Technically Sick:

[00:00:48] Monica (Recorded): Hi and welcome to Technically Sick! This podcast explores how technology can increase access to education, employment, transportation, and improve socialization for the disabled and chronic illness communities.  

[00:01:03] I’m your host, Monica Michelle.   

[00:01:07] [Music Ends] 

[00:01:07] Today I’m going to be speaking with Dr. Dustin Cotliar – a Board-Certified Emergency Medicine Physician and Health Policy Consultant who is so passionate about digital health, telemedicine, patient advocacy and healthcare navigation. 

[00:01:24] When many think of the recent advancements of technology in medicine, telehealth services are at the forefront of the conversation. Though telemedicine and remote care have been in development since the 1970’s, it has gained prominence over the last few years. Today is part one of a two-part series on telehealth.   

[00:01:44] In this episode, we will be learning about the use of telehealth from a doctor’s perspective. Dr. Cotliar will share why he has devoted himself to being a telemedicine practitioner and the many ways that this technology can be useful for patients.   

[00:02:00] Welcome to Dr. Cotliar!   

[00:02:04] Monica: I’m really excited to talk to you Dustin. This is a subject near and dear to my heart. [Laughs] 

[00:02:08] Dr. Cotliar: Me too. Me too. I’m so excited to be here.  

[00:02:11] Monica: When did you first realize that telehealth was going to be such an important thing for the disability and chronic illness community? 

[00:02:18] Dr. Cotliar: That’s a really good question. I am somebody who has been interested in patient experience and how people experience healthcare for a really longtime. As an ER physician, I’ve seen it all. The emergency department really is ground zero for the dysfunctions of our healthcare system. I’ve just come across so many people with lifelong, debilitating conditions, of all kinds, end up in the ER because they just weren’t able to follow up with their doctor or have that accessibility with their doctor. I also do health policy research, studying the healthcare system, with the Kaiser Family Foundation. Also know a lot about the dysfunctions of our system as well. For me, my aha moments came over the last couple of years. 

[00:03:00] I have somebody in my life that’s – I’ll keep this sufficiently vague to protect their privacy, of course – but I have someone in my life who I care deeply about who has so many chronic conditions and has various disabilities that don’t let her really leave the house or makes leaving the house really, really challenging for her. Before I started helping her out with her healthcare she really had given up. Her doctors really weren’t on top of things. It’s really hard for her to get to see her doctors. She just had an impossible amount of medications to manage and various issues to stay on top of that is challenging even for someone like myself, honestly, to keep together.  

[00:03:35] As I got more involved with her care and trying to help her out I started to see a lot of the areas in which she was having trouble and the different problems that she was having. And I noticed that really one of the main issues for her, and I think this really applies particularly to most people and most fears of the show, is that a lot of the problems that she has really are dynamic in nature – so, something changes, symptoms get worse. It’s really important for somebody to have that direct access to their medical doctor and be able to ask questions and be able to follow up easily and so forth.  

[00:04:11] I noticed that with her doctors, her primary care doctor, out of all of her – she’s got so many different docs that she sees – but her primary care doctor is the one that has helped her the most because she actually will respond to her messages. So she goes on the portal, and she’ll write her messages, and then her doctor will respond. Which in my experience, I think is highly unusual in today’s healthcare landscape. I just started to think about how important that is and how many times we will be together and something would happen with her medical care and she would need to see XYZ doctor and it would take three weeks to follow up in the clinic. 

[00:04:41] And it just really never was sufficient. Those types of experiences that I believe telemedicine will be able to solve. And I think that it’s going to be a huge shift in how doctors deliver care and patients receive care in terms of accessibility and convenience and making things personable. That’s sort of how I wandered into this space. 

[00:05:01] Monica: So if I’m hearing you correctly – some of the things that I’m hearing that are very important with telehealth is timeline. It allows for people to catch dynamic situations earlier, and it sounds like it would keep more people out of the emergency room if they’re able to catch dynamic issues quicker.  

[00:05:18] Dr. Cotliar: Absolutely agree with that. When we talk about telemedicine or digital health, that’s a really broad concept, right? There’s so many ways that this technology could evolve, but that includes things like talking to a doctor on the phone, or video, to texting, to email. Even the wearables, right? If people have apple watches that they use and they check their heart rate and syncs up with their health data, but that could be so expanded upon. 

