'E-health is great. But if we lose the analogue heart, then we've missed it’

August 1, 2017
‘I've always been fascinated by music and the power that it had to move peoples' emotions. My other fascination always been  science and medicine, and the idea that we could improve people's lives through technology and science. What I saw lacking, was the connection between the emotional component and the and the science component.’ Zubin say's in a interview with ICT&health. In medicine we are trained to really separate those pieces. To compartmentalize and to not use our intuition and our emotional side. We have fewer and fewer stories and give more facts. That  seems to be how it's evolved over time in science and medicine.  I felt that this was wrong, because we were seeing the failure of this reduction in medicine. When I started really acutely noticing that, was when I was in practice as a hospital doctor at Stanford for several years ago.

Patients on a treadmill, doctors burning out

I started noticing that all our patients were just on a on a recurring treadmill, where they would be discharged from the hospital and they would come back with the same thing. We hatched them up and they would go back again. And nothing was changing. And on top of that I was noticing my colleagues were burning out. They were having very great difficulty maintaining enthusiasm. They were losing empathy becoming that disconnected. And so, in all of that I realized I was having all the same problems myself. I was getting disconnected. Feeling like I was not living a story that was mine. So I was living the story of the health care system, which was really nobody's story. This was just a monster. The making of the music was a way to reconnect personally with myself with my core passion, which was moving people's emotions. Making them laugh or making them cry or making them feel something. I thought why can't that be a way that we actually focus on preventing disease, On improving our medical system. On taking care of each other as clinicians as well as our patients. So that was how it started in 2010, when I just kind of threw my hands up and said if I don't do this I'm going to become one of those doctors that I've always thought  I would never become. What's was the little spark, what made you decide to do things in a different way? This is first time people are going to know this, because I've been waiting to be asked this question. I think it's really interesting, because it's how the human mind kind of works. Sometimes you bear of a lot of suffering and you bear a lot of inertia especially in health care. Easiest path is to listen to what the sort of hierarchy is telling you and continue to plug along until you retire. And that's what my my plan was in 2009.  I had a retirement plan, I had a house on the hill, I had all. And I had a job, that my immigrant Indian father really thought was fantastic. So here I am at Stanford, seeing patients and everything he always dreamed for his kids. And the same time I'm trying to manifest my underlying unhappiness through all kinds of materialism. So I'm obsessed with stereo equipment for instance. Just an neurotic obsession to electronic component.
Then I went home and I had a complete meltdown
Then a friend of mine in Silicon Valley, a tech person, who sold his successful company, just asked me a simple question: 'Are you happy in your life doing what you're doing?' I looked at him and said ‘Well why wouldn't I be happy? I'm a doctor,  I'm at Stanford. Of course. I see patients every day. I help people.’ That was what I told him. Then I went home and I had a complete meltdown. Of course I'm not happy. This is absolutely somebody else's story that I'm living. I’m struggling every day to even make a difference for anybody. So that simple question 'How are you' threw me into one of probably the worst depressions of my life. But I was still going to the hospital and rounding up people no one could tell that I was depressed. And I was so immobilized. I couldn't get out of bed. I started watching the YouTube videos, because I was just stuck in bed like and I noticed These guys doing shows. Guys talking about topics and they're satirizing things and they're making money of it. Then I realized 'Wow'!, I could make music parody videos, I could do comedy stuff. We could do satire. We could raise awareness. We could educate. Tons of people could see it1 An nobody's doing it. Zero! And that's when it clicked. I thought if I don't do this, I'll be missing the greatest opportunity of my life. Then I got the MAC and realized I could actually edit video. It took six years to really get any degree of success. There's a book called The Happiness Hypothesis by psychologist called Jonathan Haidt. He wrote about the idea that sometimes a simple act of forcing you to look at your narrative, and see if the story you're living is a story of positivity or not. So that's was the start of your career as a doctor but also as an artist. How do you feel people respond to you? it's interesting, because in the early days it was sort of for novelty. I developed this hardcore fans that really understood me, because I think they were like me. They were people who were frustrated creatives, who worked in health care who really got it. And that was it. It took me 4 to 5 years to develop ten thousand followers on Facebook and Youtube, and to reach a million collective views on You Tube. And then something snapped in 2015. We put out a video called readmission which was my first collaboration with a video production group in Las Vegas. They shared a similar philosophy. The director was married to a nurse practitioner and he just really understood the sensibility. And suddenly, we had the ability to really express ourselves in a much broader palette. That one went viral. The next thing I knew things were just accelerating and now I've got maybe one hundred thirty million collected views between Facebook and YouTube and 440.000 Facebook. Almost all of them are either health care professionals, or activist patients. From that point we started getting a movement: a health 3.0 movement. That is focused on improving health care for everybody. Clinicians and patients. That's where we are now.
Younger people come to the shows, because they're excited that the future of medicine isn't necessarily what they're hearing, namely darkness and misery
