Dr. Danny Sands, co-founder of the Society for Participatory Medicine, shares candid insights on overcoming clinicians’ #1 concern about engagement, a patient who changed his lifestyle after seeing his doctor’s office notes, how technology tools should speak to the workflow of both the user and the health care system, and a word of caution to health IT vendors who think they can “fix health care” on their own.
Air Date: March 30, 2016
Guest: Dr. Danny Sands, co-founder, Society for Participatory Medicine
|0:30||Take the listener survey and tell us how to improve|
|0:58||Who is listening to the podcast?|
|3:12||Introducing Dr. Danny Sands|
|6:02||When a clinician wants to be engaged with patients, where does he or she start?|
|8:25||The power of “I don’t know”|
|11:58||Many physicians are uncomfortable communicating with patients online|
|12:56||A patient who finally changed his lifestyle after seeing the doctor’s notes|
|16:43||What pain points do clinicians still have with empowering patients?|
|18:05||Patients forget half of what they were told as soon as they leave the office|
|20:00||Understand the workflow of the users and of the health care system|
|22:45||Concluding thoughts for health IT vendors|
|24:50||Bonus question: If you could join a rock band or music artist for a day, who would it be?|
About Dr. Danny Sands
Dr. Danny Sands is passionate about healthcare transformation, non-visit based care, collaboration in healthcare, and participatory medicine. He spent six years at Cisco, most recently as chief medical informatics officer, where he provided both internal and external health IT leadership and helped key customers with business and clinical transformation using IT. Danny’s prior position was chief medical officer for Zix Corporation, a leader in secure e-mail and e-prescribing, and before that he spent 13 years at Beth Israel Deaconess Medical Center in Boston, where he developed and implemented numerous systems to improve clinical care delivery and patient engagement.
He has earned degrees from Brown University, Ohio State University, Harvard School of Public Health, and trained at Boston City Hospital and Boston’s Beth Israel Hospital. Dr. Sands currently holds an academic appointment at Harvard Medical School and maintains a primary care practice in which he makes extensive use of health IT (much of which he helped to introduce during his tenure at Beth Israel Deaconess).
Sands is the recipient of numerous health IT awards, has been elected to fellowship in both the American College of Physicians and the American College of Medical Informatics, and is a founder and co-chair of the board of the Society for Participatory Medicine. In 2009 he was recognized by HealthLeaders Magazine as one of “20 People Who Make Healthcare Better.” He is the co-author, with e-Patient Dave deBronkart, of Let Patients Help.
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Jared Johnson: Hello, my friends, and welcome back to the Health IT Marketer Podcast, the podcast that’s telling the story of innovation in health IT. I’m your host, Jared Johnson, of Ultera Digital, health IT influencer and content marketing. This is the first and only podcast dedicated to the health IT marketing community. Welcome aboard.
You can leave a review and subscribe on iTunes and listen on Stitcher Radio. Thanks to those who have been leaving comments lately. I really hope you, the listeners, continue to find this valuable and that you can tell me how to improve. In fact, I have a new listener survey up now that you can do just that. It only takes three minutes. You can find that at bit.ly/hitpodcastsurvey2.
This program tells the story of innovation in health IT so all parties can better understand what’s happening in today’s healthcare revolution. It’s a thought leadership series that facilitates the conversations that are needed to make that transformation happen. In fact, as innovation in healthcare technology has exploded in the last few years, there’s a greater need to include more voices in the conversation.
On this program we focus on five key audiences, three of which are part of the hospital or provider community. From within the hospital or provider, those three voices are first and foremost, marketing; second, IT leadership, which I usually start with the CIO and CMIO; and third, what I call connected clinicians or clinical transformationists, members of the clinical team who are interested in bringing themselves into digital health care. Then from outside the hospital, those other two voices are health IT vendors and patients. So those are the five groups of listeners.
The reason that this podcast targets those five groups is that those are the ones needed to be part of this conversation. The podcast especially targets those who market health IT technologies to hospitals, aka vendors, and vice-versa, those who are marketing their providers’ services. So we bring together all the voices needed to tell the story of innovation in health IT.
Marketers must understand and include the viewpoints of an increasing number of voices. This program isn’t necessarily only how to market, though we do talk a lot about the latest marketing tools and trends with an emphasis on content marketing and influencer marketing.
