Episode 8: Highlights and Insights, Part 2

Take a deeper dive into the paradigm shifts discussed by previous guests Dr. Justin Smith, a.k.a. @TheDocSmitty, and practice administrator Terry Leidner. Join Scott, Michael, and Jared as they share additional resources and reactions related to teamwork, new patient relationships, administrative challenges, and humanizing doctors.

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Archive of previous episodes: http://paradigmshift.health

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Show Resources

  1. https://www.p3inbound.com/blog/episode-6-the-3-es-of-the-new-healthcare-relationship/ – Episode 6 – The 3 E’s of the New Healthcare Relationship – full interview with Dr. Smith
  1. https://www.p3inbound.com/blog/episode-7-the-practices-backstage-evolution/ – Episode 7 – The Practice’s Backstage Evolution – full interview with Terry Leidner
  1. https://www.instagram.com/thedocsmitty_pediatrician_dad – Dr. Smith’s Instagram, including highlight videos for baby well checks
  1. https://www.checkupnewsroom.com/ – Dr. Smith’s blog and patient education website

Full Transcript

Announcer: It’s time to think differently about healthcare. But how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell. Here. We leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together. And here’s some amazing stories along the way. Ready for a breath of fresh air, it’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts with my co-hosts, Jared Johnson and Scott Zeitzer. On today’s episode, we’re digging in deeper for our two most recent interviews. We’ll talk about patient experience in social media from our conversation with Dr. Justin Smith. And we’ll cover the challenges that Terry Leidner brought up for practices.

Scott: Yeah, you know, people inexperience is a huge factor, Dr. Smith, and if you were listening to our previous podcasts with Dr. Greene and Dr. Kirshenbaum, they all have systems that they have developed. So it’s not just that they’re charming. It’s not that they just care because I think there are a lot of charming caring people, but they took it to the next level by having a lot of systems put into place that worked for them.

Michael: Absolutely. I love hearing the different contexts around the systems that they’ve put in place. So doctors Greene and Kirshenbaum are both orthopedic surgeons. They work with adults. They have very specific systems that Greene talked about how he sits with patients, how he interacts with patients, that sort of stuff. Dr. Kirshenbaum has an entire system all the way through his team for like every single aspect, it seems like the way that the practice interacts. And then Dr. Smith is working with families, working with completely different demographic there.

Scott: Right, pediatrics, but the link in principle here is this teamwork. Greene make sure that he’s sitting in the right place and looking at the patient the right way, that his team knows that this is where he would like to have the patient sit. This is the type of information that he would like to talk to the patient about as well as the individual people, what they should be talking about and remembering to take care of what Kirschenbaum is doing with patients, but what all the team members, like when they walk in, when they walk out and the workflow that he needs to manage just because there’s such a large volume. And then to your point, a whole different audience, shall we say, a pediatrics, where he’s not only having to take care of the patient that is the child, but the patient that is the parent of the child.

Dr. Smith: I want to engage really at this point now. I’m looking at Gen Z parents. When I first started, it was really trying to figure out how to engage with millennial parents. But now it’s really that next generation. And I don’t think that I really have the luxury not to figure out how to use digital help because that’s critical to what that my new parents and what’s important to them. They’ve grown up digital natives, it’s just the part of their lives. So I think it became just something that I saw as a need and it’s only growing more as a need.

Jared: One thing that I think Dr. Smith, you know, focused on that it stuck with me was how he sees patient experience as something way beyond just what happens in the clinic. He talked about three different stages: pre-encounter stage, encounter stage, and post-encounter stage. And I think even just that as a paradigm, that is something that has changed in the provider community because they realized that our experience with healthcare happens a lot more than just what they tend to focus on and the types of things that we did hear about, about how to set up the clinic, you know, from some of our previous guests, like you guys mentioned, those things are all important too.

And this is kind of like an additional piece of that experience is to think about what happens as we are searching for information about our health before we come and speak with the provider, and then afterward. And just thinking in those stages, hearing I guess a doctor put it in those terms really kind of crystallized it for me. Helped me realize that they’re thinking about it a lot in a lot of cases and they’re trying to figure out how to interact with us in those times when they’re not seeing us face to face.

