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Join Matthew Troup, a physician assistant and health care executive, as we explore the critical issue of balancing empathy and efficiency in modern medicine. Matthew shares his personal journey and the challenges he faced during his clinical practice, shedding light on why he ultimately left the field. Discover how recent advancements in AI and technology are poised to revolutionize health care by allowing clinicians to prioritize patient care and regain the precious time needed for empathy.

Matthew Troup is a physician assistant and health care executive.

He discusses the KevinMD article, “Why I left medicine – and why AI might convince me to return.”

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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 Matthew Troup. He’s a physician assistant and health care executive. Today’s KevinMD article is titled “Why I left medicine, and why AI might convince me to return.” Matthew, welcome to the show.

Matthew Troup: Kevin, it’s great to be here. Thank you for the time today.

Kevin Pho: So we’ll get to your article in a little bit. First off, briefly share your story and journey.

Matthew Troup: I trained as a physician assistant, graduated from school about 14 years ago and have been in clinical practice since that time. I started out in neuro-oncology. I got into medicine from an empathetic point of view; growing up, I really wanted to do my best to connect with humans, and when you’re good at science and you have an empathetic background, the natural progression in your career seems to be ending up in medicine. So, probably like most people, that’s where I naturally landed.

Moving into neuro-oncology to start was such a wonderful landing spot for me. I walked into a department serving mostly patients who had terminal illnesses, and I got to spend wonderful quality time with them at the bedside, listening, not sacrificing whatever else had to happen in that moment, and just engaging with them. So my first couple of years in medicine really felt like I was living out the perfect experience of what I wanted from medicine, which was quality time with patients. After that role, I spent about a decade in hospital medicine, spent the COVID pandemic at the bedside in a hospital in Chicago and then eventually moved to digital health, looking for solutions to our clinician burnout problem.

Kevin Pho: So you mentioned that the first few years of your clinical practice were your ideal. Tell me what happened to that ideal as you progressed through your clinical career.

Matthew Troup: I think what happened is what happens to most clinicians. You come out of school wanting to deliver the best-quality care possible and to spend as much quality time with patients as you can. What often happens is that over time, the number of tasks and the number of patients you have to see in a given shift start to balloon, and the time actually spent with patients starts to decrease. As I moved through my career, and a lot of this was exacerbated in the last couple of years by the COVID pandemic, I reached a breaking point where I couldn’t give patients the time and energy I wanted to without sacrificing something else.

The data reflect this. I think on any given shift, providers are spending 15 percent of their time in front of patients, so the other 85 percent is spent on all these other things that start to pile up over the day. In my previous role, at the hospital I worked at, the walk to work was about 10 minutes, and I would already feel a sense of dread that 12 hours was not going to be enough time to do all the things I had to do without sacrificing the time with patients I was committed to. There’s a balance you have to strike: I’m not sacrificing that time and the empathy I want to provide my patients, but I also know I’m going to push those hours later into the day, and what we now know ubiquitously as pajama time is going to happen night after night. Eventually there’s a breaking point.

Kevin Pho: Your KevinMD article is titled “Why I left medicine, and why AI might convince me to return.” When you made the decision to leave clinical medicine, was it a singular event that tipped you over the edge, or was it a culmination of what you described over the years that brought you to that breaking point?

Matthew Troup: A culmination. There’s not a single moment I can look back to and say, “Yes, this was the straw that broke the camel’s back.” But looking back, I can see the symptoms of a bigger issue that were starting to pile on top of each other. It’s easy to see now, but at the time it felt like more stress about the job itself, again, that sense of dread I would have going into my days in the hospital, knowing that there was just not going to be enough time to deliver the care I wanted and that I would have to start sacrificing in ways I didn’t want to. I think that more recently, the once-in-a-generation COVID pandemic exacerbated that and pressure-tested an infrastructure that was poorly designed in the first place, and we started to see even worse outcomes from a health system that has largely been built on outdated infrastructure and poor digital technologies. So in the last few years it has probably been even more apparent to me, but I’d say it was a progression.