[00:05:41] There’s also apps that people could use. So, if you have a chronic condition, let’s say, and you’re trying out a new therapy and your doctor wants to know how are things going? You can actually go on the app and be like, “I feel better”, or “I don’t feel better”. Or “I’m having these issues”. Your physician could then see that data in real time and then can discuss with you about maybe changing treatment. I agree with you a hundred percent. I think there’s so much potential to increase continuity and reduce those unnecessary ER visits and hospitalizations. 

[00:06:08] Monica: You brought up a really interesting point about the tracking. When people go in to see a doctor in person a lot of the times they’re tired, they’ve gone through a lot to get there. And I personally have white coat anxiety, which means that I’ll answer things based on what I think they want me to say, or I’m just jumbled and trying to come up with the best answer. It sounds like a with all these tracking apps we’re not dealing with emotion. We’re going to be dealing with facts and numbers instead of what someone can come up with right there in the moment. 

[00:06:36] Dr. Cotliar: I mean, honestly, even as a doctor, when I go see the doctor I’m the same way. [Laughs] So don’t feel weird about that.  

[00:06:42] Monica: That makes me feel better. Thank you. [Laughs] 

[00:06:44] Dr. Cotliar: Yeah, of course. I mean, there’s like: you have a limited amount of time, it’s hard not to feel pressure that you’re not asking the right thing. I think all of these things like the tracking devices, wearables, I think they’re a great compliment to that more personal care. I don’t think it’s in any way a substitute. I think it’s just something that is a great adjunct for people when they’re home and they’re not with the physician. It has a lot of potential for your care team to really be proactively being on top of your care and helping you do that.  

[00:07:10] Monica: So we just got a huge push for telehealth with COVID a bunch of types of health, that all of us who are disabled were told “never, you will have to find a way here”, got opened up. What are you seeing? That’s a big change now that we’ve gone through COVID and we’ve had telehealth.  

[00:07:26] Dr. Cotliar: I started seeing this from two different angles. As a researcher with Kaiser Family Foundation. We definitely have published some work on telemedicine utilization and it basically shows that telehealth use skyrocketed during the pandemic, but then as the pandemic started to wane, it really fell back, but at a level that was much higher than before COVID, which is really interesting. And then as a telemedicine provider, you really hit it on the head. The access really got disrupted for everybody.  

[00:07:52] The telemedicine that I currently do at the moment is more kind of urgent care based, although there’s some primary care components to it. People call me up with all sorts of things, like will be really apologetic. Like “I’m so sorry. Can you refill my prescription? I couldn’t see my doctor”. I’m like, “you do not need to apologize. This is why I’m here. It was just a lot of calls like that, of people who just need help with various things, that just were not able to get in to see a doctor at all. 

[00:08:17] Monica: You had mentioned a fallback, was the fallback from people not wanting to go in or was it… Like, what I’m experiencing personally is that my clinic is forcing us back. Is that a doctor-led thing, an administrative-led thing? Or is it people who are not enjoying this process, or don’t have access to this process because we have to have internet for a lot of the telehealth experience? 

[00:08:39] Dr. Cotliar: I think it’s multifactorial. I did notice that at the height of the pandemic, there just wasn’t a lot of availability. So, the schedules were really booked up. I do think that people just generally speaking were free to venture outside more, especially if they would have a condition that might predispose them to getting ill, something that lowers the immune system.  

[00:08:58] But I also think too, and this is something that I feel strongly about in terms of why telemedicine is really the future, is because I think in our general daily lives, outside of medicine, we’re so accustomed to doing things digitally from zooming with each other, to texting, to Amazon, to getting delivery. I believe that that’s heading towards the healthcare space and I think people really have an appetite for it or will continue to do so. But in terms of like why this happens during the pandemic, I think there’s kind of multiple levers there that are contributing to that.  

[00:09:27] Monica: What are some of the roadblocks you’re seeing from people wanting to do telehealth? 

[00:09:32] Dr. Cotliar: I think really one of the main roadblocks now is reimbursement or payment policy – how one’s insurance plan or Medicare and Medicaid actually pay for telemedicine. And there’s been all sorts of emergency changes during the pandemic that sort of allowed more telemedicine to be used, but as telemedicine becomes more robust, it doesn’t really match up with payment. That’s really sort of inhibiting a lot more adoption and more use of telehealth. 

