NOEL:  Hello and welcome to Episode 26 of the Tech Done Right podcast, Table XI's podcast about building better software, careers, companies, and communities. I'm Noel Rappin. After you listen to the episode, there are several ways for you to join the conversation. You can follow us on Twitter @tech_done_right. There you can get notifications of new episodes and tell us what you think. You can leave comments on our full catalog of past episodes at TechDoneRight.io. We're really curious about what you like and don't like about the show and also, what youÕd like to hear us discuss in future episodes. So, please let us know. If you want to help other people find the show, leaving us a review on Apple Podcasts is a great way to help us out. Thanks. 

Today on Tech Done Right, I'm talking to Dr. Ed Livingston. He's a practicing surgeon and an editor at the Journal of the American Medical Association. As the Journal got into audio content, Dr. Livingston became the voice and writer behind many of their podcasts. He invited me to their studio in Chicago. And we'll talk about podcasting and why the Journal thinks that audio is important to their future. If you're interested in starting off in podcast or in audio, he's got some ideas about where to start and who to look at for guidance. Here we go with Dr. Livingston. 

Ed, do you want to say who you are and what you do?

ED:  So, I'm Ed Livingston. I'm a surgeon. I spent 20 years in academic surgery as a Chief of Surgery for most of those years, both at UCLA and UT Southwestern in Dallas. And then along the way became an editor at the Journal of the American Medical Association, or as we say, JAMA. Everyone else says 
JAMA [sounds like jam-a], we say JAMA [sounds like drama]. And five years ago, I came to the Journal to become a full-time editor for the Journal. I'm the Deputy Editor for Clinical Reviews and Education for the Journal.

NOEL:  And eventually you became their podcast voice, or one of their podcast voices.

ED:  I became the voice of JAMA, yeah. 

NOEL:  And how did you become the voice of JAMA? Why did JAMA decide to start doing podcasts? What kinds of podcasts does JAMA try to do?

ED:  So, they had been moving into the audio arena for quite some time and they had been doing two major things. One, are author interviews. So, they would have articles and have the author of the article be interviewed by somebody. Those are pretty straightforward, just kind of question/answer sort of thing. And then they did a thing they called the weekly editor's audio summary. We publish every single week. And that would be a summary of what was being published that week. And that's kind of what the extent of the audio was for quite a long time. Then, we did a survey, I think it's about three years ago, of young readers. We wanted to know what young readers wanted to get from the journal. And we went all over the country and talked to people and had them sit in their offices and tell us how they acquire medical information and what they want. And one of the things that came from every single person is they said they wanted their content delivered in audio fashion. And at the time, the podcast Serial was running. And to a person, they all said, "It should be like Serial." 

NOEL:  [Chuckles] That seems tricky for medical research papers.

ED:  Absolutely. It's a very tall order. So...
 
NOEL:  The diagrams alone would be pretty challenging.

ED:  Well, yeah. I'll get into that in just a sec, because that's what they said and I had been listening to Serial and it's a phenomenal podcast. But it still wasn't something I was intending to do. And then one day, I was sitting in for somebody who was doing one of their audio interviews or something like that. And the engineer who's here, Eric Butkus, he said to me, "You know, you could do this. You could be a podcaster. [Chuckles] And I was like, "You're nuts. I don't have the talent," and I hated my voice. I thought my voice was awful. And he said, "No really, you can do this." And so, back then we were staffed less than we are now. And so, Eric and I worked together on pretty much everything. And he kind of helped me learn how to use my voice and how to negotiate the whole audio thing. And then also, for me, I edit a journal and I'm very used to editing for written text. And it became a very different experience to write for audio.

NOEL:  Oh, yeah. It's much different, yes.

ED:  It's completely different. So, it took me about a year. And I'm a surgeon. I've done a lot of things in my life, and the hardest things that I have done is learn how to do this, this podcasting.
 
NOEL:  So, let me pick that apart a little bit. Now what kind of podcasts do you do, are you doing?

ED:  So, what we wanted to do was try to make it like Serial. So, you take some mundane, some boring clinical topic, and try to turn it into a story. So, we try to storify everything. And that's really, really hard for medical stuff. 
So, it's been a real challenge to figure out how to present medical information in a way that's interesting and engaging for listeners. 

NOEL:  Let me walk through that. So, you take a clinical paper for example, and you start looking at it and you start adapting it for a podcast. What do you look for?

ED:  So, I'll give you an example. So, I've done different things. The most common is to try to just tell a story. So, the medical news people had done a story on bacteriophage treatment for some fellow that got a really bad infection and he was dying. None of the antibiotics that he was getting would work. And so, in kind of a desperation move, they gave him these bacteriophages, which are viruses that kill bacteria. And it worked, saved him. And it was in the news and our news people wrote something on it. And I was going to take that audio and make it into an entire podcast on the concept of using bacteriophages instead of antibiotics to treat infection. 

So, to put that together as a story, first you start with the history of bacteriophages, which turns out to be really fascinating. And they were discovered long before there were antibiotics. And it was a major... it was something that was going to be a major way of treating infections before antibiotics came around. So, there's a lot of bacteriophages out there in the therapeutic world, in the 1920s and '30s, a million papers in JAMA. There was a commission from the American Medical Association published in JAMA about how to use bacteriophages and all that kind of stuff. This is very rich literature and very rich history. So, you start with the history.

