Latest / Becker’s Healthcare Podcast / Restoring the Joy of Medicine at Enterprise Scale

Transcript

Restoring the Joy of Medicine at Enterprise Scale · Becker’s Healthcare Podcast

• 0:00
  Welcome. It's such a privilege to be here.
• 0:02
  You know, we spend a lot of time
• 0:03
  in health care talking about strategy,
• 0:05
  scale, and technology.
• 0:07
  But underneath it all is a person, a
• 0:09
  human who chose this profession for a reason.
• 0:12
  And if we're honest, systems that we've built
• 0:15
  around that person including some of the technology
• 0:18
  we've celebrated
• 0:19
  haven't always served them well and have certainly
• 0:21
  sometimes introduced even more friction.
• 0:24
  And today I'm sitting down with two clinicians
• 0:25
  to talk about what it really feels like
• 0:27
  to practice medicine right now. We're gonna get
• 0:30
  into AI, adoption, burnout, purpose,
• 0:33
  and what separates a true partner in this
• 0:35
  work from just another vendor promising to fix
• 0:37
  it. I'd like to welcome Scott Holmes from
• 0:40
  Petaluma Health Center and doctor Maria Byron from
• 0:42
  UCSF.
• 0:43
  It's wonderful to have you both on this
• 0:45
  podcast today. I'm really excited for the discussion
• 0:48
  we're about to have. The calling has has
• 0:50
  been threatened a bit by
• 0:52
  where we where we're at now with the
• 0:54
  the burden of administrative tasks and feeling like
• 0:57
  there's some more disconnectedness with
• 0:59
  the other human in the room with us.
• 1:01
  How have you seen that evolve over your
• 1:04
  career
• 1:05
  and what do you think is the cost
• 1:06
  of that when
• 1:07
  things start to pile up and get in
• 1:09
  the way of that dynamic we have with
• 1:11
  patients?
• 1:12
  Marie, I'll start with you. Yeah. I mean,
• 1:14
  unfortunately,
• 1:16
  when the thing you love most is that
• 1:18
  interaction with
• 1:20
  the person in front of you,
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  and instead you you feel like you're
• 1:25
  just getting, you know, sort of piled on
• 1:27
  all these things you need to check off,
• 1:30
  people start to feel really burnt out,
• 1:33
  and that has really negative consequences in medicine.
• 1:36
  You know, we see,
• 1:37
  frankly, lower quality of care.
• 1:39
  Certainly, it affects your connection with that person
• 1:42
  in that moment.
• 1:44
  And then,
• 1:45
  you know, unfortunately, you also see doctors even
• 1:48
  leaving medicine
• 1:49
  or cutting back on their practice, and then
• 1:51
  that threatens access for all of us to
• 1:53
  the doctors that we need.
• 1:55
  We are all,
• 1:56
  you know, individuals that pride ourselves in in
• 1:58
  really working hard and taking quality care of
• 2:01
  our patients, and then you feel like you
• 2:03
  just can't
• 2:04
  ever do enough to get there. And I
• 2:06
  think that is really hard
• 2:08
  for all of us to experience.
• 2:10
  It's humbling in many ways. And so we're
• 2:13
  trying to
• 2:14
  reach for tools or anything that can help
• 2:17
  us along the way. And so far,
• 2:19
  it's been really difficult. There's been lots of
• 2:21
  things that vendors have presented
• 2:23
  that is a a shiny new tool that's
• 2:25
  gonna enhance
• 2:27
  that
• 2:28
  process or that's going to make
• 2:30
  practicing medicine more efficient.
• 2:33
  But
• 2:34
  we haven't found those tools up until recently.
• 2:36
  And I think that
• 2:37
  it always goes back to why we got
• 2:39
  into medicine, which is taking care of a
• 2:41
  person and being able to look someone in
• 2:43
  the eye and not have to check off
• 2:46
  boxes that will,
• 2:48
  you know,
• 2:49
  indicate whether or not we're
• 2:50
  practicing quality care based on metrics, but actually
• 2:53
  practicing quality care in the eyes of that
• 2:55
  person. Do they feel like we are present
• 2:57
  for them in that moment?