The thrust of this program is bringing you the voices of the thought leaders in those five persona groups that if you listen to what they’re saying will help you market better.
I’d like to hear how it has helped you in your marketing to better understand all of those different voices that are going on in health tech these days. Tweet me or comment about that. Let me know. Has that helped you to understand and hear those voices of those other groups involved in it? Tweet me your comment at @jaredpiano.
My guest this week is practicing primary care physician, author and co-founder of the Society for Participatory Medicine, Dr. Danny Sands. Dr. Sands, thanks for joining us today. How are you doing?
Dr. Danny Sands: I’m doing great. Jared. Thank you.
Jared Johnson: The very first most important question is I wondered if you are into March Madness at all and if you did a bracket this year, and if so, how’s that going?
Dr. Danny Sands: I am not into March Madness. I’ve never been really an intense sports fan. If my home team is playing, I’ll be on top of it a little bit, but, no, I’ve just never had the patience for it.
Jared Johnson: Well that makes me feel a little better actually because this year I have not even submitted a bracket anywhere and I had a hard time keeping up with it myself, so we will try to steer clear of the Madness today because we actually have some very interesting topics to talk about.
I was just mentioning to you before the interview how I’ve followed a lot of the work that you’ve done as a leading clinician in this participatory medicine movement. We’re going to get into that, but first I wanted to give you a chance to tell us a little bit more about your background and where you are now, what you’re doing in your current work and your practice and for the Society for Participatory Medicine.
Dr. Danny Sands: I’ve been in healthcare for a very long time. I finished my residency and became interested actually in information technology and how that could be applied to healthcare. I finished medical school in 1988 and I finished my residency in 1991, and I was interested in why we don’t use more computer technology. I had a technology background, and although I wound up doing training in clinical informatics at Harvard and Beth Israel in Boston, I started my career there doing work to change the way we handle the information and we make clinical decisions by leveraging information technology. So it was tools for clinicians.
One of the things I became interested in from very early on is how technology could actually be a tool for patients as well and it could actually help connect patients. So that really is the whole start of how I got into this participatory medicine movement.
Jared Johnson: I’m looking at a copy of “Let Patients Help,” which you co-authored with e-Patient Dave, Dave deBronkart. This came out in 2013. It’s titled a “patient engagement” handbook – how doctors, nurses, patients and caregivers can partner for better care.
Today we want to talk about and give other clinicians some ideas along those lines. One of those would be, first and foremost, just starting off with when a clinician does want to be engaged with their patients but isn’t sure where to start. What do you tell them then?
Dr. Danny Sands: At one level, I teach them how to most effectively and engagingly use technology in the office. So that is really how you’re going to interact with an electronic health record with the patient. So that’s a set of learnings that’s really critically important, especially now that physicians are having to document everything in electronic health records.
It’s important that physicians understand how to use this, how to still listen to the patient, how to engage the patient in their record by sharing the information that’s there, among other things, sharing the screen with them. There are a lot of aspects to this. That’s a critically important piece.
But it goes beyond that. So that’s a kind of sharing of health information within the office visit, but then there is the whole attitudinal shift about sharing information beyond the visit. When you’re talking about that, you’re typically talking about patient portals today. Have a patient portal. You should have a patient portal. I’m a big believer in transparency of all kinds, but particularly around what we’re documenting in the patient’s record, their test results and so on. So that’s another set of learnings for physicians.
Then coming back into the office, there’s this phenomenon that we have when doctors are seeing patients and they’re confronted with something where they’re not sure what the answer is. It’s an interesting dynamic because we’re often taught that we need to know everything, but the reality is we can’t know everything. When you talk to physicians in a non-threatening environment – I do this all the time. I ask them, “How many of you think you know everything there is to know in your specialty?” And nobody raises their hand. Nobody.
Yet we are sort of acculturated to believe that we must act like we know everything in front of colleagues, in front of nurses, in front of patients. So my learning in this area is admit to yourself that you don’t know everything. Admit to your patients that you don’t know everything. I call this the power of I don’t know, which is when a patient asks you something and you don’t know the answer, don’t have a deaf ear so that you pretend you didn’t hear them and keep talking about something else. Don’t walk out and ask one of your colleagues or look it up. Look them straight in the eye and say, “That’s a really good question. I don’t know. I don’t know the answer to that.”
