Month: September 2018

Going Below the Belt: Refractory Pelvic Pain

As an otolaryngologist, if I had a patient who mentioned pelvic pain, I’d send them to an OB-GYN, or urologist.  I’d never think to send them to a physiatrist, a specialist in physical medicine and rehabilitation.  This is why Dr. Tayyaba Ahmed is on the show today.  She treats the muscoloskeletal causes of pelvic pain and patients that she often sees have been refractory to multiple other treatments. 

Dr. Ahmed is a fellow of the Academy of Physical Medicine and Rehabilitation and a member of the International Pelvic Pain Society and she is my first interviewee to date the use the phrase “kicked in the balls.”  

She can be found at

https://www.facebook.com/pelvicpainspecialistcommunity

http://www.instagram.com/drtayahmed

http://www.pelvicrehabilitation.com

 

Going Below the Belt: Refractory Pelvic Pain

As an otolaryngologist, if I had a patient who mentioned pelvic pain, I’d send them to an OB-GYN, or urologist.  I’d never think to send them to a physiatrist, a specialist in physical medicine and rehabilitation.  This is why Dr. Tayyaba Ahmed is on the show today.  She treats the muscoloskeletal causes of pelvic pain and patients that she often sees have been refractory to multiple other treatments.

Dr. Ahmed is a fellow of the Academy of Physical Medicine and Rehabilitation and a member of the International Pelvic Pain Society and she is my first interviewee to date the use the phrase “kicked in the balls.”

She can be found at

https://www.facebook.com/pelvicpainspecialistcommunity

http://www.instagram.com/drtayahmed

http://www.pelvicrehabilitation.com

 

