Dr. Little

Tue, Sep 24, 2024 12:55PM • 26:16

SUMMARY KEYWORDS

patients, recorded, people, recording, providers, feel, emergency medicine, conversation, discharge instructions, discharge, julie, physician, study, interesting, reasons, worked, empowered, medical, leave, fever

SPEAKERS

Julie Soukup, Dr. Andy Little

Julie Soukup 00:02

Julie with medical memory recording hundreds of 1000s of patients with their HIPAA compliant mobile app, we felt it was relevant to start discussing the best practices in patient communication, especially now that so many providers are recording these patient interaactions with video. My name is Julius, and I've spent 15 years working with physicians to strengthen their communication skills. Listen in as we learn tips from the industry's best in patient experience. How can we strengthen these patient and family conversations and help our nurses and providers optimize their time, especially now that the camera is on so quiet on the set, Roll camera. This is scene one take one patient now. Asha, hi. My name is Julie Soukup. Thank you so much for joining us for another episode of take one patient, a podcast about communication excellence today I have with me Dr Andy little. He is the program director for the ER at Advent health Central Florida. I'm going to let you introduce yourself, but I think it's interesting how I Found You was actually a study that you were doing where you were leveraging recording and the impact kind of that was on providers and their perspective about all that. And so I was like, Oh, I'm going to email you and see what you think, because obviously medical memory, that's what we do too. So I thought it was interesting even how we met was just from this, the study that you did and finding your name. But why don't we start first? Why don't you tell us just a little bit about you and what you do, and kind of what led you into going into emergency medicine?

Dr. Andy Little 01:43

Yeah, so like Julie said, I'm Andy little program director for the emergency medicine residency at Advent health Orlando, in central Florida. I have always wanted to do emergency medicine, but Julie and I were doing the prep it was I grew up wanting to be a firefighter, and then somewhere along the way, realized I really liked the idea of going into medicine, because my dad, you know, changed his career in his 40s and became a physician's assistant and did emergency medicine. And I grew up around the culture that the physicians, the families, the, you know, everything. I just really, really loved it, and went into medicine, specifically with the idea of doing emergency medicine. And luckily, as it all worked out, that's what I do now, Julie brought up, you know, how did we meet? And it was, honestly, I attended a leadership meeting early on in my career, after graduating from residency, and came across this idea of being recorded by patients. And so in that, I thought, Man, this is a really interesting idea that made me kind of ponder, would I benefit from recording parts of our encounter with patients. And so I actually started recording discharge instructions with patients, because I found that sometimes our patients have the most questions. And so I started doing that personally. And then we did a study at where I was working at the time, at Doctor's Hospital in Columbus, Ohio, and did a small pilot study with Ed nurses and Ed physicians and residents, and really got some interesting results. For me. I found it very helpful and felt very good about doing it, but found that overall, there was a ton of concerns from providers about being recorded, whether it was for legal reasons or quality reasons, and it's, again, not the findings we were suspecting of having. But despite that study, it's still something I do on a routine basis. I just finished four night shifts. And last night, you know, 230 in the morning, had a young family bring in their child with a fever and walk them through. Hey, the exam actually looks really good. But as we know, fevers evolve and diseases evolve. So here are the reasons to come back. And so actually recorded on the phone with the mom and the dad who were there at bedside, because at two o'clock in the morning, one, you're tired, and three, I say a lot of medical words that nobody understands, and so having that actual recording is helpful, because hopefully they'll, later today, if they still have a fever, they'll be like, What did Dr little say? And they can pull up that audio recording I made on their phone, and then they can make it a good decision to come back to the ED or to go see their pediatrician, but be empowered with that information. So that's, that's how kind of how we're today. And I feel like this is a great topic to talk about, because there is some stigma involved with it. And I was talking with one of my colleagues about this recording session, and they know that I record, and they even said that you're not worried about being sued and and my answer was, how am I going to get in trouble for doing what's right for patients, and so as long as I'm not doing something stupid?

