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Question: Describe the genesis of the idea for Hello Health.

Jay Parkinson: When I finished residency at Hopkins, I really didn't know what I was planning on doing with my life.  But I knew that there were a ton of my friends who were photographers, like myself, who didn't really have any sort of connection to the healthcare system.  So they would always send me an email or an IM chat with some photo of some rash or something like that they they'd be like, "What's wrong with me?"  And being the nice friend that I was, I would reply with some advice, or you should just see the doctor or hang tight you'll be fine.  But then I just thought if I could do that for my friends, I think I could do that for my neighborhood.  So, that's what really gave me the idea.  Just knowing that we are all sort of communicating differently as a culture now, especially millennials and Gen Xer's, I just figured why not tailor a practice in Waynesburg Brooklyn that makes internet communication with house calls and PayPal?

Question: How did you execute on that idea?

Jay Parkinson: I just designed my own website that had a different promise.  And that promise was I'm a new kind of doctor.  You can communicate with me the way you communicate with your friends.  And that to me was just sort of the beginning of everything, and it just had a little button that said "Make an Appointment," and that would bring up my Goggle Calendar where you could input your symptoms and your address and that would send an alert to my iPhone and I would go do a house call and they would pay me via PayPal.  But it was great because I could charge anywhere from $100 to $200 a visit, which is less than most office visits in New York, and do five or six a day and make a very comfortable living because my overhead was nothing because I worked out of my apartment and didn't have an office or staff.  It was really about simplifying things.  Simplifying my life and that led to simplifying my patient's lives.  So, to me, healthcare should be simplified down to its bare essence because 90 percent of us are sort of light users of healthcare in America.  So why can't we just make it simple again?

Question: What is Hello Health?

Jay Parkinson: In the very beginning, you create a profile and you search for a doctor in your neighborhood, and you like a doctor, so you add him to your team.  When you add a doctor to your team, they can read and write to your medical records.  They are all encompassed within HelloHouse.com and your profile.  So, once you add a doctor to your team, you can make an appointment with them and it's all sort of like renting a zip car, it's a really nice interface to just sort of make an appointment with your doctor, and you meet up with that doctor in his or her office and the doctor's got total freedom to set how much time they spend with you.  So, they may only need a half hour or so, or an hour.  But it's really about just establishing a relationship and maintaining a relationship.  Because once you've seen the doctor in person that opens up a whole new world of communication tools; so you can email or you can video chat, you can IM with your doctor.  But your doctor has to get paid for communications, so he or she charges an hourly rate for communicating.  So, if it takes your doctor 15 minutes to reply to an email, that's a quarter of an hour.  It's up to the doctor to have a membership fee if they want.  But I don't know if that's the future.  I think it's just pay as you go. 

It just changes the way doctors are paid.  Doctors right now are paid for office visits and procedures and that encourages them to do as much as they can.  If you pay them an hourly rate that they set, it changes how they practice medicine 

Question: How does the relationship evolve between doctor and patient? 

Jay Parkinson: Right now the evidence says that about 50 percent of all doctor visits are unnecessary.  But they only get paid to bring you into the office, so that's what they do.  So, if you don't have that incentive, that means 50 percent of problems can be taken care of without physically seeing you, but augmented with good communication.  So, it actually depends 100 percent on the doctor and the patient.  There are some doctors that are very, they just want to see you all the time and some doctors are sort of, you know, if they know you and know you're a great capable person that can take care of themselves; they might tend to do more over the internet than in their office.  So, it's really a difficult question to answer because we don't know.  It's very patient and doctor dependent. 

Question: Are house calls more effective than office visits?

