Pediatric resident and doctor blogger Sarah Bernstein gives her take on how digital health impacts residents as well as seasoned clinicians. One of her most engaging blog posts regarded her experience as a teenage patient and what it meant for her cardiologist to remain professional, yet show his human side. This is just one of many ways in which the young clinician’s voice is important to consider in marketing messages. Health IT companies that find ways to help physicians be more accessible to patients have an advantage, and Dr. Bernstein explains why.
Air Date: July 16, 2016
Guest: Dr. Sarah Bernstein, pediatric resident and doctor blogger
|1:25||Introducing Dr. Sarah Bernstein|
|4:37||How digital health can advance pediatrics|
|7:00||The clinician community resisting change|
|8:19||Why doctor blogging?|
|11:35||Accessibility is important with doctors|
|14:32||The role of health IT tools in the patient experience|
|19:02||Where does the health IT community start to improve PX?|
|21:35||Final thoughts for health IT|
|22:32||Bonus question: If you could join a rock band or music artist for a day, who would it be?|
Aspiring Doc Diaries
Sarah contributes regularly to the Aspiring Doc Diaries. Check out her work there.
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Jared Johnson: Hello, my friends, and welcome again to the Health IT Marketer podcast, the podcast that tells the story of innovation in health IT. I am your host, Jared Johnson, your pilot on this crazy rocket ship called health care. This is the first and only podcast dedicated to you, to the health IT marketing community. Welcome aboard. If you want to keep up with the voices, trends, and marketing tools of today’s health IT and health care technology, you are in the right place.
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All right, listeners, well, our guest this week, we’ve got a treat for you. My guest this week is Dr. Sarah Bernstein, and I wanted to welcome her to the program. Dr. Bernstein, how are you doing today?
Dr. Sarah Bernstein: Good, good afternoon. Thank you so much for having me.
Jared Johnson: Yeah, first and foremost, how does it feel to be called Dr. Bernstein?
Dr. Sarah Bernstein: It feels good. It’s starting to settle in now after a little over a year, just barely.
Jared Johnson: Yeah, yeah, we ought to give our listeners a little bit more background, give them a chance to get to know you a little bit better. Why don’t we get started that way? Tell our listeners a little bit about, kind of, why we were just saying that in terms of this is something that’s a recent change in your life, but where’s your background, what are you doing in your current role and, you know, let’s just go from there.
Dr. Sarah Bernstein: Sure. So, in terms of my background, I was born and raised in Chattanooga, Tennessee. I then received my bachelor’s and master’s in health administration from Cornell University. During that time, I worked as a health care consultant in the population management field, where my goal was to show insurance companies that there was a return on investment for providing weight loss/smoking cessation programs to patients. I then went on and received my MD from Emory University, and now I just started my second year as a pediatrics resident at the University of Illinois at Chicago.
Jared Johnson: So, you know, what has surprised you the most in your first year since graduating? You know, what are some of the experiences that have stood out?
Dr. Sarah Bernstein: So, honestly, before going into residency, I kind of pictured residency in general, particularly intern years, as sort of soul-sucking experience. It’s been so much better than I had anticipated. I’m really fortunate and I work with some amazing co-residents and faculty. They’re all very supportive, so I think that makes a huge difference when you spend so much time together.
Some of my favorite patient experiences have involved watching patients grow. So, as a pediatrician, I’ve gotten to be present from all aspects of patient care. I have a few patients that I helped deliver in the OR, and then I get to see them at their two-month and four-month and six-month visits, and watching them reach those milestones has been really exciting.
Jared Johnson: So how did that background in pop health, in particular, like, how did that help, kind of, prepare you for actually seeing patients?
Dr. Sarah Bernstein: So I think it gave me a focus on all the other aspects that influence patient care. So, as physicians, we tend to see this point of care in our office and we have these guidelines, and we sort of look at it from that perspective, whereas this whole population management kind of forces you to look at things more holistically, so what foods are available in a neighborhood, do they have access to exercise programs, are there playgrounds around, are there resources for smoking cessation. And so, things like that, I think, are also really important to managing patient care, and maybe that gives me a little bit of a different perspective.