Kevin Pho: So your KevinMD article talks more about this journey. Tell us why you decided to write it and what it’s about.

Matthew Troup: I think there’s a lot of guilt that comes with leaving the practice of medicine. So many of us have invested a lot of time, whether you’re a nurse, a nurse practitioner, a PA, an MD or a social worker. We have all committed to the journey of medicine and to providing humans what they need to live their best lives. And at some point you realize that all of that work and all that effort is starting to break you internally, that the burden has piled up, and that you’re starting to feel what is now called burnout. That’s hard to accept. I think the first time I actually used the word “burnout” was long after I left my role in health care, because it’s hard to accept, and there’s guilt that comes with it. But it is the reality, and the research is starting to show that it’s true in multiple ways, including recent articles that show there are just not enough hours in the day for a primary care physician to do all the things they need to do.

So I started to think about what opportunities would exist outside of care that could help change the way we practice as clinicians, and I think technology offers the clearest line of sight to changing the paradigm. The digital health tools that providers have been given so far have not necessarily delivered on the promises we expected. Oftentimes the tools are full of friction, or clearly designed without any intentionality toward care team workflows. But that doesn’t discount the fact that technology can actually play a meaningful role in how we practice medicine.

Kevin Pho: Tell us more about some of the tools you’re working with, and what makes what you’re doing different from the countless other health care professionals who have tried to move the needle in the health IT space.

Matthew Troup: There have been a lot of us who have done it, and there’s a lot of great technology out there, and I think there’s a more meaningful push now to design technology that actually does impact care. A lot of times we’ve leveraged digital tools focused more on patient engagement, and it’s been at the expense of the care team experience. What I’m really focused on now is how we leverage technology that can simultaneously improve the patient experience and the care team experience, because it is possible, and I think the clearest opportunity for that is leveraging advancements in AI. In some areas, we still need to understand the impact it can have and make sure we’re setting proper safety guidelines so that we don’t affect patient care negatively. But the research and innovation happening right now provide an opportunity for us to augment the way care teams practice, and I’ve started to see that firsthand in the work I’m currently doing at Memora: intelligently enabling providers to practice better medicine, giving them more time back in their day and making patients feel much more supported during their patient journey.

Kevin Pho: So tell me more about what you’re doing and how your interpretation of AI improves both the patient and the clinician experience.

Matthew Troup: Specifically, what I’m dedicating my time to right now is building a platform that leverages AI to connect in a very human way with patients. We prioritize SMS text as the platform, interacting with patients automatically and using NLP techniques to answer questions and generate responses, so there’s a first layer of interaction that can be taken off clinicians’ plates. Very much in the news right now is the burden of in-basket messages that are piling up for clinicians. I know this quite well myself from hospital medicine. It’s just one of the tasks you have to do as part of a 12-hour shift, and every one of those messages, two to three minutes at a time, takes away from the direct patient care I want to be delivering. So if this platform can start to remove that, and that’s the evidence we’ve seen so far, it can free up the care team’s time and energy and refocus it on other areas.

At the same time, there’s an opportunity for peace of mind for the clinician. Whenever I discharge a patient home, I am always thinking about what’s going to happen to that patient in the next hour, the next day, the next week. Oftentimes, and this was even more true during COVID, I would pick up the phone and call the next day, because I just wanted to make sure: “Oh my gosh, did you pick up your medications? Did you make that appointment with your provider to go see them after discharge?” But now there’s a platform that can automate those steps and provide that information back to me longitudinally, so I can understand that these touch points and milestones have been achieved by a patient, without having to take time away from other patients to do that.

Kevin Pho: So give us a case study or a story of your AI solution in action that can really illustrate the point and paint a picture in our listeners’ minds.