I think that that is shocking at first to some patients and it’s uncomfortable for many physicians, but I think it’s very, very important because it helps people understand that one can’t know everything, and if one thinks they are and you’re saying you know everything, you’re just lying.
Once physicians get comfortable saying, “I don’t know,” the next stage is saying, “I don’t know” and following that up with, “Let’s look it up together.” Spend just a little bit of time getting at least the beginning of an answer with the patient right there on the computer. I think that’s a very powerful thing to do.
The next set of early education would be to ask patients. One of the major things that people do online is they look for health information. It’s among the top three activities in every single demographic group. The problem is that many physicians either actively say or act as if they say that they think that patients shouldn’t share information with them online. More importantly, the patients shouldn’t be looking online. They think this is a terrible thing, and that all information, the source of all knowledge should be from the physicians. That’s not realistic because we know patients are going online looking for information. So we need to embrace that and we need to understand that they’re doing that.
My recommendation in this area is every year when you go through an annual review, you’re asking patients about their smoking and their drinking and their drugs and their sexual habits and maybe strong religious convictions, and ever since a seminal paper by David Eisenberg was published, many of us ask the question, do you practice any complementary alternative health techniques. That’s important. It’s similar to going online to look for health information. Many people are using these techniques and not sharing it with their physicians because they feel like their physicians will be offended by this or not condone it.
So in a similar way, I ask every single one of my patients every time I do an annual review or every two-year review, whenever you get them in for that wellness visit, I go through these questions and I say, “Do you go online? Have you gone online to look for health information? If so, what are some websites that you’ve found helpful?”
By the way, I write this down in their record. I write it down in the note. By having this conversation with patients, what that’s doing is it’s helping them understand that you care about where they’re getting educated about their health. You care about that and you’re receptive to it. By the way, that’s an opportunity to teach them. It rarely happens, but if the patient is getting their health information from an unscrupulous website or a highly biased website, that’s an opportunity to have a conversation with them. That is opening the door to future conversations and leads them to future honest disclosures, which leads to this healing relationship and trusting, healing relationship that we need to have.
Finally, in the area of communication, many physicians are uncomfortable communicating with patients online. They feel like all communication should be in the office and if necessary, by phone. But we need to encourage patients to communicate with us online because it’s more convenient for our patients and it’s more convenient for us ultimately.
Physicians don’t necessarily feel comfortable with that. They’re afraid it’s going to take up a lot of time or it’s going to be patients e-mailing them all the time and so on. In that situation, I say, “Look, just understand that there’s not a large volume of [messages 12:34] that’s coming your way. That’s been shown in study after study. And if you’re uncomfortable with this, start by letting a handful of your patients, your most trusted patients, use this technology, and then expand from there. Eventually, you’re going to have all of your eligible patients using this. Any patient who’s online will do this and you’re going to become increasingly comfortable with it.”
Jared Johnson: I know in one case, you recently blogged about a patient who was motivated to change his lifestyle simply by seeing his office notes about what you had documented about his visit. You had tried a lot of other things. Can you tell us about that experience?
Dr. Danny Sands: I’d encourage your listeners to read the blog post, but I’ll summarize it. I had a patient that we’ll call Joe who came in for his annual visit. Joe was 60 years old – almost 60. I can’t remember the precise age. But he came into the office for a checkup. Joe had not been taking care of himself for as many years as I’d been taking care of him, which is probably close to 20 years.
He had been overweight and he was gaining weight; not losing it. He really never adopted any of the ideas and suggestions and encouragement that I gave him to really change his lifestyle. Over the years, he got started on blood pressure medicines which he took to reduce his blood pressure and cholesterol medicines and so on.
When he came to me for this particular visit, his weight was increased again. He was complaining of a number of symptoms. He was having gastroesophageal reflux; he was having a lot of heartburn. He was having back pain and various things. For each of these problems, I said, “I think if you were able to lose weight, it would really help you manage these things, but here’s a medication that may help you” for each of these things that he had.
He left the office with two or three new prescriptions and, again, encouragement to work on his weight. He came back in a few months. I wanted to check on him, his blood pressure being up, and he had these symptoms. When I walked into the office, I didn’t recognize him. There was Joe, and he was wearing workout clothes, including a muscle shirt. He was wearing running shoes. I had never, ever seen him like this. I wasn’t even sure I was in the right examination room.
