Rapid Response: Crisis lessons from inside the ER, with Dr. Bon Ku

The very best founders I know are brilliant at building systems. They connect teams, they remove bottlenecks, and they eliminate single points of failure. And yet When it comes to their own wealth. Most are running a disconnected stack. A tax accountant here and a state attorney there, a wealth manager who doesn't talk to either one of them.

Creative planning was built to fix exactly that. One integrated team of tax professionals, state planners, investment specialists, all coordinated by a dedicated wealth manager who sees your full financial picture and keeps every piece working together. Proactive tax efficiency, state strategy, investments all under one roof. Creative planning where wealth works together. Learn more at creative planning dot com slash masters of scale.

Global hiring is such a headache when you're building fast, but companies like Eleven Labs are scaling effortlessly with deal. They quadrupled their workforce in twenty twenty five. Without hiring an HR team. Build your global team with deal. Visit deal.com slash MOS and start expanding your business today. That's D E L

dot com. Slash M O S. Hey, folks, Jeff Berman here. I am thrilled to share some of the new names who will be joining us at this year's Masters of Scale summit. This may be our biggest stage yet. Reed Hastings, Meredith Whitaker, Van Jones, Amjad Masad, and more.

Will be there with us October 20th through 22nd in San Francisco. If you're building something great, or you want to build something great, We want you there with us too. Join us at masters of scale dot com slash apply twenty six. That's mastersofscot com slash apply. twenty six.

When this first started, it was very dramatic. The emergency room literally changed overnight. I wish More people can see. What is going on in hospitals.

I don't think we're seeing the images that we really need to see in those stories. I cannot trust enough to people that Thousands of deaths. That we're seeing now are preventable. I've seen a lot of

Creativity and hustle. going on in my hospital and hospitals across the country. We have this opportunity to Fundamentally redesign our health care system and We are never gonna go back.

to the old normal. That's doctor Bon Ku, an emergency room doctor in Philadelphia. He's been on the front lines in fighting covet nineteen. Trying to manage health care for a flood of patients. It's required constant iteration.

From sourcing treatment options via Twitter. To three D printing test swabs. This is Bob Safian. Host of Masters of Scale Rapid Response. Banku's experience is emblematic of the resourcefulness, risk.

And hope. of medical first responders in the pandemic. He says he's pretty sure that he'll get Covid nineteen at some point. And he worries about infecting his family. He also worries about faulty incentives in the medical system and offers on the ground business lessons.

For all of us to take away from the crisis. I'm Bob Sapian, and I'm here with Dr. Bon Ku, an emergency room physician working in the COVID ward at Jefferson University Hospital in Philadelphia. He's also an assistant dean at the medical school there, director of the health design lab, and author of the book Health Design Thinking. He's been doing regular shifts at the emergency room, staying at a nearby hotel, and then on off days returning to his family. He's coming to us from the hospital itself, just across from the emergency room, as I ask my questions.

from my home in New York. Bon, thanks for joining us. Thanks for having me. He worked directly in the COVID ward. How did you get that assignment? I'm an emergency room doctor, so all of us who work in the emergency room spend some shifts in the what what's called the hot zone of the emergency department. So We s patients who have symptoms.

Uh Covet nineteen there. And those patients go to the hot zone because we want to eliminate Those patients who seek regular care in the emergency department from being infected with covet nineteen.

So I just did a string of shifts over the past ten days in In that part of the emergency room. So what is a typical shift? Is it change from what a shift was like six weeks ago, even four weeks ago? Like is it changing all the time? When this first started, it was very dramatic. I had worked an overnight shift in the emergency room.

The volumes have been Down by Almost about fifty percent on some days. And it's been eerily quiet in the emergency room. It's been like an empty ER And then when I return, this was in early March, but then when I returned to working in the emergency room

All of a sudden I saw my Colleagues wearing Full on protective gear. They're wearing those scary looking hazmat suits with a Pappers, these are those

Hoods and masks that you put on And I had come on to my shift and immediately I had to Intubate a patient. who was suspected of having Covet nineteen.