And then you go through what they do. And you try to orient the podcast to learners like students and residents. So, we talked about what they are, what they do, how they work, and then what their potential is, and then finished it with, "This is what we think we'll be able to do with bacteriophages and that they have this tremendous potential that's really been unrealized." And in an era where bacterial resistance to antibiotics is becoming a really big problem, this is something to think about. So, put the story together that way.

NOEL:  So, are you using existing audio? Are you writing scripts? Are you doing interviews and piecing them together? How does that come together?

ED:  All of the above. So in that case, they had interviewed some people and then I just weaved in a story on top of it. Most of the time, I interview people and then try to get the pieces of the story from those people and then write a script and then do voice-overs from that script and then the engineers put it all together. 

NOEL:  So, you're interviewing to be edited...

ED:  Yes.

NOEL:  Down into the script. 

ED:  Absolutely. Everything is edited.

NOEL:  Rather than this, for example, which is... going to be much less edited. 

ED:  No, we don't do anything conversational. I'd done occasional conversational straight-up interviews when I'd had really interesting people and they just, they told stories that by themselves were fantastic. So for example, there's a disease called Lyme disease and it's very controversial. And I happened to get the guy who discovered it on the phone. And so, we did an interview with him and just let him talk. And he told the story of how he discovered this disease which is, from a scientific perspective, a fascinating story. So, we just let him talk. But most of the time, we take the snippets of conversation and edit them. The goal being by the way, my dream is to have our podcast be like Freakonomics. I think they do the best job. They tell a story and then they weave in the interviews into that story but they're telling the story. They don't let the interviewees tell the story. That's where I'm trying to go.

NOEL:  To what extent do you assume technical knowledge on your audience? Do you assume your audience are learning the topics that you are presenting? How do you approach that?

ED:  So, we assume that our listeners are clinicians of one form or another. They're not intended for the lay audience, but they're intended for a range of listeners from medical students who are just learning things for the first time to practicing clinicians. And so, I put in content that appeals to all those groups and also enables a student or resident listener who may not have all the knowledge they need to understand the topic learn enough while they're listening to it that they can understand the entire podcast.

NOEL:  So yeah, so there's a baseline set of assumptions that you make.

ED:  Right.

NOEL:  Facts, things you don't define.

ED:  Right. So in the bacteriophage example I gave you, what I did with that one is I went into the basics. This is what a bacteriophage is. This is how it works. This is the kind of bacteria it kills. To an experienced clinician, I don't need to say that. But a medical student may not know that. They may not have learned that yet in their medical school curriculum. So we would just lay it out for them so that they can understand the rest.

NOEL:  Do you ever find... are there certain kinds of articles or things that are more or less amenable to the story treatment? Do you ever find that the story treatment works particularly well or particularly poorly in getting the point across?

ED:  In our world, it's mostly review articles that cover an entire topic in a review fashion, soup to nuts. Everything about, say, atrial fibrillation, which is a disease of the heart. Since you cover everything about it like what causes it and how it manifests and what it does to patients and how you treat it, you can build a story out of that. It's really, really hard to take something like a research paper that would say, "Well, we gave drug X to these kinds of people and they had this kind of response," and it's a very narrow finding, it's really hard to turn that into a story.

NOEL:  It's a very slow-moving story.

ED:  Yes. And it can be told in like, three minutes. 

NOEL:  Yeah. And it leaves out all the staring at data.

ED:  Right.

NOEL:  So, what kind of response do you get? How do you engage with your audience? How have you found this to be useful?

ED:  So, because of the nature of what I do for the journal, I go around and talk to groups all the time. So, I talk to students and I talk to residents and I go to meetings where I talk to practicing physicians. And I'll ask them if they've listened to the podcast and if they have, get their feedback on it. JAMA is an enormous vehicle. So, most of the time when I talk to people, they have listened to the podcast, especially younger people. And they generally have good feedback on what they like and what they don't like. We haven't done anything as formal as a survey of our listeners. We're planning on doing that in the future now that the app came out yesterday. So, we're planning on doing a lot more to try to understand what our listeners want once that's matured. But we've only done an assessment in an informal way.

NOEL:  Do you have... has anything come from your listeners that has lead you to explore different topic areas or change the structure? Or have you mostly been successful with what you started with?

ED:  Yeah. The feedback from the listeners has been very helpful because it's pretty consistent. They want the stories. And so, when they listen to one that's more interview-ish, they don't like it. And so, they tell us they want the stories and they like the music and they like the way they're produced and all that kind of stuff.

NOEL:  That's very encouraging for an interview podcast.

ED:  There you go.

NOEL:  Like the one I'm doing. 

ED:  Gotta up your game, man. 

NOEL:  So, once upon a time I came to JAMA Studios.

ED:  That's right. 

NOEL:  We'll put in some tinkly piano music and...

ED:  Saved me.

NOEL:  My cabdriver got lost and here we are. So, I've only done interview podcasts. I've never put together a narrative podcast with edit cuts and music and things like that. How many people work on editing? How do you pick other elements?

ED:  So, we have a group of very talented producers. And so, they do... so, you got Daniel Morrow here in the studio. We have four of them. We're a pretty big operation and we're turning out a lot of different things.

NOEL:  How many shows do you put out? 

ED:  Mine comes out about every other week, five a week. So, there's Daniel Morrow, Jesse McQuarters, Eric Butkus, Michelle Kurzynski. So maybe we have four. And Eric's now just working on video, so it's about three that do audio. But that's for producing five shows a week and we've got 12 journals that we have to support. So, there's a lot of activity. And then my clinical reviews podcasts are heavily produced. So, that's a lot of work for them, because they have to work the audio, pick the clips, clean them all up, and then put in the music and all that kind of stuff. It's very labor-intensive. 

