TEDMED Great Challenges: Improving Medical Communication

01:03:02
https://www.youtube.com/watch?v=DR5E9wY-DGo

Resumo

TLDRThis Ted Meds live event discusses the complex challenge of improving communication in health care. Given the importance of such communication for diagnosis, treatment adherence, and error prevention, experts gathered to exchange ideas across disciplines. While technology offers tools for better data capture and education, the human aspect remains crucial. The event highlighted barriers like time constraints and cultural differences that impact communication, stressing the need for clear, non-technical language and for equipping patients with the right questions. Building trust and understanding through informed dialogue was emphasized as essential for optimal patient care.

Conclusões

  • 🎙️ Effective communication is crucial for healthcare success.
  • 📱 Technology aids but does not replace human interaction.
  • 🤝 Building trust in doctor-patient relationships is essential.
  • 🕒 Time constraints are a major barrier to communication.
  • 🌍 Cultural differences affect patient-clinician interactions.
  • 📚 Equip patients with the right questions for better care.
  • 👨‍⚕️ Clinicians should use non-technical language.
  • 🔄 Signposting in conversations helps manage expectations.
  • 💡 Patients with more information can feel more empowered.
  • 🔍 Transparency and privacy in patient data handling must be maintained.

Linha do tempo

  • 00:00:00 - 00:05:00

    Emily Paulson welcomes viewers to a Ted Med event on improving medical communications. It includes experts discussing patient-clinician communication's critical impact on healthcare outcomes. The event is interactive, encouraging questions via social media.

  • 00:05:00 - 00:10:00

    Experts, including Dr. Robert M Arnold and John Cox, discuss medical communication challenges. They emphasize understanding from the patient's viewpoint and cultural impacts on communication.

  • 00:10:00 - 00:15:00

    Dr. Arnold and Dr. Selma Call discuss patient perspectives influenced by culture and personal experience. They highlight the importance of a non-judgmental approach to foster patient comfort.

  • 00:15:00 - 00:20:00

    John Cox and Barbara Kara discuss the healthcare system's role in communication. Cox highlights patient engagement importance while Kara emphasizes patient preparation for consultations to maximize time.

  • 00:20:00 - 00:25:00

    The panel discusses patient empowerment and the healthcare system's responsibility in educating patients. Dr. Arnold emphasizes trusting healthcare providers over expecting patients to act like doctors.

  • 00:25:00 - 00:30:00

    Communication strategies in medical education are discussed with a focus on patient relationships. The impact of social media on patient engagement and the need for healthcare systems to adapt is highlighted.

  • 00:30:00 - 00:35:00

    The role of technology and email in patient communication is debated. Experts express the need for balance to ensure technology aids rather than hinders personal interaction.

  • 00:35:00 - 00:40:00

    Dr. Arnold and Dr. Call discuss the nuances of shared decision-making in medical care. Different cultural expectations and communication styles between patients and physicians are explored.

  • 00:40:00 - 00:45:00

    Experts stress simplicity in medical explanations to patients. They address the challenges high information volume presents, urging trust and reliable sources in patient research.

  • 00:45:00 - 00:50:00

    Panelists discuss methods to solicit patient questions effectively during medical consultations. Emotional connection and active listening are highlighted as crucial for patient satisfaction.

  • 00:50:00 - 00:55:00

    The role of social media and peer-reviewed content in providing reliable medical information is debated. The conversation touches on balancing information accessibility with quality control.

  • 00:55:00 - 01:03:02

    As the event concludes, the necessity for ongoing communication improvement in healthcare is emphasized. Trust, privacy, and technology's role in modern medical practices are underscored.

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Mapa mental

Mind Map

Perguntas frequentes

  • What is the purpose of the Ted Meds live event?

    The event focuses on improving medical communication.

  • Who sponsors the Great Challenges program?

    The Robert Wood Johnson Foundation sponsors it.

  • Why is effective communication important in healthcare?

    It leads to faster diagnosis, better treatment adherence, fewer errors, and better care coordination.

  • What impact do patients having more information from the internet have on healthcare?

    It can empower patients but may also overwhelm or misinform them.

  • How can technology aid medical communication?

    By providing tools for better data capture and patient education.

  • What role does culture play in medical communication?

    Culture can influence patient expectations and perceptions of doctor-patient interactions.

  • What are some common barriers to effective medical communication?

    Time constraints and language barriers can prevent effective communication.

  • What approaches are suggested to overcome communication barriers?

    Signposting conversations, using non-technical language, and involving health educators.

  • Do mobile technologies help in medical environments?

    Yes, they can provide valuable tools but should not replace human interactions.

  • How can clinicians better engage with patients?

    By being present, making eye contact, and ensuring understanding of patient concerns.

