Dr. Danny Sands, Health IT Consultant and Speaker at Zev Enterprises / DrDannySands.com

Why Healthcare is Like A Carwash and What We Can Do to Change It with Dr. Danny Sands, Health IT Consultant and Speaker at Zev Enterprises / DrDannySands.com

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Welcome back once again to the Outcomes Rocket podcasts where we chat with today’s most successful and inspiring healthcare leaders. I welcome you to go to outcomesrocket.health/reviews where you could leave a rating and review for today’s episode because our guest is an outstanding individual. His name is Dr. Danny Sands. He’s an innovator and primary care physician and wears many hats in the field of medicine. He’s contributed in many ways very well-known for being the board chair co-founder and past president for the society of participatory medicine. We’re going to dive into some of that in the podcast. He’s a senior partner in SP consulting is a primary care physician as I mentioned and he’s served as advisor and faculty and chief medical officer at various startups as well as various well known health care companies. And so what I want to do is welcome you Dr. Sands to the podcast.

Danny Sands: [00:01:20] Thank you. It’s good to be here Saul.

Saul Marquez: [00:01:21] It’s a pleasure to have you on and anything that I missed in your intro that you want to add there.

Danny Sands: [00:01:26] No I think that’s pretty good. People can obviously read more about me online. We don’t have to spend time on the podcast talking about that.

Saul Marquez: [00:01:32] Awesome. Sounds great. I always like the kick off the show Danny with the Y. And so I ask all my guests why did you get into health care because it’s the genesis of the fire. So what was it for you that got you in the medicine.

Danny Sands: [00:01:44] It’s a good question. Saul so I don’t have any doctors in my family. I was certainly always interested in math and science but also a lot of other things I did get exposed to healthcare as a kid really as a student in high school through a dear friend of the family who is the chief of neurology at the Cleveland Clinic. Oh he was kind enough to not only show me around the hospital and this is the Cleveland Clinic show me around the hospital teach me things about how neurology was practiced but then as I got a little older he actually let me go on rounds with him all along with his retinue of students and residents and that was just fascinating. Give me a white coat and it was kind of like I was very the corner of the team and he asked me like he would go around and ask his resident fellows questions and sometimes he turned to me and asked me a question particularly one that they wouldn’t answer or they couldn’t answer. And I didn’t know anything of course but the expectations were low and it was just really interesting to be forced to think like that. Wow. When I eventually went to college I was on the fence between choosing medicine or because I have worked in technology. I was also interested in the field of engineering called operations research and I was also interested in law. Believe it or not really. Yeah it took me about a year or so to figure it out and I decided that I didn’t like those huge books that the law people had to read a lot and I didn’t like the very strange people I’d have to hang out with if I studied advanced mathematics and stuff in that engineering space. And the strange thing happened which was for reasons I still don’t understand. To this day my freshman Hall despite the fact that I wasn’t even premed my freshman Hall whenever somebody got sick they came to me. So they’re saying that.

Saul Marquez: [00:03:27] That’s crazy. It’s a sign it’s a calling.

Danny Sands: [00:03:29] That’s what I figured I think you know. Well I ruled out the other two things in this health care stuff was pretty cool. And that’s really what drove me into that. But as you know because you’ve read my bio I did health care but I was frustrated as I was in health care that we weren’t taking advantage of information technology.

Saul Marquez: [00:03:46] Yes.

Danny Sands: [00:03:46] And honestly it was like this alternate world where it was an information technology free zone. So like in training I’d have attending physicians who would be asking the medical students the residents say they would say for example Mrs. Smith got admitted with hyper Kaliati hour or high potassium. What was her potassium when she came in and they’d be asked to recall what her potassium was when she came in. And then they say all right what was it a week ago when she was at home and they had asked to recollect this and it was like this recalling information or another example Mrs. Jones was admitted last night after having fainted she had syncope is what we call it. Right. And I’d like you to name 10 of the 50 known causes of syncope. And you know it was just this ridiculous recall and you know we had to prescribe drugs and keep track of drug interactions. And I knew that information technology was going to improve the way we provided care for patients. And so I sought out training in that area I really wanted to make a difference there. Good for you. Why did training in clinical informatics and that really was an important change in my life.

