Dr. Shah is the CEO of MyMeds (www.my-meds.com), a digital health company whose medication adherence platform engages patients, physicians and pharmacists to work together.
Technology is disrupting consumer industries across the globe. In healthcare, technology is being used to improve systems, but the new disruption will be driven by people – patients and pharmacists. Like never before, patients are demanding consumer technologies to help them become more engaged on their changing health care team. The new team brings pharmacists off the bench and puts them in a starring role to help solve one of healthcare’s biggest issues – the $300 billion problem of medication non-adherence (not taking medicines properly).
Dr. Shah is the CEO of MyMeds and a Board-certified nephrologist who practices in Minneapolis. Combining his front-line experience of understanding the multiple roles (patient, provider, entrepreneur) in a rapidly-changing health environment, and his dedication to implementing digital health IT to improve health outcomes, Dr. Shah provides a unique perspective on innovation in healthcare today. He received his M.D. from the University of Minnesota Medical School, and attended Boston University, from where he graduated with a B.A. in Cognitive Psychology with a focus on memory creation. This provided the foundation on which the MyMeds adherence platform was created to improve medication-taking behaviors. He has been recognized for his work in business, medicine and philanthropy with the Virginia McKnight Binger Award in Human Service, 40 Under 40, Ten Outstanding Young Minnesotans, and Real Power.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx
About the last thing we need in our badly broken healthcare system is more Rx. We are in an epidemic of overtreatment which is one of the root causes behind our exploding healthcare costs. These drugs alone are NOT the answer.
The best proven form of medicine (for our chronic illness explosion) is lifestyle.
The most helpful part of the equation that Dr Shah promotes is the 'health coach.' If you have never tried using one yourself, do yourself a favor.
Boy and how. 2018 is the definite kill the Chronic Pain Patient year. with the Pharmacists pulling the trigger of the CDC loaded Gun... WELL DONE, The HUGE UP SWING IN SUICIDE due to pain is DEFIANTLY driving up the Death Businesses. BUT! here are THE BUT!
I am glad that some MDs think this way. Unfortunately, we have yet to have a profitable model for the corporations to make pharmacists more relevant so they can deliver both better clinical patient care with their trainings and better financial bottom line for those corporations. I graduated from pharmacy school almost 2 decades ago and have been practising. When my older brother went to Tufts Medical School and subsequently did his cardiology fellowship in Scripps Green, San Diego, CA, he said one thing to me. He said "You [as a pharmacist] are not important. No one dies when you are not around. People die when I am not around." That was about 9 years ago. He was very well liked by his patients and colleagues. Assuming he is not an odd ball whose mental and social perception lie outside 3 standard deviations from the middle of the bell curve in the medical student community, his perception as a provider of pharmacist is likely shared by many providers of even the younger generations. As optimistic and hopeful as Dr. Shah's talking points , it will take long time for this kind of pointed professional discrimination and denigration to be, at least, mostly, eradicated. Today, a lot, though not all, physicians and medical students have been conditioned to believe they are the top end of the intellectual ladder in medicine and everyone else are below them. In some ways, I have to acknowledge that is true if we compare GPA...etc. etc. But, we know that certainly does not represent the entire equation that represent patient health outcomes, if we are to quantify them..... well, food for thoughts for the readers. Shah is right about one thing. Pharmacist is the "forgotten member of the healthcare team." They are rarely acknowledged in the media.
In terms of the UK one solution to the shortage of GPs was to increase the number of GPs however pharmacists seem to be more ideal as they are worth 1/3 of the GPs time. Pharmacists also spend half as much time in education than a GP.