NOEL:  Do you do the writing yourself?

ED:  Yes, I write... for mine, I write the scripts.

NOEL:  For yours, you write the script.

ED:  Yeah.

NOEL:  What's that process like?

ED:  It's a lot of work. It's like writing a paper every other week. And writing papers, even though I'm an editor, it takes a lot of time.

NOEL:  Not exactly what you got into surgery to do?

ED:  Yes. That's a whole other thing.

NOEL:  [Laughs]

ED:  What's a surgeon doing all this for?

NOEL:  Well I mean, editing, cutting.

ED:  Yeah.

NOEL:  It's not really related, but...

ED:  It's funny, because I just gave a talk to a group of medical students from the AMA. And they wanted to know about my career development. And I told them, you know, if you told me when I was at their stage 30 years ago that I would do anything that I did in my career, I'd say, "You're nuts." And even if you said five years ago, "You're going to be a podcaster," I'm like, "[Chuckles] No way. It's not going to happen." But you wind up doing it. And I struggled along with my production team to figure out how to do this the most efficiently. And I've tried all kinds of different ways of doing it. And the funny thing is, I read a... at the very beginning read a book by, she wrote the book on This American Life, but this woman kind of hung out at This American Life and wrote how they do things and all the processes. Read that. And then tried what they did. They do interviews, they get transcripts, and then from the transcripts they write scripts and they go through this iterative process.

NOEL:  Yeah.

ED:  I did that. So, that's a waste of money on me to do that. I have an engineering background, so I learned how to do all the audio. So, I got Reaper and Pro Tools and all that. And I started doing audio work on my own stuff and then trying to put the podcast together from clips that I would develop right out of Pro Tools. That was a huge amount of work.

NOEL:  Yeah. I've done that a little bit. We now have an actual editor who knows how to do this. And it's incredibly time-intensive...

ED:  Yeah.

NOEL:  To do that well.

ED:  It's a lot. So now, I've gone back to the beginning which is getting transcripts. So now, when I do an interview they get a transcript done right away and I just, I write my scripts from that transcript. And then after the script is done, I'll do a voice-over. The engineers put it all together and then we'll listen to it and tweak it. But it's a lot of work.

NOEL:  Yeah. I think that produced audio, coming from a field of custom software development where people often underestimate how much work it takes, I say produced audio takes a lot more work. And I've never done any produced pieces that were just audio. I have done a couple of sort of produced pieces that were screencasts. 

ED:  Yeah.

NOEL:  It's audio, not even over moving people, but just over screens.

ED:  Yeah.

NOEL:  And it's very precise, very time-consuming.

ED:  Yeah. It's a huge amount of work and then it's like writing anything. Because I come up with a script roughly every other week. And I'll sit down in front of my computer every other week with a blank screen with a typical writer's block saying, "Where do I start?"

NOEL:  [Laughs]

ED:  It was a dark and stormy night.

NOEL:  Yeah.

ED:  And then where do you go? And it's really, really hard sometimes to figure out how to structure them, where you want to go with the story. Getting them started is the hardest thing. Once you have a flow, it just follows the flow. But getting started can be really, really tough.

NOEL:  Do you outline?

ED:  No. I just don't. That's what they tell every writer to do, but I've never outlined even in my writing.

NOEL:  Yeah, I've seen professional writers who do and professional writers who don't. 

ED:  Yeah.

NOEL:  And I've never really gotten the hang of it, myself.

ED:  I try to have the outline in my head. But I don't write it out.

NOEL:  So, the story structure emerges as you put the script together?

ED:  Yeah. You sit down at the blank screen, figure out. You've got your transcript. You've read your transcript. Figure out how you want to tell the story, where you want to start. And that is the hardest part, trying to figure out the basic structure. That's the equivalent of an outline. Instead of writing it out, I think about what I'm going to do. And then start writing. And invariably, you start, you stop. You start, you stop. Get rid of what you started, start over again. And then once you have a flow, then it gets much easier. But getting to that point where you have a flow can be really tedious. 

NOEL:  Do you find that you put a lot of effort into that first beat of the story as something that's going to be the introduction... 

ED:  Yes.

NOEL:  To the story? What do you look for?

ED:  So, you want to draw a listener into the story. So, within the first few sentences you want to have them know what this is all about and make them want to listen. And that can be a big challenge. And so, you have to come up with that, the written equivalent of a lede, and engage them. And then have that set up the rest of the story. 

NOEL:  Yeah. I would imagine that in your case, I guess I should ask this as a question. Do you find that you're dependent on discovery? In other words, you're not trying to hook in people who aren't already JAMA subscribers to some extent. Or are you? I guess.

ED:  No, we are trying to grow. The growth of our podcasts have been exponential. And so, we're trying to get new people interested in them. So,we do try to tell a story so that it's not just appealing, appealing not only to our existing audience but to a new audience.

NOEL:  So, you're looking for that solid first beat in the story and then probably the next most important thing would I guess be the last beat.

ED:  Yeah, so that last beat sort of summarizes it. Because you know, as they're listening, they're not going to pay attention to every second. So, that last part of the podcast has to sum it up so that they... and you have to restate the important things that you want them to remember after the podcast is over. So, it takes some effort to have that last paragraph be a summary that works for the audience.

