Dr. Theophil Stokes, Chief of Neonatology, Walter Reed National Military Medical Center

Can physicians of the future be experts of science and empathy? Dr. Theophil Stokes, Chief of Neonatology at Walter Reed National Military Medical Center, believes they can as he shares stories from his experience as a neonatal doctor that proves it’s not only more beneficial to the patient, but also to the doctor and medical staff. 

Dr. Theophil Stokes is the Chief of Neonatology at Walter Reed National Military Medical Center and an Associate Professor of Pediatrics at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. He previously served as President of the Medical Staff, Chair of the Provider Wellness and Healthcare Ethics Committees, as was the Associate Program Director for the National Capital Consortium’s Pediatric Residency and Neonatal-Perinatal Medicine Fellowship programs. He has developed educational initiatives aimed at improving communication between patients and their healthcare providers, and his work in this field has been highlighted in national and international presentations and peer reviewed publications. Dr. Stokes was recognized as a Walter Reed Master Clinician in 2016, and in 2017 was selected as a Regional Finalist for the White House Fellows Program. He is a Fellow of the American Academy of Pediatrics, and is dual board-certified in General Pediatrics and Neonatal-Perinatal medicine.

Show Notes

• Dr. Stokes ponders what health care will look like in 2049 by describing a typical doctor visit in 1849. [2:14]

• What’s missing in medicine today that will be a prerequisite for doctors in the future? [4:43]

• How can we achieve this new vision and how much will it cost? [6:18]

• The defining moment that made him decide to become a neonatologist. [7:33]

• A non verbal exchange with a patient that showed a disconnect between the patient and hospital staff. [11:50]

• A breakdown of a well-intended, standardized medical approach to caring for an emotional patient. [13:33]

• What’s the best way for a doctor to counsel a family in distress? [17:47]

• What are some of the obstacles in teaching empathy to doctors? [25:13]

• What can we do as a society to encourage doctors to take an empathetic approach to care? [28:48]

• What causes the resistance to empathy in the medical field? [29:17]

• An example of a behavior between an emotionally detached doctor and one that is connected, emotionally engaged and present. [31:17]

• It’s time to reanalyze and reassess how people get into medical school. [33:18]

Transcript

Bisi Williams: I'm Bisi Williams and you're listening to Health2049. 

Dr. Theophil Stokes: In medicine, I think for a long, long time, there was a notion that one needed to be emotionally detached in order to do their job effectively. This idea that objectivity is what the gold standard should be I think is a big problem because I don't think our patients actually want us to look at them as objects. I think patients want us to treat them as real people.

Bisi Williams: My guest today is a neonatal intensive care physician by training and a humanitarian, but his overarching interest goes beyond his specialty and extends to the world of physician communication and empathy and the critical role that these factors play in the lives of our patients and their families. Dr. Theophil Stokes, welcome to health 2049. 

Dr. Theophil Stokes: Thank you so much for having me. I'm really excited to be able to talk to you today and looking forward to our conversation.

Bisi Williams: We're excited to have you today, too. I’m going to jump right into it. What does healthcare look like in 2049, from your perspective?

Dr. Theophil Stokes: I love the question and I love being asked to think about it this way. I think to look forward, I want to just quickly look back to 1849, which I know is going backwards, but I'm going to get back to the point here in a second. So in 1849, healthcare was very different, obviously. The things that doctors carried in their bags and the medicine that doctors were able to provide in 1849 was obviously vastly different than it is today. Interestingly, 1849 is the year that the first female physician was trained in the United States of America, which I didn't know until I went back and was reading about 1849.

In 1849, doctors basically came to your house and they had their bag, which had some things that might help. And they also had things that might harm you. They had leeches, they did things like bleed patients in their houses, but the things that they did made us feel better in terms of feeling better–when we say feel that means a lot more than just going from being sick to being well–a lot of how we feel is wrapped up in our emotions and there’s so much more to healthcare in our overall wellness than just treating a disease. The good doctors back then, although they didn't have antibiotics, and the medicines were limited and sometimes even harmful, but they made you feel better because they came to your house. They came to your space. They listened to your story. They were attentive to you as a person. They did this to avoid hospitals, which were cesspools of infection and weren't kind of happy places to go, not that they're happy to go to these days either, but they came to your house, they listened and they got a glimpse of who you are as a person.

