In this episode of The Whistler Podcast, Mayor Jack Crompton and Cole Stefiuk speak to Dr. Clark Lewis about his primary care practice BettrCare that has used technology to modernize the house call, in a community with a shortage of family doctors.
Dr. Lewis is an ER doctor, skier, mountain biker and surfer who, over his career, has watched access to primary care get more difficult for patients, and Dr. Lewis decided to bring back the house call to help fill that gap. During the pandemic, BettrCare has also offered COVID testing for travellers.
In this episode of The Whistler Podcast, Mayor Jack Crompton and Cole Stefiuk speak to Dr. Clark Lewis about his primary care practice BettrCare that has used technology to modernize the house call, in a community with a shortage of family doctors.
Dr. Lewis is an ER doctor, skier, mountain biker and surfer who, over his career, has watched access to primary care get more difficult for patients, and Dr. Lewis decided to bring back the house call to help fill that gap. During the pandemic, BettrCare has also offered COVID testing for travellers.
Today on The Whistler Podcast,
Clark Lewis:Maybe a bit of a precipice with our healthcare system right now. It could, it could easily just implode.
Dr Clark Lewis:Hello everyone. I am Jack Crompton. He is Cole Stefiuk. This is the Whistler Podcast as always. We want to acknowledge that we live, work and play on the ancestral unceded territories of the Lil'wat Nation and the Squamish Nation. Uh, today Cole, we're going to be talking to another doctor, Dr. Clark Lewis, um, about the future of medicine here and, uh, around the world.
Cole Stefiuk:Yeah, me too. I have been working so hard, uh, to stop my like anxiety with hospitals and doctors. And you keep bringing doctors on the show. So looking forward to,
Dr Clark Lewis:Um, okay, well, let's get to ask Jack anything, ask Cole anything. My question for you Cole is you work day to day in a very public, uh, location. I walked by yesterday. I saw you in there doing your job. And I thought to myself, man, oh man he must get interrupted, like in the middle of work all the time. It must be very challenging. Uh, tell us what it's like to be sitting in the middle of the village, doing your job. Well,
Cole Stefiuk:First of all, how long were you? I noticed that you had worked kind of stationary. How long were you standing there waiting for me to notice you?
Dr Clark Lewis:Oh, I don't know, like 15 seconds
Cole Stefiuk:Okay. Cause I was like, I was actually on my phone. When you walk by, I looked at him like, oh, there's Jack. Uh, um, yeah, it's sometimes I feel like a zoo animal. It's such a weird thing because, because if you, if you haven't been it's, it's an, a kind of a quiet corner of the village though, right? Under the Earls there beside the Shoppers. Um, but yeah, sometimes people will come up and make fools of themselves. I had a group of children who all came up one day and started smashing their head against the windows. It was very uncomfortable.
Dr Clark Lewis:Yeah. All right. Ask Jack anything.
Cole Stefiuk:All right, Jack. Today, as we record this it's October 1st, we got to have winter tires in the car. Do you have winter tires on your car today?
Dr Clark Lewis:Yep. I do. I did it. Yes I did. And in fact I pleased with myself because most years, if you'd asked me on October 1st, if I have a winter tires on my car, the answer is probably no, but this year we did it. So, whoa. I'm so glad. That was your question so that I could answer yes to it.
Cole Stefiuk:I was trying to catch you off guard and catch you slipping, but not today. Not what those winter tires on. You're not slipping anywhere
Dr Clark Lewis:Sweet victory. Okay. Uh, last week's headlines. Here they are. I give you three. You choose one. We talk about it. First is water testing at RMOW facilities finds elevated lead and copper, to Vail replacing Whistler's Creekside Gondola and Red Chair. And three: Can multi-home lots address Whistler's missing missile middle housing. All three are interesting.
Cole Stefiuk:I have to, if there were some missing missiles, I would've picked that one, but out of those headlines, I am most excited for the Creekside improvements. Okay. Uh, so let's talk about a little bit about that and let, because I just, I feel like that is something that I didn't know that I wanted in place, but now that it's there. Absolutely.
Dr Clark Lewis:Yeah. I'm, I'm interested. I want to talk to, we should have Geoff Buchheister on again. Cause I wanted to talk about the decision making around having it be two gondolas rather than one to the top, because I would have thought like the dream scenario would be one gondola. Like they have on Blackcomb, that's got a mid station and it just kind of goes to the top. But what I understand is that it's two, it's still going to be sort of a Creekside gondola to mid station and then a gondola.
Cole Stefiuk:It might be. Cause one of the challenges with Blackcomb Gondola is when it's windy up top, it was member at the beginning, it was having a hard time continuing to operate when it was windy up top. And Then that impacts the bottom half of the gondola as well. And if they're two separate, um, lifts, then you can keep the bottom operating and getting people up there. And your issues are sort of segregated to the top of the mountain where there's the most wind. And then it makes sense too, because if on the Blackcomb Gondola, if that's closed, it's like a five minute walk to Excalibur or to the Whistler Gondola, whereas Creekside you're you're out of luck.
Dr Clark Lewis:Yeah. So all of that is speculation from people that do not know anything about, uh, lifts.
Cole Stefiuk:I bet you, somebody looking at, they got some ideas in their head too, so I don't mind it, but uh, okay. Um, before we jump into our interview though, cause I did, we ended asking you about your tires, but I do have another question cause I want to, I wasn't able to go there say I'm assuming maybe, you know, someone who was, or maybe you were there, uh, about the, uh, Truth and Reconciliation and all the stuff they were doing at the SLCC, obviously when this comes out and it's going to be probably about a week passed, but uh, were you, were you down there yesterday?
