Latest / Get Savvy...Demystifying Healthcare / Episode 143: Speak Up at the Doctor’s Office: What Matters Most

Transcript

Episode 143: Speak Up at the Doctor’s Office: What Matters Most · Get Savvy...Demystifying Healthcare

0:00
SPEAKER_00: Trust is at risk, I feel like more than it has been at any point in my career.
0:05
SPEAKER_00: And a lot of that is because of this just sea of information that is surrounding us.
0:10
SPEAKER_00: We've got Google, we've got ChatGPT, right?
0:13
SPEAKER_00: We've got all of our AI tools.
0:14
SPEAKER_00: We have patient forums and patient groups where we are getting information from other patients who or parents of kids who've had similar diseases or experiences or have had operations.
0:25
SPEAKER_00: And sometimes these are really common and the experience is more generalizable.
0:30
SPEAKER_00: But sometimes if somebody's had a very bad experience or very good one, it's like their the loudest voice is heard.
0:37
SPEAKER_00: It's not always the right one.
0:43
SPEAKER_01: If healthcare has ever left you feeling frustrated, overwhelmed, or stuck, this show is for you.
0:48
SPEAKER_02: Welcome to GetStabby, the mystifying healthcare weekly podcast, where we take complicated healthcare topics and make them simple.
0:56
SPEAKER_01: We bring you experts in real-world strategies from choosing health insurance to lowering prescription costs to patient advocacy and the latest healthcare trends so you give more options on your turn.
1:08
SPEAKER_02: GetStabby with your host, Daddy Kibling, changing how healthcare knowledge is shared.
1:18
SPEAKER_03: Hello everyone, before we get into the show, just a quick 90-second update.
1:23
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1:28
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1:31
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1:36
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1:39
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1:40
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1:48
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1:56
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2:10
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2:27
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2:32
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2:33
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2:35
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2:42
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2:44
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2:48
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2:51
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2:57
SPEAKER_03: I'll drop a link to it.
2:58
SPEAKER_03: Check it out in the show notes.
3:00
SPEAKER_03: Let's demystify AI together.
3:03
SPEAKER_03: And now on with the show.
3:05
SPEAKER_03: Show the conversation that decides your care, what really happens in the exam room.
3:10
SPEAKER_03: What happens in the exam room goes far beyond a diagnosis or treatment plan.
3:14
SPEAKER_03: The words a physician chooses, the questions left unasked, and the level of trust between doctor and patient can shape how families understand their options and the decisions they ultimately make.
3:24
SPEAKER_03: In a healthcare system that often feels complex and impersonal, communication can become one of the most powerful and overlooked parts of care.
3:33
SPEAKER_03: To help us get more into this topic today is Dr.
3:35
SPEAKER_03: Emily Boss.
3:36
SPEAKER_03: Dr.
3:36
SPEAKER_03: Boss has a Master of Public Health, is a pediatric ENT surgeon and director of pediatric old laryngology at Johns Hopkins University.
3:45
SPEAKER_03: Doctor Boss is a surgeon, scientist, and health systems leader.
3:48
SPEAKER_03: She studies how families, physicians, and institutions navigate decisions about children's health.
3:54
SPEAKER_03: Dr.
3:54
SPEAKER_03: Boss is a mother and a physician and brings evidence, empathy, and clarity to the conversations patients and families struggle with most.
4:03
SPEAKER_03: Welcome to the show, Dr.
4:04
SPEAKER_03: Boss.
4:05
SPEAKER_03: Thank you so much for having me.
4:06
SPEAKER_03: It's great to be here.
4:08
SPEAKER_03: Thrilled to have you.
4:09
SPEAKER_03: You're you're doing so many great things.
4:11
SPEAKER_03: So with that, why don't you start by telling us your story and how it has led you on the journey you are on today?
4:16
SPEAKER_00: Sure, I'd love to.
4:17
SPEAKER_00: And you gave me such a kind introduction.
4:19
SPEAKER_00: I feel like you've told a lot of the stories, so thank you for that.
4:22
SPEAKER_00: You know, I am a physician.
4:24
SPEAKER_00: I've lived in Baltimore and worked at Johns Hopkins since 2008.