So thinking about healthcare in 2049, we fast forward to where we are today and clearly medicine has made huge strides, our technologies are incredible and we have the ability to fix and to cure diseases that would have been unimaginable in 1849, however, some of the things that we've lost, in this quest to improve our healthcare, is that bedside manner, that attentive physician who was present with you as an individual who was able to listen to your story and treat your disease within the context of your life. I mean, literally being in your home, in your bedroom, you can imagine how that would facilitate a healthcare plan that is individualized and attuned to you and attuned to the family living around you.

So my vision for 2049 is that our healthcare system in particular doctors, we as a society will have doctors that are trained, obviously in the highest technologies, understanding the most sophisticated medical technologies and medications, and that'll be a prerequisite of what we expect of our physicians. But in addition to that, we will as a society have made a decision that just being a technocrat, just having a scientific mind is not in and of itself enough to be a doctor or physician and that we will have learned that so much of disease is wrapped up, not just in the physiology, the medicines and the procedures, but also of the way that we feel on an emotional level. Being a good doctor entails to being able to provide care that is attuned to the individual that's sitting before you. And so our healthcare system in 2049, we'll have come back to that place where we're able to combine those aspects from 1849, that bedside manner, those physicians that truly knew you and cared about you, with all of the rapid increases that we're going to continue to have in medical technology. And that's my vision for where we can go and hopefully that's where we're going to be.

Bisi Williams: That sounds wonderful. Why are you confident that your idea of this attuned doctor, physician with bedside manner can be achieved in 30 years? 

Dr. Theophil Stokes: I'm confident because this is what most people already want and it doesn't take any more money. In many ways, it's a lot less expensive to select and train individuals in these kinds of skills than it is to think about all of the money that we pour into research and technology development, which is obviously important, but these are inexpensive things. When we are truly sick, ill and fragile and when we are in need of somebody else to care for us, when we're vulnerable and afraid, these are the things that we all want. I've been with people at the end of their lives or the end of their loved one's lives, and you see this over and over again that when you get to those places, we need people that care about us and we need to feel cared for and we all expect this. It's not something most of us are thinking about until we need it and if we can, as a society, start to have these conversations, this is something that we can easily have. We just have to say collectively, this is what we expect and what we deserve as people. And that is why I feel optimistic about this. 

Bisi Williams: I love your optimism. So tell me what made you decide to become a neonatologist. 

Dr. Theophil Stokes: Yeah, so it's an interesting specialty, it developed kind of later in the game. I trained as a pediatrician, so I went to medical school and then I did a residency in pediatrics. Neonatology is a subspecialty of pediatrics that requires an additional three years of training as a fellow, what they call neonatal perinatal medicine. 

What really grabbed me about this was in medical school at Boston University, I remember I was on one of my pediatric rotations and I was just outside of the NICU, the neonatal intensive care unit, and don't remember all the details, but I got pulled into this case where there was a mother who had been admitted and she was a recent immigrant. She didn't appear to have any family or support. She was all by herself. She was Urdu speaking. I remember there was not a translator available and she was in labor at around 24 weeks gestation into her pregnancy. A normal pregnancy is about 40 weeks long. She was literally just halfway into her pregnancy point where babies that are born at that age are just beginning to have enough lung development to be able to survive outside of the womb. 

And so in neonatology, there's this very unique circumstance that arises in those cases where expectant mothers, who are about to deliver in these extremely premature age ranges, that we as neonatologists are expected to have a conversation with the expectant mother. And essentially what we're doing is we're trying to have an informed consent conversation about if their baby is born this early, do they want their baby to be subjected to all of the things that we have to do in order for a baby to survive at that age. And the reason we have this conversation is because in many cases, babies born that early are unable to survive outside of the womb, no matter how many things we do. So when parents make this decision, it can mean that they're not going to have any time to really hold their baby or to be with their baby because we have to whisk the baby away right after birth and get them to the NICU and do all kinds of procedures that make the baby that very inaccessible to the family. In spite of all of that, many of the babies still will not be able to survive. 

This is what we call gray zone of viability, where it's ethically been determined that it's okay to go ahead and try to do these intensive care things, to try to help the baby survive. But that also for some families, it is ethically permissible to say, you know what, I'm not going to do all those things for my baby. I just want to be able to hold my baby for the little time that we have. And for my baby not to be subjected to that. So we're asking somebody to make a life and death decision about their child that they've never met, that doesn't actually exist. It just struck me as such a superhuman place to be. And I was fascinated by, was it really even possible to have such a conversation? Could people actually, as human beings be expected to really make that decision and how do these neonatologists that are supposed to be having these conversations, how do you do it? Because it just seems like this superhuman feat.

