Dr. Justin Smith, better known as the popular online pediatrician @TheDocSmitty, advocates the value of clinicians being active with social media and digital health tools. Unlike other physicians, he chose years ago not to complain about patients who empowered themselves and researched their own conditions. In his words, “If we’re not creating good health information, how can we complain about the bad information they are bringing in?” Learn how he gained institutional support as a clinician to make a national name for himself – and consequently for his hospital, Cook Children’s – as well as what mhealth tools he foresees being part of the pediatric clinic of the future.

Show notes

Air Date: January 13, 2016
Guest: Justin Smith, M.D., a.k.a. @TheDocSmitty, general pediatrician, and Medical Advisor for Digital Health / Director for Primary Care Innovation for Cook Children’s Hospital in Ft. Worth, Texas

Memorable quote

“If we’re not really creating good information, how can we complain about the bad information they’re bringing in?”
—Dr. Justin Smith, on the need for clinicians to be engaged with patients online

1:55	You never know what posts will go viral
4:08	Introducing @TheDocSmitty, Justin Smith
5:40	How does he stay active on social media and what topics is he addressing?
6:50	“Mark Zuckerberg vaccinated; that’s great, but I don’t care!”
8:10	How do you know when a topic is good to talk about?
9:19	What’s the value to him as a clinician to spend so much time on social media?
10:30	Gaining institutional support to be a digital doctor
13:23	Mobile health tools for the healthy, not just for patients
16:00	Patient care involves the family, not just the patient
18:15	How to include families of patients
20:42	The pediatric clinic of the future
22:12	Other tools for health IT professionals
23:44	Bonus question: If you could join a music group or rock band for a day, who would it be?

About TheDocSmitty

My guest this week is Dr. Justin Smith, a general pediatrician, the Medical Advisor for Digital Health and the director for Primary Care Innovation for Cook Children’s in Ft. Worth, Texas. He is also the father of three young children (all 5 and under) and generally very tired. Probably just like many of us. You may know him by @TheDocSmitty on social media and on his blog, which can be found at checkupnewsroom.com/thedocsmitty. Justin shares what he has learned as a pediatrician taking care of families, updates concerning medical news topics and a healthy dose of my triumphs and trials as a dad. He frequently reminds us that we are all in this together.

You can reach him at his blog, checkupnewsroom.com/thedocsmitty, and on Twitter at @TheDocSmitty.

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Full Transcript

Jared Johnson: Hello, my friends and welcome to the Health IT Marketer Podcast, the podcast for the heartbeat of healthcare. I’m your host, Jared Johnson of Ultera Digital. This is the first and only podcast out there dedicated to the health IT marketing community. Welcome aboard.

The awesomeness continues with our guest line up. In 2016, I’m bringing you more guests who live in the trenches everyday using the tools that you develop. Last week, I announced that upcoming guests include Christoph Trappe from MedTouch, Aaron Watkins from Johns Hopkins and Seattle Mama Doc, the original Dr. Wendy Sue Swanson.

I can now announce that “e-Patient Dave,” the one and only Dave deBronkart, will also be joining the program in the coming weeks. So, if you have a question for any of our upcoming guests, tweet me @jaredpiano, and you may have a chance for your question to be featured on the program and for the guest to address your question.

Here is also a plug for HITMC, the Health IT Marketing and PR conference. If you haven’t registered yet, you can save $200 with advanced registration through January 15th. It’s coming right up. If you’re responsible for marketing or PR, for digital marketing, anything related to that for health IT companies, then this is the community for you. You can find that at HealthITMarketingConference.com.

You can help us improve this podcast by taking a short three-minute survey at bit.ly/hitpodcastsurvey. That’s bit.ly/hitpodcastsurvey. We’ve made a number of changes in the program throughout the last few weeks based on your feedback. So, I hope you’ll continue to offer that for me.