4:27
SPEAKER_00: And as you said, I'm a pediatric odolaryngologist, ear, nose, and throat surgeon.
4:31
SPEAKER_00: And I have this cool array of jobs aside from practicing practicing medicine and surgery, where I do research on how patients and physicians talk to each other and make decisions for care.
4:44
SPEAKER_00: And I also work with different health systems initiatives around improving performance with the revenue cycle and with medical necessity of care and different clinical operation issues, like how much block time we're using and and how to get patients through the door and make patient experience overall better.
5:03
SPEAKER_00: I I just say all that to say I have this great opportunity to have perspectives from all different seats as a as a clinician, as a scientist, as an administrator, and as a as a mom and stepmom to some always very pleasant teens.
5:18
SPEAKER_00: So I was an artist by training, and I I thought I was gonna be an art and religion major in college.
5:26
SPEAKER_00: In the middle of college, I had some reflection about my younger sister.
5:30
SPEAKER_00: My younger sister is now a healthy adult woman, but she had leukemia when she was four years old and I was nine.
5:38
SPEAKER_00: And I really reflected on how my parents experienced having a child with illness.
5:43
SPEAKER_00: And that was an impetus for me to undo all of my rocks for jocks and science requirements that I had already gotten out of the way and pursue pre-medical sciences along with an art degree.
5:54
SPEAKER_00: And so, so it was really driven by that experience that my parents had talking to physicians, you know, working their other children and working with their community around having a child with cancer.
6:06
SPEAKER_00: And that really encouraged a lot of the research that I'm doing today.
6:10
SPEAKER_03: Oh, isn't it interesting how life kind of takes us on a journey and then we pivot and go in the direction?
6:15
SPEAKER_03: And I just want to say thank you for all the work.
6:17
SPEAKER_03: Physicians are busy enough.
6:19
SPEAKER_03: Let's clear that up.
6:20
SPEAKER_03: And doing all the things that you're doing on the side, because I always say that our healthcare system is complex, it is fragmented, it is, it is expensive.
6:28
SPEAKER_03: And tell us more about your work and what do you mean when you say the conversation in the exam room shapes care?
6:35
SPEAKER_00: Thanks.
6:36
SPEAKER_00: And just to speak to the fragmentation that you discuss, you know, we there are just so many competing demands for patients that are walking into an exam room or a visit with anxiety or or they're, you know, they're they're nervous about a diagnosis or treatment recommendation, and and physicians might be seeing 40 patients truly in a day, if it's a clinic in the morning and afternoon, and there's all sorts of demands on coding and documenting and making sure you have the right information, which that is all very important, but there are just these increasing elements of pressure that the other sides don't necessarily see.
7:12
SPEAKER_00: But that human connection that's happening in the exam room is so pivotal to what happens down the down the road and how the rest of the care for the patient is shaped.
7:21
SPEAKER_00: So I'm a surgeon.
7:23
SPEAKER_00: I do, I've done performed thousands of operations, and I I am a pediatric ENT surgeon.
7:27
SPEAKER_00: So I it's some of the most common surgery that that kids experience ear tubes and removal of tonsils and removal of adenoids.
7:34
SPEAKER_00: But you know what I do a lot more than operate is talk to patients and families.
7:38
SPEAKER_00: So if we were to start thinking about the the exam, you know, just the the first encounter with the patient as a procedure, then we would really hone our craft and hone our skill.
7:50
SPEAKER_03: So what are you seeing when uh maybe parents come in?
7:53
SPEAKER_03: Because usually it's going to be parents with their child in your case.
7:56
SPEAKER_03: What can people do better if they're walking in there?
7:58
SPEAKER_03: I mean, are they asking the right questions?
8:00
SPEAKER_03: Are they prepared for that exam room discussion?
8:03
SPEAKER_03: Is there intimidation?
8:04
SPEAKER_03: I mean, what are you seeing that parents can do better in talking with their physician?
8:09
SPEAKER_00: Thanks.
8:09
SPEAKER_00: And I do want to say there's a lot of things the physicians can do better.
8:13
SPEAKER_00: And we're spending with I've focused so much work on trying to educate the physicians and the clinicians who are conducting these conversations.
8:22
SPEAKER_00: But the patient can really become more empowered and engaged in care.
