Transcription of Podcast

patient, providers, record, checklist, consent, physician, medical, recording, emergency department, started, interesting, emergency room, discharge, utilize, video, information, emergency medicine, provide, explained, mentioned

Hi, my name is Julie, I'm here with another episode of take on patient. I'm here with Dr. Eric Wilkie. I'm very excited to connect with him and kind of have him share some of his insight, being not only a physician, but also an entrepreneur and really getting into a lot of the tech that goes along with

the emergency room and also just patient communication and patient care. So thank you, Dr. Wilkie, for joining us today. Sure. Thanks, Julie. So why don't you start a little bit and you give a little bit of background cuz you'll do a lot better job than I will about kind of you started as an emergency physician and kind of a little bit of your medical background before we dive into the other pieces that you're doing? Sure. So um, I went to medical school in Texas, and

started off thinking I want to do one thing, but then as you get exposed to other specialties and whatnot, I really gravitated towards emergency medicine.

I liked sort of the fast pace, you know, the little adrenaline junkie that had an hour plus it was, you know, other than nights, weekends and holidays, shiftwork, you know, when you're home, you're home. And so it was kind of a nice for a family life, wound up doing a residency out in Phoenix was there for years and

then was in emergency medicine, clinically practicing for 25 years still do some, but now it's a lot more admin and some other things that are, you know, we've got in the, in the development, so.

So yeah, that's kind of the Quick, quick run a quick run of it. So, so definitely, I've been practicing for quite a long time you started to see, I'm sure a lot of advancements, especially in the past 20 years, you said you're practicing in technology and different ways that patient care could be handled, what were some of the gaps that you kind of started to see in the emergency room that you wanted to address now moving into the the physician standpoint, or the entrepreneur standpoint? Well, you know, as we, as we got involved in these freestanding emergency departments that were popping up, everywhere, probably too many of them.

And we're just looking at documentation solutions. And one of the things that we were interested in is,

you know, how do we record the conversation between the physician and the patient, because what we know from studies and data, even highly educated patients, patients with advanced degrees, you know, Masters or a PhD, their retention of what is told to them is surprisingly low.

And so I think the physicians have an idea that everything's being communicated and being communicated well. But the reality is, that's not the case. And then, the number one thing in the trash can outside of an emergency department is the paperwork, you know, with all the printed, you know, novella of information that gets given to him.

And then, so again, as we started diving in and looking at what's published, we really wanted to condense down our instruction, our printed instruction sheet to one page or less, you know, maybe sometimes it's a page and a half, depending on what it is, but really shrink that down. And then we wanted to do an auto recording.

Nobody was doing it, we couldn't get anybody to do it. And so for better or worse, we wrote our own EMR our own charting software. And as part of that was a media function. So you could add pictures, you could add audio, we didn't do a video, which is kind of how you and I got in contact. But I think the I think that

that recorded content given to the patient, so they can listen to it again, digest it later, share it, I think he's been a great one. And then, you know, you get some of the initial pushback, it's like, well, you know, what, if I don't say everything I should say, or, you know, what if I, and then the problem is if, if you don't tell them what you're supposed to tell them, it doesn't matter whether you record or not. And then on the flip side, you know, everybody has the phone in their pocket, right? And so

you should just run on the assumption you're being recorded. Anyways, I think there's a couple of cases, one in anesthesia in particular, where they did not run on the assumption and the patient was under anesthesia, and they said a bunch of stuff and got that person in a lot of trouble. So, again, I think if, you know, I think this has the opportunity to really help patients. I think the concerns that people have are mostly unfounded and like said,

don't be surprised if you're getting recorded, you know, at any point anyway, so yeah, well, and it's interesting to as you say, I mean, originally

I so appreciate that. The reason I started doing it was like, you know, patients are not even reading this information, you know, how can we provide them a second medium, so that they're really understanding what's going on. And they're really understanding the information because I had dealt with a dad that had was discharged from the hospital just from having a scheduled surgery. Like, I can't even imagine the emotion that also is wrapped around someone that is going into a medical situation unexpectedly, whether it be heart attack, or shortness of breath, or any of those things, where you weren't expecting to they're planning to be there, like, naturally, everything's going to be also a lot higher. And so providing us to the patients, I mean, is is of tremendous value there. Now, when you guys started doing that, you what, what was, you mentioned, kind of the initial reaction of the providers. But what did you see as far as the impact it had on you outside of just patient care? And making sure that the patient has information, but what kind of things did you see that impacted years ago when you started this on your individual practice? And even Are you as like, as a provider? Well, you know, one thing that we discovered, or what I discovered for myself, as I thought, you know, I do a pretty good job of explaining this. But as we moved into the audio recording, we created a basically a structured checklist of things to tell the patients, and then as you start doing just over and over and over, you realize, well, maybe I wasn't doing as good of a job as I thought.

