Latest / CareTalk: Healthcare. Unfiltered. / How to Treat Health Misinformation with Dr. Geeta Nayyar

Transcript

How to Treat Health Misinformation with Dr. Geeta Nayyar · CareTalk: Healthcare. Unfiltered.

• 0:00
  Misinformation has always plagued healthcare, but it's gotten worse recently.
• 0:05
  Today's guest, Dr.
• 0:06
  Geeta Nayyar, is author of the forthcoming book, Dead Wrong, Diagnosing and Treating Healthcare's Misinformation Illness.
• 0:13
  Dr.
• 0:13
  G, as she's known, is a nationally recognized leader in healthcare IT, former chief medical officer of Salesforce.
• 0:20
  She wrote the book to help healthcare leaders see health and misinformation's impact up close and to give them solutions to fight back.
• 0:35
  Welcome to CareTalk, America's home for incisive debate about healthcare business and policy.
• 0:40
  I'm David Williams, president of Health Business Group.
• 0:43
  And I'm John Driscoll, Walgreens Health.
• 0:46
  Well, if you like CareTalk the podcast, you'll love CareTalk the newsletter.
• 0:51
  It's where you can read trending healthcare industry news, keep up with the latest podcast episodes and highlights, access original blog posts by healthcare thought leaders, and dive deep into our podcast topics.
• 1:03
  Subscribe today, and you'll be entered into a chance to win your very own CareTalk baseball cap.
• 1:08
  And David, we've got actually some lots of new subscribers to the newsletter.
• 1:12
  It's exciting.
• 1:13
  Welcome, Dr.
• 1:13
  G.
• 1:14
  Thanks for joining us today.
• 1:15
  Absolutely.
• 1:16
  I hope I'm getting one of those baseball caps.
• 1:17
  That's what I was told.
• 1:19
  Well, here's the thing.
• 1:20
  Last on last week's episode, John was actually wearing one of the caps and I think he may well have sent it off somewhere.
• 1:26
  So you don't want to use one.
• 1:28
  So we'll wait till we have a fresh batch, Dr.
• 1:30
  G.
• 1:30
  And we'll send one right out to you.
• 1:32
  Definitely.
• 1:32
  Sounds great.
• 1:33
  Thanks guys.
• 1:34
  So listen, you've said that the internet.
• 1:36
  It can't only take you to strange places, it can take your life.
• 1:41
  Do you really mean that?
• 1:42
  I do.
• 1:43
  You know, I think in this post pandemic world, that's exactly what we've seen and not just as it relates to COVID or vaccines, but so much of what we experience in healthcare is misinformation every day from patients taking supplements that aren't necessary, that blow out their liver, to people who don't believe in vaccines, to unfortunately people who lose their life over cancer treatments, fertility treatments.
• 2:06
  This has been a chronic, ever present issue in healthcare since the beginning of time.
• 2:12
  But, but, isn't, you're, you're not arguing, Dr.
• 2:16
  G, that people shouldn't use the internet to actually try to navigate their health.
• 2:23
  I mean, gosh, that's, that I think has been one of the, the, the great victories of the internet is making, is democratizing healthcare information.
• 2:32
  I mean, you're not suggesting that folks Don't research their health, right?
• 2:37
  No, absolutely not.
• 2:39
  You know, I think that it's about meeting the moment where we have so much technology and so many tools.
• 2:45
  So the question is, how do we meet the consumer and really give them the information that they want to make them an expect best action for their health?
• 2:54
  And you're absolutely right, John.
• 2:55
  I'm a pro tech person, right?
• 2:57
  You know me from salesforce.
• 2:58
  You know me from a dnd.
• 2:59
  I'm absolutely protect.
• 3:01
  But it is about what?
• 3:03
  ensuring that the consumer knows where to go, whom to talk to.
• 3:07
  And still to this day, 57 percent of Americans trust their doctor.
• 3:11
  So the real key and the real magic is not just finding information, but also being able to find someone that proposes that information.
• 3:18
  And if something should go wrong and or customizing that to you, you have someone to go to.
• 3:24
  Ultimately, it's about really bolstering that trust and empowering that relationship.
• 3:29
  There's certainly been a lot of attention to misinformation.
