Welcome to The Healthcare Cure podcast, a podcast dedicated to the bold mission of fixing healthcare. Now, here’s your host, healthcare futurist, best selling author and adjunct professor Nick Webb.
Welcome to another podcast of The Healthcare Cure. Today I have two of my favorite people. Once again, I have Dr. Ray Power from Dublin, Ireland, our partner in the Fixing Healthcare movie, and somebody who has encouraged me all along the way. It’s great to have him sitting shotgun, and another one of my very, very favorite people. Dr. Paula Crone and I have the great honor of working with her at Western University of Health Sciences and I’ve learned a lot about healthcare. Even though I’ve spent 40 years in healthcare I’ve I’ve finally had the opportunity to be at the headwaters of where we educate these amazing caregivers and doctors, and I love her I mean she, I love her humanism. I love how much she cares for her students. I love how much she cares about the awesome privilege of being able to educate caregivers that are going to impact the lives of so many people. And you know, despite the prestige of her position, her humility, and her thoughtfulness in in that position is just always been an incredible inspiration for me and Paula, with that in mind, I’d like to start with you. Tell me about your perspective of what is changing right now in the way you’re educating the doctors of the future.
Oh my, Nick. There’s so much that’s changing right now as far as medical education goes, and it’s so many of these changes have been long and coming and have been something that as medical educaters, all over the country I’ve been looking for and wanting to do for, really for decades. But primarily, I think the biggest change that’s happening is a transformation in realizing that there’s just such a volume of information. And we have to start focusing on what really needs to be taught during the very short period of time, those four years that we have our students in medical school, what kind of foundational layer educational base do we really need to lay down for them so that they can continue to build upon it and ultimately go out and be the type of care providers the type of physicians that we hope for them to be and that they want to be?
Right and it seems like it’s a moving target now, right with COVID-19. All of a sudden, telemedicine, which many clinics and hospitals have resisted, have all of a sudden built tremendous levels of sophistication around telemedicine and beginning to realize that not only can you deliver instantaneous, thoughtful care It’s not necessarily a subtractive environment when done right?
Oh, absolutely not. In fact, for this generation of students who have grown up with all this technology and grown up in the digital world, it’s a very comfortable place for them to be. And, quite honestly, it’s, for many of them. It’s what they’ve been asking for all along. They want, they want to absorb as much of their information as they can, in the manner that they’re comfortable with. So, getting the didactic portion delivered in a telemedicine in a digital way is a very comfortable way for them to receive the information. Well, we have to never forget is the human component of that. So it’s not all about receiving and building knowledge. It’s also about the relationships, developing the relationships, learning from those relationships and learning how to make them impactful as they move forward. So it’s the challenge with the way we’re delivering education right now during the pandemic time is to remember to continue to foster the relationship development
Absolutely. And I think that’s one of the challenges is that equilibrium between the use of technology and digital interface and the ability to, to really maintain that personal human connection. It’s the high touch high tech approach. Ray? You have the opportunity to work with a lot of young physicians in your practice and what do you see differently about the physicians that are being released into into clinical environments?
Thank you, Nick, and lovely to chat to you as well, Paula, as I referenced that, I have to reiterate what Paul is saying about the students that I’ve actually seen in the campus of Western U when I visited Pomona in May of last year. And there is a spirit and a humanism that is absolutely genuine, which is the gift of a vocation as a professional and that is the same gift perpetuates in the med schools over here. In Ireland, and sometimes we kind of don’t see the wood for the trees. And the reason that our younger colleagues have chosen a career as a doctor or a nurse or a caregiver is because of that vocational spirit. What happens along the way, then is that there’s a lot of noise, a lot of interruption. And we’re looking to do through our movement around the fixing healthcare, and the healthcare cure, is to make an awareness that we be able to garner that enthusiasm, that spirit, that idealism, and, I guess inspirational attitude that young graduates have and to commend your group of 2020 Paula, I know it was a virtual commencement there recently, but I did see it on the internet, and I can see the spirit and the ambition and idealism that that cohort share. So it behoves us, as I guess, established professional caregivers to help to nurture that environment. I’ve noticed, particularly over the last few months with the COVID crisis, that we’re really pushing an open door with our patients. I think we underestimate the silver generation around their propensity for innovation. We’ve now switched to teleconference video conference. It doesn’t replace the human touch. Paula, you’re absolutely right. But what it does give through this connected technology is what you might describe as a perpetual touch. So that’s 24/7, you’re able to be tuned in to your patients and they gain the confidence that they know that they’re being cared for. And as well as the video and telephone calls. Once the shutter is lifted as it were, over the next few weeks, we can get back to seeing our patients into laying on hands, which is the spirit of what we’re all about.