And that means putting that patient on a mechanical ventilator. So the emergency room literally changed. Overnight, it seemed like. And

Has it then stayed at that same Feeling that same pace. Since early March? We we've saw a rise in cases dramatically. And it seems like right now it's

Plateauing. The number of COVID nineteen cases. And what's also been encouraging is that people Who has regular

Diseases. that are outside of Covet nineteen. I'm talking about heart attacks and strokes and People with appendicitis.

those patients are starting to come back to the emergency room and seeking care. So our volumes have been Picking up but the Number of sick covet cases. Seems like it's been plateauing. But the situation changes from day to day.

So it's it's really hard to Provide a Day by day analysis, I think what we are looking for is trends in that data. Watching and reading the news. It can be hard to keep track for me of sort of what the medical and treatment information is that's current.

For a doctor like you on the front lines How do you know what is most relevant? How do you keep up? It's hard to keep up with the news. There's so much misinformation and disinformation out there. In terms of treating these patients

It is very complicated because it's a new disease that we've never seen before. And we don't have the randomized control trials that normally guide our medical management of these patients. So What I've been doing a lot is talking to my emergency room colleagues in New York City. Getting advice from them.

Uh lot of doctors like myself have gone on social media actually on Twitter and on blogs and podcasts and learning from those doctors who that I trust. Who have managed many more of these patients than I have.

and getting the real time advice because A traditional Method of learning through scientific journals, it's too slow right now. There's a whole community.

It's called foam, uh, free open access in in medicine and there's Some experts That I trust as authorities, uh, one of them is doctor Rich Levitan. Uh Have

been talking about best practices in the management of patients with COVID nineteen. And so a lot of Experts have been sharing their management of patients on on Twitter and On blogs.

I'm reading a lot, always trying to educate myself. The Public health information seems like it's so So fragmented, right? And you're not necessarily able to rely on your own hospital, your own hospital system, or or I guess your own hospital system may not have enough I think

This is expose. Some fractures that we have in our healthcare system. And one of them is the ability to Act on real time data. Because

data and especially data from electronic health records are siloed. It's very difficult for me. A doctor in Philadelphia. To learn About

The management of these patients From doctors in New York City who've seen just more cases than me. So that's why we've been relying upon social media to get some of this knowledge. And our our way of disseminating data is Full of roadblocks. The electronic medical records. So those are not

designed to be linked up in this kind of way for community health purposes. Correct. Electronic health records are amazing. They're great, but They've been primarily design for For billing.

And they have not been designed for doctors in real time. to make a decision at the patient's bedside. And I think what we can learn from from this crisis is

How do we fundamentally change our data systems? How do we redesign them. In order for us to make real time decisions based upon quality data. I know you're Have long been interested and invested in the

interaction between design And health and medicine and how to make that Work better. I know amid your role with your patients you're contributing to and encouraging design solutions. There's two different projects that the Health Design Lab that we've been engaging with. One

You know, it comes from This need For Mechanical ventilators. And

back in early March. What's It was projected that we would not have enough ventilators and that we'd be in a situation Like our Italian

colleagues were they were making decisions on These horrible decisions on Who gets a ventilator and who doesn't. And

I w was fortunate to link up with a team from um MIT who's working on a Bridge ventilator, as they call it. as a temporary solution until a hospital ventilator became available. And so this team of MIT engineers work with

uh several companies in In New York City, actually. New lab and and tenx beta. to design and manufacture a ventilator.

within a month, which has been amazing. On our end, we've been working on a project of how to safely manually ventilate a patient. So that means training a volunteer corps of humans to bag patients If there were no ventilator, so we just did this because we're

We're literally trying to build a plane while flying it. We don't ever want to be in the situation where As a doctor, you have to decide who gets to live and who who gets to die. And so It was important for us to act quickly and to come up with

Options. fortunately the way that pandemic is going. It looks like we're gonna have enough ventilators for this phase in in the spring. Well, that's reassuring. Certainly. But I can see why you wanted to have other options. Now you you also have a

A three D lab at the hospital. What are you doing in the three D lab? So my colleagues have been working on a project to Three D print. Uh swabs for covet testing. What has happened as we've

expanded our ability to test patients. For Covid. We run out of these little sticks that you put in a patient's No.

in order to test for Covid. If we don't have those sticks, those swabs, we can't test. And There have been researchers working with three D printing companies to open source how to three D print these. So

what we've been doing over the past week is repurposing our lab in order to manufacture these Covid swabs in house. It's like you have to be your own supplier. As a last resort. It is. What this pandemic has exposed is the vulnerability in our supply chains. For hospitals.