Dr Clark Lewis:Oh yeah, it was amazing. I mean, I it'll be interesting 20 years from now to look back on that day. Uh, and, and it was the first right. It's the first time that we did this. And so, you know, the first time they did Remembrance Day, what did they expect? It would look like in the future and what it looked like yesterday was a lot of learning and listening. Uh, and, and I just was so grateful that the two, the, um, Squamish and Lil'wat people and their willingness to spend this day in Whistler sharing about the truth of our history on this land, because that's a big ask. I mean, it's a really big ask to say,'Hey, can you spend a day sharing with hundreds and hundreds?' I think there was something like 1200 people that went through the SLCC(Squamish Lil'wat Cultural Centre) yesterday.'Will you come and share, you know, this heartbreaking, devastating, horrible reality with a huge number of people.' And they did so with kindness and grace and honesty, like it was a day of hearing some really hard truths in a way that seemed very loving. So, um, I was so amazed. It was pretty, it was a good day.
Cole Stefiuk:Yeah, good. I wasn't able to go cause I had, I was working yesterday, but I spent the whole day like watching and listening to stories and uh, I cried on air. I'm not even gonna lie. I cried on there. Like I can't believe some of the stuff that I heard
Dr Clark Lewis:Yesterday. And I think yesterday was like maybe the first, like it hit the deepest yesterday. Like I, I started to kind of understand everything better over the past few months, but yesterday was, yeah, it was heavy. Yeah. It'll be interesting to see what what it's like 20 years from now.
Cole Stefiuk:I hope we get the change that we need. I hope, I mean that they deserve the people who have gone through all this.
Dr Clark Lewis:Yeah. Yeah. Well, thanks for asking. It's an important conversation and one that we, we need to continue to have, uh, one of the, the people who spoke so well yesterday is, is, uh, um, Gélpcal Chief Ashley Joseph, he's the cultural chief for the Lil'wat, and he'd be a really fascinating person to have on, on the podcast at some point to really hear the stories and hear the history. He's a great presenter to a group of people. And, and when I say with honesty and love, that's what I really took from what he said yesterday is just a willingness to put himself out there and share the truth with love, which is pretty cool.
Cole Stefiuk:Yeah. Yeah, absolutely.
Dr Clark Lewis:Okay. Let's talk to Clark Lewis. Dr. Clark Lewis. Clark Lewis is a doctor, a mountaineer, an entrepreneur, and a family man. He grew up in Manitoba, but has been serving the Sea to Sky as a doctor since the early two thousands. He loves to surf. He loves the people here, and he has served us well for a long time. And I have to say how impressed Clark I've been with your work through COVID. I think that, um, you're one of many people who have served us extremely well, but you for sure have been a stalwart. And then someone who's been in my ear and helping me understand what we're facing. So thank you for your service over the long-term. And thank you for your service over the last 20 months. Uh, we're grateful for it. Thank you. Nice to be here. It's nice to have you. Uh, so the way we do this is that we start with some rapid fire. So we want to understand and get to know you a little bit better before we start talking about, uh, your work and, and all that you do. So we'll start with this. Tell us about the music you like. Okay. I listened to a lot of, uh, I think like most 40 year olds, they listened to a lot of music from my younger days. And, uh, so it's a lot of like, uh, punk and metal and, and, uh, and Wean and Pavement and, uh, old school rap. Yeah. Funny stuff like that. So that's really dating myself. Uh, but yeah, realistically we're a pretty musical family. I, I play a bit of drums and, uh, with some friends and, uh, my girls are into music and my wife. And so there's always kind of music playing in the background and we'll listen to it pretty much anything. We don't, we played the, yeah, we like play together a little bit, but I, I have a little jam band, but we haven't been playing much during COVID, but I've got some friends at it. We've been playing together for a long time and we just basically goof around and I, I kinda miss it. We haven't been doing it much lately. Do you have a name for your, your jam band? Okay. Uh, someone named it, The Rotor Bolts, which is the loose association of buses through, through bike riding. So, so I'm not, for some reason we ended up being called The Rotor Bolts, right? No idea why, Ah, I interrupted you, you were saying something about your, your wife. Oh, I was saying she even likes country music, which is not, it's not my thing. That's kind of the one, the one type of music. I'm not that into, but I'll listen to anything. Um, the, I, you know, the song, I Hate Winnipeg, you know, we hear that. Yeah. I, yeah. I went to a bunch of their shows. Are you from Winnipeg? No, I just, they're the one band I know from Manitoba. Yeah. Yeah. They're from Winnipeg and they, uh, they were part of my growing up, I guess. And I've seen them quite a few times live. Um, yeah, that's funny. I haven't thought about that song for a long time. It's one of my faves. It's funny. It's I think, I always think of the weaker then is, is the, the Manitoba equivalent of Spirit of the West. Because as a kid that grew up in BC, I saw a Spirit of the West more times than I can count. And it's because they were always the show that was moving through town. Huh. Yeah. Um, so what are you, what are you curious most curious about these days? Well, I've, to be honest, I'm pretty consumed with my, uh, business, which is, it's a bit unmanageable right now. Um, but if I zoom out, uh, I'm, I'm curious about a lot of different things. I have, uh, I have some hobbies that I enjoy, uh, but I'm kind of missing a little bit like surfing and mountain biking. I haven't done that as, as much as I'd like normally. Um, and, and then, you know, I'm pretty, I spend a lot of effort, uh, with my kids and my family. That's kind of my big priority. Um, but work has kind of been this big sort of veil over everything lately. And, uh, so it's a good question. I'm doing, we're doing some, we have a little team that we're redoing some psychedelic therapy training right now. So there's been a lot of curiosity with that. That's been very interesting, and then I'm quite interesting kind of longterm in, um, in, uh, things