This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. We’re Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers. This podcast is intended for medical professionals. The information is to be used in the context of your own clinical judgment and those on this podcast except no liability for the outcomes of medical decisions based on this information. As the radiologists like to say, clinical correlation is required. This is not medical advice. And even though the magic of podcasting may make it seem like we’re speaking directly in your ears, this does not constitute a physician patient relationship. If you have a medical problem, seek medical attention
Unknown Speaker  1:00
On today’s episode we speak to Dr. TR med, a physical medicine and rehabilitation specialist who is focused on pelvic pain in her Manhattan practice.
Unknown Speaker  1:10
We discuss the importance of having those difficult discussions with your patients that sometimes reveal the causes of their pain that might go overlooked and why it’s important to take a multidisciplinary approach to these very challenging problems. Welcome back to the physicians guide to doctoring. On today’s episode, we have Dr. Tiago Ahmed, who is a physiotherapist for those who don’t know what that is, if is it trust is someone who specializes in physical medicine and rehabilitation. She did her bs do at the New York Institute of Technology where I am from on Long Island and then did her residency training at NYU Rusk Institute for rehabilitation. She then decided to further sub specialize in Focus on pelvic pain of all things. Now I, before I chose to do ordinary ology I actually thought it was going to be a physiotherapist. And so I have some knowledge of it. And this is something that I did not realize was something that is treated by people in this specialty. So one of the reasons we decided to talk today is she sees lots of patients that really benefit from her help, but frequently, practitioners don’t know that she’s out there as as a resource to send their patients to. So first, Dr. Men, thank you so much for taking the time to be on the show. And if you could let us know how you ended up deciding to specialize in this.
Unknown Speaker  2:44
Thank you so much for having me. And I will kind of just honestly, I was doing my residency at NYU. I met my colleague, Dr. Condi Allison chiffon day and charity Hill, and we kind of went out Ways after residency, Alison has started doing a Women’s Health Institute at Cornell. And then I had two kids. And then when she started to see that there was like a huge need for this. She had asked if I wanted to shadow her and kind of come in and see what she was doing. And, you know, I did, I spent a couple of months with her and I saw that it was way more rewarding than doing what I was doing as a sports medicine doctor. And then we decided to join together when we started our own clinic. And, you know, the rest is history. We’ve just been we’ve been doing only pelvic pain and essentially what we what I was doing before was treating the muscles joints and the ligaments of the ankles, the knees, the back and shoulders. But now I just do it up the pelvis, so anything below the belly button and above the knees
Unknown Speaker  4:00
In any NT, it’s from the dura to the pleura. So
Unknown Speaker  4:05
there’s maybe a little a little rhyme that we could make for that. So So do you think that was the as specific as that is? Do you find that there are enough patients that suffer from these problems to keep up to keep your practice busy?
Unknown Speaker  4:21
I would say so, you know, we’ve been, we’ve been doing that let me see about, you know, a lot of patients a month maybe I don’t really know I don’t actually know the numbers between all three of us because we all work part time all sort of our time. I’m like four days my other colleagues are four and one two days. But we, we do I mean, the thing is, is a lot of our patients are coming from July ends and they’re coming from gi doctors and urologist, and their patients who kind of exhausted these other doctors in these other subspecialties saying, you know, I’m having this urination problems. I’m having this gi constipation problem I’m constantly have a pain with sex. And I don’t know what to do and these other subspecialties aren’t able to help them. Mostly because they aren’t addressing the muscles and the joints and the nerves of the pelvis. And they’re only looking at their orient system. So what we’re doing is stepping back and looking at all the organ systems and trying to figure out what’s wrong with the muscles. And, you know, sometimes we find hernias and sometimes we find label tears. And that’s because we’re sports medicine doctors, so we’re looking for those things. Whereas I’m not looking for, you know, an ovarian torsion and I’m not looking for prostate cancer. So, you know, we do get a lot of patients who, you know, how many of our patients have like actual GYN or gi issues? Not a lot because most of the time they’ve already been to multiple doctors multi, you know, three or four year colleges two or three GUIN And then they come to us.
Unknown Speaker  6:01
So who would you say is your ideal patient? So for those that now know that there is a pelvic pain specialist out there who who specialized in the musculoskeletal system. So you mentioned the the urologist and GYN, who are the patients that they should be sending you that maybe they’re they’re not aware that you’re out there for you to send them to
Unknown Speaker  6:28
felt Well, if a patient is chronically constipated, and they your the GI doctor is done a colonoscopy doesn’t see any hemorrhoids doesn’t believe there’s any fissures. And, you know, they most doctors should know about the pelvic floor muscles. And doing a rectal examination shouldn’t be able to take the muscles and see if they’re tense and tight. You know, that that cocktail just to jack patient. Sometimes that people reptile is muscle. tight and when you do you relax it. They are now are able to go to the bathroom and have regular bowel movements. So those are the types of patients. You know, it seems like a lot of times a lot of these patients go straight from their gi to a colorectal surgeon and then they get Botox on those muscles. But as we know, Botox is a temporary solution. And so these patients are I saw a patient who’s 22 yesterday who came from a health you know, health center, academic huge Academic Center in the city and I can give it away and went straight from gi to colorectal and got Botox and didn’t know about pelvic physical therapy, didn’t know about rectal values. depositories, you know, didn’t know about trigger point injections to the pelvic floor. So she went from like a mildly conservative, kind of like workup making sure there’s no like, you know, cancer anything to a drastic procedure that, you know, is going to be every three months. And that’s kind of Ella solution, one for the patient and to the back end of it is why is she con chronically constipated? There’s a good chance this young woman has endometriosis, which is a gynecologic condition. That’s often not really a big you know, in medical school we didn’t really learn a lot about it. were basically having endometrial tissue in the that supposed to be in the uterus now outside of the uterus. The problem is, is that it can be on the bowel, which can cause that chronic constipation. It can also be on the pelvic floor which can cause that muscle tightness and it can also be on the bladder which can cause urinary frequency and urgency that causes patients to be you know, have abdominal bloating, cramping and and terrible periods. So, period pain, not just like pain, you know, little cramps here, take a Motrin like the type of debilitating pain that they have all month long or this could be with every with periods but it can also be throughout The rest of the month because this is endometriosis is there on you know it’s not exercised properly these conditions so this young woman when she was 13 she had a terrible painful periods and then soon after she had this chronic constipation but it didn’t you know she’s so far gone to a GI and a colorectal but nobody’s really addressing the actual problem and you know if I if you asked her like how are you? Like oh so terrible and what are you doing about it well and nothing I just, you know, deal with it. I thought it was normal to have painful periods. But like it’s not and I don’t think both the reason she’s still here still chronically constipated despite having Botox and coming to see me is because she’s like was payment like, you know, paying with my periods and I have urinary frequency and I have pain with sex because I can’t nothing can actually get inside of me because my muscles are so tight, despite having Botox. So that’s the type of patient needs to get to me because, you know, we try to do a multidisciplinary approach and look at it and step back and see, you know, not just deal with the GI and not just deal with the Euro, you know, we have to deal with everything, otherwise people don’t get better.
Unknown Speaker  10:15
So it sounds like you’re at the center of that multi disciplinary team. So you make sure that everybody has crossed their T’s and dot their eyes and see, and that everybody has seen all the appropriate specialists in addition to doing the musculoskeletal care that is, sounds like frequently neglected. Just because, yeah, this is an artist aren’t aren’t as aware as they could be. So So you mentioned you know, learning that we all learned about it endometriosis in medical school.
Unknown Speaker  10:46
So
Unknown Speaker  10:48
was there anything that you found that you learned in medical school that turned out to be incorrect when you became as specialized as you are now?
Unknown Speaker  11:00
Well, I feel nervous. I don’t know about medical schools long time ago, but in residency, I felt like we were always told that like, you know, I think I remember one attending saying that like pelvic pain, you know, it’s kind of in their head. And these people, they don’t, you know, they, they cause it and psychosomatic. And I mean, it just just like kind of crazy to me that that’s what they used to deal pelvic, like, treat pelvic pain with. And a lot of these women, they do hear that over and over again. And, you know, there’s a huge psychological component anxiety when you’re chronically clenching, and you’re very, you know, there’s that personality that type A personality that has by agreeing that clinches their teeth and so they might have TMJ that pleases their pelvic floors all day long male than female, surprisingly, we feel a lot. We see a lot of males with this
Unknown Speaker  11:53
very common presentation of TMJ, ear pain, so those patients end up seeing us because they think they’re getting your infections are they’ve even been diagnosed with ear infections. So I need it. We definitely I didn’t think that that our two specialties would have overlapped at all, but there is we found some common ground. And yeah, I can see how those become then feedback loops, right. So your stress and anxiety creates this sensation, which causes you more stress and anxiety, which then creates the sensation. And then
Unknown Speaker  12:22
you have depression, anxiety, pain, and that central sensitization. And now these people are very sensitized to have hot, incredibly high specials of pain, but they are super sensitized, and it’s harder to get them out of it. And so we treat them with a lot of neuropathic medications, we try to treat them but we also have to get to the root of it. Sometimes these patients have, you know, actual psychological conditions that that actually start. You know, that’s the beginning. I mean, it we call it we have this circle chart that we do at at work and patients come in and out of that circle. We don’t know where they’re coming in in the cycle, and sometimes You know, they’ve been raped. Sometimes there is trauma sometimes, you know, I always ask every patient about unwanted sexual contact, you know, there’s a huge amount of patients with pelvic pain that have been great have child abuse in their past. We ask everyone whether, you know, even if it’s just like sexual assault that’s not necessarily rape and not necessarily related to their, their general. You know, people really I mean, we we see a lot of it and there is a lot of suicidal ideations and two sides from some of some of these conditions. So, it’s not that there isn’t a mental component, there certainly is, but we have to believe our patients. If and, you know, because when I do my physical exam, I find physical finding. If I didn’t, well, then I might, there might be an issue but if, but if I’m finding physical findings, and they’re having painted their alien vinyl nerve and they’re having pain over their pubic senses, This chances are the calls for muscles are very tight when I do internal exams, I do feel that but we, you know, I take that seriously and I treat my patients like a patient asked me today if I believed that she was actually in pain, because she herself didn’t know if she was just like, She’s like, Am I crazy? Do I, you know, am I am? Do I have problems? Why am I having pain with sex? Why is this not going away? Nice, it’s not getting better. And, you know, they start to doubt themselves too, because they’re not like, is this in my head and so we really have to believe our patients and leave any mental illnesses tour to the psychiatrists and that’s why, you know, we I refer to a lot of patients to cognitive behavioral therapy, em, Dr. You know, if they just need a therapist to talk to a sex therapist, sometimes my patients will be doing great and then they still have pain and you know, they need to see a somatic therapist and then they got 30 You know, separate the mind and body and things are getting better. But, um, I feel like a lot of this stuff we didn’t learn. So, you know, somatic therapy, you know, I come across a few in Manhattan. And there, there’s a therapist who I work with. And, you know, she works one on one with patients and trying to identify what is actually physical and what is mental and kind of get into the patient’s mind and body and spirit and emotion and kind of like, allow them to feel. But it’s more of like talk therapy, but, but she’s like, you know, she works specific with patients who aren’t able to separate the mind in the body. Yeah. It leaves it. There’s a lot of like adjunct fields that like in pmmr I know about whereas I think a lot of you know, my husband’s anesthesiologists. She knows no, she’s like, never even heard of like, You know, read Reiki or cupping and you know different things like you know, I deal with a lot of alternative medicine with my you know in the field because you know patients are tend tend not to be on opioids are my patients tend to try to deal with a lot of the rehab rehabilitating the body with acupuncture and meditation and cranial take girls from osteopathic manipulation. So there are different alternative things that they can try. And you know, I think in medical school, they should teach these things as an option. Besides just like one clot
Unknown Speaker  16:36
Yeah, I think that’s, that’s a topic for another day, but I’m on the same page as you there’s, there is a finite time that we have to spend and I’m going to be changing the name Actually, I might, I might end up doing it for this episode, not changing the name of the podcast, but the tagline being everything that we do. should have learned while we were memorizing the Krebs cycle, like knowing where humor rate and Molly are in the citric acid cycle bear no nothing to my practice right now but really could be spent on learning. The fact that, that in issues with chronic pain psychotherapy is, is valuable, and also how to approach the patient that this is a possibility and get them to be on board with it. Right. And I think this is, this is a challenge
Unknown Speaker  17:36
for us now, honestly, I feel like a lot of doctors are very scared to say the word like, have you ever considered suicide? And honestly, you know, I’ll admit I was one of those. And I just realized that like, with mental mental health if I don’t ask it, like you just never know who’s going to do it. Yeah. So I now Anytime I ask a patient at any initial console day, you know, we go through the list of rules, new systems, and I say, how are you? Do you have an anxiety? Yes. Do you have any depression? Well, yeah. And have you ever thought about hurting yourself?
Unknown Speaker  18:14
No, No, I wouldn’t. Maybe once or twice. I mean, we have to ask these things. Otherwise, it’s on us. It’s our, you know, that’s part of our job. Do you find that approach to be the one that works for you to just cut through all the baloney and just
Unknown Speaker  18:30
be as direct as possible now?
Unknown Speaker  18:34
I think they actually appreciate it, because I think they’re so used to people not asking it. Yeah. And, you know, it’s like, when you’re talking to a friend who’s like, really sad, like, you don’t want to, you don’t want to like step on their toes, but at the end of the day, like we owe it to our patients, like not to treat them like friends to treat them like patients. And, I mean, that’s how I feel. And in the beginning, I felt like oh, you know, like, for instance, like, you know, you don’t want to breach was weird topic. They’re not weird topics, but they shouldn’t be weird topics like if a patient kinda seems like you might be a homosexual, and I’m treating pelvic pain, and I don’t ask him if he’s receiving or giving or taking, like, how am I going to know what his pelvic pain issue? You know? Like, could that be affecting his rectum or his penis? So, you know, it’s awkward and it’s weird, but I’ve kind of like, I have to ask these things.
Unknown Speaker  19:28
Yeah, in your in your specialty. I think I’m not sure how you go through a day with that without talking to every patient about questions like that. It seems like that is Yeah. Know how most of your day?
Unknown Speaker  19:42
