Transcription of Podcast

Julie Soukup Take 1: Patient Podcast  0:00  
Hi, I'm Julie Soukup with another episode of take one patient, where we talk about patient communication excellence and things that we can learn from industry experts about the way that we communicate with patients. As we're starting to utilize more video more telehealth, we wanted to always make sure we have provided a resource for for our doctors and our nurses that are really doing this every single day. I'm very excited to have Dr. Kyle Hornbeck with me today. He has a a huge background in clinical insurance, biopharma military, and and he brings a wealth of knowledge and perspectives about patient communication, and why it's important. So I'm gonna let you first introduce yourself, and then we'll kind of dive a little bit more into our topics today.

Dr. Kyle Hoedebecke  0:55  
Awesome. Thanks, Juliae for the kind introduction having me on. Again, my name is Dr. Kyle Hoda Beck. I'm a board certified family physician by training, I spent my first 10 plus years on the clinical side, running outpatient clinics, as well as is doing full scope, delivering babies all the way to end of life care, inpatient outpatient, ran the full gambit Gambit there got out in 2019. For the military, that is transition to a pair side of medicine. So I've been working at Oscar health for the last several years since 2019. Where I'm currently at today, on the side, I do a lot of work as a mentor and advisor for healthcare startups with a specialty in applying technologies and improved systems to healthcare so that we can improve our outcomes and decrease our cost. So that's a little bit about me.

Julie Soukup Take 1: Patient Podcast  1:53  
Yeah, absolutely. So one of the things that brought me to where I caught you, where you caught my attention, was actually in a paper that you had written a little bit ago. Um, you know, medical memory, our app, we utilize it a lot for video recording, informed consents of some of our biggest neurosurgery clients use it to be able to do so and one of so we do a lot of research and digging about informed consent and what that means and why it's important and, and kind of giving more depth and breadth to that conversation, especially now that people are recording it and utilizing resources outside of, of just, you know, a paper. And so one of the things is you have written an essay, or excuse me done a an IRB study on informed consent, where you talked about the reading level and the language of it. Um, so first, tell me a little bit kind of what drew you into looking into this and doing a study about the reading level of informed consents, first, and then we'll kind of dive into kind of more of what you what you found from it.

Dr. Kyle Hoedebecke  3:00  
Yeah, for sure. Um, I don't remember the year that was published maybe five or six years ago, but

Julie Soukup Take 1: Patient Podcast  3:06  
1313.

Dr. Kyle Hoedebecke  3:10  
Awesome. So it's, it's around that time, quality standards started to include the language that we use to talk to our patients. So as you know, in medical school, for example, we learn over 200 to 300,000, new words, most of those words are not very common, you know, pseudo pseudo hyperparathyroidism, what the heck does that mean? It's difficult for a doctor to say, imagine just someone who doesn't even have a high school degree. So research shows that approx the approximate American reading level, this goes across the gambit, again, everyone we see as patients is about the six to eighth grade level, which means that when we communicate with patients, it should be at the level he or she can understand. So if I'm using physician level verbage, for someone who hasn't completed, you know, college or height in high school or a pediatric patient, we wouldn't speak to them that way. Right? So why, why are we doing this with adults who may not have that ability to comprehend that level of language. So it's really about speaking to the patient and his or her level, making sure that they're most comfortable to understand what's about to go on treatment wise, and to give them the appropriate options. So it's considered a quality metric. Now, having that six to eighth grade language, both on the clinical side as well as on the insurance side, getting into I guess, the outcomes, at least at that time. A lot of our consent forms so those those forms you signed before you go in to surgery or have any major major intervention just to say that you're not doing this without the patient's understanding or knowledge. Most of those at our facility at that time when we researched it was about at least the 11th grade. level, but one of them even been over 12 grade levels of being in the college level. So well above that six to eighth grade range. So that that is what we found that maybe you know, we're not communicating as well as we think we are.

