Latest / Here to Serve - A United Regional Podcast / Dr. Brett May, general surgeon and Chief Medical Information Officer at United Regional
Transcript
- United Regional: Welcome to Here to Serve, a United Regional podcast. I'm your host. My favorite part of being the Director of Patient Experience at United Regional is the incredible people that I meet and work with on a daily basis. And I want you to meet them too. Join us to meet the people behind the badge and to highlight those who are here to serve. Dr. May, welcome to the Here to Serve podcast. We are glad to have you today. Been really excited to bring you on. ⁓ thanks. I'm glad to be here. All right. I've got so many things I want to talk to you about. So many questions. I've got some juicy questions to ask you today. Finally, we're getting into the people that make the hospital of Ryan. ⁓ yeah. Absolutely. So let me start with this. Tell me what your actual title and role is at United Regional. OK. ⁓ I've got a lot. I'll try to cover them all. ⁓ So I'm a general surgeon. Been in practice here for about 21 years. ⁓ I'm the chair of the Department of Surgery. I oversee and kind of the managing partner of our trauma acute care surgery group, which is a group of surgeons that provide acute care trauma coverage for the hospital. ⁓ I serve as the chief medical information officer at CMIO at I-Regional. And then I guess the final thing is I sit on the board of directors at the hospital. So lots of different things. lots of free time. Yeah, he's just bored a lot. can't get no a lot of a lot of meetings at night Yeah Yeah Well, thank you for all of the things that you do And I didn't even know I knew a few of those but I didn't know all of those so you made me feel like I need to be trying harder to be honest I can Keeps me out of trouble. Oh, that's a that's a pretty good rule. Yeah pretty good rule. So But you you're you're I guess your first love maybe I would say is surgeon. Is that where this all this began? So tell me about that, your role to surgeon. Was that something you always wanted to do? Like as a kid, you wanted to be a surgeon or how'd that come to be? No, I wanted something that gave me ⁓ stability professionally, but was also a challenge. ⁓ think medicine was kind of in my wheelhouse academically. I was good at science and math. I was good at taking tests. The other thing I thought about was law, but I was not good at writing. I didn't like reading a lot. So this fit in my wheelhouse. And then as you ⁓ kind of got some experience, I enjoyed the surgeons. It's kind of, ⁓ I don't know, it's an academic camaraderie in a way. I was involved with athletics a lot. And so that locker room kind of, you know, and it just- Similar vibes for sure. Yeah, it was just fun. Yeah. And where did you do your schooling and all that at? So I did a couple years at UT in Austin. Decided that it was going to be tough to get to know my professors for references for medical school, so I came back to Midwestern. OK. Graduated from Midwestern. Midwestern at that time, and still to this day, has a top tier pre-med program. OK. Back then it was a 99 % acceptance rate. I was also able during that time to do some internships at the old General Hospital. OK. where I would rotate through surgery in the recovery room in the emergency department in the summer. Yeah. And get some experience. That's where I actually met my wife. Okay. Yeah. And then from there, went to UT Southwestern down in Dallas for medical school. And then did five years of surgery residency at Scott and White. Now, are you from Wichita Falls originally? I was not born here, but my family's all here, so I moved here in junior high. ⁓ okay. Yeah. So pretty much there. Yeah. ⁓ yeah. much. Yeah. Awesome. So ⁓ Did you work anywhere else besides United Regional? I did. When we came out of residency, I looked to come back to Wichita Falls. I would tell you that the dynamics amongst physicians was very different than it is now. It wasn't going to be the easiest thing to come back because there wasn't thought to be a need. So we went to a place called Mountain Home, Arkansas. Mountain Home, Arkansas. Up in the Ozark Mountains. was a town of about 10 to 15,000. But again, it was kind of a referral center. So people from Northern Arkansas, Southern Missouri would come see us and I would do big operations, aortic aneurysm repairs, carotid endarterectomies, lung resections, big things. But ⁓ about three and a half years into that, we had met a lot of great people, but as life does, it threw us a curve ball. ⁓ I diagnosed my wife with breast cancer. ⁓ my word. Yeah. And so ⁓ we had to go through some surgery and some chemotherapy and had three young children at the time. ⁓ man. And decided that, you know, we needed to be back with family. Sure. So we decided at that point, we were coming back to Wichita Falls, kind of found a place to land and have been here since. Wow. Wow. Well, I truly hate it. your wife and your family went through that, but I'm thankful that you guys landed back here. Yeah, and that was 21 years ago. She's doing She's doing great. Awesome. Yeah. Awesome. But yeah, it was a challenge. I can remember one point, she starts doing chemotherapy and her hair starts falling out. And so we took the kids to the beauty shop and let them shave her hair off. so yeah. Wow, what a deal. And one of those things that ⁓ shows you the importance of family, you know, it's like, man, we need to be near our family ⁓ during this. Is her family here? It is. ⁓ Man, man, I had no idea. Yeah. I had no idea you guys did that. So that actually begs a question for me. Because one of the things I wanted to ask you about, and