Reflections on Medicine and Technology: Challenges and Accomplishments

Having an extensive experience in the field how would you describe the development of healthcare to this day?

Fast, furious, and unexpected!

My father, who graduated from medical school in 1942, trained in a time before the discovery of antibiotics. He once shared with me a fascinating tidbit about the treatment of syphilis during that era. Soldiers with syphilis would receive injections of mercury in their buttocks, and the resulting x-rays would appear illuminated. It is incredible to think about the unconventional methods used in the past before the development of modern medicine.

As a medical professional who attended school prior to the internet age, my children can hardly fathom how I managed to complete my studies without this ubiquitous tool. Back then, I relied on traditional methods of learning such as reading textbooks and journals, visiting libraries, and scouring old charts in medical records. These records were often stored in dark and dusty basements, and I had to dig through them to find old operation notes before assisting surgeons. In contrast, present-day medical students can simply pull out their phones and quickly search for information in seconds. It is amazing how technology has revolutionized medical education and practice.

I often joke with my children that their offspring will be amazed to learn that their parents actually had to touch patients in order to diagnose and treat them. However, to be fair, I do not really know what their children will think or say because the field of healthcare is constantly evolving. It is possible that a new and groundbreaking technology or approach will emerge that is beyond the scope of our current imaginations. The future of healthcare is an exciting and dynamic landscape that is always pushing the boundaries of what is possible.

The digital age is quickly revolutionizing medical practice management, and there are numerous innovations and growing trends already having a significant impact on streamlining practice workflow and boosting efficiency. Can you discuss what are some of the new trends that are helping you in the industry?

As a healthcare provider, there are many factors that come into play during a patient encounter. Beyond the traditional physical exam and patient history, I also have to navigate the world of electronic health records (EHRs) and constantly think about the role of technology in healthcare. This includes using tools like voice recognition and artificial intelligence (AI) to streamline documentation, as well as incorporating evidence-based medicine into our workflows. It can be a challenge to balance the benefits of technology with the potential cognitive overload it can cause for providers. At the end of the day, my priority is always to provide the best possible care and improve patient outcomes, and that requires careful consideration of how to integrate technology in a way that is efficient, effective, and user-friendly.

When it comes to virtual visits and remote patient monitoring, there are a lot of considerations that come into play. I am always thinking about what tools and technologies we can leverage to provide safe and effective care without the need for face-to-face interactions. One key aspect of this is remote monitoring, which can include tools like wearable devices that can track a patient's heart rate, oxygen saturation levels, and other key metrics. When I can see this data in real time during a virtual visit, it can be a huge help in providing reassurance to my patients and making informed decisions about their care.

As a healthcare provider, administrative tasks like refilling prescriptions and reviewing results can be overwhelming. Some medical groups have used dedicated refill centers to streamline this process, freeing providers to focus on more complex patient care. Finding innovative ways to reduce the administrative burden could help providers work to the top of their license.

I am concerned about the younger generation's reluctance to pursue primary care. To create a new golden age of medicine, we need to restore the joy to healthcare. This joy comes from personal interactions, comforting patients, and solving diagnostic puzzles. Can we use technology, like digital tools and AI, to eliminate pain points and make primary care more enjoyable?

“The future of healthcare is an exciting and dynamic landscape that is always pushing the boundaries of what is possible.”

As far as the pain of documentation, we really need as an industry to step back. In the past, physicians documented patient information on simple index cards that conveyed essential details, such as the diagnosis and prescription. Today's records, however, are filled with extraneous coding and compliance verbiage that buries the useful information. Despite new coding guidelines that suggest eliminating the review of systems, physicians still include it in their notes, fearing potential compliance issues. Moreover, physicians incorporate all available lab and imaging data, even if it does not justify their coding. To simplify documentation, we should return to the basics and focus on documenting the patient narrative and medical decision-making. We should let computers handle the rest and use the audit trail to track actions taken. By streamlining documentation, we can better manage patients' history, medication list, and problem list without creating bloated notes.

Can you discuss what are some of the major challenges that the healthcare industry is facing nowadays?

The challenges facing the healthcare industry are multi-faceted. Our population is aging, leading to increasingly complex medical issues, while fewer individuals are pursuing careers in primary care due to factors such as onerous call schedules. Additionally, there has been a shift in the perception of physicians, with many no longer being held in high regard. The path to becoming a physician involves substantial debt and personal sacrifices, including missed social events and delayed career starts, only to face criticism from patients who rely on Google to diagnose their symptoms. These challenges are a reality that must be addressed as we work towards improving the healthcare system.

Despite the challenges faced by the medical profession, I am heartened by the fact that my daughters have chosen to pursue careers in medicine. My oldest daughter is working towards a PhD in biomedical engineering and is married to a radiation oncologist, while my middle daughter is completing her orthopedic residency and will soon begin a foot and ankle fellowship. Meanwhile, my youngest daughter is wrapping up her internal medicine residency and preparing to start a pulmonary-critical care fellowship. I am proud that they have recognized the rewards that come with a career in medicine, despite the sacrifices that may be required along the way.

In today's age of technology, the amount of information available to us is vast and ever-increasing. In the past, although it was a lot, one could learn a set amount of knowledge from textbooks. Now there are over 2 million scientific articles published every year, with the number likely to increase to 3 million by the time you read this. With so much information available, it is impossible to keep up with all of it, making it challenging to determine which articles are relevant and which ones may contain falsified data. The questions we seek answers to remain constant, but the answers themselves are ever-changing.

What can we do about prior authorizations? The cost of novel medications? While the use of AI to develop targeted cancer treatments is a remarkable achievement, it is marred by the reality that some patients cannot afford these drugs due to the exorbitant costs.

Can you give us a brief background about your roles in the organizations you have worked for? How does the experience augment your role and responsibility at your current organization?

I practiced family medicine for 21 years at Sutter Health, where I had a busy cradle-to-grave practice. During that time, I also took on various leadership roles, such as serving on the medical group's Board of Directors, the Foundation Board, and ultimately serving as its chair. Additionally, I was the chair of the family medicine department and later became Chief of Staff at Memorial Hospital in Modesto, CA. I was also a member and later served as the president of the Stanislaus Medical Society. In 2000, our group implemented Epic, and despite not considering myself tech-savvy, I became a local Epic Champion and eventually a regional Epic Lead for Sutter Health. In 2011, I returned to Los Angeles and took on the role of Medical Director of Ambulatory Implementations at Cedars-Sinai. Over the years, I have also served on various committees, such as the physicians committee for HIMSS and committees with AMIA.

As an ending note, what is your advice for other senior leaders and CXOs working in the healthcare industry space?

Brace yourself for the ride!