Once again, I have my sidekick, spiritual leader, and genius partner, Dr. Ray power with me today and I’m really excited to find out that he brought in one of his colleagues on the Irish side to share some great ideas. And I love the fact that we have an international film here where we’re getting ideas from around the world from some of the smartest people to really address how we take healthcare from a broken state to a fixed state. And I know that sounds almost hard to believe that it’s doable, but we’re finding from interviewing some of these amazing cast members is that this is fixable. The good news is is that we have discovered over the last beeks and diving deep into this far beyond the research of my book, that there are three things number one, healthcare is broken. Number two, the good news, it’s fixable. But number three, we have to fix it. It’s broken, it’s fixable, but we have to fix it. And I really think that if we can do nothing more than just change the conversation, to start talking about how we leverage consumerization, how we leverage emerging technologies, connection architecture, models that change the economic incentives towards wellness prevention, and anticipatory healthcare. Like we can do these things, we can make a major, major change. So with it with that, Ray, I’d like to introduce Have you introduced Paul, and share with us his incredible background, which he shared with me earlier today.

Great, thank you, Nick. And Paul, it’s really great to have you part of our journey on the healthcare cure, and I look forward to having more collaboration with you over the next number of months those with us and get In Ireland with our endeavor to produce this great documentary and indeed a movement to promote the shift towards a health and wellness model rather than a sickness model. for everyone’s introduction, Paul and myself have been colleagues, partners now for over 20 years. And when and Paul moved to Ireland 2001. And prior to that we overlapped when I was living in Western Australia, where Paul hails from and Ireland out into his own introduction in a minute. But what has struck me has been how Paul has brought a lot of his expertise from Australia, and he’s no senior partner in a large primary care facility in Dublin and is the head of the communications across the pond, clinical colleagues within the centric Health Group. And one of the aspects which we’d like to talk to you about today is The challenge we’ve had in the C 19 euro, to retain our connectivity with our patients, we’re actually 12 weeks into a shutdown in Ireland for the management of the epidemic as it’s hit us. And it’s been a really fascinating journey because our patients have embraced the new technology, just as you alluded to, in your introduction, they and now more and more, we’re using both telephone and video conferencing to communicate with our patients. And we’re also now starting to bring our patients back in to us. So, Paul, I’d love to you to give your context and introduction. And then perhaps we can have a conversation about our communication access and how it’s evolved maturities for the better over the last 12 weeks under models that we can continue to harness going forward into the future.

Yes, dude, thanks very much Ray and Nick, great to be a part of this movement and to be a part of this podcast. Paul Carroll is my name. And yes, I’m originally from Western Australia from Perth. As you said, I spent my first 25 years or so there, and then graduated in medicine, worked in the hospital system in Australia for a couple of years, and then got the wanderlust and went traveling ended up in the UK for five years, working in various hospital mainly rotations throughout the National Health Service in the UK. And then my visa ran out and I was about to be deported. So I had to find somewhere else to go and the only other English speaking country that would have had short notice was Ireland. So by by quirk of fate I ended up in Ireland in 2001 and I came for a three month Working Holiday