• 3:32
  recently.
• 3:33
  Um, and as you point out, it goes, you know, way back to the dawn of medicine, but I thought it was interesting in your book.
• 3:39
  And I downloaded the first chapter as anybody can, uh, from your website.
• 3:42
  And I read about the story of your patient, Jerome, and about the misinformation that was surrounding HIV.
• 3:48
  So that's one that's far enough back that it's, you know, it's not the HIV is still with us.
• 3:53
  But I remember those times.
• 3:55
  And I'm wondering if you could reflect on that.
• 3:57
  What did you learn from that experience?
• 3:59
  And what are some of the broader lessons that we should draw from it?
• 4:02
  You know, some of the hardest parts of public health we saw firsthand during COVID is actually not the science.
• 4:08
  HIV AIDS is no different from that.
• 4:10
  It's now a chronic disease, effectively.
• 4:12
  It's really the communication.
• 4:14
  Right where we break down so much in health care and public health is really around communication and we saw that with HIV AIDS I demonstrated with the story of Jerome when I was in my early 20s as a resident that I saw so many patients time and again dying from HIV AIDS because they simply thought it was a It was only a disease that homosexuals could get.
• 4:34
  There was not an understanding of this is a equal opportunity threat to your health and that there were preventive measures that you can take.
• 4:42
  And this was seen time and time again.
• 4:44
  And I remember when COVID happened, feeling the same.
• 4:48
  The same feeling that my goodness, people are dying from this.
• 4:51
  And we have the information, we have the science, but somehow it was lost in translation.
• 4:56
  And people were going down the vortex hole of the internet where they were surrounded by the wrong characters and really bad players who were manipulating the communication and really profited from that, right?
• 5:08
  So the trick is how can you use all of this technology?
• 5:11
  Look, tick tock is awesome.
• 5:13
  Social media is awesome.
• 5:14
  Artificial intelligence.
• 5:15
  It has so much promise and opportunity in healthcare, but it's all how we use it.
• 5:19
  It's all how we implement it.
• 5:21
  It's all how we actually meet the consumer and ensure that they're actually getting what they're buying.
• 5:28
  We had a really interesting conversation, uh, you know, with Dr.
• 5:33
  Peter Hotez, who's really been a lead, a courageous leader in getting, at least in our view, I think yours as well.
• 5:40
  An honest, accurate and complete view of what's going, what was going on with covid.
• 5:45
  And yet he's really been pilloried or and targeted personally by some of the, the, the, the, the, the productive frauds in on, on, uh, who, who really undermined.
• 5:58
  the science and the recognized and agreed upon science around COVID.
• 6:03
  But one of the things that occurred to me, at least after speaking to him, is it, is it because we have underinvested in communicating and supporting a true public health voice?
• 6:15
  I mean, there really are no resources that can compete with professional communicators and politicians in a crisis.
• 6:23
  That's just not the role that we've asked our leaders in public health.
• 6:27
  In fact, I would argue that public health has been underinvested in in general and certainly hasn't in the current, you know, public health information war.
• 6:36
  Our, our side, the side of science isn't always funded or supported.
• 6:39
  Is it really just because we haven't put the resources in to balance it out?
• 6:44
  I mean, because, because, because people are going to use the Internet.
• 6:48
  So definitely not proposing that people don't use the Internet.
• 6:51
  I think what we've done, John, is we have not made it a priority.
• 6:54
  Peter Hotez has got a significant, uh, part, portion in the book.
• 6:58
  There's a chapter, had a good discussion with both Megan Rainey and Peter Hotez.
• 7:02
  I think Peter is a true hero and someone who.
• 7:05
  Certainly should not be vilified the way many, many have done, but it said it's not a priority.
• 7:11
  Right?
• 7:11
  We, we developed a vaccine that had never been developed in 9 months.
• 7:15
  And then we proceeded to box the entire communication.
• 7:18
  Not because we couldn't not because we didn't have the technology.
• 7:21
  It wasn't a priority.
• 7:23
  And that's where we are in the digital age.
• 7:25
  Now, misinformation and disinformation has to be a priority if you're interested in patient retention, patient acquisition, value based care.