I am a doctor for the past 36 years. When I entered the medical school, patients said "Doctor, you know best" and doctors tried to give them their best. When I was a young physician, a GP, patients had started telling GP's "It's my life & my body and I know my body. You just deliver what I want and everything is going to be fine". And most of the time what the people sought from the 'healer' was self-destruction !!!! But when faced with a specialist, they reverted back to the old kind of doctor patient relationship: "you know the best......". So, I worked hard and became a specialist in Internal Medicine. At some point down the line, "empowered" by the internet, patients began to seek 'self-destruction" from even the specialists. If a GP or a specialist was honest to his professional ethics and refused to yield, they had the option of finding someone else. But they reverted back to the good old paradigm "doctor, you know the best" when faced with surgeons and those physicians who performed invasive procedures. Such physicians are called 'super specialists' in Europe and 'sub specialists' in North America, e.g. all kinds of "....ists" like Cardiologist, Gastroenterologist etc etc. So I had to rejig my professional life all over oncr again to become a Cardiologist. But please be informed: I could have done a lot more for my patients as a GP and I WANTED to be a GP...... alas, destiny willed otherwise. BTW, there is no GP today: even a family physician is called "Specialist in Family Medicine". How much more "disruption" this speaker wants to bring about, only future will tell but I am ready to adapt even at this age. So do millions of my colleagues world over...... quietly & silently.
The doctor used to comer to my house and saved my life as a child. My question: are you working for Dr. Phil? this is a completely wrong idea. I want a hands on doctor period. Not a computer doctor. Then I go get my meds from my much loved pharmacist that I have known for years. My husband was and is a hands on physician he was available all the time. His patient was the center of his life.
What we need is the administrators out of the way and insurance companies.
We need less disruptions in medical care. I agree with Dr. Shah that it is the patient's life. The key to healthcare is that the patient should have the right to make every decision, including decisions the healthcare providers disagree with, and the providers should nevertheless facilitate the patient's wishes. For some, using a pharmacist for medical advice may seem to be a good idea. But is the pharmacist doing this for free? Personally, I want the pharmacist to fill my prescriptions, accurately, and nothing more. I view the pharmacist as a random person, hired by the local pharmacy, who happens to be on duty when I need a prescription filled. I don't downplay the pharmacist's knowledge and skill, but he is not my chosen doctor. The pharmacist does not know me, my medical history, or my needs. I don't want some pharmacist telling me what I can or cannot have. A more enlightened view recognizes that allowing the pharmacist to disrupt the medication prescribed by the doctor unnecessarily interferes with the doctor-patient relationship. If the patient wants the pharmacist's help, I say yes to that. But I do not want the pharmacist forced on me. It is easier to dump a doctor than a pharmacist (and thus a pharmacy chain), particularly in these days of highly managed care. I prefer to let pharmacists do what they do, fill prescriptions, and let me worry about my medications and dosing with my doctor.
I totally disagree with you there. There are many different pharmacies in which you can go to in your area (unless you live in a very remote area) most likely they are more pharmacies near you then doctor's offices. As well if you go the same pharmacist for a little while they will know you, your medical history and your needs. The pharmacist may not seem important to you but (I work at a pharmacy) and many people are on many many drugs and the pharmacist is someone who knows them and their medications very well. In many of these cases these drugs are prescribed to them by different doctors so the pharmacist may even have a better relationship with them then their doctor.
I think you may only be imaging a pharmacist in a dispensing role in a community pharmacy. Pharmacy is a much broader profession which I believe this video refers to. Thousands of pharmacists work in institutional settings. Many of them pursue residencies and specialize in areas like pediatrics, infectious diseases, cardiology, organ transplant, emergency medicine, etc. Many round on treatment teams daily where physicians seek their opinion on treatment options. Remember that where there are drugs there is a pharmacist. This includes hospitals and clinics. So if you are ever in the unfortunate situation of being hospitalized, remember that a pharmacist definitely prepared and assured its accuracy but potentially even recommended it's use in your treatment plan.
In their current role, the Doctor of Pharmacy (PharmD.) professional is the most over-educated but under-utilized healthcare provider. They are the medication experts and know so much!!! They need to be included more in the Interprofessional/Interdisciplinary Team. They already have the education, we just need to expand their role. The patient would benefit the most.
Although the emphasys on "Pharmacists as new disrupters of health care" is positive, it is dangerous to advance all these informal powers to untrainned non-MD as Pharmacists are, without expecting them to be responsible for the commitment it implies. Talking something different just because of that is sad and potentially dangerous. This is healthcare.