Well, as someone who lives and breathes social media, I’ve got to tell you a quick story. You’d think I’d be able to predict which posts would get the most engagement. But this just goes to show you that you really never know. So, last week’s HITSM tweet chat, stands for Health IT Social Media, last week’s #HITSM tweet chat was hosted by Linda Stotsky.

It was on simplifying healthcare and one of the questions had to do with how clinicians could simplify the relationship with patients. And I had just finished reading e-Patient Dave’s book, Let Patients Help, it’s been out for over a couple of years now. But for some reason or another, I just now got around to reading and it was sitting here literally on my desk, right next to my MacBook. And I remember there is a list in the back of ten things clinicians can say to engage patients.

So, I quickly grabbed it, I took an amateur’s picture with my iPhone. It wasn’t up to my normal standards. The lighting wasn’t even that good. It was a little crooked. But tweet chats move really fast so I wanted to get it posted. So, I got it out there and I made sure to mention e-Patient Dave and his doctor, Dr. Danny Sans, who wrote the list. So, by the way, I always give proper attribution, no matter what. That’s just the rule. It’s as easy as saying “Via so and so” at the end of the tweet. So, anyway, side bar, I always give proper attribution.

But anyway, I was already looking at the next question in the chat and I was thinking my next response when tweet deck started going crazy with retweet after retweet, like after like. That amateur’s picture really caught fire, really resonated with people. So, needless to say, a few days later, we’ve had a weekend since then but there have been over 70 retweets. It’s still going. I’m still getting them this morning.

Now, did I take the time to make a big deal out of it? Did I make a meme out of it? You know what, that might be a good idea. Maybe I could make a meme out of it and extend that. No, but you know what I mean? Did I put a lot of time into that tweet? Sometimes I take forever thinking of the exact right way to post something and then it barely gets any notice out there. So, this just goes to show a couple of things.

First and foremost, we never know what will resonate the most. And second, that you, the health IT community, you are craving more information about patient engagement and empowered health.

So, my guest this week is Dr. Justin Smith, better known as The Doc Smitty on social media and his blog. Dr. Smith is a general pediatrician. He is a medical advisor for digital health and the director for primary care innovation for Cook Children’s Hospital in Fort Worth, Texas. He is also the father of three young children, all five years old and younger and generally very tired. Not surprisingly, probably like many of the rest of us, right?

You may better know him as The Doc Smitty on social media and on his blog which can be found at checkupnewsroom.com/thedocsmitty. Justin shares a lot on his blog and on social media about what he’s learned as a pediatrician taking care of families, as well as updates concerning medical news topics and a healthy dose of his triumphs and trials as a dad. And those are some reasons I think that he is finding such a good response to what he is doing out there. And as always, he always reminds us at the end of all of that that we’re all in this whole thing called healthcare together.

So, Justin, welcome to the program. How are you doing this fine wintery day in Texas?

Dr. Smith: I’m doing good. It’s chilly for us here but everyone outside of Texas will probably just be laughing at us.

Jared Johnson: So, you don’t want to reveal what that temperature really is?

Dr. Smith: Yeah. It’s like in the ’50s I think today.

Jared Johnson: Hey, having spent most of my life in Texas so I can understand what you’re talking about. We have people wanting to laugh at that kind of temperature. But hey, if it’s cooler than normal, people just don’t know really what to do. Awesome.

I’m excited to have you on the program today because as you and I were just talking about, there are so many different things that you have going on and I thought it might be a good place to start, just to let our listeners know about some of the things that you have going on in social media. When and where are you doing things and what are some of the latest topics that you’ve been talking about.

Dr. Smith: Sure. So, I stay pretty active on two different channels. I’m active on Facebook and Twitter as The Doc Smitty and I find that both of them are good places to interact with various people. I do find that the audiences are quite different. I have quite a few patients who follow me on Twitter, not direct patients, necessarily, but people with children from our local area and even nationally. And then I find on Twitter that I have much more of a professional following with other doctors and media folks and reporters, people who are interested in what we are having to say.