8:26
SPEAKER_00: And I hate to act like I'm giving any homework to patients or families or parents, but it is so helpful if you come into a visit ready, you know, knowing all of those different pressures and all the time demands that everybody is experiencing and all the time you've probably spent waiting for this visit, waiting for maybe these 10 or 15 minutes for your child or for yourself to receive care or, you know, have an examination, having a really good understanding of what is the problem that brought you in.
8:55
SPEAKER_00: Maybe it's just, oh, my doctor saw something and said I should go see an ENT, or my child has been snoring and it's been going on for a year and I am scared about this.
9:06
SPEAKER_00: You know, people will say to me, I am most concerned that my child is going to stop breathing at night.
9:11
SPEAKER_00: Or they'll say, I didn't think that something was a problem, but we went to the dentist and the dentist thought that the tonsils were big, so they told me to come here.
9:17
SPEAKER_00: So that immediately gives a little bit of context to what is the main problem that brought somebody in and how should we go about eliciting more information.
9:27
SPEAKER_00: Now, sometimes people will come in and there are a host of problems and they've tried a bunch of different treatments or medications, or they've had surgery before, or they've seen other specialists, and they'll say, it's all in the record.
9:38
SPEAKER_00: I'm sure it's all in the record.
9:40
SPEAKER_00: And I, you know, we do look through records in advance and try to find this, but you probably know, like there's not a there's not a mom behind the system.
9:48
SPEAKER_00: You know, these records can be really complex and detailed, and the information is stored in a million different places, and some of the systems don't have medical records that cross over with each other.
9:58
SPEAKER_00: So being able to pinpoint this is the the timeline.
10:02
SPEAKER_00: When people say it's happened my whole life, that's not that that's not as specific.
10:07
SPEAKER_00: So really understanding when things have become problematic or what has made you recognize that something's be become problematic.
10:14
SPEAKER_00: What's the real timeline or about seas e even if it's a season or it's a it's an average, like I think this has been months or years, or where it was really bad when he was two, and then it got better, and now we're noticing it again.
10:26
SPEAKER_00: That's that's really helpful to have.
10:27
SPEAKER_03: You know, I want to talk about that for a minute because boy, is it ever a problem?
10:31
SPEAKER_03: We think as advanced as technology can be, you know, you leave one system, and I I say maybe if you're like an HMO, like with a Kaiser, and then and that was my scenario.
10:40
SPEAKER_03: And then I left and went on my husband's plan on a PPO, and now I'm free in the world outside of the walls, in this case a Kaiser.
10:47
SPEAKER_03: And literally, I one of the things that I did is I had my medical record like in a PDF, and I'd have it on my phone.
10:54
SPEAKER_03: And you know, I was kind of hesitant because I didn't want to be, you know, obnoxious or be appear that way.
10:59
SPEAKER_03: But I I really thought, gosh, you know, this provider is running from room to room to room.
11:04
SPEAKER_03: And I, you know, what I had to say counts.
11:06
SPEAKER_03: So I actually had on my phone, hey, I'm not sure if you're aware of this, but I've had this done or that done.
11:10
SPEAKER_03: Happy to share with you whatever.
11:12
SPEAKER_03: So I I I think that in my mind, that was like a, hey, let's be proactive, let's be helpful.
11:17
SPEAKER_03: Is that really helpful?
11:19
SPEAKER_00: It's really helpful.
11:20
SPEAKER_00: I the other, the other it was last week, I saw a couple of kids in a row.
11:24
SPEAKER_00: I actually asked the moms, I was like, What did you all talk to each other in the waiting room?
11:28
SPEAKER_00: Because they were so organized in their approach.
11:30
SPEAKER_00: They're like, and and some of the symptoms were really severe.
11:33
SPEAKER_00: I mean, when the children had had multiple other illnesses, different specialists, but she had everything ready, including, and there was a sleep study done, and you probably have the result.
11:42
SPEAKER_00: But if not, I have a copy of it right here, and this is the highlight of it, and this is what it showed, which I don't expect everyone to be that organized, but you better believe it's helpful.
11:50
SPEAKER_00: And also the way that you present the information to me, if you've organized your own information about this is these are the things that I really want this doctor or this clinician to know.