• 7:33
  Because remember, the cleanup happens in the emergency room.
• 7:36
  If people are misinformed, this is what happened with code, right?
• 7:38
  No matter what, the system has to take care of them and will be the one cleaning up misinformation for good or for bad.
• 7:46
  And so the real question is, how do we prioritize it?
• 7:49
  And use these tools for good and ensure that the voice of science, the voice of the patient physician relationship is louder.
• 7:58
  Then those that are not representing that and that's really the disconnect.
• 8:03
  John, I never thought we'd say this, but if we sort of look back on the good old days of HIV, if you remember, you know, what happened in the public sphere, we had, uh, Dr.
• 8:10
  Everett, C.
• 8:11
  Everett Koop, uh, Surgeon General at the time, who really was, you know, sort of rose to the occasion in a way that wasn't expected.
• 8:18
  Tony Fauci, dare I say the name, uh, you know, was also effective.
• 8:22
  And you had people that were not necessarily peddling misinformation but may have been somewhat misguided in terms of their approach that actually eventually came around to the side of, you know, from throwing blood and paint on the, uh, at the FDA and locking the gates to actually being very constructive and totally transforming the way, uh, that drugs were developed.
• 8:43
  And also, really, um, you know, getting the resources on the funding side so that HIV was very well funded.
• 8:50
  Yeah, no, I think, I think that's a, an interesting but probably a relevant point, David.
• 8:55
  Because, I mean, I haven't, I haven't downloaded, uh, uh, Dr.
• 8:58
  G's book yet, but I think the In the public, you know, Internet market.
• 9:12
  And yes, I can come up with other V's if you'd like, David.
• 9:15
  Um, that creates a different kind of imbalance.
• 9:19
  And I think that's what Dr G is, is, is, is, is, is, is, is fighting about or fighting for.
• 9:25
  Because I think that's.
• 9:27
  That's what we are.
• 9:28
  Everyone is going to use the digital tools where we are all going to be digital health care natives, if you will, in that, in that, in that village is it's growing with all these different ways to people to make money.
• 9:42
  The attention economy.
• 9:44
  You know, honestly, Dr.
• 9:45
  G, I'm, I'm kind of terrified of what is going to happen.
• 9:49
  You, you touched on, on ai, you know, we can no longer rely on a, you know, a guy with a, you know, a, a full head of hair and a beard, you know, and a bow tie, like see Everett coup to kind of, to be like the, the, the, the, the almost Hollywood version of an expert.
• 10:08
  And when people are going to be navigating this individually, you know, and also from a position of vulnerability and fear, which is, which is what most of us, how all of us, I think, come at healthcare.
• 10:18
  I mean, how do we navigate this?
• 10:21
  So, you know, a couple of things.
• 10:22
  So, so first of all, I, I agree, right?
• 10:24
  The sea of recoups of the world.
• 10:25
  We have that in every zip code.
• 10:27
  Again, healthcare is local.
• 10:29
  Right.
• 10:30
  So starting with the doctor patient relationships in every zip code, there are surgeon generals in every zip code as far as I'm concerned, those ones who are really the heroes every day.
• 10:38
  So how do you give those, those individual physicians then a voice?
• 10:43
  To actually affect a population, and that's where an enterprise strategy comes in, right?
• 10:48
  We we know that medicine has become consolidated.
• 10:51
  This has to be an enterprise strategy between the chief marketing officer, the chief information officer, and the chief medical officer.
• 10:57
  Right?
• 10:58
  And I think that's what we've done.
• 10:59
  Wrong.
• 11:00
  When we think about digital transformation in the past, it was, well, it was all about the EHR implementation.
• 11:04
  Then it was about patient engagement or how to do the digital front door.
• 11:08
  It was to close the office, open the office through COVID.
• 11:11
  But now we're in a world where we've done all these things.
• 11:13
  And telemedicine is now part of hybrid care, right?
• 11:16
  So there's no lack of tools and technology.
• 11:19
  There's no lack of smart people, but prioritizing it in this cross collaborative way, because no one's waking up saying, Hey, what's your misinformation strategy, right?
• 11:27
  But they are saying, how do we improve our life?
• 11:30
  How do we actually attract patients and then keep them?