[00:09:56] It’s something that I think that I see more in data and studies that I’ve worked on, but also in my daily practice that using telehealth, especially now, requires some degree of computer literacy, right? So, if you’re elderly, it’s really, really challenging. Like the story that I shared before – she’s in her mid-seventies and she really struggles to use a computer and the phone. I’ve had to help her with some of that stuff as well. I think these doctor’s offices who will sometimes use telemedicine, just assume that their elderly patients are going to be able to jump on a zoom call and figure that out. But it’s just not reality. [Laughs] Those are some of the barriers that I see: how it gets paid for and computer literacy.  

[00:10:32] Monica: I’m just curious, what are some of the ways that you think that we could work on the computer literacy? If we’re looking at transportation being a huge issue, you’re looking at an elderly population that either can’t drive, shouldn’t drive, or it’s difficult, what would that computer literacy look like? Would that come from doctors? How would we work on that population?  

[00:10:51] Dr. Cotliar: That’s such a good question. I think really what it comes down to is just making things really, really easy to use. For the most part I think people who are elderly – and I say that very generally speaking – but I think really it comes down to making the tech so simple, so seamless, that almost anybody could use it. 

[00:11:07] One example that comes to mind: there’s this new service that you can use through Amazon. It’s called Alexa Together. And basically what it is, it’s a program where you would have Alexa in your elderly parents home, and it will detect if they fall and it helps you communicate with them. You can give them reminders, all sorts of tools to help you take care of your elderly parent. 

[00:11:30] It’s really designed in a way where it’s just an Alexa and that person who’s elderly could just speak to the Alexa and make things happen for themselves. Do you have any thoughts on how that could be made easier for people?  

[00:11:40] Monica: The only expertise that I have is just in personal life, but I used to work in Silicon Valley, and one of the things I used to love hearing was UI should be so simple you could hand an iPad to a five-year-old and within 10 minutes they would be able to function through that app. And I think that’s such a good benchmark. There should just be zero frustration.  

[00:12:01] And physically, I don’t think a lot of people realize how hard it is to move hands and to hold things. That’s another thing that would be really wonderful to hear. I like what you were saying about Alexa is, while it can feel a little dystopian, those sort of technologies allow autonomy in a way that people who are generally healthy don’t necessarily have to consider.  

[00:12:22] Dr. Cotliar: No, that’s a great point. From my experience, just talking to patients, I think that is just one of the most important things that people want to remain autonomous. Technology that allows people to do that is really, really impactful.  

[00:12:34] Monica: What I was curious about is privacy, and not necessarily just from a HIPAA perspective, but if someone is at home, there’s other people at home as well. How do we ensure that privacy of the person who needs to talk? 

[00:12:47] Dr. Cotliar: Yeah, it’s a big problem. I think definitely laws like HIPAA help companies that are providing care over the phone or video go to great lengths to protect patient confidentiality and data. Aside from tech safeguards, a lot of the responsibility, I think, falls on the side of the provider to ask patients questions like, “is it an okay time to talk? We might be talking about sensitive subjects. Are you alone right now?” If they say no, having the ability to call them back. Those types of things that can help, but obviously with most new technology come unforeseen challenges and privacy – it could be one of those challenges. 

[00:13:25] Monica: I’m curious your views of the other side of privacy, which this does allow privacy, in that the person is not having to show up at a doctor’s office, that maybe they don’t necessarily want people to see them at. Is this a way of doing that? I was thinking of some of my friends who are working through gender issues and the lack of safety when they live in areas that don’t embrace that, there’s a way that you could actually see doctors in other states, other countries. What do you think about that aspect of it? 

[00:13:54] Dr. Cotliar: I think you are totally right. I’ll see patients on telemedicine or in person and they’ll say, “I’m really embarrassed, but…” And I’m always like, “I do this all day everyday. You have really nothing to be embarrassed about. Like, try me, trust me. I’ve seen it all. I’ve heard it all. Like there’s nothing to be embarrassed about”.  

[00:14:10] But on that note, aside from seeing a lot of patients call in for relatively simple things that maybe they could go in in person, but I could just tell they call in because they feel embarrassed to go in person and do that. I also see there’s a lot of telemedicine companies that are filling specific niches for that reason. 