Saul Marquez: [00:04:55] Wow. And so you saw it coming. You knew that it was a way that it was going to improve. You took a deep dive. And what was a result of it.

Danny Sands: [00:05:01] Well it really did change my life because after I finished my residency and I did this training in clinical informatics I assumed operational responsibilities for lots of clinical systems at Beth Israel in Boston which became Beth Israel Deaconess. And that was really what I was into I was all about this how technology can improve the care of patients but then I took a leather little detour because as I was doing this I was developing these technologies. It’s like an electronic health record and clinicians portal and I helped develop patient portal and all this other stuff. A funny thing happened which is that in my own practice while I was using these tools I was learning how game technologies similar technologies at least could be also useful to patients and to connect patients to clinicians. So for example I was using e-mail in my practice back in 1991. You were ahead of the hand when the web came out of the sea and I was found. All these health Web sites and I was prescribing information to my patients. And this became a real passion of mine at how this technology can be a tool for patients as well. And that ultimately led me to help develop one of the nation’s first patient portals that I mentioned at Beth Israel and then I went off to industry and while I was there I helped found this nonprofit called the Society for participatory medicine created then in 2009.

Saul Marquez: [00:06:24] And it was so interesting that learn about that. So listeners I was at Health 2.0 a couple of months ago and that’s when I had the pleasure of meeting Dr. Sands. We were out for one of the lunch breaks and sat next to him and talk about just a highly engaging highly likable person. We sat there and he had a badge and and I asked him about the society and so maybe Dr. Sands for the listeners that don’t know about it maybe you could tell them a little bit about what it is and just a little bit of that analogy you shared when we were together.

Danny Sands: [00:06:56] Sure. I think that I’ll tell you just a little bit if this OK this could be on the cutting room floor but about how this organization was created would be wonderful starting around let’s say around 2000 2001. There was a guy named Tom Ferguson who was a doctor but never practiced. Instead he became interested in how patients could really be their own doctors they could take care of themselves. And the existing healthcare system really needs to change new to be less paternalistic in all these really fascinating ideas that he had been working on for a long time. And Tom collected people. He collected ideas and people and over time he brought together a group of people. It changed over time but it was a core group of people who were doing interesting things in healthcare. And they were people like Susanna Fox who was doing research on the impact of the Internet and on health care. Alan Green who is a pediatrician who created an information site for parents about kids about pediatric health really it’s like Dan Hoque and Jon Lester who together ran this incredible online support community for Neurologic Diseases. These are the kind of people that were all brought together and I was brought in because of my interest in the use of e-mail with patients and letting patients see their records through patient portals and we use to get together annually and then sort of talk about health care and how we’re going to you know we’d like to make a difference how it could be different and it was great. Tom unfortunately died in 2006. And he died and he was almost done writing a white paper about this new world of health care but through a grant from the Robert Wood Johnson Foundation. So after Tom died we continued to meet every year and talked about these same issues. We completed that white paper which you can now find on our on our Web site. And then in 2009 we said Goll darn it we’re going to make something of this we’re going to create an organization out of this alive. We created this society for participatory medicine and we knew a few things initially we knew that we wanted to represent the diverse voices in healthcare. We didn’t just want to be about patients we wanted to get doctors and other health care professionals as well. We want it to be about caregivers want it to be about other stakeholders in health care like health care executives not to manures because we knew that we needed to change that culture of healthcare. And from the very start we actually created a journal a peer reviewed journal the Journal of participatory medicine and we knew we wanted to have members and we wanted to set the bar low for memberships so that even patients who were struggling with serious illness and financial hardship would join us. And yet we wanted to have the gravitas of a medical society so that we could actually engage health care professionals as well. So that was the start of the organization. And one of the cofounders of the organization I should mention is someone who is goes by the moniker e patient Dave. His name is Dave Doubront cart and I actually brought him into this group because he’s a patient of mine and he’s a patient of mine and one of the interesting things about our relationship is that we used a lot of interesting technologies and there’s an interesting story that we’ve written about. He’s written about about what happened when one day he was diagnosed with medicine at a cancer and we diagnosed him menaced had a cancer and he went through treatment and I went through a lot. There’s a lot to talk yourself I’m sorry. I know the sentencing rate greatly. But what of the interesting thing is how we use technology and how we used our relationship to really help him through that. Among other things I prescribe a patient online patient support community to him and to this day. Dave says My doctor prescribed a core that was the name of the Web site of the support group. My doctor prescribed a core and it saved my life. And it really did. And he’s written about that. But I digress. And that will be one of the founders of this group. The organization is really trying to transform the culture of patient care and in order to do this we focus or healers. And I’ll tell you about this post in one second but I want to give you that metaphor that grabs you so much that we talked about we were sitting outside of Santa Clara.