• 11:32
  How do we do cradle to grave health care?
• 11:35
  Right?
• 11:36
  And so in that prioritization has to be the connection between marketing and tech and the clinical leadership, which has often been missing.
• 11:45
  In healthcare, right?
• 11:46
  So often technology is thrown at doctors and patient and physicians at the end.
• 11:49
  So there really has to be a shift in how we think about the next era of digital transformation.
• 11:54
  You're, you're, you're almost suggesting a different version of digital hygiene, where we look at misinformation as a virus.
• 12:01
  See, David, I told you I'd come up with more of these.
• 12:04
  And that virus and that virus management is something like a, like a, you know, like sepsis.
• 12:11
  You just have to constantly be.
• 12:13
  Looking for that.
• 12:14
  You're I think what you're saying is that virus is going to be with us no matter what.
• 12:20
  Correct.
• 12:20
  You just have to manage it.
• 12:23
  Like another form of a public health problem.
• 12:26
  Correct.
• 12:26
  And, and prevention is the key, right?
• 12:28
  Not reactionary strategies, but instead prevention being proactive.
• 12:32
  Look, poo season is upon us, right?
• 12:34
  So, you know, reaching out and, and reaching out very thoughtfully to, to members, to patients who are eligible, who have insurance, who don't have insurance.
• 12:41
  I mean, Walgreens, right?
• 12:43
  You guys are in this space.
• 12:44
  This is something Walgreens does very well.
• 12:46
  So providers need to also provider systems enterprise level.
• 12:49
  It's really at the enterprise level where I think we can make the biggest difference if we're thinking about this and we're mindful as it being the underlying current behind patient engagement, the underlying current for how you do patient acquisition and retention.
• 13:04
  You know, I think the landscape is not entirely bleak.
• 13:07
  You're pointing out what should be done, but I think there's also probably some examples of organizations at that local level or regional level.
• 13:14
  That are doing a good job on those areas where you do see that type of coordination that you've described.
• 13:18
  Have you seen any of those?
• 13:20
  Definitely look in pockets.
• 13:21
  We do things great as an industry in pockets.
• 13:24
  My goodness, you can see any number of sort of celebrity tick tock doctors out there that have used social media to harness their practice, to harness their voice, to harness science at scale.
• 13:34
  You know, we had a great conversation with Paul Mattson, the head of Mark comms at Cleveland clinic, and they really described they took individual positions, individual storytelling.
• 13:43
  brought it up to an enterprise level and really drove that patient acquisition and retention.
• 13:48
  And, and we can see that, right?
• 13:50
  If you go online, Cleveland Clinic is one of the top sources for anything.
• 13:54
  And Oh, by the way, you can also make an appointment and get a personalized conversation and personalized care, which is even.
• 14:00
  Really, the ideal situation is you're not getting anonymous information, but you're actually remembering that everybody is truly different.
• 14:07
  And so everybody does need a physician and ideally not when they're sick.
• 14:13
  And so there are ways to do it.
• 14:14
  I also think from medical education standpoint, John, I think you touched on this earlier.
• 14:18
  Look, doctors are really good at one thing.
• 14:20
  They go to medical school for one thing.
• 14:21
  It's to take care of patients and because they're really big science nerds.
• 14:24
  So communication is not generally our strength.
• 14:27
  And that is okay, right?
• 14:29
  That's okay to recognize.
• 14:30
  That's okay to train in and it's okay then to bring in communication experts and marketing experts and tech experts and work with clinical leaders.
• 14:38
  That's the whole idea, right?
• 14:40
  Is we're all good at different things and we have.
• 14:42
  I also think it's.
• 14:43
  I think it's hard, Gita, because I think patients live in, in, in, in, in a narrative world and, you know, doctors live in, in, in functional, uh, science silos.
• 14:53
  And that's a good thing because then you become experts at that science.
• 14:56
  But if you can't communicate it and tie it into the narratives of people's lives, I mean, that's where I think people, fear mongers tend to attack it.
• 15:05
  But how do you, do you, do you see, can technology help?
• 15:09
  Doctors and patients.
• 15:10
  We've talked about how access to technology and information can be dangerous.
• 15:15
  But how do you see that playing out?
