Neuro Endovascular Surgeon Dr. Mohamed Teleb, Creator of the VAN Stroke Assessment

In this episode of "So You Want to Work in Healthcare," host Leigha dives into the world of healthcare professions, providing listeners with an insider's perspective on various career paths. Today's guest, Dr. Mohamed Teleb, an endovascular surgical neurologist based in Arizona, shares his journey from engineering to medicine, emphasizing his passion for working with people and his background in math and science. Dr. Teleb, who completed his residency in neurology followed by three fellowships in stroke, neuro ICU, and neuroendovascular, offers listeners a glimpse into his decision to pursue medicine and the dynamic experiences that have shaped his career. Join us for an engaging conversation that aims to inform and inspire those interested in a future in healthcare. And remember to subscribe to the podcast on your preferred platform to stay updated with the latest episodes.

*Not Medical Advice. Our views do not reflect the views of our employers.*

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Transcript

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So you want to work in healthcare, but you're not sure where to start. I'm Leah, your host of this podcast, and I'm bringing you the inside scoop on healthcare professions. From doctors to PAs to healthcare administrators and CRNAs, my goal is to let professionals tell their stories and give honest reviews of the careers they have chosen. So whether you're considering a job in healthcare or you simply have an interest in what we do, this show is for you. Welcome to the So You Want to Work in Healthcare podcast. I'm your host, Leah, and today I have the pleasure of welcoming Dr. Telev. He is an endovascular surgical neurologist and he's located in the Phoenix metro area. After his residency in neurology, he actually did three fellowships, including a stroke fellowship, neuro ICU, and neuroendovascular. He's been heavily on social media in the last year or so, trying to promote Thank you for having me and yeah, looking forward to this And real quick, thank you for everyone who's already subscribed. Don't forget to subscribe on whatever video or listening platform you're listening on. So let's get right into it. The first question I ask everybody is why medicine? Because the whole point of this podcast is to help people understand what we do better, but also guide students into what type of medicine they might want to go into, what form of health care. So That's a good question. So I've been asked this before. So this is not a new question. But it's, it's funny, because I think our memories change. Like, you're like, Oh, I think I went into medicine. Maybe I didn't go into medicine for this, you know. But I went into medicine, honestly, I was an engineer before. Going to medical school. Yeah, and I just liked working with people and I knew that I was good at math and science. And so then I volunteered at the hospital and then I just liked the interaction, you know, I'm a people person. So if you look at my personality assessment, there's something called DISC, which is like looks for dominance, influence, how steady you are, how compliant you are. And it divides it up between being an extrovert and people-focused versus task-focused. And I'm so people-focused, right? That's just who I am, you know? And so that's basically what led me to medicine. I'm like, I'm good at science and I'm focused on people. That's what motivates me. So that's basically how I got into medicine. I said, this seems it'll work and I volunteered and I kind of, fell in love with Awesome. So you were an engineer first. Where are you Well, my parents are from Egypt, but I grew up in Northwest Wisconsin. Oh, okay. So yeah, so from the Middle East to the Midwest. And so yeah, I came here, I think I was six years old or five, lived in Chicago for a little bit. My dad was finishing his PhD. And then we moved to Northwest Wisconsin in a small city of Wow. I want to ask before we move forward with your story, because a lot of people ask me, it's probably one of the most common questions I get. Why did I choose PA school over med school? Because I was also pre-med in undergrad. Um, so, so did you consider any other careers in healthcare or were you just like, I want to be a doctor. That's it. Yeah, so it's funny you asked that because I was considering going to PA school as well. Oh, really? Yeah, for multiple reasons. I was an engineer, so everything I'm like calculated. How many years? How much am I going to make? How much time is it? I made this entire spreadsheet. I'm like, so I was this close to going to PA school. Actually, one of my good friends, one of my best friends from from undergrad, I'm just going to call him out, Jay Parlay. So Jay and I, we were both considering going to PA school, yeah. Interesting. And I don't know. I'll be honest. I said, you know what? I took my MCAT once. I said I'm going to apply to medical school once. If I get in, great. If not, I think this may be a better option anyway. I guess I did consider it. I mean, it's the point where I made an entire spreadsheet about it. I looked at everything about it. So yeah, and I don't know why I ended up going into medicine because after, you know, like going through medical school, I mean, because now that I think about it, I probably would have been just as happy. No, it's okay. I think that A lot of PAs go into PA school because we want, obviously, like we want the patient interaction, like