Julie Soukup Take 1: Patient Podcast  5:13  
Right? Well, and that's one of the things is I can see, especially in an informed consent, when you're about to have a specific surgery, a lot of those verbiage in those words are necessary to be able to even just explain what you're doing. I mean, a lot of, of course, doctors, they just have a whole level of language that your average person, we don't even need to know what these words are, you know, like it doesn't fit, unless we're in it, and it's us or a family member. And we're the ones having having those surgeries. So so as far as when you were seeing that, okay, there is a huge discrepancy between like, what they're saying is the language of level like language level that is needed and what it is, what were some of the pieces that you kind of started putting into place to ensure it kind of still was covering that litigation piece of it, but also making sure that you were speaking more to a to a patients or their family members level?

Dr. Kyle Hoedebecke  6:07  
Sure. So a couple of things. So first, we implemented a couple of so for example, even just Microsoft Word, as has its own ability to tell you what your reading level is that you could also find other ways of measuring online, there's three common ones, beyond the preview of what we're talking about today. But just checking afterwards. That's what I'm trying to get to you check and say, I think this is very clear. What grade level is it? Oh, shoot, I wrote at the 10th, grade 10th grade level, okay, how can I maybe adjust it to get it down as close as possible to that six to eighth grade. So that's one way. Another way is if you do I mean, if you're having a cold cystectomy, ie having your gallbladder removed, you can say Hola, cystectomy, that is what you're having. But at the same time, you should maybe have in parentheses, the Remove surgical removal of your gallbladder surgery to remove your gallbladder. I've gotten to the point, at least internally in my head, where if I'm writing a, something to a patient, on the insurance side, if we're not approving something, we have to explain why we're not approving a requested service. So if it, for example, is a colo cystectomy, I can still say that, but the same time, I'm going to say, a removal of your gallbladder by surgery, something like that.

Julie Soukup Take 1: Patient Podcast  7:26  
Well, and that's interesting. So a lot of the words are like, Okay, we're gonna keep all that information still in there, but make sure that we're having it kind of more in layman's terms in that place. So you had mentioned that insurance is starting to really look at like the quality metrics that kind of come from that, if the language is like art at a place where a patient can understand. Tell me just a little bit more about that. That's, that's kind of a new thing that even I'm learning.

Dr. Kyle Hoedebecke  7:50  
Okay. So there's an organization called NCQA. And they look at a lot of known quality metrics. And that is both on the clinical side, as well as on the insurance side as well. One of those just happens to be at what language you're communicating with your patients at some. We found when I first came on 2018, doesn't 20th 2020 ish, excuse me, at Oscar that we were pretty pretty high in some areas. So we've tweaked it down. And we do use some templates as well. For verbal communication, those templates, we already know what the grade average is, we have it listed after each template. And then there is an area where you add specific information for each patient. So just keeping that in check. And then we also have a list of words, we have a list of Doctor words, and what is a provable for NCQA purposes, so call it so you know, the removal of the gallbladder would be something we could say to a member instead, of course, discectomy Sure,

Julie Soukup Take 1: Patient Podcast  9:08  
sure. Well, I was interesting, because one of the pieces that you had written about in your study was, you know, as the threat of malpractice, as the threat of mitigation started to become a little bit more profound, especially in the past, you know, 20 years or so that that's where a lot of this more on thorough language, and even legal language as much as you know, medical language started to really evolve in a lot of these consents, which is, of course important for providers also know their risks and be able to kind of make sure hey, you know, am I covering myself to make sure that we're both on the same, same page. So it was interesting, and it almost seemed to kind of right rile up and now it's starting to say, Okay, well now how do we kind of clean that up and clarify that and make it a little bit simpler, you know, to?

