Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join Drew Remignanti, an emergency physician, as he delves into the fascinating world of medicine and discusses his book, The Healing Connection: A Partnership for Your Health. Get ready to explore the insights and experiences of a medical professional who has dedicated his life to saving lives and fostering a deeper connection between patients and health care providers.

Drew Remignanti is an emergency physician.

He discusses his book, The Healing Connection: A Partnership for Your Health.

Careers by KevinMD is your gateway to health care success. We connect you with real-time, exclusive resources like job boards, news updates, and salary insights, all tailored for health care professionals. With expertise in uniting top talent and leading employers across the nation’s largest health care hiring network, we’re your partner in shaping health care’s future. Fulfill your health care journey at KevinMD.com/careers.

VISIT SPONSOR → https://kevinmd.com/careers

Discovering disability insurance? Pattern understands your concerns. Over 20,000 doctors trust us for straightforward, affordable coverage. We handle everything from quotes to paperwork. Say goodbye to insurance stress – visit Pattern today at KevinMD.com/pattern.

VISIT SPONSOR → https://kevinmd.com/pattern

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/9p8fg6

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Drew Remignanti. He’s an emergency physician, and we’re going to talk about his book, The Healing Connection: A Partnership for Your Health. Drew, welcome back to the show.

Drew Remignanti: Thanks a lot for having me, Kevin.

Kevin Pho: You were last on about a year and a half ago. For those who didn’t listen to our first episode together, just briefly share your story and journey again.

Drew Remignanti: Well, I’m actually now a retired emergency physician. I retired as of April of ’20, which put me at 40 years in my career. I chose that not because of the pandemic, but because I was getting on, and it was convenient timing, because I got to leave the emergency department during the pandemic while I was on a couple of immunosuppressive medicines. In addition to having a 40-year career in emergency medicine, I’ve had a 50-year career as a chronic disease patient with an autoimmune disease. Unfortunately, that career doesn’t offer retirement options, so I say I retired from work but not from being a patient. I wrote the book as a series of reflections and insights I’ve gained over those 40- and 50-year careers.

Interestingly, I had a little mini-reunion with half a dozen medical school classmates, and we were all commiserating about the fact that it feels like the corporate takeover of medicine happened on our watch. It’s happening in a way that I think many patients are really not even aware of: the degree to which dollar-driven decision-making is driving what happens in the office between you and your physician. I think we need to try to put a halt to that, and so I’ve written a book to try to begin a conversation about how we halt that process.

Kevin Pho: So before going into more detail on that, you mentioned that you’ve been an emergency physician for 40 years, and I know you’ve seen a lot of corporate influences, specifically in emergency medicine. Tell us a little bit more about that evolution over the decades in emergency medicine.

Drew Remignanti: Here’s the way it manifests. I started my career as a single doctor in a moderate-sized emergency department. When we were trained, we were told you need to be efficient in your practice, because you need to be aware of what’s going on in the entire department, but the idea that we needed to be productive was never mentioned. What’s happening in health care now is that the patient-physician relationship is rapidly being converted into a consumer-provider relationship, and I’m offended by being considered a consumer rather than a patient, and I’m offended by being considered a provider rather than a fully trained physician. Basically, what happens on a day-to-day basis is that we’re told to see more patients, see them faster, keep them more satisfied, and, oh, by the way, don’t make any mistakes. It’s really only the last one that I’m worried about.

Kevin Pho: So when you talk about those competing pressures, see them faster, don’t make any mistakes, maintain high patient satisfaction scores, how does that influence you as a physician? How does it make you feel emotionally, practicing emergency medicine in that environment?

Drew Remignanti: Well, it was extremely stressful. The term burnout is being used, but I like the alternative term that Dean and Talbot brought up, which is moral injury. Basically, you’re being forced to make rapid decisions in a setting where you don’t think rapid decisions are in the patient’s best interest. I think what we need to do as physicians is establish what we think is required to have the proper interaction with our patients and adhere to our own values that we’ve developed over the course of our careers. But you’re constantly being pressured: “No, that’s not right. You need to get on to the next person, get on to the next person, get on to the next person.”

Time is really the most valuable thing in a patient-physician interaction, the time you can take to communicate. We’re in a setting now where high tech is ruling in medicine. In emergency medicine a lot, but in all of medicine, high tech is what everybody’s excited about, and what we’re losing sight of is that we need a high-touch and high-talk environment, too. Getting to the proper diagnosis and arranging the proper treatment plan for a patient requires the time to converse and get to know each other.

Kevin Pho: Now, we talked about the effects of that on physicians, specifically moral injury, or what some call burnout. How about patients? How do these competing pressures that a lot of physicians experience affect patients?

