Hi, this is Nick Webb and welcome back to the final of my five quick videos on fixing healthcare by reestablishing the amazing relationship between a caregiver, a doctor and a patient. That relationship has to be reestablished before we can fix healthcare. Yes, we have technologies. Yes, we have the economic aspects. Yes, we have all of these other complex variables, but without that essence that that relationship between the doctor and the patient, we're never going to be able to fix healthcare. 

So in this series, I talked about four things that have to happen immediately. Number one, I talked about time, you know, believe it or not, there are there are consultants that are crawling around the country, providing consulting services that we call patient movement analysis. Or patient throughput analysis and optimization. And these are fancy consulting terms, meaning how many patients can we shove on this conveyor belt and get them through your clinic so you can make the most money that's actually happening. So we have to give caregivers time, we have to give them time. patients want to talk to their doctor, they have questions, they have concerns, this is their life. This is their health. And doctors want to know their patients, not as a biological node that they transact by providing prescriptions. They want to know their patients from a perspective of ethnography. How do they live? What is their current mental state? What are the stressors? What's their economic situation? What are some of the things that is impacting this human in their journey here in life that is ultimately resulting in the causality of disease and illness? Because if we don't understand that we can't really have the essence of what we need for prevention. So we need to have time. We need to buy back time for patients and doctors. We have to bring back the time. Nobody talks about this. But you can't have a thoughtful, meaningful relationship. In a minute and a half or two minutes. You're overweight, you're hypertensive. Here's your prescription. Thanks for coming. 10,000 of those are happening right now, across the country as we speak. And it's not the doctors fault. The doctor is disincentivized to spend time with the patient. The doctor is economically disincentivized for prevention. But ironically, many caregivers are incentivized to do surgery on that patient or to do a treatment on that patient. And they're incentivized just to write script just to get them out. Because they have to comply with patient throughput. It's horrible. It's horrible, but it's real. Got to get patients and doctors time again. 

The other thing that we need to do is we need to get far better data. And in order to get better data, we're going to be using continuous patient monitoring. sounds scary. I know most people think it's Orwellian. But the truth of the matter is, it will have an amazing impact keeping people happy and healthy. And well, it really will.

The third thing we have to do is we have to give doctors two types of resources. We have to give them training resources on prevention and wellness, and to really help them understand how to use new tools to focus on wellness and prevention over gratuitous intervention. And then the other thing that we need to do in the area of resources is that we have to train them, we have to train them and we have to give them the tools, training and tools are the two resources that doctors need today. I work at one of the largest medical schools in the country. And I can tell you that, you know, historically we have not done much in the way of teaching nutrition and prevention and wellness. But luckily because of the great work of our medical school, we are actually focusing on all kinds of modalities from integrated health to prevention, wellness, anticipation, predictive analytics, new telemedicine solutions, and the list goes on and on.

Hi, this is Nick Webb and welcome back to another episode of fixing healthcare. This is video number four in my five part series on how we reestablish the important relationship between the doctor and the patient. Now in my first module, I talked about time, there is no way in the world that we can fix healthcare without giving doctors and patients more time. As I mentioned in that module, believe it or not, there are consultants traveling around the country, helping hospitals and clinics do what we now call patient throughput optimization. What is that you ask? It means shoving more patients through a clinic every day. Why is that good? doctors offices, clinics and hospital they make money seeing patients the more patients they see, the more money they make. Why is it bad? Doctors cannot have a meaningful, impactful, especially preventative dialogue with a patient without more time. So we're going to need to fix that through changing the economic incentives and the focus of these consoles. 

The second thing I talked about in my last program was the importance of data. Unfortunately, the average caregiver is data starved. They're looking in your ear with an otoscope. They're taking blood pressure, which is oftentimes falsely elevated because of the white coat syndrome. We also have problems with just fractional data from listening to the chest with an acoustic telescope, our stethoscope, so we don't really have the right instrumentation and the information we get is very cursory. It's just a moment in time so that we know that in order to ultimately fix the data starvation that we have in healthcare, we are going to have to move towards continuous patient monitoring. A lot of people are afraid of that concept, it'll be the best thing that ever happened to individuals because we're going to save, and I'm not exaggerating millions of lives by using continuous sensors to monitor all of the vitals of a person so that the artificial machine can look at those disparate data signals to find potential problems so that they can notify your doctor before becomes deadly or become before treatment options start to fall off the table, which will be even more common. In fact, one of the major common causes of a severe cardiovascular condition is death. That's the symptom. So the key is to know what's going on before you get that troubling symptom. Right. 