Jay Parkinson: I think that it depends on the situation, absolutely.  But, yes.  If you can see a person's life and see where they live and how they interact and see what's in their refrigerator, see if there's Twinkies on the counter.  You can say, well hey, I don't know if you're really living the best sort of lifestyle for you.  However, at the same time, it doesn't really -- most people know that they aren't living the best lifestyle if they aren't living the best lifestyle.  Doctor's aren't really trained to encourage you to change your behavior, we're trained from day one to write prescriptions and do procedures.  We're absolutely horrible to get you to change your lifestyle.  So, I actually think that doctors shouldn't be involved in lifestyle changes. For the past hundred years, our training is fully focused on making a profit off of sickness.  Which is wrong.  So, I think a whole new profession needs to come in and start making a profit off wellness and keeping you out of the sickness industry.  The best way to do that is through most likely just careful listening and careful understanding of the client to understand whether or not they can change certain aspects of their lifestyle. 

House calls are probably a good situation for that profession, but for doctors, I mean, their time is just too expensive to be traveling all over a city.  It's probably not the best use of resources. 

Question: Does giving out your cell phone compromise the traditional doctor / patient relationship?

Jay Parkinson: Whenever you give patients a number and there's a real person on the other end that's they're doctor, they're not going to call you at 2:00 in the morning unless there's really something wrong.  If they get a 1-800 number to some faceless person, they'll call at 2:00 in the morning because they just don't care.  But yeah, so the deal is, I think that increasing accessibility in the doctor patient relationship actually minimizes poor communication because I think there's a certain respect that people have for one another. 

Now, that's not saying that there are a few patients, every doctor has a few patients in every practice that are just sort of over the top in terms of communication.  And yeah, that's when it gets sort of difficult.  But at the same time, there's ways to handle that.

Question: What are some of the shortcomings of our current health care system? 

Jay Parkinson: I think the main shortcoming is that patients aren't the customers of healthcare.  Customers are people who purchase or buy goods or services.  And as patients, we just sort of turned that duty over to insurance companies.  To sign contracts with large groups of hospitals or doctors and all of a sudden you've sort of relinquished control of customer status.  And when you do that, you're not really treated like a customer.  You're not really treated like the Apple store treats you whenever they're trying to take care of your computer when it breaks.  And that's sort of what healthcare has become, a sort of faceless institution that really isn't focused on the patient's needs, you know like satisfaction.  

Question: Are there any countries getting it right in terms of health care? 

Jay Parkinson: There's countries like Norway.  The deal is, Norway has 4.8 million people and Kaiser in California covers about 10 million people.  So, you can't really say are there any countries doing it correctly because that's like apples and oranges.  Are there systems in the United States that are doing it properly?  Absolutely.  Kaiser, Geisinger, Inter Mountain, Bassett in Up State New York.   Absolutely.  Those guys are just really, really narrowing the proper delivery and payment for healthcare. 

Question: What are your views on universal health care?

Jay Parkinson: I think it's a bad policy given the current situation of paying for sickness because the sicker a population gets the more expensive it's going to get.  The older a population gets, the more expensive it's going to get.  So, in the widget that we sort of live and die by in healthcare is sickness, it's designed to skyrocket out of control.  So, the business model of healthcare delivery has to change before we institute everybody -- you know mandating everybody paying into a system that's designed to not do what's best for you, it's designed to do what maximizes their profitability.

Question: Would a shift to electronic medical records help the situation?

Jay Parkinson: Theoretically, a shift to electronic medical records would help significantly; however, electronic medical records don't solve the problems that doctors face.  They're designed for insurance billing as well as protecting them legally from lawsuits.  So, they're designed to produce as much information about an interaction as possible and data is often irrelevant to actual clinical care, to the case at hand, because the last visit, it might have been a one minute visit, but it's five pages worth of notes that are just designed to protect your butt. 

So, the interfaces are designed like Windows 95, these things were built 15 years ago, these legacy systems.  They are built in like the Windows 95 era.  They're siloed pieces of bad technology.  So, I do not support current electronic medical records being mandated across the United States because I think the electronic medical record industry needs to be disrupted with today's technology.  