Yeah, I mean with with everyone, I definitely asked Okay, all those you know, sex questions, but you know, in the beginning, I would feel strange because I’m be like, I don’t want someone to say like, you know, I’m homophobic or, but I think I’m homophobic if I don’t ask it. Yeah, so Excellent point. I don’t know. So that’s, I didn’t realize, you know what, I’m just going to be a better doctor and just asked, I think, and I hope, I don’t
Unknown Speaker  20:11
know. And I think you can’t be afraid of stuff like that because the patients in a safe space and you need to know what you need to know, in order to get them better. And you could even I think you could even preface it with, please recognize that what we’re dealing with can sometimes seem silly or funny, or maybe even offensive, but I have to ask these questions in order to figure out how to how to help
Unknown Speaker  20:31
you better but I’ve actually had patients tell me they didn’t want to kill themselves, and they have plans. And that’s the thing that scares me because like, when they do then you’re like, Okay, now, and I smiley will is my responsibility to make sure that they have a psychiatrist and an appointment scheduled and make you know, that I mean, it’s way more work and I could see why people don’t want to ask it because now you’ve added like all this work and documentation, but you know, my But at the end of the day,
Unknown Speaker  21:01
yeah, this is our life. This is this is our obligation. So
Unknown Speaker  21:09
I think we’ve we’ve digressed into into a little more of a darker place than we intended to. Can, because I think your your specialty lends itself to that. But it also lends itself to some to some levity.
Unknown Speaker  21:23
Right? Are there
Unknown Speaker  21:26
what are some of the things that that you see that that our listeners might might maybe give someone a chuckle? Or if that’s not appropriate, which, as I’m saying that I recognize it might
Unknown Speaker  21:41
go some of the more again, some of the more common console?
Unknown Speaker  21:45
Well, I do hear some of like, I do hear a lot of like, the funniest stories. You know, I don’t know. My patients don’t necessarily appreciate we making my joke, that they’re Eric Spence Yeah, I
Unknown Speaker  22:03
think we shouldn’t go down that road now that I recognize that we’re doing that. How about how about this? Just what are some more common concepts that you see right common things that that that the gastroenterologist, the neurologists, obviously as
Unknown Speaker  22:21
you should be sending to you,
Unknown Speaker  22:23
your eternal burning, a lot of people will, they’ll go to their, you know, urgent care and they’ll be like, can I have antibiotics, I’m getting antibiotics, the culture will never be done or it will be done and it’ll go back, it’ll come back negative and then they’ll go to another year they’ll go to their colleges, neurologists will give them a month of antibiotics and then they’ll go to another urologist say that they think that urologist missed something and then they’ll go to another surgery. So burning urinary frequency, urgency, or hesitancy were or soon after, usually they’ll start to have some pain In their parents, and I’m talking about males now. So paint well, male and female, the pain in the parents and but males especially paint soreness after they ejaculate. And usually, sometimes, usually one or the other. It’s either the testicles or the penis, it’s usually not both. But sometimes it’s both but sometimes it’s just to the tip of the penis or the shaft of the penis or one sided. Sometimes it’s just like one testicle. So, you know, a couple patients came in, one had trauma to the like, kicked in the balls by his friend, and not a great friend and then had to feel her pain. Particular pain and so, you know, that was painful. And it’s hard because once those muscles and nerves are irritated, so I’ve had a patient actually have the testicle removed because it hurts so much. And he was like in his 20s and it didn’t help because now he has pain. So you know, at the end of the day, yeah, and that was after some rough internal course. You know, it’s kind of crazy, because everybody’s talking about, like, you know, I was talking to a friend today was also physician who were talking about how I’m always shocked at how much sex people are having. And she was like, you know, it’s because of Tinder. And all these apps, young Millennials are able to access internet, like, have intercourse. so easily now, like people barely have to have any conversations. And they’re like, young, they’re just going out having sex all the time. And they’re not even in relationship. So like, it’s just like, they’re just having sex with a different person every day. And so of course, like, they’re very well aware, but there’s a lot of like, guilt with this, but sometimes people are like, Oh, I cheated on my boyfriend. And now my I feel like I have a UTI. And then I was on these antibiotics. And like I said, I don’t understand and then I examine them and they’re, their muscles are tight and they’re like, Why are my muscles tight? How could this I just all I do is cheat on my boyfriend. Now my muscles are tight enough. How did this happen? And I try to explain the pelvic floor dysfunction doesn’t happen overnight. Usually it’s like the perfect storm and it happens after, like, a few years at something. And then not
Unknown Speaker  25:08
because you didn’t just once it sounds like it may have been because she cheated a bunch of times and all of that
Unknown Speaker  25:16
intercourse.
Unknown Speaker  25:19
It could have been just like, okay when he was a kid, or like he was like in high school or college, he had like a fall, snowboarding for instance, or a horseback rider. And so chronic injuries or the tailbone, and then a few months of being really successful type A personalities sitting on chairs all day long, 12 hours at a time, and then they go and they have, you know, unprotected sex or something with someone and cheated on someone and then that was that person like, but you know, I’m basically going through the whole history from like, puberty to like now and then figuring out what could be doing it. And sometimes I have no idea I’m like, Well, are you sure you’re not this and they don’t tell me they basically don’t want to tell me stuff. Or sometimes it’s something like oh I when I was a kid I had I had a undescended testicle, and then I was, you know, 18 and I had a vinyl hernia. And then when I was 25, I add, you know, and you know, a lot of sex or something, whatever. And then my hernia and like, now we find a hernia again, and hernias are very closely related, obviously. So the testicles and and to the groin, and the aliens vinyl nerve and all of it is very much connected. And then it runs right into the pelvic floor. You can kind of see that right even as like, just the regular doctor, we understand that the like, just because they’re not in they run within each other. Like I try to explain to patients like your quads and your hamstrings, there’s no line dividing the two thing. These muscles are not connected to those muscles. They’re totally independent of each other. Just the same way. Going lens right into your genitals So, and your pelvic floor muscles. So I, they can they finally kind of see it? And then we like well get them to a hernia specialist and they’ll fix their hernia will relax their pelvic floor will and then they get better.
Unknown Speaker  27:16
When you say we relax the pelvic floor, what does that entail?
Unknown Speaker  27:22
So it’s like a whole comprehensive plan. I, like tell my patients that I kind of treat you like a dartboard and I throw all my darts at you because usually when they’re coming to me, they’re really distressed and distraught, and they have like, they’re at their wit’s end. And a lot of times, there’s a lot of crying even with the males, there’s crying involved. And so I might say let’s start with that that rectal or vaginal value, which is what it is. It’s a suppository that you put value to your muscles to relax your muscles. We might start start with some nerves, medications for the energetic inflammation. We might start trigger point injections, they’ve never gone to a physical therapy. So public physical therapy is pelvic physical therapy. So it’s actually a so I’m not a physical therapist, despite what a lot of people think, besides just do we, we prescribe physical therapy and we love our physical therapists and work with tons of New York City and New Jersey and Connecticut, we know all of them. And they do internal work on their patients. So if you had a tight muscle in your neck and you would go to get a massage or a physical therapy session to work on cervical just same thing, except the biologists in your pelvic floor. And so we’re trying to have the therapist loosen that up. Women tend to start using violators to relax to stretch the muscles for you know, entrance type pain, and now we’ll use male and females will they can get a wand, which is a tool to use in intro wrestling or internationally to work out trigger points. So it’s not effects joy, it is an actual device to relax those muscles and trigger point injections, we do them externally. So we’re going through the butt cheeks using landmark with ultrasound guidance. And then of course we’re, you know, ordering imaging. All the while and, you know, some patients may end up needing Botox if they’re not able to relax those muscles. But that’s definitely not first line.
Unknown Speaker  29:31
Interestingly, when you’re doing a catalyst, the repositioning maneuver, you might have heard of the maneuver, some internet actually use a vibrator to jiggle the crystals when they’ll hold it to the master as they’re doing the maneuver. So you’re not the only specialty sex toys in the office. I’m glad you use that, that approach. I was a little afraid because you mentioned acupuncture before and then you mentioned the dartboard, so you’re not
Unknown Speaker  30:04
a dartboard. That’s not your comprehensive dartboard approach, okay?
Unknown Speaker  30:09
I’m just, I’m just throwing a lot of darts at one time.
Unknown Speaker  30:12
You have a lot of arrows in your quiver, and you’re using many of them at the same time, because these are patients that because when they tend to find you, they tend to find you after and at the end of a very exhausting search.
Unknown Speaker  30:25
Yeah, I don’t think it’s fair to just, you know, have them come spend an hour and a half with me talking about it and just throwing them to physical therapy. Yeah, I mean, physical therapy can work alone. But you know, I’ve had patients do it and say, I want to be super, super conservative. It just might as well be physical therapy, and they go and they get a little bit better, but then they flare or they’re sitting for long periods of time, and so they continue to flare. It’s not really fair. I like to if they’re open and interested in trying everything. They actually get better when there was They’re willing to try everything. And then the people who who have like this, the earlier you get diagnosed and treated, the better, obviously, the responses. So someone’s coming to me after seven to 10 years of having this is way harder to treat. You know, that’s why I also don’t want to spend like six months, six months in PT and then being like, Lyft the ad and everything now like, I want to just get the ball rolling. Yeah,
Unknown Speaker  31:30
yeah, yeah, you recognize that the there to use the quicksand analogy, and they’re pretty deep in that quicksand. And you need to do everything you can to get them out in a reasonable period of time. Otherwise, they’re not going to experience relief in a time period that they find timely. And and my abandon treatment, which we know physicians happens all the time.
Unknown Speaker  31:53
Oh, definitely. And then you all you feel guilty, and so feel bad when people aren’t getting better. quicker so you want to do everything you can to get them better. So
Unknown Speaker  32:06
this was a fantastic interview, I really, really learned. First, I never thought I’d be doing as an EMT an interview about pelvic pain but to learn so much about it in such a short period of time really great learning experience for me and for the listeners. Is there anything that we didn’t mention today that you you do want to mention?
Unknown Speaker  32:26
Um, I guess just really quickly like a couple of diagnosis is that like a lot of people don’t have never heard some euro. So if there’s any people have ever heard of like the term hard placid and P Gad persistent genital arousal disorder. Both of them are like sexual dysfunction disorders that could very easily be brushed off as in your head type, diagnosis. Persistent genital arousal disorder, typically seen in females, our right we’ve seen a few in males, where they’re persistent. Playing around. And that that female does not mean that they are direct. It’s not like pre prism. That just seems they feel around. But they’re not necessarily direct and they don’t want to feel around. They want it to stop and they will. And it’s very disturbing. They can’t function. So it is, you know, a lot of people like laugh when I tell them what that is. And that’s like, actually the worst when I hear a doctor laughing at that, because they’re like, that sounds like a great problem to have. It kind of gets Hillary hating because these people have the highest suicide rate. They’re there. They’re very distraught, they have to quit their jobs. They can’t function. Incredibly, you know, I get a lot of Instagram messages on social media where people find me because of the hashtag p dad and they’re like, all over the world and being like, how can you help me? How can I, you know, I’ve had this for six years. I’ve had this for two years that won’t go away. What do I do? And it’s very hard. It’s very difficult to treat to because we don’t actually know how it’s happening. And my Just kind of treating the pelvic floor and trying and hoping that we relax it. Similarly, hard placid is another condition where a male feel hard, but is actually in a state of being placid. And it feel it would be a lot of young patients to do this. And what’s crazy is that I think they’re doing this to themselves, when they’re reading about how to be good at sex and magazines, and like GQ magazines where they say, you know, 200 kilos every day and your penis will be longer and all these like, crazy things that they’re doing because they’re like, you know, and their team, and then they’re over contracting their muscles. And now, they can’t get it to stop and there’s that sensation of feeling direct when there are hard, you know, not necessarily direct, it’s like 40% of an erection when they when they don’t want to. So if it’s kind of confusing and You know, honestly, we we don’t even know that much about these conditions but like, I just want people to know that they’re real. That’s it.
Unknown Speaker  35:08
Yeah. And and one of that’s one of the benefits I guess of social media as well as a but but in your situation people are going to have a challenging time finding their community of people with these disorders because there’s such a stigma that they yeah it’s you’re not going to find your fit your P Gad Facebook group so easily.
Unknown Speaker  35:30
No, no, no. And, and that’s the thing. I had tons of patients find me on Instagram for endometriosis who come to me and, you know, have actually flown in from different places to come see me. But p Gad, there’s only like a handful of hashtags and they’re all mine. You know, because nobody wants to hashtag that. And you know, they’re they’re all like the same people finding being them and they’re too scared and even my my PDF patient Could you write something about like p Gad or something? And you know we can, because if you google PN and you read any of like the Cosmopolitan or articles like the, you know a little articles about it, they’re really bad. They’re like all saying how there’s no treatment, there’s no cure, and you basically are stuck with it. And so it gives these people like, no hope. That’s why Yeah, and so, but then these patients are like when when they just get better, they’re like, I don’t want it I don’t want I don’t want to talk about anymore. I don’t have it anymore. I’m done with it. Like they’re so they they’re like, so like, I don’t want to associate myself with having to get I don’t want to like talk about it. So embarrassing. And, you know, there’s nothing we can do about that. But as a physician, I feel like I have to talk about it. So I would mention it somewhere where nobody’s talking about it. So you mentioned social media. So
Unknown Speaker  36:49
if you could tell us where can people find you?
Unknown Speaker  36:54
on Instagram. My name is at Dr. TAYH And ED, on Facebook I, Dr. Tayyaba Ahmed pelvic pain specialist. And do why do you have two eyes and one be? And that’s pretty much all I can extend to. So I don’t really do much on Twitter or any of the other ones. What about your website? Our website is pelvic rehabilitation. com. So that’s nice and easy as long as you spell rehabilitation correct. And we’re in midtown Manhattan, right? I five Grand Central Station. Now super convenient for a patient to come in.
Unknown Speaker  37:41
Well, thank you very much, Dr. Med for your time. It has been a pleasure.
Unknown Speaker  37:44
Thank you so much for having me.
Unknown Speaker  37:47
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts or wherever you get your podcasts and write us a review. You can also visit us on Facebook At facebook.com slash physicians guide to doctoring, if you’re interested in being a guest or have a question for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai

 

Benefits of Social Media for Physicians and Their Patients

Dr. Shikha Jain has amassed 1000 twitter followers in a year by making breakthroughs in oncologic research accessible to non-physicians and colleagues alike on twitter.  She is also the moderator of two physician Facebook groups.  We discuss the importance of having an online presence in order to build your practice and why physicians in particular need an online presence in order to combat the spread of misinformation by facilitating the spread of peer-reviewed, science based, relevant information.  