Saul Marquez: [00:11:05] Oh man I’ll never forget it. And then this Get ready. This is really good.

Danny Sands: [00:11:11] I think that too often we meaning both health care professionals and patients think about healthcare as if it’s a car wash. And what I mean by that is that the patient is the car and they’re somehow dirty they’re unhealthy or dirty and they’re passively cruising through this health care system which is the carwash and they’re getting health sprinkled on them and somehow they come out the other end and they’re healthy. So that is the problem that is a major problem that we have with health care is that nobody is engaged. The experience isn’t great and we’re not getting the outcomes that we want and it’s not cost effective. So we need to change that we need to think about healthcare differently. It’s not a car wash and it’s not a typical service industry. It is a collaboration. It’s a collaboration between the patient and the doctor or the healthcare professional and the subject of that collaboration is the patients health and just like any collaboration. Forget health care for a second you collaborate with your colleagues about whatever you can to collaborate with your spouse about child care whatever it is it’s going to have five elements to make it success. One is free flowing communication. Another is sharing of information. Nobody hoards information it’s shared decision making. It’s mutual respect and finally it’s engagement so we want that to be what health care is all about. So when we think about this we’re trying to change this culture of healthcare. Right. And if we want to do that we can’t just do this is not a simple silver bullet solution. We’ve got to think about different areas so we focus on four pillars. The first area is this community. We have conversations among this community of diverse stakeholders in healthcare. And I’ve already described that diverse community to yes and we do that both online and in person. We just had our first face to face conference.

Saul Marquez: [00:13:09] Oh did you really? Congratulation.

Danny Sands: [00:13:11] Thank you. It was terrific that it was in Boston. We were an international organization but we certainly have a lot of people in the Boston area and we will probably want to do this on the West Coast at some point as well and maybe other places. But this was a really great first conference very engaging wonderful speakers and on our Web site you can actually view videos of all of our speakers.

Saul Marquez: [00:13:31] Ah fantastic. We’ll have to include a link to that. Danny for the listeners.

Danny Sands: [00:13:35] Sure. And in fact there’s a special bonus which is that at the closing session we watch the video for that because there is a special treat that Dave and I did really and I won’t spoil it for you but you got to look at.

Saul Marquez: [00:13:47] Oh man. All right. So listeners that conversation don’t worry about how to get there. What we’ll do is on the show notes of this we’ll put a link to that and we’ll make a little note for you to remember to check out that closing session. I’m excited about checking that out. Put the hook in Danny put the hook in. I love it.

Danny Sands: [00:14:03] So that was that was conversation community. And then we do a lot of online conversations as well. And then the second areas of advocacy what we’re trying to influence public policy and influence the hearts and minds of the population. Yes. So whether that’s responding to public policy that’s being proposed or whether that’s choosing an issue and pushing that out. That’s the advocacy piece. The third area is in research and although we don’t do research we publish research in our peer reviewed journal Journal of purchase between medicine which is now as of just recently is now being published by the JMIR are the Journal of Medical Internet Research. It’s one of their journals.

Saul Marquez: [00:14:38] Oh nice.

Danny Sands: [00:14:39] And then the other project we’re starting and research in the early stages is we’re creating a research library so that anybody who’s a member can find out the best peer reviewed evidence for things that we do in participatory medicine. So it’s kind of like a Cochrane library if you know what that is. But this is focused deep and participatory health care.

Saul Marquez: [00:14:59] That is wonderful. That’s so cool.

