Episode 305 - Fragmented: Health Care and Data with Ilana Yurkiewicz
Today's guest is Ilana Yurkiewicz, author of Fragmented: A Doctor's Quest to Piece Together American Health Care. The conversation starts with our health data, but goes into practical advice for patients and doctors.
Ilana Yurkiewicz
Ilana Yurkiewicz, MD, is an oncologist, internal medicine physician, and professor at Stanford Medicine. She is also an award-winning medical journalist whose work has been published in The Atlantic, Scientific American, Time, Undark, The Best American Science and Nature Writing, and elsewhere. Her first book is Fragmented: A Doctor’s Quest to Piece Together American Health Care.
Links
Dr Ilana Yurkiewicz, MD - Website | Fragmented
Transcript
Max Sklar: You're listening to the Local Maximum episode 305.
Narration: Time to expand your perspective. Welcome to the Local Maximum. Now here's your host, Max Sklar.
Max Sklar: Welcome everyone, welcome! You have reached another Local Maximum.
Now, I don't know if you've used the medical system recently, whether you're in this country in the United States or another country. I know I have. I don't think there are many people who go there who don't think things could be running a little bit more smoothly around here, a little bit more logically.
Well, today, we're gonna have a conversation, in a little bit, that's at the intersection of technology and the medical system. But it also includes a lot of practical advice for you as a patient, which, if you're not right now, congratulations, you're not a patient, but you will be. Everybody will be someday so don't worry, this will be relevant to you.
I hope you enjoyed last week's episode, which was more focused on current events. Last week's episode was on the drama that unfolded recently at Open AI. Looks like the future of this technology, particularly open AI GPT models, and everything they're working on, and who owns it is in incredible flux due to their complex board structure. So this story obviously evolves significantly over the last week with CEO, Sam Altman. Before last week's episode, being kicked out by the board, then he was going to Microsoft at first, and now finally, he's back in at open AI. So maybe we'll get a chance to discuss that whole story and the follow up with Aaron in the next week or so.
Alright, so let's get into the main event today. My next guest is an oncologist and internal medicine physician, and a professor at Stanford Medicine. She is also an award-winning medical journalist and the author of Fragmented: A Doctor's Quest To Piece Together American Healthcare.
Ilana Yurkiewicz, you've reached the Local Maximum. Welcome to the show.
Ilana: Thanks. It's good to be here.
Max: All right, we're here to talk about your book, mostly your book, we could talk about other things, too. The book is called Fragmented: A Doctor's Quest To Piece Together American Healthcare. As the title suggests, you talk about the fragmented data systems that our medical professionals face. And I do want to talk about both how we can rethink the system and the technology. But I think the other draw of the book where I want to start is the really gut-wrenching emotionally charged and high-pressure decisions that doctors, patients, and their families sometimes have to make. You have a lot of stories about that in this book, which I think makes it more interesting than just kind of a rote, here's some technology, here's a list of pieces of technology book, which maybe wouldn't be as interesting.
So tell me, how do doctors tend to manage these situations? Do you think it takes a certain sort of person to become a doctor who deals with these types of emergencies and unknowns?
Ilana: I think it's a personality trait that can be learned but I do think if you practice medicine long enough, you get very accustomed to being calm in the chaos and trying to make sense of situations that are inherently complicated where you might have to make hundreds of high stakes, sometimes life or death decisions in the course of the day. You might not come into medicine fully ready and trained to be able to do that. But I do think you develop a personality just by doing it long enough.
I've led emergency responses on patients many, many times. And I've gotten accustomed to saying things like, I need two units of packed red cells and four units of platelets, as though I'm ordering a burger and fries. You have to stay calm in those situations.
I wrote the book in that way intentionally, because that is what practicing medicine is like. And I wanted people to see the reality of it, not just from a patient's point of view, but also from a doctor's point of view, and how we have to make sense of information very, very quickly and be decisive.
Max: Do you think that staying cool under pressure… Do you have any tricks to learn that personality trait? Or is it just something where you just have to be in those situations for a long time? Because I think everyone in life wants that and I feel like sometimes, okay, I can calm down but now I'm not getting anything done.
Ilana: They say in medicine when you show up to a code, which is a cardiac arrest, and a patient loses their pulse, the first thing you should do is check your own pulse. I've abided by that logic in other high-stakes medical situations as well. Even though we have to make a lot of decisions quickly, I would say you do often have more than a few seconds and often more than a few minutes to make a good decision. So the first step is just taking that deep breath, and calming down, and recognizing that you have a little bit of time to think.