Hospitals. are designed for maximum Efficiency. Which is good, but it leaves no room For hospitals to build this surplus of

supplies and medications and equipment that's needed. In order to meet surge capacity. We're running out of some of the most basic medication. Some of my New York City colleagues have told me when they intubate a patient and put them on mechanical ventilation, there's not enough Of the proper meds to sedate a patient.

It's a scary thing that within a matter of weeks a virus has totally Upended the supply chains of hospitals across the country. And I guess some of this is if you're running your hospital From a business point of view. Before this, well, you don't want to pay for equipment or medication or beds that you're not using. So you try to keep things as full and as efficient and as spare as possible.

And then you get a surge like this, and suddenly That whole approach is Well, the limitations show. Oh absolutely. We're Hospitals have

In the hardest hit areas. have become overwhelmed because hospitals weren't designed to meet search capacity. Hospitals weren't designed to Deal with these pandemics. And hospitals make money from

Elective procedures and operations, schedule T specialty care outpatient visits. They lose money on primary care. Hospitals lose money on public health prevention. Hospitals don't get paid for preparedness. And

I believe that healthcare is fundamentally going to change. There's there's gonna be no going back to normal pre-pandemic that There's gonna be a new normal and that They're has to be um

A federal mandate of how we reincentivize hospitals of changing our payment system so we incentivise public health. Right now because public health, because primary care are money losers. What we see now is Some hospitals are closing down.

Some hospitals are laying off healthcare workers. In the worst public health crisis in the century. There's irony around that. When you build substantial wealth through your business, it's often tied up in a single equity position. The upside is real, but so is the risk, and knowing when to act isn't always obvious.

Creative planning works with business owners to build a strategy around concentrated equity. When to diversify, how to manage tax risk, and how to protect what you've spent years. Building. Creative planning where wealth works together. Lear more at creative planning dot com slash masters of scale.

Humans will never be more intelligent than AI. Those were great at AI and those that went out of business because they weren't. How do we build a future? That is human centered. I'm Rana El Calyubi. And on my podcast Pioneers of AI, we answer that question and so many more.

As an AI scientist, entrepreneur, and investor, I know what it takes to build AI that works for everyone. Every week, I sit down with the pioneers shaping our future. And we take you behind the scenes of the AI that's transforming our lives. Find pioneers of AI wherever you tune in. Hey listeners, Bob here. If you listen to Rapid Response on Masters of Scale, you may be missing half the show because every Friday we release a second Rapid Response exclusively in the Rapid Response feed. The guests and topics are just as compelling and timely. From Ford CEO to NASA's administrator to the lessons from The Devil Wears Prada. It takes about 10 seconds to find, just search rapid response wherever you listen to podcasts and hit follow to make sure you never miss an episode.

I hope to see you there. You mentioned earlier that there was a a point where the flow of patients who You normally s would see in the emergency room. Slow down.

What happened to those people? Where did they go? We don't know across the board when I speak with my colleagues, um, my emergency medicine colleagues, and some of the data that we've gotten is that there's been a forty to fifty percent decline in volume of emergency room visits. One explanation is that people are afraid.

To go to the hospital. A relative of mine She had called me last week and She was in severe pain, and we FaceTime each other, and I looked at her. And I said

You gotta get to the emergency room. And I thought she had a kidney stone which ended up She did have, but I said. It's safe. To go to the hospital. We're going to protect you from getting sick.

So you should go to the hospital. But I think a lot of patients what we're seeing is a delayed diagnosis that They're staying at home when they're having symptoms of a heart attack. Symptoms of a stroke. Symptoms of a severe infection.

when they should be getting care. Because when I think the public looks at what's going on in emergency rooms, they think it's what's happening In New York City. Which is not the case for most hospitals.

across the country. Yes, some hospitals are like that, but A lot of hospitals Can accommodate. you and it's safe for you to go and see care.

And as you describe this sort of Forty or fifty percent drop. And this kind of delaying Do you think then there'll be some sort of Second order impact, like another wave of different kinds of patients.