• 3:00
  The power of feeling seen and heard, I
• 3:02
  think, is so critical. And and there's a
• 3:04
  there's a feeling, at least for me in
• 3:06
  my experience as a clinician, that we I've
• 3:08
  started to lose that, or I I felt
• 3:09
  like I was losing that. And,
• 3:11
  Scott, you said that you brought that perspective
• 3:13
  on on shame, which I think is something
• 3:16
  we don't talk enough about, in health care
• 3:18
  of, like, I can't do what I need
• 3:21
  to do. And so some somehow
• 3:23
  as an individual, as a clinician, I I
• 3:25
  feel that shame of, like, I'm not doing
• 3:27
  I'm not living up to the expectations of
• 3:29
  what I should be as a clinician to
• 3:30
  take care of this patient, to take care
• 3:32
  of a panel of patients. And And there's
• 3:34
  just, like, not enough time in the day
• 3:36
  to do it. And feel like that leads
• 3:37
  us to this feeling that, like, we're
• 3:39
  yeah. We're never going to catch up. We're
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  never going to hit every clinical gap, close
• 3:45
  all the gaps, discuss every
• 3:47
  preventative need. And so kinda like where does
• 3:49
  that leave us as clinicians?
• 3:52
  Yeah. I mean, I think every
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  human likes to feel like they're good at
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  what they do. Right. Right.
• 3:59
  Yeah.
• 4:01
  And I
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  and, Maria, you were kind of giving us
• 4:04
  perspective as well of, like,
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  the value of that time. Right? The value
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  of time where I can sit and be
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  present
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  and what it means if you're not. And
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  I think the the downstream consequences
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  of that. And so
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  maybe transitioning a bit here, and, Scott, you
• 4:21
  started to allude to this. So, like, historically,
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  maybe the the tools that we've used that
• 4:27
  have promised some of this
• 4:30
  efficiency back in our lives as clinicians haven't
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  always delivered, and there's been maybe more friction
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  as
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  some some technology has been rolled out.
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  What is the difference in your mind about
• 4:41
  technology that is built and implemented that
• 4:44
  actually it provides impact, which is that versus
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  what just provides noise?
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  Yeah. I mean, I think it's
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  you know, we're we're sold on something that's
• 4:54
  gonna reduce burden.
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  But, ultimately,
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  if there's gonna be something that's useful that
• 4:59
  providers want to use, it's not gonna be
• 5:01
  an obligation.
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  This is ultimately
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  something that is not additive. It's not a
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  tech stack that it we're being sold, but
• 5:09
  it's something that people want to use.
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  I think,
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  you know, when we're looking at the the
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  landscape right now when it comes to AI
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  and the ability to help us in the
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  workplace,
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  I think, hypothetically,
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  we ask ourselves if that system
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  were down for a day,
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  how would people feel?
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  Yeah. People care
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  when they lose something that is meaningful to
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  them. People notice.
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  And it really kind of
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  gets to the point that something that is
• 5:42
  additive without purpose,
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  people aren't gonna use. I think, ultimately, when
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  we have tools
• 5:48
  that are meaningful,
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  we can feel that the moment we start
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  using it. And
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  in the instance of using a tool for
• 5:55
  clinical documentation
• 5:57
  with use of AI,
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  that gets
• 5:59
  to the heart of
• 6:02
  why we got into patient care is to
• 6:04
  to look patients in the eye, to be
• 6:06
  able to connect and not have to think
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  about
• 6:10
  being pulled away from that patient care
• 6:13
  to look at a computer screen.
• 6:15
  And for sure, when you take that away,
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  I can tell you that each of the
• 6:18
  clinicians I work with, they notice if it
• 6:21
  if it's not there or they don't have
• 6:23
  it now,
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  there is a noticeable difference.
• 6:27
  What's been interesting lately is I I've been
• 6:28
  thinking about that concept of, like, routines in
• 6:30
  medicine and, like, why change management is so
• 6:33
  hard. And I think the routine is often
• 6:34
  us having, like, the resistance to change because
• 6:39
  the routine we have works sometimes even if
• 6:41
  it's not very good and we just kinda
• 6:44
  get settled in. And I think that's made
• 6:46
  change management really hard in health care is,
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  you know, you've tried something in the past
• 6:50
  that hasn't worked and you're like, why did
• 6:51
  I even try? I
• 6:57
  have so much work to do. I just
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  need to continue doing what I'm doing. I'll
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  figure it out. But, Maria, curious, like, how
• 6:57
  that's been from especially in your role, you
• 7:00
  know, as a leader and and thinking about
• 7:02
  change management and adoption of technology.
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  What have you seen as, like, the
• 7:07
  indicators that, like, this is this is this
• 7:09
  time it's different. Right? That with AI that
• 7:12
  maybe this one actually has, like, a real
• 7:13
  opportunity to make change versus what you've seen
• 7:15
  in the past where it just hasn't worked
• 7:17
  the way it intended to.