Dr. Jain can be found at 

http://shikhajainmd.com

http://facebook.com/shikhajainmd

 

Benefits of Social Media for Physicians and Their Patients

Dr. Shikha Jain has amassed 1000 twitter followers in a year by making breakthroughs in oncologic research accessible to non-physicians and colleagues alike on twitter.  She is also the moderator of two physician Facebook groups.  We discuss the importance of having an online presence in order to build your practice and why physicians in particular need an online presence in order to combat the spread of misinformation by facilitating the spread of peer-reviewed, science based, relevant information.

Dr. Jain can be found at

http://shikhajainmd.com

http://facebook.com/shikhajainmd

 

This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. We’re Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have learned while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
Unknown Speaker  0:26
Welcome back to the physicians guide to doctoring. On today’s episode we speak to medical oncologist, Dr. Chica Jean about the benefits of social media. In addition to being an oncologist, she’s a writer, moderator to physician Facebook groups and has amassed a large Twitter following. We discuss the importance of physicians being present in social media to fight misinformation, the benefits to both academics and private practitioners and growing your practice and some tips on how to increase your following.
Unknown Speaker  0:54
Welcome back to the physicians guide to doctoring today we have she could Jane she is a physician who is very active on social media. She’s actually the moderator of a few social media groups, Facebook groups for physician and as as active on multiple platforms. She is a oncologist, she did her medical school Michigan State residency at University of Illinois, Chicago, and fellowship at Loyola and is now an attending at Northwestern. And as the story goes, she was asked by Who was it that asked you to get started on social media?
Unknown Speaker  1:32
The media department at Northwestern asked me to create a Twitter account. So that’s how I kind of catapulted into social media professionally.
Unknown Speaker  1:40
And so thank you very much for for taking the time to talk to us today.
Unknown Speaker  1:47
Of course, happy they’re happy to talk to you.
Unknown Speaker  1:50
So you are asked to to start a Twitter account for for the oncology department for the entire department of medicine.
Unknown Speaker  1:59
Now, again, Professional Twitter account for myself. And the main reason they recommended it was at that time I was writing articles for places like Kevin, MD and creativity. I’d done a couple of interviews on social media as well as on oncology based papers and studies. And so they described Twitter and other social media platforms as a good way to engage with patients and get information out there as well as to kind of promote the writing I’ve been doing to have it reach a larger group of people. And I subsequently found it was also a wonderful way to network with other physicians as well as keep up to date on a lot of oncology breakthroughs. So it was a win win for me in the end after I joined after I went through some growing pains and figured out how to use Twitter,
Unknown Speaker  2:52
so could you go into a little bit of detail about those Growing Pains as we all experienced, and I experienced before I got Put you on the phone today.
Unknown Speaker  3:03
Sure. So I made a Twitter account. And I wasn’t really sure what to tweet or how to tweet or how to hashtag or any of those types of things. I used to make fun of people for hash tagging things because I didn’t I didn’t get it. I might one of my first tweets was I was tweeting something to my brother or about my brother, because he’s a. He’s somebody who’s pretty active on Twitter because of his business, which is baseball. And he called me about 20 minutes later and said, you just tweeted something, the only person who can see it as me, and the thing you both did was obviously meant for a larger audience. So let me teach you how to tweet so it doesn’t come just to me. So he was my first Twitter teacher, as I started the process. That was that was a learning experience. And then just through learning from other physicians and kind of trial and error, I learned How to hashtag how much to hashtag how to tag somebody in a post, but make sure it went to a wider audience. So there’s a lot of minutiae and intricacies that people who are very adept at Twitter know, I still don’t know, most of them, but I think I’ve gotten enough to at least be a active Twitter participant. Can you
Unknown Speaker  4:21
hashtag too much?
Unknown Speaker  4:24
You can I recently went to a talk by Dr. Esther Chu, who is in my mind, the queen of social media when it comes to physician and she said that tweeting more or hash tagging more than probably about two hashtags in a in a tweet is probably going to be too much of an aloof people interested in so you should try to focus your hashtags on the topic as opposed to trying to fit as many hashtags that you can into a tweet. Interesting, interesting.
Unknown Speaker  4:58
So when was it that you sent your first tweet to inadvertently to just your brother.
Unknown Speaker  5:06
I think it was about a year and a half ago to
Unknown Speaker  5:10
a year and a half. What you told me before the interview is that you are now at 1000 Twitter followers. So in a year and a half, you went from not being familiar with Twitter to having 1000 followers. That is fantastic. That is, I think, inspiring for anyone who’s listening to this, who is considering making their foray into social media.
Unknown Speaker  5:35
That’s Well, thank you.
Unknown Speaker  5:36
So not only are you active on on Twitter, I and and I met you actually, this is a perfect example of why physician should be active in social media. I met you through social media. I’m a member of doctors on so you’re a moderator of this. And you’re a moderator of other groups as well on Facebook. What are some of the other groups that you’re a moderator
Unknown Speaker  6:00
I’m the moderator of one other group. It’s called the dual physician family group. I started about two, maybe three years ago. And the reason I started that so my husband is also a physician. And there are very unique challenges and questions that come up in a dual physician family. So I created the group just to start asking some questions that I had, you know, how to manage calls scheduled with young children, how to have backup care, how do you balance household work, how to manage your finances, and it started off with about maybe 50 people in it. And now it’s blossom to over 2500. And it’s open to both men and women. It’s open to any family or any partnership where both spouses are position.
Unknown Speaker  6:55
Wow. So you, you basically created the group that you wanted to see
Unknown Speaker  6:59
Exactly I looked and saw there wasn’t a group of its type. And I created it. Not sure if it was going to take off or not. But I’ve actually had a couple of interviews on that. And that group because it has grown so much, and because people have found it pretty useful. That’s great. That’s
Unknown Speaker  7:19
great. That’s actually why I created this podcast. It was, I’m a podcast feed. That’s what I’m always listening to on my
Unknown Speaker  7:27
computer when I’m doing the dishes.
Unknown Speaker  7:30
And I couldn’t find what I was looking for. So ultimately, after years of observing, I decided to just just make one. So when so when you were first starting, did you get any advice? I’m not asking for legal advice, but kind of, um, did you get any advice from the department? Are you Is there any oversight from your legal department to make sure you’re staying within bounds?
Unknown Speaker  7:55
So the main thing for anyone who is in social media or Media is you need to make sure that first and foremost you don’t break HIPAA or violate HIPAA, which I think is incredibly important. I was one of the first, like 100 members of this very large group, I’m sure many physicians have heard of it, the physician mom group. And so I took some advice from their code of conduct and read what they said was allowed and wasn’t allowed and got some ideas from that as to how to be careful in these scenarios. I’ve been fortunate and then there has there hasn’t been really in any of the groups that I moderate anything that would be even close to a violation of HIPAA or a legal issue. If someone does post something that I think would be concerning, I usually contact them directly and say, you know, this is something that either isn’t in line with our policy or it is something that I think is unethical, but I’ve never had That issue and of course, in the doctors on social media group, there has been people, there have been people who recorded posts periodically. And when that happens, myself and the other moderator, Dr. Corey L, we look through and make sure that the posts that are being reported are addressed.
Unknown Speaker  9:19
What is the theme? Or is that just people getting a little aggressive with each other?
Unknown Speaker  9:24
No, I mean, sometimes it’s more and most of the posts that have been reported haven’t actually been a major issue. One was, someone was a little upset with the tone of what someone else had said. Another one, they weren’t sure if the post actually was in line with what the purpose of the group was. So a lot of times we get things where people report it and they just write a question to the extent of is this in line with what this group is for? I’m not really sure so I thought it would bring it to your attention, usually very polite, and it’s usually very benign. I haven’t had any major issues yet. Knock on I’ve been lucky.
Unknown Speaker  10:01
Yeah, I’m on physician side gigs as well. And sometimes someone will post something like I’m thinking of getting into Botox. What do you recommend that I reply? Do what I did do a six year residency in plastic surgery?
Unknown Speaker  10:16
You know, they get exactly yeah, little aggressive little snippy with each other. So you see, you’re on Facebook, you’re on Twitter, are you on any other platforms? I’m on LinkedIn, but I mainly I haven’t really done much with LinkedIn. I’m on there. I use it a little bit for networking. And I’ll occasionally post an article that I’ve written on there. But I’m not as active on LinkedIn, as I know, some other people are. I have a professional website that I have been working on, but it’s kind of a work in progress. I haven’t put as much time or energy into that just because, you know, I do have a full time job as well. So it’s something where I’ve used to store the things that I’ve written and it’s often it’s public, and people can find it. But it’s not as elaborate or as kind of user friendly right now as I would like it to be. So my hope is in the next year so I can work more on that. I know a lot of people use Instagram, I’ve never been wanting to do Instagram, maybe it’s something I’ll do down the line. A lot of physicians are getting into Instagram. And it’s good for promoting your personal businesses or promoting your practice. Some people like to use it to promote other things they do, for example, there’s some position to love to bake and have beautiful baked goods that they make. So they posted along those lines. And I haven’t made the foray into Instagram yet, but maybe that’s something I’ll look into down the line.
Unknown Speaker  11:44
Yeah, I think my last post was I smoked pastrami. We my wife and I we made ground corned beef out of a brisket brined it for two weeks for astronomy, and I posted that all over Facebook. I was so proud.
Unknown Speaker  12:01
Maybe maybe Instagram would be appropriate for you absolutely. Do that.
Unknown Speaker  12:06
So you you post a lot of
Unknown Speaker  12:10
information through your patients, which is one of the things I really appreciate about your what you do online with your with your Twitter page, because I feel like for physicians, we have this with this, what seems to be an insurmountable uphill battle. You know, the internet has led to the democratization of information, which is great, because if you want to find out, you know, some some information, so, the patient comes to you, they’ve been diagnosed with cancer and something that I tell my patients is, if you don’t know your diagnosis, don’t start googling. Inevitably, you know, lead you down a path that might not be the wrong one might not be the right one, but but once you have your diagnosis, then then the internet can be a powerful tool. Because previously in order to find information, you’d have to go to your go to the library right journals. I remember when I was when I I was younger and had to do any type of scientific research. My mom would have to drive me to the nearest University Library and we’d be photocopying journals. chicas makes me a little bit and and now it’s great, it’s great because there’s all there’s all this access, but at the same time, there’s been the democratization of misinformation as well. And so you have celebrities that are telling people that the crystals are going to heal their cancer, right. And it’s unclear, you know, they might be asking you whether they should you know, how they should be applying those crystals as one of their first questions, you know. And so, so I just, you know, I find hope in in a Twitter account like yours, where you’re just making it you’re, you’re, you’re giving physicians more of a voice and making scientific information, more, more, more available. And so, I guess, how’s that going so far?
Unknown Speaker  13:56
Well, thank you. I appreciate the compliment. I take that as a big compliment because That’s one of my purposes on Twitter. Because you’re absolutely right. There’s so many pieces of misinformation or, you know, shock news or, you know, shock articles or false articles out there. And I do have a lot of agents come in saying, you know, I did my research, and this is what I found. And some of the stuff is very scary. I’ve had patients come in who have, you know, looked into things and they say, well, this paper says that, you know, 80% of patients with my type of cancer were cured by doing this cleanse, and they go into the cleanse and they end up really sick. So that’s not to say there aren’t some, you know, complementary medicine that’s very useful. And that can be very helpful. But I think you’re absolutely right with the misinformation and the mountains of misinformation that’s out there right now. It’s our job as physicians and as scientists to continue to promote the truth and explain and educate as much as we can. And a lot of times what happens as divisions We tend to explain things and sometimes we explain it in ways that patients might not understand or it might be more difficult for them to understand. And my biggest job, I think, as an oncologist is to try to explain things to patients in a way that they can understand to the best of their ability. And we hope to make an informed and educated decision. Because at the end of the day, it’s their bodies and their lives, and I want them to make a decision that’s going to be best for them and for their life. And if they’re making those decisions, without the accurate, correct information, they can ultimately be doing a great deal of time to themselves. So what I try to do is, you know, I’ll post articles that are very academic, and then I will try to put a little summary to explain in more layman’s terms what the main point of that is, and by doing so, I’ve been able to engage Patients who will message me and say, Wow, that’s really interesting. I didn’t know that or can you explain that a little more. So it’s been a great way to bring very complicated information in almost a sound bite to patients. And it, I think it can be extremely useful. And I even had my own patient Crimea on Twitter and come in with questions based on what I tweeted. So I think that it’s a very powerful and effective way for physicians to engage with patients and make sure that we’re giving them the best and the most information. And
Unknown Speaker  16:32
so you found this also to be a referral source. So people will find you through your Twitter, Twitter handle, and then come to you as patients.
Unknown Speaker  16:42
I found that not as much I’ve been at a couple of times where they said, Oh, I saw you on Twitter or my friend follow you on Twitter. So that’s happened a couple of times, not as often as I think it probably has some of the bigger tweeters out there, but it’s happened a few times to me Yeah.
Unknown Speaker  17:00
Do you think your presence allows you more
Unknown Speaker  17:05
leverage? Is there a word or headway? When you were a treating patients that do come in with this? I like to call it non scientific advice. I so that I think, as physicians, we should reclaim the term holistic, there’s holistic medicine, yeah, I think tends to be non scientific medicine. And I would imagine, from from interacting with you, when I, if I were to walk into your office and be one of your patients, you’re actually being a holistic doctor, you’re taking into account my job and my family and my hobbies and my other medical problems and my medical, like, the the entire patient may so I think, differentiating you know, us as holistic physicians, and then differentiating by scientific versus non scientific. So, what I’m getting at around about ways is is your social Media Presence allows you more leverage or when when
Unknown Speaker  18:06
discussing care with patients that come in with a stack of information that is non scientific. I think it has a certain extent because I do also tweet occasionally about complementary medicine and about treating the whole patient and making sure that you’re taking into account what the patient is going through. I wrote an article for I think it was on Kevin MD about the never ending Oh, no, it was on doc somebody about the never ending bucket list and the stage four lung cancer patient. So I, I think people have read some of the things that I’ve been writing and they know that me as an oncologist, I very much focused on treating the patient as a whole and keeping in mind all of the other things that you mentioned. And on top of that, I also believe in treating the symptoms that patients have some with medications and sometimes with complimentary care that has been found to be helpful in certain cases where there’s certain vitamins that can help with certain symptoms or that but but again, the only times I do that is when there is some evidence behind it. So I think that people trust me, because I’m willing to listen to what they have to say. And I’m willing to try to work with them as much as possible. But if they’re suggesting something dangerous, or something that I think will be detrimental or will interact with their chemo, they know that I’ll be honest about it. Because at the end of the day, we all went to medical school and residency and fellowship and you know, whatever training we did to help people to help the patient, our goal is to help them get through what they’re getting through. And so my hope is that through my social media, and through my writing, I’m able to impart that to patients that if they bring something to me that I don’t think is a good idea or I don’t think it’s safe in a scientific from the scientific banding that they trust. I’m saying that not because I’m skeptical, but because I want to do what is best for them, or I want to suggest what’s best for them using the science and the information that we have available to us. I read that article. I thought that was a beautifully written article. Thank you very much. Yeah, I would I would suggest to anyone that I guess you just google google your name and proximity, or actually any bucket list. Yeah, exactly. it’ll, it’ll be easy to find. Yeah, I really I really enjoyed that. And it sounds like actually that was the what you’re saying the beginning that that was that was your start. You were already writing? Yeah. I think I saw an article medium and proximity to you’re already doing those. This was already something that you I guess enjoyed doing. It was I actually I started writing about two and a half years ago and it it started almost on a whim where I somebody had written an article about For for about doctors don’t let your children become doctors or something like that. And I wrote a character EP, kind of as a counterpoint to that. And the title of it was why I would encourage my daughter to become a physician, something along those lines in Kevin MDY would still encourage my daughter to become a physician. And that is the first time I published anything and it really just started because I was very passionate about medicine and about encouraging our next generation of physicians. And so, after that article was published, I said, you know, maybe maybe this is something I can kind of do when I have free time or when I have a topic I’m passionate about. That’s how I got started and all the social media stuff around the time they asked me to create a Twitter handle.
Unknown Speaker  21:48
So do you have any advice for physicians that are considering getting dipping dipping their toe you headfirst. But for anyone who’s considering, you know, you mentioned a couple things you mentioned networking, you’ve been able to network with a lot of physicians. And I mean, clearly being the moderator of two groups on top of an active writer, Twitter poster and mother, full time position. And you just you just finished fellowship three years ago. So you started writing, I guess, right after you finished. We had a little, you decided to use it. Use it pretty actively. So so. So if someone wants to just kind of dip their toe into the field, what would you say is like high return on investment, so it’s going to be encouraging if they if they do something and then you can pretty quickly see some return on their investment, like what platform what what reason would you recommend to someone who’s getting started,
Unknown Speaker  22:58
so I think Twitter is a great Good way to start. And I say that because there’s a lot of ways to increase your followers very quickly. I did not necessarily know that the first year the first year I was on Twitter, I was actually pregnant with twins. So my, my social media was, it wasn’t as much as it probably could have been if I if that had not been the case. But the biggest way to increase your followers at Twitter and Twitter I found is there’s a lot of roundtables or they’ll be discussions on Twitter you can get involved in, there’ll be forums where they’ll be asking, you know, people to give their input. If you’re a female physician in medicine, there’s a women in medicine chat that happens every Sunday evening. If you just look at the chat and they’ll post a question and you can post answers you know, give your opinions on it. People then you get more visible to people who are like minded to you or earn similar to To you, or, for example, are in healthcare. And that’s a good way to start. And then you can see who they follow and maybe follow some of those people tweeting a couple of times a week is a good way to start. And it’s, it’s just kind of putting something out there. So I think Twitter’s a good place to start. And you can be as active or as minimally active as you want to be, which is why I think it’s such a great social media platform. And if you’re interested in writing, I say, just write something. Just write something, you know, have a close friend or family member, look it over and say, Is this any good? You think I should submit this somewhere and then submit it? The worst that can happen is they say no. When I wrote my first piece, I really didn’t think it was going to get accepted. So the really great places to submit for positions I think Kevin MD is a great resource. Doc activity is another great resource and they’re both always looking for articles. And that does not position that anybody in healthcare, you know, nurses, social workers, articles from pharmacists from just about everyone. So those are really good forums to submit to. And don’t get discouraged if you get rejected from one, you know, make, they might give you some suggestions, make some edits, and maybe either submitted again or submitted to a different platform. So Dr. Moody and Kevin MD are really good. If there’s something that happened in the world that you think is directly related to your field, and you think you’re an expert, or you feel like you have a very strong opinion on it, you could always pitch your idea to, you know, the Huffington Post or New York Times if you’re feeling especially lucky, or I guess you could say, or especially especially powerful at the time, they take positions writing often on you can usually just find there’ll be an op ed editor or something that you can email through and say this is my idea and pitch it to them. And I think those are some really good ways to at least get started. And then Facebook
Unknown Speaker  26:01
If you’re interested, I’m sorry to interrupt that says if you’re interested in, in networking with other physicians, but let’s say so I’m in, I’m in private practice. And so if I’m just getting started in my area, I want to, you know, developing a patient following. What used to happen is you would hang out in the hospital, in the cafeteria, talk to other doctors, go to the physicians lounge, talk to the doctors there, and all of a sudden, they’d start sending you patients that when I first started in my area, I, I would go to a bunch of doctors offices, I’d bring them lunch, I try to chat with them. They wouldn’t be interested. They they had the doctors that they sent to me, right. They had the doctor said to and they were not interested in changing nor did they have any time to chat with me because they use their lunch to not to schmooze with, you know, whoever brought them lunch that day, that’s for the staff mainly. They’re busy, they’re busy. And so, you know, the way that I ultimately built my practice was I just, you know, just put my head down and tried to be the best doctor that I could be. Right. And ultimately, you know, that news, I think got back to their
Unknown Speaker  27:22
referring providers. And, you know, they would Oh, yeah, so this great doctor, so, so it worked in different way. And also social media has helped me out a lot because you have all these local Facebook groups where, you know, does anybody know good ENT? And then, you know, quiet times, some some by looking at the ones that she’s always very proud when, when when my name happens to be mentioned. But, but if if I’m, you know, a local private practice physician, how can social How do you think social media might be able to help me build my practice? Oh, there are so many ways you could use it. So number one, so let’s talk persistence. Twitter. So if you’re on Twitter, you should find other physicians referring physicians, especially if they’re on Twitter and follow them and send them a message and say, Hey, I am just starting practice, or I would practice on the street. These are the types of patients I see, I would love for you to send me anybody. And, you know, if I need to have a piece of tea, I’d be happy to send back to you, things like that. So that’s almost doing the meeting in a doctors lounge type scenario only over social media. The second thing is if there’s any organizations in your area that are very active, so for example, in Chicago, we have children’s clubs. So if you’re an oncologist in Chicago, you would follow builders club, and then when you start posting things, they might follow you back or you could even send them a message and say, Hey, I’m an oncologist in Chicago, I’d love for you to follow me. And you will definitely get patient referrals from things like that. The other thing that I think Twitter especially is great for is and it’s something a lot of physicians feel uncomfortable doing, but I think the ones who are most successful are the ones who are able to do some self promotion through Twitter. So posting something along the lines of you know, my office is open from these hours or something unique about your office. Let’s say your office has three coffee in the lobby day, you know, you can mention that. things, things like that for self promotion is something I think that we physicians suffer from a lack of being able to really do successfully because many of us are not, don’t feel like we have the ability to do that. But Twitter gives you that forum. Once you have some followers, you can, you’ll be directly conversing with them. And some of the conversations might even be in public, you know, in the public Twitter, Twitter verse as opposed to direct messages, and patients will see those conversations so if you have a dialogue with you know, you’re a primary care doctor and you’re having a dialogue with an endocrinologist. People will see that and they will see that your Engage or you’re asking the appropriate questions, if you post information. So, you know, the new study came out about a new type of surgery and you posted about it, patients will see and say, Oh, this position is up to date, he knows that you no longer use the surgical procedure, they’d be more likely to come to you. So by being active on Twitter and putting things out there that show that you are up to date and show that you’re engaged and that you’re willing to, to look at things in different ways. All those things will bring patients to you. On Facebook, it’s extremely useful to have a page, a professional page, where you can do similar things. You can post things you know about articles you can post about events that are happening, if you have an event in your office, or if you know there’s an event in the city that you live in, that’s relating to the disease you treat or if you’re giving a talk or Lot of physicians give talks in you know in different forums. So either they’ll give a talk in a community center or they’ll be a part of a support group, you can put on Facebook or Twitter that you’re going to be at that. So by putting yourself out there more and more people are going to know that you are there and they’re going to come to you you’re going to become a household name. You’re going to be someone who don’t those friends went to this end and Oh, he also you know, post on Twitter and Facebook and mean he’s been very smart or you seem very you know, up to date. So that’s, that’s how you start to get not only referrals from physicians but also patient to know about you and care about you and they will come to your office.
Unknown Speaker  31:41
It is a brave new world out there very different from from a few years ago, were actually hanging out in the in the lounge would get you and just sitting there drinking coffee would get you your referral sounds like we need to be very active but there is a lot of opportunity as well. Dr. Jane, I really appreciate you taking all this time to talk to me, if you would just let us know where where can people find you.
Unknown Speaker  32:08
So if you would like to find me on Twitter, I’m at Chica Jane. So that’s FHIKHAJAINMD so that’s my Twitter handle. If you want to find my web page, which like I said, is a bit of a work in progress. Currently. It’s www dot Chica Jane and the.com and you can also find me on Facebook I have a professional page that is public and it is also sugar Jane MD, and that spelled FHIKHA. And then the last name is JAIN. I’m also as you mentioned earlier, I’ve been published on Kevin MD and activity so if you Google my name, I’m sure you’ll be able to find some article or another that I Britain in the last couple of years.
Unknown Speaker  33:01
Wonderful. Well, again, thank you so much for taking the time out to give our listeners and me especially some excellent advice to the hows and whys of social media as a physician.
Unknown Speaker  33:13
Thank you so much for having me. I really enjoyed it.
Unknown Speaker  33:19
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash physicians guide to doctoring. If you’re interested in being a guest or have a question for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai

