Rocket scientist-turned-neurosurgeon, Dr. Eric Eskioglu, Chief Medical and Scientific Officer for Novant Health, talks about his stellar journey, the power of AI and why comedian Robin Williams remains one of his heroes
Dr. Eric Eskioglu is Executive Vice President, Chief Medical and Scientific Officer for Novant Health. Before joining Novant Health, Dr. Eskioglu held several leadership roles including assistant professor of neurological surgery, neurosurgery, and radiology at Vanderbilt University Medical Center.
He also practiced as a neurosurgeon but before his career in medicine, Dr. Eskioglu worked as an aerospace engineer at the Allied-Signal Aerospace and Boeing. Passionate about data analytics, he continues to apply his engineering background in efforts to streamline healthcare, decrease errors, and improve patient satisfaction.
As a former rocket scientist, what initially sparked your interest in medicine and subsequently, AI in medicine?
My father was a physician; he was a neonatologist who dealt with preemie babies. I didn’t want to be a physician because I was, and I still am very math-oriented. I am a numbers guy; fascinated by space and rockets so that’s why I ended up becoming an aerospace mechanical engineer and working at Boeing for three years which I loved. At that time I also volunteered at a children’s hospital. I found medicine to be equally fascinating because I saw how doctors were creating treatment plans for children that were as unique as their fingerprints.
So I went to medical school in Kanas, becoming one of the first to go to the National Institutes of Health (NIH) for a research training program to groom a new generation of translational researchers in medicine; people who could take new clinical discoveries to the bedside for patients. Later on, during a neurosurgery rotation, I saw a skull open for the first time and how the brain was pulsating, that love at first sight moment got me to become a brain surgeon at Vanderbilt.
The reason why I was attracted to AI is because throughout my 25 years in medicine, I repeatedly witness how some processes remain very cumbersome. Every now and then, we see that other industries are improving their productivity by incorporating technology so that humans don’t have to do mundane stuff. Healthcare is probably the exception. My initial love for AI comes from my years at Boeing. We used to deal with a system called CATIA. It’s a multi-platform software suite for designing manufacturing and engineering. Back in the 1980s, CATIA was widely adopted by aviation for the 3D simulation of plane designs.
The other thing which I love about AI is its ability to decrease the amount of variation, whether it’s in the production line, assembly line, or the design process. I was particularly drawn to Professor William Edwards Deming’s Principles of Total Quality Improvement and Continuous Quality Improvement. The idea to empower every employee to have control over their environment and try to find ways they can improve and in turn, contribute to the overall improvement of the entire company. I wish to achieve this in medicine, but the thought process is different because it’s hard to break down barriers in this domain.
I thought the time has finally come as the COVID-19 pandemic becomes a silver lining to accelerate technology adoption and make us more forward-thinking. I hope this can continue. I look at AI as something transformative, especially in medicine. It’s going to help us reduce variation and even equity and ensure people are provided with the same quality of care.
Where do you think the next big advances of AI and medicine will be?
Sometimes, people are surprised when I say AI will have the biggest effect on primary care and family medicine. What they fail to realize is whether you go to a primary care service in a rural area or big city, you undergo a similar process. The physicians will perform cursory examinations, check your vitals, request lab tests when necessary and come up with a plan. They may refer to some of your medical history, but most of the time, they won’t go back to what happened to you 10 years ago or when you first started to see a doctor.
Since doctors are not looking at the overall picture and trends, they are missing out on the wealth of data that each patient has. In this case, AI is going to help fellow primary care physicians to underline trends and get more insights into a patient’s health. AI will also do away with the mundane and allow doctors to spend more time with patients rather than doing data entry. This will make medicine more efficient and effective.
Bear in mind that AI will never replace human physicians, not even radiologists. Instead, I can guarantee you that in the next 10 years, physicians who embrace and incorporate AI into their practice will put those who don’t, out of job. AI is going to give much more independence and joy in clinical practice.
What are you most excited about the future of AI in your specific domain of expertise, neurosurgery?
I’m really excited about remote operations. Right now, we have remote patient monitoring. I do not have to meet a patient face-to-face; I can do that over video conferencing, and it will eventually evolve into wearables or infrared cameras that measure in real-time, a patient’s heart rate, blood pressure, temperature and even mood. Likewise, we have robotic surgeons now and I hope it will evolve into a future whereby I am remotely maneuvering a surgical robot.
I can sit in front of a monitor and via 5G or even 6G or a 7G network, the patient’s brain will be live-streamed seamlessly for me to operate on. All this will depend on how we are training the present generation of physicians. I am not expecting medical school graduates to take up programming, but they should at least have a basic understanding of what is data science, what can it do and how we can utilize it. We need a workforce that’s capable of creating the future that we are envisioning now.
You’ll be moderating a panel discussion on regulations, ethics, and legal aspects of AI at the upcoming AIMed Clinician Series. How should AI be regulated in the future you just described?
I like to call it the ‘dark side of AI’. Unfortunately, technologies tend to be years ahead of social norms. One of the things that worries me most is in the old days when I was doing my medical training, patients’ medical records were in papers and they would be gone, together with the patients, when they died. Now, we have patients’ medical records on the Cloud or in an electronic health record system forever. So, what happens to a person’s medical data when he or she passes on? Whose property is that? Who owns the rights to such valuable information? We need a considerate system to address these questions.
The other thing which worries me is, who should physicians believe? Their judgment or a recommendation from an AI model? For example, physicians are less likely to operate on a 98-year-old patient whose brain is bleeding because he or she may not be able to survive a complicated procedure due to old age. The cut-off is usually 75 depending on comorbidities. Nevertheless, when it comes to hip replacement, a procedure that is less risky and enables one to recover his or her mobility, many physicians may say yes. This is where the concern is. Are algorithms able to exercise such flexibility or are they going to decide based on a certain set of characteristics?