Looking back through the last couple of weeks of what we’ve covered, I do write my own blogs and those we’ve covered, for instance, why we haven’t seen a lot of flu in our area to this point. As far as more news topics, we’ve covered the Zika virus which is something that we saw as kind of a trend of people having concerns about, so we addressed that. Then we also try to cover evergreen topics that are just general pediatric topics that our audience would also be interested in.

Jared Johnson: Yeah, I know one of your most recent topics and maybe from this week on the blog was responding to Mark Zuckerberg’s post about how he had vaccinated his child and you said, “Hey that’s great, but I don’t really care.” You want to tell us a little more about that one?

Dr. Smith: Yeah. So, we saw that picture of him and his child the day he got his vaccines last week and it struck me as like, “Wow, that’s pretty cool.” And then I saw some of the negative comments he got on his post about it and I then I started thinking, “Hey, why don’t we share that, we’re for vaccines. Why do parents have a hard time sharing that?” I think it boils down a lot to just concerned about the backlash that they might receive for doing so. And it ends up being a [inaudible 00:07:33] has a loud voice and it kind of quiets the rest of the people who are more pro-vaccine.

And actually right in the middle of an interesting discussion on my Facebook surrounding the post that I released, just getting lots of people feedback about why they would be hesitant to share and it’s been really, really valuable. I’ve learned a lot from the community and that’s something that you find I think, is if you’re open to a little give and take from your community, you’re going to end up gaining a lot more insight.

It’s really great fuel for future posts, it’s great insight for your practice. You end up learning a lot about what is your audience online, but is actually good stand-ins for the patients that might walk into your clinic.

Jared Johnson: Now, talk about that give and take a little bit. How do you know when a topic might generate that type of response and how do you know that’s something that’s okay to talk about?

Dr. Smith: Yes. So, we have certain list of topics in pediatrics that are particularly hot right now. Vaccines are always going to be a big one and so we kind of know when those go out. I ask my editor not to release those on a day that I’m off work. So, I want to be around so that I’m listening to the conversation and able to be engaged.

We have other topics that we’ve covered such as essential oils, use of chiropractors in pediatrics and we just kind of know what those topics are that are particularly hot. Also things that are news that potentially present a danger to our patient population. We know are particularly . . . can be really interactive and really need us to be involved in engaging the conversations.

So, we kind of have our list of concerns and then you never know, there’s some times things surprise you. You’ll put some things you think is relatively benign and ends up getting a pretty good response, both positive and negative.

Jared Johnson: What’s the value to you as a clinician to be out there and spending that much time?

Dr. Smith: Yeah, I think, like I said, it’s really valuable to me as far as learning about what my parents who are in my office are concerned about. Using the online space as a proxy for that. But then also I really feel that we are getting to a point now where people are getting so much information online. Studies, every time I see a new one come out seems like the percentage of people who have searched for their health conditions online gets higher and higher and I really feel like it’s almost becoming, at least for some of us, a duty to be out there and providing good information.

That’s really why I got into it from the beginning. I mean there was all this sort of talking and condescension about, oh the patient who brings in a lot of information they got online and I finally got to a point where I said, “If we’re not really creating good information, how can we complain about the bad information they’re bringing in?” I think it’s important that we are out there creating and sharing good data, good information if we want our patients to have access to it.

Jared Johnson: Very good. And part of that has got to be the response you have from those on your team, who are clinical and non-clinical, your hospital administrators and so forth. You’ve mentioned to me before that you’re fortunate to work for a system that supports your approach to social media. Can you tell us a little bit about that? How did you gain support with the hospital administrators, everyone else who needs to be involved in that decision? How did you work through that process?