Max: Yeah right. Those are often… I'm picturing in my mind, high stakes emergency room situations, there's also situations where I've been in and family members of mine have been in which are maybe less ‘oh, what do we do over the next few months? Or what do we do over the next few days, that's maybe a little bit less like playing live sports or something like that?’
Ilana: Yeah, those are more like a game of chess. I feel like you're trying to make good decisions in the long run and taking into account multiple factors. Not just taking into account those multiple factors, but learning how to communicate that well to people who don't have a background in medicine. That, I think, is actually one of the great joys of medicine for me. And I think for a lot of my colleagues.
Max: Yeah, so you mentioned there are things that patients can do to get better care at the doctor's office. I know I've learned a few of those. Let's talk about some of those. In particular, sometimes you're a patient, either you're a family member or you're a patient. If you're patient, you're just sick.
I've never been able to ask the doctor lots of questions and try to figure it out. I've never been able to do that while sick. Then when it's a family member, you kind of feel like, oh my God, I'm not I'm not asking enough or something.
What do you think that patients can do, now that we're all listening to this, and we're all presumably calm, and well, or at least the vast majority of people listening to this? What's something you could think about now that would help you get better care when you're at the doctor and you don't have time to learn all this?
Ilana: The first thing to know, and I would say the most important thing to know, is not to assume that your doctors know your full medical story. Even if you've come into the same doctor multiple times. Even if you've come into the same healthcare facility multiple times. The entirety of the book is about how, on the other end, on the doctors, the healthcare system is so fragmented that doctors are constantly working in a state of being partially blindfolded to the full details of your story.
That happens in a multitude of ways. It happens when your data, your health data gets lost between different facilities or even gets lost within the same muddled electronic chart. And it happens when you see different providers and communication gaps persist between the different providers.
From a patient or a family member's point of view, first things first, don't assume that they have the full details of your medical story. Get used to repeating yourself. I recognize this isn't fair, and I'm saying this on air, that you're absolutely right. If you are sick, the last thing you want to be doing is being the shepherd of your own medical story because you're not in a state of mind to do that well.
So if you do have a family member or an advocate who can be with you, that is something important that I would encourage everyone who's listening to this to discuss in advance. So it's not just you, but you have someone else in your life, who knows your medical history, and who can advocate for you in a situation where perhaps you can't advocate for yourself.
But if you are in a state of mind where you can communicate well, I would suggest a couple of things. One is to have an elevator pitch of your medical history. So a shorthand version, that when doctors are kind of clicking and clicking through your electronic chart, trying to piece together a coherent narrative themselves, it's really helpful if you can give them the highlights. Like, I am a 35-year-old male with a past medical history of type two diabetes or I take insulin and this is what I'm here for, this is my chief complaint. So having that shorthand version can be really helpful to doctors when they're trying to piece it together themselves.
Max: That's a really interesting idea because I feel like you might have a tendency to go into your life story and it's not clear to a patient what's relevant and what's not relevant.
Ilana: Yes, and that is very true. This happens to me all the time where I have patients come to me and and just bring up everything because they're not sure if a rectal bleed they had 20 years ago is relevant to the chest pain they've had today. Definitely, when you have the luxury of time, it's always better to bring something up than not to bring it up. So the situation is different, let's say when you have a scheduled 30-minute doctor's appointment in the primary care setting, or if you were in the emergency room, critical, very, very sick with something. If you can adapt different versions of your medical history for those different situations, that would ultimately get you the best care.
Max: If you were to advise your family members who are looking for doctors, and I realize we're gonna get to the technical stuff, but I think this is important for people to think about. If you're advising family members who are maybe seeing a doctor for the first time or are thinking of switching doctors, what are some good and bad signs to look for? Like whether you're getting along with your doctor, whether you're getting better care, etc. Sometimes, a patient might feel like I don't have anyone else to go to. I've already invested too much into this person.
Ilana: I think you want to look for a doctor who listens. I think that's one of the most important qualities in a doctor. It's another adage in medicine that often you will get the diagnosis from the patient's history. from what the patient is telling you, sometimes even more than the objective data that trickles in later.