Julie Soukup 04:21

Yeah, well, you and you hit on a lot of topics. You know, we also have been working with a few different ER doctors and programs, kind of throughout the country, where, similarly, they chose, you know, I want to record this message. You know, emotions are high. It's late at night, potentially, like the main caregiver might not be there, or people at home might might be, you know, needing this information. And so, of course, with medical memory, you know, they're recording it, and it's all at a HIPAA compliant platform where both people have have access to it. With you. I know that you're, at this time, kind of using your phone, so let's kind of take one step back. So talk about what, what is it like if you were gonna like, is there a mom? You follow, or what is kind of the pattern or cadence of what you actually are recording with these patients? Yeah,

Dr. Andy Little 05:07

so it's the we know that, in least from an emergency medicine standpoint, there's the initial touch point where I introduce myself, I do the history and physical I make some decisions on what I'm going to order. And then there's usually a result conversation where we go over results and maybe have to, again, reassess interventions we've given, whether it's pain medicine or fever medicine. And then there's the discharge discussion, and to me, I find the biggest bang for my buck is to offer them. Hey, would you like me to record this on your phone as we talk about it, so you know why you should come back or why you shouldn't come back? And that's, again, I don't offer it to everybody, but I offer it to possess. I offer it to special scenarios. I usually do it a ton in pediatric patients, especially with young parents or when one parent isn't at the bedside. You know, as a father of four, I have had to take my patient to the I've had to take my kids to the hospital when my spouse is not available and so and even as a physician, I know that they said stuff to me that I didn't I'm like, Yeah, whatever. Just give me the paperwork. I just got to go. And it would have been nice to have that recorded. And so those are kind of people I definitely reach out to. Or it's the Hey, it's an elderly patient who's here with a caregiver, but POA, whether it's a child or a spouse, is not available. So I'll offer to them, and I just say, Hey, this is Dr little. Wanted to run over the visit with Mary. Mary was here today for abdominal pain. You know, we did we did some blood, we did some blood, we did some imaging. We didn't really find a good reason of it, but we know that abdominal pain changes over time. Here are the reasons that Mary should feel good about what we did and kind of walk through that. Hey, the blood work was negative. The imaging didn't show this. She was concerned about, say, a bowel obstruction, and the CAT scan didn't show that. But here are some things. I'd want Mary to either go see your family doctor for in a few days, or I'd want her to come back to the emergency department, and it's just a natural conversation, and that's what I would typically have with the patient anyways. And I say, let's just record it. And again, it's one of those where I'm supposed to do it, so I might as well record what I'm doing so the right people get the information so they can make a good decision.

Julie Soukup 07:01

So yeah, and that's, it's so funny that you say that, because, you know, even we say that all the time, it's, you're doing this information, you're giving this information no matter what, just record it so that they can have that reference. And so it sounds like, even for you, you're not recording this whole visit or anything along those lines. It's really just this, like, maybe two to four minute snippet of kind of what they can expect upon leaving the hospital and in the next few days,

Dr. Andy Little 07:27

yeah, and it's one where I've gotten to see some people in, you know, we call bounce backs, you know, back within 72 hours. And and have gotten to see that patient come back and they're like, hey, I really appreciate the message. It empowered them to know that, no, we need to come back to the emergency department. And then I've seen a couple then I've seen a couple where they'll come back months later with a different family member, and they'll be I walk in the room and they're like, Hey, Dr littler, and I'm like, I don't remember you, but I appreciate that you enjoyed our visit. And they'll say, hey, I really appreciated your visit because we had some concerns. But what you put in the in the message helped us not come back, because we knew that, like, everything was okay and and in there, I have usually the frank conversation your pain might not get better in the next 24 hours. And I also set some expectations of their disease process, knowing that you know, if you have the flu, you're going to feel kind of terrible for three or four days. So it's okay to feel terrible for three or four days. And I think people just they want reassurance for either side of the coin, whether it's reassurance to come back, or reassurance that to stay the course with their with their disease process, knowing that they just don't know.

