The Birth of Ambient Documentation: How an ER Doctor and College Student Built a Healthcare Tech Revolution

In 2014, an emergency room doctor and a college pre-med student took a leap of faith that would transform healthcare documentation. Their startup, iScribes, eventually became Dragon Ambient eXperience (DAX), now a cornerstone product for Microsoft and Nuance. Here's their remarkable journey.

An Unlikely Partnership

It began in a Virginia emergency department, where pre-med student Christopher worked as a scribe for Dr. Jared Pelo. Christopher's endless curiosity about medicine caught Jared's attention – he kept asking questions about X-ray interpretations and clinical decisions instead of just taking notes.

When Jared approached Christopher with a business proposition, Christopher was deep into medical school applications. The choice was stark: continue on the safe path to medical school or join a risky startup venture. After a surprising conversation with his father, who told him "You can go to school anytime...the experience you'll get is invaluable," Christopher joined the iScribes mission.

Building from Nothing

The early days were characterized by bootstrap ingenuity:

• Working from an unheated house with Bitcoin miners providing warmth

• Hand-ironed company sweatshirts

• Minimum wage pay for dedicated employees

• Personal loans and retirement savings keeping the company afloat

Two pivotal moments shaped their success:

1. A cold email to info@triangleortho.com led to their first customer and investor

2. Meeting David Meisner, who brought crucial business and financial expertise

Culture as Foundation

Despite financial constraints, the founders prioritized building strong company culture:

• Weekly updates and celebrations

• Company sweatshirts after one year

• A mission-driven community

• Three core values consistently reinforced

The result? A loyal workforce of 250 employees who often felt guilty about leaving even for double the pay.

The Technology Bet

The team made a prescient decision to record and store all their documentation data, believing that someday AI could transform it into automated documentation. While their initial competitive moat was this massive dataset, the emergence of large language models changed the landscape. Nevertheless, DAX became a cornerstone product mentioned in Microsoft earnings calls.

Key Lessons

1. Bias toward action: "Be wrong by trying, don't be wrong by hypothesizing and not going for it."

2. Deep conviction matters: The level of commitment required means you need to truly believe in solving the problem.

3. People first: Success came from improving life for doctors, patients, and employees alike.

4. Build community: Strong culture creates resilience through hard times.

The iScribes story demonstrates how vision, persistence, and the right team can transform an industry. From a college student's curiosity to a product used by healthcare systems nationwide, it's a testament to the power of taking risks and believing in possibility.

Ten years later, both founders reflect on this journey with gratitude – for the lessons learned, the friendships forged, and the impact they've had on healthcare. As Christopher notes, "What a blessing to carry these lessons forward at 34." Their story continues to inspire entrepreneurs and innovators in healthcare technology.

Key Timestamps:

• 00:10 - Introduction and background

• 02:06 - Earliest days of iScribes conception

• 08:09 - The pivotal dinner meeting

• 14:22 - Early company milestones and strategy

• 15:34 - Key turning points: Triangle Ortho email and David Meisner

• 22:17 - Office space evolution and growth

• 27:43 - Building company culture

• 33:05 - Challenging moments and near-failures

• 36:27 - Personal sacrifices and financial risks

• 40:52 - Key lessons learned

• 43:51 - Impact on personal growth and relationships

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Fueling Peak Performance: Insights from Elite Sports Dietitian Jenn Gibson

In a recent podcast, Dr. Jared Pelo sat down with Jenn Gibson, an elite sports dietitian with nearly two decades of experience working with Olympic and professional athletes. Their conversation offered a wealth of insights applicable not just to elite athletes, but to anyone looking to improve their nutrition and overall health.

Back to Basics: The Power of Whole Foods

One of the most striking takeaways from the discussion was Gibson's emphasis on the importance of whole foods. She introduced the concept of "first generation foods" - foods that are consumed in their natural state, like a carrot straight from the ground. Gibson advocates for a diet composed of at least 90% whole, real foods, steering clear of heavily processed alternatives.

Navigating the Supplement Noise

In an era of information overload and aggressive marketing, Gibson stressed the importance of critical thinking when it comes to supplements. She highlighted that many elite athletes in countries with limited access to supplements still perform at world-class levels, reminding us that human physiology hasn't fundamentally changed - only the marketing has.

Gibson's approach to supplementation is evidence-based and personalized. She uses blood tests to identify specific deficiencies before recommending supplements, rather than adopting a one-size-fits-all approach.

The Microbiome Frontier

The podcast touched on the emerging field of microbiome research in sports nutrition. While exciting, Gibson cautioned that we're still in the early stages of understanding how to effectively manipulate the gut microbiome for performance benefits. She emphasized the need for more research and reliable testing methods before making broad recommendations.