Drew Remignanti: Well, I think patients, in the moment, are satisfied if they can get things done in an efficient and convenient fashion. I am, too, when I’m a patient. I like convenience as much as anybody. But I think they don’t understand that the convenience of getting in and out with someone who doesn’t know you is not as valuable as spending more time with somebody who does. In my book, and I have over 280 references, I’m going to hold up the book for you, one of the things I’ve pointed out repeatedly is that, as patients, if we know our doctor well and we can trust our doctor, that helps us. And even more importantly, if we feel known by our doctor, we’re more likely to become engaged in the planning of our treatment plan, and then we’re more likely to adhere to carrying it out. So you have to have that engagement with somebody who knows you. The downside of the emergency department is that I’m usually meeting people for the first time, sometimes repeat visitors, and we try to establish a useful exchange as quickly as we can. But primary care is really what we need to incentivize more in the U.S. health care system.

Kevin Pho: So your book is called The Healing Connection: A Partnership for Your Health. You mentioned that this book has many, many reflections from your decades-long career as an emergency physician. Tell us some of the main themes and messages that run throughout your book.

Drew Remignanti: What’s interesting, when I started to do the research, is how strong the science is behind the utility of having that kind of fully engaged partnership. Study after study, and I quote five or six of them in the book, shows that it can cut our mortality rate risk in half. If those studies had concluded that maybe it’s a 5 or 10 percent reduction in mortality rate risk, you’d say, “So what? That’s nice.” But literally, you’re half as likely to die if you are a more knowledgeable, more engaged patient, because people who are more knowledgeable and more engaged in planning their treatment in partnership with their doctor are more likely to follow through with that plan.

I would say to folks, next time you’re in your doctor’s office, say to yourself, “When I leave here, I’m going to have to do everything that my doctor and I decided we’re going to do.” If you went in with that expectation, that you’re going to have to do it, that you’re making a commitment to do it, you would ask the questions you need to ask while you’re there in the office. You wouldn’t do what I think a lot of people do, which is say in the back of their mind, “Yeah, yeah, yeah, there’s no way I’m going to do that.”

Kevin Pho: So when you say patients need to be more engaged in their own health care, what exactly does that look like? What do patients have to do going into a primary care office to be more engaged?

Drew Remignanti: Well, I’m a big supporter of the idea that people need to advocate for themselves, but I think some people are distorting that into the idea that they can become their own doctor, and your health care is really not amenable to being a do-it-yourself project. We can become very knowledgeable as patients, but we cannot develop the degree of insight that a medical education delivers, and all the years of practice thereafter. So I would say to patients: Don’t take any piece of advice from your physician without questioning it. You can question it internally, and then you need to overtly ask those questions: “You said I need to do this. Do I really need to do that?”

I have the advantage, when I’m seeing my doctor for my chronic condition, that he can tell me things like, “Gee, Drew, we’re going to try this medicine for the next six months. We’re not really sure it works.” He said that to me honestly. If you have that kind of relationship with your doctor, you can get over those hurdles: “OK, this one is going to potentially cause these side effects. Let me know if those side effects become unbearable for you, and if they are, we can switch to something else. But if they’re not, let’s give this a six-month try.”

So I call it a partnership, and it’s not an equal partnership, because we have different strengths. The patient’s strength is knowing what their concerns are, knowing what they’re feeling and what goals they want to achieve with their health care, and they need to take the time to convey that to us accurately as physicians. On the physician side, we have the expertise of knowing how best to get you where you want to be and what the risks are.

Kevin Pho: I talk to some patients, and they say they have so many resources available to them. Of course, there’s everything on Google, but now we have artificial intelligence. We have ChatGPT, where they can simply ask questions and have plausible answers come back to them. Maybe you could give us an example of how that partnership with a physician can be more important than patients just looking things up with artificial intelligence tools and Google.

Drew Remignanti: In the book I go into issues like the bias and denial that we can have as patients, which is too much information to summarize here. But you need to be a fully engaged individual in that interaction. You cannot take a passive role. In the old-time passive role, the paternalistic attitude we took as physicians, patients adopted the attitude, “I’m just going to go in there and wait to be told what I have to do.” We have to abandon that, but we can’t replace it with the idea that, as a patient, I’m correct and the doctor can’t possibly be correct. I refer to it as rejiggering it into a parental relationship: I have a parental type of concern about you as a patient. I’m not going to treat you like a child, but I’m going to have that degree of concern about you, and I want you to have that same degree of concern about our interaction. You come in thinking, “Gee, this is very important.” I think people don’t make that degree of commitment, and we can do that.

I mean, tonight you could decide, “The next time I’m in my doctor’s office, I’m going to say to my doctor, ‘I’ve decided to become a much more knowledgeable and engaged patient in our interactions, so I’m going to be asking a lot more questions.'” You’ll have to take a pause at that moment and help your doctor back up off the floor into their chair, because they’ll have passed out. I think we’re desperate as physicians to get patients that engaged in what’s going on, and we’re ready for it, some of us, anyway. And if you find your doctor can’t work with you that way, it’s time to look for another doctor, I think.