We're gonna see that the collateral damage from covet nineteen is probably worse than the coronavirus itself. Dad. There are going to be a lot of patients. Who have not gotten the

care for their chronic conditions that They have delayed diagnoses that they're gonna have. Worse health outcomes. I have to ask you this question. How much do you worry about?

Your own health. I don't think about my own health that much. Because I had already resigned myself to probably getting

Covid nineteen. From the beginning. And That is a risk that I take.

I I feel very fortunate at my hospital that the leadership here has done An amazing job of preparedness. So we have stockpiles of uh PPE. that every time I go to the hospital I could wear an N ninety five mask. I have the Papper, the hood.

That I can wear. So I feel very actually protected at work. What concerns me more is potentially infecting my kids and my wife. And that's cause me to sometimes stay in a hotel room, sometimes not.

And I I get very concerned of potentially having Covid. being asymptomatic, not showing symptoms, and in that Laten period.

Infecting my children. I was able to string A bunch of shifts together. And so during that time I said, Well, since I'm working a lot in the hospital this week, I'm going to go and check into a hotel.

And now this week I'm not working that much. I've been sleeping at home, but I've been away from my family. We have a a spare bedroom that I've been sort of sheltering in place there. But it's it's hard. It's hard on a lot of

emergency room doctors, a lot of frontline healthcare workers and nurses. It's this. mental stress that's always In the back of our minds I've

Spoke to some of my colleagues In the New York City area, uh, several of them had Covid. Learn that Че май коліг, мам здав ковід. In the past week.

And another doctor. Mom is currently in the ICU with Covid. So It's a lot of mental stress on many of those who are working in emergency rooms, are working in ambulances. Of

Am I infected and am I gonna affect others? I've a whole protocol as soon as I'm done working a shift in the emergency room, I go to my office, which is right above the emergency room. I Shri out of my sh scrubs. Um, I leave my shoes in my office. I put my scrub in a

Trash bag. And I put on a new set of clothes. And as soon as I Get home. I usually have a bag of scrubs I immediately put into

The laundry And then I go immediately to To shower. That's a routine that I and a lot of health care workers have

been doing. I've heard some of my colleagues Actually strip down at the front door before they even enter into the house. So they're you know, they're literally getting naked and probably their neighbors can see them, but they're they say, I don't really care because

It's either me exposing myself or or me potentially infecting my family. And when you come in. How do they react? To you when You come home, are they like, Oh, Daddy's home?

Yeah, they sometimes they go, Oh, I thought you were sleeping in the hotel and then I'm really affectionate with them, I and I wanna touch and hug them, but I can't and so that's very difficult. I think it's hard. I think it's hard for them to understand The chaos that A lot of

Health care workers are seeing in hospitals and how dangerous. this disease and viruses it's Kind of like When you get a weather alert on your phone and there's a storm coming, or there's a storm here, a thunderstorm.

And what I usually do is I I look out the window And I go, Well, it's it's actually kinda bright and sunny outside. That reality doesn't match the data that I'm getting from my phone, but I wish

More people can see what is going on in hospitals and what frontline healthcare workers are seeing in some of these sick patients, so they can Understand this this is a very serious disease. It's something that We have not seen before.

And we don't have good data out there and And a lot of times we can't tell who's gonna get better. And who's not? You're on the faculty of the medical school there. What impact is this likely to have on the medical school situation?

We have not had medical students rotating in the hospital. One is because we don't have enough uh you know no hospital has enough PPE to protect all our learners, all our medical students. And they are missing it. They want to be In the thick of it.

There's a group of medical students here who started a an organization to help provide PPE to to local hospitals. They have this sense of optimism that they want to help, they want to support. And They want to help out their fellow Americans.

Is telemedicine Useful right now? Is it Filling in some of the gaps of people not coming into hospitals or What is the role of telemedicine likely to look like as we move out of this? Telemedicine is here to stay.

And I think Unfortunately, it took a pandemic to convince Both. Patience. And doctors that.

It's going to be really part of the backbone of our health care delivery system. So as We think about The future. And we think about how we're going to redesign

the healthcare delivery system, telehealth is gonna play a pivotal role in that. What is encouraging is a lot more patients and doctors are getting more comfortable. On this platform. And I think that is going to continue. Post pandemic.