I wonder if you understand what you saying cause you not making sense. You saying pharmacist are not trained? What was the purpose of them going to varsity, doing internship or residence if that is not for training pharmacist?
Technology is definitely a factor that has impacted our society and changed the way many careers are handled, the medical and healthcare field being one. I thought speaker Shah pointed out something that isn't pointed out very often as that in the past doctors went to the patients, and in today's world, sick patients are expected to go to them while possible waiting for hours just to see them for a few minutes, and maybe not even enough time to discuss everything they had intended too. Since technology is a huge factor, why not let it be driven by the patients instead of the medical staff as that I agree the patient is the most important part in any patient to medical staff relationship. Even though the doctor is very important as to give the patient a diagnosis, I agree that pharmacists are just as important as that the prescription given is what is expected to help the patient, and since the pharmacist has a great amount of knowledge about medication, they can help. Incorporating them into the team as to assist to the patient's needs, I feel that getting the patient where they want to be faster, is achievable. DR. Shah makes the statement at the end that "by the future of technology being driven by our patients and pharmacists joining our team, these are the new healthcare disrupters" which sums up most of his talk as that these disrupters are problems that need to be addressed.
There are many disruptions and holes in healthcare and a lot of them have to do with the doctor and patient relationship. Many of the times there happens to be a miscommunication between the doctor and patient. This miscommunication can cause a lot of problems for the patient. These problems can cost the patient valuable time and money. Although this problem can be fixed with a better patient to doctor communication system. This communication system can help save time for both the doctor and the patient. Many patients either are confused with medical terms or are completely unknowing of what the situation. If we can improve how we inform patients on their medical condition and medication, we can help include all parts of the medical system and fix the problem in communication. In the case of Rajiv Shaw, he uses the example of the lady with uncontrolled diabetes and kidney failure. The patient did not know how to properly take her medication so she just simply did not take it. Since she was not taking her medication at all it was making her diabetes and kidney failure worse. So she went and talked to her doctor and he finally told her to talk to her pharmacists. He told her this so the pharmacist could explain how the medication worked and when to take it. After the patient proceeded with the doctors orders, her health had significantly increased since the last time he had seen the patient. Her diabetes had went from twelve percent to seven percent (seven percent being the normal percent according to Dr. Shaw). This simple fix in communication can save the patient time, money, and even their life. So we need to configure a system for a patient to follow so they can get the best possible treatment. But how will the system work? Do we need to include the insurance companies so they cover the multiple doctors the patient has to visit? Do we include the pharmacists immediately if the patient needs a specific medication and needs help to gain the capacity to use the medication correctly? These are all questions we need to ask and figure out a system for patients and doctors to help make the whole process much more simple on both ends of the deal.
what exactly is the pharmacist supposed to do ''off the bench''???? pharmacists are already playing their part making the drugs and ensuring availability a huge role if you ask me a huge instrument part! . the case here was not that there was no knowledge of the drug surely the doctor knew the adverse effects of the drugs but the problem here is one thats ever growing and seems to be ignored , patients have become just files on a doctors desk humanity in health care is on a serious decline . DOCTORS DONT CARE anymore. its the truth . patient care and bed side etiquette have become terrible . humanity is the missing link here . doctor has knowledge of the human body and its functions find sout whats wrong the pharmacist makes the drugs to induce changes to make one feel better thats a huge role , true there is no medicine without pharmacy ..buut there isnt any care..a doctor wont even tell you to drink lots of water with a certain drug to reduce gastric irritation he or she just writes the prescription and sends you off ..at the pharmacy they just hand you the drugs.you get home take the drug with half a cup of water and bam!diarrhoea fire out of your rectum ofcourse you wont take the drug!! ....lets bring care back into the system and we will see shorter waiting times in waiting rooms, more information being conveyed between the patient doctor and the pharmacist , patients understanding why and what they are taking , less medication non adherence , more satisfied patients , better healthCARE even better preventive care due to understanding of disease etiology due to more information between doctor and patient and a healthier generation ..we need more love !!