One other thing, going back to the beginning, one of the most engaging ways to lure somebody into a podcast is to have a patient tell a story or some other kind of audio event. It may not be me talking or anyone else talking or the interviewee talking, but a patient. So, we've done that a couple of times, had patients just talk and that starts it off. My very favorite podcast that we did is on PTSD and we started out with news clips from the first Iraq war. And they're very dramatic, because you hear the newscasters telling the story and there's the music from the news of the day, from 1991. And it really set it up. It makes you get drawn into it. Then we have a patient telling his story and it's weaved in and out of this whole podcast. And his story was just incredible. And because his story was incredible, it made the podcast, at least in my opinion, very engaging.

NOEL:  And you're proud of that because of the story and you're proud of the way that you structured the story to be able to get that content out.

ED:  Yes. Yeah, because the patient told his story. It was his story. And it turned out that his story was classic for PTSD. And a lot of doctors don't really understand PTSD or they don't really acknowledge it. They don't recognize it. But it has very characteristic diagnostic features. And this guy had them all. And he didn't know he had them all. The guy was a cook in the army. And he just happened to see horrible things. But he had every one of them. So, it was a fascinating way to tell the story that was not only engaging but it told the story in a way that people would remember. So instead of me or the interviewee saying, "These are the four things that you need to look for when you're trying to make a diagnosis of PTSD," we said, "Number one is you should have this," and then we flipped to the guy telling, "I wake up at night and I have all these nightmares," and all this stuff. Number two, you should have that, and then he's saying, he's describing the very symptom that you just talked about. It was a really neat way to drive that message home to people who don't understand that disease and to learn about it.

NOEL:  Right. Because you have a dual brief here. You need to present the story but you're also, you're not trying to just present the story the way that This American Life or something like that might be content to just tell an interesting story. You have information that you're also trying to convey.

ED:  Yeah. There's learning points.

NOEL:  Yeah.

ED:  There's learning points. We want to get those learning points across and try to do it in a way... you know, most of the other medical podcasts just tell it. There's some guy talking. And it's really, really hard to stay up with those because they're just talking. Many of them have more listeners than we do, so I don't get it, but... 

NOEL:  [Laughs] Well, I mean two people talking. That can be engaging, right?

ED:  [Laughs] It can be good, yeah. [Chuckles]

NOEL:  You know, I see that there are a lot of technology podcasts that are a panel of people talking about a topic. And many of them I listen to and many of them I like, but I don't know of a technology or software focused podcast that really is able to take that kind of storytelling approach. I'm not even a hundred percent sure how you would do it.

ED:  You could find a way, though.

NOEL:  Yeah.

ED:  Because it took me a year to figure out how to do it. It didn't just come up to me. The first year's worth of podcasts were a real challenge to figure out, "How do I take this?" Because I had no experience with it and there was no one I could really turn to to say... you know, apart from listening to Freakonomics or This American Life or Planet Money to say, "Well, here's a medical podcast and this is how they took this topic and converted it into a story. There's the road map." We had to build our own road map. And that was really, really hard.

NOEL:  So, what were some of the early lessons that you learned as you were struggling in that first year trying to tell those stories?

ED:  The most important was that it's an audio format, not written. We're a written journal. There's 200 people that work on this floor and they all produce written journals. And this is the first time we're trying to convey information in audio format, in a learning format. And so, getting people to understand things from audio is very, very different than written. That was the number one.

NOEL:  So, rhythm of the language.

ED:  And the use of language.

NOEL:  Yeah.

ED:  And word structure and placement. So, it's very different because when you're reading and you miss a concept, you go back and read it. You can't do that in audio. So, you have to be cognizant of the fact that if there's some key concept and the listener has missed that concept and you've only said it once, you've lost them for the whole podcast. So, you have to figure out what it is they may not pick up on and repeat that, and make sure that they have other opportunities to pick up on the notion.

NOEL:  Is that where you... and you also have the ability then to use other audio cues, I'd imagine. Music or to cue people into... 

ED:  Yes.

NOEL:  Something important is about to...

ED:  Absolutely. So, I don't do that. Daniel and those guys do it. 

NOEL:  Right. But then I guess, do you have...

ED:  Right. But we do that.

NOEL:  Yeah.

ED:  Yeah, we absolutely use music to enhance the listening experience and also to highlight the things that you want them to listen to, either by the music coming in, coming out, some specific sound. We even played with one or two podcasts where they had continuing medical education questions at the end of it. So, we had a little ding. Anytime there was a concept that would be asked about later, it would go ding. So you'd say, "I have to pay attention to that." So, that was probably the most important thing. 

And then learning how to write for audio, apart from what I just said about keeping track of the fact that there are concepts that they can't go back to, it's also the word structure in language. It's very easy to write for the written language and then sit here in the studio and read it. And it sounds like you're reading for written. And it's very, very hard.

NOEL:  It's very hard to do. I do, I've written, to a very limited extent, dialog that has both been on the page and spoken and also write out talks and things like that.

ED:  Right.

NOEL:  And most people are not good at hiding the fact that they're reading something that sounds like written text and not...

ED:  The other thing that was hard for me personally was figuring out how to use my voice to highlight things. So, I can now take some written thing and read it and read it in away that is intelligible when listened to in audio. That's not easy. It took me a long time to figure that out. And when other people do it, it's so obvious that they're reading something that was written for being read, not spoken. And it's awful. You can't keep track. You can't follow it. So, there's ways to inflect your voice, to pause. And a lot of... the producers here, Jesse and Dan and Eric and Michelle, when we're in the studio they'll say, "Well, can you make your voice go up? Make it go down. Stop here," while we're recording. It's really helpful. Because they're listening to it in a different way than I am. And that can be really helpful. So, that was the third skill that was really, really hard to learn and figure out how to use the voice to convert what would otherwise be awful script into something people can absorb in audio fashion.