Jared Johnson: Well, I want to [inaudible 00:04:18] to digital health and, in particular, from your standpoint, things like you being active on social media and blogging, in particular, how some of those things have helped, what your motivation is to participate in those, and then we’re going to dive into patient experience a little bit after that. So, I think, one place to start would just be with digital health in particular, about some specific ways you’ve seen that that can advance. You’re a pediatric resident, so how does that . . . how can digital health advance the field of pediatrics?
Dr. Sarah Bernstein: Sure, so I read recently this article about medical schools incorporating virtual reality into the classroom, particularly in anatomy. I think that’s a great way to supplement education, really, before even residency and as a provider, because a lot of you look at things in real-time and sort of see how the heart works or the body works, and anything that can sort of supplement our education, I think, is a great thing.
But then, recently, there’s a new program that allows students to see what it would be like to live with sensory deficits or Parkinson’s, so I think that this, long-term, could be a really interesting way to teach kids about tolerance and what it’s like to live with a disability. In terms of the day to day on the patient side of things, stuff that we’re already using already in terms of technology, so we have a mommy pager, a parent pager, and parents have access to the doctor on call, 24 hours a day, which I think is a great resource, especially for new parents and it saves a lot of ED visits because it’s a way for us to triage. You have a new parent and they call in the middle of the night, and help them kind of understand, is this a true emergency, do we need to go to the ER, is this something that can wait until the morning.
That being said, I think, over the phone you tend to miss a lot of information, you may not be able to physically see the patient, whether they’re working hard to breathe, etc. But we already have things like Skype and FaceTime, and that would make answering some of these questions a lot easier. So I think it’s just a matter of incorporating some of the technology that we already have into our daily practice.
Jared Johnson: Well, it seems simple, really, because it only makes sense, it seems like, for a lot of us and there are those out there, there are clinicians out there, have been doing their practice for so many years, and then digital health comes along and things like, you know, EMRs come along and they’re either forced to implement those or they don’t have a choice, or some are still kind of resisting, just really the advent of digital health in general. So it’s interesting to hear from your perspective, again, just how these things seem pretty . . . it seems to make sense so far, I guess, in terms of different types of digital tools that you’re using. Is that a fair statement?
Dr. Sarah Bernstein: Yeah, absolutely, and I think part of the point that you mentioned about people resisting change, I think any change can be really hard. One of the things I’ve noticed with EMRs in general is that, I think with my background, with the master’s in health administration and then also the physician, I notice that a lot of the things that have been implemented are done from an administrative side sometimes, and they don’t seem like they really fit the clinical picture, the patient. And so I think a lot of doctors tend to get frustrated and sort of want to rebel against technology when, I think, the answer would to have physicians be more involved in it, because I think that we have this opportunity to shape tools so that they are the best resource for us and the patients.
One other thing I forgot to mention but I think is really neat, that some people are taking use of all these tracking systems. So whether it’s the weight loss and the Fitbit or measuring glucose or blood pressure, technology allows us access to a huge pool of data that we didn’t previously have access to. And so it’s like you see a patient two to three times a year, you only have those data points to go off of, whereas if you have something that your patients are already using and it gives you access to how many steps they’re taking a day or what their glucose looks like, I think that it would be a shame not to use that.
Jared Johnson: Well, I know you, yourself, you’re part of a couple of doctor blog communities, and I’m curious about that. [Inaudible 00:08:25] for a couple of minutes in terms of, you know, how that benefits clinicians in your mind and, really, how you even find time for it.
Dr. Sarah Bernstein: Sure. So for me personally, I’m very into self-care and, for me, writing is a bit of a necessity because it allows me to process things. So I write about a variety of things. I try to pay attention to anything that makes me feel something, whether that is anger or frustration, grief, excitement, but putting it into words helps me to sort of understand my own experience. And then, I like to share a few blogs or articles because I hope that if a situation has made me feel something or if I’ve learned something the hard way, that maybe I can communicate that to someone else and they can benefit from it. So I think that’s sort of a little bit of a dual purpose in how it benefits me, and also why I share what I write.