technology is good yes but human interaction is necessary ..a physical exam is a fundamental part of diagnosis and cannot be disregarded .this doctor popping up on screen stuff is not feasible and frankly quite dangerous ..if you want it in patient care terms :) we all want a doctor who smiles at us puts a hand on our shoulder tells us it will be alright we need that we are humans we dont need science to prove that humans need humans its how we are made .technology helps in diagnosis and decreases human error yes we love it :) but human support and care is itself a potent drug hugely underestimated cheap with no side effects and no maximum therapeutic index . lets bring back care ..yes health care has a long way to go so much is ''wrong'' so many errors but hey lets fix the ones that dont bleed anyones pocket and benefit everyone .WE LOVE PHARMACISTS :)
Although your response to this video is short and a little bit rude, I suppose I can understand your viewpoint. You appear to take the stance that taking action is the best way to get things done. I do not disagree. I fully support your viewpoint that action being taken as soon as possible is indeed very important in moving towards solving a problem. However, I believe you’ve overlooked one important aspect. You are unable to take action until you have a plan of attack. A plan of attack for complex problems such as these cannot begin until you discuss the issue at hand. Something that I learned during this video that I was unaware of is that pharmacists are indeed doctors. He refers to them as “doctors on the bench.” The issue that Dr. Shah discussed in this video that you may have missed is that doctors are in need of some help. A doctor can only do so much. Dr. Shah is discussing solutions because he wants to put your “fighters” into action, which would be your currently underutilized pharmacists. Dr. Shah fully admits that he is able to help his patients when they come in to him with their problems, but there are certain things that he is unable to do because he does not possess all of the knowledge in the world. Dr. Shah is a specialist, and he is very educated in his specific line of study, which would be kidneys. When it comes to the specifics of your medications, Dr. Shah would like to see our pharmacists become another tool to be utilized by patients in their fight for good health. There is no secret that medications have all sorts of risks. Medications have side effects that are sometimes worse than the problem they are trying to fix in the first place, and when combined with other medications, they can cause even further complications. I am a nursing student, and in my ethics class we have been discussing a term in which I believe applies to this situation perfectly. This term that I am referring to is nonmaleficence. The definition of the term nonmaleficence is “to inflict the least harm possible when trying to reach a beneficial outcome.” The combined team of your doctor and your pharmacist will help to achieve this goal. Your doctor can prescribe your medications for your problem, and you can go in and talk to your pharmacist and they will break it down even further for you. Your pharmacist should be able to tell you what kinds of things you can expect when taking certain medications. They will be able to tell you what you will feel, the things that may happen when you combine the medications that you have been prescribed, and possibly offer an alternative to how you can take them in order to minimize the negatives. I hope you will see this point of view and understand that action is on the way, but before we can reach that part of the solution, we need to first agree on a plan of action.
Technology has defiantly changed our lives. I agree with Dr. Shah that there is something wrong with the sick people going to see the doctor instead of the doctor going to see the sick person. I think it would be a good idea to bring the doctor to the screen. Instead of having a sick person get up and go to the doctors to wait a few hours, they can just get on their phone or laptop to see the doctor. Like Dr. Shah said, this brings healthcare back to being personal. I think technology could improve our healthcare system if it does work. There doesn't seem to be enough time with their doctors. Usually you only talk to your doctor for fifteen to twenty minutes. There needs to be more time to talk to them and really explain your symptoms. Technology could really improve this by giving patients that time to talk. Pharmacists could help in a way they haven't before and really change healthcare.
Technology is a very huge component of disrupting our society as a whole. It has leaked into disrupting health care, and it will continue to as time progresses. Dr. Shah made a good point in mentioning that when we are ill, WE have to be the ones to go visit the doctor, even feeling as terrible as we may. And once you are at the doctor's office, the wait time is usually long for a 2-minute conversation, which then sends you to another destination to wait; such as the pharmacy. I agree that technology is making healthcare more personal, and patient-centered, but it is not the only thing disrupting healthcare. You can digitally see a doctor from your own home, putting the power in the patient's hands. Personally I still prefer a face-to-face interaction versus online. I think that Dr. Shah really brought to light that Pharmacists are the forgotten doctors of today, and branching together the patient-pharmacist relationship would solve a lot of disruption. The majority of most patients issues deal with their medicines, and pharmacists are the only ones that can shed some light on those issues. Medicine seems to be the solution to every health issue nowadays, and Dr. Shah is spot on when he touches on the fact that we need to bring Pharmacists more in to focus, and utilize them and all their knowledge fully.