Dr. Kyle Hoedebecke  9:57  
Yes, it's um, I chuck a little bit because when a physician when the patient comes to see their doctor, they want their doctor to be, you know, perceived as really smart the bet they want, you know, to go to the best doctor best this. And usually that's not using six to eighth grade language like, we're from Texas. So if I say, yeah, we're just gonna dig down in there, take out something and you'll be alright, lickety split, there may not proceed to be the, you know, the best service, even if I were the best doctor out there. But at the same time, getting that competence across well getting the message across is, is it's a double edged sword, and that we want to come off, you know, with confidence with that report, but at the same time understanding for the patient. Yeah,

Julie Soukup Take 1: Patient Podcast  10:49  
which is a very like hard like a very blind balance, because even as you're mentioning that, and fortunately, I haven't really had any, you know, surgeries, but like, my dad had spine surgery, where we got a video of the rest benefits, alternatives that kind of explained it more. But definitely, in conversations with his provider, we were like, No, I kind of wanted him to be a little you know, about that. It didn't make me feel more confident. He knew what he was talking about, even if I wasn't kind of understanding all of the pieces, you know, at the time. So it's interesting. Can you say that it is it does build confidence, but then, you know, is someone even understanding what's, what's going on there.

Dr. Kyle Hoedebecke  11:26  
I don't know what he just said, or she said, but

Julie Soukup Take 1: Patient Podcast  11:31  
Well, that's I think goes to what you also said in that study about, you know, using other resources using other materials, that it's not always just a conversation and assign sheet of paper, they if you're having some of these other pieces, that that informed consent is a conversation. It's not a signature, and we had a podcast a little bit ago, with a doctor and a lawyer, who had who had both doctors, and he was kind of saying, you know, the more the more you think of it as a conversation that we're doing together, the more resources you can provide around it, it actually shows better in a malpractice situations or mitigation. Place that that you're doing everything, you can best educate your patient. And so that's where it's kind of gotten interesting, especially with, you know, even some of our clients that have recorded, you know, here's the risks, the benefits, the alternatives, like everything, that's kind of a more broad statement, patient, here's access to the video, here's access that your family can watch this video, we're going to timestamp that we can see that you watch the video, and even have a question of like, Do you have any questions? What other information do you need? Is there anything you're not understanding here, to ensure that that's, that's a dialogue and providing that dialogue? And so even for a lot of these providers were like, I don't, I just can't, with my level of schooling and my level of education and practice. I'm not good at speaking at a six eight level, as you said, you're like, that's just not how I speak normally, because of because of the words I know and what I do. But they're having these resources that well, even if you're having that conversation, there's there's the supporting documents, either paper wise, education wise, or like a video, like medical memory that you can use? Um, yeah. So is that kind of what you're seeing happening more often, or what other things are using providers doing to kind of offset that?

Dr. Kyle Hoedebecke  13:21  
Sure. So I'm seeing a lot of resources being sent. So not just, you know, a standard sign this consent form, either paper or, you know, electronic signature now, but also Here are additional resources mentioned, for the protection purposes as well. But ensuring that a member or member is what we see on the parasite patient on the clinical side, actually opens up each of those links in order to ensure that they did least get that information visualized. Hopefully, some, you know, some or all of it went in. I know I mean, I say that because I know on my end, I'm just like, Okay, I just want to click this and get through it. But yeah, it is important for remember, slash patient to know what he or she is getting into other things. I see a lot of our both researchers and clinicians getting on social media a lot. I think, I think that's a great thing. Actually. I've literally had people in my family, get medical advice from memes. So anything that we can do to you know, provide a positive influence on social media think including podcasts, just like this is a great resource for patients. So there's a lot of there's a lot of trends that way to make sure that we are located not just physically but digitally, wherever our patients are.

Julie Soukup Take 1: Patient Podcast  14:50  
Yeah. Well, it is interesting. You mentioned that because you guys also did an IRB study about social media that I thought was incredibly interesting and and One of the outcomes of even just li i think was a Twitter where you can only have so many characters, that it kind of forces you to kind of speak at a more basic level or type and more basic level. And that when you're starting to compare some, I'll let you kind of speak to it. But when you're comparing, you know, social media posts versus like, educational documents in the office already, you're, you're leaning more towards a younger reading level that's more appropriate for the public.