Michael: I agree. It really helped clarify Dr. Justin Smith towards his approach towards how he interacts with patients online, how he provides content for people and in all the different places that he provides content. If they’ve got content on the hospital’s website, he’s got content that’s going out to social media. And again, this has very much been a theme of the show as we’ve been talking to different people, good education kind of material. And it’s something that patients can relate to very easily. It’s not written at a level that’s very clinical, that’s very high up. In review for this show, I actually went back and I was looking through some of Dr. Smith’s Instagram posts, and it’s a one little nugget of information, right?

It’s Instagram, so stuff is blowing by very quickly. But here’s this one piece of information that as a parent you can kind of put that in your arsenal. Here’s what to do when I come across this situation. And even how he was talking about families going back to things like Instagram, Facebook page, and searching for posts they’d seen previously, to be able to get that reminder. You know, I saw this at one point, here’s how I can get back to that information. It reminded me also of how Robin from the Colitis Foundation, how she had talked about that need for content to be out there. There’s this interesting dynamic.

And this is something that even came up in a Twitter chat that I was a part of even last night where we need to be able to provide information to patients when they’re looking for it. When I know I have problem X and I need to be seen for this thing, I can go and find the information that I need to feel better about all that. But then there’s the proactive part of it, which is just getting information out there about something that may become relevant to somebody later on. And it’s very hard to do that in an engaging way consistently. You can blast information out all day long but for people to be able to see that and understand that this is something that I eventually will need to act on, it’s a real challenge. It’s not an easy thing for healthcare in general to know how to tackle.

Jared: That just brought to mind I guess that those exact Instagram highlights videos that Dr. Smith was talking to, he was referring to. And I likewise, Michael, I went back and I actually checked out some of those videos after our interview with them. And for those of you who are tuning into this episode and haven’t had the pleasure of listening to that interview yet, Dr. Smith, for each monthly well visit for children, I think he has them up to seven or eight months. You know, so for your two-month visit, he has a little highlight video. You can go onto his Instagram account and watch. It’s a couple minutes.

And it’s him saying, “Here are the questions I’m going to ask you. Here are the things you might want to ask me. Here’s what we would typically expect at the two-month checkup so here’s how you can be prepared for that.” And he just went on and on about how having that available. He points people to that he created it himself. And then he can point patients to it before they show up so they can know what to expect automatically. They have a different, higher comfort level as soon as they step through the door, they know what to do. And all those things. He just sees them all as kind of little pieces that help contribute to a better experience.

Scott: Yeah, he actually puts the patient on the team, I think is the best way to put that. You know, Greene and Kirshenbaum are orthopedic surgeons. They have a very team-based approach, but they work on fixing things. Orthopedics is about fixing things. You know, if something hurts, please fix it. With long-term care…and pediatrics in a way is that…hopefully it’s all well visits as part of the long-term care. But from a long-term care perspective, it’s very helpful to be empowered with good well-vetted information. Heck from any perspective, it’s good to be empowered with good, well-vetted information.

I know a lot of doctors over the years that I’ve spoken with will come in and they’ll roll their eyes like, “Man, I can’t believe somebody came in talking about whatever, you know, magnets curing arthritis.” I’ll take that out of thin air. Well, if you don’t want them to come in talking about magnets curing arthritis, well, then be proactive and have some good information about what that is. And there was Justin Smith saying, “Hey, at two months, this is what I’m going to talk about.” And I thought about all the well visits where I walked in completely unaware with the first child. You know how much smarter I was with the second child and laid back. You know, with the first child, I didn’t know what I was doing. And if I could have seen that and then walked in the door, I could have had better questions. I could have been less worried…

Michael: But you had interviewed Dr. Smith before on a previous podcast. And he was just at the phase of trying to convince more people within his hospital that, “Hey, this whole content of, you know, the idea of putting content online, this is a good idea and it helps people.” And, you know, that situation has transformed quite a bit in this conversation in particular. I’d love to hear a little bit more about that process that you’ve heard it from him.

Jared: Yeah, so it was about three and a half years ago. So think about that, just really a little over three years ago that I last interviewed him on a podcast. And the progress that has been made in the clinical community since then, I think, is one of these paradigm shifts that is good to focus on. Like you said, Michael, I think it’s something that’s noteworthy. I think it’s something that’s going to keep happening. So, like you said, when he was originally even at that point. He had already been blogging for several years, right? And he had made a name for himself, even before he made it to his current hospital at Cook Children’s. He had been out in rural Texas and he had been doing the same thing.

