DHC:   Forbes   said   recently   that   less  than   half   of   physicians   encourage  their   children   to   also   become  doctors.     What   would   you   tell   a  college   undergrad   today  considering  medical  school?    It  is  an  excellent  question.  I  do  find  my  professional  life  to  be  rewarding  and  I  truly  enjoy  what  I  do  for  a  living.  I  love  working   with   the   staff   and   the  excitement   of   my   particular   specialty  (interventional  cardiology).  I  still  have  the   opportunity   to   work   as   a   team  almost   every   day   and   that   has   always  been  my  strong  suit.        

“Treating  patients  who  are  actively  having  heart  attacks,  and  being  timed  by  the  state  while  I  do  it,  still  thrills  me  and  the  feeling  of  performing  a  truly  life-­‐saving  procedure  never  gets  old.  That  said,  there  is  a  very  scary  imbalance  that  has  now  reached  a  critical  tipping  point  

in  this  country.  “      The   average   medical   school   graduate  will   leave   school   with   >$150,000   in  student   loans!   And   while   inflation  rises,   and   healthcare   executives  salaries   do   the   same,   the   income   for  the   primary   care   specialties   has  remained  flat  and  is  now  an  untenable  economic   prospect   for   graduating  MDs.   Beyond   that,   there   have   been  numerous   stories   in   the   lay  press   and  journals   of   late,   describing   the  increasingly   common   sentiment   of  physician   fatigue.   My   colleagues   are  tired   of   working   such   long,   stressful  hours  for  moderate  pay  and  maximum  risk.  We   deal   with   frustrated   patients  and   families   going   through   some   of  their   worst   times   and   often   bare   the  brunt   of   their   sadness.   Nurses,   too   -­‐  and  maybe  even  more  so  -­‐  face  similar  challenges.   The   cost   of   medical  education   should   be   examined   and  potentially   subsidized   to   encourage  graduating   doctors   to   consider   less  lucrative   -­‐   but   certainly   not   less  important  specialties.        

An  Interview  with    Dr.  Jordan  Safirstein  

 After  Dr.  Safirstein  appeared  at  a  recent  DHC  Summit  to  provide  attendees  with  his  perspective  on  EHRs,  the  DHC  sought  him  out  in  order  to  dig  a  little  deeper  into  his  experiences  in  the  field,  especially  as  it  relates  to  digital  health  communication.    We  are  grateful  that  Dr.  Safirstein  was  willing  to  share  his  time  and  thoughts  with  us,  and  trust  that  readers  will  find  this  interview  both  instructive  and  thought-­‐provoking.    

 

DHC:   How   are   you   using   social  media   as   it   relates   to   your  professional  life?    I   love   Twitter   @CardiacConsult  because   I   am   able   to   cull   what   I   like  and  pick  out  the  stuff  that's  interesting  and   relevant   to   me.   I   also   share  interesting   findings   with   colleagues.  My   group   has   a   Facebook   page  which  is  probably  not  utilized  enough  by  me  but  does  provide  a  wonderful  medium  for  sharing  interesting  and  educational  articles   and   advice.   My   fellows   at  Morristown   Medical   Center   have   an  Instagram   account   (@CardioPix)  where   they   share   interesting   and   of  course,  de-­‐identified,  cardiac  images.  

 DHC:  With   the   continued   evolution  of  the  empowered  patient,  is  there  a  “typical   patient”   anymore?     How  would  you  describe   that  patient,   or  alternatively,  the  major  groups?    There   really   is   no   "typical"   patient  unless   you   are   talking   about   specific  maladies  that  are  unique  to  one  group.  If  we  are  generalizing,  age   is  probably  the   easiest   way   to   separate   large  groups   of   patients   and   their   behavior  patterns.   Education   level   and  socioeconomic   status   also   makes   a  large   difference   in   how   patients  engage   with   their   physicians,   i.e.  wealthier,   educated   patients   seem     to  challenge   and  discuss   their   conditions  more   readily.     This   upcoming  generation   of   patients,   who   are   living  on   their   smartphones   will   be   more  inclined   to   accept   more   progressive  management   strategies,   like  telemedicine.   It   is   probably   not   too  

dissimilar   to   the   banking   industry.  Those   of   us  who   grew  up   and   trusted  the   Internet   had   no   problem   making  our   lives   easier   by   making   our  transactions   online   -­‐  while   those  who  were   not   as   familiar   felt   more  comfortable   cashing   their   checks   in    person.      “Adoption  of  remote  monitoring  

and  telemedicine  will  be  a  necessity  as  cost  of  inpatient  

care  and  readmissions  continues  to  rise.”  

                 DHC:   Are   you   seeing   patients  integrating   wearable   devices   into  their  lives/healthcare?  If  you  are,  do  you  think  it’s  helping?    Yes.   And   sort   of.   It's   always   better   to  have  an   idea  of  your  activity   level  and  probably   if   you   looked   at   those  patients,   they   would   be   healthier  overall   since   they   care   about   their  health  enough  to  purchase  a  device  but  the   data   that's   achieved   is   more   of   a  suggestion   than   a   fact,   in  my   opinion.  Is  it  good  to  know  how  many  steps  you  take   and   how  many   hours   you   sleep?  Sure.    