And so, you know, having that, you know, what we call the, you know, the discharge checklist, you know, and, and so you just kind of go through and, and hit all the items and make sure you know, one of the last things is like, Do you have any questions? Do you feel like you understand everything we told you? Is there anything that we need to go over again, and

that's, I think that's very, very helpful, I think, without developing and you can do that process, obviously, without having to be recorded. But I think applying that, that Checklist Manifesto approach to making sure we communicate to the patients, you know, and you mentioned, like, I have medical training and doing this for a long time, but my mother in law was diagnosed with lung cancer, and so I was going to some of the appointments with her. And you know, I'm feverishly taking notes, because this is, you know, although I understand a lot what's going on, this is definitely outside of my field of expertise. And I'm not familiar with the different types of immunotherapies, or chemo that they're looking at doing. And so,

you know, I was very poignant to be like, you know, what, let me I'm gonna pull up my phone, I'm turning on the audio meme, you know, Voice Memo, and I'm gonna record this because, you know, there's just too much information going back and forth, to me being able to write down everything that I need to. So

I think this is is an important thing that should be embraced heavily. Well, the other thing is, a lot of our providers have even said, you know, it also you can almost see the patient relax, you can almost see like, okay, like on a recording this, like, now I can actually listen to what you're saying without frantically feeling like I have to memorize everything that's coming out of your mouth. And so I think that some of it is, you know, you even had mentioned before about patients, like you should always pretend like a patient's recording anyways. And they've done a bunch of studies that like 30 to 40% of patients secretly record which is, which is why is the need for to be secret. But but but because they're just needing that they're just like, I just don't understand that. I don't know, they're not trying to get anybody in trouble. They're just, I need more information. I don't I don't, I'm nervous and scared. You know, they're embarrassed to ask if it's okay to record, you know, and so that they're just going to do it on the download and, and, but, yeah,

for sure. Well, I knew when we started actually, with one of our providers, and we found a similar thing we utilize video as you guys are utilizing audio soon to be video hopefully.

Is that is like what we saw our first like, I'm just really nervous to be sued. I'm really scared of that. And we did a bunch of different work to see okay, what are the implications talk to a bunch of malpractice insurers and lawyers and all of that, and they're like, No, I mean, it's you're showing, you're educating it's, it's, you know, providing everything you can do for the patient. And I still have never forget, the one doctor was like, Well, what if I say something, like illegal and I was like, Well, don't say anything illegal to me saying, wait a minute, like, let's rewind this like interaction really quick because like, Oh, um, you shouldn't be doing that anyways, regardless of like, well, that's a whole nother value thing, man, because heartless there. We did something similar, you know, so we took some actual recordings. And we've got we're part of this captive insurance from our med mal. And we gave it to the lead defense attorney. And so she listened to it. And her comment to us was please do this on every single patient.

Why now?

Why Why was she say it wasn't probably had a lot to do with the checklists that you guys were implementing. But what what was? What was kind of the bubble around that? Yeah, I think her view was like, this is concrete documentation that, you know, the patient was given the right instruction, they were told these things, you know, and, and so, she saw it as a great medical legal protection.

You know, and that's, we were, we were approaching it to make sure we weren't getting in trouble. You know, because we had to answer that question to the physicians, you know, within the group is like, this is going to cause you don't want to get in trouble. So we weren't looking at it as a medical legal defense. We were just wanting to make sure, we could reassure the doctors, no, there's no problem with us, you know, as long as the patients are informed and consenting and everything else.

And so it was a little bit surprised when she came back and said, this, this is a great thing to do. Please, please do this. Well, I'm It's interesting also, right off the bat that with what you were saying with the checklist, and a truly is that The Checklist Manifesto, but you're referencing,

I don't can't remember the last time, I can't remember it. But um, it's interesting that you say that, because for a lot of providers that are considering recording, they're like, I believe in this I, especially since COVID, the impression of recording patients, and that virtual aspect has shifted drastically. And so for a lot of them is just like, I don't know what to record. And so I think having like, okay, these are the five things that you should cover Are these even for a nurse, these are the six things that you can cover, it takes the gray away and provides it just as you are like as that lawyers had said, like, Okay, if you're covering these six things on every single one of these videos, do it every time and I think that probably is why that success has kind of happened have not just okay, here record, what you should record your discharge instruction. And it should be kind of, like this is this is how that goes. I mean, have you found that your providers find that easier? Once you kind of provided that framework? Or what kind of made you kind of go into that space? Where yours was did that? No, no, I think, you know, if we're gonna record, let's make sure we do it right, and do it the best we can. So it's like you, the patients need to know what they're working diagnosis is they need to know, the tests that were done, and the results of those tests and the treatments. What the expectation for follow up is, you know, and, you know, make sure we answer the question. So it's just very basic things and but it's just to make sure you, you don't blow through it, or, you know, think you told them but you didn't because you're just moving kind of quick. And you know, there's, it's not a not a fault of the physicians, but the emergency department is just rife with interruptions, right? There's so many things. And so there's all this task switching. And every time you have one of those task switching, like