like artificial intelligence and healthcare. And, um, and just thinking about climate change in term for sort of through a lens of healthcare, as well as just general life. So those are kind of my, I guess my sort of main areas of interest in terms of my, my spare seconds that I have to, to read and, and think these days, Tell us about AI in healthcare. What do you see moving forward? Well, no one really knows, but it's, it's no secret that big tech has invested a lot of time and money in health care programs. And we haven't seen that come to life yet. Um, but I think we will the next couple of years. And so that includes like Google, Microsoft, Amazon, you know, huge companies. Um, and I think a lot of it's going to be sort of American centric, but they'll perhaps be some spill over into Canada eventually as well. And, um, so from, you know, there's this concept that technology is exponential and not it's deflationary. And what that means is that it grows at a rate that we can't understand, uh, because humans are kind of good at linear thinking. We're not good at exponential thinking. And the deflationary part is that it basically makes things more efficient. And so it, one of the side-effects of that is it needs jobs. And we're going to see that in healthcare, uh, you know, eventually as well, um, including my job eventually, which is impossible to believe right now in 2021. Um, but that's, you know, it it's inevitable that it will be a big part of our job eventually. And I see it, I see it maybe entering the primary care world in terms of family practice a bit earlier, um, where it can be used to help do things like triage and scheduling a bit easier and things like that. Um, but there's all kinds of crazy pie in the sky work going on right now, um, around pretty big stuff. And, you know, one day down the road, you know, we'll probably have some version of a robot doing my job. Uh, I just don't know if that's in 20 years or 50 or a hundred, but it is inevitable. And, uh, and, and not, I find that really interesting to think about it because it's, there's so many things that have to happen between now and then, uh, it's almost impossible to wrap your brain around that idea. Yeah. Even starting with something like biomonitoring and the ability actually for you as a working doctor to know more about me as a patient on a more regular basis. Yeah. A good example of that is, uh, something quite simple, the Apple watch, which can now do it, can take all your vitals. Uh, and there, they bought a diabetes program coming up soon where it can monitor your sugar and it's got an integrated, uh, insulin pump. Um, cause there's lots of examples of that now where you've got a little monitor that people were in their skin and it's got a Bluetooth attachment to your phone, uh, and it coordinates with the insulin pump that they're kind of janky. They don't work that well. And the Apple one will work really well, probably. Um, and then it's only a matter of time until it can do other blood work and better monitoring, more monitoring. Um, but people are already starting to pick up things like arrhythmias and, and, um, things like that with your watch, which is interesting, it's super early days, but that stuff is the wearables thing is going to get better and better and better. And I mean, there's even technology that exists now that could easily probably be actioned and maybe is in some places where my, my vitals have a spike and my watch, uh, communicates with your office and sets up a, uh, an appointment. And I am informed of the appointment, um, without my consultation, because my I've given some ability to the watch to make those kind of things happen in my life. It's fascinating. Yeah. And even, even beyond that, you know, we, we look at our phone constantly and our phones, your phone knows what you look like really well. Facial recognition is already quite powerful. And I foresee in the fairly near future, your phone being able to do the bulk of the triage for whatever's going on with you. Um, so if you look like you're dying, it will know what that looks like. And it will be able to, you know, can take your vitals and realize that it needs to call you an ambulance. And that just happens automatically. Or you're not that sick it'll, it'll, uh, call an ambulance to, um, maybe to take you to emergency, but it's not a huge emergency or maybe just post-call. Um, but I think between, uh, your phone, your watch shield, a lot of the kind of primary care triage will be able to be taken care of in the fairly near future, like five or 10 years kind of thing. Um, and then it, you know, the sky's the limit with that. It, it will just continue to get better. Um, but I think that's, there's this idea in medicine called gestalt, which roughly is the idea that the concept of that the, the whole is more than the sum of the parts. So we have this idea in medicine that some people are really good at being able to identify who looks sick and who doesn't just with their eyeballs. And, um, and some, a lot, it's a big part of emergency practice. Some people are really good at it. Some people less, so, and restorative talk medicine that it's just a gut thing, this gut feeling. But I don't believe that I believe it's probably our brain's ability to process what someone looks like based on a few hundred different things like the angle of your eyebrows, color of your skin, blah, blah, all this stuff. And you can teach a computer to do that. And I bet that Siri knows what you look like better than like, you know, better than anyone else. Cause she looks at you constantly. That's I think that's one way that AI will make a really big difference in terms of primary care triage. Hmm. You, you completely wrecked our podcast. Hey Cole, this was the rapid fire section of the,
Cole Stefiuk:I honestly don't even care who this is so fascinating
Dr Clark Lewis:Wreck away wreck the podcast. That way you have any questions about the future of uh,
Cole Stefiuk:Oh, the health care. Cool. No, I think this is awesome. It's funny. Cause we heard like, uh, we had obviously Dr. Kausky on like earlier in the year talking about like social prescriptions and stuff. And I feel like we're getting a lot of like technological prescriptions, uh, from you Clark, which I think I just I'm. So I am such a hypochondriac that that kinda technology excites me because then I don't have to worry about being unhealthy. My watch will tell me if I'm like, you know what I mean? I don't have to be a hypochondriac. My watch can do it for me.