So there's a lot of data about how doctors interrupt patients after a really short amount of time. It's something like 12 or 18 seconds in the outpatient setting. And I do want to say there are a lot of factors that go into that, that are beyond doctors' control. We are pushed by payment models that incentivize for shorter and shorter visits. But that being said, you do want a doctor who's going to listen to your story. You want someone who will ask you follow-up questions based on things that you say. I don't think you want someone who will just come in and act like they know everything before hearing your story and I think there's good data to support this too.
Max: That's good to know now because once you go in there, sometimes you feel like, well, they're dismissing me because they already know the answer so I might as well listen to the expert. But it's good to know that, hey, I should be looking for someone who was listening to me.
Ilana: I think that was an old way of doing medicine, to be honest. Very top-down, doctor knows best. In the last decade-plus, we've shifted more to a model of what we, in medicine, call shared decision-making. So you're making decisions together between a doctor and a patient. And that is the best way to practice medicine because who is more invested in your own health than you. Maybe the doctors know more about the medicine than you do but you know more about yourself. So in order to come up with a treatment plan that fits into your life and matches your values, your doctor needs to know those values and that comes from you sharing them.
Max: All right, so great. So now let's get into the technical bits. Everyone's patient data is everywhere. I know I have my charts on like five different places. The more problems you have, the more doctors you see, and the more spread out it gets.
Do you see a solution to this problem? Maybe the solution could be technical, or maybe it just could be organizational. I know a lot of people who have a lot of good technical solutions for medicine, but maybe can't get it implemented.
Ilana: Just very briefly before I mention solutions, I just want to lay out what the problems are because there are two and I think they are related but also somewhat different problems about how our healthcare data is organized.
The first problem is lack of data sharing between different facilities and between different electronic health vendors. We are in a situation in the United States where there are hundreds of different electronic health vendors who have control over your medical data and your medical records. And this came from a push in 2009 where Congress authorized and funded legislation, I won't get into too much of the weeds here, called the High Tech Act, where they tried to stimulate the conversion of paper charts to electronic medical records.
For the most part, hospitals and doctors' offices did this successfully. However, they often did this in silos, meaning that there was no related push or stimulus from the government requiring that these different systems communicate with one another.
Now, over 10 years, almost 15 years later, we are in a situation where we lack what's called interoperability, where, again, if you transfer as a patient, let's say from one doctor's office, even to another doctor's office, just up the street, if they use a different electronic vendor, your records will not be seamlessly shared and integrated. Sharing data is just step one. Integrating data is step number two.
We rely heavily in medicine, in the year 2023, on fax machines. I learned to use a fax machine when I was an intern in residency. We still do that and 90% of healthcare facilities still use fax machines because even if you can share data across facilities that way, it's not going to be integrated in your medical story in a meaningful way. The solution to that is interoperability, true interoperability, which means, again, not just sharing, but integrating data across different systems.
I want to emphasize that this is more of a, it has been historically more of a bureaucratic problem than actually a technical problem. There are technical solutions to be able to do this. And there are some electronic vendors that have already implemented and made a lot of progress in this space.
The most commonly used electronic vendor Epic has a platform now called Care Everywhere, where with a click of a button, you, as a health care provider, can access your patient data from outside facilities, as long as these outside facilities have also agreed to share that data. So it is being integrated across some institutions, it just wasn't set up that way so progress has been slow in the last 10 to 15 years.
The second thing I do want to just bring up is how data is organized, even within one system. So again, interoperability refers to how we share and integrate healthcare data across systems. But even within one electronic vendor, I write in the book a lot about technical and organizational issues that arise when your data is scattered throughout an electronic ecosystem that just isn't well organized, to be frank. That wasn't created with the user in mind.
A very quick example of this. In my practice, there are, I would say, maybe 5, 10, places where you can pull up a patient's medication list. Some of those medication lists are updated when the patient updates it at home through their patient portal. And some of those medication lists aren't updated.
So it's literally just a problem of how the current EMRs are organized that there's so many different tabs that I believe were not created fully with the user in mind, the user being the doctor or the healthcare provider, so they can put all these pieces together in a seamless way.
The solution to that, or a solution to that, I would say big picture, first things first, anyone who's creating this technology needs to have the right stakeholders at the table. They need to have the users at the table. I think historically, that was not done particularly well and that is how we have spiraled to a situation that we have now.