Matthew Troup: That’s a great question. One of our programs that is most effective, and I think best captures this, is a postpartum program that we built in partnership with a few different health systems. The postpartum journey is a great example of a time in a patient’s life when there is a brand-new experience, a multitude of questions and a lot of unknowns. Think about a mother going home with a newborn. It’s similar to my previous comment about leaving the hospital: Both the care team and the new mother are thinking, “What’s next?”

Our program is able to anticipate the needs that arise on a maternal journey and guide the patient proactively through that process, ensuring that she feels well supported. In the middle of the night, if she has a question, and one we get quite often is about baby poop, or a question about feeding, the answer is just a text message away, yet there doesn’t have to be somebody on the other side in that moment to answer it for her. And the care team can ensure that the new mother feels well supported in the journey. They have the data points to understand that she’s tracking and trending in the right direction. We see this wonderful interaction that happens; patient satisfaction scores are wonderful for that program, and the care teams really feel like it augments the way they can practice.

Kevin Pho: So is the AI technology, the natural language technology, at a point yet where the information it gives is universally medically accurate?

Matthew Troup: For us, it is. We use natural language processing and AI to interpret what a patient texts to our platform, but the response sent back to patients comes from our database of content. We write all that content. We use evidence-based guidelines to write thoughtful, empathetic content, but it’s all designed by us. At this point in time, the platform itself is not autogenerating a response to the patient, so we actually have the ability to control it, for now. I think there’s a future, and we’re seeing it already, where generative AI could be unleashed to start responding automatically to patient inquiries. But I think there’s still a moment in time here where we have to be careful, and it’s OK to be risk-averse at this point, when we have all surely played with ChatGPT and know that it’s not always accurate. So we need to be delicate with what we’re sending to patients at a very important time in their journey. Memora prioritizes a retrieval-based model, sending only content that we create.

Kevin Pho: We’re talking to Matthew Troup. He’s a physician assistant and health care executive. Today’s KevinMD article is titled “Why I left medicine, and why AI might convince me to return.” Matthew, in the next three to six months, the foreseeable future, what kinds of trends do you anticipate arising at the intersection of AI and health care?

Matthew Troup: Well, I think AI is only going to continue to be a hot topic in health care, as it is in all industries, but I think we’re going to see really impactful improvements in how the technology is deployed. Even at Memora, internally, we’re progressing very rapidly in the way we design programs and guide the interactions that happen between our platform and patients. In the industry itself, you’re going to see a lot more applications of the technology: autogenerated documentation of clinician and patient visits, and predictive analytics to hopefully anticipate when patients get off track. These are the new frontiers and the potential promise of AI as we continue to hone the technology and ensure that it’s well designed for use in health care.

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

Matthew Troup: It’s a reminder that empathy is non-negotiable in health care. The infrastructure of health care right now has tried to squeeze every last bit of energy out of clinicians to do a variety of tasks, and 12 hours in a given shift is not enough to do that. My wife always asked me why I couldn’t eat lunch during my shift, and I just said, “I can’t explain to you why, but I can’t. There’s no time.” And yet the work would still spill over into the evenings.

But we have to remember that, as clinicians, we exist in a critical moment in the lives of patients. We have the privilege to walk through the door into a patient’s room at a moment when they’re often experiencing a significant event in their life and are worried about the minutes, hours, days and weeks to come, and we can’t sacrifice that because we don’t have time. That narrative has to change, and the way we do that is to start leveraging technology that can take other things off clinicians’ plates and allow them to spend that moment in the room with the patient.

I talked about this in the article a bit, but there is a moment when you talk to a patient when you really need to forget about the pager, the in-basket messages and everything else on your plate, because the engagement there is critical. It’s critical for their own satisfaction with health care, but more importantly, it’s critical to the clinical outcomes that happen after they’re discharged from the hospital. So companies like Memora need to think about how we build technology that augments the care clinicians provide, accounts for care team satisfaction and, honestly, feels like the right tool, finally, at the right time for clinicians.

Kevin Pho: Matthew, thanks for sharing your perspective and insight, and thanks again for coming on the show.

Matthew Troup: Appreciate it, Kevin. Thank you.