this may have nothing to do with it, but maybe it does. ⁓ One of the things I've noticed about you and I've been here for a long time, so I've interacted with you both many moons ago as a nurse and then in the current role of ⁓ director of patient experience, and then I've also interacted with you through our ethics committee. We've involved you heavily in that ⁓ many times, and I've seen you kind of in some of these horrible situations where the stakes are high, emotions are high, ⁓ and you do something extremely well that, ⁓ Don't want to mean this is an insult to other surgeons, but not all surgeons do this well, right? There's kind of the trope with surgeons of sometimes not being the most compassionate based on their personality types and all that sort of thing. And there are some that are extremely compassionate and don't want to lay broad strokes by any means. But I have seen you, you're a highly skilled surgeon, but also highly skilled with compassion. And I believe it is a skill set that, and we'll maybe get into that in a minute, but it makes me wonder is, Were you always kind of geared that way or is that something you learned and especially having gone through a scary medical situation yourself? Do think that's played in at all? I think it was always geared that way a little bit. In other words, I was always thought that doctors came in and talked to people above their level of understanding and talked in a kind of a foreign language. So I always wanted to be able to speak to people and words that they understood. So that was my base. But going through that, certainly changes your perspective. ⁓ I can, I remember prior to that, that money was very important to me. Setting up for retirement so I could retire. Once you realize that, something can happen that in two years, you may be gone in that retirement, that means nothing. And so it changed my view on life, but it also gave me, as we all go through life experiences, understanding. ⁓ And understanding what that person or their family is going through, ⁓ I think that absolutely impacted that. Yeah. That's powerful. ⁓ That way, the word you're using there, understanding what they're going through, ⁓ I've done a lot of thinking and talking about this over the years, and so I try to kind get down to definitions. And one of the things I've kind of landed on recently is empathy. is trying to understand what the family or patient or whoever it is, what they're going, the empathy is noticing it and trying to understand it. And then compassion is then trying to do something about it, like some sort of action, whether that's a, could be as simple as a hand on the shoulder or communicating the way that they understand and compassion is taking action on that. And so, I mean, I appreciate that so much about you and I've noticed you really do. ⁓ go the extra mile when you're communicating with families to make sure it's on their level because sometimes, I mean, you have to go in the room and communicate something extremely complex that's taken you a decade of learning and then they've never even heard this term. And you have to then explain this complex life and death situation that they're fixing to have to make a life altering decision and they've got to trust you. in the next five minutes as you talk them through this. That's a hard thing to do and it has to be done very intentionally, I would think. Absolutely, and a lot of times, as you mentioned, in a very tight time, time constraint or timeline, know, somebody comes in with, you know, bow that's dying and we've got to take him to the operating room and they're, say, 78 years old, getting towards the end of life, maybe 85 years old, they've got to decide, is this something I want to do or is it not? You've got to... help them work through that in literally five to 10 to 15 minutes. And it's crazy. And what a, I think this is something that gets missed. I think it's becoming more and more apparent as we get more data on it. There's a science to this. It's not just a feeling. There's a science to it. But it is a, I think, I'd be curious when you're taking this. I think it is a learnable skill set. I think it's a very difficult skill set to take, to be able to communicate in intense situations. very clearly and on a, the last I saw, I don't know if this is still true or not, but the last I saw the average reading level for Wichita County was like a fourth or fifth grade reading level. And that's not for everybody, but let's just say on average you gotta take this and then enunciate it in that way. Any tips or just things you've learned that have helped you do that over the years? No, I think that's a great point is to try to. communicate at a fourth or fifth grade level. mean, like you were talking to our fourth or fifth grader to help them understand. And again, you adjust. You obviously have people that come in with different understandings, different educational levels. I'm talking to you as a nurse. You understand different things, and so we can get into a little bit more of the weeds. But the other thing that I've noticed is that, and this kind of is a throwback to old times, a lot of times they just ask you, Doc, what should I do? And that's a throwback to old medicine. We don't do that now. Now it's not my job to tell patients you need to do this. It's my job to explain what your options are, what the risk, what the benefits of those options are, and then to help you get to decision that's best for you as the patient. I love that. I heard a provider one time say, I'll be curious your take on this, he said there's kind of the old school was what they called the paternalistic provider, right? So whatever