NOEL:  Yeah. I find in public speaking at least that most people don't take advantage of the dynamic range of their voice as a way of getting people's attention, not just the pitch, but the rhythm and the volume. 

ED:  Right.

NOEL:  That people pay attention to somebody getting quiet, speaking more quietly and more loudly is a cue to pay attention. Any change, people sort of perk up.

ED:  Yeah.

NOEL:  Were there particular audio performers that you looked to as examples of what you were trying to do with your voice?

ED:  Well yeah certainly, the people in This American Life, right? So, that's where everybody starts.

NOEL:  Sure. And they spend a tremendous amount of time on story.

ED:  Right. Everybody wants to be Ira Glass. Nobody can do Ira Glass. He's got this very distinctive way of presenting that none of the rest of us can do. But I would listen to him over and over again thinking, "How is it that he uses his voice, says the things that he says, in a way that's so engaging?" and realize, "I can't do that. I'm not Ira Glass." And then I would listen to a lot of his disciples, like the people on Planet Money and 99% Invisible. And they all have different approaches and different ways of using their voices. Some of them that will remain nameless, I just can't stand. There's this type of voicing that apparently young people like and they use a sentence structure and inflections that I hate. But it's clearly something that the younger generations like. And you notice that once you start paying attention to this. Like, "Oh, this is... they're doing this on purpose." And the one I settled on as the model is Freakonomics. I really, really like the way he tells a story and he's telling the story. He's in command of the story and then using the interviewees to pop them in and out, to highlight his story. But it's his story, not their story. And I really, really like that. I'm trying to get there. I'm not there yet. But right now, that's... I listen to all the podcasts from Freakonomics. I listen carefully at how they're doing things. To get kind of psyched up when I'm coming in to do voice-overs or writing scripts, I'll listen to it on the... I ride my bike back and forth to work, so I'll listen to it on the bike to get pumped up. You come to the office and say, "I'm going to do this." [Chuckles]

NOEL:  So, your pump-up jam is the Freakonomics podcast. 

ED:  Freakonomics, yeah.

NOEL:  Sure. That's common.

ED:  That works for me. 

NOEL:  Well, as you become a practitioner of something that you previously were a consumer of, you kind of have that switch where you start looking at podcasts from the perspective of a podcaster. 

ED:  Yeah.

NOEL:  Novels from the perspective of a writer, or whatever it is. And you start dissecting, "What are they doing that I like? What are they doing that I don't like?"

ED:  So, that's so true. Because I can't listen to a podcast as a consumer anymore, right? So, when I started all this, I could listen to Serial and say, "Oh that's so cool." But now it's like, "How do they do that? How do they use that particular interview? And how did she use her voice? How did she structure the information?" And so, now I listen to podcasts with a very, very different orientation than before.

NOEL:  Are you familiar with the Memory Palace?

ED:  No.

NOEL:  It's a history podcast of very, very short 9 or 10-minute episodes. And in my opinion, it's... he's both a writer who's very evocative with both his words and his voice in creating a mood in a very short amount of time. And I'm doing an interview podcast. I'm not trying to do the same thing and I don't think I could do that. But that's something that I listen to and I think, "Wow. This person has this particular skill at a very, very high level."

ED:  Yeah.

NOEL:  And yeah, it's a different kind of appreciation, I think.

ED:  Yeah, yeah. No, you just, you glom onto the person who you want to emulate the most.

NOEL:  Right. I started listening to interviewers and started thinking about, "How are they planning the next question? What are they thinking?"

ED:  Right. So, the other one I listen to a lot, Fresh Air.

NOEL:  Fresh Air. She's the... Yeah.

ED:  So, you listen. Terry Gross.

NOEL:  Right.

ED:  So, you listen to Terry Gross. She's like, the perfect interviewer. There's no one better than her. And she sounds so relaxed. And she's so...

NOEL:  Prepared.

ED:  Prepared. And I was listening to a bunch of hers. I was in Hawaii a few weeks	ago at a meeting and I was listening to a whole bunch of them. And I just thought, "I can never be Terry Gross. And I could never do what she does." She does it so effortlessly.

NOEL:  There was a really interesting podcast series over the summer called The Turnaround from Jesse Thorn and Maximum Fun. And he interviewed a bunch of interviewers.

ED:  Oh, really?

NOEL:  So, he interviewed... he started with Ira Glass and he ended with Terry Gross and interviewed a wide range, like Jerry Springer and Larry King and other radio voices, and was asking them, how do they prepare, how do they approach. And it was such a wide range of things. Like Larry King didn't prepare. He wanted his gut... he was happiest when... I guess when he was a young radio person they would do a thing where they wouldn't even tell him who the guest was. They would just put him on the air with somebody and they would just talk. And he loved that. And that's so not the way Terry Gross approaches an interview. 

ED:  Right.

NOEL:  It's so interesting to me how varied that simple sort-of performative conversation can turn out to be.

ED:  And then they all have their different styles and they all do it really well. And it's engaging even though they're different styles. It isn't like there's one formula that works for everybody. The woman who wrote the book about This American Life, her name is Jessica Abel. And she did the same thing. She wrote this book where they let her hang out at This American Life. She's a cartoonist, so she wrote this cartoon book. 

NOEL:  I think I've seen it, yeah.