Max: I'm used to working at a social media company where you're constantly looking at the usage pattern of the software and you're constantly updating it. It could feel very slow. But if you do that over the course of 10 years, it gets great. So why is that not happening here?
Ilana: I think it is happening, I just think it's very slow. I think if you compare how EMRs, electronic medical records, look now, versus when I started out in practice in 2015, we have made progress. I think a lot of this progress has been tinkering around the edges, which is fine. You can't really start from scratch, you can't overhaul an entire system. And there's a lot of initiatives now that are coming from inside the house, per se where doctors are getting involved in how the technology is organized.
Max: Yeah. Even something as simple as, you mentioned the list of medications that someone's taking. And then it's like if you want to you get it, what five different ways five different places? Are those all gonna give the same answer or are they're gonna give different answers? And then if you want to integrate them, which one is the right one? It just seems like that's a problem where you don't have to write code to solve that problem, you've got to find out what the right thing is.
Ilana: Exactly. As someone who has written plenty of code before I went into medicine, yes, I can see that pretty clearly. It would be simple enough to just have one medication tab. There's no reason that it needs to be confusing like that, where doctors can literally miss what your latest meds are just because they happen to click the wrong button.
Max: Yeah, that’s rough. Are there any proposals that are being floated around or dreamed up today that you're optimistic about or intrigued about?
Ilana: I think one intriguing thing is how electronic vendors are potentially now working a lot more with big tech companies to solve this problem. I can also say I'm excited about this as someone who lives in Silicon Valley. I can bike to the Google headquarters in 30 minutes, but then I’m still in a situation where I can’t always pull up test results a block up the street.
I write in the book a bit about how big tech companies have tried to interfere in this sphere because the logic makes sense. I mean, who better to organize big data in health than the people who are most used to organizing big data outside of health? They were blocked, I would say, more by bureaucratic and red tape obstacles than they were by technical ones but this is changing.
In 2018, for example, six big tech companies convened and pledged their assistance to getting involved in the healthcare sphere to better facilitate this problem of interoperability or sharing data. I can give one concrete example that I wrote a little bit about in the book and has been updated since, which is Google's initiative where they paired up with Essential Health a couple of years ago, which was the second largest healthcare organization, and tried to create a search tool within the cluttered EMR that would allow doctors to search, for example, even if there are typos and errors. Like if you call a myocardial infarction, a heart attack, and you search heart attack you should still be able to pull up data even if you use that synonymous term or if you make a typo.
So I am excited about a potential partnership between big tech and medicine that I think is long overdue. I think this needs to be done hopefully. I do write in the book about some of the controversies that have come up about privacy and patients fully opting in order for this to be done well while adhering to HIPAA rules.
Max: What do you think are the promises and maybe pitfalls of pattern recognition technology when it comes to machine learning AI more popularly expressed? Like, hey, we could have some system look at a patient's entire history, images, and maybe find some patterns, maybe find some diagnoses that a doctor could miss.
Ilana: I think there's a ton of promise there because right now, the pattern recognition is happening manually. We're learning a lot more about this, but I think this has been studied in a couple places. For example, They had doctors, cardiologists, read EKGs, or electrocardiograms of the heart and they had machine learning do it. They asked them to spit out a diagnosis of a heart attack. It was that the computer could often do it better than the physician.
So I think there's a lot of potential here for some of the low-hanging fruit and medicine. And I do think the low-hanging fruit in medicine is the pattern recognition. I think there's still plenty for doctors to do beyond recognizing the basic patterns when it comes to decision-making and taking into account everything we talked about earlier, like the patient's values and preferences, your values and preferences and experience. The hard part of data should not be the data entry or the pattern recognition. I wish we had a system where the technology is doing this better for us.
The pitfall, of course, is that there's going to be errors and they do have to be manually checked. When you search through, it's kind of a garbage in, garbage out problem. If there are errors in the electronic charts, which there currently are and we could talk for a long time about why that happens, you can't change the past of an electronic chart. So there are errors that are actually just embedded in your medical history. If the data that goes into this pattern recognition software is not correct, the data that comes out of the pattern record recognition software could also not be correct. So we will still need manual checks.
One of my concerns is that this technology might actually increase the burdens that are ultimately placed on human beings where we already have a ton of burdens. Our job, like I mentioned, should not be pattern recognition, per se, or double-checking technology that we're trusting to do some of this stuff for us. I worry about hours and hours of labor that are going to be placed on already busy physicians because truthfully, that is what has happened over the last 10 years.
