Why we can't fix our healthcare system | Ayesha Khalid | TEDxBeaconStreet

This talk was given at a local TEDx event, produced independently of the TED Conferences. Ayesha Khalid, surgeon at Harvard Medical School and recent MBA from the MIT Sloan Fellows Program, is at the intersection of disruptive innovation in healthcare and the digital health experience. Ayesha previously pioneered groundbreaking research in sinus disease including muco-ciliary clearance and outcomes following surgery. She is now a passionate believer that disruptive innovation in healthcare requires collaboration, not competition. Using a systems thinking approach, Ayesha wants us to suspend our belief that adding more process to our healthcare system will add back "health" and "care" to a broken system. Instead, this compelling talk provides an imaginative way to approach the redesign of our health care system to one that promotes "health" and works "systematically" for the patient.

A sinus surgeon at Harvard Medical School and recent MBA graduate from MIT, Ayesha Khalid is a healthcare innovation enthusiast involved with entrepreneurial ventures at the intersection of healthcare innovation and digital technologies. She has pioneered groundbreaking research techniques in inflammation and sinus disease and is working to create different funding paradigms to accelerate clinical research.

About TEDx, x = independently organized event In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TEDx event, TEDTalks video and live speakers combine to spark deep discussion and connection in a small group. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized.* (*Subject to certain rules and regulations)

[ownvisionsb]

The best doctor I have seen ask me what I think is going on then examines me and gives me options in resolving my concerns.

[justinnorwood]

The most important part of this speech is when she covered the patient-physician relationship. I can say from experience that doctors don't take the time to build a relationship and really understand why the patient is there. As a doctor in the healthcare system, you're obligated to treat every visit separately and form conclusions from hard evidence. Hard evidence is of course what shows from the tests, but also the patient's story. If this first step was taken more seriously, I really feel like our healthcare systems will be more efficient. This might seem like a small “issue” but in reality it can make or break the healthcare system’s reputation. I’ve been to some doctors before where they assess me and get me out of there as fast as possible. That forms a void in our relationship, and made me not go back to that doctor again.

[meghannackerman]

Great points, Ayesha! The biggest take away for me is remembering to slow down, ask questions, and look outside of the immediate problem area.

[arkaditnkodia]

all aspects of health must be taken into account because health is not just the absence of the disease in the human body, we must go towards the promotion of health

[Lizzard]

Had my Doc for many years now but sadly management keeps changing. Our appointment times keep getting shorter and basically everything is now on a fifteen minute schedule block to get in as many patients as possible. Doesn't matter how long you've been at the clinic or how far ahead you scheduled. Corporate greed is constricting so many GOOD Docs.

[zards]

"Asking if we are asking the right questions is so true." I see so many times from the entrepreneurial perspective that people just dive right in on specific solutions with no regard to the bigger questions of "why"?

[onlyonedeedee]

To answer your question: why aren't the Charlies of the world getting the necessary diagnoses? I offer this response which is based on both personal experience as a patient and a fellow healthcare professional. Apologies if the answer appears emotional but I am passionate about delivering care and it peeves me that professionals at times stumble at the most basic of principles: listening to the patient; I totally agree with you on that one. The first thing we are taught as nurses is the importance of communication, delivering information so the patient could understand it, benefit from the treatment and make an informed decision. the second part of communication is listening; not only hearing the words but attentively and seriously. My personal belief is that most doctors are problem solvers; as they listen to the patient, they are 'solving' the case study they are being presented with. The flaw here is that this is not holistic.

I hold my hands up, as a student, I was given that exact feedback: "the patient could hardly breathe and you bombarded him with 20 questions!". My reply " I needed information so I could help him". So, although the intention is benevolent, the application was lacking and non-holistic. Another point, is that the patient is the one who knows exactly what they are feeling or experiencing even if they can not provide a self prognosis or name the cause of their current predicament. This is where the 'listening' part comes in. Listen to what the patient is saying and ask probing questions in order to hone down on the symptoms. Do the tests for pete's sake! Not just because you failed to determine what is going on but as a precautionary measure (forget cost!). If certain causes are ruled out early on, this would prevent diagnostic overshadowing or failure to diagnose and limit the number of people returning with more serious conditions.

Apologies again for the emotional rant, but doctors have to stop believing they know better than the person who is going through the ailments (in certain cases), and hone their social and communication skills. I understand pressures and demands of the job could lead to some form of malignant alienation and a coldness on the doctors part but the patient remains a human being in need of help; and they are reaching out. Instead of the conversation flowing between adults, it becomes a parent-child interaction: 'take this because I say so, you don't need to know why'.

