Julie Soukup  0:01  
Hi, thank you so much for joining another episode of take one patient podcast. My name is Julie Sukup. I work with the medical memory. And I'm very excited about our two guests today. Dr. Grande Lord and then Dr. Jolly with empathic, thanks so much for joining us. So I want to actually let you guys start by introducing yourselves and talk a little bit about what you guys are trying to accomplish as it relates with Dr. Communication. And then we can kind of talk a little bit more about what we're doing and how we, you know, partnered or looked at partnering. But yeah, why don't you guys go ahead and start by introducing yourself.

Grin Lord  0:39  
Great, thank you so much for having us. I'm Dr. Grin Lord, I'm a licensed clinical psychologist. I've spent the last 15 years studying what are the words and phrases that lead to increased empathy and trust and doctor and patient communication. And most recently, we've been giving performance based feedback and coaching using AI. So rather than having a human coach say, here's what to say next. And let's look at this, we actually have had hundreds, if not 1000s of humans, build this AI experts in communication to then deliver that at scale. I'll let Dr. Jolly, introduce yourself. Hi,

Dr. Jolly  1:17  
I'm Dr. Jolly, and I am a licensed counselor. And I've been working with grin with Dr. Lark for the last three years. And I'm one of the humans who's behind the AI who is helping who's helping create the performance based feedback and who's been like overseeing the teams that are that are generating our AI.

Julie Soukup  1:40  
Awesome. So as you know, we've we've met you know, we My background is in performance coaching with cosmetic sales with with trainers, you know, working at clear choice, and one of our partners being so Novello, where we actually were using coaches and trainers a lot where we would record, you know, our consultants and the way they engaged with patients in the way that they communicated. And then we were recording it and then trying to train and coach remotely and leveraging medical memory with that. Tell me a little bit more about kind of what what it is that you guys are really looking for in a lot of these videos. And then also, how are you going about measuring it? Yeah,

Grin Lord  2:22  
that's a really good point. I should say, too, I was also a coach, medical coach for a long time before I became a psychologist. And it is really tedious to listen to these recordings and try to be objective and unbiased, especially when you've been, you know, doing that a lot. We one of the kind of things that inspired empathic was nationwide study, the Clinical Trials Network where we actually had I think, was the largest phone coaching study that's been conducted to date, where we listened to providers and doctors and marked all the good and bad things they did, and then coached them and had them do role plays and rehearsals. And at that time, actually, we used an objective measure called the mighty, which was based on motivational interviewing, has a lot of research around if you use things like reflective statements, open ended questions in the medical context, that that actually improves health care outcomes. So we use that objective measure to rate sessions, but it was super late. And you know, people would get feedback about two weeks after they saw a patient, they wouldn't even remember who the patient was. So even though the coaching worked, you know, similar to learning a sport, that that's how you want to get your feedback when you're training and communication behavior, it didn't really work to have it be that delayed. So that's when we built some of our first AI models was taking all of the things that coaches did training AI on it, and going from there. But that became the basis for a lot of the science behind our work was starting with lessons from Counseling and Psychology and healthcare coaching things that we, you know, are tested and have been working for at least the last 20 years in healthcare settings to show objective ratings of empathy. I know Dr. Jolly, you can talk a little bit about how we define empathy because and trust and these things, that it seems like, you know, subjective even though we have objective definitions for

Dr. Jolly  4:27  
it. Yeah, we take a broader understanding of empathy, and we really try to look at it as accurate understanding. I know in a lot of psychology and in counseling spaces, they often talk about empathy as being able to walk in somebody else's shoes. And that can seem a little bit intimidating for people who maybe don't have that background, um, or that training. So what we're really looking at is, is this person able to accurately understand are they making attempts to really you know, summarize restate or, or yeah, just create increases Understanding in the conversation. And really,

Julie Soukup  5:05  
I was just gonna say it's, it's, it's interesting too, because what and we face this challenge as trainers and coaches for our consultants is, is is trying to take that subjective nature out of it, how do you how are you measuring it and how to kind of make it be okay, this isn't just my opinion, this is something that potentially you need to see and change or shift behaviors, you know, as it relates, you know, to your conversation or the way that you're talking to people and, and whatnot. Now, tell me a little bit, I mean, I was in cosmetic sales, which which was obviously you want to get, you know, encouraged or motivate someone to change their life and do something different. But we met in a neurosurgery space, which is tends to not be a place where you know, communication is always like the main important thing you know, these are, you know, the best of the best in some some surgery spaces. So, what were you guys kind of trying to accomplish and how you got started working with Virginia Mason, which is actually where we met? Yeah.