 

The Physician’s Road

Eric Tait is an internal medicine physician with an MBA and his own private equity investment firm, which he manages while still practicing medicine.  He has found the keys to happiness and fulfillment as a physician and wants to share it with the profession.  He breaks it down into paths or touchstones, broken down into wealth, practice, health, relationships and personal development.  

Find more about Dr. Tait at the links below.

https://www.facebook.com/thephysiciansroad

http://vernonville.com

http://Thephysiciansroad.com

 

The Physician’s Road

Eric Tait is an internal medicine physician with an MBA and his own private equity investment firm, which he manages while still practicing medicine.  He has found the keys to happiness and fulfillment as a physician and wants to share it with the profession.  He breaks it down into paths or touchstones, broken down into wealth, practice, health, relationships and personal development.

Find more about Dr. Tait at the links below.

https://www.facebook.com/thephysiciansroad

http://vernonville.com

http://Thephysiciansroad.com

 

This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:03
Welcome to the physicians guide to doctoring Podcast, where Dr. Bradley Block otolaryngologist interviews experts in and out of medicine in order to get their take on how physicians and all healthcare practitioners can better help their patients, practices, colleagues, communities, and most of all themselves. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.
Unknown Speaker  0:34
Welcome back to the physicians guide to doctoring. On today’s episode, we interview Dr. Eric Tate. Eric has an MD MBA and actually has his own podcast called the physicians road, a website of the same name. And what makes him really special is one year out of residency. He founded the Vernon mill asset management firm, which helps physicians to invest in private equity. He’s found the key to happiness as a physician He breaks it down into five overlapping paths. He calls them the path of personal development, path of practice path of health, path of relationships and path of wealth. And we get some excellent advice from Eric on how to focus and improve on each of these.
Unknown Speaker  1:18
Without further ado, Eric Tate.
Unknown Speaker  1:22
Welcome back to the physicians guide to doctoring. We’re here with Eric Tate, MD MBA, who actually has his own podcast and website and asset management company, which is one of the great reasons why we have him on the show here today. It’s called the physicians road. You can find him on Facebook on the website, the physicians road calm, and on the podcast, the physicians road and we’ll circle back to that at the end. Eric went to Morehouse undergrad and then went to the Baylor rice MD MBA program, and then did residency in Internal Medicine. But the thing that really makes him fascinating is just one year at a residency, he founded an asset management firm called Vernon Ville asset management, you can find that on what was the website again, Eric burns, oh, calm. It’s Vernon
Unknown Speaker  2:14
Ville. com. Yeah. vrnonville.com.
Unknown Speaker  2:22
So it’s an investment firm that helps people manage private equity. While and when he started, he was working as a full time position. But over the years, because of the success of this firm, among his other ventures, he’s actually managed to scale back from a full time position and only sees patients one day a week. I think that’s something that a lot of us would would dream about. And he manages to use the other six days of the week to work on himself, his family, his asset management firm, and then helping other physicians to do the same. And so, Eric seems to have found the key to physician happiness and he talks about it in terms of the Five, touchstones and key is just making people more mindful of these touchstones he calls them the paths. So there’s the path of personal development, the path of practice, the path of health, health, the path of relationships, and the path of wealth. And at any point in your life, you’ll be working on one or more of these, it just recognizing though that, that it may be to the detriment of the other, because in your life, they’re always fluctuating priorities. But it’s important to be mindful that all of them are out there, and all of them need to be worked on and the more that we can be mindful, the more we can actively manage them as, as an active participant in instead of just being along for the ride. And so I really recommend that everybody check out his websites and his podcast as he really takes much deeper dives into all of these issues. And so what we’re going to ask of Eric today is to just give us some some easy, actionable items on each of those things. So Physicians get kit and other health care practitioners can can get a taste of what he’s discovered. So Eric, thank you so much for taking the time to be here today.
Unknown Speaker  4:09
No, thank you, I truly appreciate the the the opportunity and, and happy to help as many physicians out there as possible kind of figure out what it is that they kind of have to say what it is you want to be when you grow up, because we all tend to get on the path of medicine. And it we we end up having tunnel vision in many ways. And so with that tunnel vision, oftentimes things get get get left behind, I often like to say we we, we kind of go through a little bit of Arrested Development, you know, put our heads down at 1819 and kind of pick our heads up again at 30. And we’ve missed a lot of milestones, a lot of growing up and maturing milestones, oftentimes in that process. So just trying to kind of help people figure out kind of what it is they ultimately I want to do outside of just being a physician.
Unknown Speaker  4:58
One of my one of my co writers Since husband’s who’s not a physician, we were out for my 28th birthday during residency. And he said, Man, 28 was a great year. It’s a shame you’re going to miss it.
Unknown Speaker  5:13
Exactly, exactly.
Unknown Speaker  5:14
I’ll never forget that was 11 years ago now and I still very memorable. Yeah, we do we do. We do sacrifice a lot in order to do this. And, you know, unfortunately, the physician burnout rate is so high. So the question was, the question is, you know, was it was it worth it? And I think it’s great that you’ve, you’ve found a way to make it, make it worth it. So So I think what we talked about was personal development is really what sets the rest of this up. So if you could just speak for a minute about what you mean by personal development. For me personal development is for me what this podcast is all about and and there’s there’s a psycho psychologist by the name of Carol Dweck and she she wrote this book called mindset and, and what what it is, is We have a fixed people kind of a fixed mindset, which means that they just feel like they have these static traits. And and it turns out that it’s not true. We don’t have static traits. They’re fluid. People aren’t born funny. You five years old, you make a couple of people laugh and then continue to figure out as you get older, what makes people laugh, and then at 15, it seems like he’s the funniest kid in class. He was just born that way. So it’s not that he was born that way. It developed over time, and just just under the radar, and so So Eric and I both espouse the belief that personal development is the fact that we don’t have static traits we can improve ourselves. So Eric, what what have you been up to? And what do you recommend that is a simple actionable thing that people can do to start down the path of personal development?
Unknown Speaker  6:47
I’m kind of the easiest thing to do in all honesty, is to start with the classic the classic isn’t, you know, Napoleon Hill, Napoleon hills, Think and Grow Rich. It’s really not about getting rich. It’s really about kind of understanding the power that we have within the power within our subconscious, to, for us to be creators, and to be the architects of our own lives, you know, Napoleon Hill birth, lots of other people all the way down through Tony Robbins and Brian Tracy and all these people. And so, you know, Napoleon Hill is kind of the easy persons introduction into the kind of personal development realm and world, the person you would know most out there would be Tony Robbins. He’s also heavy into personal development. But for me, the simple thing about personal development is that what I’m trying to do, at least personally is strip away everybody else’s expectations of who I am and what I should be, and really get down quietly into the core of what I what I really want and what significant contribution I want to make to the world. What that is without any cultural overlays, religious overlays, racial overlays, gender overlays, Just kind of Who am I, in my essence? And how do I want that to manifest kind of in the world?
Unknown Speaker  8:06
So what was the name of that book one more time? Napoleon Hill. Yeah, Napoleon Hill, Think and Grow Rich thinking grow rich. So in order to start down the path of personal development, if you’re looking to improve yourself, his recommendation is thinking Grow Rich by Napoleon Hill. Great, great recommendation, not something that I’ve read yet but it is now on the shortlist. So thank you for that, that recommendation. So then the next path that you you discuss is the path of practice. So when you say practice first, what exactly are you referring to?
Unknown Speaker  8:39
So what I mean by practice is actual our professional lives. And so, in the end, I don’t want to bother people in and say, well, you need to be a practicing clinician or you need to be out of clinical medicine, in the in really the path of practices about your professional development. What, irrespective of what pathway you’ve chosen in terms of clinical versus non clinical. How do you effect The most effective use of your professional time? And how do you Marshal resources to make that be to create the kind of professional life that you really want to have? So
Unknown Speaker  9:11
how would we find an action item in that? And so if people are looking to start down the path of practice and improve their professional life as a physician, is it the physician patient relationship? Is it their relationship with their colleagues or their staff? Is it somehow improving their their reimbursement, like, what is something that they can they can do to start improving their practice?
Unknown Speaker  9:40
And so a lot of it’s going to be where you where you’re finding most of your problems, and so that the old adage is where you where you find resistance in your life as a place you really need to look. And so the thing that you’re resisting most the thing that kind of irks you the most is probably the thing you need to dig out a little bit and figure out what that is. And so yeah, exactly, you run towards your freedom is in your pain. Technically, and that’s very true. And
Unknown Speaker  10:05
find what you wait to do till the end of the day because you really don’t want to do it. And that probably the thing that you can explore, why don’t you want to do it and what can you do to make that less painful?
Unknown Speaker  10:18
Absolutely. And the other thing is what I find with with working with physicians is we tend to be do it yourselfers, as opposed to on the business side, we bring in teams for everything. And so ultimately, because we tend to do a lot of CMS around subject matter of medicine, we don’t tend to do the same kind of professional development as it relates to non subject matter things. And so whether it is hiring a coach, whether it is bringing bringing in an outside billing company, whether it is you know, taking things off of our plate and giving it to people who are experts, as opposed to us trying to necessarily muddle through it. Sometimes going and finding expertise can actually Free us, as opposed to, we tend to assume oftentimes I think in my personality is that way that I can do it better than everybody else. And, you know, playing in business a lot I realized that no, you don’t want to be the smartest person in the room you want to bring in people smarter than you and the subject matters where you are having the most pain.
Unknown Speaker  11:16
I forgot where I heard this but you want to hire the smartest person in the room you don’t want to be the smartest person you want to be in a correct in the position to hire that person.
Unknown Speaker  11:26
Is the old Henry Ford story.
Unknown Speaker  11:27
What was a What was your either your first or most memorable pain point that you were able to outsource? What what really either sent you down this road to improve your path of practice that you found to be most painful, or the most significant?
Unknown Speaker  11:46
over me was probably starting my own practice the first 10 years out. I was employed as I never wanted to own a practice because I’m primary care. It’s very low margin. Didn’t want to deal with the hassles of the headaches of employees in the back office, and all those kinds of things. And when I made the decision to spin out of being employed, I just created a small micro practice. It’s kind of, you know, the one thing I said I would never do, I’m doing and ended up giving me the most freedom in that process. So, for me, that was the biggest kind of bridge to cross in my own life in terms of looking at the thing that I said I would never do, and then actually end up doing it.
Unknown Speaker  12:24
Oh, that’s interesting. So my experience has been quite the opposite. I joined a practice right out of residency, that is a well oiled machine. So if you want you can get involved in some aspects of the management of the group, or you can just put your head down and see your patients and go home and you can get as involved as as as you desire. And so I’m certainly involved in in some of the committee’s but the fact that most of the aspects of running a running the practice just happen in this well oiled machine has been has been for me, I think great, because then it just just just simplifies just simplifies my life that we have two or two, were two sides of the two sides of the coin. Absolutely. And
Unknown Speaker  13:11
it clearly that was not your pain point.
Unknown Speaker  13:13
No. Well, I mean, I didn’t I was read residency. So I didn’t, I didn’t think that running a practice, I didn’t even think of it as as being an option. So, but it’s nice, I think for a lot of our listeners to hear that it is it is possible to do. So. So the next is the path of health. Obviously, that is your physical and mental health. So what what is when you when you meet with physicians, what do you find is a common issue that they have that is obstructing them from going down the path?
Unknown Speaker  13:46
Well, and the thing about it is, you know, it’s not just the physical, right, it’s also the emotional, the psychological, the spiritual. You know, many of us got into medicine. As a calling. We got into it to help other people and Many of many of the of that light and that passion ends up getting beaten out of us through the training process and then coming out and and dealing with all the hassles and rigmarole of medicine. And so honestly, it’s really the broken spirits that are what we see more often than anything else, not necessarily kind of people were massively overweight or, you know, that has a population. I don’t think we as physicians are overly unhealthy. Visa v the rest of the population but from a spiritual and emotional. That’s a low bar, though. Yeah, well, that may be true, but but from a from a spiritual and emotional standpoint, that’s where you see the issue. That’s where you see the suicidality where we are much higher than the population, the general population. So these
Unknown Speaker  14:44
are these aren’t really separate paths. This is more like a Venn diagram, right? Because clearly, your recommendations for the path of practice finding your pain points and outsourcing them is going to then improve the path of health.
Unknown Speaker  14:57
Exactly. This is wrong and intertwined.
Unknown Speaker  15:01
It’s a life balance wheel and it’s all intertwined. They can’t
Unknown Speaker  15:03
eat more salads. No, it’s,
Unknown Speaker  15:06
I mean, of course, I mean, we can all probably do that. But that’s not the big point that I’m seeing when I’m interacting with physicians on a regular basis. It’s really that that that that emotional, and spiritual and mental kind of breaking point that people are at right now that that’s the big big issue. And they should eat more salads and then she works out
Unknown Speaker  15:28
and exercise more. Okay, and probably stretch
Unknown Speaker  15:31
it. But I think meditation Yes, meditation is huge. I think and this is something I’m I’m because I can’t touch my toes. Stretching is you know, when you see people older, if you walk like an older person you would think would walk that’s mostly a flexibility issue and flexibility decreases as you age and so if you want to continue to be vibrant flexibility also for for injury prevention, so but that’s, that’s
Unknown Speaker  16:00
Absolutely, I have mostly Medicare patients, and I’m sending them to yoga classes all the time.
Unknown Speaker  16:06
Fantastic. And that that gives them a community as well, which is, which gets us to the next path seamlessly, seamlessly, the path of relationships seemingly, if you get rid of some of your pain points that improves your mental health, and that will spill over into your relationships. But is there something specific that you’ve seen with physicians again, and an actionable item that you think our listeners can do to improve their relationships, be it with their spouse, their children, their partners, their employees? What What do you think is either something easy to do or something that you commonly see as as a problem?
Unknown Speaker  16:44
Well, again, you said it and it’s true. It’s it’s, it’s the mindfulness, right? It’s the understanding that those human interactions and connections can’t just be put on autopilot, that you actually have to see the person and I don’t mean just, you know, visualize them but as he See the people that you are with, whether it be your colleagues, your significant others, your, you know, your parents, aging parents, you know, children, being present with the people you are with, when you are with them, you know, be or the proverb says, you know, be where your where your feet are, where your feet are planted. And that’s why I say a lot of these are touchstones, because being cognizant that these things are important, is often enough that you will take the half second, the five minutes just to connect with someone, right? But we oftentimes get so much on the treadmill, that this stuff just kind of, we’re just not thinking about it. We’re just trying to get through our day. We’re just trying to get to our charts. We’re just trying to trying to figure out kind of how to keep our heads above water. And some of it is just taking the pause and saying, Oh, I have somebody in the house with me. I have a child. I have an adult who’s thinking about me, I have family members who I haven’t connected with. And so some of it is just a reminder like, oh, okay, I need to spend some time with these people. And a lot of time there’s not a lot of time. That was the fact that you’ve made the gesture to prioritize someone else. And then they know that you’re prioritizing them, that makes all the difference in the connection. And so, you know, from a, from a pure practical standpoint, you know, retreats are always good if you’re talking about kind of couples or significant other types type things where it’s just dedicated time. From that standpoint, if you’re talking about colleagues, and I think about a sphere in a toxic kind of work environment is, you know, it’s hard, right? Because if you if you’re not the person who runs the and runs that particular environment, you may not be able to bring in outside mediators or team building exercises. These are all kinds of things that rarely happen. We don’t see them happening a lot in medicine that the business world tends to do now without the business
Unknown Speaker  18:46
because those are patient. That’s time that can be spent seeing patients
Unknown Speaker  18:49
exactly going to retreat. Exactly. And so, you know, some of that resetting of, of expectations, and I don’t mean lowering equities, I mean resetting of expectations as to what our lives look like, because the only reason why you’re pushing the productivity of seeing more patients is so that you can create more revenue. Right? Well, you know, that will very easily and seamlessly move us into the next pathway, in terms of kind of how you take those revenue pressures off of yourself personally.