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Legendas
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Rolagem automática:
  • 00:00:01
    hello and welcome to Ted Ted meds live
  • 00:00:04
    event focusing on the great challenge of
  • 00:00:06
    improving medical Communications I'm
  • 00:00:09
    Emily Paulson and I'm moderating today's
  • 00:00:11
    discussion which will run about an hour
  • 00:00:14
    the session is part of the Great
  • 00:00:16
    challenges program sponsored by the
  • 00:00:18
    Robert Wood Johnson Foundation the goal
  • 00:00:21
    of the great challenges program is to
  • 00:00:23
    look at 20 20 of the most complex
  • 00:00:25
    problems in health and Medicine issues
  • 00:00:28
    that can't be solved with a bullet or a
  • 00:00:32
    one shot cure or policy our mission then
  • 00:00:35
    is not to solve these issues but to
  • 00:00:37
    share ideas from many disciplines to
  • 00:00:40
    reach a better understanding than we had
  • 00:00:42
    before we'll be taking questions from
  • 00:00:45
    viewers on Google Hangout Facebook and
  • 00:00:48
    Twitter you can tweet your questions to
  • 00:00:51
    tedmed just tag them with hash great
  • 00:00:55
    challenges one word and we'll try to get
  • 00:00:58
    to them as I mentioned my name is Emily
  • 00:01:01
    Paulson and Ted Med has asked me to
  • 00:01:03
    moderate today's event I'm a writer and
  • 00:01:06
    editor focusing on Health Care topics
  • 00:01:09
    such as patient engagement health
  • 00:01:12
    literacy patient
  • 00:01:14
    education health information technology
  • 00:01:17
    and quality
  • 00:01:18
    improvement today we're delighted to
  • 00:01:20
    welcome a great team of experts who make
  • 00:01:23
    up our challenge team and they're going
  • 00:01:25
    to discuss this topic our experts are Dr
  • 00:01:30
    Robert M Arnold he's a professor at the
  • 00:01:33
    University of Pittsburgh he has
  • 00:01:35
    published on end of Life Care Hospice
  • 00:01:38
    and paliative care doctor of patient
  • 00:01:40
    communication and ethics education he
  • 00:01:43
    currently focuses on educational
  • 00:01:45
    interventions to improve communication
  • 00:01:48
    in life limiting
  • 00:01:50
    illnesses John Cox is president and CEO
  • 00:01:54
    of visible Health a company that
  • 00:01:57
    develops web-based and mobile products
  • 00:01:59
    to help patients better understand their
  • 00:02:01
    medical conditions and treatment options
  • 00:02:04
    and to work more collaboratively with
  • 00:02:06
    their Physicians and other Healthcare
  • 00:02:09
    Providers Dr John fedar is founder and
  • 00:02:12
    director of the center for connected
  • 00:02:14
    Health at Partners Healthcare he's
  • 00:02:17
    creating a new model of Health Care
  • 00:02:19
    delivery developing Innovative
  • 00:02:21
    strategies to move care from the
  • 00:02:23
    hospital or the doctor's office into the
  • 00:02:26
    day-to-day lives of
  • 00:02:28
    patients Barbara Cara is an
  • 00:02:31
    award-winning broadcast journalist
  • 00:02:33
    featured writer for The Huffington Post
  • 00:02:36
    Health educator and health advisor her
  • 00:02:39
    website healthin 30.com provides
  • 00:02:42
    consumers relevant jargon-free health
  • 00:02:44
    information she is also a registered
  • 00:02:47
    nurse and a leading nurse voice in
  • 00:02:50
    health Dr Selma call is a applied
  • 00:02:54
    developmental psychologist and a
  • 00:02:57
    research scientist at child Trends her
  • 00:02:59
    current work examines the reproductive
  • 00:03:01
    Health behaviors of young adults partic
  • 00:03:04
    particularly of racial and ethnic
  • 00:03:07
    minorities welcome
  • 00:03:09
    everyone our topic today is medical
  • 00:03:12
    communication an essential ingredient to
  • 00:03:15
    Quality Healthcare although there are
  • 00:03:17
    lots of types of communication in
  • 00:03:19
    healthcare today we'll focus primarily
  • 00:03:21
    on the communication between patient and
  • 00:03:24
    clinician Studies have shown that
  • 00:03:27
    effective communication between patient
  • 00:03:29
    and clinician leads to faster more
  • 00:03:32
    accurate diagnosis better adherence to
  • 00:03:34
    treatment fewer medical errors and
  • 00:03:37
    better coordination of care in short
  • 00:03:40
    effective communication can save money
  • 00:03:43
    and more importantly save lives here are
  • 00:03:46
    some revealing statistics about the
  • 00:03:48
    importance of Communications in Quality
  • 00:03:50
    Health Care a study reported in the
  • 00:03:54
    December issue of the Journal of
  • 00:03:55
    American Medical Association found that
  • 00:03:58
    would patients feel their doctors
  • 00:04:00
    listened to them and involve them in
  • 00:04:02
    decisions they were more likely to take
  • 00:04:05
    their medication as recommended The
  • 00:04:07
    Joint Commission says that as many as
  • 00:04:10
    70% of medical errors can be traced to
  • 00:04:12
    breakdowns in
  • 00:04:14
    communication and a National Consumer
  • 00:04:16
    survey on health it showed that 60% of
  • 00:04:21
    patients wished their doctors had more
  • 00:04:24
    time to talk to them so let's start the
  • 00:04:27
    conversation by talking a little bit
  • 00:04:29
    about the expectations and perspectives
  • 00:04:31
    that come together in a typical medical
  • 00:04:34
    encounter say for a patient recently
  • 00:04:37
    diagnosed with diabetes what's on the
  • 00:04:39
    doctor's mind as she walks he or she
  • 00:04:41
    walks into the exam room what's the
  • 00:04:43
    patient thinking Dr pedar can you give a
  • 00:04:47
    us a glimpse of what's the patient the
  • 00:04:49
    physician's situation in that
  • 00:04:52
    situation sure I I think the big uh
  • 00:04:54
    challenge that we as doctors face in in
  • 00:04:57
    any of these situations is that we are
  • 00:04:59
    we've seen this whatever is in front of
  • 00:05:01
    us thousands of times and for the
  • 00:05:03
    patient it's the first so in my own case
  • 00:05:06
    I have to be really really focused on
  • 00:05:09
    making sure that I view it through the
  • 00:05:11
    patient's eyes and communicate in a way
  • 00:05:13
    that's clear wait for questions be
  • 00:05:16
    thoughtful and uh and not hurry on and
  • 00:05:20
    assume uh that the patient understands
  • 00:05:22
    it in the way that I have seeing
  • 00:05:24
    something over and over and over again
  • 00:05:26
    through my career
  • 00:05:31
    and uh Dr Arnold what might be going
  • 00:05:34
    through the patient mind at that at that
  • 00:05:36
    time well it depends a lot about who the
  • 00:05:40
    I mean who the patient is I mean our
  • 00:05:42
    other family members have diabetes have
  • 00:05:45
    they've been told that they are
  • 00:05:47
    pre-diabetic beforehand what's their
  • 00:05:50
    relationship with the doctor I mean I
  • 00:05:52
    think for patients the question is
  • 00:05:54
    what's wrong with me what does it mean
  • 00:05:56
    to my life and what can be done and I
  • 00:05:58
    think that
  • 00:06:00
    the issues with diabetes which is
  • 00:06:03
    largely an is uh a disease of uh obesity
  • 00:06:08
    in our country has to do with issues
  • 00:06:11
    regarding beliefs in medicines versus
  • 00:06:14
    changes in habits and how doctors and
  • 00:06:17
    patients negotiate those two
  • 00:06:19
    factors right Dr call can you talk about
  • 00:06:23
    what culture and past experiences what
  • 00:06:25
    role they play in the patients
  • 00:06:28
    experience sure I um one of the things
  • 00:06:31
    that um patience my experience is what
  • 00:06:35
    have I done to create this um and so uh
  • 00:06:39
    they're going to have in in some ways
  • 00:06:42
    because In some cultures the other is
  • 00:06:45
    very important um they might have the
  • 00:06:48
    the idea that the patient the the doctor
  • 00:06:51
    is going to judge them uh again because
  • 00:06:54
    of the cultural uh perspective of um you
  • 00:06:57
    know the collective uh uh culture of of
  • 00:07:01
    you know whoever it is so I think that's
  • 00:07:04
    the main thing how how am I going to be
  • 00:07:06
    perceived by this doctor and so that's
  • 00:07:08
    when um a non-judgmental doctor might
  • 00:07:12
    definitely uh be able to to make this
  • 00:07:16
    patient feel comfortable and uh and then
  • 00:07:18
    from there be able to uh to engage in a
  • 00:07:23
    conversation and this this inovate
  • 00:07:26
    conversation between the physician and
  • 00:07:29
    the patient if it leads to better care
  • 00:07:33
    or in the case of miscommunication a
  • 00:07:37
    problem and and more expensive care the
  • 00:07:40
    health system also has an interest in
  • 00:07:42
    that that interaction John could you
  • 00:07:46
    talk a little bit about the health
  • 00:07:48
    system and and what why does it care
  • 00:07:51
    about what goes on in the medical in the
  • 00:07:53
    in that personal encounter between a
  • 00:07:56
    physician or clinician and a patient
  • 00:07:58
    sure I think
  • 00:08:00
    I think there's two two pieces to that
  • 00:08:02
    that are pretty obvious one is um first
  • 00:08:05
    I think um the healthare the system is
  • 00:08:08
    cares about the the overall patient
  • 00:08:10
    outcome across the the that encounter
  • 00:08:13
    plus all the other encounters and I
  • 00:08:15
    think at least from my perspective it's
  • 00:08:17
    very critical for the patient to be a
  • 00:08:19
    very engaged participant in that and and
  • 00:08:22
    first and foremost is to understand um
  • 00:08:25
    to understand the conditions to
  • 00:08:27
    understand their procedures to
  • 00:08:28
    understand their options and to become
  • 00:08:29
    partner with their physician um you know
  • 00:08:33
    like uh like Dr kedar said that uh for
  • 00:08:35
    him it's a it's he's gone through that a
  • 00:08:38
    number of times for the patients the
  • 00:08:40
    first time and um I think both parties
  • 00:08:43
    need to recognize that and and uh and
  • 00:08:46
    work together work together more closely
  • 00:08:48
    and it starts with understanding right
  • 00:08:52
    and Barbara doctors are pressed for time
  • 00:08:55
    how does that or and clinicians I me
  • 00:08:57
    everyone in in healthcare is pressed for
  • 00:08:59
    time how does that affect medical
  • 00:09:02
    Communications it it definitely affects
  • 00:09:04
    it and uh regarding the time Factor the
  • 00:09:08
    best thing patients can actually do is
  • 00:09:10
    to really be an empowered patient and
  • 00:09:13
    engaged patient and be prepared before
  • 00:09:16
    visits if they write their questions
  • 00:09:18
    down in advance that may save a little
  • 00:09:20
    bit of time if they're prepared if they
  • 00:09:22
    do a little bit of research searching on