Grin Lord  6:07  
Well, there are some incredible surgeons out there that actually understand the literature and value, you know, bedside manner and doctor patient communication. And Dr. Farooqi at Virginia Mason was one of them who had been already trying on his own to improve the coaching and in a more objective way of his residents. Other surgeons that are training, as well as team members, they would do a, I think, a kind of a Grand Rounds thing once a year where they would have 15 surgeons come in to watch a surgery and give feedback, incredibly resource intensive and rare. And if you can imagine being a surgeon getting feedback one time a year, doesn't, you know, totally shape your behavior. But the reason he was so excited about that is because there is research that shows that what they call non technical communication skills. So that's everything that doesn't have to do with communicating about the surgery actually predicts better surgical outcomes. So that's how the doctor or surgeon talks to their team, as well as how they talk to the patient. If they increase empathy, trust and understanding in those conversations and actually reduces things like length of stay, you know, other medical outcomes, healing errors that happen in the communication, more trust is built between the team so there people are more likely to bring up issues or stay, you know, on that team and not churn. There was an interesting study that came out about physician's assistants, churning, under surgeons, you know, that are operating in a more like traditional stereotype we have about surgeons, you know, being the king of the hospital and coming in and meeting all these things and demanding them, the more collaborative ones have a greater retention, again, better health care outcomes, so I can keep going on the literature. But yeah, Dr. Farooqi was really interested in how do I improve? How can I monitor this, and then with medical memory, they were already using medical memory to help with, you know, patients that after a neurosurgery, you know, maybe wouldn't remember what the doctors said, because obviously, that's very traumatic, or they just found out, you know, they got brain cancer or something. And, you know, we as psychologists know, anytime you have a trauma, psychologically, memory is one of the first things that's that goes, and then add on top of that a surgery to the brain, you know, you need to have video playback review of what's happening. So he already was invested in medical memory and that communication, and then wanted to add on top of that, how can I improve this, from my perspective, not just, you know, for the patients to learn and remember, but how can I actually like use this to maximize my time, workflow speed as well as performance? Yeah, yeah. And

Julie Soukup  8:59  
it's a really amazing kind of this, this time that's evolving, and especially with what you guys are doing with these tools is, yes, you're able to capture more things on video, whether it be conversations with your patients, conversations with your team, to be more effective, you know, and collaborative leader all lead leading to, you know, hopefully, better patient understanding and better patient outcomes. But I think it's amazing that taking that resource, like okay, now you have this video, what are we going to do with it, and be able to kind of pull that information out and analyze it, you know, in in empathic and be able to understand, you know, what are these metrics that we're trying to uncover with the transcripts and the words that are said and all of those things, where it's allowing people to kind of really be, you know, more introspective or more aware of themselves as it relates to their team, but also it's like, okay, well, now you're now you're being recorded. For those of your partners or even for rookie, I guess he already was in the medical memory but for someone Have your other partners that are like, Okay, well, I want to plug this into here. But I'm nervous about having this recorded and kind of how do you help encourage or, or, or persuade or whatever as far as like, well, this is what you could learn from this.

Grin Lord  10:13  
Yeah, that's a really good point. I think provider buy in on all of this is extremely important. And for us, we prioritize, you know, self review, first in our system. So the idea isn't, you get a recording, and it goes to your supervisor, and then they shame you or, you know, reduce things for you. The idea is that you are the first one to look at that. And jelly, I don't know, if you want to talk about maybe some of the structure of the feedback with like, strengths and challenges how we actually give the feedback so that it is you know, digestible? Yeah.

Dr. Jolly  10:48  
So yeah, our goal of the feedback is to, you know, shape behavior and encourage people to help people understand where they're doing well, and where they where they might need to improve. So we don't just hone in on areas where like, hey, maybe this was a little confrontational, or you could have asked a question differently, we also hone in on the strengths. So you did a really good job summarizing here, or this was a great reflective statement, because we want it to be balanced. And we know that if you just focus on, on the areas that somebody's not doing well, it becomes demoralizing. Yeah. And so we really want the feedback, too, we want the people to be engaged. And so we know from the research that in order to do that, there, there needs to be a balance of positive and constructive feedback. Yeah.

Julie Soukup  11:32  
And we even see that working with like, you know, our cosmetic surgery coaches, and their training these guys is, sometimes it's like, do you, you did a great job with this one thing, this is awesome, you should do this all the time, you know, like, as far as like, asking more open ended question or slowing the pace down, you know, to show more empathy, that a lot of times, it's being more aware of the things that you might already do really well, that you just, it's just automatic, you don't even think about it anymore. You know, some