Consider this event which happened to me the other day during a suicide prevention lecture: the lecturer made a statement that during the first two weeks of administering anti-depressants, the 'subject' may experience increasing suicidal thoughts and requested that doctors be mindful of this while informing patients as they prescribe the meds. The shocking response from a doctor present was: but research shows that 'prescribing someone a pill as effective as offering them talking therapy'!!! Shocking and mind blowing insight into how much faith doctors have in pills but not enough in human contact (and into how some doctors think). I hope more people stumble on your lecture and appreciate the importance of establishing a therapeutic relationship/partnership with the patient so instances of misdiagnosis would be a thing of the past. Thank you.

[paulstewart]

hello I!m from the uk in this country we give our doctor as much information as we can so he/she can make a diagnosis and direct us to a solution and treatment without fear of the costs.however in your country maybe patients do not disclose for fear of high bills or affordadlity ostrich and sand .

[ayeshakhalid]

Thank you for listening and look forward to your thoughts!

[MedschoolMom]

I appreciate Dr. Khalid’s question: “Are we asking the right question?” To really do our work effectively, we have to take the time to ask the right questions. We have to consider the patient’s full story, and not be hyper-focused on a certain symptom or a certain part of the body. I think it’s an ethical imperative for each physician to take the time to get to know each patient in order to be able to provide the best care. Without knowing a fair amount about your patient, it would be very difficult to effectively treat them. That’s what leads to misdiagnosis and errors. It seems in many instances it would be better for a physician to take a little more time to fully understand the patient’s story instead of trying a whack-a-mole approach of quickly guessing at a diagnosis and hoping it’s right as you send them out the door. It’s our ethical responsibility to try to do better. It’s also our obligation, as Dr. Khalid suggested, to be willing to admit when we don’t know and commit to keep trying instead of just sending the patient out the door with a medication that likely won’t help. We also need to be willing to ask for help from colleagues and collaborate to find what’s best for each patient.

[jessicakirk]

I especially enjoyed the point of view that Dr. Khalid took that healthcare is a partnership with your patient. It is a good reminder as a future healthcare worker to slow down, listen to our patients and really listen to what they are telling us. Physicians are always taught to first do no harm, but in a world that is continually pushing healthcare to become faster and more efficient we lose sight of the most important part of healthcare, the patient. Patients are not going to feel safe and willing to open to their doctor if they don’t feel like they can form a connection with that person. I agree that the first steps to solving our issues with healthcare is to begin by asking the right questions and looking into how patients are being treated by their physicians.

[alexsismiller]

I agree very much with Dr. Ayesha Khalid in her stances on the modern day health care system. Her approach to better the health care system could really make a difference in how doctors treat and assess their patients today, and could also really help with failures in the system. In the video, Dr. Khalid talks about a personal story with a patient named Charlie. Charlie went to her office seeking help that he has not received from many other doctors. He then explains to Dr. Khalid how frustrated he is with the healthcare system because he has been to so many doctors and specialists and not one has been able to tell him what is wrong or diagnose him with anything, and he knew something was wrong. Dr. Khalid was very bothered by his frustration and reassured Charlie that she will end his streak of being let down by other doctors. She tested him for everything she could think of with his symptoms and every test was coming back normal or negative, so she then ordered a CAT scan. The CAT scan did not seem to be necessary with all the work she had done prior to, but she was not letting Charlie leave without answers. When the results came in from the CAT scan, everything seemed fine, but that was not good enough for Dr. Khalid. She went through the images herself and ended up finding a mass on Charlie's brain. As she told the news to Charlie and his wife, Charlie felt a sense of relief and thanked the doctor. Charlie's reaction speaks volumes. He was RELIEVED to find out he had a mass on his brain only because he finally got his answer. This addresses the problem that Dr. Khalid is attempting to fix in the healthcare system. Doctors not taking the extra step in finding a diagnostic for a patient mainly due to the fear of failure. With this problem in mind, Dr. Khalid proposes three questions; How can we get doctors and patients to talk as friends, why is it that competition is so bad for health care, and why does the medical field fear failure? An answer brought up that addresses all three questions is that we need to make doctors more focused on bettering the patient and not themselves. Directed at the first question (getting doctors and patients to talk as friends), doctors need to be willing to take the extra step in getting personal with their patients so they are comfortable to tell them that they might be unsure of the answers for them at the time, but will do everything they can to get them their answers to solve the problem. In turn, the patient needs to be willing to accept the doctor's answers and understand that they will do anything possible to help. To address the second question (competition in healthcare), doctors today are more worried about getting higher up in their practice and making the most money than connecting the right way with their patients. This is not to say that all competition is bad, some competition can be positive as well as some can be negative. Some positive aspects of competition is that it weeds out the weaker party trying to be doctors in which is a big part on what is saving patients lives to this day. Another is that it makes doctors strive to be the best at what they do, meaning they will gain more patients and in turn gain more experience to help further them in their career. The problem is, is that there are overpowering negative factors to competition and that the negative factors tend to be more commonly noticed than the positive. One negative part of competition is that it turns doctors and other medical professionals against one another, which denies them the opportunity to gain knowledge from fellow superior or non-superior colleagues. Another negative aspect of competition in healthcare is it brings more of a focus on social gain such as status, ranking, or money earned. As said in the video, doctors need to focus on gaining better relations with patients and fellow medical professionals to help them have a better chance of succeeding in their career. By doing this, it will not get rid of competition as a whole. It allows you to take Dr. Khalid's advice while still preserving the most important positive aspects of competition while also allowing us to remove the negative aspects. To address the final question (medical field fearing failure), this connects all the points Dr. Khalid made together. Doctors in today's world are so afraid of failure, they settle. They settle for the easiest route, whether that be diagnosing too quick, or not giving any answers. There is currently a 15% chance of diagnostic error on a patient's first visit with a physician, as said by Dr. Khalid. By implanting these questions in the healthcare field, that rate could drop tremendously. I strongly support Dr. Khalid with all of the points and solutions she addressed in the video. She allows her audience to see all different angles and perspectives of the topics she discusses which gives a fair opportunity to decide your stance on the topic.