Julie Soukup 08:25

So yeah, and I think that you really you know, especially our initial conversation and just how you said it, now it does shift that thinking a little bit, especially, you know, we're so focused on preventing readmission, preventing readmissions, and doing everything to prevent it, and that kind of becomes like, Oh, these are the tools, or this recording is a tool to be able to prevent that, and for a lot of patients, okay, now I do know I'm supposed to be in pain. Okay, it is supposed to be a couple days. I'm watching that video again. You said four to eight hours. It's only been 24 you know, I know that it, this is the course that, like, my body has to go to but I think what you said also was really profound in that these are the reasons to come back in, and so that you can also say, Hey, I feel empowered, not like a nuisance, not like it's a problem, but empowered that if these things that you said in these videos, that that is a reason to come back in, and so that they're coming back in truly for kind of the right Reasons, and not just fear or lack of understanding.

Dr. Andy Little 09:22

Yeah. And I find that, again, having the audio recording makes a difference. Because, you know, when I talk to colleagues there, they all say, Well, that's what, that's what the printed discharge instructions are for, and now it's the that's what the electronic discharge or for, because patients get on the phone and and we have a stack of where I trained, we don't, we don't use blue paper here, but where I did residency and worked initially, we gave all of our discharge instruction papers in blue, and we just had, like a recycling bin outside that was all of the blue discharge papers, because patients leave the emergency department and treat it kind of like the takeout receipt. They just throw it in the trash can. And so it's the I'm not providing them with a service by printing them discharge instructions, but if I can give them a little audio recording, so. Or the right patient, it makes a big difference.

Julie Soukup 10:02

Yeah, absolutely. So let's talk about a little bit about your study that you did with the results that that you said were a little bit interesting, and I believe it was kind of the provider correct me. If I'm wrong, provider perspective on being recorded during and during the emergency or in in the emergency, it's really it's focused on the provider perspective as it relates to whether patients have the rights or not, or whether this should or shouldn't be happening. Go ahead and share if you have them. I might even have the numbers too, if you're not right off of of what you really learned in that study.

Dr. Andy Little 10:36

Yeah. So again, it was a small study. It was done at our hospital through Ohio Health Doctor's Hospital, 57 people, which again, might sound small, but compared to other studies that have been done with this particular question, was about the right size. Again, doctors, nurses and em residents, and really focused on a couple different phases of care. So one, it was the overall question, have you been recorded? Or no, end to been recorded. And surprisingly, I think people forget that now, in the age of cell phones and technology, I know that yesterday, I was recorded four or five times because people people had their phones out, whether I was doing a procedure or whether I was talking without really my initiating, that I got recorded. And so we know people are recording, so a lot of people didn't think they were being recorded. So that was interesting to again, to get that perspective of, well, people assume I'm not being recorded, but I know that's not the case. And then the second part was, when would you want to be recorded? And we asked, Would it be during the initial evaluation, during discharge, during result conversations, or during the physical exam? And across the board, people just didn't want to be recorded. And again, when we looked at the reasons why, the biggest ones were related to risk for malpractice, privacy, and then overall, just again, the uneasiness of being recorded. But at the same time, people agreed that people had the right to do that. And so it was really interesting to where, as much as people didn't want this to happen in any phase of the care and didn't think patients were going to do it. Most people believe that people had a right to do that. And so I think it's where we have these kind of competing interests with these results, which is why it's interesting, because it's the people realize that people have a right to record this because it's their medical visit, it's their health record. But I also don't want them to do it because I'm concerned. You know, I might say something wrong, something I might say, might be taken the wrong way, and they could lead to litigation, right? And