So I was really interested in trying to understand how this could be done. And going back to that woman I described, clearly what I saw there was the way not to do it. There was never anybody there to translate for her. She ultimately had the baby, the baby was resuscitated and taken away from her. I don't actually even know what happened after that, but I just remember being struck by the humanity of that and wanting to understand and to potentially be a part of helping people through what seemed like such a crisis in their lives. So that was kind of the root of how I got interested in the profession.

Bisi Williams: So as a young medical resident, is that the correct term? Were you a resident?

Dr. Theophil Stokes: Sure, I was a resident then, yep, in pediatrics.

Bisi Williams: As a young resident and going through your rotations and you see this woman who we have no means of communication, there’s a language barrier and she's alone. What did you see in her? And what was the experience like for you? I mean, obviously it was a non-verbal exchange. 

Dr. Theophil Stokes: As I think back, I was actually just a medical student, so even lower on the totem pole than a resident. And as a medical student, you're very much an observer. You’re kind of like a fly on the wall and occasionally somebody will pull you in and say, hey, help us do this or something, but in that particular circumstance, I was basically an observer. I remember being struck by this woman's fear and just the look in her eyes of fear of not understanding at all, what was happening and being struck by the lack of support and how alone and afraid this woman was and how wrong that seemed. And also how normal it seemed to the team taking care of her, how this just seemed like something that happened all the time. I couldn't shake how discrepant those feelings were, here you have somebody in the pit of despair who is clearly suffering and then a team of people who sort of seem like this is something that happens every day.

Bisi Williams: When I think about the progression of your life and work, there are sort of seminal moments I feel that get you to this place where you can really look at compassion and empathy and communication as clear markers for a well-trained physician, if you will. These soft skills are really hard skills. 

Dr. Theophil Stokes: That’s right. 

Bisi Williams: Can you tell me another instance in your journey to be a comprehensivist physician, that you realize where as a profession you could do better?

Dr. Theophil Stokes: Yeah. So that was me as a young, nobody medical student with no power and really no voice. But fast forward to, now I am a brand new neonatal staff, so I've done my residency in pediatrics for three years and I've done my fellowship for three years as a neonatologist, and now I am an attending physician and I found myself back at the training program where I actually had undergone my training and so literally on the other side of the glass. 

For the fellows, the doctors in training, we have these training scenarios where we use actors to play the role of patients. And I was sitting on the other side of a one-way mirror looking at a one of our NICU fellows and an actor playing the role of a mom about to deliver her baby prematurely. I remember the actor was really strong and she really embodied the character of a mother who was there. And in this scenario, she was there by herself and alone and afraid. And the objective for the neonatal fellow was to go in the room and to counsel this mother on what it would be like to have a premature baby. I had in front of me a checklist that said, the fellow should talk to the expectant mother about all of these potential complications of prematurity. And as the fellow went through and said the different complications, I was supposed to kind of check off on my box. And if the fellow had talked about all of the complications that could arise, then the antenatal counseling was deemed to be a success and the fellow sort of check that box and it had demonstrated competency. So this was how this was supposed to work. 

Bisi Williams: Wait, let me just stop you there for a second. So as a part of the best in class training, is to talk to a woman who's in the throes of distress at the worst moment of her life and then to have a checklist that you want to talk to her about everything that could go wrong with this little baby inside her.

Dr. Theophil Stokes: That is absolutely right. I'm not exaggerating. This is the way that we were taught to do this. And It seems now talking about it and it seemed then, insane. It seemed particularly insane with watching this actor. She was really good. I watched her as the fellow started to talk and this is how we were taught to say, now, here are the problems that your baby could have. I'm going to start at the head and go down to the toes. And we would talk about, inter ventricular hemorrhage and bronchopulmonary dysplasia and patent ductus arteriosus. We call it PDAs, IDH, BPD, CLD, like, all of this alphabet soup and I kid you not, we were supposed to just go through all of these things. And the idea was, if we didn't say all of those things, that we were not providing adequate informed consent. Our healthcare system has become, I don't want to say obsessed because it's rooted in a good intention, we want people to be informed and to be able to make informed healthcare decisions. But I think we've taken the idea of informed consent, we've sort of taken it well beyond what it was intended to do. 