Dr Clark Lewis:Yeah. And obviously, you know, there's, there's a lot of, um, so the flip side of all this is, is, uh, that you still need a human for the next long time to, uh, to bridge that gap between your anxiety and what your, what your computer is, is thinking is going on with you. Um, so you still need some kind of health translator, and maybe that's what humans, you know, maybe that's what doctors turn into at some point know, there'll be, there'll be some that need to teach the computers how to do their job. And, but there's still going to be some that need time to look after people. Um, because it's going to be a long time until technology is good at this. And, uh, we're, we're not even very good at it. Sometimes there's, you know, you still have huge gaps in our knowledge. And, uh, but, but what we're really good at is, is, um, that sort of human connection and it's hard. I think it's gonna be hard to replace that and maybe it never will be. I don't know. Um, and that's, that's one of the things that I think gets lost, uh, with virtual consult virtual care, which has become really common during COVID for good reasons. And it's wonderful for a lot of things, but it's not great. It's not as good at establishing rapport that can, that human connection that is actually a really important part of medicine. Um, you'll have a much better patient encounter if you can establish a bit of a trust bond. And sometimes you only have a very short time to do that. Um, because it often it's with someone that you don't know. And I think it's harder to do that over Zoom. Um, so that part of medicine I think is maybe never going to go away, uh, because you know, people still need that human, human connections, human contact. And I think that, uh, a robot will leave, have a lot to be desired in that way. Um, how well are we, are you seeing the health care system in BC starting to prepare itself for this transition? Or is, are we just way too far behind and it's going to hit us and we won't know what to do. Yeah, I don't, I don't think, I mean, there may be some discussion about it in the, in the background, but, um, I have not seen any evidence for any sort of thinking along these lines. Most of this, most of this thinking is just based on my interest in pretty tech stuff and it must've been, comes out of the US and, uh, you know, I think our, our healthcare system is, uh, super challenged right now, very stressed. And I don't think there's a lot of longterm thinking going on right now. It's sort of like, let's, let's keep the ship afloat. Yeah. So I, I don't think there's a lot of, uh, sort of zooming out and future thinking going on to, to a large extent, because there's, it's kind of all hands on deck right now just to keep things afloat Survival mode. Hmm. Yeah. Well, I think we should move on from rapid-fire, uh, if we can and, and, and we want to stay talking about health care. So tell us about, uh, your, tell us about BettrCare. Tell us about the, the decision that you made to, uh, start a business. And, um, and, and how long has it been, how long has BettrCare been operating? Uh, the idea came about last fall, so nearly a year ago, and it was sort of a COVID idea. Um, we were pretty quiet at work, uh, because the tourists were gone and, uh, we weren't making much money cause that's a big part of our income. And, uh, I sort of realized through my investing and business sort of hobby and interest, I realized that it's important to diversify my income, um, because I had basically one revenue stream that went, got cut by 60%, all of a sudden it was stressful. And, uh, and then at the same time saw this, uh, difficult access to primary care for people. And as sort of a thought that maybe, uh, some kind of resurrection of the house call could be like a good idea, um, just to get, give people an option besides just virtual care or emergency. But that's what was happening was people were accessing care, uh, virtually. And then we were seeing a lot of people, uh, being sent to ER, because they need to be seen in person. And, and there was no other mechanism for that because a lot of the clinics kind of closed down, during COVID a little bit at beginning and, um, and it's not great. It's just not good medicine. It's not good care. So I sort of thought, oh, maybe a happy medium. It could be, you know, the same sort of everything come to comes to your home theme that we've seen over the last few years where, you know, along the lines of Uber or there's delivery services for groceries, or like that sort of theme, um, why not deliver myself to people's houses? And, uh, there is, there is a billing code for it. That's rarely used, uh, and it pays, it pays more than a clinic visit to kind of make up for that travel and efficiency. Um, and it crunched the numbers and I thought I could make it work. And I thought, you know, the other part of it was maybe building, trying to build a scalable model that I could, uh, you know, start it here, figure out a system and then bring it to other communities and maybe actually create a business around it. Um, and so super complicated, lots of politics around it, which has been challenging. Uh, and I am also not a business person. Uh, it's something I have a bit of peripheral knowledge about just through my investment hobby, but, um, I don't really know what I'm doing. And so I had, I had some good help from, uh, uh, I had, uh, uh, an actual business person to helping me out for a while, beginning to kind of get it off the ground. Uh, someone local here was super helpful and, um, and it's, I kind of launched in May, like a soft launch. And I took a sabbatical for the year, which goes until Christmas and, uh, and then kind of got quickly pretty busy through the summer. Uh, and then it started getting a bit difficult to get paid by MSP because I was billing so many house call fees that I made myself an outlier, which you're not allowed to do in Canadian medicine. If you're an outlier, then all these flags go up and they, they kind of have to zoom in and see where you're up to. Um, and I knew that was going to happen eventually, although it happened quite quickly. And so I'm kind of getting dragged through that whole process now, which is, um, just sort of defending the billing, you know, uh, cause they, you know, I've built 4 or 500 house call codes, the summer sort of most physicians do on average zero house calls. Uh, there's a, you know, a handful of us might do a few a year and there's a couple of, uh, geriatric practices in the city that function like this. But again, they would not be seeing very much volume. So, um, so yeah, so that's, that's kind of where things are at. And then I started doing COVID testing for travelers because there was a gap here with that and that's been super busy more than I expected. And so I've kind of been a bit more shifted towards that while I sorted the MSP stuff. Um, I would like to be able to do both obviously, and, but I also have to go back to Emergency in December and um, so I need, I need to figure out either a way to clone myself, uh, or I'm going to have to sort of pick and choose. Uh, cause right