Practical Tips for Everyone

Gibson shared several practical tips that anyone can apply:

1. Focus on whole foods, shopping primarily on the perimeter of the grocery store.

2. Get back to basics in the kitchen, prioritizing home-cooked meals.

3. Be critical of diet and supplement marketing claims.

4. Consider consulting with a registered dietitian for personalized advice.

5. Use blood tests to identify genuine deficiencies before starting supplements.

The Joy of Eating

Perhaps most importantly, Gibson reminded us not to lose sight of the joy and cultural significance of food. She encouraged a balanced approach, where it's okay to enjoy treats like birthday cake or a homemade pizza without guilt.

Her parting message was one of reassurance: many of us are likely doing better with our nutrition than we think. If you're maintaining a healthy weight, feeling good, and your regular check-ups show good health markers, you're probably on the right track.

This conversation with Jenn Gibson serves as a refreshing reminder that good nutrition doesn't have to be complicated or stressful. By focusing on whole foods, being critical of marketing claims, and not losing sight of the pleasure of eating, we can all work towards better health and performance - whether we're elite athletes or just trying to live our best lives.

Key Timestamps

00:00 - Jenn's background and journey to becoming a sports dietitian  

03:19 - How elite athlete nutrition differs from general population  

05:36 - The impact of nutrition on an athlete's career and livelihood  

08:14 - Using blood tests to inform supplementation decisions  

10:10 - Emphasis on whole foods vs. supplements in an athlete's diet  

12:57 - Navigating nutritional information and marketing hype  

19:19 - Potential issues with overuse of electrolyte drinks and caffeine  

26:04 - Current state of microbiome research in sports nutrition  

35:27 - Practical nutrition tips for shopping and cooking  

39:51 - The importance of a balanced approach to nutrition and enjoying food

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Revolutionizing Physical Therapy: A Conversation with Twila Ruefer

In a recent episode of our podcast, we had the pleasure of speaking with Twila Ruefer, a passionate physical therapist and the founder of Longevity Institute of Virginia. Twila’s journey from Navy service to revolutionizing physical therapy practice offers valuable insights into the future of healthcare and personal wellness.

From Navy to PT: A Journey of Discovery

Twila's path to physical therapy was anything but straightforward. After joining the Navy at 18, she initially pursued a career in electronics. However, her involvement in command fitness activities and coordinating care for injured sailors sparked her interest in fitness and rehabilitation. This led her to pursue a degree in kinesiology and eventually a doctorate in physical therapy.

The Birth of Longevity Institute

Frustrated with the limitations of traditional insurance-based physical therapy, Twila recently launched Longevity Institute of Virginia. This cash-based clinic allows her to spend a full hour with each patient, focusing on holistic care that goes beyond just treating symptoms.

Key Principles of Twila's Approach

1. Relationships Matter: Building trust and understanding each patient's unique story is crucial for effective treatment.

2. Consistency is Key: Small, consistent changes can lead to significant improvements over time.

3. Mindset is Everything: Addressing mental and emotional aspects is essential for overall health.

Holistic Care: Beyond Physical Therapy

Twila's approach incorporates several "longevity pillars":

• Eating well

• Moving often

• Prioritizing sleep

• Cultivating quality relationships

• Living with purpose

• Reducing stress

By addressing these areas, Twila aims to treat the root causes of pain and health issues, not just the symptoms.

The Cash-Pay Model: Quality Over Quantity

By operating outside the constraints of insurance, Twila can:

• Spend more time with each patient

• Address multiple health factors in a single session

• Provide personalized, comprehensive care

This model allows for better outcomes in fewer sessions, potentially saving patients time and money in the long run.

Spirituality in Healthcare

Twila isn't afraid to discuss spirituality with her patients. She emphasizes that spirituality can take many forms – from meditation to religious practice – and can play a crucial role in stress reduction and overall well-being.

Resources for Longevity

Twyla recommends several resources for those interested in longevity and holistic health:

• "Outlive" by Peter Attia

• "Built to Move" by Kelly Starrett

• The Longevity Institute podcast

Looking Forward

As Twila settles in Virginia Beach and continues to grow her practice, she represents a new wave of healthcare professionals prioritizing quality, personalized care over volume-driven models. Her approach offers hope for those seeking comprehensive solutions to complex health challenges.

To learn more about Twila and Longevity Institute of Virginia, visit www.longevityvb.com or follow @LongevityVB on Instagram.

Key Timestamps

For easy navigation of the podcast, here are the key timestamps and topics discussed:

00:16 – Twila's journey from Navy service to physical therapy

08:30 - The value of spending quality one-on-one time with patients

11:54 - Building trust and establishing strong patient relationships

14:35 - Guiding principles and longevity pillars in Twila's practice

21:04 - Twila's approach to maintaining her own sleep habits

23:50 - Benefits of the cash-pay model in physical therapy

29:07 - Unique skills physical therapists bring to holistic health care

31:45 - Book recommendations for longevity and health

34:17 - Incorporating spirituality into physical therapy practice

38:12 - Contact information for Longevity Institute of Virginia

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