  • 00:09:24
    the internet um getting their questions
  • 00:09:26
    down and then bringing them to the phys
  • 00:09:28
    or the clinician
  • 00:09:30
    um and they can help guide them and help
  • 00:09:32
    them through their their prognosis or
  • 00:09:35
    even regardless of what it is I it they
  • 00:09:38
    can help them through their uh situation
  • 00:09:41
    at that moment but if they're prepared
  • 00:09:44
    that is like a that is key because it'll
  • 00:09:46
    help save time because there is such uh
  • 00:09:49
    a rush for time with with the
  • 00:09:52
    visits right some are what are the other
  • 00:09:55
    things that patients can do to just
  • 00:09:58
    improve their situation as they're going
  • 00:10:00
    into this this encounter with a
  • 00:10:02
    physician or a
  • 00:10:04
    clinician
  • 00:10:05
    um um hearing um hearing the uh the
  • 00:10:09
    previous
  • 00:10:11
    answer um I think that we also can come
  • 00:10:14
    across a lot of patients that may not
  • 00:10:16
    have the inform the information the
  • 00:10:19
    knowledge to know which questions to ask
  • 00:10:22
    and so I think that one of the things
  • 00:10:26
    that and I know that we're talking about
  • 00:10:29
    time
  • 00:10:30
    but I think that it would be sort of for
  • 00:10:33
    the doctor to to also feel more like an
  • 00:10:37
    educator um for a person who uh who
  • 00:10:40
    might not have the the knowledge and it
  • 00:10:44
    things might not be worked out um on one
  • 00:10:47
    visit I think it may require multiple
  • 00:10:49
    visits um because in my work we've
  • 00:10:52
    encountered a lot of um patients that um
  • 00:10:55
    are not knowledgeable and and to the
  • 00:10:57
    point where they don't even know where
  • 00:10:58
    to start to ask questions um so this is
  • 00:11:01
    where maybe also uh nurses can come in
  • 00:11:04
    or maybe a health educator can come in
  • 00:11:07
    right before they actually see the
  • 00:11:09
    doctor to to see if if the person has
  • 00:11:13
    generated some questions based on the
  • 00:11:14
    information that maybe a health educator
  • 00:11:17
    uh G her or um or or a nurse so I I
  • 00:11:21
    think I I think it's a great idea for
  • 00:11:23
    patients to come up with questions
  • 00:11:25
    before but but I think that they first
  • 00:11:27
    have to have some B basic
  • 00:11:31
    knowledge uhuh yes so the health system
  • 00:11:36
    has to work with patients in order to
  • 00:11:39
    help them be that empowered patient it's
  • 00:11:42
    it's a complete switch in roles for a
  • 00:11:44
    patient we've been expecting them to be
  • 00:11:46
    in the sick role for for years and years
  • 00:11:49
    you go to the pediatrician as a child
  • 00:11:51
    and the pediatrician talks to your to to
  • 00:11:54
    your mother instead of you so we we grow
  • 00:11:56
    up not knowing that we're supposed to
  • 00:11:59
    talk to the doctor um so what can the
  • 00:12:02
    health system what can what can we do to
  • 00:12:05
    encourage patients to be more open
  • 00:12:10
    um what's what's being done in medical
  • 00:12:12
    school Dr Arnold so I guess I I think
  • 00:12:16
    it's really important to empower
  • 00:12:18
    patients it's really important for
  • 00:12:19
    patients to understand what's going on
  • 00:12:22
    and I think that we need to be careful
  • 00:12:24
    in the pendulum so we don't blame uh
  • 00:12:28
    people people who are sick because they
  • 00:12:30
    quote aren't empowered enough or aren't
  • 00:12:33
    good enough consumers they are sick and
  • 00:12:37
    it seems to me the real question is do
  • 00:12:39
    you find your doctor trustworthy and how
  • 00:12:42
    can you help your doctor how can you
  • 00:12:44
    find a doctor and a team that you're
  • 00:12:46
    going to trust because you know the
  • 00:12:49
    bottom line is patients aren't going to
  • 00:12:51
    know as much about medicine as their
  • 00:12:53
    Healthcare team I don't know as much
  • 00:12:55
    about cars as my mechanic and if I don't
  • 00:12:57
    trust my mechanic however empowered I am
  • 00:13:00
    it's not going to work out and so I
  • 00:13:02
    guess I I want to put a little bit of
  • 00:13:04
    caution that we don't sort of
  • 00:13:07
    convince patients that they have to be
  • 00:13:09
    doctors to work in a Health Care system
  • 00:13:12
    that shouldn't be their job their job
  • 00:13:14
    should be to think about what's most
  • 00:13:16
    important to them and to negotiate that
  • 00:13:18
    with their healthc care team so they can
  • 00:13:21
    focus on what's most important and I
  • 00:13:22
    didn't answer your question at all I'm
  • 00:13:25
    sorry that's okay
  • 00:13:29
    and and I think that this is why um in
  • 00:13:32
    terms of the medical system I think this
  • 00:13:34
    is why the idea of Health
  • 00:13:37
    Educators uh it's a good one because if
  • 00:13:41
    if we're if we're talking about folks
  • 00:13:43
    that may not have the information and
  • 00:13:45
    maybe we like the doctor said we may not
  • 00:13:48
    want them to be doctors themselves but
  • 00:13:50
    we do want someone to sort of walk along
  • 00:13:53
    with them and we understand that doctors
  • 00:13:55
    don't have the time to do that but if we
  • 00:13:57
    have someone to walk along with them to
  • 00:14:00
    uh Empower them as we've been talking
  • 00:14:02
    about would be a great can I just t on
  • 00:14:04
    that a little bit um just from my
  • 00:14:07
    experience um work as a nurse in the
  • 00:14:10
    hospital from years ago until until now
  • 00:14:14
    there's such a change with patients
  • 00:14:16
    because now patients are asking a lot of
  • 00:14:19
    questions when I first started no one
  • 00:14:21
    really asked any questions and their
  • 00:14:22
    families was were not even around but
  • 00:14:25
    today patients are asking questions
  • 00:14:28
    their families asking questions and not
  • 00:14:30
    only they're asking questions but
  • 00:14:32
    they're almost demanding that they get
  • 00:14:34
    the answers and they want the answers
  • 00:14:36
    right away and um and this the doctors
  • 00:14:39
    and the nurses are so in tune to the
  • 00:14:41
    clinical aspect of of things um that I
  • 00:14:45
    think we're losing focus in a way with
  • 00:14:48
    how to deal with the empowered patient
  • 00:14:51
    who's asking so many questions so I
  • 00:14:53
    think communic and I think this is all
  • 00:14:55
    due to social media it
  • 00:14:58
    has transformed healthcare because the
  • 00:15:01
    internet everyone is searching and
  • 00:15:03
    gathering information and I think in
  • 00:15:05
    terms of medical schools and nursing
  • 00:15:07
    schools I think communication from
  • 00:15:09
    social media needs to be tapped into
  • 00:15:11
    which I know some schools are doing that
  • 00:15:14
    um but also communication face to face I
  • 00:15:17
    think we're kind of losing the art of
  • 00:15:18
    communicating because we're so involved
  • 00:15:20
    with so many other things in the
  • 00:15:22
    hospital everyone's trying to get their
  • 00:15:24
    meds out or trying to get the orders
  • 00:15:26
    from the labs or the pharmacy or
  • 00:15:28
    whatever the is issues are there's so
  • 00:15:29
    much going on so these patients and
  • 00:15:32
    these families that are asking these
  • 00:15:33
    questions it's almost as if there's no
  • 00:15:35
    time to answer them because they're
  • 00:15:37
    involved with so much more so I think we
  • 00:15:40
    need to get the face-to-face
  • 00:15:42
    communication um in dealing with
  • 00:15:44
    patients and families and I know
  • 00:15:46
    Cleveland Clinic I know Dr James Marino
  • 00:15:48
    speaks about this um often where their
  • 00:15:50
    physicians in the Cleveland Clinic are
  • 00:15:52
    being trained in communication to help
  • 00:15:56
    uh Foster better communication between
  • 00:15:58
    patient Andor doctors but I don't think
  • 00:16:00
    we should leave it to just doctors
  • 00:16:01
    because nurses are there consistently
  • 00:16:03
    247 with the patients so I think we need
  • 00:16:06
    to bring social media Communications and
  • 00:16:08
    verbal
  • 00:16:10
    Communications out and really go full
  • 00:16:12
    force with it because patients are
  • 00:16:14
    really speaking up a lot and they really
  • 00:16:17
    do have a lot of questions right right
  • 00:16:19
    and they need a lot of time with that it
  • 00:16:21
    doesn't do any good to impower someone
  • 00:16:24
    if they're met with a brick wall U or
  • 00:16:26
    with other obstacles to communicate
  • 00:16:29
    can you speak a little bit about that
  • 00:16:31
    comment on what Barbara said Dr Fedor oh
  • 00:16:35
    absolutely I I think it's a spot on I I
  • 00:16:38
    I guess our experience at the the center
  • 00:16:40
    for connected health is when we
  • 00:16:43
    ask uh things of our patients as long as
  • 00:16:46
    we arm them with good data and tools and
  • 00:16:48
    meet them where they are we get fabulous
  • 00:16:51
    engagement and fabulous results and
  • 00:16:54
    indeed some of the cases we are able to
  • 00:16:56
    let them be their own doctor uh for
  • 00:16:59
    their narrow focus of their illness so I
  • 00:17:02
    think all of this is is quite possible
  • 00:17:04
    and we have all the tools but it's a
  • 00:17:08
    matter of of listening really carefully
  • 00:17:10
    uh to and meeting them where they are uh
  • 00:17:14
    so I'm quite um encourag the other thing
  • 00:17:17
    I'll say that as a provider or a
  • 00:17:19
    provider system we we need to embrace
  • 00:17:22
    people that Barbara's describing because
  • 00:17:26
    those people who are asking lots of
  • 00:17:28
    questions they're for they're in uh
  • 00:17:30
    engaged and in in their care are much
  • 00:17:34
    more likely a to have a better outcome
  • 00:17:36
    and B if things go sour they're less
  • 00:17:39
    likely to hold you accountable because
  • 00:17:41
    they were in the decision-making process
  • 00:17:43
    with you right John would you like to
  • 00:17:46
    comment on this yeah I mean I think uh
  • 00:17:49
    kind of going back to the idea of a
  • 00:17:50
    partnership um you know the time that
  • 00:17:52
    you get to spend with a physician or any
  • 00:17:54
    clinical professional for that matter is
  • 00:17:57
    precious and it's limited and
  • 00:17:59
    um you know to to Barbara's Point
  • 00:18:01
    earlier you need to be prepared as a
  • 00:18:03
    patient and you and you head into those
  • 00:18:05
    conversations and I think um one of the
  • 00:18:08
    great things about the sort of
  • 00:18:09
    Technology boom and the social media
  • 00:18:11
    boom and and uh mobile health and and
  • 00:18:15
    the like is that it's um it's not
  • 00:18:17
    replacing any of these conversations