12:00
SPEAKER_00: I want to walk out with an answer.
12:01
SPEAKER_00: I can, I know then a little bit about what is actually most important to you.
12:05
SPEAKER_00: You know, some people will start with what they are the most scared of.
12:08
SPEAKER_00: And I uh I really value those statements because I can I know how to address it, right?
12:13
SPEAKER_00: Like if somebody comes in and says, my kid is failing in school because they can't hear, because they got this fluid behind their eardrum, I know how to address it.
12:21
SPEAKER_00: If they come in and say, we really don't want to do anything, we're really anti-surgery, it gives it just gives me some background information about how to how to move forward and ask questions.
12:30
SPEAKER_03: I'm gonna ask you a different question, but it just came to me, and I think it's worth asking.
12:35
SPEAKER_03: Sometimes as a patient, people come in and they want to maybe they've been diagnosed with something and they want to go immediately to surgery.
12:42
SPEAKER_03: And one of the things I hear often from physicians is unfortunately they can't move right to that, or if they do, it's a process because things have to be handled by their insurance company.
12:52
SPEAKER_03: So maybe they have to do the step therapy, I like to call it.
12:56
SPEAKER_03: They have to do medications first or physical therapy first before they get to surgery.
13:00
SPEAKER_03: That has to be a hard decision to a family who says, you know, I want my child to have this now, but there's certain things that may be limited by the insurance company.
13:09
SPEAKER_03: I mean, how do you deliver that message?
13:11
SPEAKER_03: One, and then two, how do you help the the family understand that from their insurance company's perspective or not?
13:18
SPEAKER_00: That's right.
13:19
SPEAKER_00: And so in this situation where there is a clear clinical practice guideline.
13:24
SPEAKER_00: So some of these orthopedic elective procedures like hip replacement or different different joint surgeries or joint issues, there are clear practice guidelines around uh, you know, the severity of symptoms and how long things have been going on and having some kind of amount of physical therapy that's and I'm not an orthopedic surgeon, so I can't I can't speak so directly, but you know, there usually are these steps that have to be taken by anyone, regardless of payer, before somebody says, I am ready to pro proceed with surgery.
13:53
SPEAKER_00: Uh I would, and then sometimes it's it's a little bit more gray, right?
13:56
SPEAKER_00: So I'm an example, I'll just use tonsilectomy, which is a very common procedure that I do.
14:01
SPEAKER_00: So in kids, I do in the United States, almost half a million kids will have a tonsillectomy with adenoidectomy every year.
14:09
SPEAKER_00: That's this lymph tissue that's in the back of our throat and makes kids snore.
14:13
SPEAKER_00: They have trouble breathing at night, and sometimes they have chronic infections.
14:16
SPEAKER_00: And um when they come in for snoring, there are some payers that will require a child has a sleep study.
14:23
SPEAKER_00: That's a diagnostic sleep test.
14:25
SPEAKER_00: It's in a sleep lab.
14:26
SPEAKER_00: It's another night of health care, it's another copay, right?
14:29
SPEAKER_00: It's a it's another layer of complexity.
14:31
SPEAKER_00: Um, but they'll require that a diagnostic study is done before a determination can be made about surgery.
14:37
SPEAKER_00: I will tell you that's not the majority of payers.
14:39
SPEAKER_00: And there's uh there are a lot of reasons where sleep studies are very important, and particularly in kids who may have more significant illness, kids who have Down syndrome, or other kids who have obesity, you know, kids or who have different medical concerns that require that diagnostic information to help with the perioperative care.
14:59
SPEAKER_00: But there are some kids that are really healthy and the symptoms are really clear, and we know we look in their mouth and they have massive tonsils that are like kissing in the back.
15:08
SPEAKER_00: So it's it's not a question of what the treatment's gonna be.
15:12
SPEAKER_00: And I think really the the truth is that the surgeons or the clinicians don't always know the difference in what different payers require.
15:20
SPEAKER_03: Yeah.
15:20
SPEAKER_00: They sh they they do sometimes, but not not always.
15:23
SPEAKER_03: No, I appreciate that because sometimes I feel like you know, somebody will say, I'm so mad at my physician, when it's really something beyond your control if if one, two, and three steps have to be done.