ED:  Yeah. And it's kind of, I think if you're going to podcast then you have to read it because it explains what they do and how they put things together, what equipment they use. But then, she ran a blog after that was published and she did interview all those people you mentioned. And she explored in-depth with them how they do what they do, what their approach is, how they structure a story. And part of it's written and part of it's audio. And it's a series of podcasts. It's really, really good, because she knows these people because she wrote the first book. And as you just said, every one of them has a completely different approach to how they go about putting together a podcast.

NOEL:  Yeah. The thing that was... so, two things that have been hard for me. One is shutting up, as the person asking questions. Because you want to treat it like a conversation, because it's sort of a conversation but not. And that takes willpower. [Laughs]

ED:  Well, it's hard without editing because I have people that will just go on and on and on and on. And as an interviewer, I don't know how to cut them off. So, I can't imagine not editing. So some people, I'm looking for three minutes of content and I have to wade through 45 minutes of speech to get it. And when you're talking to them, it's really hard to cut them off. 

NOEL:  That's actually a huge divide in the Jesse Thorn interview series, is between the people who have the luxury of talking to somebody for 45 minutes and picking the best five minutes...

ED:  Yeah.

NOEL:  Versus somebody who needs to try and keep something on track live or close to live.

ED:  Yeah. And that's why I listen	so much to Terry Gross, because somehow she can manage the conversation better than anybody. And so, you listen to her thinking, "How is she doing it? How is she controlling this?" And somehow she does. I still don't know how she does, but she does.

NOEL:  The thing I struggle with when I'm interviewing is asking really complicated questions. I want to ask every question at once. And I'm doing it now. Like, I'm just talking and talking. And what do you do to approach the interviews that you do?

ED:  One of several things. I like to just talk to people. Because half the time, I don't know the content nearly as well as they do. I should say most of the time, not half the time. So, when I'm interviewing, I want to try to learn enough about the topic so that I can write a script on it. So, I'll just talk to them to learn. And then I do let them talk. Just say, "Tell me about X," and let them go. I interview a lot of academics and professors and they love to talk about their subjects. You get them started, they go.

NOEL:  Sure.

ED:  They're on autopilot. And then towards the end of that, and sometimes I used to get complaints from the engineers when I first started doing this because they're like, "You went for an hour." 

NOEL:  The engineer is smirking, by the way.

ED:  This actually predates Dan. 

NOEL:  Yeah, I don't know. He has kind of a knowing look on his face, I've got to say.
  
ED:  I think I won the battle, because I was like, "I'm going to do it anyway." [Chuckles] But when I first started I'd get, "You talked so long with these people," and it's because I need to figure out where I'm going. But then once I've figured it out, I can ask some targeted questions towards the end of the interview and because we edit everything, then I could just use that last part.

NOEL:  We edit a little, but we don't edit. We use most of the animal, I guess. But one of the things that I've been able to look at it as, is a chance to sit down and have a 45-minute long conversation with colleagues who I would otherwise never have the opportunity, the time logistically, just to speak to them in a focused way. And that's been really satisfying, just to have that professional experience. Do you feel like you've had a similar kind of experience where you feel like you learn along with the audience?

ED:  Yes, absolutely. Because a lot of times I'm interviewing people, I don't know anything about their topic. So, I am learning. And learning to the extent where I can put a script together. But when I'm talking to them I'm learning, because I just don't know. And that's how I learn, by talking to them.

NOEL:  Do you ever have something that you just can't stand to lose in the edit that was just, doesn't fit the story, but was just too good?

ED:  Oh, yeah. [Chuckles] Yeah, that would happen all the time where they've said some really great snippet and it just doesn't work. And I started keeping a database of all those. I figured someday I'll use them, and then I never did. 
[Chuckles]

Never kept up with it. But yeah, there's a lot of stuff we lose that is precious that would be really great. This one interview I mentioned earlier about the guy who discovered Lyme disease, that's the way we started. I just said, "Tell me about your whole experience," and then he talked for 45 minutes. It's a very long story. It's a complicated story. But he talked and I just sat and listened to it. And we decided to run two podcasts. Just said, one podcast is this guy who's really famous who's done something really important who's an inspiration to young people doing research. Just let him tell a story. We'll shut up and let him tell a story.

And we did that. And then the second podcast was a story form where we told the story of Lyme disease and all the things that doctors need to know about it. What it's caused by, how you get it, what it looks like, what you treat it with, and all that. And we weaved his conversation in and out of it as well as others. But we broke it up into two because there was so much in that one interview, we just ran it.

NOEL:  How would you recommend that people get started? If someone's listening to this and they're at a company and they think that they can... or they're just working on their own and they feel like they can start to express themselves in a podcast, how would you recommend somebody get started? What's the best way?

ED:  Well, that book by Jessica Abel on This American Life is really, really important. It's really good because it explains everything they do and even has lists of equipment. And if you want to start this, this is what you should buy. So, that's one. I think reading that particular book is helpful because it gives you that notion. The other is, the equipment's not that expensive but it really makes a big difference to get good equipment. And you listen to some podcasts put together by people with bad equipment and they're just painful to listen to.

NOEL:  Yeah.

ED:  And the equipment these days... so, when I got started, the engineers set me up with this portable setup, which I think the whole thing cost 1500 bucks. It's a boom microphone and... I mean a shotgun microphone and this TASCAM recorder. The quality is amazing, absolutely amazing. So, I'd go running around anywhere and record stuff and it didn't cost that much. And so, getting good equipment is important.

NOEL:  Yeah. There's a site called PodcastMethod.com which has some good recommendations for relatively inexpensive audio equipment. I believe, we don't have a dedicated setup but we do have a mobile setup that we can do with mics and a passthrough 4-line interface. And yeah, it was under $750. 