These over a three month Working Holiday and I’m still here 20 years later. So that’s the the attraction that the place has on you. And so and as you said, Ray and now I work full time in a family physician practice in Dublin in Ireland. So communication is one of my bugbears one of my passions, one of my things that I get excited about, because it’s all very well, people having lots of knowledge. If you can’t share it with anybody, then it’s that’s a waste of time. So my interest is about communicating both with doctors to patients and to the wider community and also doctors between each other. And there’s no point in again, we that we have a very good network of over 200 physicians, primary care physicians, but there’s no good one of them having a whole lot of knowledge if it’s not being shared with the rest of them. So, we have increased the the mechanisms by which colleagues can communicate with each other By engaging in a lot more dialogue between physicians and between not only the physicians, but the other important team in the practice as well, the nurses and the administrative team that keep the whole show running. So we have a lot more contacts, and we’ve set up twice weekly webinar, where representatives all those groups, join in twice a week that I host and we share information, share advanced just share knowledge, share developments, share ideas, and try and not have 60 different practices, reinventing the wheel, and it works really well. The second angle of what you mentioned there about communication with patients, which is obviously also is very important. And by golly, I’ve never seen in my experience, I’ve never seen the sands shift so quickly as they have over the last 12 weeks literally. You know what’s what’s perceived wisdom one day is heresy the next. So it’s very hard to keep up with everything. The rules are changing fast, the guidelines are changing fast. And it’s a really tricky beast to try and keep your head off this virus. But I think we’re doing a pretty good job. And our patients are, you know, thirsty for the knowledge as well. So we have to keep on our toes. We can’t, we can’t bluff on this one because patients are well informed and they know as much as nearly as much as we do sometimes. There’s a lot of very good certainly in islands a lot of very good public health education going on. The chief medical officer is on the nightly news, every nice explaining this aspect and that aspect and there’s a lot of very good public health information for the general public, who obviously are our patients as well. So that has been a big shift in in general kind of knowledge to the to the general public. And then to our individual patients. Obviously, we initially our reaction was to close up shop. Really interesting. reduced the number of people coming in the door. Whereas our model would have routinely been, you know, routinely seen 25 to 30 people a day face to face, less than two meters of pass for 15 minutes at a time, all the things you’re expressively not supposed to do. But that was that was our bread and butter. And that’s what we did all day, every day. So we had to turn our kind of business model on its head overnight, and go get away from that, that tradition as quickly as we could, because it just wasn’t safe to be in the same room as people for an extended period of time. What if we could avoid it. So that meant that we initially closed the door completely and really didn’t see anybody for a number of weeks and tried to do everything as much as we could via phone calls and via video calls and via email and as many different other ways as we could and things have sort of the pendulum has swung back a little bit and I’m seeing a lot more patients face to face now but we’ve got the the masks and the gloves and you know The room is much more spaced out, there’s a lot less stuff around a lot less clutter in the room so we can clean it quickly if we have to. And we have the whole kits to wear, you know, should we need to, if we’re suspicious that somebody might have this virus. So it’s been a whirlwind out of their head spin off things, just changing so quickly, that it’s hard to keep up with what’s happening in your own practice, let alone what’s happening out there in the big wide world. So that’s been the challenge. And particularly when you have a group of people, your patients who you are used to dealing with, in a certain way used to interacting with, you have a rhythm and a routine and a method of communication that’s comfortable. And then suddenly, you have to turn that on its head and a lot of people didn’t like the fact that we were just doing stuff over the phone, they really wanted to come in. And then a lot of people just didn’t want to and still don’t want to come anywhere near us.

Because they’re so you’ve turned hoes and patients in your practice poll in and around that type of number. And what proportion of your data Face to face as compared to telecom for the sort of video conference. What proportion is between video conference and teleconference? Because you and I were over in Colorado visiting the CPM group in Denver, the Kaiser Permanente group. And what we found over there was that 60% of the consultations were virtual. And the majority of that 60% were teleconferences rather than video conferencing. So if you’re new world, what is the breakdown between those three media channels?

Well, it’s funny, it depends what day you’re asking because it seems to change very quickly and there’s certainly a push from a lot of our patients to try and get back to the normal as much as possible. A lot of people kind of resent the fact that they have to do things on the phone. When they really get their the most benefit and they’re most they see most value out of a face to face consultation. So things have swung back from zero face to face, only a matter of two or three weeks ago. To now, it could be up to 50% of the contacts would be face to face, and then about 30 or 40% on the phone and only about 10 to 20% video at the moment, which I’m a little bit disappointed about because I was expecting that, like we had never done video consultations before I had spent years ranting about how unsafe and how unprofessional they were as a method of communication. And now all of a sudden here I am doing them all day. So even, you know, the rest of us have to swallow our words sometimes. So we’ve been doing I’m surprised that it hasn’t been a bigger take up of them. But I suspect that’s because most people are still not necessarily at work. But when they go back to work, I think a lot of people will certainly younger professional people will benefit from being able to just do a video call to us rather than having to take time off drive all the way here. Wait in the waiting room and and see us that way. So I’m quietly confident that the video thing will will start to pick up again as people Getting