• 7:20
  Yeah. I mean, as you said, change is
• 7:22
  always hard,
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  and especially, you know, we are talking about
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  burnout.
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  You're a doctor that's already feeling really overwhelmed
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  and behind. Even a tool that's hopeful takes
• 7:32
  you time to get outside of the routine
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  you had and try something new.
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  And that and that can be really hard.
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  But, yeah, I think, you know, one of
• 7:41
  the things we've seen with these AI supported
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  documentation
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  tools
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  that we hear it's really helpful, and it
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  gets back to that purpose we were talking
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  about. And so when you start hearing other
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  people talking about that, it's been really great
• 7:56
  to see how quickly it spreads that people
• 7:59
  see the benefit of taking a minute and
• 8:01
  and learning and trying a new thing,
• 8:05
  because they are so excited
• 8:07
  to have that benefit for themselves.
• 8:10
  So I wanna get to
• 8:12
  what your experiences are as leaders in implementing
• 8:14
  AI in Abrige, but maybe just as
• 8:18
  individual clinicians now, both still seeing patients.
• 8:21
  What is your experience been like with Abrige
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  now
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  thinking about
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  where you all both started, the idea that
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  you wanna be
• 8:30
  taking care of humans in the room presence,
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  to now having the feeling that you can
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  maybe
• 8:36
  start to do that again? What is that
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  what is that been like just as a
• 8:38
  clinician? And then I'd love the transition to
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  what that's been like to think about your
• 8:42
  colleagues and medical staff.
• 8:45
  Oh my gosh, Matt. I I love this
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  question because I have to say, you know,
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  I'm in I'm in informatics, and so it's
• 8:51
  my job to evaluate technology that's gonna help
• 8:53
  doctors and patients. And,
• 8:56
  you know, when we first first started paying
• 8:59
  attention to,
• 9:01
  and getting excited about AI scribes, I was
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  like, well, you know, I'm gonna try it
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  myself, of course, see what I think. And
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  I have to admit I was a skeptic.
• 9:10
  I thought I'm pretty facile at typing. I
• 9:12
  can maintain eye contact and type during my
• 9:15
  visit while while I'm with the patient.
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  And,
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  you know, I was wrong. I'm not good
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  at multitasking.
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  Multitasking as we think we are. Because
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  freeing me up from that to just, like,
• 9:31
  have the conversation with the patient, it just
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  made I feel so much better able, not
• 9:36
  only to connect with them, but also to
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  think on the fly. Because you're doing a
• 9:39
  lot of very active problem solving.
• 9:41
  Right. You know, when you're talking to the
• 9:43
  patient, they're telling you something, and you're thinking,
• 9:45
  what else do I need to ask? What
• 9:46
  could this be? How do I need to
• 9:48
  investigate that? What are the next steps? Like,
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  all of that's happening at the same time.
• 9:51
  And so to to not then have to
• 9:53
  worry about typing out something you're actually saying
• 9:57
  to the patient also, by the way, and
• 9:59
  used to have to go back and then
• 10:00
  also type it in addition to saying it.
• 10:03
  What a great thing then at the end
• 10:05
  of your visit to have a, you know,
• 10:07
  really good draft of everything you just said.
• 10:10
  I'm sure you have to edit it a
• 10:11
  little and maybe add a few things you
• 10:13
  didn't say out loud. Mhmm. But that has
• 10:15
  been just transformative,
• 10:17
  and it's so exciting.
• 10:19
  I love that perspective that you thought you
• 10:21
  were one thing. You thought you were efficient.
• 10:23
  Yeah. And then and then it's hard because
• 10:25
  you when you don't have the data point
• 10:27
  of, like, what is possible,
• 10:29
  we all just assume that we're we're good.
• 10:31
  We're status quo. Mhmm. So I love that
• 10:33
  juxtaposition of, like, wait. Maybe
• 10:35
  maybe this is possible to
• 10:37
  to have that kind of visit I really
• 10:38
  want. Well, and then and then I remember,
• 10:41
  you know, initially, I thought, well, I don't
• 10:43
  I wonder. Am I saving time, or do
• 10:45
  I just feel better? Yeah. Yeah. And if
• 10:47
  I just feel better, that's okay too. That
• 10:50
  would be enough. But I immediately wanted the
• 10:52
  data on was I actually also saving time,
• 10:54
  and sure enough, I was. Awesome.