Social media is all about where you are. My followers on Youtube are youngers and mostly males, whereas my followers on Facebook are predominantly female, 25 -45 years old.  In both cases people who are in the game. They see the dysfunction. A lot of them are nurses,  a lot of them are medical staff and a lot of them are doctors like emergency medical services people, pharmacists etc. When I travel also younger people come to the shows, because they're excited that the future of medicine isn't necessarily what they're hearing, namely darkness and misery. Ain't a way to die’, an Eminem/Rihanna parody got 6 million views on Facebook. Almost everybody related to this. My personal favourite is The Confrontation and Seven years, probably my favourite video. https://www.youtube.com/watch?v=NAlnRHicgWs&feature=youtu.be   Tell us about your vision on e-health? Health care is an analogue process, it is a human relationship process. Humans have evolved to be hyper social creatures. A lot of the healing and the sickness that we suffer, is due to social issues and miswiring. Even the placebo effect is such a powerful phenomenon, we don't even understand. We can have an analogue heart of medicine, that is amplified by digital technology. But if we lose the analogue heart then we missed it. ‘Technology is absolutely the key crucial leverage agent that's going to take us to the next level. But we have to we have to implement it correctly.’ I think the first iteration of trying to implement electronic health records missed this idea. We've damaged the relationship. Technology is absolutely the key crucial leverage agent that's going to take us to the next level. But we have to we have to implement it correctly.  We can get there, but our initial spits and starts have been a little misguided. If technology is disconnected from any accountability, if it's disconnected from other human beings and nobody cares, we 're just stop using it.
When it comes to Epic I think this is just a billing platform, with patience stuff tacked on. It doesn't  serve what we fundamentally need
For me, technology transformed everything that I do, From social media to the camera technologies that allow us to share to Facebook live. So I'm a huge believer. But when it comes to Epic I think this is just a billing platform, with patience stuff tacked on. It doesn't  serve what we fundamentally need yet. What would you say when you wake up thinking middle of the night with your magic wand and everything you say becomes true? This has been one of the great challenges and opportunities in in my life and I think in how we are as a whole. How do you shift to value prevention and whole-ism the health-community? Tony Shieh the C.E.O. of Zappos, gave me this crazy opportunity to actually do something: “Look we'll give you a little bit of a start-up money and what you what you have to do is it has to community oriented. I don't care what it is, but it has to has to make a dent in the universe in some way. Be a be a beacon.” So we started Turntable health. Over 3 years we partnered with another company called IORA in Boston. We implemented this model of team based, health coach driven. These folks are drawn from the community, they speak the language of our patients. We really focused on implementing what the doctors plan is. How do you get somebody to change behaviour? Our most complicated wearable was an eight dollar pedometer that we gave out for FREE to patients. We had them connect with us by text messages. They told us how much they're walking and then we would have contests. Also, we created our own electronic health record with IORA. It did not focus on billing insurance or on compliance, because we didn't care about those things. But we focused on managing a population and allowing patients to read and write in the chart. Even the design of the facility was transparent: every room has an L.C.D. screen that allows the patients to see what was written down. In this way you are building transparently in real time. What we found  was that the model of care worked tremendously. Patients had their lives transformed, clinicians had their lives transformed because they were finally empowered to the right thing for patients. Why we ran into trouble was: integrating into the community. It is very hard when you build a clinic in what is effectively a demilitarized zone. The second thing was finding partnerships of people who are willing to pay. Like an insurance plan or a US employer union to do that is much less difficult. But they have to be willing to do something innovative. And finding those payers was hard. Our biggest payer, Nevada Health co-op went out of business for a variety of reasons, related to the Affordable Care Act. And as a result we had three thousand patients, and the next day we had zero. It was a tremendous challenge, but we are working in multiple states with more table payers outside of Las Vegas. And they've been successful. We closed our first turntable clinic in Vegas at the end of this month for that reason because after three years we realized:  if you don't get a big payer and have enough scale it's not going to work. We might have been too early. What is your advice to somebody who wants to do likewise? Don't compromise. We had a lot of pressure to do the kind of typical games that people do stay in business. We refused to do that. If everybody keeps refusing the pair's and the networks will start to realize this is the way to go when you incentivize prevention and caring. If it is paid based on outcomes instead of quality measures that don't measure quality. You will actually start to tip the systems. Just be patient. Push it. These patient centric and clinicians centric models do work. It is going to be a time before the payers catch up, But they're getting there. Certainly now is the right time. Everybody should start pushing. So I would encourage people. Also in European systems. What's the biggest challenge healthcare in the U.S. faces right now? The biggest challenge is that we have one foot in health 1.0. Which is the old system: hierarchical,  paternalistic, non-technology driven. And one foot in 2.0: the administrative, technocracy, quality measures, E.H.R.'s  and all the other mechanization. What we need to do is, instead of trying to rip our pants at the seams with one foot in each, we need to be jumping into 3.0. Which really transcends and includes both of those systems. The best aspects of both. And what emerges is bigger. Which is an outcomes based,  really personalized medicine, that is leveraged by technology. That is equitable. That's going to take a generational epic struggle, the likes of which we really haven't seen for a long time. Since maybe civil rights.   https://www.facebook.com/ZDoggMD/videos/10154144055212095/