Time can certainly be a challenge, so sometimes I write in the middle of the night when I just feel like I have to get something out, or there’s something on my mind, and I found that night shifts can occasionally be a good time to write. A lot of times there’s a lull at the hospital between 2:00 and 4:00 a.m., so there aren’t a lot of other distractions. But most of the time I try to schedule writing time. So if I have a day off, I like to use around from 8:00 to 11:00 as my quiet time. I don’t answer phone calls or emails or make other plans, and it’s sort of my protected time, if you will.
Jared Johnson: So what’s a topic recently that you’ve written on that got a pretty good reaction or got some creative engagement from people who are reading it?
Dr. Sarah Bernstein: So there’s actually an article coming out on the AMC Aspiring Docs website Thursday, so keep a lookout for that. Hopefully that’ll get a good reaction. I think, probably, the one that’s gotten the most responses was, sort of, this interview that I did at the AMC, just about my experiences, what brought me into medicine, and then some of the challenges that I overcame.
And one of the things that I realized is how universal a lot of these challenges are for people who go through medicine. I’ll just give you a quick example. So, I think, when I was a pre-med, I really struggled in chemistry, and I felt very much alone in that. I think that as budding physicians or medical students, a lot of people want to put on this protective shield a little bit and be like, “Everything’s great, I’m doing awesome, I’m doing fine,” and so when you’re struggling, I think that it feels very lonely.
And so, I kind of put myself out there. I’m like, “Hey, listen, I struggled, this was hard. This is what I did to overcome it,” and I noticed that a lot of people are really responded to that, and [inaudible 00:11:12] like, “Thank you, I felt the same way, and I felt so alone,” and so I think sometimes sharing in our loneliness or at this phase in our grief and acknowledging that, yes, medicine is this amazing, incredible, rewarding experience, but it also comes with a lot of personal and professional challenges, is something that can kind of unite us.
Jared Johnson: I wonder if part of that . . . the success of that post would be the level of engagement your [inaudible 00:11:40] had to do with this feeling of here’s somebody who’s got an MD after their name and they’re showing that they’re vulnerable in one thing or another, and not everyone’s used to seeing that side of the medical community. I mean, is that how it’s come . . . that’s just kind of from one perspective.
Is that one thing you’ve seen on your side as well? I mean, is that just . . . or maybe [inaudible 00:12:06] accessible, somebody feels like they could respond to something that is pretty personal for you, and being able to be a part of that experience for you is helping them connect with you. I mean, it seems like that’s one reason that there’s such a reaction to the types of posts you do.
Dr. Sarah Bernstein: Yeah, no, I mean, I think that makes sense, and I think that, like you mentioned, not everyone likes to be vulnerable and likes to put themselves out there, and I think that a lot of my motivation from [inaudible 00:12:37] older posts is that I was a patient, I had a heart condition – still have a heart condition, but it was a lot worse when I was around 15 to 16 – and I was very fortunate in that my physician at the time, my cardiologist, was very vulnerable and open with me and my family. He expressed how much he cared, so I actually had an operation and he sort of . . . it was almost like this confession, like, that he couldn’t sleep and that he was really stressed about it, and he worried about how it would go.
And so I think, having been a patient and having had multiple cardiologists around that time, I realized how much it meant to me that he cared and that he put himself out there, and that he wasn’t this cold clinician who was smart but didn’t care about me. He was a person, and he had anxiety and really cared about the patient experience on that very basic level, and so I think that that was a real teaching moment for me.
And I think that it’s come across in the way that I interact with other residents, in the way that I interact with med students, like you said, in terms of putting myself out there and being accessible and then, also, the way I interact with patients. So I think that professional boundaries are really important, but I think that sometimes, from a healing perspective, it’s important for patients to know that you . . . well, it’s not in the same way that you grieve with them, that you do care about their lives, that you are really invested in what they’re saying.