I said, “Joe, what’s going on?” He says, “Well, I was reading the note that you put online, and even though you wrote the note with me there and you talked about it openly all the time, I kept reading that word obesity and that this was caused by obesity, that was obesity, and I just sat and stared at that note online and I decided I don’t want to be that guy anymore. I signed up for a gym and I got a Fitbit. I connected with 16 friends and family around the country. And with my Fitbit, I’ve found that I walked two million steps since I last saw you.” It was just incredible. It’s an incredible number of steps each day; I think 16,000 steps a day. He’d lost weight; I could see by the numbers he’d lost weight.
He said, “All of my symptoms went away.” He made these dramatic changes through the combination of looking at his notes online and not liking what he saw there, but also through some self-motivation and a group motivation by using a Fitbit; fitness tracking.
I think it’s a fascinating story and I have encouraged many patients to use Fitbits. Not all of them who really need a Fitbit or need to track – need to improve their exercise have done that. Many of them won’t, but he did, and he did extraordinarily well. I think that’s an important lesson to us that we should never give up and we should always be transparent with people. If we’re thinking that the patient’s obesity, call it what you will, is the cause of something, we shouldn’t mince words. We need to be perfectly honest with our patients.
Jared Johnson: I know a lot of clinicians still remain skeptical. You’ve already delved into some of those reasons there. I’m curious what pain points you still hear out there in the clinician community from those who are still resistant to the idea that they should be empowering patients or using digital health tools. What are they saying out there, and what do you say in response to those who remain skeptical?
Dr. Danny Sands: The biggest thing I hear about is that physicians are going to spend too much time doing this. I’m going to spend too much time, doc. It sounds like an interesting idea, but I can’t spend any more time. I’m already working late every day. I’ve got too much to do. I’ve got so many patients and so little time.
So I think it’s the concern about the amount of time that this all takes, which I think is a fundamental misunderstanding of this. To me, this is a change in attitude about transparency, about information sharing, about how we partner with patients; how we make decisions. That’s really what this is about. It’s a change in attitude which does not have to obligate more time.
Here’s a great example. We’re talking about notes, open notes, right? Physicians talk to patients. They spend their 15 minute visit with a patient and they tell them things or ideally they’re discussing things, they tell them things and give them instructions. We agree on instructions. We know that when patients leave the office, as soon as they leave the office, they remember less than half of what they were told.
Every single physician I’ve ever spoken to in groups knows this statistic. They know this. I ask them, “If you know that statistic, how many of you send your patients home with a video recording of your visits?” The physicians all sort of laugh nervously and say, “No, we don’t.” And I say, “Okay, then you probably just do an audio recording, right?” And again, same nervous laughter. “No, we don’t.” And I say, “So you have to repeat yourself over and over and over and complain that your patients never remember anything that you tell them?”
That’s fundamentally what we’re talking about here. Patients can’t remember everything that goes on in their visit and there’s not enough time to write down a lot of what was said. So why not have that conversation which is already essentially captured in your note, why not have that be available to patients after the visit so they can check on that note and they can remember what the plan was that they discussed in the office and they can remind themselves by reading that note again and again, particularly before they come back for their next visit so that you’re achieving common goals, you both have the same worksheet essentially? That’s powerful. That’s an example of something that you can only do though this kind of transparency.
Jared Johnson: How can the health IT community help clinicians to get participatory medicine? To join this movement and to start implementing it themselves? Is it by developing different types of tools, or is it by helping clinicians to understand how to better use the tools that are already out there?
Dr. Danny Sands: It’s very common that I meet young people who think, oh, I know healthcare because I’m an engineer and I’ve got a couple other friends who are engineers and we can create an app that can fix healthcare. I think that kind of arrogance doesn’t go very far because there’s a lot to understand. There’s a lot of infrastructure there, a lot of – perhaps infrastructure is the wrong word. Most people who seek healthcare are not young invincible millennials. They are people who really have chronic conditions. They are people like Joe. So we need to keep that in mind as we develop tools.
Also, and this is very important, it’s important to understand the workflow of the users and the workflow of the healthcare system, the providers of healthcare, if that’s who you’re interacting with; the doctors, the nurses and folks.
It’s important to work within that environment and understand how the workflow is going to work. For example, there’s a company that I’m the Chief Medical Officer of called Conversa Health. We provide an opportunity for patients to generate their own health information to let doctors know how they’re doing.