Unknown Speaker  19:17
But before we do, there was something that you mentioned. And it’s you said, Be present. And I think that is something at least for myself, that I found to be hugely important for both my practice and my relationships. So with my practice, you know, they were medical school, you have to listen, your patients want you to listen, don’t interrupt your patients. They don’t think you’re listening. You’d be a better listener. Right? Well, listen, listen, listen, I don’t think it’s such great advice. Because it’s not actionable, but I think being the concept of being present, so not only should you be present, which means you’re focused on your patient and you’re not thinking of anything else, but you should also look like your Present. And so even though it might seem like, you know, might seem to your patient, like when you’re typing on your EMR, that you’re playing Minesweeper, just, you know, informing them that you’re just, you know, writing them to. So it’s important for you to be present, so that they, that they feel like their time is worth something. But also, that you also make it appear that way. So it doesn’t, even though you are present, make it look like a present. And that’s something from my relationships, that it’s helped me with my kids. You know, I keep on hearing. It goes so fast. It goes so fast. It goes so fast. Great. That’s great advice. Thank you so much for telling me that it’s going to go fast. Because you know, it hasn’t been five minutes, that someone else hasn’t told me that it goes off as I recognize that it goes right. The days are long, but the years are short, right? But I think something that that is actionable for that is be present. When you’re with your kids. Don’t think about work. Don’t think about your business. Don’t think about the renovations your house, don’t think about your bills. When you’re a kid with your kids. Just make sure you’re going to find your mind wandering, which is kind of what you were mentioning about meditation. Right meditation is a practice that helps you manage that mind wandering issue. But I think being being present when you’re with your with your friends being present with your with your family, that that’ll help your practice and it’ll help your relationships and it takes practice kind of like that whole thing I mentioned with Carol Dweck and mindset, it’s something that you can improve with practice. So, so I appreciate you mentioning that because I just, I found that to be so hugely important being being present. And so, you know, making enough time for for relationships is hard if you are working a ton, so then, as you mentioned, leads into the path of wealth. And so as someone who founded and manages an asset management firm, while he’s a practicing physician, obviously that gives you tons of credentialing with our physician audience. You were pretty that’s pretty incredible feat. And so why don’t you talk to us about getting physicians on the path to wealth.
Unknown Speaker  22:01
Yeah, I mean, the easiest thing I what I tell people is I really give people you know, I really tell people what to do what I what I can tell people is, I can show you what I’ve done, right? And so I realized that an early step. Actually, when I was in business school, I realized that there’s only so many hours in the day you can labor. And that if I wanted to be able to not have to labor, for whatever reason, right for me, it was I wanted to practice in this particular kind of way. I want to practice medicine in a specific way. And I didn’t want the pressures of productivity and assembly, line medicine, getting in the way of that. And so what I figured was, I would need to replace my income in some way, shape, form or fashion. For me, you know, doing franchises or operating businesses wasn’t going to make sense because I was a practicing physician. And so, you know, investing in real estate and being kind of a silent partner and businesses, but with the understanding that I was not going to invest in anything that did not generate income directly to me. Because I wanted to replace my medicine, medical income. And so that was the whole focus of everything that I did. And so the investment firm was really set up by my accountant, for us to manage our own properties. And then over time, we just had other physicians who wanted to invest with us. So when we allow other physicians to join us in the things that we were doing, but this is the way I’ve always invested our family money in the world, to give us the time, to be able to operate our practices, pay attention to our health, have great relationships. And so what I understood was from the personal development side, I figured out what I wanted. On the wealth side, I figured out how to achieve it by getting more time and then that allowed practice health and relationships to follow from that. And that’s why this whole thing kind of intertwines, from that standpoint.
Unknown Speaker  23:48
So it sounds like you’ve found for you, for you, the path to wealth has been investing specifically in real estate. Is that correct?
Unknown Speaker  23:57
Yeah, I mean, I would say probably a percent. Yeah.
Unknown Speaker  24:00
So So if a physician wants to
Unknown Speaker  24:05
dip their toe in that
Unknown Speaker  24:09
pool, how do you get started doing something like that it would seem, you know,
Unknown Speaker  24:16
for physicians that are kind of early on in the careers with not much savings, right? Because we have that delayed delayed gratification, delayed monetary reimbursement. We don’t have a lot of savings. And so if, if you’re talking about buying $150,000 apartment that you’re then going to rent out to someone else. That is a substantial amount. That’s, you know, sounds like a substantial risk. How do you recommend we get started in something like that?
Unknown Speaker  24:41
Well, well, the first thing you want to do is figure out if it’s if that’s even what you want to do, right? So it goes back to kind of the person development kind of figure out what what are your ultimate goals, right? So then you start with the ultimate goals, what is it that I want to accomplish? And if you’re like, Okay, well, I want income streams that are recognized that I want to have, well, you’re talking about dividend producing stocks, even though the the rate of return is below inflation, bonds, same issue you have with that private businesses, real estate, things of that nature. So have to decide if that’s what you want, once you decided that that’s what you want. Now you have to figure out how do you want to do it? Right? Do you want to be the person that manages it? So you’re probably not gonna buy an apartment for 150,000. But you could buy a house. And you don’t have to have 150,000, you only have to have about 30% of that. And so you’re talking about, I don’t do math in my head, quickly, easily. So it’s 2030 $40,000. Right? And so it’s just a matter of choice, right? I chose to, to personally direct our resources to doing this thing. people choose to direct the resources. Other places people choose to put them in 401k is people choose to put them in IRAs. Again, that’s a personal choice, but everyone has to live with the consequences of their personal choices, right? And so that’s why figuring out what you want to do with the first thing first, and then you have the Go and find strategies that makes sense for you to be able to do that. If you decide that Yeah, I want to be in real estate, but I don’t want to, I don’t want to manage any of that. Then you would end up going to syndications which are larger group investments, you know, anywhere from you can go the crowdfunding route, which is, you know, zero to $20,000 to, you know, more of the private syndications which are usually 50 to $100,000. Right. Again, it all depends on kind of what it is you ultimately want. And then if you’re in private practice, you can have accounts that use your tax deferred money and you can put that into real estate if you wanted to as well. Now, most financial planners don’t tell you anything about that. But the IRS absolutely allows you to do it. And then you know, the overall conversions are there are lots of ways to skin a cat. But again, it all is going to start from what it is you want to accomplish. Not what other people telling you should accomplish, not what you’ve heard other people do. But would you within yourself. Say hey, this is what I’m I want my life to look like in the next two years, five years, seven years, 10 years from now. And then how do I have my investment portfolio support the goals that I’m trying to achieve?
Unknown Speaker  27:11
So it sounds like, you know what you were saying 80% of your investments are in real estate. And if a physician wanted to do that, in a rather get started, in that rather than being the sole owner of a property, they could seek out a syndication
Unknown Speaker  27:32
or crowdfunding syndication is that
Unknown Speaker  27:35
well said well, crowdfunding is a type of syndication, although syndication isn’t a group investment. So any any major building UC hotel, apartment farm building, they’re all syndications. It doesn’t matter whose money is being used, whether it’s your insurance premiums through your insurance company, whether it’s through private equity, whether it’s through a group of doctors getting together and doing it. All of the major developments that you see out there are syndications. The crowd for As for individuals on on kind of a lower income, not lower income, lower investment amount end. And the bigger syndications are usually on a higher end. But all it is is a group in bed mean technically, all a mutual fund is a group investment, you pulling your money to go buy stocks, right? So it’s just group investing but buying a different asset class.
Unknown Speaker  28:20
But that sounds to me. So, you know, one of the one of the benefits of investing in the market is your diversify, right? So, if you invest in the market, and you buy an index fund of the whole market, it’s hard to be more diversified than that. But if you’re taking a significant sum sum of money and putting it into a building, that to me sounds less, less diversified and US have bigger risk, clearly bigger rewards, but also a bigger risk. So I would think that that’s what would cause physicians on top of just not knowing that things like this are even out there as an option right? Probably most people think own apartment building is too complicated as a lot of headaches. It’s a lot of hassle. You’re making it sound like no, actually, it’s much simpler, as long as you know who to talk to and where to find it. It’s much simpler to do than that. But another thing I think people would be concerned about is now it sounds like you’re less diversified. More of your eggs are in fewer baskets. So isn’t that putting your your your money at higher risk?
Unknown Speaker  29:28
Well, depends on how you define risk, right? I mean, ultimately, you know, for me real things. The risk is always in the investor and not the investment. So it’s really just a knowledge base, right? I could ask anyone who, who has a 401k and ask them what’s your largest holding in their 401k? They wouldn’t be able to tell me they couldn’t tell me who the biggest competitors are of the largest holders and their 401k. I mean, so, again, risk is in the investor, not the investment. I would say from that standpoint. The second thing is it’s purely from an asset allocation. Stay One point, having all of your money in the publicly traded stocks and bond markets, you’re not diversified, you have to have some private investments to be truly diversified. We saw in 2008 in 2009, something called correlation. And so what that means is the linkages between all asset classes, stocks, bonds, everything in the public markets is very tight these days. And I can go into a lot of technical reasons why that is. But what we saw is that all these asset classes fell at the same time, which is technically not supposed to happen if your quote unquote, diversified, right. Well, you know, on and I don’t want this to be a stocks was real estate thing, because and again, I’m about asset allocation. So there wasn’t
Unknown Speaker  30:42
that the market fell because the
Unknown Speaker  30:44
real estate market crashed. Well, no, actually it was basically the 20% techcrunch’s of securitized funds, that went bad and the problem was the people in written derivatives off of those and so once the value of the ratings of those mortgage bonds because wasn’t the real estate was really the bonds. Once the valuables bonds dropped, it caused a cascading chain of react chain reaction where people had to get liquid. And the only thing they could get liquid with was kind of stocks, bonds and those kinds of things. And so big I, you know, I don’t want to bore your listeners with the technical analysis of all that. And there’s a great book if anybody wants to read it, called the differentiation of capitalism, david stockman and maybe getting the the title incorrect, but david stockman, who was Reagan’s budget director, wrote a perfect treaties that explain exactly what happened during the meltdown, and that it was pretty well contained. But for reasons that the government likes to kind of back the Wall Street guys, that all that bailout happened, which has created an even further distortion in the market today. But again, we’re going off on a much more technical situation. So now moving it back to diversification. I mean, I looked at my own portfolio. mean we own single family homes, multifamily properties, farmland, commercial strip centers, mean I’m pretty well diversified. We own in the United States outside the United States and foreign countries with foreign currencies, pretty well diversified, right? So it’s really more a matter of your understanding of what you’re actually invested in, which will kind of determine the risk, right? Me an apartment is pretty easy. People need a place to live, of course, you have to ask yourself is is there good job growth in the area? are they building a lot of other apartments in the area? I mean, these are all things that, you know, a high school kid can understand. And so for me, that’s why it’s, it’s a much they’re far less moving parts than me trying to figure out what you know, the Fed is going to do and how it’s gonna affect my 401k and Ira balance and just that that’s just too opaque for me personally.
Unknown Speaker  32:50
Well, I think, you know, the reason that one of the recommendations for investing in index funds, instead of trying to pick stocks is that it’s opaque. Everybody, right, like, unless you have some insider trading information, then and that’s really what I think you’re you’re saying here is, is, is the market in general is also everybody knows everything about what they should know about the market, right? Everything is transparent. But you’re what you’re doing is you’re finding investments that other people don’t have information on, because you’re getting the information about the school districts and the job opportunities. And, and because this isn’t maybe public information, these these investments aren’t available to everybody that puts you who did the research on these things. Add an advantage. It’s almost like insider legal insider trading information, you know, something you have access to information that other people may also have access to. But but in contrast to the market, where you have tons of people doing research on these things, and, you know, recommending that their funds do these things. You know, this apartment building in the outskirts of Houston. A lot of people are doing This is the research on this. So you’re not, you don’t have that that competition.
Unknown Speaker  34:06
Perfect example. So the last project we did is 100,000 square foot commercial strip center that a bunch of physicians who joined us on that project a week was selling it. And the President of the region even realize the junior guy was telling me that by the time the contract was already signed, there was a little bit of vacancy 70 plus percent of the of the place was occupied by credit tenants. So, TJ Maxx and things like that. The day of closing, our partners had two other leases, signed ready to go. That added roughly two and a half million dollars to the bottom line. So that was relationships, that was understanding the market. There’s so much information asymmetry when it comes to real estate. That’s the inefficiencies that you can exploit.
Unknown Speaker  34:51
That’s the word I was efficient. The market is perfectly efficient, but what you’re identifying is the inefficiencies in These other private equity investments and then capitalizing on them. And I may be incorrect about this, but I’m pretty sure Arnold Schwarzenegger did not make most of his money from Conan the Barbarian, which I would argue is one of the greatest movies of all time. But it was it was from twins. No, it was from real estate investments. So I think he made most of his money there. I mean, he was able to make these investments because of what he made from the, from the movies, which he, you know, are bodybuilding, but, but most of his money was was was in real estate investments.
Unknown Speaker  35:32
Absolutely. If you look at the Forbes 400 outside of the tech guys, most of that list is real estate people.
Unknown Speaker  35:38
So just to if someone wants to dip their toe into it, just to get just a taste, right, of what that means. Where do you find that? That crowdfunding, how do I what what’s the website that I look at? What’s the book that I read? What is how do I how do I find out more about this?
Unknown Speaker  35:59
Oh, Off the top of my head because they’ve approached us for some of our projects, and we’ve never gone with them. I mean, Content Management know how to crowdfund, you know, we’re not crowdfunding we don’t we, we believe in actually having a personal relationship with people. The issue with crowdfunding is you’re not going to ever meet the person who’s putting the project together. And I’m not saying that there’s there’s anything wrong with it, you can buy it like a mutual fund,
Unknown Speaker  36:22
and also your well really is your investment as liquid as that.
Unknown Speaker  36:27
That’s not as liquid but you can point and click
Unknown Speaker  36:30
guys got it. Okay, so it’s easy to Easy, easy to do
Unknown Speaker  36:33
was coupon important?
Unknown Speaker  36:35
liquid? So yeah, that money. You can’t get it as easily as you can. No,
Unknown Speaker  36:40
no, I would just say Google crowdfunding. And really, again, it’s about you understanding what it is you’re investing in, not the not the mode, which you’re getting the investment, right? Because they’re all syndications. So you still going to have to understand what a syndication is whether you go crowdfunding with a private and you have
Unknown Speaker  36:56
a fantastic podcast on that that I was listening to. So I think in order to wrap this up the Eric Tate thank you very much for your time. This was a great I was blown away I really appreciate your sharing your wealth of knowledge with us. And if you found this as interesting even as half as interesting as I did, you’re going to want to know where to find him. So again, the physicians road calm the physician road has a Facebook page as well that you can find his company Vernon Ville asset management is it Vernon Ville calm his podcast, the physicians roads and look that up on Spotify or Stitcher or iTunes or Google podcasts or wherever you get your wherever you get this podcast clearly for listen to this, you know where to find podcasts? Is there anywhere any last words or any other places where they where they can find you?
Unknown Speaker  37:50
know, I think that’s pretty pretty well it I mean, I’m easily Google Google. My last name is TTAIT. But I want to thank you and for what you’re doing for for physicians and highlighting other physicians and kind of giving a platform to let the world know that there are many ways for us to exist in this space and so, Brad, I really appreciate you having me on. It’s been a pleasure.
Unknown Speaker  38:17
That was Dr. Bradley Block at the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, Google podcasts, or wherever you get your podcasts and write us a review. You can also visit us on facebook@facebook.com slash positions guide to doctoring. If you are interested in being a guest or have questions for a prior guest, send a message or post a comment.
Transcribed by https://otter.ai