your colleagues for me. Personally, I had to self isolate for a couple of weeks and for cold, positive tests, and I was nervous going back into a room and having a patient in front of me, and was making sure it was my last for longer than perhaps is necessary, just to be sure to be sure. Were you finding that your colleagues were very nervous seeing patients? Did you find that? As you’ve told me, sometimes the patients were very careful about their their masks until they arrived into the room in front of you and then the game? Ah,

yeah, yeah, I had a guy this morning, whose head is at the front of me and said, Is it okay? If we both cheat and take off our masks? I said, Well, listen, man, I’m not taking mine off. So. So every time I have to have the explanation about my mask is not to protect me. My mask is to protect you. And therefore your mask is to protect me. So it only works if we’re all doing it. And that’s the kind of explanation I give to them all. So and but in terms of colleagues, we’ve been very lucky touchwood that none of our colleagues have been sick. We had a couple of administrative colleagues earlier on our manager and one of our administrative staff who had symptoms and had to be tested. And in those days, it was taken two weeks to get a result back. And so we lost them for that time, but thankfully, we haven’t had one since now, although we do have a an excellent phlebotomist and patient, a primary care assistant, who has been told on advice of her specialist because of the medication she’s on that she’s not to come back anywhere near us for at least the next four months. Which is disappointing because she’s fantastic and we are starting to struggle with so so it depends more about the individual circumstances of the staff, I think and but look, you know, we just don’t know what you can’t see the supplement thing. So we don’t know what our exposure is like. We’ve actually or all the stuff in the practice here has been Their blood taken yesterday for an antibody test to see if we’ve ever been exposed as part of a survey, a study that on our local hospitals is doing. So we just don’t know what the prevalence and of course the thing everybody’s terrified of including us is what the asymptomatic you know how many people out there without symptoms have either been exposed to the virus or have had an infection that they didn’t even really particularly notice. So it’s a bit like anything, when it doesn’t affect you personally, you tend to reduce your level of worry about it, and then when it affects you or your family personally, suddenly it’s, it’s up there in your face, and it’s important. So I guess the prevalence in the inner part of the community anyway has been reasonably low. We’ve had many many positives, but not they all kind of came at once. We haven’t had any, any positives for at least the last two weeks. So there’s a certain sense that you know, the the crisis is over and we can all get back to normal all the shops are opening, the pubs are opening the restaurants are opening soon. And people are saying well How come you’re not open? And how come your your doors locked and how come we can’t get in without a password? So

that’s and Paul, you’ve a lot of patients with chronic disease, unfortunately, there are patients who are developing cancer symptoms who have been waiting at home and have me come in to see their their doctor. So you have actually used your website to try to encourage people to come back to to to have the perpetual touch with the hands on experience with her GP. Can you tell us about that?

Yeah, we were starting to worry that, you know, we were a practice of five GPS, five family physicians, and we’re usually very busy and then there was this period of several weeks where the phone wasn’t ringing very much and you know, people are still getting sick. So it was about and people will make In their own judgment about am I am I putting myself at risk of becoming more unwell by going to the doctor rather than staying home and toughing it out. So there obviously is a level of chronic disease that has gone unchecked and unmanaged. We don’t have any way of really telling what that is just yet. It’s only when people start to come back more, and that we’ll have a handle on what we’ve really missed. But there’s obviously going to be huge amount of stuff that has either developed further with it without us being able to see them. And of course, the thing we worry about his early symptoms of diseases like cancer that we would otherwise pick up quickly and early. where time is is critical. We haven’t you know, it’s an unknown unknown, I guess we don’t know how many of them there aren’t because we haven’t seen them, but we know they’re out there because they would normally come to us and they’re not sent a message out through places look Video like, yeah, sorry. So we did, we decided that we had to do as many different things as we could to try and let people know that although the doors closed, we were still open, and we’re still actively looking after their health. So we went around the practice, we took a little video, stitched it together of all the stuff in the practice chipping in a few lines, basically just saying that we’re open, we’re still seeing you. Things are different. You know, we’re all wearing masks and gloves, but our standard of care is exactly the same, even though we might be doing things a little bit differently. And please, please, please don’t hesitate to get in touch with us if you’re worried about any aspect of your health, not just the Coronavirus. And I was talking to a patient yesterday on the phone who said oh, I saw your video on the website. And he said, he said, he said I found it very reassuring. I said this to me. It made my day. I didn’t even solicits that kind of feedback. And he said he found it reassuring, which was lovely to hear. Because we put a bit of work into us and it’s something nice for the staff to be fronting center of the communication to patients, which I think is really important.