15:32
SPEAKER_03: But I always think that that kind of going back to the conversation topic that blends in, and I it it's side of that bureaucratic layer that I think physicians as well as families have to navigate through.
15:41
SPEAKER_03: But I always think working in that partnership together um will help get to hopefully that goal that meets that health need.
15:49
SPEAKER_03: So moving on, what are doctors actually saying intentionally or not that influences patient decisions?
15:57
SPEAKER_00: Yeah, I there's there's so many micro moments of how the patient and the doctor are uh forming impressions of each other, and a lot of that is happening in the just in the very beginning of the visit.
16:08
SPEAKER_00: We don't even know.
16:09
SPEAKER_00: You know, if you are cu coming in and there are five other family members and uh everyone's looking at me really intently because there's there's fear about a diagnosis, like it gives me it that that gives me a different sign.
16:20
SPEAKER_00: I've already formed an impression about level of worry or uh right.
16:25
SPEAKER_00: I I people a lot of people won't say that out loud, but it's true.
16:28
SPEAKER_00: We do this with every conversation, healthcare or not, you know, immediately making these um these impressions or these thoughts about each other.
16:36
SPEAKER_00: This is where that conversation is so important because a lot of times we we make assumptions because we have experience talking to tons of people in our lifetime, right?
16:44
SPEAKER_00: But uh it's just knowing when the assumptions are wrong.
16:46
SPEAKER_00: And so that's when a patient being more vocal about, I want you to understand what I am most worried about, like or this is what is most important to me, really helping to direct the question and what their real value or or or in or fear or concern is that that is important.
17:04
SPEAKER_03: Now let me ask you this.
17:05
SPEAKER_03: We hear this a lot from from patients and and just general conversations and certainly being a patient myself, there's just not enough time in the visit.
17:14
SPEAKER_03: I mean, you have your questions ready, maybe you'd like some clarification, maybe you want to say, hey, make it simple for me.
17:20
SPEAKER_03: But the truth is in our traditional system, sometimes you're back to back and you have, you know, it's allotted set time of 15 minutes, 20 minutes, whatever the code for EM visit is being used and evaluation management, but or consultation, but can a patient use other tools that you might find helpful?
17:36
SPEAKER_03: Like we have patient portals now.
17:39
SPEAKER_03: We have different ways to communicate.
17:41
SPEAKER_03: If if not all questions are being asked in that one conversation, can patients use that portal?
17:47
SPEAKER_03: Is it really valuable as a communication tool?
17:49
SPEAKER_00: Yeah, absolutely.
17:50
SPEAKER_00: The portal is valuable as a communication tool, and most practices have some element or some some way to respond to questions and provide further education through through human participation.
18:03
SPEAKER_00: If we're if we on the healthcare side are doing it right, we're at least giving you good links, right?
18:08
SPEAKER_00: Good pamphlets, good uh good information in our visit summaries.
18:13
SPEAKER_00: And I just want to know, I'm such a believer in AI making healthcare more human, right?
18:18
SPEAKER_00: Because um because we we once we can hone down on this is what's going on with your kid, then then then the the the parent or the patient can go in and and work with all these amazing, you know, now it's not up to you as much to synthesize the information that comes out in a web search and open every single link.
18:37
SPEAKER_00: You know, there's a a lot more synthesis that's going on for you.
18:40
SPEAKER_00: So so those are great.
18:42
SPEAKER_00: I mean, this is another example of some patients come in thinking that they're being annoying asking too many questions, or they'll come in with the question list.
18:50
SPEAKER_00: And there's this idea that physicians get really, uh, really annoyed and and bristly.
18:55
SPEAKER_00: And that that may happen.
18:56
SPEAKER_00: I I don't doubt that, but I love when somebody is ready to go and has the questions that they they have, because they're actually usually usually easier to answer than trying to guess what somebody is understanding.
19:09
SPEAKER_00: We know after we leave the room that a lot of times the patient thinks something was said that wasn't, and the physician thinks they communicated something that they didn't.
19:18
SPEAKER_00: We know this because we've played back, we've literally played back the tape and gone through and and listened for these statements.
19:24
SPEAKER_00: That's so, so true.
19:25
SPEAKER_03: And I appreciate you saying that.
19:26
SPEAKER_03: I think people need to hear that.