you lose the momentum of what you were doing. And so then you got to go back and, and so if you get an interruption or something being you know, hits on your phone, or you hear something, and then you trying to come back and pick up where you were with a patient, you may in your head have thought, Well, I told them, they need to see their doctor in a week, but maybe it didn't come out, you know. And so, again, when when you're sitting there looking at the checklist going through, it's just it's just a tool to help combat some of the chaos that's in the emergency department. Right? And that's very interesting that you say that too, because I guess I would have thought about that is it? It's not even just like having I mean, my dad again, no, like interaction I've had as a discharge that's like, we're going to discharge you I think, very planned, because it was a scheduled surgery. And even sooner, like what like, let alone like, okay, he just left the room once he was explaining that. And it's almost like wrapping this whole interaction in a nice, like, bow, if you will being like, okay, let's finalize what just happened here in the past hour, or whatever that might be. Now for those providers that are, you know, thinking about recording or nursery or recording and like what I can say at all day, right, but what, what as a provider? What advice or thoughts would you have, as far as those contemplating starting to utilize technology like this?

I would say number one, assume that it's already happening, right? Assume that the patient's doing it. And so if you provide some kind of structure

or system in place, then that that kind of,

you know, brings it into the light. Don't be afraid of the medical legal risk, because I think that's been, you know, fairly definitively squashed. You know,

I think the the information that we have back from patient satisfaction is tremendous, like they patients really like it.

I think it's very helpful. Again,

just like you mentioned before, as I'm scribbling notes in the oncologist office with my mother in law, once I start recording then then I just write down and I was more able to concentrate on the discussion.

Rather than wait, wait, wait, you know, get that right what what did he say?

And so it's just it's a great tool, like,

why would you not want to use it?

Is one of the questions that I would ask, right. And I do think that's, that's where we've come so far with, with COVID. And the ability for people just to feel comfortable. But also with phones, I mean, everyone's record, I mean, just as you said, just assume it, like all the time, and then take ownership of it and take control of it. And as you guys have done really well, you know, in your your setting is and then build out that checklist of like, okay, great, if we're going to do it, let's do it, right. And those are the things that we can cover, just to make sure it's covering us and them and all of the pieces. Awesome. Because the the screen that we have in our EMR, it's like when you hit the record button, it's the page list all the things that you're covering, so you're sitting there looking at as you're talking to him, so that's great. Well, and we've, it's interesting to see different capacities of how people have used it, like, we have some we have, you know, medical memory has video recording option that the patient can have access to and then share it. But as far as you know, like a NICU nurse, she'll like I've just read the discharge instructions, like almost over, I'm like just recording the baby, as I'm doing it. Versus like, with, you know, we're gonna show scans, or we're gonna, you know, different for different genres or oncology, let's go over the medications, because all the pieces are just different. And it's been amazing to see how different facilities have utilized it built their own checklists, built even, like, here's how to get in and out of bed after surgery, like adding all those elements that you don't think about at the time that you're like, wait, what, and the different specialties. So I appreciate that you do that and use that, especially knowing like the value I've I've seen it provide for myself and my family, uh, let alone, you know, patients in that respect. So, you know, thanks for taking the lead on something that I think is just going to become pretty commonplace, you know, pretty fast as far as a tool for patient care. Yeah, well, and we're talking a lot about, you know, the discharge process. But there's, I think another crucial element is, and that's patient consent, right?

Again, because if you know, handing handing them a piece of paper that the nurse takes in, and the patient signs, that's not going to meet the bar of patient consent, like it needs to be the one that's going to be performing the procedure, then, you know, make sure all the stuff. And so

and again, in the emergency room, sometimes consents a little tricky, like if it's emergent, you know, you just do it like you don't worry about that. But in these other cases, where you've got a little bit more time, we've used it to document our consent, and maybe, you know, so we've explained the risk, we've explained the benefits, we've explained, you know, the options for, you know, other options, if we don't do this procedure,

they get to ask questions, and then you hear them say, I consent like so I think it gives a much stronger in a much better format for patient consent on procedures. Right, which, which protects everyone, but then also is a checkbox for that provider of saying like, you know, we did we have this conference sheet conversation too, because definitely, that's one of the biggest things that we've seen, especially with medical memory is, you know, a lot of our providers upload, you know, videos that they created before that go over just that risk, benefits, alternatives, everything, and that it becomes more of a blanket of edge education and understanding for that patient versus like, okay, sign this, in that respect. And I know you guys, as far as with the emergency room have kind of created a lot of those type of videos or content that also is saying, okay, these are all the things that you need to be aware of patient for the things that maybe you say most often too. But that's interesting, as far as an emergency room, how much more that consent is probably relevant or needed, because of a little bit of the rush, I guess. I mean, obviously, they're coding and those things you just go but still on some of that, like you know, of appendicitis or those where they're still aware, it's okay. Well, we're going now like we're doing, you know, to

Awesome.

Well, great. Well, thank you so much for joining us and talking about, you know, this this kind of new technology and how you guys are utilizing it. I know medical memory is very similar and close and how we're looking at video recording patients and providing that that record, so appreciate what you do. And thanks for hopping on with us today. Thanks really, more. We're looking forward to kind of getting ours integrated so that we can add in that video component. So awesome. Thank you so much. All right. Thanks.