I mean, his attitude towards it hadn’t changed at all. He had always been creating content. His attitude has always been, “How can you complain about the bad content if you’re not putting out good content yourself?” Yeah, if you’re just not putting out that vetted information yourself, like what are you complaining about? Like how can you tell people not to Google things? Like that’s where we go for information. So like drop that and figure out what to do about it. And so he kind of was looked at like, not necessarily, you know, an outcast, but he was looked at very skeptically by his colleagues, by fellow doctors at that point, even three years ago.

And now, what he expressed was how much that’s changed. He said something along the lines, I can’t remember exactly, but a good portion, it seemed like half or more. Like almost half of the clinical staff at the hospital, several 100 other providers had contributed some kind of content. They had either written a blog post or they had put something out there in social media on behalf of themselves and the hospital. And he said, yeah, he’s not the one who’s seen as the one who’s doing odd things anymore. Now they’re coming to him. They see him as a consultant and as a help and as an advisor. Like, “Hey, help us figure out how to do this. Where do I start? What do I put out there? Like aren’t I just going to put out the same things that other people are already putting out there?”

And then he works with them to help explain that. And like that’s pretty significant. And it’s a fairly short amount of time that that’s happened. And I think that was very encouraging for me because, again, I put myself in the healthcare consumers’ hat, first and foremost, just like the both of you do. We think of it in terms of, “Okay, my own healthcare experience. Yeah, absolutely. When I Google something, I don’t want things that I have to go vet out, and I’m not sure about and then just make me more uneasy about going to see care. Number one, I want to find answers. I want to connect with answers. I might not even need to seek care for this thing. So I need some answers first. You know, that’s before I even click through to go to a provider directory or whatever. I want to find answers. And I want to trust those answers.”

And increasingly, it’s hard to do because, in my mind, there aren’t enough providers putting out good information. So I think it all just kind of contributes to the same thing. Like I said, it’s encouraging to see this shift in particular happening because there’s so many implications at the end of the day for all of us to connect with the answers that we need.

Michael: Absolutely. One of the things that Dr. Smith was kind of championing around all of this discussion was providers getting online, getting on social media. And, you know, even going back, like looking at kevinmd.com, there’s been a lot of discussions about doctors on social media for quite some time now. But it seems like it’s really picking up a momentum at this stage that we haven’t seen before. And even, you know, Jared, with the interview that you had recently with Dr. Chang about his level of involvement with social media, I’d love to hear like kind of how he’s doing that as compared to like what Dr. Smith is doing and kind of that overlap where they seem to share a pretty common mission there.

Jared: They do. So Dr. Austin Chang, he was the first chief medical social media officer at a major hospital. And this just happened earlier this year, very recently in fact. And for that to even be a thing, I think, as part of this same evolution and paradigm shift that we’re talking about out there in the clinical community, recognizing the need for and, “Hey, how do we do this?” And he shared very similar perspective in terms of he’s a lot closer to having recently come out of his residency and, you know, and really being an attending physician now. So he comes at it from an even more recent perspective I think than even Dr. Smith. And where they share, you know, almost the exact same perspective is the need to interact.

So Dr. Chang really focuses, especially on Instagram, connecting with fellow colleagues, with fellow doctors, nurse practitioners. And he will just about every day because now I’m following him with a lot of interest, just about every day he posts something out there. It’s a question for his colleagues to get them thinking. It’s also to help, as he described it, to humanize the doctor on behalf of those the doctor is seeing. So if we see them as a real person before we see them in the clinic, we’re a lot more likely to empathize with them and maybe at least have a little bit more understanding and try to see that, yeah, we can’t generalize and say every doctor is the same way. There’s a million doctors in the U.S., right, there’s a couple million nurses.

It’s pointless to say they all feel the same way. I think we all just made that case that some are on clearly on a different side of this perspective, they have no interest, they still see this as just downright blasphemy to even be digital and put anything out there and that every patient just needs to trust them fully and not ask any questions and, “Just take my word. Hey, take the blue pill, take the red pill,” you know, kind of a thing. So it’s this whole new generation of doctors. And it’s all not necessarily just digital natives or Gen Y, Gen Z, whatever. I think it’s kind of even pointless to try to even label it that way.

The fact is, there are a lot more doctors now who are using social media and for a lot of different ways. And I guess just coming back to that humanizing themselves, I think that was one of the reasons that Dr. Chang’s interview stood out to me is because he’s consciously out there building his brand by showing himself that he is a human. The questions are really interesting that he posts out there that, “Hey, this one treatment, this wasn’t easy to figure out what to do. What do you guys do? Here are the 12 different steps, here are the 12 different options for this procedure when the film reads this.”