Dr. Kyle Hoedebecke  15:30  
Right? So this was this all came about? So we had our initial study that we just mentioned, with the written paper consents. And then I was thinking, Well, I'm wondering what social media is written at. And it just so happened, there was a Stanford University in conjunction with a company called a MedX, they had this challenge, and it was through Twitter. So I, my thought process was Twitter. At least at that time, had a I think it was 140 character limit. I wonder what the grade level is, for those 140 characters, were able to, through the resources provided by this competition, able to look at a lot of different metrics of it was actually pretty cool. So like the different hashtags, different handles, we can see who were more influential, we could see the grade levels, and then it came out, if you recall, the first study with the written consents was just over 11th grade, and this was around the ninth grade level. So a couple grade level improvement, which means that hypothetically, it'd be a lot easier to understand for the general public. The other thought processes, these are going out internationally. So there's a lot of English as second language or even third or fourth language eaters, so you also want it to be at a lower grade level so that international folks can enjoy appreciate and soak in that knowledge that we put out there.

Julie Soukup Take 1: Patient Podcast  17:03  
Yeah, absolutely. And I think especially when you're going to your specialty, and the things you do most often, you know, even some of our like, I always speak to neurosurgery because that's what I know the best, but we have orthopedic pediatric oncology, all of it, but, um, it is they started to kind of even cartoon eyes or anime or like cut down even little pieces that are more digestible to so that there are like shorter clips or shorter words or shorter themes to continue to educate their their patients, but especially when a more of a general situation like you are where it's, you know, diabetes, the risks, or, you know, cholesterol or those type of things where people are starting to consume that easier, that we're kind of just already leaning into that education level.

Dr. Kyle Hoedebecke  17:50  
It's a good point with the animation, also the gamification of, of knowledge and increased internal interactions with patients on the on the clinical side, one company I work with out of Florida called hy Neo, they, they are working with clinicians as well as insurers, focusing on patient clinical understanding, and augmenting medical knowledge of the general public. So that I think that's a pretty cool idea and trend I've seen as well.

Julie Soukup Take 1: Patient Podcast  18:23  
Yeah. And start to tweak as we're learning and technology is becoming more advanced. I mean, I think one thing is, as we, you know, we're all taking a road with COVID is that we learned, hey, we got to lean more on it more into telehealth, and you have to lean more into video and lean more into recording and, and lean into some of these resources that are available to you. And a lot of that is things like you said is like technology that might be able to kind of take some of these pieces away or, or do things in that capacity to make it simpler. So you're not always like, Oh, am I doing what I'm supposed to but well, maybe I'm relying on my resources, like that program that you just had mentioned, or, you know, medical memory and their video tool, like just seeing kind of the pieces that you can add into what you're already doing to to make sure that you're covering all bases.

Dr. Kyle Hoedebecke  19:11  
Exactly, exactly. So pulling different resources. Again, it's really as we society moves on to the internet. not replacing in person, context, but augmenting it through logic.

Julie Soukup Take 1: Patient Podcast  19:27  
Yeah, bringing more things around. So that being said, I mean is is if you are going to kind of say okay, someone's listening right now and they're like, Okay, my, my communication style is too, like too high too aggressive. I know it is. I've been told I need to, you know, make it more basic. I still can't what you what are kind of the three tips that you would say, for providers that are wanting to improve improve this piece of communication in their practice?