Grin Lord  12:00  
of it is a knowledge gap to there can be highly empathic people, they get good patient satisfaction ratings, but, you know, they may not even themselves understand what is the exact skill that they're doing that is leading to that. So they can't train others in it, you know, it becomes like, you know, this industry knowledge to this one person. So this also helps people, you know, share what they are doing well, with others. You know, for some of the surgeons where there's less buy in on recording, they're not interested in improving that, there is some good research, you know, showing that recording these conversations does not increase any malpractice suits, some people worry about that, that if we record this, and suddenly, we're adding to the record, in fact, it's the opposite. And legal teams encouraged to have these records and ongoing communication with the patient that is recorded. So there is a lot, you know, understanding is increasing, just through that medium alone, let alone the skills. And then again, you have some of these workflow, things that can be sped up, one of the things that we can kind of double dip into with our AI recording is summarizing the session so that surgeons can very quickly understand what is going on, they can use that for their clinical note, if they'd like to, they can use that for a patient summary. So it is it's helping them with their memory as well. Right?

Julie Soukup  13:21  
And what they can kind of copy and paste and be able to give off to a patient, even if they're not wanting to give the video or whatnot. Right there. Yeah. So from a lot of these, you know, doctors and psychologists and your analysis is what would you say, just even a skill sets, you know, really separates, the ones that are are much more empathetic and collaborative versus ones ones that don't like what whether like kind of the key things that separates talk communicators in that space?

Grin Lord  13:50  
Yeah, it's interesting, because we can talk about two, two areas there. One is what we call common factors, which are the things that in psychology research basically have been shown to be the active ingredient or component and psychotherapy and coaching. And then the other is more specific to surgeons themselves, and that we actually use a metric called the knots, which is the non technical skill set. I'm not sure exactly what non technical skills for surgeons, which is a measure that comes out of the UK. And so how we like to think of these skills is what skills like what happened versus how skills like how did you do it? So jolly, do you want to talk a little bit about like that? How skills and I can talk about the what? Yeah,

Dr. Jolly  14:41  
so the house skills are kind of more about like, how collaborative you are. Are you asking like really curious types of questions. Are you you know, respecting other people's expertise, inviting them into the conversation and using a I restatements and summarization and things like that. So kind of more about has more about like your presence in the conversation. And so

Grin Lord  15:11  
yeah, like collaboration and power sharing is a really important one emphasizing the control of the patient during their process so that they know, at any point, you know, if they have questions, or if they want to stop, or if they don't want to move forward with something, that they have options and choices, and there are little phrases that you can say, to emphasize control, like, what do you know about the surgery before you tell them? Like, tell me about your understanding of the risks? Before you tell them so that you can get a sense of like, well, okay, where where do I need to focus my energy, and having them come across as the expert will increase their confidence going into that surgery? Or things like did? Did you understand that? Did you have any more questions, which is like a super obvious thing to those of us here that are coaches, but a lot of people they come in, and we can talk a little bit about the bad behaviors, but the bad behaviors are things where you just dump information on people. And you don't pause, you don't check for understanding you don't like that power share in that collaboration piece that Dr. Jolly is talking about is like one of the many metrics we focus on. And it's actually super easy to fix. You just have to know to pause to be like did. Are you understanding this? Like, what is your understanding? Throughout the conversation? We have other metrics, too. I don't know if you want to talk a little bit about curiosity, or? Yeah, yeah.

Dr. Jolly  16:39  
And so for curiosity, that's more about like asking, like, really curious questions. So asking open questions, questions that are inviting other people to, to expand? Because a lot of times, you can start with an open question. So tell me about tell me about what's bringing you in today. And then from that, you can get you can get a lot of information. Rather than say, being a little bit more directive, asking a lot of closed questions. We know that there's a time and space for closed questions, when time is limited, when there's very specific assessment that that you need to that you need to follow up on. So we're not saying that closed questions are bad. But what we do recommend is starting with the open questions, to give people a space to really give the history of their problem, the history of what is bringing them in. And then from that asking those follow up questions to get a little bit more targeted discovery. Sure.

Grin Lord  17:31  
We have like a highlights and challenges that pop up. And one of the ones that we see frequently with questions, that's a problem is when people will do stacked closed questions without letting the patient respond. Or they'll do an open ended question like, what brings you in today? Was it your knee pain? Was it your shoulder pain? Was it your thing with your Bible, and I just like to begin, like you see, there's just presidents a lot, they'll just begin a medical checklist because a lot of medical school training is that diagnostic rollout type thought process. It's like you can get to the rollout with just asking the first question. So it's a lot of like unlearning some of that thought process, they think actually will lead to speed and accuracy. And again, that the research says no, if you let the patient tell the narrative, first, you're gonna get all the information you need with like, nudging and reflecting your understanding, rather than going through your checklist.