So in this module, I want to talk about the resources that patients and doctors need in order to be able to fix healthcare. Now, there are two hemispheres to these resources. One hemisphere is wellness and prevention tools. The other is training. So there's tools and training resources that are needed in order for us to fix healthcare. Now I work at one of the largest medical schools in the country. And I can tell you that historically, there's been very little emphasis a matter of hours of training on nutrition and prevention. And that's unfortunate because that, of course, is where the greatest opportunity is. So we're going to now today through CME programs and through new programs, like our university has the physician of the future program, we're going to bring these new tools and these wellness and preventional modalities to our students to help them leave their medical training with the knowledge to be a wellness practitioner, a health practitioner, rather than just a person that transacts interventions. We can't just transact interventions, that is a beautiful thing. So tools and training are going to be key. 

Hi, this is Nick Webb and welcome back to another episode of Fixing Healthcare. This is module number three in my five module program and we are talking about how can we improve healthcare, fix healthcare by reestablishing the competency of that amazing relationship between doctors and patients. Now, in the last module, I talked about time we need to give doctors and caregivers the time they need to be able to have for the caregiver to understand that patient at an emotive and an ethnographic level. In other words, understanding the patient beyond them as a, a set of biological data points and rather than it being a  transaction, it has to be a relationship and relationships require time. So doctors need more time with their patients because they need to understand the patients. What is their mental health issues? How can I prescribe solutions that are going to be compliant for this patient? What are the kinds of environmental and social and economic situations are occurring in this patient's life that are causing some of the manifestations of their condition? Understanding them at that level allows us to intervene not automatically through a prescription, but through an improved and permanent change in their lifestyle. 

Now, the problem is, is that there are consultants out there that are doing patient throughput analysis, that are showing hospitals and clinics how to significantly increase the amount of patients that go through the conveyor belt of a clinic. What does that ultimately mean? That means that the patients have very little time with a doctor so a patient comes to a doctor. They're 30 pounds overweight, they're hypertensive. They have a horrible lipid profile. They have other conditions, other comorbidities. And so what does the doctor do today they write him a prescription for statin drug and get them out because the conveyor belt is still moving. We need to change that. We need to give doctors instead of prescription default scenarios, we need to give them resources, wellness resources, prevention, resources and training resources to focus on keeping that patient healthy, rather than reactively treating that patient for disease. 

So we talked about time before. Today we're going to talk about data. Now, this is exciting for me, because where we are ultimately going we're going to see this over the next three to five years. The COVID-19 was very, very instrumental in weaponizing rapid innovation towards the movement of continuous patient monitoring. But before I continue, I know there's a lot of people that worry when they hear continuous patient monitoring. Isn't this part of the conspiracy, the so called surveillance economy to sell me stuff? Look, I can remember 30 years ago when they were saying that Amazon was going to be a guaranteed failure because nobody in their right mind would ever put a credit card on the internet. And guess what? It worked out for Amazon, people realized that the risk of exposing their credit card number, in contrast to the benefits of Amazon, that the benefits outweighed the risk. Right? And the risk has been extremely minimal. Same thing is true. Nobody cares about your medical condition. Nobody wants to monitor it. And we're going to use blockchain and other technologies. I know this sounds coarse, but that's the truth. We are going to be able to protect your data, no problem. 

The bigger concern is what are you going to do to protect your life? Because continuous patient monitoring can take dozens and dozens of bio signals, it can send it to an artificial machine. These are already in development. I have several patents on these technologies myself, and the learning machine can take, do the heavy lifting the grunt work, if you will, of looking at all of your vital signs, always every day.

Welcome back to my five module series on fixing healthcare specific to the doctor patient relationship. Now I put together these five videos as a compartmentalised group of videos because I really want to talk about the importance of the doctor patient relationship. This is really, really important because at the core, we need to be able to have that relationship, re-established. Now, as I mentioned in the previous video, believe it or not in America today, there are consultants roaming around the country, helping hospitals and clinics, increase patient flow. In fact, they call it 'patient flow analysis' or 'patient throughput analysis and optimization'. Now, these are consulting terms that talks in very simple terms about how can we see a whole bunch of patients really quick today, how can we shove more patients through the assembly line? That's what this is about. In fact, believe it or not, these systems are borrowing methods from McDonald's and other fast serve restaurants to figure out how we reduce time movement. How do we get them in and get them out? It's unbelievable. 

If we want to fix healthcare, we don't try to see more sick people every day. We try to give the doctor the time necessary to have a consultative human relationship with a patient. Now here's what's here's, here's why time is so important. The doctor needs to know the patient's a little more about the patient as a human, not just as a diagnostic node. So you know, what's your socio economic situation? How's your family life? What's your current state of stress? Tell me more about you. I want to know you as a person, not as a biological system that I intervene with drugs. I wanna know about you as a person. I want to know about how you live, because if I can understand that, I can do two incredible things. 