Dr. Smith: So, I came to Cook Children’s about two and a half years ago and at that point, I was already kind of doing some Facebook and blogging on my own. I had a little bit of a voice already built out in my little sphere which is a small town in West Texas. But as I came over here, they were actually in a process of transitioning over to a more newsroom style publication and moving away from a twice a week blog to actually creating news in the pediatric space for our area, for our state, and really for the country.

And it was really fortuitous that I came along when that ball had already started rolling. I was able to come onboard and say, “Hey, I’m willing to oversee the . . . be sure that we’re providing good information” and then help to recruit other physicians to contribute as well. We have a great team that has interacted well with our clinical staff for years but just having a doctor on the team, I think lends us some credibility that increased our participation from clinicians across the system.

Jared Johnson: You know, I can tell you from experience on the other side, that absolutely does increase your credibility out there by having somebody with the letters MD after their name, out there actually doing a lot of this work and putting out the content like you’re talking about.

So, you said some of those conversations have kind of already taken place. But is there still some give and take? Are there still some in the system who say, “Hey, why are we spending so much time on this?”

Dr. Smith: Yeah, I mean I think there’s probably some who understand the value more than others. But overall, they’re just very supportive and they’ve seen the traction that we’ve gained and sort of the reach that we have, the level of connection engagement that we have with our followers. And once they see that, certainly they’re much more open to trying new and different things with us.

Jared Johnson: And is there a particular statistic in there? You don’t have to share the numbers themselves, but is there a certain number in there that helps make that case for you? You talked about the way that you engage with people, is there a certain number that you say, “Hey, look how many parents we’ve talked to this week” or something like that?

Dr. Smith: Yeah, I mean I think for us, as a digital marketing team, we are looking at statistics past reach. But still when you’re communicating with people who don’t understand that sometimes reach is a really powerful discussion point. And it’s something that’s fairly easy measurable over time and it can be something that they understand. We particularly are more interested in engagement on our team. We think that’s an important measurement for us.

Jared Johnson: That makes a lot of sense. Well, let’s talk about digital health in a slightly different view and that’s the mobile health tools that you as a clinician are able to actually use when taking care of patients. Are there any tools that you actually use in patient care itself and if so, why do you like them?

Dr. Smith: So, we’re really getting started on a new initiative and that’s sort of my certain title at Cook Children’s is the director of primary care innovation. We’re really looking at integrating more digital health tools, mobile health tools into the pediatric clinic. I think there is a lot of momentum and movement in digital health, so we’re not alone.

One of the things that I think we’re seeing a little bit of a gap in is just through the day-to-day, how can digital health tools help the healthy family, the healthy child who’s needing checkups and routine [inaudible 00:14:17] is how can we use digital health tools to help make their life easier. We’ll actually be opening the clinic in May, but over the last year, we focused on building out that clinic in a way that the technology is patient friendly and not an interference in our relationship with them.

So, I think tools that just tell a medicine, remote ear exams, those are some of the things that we plan to have the day we roll out. We’ve done pilots and studies and feel comfortable with those two technologies as early technologies you want to adopt. And basically just to make things more efficient for our families so the things that we can handle remotely without a trip in, we can. But then still providing solid pediatric care in office. So, it’s not a replacement for a good pediatric care, but it could be, I think, a supplement.

Jared Johnson: Well, that jives with this piece of research I just read about last week. There is a new report from Accenture that came out last week that said only 2% of patients in the largest US hospitals are using hospital provided mobile health apps. Does that number surprise you?

Dr. Smith: A little bit. I think that’s because I walk in a circle where that’s what we talk about a lot. So, I think that’s another reason why it’s important to stay on top of studies like that to actually solicit and listen to feedback from your patients to see what they’re actually doing and what they’re actually interested in.

So, I think a lot of these apps are designed by a clinical team that thought it was a really cool idea. But if only 2% is the uptake, well how valuable was all that time and effort [inaudible 00:15:51] built the coolest app ever if no one downloads it and no one downloads it and you say, “Well, how cool is it actually?”