Dr. Kyle Hoedebecke  19:57  
Three pieces, okay. Um, one piece of a writ for written especially rips in communications, after completing it, just especially if you do it in Word, just look up the grade point average, or the the grade reading level that you used, the word will spit it out for you. You can search it up online reading reading level, for writing, whatever the search is, and then throw it in, and then it'll come up with a number for you. That would be one thing, another thing would be, so taking that you can have templates, both written as well as video recorded templates. So that would, that would, one reduce the amount of work each time you're either doing consents or written information that you do often. And reduce the work down while ensuring you meet that six to eight grade. Then

Julie Soukup Take 1: Patient Podcast  20:55  
I thought that was interesting that you I didn't even know that you could just Google it be able to figure that out right away, you know, it's sort of like where am I at, which is a good just check off aware of what what your stuff is, and then start looking at the resources around you like medical memory, or other things that are that are available to help just a little bit, you know,

Dr. Kyle Hoedebecke  21:15  
exactly in then I've gotten to the point. So if I'm, in general, if I'm speaking to a patient or anyone I, just to be respectful of in our communications, like, it's good to know what level of education that person has, just as it's good to know what their primary language is, right? If someone primary English speaker and you have the ability to speak that language, or you have a interpreter or whatever that may be, you would want to bring that person involved. Same thing for for language. So if there's something that I think that so again, I've been studying this a little bit, so I have a pretty good gauge that the average person probably doesn't pick up, then I would so cool. cystectomy, no big word. Gallbladder surgery. Okay, great. Now I understand. The other thing is, is closed loop communication. So after you tell the person can you can you can you tell me what you heard? And when that person can tell you? And hopefully, it's exactly what you told them? If not, then you need to find another way to better communicate that information to the individual.

Julie Soukup Take 1: Patient Podcast  22:24  
Right. And it's interesting that you're saying that because even to that is exactly what Dr. Homie said to me. I think, episode four, where he was talking about that have making sure it's a dialogue, making sure it's a conversation is, Are you understanding everything? What did I tell you? What are we doing? What are we having, and making sure that if they're not able to kind of repeat it back, that's take a few steps back, use other resources or do anything along those lines. And so for even providers that may not always have the time even to do it at that minute is what kind of systems you have for a feedback via, you know, like, like medical memory has like a survey question that when a patient's watching, maybe informed consent video with risks, benefits and alternatives all listed that that says like, I am, you know, do you understand all the pieces of this information? Like what are like what is the questions that you may have? And making sure that that just simply saying, Are we good? Like you got anything? Like, are we on the same page, that extra a couple of seconds at the end of that conversation, just to ensure that can be huge? In that discussion?

Dr. Kyle Hoedebecke  23:26  
Exactly. And then some of it is even beyond just did you understand yes or no there for like some surgeries? You can't take blood thinners? Probably for most surgeries? Yeah. Really important to ensure that those things are communicated and understood for the best outcomes?

Julie Soukup Take 1: Patient Podcast  23:44  
Yeah, absolutely. And, and because some people maybe don't really think about it, just take I take it every day, I've done it for 10 years, and then a weight, like all of a sudden, I'm having to shift it even a simple behavior, but at least understanding the why and okay, I'm totally on board a board with what you're what you're talking about. So, well, that's great. I mean, I again, I appreciate, you know, your your intellect and your thought and the perspective that you're providing, especially with the studies of, of just being more aware of where our language is fall, some resources that providers can utilize. And even just kind of going back into more like social media, as you said is, you know, leveraging that platform, which in and of itself helps simplify things. I think a lot of the you know, studies that you're doing the work that you're doing is really saying hey, I'm an advocate for patients, I'm wanting to make sure that that that we're providing the best resources and care to ensure they understand the information that's being presented to make you know, better decisions or have better health outcomes. You know, that's our our company medical memory, very much alliance with that value. That's why we were even built so I really appreciate your like minds and your intellect and taking the time to really talk about some of the things that you're an expert in and Have some research and so of course

Dr. Kyle Hoedebecke  25:02  
Sure yeah allowing me to discuss and something I'm very passionate about and glad to see other people passionate about as well

Julie Soukup Take 1: Patient Podcast  25:08  
awesome Well thanks again for joining us and we'll talk to you more soon

Dr. Kyle Hoedebecke  25:13  
awesome Julie Thank you have a nice day thanks

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