[00:14:26] A good example would be erectile dysfunction, let’s say. There’s a lot of platforms now where you can not only obtain those medications, but do so in a very discreet way where there’s not even video chat, it’s just text. I think that’s so appealing to people because if they are struggling with that issue, not only do they have to not go in in person, but then they don’t have to even see the person. It just removes some of that personal factor. And I definitely think it would be a huge draw for people in various situations.  

[00:14:52] Monica: There are so many disorders that we have in the disability community that most doctors have never heard of. How do you see this working as far as being able to see a specialist? You live somewhere where they don’t have a bunch of specialists and you have a very rare disorder. How could this work for people?  

[00:15:08] Dr. Cotliar: So, I’m so glad you brought that up because that actually makes me very excited because that’s actually something that I really, really am interested in. I’m really passionate about care navigation and patient advocacy. This is the exact situation that I love, that I love to do, that I love to help people with because it’s really, really hard, if you have a rare condition, for example, to know who to see, right? I actually really love helping people find the right doctor for that condition and making sure that it’s the right person, that they’re the best in that condition, and make sure that their insurance covers it, or if their insurance doesn’t cover it, twist their insurance’s arm to make sure that it’s covered. 

[00:15:45] I really do enjoy that because I don’t think that there’s anything built into our healthcare system naturally that helps guide people along, in that way. No one’s really looking out for people with rare conditions like that. They’re sort of out on the street all by yourself. There are actually telemedicine-like services out there that will actually help people, in that situation, find the right doctor for their condition. Usually most of those services are something that you might get as a benefit through an employer or something. 

[00:16:11] I think there’s just enormous potential. You can see people in different states if you have a rare condition and the person is at Mass General in Boston, but you live in Houston. Perfect. You jump on a video, they can review your chart, everything, all your information, digitally, jump on a video visit. If things need to be done in person, they will. But that’s just a great application of telemedicine to make sure that people get the right care.  

[00:16:35] Monica: You had mentioned an employer, and I think this is a really interesting idea just for anyone who’s listening, because there’s someone who’s an employer or a boss. This is a really interesting idea for keeping your staff healthy without having to lose a lot of work time.  

[00:16:51] Dr. Cotliar: I totally agree. [Laughs] It’s one of those things where in an ideal world, something like that wouldn’t even need to exist, but our healthcare system is so dysfunctional that it’s very appealing to a lot of people, right? 

[00:17:02] You could see how that might reduce wasteful costs. People are going to get the right care. You’re not going to bounce to four different doctors, and then finally get to the right doctor while all these other doctors saw you and didn’t know what the heck they were doing.  

[00:17:14] Monica: I didn’t realize you read my medical chart. [Laughs] That’s pretty much what I’ve been doing. [Laughs] 

[00:17:19] When you were talking about waste, just to bring up transportation, because those of us with wheelchairs who can’t drive, to get to my doctor costs $60 for an Uber one way. So, that’s another huge cost that you’re looking at. And with wheelchairs, getting into the car, getting all of your stuff together and packed that takes a lot of time out of the day and leads to a tremendous amount of exhaustion. So that’s pretty much the only thing that most of us can do in the day is to see the doctor and get home and then curl up for the next few days to recoup our spoons.  

[00:17:51] Dr. Cotliar: What’s so exciting is that most telemedicine now at this point is communication, right? So, video texts, phone, but a lot of companies really see that people would love in-home services. There are various companies that you can get lab work done in your house.  

[00:18:06] Let’s say we were talking and I was your doctor. We know each other a really long time. And I say, “you know what? We really need to get you some blood work. I’m going to put you in and we’re going to have a nurse come to your house” and then, “oh, I’m going to have your prescriptions delivered. And I’m going to make an appointment for you for a cat scan on this day”. All these different things.  

[00:18:23] That allows you to weave this all in with your regular day, right? It’s not a waste of time to pack your stuff up and go to the doctor, but it’s so challenging that you could really have much more time to do things for yourself and do things that you care about as opposed to traverse the health care system in a way that doesn’t work for you. 

[00:18:39] Monica: You’re bringing up exactly what I love about this topic and all of the topics around technology and disability, which is: creating access for disability doesn’t just help the disability community. This is tremendously helpful for everyone.  

[00:18:53] Dr. Cotliar: I definitely agree. Back to my loved one that I brought up in the beginning of the show, she has had so many unnecessary hospitalizations because of access issues. She doesn’t want to be in the hospital, so that helps her, but also there’s a lot of costs to that as well to her, and to let’s say Medicare that’s paying her bills. So many of these things could have been prevented if her doctors were more on top of her and more proactive about her care and just more accessible in general. 

