Dr. Christine Mueller on Healthcare, Patient Communications, and Practicing Medicine During COVID
We recently sat down (virtually) with Dr. Christine Mueller to talk about how healthcare communications—and doctor-patient relationships—are changing.
In this wide-ranging interview, we discuss not only how COVID has impacted her communication with patients, but how generational attitudes among doctors and economic forces in the industry are driving different expectations of medical practitioners.
10 minute read
DR. MUELLER, THANK YOU SO MUCH FOR SPEAKING WITH US TODAY! TELL US A LITTLE BIT ABOUT YOURSELF AND YOUR MEDICAL PRACTICE.
I've been a family practice doctor for 30 years, primarily in the Chicago suburbs. I did my training at Cook County Hospital. From there I joined a group practice for about 24 years, where I did full-spectrum family practice including obstetrical and even surgical procedures. We did C-sections and so on, which made us a little unusual. Then several years ago I transitioned into concierge medicine.
Actually, mine is more of what I would call a “membership practice”; basically, people pay an upfront fee every year — think of it like a membership to a gym or anything else — then they get me 24/7, they get me at the hospital, they get me doing a lot of case management. You get much longer, more flexible appointment times, so instead of that 15-minute appointment, they say “I'm going to be in town on Thursday” and I say, “Yes I can do that.” That kind of thing. That's what I've been doing for the last five years and I’ve really enjoyed it.
What were the communications expectations on doctors and care providers pre-COVID, and how they have intersected with marketing yourself and your practice?
Well, I think actually the communication expectation has changed, and it hasn't changed because... [phone rings]. One sec.
Dr. Mueller had to pause briefly for a call about a patient.
People are tired of being in that 15-minute time slot, and I've had patients actually come to me who have said “Oh, my former doctor told me I ask too many questions” or, you know, their doctor says, “I can only deal with one thing today. If you need something else you have to call me back tomorrow and make a new appointment” or something.
So I think there's been a disconnect for patients with their physicians in the past. And I think COVID-19 accented that, but also highlighted some ways to get around it.
COVID just brings up more questions. You know, people will say “Do I have to do this?” or “Is it safe for me to do this?” and that kind of thing. Or, “Gee, I was supposed to have my cataract surgery. Is it safe for me to do that?” COVID-19 is a new illness; I mean, it is a novel coronavirus, so again it's not like we can go look this up in the textbook. So yeah, it's been an interesting time.
Initially, I spent a lot of time on the phone during COVID, doing wellness checks and answering questions, passing on masks when needed, and then transitioned to doing more in office visits and catching up on annual physicals and the like once restrictions lightened.
Some patients prefer electronic communication, such as texting, web messaging, or patient portals that can allow refill requests, appointment scheduling and access to lab results.
Bottom line—people want to be informed of lab and x-ray results and what it means for them. They want access to accurate and personalized information. Many still want a relationship with their physician.
HOW DO YOU GO FROM THE NEEDS OF ONE PATIENT TO BROADER PUBLIC HEALTH COMMUNICATIONS? DO YOU ADDRESS THOSE THROUGH YOUR PRACTICE BY USING YOUR VOICE AS A DOCTOR MORE BROADLY?
Medicine still is one-on-one. There have always been attempts to meet broader audiences, and I think we obviously see examples of that now.
You know we have the Dr. Faucis and the Dr. Sanjay Guptas and the hero people who are on your local news stations. We have always had certain experts who are out there to impart information to people and to give some credibility. Because are you going to believe it more from a doctor or are you going to believe it more from, you know, some guy sitting behind a news desk?
Now, my electronic medical records have a patient portal that allows me to send messages to all the people who are web-enabled — in other words, anybody who's given me their email. The second way to do that is… honestly, for me personally, I've used Facebook. I have a Facebook page for my practice, so I will put things up there.
In the past, too, as I've had to repeat myself about certain topics, I have taken it upon myself to write out little hand-outs. I have my “cough and cold” hand out, and I have one on women and hormone use, and women and heart disease, and so on. I have those hand-outs available because, one, I got tired of repeating myself, and two, it gives people the opportunity to say, “Now what did she say about estrogen? What did she say about soy? I don't remember.” That way they have a written reference as well, so it's a little bit old school.
There are practitioners who do much more electronic communication with their patients. Recently, of course, there have been changes from insurers about virtual visits. The insurers have finally gotten on board only because they had to. Previously, they had sort of frowned upon telemedicine. Now, they're fully embracing it, which is great! So yes, COVID has taught us a lot.
WHAT ARE THE CHALLENGES FOR DOCTORS AND PRACTICE MANAGERS IN MEETING THOSE NEEDS?
There are still practices across this country that are very old-school, with paper and pencil charting and so on. My electronic medical records incorporate a way to do video and telemedicine visits. Have I learned fully how to use that? No. It comes down to taking the time, and so much is new. There’s a learning curve.