ED:  Yeah. So, you need that. And then you have to find your voice. You have to figure out what it is you can do and what your personality is going to be like and then figure out which podcaster you want to emulate. It's like I said, I listened to a lot of podcasts and decided, I'm headed towards Freakonomics. That's the way I want to present my material. That won't work for other people. Everybody has their own thing. 

NOEL:  Right.

ED:  Somewhere out there, there's another Ira Glass and they'll find their voice and they'll hook onto that. Because you have to figure out, you listen to podcasts and figure out where you want to go. And then break that podcast down and then keep practicing until you get to be closer to where you want to be. It takes a lot of practice.

NOEL:  Practicing on the tools, too. Not just practicing in front of the microphone but practicing with editing tools. And I would assume, because I don't do it, but layering in music and things like that, that are not skills you would use otherwise.

ED:  Yeah. Even though I don't do it very much anymore, I found that learning how to edit is really helpful. And it especially makes me sensitive to what the producers go through, because I may ask them to be doing a lot of work.

NOEL:  Does it help you in an interview, do you think about that when you're interviewing somebody?

ED:  Yeah, because I think about what they need. In fact, I just listened to an interview I did yesterday. I did the interview a couple of months ago, but I was listening to it yesterday and thought, "Oh my god, I screwed up." 
[Chuckles]

I didn't have the settings right on the recorder and I didn't pay attention when I was doing it. And listening to it I thought, "Oh my god. It's going to be hard for these guys." So yeah, because they got enough to do, let alone try to fix your screw-ups. So, learning the basics of editing is really helpful. 

NOEL:  I find that what frustrates me when I re-listen to something is realizing there's a question I should have asked that I didn't think of in the moment that would have been a more interesting conversation.

ED:  We all have that.

NOEL:  Yeah. 

ED:  Everybody has that. 

NOEL:  Are there new areas or new kinds of things that you're planning to try in the future? Or are you just trying to grow? Or new ways that you're trying to reach your audience to grow?

ED:  Well, the app that came from I guess the company you're with.

NOEL:  Table XI, yes.

ED:  Yeah, so that's our biggest thing right now. So, we're hoping that... so, here's the deal. My belief is that journal publishing is probably on track just a little bit behind the Sears Roebuck company. So, we all know what happened to Sears, especially here in Chicago. Big huge company, lots of stores, and now they could be going broke.

NOEL:  Yes. Yes, I worked for them as a web developer for a while.

ED:  Oh, did you?

NOEL:  Yes.

ED:  So, you know more about it than I do.

NOEL:  No, I really... I mean 
[Chuckles]

NOEL:  I know that their catalog skills did not translate into web development.

[Laughter]

ED:  Yeah, well, and they're a classic story in business because they should have been there first.

NOEL:  Right.

ED:  They had the catalog.

NOEL:  They absolutely could have owned... I think of them as they should have owned web software the way...

ED:  They should have been Amazon. 

NOEL:  Right, the way Sony should have owned digital audio, Sears should have owned digital.

ED:  Yeah. They should have been ahead of Amazon. And they had all the... they had everything they needed to do it and they didn't see it coming. And Amazon built it from scratch. So, there's lots of messages in that. But I look at Sears and say, "I work for a journal. Print advertising is way down. Our revenue streams are changing. They're not what they used to be. The old model's never coming back." 

And I've done these interviews with young people. And young people are our future. And I've talked to lots of medical students and lots of residents and the last time I met with a group as a group six months ago, I asked them, "Do you read our journal?" These are all medical students who belong the AMA who get our journal for free. And to a person, they said, "No, we don't." [Chuckles] And I said, "Why not?" And they said, "We don't read journals." And three years ago I asked that question and they did read and they told me certain things they'd read and what they wanted. But in a three-year timespan, a new group of medical students comes up and they say, "We don't have time to read journals. We don't read them." And I said, I asked them, "What do you do? Where do you get your content?" They said, "Podcasts. There's a million podcasts out there. We just find one that has what we're looking for." 

So, the world is headed towards audio. It's a long way of saying that I see the future as audio. The reason I've invested a lot in this particular line is because I think this is a space we have to be in as a medical journal. And fortunately we got there before most, in terms of what we're doing with the clinical reviews podcast. And then we have to figure out how to make that work for us. We have to figure out how to have it be engaging for our listeners, to become indispensable for our listeners. You know, 30 years ago, 40 years ago, JAMA was indispensable to doctors. They all read it, every one of them. And it carried a lot of weight because everyone had to have it. We would like to have that happen with audio. So, we need to be in that audio space. 

And then we also have to figure out a business model that works for it. So, we have to figure out how we're going to do this and stay afloat financially. So, the app was our first foray into that. We all sat around. We all agreed. This is a space we need to go into. I had spent a couple of years developing the clinical reviews format. Everybody agreed and the numbers showed that it's working well. The listenership is growing exponentially. And so, we invested in this app and said, "We think this is an educational platform, or this should be an educational platform. And there should be CME," and we invested some money into this thing to see if we can make that work. And that's our first step in a certain direction that I think we as an organization need to go.

NOEL:  Has your own medical experience influenced the podcast in any way?

ED:  Yeah. So I'm the clinical editor of the journal, so I'm the only one here who works here full-time that still practices medicine. And every couple of weeks I'd go down to Texas and take call at the VA hospital. So, I was rounding one day a couple of years ago, two or three years ago, and the residents were telling me about this patient that we needed to operate on during the weekend to fix something up. And it was a patient who'd come into the emergency room with a really fast heartbeat. And they thought he had some kind of cardiac arrhythmia. So, they admitted him to the cardiology service. And he sat there all night long. 