you were saying before. But I think people are I'm trying to be real honest on this podcast. So I'm just gonna say it. I didn't want to at that point in my life, go forward with more testing, four years of med school, and then potentially, you know, up to seven years of residency, right? So for me, it was a lifestyle thing. And I liked the the way we can just move around if we want to. Yeah. But sometimes I find that I wish I had the final say, meaning like, I wish I had a little more autonomy. And that might, that's the one reason why I think going to med school, becoming a physician, that might be the factor here for a lot of people is getting to make the decisions and having the final say. And you know, if you don't agree, Like, if I don't agree with the people above me, I have to just do what they say, right? So that would be maybe like one reason why I would have gone to med school over PA school, but I'm very happy with my Yeah, no, I mean, the flexibility with being a PA, like being able to work anywhere, you know, probably taking less call, I'm guessing, less Okay. So yeah, there's, so yeah, so I see those, those advantages as well. And your thing about making the final decision. So I work with four NPs right now. At one time, our neurovascular stroke team had five NPs. I'm going to be honest, you know, they may watch this. they really make a lot of the of the decisions because they've been I mean, we've had this program for nine and a half almost 10 years. And our first the first nurse practitioner that worked with me, Anna, she's been there for eight years. And she was a neuro ICU nurse for like 10 years. So we really trust their their opinion. And it's in and it's to the point where I feel like They do an amazing job and how much I add is in limited cases, I would say in like 5 to 10% of cases of that. It depends on who you're working with really. Totally. And I pride myself and my team, the fact that we've had like nobody leave for that long in healthcare. That's kind of like, You know, it's, and I think it's because if you treat people with respect, and you allow them to work at their highest intellectual ability, people realize when you're being genuine, and you're allowing them to grow. It's kind of like, you have to challenge enough, but support enough, right? Because if there's too much challenge, then you're just asking me to do stuff. It's like the unreal, it's the unrealistic boss. If you're too supportive, then you're like, why aren't you letting me rise up, right? It's that balance of support and challenge, right? I think if you do it right, people Yeah. And I honestly, I, I have been with my boss, the my surgeon for nine years. So he's amazing. I guess I was just speaking from what other people have told me. But there are like, there have been a few times where I'm like, maybe I would have done something differently. But he's he's really great at like, listening to my opinion and asking me my opinion, which is really cool. So it sounds like you're like that, too, which is awesome. And it really is. Allowing your team to have a voice, it's better for the patient overall because when people are afraid to speak up, we know that that's when bad things happen, right? Correct. Yeah. I mean, you've seen that study. You know, surgical outcomes are better when there's a more open environment as opposed to a surgeon who's like, I do something called case of the week. I've been doing it for over a year where I give some advice I go over a case and one of them was talking about that how to use everyone in the room and part of it is I create psychological safety, and I always haven't been good at this, right? So we all have to work on ourselves. I create psychological safety. So I'm listening to the tech, I'm listening to the nurse, I'm listening to the anesthesiologist, I'm listening to, to the basically the device rep, right? Because they've been through 500 knee replacement surgeries, and this may be only your 50th or 100th, right? And so like you have to take advantage of, you know, because everyone has a different perspective and you can learn from everyone. So I think coming at it from that point of view, like what you said is absolutely true. I mean, and I've seen it multiple times. I mean, I've seen my texts and cases say, hey, look, there's this and I'm like, oh, thank you. And if you allow people to speak up, not only does it save you, but it saves the patient more. Yeah, exactly. And it's the surgical techs, I can't stress how amazing they are. And whenever a new fellow comes in and works with us, I always know when they're going to be good if they listen and take direction from the surgical tech. Because these techs have been doing this for, like you said, for years. And these are their first cases that they're doing almost on their own, right? So they're so crucial to the OR. Just wanted to point that out. Okay, why neuroendovascular surgery? Yeah, or neuro IR interventional neuroradiology. So, so this field, you know, it was started within the realms of interventional neuroradiology, but really lots of surgeons have started to do this to neurosurgeons and lots of neurologists like myself. And so really, we decided to call the field neuroendovascular surgery, where basically it doesn't matter which background you come from radiology, neurology, or neurosurgery, We're all one group, you know, and we have our conference together and everything else. So why? That's a good question. So I'll start with why I went into neuro, into neurology in general. And if