Dr. Brian Goldman: the secret language of doctors versus the digital health revolution
One of the highlights of this year’s Digital|Health Days is sure to be Brian Goldman, MD as a speaker. Dr. Goldman is a practising emergency physician at Mount Sinai Hospital in Toronto as well as the author of bestselling books The Night Shift: Real Life in the ER and The Secret Language of Doctors. He also hosts CBC’s award-winning radio show White Coat, Black Art. Dr. Goldman’s TEDtalk ‘Doctors Make Mistakes. Can We Talk About That?’ has had over a million views. As his bio says ‘Goldman is on a lifelong campaign to confront medical errors and create a culture of safety for patients. He has proven unafraid of using his own medical mistakes to suggest how doctors can improve.’
Elizabeth Nelson talked to Dr. Goldman for Humans for Digital Health.
I’m really looking forward to hearing you speak, Dr Goldman. What will you be talking about?
I’m still in the very enjoyable stage of considering all the angles but you can be sure whatever I talk about will relate to both my concerns and to digital health.
Could you remind us of your concerns?
Sure, I see myself as someone who’s doing everything they can to bridge the gap between physicians and the public. I explain the culture of modern medicine, the good and not so good things, so people feel more of an equal partner in their treatment.
I have to ask, how do medical professionals feel about what you do?
My colleagues love it, as long as I’m not talking about them. I’m holding up a mirror to the culture of medicine, in general, and I freely acknowledge my own mistakes. It’s my way of starting a dialogue.
In what way?
I try to explain the culture of medicine – the sociology of health professionals, if you like. Doctors have traditionally believed themselves to be smarter than patients. They’re also under a lot of pressure and, in the past, have viewed patient participation as an obstacle to getting things done.
Where does digital health fit in?
I’m still figuring that out but, of course, digital health offers patients the opportunity to feel better informed about their own health. People are measuring the number of steps they take, their sleep patterns or whatever. But they’re not sharing this information with doctors and the data could be very useful for diagnosis. Technology is also enabling people to feel they’re owning their treatment. But an informed patient is seen by some doctors as an obstacle. Some of us physicians call this ‘Doctor Google’.
What does ‘Doctor Google’ mean?
It tells you a lot about what physicians think about patients who want to take control of their own treatment by using Google. There’s lots of deep scepticism. The argument is that physicians can tell the difference between good or bad information online but patients can’t.
You have to understand that the idea of the physician as God, as a supremely condescending being, comes from the physician’s own insecurity. They’re terrified a patient will find a piece of information that will contradict them.
How can that change?
Physicians and patients have to stop what I call the challenge business: either I’m right or you are. We need to create a situation where the physician is receptive to the patient’s input but, of course, that also means that the information and the way it’s delivered has to be truly credible to the physician. I’m not sure what the answer is to that.
And, don’t forget, physicians are always nervous about getting sued.
What is your take on how doctors relate to the new technology?
As far as I can see, medical students use apps for entertainment and not to learn. In general, my experience is that hospital adoption of technology is a complex question.
For example, in my hospital we continue to use telephones but our patients use texts. I can’t text the people I work with – a radiologist, say – I have to go through the switchboard. This acts as a buffer and enables a kind of ‘out of sight, out of mind’ mentality, slowing down the process of communication to make us feel less pressurised. We feel we need all the breathing space we can get.
How do you see technology being of benefit in hospitals?
I’m all for promoting empathy and technology does this. When you empathise, seeing things from the patients’ point of view, good things happen. So, for instance, an app that posts waiting times in a doctor’s waiting room is a gesture that says to patients ‘we care about you’.
Could a doctor endorse an app?
Doctors are supposed to be neutral. We can’t endorse apps but we can talk about them. I could do this on my radio show.
What do you think still needs to happen?
There needs to be a major upgrade in both health and technological literacy. And this will take a major change in education. Health providers can’t do it alone. The problem is that the biggest trends are being led by technology companies who’ve never taken the Hippocratic Oath, which as we all know binds doctors to certain ethical standards, including patient privacy. It’s vital to understand that patient privacy is of the utmost importance to doctors. Privacy is absolute for us. If we don’t uphold it we could lose our medical license.
All the concerns about patient privacy are very real. Insurance companies can be hacked. Information can be gathered by wearable technology that comes back to haunt a user. Imagine if an insurance company could access a customer’s blood sugar levels and they saw the person wasn’t taking care of themselves. What would do it to that person’s premium or, indeed, their ability to get insurance in the first place?
Discrimination is a big issue. Bad health data could be the new obesity.
Can you go into this in more detail, please?
Sure. Right now the big debate in healthcare is where to place people on transplant lists who have liver issues caused by alcohol. Should someone remain on a transplant list if there’s an app that can tell you whether they smoke or drink? What if someone is on a transplant list and a photograph is uploaded to Facebook that shows them smoking or drinking? These are not cut and dried issues. They relate to human rights.
But it’s also true that physicians use concerns about patient privacy to avoid moving forward with technology.
So, what about the positives?
If, for example, technology can do things like diagnose whether someone’s having a stroke or not, that has to be good. Every minute counts in those situations so if someone comes into a hospital and says ‘Get me to a cath lab’, that’s much better than a triage nurse saying ‘We need to get ECG’. Obviously, the technology has to be extremely accurate and is that the case?
And now the big question: do you use wearable technology?
Nope. I’m a luddite. I run and I used to measure my performance but I found I was paying too much attention to the technology and not being meditative. Being mindful is the reason I run in the first place.
Why don’t some doctors look after their health better?
Good question. Lots of reasons. They believe in the false notion that because they diagnose diseases they won’t get them. But, of course, doctors are just as vulnerable as other people.
Looking at the question from a different angle, you’ve got to remember that many doctors are in the early stages of burn out. Work-life balance is a major issue among people in healthcare.
We have to stay constantly vigilant and up to date in our knowledge. We’ve learned that anything that can go wrong will go wrong. And a momentary lapse could kill a patient. Physicians are made to feel very insecure.
So, a lot of doctors would see something like a Fitbit as the same as having yet another person peering over their shoulder observing them 24/7. Technology makes us constantly vigilant but we have a deep elemental need for mindfulness.
So, is it fair to say that one of your messages will be that doctors should take more of a lead when it comes to digital health?
Absolutely! The majority of us involved in modern medicine are clamouring for change and there are options staring us in the face. Digital health is one of them.
On that note, thanks for your time Dr. Goldman. I’m looking forward to your presentation at Digital|Health Days even more now.
Read more about Dr. Goldman’s upcoming presentation here.