  • 00:18:19
    it's not uh it's not taking them out of
  • 00:18:22
    the picture but I think what the real
  • 00:18:23
    the real benefit of it is is it gives an
  • 00:18:25
    opportunity for uh for people to try to
  • 00:18:28
    maximize time together you and and make
  • 00:18:31
    that you when you are talking with your
  • 00:18:33
    physician be prepared with the right
  • 00:18:35
    questions be ready to capture that
  • 00:18:37
    information that you need and to go
  • 00:18:39
    outside of that visit and uh investigate
  • 00:18:42
    your your condition your procedures your
  • 00:18:44
    treatment plans and your options better
  • 00:18:46
    and then have a conduit to to to get
  • 00:18:49
    your questions answered even if it's not
  • 00:18:50
    inside of a visit when you can't get
  • 00:18:52
    that time so right one of we have a
  • 00:18:55
    question from uh Twitter um in what ways
  • 00:18:59
    can technology ease the communication
  • 00:19:01
    process in healthcare does email
  • 00:19:04
    help facilitate a more relaxed
  • 00:19:07
    conversation between the patient and the
  • 00:19:09
    Health Care
  • 00:19:11
    System um I'm I'm I'm happy to go first
  • 00:19:14
    on that because I email a lot with
  • 00:19:16
    patients uh and what I find is that
  • 00:19:19
    email has to be very contextual that
  • 00:19:22
    first of all to to start just setting
  • 00:19:25
    sort of context I don't take emails
  • 00:19:28
    about healthare from people I've never
  • 00:19:30
    met before uh which I guess makes sense
  • 00:19:33
    but some people think that maybe you can
  • 00:19:36
    uh sort of get get get a doctor's advice
  • 00:19:39
    by just sending them a random email but
  • 00:19:41
    for my patients we email a lot and we
  • 00:19:43
    use secure email because of uh privacy
  • 00:19:46
    concerns but we email a lot and it's
  • 00:19:48
    really about uh gwiz this happened after
  • 00:19:52
    I came home I thought of this what do
  • 00:19:54
    you think of that or I'm a dermatologist
  • 00:19:56
    so people that I know well will send me
  • 00:19:58
    images do I have to come in for this is
  • 00:20:00
    this something we can fix without
  • 00:20:02
    without having a visit and it works
  • 00:20:04
    quite well so I see it as supplemental
  • 00:20:06
    and when you have a good relationship
  • 00:20:08
    with a patient it works quite
  • 00:20:10
    well John can you talk about other tools
  • 00:20:13
    technology tools that that can help with
  • 00:20:15
    the U to make the conversation between
  • 00:20:19
    the patient and the Health Care System
  • 00:20:20
    go more smoothly well I was going to
  • 00:20:24
    say h sorry feedback um what I was going
  • 00:20:27
    to say was you know being an industry
  • 00:20:29
    software where we spend a lot of time
  • 00:20:31
    working remote we do a ton of
  • 00:20:32
    email-based communication around our
  • 00:20:35
    projects um a lot of the nuance and a
  • 00:20:38
    lot of the the obviously the non-verbal
  • 00:20:40
    elements of the conversation are are
  • 00:20:42
    lost and I think you know email and chat
  • 00:20:44
    and social media and all those are great
  • 00:20:47
    for filling in the details but they
  • 00:20:50
    don't they don't replace they don't
  • 00:20:52
    replace it and they you know the concern
  • 00:20:54
    and the the empathy and the the
  • 00:20:56
    non-verbal elements of that
  • 00:20:57
    communication I think technology is good
  • 00:21:00
    for helping to to uh to be a conduit for
  • 00:21:04
    uh conveying and capturing the the the
  • 00:21:07
    details and the data and the decision
  • 00:21:09
    points uh and and things like that and
  • 00:21:11
    you know this the things that we do with
  • 00:21:14
    some of our applications are trying to
  • 00:21:15
    make some of that conversation visual uh
  • 00:21:18
    and capture that in a digital format so
  • 00:21:20
    it's something the patient can take with
  • 00:21:22
    them when they leave that leave that
  • 00:21:24
    conversation but would you know I still
  • 00:21:27
    think it's important that with the the
  • 00:21:29
    Advent of tablets where we can kind of
  • 00:21:30
    stand there shoulder-to-shoulder and
  • 00:21:32
    have a conversation and use the
  • 00:21:33
    technology as an aid but don't let it
  • 00:21:36
    get in the way right right so how do you
  • 00:21:39
    not let it get in the way um you hear
  • 00:21:42
    stories of of the the Doctor Who's
  • 00:21:44
    staring at the the computer trying to
  • 00:21:47
    figure out what to do because he's just
  • 00:21:49
    got this new EHR and he doesn't know how
  • 00:21:51
    to use it how do how do you prevent that
  • 00:21:55
    how do you keep technology get the good
  • 00:21:57
    of Technology without getting that bad
  • 00:21:59
    stuff it's a great it's a great question
  • 00:22:01
    uh I mean from the software side of
  • 00:22:03
    things a lot of that has to do with user
  • 00:22:06
    experience behind the technology if
  • 00:22:08
    we're talking about emrs for example it
  • 00:22:11
    has a lot to do with the design uh and
  • 00:22:13
    of that and mobile technology is great
  • 00:22:16
    because it uh it it has the potential to
  • 00:22:21
    bridge that that kind of face- to-face
  • 00:22:23
    side by-side conversation unless you
  • 00:22:24
    know kind of walk around buried in your
  • 00:22:26
    your iPhone or your iPad but um a lot of
  • 00:22:28
    that has to do with usability and you
  • 00:22:30
    know this is a um I think it's a
  • 00:22:32
    marathon not a Sprint in the sense that
  • 00:22:35
    it's going to take a while for for you
  • 00:22:37
    know software companies to to to develop
  • 00:22:40
    out and to get more Nuance with the the
  • 00:22:42
    specific
  • 00:22:43
    workflows uh I mean if you think about
  • 00:22:46
    um you know there really should be an
  • 00:22:48
    EMR for every combination of where you
  • 00:22:51
    went to medical school where you trained
  • 00:22:53
    where you are today um that's a lot of
  • 00:22:55
    different permutations of of of VMR so
  • 00:22:59
    it's a it's a very difficult problem to
  • 00:23:00
    solve that um that these companies are
  • 00:23:03
    working on Dr Arnold did you have
  • 00:23:05
    something to add to that yeah there's
  • 00:23:07
    some easy things I mean if there's no
  • 00:23:10
    reason why your patient and your doctor
  • 00:23:13
    shouldn't be in the same line of sight
  • 00:23:15
    regardless of whether there's a computer
  • 00:23:17
    there and some of it is saying can you
  • 00:23:20
    please can we move the chair can we
  • 00:23:22
    structure the office so that I don't
  • 00:23:24
    have a computer in front of me and a
  • 00:23:26
    patient beside me so I can't look at
  • 00:23:28
    both of them at the same time the second
  • 00:23:30
    thing is that some of it is remembering
  • 00:23:34
    and I think this is what what John had
  • 00:23:37
    talked about that at important parts you
  • 00:23:40
    need to stop looking at the computer I
  • 00:23:42
    mean today is Valentine's Day right and
  • 00:23:46
    you know if you're looking at your cell
  • 00:23:48
    phone while you're making uh comments of
  • 00:23:53
    of connectedness it you may be lonely
  • 00:23:56
    tonight uh and it seems to me that when
  • 00:23:58
    I'm having the part of the conversation
  • 00:24:01
    that is affect Laden I should not be
  • 00:24:04
    typing I
  • 00:24:06
    should I should change my focus and my
  • 00:24:10
    attention and the patient understands if
  • 00:24:13
    when I'm collecting data I'm at the
  • 00:24:15
    computer but when I'm now saying here's
  • 00:24:17
    what the plan is I need to look away
  • 00:24:19
    from the computer and for those three to
  • 00:24:22
    five minutes give the patient 100% of my
  • 00:24:25
    time and
  • 00:24:27
    energy Dr K you're nodding your
  • 00:24:30
    head do you have something to add as
  • 00:24:32
    well uh yeah in through the voices of
  • 00:24:35
    the women that that we have interviewed
  • 00:24:38
    uh that is one of the major issues that
  • 00:24:42
    they bring up that not only do they feel
  • 00:24:45
    that there's not enough time but within
  • 00:24:48
    the time that they do have with the
  • 00:24:49
    doctor the doctor is not even paying
  • 00:24:51
    attention to them and that really really
  • 00:24:55
    uh sort of sets the stage uh for how
  • 00:24:58
    she's perceiving that interaction so I
  • 00:25:01
    completely agree that um one idea that I
  • 00:25:05
    think uh could work is the doctor can uh
  • 00:25:08
    or whoever is interacting with with with
  • 00:25:11
    with the patient to review the date the
  • 00:25:13
    records uh whatever data they have on
  • 00:25:16
    the patient and then after
  • 00:25:20
    that and then I'm so sorry and then
  • 00:25:23
    after that
  • 00:25:24
    um just try to you know just engage uh
  • 00:25:28
    you know eyee to eye interaction or
  • 00:25:30
    face- Toof face interaction and really
  • 00:25:33
    it's almost like uh qu quality time that
  • 00:25:36
    we talk about it spending with with kids
  • 00:25:38
    that's that's exactly the way that I
  • 00:25:41
    would that I was envisioning when women
  • 00:25:43
    would tell us about how uh it it's been
  • 00:25:46
    for them in in some
  • 00:25:48
    situations right you know I uh I see uh
  • 00:25:53
    20 patients in a half day uh it's a high
  • 00:25:55
    Dermatology is a high volume practice
  • 00:25:57
    and so every minute counts and I don't
  • 00:26:01
    do any charting in the room with the
  • 00:26:03
    patients it's completely I'm completely
  • 00:26:06
    present for them and I do my charting
  • 00:26:09
    outside of the room not that that would
  • 00:26:10
    work for every specialist in every
  • 00:26:12
    situation but just to to sort of drive
  • 00:26:15
    home the point that we're all making
  • 00:26:16
    that as human beings we we've somehow
  • 00:26:20
    lost the ability to be present and
  • 00:26:24
    presence is such an important part and
  • 00:26:26
    it's so powerful and valuable to the
  • 00:26:28
    doctor patient or or provider patient
  • 00:26:30
    relationship shouldn't be that hard for
  • 00:26:32
    us to uh to pick up those skills and
  • 00:26:34
    utilize them so just agreeing with what
  • 00:26:36
    others have said right I think the part
  • 00:26:38
    I think the part of the issue is to go
  • 00:26:40
    slow to go fast and so the first three
  • 00:26:44
    minutes of the interview my job is to
  • 00:26:47
    make sure that the patient and I have
  • 00:26:48
    the same agenda and to explain what the
  • 00:26:51
    heck I'm doing I mean it's okay that I
  • 00:26:54
    type things I I need to say you know at
  • 00:26:57
    the beginning we're now to the part
  • 00:26:59
    where I ask you a lot of questions about
  • 00:27:01
    yourself so I can sort of figure out who
  • 00:27:02