I think it's going to eliminate some of the traditional barriers that we've seen to accessing health care. But I also wanna Stress too, we still gotta think about our vulnerable populations and

Going forward How are we gonna do a better job protecting them. This virus has disproportionately impacted Communities of color.

It has impacted And really killed a lot of People with unstable housing. A lot of people in our prison system.

Those who work in factory jobs like me packing facilities. how we as a society how we as a country are gonna protect.

the most vulnerable in our society because how are we going to protect those populations over society who are disproportionately impacted. I think telehealth may play a role, but we gotta make sure Those patients have broadband access and they can access telehealth. Not all patients can. It sounds pretty stressful.

How do you manage your own stress? In this environment. What's been helpful this past week is connecting with My

emergency medicine colleagues, a lot of colleagues that I've trained with. were in different areas of the country. It was a very traumatic week for us'cause One of our colleagues In New York City had died by suicide. Uh she was uh

Emergency room doctor. Someone who was our friend. A friend of mine that I train with it's a very stressful time and me, what helped us getting through is reconnecting with

Those who knew her reconnecting with Those who are going through the same thing that we are. uh go you know, in just different areas of the country and It is

Extremely stressful time for many of us. We had a Online Zoom Memorial Service. for her yesterday that her department.

From Erense Medicine did and So three hundred ER docs on that. memorial service expressing our just grief and mourning. And tha that was very helpful for all of us to Process. And

What gives me hope is that there are some really good people who are Or on the front lines and who are trying to do their best to take care of patients in hospitals across the country. It gives me hope. You said to me at one point that working in the hospital is the most normal part of my day.

Can you explain what you mean by that? It's surprising that for me going into a shift in the emergency room or going into my lab is actually the most normal part of my day. It's because We are doing What we did. Before the pandemic, we're trying to just take care of patients of a

We work in teams, so I work a lot of overnight shifts and it's great to work with the same team that I've worked with Before. The pandemic. And

I'm not at home working alone and sometimes when I'm At home. Just writing emails and Reading on This pandemic.

It's actually more stressful, at least I feel in the hospital. I've been trained to take care of patients. And It feels a lot better being able to practically do something.

I've had so many great people reach out to me and go, What can we do to help? And I'm fortunate enough to have a job where I can go and actually make a difference during this time. So It gives me A sense of purpose during this pandemic. Do your kids

understand and appreciate the risk that you're Putting yourself under That you coming home puts them under like Do they understand it? I think they do. this past week when it was a very difficult week for me, I

Been very just upset by what had happened. And they've seen that in me, you know, the usually I'm a Pretty optimistic. guy who doesn't like to cry and they they've seen me crying this week and so it's been so I think they see that it's um just a extremely stressful time.

Certainly, you know, what's happened in the last week underscores that the Burdens that folks like you are under your own mental state can become more fractured. You mentioned that you have seasonal allergies. Sometimes. You get sniffles and that you start to worry like, Oh, does that mean I have something? Yeah, I if my allergies have been kicking in, then I'm thinking

Hmm, am I my stuffy nose, is that related to COVID or is that just my just my allergies and I'm trying to a test I to do every morning is uh make sure I'm able to smell the coffee that I make and I'm like relieved when I when I have that sense of smell and I'm relieved when after taking my allergy medications My nasal congestion has gotten better. What really gives me hope, but really helps me to get through each day is

I see my colleagues. The nurses, the other doctors, the paramedics. the environmental services who clean the rooms in the hospital. They're just showing up and doing their job. And we're keeping the doors open so we could take care of uh

People in our society. And that that really gives me a lot of hope. Is there anything that we haven't talked about that folks listening in Should know about A point that I want to highlight is

That We have this opportunity to fundamentally redesign our health care system and We are never gonna go back. to the old normal.

And what are we gonna do moving forward? How are we gonna do everything from redesign emergency rooms to Make it safer. for patients getting care that they're not exposed to covet or other viruses. How do we need to

just change the financial incentives for hospitals. So That we pay for public health. That we pay for preparedness. Because there's gonna be Most likely a second wave happening in the fall and wintertime.

And what are we gonna do to Prepare for that. I Can I trust enough to people that Thousands of deaths. That we're seeing now.