Julie Soukup  18:31  
Well, I don't even that's what you're saying is, is if you're saying, okay, like from all that is, we were gonna say, Okay, here's two keys for any provider that we've learned throughout the analysis. And the data is, you know, even right, pause on your hand, just have that that one open ended question at the very beginning. Right? All right, pause on your hand just for those check ins. And even just in and of itself, that little things, a better patient experience,

Grin Lord  18:56  
or reflective statements, like when they say something to you repeat back what you heard before you go to your next question, you know, especially if it's an open ended one where you've gotten a lot of information. And I've seen this happen live with providers that are just using reflections and then get so much more out of the conversation in terms of really understanding what their patient where their patients at, just through repeating it back. Because sometimes patients themselves don't know they don't, they don't know if they're making a medical decision. That's a big one. Even if it's something again, in your industry in the cosmetic industry, you know, people are ambivalent, they, they aren't sure. Do I really want to do this? Do I not am am I okay with the risks and so just repeating back, okay, it sounds like on the one hand, you really like looking forward to this. On the other hand, you're a little bit concerned about the follow up because of your past experiences. Like where are you at right now, between those two things, like just repeating that back to them can help them come to a decision where they're going to have more confidence in you,

Julie Soukup  19:58  
ya know, and that's Very true, when we would look at like coaching or dental consultants or plastic surgery consultants, a lot of times these people would come in. And this is the first time they've even talked about it, like the first time they like, like, you don't go somewhere be like, let me show you my biggest insecurity, let's talk about it, like, you know, so a lot of times, they just needed to, like, just talk for a minute, get that get that kind of out. And even similarly, I mean, in the more traditional medical setting, it's not as much but you know, this isn't something even having my dad deal with spine issues, these are not telling everybody about these things, this is sometimes not a rehearsed thing, that they almost have to work through a little bit and have that space, you know, kind of to do it, which is where you're saying is those check ins and that open ended, you know, is even reflecting in the data that providing them that control back and at least that space to be able to communicate about it a little bit, you know,

Dr. Jolly  20:53  
Jolly Oh, yeah, I was gonna just tag on about the reflective statements, it also really helps uncover any of your own miscommunication or misunderstandings. And so if I'm just saying it sounds like, you know, it's been really bothering you in this area, and then that gives the patient a chance to correct No, say, No, that's actually not. Yeah. And so there's, there's a lot of benefit to it. And so I think it you know, it's just a really important skill for us to, to keep practicing and using. Awesome,

Julie Soukup  21:28  
well, I'm so excited, I'm so excited that we've gotten to meet you, especially, you know, with medical memory being a tool that cannot capture these videos, that cannot be analyzed, whether that be in neurosurgery or cosmetic surgery or, or just trying to learn a little bit more of some analytics behind some coaching, I think, is going to be super, super powerful. And, and being more aware even of this, you know, personally, as well as starting to kind of have some of our clients start to see this, I think is going to be incredibly helpful for you know, giving that expert coaching without necessarily having someone sit right next to you in the room, which of course can only help improve, you know, communication with our teams, or patients, or whatever it might be. So I'm so excited to continue to see how this is going to evolve, as well as what we're going to learn, you know, in these different specialties, about communication. Is there before I wrap up? Is there anything else that you guys want to add or anything? I think

Grin Lord  22:30  
one part that we're really excited to get into too is benchmarking some of these skills against other objective measures like patient satisfaction, Press Ganey scores, things like length of stay, and even against other surgical teams or other teams, you know, in a more anonymous fashion, so that people can really get a sense of how am I progressing? How, why does it matter that I have an open ended question and emphasize control, it's not just to be nice, like this is the actual impact on that. So having almost like this feedback system on, I'm doing these behaviors, and this is the impact that it's having can be very motivating. And that's where we're headed next, you know, is not only analyzing what's happening and comparing it to what we know, works, but also comparing that and benchmarking that against teams, against hospitals, and then pulling in some of this other objective data. So I'm really looking forward to that too, since that will be I think, maybe one of the first times at least that I'm aware of that, there'll be that direct connection that isn't based on just a complaint surface scene, so something's bad, then you look into it, it's like, okay, we're going to know, in real time, like what's contributing to these good, you know, scores versus the others, right,

Julie Soukup  23:50  
which takes time, a lot of time as far as to be able to, like, get the information to pass it along, especially as it relates, I know, with H Capps when we when we were working on a few studies, during COVID, which was, you know, showing that adding medical memory for doing rounds, and doing patient updates did lead to patient satisfaction as far as understanding communication, whatever, but I know even when we did, it was such a, it was such a lag in that. So it's exciting to see, you know, kind of just as you said, how you can shift these little nozzles here, and what a really big impact it will have on these other places. So I'm excited for that. So thank you guys so much for joining and hopping on. You know, it'll be really interesting and exciting to watch. All we're going to be able to learn from from this technology that you guys have built so awesome.

Grin Lord  24:41  
We're excited to thank you so much.

Julie Soukup  24:43  
Yeah, thank you

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