    you are and I type it so that next time
  • 00:27:04
    you come in I have it all written down
  • 00:27:07
    patients get that that's understandable
  • 00:27:10
    but if they just see me typing they
  • 00:27:11
    don't know that I'm not doing my email
  • 00:27:13
    or sending Twitter feeds during the
  • 00:27:15
    conversation and so some of it is just
  • 00:27:17
    to say okay now what we're GNA do is
  • 00:27:19
    we're going to talk about what's next
  • 00:27:21
    and when we talk about what's next that
  • 00:27:23
    part requires sort of face- tof face
  • 00:27:25
    time and it's I don't need to type
  • 00:27:28
    anyway it won't help me and so some of
  • 00:27:30
    it is just learning to say here's what
  • 00:27:33
    I'm going to do next what we're going to
  • 00:27:34
    do now is a physical
  • 00:27:36
    exam now we're going to talk about what
  • 00:27:39
    comes next and I think the problem is
  • 00:27:41
    that doctors do it so often that we
  • 00:27:43
    often don't signpost the way that we
  • 00:27:45
    ought to sign post uh and I think that
  • 00:27:49
    some of it is just being explicit we
  • 00:27:51
    have about 20 minutes today what are the
  • 00:27:53
    things that you want to make sure that
  • 00:27:55
    we accomplish and and just to tap into
  • 00:27:57
    that though I think what's really
  • 00:27:59
    important too is for the patient really
  • 00:28:02
    to give 100% accurate history of of
  • 00:28:06
    their medical condition um regarding
  • 00:28:09
    what they take too because we find that
  • 00:28:12
    patients may not be so forthcoming with
  • 00:28:15
    information whether whether they have a
  • 00:28:18
    history of drug addiction and they they
  • 00:28:20
    might hold that back or they may have uh
  • 00:28:23
    they may take supplements and they might
  • 00:28:24
    not let let your physician or clinician
  • 00:28:26
    know that which is really important
  • 00:28:28
    because that can interact with other
  • 00:28:30
    medications so I think in terms of
  • 00:28:32
    communication it's really important for
  • 00:28:34
    patients to really be 100% clear on what
  • 00:28:37
    they're telling their clinician and
  • 00:28:39
    honest 100% honest so it could avoid any
  • 00:28:42
    kind of
  • 00:28:43
    complications and if you're insured just
  • 00:28:46
    asked so when the doctor says what
  • 00:28:47
    medicines are you're taking and you're
  • 00:28:48
    on 12 vitamins you might say do you want
  • 00:28:50
    to hear about my vitamins too because
  • 00:28:52
    the doctor maybe should have said what
  • 00:28:54
    pills do you put in your mouth but
  • 00:28:56
    sometimes we sort of have a narrow
  • 00:28:58
    perspective as well right so there's
  • 00:29:01
    things that that there's training that
  • 00:29:06
    Physicians need and and maybe patients
  • 00:29:08
    need too but focusing on on what what
  • 00:29:10
    clinicians get what training clinicians
  • 00:29:12
    get what what helps them the there's the
  • 00:29:15
    four habits model of of medical
  • 00:29:18
    communication there are there are other
  • 00:29:20
    models what helps
  • 00:29:23
    clinicians develop those habits because
  • 00:29:26
    they don't seem to come naturally to of
  • 00:29:28
    us well wait a sec we ought to be let's
  • 00:29:30
    be really clear they don't come
  • 00:29:31
    naturally to anybody otherwise you
  • 00:29:33
    wouldn't walk in bookstores and find row
  • 00:29:36
    after row of relationship books we think
  • 00:29:40
    that we communicate well and yet we have
  • 00:29:42
    pretty good data that in most of our
  • 00:29:45
    intimate relationships in which we talk
  • 00:29:47
    about emotions we have lots of problems
  • 00:29:50
    I think that we need to view
  • 00:29:51
    communication as a skill and that I
  • 00:29:54
    think in medical schools and nursing
  • 00:29:56
    schools now they're using many more
  • 00:29:58
    simulated patients to allow people to
  • 00:30:01
    practice and get in the- moment feedback
  • 00:30:05
    and then try it again that we need to
  • 00:30:07
    view Communications just like other
  • 00:30:10
    things that people do and we need to
  • 00:30:12
    help I think healthc care providers have
  • 00:30:14
    more ability to have emotional
  • 00:30:18
    flexibility and mindfulness and there is
  • 00:30:20
    also a big movement from Ron Epstein and
  • 00:30:24
    at University of Rochester and Tony Bach
  • 00:30:26
    at the University of Washington to try
  • 00:30:28
    to teach Physicians to have the ability
  • 00:30:31
    to deal with some of their emotions and
  • 00:30:34
    distractions so that they truly can be
  • 00:30:36
    present as other people have suggested
  • 00:30:38
    that's great Dr pedar do you have
  • 00:30:40
    anything to add to that no I think it
  • 00:30:42
    was well spoken uh it it uh I I really
  • 00:30:47
    can't I can't do better than
  • 00:30:49
    that great I I did want to add really
  • 00:30:53
    something really quickly this is uh um I
  • 00:30:57
    think those commun that type of
  • 00:31:00
    communication would come in so handy
  • 00:31:03
    when working with patients of different
  • 00:31:05
    cultures because that is one of the
  • 00:31:09
    major I think themes of that that we
  • 00:31:12
    found was that because the doctor or at
  • 00:31:17
    least uh some of the women thought that
  • 00:31:18
    the doctor couldn't really be flexible
  • 00:31:20
    with what he was thinking um it it
  • 00:31:25
    really created some kind of uh not not
  • 00:31:28
    not feeling like the like she could
  • 00:31:30
    trust that doctor so I think that um
  • 00:31:34
    with with women who or or just patients
  • 00:31:37
    from different cultures that
  • 00:31:40
    non-judgmental um stay in the moment uh
  • 00:31:42
    type of skill would be
  • 00:31:44
    helpful and a large component with that
  • 00:31:47
    also I think is is empathy which some
  • 00:31:51
    it's easier I think for some people to
  • 00:31:53
    to feel empathy for others but I think
  • 00:31:56
    that's a skill that could be taught that
  • 00:31:57
    was that was mentioned previously um
  • 00:32:01
    empathy there's so much written on the
  • 00:32:03
    topic and I think it's such an important
  • 00:32:05
    component in healthcare today and I
  • 00:32:08
    think when you encounter a physician or
  • 00:32:11
    clinician with empathy I think your care
  • 00:32:13
    and treatment is much more well-received
  • 00:32:15
    and I think there's better outcomes with
  • 00:32:17
    that um so if patients aren't feeling um
  • 00:32:21
    a partnership as which has been
  • 00:32:22
    mentioned earlier um with their
  • 00:32:24
    physician I think they should maybe
  • 00:32:27
    really try to find somebody that fits
  • 00:32:29
    their their needs because that will
  • 00:32:32
    ultimately help them live live a live a
  • 00:32:35
    better life and they can work towards
  • 00:32:37
    goals when they're working
  • 00:32:39
    together but empathy I think is crucial
  • 00:32:42
    and I think it's kind of missing so I
  • 00:32:44
    think it all needs to be in schools
  • 00:32:47
    medical schools nursing schools Farm
  • 00:32:50
    dietitians physical therapists no matter
  • 00:32:53
    what where you are in healthcare it's a
  • 00:32:56
    big component
  • 00:32:59
    right um medical information is often
  • 00:33:03
    presented as hard facts this is your
  • 00:33:06
    diagnosis and it has a x you know
  • 00:33:08
    percent cure rate but in reality the
  • 00:33:12
    choice of of of treatment and um and how
  • 00:33:17
    you're going to go about dealing with
  • 00:33:18
    this illness is is driven by values it's
  • 00:33:22
    driven by
  • 00:33:24
    individuality how do you bridge that
  • 00:33:26
    with the how can Physicians and
  • 00:33:29
    clinicians work with patients to share
  • 00:33:32
    decisions um in a
  • 00:33:34
    way that they're imparting impartial
  • 00:33:38
    information that then gets processed by
  • 00:33:41
    the individual patient Dr K could
  • 00:33:45
    you respond to
  • 00:33:49
    that
  • 00:33:53
    she's failure of communication
  • 00:33:58
    I think you got you're on mute Dr call
  • 00:34:01
    yeah I I think I had um technical issues
  • 00:34:04
    I'm sorry
  • 00:34:07
    question Dr Arnold would you like to
  • 00:34:09
    take that one uh now I forgot what's
  • 00:34:13
    going sure um I Shar decision making
  • 00:34:19
    and the first question is you ought to
  • 00:34:22
    negotiate
  • 00:34:24
    whether um the patient wants to do
  • 00:34:26
    shared decision making
  • 00:34:28
    I mean some patients do and some
  • 00:34:31
    patients don't I I do HIV pain and I
  • 00:34:35
    have to say some of my patients don't
  • 00:34:37
    want to make the decision they don't
  • 00:34:38
    want full information what they really
  • 00:34:40
    want is they they want me to talk to
  • 00:34:44
    their loved one and I think that there's
  • 00:34:46
    this certain sense at the beginning in
  • 00:34:48
    my first visit where we can talk about
  • 00:34:50
    are you the kind of person who likes to
  • 00:34:51
    hear all the information are you the
  • 00:34:53
    kind of person who would rather I talk
  • 00:34:55
    to you know your son or your daughter
  • 00:34:58
    are you the kind of person who likes to
  • 00:35:00
    sort of hear the information then make a
  • 00:35:02
    first decision or would you like my
  • 00:35:04
    recommendation I think they're really
  • 00:35:06
    needs to be upfront a negotiation about
  • 00:35:09
    Styles because you and I have never met
  • 00:35:11
    before and if we don't talk about it at
  • 00:35:14
    the beginning it is unlikely to work out
  • 00:35:17
    you're not going to read my mind and I'm
  • 00:35:18
    not gonna read your mind it's
  • 00:35:20
    interesting I I drag them all into
  • 00:35:23
    shared decision making and and most uh
  • 00:35:27
    the occasionally you get someone who
  • 00:35:28
    says oh I don't know you're the doctor
  • 00:35:31
    and and I take that as the cue to uh to
  • 00:35:33
    be more prescriptive but but what I said
  • 00:35:36
    earlier I think is really true that
  • 00:35:38
    people people that are engaged and
  • 00:35:40
    involved do better and so I I remind
  • 00:35:43
    them that it's their body and their life
  • 00:35:45
    and I'm only there as a steward and most
  • 00:35:48
    of the time I can I can get people to a
  • 00:35:50
    point where they will participate in in
  • 00:35:52
    a shared medical decision making and I
  • 00:35:54
    think we do better with it but you're
  • 00:35:56
    right there are some people people who
  • 00:35:57
    don't want anything to do with it I
  • 00:35:59
    really am a little bit of a beware of
  • 00:36:02
    those folks though because I think
  • 00:36:03
    they're also abdicating their
  • 00:36:04
    responsibility to do their part in
  • 00:36:06
    getting
  • 00:36:07