[wellbodisalone]

Those were great points! The conversation between the patient and the doctor should be more about listening than hearing.

[madieteltow]

I do agree with Dr. Khalid when she says there is something they need to fix in healthcare. She understands how frustrating it may be to not know what is wrong with you and to not be able to figure out the problem. The patient and doctor both want answers and want to figure out the diagnosis. Also, the patients need to understand it will take doctors some time to figure out what is wrong with them. Sometimes it takes days or weeks but they need to be patient. Doctors also need to know they will fail but can learn from it. Doctors will not be able to satisfy every single patient that comes through the door. I believe Dr. Khalid is right when she says they need to change the nature of the conversation and ask physicians to make the time to step back and listen to the patients stories. Nothing should be rushed.

[joshholton]

Ayesha Khalid's first question, to me is the most important aspect of health care. The patient-physician relationship is the first thing that should be analyzed, and I feel should be focused on more. Doctors don't take the time to build a relationship and really understand why the patient is there. Yes there are plenty times when people get checked out and its not severe. But as a doctor, you're obligated to treat every visit separately and form conclusions from hard evidence. Hard evidence is of course what shows from the tests, but also the patient's story. If this first step was taken more seriously, I really feel like our healthcare systems will be more efficient.

[foxxysoftball]

One very important part discussed in this video is the patient-physician relationship. I know from personal experience that sometimes doctors really lack in the bed side manner part of training. My doctor back home is not very friendly and that makes going to the doctors even harder. She always has this tone in her voice they she doesn’t want to be there and it makes me feel bad sometimes like I am wasting her time and that’s not okay. Doctors are supposed to make you feel comfortable, like you can go to them with every and anything. She just seems like an all around grumpy person. I know personally I would feel much better as a patient if my doctor was cheery and happier.

[llevymoraes]

Excellent points. It reminded me about the manager's mantra "Don't come to me with a problem if you don't have a solution". A big mistake in my opinion, which threatens effective communication and limits problem solving in both organizations and in the physician-patient relationship. 

[davidfogel]

Excellent thoughts.  Very true that physicians feel strong time pressures in dealing with patients.  i also recall our conversation about how patients need to self-advocate and not assume that the doctor's initiatives in solving medical problems are correct.  We talked about the many options that cancer patients are presented and how difficult it is to navigate these options without good guidance.

[gagaming]

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[Elevin-rljl]

I had this happen to me. Was the victim of an assault, guy broke my nose. first doc throwing meds at it, and then finally ordered a CT said nothing wrong, second doc looked at the CT saw that my airway was the with of a sowing needle, said go to see a plastic surgeon. Surgeon 3 hr north looked at CT and said she couldn't touch it identified that the septum was bent into an S shape, and was shoved to within 2mm of my brain. She refereed me to Georgetown Medical school, the head of Maxilla facial surgery, who was the only one qualified to repair the damage.