And it helped me even see that like no wonder they’re not always right. You know, it’s just not a clear cut X or Y sometimes. It’s just not that easy. So I guess where that just leaves me is that there’s a convergence in my mind of us as patients that we can empower ourselves, we can go find information online, we can go look it up, we can go vet that information, we can bring that to our provider. And then we can also recognize that we can try to take those steps and see our doctors as humans.

Terry: We found one of the things that frustrates our patients more than anything, it’s such a silly thing. But when we go to make an appointment for them, the first thing we have to ask them is, “What’s your insurance?” And they’re angry. “What do you mean? You only care about my insurance. You don’t care about me.” “No, that’s not true. We’re trying to look out for you.”

Michael: Along that line of humanizing healthcare in general, I felt like the discussion that we had with Terry helped me understand a lot more about what’s happening beyond just the initial doctor visit. I go in and I see the doctor but there’s a ton of stuff happening around all that.

Scott: Yes. It was fascinating to me to get a little bit of Terry Leidner’s thoughts on that Terry is a practice manager at an orthopedic practice that I have worked with for a very long time. They’re very well run and the patient seem to be very happy, the doctors seem to be very happy, the people working there seem to be happy. Those are good things. And everybody from a patient perspective, basically, we just talked a lot about like being part of the team, empowering yourself with good information. And I think that that’s critical to have a good visit. And we talked about how social media can help and systems can help. And the other thing, and the most basic, and I make the joke all the time, it’s like if I made an 11:00 appointment to go see Dr. X, I would assume it’s pretty simple to be ready at 11:00.

And frankly, it’s not that simple. At best, you would think that you would know your business after 30 years because that’s how long I think Ridgewood Orthopedic has been around that you would know like how to get someone to be seen at 11:00 for their 11:00 appointment. But lots of things happen that are not under your control. You know, now I’ve got to go work with the patient, with the patient’s insurance, with the hospital, so many different moving parts to make sure that that surgery or that procedure is going to take place, is going to happen correctly, and is going to get paid for. It’s not so simple, everybody, if you listen to a particular podcast, man, there’s a lot of heavy lifting going on back there. I forgot how many people she had that just made sure that everything got approved by insurance.

Michael: For a very silly comparison, we were just out over the weekend. And I was trying to get my family some fast food. So if you ever meet me in person, I’m an introvert. I hide in my office every once in a while just to get stuff done and that sort of stuff. But so, you know, I get the app to be able to order my fast food before I arrived. So that way I don’t have to talk to people. I can just walk in, supposedly, and pick up my food and walk out. I won’t eat in the restaurant in particular. But I will tell you it was not that smooth an experience. What I had hoped for out of the app and what I actually got when I got there was a completely different experience.

And this is fast food that we’re talking about. This is a completely different experience than actually going and getting medical care. But we now have this expectation as customers, as patients, as whatever, that we can just go in and do the thing. And I can’t tell you how surprised I was that my fast food experience was as bad as it was because I’ve used the app. That should solve everything. And, you know, I think about that in terms of like online scheduling and all that kind of stuff that’s now available.

Scott: I said 11:00, why aren’t you seeing me?

Michael: Now I’m ready to go.

Scott: I’m ready to go. It’s fascinating to me about how we get focused on what we want to get done and it should just get done. And it’s just a lot more complex than that. I have a friend of mine. We do marketing help for this particular surgeon. And he actually likes to take the time to talk to his patients. And he will not leave that patient till that patient is comfortable. And with the game plan and next steps and what he said he won’t stop, he will make sure they’re comfortable. But because of that he’s always a little bit behind. It’s just the way he runs. And he told me that he was getting some bad marks, you know, on a survey results, because he does some reputation marketing. And he was getting some bad marks that he’s late.

And I said, “Well, why don’t you embrace that? You know, why don’t you set an expectation that, ‘I might run 5, 10 minutes late because I’m never going to leave my previous patient in an uncomfortable position. I’m going to make sure they’re happy.’ And if you need be seen at 11:00 and you don’t care about that, about being taken care of that well, well, then I may not be your right choice. And it’s about expectations, everybody.”