    better um can you hear me now yes you
  • 00:36:10
    can okay um in response to that question
  • 00:36:14
    I think that I I do agree with others
  • 00:36:16
    that that are talking about sort of
  • 00:36:18
    meeting the patient where they are
  • 00:36:20
    because you will come across some
  • 00:36:22
    patients well where they definitely want
  • 00:36:24
    to have a lot to do with the decisions
  • 00:36:28
    that they have to make but um when we
  • 00:36:30
    look at uh some patients that might come
  • 00:36:33
    from other cultures for example Latino
  • 00:36:36
    culture um in in in their country
  • 00:36:41
    they're used to authority figures and so
  • 00:36:44
    whenever they come across a doctor
  • 00:36:47
    they're going to think the doctor has to
  • 00:36:49
    say it's the doctor's uh how how could I
  • 00:36:52
    tell my doctor how he should do his job
  • 00:36:56
    and and that's that's when doctors can
  • 00:36:59
    can make sort of like the decision is
  • 00:37:01
    this someone who really wants me to make
  • 00:37:04
    a decision because they really don't
  • 00:37:07
    have information or is it because it's
  • 00:37:09
    their culture or is it so sort of like
  • 00:37:12
    play it you know based on where the
  • 00:37:14
    individual is in some situations
  • 00:37:17
    patients may want to V voice their
  • 00:37:19
    opinion but they feel like they
  • 00:37:21
    shouldn't so again we go back to the
  • 00:37:24
    relationships uh what kind of
  • 00:37:26
    relationship uh has a doctor build so
  • 00:37:28
    far with um uh with a patient uh but I
  • 00:37:33
    think that again it's on the individual
  • 00:37:35
    basis
  • 00:37:38
    um and another issue actually on top of
  • 00:37:41
    that would be um with health literacy
  • 00:37:43
    too um in terms of explaining things to
  • 00:37:46
    patients make sure it's really in simple
  • 00:37:48
    terms without medical jargon and just
  • 00:37:50
    really really simplified level because
  • 00:37:54
    even the even someone who has is high
  • 00:37:57
    educated though too if they're getting
  • 00:38:00
    news that is not very good news um
  • 00:38:03
    everything can kind of break down and
  • 00:38:05
    they're not even hearing what's being
  • 00:38:06
    said so the simplest language in simple
  • 00:38:10
    simple terms really can help the
  • 00:38:13
    communication process as well um just
  • 00:38:17
    one thing on that um as well uh in in
  • 00:38:21
    our work as well we have heard even
  • 00:38:23
    though the there I've been speaking a
  • 00:38:25
    lot about those that might might not
  • 00:38:27
    have
  • 00:38:28
    uh great knowledge the ones that they
  • 00:38:30
    feel like they do have knowledge if the
  • 00:38:33
    doctor sort of approaches them in in a
  • 00:38:35
    way that let me tell you or let me make
  • 00:38:38
    the decisions they do feel as if they're
  • 00:38:41
    um not being respected um so again it's
  • 00:38:45
    it's it's all about meeting the patient
  • 00:38:46
    where they
  • 00:38:48
    are this relates to a question we got
  • 00:38:51
    from a Facebook user
  • 00:38:53
    constant
  • 00:38:55
    katar Kat
  • 00:38:58
    nness we once I once heard that if I if
  • 00:39:01
    you ask a patient do you have any more
  • 00:39:04
    questions the average length of time a
  • 00:39:06
    patient will talk or ask questions is
  • 00:39:08
    about 90 seconds I feel like if that and
  • 00:39:12
    in my experience it it's true we're
  • 00:39:16
    missing a wonderful opportunity with our
  • 00:39:18
    patients to make them feel rightfully so
  • 00:39:20
    like an active participant in our in
  • 00:39:23
    their health care is this true have we
  • 00:39:25
    done studies on this are there so are
  • 00:39:28
    there studies about how the time in a
  • 00:39:32
    medical encounter is used by The
  • 00:39:34
    Physician and the
  • 00:39:35
    patient John do you
  • 00:39:37
    have um I I can't speak to the studies
  • 00:39:40
    but I think um I think uh sorry I I
  • 00:39:45
    completely lost my train of thought
  • 00:39:46
    there but
  • 00:39:48
    um uh sorry that was that was bad um I
  • 00:39:52
    think one thing uh next next presenter
  • 00:39:56
    I'm sorry me I'll give you a break uh
  • 00:39:59
    there is a a rather famous uh a study
  • 00:40:03
    that was done at the hospital bedside
  • 00:40:05
    that that relates to this and what they
  • 00:40:06
    did was they had rounding uh teams of
  • 00:40:09
    physicians in the hospital uh spend five
  • 00:40:12
    minutes every day with a patient but uh
  • 00:40:15
    it was mixed up so that one day it was
  • 00:40:19
    five minutes at the bedside at IE level
  • 00:40:22
    uh another day it was 5 minutes uh at
  • 00:40:24
    the doorway and and a third day it was 5
  • 00:40:28
    minutes at the bedside but standing and
  • 00:40:30
    then they went around and asked the
  • 00:40:31
    patients how much time did your doctor
  • 00:40:33
    spend with you today and if you were
  • 00:40:36
    kneeling down at I level with the
  • 00:40:37
    patient for five minutes they thought it
  • 00:40:39
    was 10 uh but if you were at the doorway
  • 00:40:42
    for five minutes they thought it was two
  • 00:40:45
    uh so it makes a huge difference how you
  • 00:40:47
    use your time and how effectively you uh
  • 00:40:50
    uh uh participate in and as as we've
  • 00:40:54
    we've already talked about that so the
  • 00:40:56
    the the issue about the end of the visit
  • 00:40:59
    and and asking is there any more
  • 00:41:01
    questions the the uh individual who
  • 00:41:03
    wrote that
  • 00:41:04
    in is is really completely on on topic
  • 00:41:08
    uh with that one because it is something
  • 00:41:10
    you can do I do it at the beginning as
  • 00:41:12
    well I just say what can I do for you
  • 00:41:13
    and I don't say a word till they stop
  • 00:41:15
    talking and people don't go on that long
  • 00:41:17
    and then they really feel like they've
  • 00:41:18
    been heard they're they're both very
  • 00:41:20
    effective ways to use a small amount of
  • 00:41:22
    time and get a lot out of it the studies
  • 00:41:24
    show that if you just ask an openend
  • 00:41:26
    question to begin with at most patients
  • 00:41:29
    the longest anyone will talk is two to
  • 00:41:31
    two and a half minutes that's right and
  • 00:41:32
    the other thing to remember is that you
  • 00:41:34
    know there are little things you can do
  • 00:41:37
    so I can either say do you have any more
  • 00:41:39
    questions and shake my head no and
  • 00:41:41
    you'll probably say no or I can say what
  • 00:41:44
    other questions do you have that is I
  • 00:41:45
    can assume you have questions and
  • 00:41:48
    continue to say what other questions do
  • 00:41:50
    you have until you say nothing and you
  • 00:41:53
    know I think that doctors worry about
  • 00:41:56
    the very vocal person who will talk for
  • 00:42:00
    hours and yet again there are relatively
  • 00:42:03
    easy skills that you can teach most
  • 00:42:06
    doctors or nurses or psychologists to
  • 00:42:09
    try to sort of remind people of the
  • 00:42:10
    amount of time that we have left and
  • 00:42:12
    most people are more than willing and
  • 00:42:14
    are very respectful of that i' I'd like
  • 00:42:17
    to chim back in after I recovered my
  • 00:42:19
    brain um uh the uh one of the things
  • 00:42:23
    that that we're finding very interesting
  • 00:42:25
    about the the work that we're doing by
  • 00:42:27
    creating tools for Physicians is they're
  • 00:42:29
    they're about educating patients and
  • 00:42:31
    they're about it's about encouraging
  • 00:42:33
    patients to be more active participants
  • 00:42:36
    but I I think due to some of kind of the
  • 00:42:40
    cultural Legacy and the way that the
  • 00:42:41
    Health Care system is traditionally set
  • 00:42:43
    up that that that is um patients are a
  • 00:42:46
    little bit scared to do that or or
  • 00:42:47
    reluctant to do that and so a big part
  • 00:42:50
    of what we're doing is about um is is is
  • 00:42:53
    giving the tools to Physicians to let
  • 00:42:55
    them lead that to basically um open up
  • 00:42:58
    the door for the patient to engage in
  • 00:43:00
    the conversation so it's not just ask
  • 00:43:02
    them if they have any questions but
  • 00:43:04
    bring the conversation to to the level
  • 00:43:06
    of understanding for example with the
  • 00:43:08
    the drawing D apps is an example with
  • 00:43:10
    simple drawings that can that can open
  • 00:43:13
    up the door of understanding to pull the
  • 00:43:15
    patients into the conversation so it's
  • 00:43:17
    it's the physicians in a position of
  • 00:43:19
    authority let them lead the charge of of
  • 00:43:22
    engaging patients and give them the
  • 00:43:24
    tools to do that in an efficient way
  • 00:43:27
    right that's great we have a question
  • 00:43:30
    from Christina on Twitter how do
  • 00:43:33
    clinicians feel about mobile health and
  • 00:43:36
    the WebMD boom has it impacted
  • 00:43:39
    Communications
  • 00:43:41
    positively who wants to tackle that
  • 00:43:46
    one so um there is nothing that strikes
  • 00:43:51
    more fear into most clinicians heart
  • 00:43:55
    than patients who come with about 5 to
  • 00:43:58
    23
  • 00:43:59
    Ines of Google searches
  • 00:44:03
    Andor uh reports uh and then wants to
  • 00:44:09
    give them to the clinician and has like
  • 00:44:11
    annotated questions next to many of
  • 00:44:14
    those pages so you know the the problem
  • 00:44:18
    is that there's so much information out
  • 00:44:21
    there that for people whose way of
  • 00:44:25
    coping is to read more and more
  • 00:44:28
    information they will end up making
  • 00:44:31
    themselves and I would argue their
  • 00:44:33
    clinicians pretty crazy uh on the other
  • 00:44:37
    hand some of the websites are great I
  • 00:44:40
    mean the NCI has great websites for
  • 00:44:45
    patients with cancer they're great
  • 00:44:47
    informational websites and patient uh
  • 00:44:51
    list serves for things from lupus to
  • 00:44:53
    chronic fatigue syndrome uh their HIV
  • 00:44:57
    patient communities that are amazing and
  • 00:44:59
    so the question is how are you going to
  • 00:45:02
    use it and to what degree do you in the
  • 00:45:06
    end trust your clinician once you get in
  • 00:45:10
    the room because if the bottom line is
  • 00:45:12
    everything your clinician says you want
  • 00:45:13
    to go and
  • 00:45:15
    Google I think you should think about
  • 00:45:17
    whether you have the right clinician or
  • 00:45:19
    not are there ways that the Health Care
  • 00:45:22
    system can help um winow down the the
  • 00:45:26
    amount of information that that uh
  • 00:45:28
    patients you or or steer them in in
  • 00:45:32
    direction of reputable
  • 00:45:35
    information yeah it'd be great if the