Some people obviously are more facile with some of the technologies than others. Also, do you know what [knowledge and technology] your patients have? Can they do a video conference? Do they have their own blood pressure cuff so they can at least report that kind of thing?
I think one of the most interesting things I’ve seen was a video that a podiatrist sent me. In Israel, they are following up with COVID-19 patients by delivering a device that can be used as both a stethoscope and thermometer right to the patient’s door.
It’s this really cool little handheld electronic device, and they say, “Okay, now hold this thing up to your forehead. Okay good, your temperature is this, and that's good. Now hold it up to this part of your chest. Oh boy, your breath sounds good. Your lungs are clear.”
I mean, it was amazing to me that they could handle checkups very safely, and yet the whole time they were talking to the patient. There will always be a mix of what is offered by physicians and desired by patients.
YOU'VE BEEN A BIG ADVOCATE OF DOCTORS TAKING ON A PUBLIC ROLE. TELL US A LITTLE BIT ABOUT WHY THAT'S IMPORTANT TO YOU.
Again, expert opinion is very important. I think there is a certain trust factor on behalf of the public. To get really good information out there is important.
You know, it's kind of funny, because for my birthday this year my husband got me a mug that says “Please don’t confuse your Google search for my medical degree.” I just find that hilarious, because it is so true.
A patient might say “Well I Googled this, and it says I might have thyroid disease.” I’m not saying to totally discount that, but there is a certain amount of cheapening of the quality of the information sometimes. Just because you read it on Google doesn't make it absolutely true! Though it can be useful to start a conversation.
I got several questions about COVID-19 rumors that were going around for a while. “What if you are an A blood type? Does that mean you're more susceptible to COVID?” This makes absolutely no sense whatsoever, other than the fact that a good portion of the American population is type A.
How physicians take a public role may change based on their community, such as giving talks to a community group, writing a column for the newspaper, hosting or participating in radio or TV programs, running a blog or webinar series, etc.
ACCORDING TO THE HEALTHCARE SOFTWARE COMPANY KYRUUS, 1 OUT OF 2 PATIENTS WOULD SWITCH PROVIDERS TO HAVE THE OPTION OF VIRTUAL CARE VISITS REGULARLY. WE’VE TALKED A BIT ABOUT THIS ALREADY, BUT HOW WOULD YOU SAY DOCTORS CAN ADAPT TO DELIVERING CARE IN AUDIO AND VIDEO FORMATS?
Audio is easy. Anybody can pick up a telephone, although doctors are not used to doing that anymore. I think that's probably the simplest thing. Simplest is the quickest. It's the minimal technology, and you don't have to worry about how to click on the Zoom link.
I had one cardiologist tell me he was calling the patients ahead of time (or his staff was calling them ahead of time) saying, “Okay, the doctor is going to call you at this time. This is the link you need. If you could please have your blood pressure readings, your temperature, and everything all set up for the doctor.” Then he'd have his staff call a few minutes ahead of time to collect that basic information. The doctor would then get on the telemedicine visit and would sit and talk with the patient about what their symptoms were, how they were feeling about this or that, did they have a particular symptom, and so on.
Some of my older patients are really quite sophisticated when it comes to computer stuff. It really is amazing to me how some people have been really good at adapting to the technology. Some people really do prefer in-person visits. I had one woman who said, “Thank you for giving me an appointment. This is the first I've actually been out of my house in 6 weeks! ”
I didn't have a lot of people in the waiting room. I had time in between to really swab down the room. I want people to feel safe about their experience here at the office.
IT’S BECOMING CLEAR THAT ONE OF THE BIGGEST IMPACTS OF COVID-19 IS ON MENTAL HEALTH. COULD YOU TALK ABOUT THAT?
Yeah, we have been handling mental health issues with our patients. We’re also thinking about how that might be interacting with other medical issues that patients are experiencing.
First of all, it’s interesting that we’re seeing every kind of reaction to the pandemic that you can imagine. But I do feel it has impacted people with an incredible intensity. That’s because it has impacted absolutely everybody, and so, yes, mental health is a huge piece.
I do usually end up spending a few minutes saying, “Hey how are you doing with this? Are you coping?” Some people sheltering at home are drinking or eating more. As a matter of fact, I was talking with somebody this morning about the 19 pounds that most of us have gained during the pandemic and how it has impacted things like sleep. I’ve had a lot of people who have talked about strange dreams.
As far as strictly medical stuff, I'm concerned about the backlog of semi-elective procedures that didn't happen due to COVID. We're starting to see people coming in who are either extremely ill because they just haven't gone to the ER when they should have, or haven't come in to see their doctor when they should have. Some of the routine stuff is getting put on hold.