now I'm working, I'm probably working 80 hours a week for the last few months and it's not sustainable and it's not what I want. Um, and so I need, I've got someone doing some admin work for me now, which has been easier. Um, but, uh, yeah, I feel the need to figure out what's next and I'd love to find another physician to join me, uh, and physios and massage and kind of have the idea would be an office-less practice essentially. Um, because running an office is complicated and expensive and especially in Whistler. And, um, so, so that was kind of the, the main concept with this. And I have no idea what it's to turned into, to be honest, uh, it's going, it's going well-ish, parts of it are going really well. It's really popular. Patients love it. Um, but there's a lot of friction and headwinds from various angles. So when you say politics, is it, is it government that is the most difficult to deal with or is it your own, um, colleagues that think that this is sort of the privatization of healthcare and that becomes a problem? Or is it just everybody got comments? Yeah. It's kind of everyone, everyone, except patients, patients love it universally. Uh, some people are just sort of like most of my colleagues are kind of wondering what the hell I'm doing. Like, what are you doing and why are you doing this? Why don't you just go to work like we do and, and get paid and not worry about all this? Um, so most, most people think like that there's a little bit of resistance, I think from a few other colleagues, um, which is fine that's to be expected because you're doing, I'm doing something weird and different and then same for the regulatory bodies there. You know, we have a few different, um, there's sort of three main camps there. Uh, and they spoke to all of them ahead of time before he started, explained that I was going to do. And they all sort of imported like this, like kind of, kind of a good idea, kind of weird. That sounds really hard. I think it's going to bring up a lot of problems, but there's nothing that says you can't do this. Um, and so all of that came true, so I'm very much coloring within the lines. Uh, but I it's a bit of an out-there idea. And so there's just, there's, there's a lot of friction to try to make it all work like that example of getting paid now, um, which is, you know, that's important. I need it to work out. Yeah. So, so, uh, and you know, not having an office is tricky using an online scheduling program. It works really well. Um, but everything kind of needs to be fine tuned because they need to travel around to all these appointments every day. And so the evening before I'll kind of rearrange my schedule, but that requires negotiation back and forth with patients. So I'm not going from Emerald, to Cheakamus, to Emerald. Um, and that's, you know, people generally have been really accommodating. A lot of people are just hanging out at home anyway, so it works out fine. It's just a lot of work. Um, and you know, eventually that can be solved with technology. Uh, but you know, like Uber is a good example of that. They've spent billions of dollars developing a software that does location cohorting so that you can conveniently match supply and demand so that it's efficient. So you don't have cars driving all over the place. Um, and so, so that, that could be solved eventually, but, um, it's still very much in the proof of concept phase first At the beginning, it seems to me to be easier to manage the supply, like the supply is in Emerald in the mornings and in Cheakamus in the afternoons. Uh, whereas if you approach it from the demand side, you're, you're wherever someone needs to be at a certain time. Um, Yeah, I thought of that event, uh, at the beginning of doing, maybe doing, having a north and south split. So there's complications with that too, where you could just have, like you, like, you know, well, some kind of like dispatch system, which is, you know, uh, if it gets busy enough, maybe you just have a live dispatcher coordinating things. Um, and, uh, obviously that's been, that's been very prominent in the taxi industry for a long time, but I don't know, but, um, I'm a bit of a one man show still at this point. Yeah. Yeah. Fascinating. Do you carry a black bag with you and do you walk in the front door of my house with a stethoscope around your neck? Uh, it's funny the stethoscope, so here's, here's a secret. We don't actually use stethoscopes very much anymore. That's your problem? This would all be working perfectly if you just use the stethoscope because then people would be like, yeah, that's legit. This guy is legit with a stethoscope. In fact, you could hire me to walk in the front door of people's houses. If you just put a stethoscope around my neck. Yeah. Yeah. People want to see that that's like the, no, when I was getting my photo was done, it was not possible to have that happen without a stethoscope around my neck, because that's what a doctor looks like. And without that little prop, uh, you could be anyone. Um, and the truth is that ultrasound is largely replaced the stethoscope in that in modern medicine. Um, and so I use it very occasionally at work. Um, but if, you know, if you took my, my stethoscope away, I'd be fine. Uh, if you took my ultrasound away, I, you know, close the doors, we can't see anyone. So it's um, but yeah, that's, I have a little, it's a brown bag. It's leather. That's the best I could do. It's not like the old school carry around type that you might have seen in the 1930s. Um, it's more of a man purse, I guess. Uh, but yeah, I, I have, I have a relatively small amount of gear. That's also something that was unknown. How much gear am I going to need? Yeah. And it turns out you don't need that much stuff. Um, and, uh, so I've got, I've got what I need. I've got a bunch of stuff that I leave in the car that's well-organized and then I go to the door with a relatively small bag, but yeah it's kind of me. Sometimes I look like this, uh, in a kind of like a golf shirt. Um, sometimes I look a little more ragged in a t-shirt. Some people like that, some people don't like that, you know, how you, how you present yourself matters to some people and not to others. And I feel like that's almost a barrier in some ways, if you, like, if I showed up in a white coat and a stethoscope that would make some people really nervous, but other people would really like that. And, uh, that's one of the things you learn in medicine, the art part of it is how to, how you carry yourself in conversation in a patient encounter, because some people will want it to be very formal and very paternalistic and very black and white and other people want to, they want to see that you don't actually know what's going on with them and that you just a normal dude doing your best and you kind of look like them and you talk like them. Um, and so, you know, there's a big, a big part of being a doctor is being a good actor and being a bit of a chameleon that way so that you can bond with people. Um, and you sort of learn to pick up after a while what's what works and what doesn't, how to read people, what they want to see. So