it's getting too long, you can just, hey, that's enough. No, so I was fascinated by the brain and how we perceive things. So as an undergrad, I took a class called Sensation and Perception, or the Neurobiology of Sensation and Perception, and I was just fascinated by how our you know, our eyes process images, you know, how our ears can actually, you know, can tell the difference between pitch, right. And we have those little hairs and the and the and the circle of canals, but then even like sensation when we touch right two-point discrimination, vibration, pain, temperature. And I'm just like, wow, you know, like how all these senses work. And even from a psychological point of view, like having a growth mindset versus a set, all these things, you know, and I was just fascinated by the brain. It's who we are. We're talking because we have brains, right? I mean, it's the command center. It makes us do everything, right? And now with the mind-body connection, I was really in tune to that a really long time ago. And now it's the thing, you're like, of course, stress leads to more hypertension, because that leads to whatever it is, like your cortisol hormone going up, which will lead to, you know, and now we're like, but that wasn't talked about, right? Yeah. So why neuro? I feel the the brain and the neurological system controls so much of who we are, and people that have neurological disease were so devastated, it really hurt. It really got to my heart. Have you seen someone with stroke? Yeah. Where they can't understand, they can't talk. It's the number one cause of disability, both in the developed world, or if someone with Parkinson's that can't walk, or they're having trouble, And I'm just like, wow, dude, neurodiseases can be really bad if you can prevent some of this or you No, don't be sorry. That was a wonderful explanation. And the mind body connection is so important. I remember years ago, I read that book by Dr. Sarno. I think there are two books. There's one like healing back pain, and then there's the mind body connection. And, you know, I think a lot of what he says is accurate. A little bit of it might be a stretch, but it's so important. There's definitely obviously a connection. And I think you're right. It's, it is one of the most debilitating things and not just physically, but, but mentally to have like having to overcome that. Tell me about how you got into the surgical part of That's, that's a good part. So neurology in the past, they used to say, well, well, well, the neurologist just makes a diagnosis. I mean, it was kind of sad. They used to say diagnose and adios, like, you have spinal cerebellar atrophy, like what? You're like, yep, sorry, there's nothing we can do. But that really changed. We have so many more epilepsy. So people that have seizures, we have way more epilepsy medications. We have epilepsy surgery, right? We have VNS, vagal nerve stimulator, right? And so, and then I'm like, wow, neuro is really changing. I'm like, but what's changing the most in neuro and what can I make the most? So it was basically stroke. I'm like, wow. their TPA, they started doing procedures to pull out clots. For brain aneurysms, they were starting to do minimally invasive procedures. where they take plastic tubes, go up to the brain and put metal inside of the brain aneurysm and stops bleeding. I'm like, neurovascular, you know, and neurological emergencies, that's where we're making the most impact. And so, you know, after my rotation on the neuro ICU, and then I saw the neuro IR doctors doing this, I'm like, yeah, this is, I feel like I can make an impact there. And I, and I'm kind of lucky in the sense that I bet on neurovascular disease, like to make this big, this big impact. And it did because, you know, now we have stroke thrombectomy. What does that mean for our audience? Thrombectomy means you're just pulling out the thrombus or clot, right? And so now we can take these plastic tubes, go all the way from the neck, well actually from the groin or wrist, go all the way up through the neck to the brain, pull out the clot. or move half their body are now coming back to life, right? That's amazing. And before 2015, we had three trials in 2013. Remember, I started training in endovascular in 2012. I started neurology residency in 2006. Yeah, I started residency. So in 2012, I'm just starting my endovascular fellowship. 2013, all three trials for stroke thrombectomy are negative. Like, there's no benefit. I'm like, But you know, but I'm like, no, no, no, no, no, no. It's the trials, the trials were run wrong. But you know, we have to pick the patients that actually have a clot. We have to make sure the tissue is not dead. And once we got that laser precision, Then all the other trials since have been positive. So in 2015, we had five trials that showed significant difference. I mean, it's so big, it's somewhere from 10 to 30% difference, meaning the number needed to treat could can range from anywhere from one in three to two, one in six, or like one in 10, right. But most of them are one in three to one in four. So you're talking about a 20-25% difference. and being completely functional at 90 days. So this was one of the biggest things to happen in medicine. So I just, you know, I guess I... just got lucky that the field really advanced, you know. And within brain aneurysms and brain bleeds as well, they have all these new devices where it used to be you used to send a lot more people for open surgery because the aneurysm neck was wide. It was in a place