American healthcare outcomes are falling. Can a collective response bring much-needed change? Authors of Ripple of Change, Todd Otten, MD, and patient Joshua Judy explain why it’s possible to Jim Cagliostro.

Episode Introduction

In a wide-ranging conversation, Todd and Joshua share their transformative patient-doctor journey, the most important component of the quadruple aim, and why healthcare providers need to ‘’put the keyboard down.’’ They also emphasize that telehealth isn’t a ‘’one size fits all’’ solution, explain that it’s OK to be vulnerable, and encourage doctors to offer hope, even when they don’t have the answer.

Show Topics

• We sorely need to talk about American healthcare

• Four components of the quadruple aim

• Three stories about patient-provider relationships

• The need for leadership at the highest level

• How to rebuild patient trust

• The positive impact of telemedicine

01:59 We sorely need to talk about American healthcare

Josh outlined the motivation behind Ripple of Change.

‘’For us, I would say it was really born out of a mutual frustration with our experiences. First, as individuals, me as a patient and Todd as, my family physician. And over time, you know, as this project got off the ground, we realized, there's really a collective frustration. And we realized our feeling was that not only did we deserve better, but everyone that's a participant in the health care space, whether it's a nurse, a staff, or all the other patients out there. And there's just too many not getting quality care that they deserve in a way that they can afford. People are feeling powerless, so we wanted to give that a voice, as well as tell our story and help others. It takes months to see your family doctor, and that shouldn't be the case.’’

04:21 Four components of the quadruple aim

Todd explained why the fourth component of the quadruple aim matters.

‘’I was an early adopter of that vernacular probably, I guess, 7 or 8 years ago, almost right when it came out from Dr Sinski and Dr Bodenheimer. But it just seemed brilliant to me. You want the best for the patient experience. You want quality care. You want lower or reasonable costs. But that 4th component is so important, that’s provider well-being. Over the years, Joshua saw me at my best, And he saw me at my worst. And, you know, that's brought out in the book, and we don't want patients getting the worst from their doctors or their providers or their clinicians. But we also felt like that it needed to be not just my idea or Joshua's idea, but anybody can take these simple principles and run with them and make them their own. Change the verbiage a little bit. Right? Like, some people don't like the word provider. Fine. So be it. Change the word. Use clinician. Use health care associate. Use human being.’’

07:11 3 stories about patient-provider relationships

Josh said patients appreciate uninterrupted listening from their healthcare provider.

‘’Story number 1 handles my hormone treatments. It's through telemedicine. But, he approaches each visit the same way. He goes over the blood results, and then he turns to me and he says, the floor is yours. And he never cuts me off or tries to subordinate. And even if the treatment plan doesn't end up changing during the visit, I already feel better. So it's interesting because it's a cash practice without the obstacle of insurance. Right? So that that gives a totally different dynamic. And so the time is there. And it’s not a competition to win a debate. It's really a competition to heal. And that's story number 2. I recall times my wife would come home after a hard day at work, and, she'd start telling me of her challenges from the day and only for me to immediately pounce and try to problem solve her issues. But that's not what she was looking for. She just wanted me not to sideline her and prove how smart I was at fixing these things. Purely listening proved enough for her. And number 3 is about an endocrinologist I saw before the doctor I described in story number 1, and he practiced with taking insurance. Each visit started the same way there. Most of the 20 minute visits were his retelling of the anatomy of the pituitary gland and how it sits in the head, so it was a competition for time. Each story shows the same thing. People simply appreciate that uninterrupted listening.’’

10:46 The need for leadership at the highest level

Todd said change is possible with a culture shift.

‘’And it I think the good thing, though, is I think it's possible. There are a lot of examples out there of good things happening, but the culture has to shift that way. People have to buy in. There needs to be the right type of leadership at the highest levels. Unfortunately, Joshua got to experience some of this in the most recent office I worked in where we called it the office utopia. There were all those pressures there and there were the time tranches too. But it wasn't the same, and we didn't treat it that way. And we didn't treat it like people were widgets going through an assembly line.’’

11:55 How to rebuild patient trust

Todd reinforced the need for healthcare providers to listen to their patients.

‘’I would echo what Joshua said in terms of listening. Frankly put your keyboard down, look the person in the eye, shut up, and listen. Don't have preconceived notions about what the diagnosis is because you might be wrong if you've already made it in 15 to 20 seconds. There might be some nugget of detail in there that is invaluable. I learned quickly on in my career that if you asked a couple questions and just sat there and listened to the person in front of you, they would usually tell you what the diagnosis this was. That would be my number one piece of advice. Joshua's case was very complicated…. near the end of our time together as physician and patient, the majority of what I did was listening, counseling and alternative methods. We wrote a book together, and that was one of the treatment protocols, and we're both better off for it.’’

19:11 The positive impact of telemedicine

Josh said telemedicine isn’t ‘’one size fits all’’ but a helpful tool in patient care.

‘’My wife who has epilepsy, she's actually never met her current neurologist, she sees her through telemedicine, and it works really well. They’ve been able to establish a great rapport and they end up talking about the book sometimes. It's just been a really great thing. You can’t really approach it with one size fits all. It's another tool on the tool bag. People should embrace it if they feel comfortable. I think things are moving in that direction. You know, so much of Ripple Change is not about leaving people behind. It's kind of about meeting them where they're at. Some folks are tech savvy, some aren't. But I see it as an overall positive thing.’’

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You’ll also hear:

Why driving change in healthcare needs a collective voice to succeed. ‘’It has to be a large number of individuals to break down those silos. Ultimately, we're probably talking about pretty significant policy change.’’

How capitalism has failed the American healthcare consumer: ‘’The mantra of profits over people has condensed the visits and put the priorities in all the wrong places. How do you get a good experience when you're afforded literally 7 or 8 minutes to go in and talk to somebody? … It has to change.’’

It’s OK for healthcare providers to say ‘’I don’t know’’: ‘’If you don't have the answer… you can offer some hope, or at least try and get somebody to the right direction.’’

The benefits of a strong doctor-patient relationship: ‘’If you do it right first time you might avoid those repeat visits and all those referrals that increase cost…. and with that good relationship you share in the treatment plan.’’

Why it’s OK to be vulnerable as a patient: ‘’It’s okay to fall down and be vulnerable, but it's what you do to get back up that matters.’’

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