“I can teach you medicine, but I cannot teach you to care” was a frequent saying from a mentor during my residency training. Empathy, the ability to understand and share the feelings of another, is perhaps the most critical component in a doctor. It is also one that is sometimes missing today in many healthcare workers. I would venture that a lack of empathy is not just less in healthcare, but in our society in general. Do you care enough to care?
Could a greater miracle take place than for us to look through each other’s eyes for an instant?
– Henry David Thoreau
Empathy is not just a good thing in abstraction but it translates to better business and better patient outcomes. In a study of orthopedic patients, 65% of patient satisfaction was attributed to empathy, the largest factor found in the study. Satisfaction was not significantly affected by wait time for an appointment, wait time in the office, time with the surgeon, resident/fellow involvement, whether or not patients were seeking a second opinion, health literacy, or treatment choice. Empathy was far more important. The study showed that physician empathy was the best opportunity to improve the patient experience. Research has shown empathy and compassion to be associated with better adherence to medications, decreased malpractice cases, fewer mistakes, in addition to increased patient satisfaction. This translates to better overall patient outcomes, fewer hospital readmissions and an improved bottom line for hospitals.
This video is from the Cleveland Clinic from a few years ago but it makes a very important point. If you could stand in someone else’s shoes; hear what they hear; see what they see; feel what they feel; Would you treat them differently?
56% of physicians said they lacked the time to be empathic, and 29% reported burn-out as the primary reason for their difficulty in being empathic. One criticism of telemedicine is the lack of an in-person personal connection to the patient. But empathy is a skill that can be utilized even through a remote connection. Telemedicine allows the provider to time-shift a patient encounter to a time and setting of their choosing. It changes their practice in a way that the provider has more time to show that they care.
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“Do the right thing even when no one is watching.” That was always one of my father’s axioms. It is a philosophy of being responsible and accountable to your own personal standard and having a standard that is independent of the setting. “The right thing” is something you know in your heart.
In business, “the right thing” is sometimes confused with “the right thing for our business” or “the right thing for our profits”. It is easy to cut the corner in business to make things more profitable. It is easy to focus on a short-term gain more than a long-term relationship. It becomes easy in business to not hold your company’s standard up to your own. It’s “just business” for many companies…
In telemedicine, we have a responsibility to get certain things exactly right every time. Security is critical! We are entrusted with safeguarding your personal information and your electronic health data. It is a responsibility that is not only vital to our company but a sacred responsibility to our customers. We have our servers hosted on the most secure cloud servers in the world at Armor (http://www.armor.com). This is a company that goes the extra mile to provide top-notch security for your data. They are responsible for the infrastructure of our servers, while we are responsible for the data put into those servers. Our team at iHeartDoc is up to date on the latest threats and phishing/social engineering schemes that are a daily threat to data security. Your electronic protected health information (ePHI) is safe in our HIPAA compliant, HITRUST certified servers. Our security team undergoes regular audits and remediation analysis to ensure the most secure environment possible for your data. Your data security is our responsibility.
As a physician, I often tell patients that the most important aspect of a doctor-patient relationship is trust. If you can’t trust your doctor, you need to find another doctor. The same goes with any company providing telemedicine or keeping your health data. If you can’t trust that company to “do the right thing even when no one is watching”, you need to find another company you can trust.
My daughter is a senior in high school. She is busy completing her college applications and the most common question is “Why (insert school name here)? It is a classic question that puts the prospective student on the spot. Do you know enough about your prospective school to say what specifically appeals to you? Do you know enough about yourself, to know what is important about a prospective school? I think that question is a basic question that must be answered for any important decision. Why?? It certainly applies to a paradigm change like telemedicine.
Why would you use telemedicine as a patient? That question is pretty easy for most patients to answer. Do you like the experience at your doctor’s office? Is the parking easy? Is the wait reasonable? Do you get a valuable exchange for the time, energy, money and general hassle that going to a doctor entails? Was it worth it? Would you prefer to meet with your doctor from the comfort of your home or your office? If you have chronic medical conditions, how much time have you spent waiting on a short provider visit, how much money have you spent, how much time off work or away from your friends and family have you lost waiting for a few minutes from your healthcare provider? Telemedicine provides a solution for many patients. You can send your data about your health from your app, smartwatch or mobile device. You can connect to your provider from the comfort of your home or office. You can forget about the hassle of parking and finding your way around a hospital or medical office. You can skip the hours spent waiting. You can connect on your terms as a patient. It can’t replace an in-person visit but it can certainly supplement that visit for many patients. Telemedicine makes a lot of sense for patients.