ONE OF THE THINGS THAT SETS YOU APART HAS BEEN THAT YOU PRACTICE IN MULTIPLE LANGUAGES. WOULD YOU TALK A LITTLE BIT ABOUT YOUR BILINGUAL APPROACH TO PATIENT SERVICES?
COVID-19 in general has, of course, disproportionately affected Black and brown communities. Being sensitive to that has been very important. In my current practice I have really very few people of color, whereas in my previous practice I would spend roughly half my day in Spanish. People would seek us out just because we spoke Spanish. Another big population in our area is Polish-speaking. Laotians form another large population in my immediate area.
Providing services to those communities is partly a language thing, but it's also a certain openness to providing the services. When I was an intern, I worked in a predominantly Spanish-speaking clinic. My Spanish wasn't quite as polished as it became, and I was having some difficulty. I saw a woman who was admitted because she was a victim of domestic violence, and I was trying to explain my feelings about that and my level of empathy for her. I ended up talking to one of the psychologists about it. He said, “You're doing fine. Yes, I'll handle the translation and I'll explain things to her, but people understand when they're cared for.”
I found that in some ways it really had less to do with my ability to have the right words in Spanish than to be able to communicate to this woman I understood. I was trying to help her. Now I think that manner and mannerisms are a big part of language.
You learn interesting things from different cultures. For instance one of the things that I used to run across was “hot” and “cold” illnesses, which is not traditionally an American thing. And for the word heartburn? I know three different Spanish words for that, depending on whether you're talking to a Cuban-American, a Mexican, or a South American.
The good news is this is where technology can make a big difference. For instance, my electronic medical record will translate and a certain number of the handouts are already available in Spanish.
This also brings up what I would call healthcare literacy. Some patients are native English speakers but are very unsophisticated when it comes to understanding their medical condition.
By the same token, you may have a foreign language speaker who has a lot of training or understanding of physiology, and it takes very little to get them to understand what's going on with their illness. Just because somebody speaks English doesn't necessarily mean they're understanding you.
HOW DO YOU SEE THINGS CHANGING FOR HEALTHCARE PROFESSIONALS MOVING FORWARD?
Well, I think we are going to start to see even more employed doctors, particularly as parts of big systems.
In the old days, it wasn’t unusual for doctors to be independent, to have their own practices and to be on staff at a hospital. Now, it’s more like the British model. The National Health Service has your hospital doctors and your outpatient doctors, and never the two shall be the same.
In many ways, doctors in the United States have decided to do that. They don't want the hassle of having to go to the hospital and then go to the office and then of being interrupted by a phone call about that patient who's in the hospital.
Even doctors in my generation are doing that kind of thing. I see it as an exit strategy in some ways, in that they get acquired and get a certain chunk of money.
That way, when they decide that they're ready to leave practice or have had enough of being told what to do (which I don’t think doctors of my generation do very well), they say, “Well I'm going to do this for 2 years or 5 years. When I leave, it's not my problem anymore. I don't have to worry about who's coming in to take care of the patients, or who's coming in to buy my office building, or who's going to or set up a 401k for my staff.” They're just going to be part of a bigger system.
My practice does kind of just the opposite of that. There are a lot of patients who don't like that systemization, who don't like that they've got 15 minutes and then the doctor is going to be out the door, because if they're going to make their their numbers they're not going to keep that next patient waiting more than a minute in that exam room. Or their numbers are going to go down, or their ratings are going to go down, or they're going to be penalized. That's part of the frustration, particularly of doctors in my generation.
I think in some ways this is a sweet spot for concierge medicine, or membership medicine, in that you have a lot of patients who are fed up with being treated like a cog in a wheel. We are not dealing with widgets here. We are dealing with people who have idiosyncrasies and individual personalities.
Even somebody who deals with a particular kind of cancer is going to have two patients with two different responses to the exact same illness. Being able to deal with that is going to become ever more important on a national level.
My one hope out of the COVID-19 is that we will end up with some kind of a nationalized or standardized healthcare program. Not necessarily that all doctors are going to be exactly the same, but that healthcare insurance for patients is going to have some kind of standard methodology, or single-payer, or something along those lines. We're heading toward pre-Affordable Care Act levels when we had 45 million uninsured people, and with 30 million unemployed now, we’re going to reach those numbers very quickly.
I think the only way we can sustain healthcare is by having some kind of a national program, so I’m hoping that that’s one of the things that will come out of an administration change or out of this next election. Between Congress and the executive branch, I think some big reform on national healthcare is going to be absolutely necessary. I think it's the only way it's going to survive.
THANK YOU FOR SHARING YOUR EXPERTISE WITH US TODAY. IT'S BEEN FANTASTIC TO TALK TO YOU.
Well, thank you very much I've appreciated the opportunity.