  • 00:45:38
    the you know and this may already be
  • 00:45:39
    done I'm not an expert in the web if
  • 00:45:41
    there were like Good Housekeeping seals
  • 00:45:43
    of approval and I think I think some of
  • 00:45:46
    the you know that some of the physician
  • 00:45:49
    uh groups like The American College of
  • 00:45:50
    physicians in fact have put together in
  • 00:45:53
    many articles now have sort of
  • 00:45:54
    information for patients if I was a
  • 00:45:57
    patient and I was Googling things I
  • 00:45:59
    would want things that have some
  • 00:46:03
    reputation behind them rather than
  • 00:46:06
    someone who's trying to sell me
  • 00:46:07
    something at the same time so I'd be
  • 00:46:09
    worried about for example Chinese stem
  • 00:46:12
    cell sites and those kinds of places
  • 00:46:14
    that that have anecdotes and don't have
  • 00:46:17
    anything that's sort of from a
  • 00:46:18
    scientific literature that's the best I
  • 00:46:20
    can
  • 00:46:21
    do you have a perspective on that I um
  • 00:46:25
    oh I'm sorry did you say me yes oh I'm
  • 00:46:28
    sorry um yeah there there is so much
  • 00:46:31
    information out out on the web and I
  • 00:46:33
    think it's great though that that
  • 00:46:35
    patients and cons consumers can can
  • 00:46:37
    search for things and bring this
  • 00:46:38
    information to their clinician I'd like
  • 00:46:40
    to say though uh um oh um Gary schwitzer
  • 00:46:45
    from healthnew review.org I I just need
  • 00:46:48
    to mention him because he has a site
  • 00:46:51
    that for healthcare journalists but also
  • 00:46:53
    for consumers that provides information
  • 00:46:57
    about what to really look for when
  • 00:46:59
    you're reading news and he mentions all
  • 00:47:02
    different networks all different print
  • 00:47:05
    newspapers and magazines and he'll tell
  • 00:47:07
    you if it's more hype or uh really solid
  • 00:47:12
    information because he goes through all
  • 00:47:14
    criteria um he mentions that some
  • 00:47:16
    journalists may just go off a press
  • 00:47:18
    release and write write an article from
  • 00:47:21
    that and they're not really looking at
  • 00:47:22
    the study and and then he he talks about
  • 00:47:25
    how to kind of dive into that study so I
  • 00:47:27
    think it's really important information
  • 00:47:29
    because there is so much information out
  • 00:47:31
    there this can kind of kind of put you
  • 00:47:34
    on track as to what's what to look for
  • 00:47:36
    and what's really useful and valuable um
  • 00:47:39
    but I think it's great that patients can
  • 00:47:41
    be so empowered to research and and find
  • 00:47:44
    information and this is where clinicians
  • 00:47:46
    can come into play and really help guide
  • 00:47:48
    them but as my point from the very
  • 00:47:50
    beginning it's really crucial I think to
  • 00:47:52
    write down information before you go and
  • 00:47:54
    see your doctor or or clinic just just
  • 00:47:57
    to help prepare yourself and kind of uh
  • 00:48:00
    navigate where the conversation will go
  • 00:48:03
    but I think the internet is amazing and
  • 00:48:06
    I think it's just moving at full force
  • 00:48:09
    and it's we haven't seen seen it what it
  • 00:48:12
    can do yet I don't
  • 00:48:15
    think I think there's a very
  • 00:48:19
    interesting parallel or sort of a
  • 00:48:21
    construct that already exists in this in
  • 00:48:23
    this situation the idea of a peer review
  • 00:48:26
    um a lot of the Physicians that we work
  • 00:48:28
    with um we have a lot of Physicians that
  • 00:48:30
    that that contribute to our applications
  • 00:48:33
    and to our products and that offer up
  • 00:48:35
    suggestions because um they want to use
  • 00:48:37
    a tool and they want to they want to
  • 00:48:39
    have information available for their
  • 00:48:41
    patients but they want to to Quality
  • 00:48:42
    Control that a little bit and they have
  • 00:48:44
    to balance that with the time it takes
  • 00:48:46
    to do that so think about the imagine
  • 00:48:49
    the idea of of of ways to do peer review
  • 00:48:53
    find what your colleagues uh are are
  • 00:48:56
    using
  • 00:48:57
    to communicate with their patients the
  • 00:48:59
    best practices the best resources on the
  • 00:49:01
    web that are vetted through their own
  • 00:49:03
    experiences and aggregate all that
  • 00:49:05
    together and use that as a way to to to
  • 00:49:07
    take that content and get in front of
  • 00:49:10
    that of the the uh the the WebMD train
  • 00:49:14
    that that Dr Arnold described you know
  • 00:49:16
    put the resources in their hands before
  • 00:49:18
    they come in with with pages and reams
  • 00:49:20
    of of of information but use the
  • 00:49:22
    technology and leverage your colleagues
  • 00:49:25
    experiences to uh to to make that
  • 00:49:28
    something that you can do with the time
  • 00:49:29
    constraints that the profess that the
  • 00:49:31
    profession puts on its its people Selma
  • 00:49:35
    did you have something to add to
  • 00:49:38
    this s you might be on
  • 00:49:43
    mute oh okay um can you hear me now yeah
  • 00:49:47
    okay great um I know that you were
  • 00:49:49
    talking about mobile um uh healthc care
  • 00:49:53
    and I in in my experience in my work
  • 00:49:58
    mobile healthc care has been so pivotal
  • 00:50:01
    when it comes to people that don't have
  • 00:50:04
    access to health care for them to access
  • 00:50:06
    it or may they may have uh clinics that
  • 00:50:09
    they can go to in their Community but
  • 00:50:11
    because of their busy schedules or many
  • 00:50:14
    other um uh things that they have to do
  • 00:50:16
    Mobile healthc Care is something that
  • 00:50:18
    they they end up using quite a bit and
  • 00:50:21
    um helpful for
  • 00:50:23
    them when you're talking about mobile
  • 00:50:25
    healthare talking about mobile
  • 00:50:29
    technology oh yeah you were talking
  • 00:50:30
    about mobile technology um um I was
  • 00:50:34
    actually talking more about you know
  • 00:50:36
    just mobile hand uh Vans and and going
  • 00:50:39
    into communities
  • 00:50:40
    really yeah uh now in terms of mobile
  • 00:50:44
    technology that's a little bit trickier
  • 00:50:46
    because at least with the population
  • 00:50:48
    that I've uh done research with um they
  • 00:50:52
    might not have access to to uh mobile
  • 00:50:56
    phone in some situations um families
  • 00:50:59
    share a phone so that may not be as as
  • 00:51:02
    um I don't know effective for for the
  • 00:51:05
    populations that I've been working with
  • 00:51:07
    but I can see for maybe other
  • 00:51:09
    populations that do have access to those
  • 00:51:11
    can be very effective especially to keep
  • 00:51:13
    them engaged while they're not in in you
  • 00:51:16
    know at the doctor's office or they're
  • 00:51:17
    not in the clinic uh that's definitely
  • 00:51:19
    has been uh pretty effective from from
  • 00:51:22
    some preliminary uh findings that that
  • 00:51:24
    um that have shown shown
  • 00:51:27
    that we question from Dan Buckland on
  • 00:51:34
    Twitter asking about outcomes how do we
  • 00:51:37
    know if you know any kind of
  • 00:51:40
    communication Improvement efforts are
  • 00:51:42
    working how do we measure
  • 00:51:45
    this John do you have some ideas on
  • 00:51:50
    this um you know it's it's definitely um
  • 00:51:54
    it's definitely tough because um you
  • 00:51:56
    know the the when it comes down to data
  • 00:51:59
    if you want to think about it in data in
  • 00:52:00
    the data sense and sort of tying all the
  • 00:52:02
    the threads together um there are
  • 00:52:05
    massive challenges from a systems
  • 00:52:07
    integration standpoint that you have to
  • 00:52:10
    you know kind of figure out how to get
  • 00:52:11
    all the systems to communicate together
  • 00:52:13
    and aggregate all the data and and and
  • 00:52:15
    look at that and kind of factor out all
  • 00:52:18
    the confounding effects and everything
  • 00:52:20
    so um you know I think it's I think it's
  • 00:52:22
    difficult there's there's you know more
  • 00:52:25
    of a holistic approach that you can take
  • 00:52:27
    is is leverage the social media leverage
  • 00:52:29
    those connections that the Physicians
  • 00:52:31
    are creating and nurturing directly with
  • 00:52:33
    their patients to get that information
  • 00:52:35
    back from them is this working for you
  • 00:52:37
    is do you feel like you're more in
  • 00:52:38
    control of your Healthcare or how do you
  • 00:52:40
    feel about your outcomes and it's not
  • 00:52:41
    the same as the statistical data and the
  • 00:52:44
    measured outcomes but it's um you know
  • 00:52:47
    there's value in it as well and it's
  • 00:52:49
    it's directional and it's um it's
  • 00:52:53
    useful I think it may be I think you may
  • 00:52:57
    um evaluated personally by patient by
  • 00:53:00
    patient as um communication if it's
  • 00:53:04
    working with outcomes if they're
  • 00:53:05
    achieving their health goals if if you
  • 00:53:08
    have certain health goals set out for
  • 00:53:09
    your patient and then they're meeting
  • 00:53:11
    them without any kind of
  • 00:53:14
    uh
  • 00:53:16
    um in you know
  • 00:53:18
    anything interfering with that then then
  • 00:53:21
    you can measure that but I understand
  • 00:53:23
    the question I don't think I really
  • 00:53:25
    answered it I think I think maybe he
  • 00:53:27
    wants a little bit more uh tangible type
  • 00:53:30
    of answer as to maybe studies if there
  • 00:53:33
    have been done with with outcomes in
  • 00:53:35
    communication I offand I I can't recall
  • 00:53:39
    any I don't know if the other panel
  • 00:53:40
    members are aware of any studies from
  • 00:53:43
    about outcomes with communication
  • 00:53:46
    and there's a there's a really large
  • 00:53:50
    literature that looks at both the
  • 00:53:52
    empowering patient literature and health
  • 00:53:56
    out comes as well as interventions to
  • 00:53:59
    promote uh Health Care Providers
  • 00:54:01
    communication and its relationship to
  • 00:54:04
    Patient trust and patient
  • 00:54:06
    satisfaction and adherence I mean uh
  • 00:54:09
    some of these were discussed at the
  • 00:54:11
    beginning I mean there there is a very
  • 00:54:13
    large and rapidly
  • 00:54:15
    growing uh literature on the effects of
  • 00:54:19
    uh clinician communication and uh
  • 00:54:22
    attempts to teach
  • 00:54:24
    communication uh and it's a effect on
  • 00:54:26
    patient care we've done a fair number of
  • 00:54:28
    studies looking at
  • 00:54:30
    oncologists uh communication and their
  • 00:54:33
    ability to sort of respond to empathic
  • 00:54:35
    opportunities for example in patient