the provider says goes. And on the other end is the consumeristic, where whatever the patient says goes. And then in the middle somewhere, there's this partnership that we're shooting for is we're gonna work together where I'm gonna give you the information that you need in a way that you can understand with compassion and help you make the decisions. And you've gotta adjust that, know, because again, to the person that wants really to just follow what you say. if you try to say you've got to make a decision, they can't. And so you've got to help them make a decision. Now to the opposite end of that spectrum, if the person is, they want to make the decision, then absolutely give them all the information so that they can make a good decision. yeah. Well, you do it exceedingly well. One of the best I've seen in these situations. So thank you for that. It makes a huge difference for patients and their families and people. These conversations, and I think that's what makes them so high stakes and makes them very It's very difficult, right? These people are gonna remember this conversation for the rest of their life. They may not remember what they had for lunch two days ago, but they will remember this conversation forever. And I think that's something that we always have to keep in the back of our mind, and we forget. It's easy for us to forget that for us, I wouldn't say it's a normal day, but it is a day of work, and it's a day that we see multiple times throughout our career. For them, it's the worst day of their life. And so they're gonna always remember that. I still remember the day I got the news from the pathologist that my wife had cancer. I mean, it just sticks with you. It never goes, and I talk to patients. That's my job is speaking with patients. And there'll be people from five, 10, 15 years ago that will bring up a specific conversation. Not only did I have this loss, ⁓ but the way this person spoke to me still haunts me. On the flip side, It was the worst day of our life, but the compassion that that nurse doctor, whoever showed, I will never forget it. And there's both sides of that. But people remember it forever. I mean, it's powerful stuff. So thank you for your work on that. And we'll maybe have to get more about that. I think there's opportunity there for you to share that wisdom with other folks as they're trying to learn. I think that learning curve is a difficult one, but it could probably be shortened. Yeah, it's very difficult. And again, it takes... Experience. mean, I'm certainly different in my approach now than I was 20 years ago. So yeah, absolutely time time and effort. Well, let's talk about your transition from surgeon into your and I know there's quite a few roles, but let's just maybe hone in on the ⁓ C.M. I.O. Did I get that right? Yeah. Medical Information Officer. So let's let's talk about that transition. How did you get interested and pulled into that? And then what does that look like? ⁓ It was pretty much just by luck. We were back, I guess in 2017, maybe 2016, the board and the hospital had made a decision before I was ever involved with the board to change the electronic health record. We were on something called Allscripts. And really felt that we needed to transition for the long term. Looking at two companies, one was Epic, one was another vendor. ⁓ And so they had those two vendors come in and demo their product. And so I got involved with that because I was kind of involved with a multidisciplinary group where we would give our feedback on what worked well, what didn't work well. So gave my opinion on which one I thought would work best for providers. And from that I got offered to, because of my interest, to be the physician champion. You made the classic mistake of doing a good job and being interested. so Phyllis and Nancy asked me to be the physician champion through that transition as we went. And so went with the initial team to Epic and started learning about it. And over that year and a half or two year implementation process and then have just continued in that role since. And as you learn more kind of transition from the title of physician champion to CMIO, but same function. Same function, okay. That's helpful to kind of have that. And that's why you would, I'm assuming it's why we would want a physician in the CMIO role versus just another person that understands Epic. Why do we need that provider in that role? Well, because a lot of my job is to be a translator. I like that. A translator between the analyst and the IT and IS folks and the providers, the bedside nurses, and to help each of them understand the limitations of the system and what it can do and what it can't do. today I was showing a group of hospitalists a new functionality. And of course, this is very typical. You show them this and they're like, that's great. But we also want this, this, this, and this. And well, yes, we can do some of that, but maybe I can do all of that. yeah. This may have occurred to you long ago, but as you're talking, it occurs to me that what makes you good at both of these roles is the same thing. As a surgeon, you're just translating. You're translating high-level medical information. Of course, you're doing technical skill work as well. But as far as the part interacting with the family is you're translating high-level things to someone. to someone who maybe doesn't understand them. And then in your other role, what makes you successful is the ability to bridge that gap between two different languages, really. that's never occurred to me, that's very interesting. Very interesting. So I never was a bedside nurse with an electronic medical record. I was