it's, yeah. Okay. Interesting. Another really interesting opportunity for, um, the use of AI, how much preference like patient preference is involved in primary care right now, some, but it's primarily because you get to know me, but you know, BettrCare moves across north American becomes a, you know, a globally recognized company at that point. One of the sort of inputs that you'll be able to actually have is client preference and patient preference around how they want to receive care, which is such a fascinating future. Yeah. And there's, there's a lot of resistance in medicine to the idea of screening, any kind of screening to match patients and, and physicians. Um, and so like, you're not supposed to ever turn anyone away. If you're a family doctor, the college of physicians says that you can't screen your patients, but it does happen. It happens anyway. And the, the reverse happens as well. There are patients who would rather have a male or female or a person that looks a certain way, a certain skin color or a certain age. Um, and you know, it's a bit of a slippery slope because you don't want, you don't want people being denied care because of those things. But at the same time, you might be able to create a better bond. Uh, if those wishes are respected somehow without turning people away without excluding anyone. Um, and language is part of that too. And that's, you know, that's the one thing where that model breaks down. So if you speak Mandarin, uh, that's going to be really valuable in certain places like in Richmond. Um, and, uh, so it's, yeah, but that's, I, you know, I've thought about as well, you know, the idea of, of patient preference, or you're not allowed to have preference as the provider. Um, but yeah, that idea of matching people with who they might bond with better, for whatever reason. Yeah. Hmm. Uh, anything else you want to tell us about about BettrCare? I think it's going to turn into something good for the community. Uh, I don't know exactly what it looks like yet, but yeah, I'm optimistic. I would like some help. I guess that would be my main thing. Please come join me. It's actually really, it's really pleasant. So I've, I've seen a lot of people now. I've had zero awkward encounters. I get invited into their house. If it's in the morning, I get to drink another coffee often. And, uh, it's a really, it helps to take down that, uh, a bit of that power differential that can exist in medicine where, uh, I think one of the things it does is it, it, it, it puts me in you on a bit of a, more of an even playing field because I'm coming to you, I'm respecting your time. I show up on time. Uh, I come into your house and it's not scary. I'm not scary. Um, and there's often a moment, the first few seconds where people are like, okay, what are we doing here? Are we just going to have this awkward chat, uh, through the door threshold, we go outside, do we go inside? And then after a few seconds, they realized that I'm not a scary or threatening. And most of the time we end up inside sitting down and having a chat. It's all good. Um, so it's really pleasant and I hope more people will consider doing it. Yeah. It's fascinating. Bringing back something that has sort of been lost to society in some ways. It's really interesting. Yeah. Yeah. I think it's, we're going to need to be creative in how we approach the problem with primary care access, which is going to get in my opinion, a lot worse in the next few years. Um, and it's all related to mainly to real estate cost, but also to just a changing demographic in, in, in terms of the providers, the younger physicians are not interested in grinding at the clinic, the way that we did and, and the generation before us did, um, they really are not interested. And it's, it's quite a dramatic shift in the last five years. I would say we got them all through emerge during training and, um, yeah, it's just a different generation. They, they, they want to work less. They want to work on their own terms. Um, and they, they don't want to work, you know, uh, they don't want to be as enslaved to the job as, as was traditionally the custom. So, um, so there's going to have to be some creative solutions to culminate for that. Perhaps this is a small part of that. That's my idea. I think it's fascinating. I really do. I think the, the, um, the way we do everything is changing so quickly, and this is such a pivot point. I think in history, as far as COVID is concerned, it it's, it's taken all of this sort of technological advance advancement. And given this moment, in order for us to take leaps forward into utilizing all of the tools that have sort of built up behind the dam of our, this is the way we've always done things kind of perspective. And it's, I think releasing those, it's funny, we in local government, I've been always saying, we, we need to be able to do virtual meetings, uh, because at the regional district, people drive four hours from, you know, a way to come to a meeting in Pemberton, uh, to discuss what's important to make decisions. And then they all go home well in December when it snows, that's a really challenging thing to do. And so when it was raised,'hey, we need to be able to do this virtually' the, the answer was always, the technology just isn't there yet. And honestly it took three weeks of COVID to release and all of the power that had been built over the last however many years, uh, and we're meeting virtually all around the province and that perspective of the tech isn't there yet. And this is the way we've always done things, um, is, has been broken in some ways. And I think also what's important to recognize is that the timeframe to take advantage of that is fairly limited because on the other side of, of COVID, if there is another side to COVID, we will lose that big opportunity. And so harnessing it now, I think is, is, is pretty important. So what you're doing is so fascinating because it's harnessing the opportunity, but it's doing so by looking 70 years into the past and bringing it to today, which is really, really interesting. So there's a real trend towards a nostalgia in the younger generation, millennials and gen Z. They're very nostalgic. And the, um, so, and that's one of the things I realized working with. Um, I have some younger friends that I ride bikes with and we get all the young residents come through work. So I have a little bit of exposure to that generation. And, um, yeah, so it's, that's, that's an insight that I, I didn't figure that out myself, someone else pointed that out to me. And then I was like, oh yeah, that's actually really true. And I think on the flip side of all this, uh, COVID hiding that's happening. Uh, people are gonna want to reconnect again in person live face to face as much as possible. Um, because that's, that's what we do. Absolutely. You know, we need that. And so I think anything that helps get us off the Zoom on the flip side of this, it's going to be really popular, even though it's great for it's much more efficient for a lot of things. Um, and it's never going to go away and it's, you know, it's incredible how they upscaled in the