Max: Yeah, these errors that come up are really interesting. You said we could talk more about that. I have something where I have a number in my bloodwork that every time it gets flagged the doctor says oh, you can safely ignore that, I've seen this before. I'm like okay.
It's kind of weird because we have access to our doctor's notes, right? So you go in, and you look at that, and they totally wrote that down wrong qnd it's kind of concerning.
Ilana: Yeah, I made plenty of errors, right? I think to explain why that happens, I do have to take just a quick step back and talk about why we're forced to work in 10-minute visits. Doctors have so much to do and they have to do it all in 10 minutes.
Very briefly, I will say that is a payment model that fundamentally does need to change. It's a payment model that reimburses doctors and healthcare organizations for a service. We fundamentally, in this country, have a fee-for-service system. In outpatient settings like primary care service is an office visit, meaning nothing else is directly compensated work. So healthcare organizations are financially incentivized to book more and more patients in shorter and shorter slots because that is the way to maximize services and to maximize revenue.
But you can imagine if you were a doctor, seeing somebody in 10 minutes, or 15 minutes and doing all the work, let's say, first a reading through their electronic chart, if you know them or even if you don't know them. Sitting down having a conversation with a patient, doing a physical exam, coming up with an assessment and plan, placing test results in the computer system, and then writing all of that up after the fact in a note, your note might have errors.
So I think doctors today really have two choices. You do the note when you're in front of the patient and then people complain about doctors not making eye contact and the software coming in between patients and doctors. Or you do it on your free time. What free time you might ask. So that's a situation where you're working at night and into the weekend doing charting.
Either way, it's easy to make a simple error like the patient reported four days of coughing and not five. There's a lot of copy-paste we use within the charts to make things easier for us, to make this process easier for us. But if you're copying and pasting, I might say that you are a 30-year-old male when now you're a 35-year-old male and I've just been copying that over the last couple of years.
Max: Yeah, that's common in software engineering as well. Just copy old code because we never want to write a whole new thing.
So what's the alternative to fee-for-service? Do you think there could be an alternate, it’d be hard to kind of turn around the entire system, but if you ever kind of think of a future where that was working better, what would the structure look like?
Ilana: The alternative, and I don't take credit for this, this is not something that I've come up with. This is something that's happening is value-based care. So healthcare organizations or doctors are paid more based on outcomes and how patients do than based on the services they provide.
You can imagine that will incentivize healthcare workers in positive directions in a lot of ways. If you are incentivized to do whatever the patient needs to get healthier, you will invest in what that is. Whether it's more time, more support staff, better tech, more frequent follow-up.
I think we are moving also very, very, very slowly towards the direction of value-based care. There are problems in value-based care, too. You don't want to be penalized if a patient has a terrible diagnosis and we can't always cure everybody in medicine. There needs to be ways to take into account the complexity and the underlying factors of the patient's health that might make their outcomes poor. But I think overall, moving in that direction, is a better way. I think there's no perfect system, but fee-for-service definitely carries a lot of problems.
Max: So I want to ask you, I don’t know if this is right. It’s written down here but this sort of reminds me of this question. I know a lot of doctors have kind of mixed feelings about patients who come in and do their own research. But the reality is a lot of people are probably more comfortable talking to Google and now Chat GPT about all their problems and being able to sit there for like 30 minutes and an hour and having that kind of like in-depth possibility. How do you foresee that being integrated into the system, into the whole process?
Ilana: I think it's great. I can't speak for all doctors but I write a bit about this in the book and how we've sort of changed our thinking over time here too. Where previously it was this more top-down model where doctor knows best and patients were not even supposed to ask questions. They were supposed to just do whatever the doctor told them to do.
I think it's very different now. Personally, I’m thrilled when a patient comes in having done their own research as long as we can have a conversation about it. It's based on trust, and they can trust me to put it in context if what I recommend ultimately ends up being different than what Dr. Google recommends, which happens very frequently. I think if you have a doctor that you have a good relationship with, it only enhances the conversation when patients can come more prepared to their doctor's visits.
In many ways, this is kind of like the flipped classroom model in education, where you do want students to do some of the legwork beforehand and watch the lectures and then you can spend the time in the classroom going through higher-level stuff and problem-solving. I would like to get to a place where it's mostly like that in medicine, too.