now with these new devices, there's this something called the web which is basically a little cage which you can put inside the aneurysm and it just opens up and it clots off like the aneurysm. And even if the neck is wide, you no longer have to do open surgery. So I feel like you make a lot of impact and you can reverse lots of disability and it's Awesome. That's so interesting. I mean, you know, I'm glad you're explaining it this way because I'm an ortho. I need it explained. But no, it sounds awesome. It sounds really rewarding and for the patient for you. So My first year as as an attending, you know, here, one of the ortho patients, I think, I think they had a broken femur, they like had some sort of fixed fixation. And afterwards, the patient became hemiplegic couldn't move their arm or leg couldn't talk. And the orthopedic surgeon, she was like, I Um, are you going to be able to help this person? Like, like, like no confidence. I can't do anything. You know because but I understand she trained in an era where there was nothing for stroke, right? Right, you know Yeah, and you know and I was my like first year out I'm like, I think we should take her for a thrombectomy, you know, so I did I took the patient pulled pulled pulled out the clot and the orthopedic surgeon she comes in and she's like How'd you do that? I'm like I'm like, that's just the field now we can actually help Oh my god, that's great. Oh, that's, that's funny. I love it. I mean, it really is amazing how far medicine has come just in the last 10 years. And I'm sure within within orthopedic surgery as well. Right? Oh, yeah. Yeah. I mean, when I started 10 11 years ago was my first job. The protocols have changed so much since then, like, then most people would stay in the hospital, like two nights, maybe longer after a knee and a hip replacement. Now, like, at least half of our patients are out the same day. And the we've really like honed in on pain control, which is cool. And robotics is huge now. Oh, yeah, that's right in the replacements. So It's changing a lot, but mostly for the better. So that's good. Now back to your schooling. You did a lot. You did a lot of years of school. So tell us real quick, how long was med school? How long was your residency and So, of course, you know, so I did like, like, like undergrad, I ended up doing undergrad five years, and I did have a basically a pre med year as well. And then medical school was four years. And then neurology residency was four years. And then neuro ICU and stroke was, I did a combined two year, but it's supposed to be two and one. So another two years. And then neuro IR neuro endovascular was another two years. So total training after medical school was eight years plus medical school, four years. So 12 years after college. Wow. And in between undergrad and med school, I was an engineer for, for a little over two years. Yeah, I was an engineer. I actually went back to Egypt to be an engineer. I worked on the national pavement system. So I was there for about seven months a year. Then I came back and I worked in Chicago actually. I was a That's so interesting. You went back to Egypt. Very cool. I think it's really relatable. I think there's a lot of people that are switching careers into medicine out of medicine, but and I think I think a lot of people are going to relate to your story having, you know, been an engineer and doing like a full career switch. I think that's, it's really, it's what's the word I'm looking for. It's really ambitious Yeah, I don't know if I would have done it again now knowing how long it took. You're like, man, I could have Yeah, yeah. Well, you know, you're doing good things. Very good things. Can I ask, did you have to take out loans? Because again, this is a question I get all the time. Like how did I pay for PA school? So how People from Menominee, Wisconsin don't have money. No, I'm just joking. I'm Yes. I'm not sure I know, that's true, that's true. But yeah, so I did end up taking out loans for it. And in undergrad, I was able to pay for my housing and there was something called reciprocity between Wisconsin and Minnesota. So I actually got to pay a lower rate than the Minnesota residents because I got to pay the Wisconsin residents. fee, which was, which was, which was pretty cheap. I will say, I think it was maybe three to $5,000 a year. It was something. Oh, wow. It was pretty small. I was like, yeah, this is pretty good for a for a big 10 school. And you know, I think they were number one in the country in chemical engineering at Yeah, definitely a good deal. Cool. So yeah, I had to take out a lot of loans. Luckily, I just got mine forgiven. So oh, Did you do the 10 year? Right? Isn't Yep, I did the it's public service loan forgiveness, public service That's what it's called. Yeah. Do you want to know how much debt I was in? If you're willing to share it, yes. So, of course, in medical school and residency in medical school, you really don't have time to work. And so, yeah, so I ended up taking, I think, over $250,000 by the time I was done. for PA school, but it wasn't just PA school. I took out loans for undergrad as well. I just decided to go to a really, really expensive undergrad school. We're about the same there, about $250. It's a lot It's a lot of money. And then starting to pay it off after residency, after fellowships, when I was in my late 30s, when I started working. You're like, I'm I mean, listen, if it wasn't for this program, I would have been paying loans for 35 years about probably. So