So this is the model that this was rooted in and, medicine being medicine, there's another obsession of standardizing things and standardization is great with airplane safety and automobiles, because we want to do things the same way every time so that you can make it as safe as possible. And there's definitely a lot to learn about, that can be gleaned from that and that we can use in medicine. However, the idea of standardizing an approach to somebody that is literally in the throws of the strongest emotions you could ever imagine, this is where it all breaks down. And I remember thinking, this may be well-intended, but we are doing this all wrong and we need to take a step back and really think about other ways of doing this. 

Bisi Williams: Could you give us an example now of how you can counsel a family going through a very difficult time? And how you solve the problem and what was the result of your you're listening to a family in distress?

Dr. Theophil Stokes: Yeah, this is a story I think that really exemplifies how patients have to be heard in order to hear. I was coming on call to cover our neonatal intensive care unit one night and my colleague, she was the daytime NICU attending, and she was extremely frustrated because a baby had been born about four hours earlier and it was clear that this baby had a condition known as trisomy 18, which is a very severe genetic anomaly that we're not able to cure. And that babies who have this often die within the first hours or days after birth, in spite of everything that we might try.

And so it was very clear that the baby had this condition. The doctor that was signing out to me, she was really upset because in her words, the parents were just unwilling to accept reality. And that they wouldn't believe that their baby had this condition and they wanted “everything to be done.” So the doctor was upset because the baby was still on a ventilator and was being cared for in the NICU. And the nurses were angry because they felt like they shouldn't be doing this to this baby because it wasn’t justified because this baby was going to die anyways, and everybody was upset.

She said don't worry about this tonight. Tomorrow morning we're going to get an ethics consultation and we'll sort this out in the morning. Then she signed out the rest of the babies and that was sort of a night. It was a quiet night and me being me, I thought, maybe I'll just go talk to this family and try to get a sense of what's going on. So I went to the room, they were up in one of the postpartum rooms and it was just mom and dad and it was quiet and they were a little bit older, I think in their early forties. It was mom's first baby. I asked them, I think I said, tell me about your pregnancy and tell me about what's happening. But basically from there, for like the next 15 minutes or so, they told me the story of their pregnancy. They had been trying to get pregnant for a long time and were unsuccessful and mom was getting older, so they were obviously extremely excited when they got pregnant. There was clearly a lot of joy when they told me the story and I could feel the joy and I experienced with the joy with them. They told me about finding out about being pregnant and their early appointments. And then they went to one of their prenatal checkups around like 16 or 17 weeks and they did this ultrasound where they could see the baby and they were so excited to see the baby. Very quickly, during that scan, it was clear that there were lots of problems and that their baby had a lot of physical abnormalities that were really suggestive of this genetic condition. And so the ultrasound tech that was all excited, all of a sudden got very quiet and wasn't talking to them and then leaves the room and gets the doctor. And the doctor comes in and then breaks this bad news and starts to tell them all of the things that are wrong with their baby. And they came back for their next appointment and it had been confirmed and they were essentially counseled that this is a condition that is incompatible with life and they should think about terminating the pregnancy and that there wasn't really any hope for their baby. They heard this and they got really angry. What they heard was that their baby was deformed, that their baby was some kind of a monster, that their baby didn't deserve to live.

And they got really angry and so they ultimately just stopped going to their prenatal checkups. They didn't show up again until mom went into labor, she had come in that day in labor and had the baby. They were explaining what the delivery room was like and mom's face and dad's face, they just lit up when they started to talk about their baby being born. He cried, he had a strong cry, and he was taken to the warmer. Dad got to trim the umbilical cord. They were just gushing, new happy parents. And I got to be there and feel that joy with them about their son who was born. Who was alive right then and there, who was four hours old and who existed and was alive in the NICU. This didn't take a long time for them to tell the story, this took a few minutes. And I just listened and experienced things with them and felt these feelings with them and probably got a little choked up. And then they eventually asked me, so what do you think is going on with our son? Then I told them that I thought their son had this condition. Essentially what I told them was exactly the same as the doctor had told them earlier in the day. 

