Become your own health advocate: Navigating the doctor shortage [PODCAST]

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In this episode, Ann M. Hester, a board-certified internal medicine physician, dives into the perfect storm brewing in the U.S. health care system and what we can do to prepare for it. The country is facing a projected shortage of doctors and the increasing number of elderly citizens with chronic diseases. Additionally, physician burnout and the COVID-19 pandemic have contributed to many doctors leaving the practice of medicine. But as patients, there are things we can do to empower ourselves and make the most of every minute with our doctor. Ann shares tips on how to prepare a brief history of present illness to explain our symptoms and help our doctor make a more focused examination. Don’t wait until it’s too late. Tune in to learn how to be your own successful health advocate.

Ann M. Hester is a board-certified internal medicine physician with over 25 years of experience and can be reached on Twitter @Patient101Book, TikTok @patientempowerment101. She is the author of Patient Empowerment 101: More than a book, it’s an adventure!

She shares her story and discusses her KevinMD article, “How you can thrive despite the looming physician shortage.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Ann Hester. She’s an internal medicine physician. Her KevinMD article is titled “How you can thrive despite the looming physician shortage.” Ann, welcome to the show.

Ann M. Hester: Thank you. Thank you for having me.

Kevin Pho: We’re going to get into the article in a little bit, but first off, briefly share your story and journey to where you are today.

Ann M. Hester: Well, I am an internist. My father was a GP decades ago, and I spent a lot of time in his office as a child. I was really inspired by all the people who would come up to me on the street and say, “Your daddy helped me,” and it meant a lot to me. I didn’t want to stay in school that much, that long, so initially I did not want to be a doctor. My older brothers became physicians, but I kind of held off.

Unfortunately, my father had a fatal cardiac arrest before he learned I was going to go into medicine and follow in his footsteps. Something that really touched me was the song at the funeral: “If I could help somebody, my living would not be in vain.” I took that to heart, and over the decades, that’s kind of been my mantra. If I can make a difference, then my life is worth living. So I’ve always had a desire to help people.

I went to medical school. I graduated in 1992 from the University of Tennessee in Memphis, and then I went on into private practice. Then my husband and I moved to the East Coast so I could have a kinder, gentler job, so we could start a family together. I’ve been a primary care doctor. Much of my career, actually, has been as a hospitalist, so I’ve kind of run the gamut.

I started with my passion of empowering patients back in medical school. As a third-year student, you remember how hard it was. You’d have time off, and when we had time off, a lot of my classmates were out doing fun things, but I just felt like I needed to get started helping people, even before I had the MD. So I wrote my first book. I self-published it, a self-help book, decades ago.

Subsequent to that, I wrote another, more general self-help book. It was called “Your Family Medical Record: An Interactive Guide to Getting the Best Care,” and John Wiley published that 23 years ago. At that point, people didn’t really seem to care that much about empowerment. Then, a couple of months ago, in November of last year, I republished the best parts of that, and I added a lot more, in a book called “Patient Empowerment 101: More Than a Book, It’s an Adventure.” So my passion has always been about helping people, literally, and empowering people.

Kevin Pho: Wonderful. With your decades-long experience with patient empowerment, you wrote a book on it. Just tell us, what does patient empowerment mean to you?

Ann M. Hester: To me, it means that patients are equipped to center themselves in the middle of their health care team. They don’t just rely on what the doctor and the nurse and the other people tell them. They actually know what’s going on, they know the questions to ask, and they know how to communicate with us.

I once timed a very loquacious patient. I knew she was going to take a long time. I asked her a yes-or-no question, and it took her 10 minutes, because she sat there and she thought about it and she went around the block many times before she came to her answer.

Now, think about what that means to us as clinicians. When you have a patient or a nurse who can come in and hit the bullet points right on, it expedites the diagnosis. It narrows down the list of possibilities, so you don’t need to order all these tests and procedures. You have a short list, so to speak, of what you think is going on. That translates into a speedier diagnosis; fewer tests and procedures, some of which can be painful, expensive, and even dangerous; less of a need for trials of medications; and fewer follow-up visits to see how the patient’s doing. So it is a huge win-win when patients are taught to communicate with us on a different level.

And you don’t have to be a doctor or nurse or have any health care background. I once did a lunch-and-learn session for a landscaping company nearby, and my audience was basically people who did the landscaping, groundskeepers. Most of them did not have a degree. After 90 minutes, after doing the lunch-and-learn, we had a mock doctor-patient session, and I did this with several of them. You would have thought that these people were doctors and nurses and had a long background, because once they’re given the skills, they can partner on a huge level, on a level that we have not imagined. They just need the information to be able to do that.