• 10:57
  That's so interesting because that's going back to
• 10:59
  the early days of piloting
• 11:01
  various products. I was getting into things, looking
• 11:04
  at the note generation, the time saving, and
• 11:07
  I still remember the very first day that
• 11:09
  I used
• 11:10
  an AI scribe tool.
• 11:12
  And
• 11:13
  what I came away with was how I
• 11:15
  felt.
• 11:16
  Everything just I just felt like I had
• 11:18
  a great day. There was the ability to
• 11:20
  just be present.
• 11:22
  And it was so interesting because, you know,
• 11:24
  not only
• 11:25
  did I feel that way. You know, day
• 11:26
  after day, I started surveying patients, and I
• 11:29
  would survey providers
• 11:30
  to kind of just get an an idea
• 11:32
  as to whether or not this was of
• 11:34
  interest to everyone, not just to me.
• 11:37
  And everyone felt really positive about it. I
• 11:39
  think it I was so surprised how
• 11:42
  well my patients accepted this and actually prefer
• 11:45
  that I was sitting there across from them
• 11:48
  away from the computer for the entirety of
• 11:50
  the visit. It it just felt different.
• 11:52
  It was less so about the time savings.
• 11:55
  That is a part of it for sure
• 11:56
  when you look back at things. But there's
• 11:58
  a feeling to its use, and it's the
• 12:01
  first time I've ever used a tool or
• 12:04
  a service where it's changed how I felt
• 12:06
  about practicing medicine.
• 12:08
  That is powerful.
• 12:10
  And then, you know, pulling on that thread,
• 12:12
  certainly, there's the there's the data
• 12:14
  and the, you yeah. The objective studies that
• 12:17
  have showed the impact on cognitive load, and
• 12:20
  we're seeing the impact on time and
• 12:23
  getting the stories about the more attention I
• 12:25
  can give to the patient. But if you
• 12:27
  really pull on that thread of, like, why
• 12:28
  we do what we do,
• 12:30
  for both of you, what what is the
• 12:32
  what do you think is actually happening? The
• 12:34
  the quality outcome,
• 12:36
  maybe even the is there a clinical
• 12:38
  outcome that's improved because
• 12:41
  we are now more fully present? I'm just
• 12:44
  I'm always curious on this idea of, like,
• 12:45
  what else haven't we've been maybe been able
• 12:47
  to even measure yet, but you just think
• 12:49
  is maybe true because in a way that
• 12:51
  we haven't been able to be before,
• 12:53
  we are looking at the patient. We are
• 12:54
  asking more questions.
• 12:56
  Yeah. What is that what is that feeling
• 12:58
  like?
• 13:00
  I mean, I mentioned,
• 13:01
  you know, earlier in our conversation
• 13:04
  how we see
• 13:06
  quality of care metrics go down when clinicians
• 13:10
  are burnt out, when doctors are burnt out.
• 13:13
  This is this is a very hard study
• 13:14
  to do, but I have wondered, like, if
• 13:17
  we were able to look at,
• 13:19
  you know, some of our standard quality metrics
• 13:21
  around
• 13:22
  quality of care,
• 13:24
  would those improve
• 13:25
  as it goes down. Because, you know,
• 13:29
  as Scott said, the so much of this
• 13:31
  is about how you feel.
• 13:34
  And so it's so important to just talk
• 13:36
  to your doctors, ask your doctors, survey your
• 13:38
  doctors. And, you know, we've seen
• 13:42
  really
• 13:43
  impressive,
• 13:44
  reports of, you know, decrease in burnout, which
• 13:46
  is
• 13:47
  so hard to get. And so I do
• 13:49
  hear would you know, do the actual outcome
• 13:52
  numbers improve also?
• 13:54
  I wanna thank you both for the candor
• 13:56
  and clarity you brought to the conversation.
• 13:58
  It was so wonderful to spend time with
• 14:00
  both of you and,
• 14:01
  yeah, reconnect on that idea of what,
• 14:04
  you know, we all came here to do
• 14:05
  as clinicians and and what we hope the
• 14:07
  future looks like as we, you know, continue
• 14:09
  to be in a room, have a conversation,
• 14:11
  and, you know, take care of a human.
• 14:14
  So, as leaders, you know, this is this
• 14:16
  is our our need to help map the
• 14:19
  vision for where this future goes. And I
• 14:20
  can't thank you both enough for being a
• 14:22
  part of that, for being clinicians who provide
• 14:24
  such valuable feedback and help us find, the
• 14:27
  path to the future. So thank you both
• 14:29
  for your time, and we'll see you next
• 14:31
  time. Thank you, Matt. Thanks. Thanks, Matt.