Absolutely. I’m sorry, go ahead Paula.
Oh, sorry Nick. I couldn’t agree with you more Ray. I think think that what we’re probably seeing right now is the opportunity for our providers and our students to actually spend more time with their patients to spend more time focusing on focusing and dedicating their their time to learning. I think if we can figure out how to balance that, that hands on component with, with the face to face and the face to face interaction, will actually have a better care system in the future in a better educational platform as we move forward.
I’m going to jump in again, Nick, we’re not giving any laneways here. What I’ve gone to the set out as a challenge to the undergraduates is not to necessarily feel that they have to choose a career where the discipline requires intervention, and to choose a career and a discipline where the emphasis is more on prevention, because as we can read the thesis of our film documentary is that hyper intervention ain’t working. It is absolutely the sensible approach to come back to basics and to seek to inspire health rather than providing health care with our patients. Personally, I decided, as a second year med student that I wanted to be a family physician. The reason was the special relationship that I witnessed as a student placement between the patients and their family doctor, I was awe-struck, and it actually inspired my discipline for my career choice and I am so pleased that I did that. And some of our younger graduates, maybe they see the shiny lights of become an interventionalist. Well, the future will be about community care delivery and I think Western U sets of not just the med school but also the nursing school. The physician assistant school, to train doctors to be autonomous independent professionals that are community setting.
Absolutely, I think one of the biggest problems to your point Ray is that we’ve created this monster machinery around modern medicine that is obstructive, it’s, it’s, it so gets in the way between the doctor and the patient that it really, really creates major, major problems. And, you know, when I completed my research in this upcoming book, The Healthcare Mandate, what I found was, excuse me is that, you know, these new medical students are very consumerized. They’re used to buying something with a few thumb movements, they’re very digitally connected. They’re, they’re very thoughtful and innovative. And one of the things that I love that, that Paula has done so well is that out of all of the deans that I get the privilege of working with, she has made innovation a mandate she has really realized that the future future of healthcare has yet to be invented. And her students are the innovators of the future. And she’s created a wide range of resources to make innovation a reality in her medical school.
And Nick and Ray, I have so much hope for the future, for the future of medicine for the future of patient care because of this generation of students that are choosing to become physicians, the students that we see coming to Western New and all of our disciplines, not just not just medicine, they’re choosing healthcare for all the right reasons. They’re excited about, about the practice of health, health, they’re excited to, they’re excited to learn. They’re coming in with so much passion and so much enthusiasm to and they’ve chose they they’ve chosen a vocation. They’ve chosen a life where they really truly hope to make a positive impact. There’s an emphasis on health and wellness and not just on treating disease is something that they come in hoping to do. I more so than ever before I have hope for the future. Because of these students.
Yeah, what we’ll be doing sorry, Nick, but what we’ll be doing, Paula is where we’re sending out our invitation to your recent grads, and your current students to come with us on this journey, we’ll have plenty of ways where they can do so participate in, I guess, a mindset where it might be called, like a card carrying believer in health and wellness because what we want to do is to reach out to our patients with that open mindedness. So when we’re on student placements when we’re graduates working out in the community, that our patients see it in our eyes and in our spirit, that’s our natural gravitation. And I think we can perpetuate that together. As a movement, I hope that your colleagues at the university in Oregon and in Pomona would come with us on that journey, because it’s really exciting. And it’s really important stuff.
It’s really important stuff. And I’m very excited for our students to have the opportunity to participate in it.