If we look at other health care systems across the world. Like Korea and Taiwan and New Zealand. who did a much better job at being prepared and containing The virus

That They have had Far fewer deaths. In our country. we really need to ask ourselves, what are we gonna do to promote health in our country? How are we not gonna

Repeat the same mistakes that we've made. And What are the changes that we're going to ask of our healthcare systems in order to prevent Thousands of deaths. It upsets me.

every time I I see a patient die, every time I hear of a На колег у вас нет ковід. A colleague's mom who has died of covet. When I think of these deaths. when I think of these people getting affected that

Many of these were preventable. This wasn't inevitable. We could have prevented A lot. of the tragedy that we're currently seeing.

And how do we move forward to not let this ever happen again? But right now you don't necessarily see that If there's a next wave that comes in the winter That we haven't put things in place, at least that you've seen yet that would Make it different.

I've seen a lot of creativity and hustle. going on in My hospital and hospitals across the country. It impresses me, but

In order to deal with a pandemic of This size. We need to have a federal national unified strategy. It can't be a piecemeal approach.

We could have been better prepared. And not just looking at data. from other health systems in other countries that They were able to test early, they were able to contain, they were able to socially distance their hospitals were better equipped with

P P to protect. Healthcare workers. But I have hope because This virus has not wiped out our country and that we are gonna learn from our mistakes and that we are gonna

change our system in order to Better protect. Or country. And and I just think The way that

Why? We have failed is is a direct result of how the financial incentives of our health care system. Health care was already broken. There are already fracture lines in the health care system. The Covid crisis just exposed them.

What We've incentivize health care. to operate on profitable procedures and operations and specialty outpatient visits and I think it's crazy that

Hospitals are shutting down and healthcare workers getting laid off in this public health crisis. That does not make sense. А фор профіт систем. that exist with these financial incentives.

That cannot exist anymore. It absolutely cannot, so There needs to be a a redesign of how hospitals get paid. That narrative isn't coming through.

Which is sad. I don't think we're seeing the images That we really need to see in those stories. And Because of that I think

People The public on whole I think they need that. They need that sort of Emotional Anchor.

To help them understand. How serious this is, how this is just ravaging so many people. Last question. How is your stamina? This has been going on a long time with a lot of stress for

Going on two months. I feel that the long hours of residency training have prepared me for enduring Some of the sleep deprivation and exhaustion of physical exhaustion. The remedy for that is I try to sleep.

And I try to exercise. That physical exhaustion I've learned in my career how to handle and deal with. I think many doctors and nurses have.

what has been more difficult is the mental And emotional exhaustion. And that's something I I and a lot of my colleagues are You know, still trying to deal with. normally we don't have that sort of

mental and emotional. Stress. So It's a day by day uh situation and we've I've been trying to reach out to colleagues, uh check in on them. People have been checking in on me, which has been great. And

I hope this is over soon. And Just take it day by day. Well, Bon, our our thoughts and our prayers are with you. I you know, here in New York every day at seven o'clock, people go to their windows and they clap for essential workers and healthcare workers like you, and I I hope some of that uh That applause and that appreciation is felt and has some impact. But uh we really appreciate all that you and your colleagues are doing and

And thanks for your time. Great. Thank you. Masters of Scale Rapid Response is a Wait What original. The show is recorded remotely using sanitized audio gear. It's hosted by me, Bob Sapian, Masters of Scales editor at large.

and Masters of Scale host, Reed Hoffman. Our executive producers are June Cohen and Darren Triff. Our supervising producer is Jay Fanjabi. Our producer is Jordan McLeod. Scripts by Christina Gonzalez.

Original music and sound design by Ryan Holiday and Daniel Nissenbaum. Audio editing by Keith J. Nelson. Mixing and Mastering by Brian Pugh. Special thanks to Emily McManus, Sarah Sandman. Kelsey Capitano, Tim Cronin.

Charlie Menessis and Saida Sapiava. Visit masters of scale.com slash rapid response to find the transcript for this episode, and be sure to subscribe to our email newsletter.

What you see above is a preview of the first minutes. One unlock costs 3 credits and covers this episode forever: full segment and word-level timestamps on this page, plus .txt, .srt, .vtt and word-level JSON downloads, as many times as you like.