only on paper. So I joke often that if I ever had to go work the floor, I would be like, listen, I'll keep everybody alive, but nothing will be documented because I don't know how to do it. And so I joke about that. But I want to ask you, what do you think that, I know there's a love-hate relationship sometimes with EMRs. What's your overall thousand foot view on electronic medical records and what they've done for us? ⁓ I think the thousand foot view is unquestionably that the electronic health record makes life much better for the clinician. and much safer for the patient. And I'm gonna give you one example, and this is just one. Back in the day, I would have a patient get a CAT scan or let's say a chest x-ray. They were in the ICU, got a chest x-ray on them. I needed to see that to see maybe where a line was placed, a chest tube, where it was located, make sure their lung was inflated. And I would go down to radiology. So I'd have to leave the bedside, go to radiology to find the film. undoubtedly the film wasn't there. Then I would go over to the reading room where they would have it on these big basically conveyor belts and we would look for it there, wouldn't be there. So now we go back up to the bedside and to see if it was there and it wasn't there. So lo and behold, it was caught in the conveyor belt. And so it took me 30 minutes to look at a chest x-ray to take care of a patient. Now it takes me literally 10 seconds to find that x-ray on the system. That's a great simple explanation. Yeah. the law of hate comes from, it's not so much the EHR, it is the EHR, but a lot of the hate toward the EHR is because it's required documentation for regulatory reasons or ⁓ reimbursement reasons. A lot of people mix those up. Sure. You know, the bedside nurse, they do a lot of documentation. ⁓ That's not so much for ⁓ reimbursement, it's more for regulatory reasons. We need to do that to make sure we're taking good care of the patient. Now the doctor has to do so much documentation to make sure we're getting reimbursed, that we're stratifying risk on that patient appropriately, so, yeah. Yeah, it turns into a lot. And so much of that could have never been done on paper. It just wasn't possible. Yeah, it's fascinating. ⁓ I'm fascinated by how fast it's growing and improving and changing. It's rapid. It's incredible. fast. If we have time, I want to get into a little bit of AI stuff in a little while. Speaking of rapidly changing so quickly, before that, I want to ask you as it relates to this role, really any role, but I'm thinking more in this role. What are you excited about that's coming up? What are we working on? What we got in the future that gets you fired up? ⁓ mean, mean, undoubtedly is AI. So ⁓ I think that's obviously the future. ⁓ I was told you was working with a group of hospitalists. So just in the last 24 hours, we're getting them to use some new functionality with AI where AI will go in and say the patient's been in the hospital for 10 days. AI will go in there and review the chart and review all the documents, all the HMPs, the operative notes, the x-ray reports, the lab, and it will draft a summary of that hospital course for the provider in about 20 to 25 seconds. And then, obviously, it's a draft. They can review it, make sure it's accurate, and then accept it. But that's a process that probably took them at least 10, maybe 15 minutes before, and now we're doing it in about 30 seconds. ⁓ With that, it even gives you notations within that draft of where it found the information. So you can hyperlink to it to confirm it. And I told literally, I think, three, maybe four people about it yesterday. They used it 22 times just in that 24 hour period. So this is going to be like one of those things that saves them an inordinate amount of time. And I'm seeing that everywhere. Everything I touch almost, I'm finding that AI can do it faster. and really well. what's exciting and scary and somewhere in between for me is it's doing tasks that a month ago I couldn't get it to do and now it does it better than I can do it. In that short amount of time. I'm pretty jazzed about ambient listening with providers. How you feeling about that? What are you thinking? Yeah, I think it's great. The technology's still developing. You know, we're using a vendor right now and there's several other vendors out there. And what's interesting is that ⁓ Epic has now jumped into that arena to have their own system. And I actually did some testing for them in the general surgery ⁓ area and it was phenomenal. And so I think it will absolutely be the way in the future that we document so that we spend more time face to face with patients. Well, that's what excites me about it is I see even the few that are already starting to use it and have benefit with it is ⁓ it gives you more face time with the patient. Not only does it give you that, but it incentivizes you to say those things that you're thinking to the patient so that they are captured. I think that's a good thing from a patient standpoint. I think it's going to be excellent. ⁓ But you're right. Somebody like me that's been doing this for 30 years, we're going to have to relearn how we have that conversation because I'm not used to verbalizing my physical exam. Yeah. Yeah. And some of those... Physical exams are in sensitive areas. But I do think, not only will it make it easier and a better relationship with the patient, I think it's also gonna make it safer. are many times I come out of a conversation with a patient and I go to do my documentation and I forget that we talked about something. ⁓ uh does a great job of reminding you, hey, we need to do something with this too