And they realized that the abnormal cardiac rhythm was not abnormal. It was a normal rhythm but just, his heart rate was going really, really fast. And when you get really, really sick you heart rate can go get really fast. You can get a bad infection, what we call sepsis. You get what's called tachycardia where your heart goes really fast. They realized it was just simple tachycardia. It wasn't a cardiology issue. So, they call surgery and the surgeons come and look and they realize, he's got a really, really bad life-threatening infection in his groin area that no one noticed. And then after they noticed it and realized that particular situation is an absolute surgical emergency, they needed to take him to the operating room. Then there's another four or five-hour delay while they're doing all the things trying to get this guy to the operating room. And every bit of it was misdiagnosis and poor communication, all this stuff. 

While the residents were telling me this story, I was thinking, "DŽejaˆ vu." I had this patient 30 years ago. The exact same thing. Patient comes to the emergency room. Misdiagnosed as the same arrhythmia, goes to cardiology, sits on cardiology all night long, sits at night, and then in the morning they come and realize that it's not a cardiology issue and they find that it's the same infection in the same place, same delays. Except 30 years ago the patient died. And they're telling me this and I just had this odd feeling. I said, "30 years. 30 years." In the 30 year interval we've had all kinds of things happen with emphasis on quality of care and patient safety and medicine, big events to try to move things in the right direction. In the 1990s there was this movement for patient quality. And I thought, "30 years, it's not any better. It's exactly the same. Things have not changed." 

So, I actually bundled up the notes and I brought them to my boss here, Howard Bauchner, and I said, "Look at what's going on out there. This is what happens. It's been 30 years and things aren't getting any better." And I showed him some of the notes and how people made mistakes and stuff. And I said, "I think we should run a new series of articles just focused on quality of care, in this way. One patient a time." Take one patient who's had a complication and analyze it and identify the problems and report how the hospital fixed it. No major journal has done anything like that. And it's really risky, because bringing these patients' stories forward. So, we did it. We started this new article. But it has a podcast. And so, if you go to JAMANetworkAudio.com.

And you look at JAMA Performance Improvement, that's where those podcasts live. And we tell these stories. In some of them we have the patient and the doctors themselves telling their stories. They're really compelling.

NOEL:  That sounds really interesting. Is there something else I should have asked you? Something else you want to say before we wrap up?

ED:  That's the typical reporter question. See?

NOEL:  Yup.

ED:  The other thing you need to learn when you podcast. The last question you ask is, "Is there anything you want to say?"

NOEL:  Right.

ED:  [Chuckles] The open-ended question. 

NOEL:  The best piece of advice I got from the interview podcast was, I think it was Ira Glass, his like, 100% applicable question which is...

ED:  Yes.

NOEL:  What did you do? What did you think was going to happen? And What actually happened?

ED:  [Chuckles] Yeah. That's so true.

NOEL:  And it applies to almost anything. And it's almost always a good question to ask.

ED:  And it's really funny because I've been, throughout my career, interviewed a lot by the press for various things that I've done on my career. And I didn't appreciate that until I'd started learning about podcasting and reading the thing, like from Ira Glass and from reporters and stuff. And they all say the same thing. And now, I got interviewed by a reporter a few months ago and he asked me those questions. I was like, "I read the book. I read your book." So, you can't fool me.

NOEL:  Yeah.

ED:  So anything, I think I've told you everything. 

NOEL:  Alright. [Laughs] In that case...

ED:  You're not going to get me on that one. 

NOEL:  In that case, thanks for having me in your lovely studio.

ED:  Okay. It was great talking.

NOEL:  And I appreciate you taking the time to be on the show. And good luck with all the future podcasts.

ED:  Great. Thank you very much.

NOEL:  Where can people find you guys online? If they want to find you online.

ED:  JAMANetworkAudio.com. It's one word, JAMA Network Audio dot com. And if you go to that website, all of our podcasts are listed. We're on Apple Podcasts and Stitcher and all those other places. But we do have a website where all the podcasts are there.

NOEL:  I would imagine that we don't... although we probably don't have very many clinicians in our audience, we probably do have some people who would be interested in learning a little bit more about the forefront of medicine. So...

ED:  Of course, there could be the people who turn to you to build apps and they can see JAMA Network Listen, JN Listen.

NOEL:  JN Listen.

ED:  They should see how you guys put it together. It's a very slick app. I've been playing with it for all day. 

NOEL:  Well, thank you.

ED:  And it's really, really nice.

NOEL:  Thank you. I will pass that along. [Laughs] 

ED:  Yes.

NOEL:  Alright. Thank you. 

ED:  Great, thanks.

NOEL:  Thanks. 

Tech Done Right is a production of Table XI and it's hosted by me, Noel Rappin. I'm @NoelRap on Twitter and Table XI is @TableXI. The podcast is edited by Mandy Moore. You can reach her on Twitter at @TheRubyRep. Tech Done Right can be found at TechDoneRight.io or downloaded wherever you get your podcasts. You can send us feedback or ideas on Twitter at @tech_done_right. 

Table XI is a UX design and software development company in Chicago with a 15-year history of building websites, mobile applications and custom digital experiences for everyone from startups to storied brands. Find us at TableXI.com where you can learn more about working with us or working for us. We still have positions open as I record this. We'll be back in a couple of weeks with the next episode of Tech Done Right.