Good Medicine - Dr. Anupam Jena on on What Economics Can Teach Doctors

Good Medicine - Episode 10 What if some of the most important forces in medicine have nothing to do with science? Dr. Anupam "Bapu" Jena—Harvard Medical School professor, practicing internist at Massachusetts General Hospital, and co-author of the bestseller Random Acts of Medicine—joins Dr. Rohan Ramakrishna to explore the hidden variables quietly shaping patient outcomes every day. Bapu is a physician-economist in the truest sense: someone who uses the tools of economic thinking—natural experiments, probabilistic reasoning, incentive structures—to expose what medicine often misses. In this conversation, they dig into why August-born children are 30% more likely to be diagnosed with ADHD, what a Jerusalem doctors' strike revealed about overtreatment, and why experienced medical doctors may actually produce worse outcomes than their younger peers. They also unpack the stubborn gap between what patients value—hope, dignity, time—and what payers are equipped to measure, and explore how AI is beginning to reshape clinical decision-making. Smart, surprising, and deeply grounded, this episode will change the way you see everyday medicine. For more from Roon, visit: ⁠⁠www.roon.com Find us on Instagram and X: @roondoctors If you have a question, comment, or suggestion for a future guest, please email us: jane@roon.care. -- 0:00 Intro and guest welcome 1:00 Why Bapu Jena is a unicorn in medicine 2:45 Preview: natural experiments, ADHD, value-based care 4:24 Meet Dr. Anupam Jena: physician, economist, author 5:09 Economics or medicine first? The origin story 6:46 The University of Chicago, a snowy day, and a fateful meeting 9:37 The counterfactual: what if Bapu had become a cancer biologist? 9:47 How economics changes the way Bapu practices medicine 11:13 Fever thresholds and probabilistic clinical thinking 12:45 Anchoring bias and cognitive forcing in diagnosis 15:11 Two economics lessons every physician should know 17:35 What is a natural experiment—and why does it matter? 19:38 Why observational data misleads us (the cancer drug example) 21:52 Steve Levitt, Freakonomics, and the origins of quirky research 23:56 The flu shot timing experiment: does when you get it matter? 27:36 Morning vs. afternoon immunotherapy: separating mechanism from causation 31:01 Random Acts of Medicine: ADHD and August birthdays 33:48 Has the ADHD birth-month finding changed clinical practice? 35:21 Redshirting, school readiness, and professional athletes 37:26 The Jerusalem doctors' strike and the paradox of less care 40:26 Non-STEMI patients and the risk of doing too much 42:12 Does physician experience predict better outcomes? 45:50 Defining value in value-based care 48:19 The limits of what payers can measure 52:16 The track record of value-based care programs 56:05 How Bapu uses AI in research and clinical practice 59:49 Automation bias and the risks of clinical decision support 1:02:47 The next natural experiment: Spotify releases and fatal car crashes 1:04:34 Quick hits: mentors, podcasts, and student wisdom 1:06:10 Closing thoughts and farewell