19:28
SPEAKER_03: And and I, as I always say, it's a partnership in health.
19:32
SPEAKER_03: So it's it's both patient and provider working together.
19:34
SPEAKER_03: Well, let's talk about what role does trust play in those medical decisions today.
19:40
SPEAKER_00: Yeah, um, trust is so important, right?
19:42
SPEAKER_00: And and trust is at risk, I feel like more than it has been at any point in my career.
19:48
SPEAKER_00: And a lot of that is because of this just sea of information that is surrounding us.
19:53
SPEAKER_00: We've got Google, we've got Chat GPT, right?
19:56
SPEAKER_00: We've got all of our AI tools.
19:58
SPEAKER_00: We have patient forums and patient groups where we are getting information from other patients who or parents of kids who've had similar diseases or experiences or have had operations.
20:09
SPEAKER_00: And sometimes these are really common and and and the experience is more generalizable.
20:14
SPEAKER_00: But sometimes if somebody's had a very bad experience or or a very good one, it's like their loudest voice is heard.
20:20
SPEAKER_00: It's not always the right one.
20:22
SPEAKER_00: Many, there's so many opinions that people will give about everybody has their parent or a friend of a friend who has had a recommendation or, you know, or or knows somebody who has what you're getting evaluated for and knows what has to be done.
20:35
SPEAKER_00: And so, so it's really hard, hard to know what to trust and like what information is the right information.
20:41
SPEAKER_00: I think there's something really important into living with that uncertainty and for the physician to be able to declare when or be really transparent around when there is not certainty, right?
20:53
SPEAKER_00: Like there is certainty around some things.
20:56
SPEAKER_00: If you terribly fracture your upper arm, you have to have surgery or you have to fix your arm, right?
21:02
SPEAKER_00: Like if you have diabetes and your insulin goes sky high, um sorry, your glucose goes sky high, you have to get insulin.
21:10
SPEAKER_00: But there's so many areas of medicine that you could um, you know, you could have surgery, like you could take a medication, you could just wait it out and see if things get better, you could do physical therapy, you know, there's all there's all, and so being able to really understand when is it true science, when is it a guideline, you know, and there's a lot of variation in the guideline, and like when is it someone's true opinion or experience?
21:34
SPEAKER_00: Sometimes that's hard for people to figure out, but but again, that goes back to the more you can help clarify like the even those questions about what's science and what's your opinion, that's really really helps to guide the conversation.
21:46
SPEAKER_03: No, I appreciate that.
21:47
SPEAKER_03: I hope you don't mind me going down an another yet another different lane.
21:51
SPEAKER_03: But you talked about AI a little bit.
21:53
SPEAKER_03: So I'm a you know, not to get into the AI debate, but I do I'm a big believer that that we can use AI.
21:58
SPEAKER_03: I kind of sit in the middle.
22:00
SPEAKER_03: We can use it for the greater good and on our terms.
22:03
SPEAKER_03: And so I'm always interested in the world of how physicians are using AI and or you talked earlier about synthesizing information.
22:13
SPEAKER_03: So maybe coming in from I what I read into that was I could come in, synthesize information, and then have a more proactive conversation with my provider, but maybe I have it wrong.
22:22
SPEAKER_03: So can you share with me a little bit about your perspective on AI, how you're using it potentially, how you're using it, I should say, as a physician, and maybe how uh you're seeing uh your patients use it that is beneficial.
22:35
SPEAKER_00: Yeah.
22:35
SPEAKER_00: And I well, as a physician, I would say the AI we're using right now is the worst it's gonna be.
22:40
SPEAKER_00: I mean, that's probably true with any of this technology, but there are so many applications that are coming up that will potentially improve the safety of care, the correctness of care, right?
22:50
SPEAKER_00: Decision making at every level.
22:52
SPEAKER_00: There is a lag between those technologies being developed and then actually implemented into full health systems or real-time practice.
23:01
SPEAKER_00: I would say that one area we're using AI a lot on in the medical side is with scribes.
23:06
SPEAKER_00: And you might have been to a visit where where your video, your, your, your visit is being recorded.
23:13
SPEAKER_00: Like we have an app on the phone and it's um the medical record, it's all encrypted.