[00:19:18] Monica: For our international listeners, we are here in the United States, which means our healthcare can absolutely create huge financial distress for us. When we’re talking about video calls, I was curious about your thoughts of being able to see your patient’s surroundings. If you’re able to garner important information just from seeing their space? 

[00:19:37] Dr. Cotliar: Yeah, you’d be surprised. It’s funny when you’re doing video conferencing, most of the time you’re actually staring at the camera. So, you do notice things and you do look at the patient and everything, but just as like a tangent, one of the best parts about being an ER doctor, like the top skills of an ER physician is just visual intuition. 

[00:19:54] Seeing so many people over so many years in so many different situations, we’ll be able to hear sounds on a hallway, kind of know what’s going on, or walk into a room and have 90% of the information I need just by looking at the person. There’s definitely a lot that can be gleaned from looking at a patient’s surroundings, but generally depends on the situation. 

[00:20:16] Monica: How are you able to create that trust with someone through telehealth? There’s a lot of trust that has to happen between a patient and their physician. How are you able to build that bond if you are on the phone or through zoom?  

[00:20:28] Dr. Cotliar: I think there’s a couple of important things medical providers need to keep in mind, and this really applies to telemedicine or in-person care as well. It’s really about listening, probably the most important thing. Trying to understand what the person’s concerns are, addressing concerns, answering questions, not interrupting. All of these things I think are super, super important and really just apply to anything in life, honestly. 

[00:20:51] Monica: I think empathy is always a good place to start with anything. 

[00:20:55] Dr. Cotliar: What about you though, in terms of your experience with doctors that you’ve liked or not liked? What were some of the things that you’ve found to be most important? 

[00:21:01] Monica: That’s a really good question. What I’ve enjoyed is I had one doctor who was my favorite ever. And it was what you just said: empathy. No point did he ever act like he did not believe what I was saying. He was the one who diagnosed my disorder. It took 36 years to get diagnosed. He said, “look, let’s just go through all of the symptoms. Don’t worry about saying too many things. Just give them all to me. I like a puzzle and I would like you to trust me that I will work on this and it might take us some time, but I really believe we’ll get there”. 

[00:21:34] I actually cried in the parking lot. It was the first time I felt like I trusted the doctor and that it wasn’t the, “you have fibromyalgia go lay down with an aspirin”. I do have fibromyalgia too. It just wasn’t the only thing I had. That was a really lovely experience to just feel cared for.  

[00:21:52] Dr. Cotliar: It’s all to a common issue. I think your story really brings up some really important points. It basically comes down to doctors are just humans like anybody else. One day you might meet somebody and it might be lovely. The next day maybe their husband or daughter got in a fight with them and they’re cranky and maybe that might come across. 

[00:22:12] That’s always possible as well, but a lot of the way doctors are paid are by volume, right? So, the more patients they see, the more they get paid or they’re under pressure to see more patients. It’s really fantastic when you meet a doctor who actually really cares – their biggest priority is to figure out what is going on with this person. 

[00:22:29] Some doctors I find, they know, right? Like, it’s fibromyalgia, that’s what it is. There’s nothing else it could be. But then there’s some doctors who maintain humility and say, “you know what, maybe there are things I don’t know. Maybe this is something else. Maybe this is something rare”.  

[00:22:43] It’s really cool when you find people like that, who really just want to figure things out and want to listen and want to stay humble. I think that’s really great that you found a doctor like that.  

[00:22:53] Monica: One of the things I was curious about: there’s a comfort level with being in your own home or being in your own space. There’s a physical comfort. And there’s also the ability to be more vulnerable. In allowing me to talk about my story, I came up with a little memory there, which the doctor had helped me with: what I thought was a mental health issue. It ended up being purely biological, physical, and chemical. So, we were able to solve this mental health issue with medicine.  

[00:23:17] I’m thinking about this because I’m thinking about comfort and if you’re in your own space, there’s a safety. There is comfort. There’s also that space where you can feel like I can take a beat to think things through, or I can rest. And then go further. I’m just curious what you think about this with the safety issue of being able to take a little bit more time for diagnosis: that is from the medical providers’ time and space to see these surroundings, to be able to look at underlying issues, and also from the patient’s perspective of just feeling physically comfortable, maybe they’re able to go a little further or deeper.  