Julie Soukup 12:25

so that was what I thought was also interesting too, because I think you had like 35% of patients, or providers agreed that patients had that right. And it's so funny, because that actually aligns with this study that was done in Jamf that was like 35 36% of patients secretly record, like without the provider renewing it. So that was a totally different study that was taken, but it's interesting that that number was the same of the people that felt that they had that right, or patients had that right, well, that's the same amount of people that secretly record, but you also had that 56% said that video or recording should be provided. But then you go into the counter side of that of of, you know, the 6062, or 63% were worried about medical, you know, legal liability. So it is, it's it's it. That is one of the biggest reasons, I think, even too for for medical memory, that we started really pushing this and promoting this wasn't necessarily to kind of catch any provider in the act of doing something wrong, but was more so seeing, hey, this is something that that is really needed taken away from a patient, feeling like they have to be sneaky or catch something. Just want more of the information and put it into the hands of the provider, and saying, we're going to give this to you because, you know, over 50% of our providers feel like this should be provided. Now, let me ask you this question, how long have you been recording your discharge instructions?

Dr. Andy Little 13:50

This will be, I started in 2017 so this we're going to eight years. Yeah, so a year out of residency, somebody posed it to me as, again, that's when I went to that conference, and I was like, this, this makes sense. And again, like, I don't do it for everybody, so yesterday I saw a large number of patients did it for four or five because, you know, you kind of get the feel that, you know, I don't know this is a patient I'm worried doesn't understand what's going on. You know, it's a new it's a new diagnosis. But people with established problems, who have established follow up, maybe I don't do it as often. And there's definitely like a feeling of like I don't feel because even there's someone who doesn't, I don't feel comfortable doing this for everybody. Yeah, but I do see a vein where it's the I know that when I see somebody for abdominal pain and their workup is negative, which means all their tests show no acute abnormalities, which includes imaging, blood work, they respond well to medication. I know that I'm going to have the same conversation with that person basically every time, with some nuances and resources, available medications I want to send them home with, and then what I want them to come back for. And so why shouldn't I build a standard way? And I do. I have a standard way I talk about abdominal pain. I have a standard way I talk about chest pain. I have a standard way I talk about pediatric fever. Yeah, and so that's where, if it's a conversation that I know I'm very comfortable with, and I feel like the patients are the right ones, I offer to them, and it's and sometimes I offer it and they're like, No, we understand. We appreciate it, we you know. Or I say, Hey, can I record it? And there's like a sigh of relief, because they know that I'm about to have this conversation that probably is above their healthcare knowledge level, whether even though I'm going to speak down to them, or speak at a level that I think is appropriate, but then it's something that they can go back to later and feel comforted knowing they have the right information. So,

Julie Soukup 15:28

yeah, so, and it's interesting that you say that, because for many of our doctors, actually specifically in the ER, and you just said, this is a lot of times when you're coming into the ER for for one reason, you're leaving with the same reason you kind of came in, everything's good, you know. And kind of, that's the goal. Like, you don't want a gallbladder surgery or appendix out or something like that. I mean, you kind of want to leave with the same thing that you came in knowing, Fear not. It's not a big thing. And so a lot of those, I think there was, like, you know, one of our physicians that has a bunch of different emergency clinics started creating, like, a lot of the same videos that you're making, of the same information that you provide over and over and over again, and pre recording that content that goes over all risks and benefits and alternatives. So that way, each you know, you know what's in that video, you know what's been covered. You can even have a little caveat of, like, this is only part of the conversation that we've had, but it's still providing that video which has more robust information than just kind of recording. So it's interesting. You say that you're like, there's some I know, and it's just like, I just spew it. Where we've worked with some providers in the ER that that saw that, like, let's at least pre record some of these to provide that that content and to potentially take a little bit of that unknown risk of what I might say, what might happen, away, because they know what's in the video, and they know it has, like a disclosure of, this is only part of your conversation, and please refer to your

Dr. Andy Little 16:53

you know, like, probably should. I probably should make my own disclosure at the end. Like, this was recorded by Dr Andrew Little. This was done over the phone. It might not be perfect, yeah, I got to come upon a disclosure now thinking about

Julie Soukup 17:04

so you've been so you've been recording for eight years now. Now, have you ever had any legal issues that have evolved from recording?