Kevin Pho: Now, we talk a lot about the decline of primary care. I’m a primary care internal medicine physician myself. It takes patients six to nine months to see me for a new appointment, and we both know that medical students today are shunning primary care for specialties. So how can patients develop long-term relationships with primary care if there’s just not enough capacity in the system?

Drew Remignanti: I almost went into that in my book, but I’m not an expert in economics, so I declined to go there, because it would take twice as many pages; 360 pages would become 700 pages. But there’s no doubt that we need to incentivize medical students and physicians to choose primary care as a specialty, and we probably need to do things like reduce their medical school debt, which is almost 10 times what it was when I graduated in 1980. Those are things we can do as a society. We can’t do them as individual patients.

I think we need to incentivize people to go into primary care, and we need to incentivize patients to put more trust in primary care. The argument I make repeatedly through my book is that there’s a lot to be gained by that simple connection. That’s why I call it a healing connection: that connection with the person who knows you best. We’re not error-free if we know each other well, but we have a much better chance of coming to a good treatment plan for you, and you have a much better chance of following through with that treatment plan. There are no panaceas, and you know that, but we need to incentivize primary care in whatever ways we can. If I were the grand guru in charge of all of medicine, I would increase primary care physician pay by 50 percent overnight. I wouldn’t take it from the specialist physicians, but I would say, “Let’s respect what the primary care physician does.” Primary care physicians, internal medicine, family practice and pediatricians, are the least-paid specialties, and yet I think they probably are in the most important role for most of what we suffer from as patients.

Kevin Pho: We’re talking to Drew Remignanti. He’s an emergency physician, and we’ve been talking about his book, The Healing Connection: A Partnership for Your Health. Drew, for the patients listening to this, and we’re all patients, tell us some of your highest-yield tips for helping patients become as engaged as you want them to be.

Drew Remignanti: As I keep saying, of course you’re at the doctor because you’re worried about your health, and you need to convey what those worries are. But you need to go in with the idea that we’re both committed to my health, and at that moment the doctor, of course, is committed to a number of other people’s health, too. Go in with the feeling that “I’m not going to tell the doctor what to do, but I won’t sit here passively and be told what to do without questioning everything,” and again, with the idea in mind that once that give-and-take happens with your physician, don’t leave the room unless you’ve had the chance to ask your questions. You might have to reschedule for another visit, or you might say, “Gee, next time can I have two slots, because I have a lot of questions that we haven’t gone over?”

And of course, if we have the time and energy, we can do more reading on our own, and not just on the internet, because there’s good information there, and there’s misleading information as well. More commonly, you might have one or two chronic disease conditions. If you’re unlucky, you might have two or three, or God forbid four. You need to become a mini-expert on your medical conditions, reading as much as you can about, say, high blood pressure and what’s most effective in treating high blood pressure, so you can have a higher-level discussion with your doctor when you’re in there. Yes, it’s going to take some effort, but it will pay off.

One of the articles I quote in my book showed that in the U.S., only about 12 percent of us adults are considered health care literate, meaning knowledgeable enough to know how to obtain, process and understand medical information. We don’t do a good job educating people about health care through grammar school, middle school, high school and college, so we need to do a better job of that. These are not people who are illiterate and can’t read. They’re people who just decide that health care is a subject they don’t need to know much about, because they’re going to rely on their doctor. That has to change. Yes, this is a subject you do need to know a lot about, and again, if it’s two or three conditions, high blood pressure, diabetes, a high cholesterol level, most people who can read can get fairly knowledgeable about them if they put in the time and effort, I believe.

Kevin Pho: And my final question, Drew: Tell us some of the take-home messages that you want to leave with the KevinMD audience.

Drew Remignanti: Well, besides obviously reading my book. I would love it if you buy my book, but get it from the library; it’s really more important to me that you read the book and think about its content than that you necessarily buy it. It’s an easy read, although there are some hard slogs, because there’s a lot of data. I have over 280 references, the bulk of them hyperlinked in the e-book version. But I put in enough to keep the reader going along, with case stories like the pericardiocentesis case, critically ill patients we’ve seen in the emergency department, but also less critically ill patients.

So read and think about your health. You don’t need to know as much about medicine as Kevin and I do, because you’re not going to have all the conditions we’re familiar with, and in the book I talk about encountering patients with conditions I’d never heard of or treated before as well. But for the handful of conditions that you have, read and read and read, and ask questions. For conditions like high blood pressure and diabetes, where diet plays a big role, you might decide with your doctor, “Gee, I’m going to have a consultation with the dietitian over at the hospital.” The doctor might say, “Well, gee, I can’t spend the time to talk to you about how diet affects high blood pressure and diabetes, but the dietitian at the hospital can do that with you.” So if you care about your health, and you should, and you want to spend your days outside the hospital and cut your mortality rate risk in half, make a greater commitment to the process.

Kevin Pho: The book is called The Healing Connection: A Partnership for Your Health. Drew, thank you so much for sharing your perspective, advice, and insight, and thanks again for coming on the show.

Drew Remignanti: Kevin, thanks so much for having me.