23:17
SPEAKER_00: You know, all of our devices are are HIPAA sensitive, protect pre patient privacy.
23:23
SPEAKER_00: But I will go in and I'll say, this is a scribe.
23:26
SPEAKER_00: This is my AI scribe.
23:27
SPEAKER_00: It's like a person that's helping to take a note and it's not going to YouTube.
23:32
SPEAKER_00: And I hope it's not going to YouTube.
23:33
SPEAKER_00: Okay.
23:34
SPEAKER_00: But but it's great actually because you know what it allows me to do?
23:38
SPEAKER_00: I actually like look at my patient and talk to the patient.
23:40
SPEAKER_00: And I am not so worried about detailing every single moment in time or uh infection.
23:47
SPEAKER_00: And then also it allows me to have better recall if I go back to tie up my notes and do coding and billing later.
23:54
SPEAKER_00: You know, it really takes out some of that burden.
23:56
SPEAKER_00: So in the space of creating time and human connection with patients and families, I'm really psyched about the scribe.
24:04
SPEAKER_00: It's not perfect, but like I said, I think it's gonna become a lot more perfect.
24:07
SPEAKER_00: And there are a bunch, a bunch of different scribes that people are using, but that that's one area where we've had a lot of success.
24:12
SPEAKER_00: In terms of clin uh clinical decision support, AI is gonna make huge leaps and bounds.
24:18
SPEAKER_00: So if you come in and you've had surgery and you're bleeding this way, when you come in, once it's all implemented, something will come up to say, hey, your patient had this procedure and is bleeding.
24:30
SPEAKER_00: Don't you want to order XX and X based on what science exists and what protocols have been agreed upon?
24:36
SPEAKER_00: So those pathways do exist now.
24:38
SPEAKER_00: They're bulky, they're um, they're great when they work, and they're really they they take a lot of resources to integrate into these medical records and systems.
24:48
SPEAKER_00: And so I think AI is gonna help help advance that technology.
24:52
SPEAKER_00: On the patient side, though, it also just helps with education.
24:55
SPEAKER_00: Like I said, like before we would we would put in swallowing problems or and pain in my neck, and um and you'd get so many different links to click on, and then you learn all these different things and you're trying, but so now you can do that in AI and you get a better synthesis of information and and that you can bring that in and we say I don't want you to worry about that, right?
25:14
SPEAKER_00: But like that happens in this scenario.
25:16
SPEAKER_00: So I I think it's it's helpful.
25:18
SPEAKER_00: And I have had situations where patients have done have gone to Dr.
25:22
SPEAKER_00: Chat GPT or who whomever it is, and they'll bring something to my attention that I hadn't considered, right?
25:28
SPEAKER_00: So that's that's great.
25:30
SPEAKER_00: That's only good for patient care and patient safety.
25:33
SPEAKER_00: And like I said, I think the time element that's being created is is really a win.
25:37
SPEAKER_03: I appreciate your perspective on that.
25:38
SPEAKER_03: And I'm excited about what's to come.
25:40
SPEAKER_03: I always like the middle approach.
25:41
SPEAKER_03: I mean, there's a lot of good to that, and and keeping that, I like to say that human in the loop to make that final call, but it really can be used as a good tool.
25:49
SPEAKER_03: So I appreciate your perspective on that.
25:51
SPEAKER_03: I have a whole other podcast on on um uh AI, but I always so I always love to ask these questions because it's just fascinating to me.
25:58
SPEAKER_03: Well, getting back to you, Dr.
25:59
SPEAKER_03: Boss, you have a lot of things going on.
26:01
SPEAKER_03: What's on the horizon for you in terms of studies or other work that you're doing?
26:05
SPEAKER_00: Well, right now we're still working on analyzing these conversations that we've recorded.
26:11
SPEAKER_00: So my lab, it's it's a cool name, it's called the Boss Lab, but we have uh a study that's funded by the NIH where we are really trying to understand what the conversation is that's happening.
26:22
SPEAKER_00: How do patients and families actually engage?
26:24
SPEAKER_00: What questions are more effective or less effective in in making the care more patient-focused and patient-centered, and what was said that helped them make a decision.
26:33
SPEAKER_00: Um, so we're we're really tying up some of that research and and moving forward.