Dr. Andy Little 17:14

No, and I think that's, I think that's the take home for me, is, is that, you know, I never want to take a small sample size and apply it to a larger base. But I have, I have done this for patients who, some would say are high risk returns, right? So people who come in with undifferentiated symptoms, who leave, and they still leave with a large list of concerning medical problems that could lead to their return. And it's again, knock on wood, haven't had it. Haven't had a poor outcome. And if anything, for the ones I've actually gotten feedback from, it's it's been universally positive again, because, you know, we've all been, if you haven't been that patient who doesn't understand what their care was, or you haven't had, you know, your grandmother, go to the doctor and you weren't able to be there, and then you wonder what happened in the visit, and then, oh, man, I called her the next day, and she doesn't feel better. What would the doctor want to happen? And the patient doesn't remember, and the person that went with them doesn't remember, like you kind of feel isolated and like you don't have the information possible. And so this is the this, I think, is a bridge for that, whether it's you do it on their phone, you have a set of discharge instructions that you already have recorded. It's just going to empower patients again to make the right decision, whether it's to come back for the right reasons, or whether it's to stay home and ride out the course of their disease or fall put their family doctor. And it's just going to make them feel empowered to understand what's going

Julie Soukup 18:35

on. Yeah, well, and similarly, you know, on a much bigger scale, you know, we've recorded 170,000 videos, if you can believe it. Now, mostly they are into clinic, orthopedic inpatient care, some discharge, you know, there's a little bit of a mix of everything. And with that, we've actually only had two legal cases where medical memory was actually used to help support the provider, because Similarly, similarly, they were saying, we've done everything we can to make sure that you understand all of this information, and I'll and now it's kind of up to you. I think one was like, Don't smoke within 48 like, whatever it was something one was smoking, and it clearly he has said that was a risk, and then the patient, you know, didn't do it, didn't follow it, and then all of a sudden, and I and it feels like, you know, when we've we've partnered with some malpractice insurers that actually say, No, it mitigates risk, you know. And we can give that opinion all day. It still is there something, you know, that providers, it makes them nervous. You know, we've had insurance companies say that, hey, we'll provide an additional writer, like, an additional amount of coverage. If you record that, it takes the way that he said, she said, But to what you just said is, at the end of the day, is the patients that tend to like Sue or get mad are the ones that are confused. They don't understand. And something happened. And so that was where, you know, the legal advice that we've been provided time and time and time again, with studies of showing that this is in benefit to it is all in alignment with unless you're recording yourself doing something, you know, there is that takes away that he said, she said, benefit the doubt. I'm doing everything I can to best educate this person and make sure that they are also reassured with what they should be doing and having the tools to share that video with whoever might also be invested in their care. Yeah, and I

Dr. Andy Little 20:30

think it's one of those when I when people ask me about it, I have coworkers asking, Why do I do it? It all comes down to, you're never going to do Sorry. You're never going to get in trouble for doing the right thing and leaving your patient better educated about their visit is never the wrong thing. And so that's kind of how I feel about it again. I don't do it with everybody, but when I do do it, I feel reassured that these are patients that I want to empower to be educated about their care, and I've never had that lead to a poor outcome. Yeah,

Julie Soukup 20:55

yeah. So if you are going to give it any advice, then to a new physician who's like, I'm thinking about using this. I know this is kind of like, just as you said, 35 Well, I said that with this jam article. But like, it said, 35% of patients secretly record which, which is then, like, they're recording anything, right? You know, what would what would you say to providers that are thinking about using it, even just to control that recording? Like, have you ever had someone where you're like, I'm gonna record this? They're like, okay. They're like, okay. They're like, turn off their phone. Like, now I know, but, but then you can decide when it's what, when and how that's recorded, versus versus the other. You know, yes, I was twofold question, but yeah, well,