Jared Johnson: I think there are a lot of lessons there that other clinicians can learn in terms of the motivation and the storytelling that you’re able to do, and how to find the time, but yeah, why it’s important for these voices to be heard out there in medical communities. So, excellent, excellent.
We transitioned here a little bit over to talking about patient experience in particular, and we could even use that example if you want. That’s you, in your past, being a patient yourself and knowing some of the touch points that either helped or made that experience more difficult.
I wonder, when we relate patient experience . . . because that’s another term that I’m learning is this has very different definitions in the clinical community, that it be more of the different care pathways in the care team, and things once the patient enters the door of the facility until they’re discharged, and maybe a little bit before and a little after. And then you could be on the marketing team, and we’re talking about, basically, almost a consumer’s entire lifespan where they are everything from they’re googling symptoms to they’re researching the doctors in their area who have accessibility, who have that specialty, that expertise, and where there are appointments available and they’re doing all of this online.
And so there’s almost this concept that I’m trying to hash out, I’d almost call it a physical patient experience but I don’t have a better name for it yet. But it has to do with how . . . maybe it’s digital health experience because there are so many health IT tools now and some of those are online, but there’s so many different resources now when it comes down to it for a consumer to get some kind of information or some kind of help for their own health care. So I’m curious of your standpoint, what the role of health IT tools are in the patient experience, and how do we improve it.
Dr. Sarah Bernstein: Sure, sure. So, I mean, I think that you really got to the point which has taken me a long time. I think I’m just sort of realizing that this whole patient experience starts way before I realized it did.
So I recently had a patient who visited and they, after our office visit, they wrote a letter and they were detailing their “patient experience” at UAC, and when the mom wrote about this experience she talked about her interactions with everyone. So from making the appointment to being able to find our clinic, to the MA, to the person that she interacted with in the hallway, to the nursing staff and her interaction with me and the attending, and it made me realize, kind of, like, you’ve touched on that what a small part we, kind of, play as physicians and caregivers in this experience.
And while it’s definitely an important piece in the terms of the overall patient experience from, like you said, from googling symptoms to finding an office, we control only a very small part of that in a direct sense. So I think that there’s this rush during that time and so it’s really important for us to try to slow down, as hard as it is with a lot of the schedules, but have that eye-to-eye contact with them and personal touch, and to down talk to people. But then, before that, I think that anything that can kind of make that experience easier is a great thing.
So, like, you mentioned pretty much everyone’s online right now. A lot of times it’s a lot easier to navigate email or message boards than it is to call your doctor’s office and wait for them to return your phone call and then miss it, and call them again. So I think that technology is a really natural solution to a lot of those issues. I think it’s just going to play a bigger and bigger role in health care, and kind of like we talked about earlier, one of the great things about being a physician is we sort of have two choices.
We can put our heads in the sand and, you know, be like, “I don’t want to deal with technology. I’m just going to deal with my patient their interaction whether it’s 10 minutes or 20 minutes, whatever my allotted time is,” or we can really get engaged with the technology and be like, “How can these patient portals benefit patients, and how can we be . . .” Like, we talked about the wearables, “How can we be tracking our patients before they come into the office, you know? Can we have that data uploaded, sort of like a, you know, when patients have halter monitors or EKGs,” so they come in and instead of wasting our time trying to figure out what’s going on we already have a lot of that information. I know that might take a little bit of setup on the front end but, like we discussed, the technology is there and I think that it’s there in a way that has the potential to really benefit both clinicians and patients.
Jared Johnson: So if we were speaking just to the health IT community and we’re trying to find one place that they could start, where do they start to help improve the patient experience?
Dr. Sarah Bernstein: So I think, right now, unfortunately, the EMR was – at least to my understanding – created as a way to make things easier for physicians and for the patient experience, and in my limited time working in the hospital, I’ve found that it’s really, honestly created this huge barrier to patient interaction because I don’t feel like a lot of the pieces were necessarily made with clinicians or even necessarily patients in mind. I think that they were very well-intentioned in a lot of respects and, having the administrative background that you touched on, I can see where a lot of them came from.