• 15:16
  And can AI be your friend?
• 15:18
  I mean, are we, are we going to have an AI health information pet?
• 15:23
  Well, listen, technology is certainly part of the tool.
• 15:25
  I don't know that it's the whole equation.
• 15:27
  I think you first have to understand the human experience and the human disconnect, but then absolutely putting a wrapper around the doctor patient relationship to query questions, query needs.
• 15:37
  Query what needs to happen in the examining room.
• 15:39
  And likewise, when you leave the examining room, which is, hey, did you understand all of that?
• 15:43
  Did you have a question about this new medication?
• 15:45
  That's really the important piece is that patients feel like they have the 24 7 access.
• 15:51
  And the number 1 thing any patient ever asked me is, how do I get in touch with you?
• 15:55
  What happens when I leave here?
• 15:56
  I feel like I vortex and then this administrative.
• 15:59
  Process takes over.
• 16:00
  So how can technology 1 unburdened the doctor patient relationship.
• 16:04
  So I think I has tremendous opportunities to take out some of the administrative burden, whether it's prior off clinical decision support documentation, that would be a number 1 priority.
• 16:13
  But then number 2, yes, how do we automate the things that should be automated, automated, automate the low triage low.
• 16:21
  Query questions to then leave the complexity for the human interaction.
• 16:25
  That is the Holy Grail.
• 16:26
  I mean, that is really the hope of all the things we've seen transpire in the industry and now available with generative AI.
• 16:32
  Now, equally, if we're not intentional, if we're not mindful of clinical leadership.
• 16:36
  The ethics, right?
• 16:37
  We could also be in some dangerous water.
• 16:39
  So this is this is really a point and a crossroads for the health care industry.
• 16:44
  And I think why we're having this conversation, because we want to be thoughtful of that and do things as best we can with eyes wide open, because there's so much we still don't understand about some of these technology.
• 16:56
  Well, I think John said AI pet, cause he wanted me to squeeze in another V for the AI vet that will go along with it.
• 17:07
  I think it's cause he has a really fuzzy, like micro, like speaker, his speaker is like super fuzzy.
• 17:09
  So I think he's missing.
• 17:09
  Are you missing your dog?
• 17:10
  I'm working, I'm working to program it.
• 17:11
  I'm looking to program it so that it can come up with snappy answers to David's questions.
• 17:15
  Well, good, good luck, John, with that.
• 17:17
  But you know, Uh, Dr.
• 17:19
  G, you've mentioned a couple times marketing, which is often a dirty word when it comes to, you know, discussing healthcare systems.
• 17:27
  They may, of course, they have people in marketing, but they don't necessarily talk about it.
• 17:30
  Now, I won't say that when you combine communications, I think that's understood within public health, but say a little bit more about.
• 17:36
  Marketing and how that actually fits in and should it be integrated with these other C level functions that you've just described?
• 17:42
  Absolutely, and it has been a bad word in healthcare for some reason and for some time and arguably underutilized, right?
• 17:50
  So, so much of marketing before was, hey, we're on the corner of fifth and seventh.
• 17:54
  24 7 appointments, yada, yada, yada.
• 17:56
  But the idea of marketing and communicating flu campaigns, campaigns around annual visits, this is marketing, right?
• 18:06
  But in healthcare, it's really patient education.
• 18:08
  And again, it is about the loudest voice.
• 18:10
  If you are not doing these things, someone else is.
• 18:13
  And likely they're selling a supplement or a subpar service or services that don't even require an MD.
• 18:20
  And so it is very important to remember if you don't have that digital presence, you don't have presence.
• 18:25
  And someone else is getting to those patients.
• 18:28
  And actually, this is one of the reasons I'm so excited by the retailization of healthcare, because I do think companies like Walgreens do this very well, they understand the consumer, they understand the value of marketing.
• 18:38
  We understand it drives behavior and next best actions and behavior.
• 18:42
  And that's largely what's missing in healthcare, right?
• 18:45
  Is, is this, this idea that we will not only just take care of you for eight minutes.
• 18:50
  In in the one visit you get once in three months or six months, but we're with you.
• 18:53
  We're here.
• 18:54
  We're available every day and anytime you need us.