Danny Sands: [00:15:02] The last area left the four pillars and then I’ll let you get a word in edgewise Saul, is education. So education we recognize that we have to education to change culture that’s a huge part of this. And initially I kind of thought that all we need to do is take care of those recalcitrant doctors that they are the problem. This is why we need this society. Because those healthcare providers those doctors in particular are so difficult. And I want to share information. They don’t want patients going online. One of the things that we realized though is that it’s not just about the doctors. Because remember that car wash metaphor I gave you only. Well this is a co-dependency, Saul. This is a co-dependency meaning that I think patients many patients and family caregivers are complicit in this and that we both the patients and the doctors view healthcare as a carwash in many cases. And that’s what we want to change. Tom Ferguson who I told you inspired this organization had a term that he created many years ago and that term is patients and the E everyone thought it was electronic. But the E actually stands for engaged in educated enlightened empowered. So we actually need to train our patients to be calm as patients so that they can be more effective collaborators with their healthcare providers.

Saul Marquez: [00:16:27] When you first said e patient Dave that’s what I thought. I thought it was e as in like online electronic but the e is for engaged empowered.

Danny Sands: [00:16:37] Exactly.

Saul Marquez: [00:16:38] Oh wow. That’s so interesting

Danny Sands: [00:16:38] We want to educate health care professionals to educate patients as family caregivers. But we actually ultimately saw want to move upstream and we want to influence health care professionals before they’re professional. So let’s get the doctors before other doctors. Yes the nurses before the nurses and for patients we want to get people before they’re sick for their patients. We want to get them when they’re in middle school and they’re in a health class they should be learning how to become patients when they’re young.

Saul Marquez: [00:17:07] How do you do this. How do you spread the word.

Danny Sands: [00:17:09] Well it’s a great question and it’s not easy in the case of education. There are different ways that we can accomplish this. So some of the many of us in the organization do this through speaking to teaching face to face if you will that’s not scalable. So we need to actually create educational modules that we can host or appoint people to education. Other people have created. So I think that’s going to be ultimately how we deal with at least the current crop of patients and professionals as we move upstream it becomes a little bit more complicated. We probably have to insert ourselves into the curriculum in pre professional education. And we’ve got to figure out how to influence public school health education so that we can include these concepts.

Saul Marquez: [00:17:53] It sounds like a lot of things are being done now things in the pipeline to do in the future for upstream but definitely a lot of things in the works. Yeah that’s exciting. Well thank you for walking us through that. Danny it’s listeners as you can tell Dr. Sanders very passionate about what he does. And we’ve had several past guests talk about self-management in health care and Dr. Sands is an example of what it is to represent this movement because it makes sense when you go buy a house you don’t get told what to do by your realtor. You’re involved in the process. And in the same way it’s a two way street so don’t blame your doctor. It’s your fault. So take the. Exactly. Yeah. Take the opportunity to take those steps to make it happen. Dr. Sands what would you say one of the areas that you’re most proud of to date in your career. And something that other other leaders in health care can learn from.

Danny Sands: [00:18:47] Oh that’s a hard question. Well I’m proud of the society I’m proud of what we’ve been able to accomplish to date. We have far to go but I think that my experiences there have been tremendous learning experiences for me. I think we’ve helped a lot of people. There are various efforts and I think we’re really at an important inflection point. So the society is certainly something that’s been great. I think that thought leadership has been something that I think I’m proud of I’ve been able to influence a lot of people through the work that I do. So that’s been an area. And finally I guess the technical work that I’ve done such as all the work I did for many years at Beth Israel in Boston developing and implementing technologies that are still in use today.

Saul Marquez: [00:19:28] And if you add the pool one thing out of that why you were able to do all of that. What words of wisdom would you share with the listeners.