Not many people are aware that insurance companies are particularly advanced in terms of leveraging algorithms to assign for the percentage of survival. When that happens, they usually ask physicians to ration our resources. That means patients are spending money on treatments that don’t necessarily help them or save their lives. Don’t get me wrong, I am a proponent of AI but I am concerned that we may need to tell family members in the future, “I am not going to operate on the patient because the AI tells me he or she only has a 28% chance of survival”. This is what I really don’t wish to see.
Do you think AI will also worsen health disparities?
I think we need to be careful. We should use AI not just when somebody is unhealthy or sick. It’s like when you put money into the bank when it starts to run out. You don’t wait until the last minute when your cheque bounces and then suddenly start to think of solutions. It’s the same logic for AI in medicine. AI should also be used to improve our health and ensure the population is healthy.
What we can do is create synergy. We need to reach out to big corporations so that they provide technology and broadband access and reach out to populations that we’ve never been able to reach before. If this is not provided, then I fear AI is likely to worsen existing health disparities.
What advice would you give someone starting their career in medical AI?
I have two pieces of advice. The first is to keep an open mind. Don’t ever resist new ideas – test them yourself and be open to changes. We need to recognize that we are always on a paradigm shift. The second piece of advice is a little more technical. If you are a data scientist who has no clinical training, make sure you are addressing a real challenge or work with someone with clinical knowledge to find a solution that fits the purpose.
Don’t walk away with the idea that if you are willing to spend some money and introduce a tremendous amount of technology, you will be able to change things. Healthcare doesn’t work that way. If you wish AI to succeed, find a clinical champion who is a decision-maker, so that he or she can influence others to change their mindsets and show them the financial returns and other benefits that AI can bring to the table.
I think if you are interested in AI, you are already a leader. So learn to differentiate between things that look good and things that truly work. Pick up the good habits of doing things that will result in good outcomes. I believe this will lead you to meet other good leaders who have similar passion.
What’s the best piece of advice you’ve ever received?
I am a doctor but I see myself as more of an engineer and I have always told my wife that I am going to die as an engineer. I believe in experiments and working out solutions as a team. So, failing spectacularly is one of the best pieces of advice I have ever had. I have failed spectacularly at least a handful of times. I learned from those mistakes and become more determined not to make them again. In the process, I became a better person. You may laugh but failing spectacularly is something that I truly believe in!
The other is to listen twice as much as you speak. Listen to people, especially brilliant people that surround you. Last but not least, be surrounded by people who are as smart or smarter than you and don’t be intimidated by them. These three pieces of advice have accompanied me through my entire career and they helped me reinvent myself every couple of years, as I continue to quench my thirst for new knowledge.
What’s been your greatest failure and achievement?
Putting together this AI model for stroke three years ago with a startup has been a great achievement. It felt great because no one knew how things would turn out. The solution facilitates diagnosis so we can act on the patient faster. For every 10 minutes we cut, we saved about 19 million brain cells. It was well-received in the end, so I considered it an achievement.
My greatest failure was early on in my leadership journey. I was 10 steps ahead of the rest of the group. I have great visionary ideas, but at the time I didn’t let others catch up, so I became a target. It was only later that I realized to get others to buy into your ideas, you must let them catch up with you first. The more people buy into what you think, the more favorable they act and the more support you will receive to accomplish what you have envisioned. I was not able to understand this 10 years ago and it was one of my spectacular failures.
Who’s been the biggest influence in your career?
I was nominated by Modern Healthcare for a ballot on the top 50 most innovative clinical executives. I went through the list of nominees and sent emails to those who have once mentored me while feeling lucky enough to have latched onto great mentors.
I think the biggest influence on me has been Professor Billy Hudson. He is in his late 80s now and still is a professor at Vanderbilt University. I met him when I was a medical student researching in his lab. He was the one who advised me to be surrounded by people who are as smart or smarter than yourself and not micromanaging them but giving them the freedom once you have trusted them. He also taught me not to carry everything with me; learn to delegate and the wisdom of enjoying life at the same time. He has been a great influence on me.
The other person would be my mentor and NIH Deputy Director for Intramural Research Dr. Michael Gottesman. I emailed him and he said he was proud of me. He taught me to get excited about science and be passionate about getting results that will benefit patients when I was an NIH fellow.
Another person who influenced me was the US comedian and actor Robin Williams. He unfortunately, committed suicide some years back due to mental health issues. He had a saying that I use whenever I get the chance. It’s an emotional thing for me but he said, “Everyone you meet is fighting a battle you know nothing about. Be kind, always”. That’s how I approach people when I am meeting them. I am sure each one of us has problems that nobody knows about, whether it’s minor or major. So, I always make sure I am kind to people. I believe kindness yields more kindness.
Finally, does space and space travel still excite you?
Oh I’m still fascinated by it. We might have missed how many rockets, whether NASA or SpaceX, were launched during the pandemic. But if you look back, we have actually been launching rockets every couple of weeks to the space station over the past year.
I believe we are ready to go to the moon again and we may even be colonizing the moon in the next few years with 150-200 people permanently living on its surface. The question is, who is going to take care of their health? We can’t specially train a nurse so that he or she can situate on the moon, right? New technologies are bound to come up to fit the purpose like the remote technologies I mentioned earlier. I truly hope I will be around to see some of these exciting discoveries!
Dr. Eric Eskioglu will be speaking at AIMed’s virtual multi-track CME-accredited event, ‘Surgery, ICU and Neurosciences’ on 30th and 31st March.
View the full two day agenda and book here