first little bit of COVID. Um, there's been a lot written about it's actually worth reading about, um, I read a good article a long time ago around that was describing the heroic upscaling of, of the Zoom platform when COVID began, it was, it's pretty crazy what they had to do and they pulled it off and yeah, it's amazing that humans are good at that. We're good at when, when we're under pressure, we're good at performing. Um, and, uh, as soon as that pressure gets taken away, uh, then we've got a bit more time to be more creative and, and kind of be more artistic. And for, I think a lot of, I think there'll be a lot of really positive stuff that comes out of all this COVID stuff on the flip side. Yeah. Yeah. And it's taking advantage of the, uh, the technological advancement as well as all of the relational importance of being in person. I that's one of the big things I hope for the municipality is that we are able to harness the advantages, provided adjust in a way that that does that. And when we're able to be together, again, recognizes the importance of human connection and, and, and does two things at the same time, which I think you're right. And when we're able to relax, the, the creative part may be, how do you take the technology and marry it to human connection in a way that serves us best? Because one of the things lost as everybody now Zooms in is water cooler conversations, creative, interesting. What did you do on the weekend? Um, kind of conversations that serve us as humans. So, so well, and so one of the things I've thought about, and we did this a little bit when I was running our software company is that you can work from away, but we are going to have times when we are all in the same place, we are riding bikes together, we're having water cooler conversations we're working. And then when we did it, we did a few trips to Tofino or Victoria or wherever, and just, we're going to have an intense work time where there's lots of opportunity to have a water cooler talk. Uh, and then we go back and take advantage of the technology. So it's, it's marrying the tech with human connection in a way that serves us well. I like that. Okay. Um, tell us about, uh, living in the mountains, tell us about, uh, raising kids and, and, and why did you in 2004 decide that you would be here rather than the Prairies. My, uh, so I grew up in Manitoba, uh, and I went skiing when I was 15. And up until then, I just played hockey, hockey, hockey, hockey, that's all I did. And we went skiing to this tiny little mountain, like a couple hours outside of Winnipeg is maybe 250 vertical feet, something like that. And, uh, and you know, by the end of the first day I was, I was in, I was stoked. And then we started doing trips to the Rockies. So we could get there from Winnipeg to Fernie or to Banff was the same distance, about 16 hours. And back then we could buy a student pass at Fernie for 250 bucks and just go on two trips, Christmas and spring break, and it would pay for itself and we'd stay at a hostel. I remember it was$11 a night and we'd eat like, uh, we'd raid the cafeteria to eat people's scraps and like all the dirt bag stuff you do when you're little. And, um, and that's how it started at night. I came to Whistler for the first time in high school in 90, no, it was after high school. I was in university 97, came out with a buddy. My dad's friend had a place here and I remember landing in Vancouver. I was 7, no, I was 17. Anyway, I can't remember the timing landing in Vancouver. Uh, my dad's buddy lends us his Porsche. He's like here, take this car and drive up and go stay at my place in Whistler. And it was crazy. And, uh, so that was my first exposure to Whistler. And we, um, we had a great time, obviously. And then I ended up doing residency after med school. I moved to Vancouver in 2003 to do residency and was sort of based loosely in Vancouver, all over the place. Eventually we moved to Squamish. Um, but I remember my, my first kind of connection with Whistler 2003, when I moved to Vancouver was my buddy dragging me up to the bike park here. It was in July and it was literally the day after I arrived. And we went up to the bike park and, uh, I didn't know anything about biking or any of that stuff. And, uh, same thing as skiing. Like after the first day I was hooked and I bought a bike the next day and I was a park rat, and that's all we did with, um, we shuttled in North Vancouver and, uh, we rode in the bike park and it's pretty funny. And then, um, yeah, just started skiing a bit more, coming to ski a bit better, I guess. Um, and we lived in, when we lived in Squamish, we were there for, from 2005 to 2010. I worked two nights a week. So I basically skied seven days a week and I would even go for bike rides, uh, after skiing in Squamish. And I was basically a professional recreator, uh, for my first 10 years here. Um, and trying to catch up to everyone and then, yeah, and then we had kids and they started working more and we got a mortgage and the usual, um, kind of baggage. And so I don't, uh, I'm not a full-time recreator or anymore, but, um, I get, I still get out a lot and, uh, I still love skiing. And, uh, even though my risk tolerance is, has dropped dramatically, which is a good thing, cause I was on pace to die for sure the mountains were going to kill me. Um, and, uh, so it's kind of getting busier with work and having kids was a blessing and it really resisted. I resisted that change when they were really little, uh, I went through the classic struggle that new dads have here, um, where they're still trying to, uh, do the same stupid things in the mountains that they were used to doing, but feeling like it was maybe not the best decision-making because now you have a bit more responsibility and it just takes a while to, to, to be okay with that. Um, so I really had that struggle at the beginning. Um, but yeah, it's still, I still get up and I ski a lot still in the winter and I still mountain bike a lot in the summer. Um, so yeah, very important to me. And then we, we spend a lot of time on the island surfing as well. Um, and that's, that's kind of a slightly newer passion, I guess. And that's, that's been a trend that we've seen happening with a lot of mountain folk. They end up getting into the ocean more and more.
Mayor Crompton:Totally. Yeah, yeah. That, that, um, that moment that you talk about, and it sounds like might be a bit longer for you. I had remember when Georgia, our oldest was eight months of skiing, like purple haze. And I had this moment where I sat down and I just had a moment of if I fall. Yeah. Um, the, the impact is different now. And I, I was frozen. I couldn't move, I skied there my whole life and I know how to get off and it's, and, and that moment has been so important in my psyche because it connects me to that, um, purpose. I think, you know, it, it, it was a moment of, of recognizing that, um, being around is, is important. It's a funny thing to say, but you're right. That parents in this town go through that when their kids are little and it's a, it's a challenging thing to go through, but I think pretty important.