Jared Johnson: That’s a really good point. So, in your approach to care, you really seem to value the patient’s family. So, a lot of the information you’re putting out there obviously as a pediatrician, it’s not necessarily at the child’s point of view. It’s at the parent’s point of view. That’s really who is the one who is driving those care decisions. And I can tell from what I read, the things that you put out there, you value that and so you are bringing the patients family into the care decision. So, as a clinician, what do you do to empower the families of the patient during their care?

Dr. Smith: In pediatrics, we’re pretty fortunate. A lot of the things that we treat and take care of are self-resolving issues and the kids generally are going to do well and get healthy. And then there are also parents who ask us just parenting questions, things that from your experience, what have you seen type situations.

So, I’m fortunate in that I often have multiple options for families to pick from and I think if evidence doesn’t support one option over the other, I just want to present the options and then take a step back and let the parents think through what they would choose for their child. So, I think pediatrics is a good fit for allowing patients to have more say, more autonomy in how their care goes.

And then also I think, one thing that we are getting better about, I mentioned it or hinted at it as far as digital health goes is, giving parents the options for different ways to receive care. And I think that asking them early on what they would like is important because I think if you get down the path of some treatment option or something else and realize that that wasn’t their goal from the very beginning, well, it’s hard to back track.

But if you involve them from the beginning, you’ll get a lot more traction with them and they’ll feel a lot more engaged. They’ll be a lot more engaged.

Jared Johnson: Well, we do use that word engagement a lot and in fact, I’ve read it a lot. I’ve just finished reading e-Patient Dave’s, you know his book from a couple of years ago, Let Patients Help, and I’ve been an advocate of his thought process all along. But I finally just got the book recently and I actually read through that over the holidays.

So, one of the points in Let Patients Help is that the urge to care for our families is just a natural thing and so he says a lot of the work of health and care is between family members, not just self-care.

So, are there any specific examples that as you’ve started writing a blog post or started sharing something on social media that you thought to yourself, “Hey, I need to make sure I speak to the whole family, not just to the patient?”

Dr. Smith: Yeah, I mean for us, it’s a little easier because we most often are dealing directly with the family. But I think one of the things that we’re seeing, a specific condition where we’re seeing that parenting involvement doesn’t work without it is pediatric weight management. We see if we’re talking to a 12-year-old and trying to encouraging him to get out and exercise and eat better, that doesn’t work without the parents being on board.

I think that’s a venue where we need to . . . There has been effort put in but we need to continue putting in more effort on bringing the family into the full and developing a plan that works for the whole family and not just throwing out simple nutrition advice and saying, “Good luck. I’ll see you in six months.” It’s more about involving the family over time.

Jared Johnson: What’s great about that approach is that you’re already thinking about what happens between appointments, like you said, versus just throwing some advice out there and say, “Hey, on your next checkup, we’ll look into that. We’ll follow up on that.”

But the thought of, I think you just landed on something really important about one reason that you as a clinician, you’re spending time in social media, you’re spending time on these blog posts is that you’re giving information that can help in between these visits. And that’s the direction that healthcare is going anyway. So, I imagine that helps make the case for how much time you’re spending in it.

Dr. Smith: Yeah, I think that, yes it’s the direction healthcare is going. I think it’s the direction that it has to go. There is so much noise parents are getting from all different channels and patients, even in the adult world, are getting from all different channels.

I think we have to be more strategic about, we’re not competing against just other healthcare providers and we’re operating in that same space the big industries with huge marketing budgets are working in and we have to be clever about how we get that messaging out there and use tools that are actually, if possible, could affect change.

Jared Johnson: Well, in one point, you and I were trying to figure out before the interview where I actually read this post. But you’ve talked about this idea of what the pediatric clinic of the future would look like, about what pediatric care in general would look like in the future, what tools will it involve and how the care itself would be different. Can you describe what that vision is, of the pediatric clinic of the future?