 “But  there  is  a  next  level  to  

wearables,  or  implantables,  that  

will  be  more  "medical"  and  hopefully  provide  us  real  data  and  numbers  that  we  can  use  to  

actually  adjust  and  tailor  medical  therapy  in  a  much  more  

accurate,  real-­‐time  way.”                                    

   DHC:   Do   you   currently   use   an   EHR  system?   If   so   –   what   do   you   love?  What  do  you  hate?    EPIC  is  my  EHR.  I'm  about  4  months  in.  I  love  parts  of  it:  

• Easy  to  send  my  findings  to  other  MDs  • Easy  to  renew  meds  and  order  tests  • Love  having  other  MDs  notes  available  to  me  IF  they  are  also  using  EPIC  

• Easy  to  submit  for  billing  purposes  • Clear  and  easy  to  read    I  dislike:  

• So   convoluted   with   TOO   MANY  buttons   and   tabs   and   unnecessary  options  -­‐  Keep  It  Simple  

• Too   many   warnings   and   alerts   and  alarms   that   are  all   basically  worthless  and  99%  ignored  #AlarmFatigue  

• I  hate  looking  away  from  the  patient  to  type  and  Dragon  stinks  no  matter  how  much  they  tell  you  it  doesn’t.  

• In   my   case,   I   still   have   to   go   into  separate   programs   to   pull   in   my  imaging   and   other   important  documents  -­‐  not  integrated    DHC:       You’ve   said   before   that   you  don’t   really   like   passing   out  [pharmaceutical]   coupons   to  patients.    What   sort   of   information  do  you  like  to  have  ready  to  share?    These  days,  I  believe  we  have  to  guide  our   patients   towards   tools   and  information   that  will   benefit   them   for  the  long  term.      “I  find  myself  recommending  apps  fairly  often  as  it  enables  

patients  to  empower  themselves  to  be  more  engaged  in  their  own  healthcare,  rather  than  being  completely  dependent  on  the  doctor  and  his/her  office.“  

 AliveCor,   an   attachment   for  smartphones   that   interprets   cardiac  rhythm   is   one   of   those   interventions.  While   patients   used   to   have   to  schedule   an   emergency   office   visit   or  go  to  the  ER,  they  can  now  take  control  of   their   own   cardiac   rhythm  management   by   having   their   phone  make   the   diagnosis.   Apps   that   count  calories,   track  steps,   log  BP  and  finger  stick  readings  are  all  helpful  additions  to   every   cardiac   patient's  

Dr.  Jordan  Safirstein    

Director,  Transradial  Intervention  at  Morristown  Medical  Center  

 Healthcare  Advisory  Board  Member,  Google  Ad  Board  

armamentarium.   I   believe   with   the  advent   of   such   technology,   there  should   be   an   app   that   correlates   and  distributes   e-­‐coupons   -­‐   like   a  RetailMeNot  for  drug  discounts.  

 DHC:   What   materials/aids/content  that   you   aren’t   getting   now   could  pharmaceutical   companies   provide  you  to  help  better  educate  patients?    Doctors   are   flush   with   resources   for  education   these   days.   We   have  UpToDate,   innumerable   apps,   our  larger   academic   bodies   and   their  support  tools.  But,  I  suppose  this  is  the  eternal   question,   but   I   think   its   a  question  that's  been  asked  for  the  past  50   years   in   pharma   marketing   and  maybe   its   time   to   ask   a   different  question:    

 “What  can  pharma  do  for  the  patient  WITHOUT  needing  the  doctor?  They  already  market  directly  to  patients,  so  why  do  they  need  the  MDs  to  get  their  

point  across?”    Most   of   these   companies   have  abundant   resources   to   come   up   with  interventions  with  newer  tech  that  can  completely  obviate  the  need  for  doctor  participation.   If   something   is   effective  and  helpful,   no  one   really   cares   about  the  branding,  in  my  opinion  -­‐  the  key  is  to   find   out  what   patients   need   in   that  space.    DHC:   The   DHC   is   working   to   help  pharmaceutical   marketers   better  understand  the  linkage  between    

well-­‐executed   physician  communication   and   patient  behavior.     What   would   you   want  them   to   understand   about   how   to  the  two  are  related?     A   good   doctor   talks   to   patients   in   a  way   that   they  will  understand.  Not  all  patients   respond   to   the   same  discussion   in   the   same   way.   All  patients  deal  with  unique   issues,   even  as   they   pertain   to   the   same   disease.  There   is   no   way   to   successfully  generalize   a   message   to   all   patients   -­‐  allow   them   to   express   their   concerns  and  treat  them  accordingly.    

Meet  Dr.  Safirstein  Online:  LinkedIN:  

https://www.linkedin.com/in/jsafirstein    

Twitter:  https://twitter.com/cardiacconsult  

 Connect  with  the  DHC:  

LinkedIN:  https://www.linkedin.com/company/digital-­‐health-­‐coalition    

Twitter:  https://twitter.com/digitalhealthco  

 www.digitalhealthcoalition.org