And I love the fact that that’s their interest because you know, after spending about 18 months in total and researching the health healthcare mandate, is that there were there’s a sort of three things that came out of that that stuck out for me is that well, first of all, the the relationship needs to be reestablished with patients and doctors and the only way that that can really happen to address the scaling of chronic disease and to move towards a anticipatory and preventative approach is we really have to change economic models to provide more time for caregivers with their patients. It’s just and patients are demanding that so we the time is no small matter. If caregivers don’t have time to understand people, not just from a range of diagnostic signals, but to really understand them from the perspective of ethnography to understand the way they live and the barriers and the psychological challenges, they may have the social or environmental challenges without without understanding that it’s really, really hard for a caregiver to be able to provide a holistic solution. The other thing that I discovered was tools, you know, it’s incredible to me how good we are at delivering interventional and diagnostic tools, which of course, are ultimately important in diagnosing and managing disease processes. But you would think, given the fact that 70 to 80% of healthcare costs are associated with with controllable risk factors that we would have in a more impressive array of wellness and prevention, and anticipatory tools, we don’t, and if we don’t fix the tool problem, we’re not going to be able to get where we need to go. And then lastly, you know, one of the things that most caregivers have in most clinical settings is their data start. You know, it’s it’s it’s interesting to know somebody’s blood pressure and pulse oximetry to listen to their chest to peek in their ear with an otoscope, and, and so on. But it’s nothing when you compare it to being able to look at dozens of bio signals over a period of time. So that you can have a rich array of about data signals in combination with having AI understand the meaning of those disparate signals, that will happen. But in the meantime, we definitely need to work on trying to bolster these we need the we need the time that’s going to be fixed through new economic models and new clinical models. We need the tools by building out wellness and prevention and anticipatory tools. And then we really, really need to find ways to be able to get continuous data because the other advantage of continuous data is that for those non compliant patients, which is a very large percentage of patients, we can actually you know, have that doctor on their soldiers shoulder walking with them throughout the day, and when, when there are signals that that anticipate a very, very early disease process, we can intervene. And I that was a part that I saw that was most interesting is if we can fix those three things, then it feels to me that this physician in the future will be able to have the time resources to do what they’ve been trained to do.
Yeah, I agree with you Nick completely. And and Paula, in Western U, you’re actually leading the way with regards to your curriculum, because you’ve got a large a large emphasis on health and wellness in your curriculum, which is really important because traditionally, in a lot of medical schools, the emphasis has really been much more on this kind of sickness model and a hospital focus model. So I really believe that you’re creating a statement through your curriculum and how that’s evolving. Preparing your physicians for that future delivery of healthcare.
I think it’s incredibly important for our students to have a strong base in health and wellness. They can’t just be focused on treating disease they’ve got to be, they have to have the knowledge base to actually help our patients find wellness, seek wellness and maintain it. And so that I couldn’t emphasize more the importance, the importance of health and wellness.
You know, we’re getting down to the last five minutes, I’d love to hear an exchange between you two about, you know, if you were to if there was a wish for, for you guys in terms of what we how we could change the structure that we have right now, and the delivery of patient care to provide an optimal opportunity for your students as they’re released into clinical settings. What what are the changes, what are the structural changes and the economic changes? But what do you see that that you feel really has to happen for us to fix healthcare?
If I might jump in here first I’ve visited a number of centers in the states that have the Patient Centered Medical Home as the model of care delivery. And what really gives me a positive spirit is the team based orientation with that model. And I really believe that the future requirement for healthcare delivery would be as part of a seamless, integrated cohesive team, everyone being as important as each other, having a focus on the patient with the patient at the center of everything we do. Having relationships that are based on trust with the patient with everyone else on your care team, being courageous to fulfill your own career potential, and I hope all of the commencement group of 2020 will write a letter to themselves before they start In the next few weeks of work about what their promise, their absolute conviction to themselves is over the next 5 to 10 years, and then to be very proud of how they achieved those goals, but to be understated about it, and hopefully over that period for their patients to be telling the stories on their behalf.
I couldn’t say it any better than that Ray. And I think that this wave of our graduates all across the country and are the wave of graduates from Western U they’re about to enter into their residences and take their place, out in the workforce will embrace, absolutely embrace that those those are the foundational principles that they chose to come to medical school and are I think are hoping to have the opportunity to go out and use to help improve and change healthcare.
Absolutely. Well, you know, I I have to say I am so excited, Paula, that you and your alumni and your students and your faculty have agreed to participate in fixing healthcare. You know, our our goal is pretty straightforward. If we can just move the needle a little bit if we can just make a maybe start changing the conversation from how do we get more interventions? How do we get more interventions? To how do we turn you know, how do we increase the speed of the assembly line of healthcare, I think if we can change that conversation to one that really is about the doctor patient relationship as the foundation for change, and then supporting that foundation through beautiful consumerized clinical models through the use of connection architecture, enabling technologies, new economic models, and, and really baking that into the way in which we educate these amazing students. I feel very, very hopeful that we can have an impact and maybe the impact is big. I mean, we’re we have this thing has to turned into, you know, Ray and I started talking to a few people that kind of test put our toe in the water to see if does anybody else see it this way. And all of a sudden, everybody we talked to literally from around the world said, Yeah, let’s change the conversation. Let’s demand this relationship. Let’s provide the support systems. Let’s fix healthcare. And I’m so pleased that you’ve been willing to share your, your thinking and your colleagues with us and we know that they’re going to be an incredible part of this amazing film.
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