Dr Clark Lewis:It's hard. It's hard. Yeah. And I, you know, I, I, I see a lot of patients I've seen through this house thing. I've seen a lot of dads who never would have accessed help otherwise, but their wives made them, see me, their wife really made an appointment for them. Uh, this is the only way he's ever going to get help as if you actually come to the house. Yeah. And, and, uh, there's a lot of, uh, suffering going on in the shadows. There's a lot of people that are really struggling then you would never know. Um, and it's, yeah, it's, it's interesting that the thing that happens, I think in most other places, uh, like where I'm from is you just kind of get fat and old and, uh, you know, you see that when you go back home, people just look haggard at our age. And, um, we're still pretty active and kind of hanging on to that, that, uh, that lifestyle, even though we're not as, you know, not being as loose as we used to be, um, still enjoying it and still being active and healthy. It's pretty cool. That's one of the, I think one of the most interesting things about this community. So when you go and visit someone in, as, as I, I'm assuming that your job, when you come to my house is primary care. Yeah. So are you connecting a lot of people to mental health during COVID more than you would have seen otherwise? Huh. So you come and see me, we have a conversation and you, and you give me a referral? Yeah. Yeah. I see. Most the vast majority of people I'm seeing are people who don't have a GP here, which is a lot of people as you know. And, um, they, they don't know how to access help, and they need to, they basically need a navigator, which is what that's what a family physician does does in part is they help people navigate our healthcare system, which is tricky making referrals and, and, you know, and sort of screening. Um, and that's not, you know, that's something I did train you. I did family practice training initially, even though I've, most of my work has been in Emergency and also a big part of Emergency, especially because a lot of people we see you can't just say follow up with your family doctor. Cause they don't have one. And so you ended up going the extra mile in ER, to get people set up, to go through, do the screening, do the extra stuff, make the referral for them. Um, because you kind of have to, so it's not a big leap for me to do it in your house. Um, yeah. That's kind of what we do anyway, but yeah, we see a lot of, we see more and more and mental health stuff, big part of the job for sure. Well, Cole I think we could hang out here all day. Uh, and uh, there's so much more to talk about we're going to have to have you back. Yeah, it's been very pleasant. I enjoyed it. A lot, but we need to finish at some point. So let's move towards a wrapping up and the way we finish these conversations with people, as we always want to hear about a book, you're reading a podcast, you're listening to something that you inspired by or learning from. So tell us what inspires you or what you're learning from. Um, the book I'm reading right now is called The Psychology of Money by Morgan Housel, who is an American, uh, money guy. And, uh, everyone should read it, actually. It, it, um, it is basically all about, he gives examples of real life, examples of why, how you should think about money and why you shouldn't worry about it basically, which is hard to do, especially in this town, because we're all hanging on by a thread. So, um, yeah, so that's what I'm reading right now. And I podcast I listened to, uh, the most lately is one called Smartless, which is really entertaining. Do you know what? Yeah. Yeah. So it's Jason Bateman, Will Arnett and, uh, and the other dude, what's his name anyway? Um, yeah, it's just, it's funny and brainless and entertaining and they're, they have such a, uh, they have such an issue with each other and it's funny and it's pretty smart. And, uh, so that's, that's kind of my way to unplug in between appointments, uh, when I'm in the car. So I've been listening to that a lot. It's funny, you said, what is so true about that podcast is that it's brainless and smart, which I find so true. Like I can check out and, but there's a lot of times where you're like, whoa. Yeah. Like that's fascinating in the middle of the brainless. It's a, it's an amazing mix. Yeah. Yeah. Those guys all have massive intelligence and uh, well, like every comedian, you can't be a comedian and not be super smart. Um, and, uh, so it's, yeah, it's pretty entertaining. Well, uh, Clark, we're really grateful for today and the time you took to chat to us and, and your work for this town, um, wish you all the best in, in better care. It's fascinating. Um, and so thank you. Thanks for having me. It was really fun. So, uh, Cole, that was interesting. You're going to have, um, a house visit instead of going into the clinic from now.
Cole Stefiuk:Uh, I might, I don't know, I'm trying to avoid going to the clinic as much because I used to go quite a bit. Um, but I kind of like, he mentioned people who don't go to the hospital if, and when his service is like Squamish, it might even, I don't know, but I want to do that for my dad. Cause he won't go to the hospital. I want to get, so I'll bring the hospital to him. Yeah.
Dr Clark Lewis:Well I think, I think, I don't know, but I thought Clark was serving the Sea to Sky.
Cole Stefiuk:I, I was, I kind of was sentenced to a Whistler Headspace during the interview, but if he is that I'm yeah. Cause my mom has been pestering my dad to go to the hospital for months. Not that he's sick, but just to like get the basics done, he's in his fifties, he doesn't go to the hospital like it's time. Yeah,
Dr Clark Lewis:Yeah, yeah. I found the first 20 minutes of that conversation. Fascinating.
Cole Stefiuk:Yeah, I was, I was blown away. Yeah. I understand what he's saying. You still in human human connection, but I just, I love the fact that AI will be able to cause, you know, even with doctors as amazing as they are, obviously sometimes you gotta, you know, you need a second opinion or you gotta do more tests. And, and I feel like AI, you know, as much as I love the doctors might be able to pinpoint stuff.
Dr Clark Lewis:It is kind of weird. Hear him talk about robots doing health care. But I, I, you know, it's not what I think of as a robot, which is like something that just trying to have look like a human it's, a computer and like the robot that is the most effective. And the one that he talks about is your watch. And it does so much for you now. And it can do so much more that, um, in a lot of ways, it's just allowing him to do a better job as a physician. And it's that assistance from technology that I think will be the most, um, involved in medicine at the beginning, the idea that a robot becomes your doctor, I think is a long way from here.
Cole Stefiuk:Yeah. I don't want to replace doctors, but I mean, the assistance is definitely cause like, like he was talking about the Apple watch and how it can detect different things in your blood somehow. Yeah. That would help a lot. Cause I hate doing blood work. I hate. Yeah. So for me that it makes his job easier and I don't have to get a needle, so yeah,
Dr Clark Lewis:Yeah, yeah. Yeah. I liked the, the, the bio-monitoring in a watch rather than like injected into my body and floating around, monitoring me, sending messages. Like it feels a little safer to just have it on a watch and have it sort of talk to my doctor and keep my doctor up to date on what's going on because now you go in to see the doctor and if they don't have your charts from previous care, then they're doing a whole bunch of sort of updating themselves on your health. But if you can just scan your watch when you make your appointment and it uploads all your records and your most recent, um, sort of health monitoring statistics that will, I think, make their job easier and yours easier as a, as a patient because you don't need to, um, be, as it sounds funny as in connected to your health history as you have to otherwise.
Cole Stefiuk:Well, yeah, I mean, I don't know. I mean, I don't know how often you go to the hospital. I had to go recently when I, when I tore my hamstring and they were asking me some questions and I, I don't know the answer. Like I've been to the hospital a lot in my life, but I don't know any of the questions they're asking me. Yeah.
Dr Clark Lewis:Yeah, yeah. Huh. Well, I really enjoy talking to Clark. That was a lot of fun. Yeah. Fascinating. Well, this was the Whistler podcast brought to you by Mountain FM and the Resort Municipality of Whistler. Thanks for listening.