Michael: Absolutely. And who is going to quarterback that scenario for the patient and/or for the practice, for the insurance company, for…on and on the list goes, you run into this unknown variable. And this is one of the things that I found interesting that Terry was talking about. You run into like a complex orthopedic process. And that was specifically what she was referencing. They have to discuss that then with the insurance company. She and her team have to go back to the patient, keep them posted on how that progress is coming. Some of her recommendation was even to go talk to the insurance company yourself. And she’s giving very direct advice, very helpful advice on how to actually get the things solved.

What’s interesting and one of the things that we had talked about before this show is when the patient doesn’t have that direction. You have this rare condition, or you have this procedure that you need and you just don’t know what to do next. And that’s such a complicated and frustrating process that doesn’t completely fit with an idea of the team, right? Like, you know, one of the ways that Scott and I were talking about this and Jared before the show started was, “Hey, ideally, we’re all on the team together. We’re all working towards a solution. The insurance company we use is kind of hit or miss on this.” And so there are times when we’ve talked to our insurance company.

And, you know, maybe we had like a billing question and we couldn’t figure out who’s responsible for what piece of this because it has to be paid for. Somebody’s got to pay the bill for the thing that we went and did with the doctor, but who’s responsible for what coverage is available, all this kind of stuff. And when we get that opportunity to talk to somebody that owns it for us, and says, “Let me conference call the group and we’ll all talk together and get this solved right now,” is this just miraculous moment, we’re going, “Oh, thank God. Now we can get to the bottom of this,” instead of having to play telephone over and over. Getting to that level of teamwork isn’t commonplace yet. I feel like we’re trying as a healthcare community with all the different moving pieces to get there. But we haven’t really reached that completely yet.

Scott: I’m really fascinated to see and very excited about the different topics we’re going to be attacking. But I do think it’s going to end up being a lot of teamwork. The patient is going to be involved, whether the patient and/or the caregiver likes it or not because I know a lot of patients don’t want to deal with it either. But I’m telling you as a patient and as a caregiver, let’s get some good expectation set. Let’s get some good information delivered to each other. Let’s be open-minded enough to talk about what concerns you. It’s all critical to the success of good care. And I have not met in the last 30 years of talking to a lot of physicians anybody who doesn’t ultimately want to take better care of their patients, that I know. And thank goodness for that.

Jared: So, yeah, you know, Scott, I agree with that, too. I feel like that concept of being part of a team that also puts the onus on us as patients to decide whether or not to be that squeaky wheel to get the care that we need. I’ve spoken with providers as well who say like, “Please do. Like be that squeaky wheel. Like do whatever it takes to get the care you need.” But I’m one. I don’t know, if you guys are the same. I have a feeling you might be the same way. Like I’m not necessarily the most comfortable doing that. That’s just not my natural way of doing things. And so I have to decide whether or not it makes that much of a difference to really call things out and to really be that squeaky wheel. So it just feels like to me that this whole comes back to this whole concept of being on the team and deciding still how much I put into that to bring my research to the doctor and to ask my questions and to be comfortable doing that when I’m a naturally comfortable usually with that situation.

Scott: Yeah, it’s funny I am a squeaky wheel. I’m exact opposite of two of you guys. And I don’t mind being that. And I bring that up and I’m very open about it when I have a conversation with my caregiver. I will leave you with this guys. A lot of people who are listening to this, I mean, more from the physician side, they’re thinking themselves like, “I do not have the time to create Instagram accounts. I do not have the time to do this.” Well, maybe you do, by the way, because I think that Dr. Smith had mentioned like he basically takes the time to explain how much time you save when you do this up front. But I’ll also say like, well, then take the time just to find some good links.

If you’re tired of somebody walking in the door saying that magnets cure arthritis, which they don’t, then put together some stuff that says, “Here’s some articles that I’d love you to read that will talk a little bit more about options.” If you want to write those articles, that’s great. If you don’t have the time for that or don’t feel like you’re up to it, that’s okay, go find them. And for patients, if you found those articles, make note of them, bring them in. I can’t tell you how appreciative a lot of doctors are to see that so that they can have a better conversation.

Michael: Guys, thank you both for this conversation today. I like that we’re taking this time to reflect on what our guests have talked about. They bring so much good information into the show that I want to make sure that we’re really reflecting on what it means for each of the parties involved in healthcare, how the team is able to take this information and do something with it. So thank you very much. “Paradigm Shift of Healthcare” is brought to you by P3 Inbound. You can find our full archive of episodes with complete transcripts at paradigmshift.health and recommend a guest or topic on Twitter @P3Inbound.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.