Dr. Andy Little 21:33

I think the answer the first part is, I've had patients when I said, Hey, do you I would like to record these our conversation about discharge, they've hung up with the family member that was secretly on the phone. They're like, hey, the doctor's going to talk to me, like, and I didn't know they were on the phone with them, because their phone's on the table. They're like, hey, the doc's going to record something for me. I'll call you back, and they'll hang up the phone. And so I've been able to control my audience to where it's with the patient. And then also, I think the other big thing is, is that you are already having this conversation where you should be giving medically accurate information, you should be acting in the best interest of the patients, and you shouldn't be saying things that are inappropriate. So you should be reassured that anything that you say could be recorded and would only benefit the patient. And so try it out on a couple people. So pick patients that you know. Well, if you're if you're in primary, if you if you have your own practice and it's established. Or pick patients that are, I don't know, maybe more low risk. So pediatric fevers. We know that most people with pediatric fevers do really well. Record that video just to reassure mom and dad. Pick people who you know, young abdominal pains, typically low risk for Fallout, for for bad outcomes to come back. Pick those ones. So pick people with lower risk diagnosis that get discharged to begin with, to get comfortable recording that and kind of building a cadence of, yeah, I do have the same conversation every time, yeah, I should feel comfortable again giving it to the patient so they're empowered, and they don't have to rely on the paper or digital discharge instructions. They're not going to read

Julie Soukup 22:55

it, right? And that goes back to even with us, is, you know, we're showing okay? It's 170,000 you know, and it's mitigating across the board. We've done a few studies with this and and as you said it, it puts that control back. Like I've, I'm, I mean, for me, I'm not confident if I was going to a provider, and he's like, I'm not confident that I'm going to record this so that you have access to it like my just instantly would relax. And I'm sure you see that wave come over patients. So just instantly. And that's what's interesting. We're almost concerned or worried about something we don't know about. Of, oh my what if? What if? What if? But study after study is starting to show it mitigates risk, it improves patient experience. So take take control of it. And so I love that you're doing it with your phone. You know, I'm still on you, and we'll try to convince you to to use it with medical memory, because then both you and the patient get a copy of the video. It's not just like in ether, you know, and I think that's one of the big things for a lot of providers, is they control that video. And so even for providers that have recorded patient gets a copy of it. They actually have a very simple medium to share it in a web portal. But also the provider can turn off the they can turn it off. So if they recorded something and they're like, Oh, that was not, like, that was a weird interaction, as they say, I or anything like that, they're in full control of it. So you're still getting this benefit of educating the patient. They know what's going on. You know, you're controlling the recording, controlling the ball, but really, like, you can turn on, you know that access and so it kind of gives a little bit more support. But I love what you what you said, you know, throughout this of like, you know, it's really empowering them and reassuring them and using this tool to do so, yeah,

Dr. Andy Little 24:31

yeah. Again, it's one of those where I want, I want my patients to leave happier that they were seeing, with less symptoms than what they came in, so in less pain, less other stuff going on, and then I want them to leave more educated. And so this, this like, leads to that baseline understanding of one of my missions as a physician, and someone who works in emergency medicine, is to calm people's nerves and to educate them about their future. So it just this. This is something that no a lot of people, again, feel worried about, but trust me, it helps. So. Cool,

Julie Soukup 25:00

awesome. Well, I so appreciate your passion about this. It was funny that I was like, people don't think this. Like, let me get you on on a podcast, because we gotta talk about it. So I so appreciate your passion, your conviction, especially, you know, it makes so much sense you wanted to be a firefighter, and that you're carrying that, like, servant heart of leadership, kind of into er medicine that you have done. So I appreciate you, and I'm sure your patience too, and thank you so much for kind of talking about it. Is there anything kind of Lassie you want to add at all?

Dr. Andy Little 25:29

No, this has been great. Julie, I appreciate you guys reaching out again this, if you're listening, this is the power of the Internet to where you can google something, find somebody interesting, and have an awesome conversation. So thanks

Julie Soukup 25:39

for having me right. Absolutely. Thank you so much. And cut thank you for joining us on this episode of take one patient. We hope you have a nugget or two you can implement into your practice with your patients today. For more information about recording your visits with the HIPAA compliant app, go to www dot the medicalmemory.com or you can follow me on Instagram at Julie recording doctors. Thanks again. You.