So empowerment, to me, means that patients can put themselves where they deserve to be, and that’s at the center of their team, and communicate with us, nurses, and everybody else on an unprecedented level.

Kevin Pho: All right, let’s talk about your KevinMD article, titled “How you can thrive despite the looming physician shortage.” Now, tell us, how did this article come together?

Ann M. Hester: It all came together based on the book “Patient Empowerment 101” and my desire to teach people what they need to know. For instance, we know we can’t just charge whatever we want to charge for a visit. We have to look at the evaluation and management guidelines. Realistically speaking, those eight bullet points, the severity, location, duration, and so forth, those things are important, not only to substantiate what we did for the patient and the complexity of the care, but also because if you cannot substantiate those things, then you could be in trouble with your billing.

Patients don’t know these things. If patients knew, “Hey, I have abdominal pain. Let me go through these eight bullet points: the severity, location, the duration, the timing, exacerbating and relieving factors, and so forth,” then when they walked into the doctor’s office, they could give a 60-second elevator speech, help the doctor narrow down the list of diagnoses, and expedite their own care. They just need the tools.

So this article came about because I really want patients to understand what they can do differently. It’s not complicated, just some very basic things that they can do to expedite their care, decrease the time of suffering, and lower the medical bills. That is a huge win-win, not only for the patient, but for the doctor, who needs to get to see the next patient, or to spend more time with that patient because that patient is sicker.

Kevin Pho: So tell us about some of these tools that patients can use in the exam room to facilitate this.

Ann M. Hester: Well, for one, I really advocate that people prepare in advance and prioritize their concerns. When patients come in with a list of what they saw on the internet and a long list of issues, and you only have a few minutes, they often don’t get to what they really need and really want to address. So they prioritize, and they prepare in advance.

Those bullet points I stress in the book, and also in the book, I go through our FAQs. If you have abdominal pain, we know what we want to know. We know, having that knowledge and those tools. We know those things, but they don’t. Often they sit in a cold room, hungry or angry because the doctor is a little bit late, or maybe very late, getting to see them, and they try to pull together the history then. That’s not the best time. We all know that when they try to do that, they can be very circumstantial and miss important things. So I stress the importance of advance preparation.

I go through a variety of common symptoms, abdominal pain, fevers, diarrhea, and so forth, and give them the things that we’re most likely to ask, so when they go and see the doctor, they can go through those things quickly.

I also encourage people to know their medical records, to have a concise, organized copy of their medical records, because when they go from doctor to doctor, or even if they end up in the emergency room unexpectedly, they need to know these things. They can’t say, “I take a little white pill.” A lot of people are familiar with that notorious little white pill, where we have no idea what they’re talking about.

So I really just try to get people to pay attention to details, and you don’t have to get into the weeds, so to speak. I ask them to get things organized in a step-by-step fashion, so a doctor can open up their medical record, with the three-ring binder or the companion guide that I made for this book, and see at a glance medications, medication allergies, family history, past history, surgeries, and so forth. Just like we keep a medical record, I encourage them to keep a concise copy of their records for emergencies and just for doctor’s visits.

Kevin Pho: Now, let’s flip this to a physician standpoint. Like you, I’m a primary care physician myself. What are some things that physicians can do to place patient empowerment in the center, especially, as you know, with increasing obstacles, bureaucracy, and time pressures? What are some things physicians can do to empower patients?

Ann M. Hester: You made a good point about the time frame. There is a lot going on. The AAMC has predicted a physician shortage of, I think, about 124,000 doctors, maybe 11 years from now, and so our visits now are going to really be abbreviated.

Patient empowerment means different things to different doctors. If your practice is set up in such a way that your patients come in with a list of prioritized questions and you can go through those questions expeditiously, then let them know that. If, by preparing in advance, you want them to go through the bullet points of those eight HPI elements, you can give them that information. You can give them handouts or sheets. You can create your own literature. You can put it on your website, in your patient portal.

So you have to prioritize what’s important for your practice. What works well for a gastroenterologist may not work so well for an internist. So what you need to make your practice run more smoothly and to empower your patients is what you would focus on, and the means by which you would do it would vary. If you have a primarily Medicare population, those tools are going to be different than if you have mainly 20- and 30-year-old patients who are very healthy. So each doctor can look at his or her practice, see how things flow, and envision how they could make those visits more effective, and then they would tailor patient empowerment to what they need or what their patients need.