For a provider, the question of “Why Telemedicine?” is harder. Doctors and nurses are creatures of habit. They don’t easily change habits that have served them well for years. Changing a paradigm of care is certainly a big thing to ask of a healthcare provider. Most are as busy as they can stand. They don’t have enough hours in the day to do the work they are asked to do now. Why would they want to learn to work in a different way? The answer is found in almost every survey of healthcare providers today: Doctors and nurses are not happy with the way healthcare is delivered today. Their job satisfaction is at an all-time low. They are asked to see more patients, spend less time with each patient, and get paid less for each visit each year. The paperwork and EMR time is increased and the time “being a doctor” is less and less. The answer for most is to work harder. That just leads to longer hours and less job satisfaction. I would propose that the real answer is to work smarter and more effectively. One of the most valuable (and least valued in my opinion) aspects of today’s healthcare system is the concept of physician time. The goal should be to maximize the most expert care by a physician for the treatment of the sickest patients and to allow routine preventive care that moved outside the hospital years ago, to move outside the doctor’s office today. Telemedicine makes sense for chronic and preventative care. It can be performed by nurses, nurse practitioners, and physician assistants as well as physicians. It can time shift appointments to a time that works for both the patient and the provider. The sickest patients still need to come in for an in-person appointment but the chronic, preventative care that is reviewing data from lab work, and tests, counseling about lifestyle modification, and asking questions searching for the early symptoms of disease, can all be done over a high definition mobile connection. Telemedicine frees up the provider’s schedule to see those patients that require an examination while allowing quality care to be performed remotely by several members of the care team. Much of that remote care is currently provided over the phone, is unreimbursed, and still carries a malpractice risk. Telemedicine allows a higher level of care for those visits and a much more personal connection and a higher level of satisfaction for both patient and provider.
Why Telemedicine? It is moving healthcare into the 21st century using advanced mobile technology to supplement the patient-provider connection, not replace it. We will look back one day and wonder how we worked in healthcare the way we currently work.
Housecall started the summer that my two daughters were away at the Kansas City Ballet Intensive. It was an idea that a doctor-dad had, as he viewed his two daughter’s ailing feet from 400 miles away. Ballerinas, for all their grace and precision, have notoriously terrible feet. They stuff them into pointe shoes and then try to balance on their toes for several hours a day. Young ballerinas learn to deal with the myriad ailments that come with dancing for hours at a time. That summer intensive was my two daughter’s first experience in dancing at a pre-professional level. Their feet were not used to the punishing schedule. So, they turned to their dad, a Cardiologist. I was giving them advice about foot care (not exactly my specialty) after viewing the various bumps, bruises, blisters, and sores that many hours of ballet had wrought. I found that FaceTime actually worked pretty darn well to get an up close, high definition view of a blistered toe or a swollen foot. A mobile phone could easily share a detailed view of what hurt. I thought about all the times I had a patient who had called in and gone into a detailed description of some bruise or swollen area. The call invariably resulted in telling them to “just come in and let me look at it.”
I researched FaceTime and Skype and discovered that neither were secure enough for a medical use. They could fairly easily be hacked. I looked around at the video conferencing apps and products that had been around for a decade or more to connect businesses remotely to their home office. I found that they too were not secure enough for medical use and that most companies that had tried to create a telemedicine product out of their video conferencing app had found that a medical appointment was a little different than a discussion of the latest product release. Several large communication companies had tried and failed at finding the right way to do telemedicine. I began to think that this was an idea whose time had come and I was in a unique position to do something different.
I also had spent years looking at lists of heart rates and blood pressures from patients. They came into my office with legal pads filled with their home readings over days, weeks and sometimes months. Many patients with hypertension have fairly good BP readings at home but very high readings in our offices. The dreaded “white coat hypertension” was reliant on accurate patient-derived data from home, but dismissed data derived by a trained medical professional in the office. I had noticed the trend of patient health tracking via Jawbone’s Up band, Fitbit, and the at the time soon to come Apple Watch. I saw that trend as transformative. The patient would collect their own health data and be able to share it with whomever they wanted. I wanted to give the patient the ability to be the collector (and owner) of their own health data but to put that data in a format that would make sense for a doctor reviewing it in a telemedicine conference. Adding that data information to a remote telemedicine visit would allow a doctor to actually treat a patient just like they did in the office. That formative idea was Housecall.