Obama has appropriated about $20 billion to get doctors to use electronic medical records.  How much would it cost to Facebook if it were designed to power medicine to sign up all 11 million healthcare workers in America?  It surely wouldn't cost $20 billion.  It would actually cost significantly less because the building technology today that is flexible enough and platform-like, like Facebook for healthcare, would absolutely be the proper way to go.  But the deal is, as in everything, the money and the corporate interests control the welfare of our country, so it's a real problem.

Question: Would Hello Health encourage more doctors to go into primary care?

Jay Parkinson: I think a system like Hello Health could definitely encourage more people to go into primary care, absolutely.  However, for the past at least 10 years, about 5 percent of the doctors have been going into primary care.  Most high performing healthcare systems in the world have about 75 percent primary care doctors and 25 percent specialists.  In America, we're about exactly opposite.  We have 75 percent specialists.  And we're about two generations behind the curve on this one.  So, once Boomers retire or die, primary care is sort of dead with them, which is unfortunate because that's what sort of controls your experience and your health.  That's the person you should be able to depend on.  But right now, specialists are making double, triple, quadruple, as much as primary care doctors, and seeing half as many patients.  So, what's the incentive for doctors to go into primary care?  There's not much.  A system like Hello Health that encourages and pays primary care doctors for communication and pays them more on par with specialists would absolutely work. 

But there are other issues where the medical institutions devalue the art and talent of primary care in exchange for the big bag neurosurgeon and the respect they get. 

Question: What would be the implications of the death of primary care in the U.S.?

Jay Parkinson: I don't know, that's going to be really interesting.  I mean, that's the kind of stuff I'm sort of thinking about right now.  What I think is most interesting about the death of primary care and the rise of the Internet as well, when you think about it, the Internet connecting me with information and connecting me with patients is actually doing something really interesting to the practice of medicine.  You spend about one hour a year with doctors, and about 8,765 without doctors.  So, what does that mean to your life?  Well, doctors aren't the cure all for your health, I mean, you are.  Right.  So, I mean, you’re sort of like the CEO of your body and your doctor is a sort of consultant that you call on every once in a while, right? 

So, that basically means there are a ton of tools that are just now springing up that connect us with good information, that relevant to you as well as connect us with other patients that are having similar problems as you.  So, I hope that the Internet can prevent office visits, especially primary care visits.  And help people take care of themselves better. 

There's tools now, you can connect with doctors via video chat.  I think those tools have serious issues though because nobody really uses video chat with strangers.  And who are the doctors who are on video chat?  Why aren't they seeing patients in their office?  You know?  But I think that there are opportunities to build systems like this. 

The issue is, how do you, when people need a prescription maybe, for say, antibiotics, that can't really be done over the Internet with today's sort of laws and regulations.

Question: Why aren't our methods of developing drugs more advanced?

Jay Parkinson:  The methods of developing drugs are sort of set up so that you try to control for a similar group of people and you give them a similar pill.  But the deal is, we don't know anything about their genetics.  So, maybe they have these certain enzymes in their body that like really turn this drug over and turn it into the active metabolite for example that helps you, or maybe you're a bad metabolizer and it builds up in your liver and causes problems. 

The deal is, the pharmaceutical companies would rather have their market not limited by 66 percent, they would just like to sort of create a drug for everybody, throw it out to the masses, and if it improves symptoms by 5 percent, well it's a drug, and it's done it's job.  But in actuality, whenever you look at it across the population, there's a significant amount of people that are harmed by that drug.  The FDA tries to eliminate that as much as possible, but it doesn't always work. 

Question: Should we still be taking drugs?

Jay Parkinson: I think that there are certain drugs that we should not be taking, absolutely.  In 2009, the FDA approved only 26 drugs.  Seventy percent of those were the Me2 drugs, drugs that were going off patent, and needed to be remarketed as the next "Purple Pill" for example.  In order to create a $400 a month blockbuster drug in exchange for a $4.00 a month generic.  I think that is a very, very, very shady practice and it's harming our health in exchange for creating a whole industry of profitability of selling snake oil and marketing gimmicks.

Recorded on March 9, 2010

 

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