[00:23:51] Dr. Cotliar: Yeah, I think that’s totally right. Being able to see somebody in their space can give important information that you wouldn’t get if you were seeing a patient in the clinic. I think telemedicine has just great potential also for medical doctors. Being a doctor can be a challenging job. Being able to be in your home I think really makes the person more able to take on the challenges of their patients and stay fresh emotionally.  

[00:24:16] And I think from the patient side, I find that there are so many patients that I see that just wouldn’t have sought out care otherwise. So, if the telemedicine option wasn’t there, they would’ve just been like, “eh, I’m not dealing with it”, but because that option was available, they were able to call or go on a video call and get something addressed that needed to be addressed or get some advice that they needed to hear.  

[00:24:35] The thing that’s so interesting to me, and there has been a lot of studies that have shown what patients really value and experience and environment is so crucial. So many medical clinics, and hospitals, they’re such a sterile type of environment. You really see these chains pop up like OneMD, for example. They understand that patients want a place that feels warm and comfortable with telemedicine. Obviously being in your own home, it’s very comfortable and you might feel less nervous and might share more. You might be less forgetful and all those different things.  

[00:25:08] Monica: You brought up something that I think is really interesting. Being a practitioner who is able to stay home, do you think this might allow for more disabled and chronically ill people to look at the healthcare as a profession? 

[00:25:22] Dr. Cotliar: Absolutely. Yes, definitely. There’s lots of different jobs in healthcare, right? Depending on the job, there’s different physical requirements. With more patients being seen on telemedicine, I think that definitely reduces barrier to entry into the profession. So, yeah, that’s a very, very good point. And I know of many doctors who had to stop in-person practice because of medical issues, disabilities, but then found a second home as a telemedicine provider. 

[00:25:50] Monica: That’s an amazing way to, not only open up the career path, but also to extend it. 

[00:25:55] Dr. Cotliar: Absolutely. It makes me think about my own father, who has been a surgeon my whole life. And he is such an expert in ophthalmology, but he’s getting up there in age and one day he’s not going to be able to do surgery anymore, but he still has so much more to offer. I always tell him that he should get into telemedicine just so he can extend his career and share his expertise with others without having to actually do surgery anymore.  

[00:26:16] Monica: On the other side of that, do you see telemedicine becoming a training tool – an ability for doctors to share information, to be able to show surgeries, to be able to show techniques? 

[00:26:26] Dr. Cotliar: Oh yeah. There’s so much going on in the digital health world, you’re tapping into something that is really exploding. The potential applications for something like this are just really limitless. You’re right, from people guiding people, doing surgery halfway around the world, to training people halfway around the world. 

[00:25:45] There are specific services and platforms where primary care doctors can send a case over to a specialist to review and get their opinion on treatment. For most people, I would say, seeing a specialist is really a pain in the neck, right? It takes forever to get an appointment usually, especially if they’re good, right? Like if they’re good, everybody wants to see them too. So, it takes like months to get in. So, it allows them to see more people and you can maybe see a primary care doctor and they can work with that specialist to review stuff and get some feedback about your care. I definitely think it helps in that way as well. 

[00:27:21] Monica: Do you think that doctors are able to see more people if they’re doing telehealth?  

[00:27:25] Dr. Cotliar: I think it depends on the type of care. For example, urgent care, which is the kind of telemedicine I do, when you see patients, let’s say in an actual urgent care, talk to the patient, and then you have to walk back to your desk, write your note, and see the next patient, or put orders in. But when you’re on telemedicine, you’re not doing that. So, there is some time saved. I do think that you can see more people. 

[00:27:45] And also telemedicine companies are really innovative in how they design electronic medical records and often make it easier to document and those sorts of things. There’s also, it saves time and it actually is one of the things I like about telemedicine, is I find that I’m spending more time with patients and less time as a slave to my computer, which is, [Laughs] I think the experience of most doctors who are doing in-person care. I definitely think there’s a lot of potential for that.  

[00:28:11] Monica: I think you could convince every doctor to switch if you just highlighted how much less computer work they’d be doing. 