But this can’t be done out of band. In other words, it can’t be sent as discreet messages to the physician outside of their workflow because that’s fundamentally going to fail. So we’ve got to take into consideration the patient or caregivers’ workflow outside the healthcare system as well as the providers of healthcare and how that works, how information is going to integrate, how the workflow is going to occur.
So that’s the biggest advice I have. I would also selfishly suggest that anybody who’s working in health information technology in this area really needs to partner with the Society for Participatory Medicine. We would love to have you involved in the society. We’re doing some fascinating things, and we’d love the input and the involvement of information technology companies.
Jared Johnson: Conversa Health is actually one of the companies that came to mind literally as you were saying that because I had the opportunity to meet Phil Marshall. He spoke on a friend’s podcast on the – the Crux Points Podcast recently that’s sponsored by Sitewire Health, and I remember one of the things he said. It’s one of these quotes I have all the time, he just says, “Patient engagement that happens outside of clinical workflow just doesn’t work.” And that makes sense when you say that it’s got to be part of what’s already happening on both the clinical side and on the patient side.
So it makes perfect sense in terms of why it can’t just be an idea that’s incubated somewhere outside of the clinical realm. I love that thought.
As we wind up here, do you have any other thoughts for the health IT community on other things that they can do to help or the clinician or even the CIO and CMIO communities on how to continue to take participatory medicine to the next level?
Dr. Danny Sands: I think there’s a lot to be done in the areas of community. These are things that the society is focused on, building communities and having conversations about this area. We need to convene conversations where we have patients and family caregivers face-to-face with physicians and developers and nurses and the whole spectrum of stakeholders and talking about how to solve these problems.
We also have things we can do in the area of advocacy to advocate for policy changes that will enable some of these technologies and tools. Research, we need more research to document the effectiveness of these things. At the society, we have the Journal of Participatory Medicine, and we’re also hopefully soon to be launching a research library so we can document the literature that supports participatory medicine. And finally, education. We have a big initiative in education this year. We need to educate not just physicians and nurses and other clinicians but also educate people earlier in their healthcare training.
Conversely, we need to educate patients, individuals and families how to become more participatory because it’s not always that the patients want it and the doctors don’t. Joe was a great example that we talked about. He wasn’t willing to engage no matter what I did with him until something tipped. There was some kind of trigger for him. But we need to encourage all patients and family caregivers to engage more in their healthcare.
I think all of these things are really important. As I said, the Society for Participatory Medicine is all about these things and we’d love to have your partnership. We have members who are patients, family caregivers, doctors, nurses, consultants, IT professionals and so on. So join us. We’ve got lots of work to do and we need all the help we can get.
Jared Johnson: I appreciate that and I appreciate your time, Dr. Sands. I do have time for one bonus question here, which is often my favorite part of the program. It’s very simple. If you could join any rock band or music group for a day, who would that be?
Dr. Danny Sands: I’ve got to say, I’ve kind of always wanted to hang out with Jimmy Buffett for a while.
Jared Johnson: Right on.
Dr. Danny Sands: I would have to give that as my answer.
Jared Johnson: That’s terrific. Right on. As always, I appreciate your time here, and for those who are interested in learning more about the Society for Participatory Medicine or they just have a question for you, what’s the best way to reach you?
Dr. Danny Sands: You can always reach me at Danny [at] DrDannySands.com, and the society is participatorymedicine.org.
Jared Johnson: Outstanding. Thanks again for joining the podcast. We’ve really enjoyed having you.
Dr. Danny Sands: Thanks a lot, Jared. Have a nice day.
Jared Johnson: That wraps up our program this week. Thanks to another rock star guest for joining me again. Don’t forget to take three minutes and fill out that new listener survey at bit.ly/hitpodcastsurvey2.
As always, I’m only a tweet away. Ping me @jaredpiano. You can listen to me and you can find me just about anywhere. You can subscribe and leave a review on iTunes, you can listen on Stitcher Radio or subscribe on really pretty much any other major podcasting app.
Remember, it is up to us to tell the story of innovation in health IT. And remember, keep building 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 Ultera Digital, health IT influencer and content marketing. For a full archive, go to healthITmarketer.com. Thanks again for listening, and I’ll talk to you again next week.