 

Improving the Patient Experience

This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.

Unknown Speaker  0:02
On today’s episode we interview Jason hair patient experience coordinator at Glens Falls hospital. We start off by defining what the patient experience is, and then dive into simple ways that physicians can improve their patients experiences. One great example was the next time you’re about to walk into a patient’s room, stop, take a deep breath, and then start the visit. So be sure to listen to the rest of the episode to find out what other easily executed high return on investment actions physicians can take to improve their patients experiences. The ideas expressed in this podcast are those of the interviewer and interviewee do not represent those of our respective employers. This podcast is intended for medical professionals. The information is be used in the context of your own clinical judgment knows in this podcast except no liability for the outcomes of medical decisions based on this information. As the radiologist like to say clinical correlation is required. This is not medical advice. Even though the magical podcasting may make it seem like I’m speaking directly Your ears. This does not constitute a physician patient relationship. You can have a medical problem, seek medical attention. Welcome to Episode Four of the physicians guide to doctoring podcast. We’re here with Jason hare the patient experience coordinator for Glens Falls hospital. I’ve known Jason, basically my entire life. And I’ve always known him as an entertainer. So it seems appropriate that he’s involved in something like this. But Jason, tell us how did you end up in that position?
Unknown Speaker  1:35
Sure. Well, first of all, Brad, thanks for having me on the on the podcast. I’m excited to chat with you about this today. So I’ve been in the patient experience coordinator role for just under a year at Glens Falls hospital. I’ve been in healthcare now for almost 20 years. I started off in credentialing and medical staff office at a hospital for special surgery in New York City. From there, I moved on to the to the health care tech side of things the for profit side, I worked at Zach Doc, I helped run their their customer service division for about six years, and recently moved from New York City to beautiful upstate New York, and was really excited to get back into an area where I would have more direct contact with patients in a very direct healthcare setting. And it’s, it’s a, it’s a great role. It’s a great role to have.
Unknown Speaker  2:30
So this is something that’s really rapidly emerging in the healthcare field where we’re recognizing that something that we’ve been lacking for a long time is, is customer service. And we’re taking cues from industries that have that have done that well. So, you know, I think that your role is really hugely important. And so I think we should explore what that what that entails. But you’d mentioned before the podcast that we should define What the patient experience is, which I think belies the fact that we, as physicians may or may not have the same perspective as the patient on what this experience is. So let’s, if you could define that.
Unknown Speaker  3:13
Yeah, absolutely. So I think you’re absolutely right that this is more of an emerging thing now and it does have ties to customer service because, you know, like it or not, our patients are consumers and they have choices. There are lots of sites you know, like Zach Doc, which I mentioned health grades, vitals, you know, whether those reviews of of providers are fair or unfair, they’re giving patients a voice and they’re giving them a choice in their, in their, in their healthcare. So patient experience does have relations to customer service, I think, what is a frequent misconception of patient experience? Is that is that it’s patient satisfaction. I don’t think they’re the same thing. I think that patient experience is not actually about happiness because we’re in health. care. We work in doctors offices, we work in hospitals, we can’t always make patients happy. And that’s okay. There are there’s no real universally recognized definition of patient experience. But one of my favorite ones, which was was said by Patrick Ryan, who’s the CEO of Press Ganey, who I’m sure that company I’m sure is familiar to some of your listeners is what he says is that the patient experience you know, it’s not about happiness, what it is about. It’s about patients. And I’m going from memory on this here, but it’s about patients being cared for communicated with respected and having their care coordinated in such a way that they can get the best possible clinical outcome for whatever their circumstances are. So it’s about you know, communication. It’s about care coordination. It’s about respect. And when you look at patient experience in that way, you’re looking at helping patients and their families, reducing their suffering, or helping them reduce suffering and reducing anxiety. And in order to do that, what you have to do is you have to look across the entire continuum of care. It’s not just the doctors, it’s, it’s the front staff. It’s the nurses, it’s the techs. It’s the website, it’s, you know, the answering service. It’s all of those things. So patient experience is really about delivering truly patient centered care, and it’s about care that is, is also safe, and really high quality care. So again, not about making patients happy. I don’t expect patients to be walking out of my hospitals, out of my hospitals smiling and in tapping their toes and with a big thumbs up, but they are that’s great. But ultimately, what I think it’s about is it’s about making patients and their families feel cared for and feel respected and feel like their dignity has been honored. And so I think that’s what it is.
Unknown Speaker  5:52
So you want them to walk out, feeling like they’ve been heard. They’ve been understood. That they’re, they understand their care and that they’re making the right decision because your your outcome may not you might get the best care possible. And your outcome might not be great, but as long as they understand that’s a possibility, and that the person that was looking after them really had their best interest. And they got the best care by someone who
Unknown Speaker  6:25
absolutely, you know, some family members will walk out of the hospital without the patient that they brought in that patient may may die, and but you can still walk away from that experience and say, obviously, this is not an experience that makes me happy. But we had a good experience. Here we felt respected, we felt cared for. We felt our loved ones. decisions were respected. You know, we that kind of thing. I think, if patients can walk away feeling like that, then you’re on the right track.
Unknown Speaker  6:55
So I don’t think any physician would disagree with that. But I think The ways that we can accomplish that would be up for debate, right? So So what are some simple things you think that we could do to improve what we’re doing already. So as a physician, I certainly want my patients to feel like I care about them feel like I’m doing everything I can in their best interest and doing everything I can to make sure that they understand what’s going on. But clearly, there’s sometimes sometimes a disconnect between those two things. So now right now, I’m just talking about not the ancillary staff, not the rest of the experience, but just that doctor patient relationship. Do you have any tips for me, so that I can make sure that that they really feel like I care about them and their concerns, and make sure that they leave understanding what’s going on? Also, respectfully, in a time efficient? Sure, sure. And
Unknown Speaker  7:53
there are you know, it’s easy for me to say, these are the things that you have to do and doctors can very rightfully saved I have all of these other things I have to worry about. I’ve got a patient roster for the day, that is, you know, down to the ground, I’ve got so many patients I have to see in this time. But at the end of the day, if you’re not taking the time to make that, that one patient that, you know, is your most important patient at that time, right? If you’re not taking the time to make that person feel cared for then then what’s the point? So? So yeah, as we’ve been saying in this in this discussion already, you know, ultimately, what two patients want, they want the same thing that your kids want, that your significant other wants, that your co workers want, and they just they want to be heard. So there’s there’s no faking that that step or you have to be very good at it to fake it. There’s but there’s ultimately you have to make sure that your patients are heard, in terms of the kind of the quick and easy things that I think can go a long way making that happen. So here’s some suggestions. Number one, before you walk in to that room, take a deep breath. Just take a second, to let everything else go, you gotta let go of that patient list in front of you. Because right now the only patient that’s important is the one that you’re about to see. Let’s say, let that go, let whatever happened before, go make yourself centered to meet with that patient, come in, introduce yourself to the patient and introduce yourself to the family, the family is equally as important as the patient. Because just from like a practical standpoint, when they return those surveys, or they leave their comments, a lot of the time, it’s not the patients leaving those comments. It’s not it’s it’s the family member that’s doing that, you know, I’m in a role where I see complaints and concerns come in from from patients all the time and it’s their, their loved one or you know, their, their spouse, their daughter, their relatives, someone like that. So make sure you’re introducing yourself to patients and family who you are, what your name is. This is a pet peeve of mine, to be honest, when doctors come into a room and they’re seeing me or they’re seeing my kids They don’t say who they are. And they don’t they don’t know they don’t start with that. Make eye contact, make sure you’re making
Unknown Speaker  10:09
an excellent point, actually, is it? The position, I just assume that they know, they’re here to see me? Right? Who they make an appointment with? They made it to see Dr. Block at 1030. So when Dr. Block What’s when someone who looks male walks in at just because I assume they can see my beard on the picture when they make the appointment. They when I walk in at 1030, and they assume that I’m Dr. Block. Now, this certainly some of my female colleagues have have problems with that because there’s this, you know, they’ll they’ll sometimes be mistaken for nurses, which is right, clearly a problem. But yes, I assume that when I walk in the room, they know that I’m the doctor because your appointment with me. Right? I didn’t make the winner for them. But clearly you’re saying that that’s a mistake on my part. Something that I’m Yeah,
Unknown Speaker  11:00
I think so it’s just when you think about it, you know, some of your patients are booking with you directly, some of them might be coming in through to the referral. Right. So they’re there, they’re told you’re going to go see, Dr. Block is the same as Dr. Smith is the same as Dr. Jones in terms of in terms of all that, right. So there could be that there could have also been three or four people that came in to see them. Before him, my daughter just went to see an EMT and the nurse practitioner came in first. And it was a little confusing at first, when that nurse practitioner came in, I thought, Wait, is this the person I’m seeing? Are we going to be seeing somebody else? So so there’s there’s that as well. But the other thing to keep in mind is that often patients are in pain, and they’re scared. So their faculties are not going to be at the same level that you might expect them to always be, especially if you’re in an area of you know, like a really emergent area, right? You’re in the emergency room or something like that, you know, so I think it’s and also it’s it’s just nice manners, right? Like, it’s just nice manners to come in and introduce yourself to someone and now you’re creating the minute you do that the minute you look them in the eye and you say, Hi, I’m so and so and you may be confirm their name for them. Are you? Are you john? Are you you know, are you? You know, are you patient and you introduce yourself to other people. You’re saying, okay, we’re here, we’re present in this room together, we’re creating a relationship. We are starting our relationship right now. And even doing that can help put people who are in pain and frightened at ease. So introduce yourself to people make eye contact with them, right? Don’t be looking away. I mean, obviously, you got to look away and make your notes right in your computer, right your notebook obviously, but make eye contact. The other thing that I really like, is and I know this is this is not a new thought, but is to sit at eye level with them when you can, right try to if there’s a way to do it, where you can sit I level and not have your back to the family. You’re in great shape. right because the family is really there. They’re potentially A very large part of the care plan. So you want to involve them in that.
Unknown Speaker  13:03
Yeah, the electronic medical record definitely makes that sure. Challenging and we hear lots of complaints. So you know, it’s it’s a barrier between me and my patient. It’s, it’s one thing that I’ve found useful is is dictation software. So I use dragon. So I’m, I receive know to full disclaimer, I’m not being reimbursed, reimburse. But, but something that I’ve found useful is, rather than sitting there typing, although certainly I sometimes do if I have to make notes, if it’s a complicated story, but I’ll listen to the entire story. And then I will dictate back to them what I heard, so that that shows that I was listening, and they were understood, and this is what their story actually sounds like when said in chronological order, because generally, when people describe their experience, it comes out in the order of severity. At least this is what I’ve found in terms of severity, or urgency or importance, which says nothing for chronology which actually makes it more difficult for us to hear and understand. So then you repeat it back in chronological order. And then they know that that they’ve been heard and so that way you’re not looking at the screen. Yeah, you’re looking at them. And we all know from from medical school this is one of the things that I think was pretty universally taught when I was in medical school, which was that the patient thinks that you’ve spent more time with them if you’re sitting rather than standing. And so they always feel like you’re trying to leave if you’re standing so make sure to sit but you’re making the point even further. Try and make sure that you’re you’re on either level and if the computer isn’t is situated in such a way, you know, it’s really the onus is really on you to situate yourself so that you can you can interact with the patient whether that means using a laptop instead of the desktop or right there. There are ways to do it if you take absolutely and I love
Unknown Speaker  14:49
Brad what you just said about taking the time to kind of understand the story and recount it back to patients. This is actually something when I was at doc doc is something that we taught A lot of our reps who are on the phone speaking with, with customers, patients or doctors every day is you want to understand what the problem is. And the best way to do that is to paraphrase it, or even sometimes just plain old, repeat it back to them and say, Okay, so this is what I’ve got so far, or this is what I hear you’re saying, or, or just just to make sure I’ve got this straight and then you go back and you recount it. We have found in the customer service world that when you don’t take the time to do that step, the two pads of what the customer is telling you where the patient is telling you and what you think they’re telling you can can diverge really quickly. And you don’t you may not even ever figure that out in the span of the interaction, right? You make or if you’re lucky, you might find out the end. So some people feel this is silly. It’s like why am I going to the person said they were here for, you know, a sinus infection. I’m going to say, Okay, let me just get I just want to make sure I got the straight so you’re here for a sinus infection. Yes, that sounds a little bit silly. But take The time to make sure that you’re repeating back or finding a way to acknowledge that back to the patient says, okay, we’ve established this relationship, and we are on the same page.
Unknown Speaker  16:11
I think that’s hugely important. Also, because very commonly, there’s a question behind the question, right? There’s Yes, there’s the question that they’re asking. But then there’s, there’s something kind of underneath there maybe a bigger problem, maybe a more complicated one, that that they really, like, there’s subtext there, that they may not, and that putting that out there, really clarifies a lot in the visit. So if you can figure that out at the beginning, if it really does exist. If there really is a question behind the question, then that also makes it and then, like, it’s in our financial best interest, because and you’ve just saved yourself a ton of time. For the rest of the day. That’s right. by by by clarifying it and putting it out. That’s right. That’s right. And I think I think when you take the time to do that, and when you’re doing it with eye contact and you’re sitting with them at eye level, You’re kind of,
Unknown Speaker  17:02
you’re kind of getting away from that classic kind of paternalistic view of the doctor patient relationship, right? The one that that says you are the patient, and you’re down here, and I am the doctor, and I am up here. And I’m going to now Tell you what, you know, I’m going to tell you what to do. Some people are very comfortable, both doctors and patients are very comfortable with that relationship. The doctors that I like are the ones that can kind of, you know, meet me on my level, you know, connect with me, you know, connect with me as a person and take the time to look at me and repeat that story back. So now they now they understand where I’m coming from, and then they can get on to the deeper parts of the conversation. Like you said, What is the story behind the story? which then gets into deeper questions like what are your What are your goals for your health? What are your goals from this visit? What do you you know, if you’ve got obviously you’re here because, you know, unless it’s a basic checkup, you’re here because something is something is broken, something is not working the way you want it to work. So is this a simple Or is this going to be more complicated? It’s like, where do you Where do you want to be in, you know, a month, six months a year, depending on you know what they’re coming in for. And once you can, once you understand what their goals are, then I think the best thing you can do is you can present Okay, based on what your goals are. These are what your options are. And we can have a we can have a dialogue about what what you feel is the best for you and what I feel is the best for you. And now we’re now we’re really having a conversation, right? You’re still the authority, you’re still the doctor. But I feel like oh, my gosh, you really took the time to understand me, you asked me questions that maybe no doctor has asked me before. And I think all of that can happen when you’re when you’re really taking the time to establish that relationship. So taking that deep breath before you go in introducing yourself to patients and family. Continue to make eye contact all of them sitting at eye level, making sure you’re recounting their story back to them and getting to them about what their ultimate goals are.
Unknown Speaker  19:03
So I think this is what we’re describing right now is similar to that book How to Win Friends and Influence People, which is full of truisms. Right. Like people like hearing their own name. Like when you smile at them people like, right, like things that everybody knows, but most of us don’t do. So I think, how do we make that stuff happen? My suggestion, and I’d be interested in your feedback on this would actually be put a little sticky note, somewhere where you go, I mean, I have my laptop where I after I leave the patient room I like this is where I type this is where I return phone calls. And what I can what I’m going to set up after this interview is I’m just going to put a little sticky note on the counter. And it’s going to say, take a deep breath. Introduce yourself, you know, look them in the eye face them recount their story. Yeah. So that Between each appointment, I look at that and remember to do that. And that’s going to need to be there for a couple of months for sure, instill it until it starts to happen every time. And if you genuinely want to do these things each time, you then you need to develop them into a habit and develop them into the habit. You need to do them over and over and over and over. And I think it’s important to not just go Yeah, I’ll start doing that, to genuinely commit to changing your behavior, at least I need to, because I certainly don’t do all of these things right now. And if I’m going to improve my relationships with my patients that I need to do them, I’m going to do that so that I don’t forget, because otherwise, I’ll start running behind. I’ll get frustrated. I will forget and I’ll just go back to what I was doing before which obviates this entire conversation.
Unknown Speaker  20:51