He described in his introduction, the whole area of patient connectivity. And if so, winding back the club four months ago with our patients, had home monitors further. Two sets blood pressure, pulse temperatures, and were able to give us through salt as a kind of like an app, their symptom and declaration. How do you think that might have impacted on how COVID disease spread within our community and in the next three to five years? Do you really believe that connected technology and that perpetual touch where our patients will, will be transformational with regards to how our, our axis of in our integration with our patients can be improved?

Well, it’s a good question. Obviously, what we’re terrified of is a tsunami of data. That could come if everybody had wearable devices measuring every conceivable parameter that would be dumped on us to interpret. Now, that’s probably a worst case scenario. But your Jon’s your question about what would have happened if people had had such things I’ve been the big thing that would have made a difference, I think personally would have been the oxygen saturation. If everybody had an oxygen saturation monitor at home, we would have been able to cut to the chase a lot quicker with people who’s infected of having either having the virus or of having an exacerbation of their that, really, a lot of the times they were coming to the doctor basically just to have their oxygen saturation level checked. And if their level was good, they could just go back home and tough it out. And if their level was low, then they needed to be in hospital. So that was the critical piece, as far as we were concerned that, you know, nearly everybody just didn’t have access to at home. So that would have made a big difference. I think, in general terms. It I think it’s a very personal thing in this, I spent a lot of my time telling patients to stop measuring their blood pressure. Because sometimes, particularly people who are a bit anxious, the more they measure their blood pressure, the more it just goes up and up and up. So I think it has to be the right person, measuring their blood pressure for the right reason, at the right interval. So it’s a useful thing. And like everything in medicine, I was always taught you don’t do any tests for any reason whatsoever, unless the outcome of that test is going to change what you do. And I’m constantly Patrick that into patients as well who go off and buy all these things. I feel like there’s no point in measuring things every hour of every day if what the result is is not going to change what you do. So I’m interested in your average blood pressure, I’m not interested in every measurement of every minute of every day at some people sometimes can get a little bit more worried about the results and they are about the symptom. So it has to be individualized and that’s the key to it. I think you have to pick your targets in terms of who’s going to be able to use this kind of technology in the most appropriate way that will actually benefit them and benefit us to help make the right decisions about their medication and their healthcare. Rather than people just doing a whole lot of readings for no apparent purpose. So I think it’s it has to be tailored to the right person at the right time for the right reasons, and measuring the right data.

And pull your parts of this move with now with us for fixing healthcare and the healthcare cure. How do you feel that we can between countries, Ireland and the states and a dude your homeland in Australia, Israel, where we’re connecting with some of the kind of groundbreaking technology How do you think we can learn from each other because you you’ve lived and worked in a number of countries now? And are you a real proponent of the sharing of experiences across countries and nations?

Absolutely. I think, as I was saying before, you know, there’s no point in one in one doctor having knowledge if nobody else hasn’t likewise, no point in one medical system or one country having knowledge. And having worked, as you said, in a number of different countries in a number of different settings, number different continents. I think each system has its advantages and disadvantages. I’ve never worked in any, I’ve never worked in a perfect healthcare system. I’m sure there’s probably one out there, but I haven’t found it. Some are better than others. And some have very good strengths, and all of them have weaknesses. And I guess it’s about tailoring the attitude and the approach that you have to make the most out of the system that you’re in, bearing it you have to be aware of its strengths and its weaknesses. And you have to play to the strengths and and try and work around the weaknesses as much as you can. And that’s as much an issue today, where I practice in Ireland as it was when I worked in Australia and in the UK. I don’t know enough about the Israeli health system and I look forward to finding out more about it.