Not everybody can do this and I do want to say that. But if patients do research on their own health and they come in prepared, we can then spend time on a conversation that's higher level and has to do with decision making.
Max: Interesting but that's good to know. My next question is actually a little lighter. But I was in the Yale University Bookstore the other day, and I know you went to Yale undergrad, as did I. There's a Yale University author section and I always thought that's just for professors who work here who are putting their books up there. I didn't realize that if you were a Yale undergrad and you write a book, you can get your book in that section. So I don't know if you knew that.
Ilana: I did realize that but I haven't followed up if my book is actually in that section.
Max: You should contact them.
Ilana: I have to call them.
Max: Once I found that out I was like, oh, crap, I gotta write a book now.
Ilana: That’s the real reason I wrote this book.
Max: Well, before we wrap up, obviously, you want to get these ideas out there. You’ve been thinking about this problem for a long time and this is a huge problem and you want to be able to contribute to the solution. When did you decide to write a book? Were there any challenges there that you weren't expecting?
Ilana: It's hard to write a book but I knew I needed to write this book. I came into it with a background in science and medical journalism along with my career as a physician so I've written articles before. Actually, the book was a deep expansion of an article that I wrote in 2018 and published in 2018 about unshared medical records.
I would say it was probably over the next year or two that I was thinking more about that and how medical records in my view are just the tip of the iceberg. There was so much more I needed to say. I kept going back to this one word, fragmented. Medical records are fragmented but there are many other factors in healthcare that are also fragmented. It was 2020 when I, it was when COVID hit, actuall, that I took some time and I wrote up a book proposal laying out all these different ways that medicine is fragmented.
Max: Yeah, that's great. Did you learn anything about the writing process that you weren't expecting? I know, we're getting into more of behind the scenes.
Ilana: Yeah, of course. Writing a book is by far the longest thing I've ever written. What I would suggest to anyone who wants to do it is to be hyper-organized upfront. When you write a book proposal, you typically do include a list of chapters and what every chapter is going to say. I took that part very seriously and then I followed my proposal very closely when I was writing the book so that I didn't get lost. I wrote a first draft and then I went back. It was ultimately about three drafts before it was the final product.
It was really important to me not to be repetitive and not to go off on tangents so the first draft just got it all down. Then the second and third time I went back to it, I just started from the very beginning. I was also ruthless with my words. Anything that didn't contribute to the overall point, I cut. I saved it in a document in case I ever wanted to use it later but I was pretty ruthless in cutting.
Max: That's often helpful also for like throwing things away too. Just cleaning up.
Ilana: I haven’t yet applied that logic to my house.
Max: Yeah, sometimes if you take a picture or if you store it somewhere, then it's easier to get it out of sight rather than just saying this is going to be burned and never again because then you're like, I don't know.
Just another question. Did you have to search for the stories? You have a lot of stories in here about patients who come in and have a crisis. Did you have to search for those or did you sort of know beforehand what stories you wanted? Were there stories that you wanted to tell but didn't get to tell?
Ilana: I didn't really feel like I had to search for stories. I've been a doctor since 2015. And I've taken care of thousands of patients. So these stories that I included were the ones that I've been thinking about, and I think I've just been thinking about them for a reason. There was something in their care that was fragmented, that contributes to this overall conclusion that I had that healthcare is fragmented.
I think I'm very privileged to have this front-row seat in medicine. But I also want to say I was very careful with how I wrote everything. If I didn't get explicit permission from the patient, everything was de-identified where I changed details of their personal history so that patients wouldn't be able to recognize themselves in the writing.
Max: Right. A lot of thanks for coming on the show! Once again, the book is called Fragmented: A Doctor's Quest To Piece Together American Healthcare, Ilana Yurkiewicz. So thanks for sharing the stories and insights. Do you have any last thoughts on this discussion today for the audience? And where can we find out more?
Ilana: Thank you for this conversation, Max. You can go to fragmentedmedicine.com to learn more and I hope you go out and get a copy of the book.
Max: Awesome. It will all be linked on the show notes page. Thanks a lot for coming on the show.
Ilana: Thanks.
Max: All right. Once again, the book is called Fragmented and you just heard from the author, Ilana Yurkiewicz. Definitely check it out.
Now, as I said before, next couple of weeks, I hope to return to current affairs in AI and elsewhere. Maybe some global events as well. So hope you'll join me for that. Have a great week everyone!
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