One is I can help move you towards a healthier state by encouraging you to participate in preventive modalities of care, rather than disease management. Time is irreplaceable. It's it's not possible to be clinically efficacious when we are creating assembly lines and putting through as many patients as we possibly can. So if we're going to fix healthcare, we've got to give them time. So we have to know them at a emotive level at a level of what we call ethnography, meaning understanding how they live in their communities, and what are the other cause factors that are impacting their current state of health. That's important. 

Now, the second reason why doctors need time is they need to be able to provide consultation, giving them advice about how to comply with some new tools. Now later, I'll talk about some of the tools that are going to be necessary in order to fix healthcare. But we have to give time back now this isn't talked about much. We all you know, but but most patients feel like you know, I would have liked to feel like I wasn't, you know, the guy wasn't looking at his watch the whole time. I would like to feel like this wasn't some transaction. I want to feel like they did in the old days. In my book The Healthcare Mandate I talked about Dr. Mandy Michelson from Bellevue, Iowa, and and how he would really understand his patients and his house calls. And because of that, knowing he was able to really, really positively impact his patients lives. 

We need to know the patient so that we can understand some of the causes of disease processes. We need to know them because we need to know how we can motivate them to comply to prevention and wellness, and in some cases, disease management. But again, the second reason is the doctor needs to consult with the patient. Hey, listen, here's the thing. Right now you're 35 pounds overweight, and I know it sounds hard to imagine that that weight can be lost. Now, don't get me wrong, there's pain associated with it. But I want to give you some resources I want I want you to download an app. 

You know, what I'd like to share with you today is four things that doctors and patients need if we're going to fix healthcare. Now, this is a five part series. There's this introduction to what we're going to talk about. And then I'm gonna go into these four areas in some detail. Now these four things are absolutely going to be critical if we want to fix healthcare. And really the best way to look at it is that the genesis the real core of what we need to do to fix healthcare, is to reestablish the competency of the amazing relationships that doctors have with their patients. Not just friendly relationships, but thoughtful relationships where doctors can understand their patients, not as a diagnostic node, but from the perspective of ethnography.

Understanding them at the core of who they are, how they live, what are the psychological and mental health issues? What is their economic situation? What are the other cause factors that impact their ability to comply with wellness and health, and to really do a better job of managing their diseases in the case of disease management. We really have to realize that there is four things that have to happen to reestablish the relationship between the doctor and the patient. Now, this is going to sound shocking, and some people may already know this, but to me it's really shocking is that as a management consultant that works across the entire healthcare ecosystem, I can tell you that there is a new body of work right now that is called patient throughput or patient flow. Now, believe it or not, these methodologies are actually using the systems that they use in restaurants drive through restaurants, you know, In and Out Burger, McDonald's, name your restaurant to get customers through quickly. So we're actually McDonaldizing, literally, the way in which we get patients through a clinic.

So the goal with these new systems is give the patient and the doctor the least amount of time so that we can see the most amount of patients. Now at some level, you would say, wow, that's great. We want to see lots of patients. But what it does is it creates the prescription default mechanism. You come in you got a chronic disease, the chronic disease could be solved your weight loss and through lifestyle, management but you don't have time to have that discussion. So you write a prescription. That is happening as we speak in 10s of thousands of clinics around the country. That's unfortunate. So in this series, I'm going to talk about the need to reestablish time. The old fashioned commodity of time is critical to reestablishing the relationship between the doctor and the patient. Now, here's the other problem, and it's really, really big. And again, in this five part series, I'll go into it in much more detail.

Doctors need more data. You know, oftentimes, a patient will come into a clinic and they'll look in their ear with an otoscope. They'll listen to their chest for obvious acoustic reads on hearts and respiratory functions. They'll get a blood pressure and they'll get body temperature. That's not a lot of information. And we already know that things like blood pressure is impacted by what we call the white coat syndrome where patients are nervous, their blood pressure goes up. So is it a psychological impact onto their blood pressure or is it a physiological impact? So one of the biggest problems that patients and doctors have is that during that relationship during that dialogue, there's not nearly enough data. We're going to talk in this series about how we fix that. The other issue is resources. Now resources really have two components to them. One part of the resources is tools. The other part of the resource is training. So from a tools perspective, doctors need easy to explain and deploy resources primarily in the areas of mental health, weight loss, stress, stress management, they have very few tools.