Thanks so much for reaching out and thanks for taking the time. And I’m ecstatic that you have insight and interest into to the work that we’re doing and helping that communication thing that we’ve been working on in terms of getting the word out and collaborating, I think. Yeah. There’s no way to hide. I’m a professor at Stanford University, so you can find me. cpugh@stanford.edu.

Saul Marquez:
Outstanding. Well, I appreciate you very much, Carla, and I appreciate you sharing your passion and the insights you’ve gained and definitely looking forward to staying in touch. Thank you.

Carla Pugh:
Thanks so much. Have a wonderful day.

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