Danny Sands: [00:19:34] So I think that keeping an open mind about one’s career is important. So let me give you an example. I work with medical students and residents a lot. And there are many people who come in and say I know exactly what I want to do. I’m going to do my residency in medicine and I’m going to get a fellowship with cardiology and then I will focus on interventional cardiology and just spend the rest of my life doing interventional cardiology and that’s good in some ways. I mean it’s fine if you know everything that you want to do. And every time I was asked an interview question because they always ask you this they say So Danny what do you want to be in five years. And I never really had an answer for that saw. Yeah I didn’t know where I wanted to be in five years because I wasn’t sure and I thought it was bizarre that people knew that answer. But at the same time I felt like I was supposed to know the answer because they were asking the question. And they didn’t want to hear I don’t know. But one of the things I’ve learned looking back on my career is all of the exciting things that I’ve done happened because of serendipity and because I was open minded about new ideas and new things coming my way. When I think about the whole informatics thing going way back in my career right why do I do that. Because I was frustrated that we weren’t using technology health care I said let me do something totally different. It was a relatively new in those days to do something like that. I started using e-mail and my practice with patients. I just did it. I didn’t like too much about it I just sort of did it. But that wound up being an important read that led me to this consumer health informatics work that I’ve been doing that has worked at Beth Israel Deaconess for 14 years doing designing implementing and evaluating technologies. And then I just realized that it wasn’t right enough and I was keeping an open mind and that’s when I moved to industry because an opportunity came up and I moved to industry. And it’s those kind of things just sort of not knowing is sometimes helpful not being too set.

Saul Marquez: [00:21:31] Yeah I think that’s such a great perspective. Danny and you know as we approach the things that we have in front of us listeners to be open minded you never know what’s going to come a solution that you don’t expect a path that you don’t expect. Be open minded and you’ll be pleasantly surprised. What lies ahead. DANNY This has been so much fun. Now as we get to the end here. You know I like to do a little syllabus for the listeners through a lightning round. And it’s the 101 or the ABCs of Dr. Danny Sands. And I’ve got four hours for you and then a book on the syllabus. We’re going to put together you ready.

Danny Sands: [00:22:07] I think so. I’m not sure I will let me fasten your seat belt here.

Saul Marquez: [00:22:10] Fasten it up baby because the car’s ready to roll. What is the best way to improve healthcare outcomes.

Danny Sands: [00:22:17] Oh really. I’m going to go low tech on you here let’s do I’m going to stay. It’s talking to the patient and listening to the patient. Sure I spend my life in technology but I’m not necessarily early adopter and I understand that technologies are great when they have value and bring value. But I think that it’s not about technology here. It’s about listening to the patient. If you listen to the patient you spend the time thinking about what they may have. I think that’s how we’re going to improve outcomes as we educate our patients. We collaborate with them as I was saying. Right. That’s going to make a huge difference. And as we’re working with them as we’re listening to them spending time with them we’re going to be able to order future tests order the right tests and get better outcomes at lower cost.

Saul Marquez: [00:23:03] I think that’s beautiful. What would you say the biggest mistake or pitfall to avoid.

Danny Sands: [00:23:08] The biggest pitfall of listening to the patients. I don’t think that we ever go wrong by listening to the patients. So I don’t think there are pitfalls there. I think the pitfalls come when we don’t spend the time to do that. I know that’s sort of a circular answer. I would say one thing though that I think that often when people hear me talk about this they’ll say so Danny does this mean that the patient is always right and I’m not saying that. I’m not saying the patients are always right and the patient always gets to tell you what to do. Right. It’s not really what it’s about. It’s about a collaboration and mutual respect and that happens both ways. So the patient can’t expect to come in and say I know I’ve been working a lot but I have a headache and I think I have a brain tumor and I demand an MRI and I examine the patient and I listen to the patient and I and I know that this is too much work and stress and that they don’t have anything of concern. It’s OK to say no but it’s also important that we listen to our patients. We need to have a conversation. So the patient deserves to be listened to and the patient deserves a rationale. But it doesn’t mean that the patient always gets what they want. And and remember the patients coming to see the doctor because the doctor has a lot of knowledge and a lot of experience. The doctor is an expert in healthcare but the patient is an expert in themselves and that is why it’s important to collaborate.

Saul Marquez: [00:24:28] Love it beautifully said. Beautifully said. How do you stay relevant as an organization or as a practice. Despite constant change.