The difference now was that they were able to hear this and they were able to process it. They were able to feel like they were hearing this information from somebody that had a vested interest in their family. And so they asked me, what did I think we should do? I talked to them about palliative care, hospice care and how hospice could facilitate them having some time with their son and that they could have some time together as a family. And that we could do all of these things to make his time here meaningful and to protect this time together as a family, as opposed to having them separate, in the NICU and in different spaces. And they were able to hear that. And then they decided that they were going to sleep on it and would make a decision the next morning. And we thought that was a good idea. 

Then I got up to leave and the dad, he gave me a big hug and he said thank you so much for taking care of my son. And I remember being very emotional, but also feeling like, in my head, I'm thinking I haven't really taken care of your son, I haven't done anything. I wasn't at his delivery. I didn't do any of the procedures. And I've come to realize now, that story was again, one of those most meaningful moments early in my career that was clearly demonstrating that, if we are to take care of our patients in the best way that we can, first form an alliance. We have to gain the trust of that family. 

Just by being there and showing them that I cared about what they were going through, they came to trust me in a very short period of time and were able to hear that. They ultimately decided to take their son home in hospice care. I heard that he lived for a few days and presumably, that was as much time as they were going to have, but they had that time together as a family.

It's sort of an example of how, as a doctor, you're not just caring for the patient in front of you, but you're caring for the family and you have to take care of the team that you lead, the NICU, the nurses and everybody. All of that came from 10 to 15 minutes of listening to somebody's story.

Bisi Williams: I'm struck by your role as a practitioner and a teacher, how many hats you wear and your insistence on training doctors that not only have awesome technical skills, but also have incredible empathic human skills. Can you tell us some of the obstacles you may encounter in teaching empathy and care to the doctors.

Dr. Theophil Stokes: Yeah, it's a question that I have thought a lot about over the years and there is not a one size fits all approach to it. It's challenging because empathy, there's a lot of research right now going into first and foremost, can we teach empathy? That being said, I think that there is a lot that we can do to acknowledge the importance of this, not just the importance, acknowledged this as a fundamental skill for doctors to have. 

So when you go to your doctor, you go assuming that they have gone to medical school and learned all of the medicine that they need and that they understand if they're going to do a procedure that you trust that they're going to have been trained to do this well. And that’s sort of an expectation that society has evolved, certainly in our society. I think for too long, there’s maybe not that expectation that your doctor will bring those human skills, the ability to empathize, to be compassionate, to genuinely care about you as a person. That hasn't necessarily been an expectation. So medical training programs, starting from medical school and going through residencies, particular specialties and even subspecialty training, they have increasingly begun to teach some degree of how we can talk to patients and emphasize the importance of that. But it really is not a primary focus. It certainly wasn't when I was in medical school and it isn't a primary focus of our residency and fellowship training programs now. So for instance, a neonatal fellow in our program who's going to be taking care of sick babies, it's an absolute expectation that that person, when they finished fellowship, they will be able to put a breathing tube in to a sick baby or to do a life-saving procedure. We would not let them finish their training without having shown us clearly that they can do that.

We don't have those expectations for our physicians to be able to sit with a family when their baby is potentially critically ill or even dying, and to be able to assist them in making these difficult decisions about some of the treatment options. What is my baby's death going to look like? I mean, these are excruciatingly painful conversations. We do not have an expectation of any sort of a minimum level of competency in these regards that these, have for too long, been thought of as, almost like, I don't want to say fluff, but like the touchy feely part of medicine. A lot of medical school training programs have elective courses in these kinds of areas, humanism in medicine. 

Bisi Williams: Wait, wait, wait, how can empathy and compassion be an elective course for a doctor? 

Dr. Theophil Stokes: Yeah. That is exactly the question we should all be asking. I think it’s one of those things where you don't realize how necessary it is until you absolutely need it. And I think that, fortunately, most of us aren't thinking about these in our day-to-day lives. You don't think about these things until you're faced with some horrible crisis where somebody that you love is sick or dying. And I think that's the problem. So it's on us in our medical profession to really begin to put some focus on this and to have this as an expectation of our medical training programs. 

Bisi Williams: Why do you think that there's so much resistance and could you mandate today for example, the doctors that you train, this is no longer an option, it's part of your training?

Dr. Theophil Stokes: I think as I go along in my career and as I continue to make a case in every way that I can, that this is critically important, we are getting there. It's small steps, but they're real steps. I think that our society could certainly demand these kinds of changes and that if our society said that this is what we expect of our doctors, then we would very quickly be able to reform and to change our practices.