  • 00:54:37
    trust there's there's an enormous amount
  • 00:54:39
    of literature yeah I don't know the
  • 00:54:41
    specific study I know Dr Marino from the
  • 00:54:43
    Cleveland Clinic wrote actually in one
  • 00:54:44
    of his blogs about uh that there's less
  • 00:54:46
    liability involved with better
  • 00:54:48
    communication with Physicians and that's
  • 00:54:50
    just a tap into it but I um he may go
  • 00:54:53
    more into detail on that in in his
  • 00:54:56
    but um I think just ongoing
  • 00:54:58
    communication is is so important and I
  • 00:55:01
    think side just to I might be getting
  • 00:55:03
    off track a little bit but the silos are
  • 00:55:05
    still so separated in healthcare I think
  • 00:55:07
    we need to kind kind of put everything
  • 00:55:10
    together and not have everyone so so
  • 00:55:12
    separated and and every and so much is
  • 00:55:15
    going on in the whole social media Arena
  • 00:55:17
    that Healthcare can really tap into it
  • 00:55:19
    and listen to the conversations that are
  • 00:55:21
    occurring whether it's on Twitter or
  • 00:55:23
    Facebook and and really see what
  • 00:55:25
    patients and consumers have talking
  • 00:55:26
    about and what they want and um I know
  • 00:55:29
    Regina holiday is a huge EP patient
  • 00:55:31
    person out in the Twitter ver and
  • 00:55:35
    Facebook and she started patients uh
  • 00:55:37
    Partnerships with patients on Facebook
  • 00:55:39
    there's so many
  • 00:55:40
    great Advocate uh advocacy patient types
  • 00:55:45
    out there and Eep patient Dave is
  • 00:55:47
    actually the first e-patient that I've
  • 00:55:48
    ever heard of he's instrumental in the
  • 00:55:50
    in the whole e patient arena for
  • 00:55:52
    encouraging empowered patients I think
  • 00:55:55
    healthcare really needs to tap into
  • 00:55:56
    these folks and into into social media
  • 00:55:59
    itself and really listen and see what's
  • 00:56:01
    going on because it it needs to
  • 00:56:04
    integrate with within the Health Care
  • 00:56:05
    System it's still separated and we need
  • 00:56:07
    to find a collaboration the the
  • 00:56:10
    dichotomy is there and we we need to
  • 00:56:13
    make it make it strong and everybody
  • 00:56:14
    work together because it's it's about
  • 00:56:17
    patients lives and they're looking for
  • 00:56:19
    answers and they're talking about it and
  • 00:56:22
    we can Healthcare can can tap into what
  • 00:56:25
    they're what they're talking about right
  • 00:56:27
    I think I got off track a little bit
  • 00:56:29
    running out of time but one more
  • 00:56:30
    question that kind of relates to this is
  • 00:56:33
    and this comes from from the Twitter
  • 00:56:35
    feed how do clinicians talk to each
  • 00:56:38
    other about their patients how do they
  • 00:56:41
    exchange information about their their
  • 00:56:43
    patients um when what's the most
  • 00:56:45
    effective way to do
  • 00:56:47
    that John Cox do you have some
  • 00:56:49
    perspective on that oh I mean I think
  • 00:56:53
    there's you know I think we've seen a
  • 00:56:55
    whole range of of of different options
  • 00:56:57
    there and I think one of the things
  • 00:56:59
    that's really great and I guess this for
  • 00:57:00
    me this is kind of what health 2.0 is
  • 00:57:03
    all about is that um it's about the
  • 00:57:05
    individuals taking the initiative to try
  • 00:57:09
    new things and to experiment um you know
  • 00:57:11
    everything from um people bringing iPads
  • 00:57:14
    into to their uh into their practice and
  • 00:57:16
    using your iPhones and iPads and bring
  • 00:57:18
    them into the practice using them with
  • 00:57:20
    the patients but also using them with
  • 00:57:21
    the Physicians as well you know sharing
  • 00:57:24
    um images and and chatting and and and
  • 00:57:27
    the like you know to people that kind of
  • 00:57:29
    get fed up with that and that they want
  • 00:57:30
    to they want to build products um for
  • 00:57:33
    their colleagues to use to to to work
  • 00:57:36
    together I mean you know you can't um
  • 00:57:39
    you know shake a stick without hitting a
  • 00:57:41
    a mobile Health startup that's that's
  • 00:57:43
    founded by a doctor that's got that's
  • 00:57:45
    got um a specific problem that they want
  • 00:57:47
    to solve that was something that that
  • 00:57:49
    was a problem for them that's exactly
  • 00:57:51
    how visible Health got started and we we
  • 00:57:53
    talk to people almost every day that
  • 00:57:55
    have the the same kind of interest um so
  • 00:57:59
    you know I that's that's what's so
  • 00:58:00
    exciting to me is the individual
  • 00:58:02
    empowerment and so I think that there's
  • 00:58:04
    not really a one-sized fit all it's
  • 00:58:06
    different Physicians have different
  • 00:58:09
    methodologies that work for them to
  • 00:58:11
    collaborate with there um with their
  • 00:58:14
    colleagues and a lot of times they they
  • 00:58:15
    may even resist some of the the kind of
  • 00:58:18
    heavy
  • 00:58:19
    structured elements and they they want
  • 00:58:21
    to kind of gravitate towards the things
  • 00:58:23
    that fit best within their Lifestyles
  • 00:58:25
    and their and their particular work
  • 00:58:27
    environments Dr Arnold do you have
  • 00:58:29
    something to add to that well yeah I
  • 00:58:31
    mean part of what I would say is what
  • 00:58:33
    works the best is picking up the phone
  • 00:58:37
    and calling someone what works the best
  • 00:58:40
    is like running into them and saying hey
  • 00:58:42
    can we talk about X Y or Z the problem
  • 00:58:45
    is that it's inefficient in our busy
  • 00:58:47
    lives and so the real question I would
  • 00:58:49
    say and I think this is what John
  • 00:58:51
    focuses on is what can we use technology
  • 00:58:54
    to do that's basically cognitive it's
  • 00:58:57
    trading cognitive information that my
  • 00:58:59
    saying it to him is no better than
  • 00:59:03
    reading it on a script and then what are
  • 00:59:05
    the things that we need to sort of talk
  • 00:59:08
    to each other about like you know
  • 00:59:10
    old-fashioned talking because I think
  • 00:59:13
    that one of the things that you see is
  • 00:59:15
    you see the bad use of the web the bad
  • 00:59:19
    use of email the bad use of sort of
  • 00:59:22
    communication where things get lost and
  • 00:59:24
    so for me it's not in either or it's
  • 00:59:27
    what can we use the web for that the web
  • 00:59:30
    has been built for and is really good at
  • 00:59:33
    and what can we use you know
  • 00:59:35
    old-fashioned talking for but that's
  • 00:59:38
    probably
  • 00:59:39
    better multimodal communication it's
  • 00:59:42
    it's not you don't have to get it all in
  • 00:59:44
    one place right you don't have to boil
  • 00:59:46
    the ocean and do that there are a lot of
  • 00:59:48
    different tools including face Toof face
  • 00:59:51
    conversation and getting on the phone
  • 00:59:53
    that that you just there's no there's no
  • 00:59:56
    no substitute for those in in certain
  • 00:59:58
    situations right I don't think any I'm
  • 01:00:00
    sorry I I don't think anything will
  • 01:00:02
    ever interfere with the face-to-face
  • 01:00:06
    relationship between patient and
  • 01:00:07
    clinician but I but I also think
  • 01:00:10
    technology is moving at lightning speeds
  • 01:00:12
    and and there's tele medicine that's
  • 01:00:14
    being used tele Psychiatry is being used
  • 01:00:17
    and I mean we're only kind
  • 01:00:18
    of it'll only go full force and I don't
  • 01:00:21
    it's not going to go away and and the
  • 01:00:23
    technology is there it's it's already
  • 01:00:25
    invented it's just tapping into it now I
  • 01:00:27
    know Kaiser I just actually had an
  • 01:00:29
    interview with uh Bernard Tyson the the
  • 01:00:31
    CEO elect and he says all uh of Kaiser
  • 01:00:35
    now is using um that they'll be using
  • 01:00:37
    tele medicine there and all their
  • 01:00:39
    Physicians are emailing patients um
  • 01:00:42
    members of Kaiser so I think it's only
  • 01:00:44
    going to continue to move full force and
  • 01:00:46
    even in the hospital P patients and
  • 01:00:48
    their families are bringing their
  • 01:00:49
    laptops with them and they're they're
  • 01:00:51
    they're Googling things as you're
  • 01:00:52
    talking with them and they're saying is
  • 01:00:54
    this best practice can you make sure
  • 01:00:56
    that everything that is being done is
  • 01:00:57
    best practice I mean I've never heard
  • 01:00:59
    anybody use best practice other than
  • 01:01:01
    Healthcare practitioners but now
  • 01:01:02
    patients are saying that and and their
  • 01:01:04
    family members so it has the internet
  • 01:01:07
    has educated consumers Beyond
  • 01:01:11
    uh greatly and it's only going to to
  • 01:01:14
    move forward so I think we need to all
  • 01:01:16
    get on board that this is what it is and
  • 01:01:18
    uh but learn to communicate still learn
  • 01:01:21
    to communicate face to face because we
  • 01:01:23
    are kind of missing that a little bit
  • 01:01:25
    too thank you bar give one last we're
  • 01:01:30
    actually out of time but I want to give
  • 01:01:32
    S one more chance yeah um just this
  • 01:01:35
    conversation really reminds me of some
  • 01:01:37
    of the the uh what I've heard from
  • 01:01:40
    patients about privacy uh no matter what
  • 01:01:44
    it is the vehicle in which uh doctors
  • 01:01:47
    are communicating with one another uh
  • 01:01:50
    it's important for uh patients to know
  • 01:01:52
    that their that their privacy is being
  • 01:01:54
    kept otherwise trust is going to be um
  • 01:01:59
    you know hurt there right a very good
  • 01:02:02
    point and it shows that we could go
  • 01:02:05
    talking about this topic for hours and
  • 01:02:07
    hours and not even scratch the surface
  • 01:02:10
    uh so thank you so much for giving um
  • 01:02:13
    your time today um the conversation will
  • 01:02:16
    continue on tedm med.com on the great
  • 01:02:19
    challenges page for improving medical
  • 01:02:22
    Communications thank you to our team
  • 01:02:25
    members who generously participated
  • 01:02:27
    today and thanks to the tedm community
  • 01:02:30
    who watched and sent questions as I
  • 01:02:34
    um you can join us for our next live
  • 01:02:37
    event where we discuss preparing for
  • 01:02:39
    dementia on Thursday February 21st at 1
  • 01:02:44
    pm eastern time and I want to wrap up by
  • 01:02:49
    saying thank you again to the Robert
  • 01:02:51
    Wood Johnson Foundation the sponsor of
  • 01:02:54
    the great challenges program thank you
  • 01:02:56
    everyone and have a great evening thank
  • 01:02:59
    you thanks bye
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