Having already known that there were distinct parts, or professions, of the healthcare system, I thank Dr. Shah for pointing out the need to view each profession, and see how they help one another. To an outside view, the interaction we have with pharmacists alone makes it seem like the easiest part; I have to go to the pharmacy and pick up the prescription from them. However, Dr. Shah points out that pharmacists are the ones that know the most about medications, and they fill your containers with the appropriate medicine. Going into a health
profession myself, I think it is important for all aspiring students going into the healthcare field to know how we influence and interact with each other. I would recommend this lecture to any professor that wants to make sure their students understand the importance that each profession has in benefitting the patient. That is how beneficence is found in Dr. Shah's lecture, by making sure that the listener knows how each healthcare professional's action help benefit the health of their patient.
This talk definitely sparked a dormant flame in me! The topic is right in line with my past efforts as a pharmacist where 5-6 years ago, I saw the need to get out there and promote the value of the pharmacist on the health care team. This was because in the course of my practice as a consultant pharmacist, I had encountered too many avoidable gaps in our health care system that I felt a pharmacist could contribute to help solve in the community - medication illiteracy and non-adherence. I left my job to pursue my goal to educate and empower patients to take control of their health care especially as related to medications. Medication Therapy Management (MTM) was the cornerstone of my unique and innovative business model based on this $300B problem pointed out by Dr. Shah. Being so passionate about this cause, I tried marketing to a variety of targeted health care providers who cared for patients on multiple or complex medication regimens - including hospitals, physician offices, home health agencies, etc. My service offerings were well received but due to a lack of financial sustainability, I had to give up my dream. To this day, the mixed feelings of passion and frustration remain, and I still feel the need is greater than ever for health care systems, managed care companies, health care providers and all involved in the chronic care arena to recognize, fully embrace and utilize the clinical skills that the pharmacist brings to the health care table. The pharmacist possesses a wealth of knowledge on medications as well as the ability to strategically ask the right questions at the right time to the patient served. This is part of the reason why we are one of the most trusted health care professionals by patients. Good talk!
Although I think that the basis of this idea is a good one, I believe that it still has too many kinks to function properly the way people will want it to. The true fact of the matter is that going to a doctor online will not decrease the overall wait time. There will still be large amounts of backlogging involved in the process of seeking medical advice. The real issue, or main disruptor, I see in the healthcare field is lack of education to the patients.
This is especially true in "Sarah's" case. She wasn't sick because she hadn't been to the doctor, she wasn't sick because it took too long in the waiting room to finally be seen, she was sick because she didn't fully understand the medicine that had been prescribed to her-which is incredibly dangerous. Many medicines don't interact well with each other and can cause adverse effects. Labels on medicine bottles aren't thorough enough to really fully understand their function and direction, with many of them only stating proper dosage, time, and route. As the video stated the few minutes with a doctor a patient gets isn't enough, they need more time and direction-whether that be oral or written.
I think it is an excellent idea to include the pharmacist into the equation for proper patient care. When you go to pick up a prescription, most of the time all you do is give them your name and then pay for the drug. End of transaction. There is no direction given to the patient from the pharmacist whatsoever and that needs to change. Pharmacists have been on the bench for far too long, it's time to get up and pitch. It's time to truly care for your patients instead of tossing the drugs at them and telling them to have a nice day.
