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Join Paul Pender, ophthalmologist and author of Standing Up & Speaking Out for Patients & Doctors, as he discusses the need for a change in mindset and a willingness to adopt new concepts in health care. Paul believes that building unique relationships within a cooperative framework is necessary for success, but that alone is not enough. Trust must also be re-established among all stakeholders.  Tune in for an insightful conversation on standing up and speaking out for better health care.

Paul Pender is an ophthalmologist and author of Standing Up & Speaking Out for Patients & Doctors and Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.

He shares his story and discusses his book, Standing Up & Speaking Out for Patients & Doctors.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Paul Pender. He’s an ophthalmologist, and we’re going to talk about his new book, Standing Up & Speaking Out for Patients & Doctors. Paul, welcome back to the show.

Paul Pender: Thanks, Kevin. Appreciate you having me back.

Kevin Pho: So Paul’s been on multiple times. Go to KevinMD.com/podcast, and in the search bar, search for Paul Pender. You can see his prior episodes and hear his story. But I want to talk about your new book today, Standing Up & Speaking Out for Patients & Doctors. So what led you to write this book?

Paul Pender: Well, you’ve been very kind to publish a number of my essays in the past, and I went back and started looking over the last four years or so and realized that there are still some things that are pertinent, and, going forward, things that I’d like my audience to think about. So I pulled together these essays and published some new things. I wanted to sort of respond to an inspiration I had just reading Charles Krauthammer’s book, The Point of It All, his collected essays. When you find someone who writes well and shows some humility and character and intelligence, it’s not a bad thing to try to mimic him. So I put this ebook together to try to explain some of the things that are the currents in current health care.

Kevin Pho: All right, tell us some of the major themes that run through this book, or run through your collected writings.

Paul Pender: Well, as I went back and read them, certain themes stood out. The essays are sort of categorized not only chronologically but by theme, and the themes include disparities in health and in power. Another is perseverance, another is gratitude, and another is burnout. There’s also a passage on narratives, and finally, on leadership. So the essays speak to these particular themes.

Kevin Pho: All right, give us a sample of some of the more poignant essays that you want to share with the audience today.

Paul Pender: Well, the one piece of fiction that I wrote was kind of inspired by a mentor that I had who was a biology teacher. When I was cajoled by my editor to come up with a fiction piece for this competition for a medical journal, I sort of contrived this arrangement whereby this young family practitioner was at the bedside of her mentor, who was dying. She had been working with him as a medical assistant as a summer job, and they became very close. He inspired her to apply to medical school, and a lot of these things are really from my own personal experience. Upon her graduation from her training program, he had given her a plaque that kind of spelled out the things that the doctor stood for.

At his deathbed, she was embarrassed to think about something that she had done during the pandemic, which was to break into the administrator’s office and download information that basically talked about how nefarious contracts were being arranged between the health system and pharmacy benefits managers, and all this stuff that essentially was going against the physicians who were taking care of patients. And finally, at the end, he said, “You are my legacy. Do something good for the house of medicine.” And the character says, “I will.” That’s where it ends, but there’s plenty more to do, as we all know.

Kevin Pho: So you said that this piece of fiction, about the administration possibly drawing up nefarious terms of a contract against the clinician staff, has a kernel of truth. Now, have you seen or experienced that in your own physician career?

Paul Pender: Well, what I can say is that I retired before the pandemic, and I enjoyed my practice of ophthalmology. But there’s a wearing down of physicians that occurs, because you’re trying to do the best you can for your patients and you’re hitting a lot of roadblocks along the way. So sure, I experienced a lot of those things. Pre-authorization is the bugaboo of every physician these days.

I think when doctors can no longer stand up for their patients, either for fear of reprisal, like some doctors experienced during the pandemic when they were subject to gag orders by the administrators, you find that you have to actually point out those things that doctors have to put up with, and that patients who are flying solo in America’s health care system need support. So that’s why I really decided to put together this ebook on standing up and speaking out.

You’ve been doing this long enough to know yourself. They’re numerous; there are too many for this particular interview. What I would say is that something I read recently that I thought was very interesting is a letter a doctor wrote to the editor of a well-read newspaper that said, “Remember when doctors and patients used to make eye contact? Now they can’t, because they’re too busy entering things in the computer,” which one of your guests, Samuel, once called the cash registers. The EMR is essentially functioning as a cash register for health insurance companies, and doctors are doing all the busy work.

Well, I think what doctors would like to do is use artificial intelligence to stop having to do all the documentation, so that a conversation could take place with the patient, like what we’re having now, and they wouldn’t be distracted. What this doctor said in his letter is that it’s like texting while driving. There’s just too much stuff that’s in the way of this doctor-patient relationship, and so I think that is something that is really coming to a head these days.

Kevin Pho: Now, you decided to share all your stories on this podcast, on my website, and in your book. What are some other ways that physicians can share these stories and bring light to some of these obstacles that you mentioned that impede patient care?

Paul Pender: Well, the serious administrators that really want to listen really should have sessions that allow doctors to be very candid about the things that stand in the way between them and their patients. There are multiple examples of why things like pre-authorization not only cause delays in care but can sometimes result in fatalities. So I think hospital systems and health insurance companies have been sort of looking at physicians like they’re just another cog in the machine. What we really need to do is respect the work that doctors and nurses are offering their patients, and in order to do that, you have to listen to their concerns, because they are very real.

Kevin Pho: Can you give us an example of how some of your writing in the past, or your ability to speak up and bring light to this issue, has moved the needle and improved the care of your patients?

Paul Pender: Well, I’ll start by saying when someone actually reads the piece that you’ve written and writes you back, that takes a lot of effort. I’ve had some communications with doctors who’ve written to me after a post on your platform.

Kevin Pho: Can you share that story, in terms of what you remember?

Paul Pender: Yeah. This is basically someone who submitted a piece to you, and you printed it later. It’s Dr. Maryanna Barrett, who’s an obstetrician-gynecologist, who wound up having a very emotional experience, a very difficult patient encounter that involved litigation. She said she had the courage to actually write this having read some of the things that I published, and I replied to her emails. So you find that if you are creating an avenue for doctors to express their opinions, so that they won’t suffer in silence, this is a good thing.

Kevin Pho: What do you hope to accomplish by sharing your writing on a broader platform like an ebook?

Paul Pender: Yeah, well, for me, it’s like, what do I want to express that may have some purpose? It’s not just griping; it’s about what direction this can take. As I told you in past conversations, I’m director of digital health communications for Vxtra Health, and it’s been my pleasure for the last several years to feel like I have some influence in being able to offer my voice as a physician to the company. I really believe that there will come a time when a model that we are proposing becomes more widely accepted, with value-based care and having some financial risk, or shared desired outcomes. So I’m excited about that, and that’s what kind of keeps me going.

Kevin Pho: We’re talking to Paul Pender, longtime recurring guest. His latest book is titled Standing Up & Speaking Out for Patients & Doctors. Paul, tell us some of your take-home messages.

Paul Pender: My take-home message is one of thanks: thanks to you, Kevin, for giving me this opportunity and a chance to speak on your platform and to submit some material that I think is important, in a setting where doctors and their patients are feeling like they’re facing an adversarial relationship with health insurance companies and health systems. So I’d like your audience to contact me about a copy of the ebook, which I can send in a complimentary fashion to those who are interested, and go from there. It’s an exciting time. It’s a challenging time, but it’s an exciting time as well.

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

Paul Pender: Thanks so much, Kevin. Appreciate your time.