26:39
SPEAKER_00: We've been thinking a lot about the weight of a proxy decision maker.
26:43
SPEAKER_00: So if you're a parent making a decision for a child, you may be thinking about things differently than if you're making a decision for yourself.
26:50
SPEAKER_00: The same could be said if you're a proxy decision maker for your own parent who may be elderly or with some kind of sensory loss or or dementia or your spouse.
27:00
SPEAKER_00: So we've been thinking a lot about how to how to refocus conversations and provide information, education that might help with those proxy decisions.
27:10
SPEAKER_03: Wow, exciting stuff.
27:11
SPEAKER_03: Thank you for doing that.
27:12
SPEAKER_03: Now, as we draw to a close, what final thoughts that you would like to leave listeners with?
27:17
SPEAKER_00: Yes.
27:18
SPEAKER_00: Okay, let's keep healthcare human, right?
27:20
SPEAKER_00: We still are we, no matter, even if all of your doctors and clinicians become robots and computers, the last I heard, we are still human beings that are seeking medical care.
27:32
SPEAKER_00: So it's so important for us to build trust and maintain human connection as we advance technology.
27:38
SPEAKER_00: And I again, I believe that that actually technology is gonna ironically make healthcare more human.
27:44
SPEAKER_00: That's number one.
27:45
SPEAKER_00: Number two, say what matters most to you.
27:48
SPEAKER_00: That means what you are most afraid of, what is the the biggest deal to you and what's going on with you or your child or your parent or the patient that you are representing.
27:57
SPEAKER_00: And that will really help your child or yourself receive the care that is most aligned with what you need, your your thoughts and values.
28:05
SPEAKER_00: And then three, trust your instincts, right?
28:08
SPEAKER_00: If you have an interaction that leaves you really overwhelmed or feeling dismissed, trust yourself on that, right?
28:16
SPEAKER_00: That's that's that's real information and we can do better.
28:19
SPEAKER_00: So that's what I'll leave you with.
28:21
SPEAKER_03: Oh, that is so awesome.
28:22
SPEAKER_03: Well, this has been such an enlightening conversation and just taking really like some basic things that, but but you've really given us some nuggets of information to really think about and and do better.
28:32
SPEAKER_03: I think I would even say to myself, I could do better as a patient and working with my provider.
28:36
SPEAKER_03: So I appreciate all the insight and the work you continue to do, Dr.
28:39
SPEAKER_03: Boss.
28:39
SPEAKER_03: Thank you for taking the time out of your day.
28:42
SPEAKER_03: A busy one, no doubt, but uh, we're so grateful.
28:45
SPEAKER_03: I say we myself and my listeners uh for your time and your expertise and service.
28:50
SPEAKER_03: Thank you.
28:51
SPEAKER_03: Thanks.
28:51
SPEAKER_03: Thanks for having me, Sandy.
28:52
SPEAKER_03: I enjoyed having Dr.
28:53
SPEAKER_03: Boss on the show.
28:55
SPEAKER_03: What an enlightening conversation and some great tips that I hope help you on your next provider visit.
29:01
SPEAKER_03: Check out the link in the show notes to learn more about Dr.
29:05
SPEAKER_03: Boss.
29:06
SPEAKER_03: In our next episode, what happens when you suddenly become the one responsible for managing appointments, medications, insurance, and impossible health care decisions?
29:19
SPEAKER_03: But what if you had the scripts, the checklist, and insider knowledge to navigate the system without losing yourself in the process?
29:27
SPEAKER_03: In this episode, we're going to cut through the confusion with the no BS guide for every caregiver trying to hold it all together.
29:33
SPEAKER_03: To help us get into the topic, I'm bringing on Tiffany Oville.
29:37
SPEAKER_03: Tiffany is a registered nurse, functional medicine health coach, and caregiver coach with more than 20 years in healthcare.
29:44
SPEAKER_03: She is the author of the No BS Guide to Caregiving.
29:47
SPEAKER_03: Tiffany knows the system from both sides.
29:50
SPEAKER_03: She spent decades working inside it, then found herself navigating it as a caregiver for her own husband.
29:58
SPEAKER_03: Make sure and join us for this episode.
30:00
SPEAKER_03: Until next time, get savvy.