Kevin Pho: We’re talking to Ann Hester. She’s an internal medicine physician. She’s the author of the book “Patient Empowerment 101: More Than a Book, It’s an Adventure.” Her KevinMD article is titled “How you can thrive despite the looming physician shortage.” You did touch upon the looming physician shortage, especially in primary care. Now, for those medical students who may be listening to us today, give them some reasons why they should consider primary care as a career.

Ann M. Hester: Primary care gives you so much potential to change lives. When I was going through medical school, the subspecialists were the ones who were really lifted up and, you know, very important, so to speak. But if you think about it, how many people die of a ruptured appendix? How many people die of a neurosurgical emergency? As the primary care doctor, you can impact people from A to Z. You have impact over their emotional well-being. The preventive aspect is huge. Lifestyle medicine is gaining speed as far as using lifestyle to even reverse diseases.

I remember I had one patient when I was a primary care doctor, and I used to always get on him, always kindly and respectfully, but I would get on him about weight management, things that he could do differently. He stopped coming. And then he came back, maybe two years later, and he said, “Dr. Hester, I wanted to wait till I had lost 100 pounds. I’ve lost 99, but I had this bad bronchitis, and I just had to come in a pound early.” So because of that counseling, this gentleman lost close to 100 pounds. Just imagine the impact that that had on his life and life expectancy. You’re able to develop relationships with people that a lot of other practices, a lot of other specialties, just are not able to do.

So again, my father was the primary care doctor. He was a GP. I was an internist. I spent a lot of time as a primary care doctor. Then I went to primary care/hospital medicine, and then I moved to hospital medicine. But some of the most precious times of my career were times like what I just mentioned. I ordered a pizza one day and opened the door, and the pizza man said, “Dr. Hester, you saved my life. You diagnosed the DVT.” There are certain things that will always stick with you. Primary care physicians have an impact on medicine and on their lives that is really just hard to match.

So I would strongly encourage everybody to strongly consider medicine, primary care medicine, because you can play a tremendous role over a long period of time in the lives of your patients, their families, and their communities.

Kevin Pho: We often hear about some of the obstacles to medicine in general, and especially primary care, whether it’s bureaucracy or electronic medical records. There’s an increasing rate of physician burnout. How do you persevere through those challenges and maintain those ideals?

Ann M. Hester: I think that people morph, and you have to determine where you are. Be honest with yourself. For me, when COVID hit, I was able to spend more time with my children. I am in my 60s, and I decided it was time for me to make a change for my family, teenage girls who need a mom to be home. So that was the time for me to make some changes.

Before then, initially, I was a primary care doctor working crazy hours with a family, and I couldn’t keep that up as a private practitioner, and I had to morph into working for an HMO. Even as the primary care doctor in the HMO, I ultimately transitioned to doing a lot of hospital medicine, and then into hospital medicine.

So in order to decrease your risk of burnout, be honest with yourself. Prioritize what’s important to you, your family, your work-life balance, and then you can determine what fits for you. If you find a good fit and you’re happy with what you do, you’re far less likely to burn out. If you stay at something feeling that people expect you to do it, that you need to do it, but deep down you’re not happy, you’re not going to stay. And if you do stay, you’re not going to be happy.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Ann M. Hester: A big take-home message I have is that we as a country are like a ship sailing gently into a tidal wave that has the potential to sink our ship. We as physicians are like the admirals of our health care system. The APPs, the nurse practitioners, the PAs, the CRNAs, and so forth, they are vital. You have to have the providers, the captains, the nurses. We can’t do it without them.

But we haven’t really taken full advantage of the health care consumers, the laymen. There are so many more of them than there are of us. We need to equip them. We need them on our side. We need them to be in the battle with us.

With this looming shortage, we must be strategic. We must think outside the box and come up with innovative ways to strengthen our health care system in spite of what we face. It means different things to different people, different things to different hospitals, different things to different practices. But evaluate where you are and where you think you may be in 10 years. If we really have that sort of huge shortage, it doesn’t matter what kind of insurance the patient has. If we’re short over 100,000 doctors, you only have so much time you can spend with any given patient. So look to the future and start making plans so you can help protect your patients, the community, and your practice’s survival.

Kevin Pho: Ann, thank you so much for sharing your time and insight, and thanks again for being on the show.

Ann M. Hester: Thank you so much for having me.

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