yeah, it's a lot. And I wish they would figure something out to decrease the cost of med school or health professions. You know, it's pretty crazy. Let's talk about your social media presence. You've been on social media a lot in the past year and you also developed a tool to identify strokes or help identify strokes. Can Yeah. So when these trials came out in 2015, Some of my nurse practitioners and also nurses are like, how do I, how do we identify the strokes that may benefit from stroke thrombectomy, or some people call it stroke surgery. And so I was like, Hmm, what do we do, you know, and so I, I ended up coming up with this mnemonic called van, right. And so I called it stroke van. And van stands for vision, aphasia and neglect. And I basically used it locally, in order basically as a quick mnemonic, you know, in order to help identify these patients that may benefit from stroke thrombectomy or stroke surgery. And then from there, I did a pilot study. And then everyone's like, Hey, you should teach this there and there. And so then I ended up rolling it out in multiple hospitals, I wrote a paper, They started using it in San Antonio, and it just basically got bigger. So what I thought, I'm like, how would a neurologist think? So I'm like, okay, if I'm doing an exam, when do I think this is likely a large vessel occlusion? And it's this, it's what's called cortical symptoms or VAM, vision aphasia neglect. and it's pretty simple and so all the other large vessel occlusion tools or massive stroke tools were looking at how severe is your weakness, like is your arm completely not moving at all, you know, is your face completely, you know, and you had to add up numbers, right, so it was quantitative, right, and what Van did which was a complete departure from the entire field in the sense is I said, no, qualitative baby, look at the quality. You just look at the type of symptoms, right? And so all I had to do, you had to have any arm weakness at all, just a little bit of weakness, arm weakness. If you have no arm weakness, you're done, you know, you're like van negative. If you do have arm weakness, all you do is need any of those ven symptoms. So vision, you either lost vision to one side, or your eyes are forced over, right? You have a gaze preference, that's vision. aphasia, as you know, is just the ability to understand and to make speech. So you have them follow two commands, close eyes, make fist, and then name two things, whatever watch and pen, right? And then, and if they if they can't do that, then they're van positive because either they're something in vision or something in aphasia and neglect is when they ignore the left side of their body. That's a little bit harder to like test. And so that's where we had to do the most training. But basically, it's usually with left sided weakness or your left side is weak. And then you you you will actually ignore like you'll show them their arm. They're like, whose arm is this? They're like yours. they neglect or deny they're having a stroke. Or they'll get up, even though half their body can move, they'll try to get up out of bed and fall. So they're basically ignoring or denying or neglecting the fact that something's happening on that side of the body. How we test it is relatively easy. We just say to touch them on their right, left arm, they'll say left, touch them on the right arm, they'll say right. When you touch both sides with their eyes closed, they'll only tell you right. So they're neglecting the fact that you're touching the left side. And you can do that with vision as well. But we do And then I made a website, I made a certification course for an hour so people can go to the website, they can get certified. I made an app so you can download the app, you can put in the VAN symptoms and it'll tell you where in the brain. Is it an M1 clot? Is it a superior M2? Is it an inferior M2? Is it a PCA stroke That's so innovative. So there is no score or there is a Van positive, baby. It's a go. Let's go. And what's cool about it. Oh, sorry, I have to add this. When we implemented this, we decreased the door to the endovascular suite, you know, by Amazing. So you're just saving lives over here. Trying, trying. Very cool. So how is this helping you? Are you are you getting you're getting the word out then obviously to your at least to your colleagues and people in the field on LinkedIn. And you know, social media is so difficult now because it's there's so many people on it, and it's hard to be different. But I think you're doing a really good job of getting the word out about stroke, about van and how do you manage with your job? I mean, you're you're on almost probably on average every other day. Yeah. So how do you manage social media? That's a good question. So one last thing. So and I use Instagram, really for locally. So all you know, most of the physicians I work with locally, the nurses, the techs, everyone's on Instagram. So I use Instagram to basically raise the morale and education locally. I I use LinkedIn for national and industry and I use Twitter for my peers. So everyone has a different goal. Right, different audience. It's a different audience and it's really worked for stroke education locally. I mean, so when the nurses see these cases of the week or this great stroke outcome, it puts neuro on their mind, right? And so now they're like, patients van is vis is van positive, right? And so it allows us to raise the local standards. That way, I just have to say that. So how do I manage it? I, I don't, I