[00:28:18] Dr. Cotliar: [Laughs] Well, you’re still sitting at the computer, but most of the time, maybe 80% of it, the patient visit is just talking to the person and then you can quickly do the documentation and then see the next patient. Whereas a lot of times when you’re in person, I think it’s like, the computer – it gets in the way. You’re like staring at the computer, trying to look at the patient or you just doing the documentation afterwards, which is a huge time-waster. I definitely think it saves a lot of time.  

[00:28:42] Monica: Where do you see this going as far as telehealth? We have these little watches that can do an EKG and test our blood oxygen level. We’re starting to get into AR, which would be like where you can have screens showing on your glasses. We’re getting more into virtual reality. Where do you see this heading?  

[00:29:01] Dr. Cotliar: Really, really good question. One thing that I think about when I was looking for jobs myself, but also just thinking about future of the industry is basically telemedicine or digital health now, like all of these companies that are being created that are starting: they’re really sort of siloed from regular traditional in-person care and health systems. 

[00:29:19] What I think is really, really important, I think where we’re headed is sort of this hybrid care model where telemedicine is just part of the puzzle. You see your doctor in person, you go home, you have some wearables, track some data, go on an app. How am I feeling? Not so great. Doctor sees that. “Not so great. Okay. Let’s have a video visit tomorrow”.  

[00:29:38] Got to do the video visit. The doctor’s concerned, wants you to get an MRI, puts an order in for an MRI. Someone comes to your house to do your blood work. You get some kind of new treatments and basically incorporating that into our usual care sort of like a hybrid type of model. And so I think wearables are going to be a huge part of that.  

[00:29:58] Monica: Even if it’s not on the horizon yet, what would you love to see in wearables? Whether it be specific types of things that are measured, or if there’s an issue with wearables that you wish was better or both would be wonderful.  

[00:30:11] Dr. Cotliar: One thing that comes to mind is definitely things that don’t really get in the way of life. One example of a wearable that has been used for a long time and is still used now is a Holter monitor. So, for people who are listening, a Holter monitor is something that would be: give it to somebody who might be getting dizzy or passing out. Whenever you go to the doctor and you get an EKG, they put these little sticker things on you, and they’re looking at a tracing, a Holter monitor basically is that, except you just wear it under your clothes for, let’s say a couple of days or a certain amount of time, and it records the tracing of your electricity in your heart.  

[00:30:42] Even 5 or 10 years ago, it used to be super clumsy, used to have multiple leads under your shirt. And the recording device looked like an 8 track tape recorder. It was just really clumsy and kind of awkward. And now I saw one recently that a patient was using, it was basically the size of a large nickel maybe, and it just had a little sticker and you stick it on one spot. It hooks up to your phone and that’s it. I think it’s really, really exciting, or even something I think about, I think a lot of companies, including Apple for example, are trying to, I think they do exist, but I think they’re trying to make it better, but basically they’re trying to make the watch not only record your heart rate, but also be able to take your blood pressure.  

[00:31:21] There’s a lot of potential for that, because, for example, I will share that I have high blood pressure and I find that I just forget to take my blood pressure. I should be keeping track of it at times. And I just forget to do it. Having something on your wrist already, that just goes on. I don’t even have to think about it, I think is a game changer. And then having that data, it’s linked up to the cloud and having some looking at that data. So, you don’t have to like, think about it or add numbers up yourself. I really think that it’s just going to improve care for people and make things easier for people in general. 

[00:31:52] Monica: I love that. And again, we go back to, we would be dealing with numbers and actual data points rather than how someone’s just generally feeling in that moment when they’re talking to their doctor. 

[00:32:02] Or for a lot of tests that have to be done like brainwave tests or EKG’s – if you’re looking for a problem you have to be having that problem right then, in the office, while being tested  

[00:32:12] Dr. Cotliar: A hundred percent. And also, you have to remember that you had XYZ problem when you visit a doctor it’s like a snapshot in time, except with wearables it really extends that out to the whole continuum of someone’s life and their whole experience as a patient and a person.  

[00:32:27] Monica: I will ask you the fun question, which doesn’t even have to be about telemedicine. It can be full Star Trek, full foundation, whatever you like. What is this technology, whether it exists or not, that you are the most excited about in the future? 

[00:32:38] Dr. Cotliar: Oh, wow. Something that I find to be, and this is definitely something that exists already, but I think is in its infancy, is this whole idea of being able to text your doctor. Going back to my loved one that I keep telling anecdotes about – basically there are various types of problems that people can encounter while they’re undergoing treatment, or they’re dealing with a chronic illness. Being able to text and continually communicate with a medical provider or staff is really, really cool.  