Danny Sands: [00:24:37] Yeah that’s hard. And the change comes in so many different ways in the health care especially in the U.S. health care system for us. I think that knowledge is the thing that changes so tremendously is just incredible. You hear all these statistics the amount of knowledge doubles every three to five years. You read two medical journals every day you’ll be several centuries behind by the end of the year and it just goes on and on. And it’s true it’s really a challenge. You know we all are expected now to maintain our knowledge through continuing education. And I think it’s getting a little more challenging because now we have what are called maintenance of certification requirements which honestly we all complain about. On the other hand having just recently gone through a recertification process where I had to make sure I had lots of intuiting education and meannesses certification I think there is a value to it because things do change a great deal and I’ve got to say that I learned a tremendous amount in working in the many months that I was working to study for this exam. So I think that we always in our professional lives both as doctors and as maybe business executives or whatever we need to always do that thing that Stephen Covey said once to sharpen the saw. We always have to keep share in whatever field we’re in. Healthcare is challenging because we have this content area and then sort of the whole payment model of healthcare is changing at the same time. And then we have to deal with all these kind of crazy different. All this is now called the metrics may be different for different payers and for CMOs and so there’s really a lot of overhead and I think waste and we need to rationalize all this and it’s very easy to get annoyed and distracted frustrated by all of it. And I think that we have to remember why we went into health care and we have to find the joy of practice and don’t dwell on the things that are frustrating. Find a way to make them work from your standpoint. But don’t lose that joy in your practice. Sit down with the patient take a breath listen to them and remember how privileged we are to be able to do this as physicians.

Saul Marquez: [00:26:46] What a beautiful message Dr. Sands. Definitely one that I’ve taken to heart then definitely remember to breathe and to enjoy the moment. What book would you recommend to the listeners. As part of the syllabus.

Danny Sands: [00:26:58] Yeah that’s a really tough one. Sol and just so the listeners know Saul told me he was going to ask me this. Not very long ago though because of my interest in participatory health and I think that this is such a huge and important aspect of healthcare. I’m going to say my patient and I wrote a book called let patients help and I’m going to recommend that and I’ll give you a bonus one. All right. Which is called participatory health care. That was published by him this health information management systems. And that was published a year or so ago and edited by Jan Oldenburg. And that’s a really neat book too and it really gives you a sense of the scope of this kind of health care which I think are important. Obviously I could recommend all kinds of medical books and all kinds of things about the health care system. There are so many books about health care that are just fascinating. We certainly to go on these books you know are just really interesting. Eric Topel work also. Good stuff but I’m going to stick with the two.

Saul Marquez: [00:28:03] I love it now Dr. Sands thank you for that information. Thank you for those recommendations and listeners. Don’t worry about jotting it down as I said to you these resources on the syllabus the books the links to the conference that Dr. Sand’s mentioned all of it’s going to be available for you to check out at outcomesrocket.health/drdanny. That’s D R D A N N Y. And why but that link and you should be able to pull out all the things that we’ve discussed. So Dr. Sands Danny this has been so much fun. Before we conclude I would love if you could just share a closing thought with the listeners and then the best place they could reach out to you or follow you.

Danny Sands: [00:28:45] I’ll just say healthcare is in a constant state of transition. This is at least the challenges and opportunities as clinicians we have the opportunity to be the best clinicians that we can be in these times of change. And as business leaders who are health care system leaders we also have tremendous opportunities both challenges and I think that technology is bringing us tremendous opportunities as well. And we have to figure out the best way to leverage these technologies. And if you’re one of Saul’s listeners that are working in a business or a technology and healthcare I really want to respect the workflow of both the clinician users of your technology as well as the patients and you should engage patients and clinicians in the development of your products and your business. That’s it.

Saul Marquez: [00:29:36] Love it. Strong message. And Danny where can the listeners get ahold of you or follow you.

Danny Sands: [00:29:41] Sure. My Web site is drdannysands.com. My Twitter handle is @DrDanielSands and my email address is danny@drdannysands.com.

Saul Marquez: [00:29:50] There you have it listeners. And don’t you worry just go to outcomesrocket.health/drdanny and you’ll be able to find all of the ways to get a hold of Dr. Sands as well as all the links that we’ve discussed. This has been such a pleasure. Just want to thank you again Danny for spending time with us and sharing your wisdom. We really appreciate it.

Danny Sands: [00:30:09] You’re welcome. A lot of fun Saul thank you very much.

: [00:30:15] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.