Jess R, I strongly agree with you on how online doctors will not be efficient nor decrease the wait time. More people will want to just click on a button to see the doctor instead of actually going in because that means they have to get ready and drive to the office. Online doctors will see the patient only over video chat, it will decrease the knowledge of the prognosis because they can not run any tests or see you physically to get a good idea of what you have. Instead they will go based on what the patient is telling them and may say they have the wrong sickness concluding prescribing the wrong medicine. This can lead to many problems with patients getting more sick or having effects they shouldn’t based on the medicine they are taking. Even though Dr. Shah made some good points when talking about how online doctors will be more efficient, it still has some things too it that will be missing when seeing a patient in person. When talking about beneficence, it means that things done are for the benefit or good for others. When you apply beneficence to the concept of online doctors it is trying to be good to everyone but when thinking about the risks that can arise it ends up being bad. I also agree when Jess says that doctors should spend more time educating patients on the medicines they are prescribing for them. So many times, like Dr. Shah said about his patient named Sarah, people have so many drugs they are supposed to take but they do not know what they are or which one if for which so sometimes they just do not take them at all. Pharmacists are also accountable when it comes the the education of the medicine they give the patients. Its their duty as well to tell them what each drug is, what it is used for and what they side effects the patient way experience.
22/2/55 - it takes 22 days on average to make an appt to see your doc - average wait time from check-in to see your doc is 2 hours - accuracy of diagnosis 55% on average. all of this to the AMA's own admission per Eric Topol. The healthcare system we live in is broken. Bring on new players. Bring on technology. Enable the patient. Great video - keep em coming!
@3:25 go to the pharmacist and wait some more. @9:45 bring the doctor off the bench
(pharmacist) and have them play a bigger role in patient's healthcare. @10:45 Have the pharmacist spend more time with the patient...... anyone see the flaw in logic here?
I am finishing my 4th year of pharmacy school and have been fortunate to work alongside medical students and MDs. It has been an eye opener on how much a pharmacist can play a part in the health of patients. In my experience, the medical students and residents were quite surprised at what a pharmacist/pharmacy student can bring to the team. I also realized that the doctors are a huge component of this team and when all the disciplines work together it yielded great results in the health of the patients. Thanks for the topic Dr. Shah!
Healthcare should be reformed, and made personal again. as Dr. Shah mentioned technology can be used to improve the health care system. by involving more people such as the pharmacist the doctor patient relationship can be made stronger, and bring more trust. One of the problems mentioned was that the patient and doctor hardly get any time together, which I can say is very frustrating. When going to the doctors and you or a family member isn't feeling well, the majority of the time should not be spent in the waiting room or with administrative staff. With technology being driven by patients health care can be greatly improved. Technology can take away some of the time that is wasted during the administrative process, and get people to the doctor quicker. I love Dr. Shah's idea of putting the patient back at the center and making things more personal in order to treat them most effectively.
In fact, it's all about people, and the ability to see 'the other'. Implying that it's not only the disease that determines what care is needed, but what's important for every individual. This will stimulate effectiveness as well as efficiency. So: no good care without dialogue!
Great talk Dr. Shah! I agree with you in each and every word about the reform in health care system. As a pharmacy student, I see the future of pharmacist working together with physicians, nurses, and other health care team to take care of patient virtually! With the clinical education that we get in school, the pharmacists can be the great help in improving the quality of life of patients.
Fantastic view Dr. Shah! Thank you for being willing to collaborate! I agree with the notion for being able to be compensated for the time of the pharmacist by the insurer when their health care provider identifies their need to have an appointment with the pharmacist. As more pharmacists change lives, the more physicians will see pharmacists in the same light that Dr. Shah does. Then more avenues will doors will be opened to insurers!
Thank you Dr. Shah! As a pharmacist who just recently graduated who wants to make a difference for patients and for the health of our nation, I am so excited by your talk. We can work together to make meaningful changes when pharmacists are brought "off the bench" and included as a key part of the health care team.
Community pharmacists are the health professionals most accessible to the public. They supply medicines in accordance with a prescription or, when legally permitted, sell them without a prescription. In addition to ensuring an accurate supply of appropriate products, their professional activities also cover counselling of patients at the time of dispensing of prescription and non-prescription drugs, drug information to health professionals, patients and the general public, and participation in health-promotion programmes. They maintain links with other health professionals in primary health care.