[00:33:05] I think there’s just so much potential there because your doctor can view those things, and a lot of companies are actually incorporating AI into this as well. And I definitely can see the downsides and sort of the dark turn that can take. Definitely don’t want to be forcing people to talk to an AI bot about their medical problems. But I think that there’s a lot of ways for AI, and that sort of thing, to collect data, figure out how to triage certain issues. Understand if you have XYZ problem. Okay. You need a video chat right now, or you need to go to the hospital. 

[00:33:34] There’s just a lot of potential there both to increase the convenience of medical care for people, but also to make things easier for medical providers as well, and make things really accessible at all times for people where they just don’t feel alone. They know they have access to something like that. I think that that is something that’s coming down the road, but it’s really in it’s infancy now. 

[00:33:56] It’s interesting that you see so many different companies working on similar kind of tech and they each have their own little angle with it. One might use AI, one might use some type of proprietary model. It’s really interesting to see where that technology advances in the future.  

[00:34:09] Monica: That sounds so exciting. This was a fascinating conversation. 

[00:31:25] Dr. Cotliar: [Laughs] 

[00:34:12] Monica: It’s so near and dear to my heart because I have such trouble getting to the doctor myself, especially with this new wave of fear of what’s going to happen in the next six months with the people who have not gone to the doctor, who have cancer, and not getting diagnosed during these last two years. And that rush that’s going to happen because people couldn’t like take a picture of a mole and send it to their doctor. [Laughs] There’s so much that could have been caught earlier if this was a better system.  

[00:34:35] Dr. Cotliar: A hundred percent. I stopped practicing in the ER at the end of December. But in the last six months before that I was seeing so many disturbing things just like that. I was diagnosing all sorts of people with cancer on cat scans. And I think you’re totally right.  

[00:34:49] Monica: I really hope that we can come back and talk in a while about AI and medicine. I can see so many ways that that would save lives and save sanity for everyone.  

[00:34:59] Dr. Cotliar: I would love to come back. Thank you so much for having me.  

[00:35:01] Monica: It’s been such a joy. Thank you. 

[00:35:03] [Music] 

[00:35:06] Monica (Recorded): Thank you for listening to my conversation with Dr. Cotliar.   

[00:35:10] I am super passionate about the access points of telehealth. There are so many different reasons why people are hesitant to seek out healthcare in their communities. From culture, to doctor patient confidentiality, and proximity to the specialists. On top of that, telehealth can reduce the amount of travel time and costs of being in transit. And the biggest plus for me, is the reduction of pain due to not needing to travel to a doctor’s office. I am really hopeful telehealth becomes a more widespread and adopted option, as it creates so many new pathways in seeking care.  

[00:35:48] The takeaway learnings from this episode are:   

[00:35:51] 1. Telehealth can allow for opportunities to catch dynamic situations earlier and only require for in person emergency care if the doctor feels it’s necessary.  

[00:36:04] 2. Telemedicine can be used for more than just a doctor’s visit. The potential applications are limitless.  

[00:36:13] 3. Digital health options create additional access for people with chronic illnesses and disabilities to be able to seek out consistent care without having to physically go to the doctor’s office.  

[00:36:28] The actionable tips for this episode are:    

[00:36:31] 1. If you are a patient, consider giving a telehealth option a try the next time you seek out care.   

[00:36:39] 2. Think about utilizing wearables you may already own, such as a smart watch, in order to track data about your own health.   

[00:36:49] 3. If you are a physician, consider implementing telemedicine services or recommending these services to patients if their care feels like it could benefit from that.  

[00:37:02] For more information on Dr. Dustin Cotliar, please check out our show notes.     

[00:37:08] Every episode of Technically Sick has a page on empoweredus.org, where you can find extended show notes – including tips and takeaways, transcripts, and relevant resource links.    

[00:37:20] If you would like to share your own tips related to this topic or just to connect with us, visit the Empowered Us Contact page or reach out to us on our social channels.    

[00:37:31] Technically Sick is an Empowered Us Original presented by Good Days, hosted by me, Monica Michelle. If you liked this episode, be sure to rate and subscribe to our show, wherever you get your podcasts.   

[00:37:49] [Music Ends] 

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