But, in terms of in practice, I think that most clinicians, I would say, feel like we spend so much time clicking on these boxes and answering questions and clicking out of things that maybe aren’t relevant, that it really takes away from the time that we get to spend with the patient and getting to know them and getting to listen to them, really. So I think that a place that health IT could really start – and physicians, too, I think, it needs to come from both sides – would be to work together to refine these tools that we have, and instead of just being angry about it, really listening to each other.
I’ll give you an actual example. So, being in pediatrics, a lot of the ranges for things for medications and for vitals were initially set up based on adults. So adults, obviously, have different resting heart rates and different respiratory rates, and so there were these things, these sepsis alerts that were set up and very well-intentioned to notify nurses and doctors when a patient was breathing really quickly or their hearts were racing. And I think that those were great for adults, but when it got implemented on the pediatric side, it was like we were getting sepsis alerts for every single patient, and then you’re like, “My patient is fine, they’re just crying,” so I think that that can be frustrating. So I think if there was a way for us to really work together, to start to use these tools in a more realistic way, I think that there’s a lot of opportunity there. Does that make sense?
Jared Johnson: It makes perfect sense, and I think your voice really resonates for a lot of the resident community and the young clinician community in general. Well, I wanted to give you a chance, if there was anything else you want to tell the health IT community, or the clinical community about any of the things you’re doing, and then we’ve got time for a bonus question after that.
Dr. Sarah Bernstein: I don’t think anything in particular. Like I said, I think that what medicine really needs is for everyone to sort of stop battling each other on a day-to-day basis, and start working together more in a way that really puts the patient at the center and makes them the most important thing, and I think that we all sort of keep that in mind but sometimes can lose track of that, so I guess that would be my one little plug.
Jared Johnson: Well, I appreciate your time today, and we do have time for a bonus question, and it has nothing to do with health care at all, and it is, if you could join any music artist or band or group for a day, who would that be?
Dr. Sarah Bernstein: So, I think right now, I’d have to go with The Lumineers. They’re such poets, and I feel like I would just like to sit around and pick their brains for the day.
Jared Johnson: Let’s see, they just came out with their new album recently here. Any favorite tracks of theirs?
Dr. Sarah Bernstein: I love “Ophelia”. I love that song. I think it sounds like it’s about love or heartache, and apparently it’s really about chasing fame, and so I think those things can be related. But I like that it’s not quite so obvious in that there is a little bit of both there. It’s a little complex.
Jared Johnson: Very nice. Well, thanks for sharing that. If our listeners want to get in touch with you in any way, is there any . . . what’s the best way for them to do that?
Dr. Sarah Bernstein: Absolutely, so I’m on Twitter, it’s @sbernsteinmd.
Jared Johnson: Perfect, and any of the blogs that you’ve mentioned, are there any of those that we’d want to point anyone to, like the one you’re mentioning that’s just coming out here? Which site is that on?
Dr. Sarah Bernstein: So it’s on the AMC, their main page, and it’s the Aspiring Doc Diaries.
Jared Johnson: All right. Thanks for your time today, and thanks for connecting with us. There’s a lot that I think the entire community can learn from your perspective, and we appreciate your time.
Dr. Sarah Bernstein: Thank you so much for having me. It’s been really nice talking to you.
Jared Johnson: Well, that wraps up the program this week. Let me know what you thought. Send me a shout-out @jaredpiano on Twitter, jaredpiano, J-A-R-E-D-P-I-A-N-O. You can also leave me a review and subscribe on iTunes, on Stitcher Radio, or on Podbean.
Ladies and gentlemen, remember, it is up to us to tell the story of innovation in health IT, and remember to build your audience one gig at a time. Until next time, I’m Jared Johnson, and you’ve been listening to the Health IT Marketer podcast. This program is sponsored by Clarity Quest, marketing experts who speak fluent health care. For a full archive of previous episodes you can go to healthitmarketer.com; that’s healthitmarketer.com. Thanks again, and I’ll talk to you again next time.