In medicine, for a long, long time, there was a notion that one needed to be emotionally detached in order to do their job effectively. Maybe the most compelling version of this argument would be with somebody like a neurosurgeon or somebody who is involved in a hours and hours, long, delicate operation, where their technical skill needs to be superb and precise and presumably having strong emotions while someone's doing brain surgery is likely not a good thing for that doctor at that particular moment. So that argument can be made effectively. And I think that there's some value there. But I think that has been more broadly applied to all of medicine. There’s this idea that, as a neonatal intensive care physician, I don't want to get too emotional because it's going to impair my judgment and impair my ability to objectively provide care. This idea that objectivity is what the gold standard should be, I think is a big problem because I don't think our patients actually want us to look at them as objects.

I think patients want us to treat them as real people and individual subjects. So this idea of objectivity has just always kind of been assumed to be the gold standard. And for a lot of doctors who spend their lives really thinking about the science and the pharmacology and the procedural techniques, we need those kinds of people. But there's not always an expectation that those people should also have these kinds of abilities to translate what they know into having an ability to really compassionately care for patients. 

Bisi Williams: So Dr. Stokes, in your professional opinion, do you feel that being subjective hurts your performance as a professional?

Dr. Theophil Stokes: I mean that's the irony of this is the doctors that I see that are “burned out” who seem to have really not cared or seem to have stopped caring or seem miserable every day when they go into work, their patients don't particularly like them. They don't particularly like their jobs. They tend to have relationship problems. There is a whole lot of depression, suicide, and relationship problems that are pervasive in medicine. 

And so for me, it's completely the opposite, having those feelings of intense connectedness with my patients is what sustains me. So I go through these difficult experiences and sometimes it can feel totally overwhelming. But to have those moments where I can just as a human being, sit with a family who is going through an overwhelmingly sad situation, be present with them, help bring them some closure and help their family have some time together with their baby who may not have much longer to live. It sounds incredibly sad and yet those moments, I find myself having felt as though I really did something to help this family to be together during the time that they had and to find meaning in the life of their baby, who may not have lived for very long.

That keeps me going and I think that has been my perception amongst people that I talk to in medicine who feel similarly, is that being connected and being emotionally engaged and present with our patients, it makes you feel like you're doing something of value. And that keeps you coming to work and it keeps you feeling good about what you do. And that kind of seems to make sense. So, I don’t buy the argument that a disconnected emotionally detached doctor is a healthy way to protect yourself from all the feelings. 

The other thing I'll say, and I don't mean to say this cavalierly, is that, some people are probably not meant to be doctors. And that is another thing that we don't really do well. So if you get excellent grades in college, you ace all of your science classes, you rotate at Mass General, you have great recommendation letters, and when you have excellent MCAT scores, then you basically get into medical school and it doesn't really matter if you don't have the ability to talk to people or to interact. There isn't really a way of assessing the quality of somebody’s personality, their ability to empathize, these aren't really part of the game. It’s very objective. And so that is a part where way upstream, we really need to reanalyze and reassess how people get into medical school. That's a big change because the way we do it now, that is not a focus of it, to be sure. 

Bisi Williams: Right, and so if you think about our expanding abilities, our technical know-how and yet, at the end of the day, there's a person at the other end of this interaction. It's a human to human experience. On the one hand, I was thinking in 2049, it might be a bit existential for highly trained, intelligent beings, professionals, like doctors to think about some of their work being replaced by machines. But in this sense, I think that there still is a future for very creative, empathic and wonderful medical experiences for doctors as a profession and for patients to be on the receiving end of.

Dr. Theophil Stokes: It does and if we someday need less doctors because there are more technologies that can do some of these jobs, then in some ways that allows us to select a more excellent person, let's look for excellence and look for those attributes that make someone an excellent doctor and focus on that. So in some ways that is another reason to be optimistic.

Bisi Williams: I think we're going to need more doctors, to be honest.

Dr. Theophil Stokes: We're going to need people, yeah, doctors, nurse practitioners, physician's assistants, there's going to be lots of people that have to translate this care. 

Bisi Williams: Dr. Stokes, I am so inspired by your vision for physician training and patient care in 2049. Thank you for your ideas and your humanity and your compassion and your skills. 

Dr. Theophil Stokes: Thank you so much for doing this and for letting me be a part of it.