really don't manage most of my social media. So when I record a case of the week, it takes me less than five minutes. I'm not joking. I mean, like, I do one one take. I mean, I wasn't very good at presenting. And I worked on it a lot. I read this book called The Exceptional Presenter. And I got really good at communicating ideas and trying to get the message across in a simple manner. I had to work on it for so long. I work with someone from the industry. He's a device rep and we That's a good way to manage your time. I need that. I've been doing everything on my own, but I need to outsource Let's get back to medicine. So my two favorite questions to ask on this podcast are, what do you love about your job? And what do you hate about your job? Or what do you not love about your job? Yeah, so you don't have to answer the second question, but but I feel like most people have an answer for it. And this is because, you know, I feel like on social media, especially, we always see is like, the good parts of our job, right? Like if we're promoting what we do on social media, we're like, it's great to be a PA, it's great to be a surgeon, you know, but I, I need to know what the challenges are. But first, tell me what you love the most What's not to love? No, no, no, no, no. I think there's lots of things to love. I mean, I mean, again, that ability to take someone who's completely disabled and make them basically you're reanimating them and bring them back to life. So the patient outcomes, good patient outcomes, I mean, that like hits hard. Okay. Or Sometimes in the neuro ICU, when no one knows what's what's going on, you're like, yeah, that's an autoimmune encephalitis. And you know, the person is in coma, and then they like wake up like that's amazing, right? That is good. Working with nurses, working with techs, working with my NPs and TAs, That team approach, oh, I love working with people. So that is awesome too, right? The innovation, you know, I love to innovate, to be part of a team, to advance the field. You know, I love that mental engagement, but also the people aspect of it, right? So that's why I love medicine. So that's the good part. The things I don't like is the over-documentation. writing notes and calls. And I'm like, as an engineer, I'm like medicine is medicine is so inefficient, I would probably fire 90% of the business people in medicine. I'm like, no, everything has to be automated. Like every like protocol automation, automation done, like a surgeon should just go do his surgery, do do do research and let and go home. That's it. I don't I don't need them writing five page notes. I'm No, but it's true. It's like we're spending so much of our time documenting and it sometimes takes away from patient care. It may everything takes longer and we try to to have templates and and tools to make it go faster. But even then, it's just every day, I feel like there's something else we have to do or check or cover. And yeah, yes, I agree. It's probably the worst That's probably the worst part. But you know, there's there's ways to make it less painful to you know, you can, you can look, look at it, or there's something that that has to be done. You can, you know, I like see some of my MPs doing this, hopefully if they watch this, I see them like making sure that the language is perfect, that like, you know, that the sequences in the ICU are perfect. And like their documentation is like, beautiful. It's just like, if you're if you're gonna do it, this is how you should do it, you know, like that ability to communicate so clearly through through the notes. I mean, so if you think about Yeah, yeah, think about it, especially now that those that patients get their get access to their notes, right away, basically, right? Yeah, yeah, it's important to communicate it. Well. But it's interesting, too. I just interviewed Dr. Corey Calendine, the orthopedic surgeon, and he was telling me that there's now AI software that listens to your visit. Yep. And just creates a note for you, which AI scares me, but it's everywhere. And I feel like if that is accurate, that will be such an amazing time saver. It'll help us take more time with patience and Yeah. And I like it for documenting what you said, what what they said. So then it's like, no, actually, Dr. Tlaib did tell you there's 5% risk of death, right? That's obvious, right? You may not document that, And so this is where I think it's helpful. But the thing I don't like about it, your thoughts, how does it get all of your thoughts? Like, the reason why I'm doing this is because x, y, and z. And then another thing, like there's the book blink by Malcolm Gladwell talking about how experts make this, this, this decisions, there are some things that you you're a decision you're making, where your subconscious is processing and you don't know why. And then you have to go back, oh, this is the reason why. And so like, how do you document some of that as well, you know, like this, this is what my thought process was. And so the note may may feel generic at sometimes with AI. And so I do think we're still going to have to be involved in some of that. Right. Yeah. I mean, I like to, I use templates and then I kind of add in my own style, right? Because it, I don't want to sound like a robot in my note. And it's true. Yeah. I don't know how they're going to figure that out, but. AI is crazy. So yeah, the documentation probably that's a common answer for when I asked this question, what's the worst part about the job? Now, is there anything you