hack (verb): to create a usually innovative solution to a computer hardware or programming problem or limitation
This past weekend I again had the opportunity to attend the excellent Medicine X conference. Despite the conference focus on the convergence of medicine and emerging technologies, the main message I left with had nothing to do with technology. It had to do with listening.
I heard from eloquent e-patients and caregivers about the importance of finding health care providers that truly listened. I learned from Dr. Leana Wen and others about the pitfalls and errors that can occur when we don’t.
I’ve been a listening evangelist for a long time now. I’ve written about it. I teach about it. I tell residents and medical students that really listening, making sure that we understand what the patients’ and families’ real concerns are, is the heart of our job. If a family goes away from my clinic feeling less than fully heard, I have failed.
Here’s the problem. We are failing. The “system” is not telling physicians to listen. It is not rewarding those who do. Instead, it is telling us to make sure we go faster, fill in all of the boxes, click all of the buttons. It tells us that it is not how well we care, but how much we do, that matters. It is increasingly hard to listen to our patients when we are given less and less time to do so.
So I came away from Medicine X this year hoping that someone will hack the clinic day. I hope someone will figure out that not every patient fits into a 15 minute visit and work some flexibility into the way patients are scheduled. I hope that creative ideas from folks like Dr. Swanson and Dr. Lee will be put into general practice. I hope one of those EMR companies out there will take innovative thoughts from students like Roheet Kakaday and put them out there for all to use.
I realize that all of this will require some real change in how physicians are reimbursed for our time. That’s fine. Go ahead and hack that too. And, I don’t mean a little at-the-edges kind of playing around. I mean really hack it.
Maybe, instead of pumping out the newest app, one of those silicon valley start-up types will come sit next to me in clinic and figure out some real solutions. And maybe the policy types will allow us to use those solutions. So I can get back to listening.
My Two Hats 
I could not agree more. After 18 years of practicing pediatrics, I can still hear one of my med school instructors say…”always make sure that your patient is better off for coming in to see you that day.” Simple, challenging and inspirational words for me. Not easy and sometimes not apparent to the clinician. Over the last 5-7 years, I know that it has gotten really hard to do this. In May, I actually stepped off the clinical practice train. I said to myself, “enough complaining…I’ve got insight into problem…so let’s see what you can do baby.” These sorts of things require increasingly huge amounts of time and commitment which is why I stopped practicing. I, now we, are working on simple solutions to common problems. Things that tend to get overlooked by admin or large tech. Our drive is to make it easier to be a doctor and healthier to be a patient. We started project out by…listening. We listened to lots doctors and patients… trying to really hear what their pain points, their challenges truly were. Late November we get to see if we figured anything out. It is an app…but it’s modeled after the little friendly paper prescription pads that used to be in our pockets. Easy to use, highly personalized by clinicians. It’s also dynamic, allowing clinicians to collaborate in new ways. Our goal is to not be very noticeable. To not get in the way of doctors and patients..but actually allow more time for high value conversations.
organize > deliver > improve
ziPede (pronounced “zipitty”)