• 18:57
  And I think that the retailers do this much better than certainly that's that's that's the hope.
• 19:02
  I mean, uh, Dr.
• 19:04
  G.
• 19:04
  We really want to.
• 19:05
  But we do believe that we've got, you know, the ability to communicate.
• 19:08
  We've got.
• 19:09
  traffic, trust and contact.
• 19:12
  And I think we take it as a really important moral purpose to get that information right.
• 19:17
  It's one of the things that one of the reasons why pharmacists are so overly precise because they really are concerned about getting that right.
• 19:25
  And we want to serve as that local resource.
• 19:28
  I guess I had an orthogonal question.
• 19:30
  What did you learn from your time at Salesforce?
• 19:32
  That's going to inform your new role as a, as the guardian of public health and information and or misinformation.
• 19:40
  You know, so much, John.
• 19:42
  I think again, we are an era where new technologies are necessary and needed very much like CRM.
• 19:48
  There is certainly a place for it.
• 19:49
  We are also in an era of new technologies like generative AI.
• 19:53
  AI is not new in the medical space, but there are more, there's more sophistication, right?
• 19:58
  And there's been more data on the things we understand and the things we don't.
• 20:02
  Some of it very amazing.
• 20:04
  And again, opportunity is endless, but some of it is a little bit scary, right?
• 20:07
  Some of it's pretty scary when you look at the hallucinations and what can happen in a medical setting.
• 20:12
  So I think it is the time.
• 20:13
  I also think it's a time for clinical leadership.
• 20:16
  I think if you do not have a physician, a true physician at the table, not just at the end, after you bake the cake, but as you're making the cake, deciding on the recipe, checking the salt, you've got to have clinical leadership throughout the process, because the thing that happens with If we are fundamentally disrupting the workflow and everything that's done in healthcare and clinicians are able to understand the disruption before anyone else can see it.
• 20:41
  Right?
• 20:41
  So you, you solve the question, you solve problem A with B, but now you've created the problem C, right?
• 20:47
  Clinicians can understand, will understand that when you change this, you've now created a new problem, which has arguably been one of the contributors to physician burnout with, with the EHR.
• 20:56
  So I think those are really the main takeaways.
• 20:59
  I also think the consumer has changed, the expectations have changed.
• 21:02
  You certainly, John, and your teams understand that if you are not.
• 21:06
  Doing these things, you will be left out to dry essentially right.
• 21:11
  This is now not just a nice to have, but a must have and truly to stay competitive.
• 21:16
  Your presence is important.
• 21:17
  Your ability to predict is important.
• 21:20
  And if you cannot communicate, you cannot build trust.
• 21:24
  So you've got to be able to do all of these things.
• 21:26
  And I, and I like the accountability also with, with marketing, right?
• 21:29
  So John said something really interesting, you know, we've got the pharmacist, we've got the retail stores and we're marketing to folks.
• 21:35
  So you're accountable.
• 21:35
  If you send me a message, I know where to find you.
• 21:39
  I can go inside and say, Hey, I got this message and I didn't understand it, or I have this allergy.
• 21:43
  So I need to know the other way to manage this, right?
• 21:47
  That's the opportunity with the clinical side is if you can.
• 21:50
  scale of the way Cleveland Clinic has, it's really the right way to do care is not just give information, but also to say, I'm here if this, you know, if this didn't work or something went wrong, that's, that's, that's exactly what we're trying to do at Walgreens.
• 22:05
  Well, John, I, I support you.
• 22:06
  I support you and I hope you buy a million, a million books because now you read the book, you're playing on the book, you're working on pre orders are available on Amazon now.
• 22:18
  That's it for another episode of CareTalk.
• 22:20
  Our guest today has been Dr.
• 22:21
  Gita Nair, author of Dead Wrong, Diagnosing and Treating Healthcare's Misinformation Illness.
• 22:27
  That's available everywhere on October 17th.
• 22:30
  I'm David Williams, President of Health Business Group.
• 22:34
  And I'm John Driscoll, the President of Walgreens Health.
• 22:36
  If you like what you heard, or even if you didn't, please subscribe on your favorite service.
• 22:40
  And thank you, Dr.
• 22:41
  G, for joining us.