would have done differently in your path to becoming a neuro endovascular surgeon? Yeah, no. Yeah. Or an interventional, interventional neuro guy. neuro guy. Just, Perfect, brain plumber. You should change your Instagram handle So, no, man, I think the more fellowships, when you talent stack, the vision you see is is something different. Like now you're seeing things from 360 degree view, you see it from the ED, you see it in the ICU, you see it from the stroke doc, you see it from the endovascular or the surgical side. So the more you do, I feel like you just get a better grasp of what's going on. I wouldn't change training from that point of view. The only thing I would change mental view, right? I would do it with more more smiles, like, everyone's like, really, you're you're always so happy. I'm like, No, man, the underlying stress, I didn't need any of that. Like, I, I think that's the one thing that I would have changed is I would have had a more relaxed attitude, you know, and a more open was so competitive, you know, that's the only thing I like that. It's a good point. I think this, at least this country is becoming so much more in tune with mental health and it's so important, especially when you're training to become a physician, surgeon, PA, because I was, I was the same way. I just like had my blinders on and PA school is so intensive for that one year that there's no time for anything else. I, I really stressed myself out. Like, I felt like I lost a bunch of hair at the end of the first year. I was like, Oh my god. But luckily, I did take some time to work. During PA school, I worked at a bar and it was really, really fun. Oh, nice. I was lucky enough to just like pick up a shift here and there. And it was, it was so good because it I always tell people you need to take time for yourself when you're training because if you don't, you're going to get burned out and it's not going to help. a better score on the test tomorrow if you stop studying an hour earlier and get an hour more sleep. Probably not. You're probably going to do about the same. Take time for yourself. Go out with your friends. Go work out. Whatever it is, it's so important to just take yourself out of school for a few hours and just do whatever you need to That is that is great advice. I couldn't agree with with you more. Now I do take the mind body connection much more serious now. I'm not sure if you saw my last one of my last posts, but Spine, foreknee, foot surgery, yeah. And you lost a bunch of weight, right? I lost a bunch of weight. You just went on It's so important, though. If you don't feel good, it changes everything. I say exercise is my medicine. I feel so different if I do not work out, but it just like sets up my whole day to be successful. And I have more patience and patience for my patients. Yeah, yeah. Last question, one piece of advice you think every student looking to become a neurologist or go into the neuro IR field would need One piece of advice. Lots of people are intimidated by neuro, right? I mean, you took your neuroanatomy part and all the different cranial nerves and the spinothalamic tract and the dorsal column and the spinal cord, all this stuff, right? I would say... Yes, I remember all of it. See, But then I realized, no, no, no, no, no. How you look at it is you take basically a basic framework and then you add things to it. So I would say take a look at the big picture, then add things. That's my advice. For instance, if you look at every higher neurological being, whether it's a dog, mammal, lizards, everything. For all of us, we actually have the same structure. We have motor and processing in the front and sensory in the back. And that's how our spinal cord is. So now you're like, Oh, yeah, you know, like, you know, so we have our ability to talk and the motor, the arms and everything towards the front, the sensory towards the back vision is back here, hearing is here. But that's how the spinal cord is, too. So if you think about it from like, let's look at the overlying archetype, and then we add the muscles and tendons on let's, let's get at least get a skeleton. Once you have a skeleton, it's a lot easier to like add things. And so that's my like, one one one piece of advice, step back and see what the overall message Love it. Love it. All right. Well, I think this has been awesome. I do think our listeners and viewers are going to get so much out of this interview. Where can they find So you can find me on LinkedIn, Mohammed Taleb. On Twitter, it's at stroke van. Great. And then on Instagram, it's Taleb T E L E B underscore neuro vascular. So Amazing. Thank you so much. I don't know if there's if there's anything else you want to add, go for it. But my my camera is actually about to die. So it Thank you so much. I love that you're doing this like podcast that's so impressive that you're I mean, it's such a good way for people to look into healthcare before going into healthcare, but also to see other colleagues and like what their like views are. So the last thing that I want to say is kudos to you and you're doing like Thank you so much for saying that. This has been great. Thanks for taking the time out of your busy schedule. And I'm sure we'll see each other again, at least on social media. Go follow Dr. Taleb. I will put his links below in the show notes and the video notes. And yeah, thanks. Have a great day. This is the So You Want to Work in Healthcare podcast with new episodes every month. 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