So I certainly don’t want that absolutely. And you know, I say all these steps like you know, and you outline them on a post it note is that they are simple, but they’re not For some people, you know, not many people might say, you know, I didn’t get into medicine to create these, you know, cushy relationships with people, I came into my I got into medicine because I want to fix things that were broken, you know, but as I said before, you know, patients do have a choice as to who they’re going to see. And whether we like it or not, patients are saying that what is important to them is not just their clinical care, they, they, you know, they expect you to be clinically, you know, wise and put them on the right path. But the honest truth of the matter is, is that even if you’re wrong, if you have taken the time to really establish a relationship with your patient, they will often let that go. And that’s the same for a lot of different a lot of different areas. You know, if you’ve got someone that’s nice, you will forgive a lot of stuff, but there’s been studies that have shown that surgeons and primary care doctors are there sued less by patients That had really good bedside manner and really good communication really good rapport and respect for the patients like, they just they do it less they say,
Unknown Speaker  22:07
they’re less likely to sue someone that you like. That’s right. They say they say, it won’t make it completely go away, but it’ll decrease them. They say,
Unknown Speaker  22:15
you know what, I, I don’t care. I don’t care if he did this thing wrong. I love him. So we were talking about some of these potentially simple thing. But the The tricky thing, the hard one is the empathy component. And that is, I think that can be challenging for anybody to know. Empathy is not the same as sympathy, right? It’s really putting yourself in patient shoes, understanding where they’re coming from not judging them because patients are savvy and can tell when you’re judging them. But it is it is absolutely a muscle that requires time and effort. And I think it’s challenging for a number of reasons. One of them and I was talking to someone in our hospital about this recently. He brought this up and I thought was a really good point is that as doctors or healthcare professionals even we may not have have the best understanding of truly what the patient experiences? Because so you’re you’re affiliated with a hospital, right? Yes. Yeah. So if if God forbid, your children or your wife or someone or you know, gets a family member gets sick, and you take him to the emergency department of your hospital, chances are, you’re probably going to say to them, by the way, I’m Dr. Brad Block, I have privileges here, etc, etc. And why wouldn’t you like I would, at my own hospital, I would do that and I’m nobody at but I would go in and say, you know, I’m the patient experience coordinator here, blah, blah, blah. Because at that moment, I want to get the, you know, I want the best possible clinical outcome and I want to use anything in my arsenal to try and get me specialized care. I become very selfish in that scenario. But we’ll, we’ll use that if we have I feel like anybody in health care will use any trick that they can have at their disposal to try and get the best possible care. But you got to think about what it’s like for somebody who has no pull Who has no connections? Who doesn’t know that building? Who is you know, and also as the same things that we have, which is that they’re in pain and they’re frightened. So I think we have to really think about what is this? Like? What is this like for for this patient, even our, you know, even our patients who come in seeking narcotics CC, no drug drug seeking patients, obviously every facility has their share of them. But we still have to try and understand those people. And if we judge them, you know, they’ll they’ll come back and they’ll tell us they’ll say I was made to feel like I was like I was a drug seeker I would feel less than. And so empathy is really the trickiest of the things that I think we all need to work on. And if we can understand if we can work to understand where patients are coming from, the whole length of our relationship with them is going to be a lot stronger.
Unknown Speaker  24:49
Do you have any, anything that you could recommend for us that would help with that, but with where, where that might help me connect with my patients a bit better. Make them feel that Connecting with them?
Unknown Speaker  25:00
Well, you know, I think it’s kind of the things that we talked about before, you know, some of those steps. But I think it and this is something that we also you know taught at at Zach doc is that you know, you have to you have to, you can let people know that you understand where they’re coming from, you know, you can say, I’m sorry, that must be really frustrating for you. Something like that. I think even just acknowledging that because we can acknowledge, you know, all day long that someone has an specific injury specific malady, right, but taking the time to acknowledge what those feelings are behind it. Sort of sort of kind of like the story behind the story, like you said before, I think that can help is actually putting putting words to it, and letting patients know that you understand where they are, right. Like I said, this whole thing is about meeting them where they are understanding what their fears and their their goals are, but saying, you know, I understand that this is a lot of information I’m giving you and I can understand that will be that might be scary for you.
Unknown Speaker  26:00
So I think this actually leads into a common patient complaint, which is when we’re running behind, so I think we can we can, we can like meeting them where they are. So I think a lot of times when I’m running behind my impulse is to maybe explain why I’m running behind. Oh, there was a complicated patient, there was an emergency. A bunch of people showed up late, you know, something like that explaining, so that’s not meeting them where they are. That’s right. Having them meet me where
Unknown Speaker  26:36
they don’t care.
Unknown Speaker  26:38
Yeah, exactly. So
Unknown Speaker  26:42
so I think to that effect, meeting them where they are would be more just apologizing and saying, Listen, because they don’t want it. Nobody likes to feel like they’re not valued. Right. You spoke about that earlier. That’s right. Like they’re not cared about. So if I’m if I’ve just made someone Wait for an hour, that person feels like I have zero regard for their time and zero regard for anything about them. So how are they going to trust me to take care of them? If they think I, I just don’t care about their time at all? So I think in that situation, my inclination is to try to explain myself, but really what I should be doing from what you’re saying is, listen, I’m really sorry. I just want you to recognize that I do value your time and I feel terrible, terribly, that you’ve been made to wait this long. And I’m really I’m trying I’m, you know, I’m, I don’t even know if I should say that I’m trying to do my best or I’m trying to give up or just just apologize.
Unknown Speaker  27:45
You know, I saw something on on on Twitter of all places recently that said, What if we reframed it instead of apologizing, instead of saying, Sorry, I’m late. We said, Thank you for waiting for me. Right? We took the net. We took the negative I just thought about this, we took the we take the negativity out of it, we take the negativity of a word like sorry out of it. And we express gratitude for their patients. You know, and you don’t have to, I think you’re on the right track here. Like I don’t think you need to. You don’t need to fall on your sword about it. You can you can say, I understand your time is valuable. Thank you for waiting for me. I’m sorry, I’m late, even if you want to say that and say, and then what you do is everything you do from that moment on proves that they’re the most important person. You know, when when my first daughter was born, my wife’s ob gyn a really well known ob gyn in Manhattan. And this guy is notorious. His patients wait anywhere from an hour to like two and a half hours. And every every time we were in that waiting room, I sat there cursing him under my breath and like a complete, complete disguise. Wait, my time is valuable. I took off. When we got in the room, he made us feel like we were the only people that mattered In his world, and and this is a guy who had like celebrity patients on the walls, right, I felt we felt like one of these people, he spent a lot of time with us. He never made it feel like he had to get out the door and see the 20 other patients that have been waiting two hours. He spent as much time with us as we needed every single time. Every single time. I walked out apartment, I was like, I love that guy. Like, like, like, like it was totally, it was totally okay. And I want to I want to justify it to myself. I’m like, Well, I can see why we got to wait so long. It’s because he spends all this time with patients. That’s it. That’s a that’s an extreme scenario, right?
Unknown Speaker  29:37
Yeah, I don’t think we should be in annihilating that is something that
Unknown Speaker  29:42
I’m not saying.
Unknown Speaker  29:44
Here’s the thing, right? You don’t have to take all that time. You just have to make sure that the time that you are taking is really quality time.
Unknown Speaker  29:53
Well, you’re not distracted, right? You’re like you’re spending minimal time looking looking at your computer. You know minute. Yeah. And and you’re really and I think the to that effect the eye contact is is really important, right? Like, if you’re not distracted by other things, then you shouldn’t be distracted by other things. And it’s it’s sometimes, you know, maybe you’re trying to document as you’re talking to them. And sometimes there are ways to do that. Maybe I’m just trying to think of myself as the example. Maybe I shouldn’t be documenting things that they’re saying as they’re saying that, because then it seems like I’m playing Minesweeper when I should be when I’m, you know, just really just typing in what they’re saying. But But yeah, if you’re really absorbed in what they’re saying, then it makes them seem like they’re the most important thing in the room. And the most important thing in the world if you’re really, if you’re really that focused on them, and I think there are ways to do their ways to, to really practice that and I think that should end up on my little index card to, right. Just
Unknown Speaker  30:58
don’t be distracted. That’s Right. And if you’re concerned about what they’re going to think about you playing Minesweeper, that’s a simple one to you can say, so listen, the way I generally do things is I don’t want to miss anything. So I take a lot of notes, I type a lot. While I’m listening and you’ve got my full attention, I’m just typing at the same time, it becomes a distraction for you let me know, something like that. Now you’ve put it out there. Now they don’t have to worry. Is he playing Minesweeper? Is he typing an email? Like you’ve you’ve told them what what it is you’re doing and why you’re doing it? You know, obviously, I would suggest that any doctor, if they’re not in this space already is get comfortable with typing, but also looking at someone while you’re typing like I can, I can do that at this point. So I could look at somebody in the eye and completely just type in I can correct my typos later, you know, but just just let let patients know what you’re doing. Don’t assume that they know. And, you know, once it’s out there, then Okay, it’s fine.
Unknown Speaker  31:53
Great. Great, great. So, so far, I think we’ve gotten a lot of recommendations from you that are pretty high return on investment. So, you know, they don’t seem like a whole lot of effort, but they will really end up paying off in the long run, if we can turn them into into habits. Do you think there’s anything else that that you think that we could do that would be high return on investment? One thing that we had spoken about before the interview was how we treat our staff. So, you know, in in our offices, there is there are multiple levels before the patients get to us. They’re the people answering the phone, they’re the people greeting them and entering their information, then maybe you have a nurse or a medical assistant or physician assistant before they finally see the doctor. And so how can what are some high yield things that we can do to make sure that those people as well are maximizing the patient experience?
Unknown Speaker  32:56
Absolutely. Because like, like I said in the beginning, right, it’s about the entire continuum of Care and that involves that involves absolutely everybody. So this is where I see patient experience going in the future is, is all of these different areas, you know, from people from the doctors, to the nurses and housekeeping staff, the dietary staff, you’re in a hospital, finding ways that they can intersect and and meet patients where they are, right. So when it comes to, you know, nurses and you know, PCs, text, things like that, they, you know, they’re a big part of this as well, especially in the hospital setting, because in the hospital setting, they’re going to see the patients a lot more than the doctors, and quite honestly, you know, those other stuff they can, they can often make or break the experience. So I think what that requires, is that requires a connected team. That’s not necessarily easy to do. But I think it really pays off right? You have to have a you have to have a staff of people that feel like they’re all playing on the same team in a tool Gawande, his book, The Checklist Manifesto. He talks about how before surgeries, the entire care team would stand there. And they would, they would all introduce themselves and what their role was. And this felt awkward and silly for some people, but it ultimately made people feel like they were part of a team, even when some of them had never even worked together before. So what that requires is that requires people you know, the office staff and nurses and all medical assistants, all of those people to feel to be made to feel as if they are just as important in the patient care. It requires people to treat each other with respect, and dignity. You know, everyone in this way, I like to say everyone is basically a patient, right? Like you have to treat everybody that way. But if, if everybody feels like they’re playing for the same team, if nurses feel like they are being treated with the same amount of respect, you know, as doctors are, they feel like the doctors are treating them well. If the office staff feels that too, and everyone’s really working for the same team, and that team is the patient centered care team. That I think that goes a long way. But when they’re when there are when there are separations between those teams when people don’t feel like they’re as they’re, they’re important that their roles don’t have value in meaning. That’s when you see people I think start to check out. And the other thing that I’ll say and you know, is obviously, being in healthcare is really difficult. You know, you’ve got, you’re seeing people who are generally not at their, they’re not the best versions of themselves when they’re coming into the office, right? They, they may be there, they’re, like I said, they’re hurt, they’re frightened, they’re scared, they’re, they’re in pain. They’re, they’re probably not presenting their best versions, and they may take it out on you, and that is not easy to handle. And that can really burn people out. But the thing that stops them from getting burned out, is if you have a team around them that take care of each other, that creates engagement. So really, you need you need like team engagement there. I make that sound very simple. It’s not.
Unknown Speaker  35:57
Exactly so what I was going to ask is If there’s something concrete that you could recommend that we do in order to make these other staff members feel valued feel like part of the team feel like they’re on equal footing.
Unknown Speaker  36:15
Sure. Make eye contact says no, I mean I’m half joking but I am also serious like you know, when we’re talking about an office setting when you walk in in the morning, I’m not talking about you bread. I’m talking about the general you when you walk in the morning. Are you taking the time to say hello to the people you work with? Are you are you making I? I am talking? Yeah, I actually I’m talking about you. Are you are you? Are you making eye contact with them? Are you talking to them asking them how their day they’re doing? You know? As a quick aside here, when I was when I was working at doc Doc, at some point in my role there I started blocking off the first 15 minutes of my day and I know not everybody can do this. I would block up the first 15 minutes of my day to just talk to Everybody on my team just because I kind of wanted to see how they were. And when surveys came back about my performance, about like, what I should keep doing. That was like the unanimous number one thing that people said I should keep doing, I should keep coming in. So
Unknown Speaker  37:12
basically, they were like, I want to just keep talking about me. So here’s my feedback. In the morning, he asks me about me, I want more of that I want to keep talking about
Unknown Speaker  37:24
well, what they want is they want to feel like this is not just I am this person up here and you are this person. Again, it’s not the paternalistic relationship, right? It’s, it’s saying our relationship goes beyond just, you answer the phones and I treat the patients.
Unknown Speaker  37:40
So if, if I may make a suggestion I so what I would recommend and granted I have no expertise in this. I all my expertise is in ear nose and throat, doctoring and surgery, but would be for those staff members. You should know their names. You should know their spouses names, you should know their children’s names. And if they it, and if they have something like some of them are studying to be an ultrasound tech, some of them are studying to go to a PA school. Some of them are right if they have some aspiration, or some just know something, no, no, no their family members names so that you can ask them about them, and then know just something additional about themselves. So you can ask, so if you’re able to ask them that, then that shows that you genuinely care about them as a person, and their work will ultimately reflect that slowly, as far as like a concrete step that you can take. Should be that
Unknown Speaker  38:42
Sure, yeah. Because they’ll want to do a better job to for you, you know, they don’t want to let your your your your patients down. They you know, you’ve you’ve created a level of respect there. And I, you know, I hope people aren’t rolling their eyes at this thought of you know, of doing these things. And you know, what, if it doesn’t feel natural and Fake it a little bit, you know, and the more that you do it, the more natural it will become, people will at least see that you’re trying, which is, which is an important thing. But yeah, get to know those people. Even if it’s just like you said, even if it’s just a small thing or two that creates a relationship, all we’re trying to do here is create relationships.
Unknown Speaker  39:21
So as a little bit of an aside, I’m, I’m going to end the podcast just talking about myself. So the reason that I became interested in even having this podcast is, is that my wife, whenever I would go to some social event with her, she would just kind of float around the room, and then leave the party. And everyone felt like they had a new best friend in her. And she loves that type of setting where she can just interact with new people and she’s genuinely concerned about you know about about every, this is why she finds all them interesting. And yeah, this is why
Unknown Speaker  39:56
your wife and my wife get along so well.
Unknown Speaker  39:59
Exactly. But if, if, and you know me forever, for a very long time until only recently I was a curmudgeon, right? I didn’t want to interact with other people, I was angry, I listened to heavy metal, I had a frown on my face all the time. Like I was just an angry guy that didn’t want to interact with anybody. And I thought it was because I didn’t want to interact with anybody. But it was really because I was not good at it, which set up this negative reinforcement cycle of I’m not good at it. But really, I’m going to rationalize it that I don’t like it. And so then I just avoided it. And it just, you know, went downhill from there. But when I started learning more about it, and you know, observing my wife and reading, and as I got better at it, I enjoyed it more and then I got better at it and I enjoyed it more and I’m I’m certainly that translates into my patients experience as well because I try to apply those interactions skills to that interaction, and I think it’s helped me and the This is one of the main reasons that I’ve launched this podcast is I think that in medicine, we really have a lot to learn and myself included in that space, so it really, I really, I think we only scratched the surface. We’ve been at this for for over 40 minutes, and it feels like time just went by in a second. So I really just appreciate your taking the time out of your busy schedule to talk to me for this interview, I’d certainly love to have you back again where we can talk about other things,
Unknown Speaker  41:30
patient experience related, and thank you very much. Thanks so much for having the beds for the conversation.
Unknown Speaker  41:40
This was Dr. Bradley Block and the physicians guide to doctoring. Find all previous episodes on iTunes, Stitcher, wherever you get your podcasts and register review if you have something nice to say. You can also visit us on Facebook search positions guide to doctor
Transcribed by https://otter.ai