so you don't forget something. ⁓ What worries you? Not, it could be AI, but just in general, what are the barriers? are the things that are, we talked about, you're excited about AI, but what are the things that kinda worry you in your role and things that we're struggling with? The things that worry me are not the things that most people comment on with AI. I'm not fearful of AI being wrong. I mean, we have to be cognizant of that. Sure, sure. ⁓ What I fear is adoption. ⁓ What I see so far in, as we roll out AI tools, People are resistant to adopting them because they lose a little bit of control. It's new. And they just don't trust it. And so, I will tell you, I have a vehicle that has something called Super Cruise on it. I can drive basically from here to Dallas without touching the wheel or the accelerator for about 80 % of that drive. Well, when my wife saw it, my... mom saw it, they were like, that's crazy, I would never do that. Well, my wife had to take my car down and she started using it and now we have a second car with Super Cruise because she loved it so much. So it's getting over that fear of something new that you may not trust and adopting it and embracing it and let's move forward with it. Well, I think in my mind, I don't, certainly, our goal today is not to have a philosophical discussion about AI, but I've given this a lot of thought lately and kind of where I've landed on it is like, trust it or not, I better learn. I better learn. This is a part of life now and my best bet is understanding as much as I can about this and utilizing it as much as possible. Even let's just say, and I'm not in this camp, but let's just say. I were to think AI was evil and it's gonna destroy us all. I still need to know as much as I can about it. Which is not the camp I'm in, but the more I use it, the more it blows me away of what it can do to save time. It is an incredible time saver. It gives me time back with my family. time back with the people in front of me is the part that I get excited about. Well, and I think, you know, I use it regularly if I have questions when I'm seeing a patient that, you know, what's the next best thing from a surgical standpoint to do it? using AI technology that's designed for that, and there are several platforms out there just for medicine, helps me ensure that I'm doing the right thing for the patient. Yeah, it's a great double check. Yeah. And I'm seeing that a lot amongst providers. And one of the newest things that I've seen is ChatGPT Health has come out with a platform for patients. I haven't seen that. Yeah, and so what it allows patients to do is to take their MyChart or their health record and upload it to ChatGPT. And now it can double check. So they come in to see me and they're on a medication and let's say they're on a blood thinner and I say, okay, let's go do an operation on you. didn't know they're on a butt dinner, they can put in some information and it's gonna say, hey, you're on a butt dinner, check and make sure you probably need to hold this. That's incredible. Incredible. It can check medication interactions, allergies. ⁓ It's gonna get to where once it knows genetics, it's gonna know more information than we could ever know. Yeah, because we can't do all that processing. I've heard stories and I was even at a conference recently where they had somebody share, I guess it had made even national news, but there was like a, gosh, I'm trying remember, was a mother, somebody that they couldn't find a diagnosis for her son and she uploaded all the scans to, know, chat.gbt and it diagnosed correctly, saved his life, did a whole, I mean, it was incredible deal where, and I know it's not. Well, in my take on it, I keep saying is like, listen, AI can't replace ⁓ necessarily the human skill, but it can. It didn't take me a lot further. So I've been saying me plus AI is better than just me. It's been my experience thus far. You know, it makes me it can take me further. Yeah, faster. So incredible. Well, ⁓ man, this has been really enjoyable to talk to you. Anything we haven't talked about today that you wanted to be sure and share. ⁓ I don't know that there's anything there. There is one other thing I will mention is that with epic we have recently ⁓ engaged in a program called cosmos and What cosmos is is now joins us with every other hospital or most every other hospital not only in America But in the in the world they are on epic and so now we can start utilizing the entire database of millions and millions of people to help design ⁓ ⁓ personalized care for each patient. And so that really excites me as well. That's cool. That's cool. And we're working, we're starting that journey. We're looking into it. on it. We're on it. Okay. Yeah. So we have a program now to your point where the mom had a difficult diagnosis. If I see a patient that has a rare diagnosis that ⁓ only a few experts have taken care of. I can directly link to those experts now at Epic and they can give me information on how to take care of that patient here in Wichita Falls. Incredible. So one less reason to have to try to get in the car and go somewhere else. Absolutely. I love it. Absolutely. So it's building a network of providers that are going to work as a team wherever that patient is located. Awesome. Well, ⁓ the best compliment I think I can give a provider or a surgeon is that I hope my family never needs it, but if they did, I would let you take care of me or my family any day. Hope they never need it. I hope they never need it. But we appreciate all you do for the organization, for its people, and most importantly for the patients. Thank you for coming on today, man. Thanks, Ryan.