And well, it’s really serious. So, Paul, we were talking to Dr. yahzee, who is going to be part of the documentary. And fundamentally, the reason that you love being a GP is the connectivity that you have with your patients. And isn’t that the transcends every national border? And what really is the reason that you’re doing what you’re doing every day?

Absolutely. I’m conscious that my colleagues in the United States don’t necessarily work in the same sort of system and that we’re very

conscious and very,

keep praying store in the fact that we are the gatekeepers, and you can’t get to a secondary care service without going through a primary care physician or a family physician in our system, and a lot of people disagree with that a lot of people don’t like that’s the way it is, but I think it works well for us. And again, it’s a strength of the system, but it can also be a weakness because people have to go through a number of hoops to get somewhere that they think they should be able to get to a straightaway. And in many cases, they’re absolutely right. But not always. So we’ve all got things to learn from each other. And that’s the beauty of it. And unfortunately, you never get to the end of the journey. It’s always ongoing and we can always keep learning and that’s what I found so far, and I only hope it’s gonna continue.

Alright, guys, thanks so much. That was a great insight. You know, I we’re seeing this across the the world where the C 19 or the COVID, post COVID-19, however you’d like to characterize it is really done two really important things that I think are very, very positive. First, you know, generally in healthcare, the healthcare industry is suffered from what I call legacy latency, right? They they’ve done something for so long, that they’re extremely reluctant to make any changes because generally speaking, it’s comfortable. And change has potential risk. I think one of the great results from All this is that we’ve started to tamper with legacy latency. And now we see organizations I just had a great conversation with one of the major hospital systems here in North America yesterday, is they’re seeing tremendous amounts of speed and a willingness to be open to the fact that things need to change if we want to make things better. I think another really great advantage of what has happened in this current environment is that is it is made innovation a mandate, it said that we need to take a look at clinical models, we need to take a look at the way in which we engage patients, you know, to the point of wearable technologies, you know, we can look at lots of District bio data sets, but the the learning machine can and the learning machine can set appetites for risk repeatability, it can look at many, many disparate signals including pulse oximetry. It can look at core body temperature, we’re even starting to look at things like head AI In other words, the the science of understanding head movement and its potential connectivity to certain forms of neural pathology we’re looking at, we’re starting to add some really cool things to telemedicine. You know, it used to be that telemedicine was seen as subtractive. But today through facial AI, we can actually determine human mood state really determine human mood state and stress based on facial recognition technology. And this isn’t theoretical, it’s now being shown very, very deeply to provide information about the the lucidity of a patient neuropathology, even potential risks of things like dementia and Alzheimer’s. We’re starting to look at breath AI being able to monitor breath and looking at the nanoparticles within breath to understand deep rich information that we’d never would have dreamed to see before. And what I like is somebody who has worked with most of the drug and device companies and hospitals around the country. I love the fact that we’re starting to exit this concept of legacy latency and moving on towards the innovation mandate. With a goal of improving the way in which we predict and prevent illness, rather than having the trigger mechanism of hyper intervention, you know, that sort of automatic prescription trigger mechanism that seems to happen? Well, listen, I loved watching your video this morning. And I really love the way in which you’ve reached out and connected with your patients. We have a patient that wants that level of human connection, while at the same time knowing that that caregiver has the technologies and the systems, not just to keep them safe, but to be able to help them move in a journey of well, wellness and, and prevention. And I just I love your model. I was really inspired. And, in fact, with your permission, I want to share this with some of my colleagues as a great example of what it means to really create that beautiful, emotive and human connection. Paul, I love your story.

Don’t get carried away though, because he does have a place for you.

Yeah, you’re right about that.

Well, Paul, listen, I really enjoyed your story. I love your insights. I love the great work that your clinic is doing. It’s an honor to have had the chance to meet you. And I’d like to thank you both again for taking time away from your busy lives to be able to share some time on today’s healthcare cure podcast.

You’ve been listening to the healthcare cure podcast. Don’t forget to visit our website at the healthcare care.com and thanks for listening