Dr. Smith: Yeah, I mean it’s going to be a place where technology is not a hindrance between the relationship between parents, patients and the doctor. And I think so much of innovation and health care, especially IT and other digital health, we have to focus on how it benefits the patient. And I think so much of what has been developed like EMRs has in some ways been a hindrance, in many ways been a hindrance between the relationship between us.

I think things that . . . tools that help with our work flow that make our time with the patient more valuable, allows us to be more mindful and pay more attention to the family that’s sitting in front of us I think are going to be huge.

I think there is going to be digital health tools that include really direct messaging capabilities. I think tele-medicine visits are going to be big. And I think more and more of the care is going to shift out of the office and maybe even into ancillary providers where the doctor is not doing everything but potentially being more of a coach for the team and have a really deep connection with the patients. But the things that the doctor doesn’t need to do are going to shift out to other people and be their responsibility so the doctor can focus on the problems at hand.

Jared Johnson: Well, I hope that vision comes true because there is a lot that can be done in all those areas. What other tips would you give to health IT professionals? Again, a lot of our listeners are working on those systems that you were just describing and the health informatics side of the world. What advisor tips would you have for them about helping us move patient care forward?

Dr. Smith: Yeah, I think we need to get both doctors and patients involved early and I think continuing to go back to them and ask, “Hey, we created this tool for you six months ago but we’d really love to refine it and iterate and make it better.” I think if we get all the players down at one table, the people who know the technology, the doctors who know their workflow and the patients who are actually going to be using the tools.

I think we’ll see so much more advancement, innovation rather than incremental change which I think is really how we’re going to get there, is by getting all down together, breaking down those silos. And just asking one another like “How can I help you? What can I do to help you?” And I think we’ll get their as a team. I think that’s the big thing.

Jared Johnson: Well, I appreciate your thought on that. Any other tips or thoughts you would like to share with our audience?

Dr. Smith: No, I think it’s good that you guys are working hard, all the healthcare podcasts. I love what you guys are doing. I think it’s a good medium for having these conversations and hopefully we can continue to get these thoughts out there and then make a difference together.

Jared Johnson: Well, I hope so too. That’s the plan for sure. Well, we have time for our bonus question which is my favorite question to ask everyone and I have never been able to even come close to guessing anyone’s response to this so I won’t try here either. But it’s if you could join any music group or rock band for a day, who would that be?

Dr. Smith: So, I was thinking through this, I have a pretty eclectic music taste, but I went back to my high school days and chose Matchbox 20, just remember like great memories of listening to their music, just like driving on my way to high school basketball games and doing other stuff with my friends and just a fond memory in my heart for that, their first really good album.

Jared Johnson: Awesome. Did you ever happen to catch them live?

Dr. Smith: I have not actually. I should though.

Jared Johnson: I haven’t either. My brother did earlier on and I was always jealous of that and then they broke for a while and . . . Yeah, great stuff. Well, Justin, I appreciate your time with us today. Do you want to let everyone else know one more time how to find you?

Dr. Smith: Yes, probably the best place is to just look me up on Twitter. It’s @TheDocSmitty.

Jared Johnson: Awesome. Well, thanks again and definitely we’ll have to do this again because I have more questions and we were just running out of time today. Thanks for joining us today.

Well, that wraps up this week’s program. You probably know what I’m going to ask you next. That’s right. I’m looking for four more reviews on iTunes for this program. It probably goes without saying I’m a marketing professional talking to other marketing professionals, but reviews obviously help build credibility and help bring other listeners to this program.

So, as my 11-year-old pre-teen daughter would say “I love you forever if you do this for me, that would be awesome.” But until next time, I’m Jared Johnson and you’ve been listening to the Health IT Marketer podcast.

This program is sponsored by Ultera Digital Marketing Consulting. Take your content further. For a full archive of this program, go to HealthITMarketer.com, that’s HealthITMarketer.com. As always, it’s been a pleasure and I’ll see you next week.