Reinventing the doctor - week 4

Bambi Francisco Roizen · September 10, 2019 · Short URL:

How is tech enabling doctors? The cost of doctor burnout; Millennials don't trust their doctors

This week, Dr. Archana Dubey (HP), Mark Goldstein (UCSF Health Hub) and I will be hosting our third salon of the year, "Reinventing the doctor" on September 12 at UCSF. 

The reason the doctor is being reinvented is because of the tsunami of data that only a machine can process in a timely fashion. Most of this data has emerged and organized in the last decade, from EHR (clinical documented data), insurance claims data, social determinants and behavioral data. There's 2.5 quintillion bytes of data created daily. [One quintillion is 1,000 quadrillions, which is 1,000 trillions.] 

We're not at the point where we'll be seeing Dr. Terminator. But there is Dr. Siri and Dr. Google. There are little robot nurses. We also have machines in the form of new devices operated by a technician or mid-level practitioner. There's also software that assists patients like a customer service desk, sending them to the appropriate care. Big databases may not need to wear white doctor jackets, but they're indeed becoming the engine behind the decisions doctors and the healthcare ecosystem. 

The questions are: Where do we see them empowering machines or mid-level practitioners to enable doctors to spend more time with patients, treat them more efficiently, and practice at the top of their professions? If technology can achieve this, then it will also have an added effect of reducing doctor burnout and reducing overall healthcare costs.  

We'll talk about these topics on Thursday, 9/12 at UCSF starting at 4:30 pm. REGISTER.

In the meantime, here's some news, information and research to answer some of these questions and will help you prepare for the discussion.

Autonomous AI enhancing the ophthalmologist's job

IDx has made the first FDA-cleared autonomous AI device to detect diabetic retinopathy. Autonomous means its results do not need a specialist to confirm. The device can be operated by a lower-level practitioner, relieving the ophthalmologist of having to do the screening. Using IDx-DR, a nurse or staffer at a primary care physician's office can operate the system. This machine test can be under $50 to a patient whereas it costs $250 to see an ophthalmologist. Ideally, for ophthalmologists, they won't lose out because they're not the ones handling the screening, but they'll stay more active with the same number of patients, just a different population. Theoretically, a larger majority of its patients will need treatment vs just a check-up. 

Read more on VatorNews 

Retail clinics treating low-acuity conditions

This Thursday, David McAughan, COO of Providence Express Care, will be joining us. Express Care is providing a low-cost way to give greater access to patients seeking relief from minor illnesses and low-acuity conditions, such as respiratory problems (allergies, bronchitis), minor burns, and dry skin. Retail clinics, such as those offered in Walgreens and CVS, are typically staffed with nurses and mid-level practitioners. Empowering nurses and staffers to do the doctor's job is one of David's objectives. "We want to create more capacity in primary care practices because we can consume low-acuity conditions," he told me. At Express Care, there is also less of a need for a primary doctor. About 90 percent of its population is under 60 yrs old and 40 percent don't have a primary care physician. The way David sees it, more mid-level staffers will increasingly be doing the doctor's job at retail clinics and even at primary care practices. "The future of primary care will be nurses and nurse practitioners and doctors will become specialists," he predicts.

What's doctor burnout costing America?

Physician burnout costs about $4.6 billion a year, according to Annals of Internal Medicine, which looked at physician turnover and reduced clinical hours attributable to burnout in the US. Much of this has to do with an increased load of paperwork and bureaucracy. Burnout is defined by the study as "emotional exhaustion, feelings of cynicism and detachment from work, and a low sense of personal accomplishment."

The increased administrative burdens come from inputting and updating electronic health record systems and increased reporting requirements causes them to be "socially isolated" and lacking in autonomy. Edward Ellison, executive medical director of Southern California Permanente Medical group, points out that physician suicide rates are much higher than the general public's and exceeds that of combat veterans.

Read more on NPR

Millennials don't trust their doctors

Millennials - those born between 1982 and 2000 - make up 23 percent of the US population. So they're a big group that needs to be taken seriously. If you can't quickly do the math, they're about 19 to 37 yrs of age. These are digital natives. There are 83 million Millennials in the US, more than the Baby Boomer generation by eight million. 

One of the biggest takeaways from this Forbes' write-up of what millennials expect is this: They don't trust their doctors! About 38 percent said they trust their peers more than medical professionals, 55 percent believe online health information is as reliable as information from their doctor. 

These findings find some support from other studies surveying Americans of all ages. In one study, nearly half of Americans self-diagnose vs visit a medical professionals. Another study showed that looking for health information is the top 3 most popular activity, behind email and researching products or services before buying them.

It's no wonder this generation doesn't really have a primary care doctor. According to Kaiser study, a third said they prefer to get their healthcare from a retail walk-in clinic, 45 percent of 18-29 yr olds do not have a primary care doctor. This compares to 85 percent of the older population, according to Kaiser study. 

While millennials may be leading the charge to having an on-demand, transactional relationship with a doctor, their habits are having an impact on overall society. 

In one study, nearly half of Americans self-diagnose vs visit a medical professionals. Another study showed that looking for health information is the top 3 most popular activity, behind email and researching products or services before buying them

Read more at Forbes

(Image source: FastCompany, Oregon.providence) 

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Bambi Francisco Roizen

Author of "Unequally Yoked"; Co-founder Vator and Invent Health; Former Columnist/correspondent Dow Jones MarketWatch; Business anchor CBS affiliate KPIX

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