“Treatingpatients*whoare* actively*havingheart*attacks...
Transcript of “Treatingpatients*whoare* actively*havingheart*attacks...
DHC: Forbes said recently that less than half of physicians encourage their children to also become doctors. What would you tell a college undergrad today considering medical school? It is an excellent question. I do find my professional life to be rewarding and I truly enjoy what I do for a living. I love working with the staff and the excitement of my particular specialty (interventional cardiology). I still have the opportunity to work as a team almost every day and that has always been my strong suit.
“Treating patients who are actively having heart attacks, and being timed by the state while I do it, still thrills me and the feeling of performing a truly life-‐saving procedure never gets old. That said, there is a very scary imbalance that has now reached a critical tipping point
in this country. “ The average medical school graduate will leave school with >$150,000 in student loans! And while inflation rises, and healthcare executives salaries do the same, the income for the primary care specialties has remained flat and is now an untenable economic prospect for graduating MDs. Beyond that, there have been numerous stories in the lay press and journals of late, describing the increasingly common sentiment of physician fatigue. My colleagues are tired of working such long, stressful hours for moderate pay and maximum risk. We deal with frustrated patients and families going through some of their worst times and often bare the brunt of their sadness. Nurses, too -‐ and maybe even more so -‐ face similar challenges. The cost of medical education should be examined and potentially subsidized to encourage graduating doctors to consider less lucrative -‐ but certainly not less important specialties.
An Interview with Dr. Jordan Safirstein
After Dr. Safirstein appeared at a recent DHC Summit to provide attendees with his perspective on EHRs, the DHC sought him out in order to dig a little deeper into his experiences in the field, especially as it relates to digital health communication. We are grateful that Dr. Safirstein was willing to share his time and thoughts with us, and trust that readers will find this interview both instructive and thought-‐provoking.
DHC: How are you using social media as it relates to your professional life? I love Twitter @CardiacConsult because I am able to cull what I like and pick out the stuff that's interesting and relevant to me. I also share interesting findings with colleagues. My group has a Facebook page which is probably not utilized enough by me but does provide a wonderful medium for sharing interesting and educational articles and advice. My fellows at Morristown Medical Center have an Instagram account (@CardioPix) where they share interesting and of course, de-‐identified, cardiac images.
DHC: With the continued evolution of the empowered patient, is there a “typical patient” anymore? How would you describe that patient, or alternatively, the major groups? There really is no "typical" patient unless you are talking about specific maladies that are unique to one group. If we are generalizing, age is probably the easiest way to separate large groups of patients and their behavior patterns. Education level and socioeconomic status also makes a large difference in how patients engage with their physicians, i.e. wealthier, educated patients seem to challenge and discuss their conditions more readily. This upcoming generation of patients, who are living on their smartphones will be more inclined to accept more progressive management strategies, like telemedicine. It is probably not too
dissimilar to the banking industry. Those of us who grew up and trusted the Internet had no problem making our lives easier by making our transactions online -‐ while those who were not as familiar felt more comfortable cashing their checks in person. “Adoption of remote monitoring
and telemedicine will be a necessity as cost of inpatient
care and readmissions continues to rise.”
DHC: Are you seeing patients integrating wearable devices into their lives/healthcare? If you are, do you think it’s helping? Yes. And sort of. It's always better to have an idea of your activity level and probably if you looked at those patients, they would be healthier overall since they care about their health enough to purchase a device but the data that's achieved is more of a suggestion than a fact, in my opinion. Is it good to know how many steps you take and how many hours you sleep? Sure.
“But there is a next level to
wearables, or implantables, that
will be more "medical" and hopefully provide us real data and numbers that we can use to
actually adjust and tailor medical therapy in a much more
accurate, real-‐time way.”
DHC: Do you currently use an EHR system? If so – what do you love? What do you hate? EPIC is my EHR. I'm about 4 months in. I love parts of it:
• Easy to send my findings to other MDs • Easy to renew meds and order tests • Love having other MDs notes available to me IF they are also using EPIC
• Easy to submit for billing purposes • Clear and easy to read I dislike:
• So convoluted with TOO MANY buttons and tabs and unnecessary options -‐ Keep It Simple
• Too many warnings and alerts and alarms that are all basically worthless and 99% ignored #AlarmFatigue
• I hate looking away from the patient to type and Dragon stinks no matter how much they tell you it doesn’t.
• In my case, I still have to go into separate programs to pull in my imaging and other important documents -‐ not integrated DHC: You’ve said before that you don’t really like passing out [pharmaceutical] coupons to patients. What sort of information do you like to have ready to share? These days, I believe we have to guide our patients towards tools and information that will benefit them for the long term. “I find myself recommending apps fairly often as it enables
patients to empower themselves to be more engaged in their own healthcare, rather than being completely dependent on the doctor and his/her office.“
AliveCor, an attachment for smartphones that interprets cardiac rhythm is one of those interventions. While patients used to have to schedule an emergency office visit or go to the ER, they can now take control of their own cardiac rhythm management by having their phone make the diagnosis. Apps that count calories, track steps, log BP and finger stick readings are all helpful additions to every cardiac patient's
Dr. Jordan Safirstein
Director, Transradial Intervention at Morristown Medical Center
Healthcare Advisory Board Member, Google Ad Board
armamentarium. I believe with the advent of such technology, there should be an app that correlates and distributes e-‐coupons -‐ like a RetailMeNot for drug discounts.
DHC: What materials/aids/content that you aren’t getting now could pharmaceutical companies provide you to help better educate patients? Doctors are flush with resources for education these days. We have UpToDate, innumerable apps, our larger academic bodies and their support tools. But, I suppose this is the eternal question, but I think its a question that's been asked for the past 50 years in pharma marketing and maybe its time to ask a different question:
“What can pharma do for the patient WITHOUT needing the doctor? They already market directly to patients, so why do they need the MDs to get their
point across?” Most of these companies have abundant resources to come up with interventions with newer tech that can completely obviate the need for doctor participation. If something is effective and helpful, no one really cares about the branding, in my opinion -‐ the key is to find out what patients need in that space. DHC: The DHC is working to help pharmaceutical marketers better understand the linkage between
well-‐executed physician communication and patient behavior. What would you want them to understand about how to the two are related? A good doctor talks to patients in a way that they will understand. Not all patients respond to the same discussion in the same way. All patients deal with unique issues, even as they pertain to the same disease. There is no way to successfully generalize a message to all patients -‐ allow them to express their concerns and treat them accordingly.
Meet Dr. Safirstein Online: LinkedIN:
https://www.linkedin.com/in/jsafirstein
Twitter: https://twitter.com/cardiacconsult
Connect with the DHC:
LinkedIN: https://www.linkedin.com/company/digital-‐health-‐coalition
Twitter: https://twitter.com/digitalhealthco
www.digitalhealthcoalition.org