Big Think Interview With Jay Parkinson

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Question: Describe the\r\ngenesis of the idea for Hello Health.

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

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Question: How did you\r\nexecute on that idea?

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Jay Parkinson: I just designed my own website that had a different promise.  And that promise was I'm a new kind of\r\ndoctor.  You can communicate with\r\nme the way you communicate with your friends.  And that to me was just sort of the beginning of everything,\r\nand it just had a little button that said "Make an Appointment," and\r\nthat would bring up my Goggle Calendar where you could input your symptoms and\r\nyour address and that would send an alert to my iPhone and I would go do a\r\nhouse call and they would pay me via PayPal.  But it was great because I could charge anywhere from $100\r\nto $200 a visit, which is less than most office visits in New York, and do five\r\nor six a day and make a very comfortable living because my overhead was nothing\r\nbecause I worked out of my apartment and didn't have an office or staff.  It was really about simplifying things.\r\n Simplifying my life and that led\r\nto simplifying my patient's lives. \r\nSo, to me, healthcare should be simplified down to its bare essence\r\nbecause 90 percent of us are sort of light users of healthcare in America.  So why can't we just make it simple\r\nagain?

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Question: What is Hello\r\nHealth?

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Jay Parkinson: In the very beginning, you create a profile and you search for a doctor\r\nin your neighborhood, and you like a doctor, so you add him to your team.  When you add a doctor to your team,\r\nthey can read and write to your medical records.  They are all encompassed within HelloHouse.com and your\r\nprofile.  So, once you add a doctor\r\nto your team, you can make an appointment with them and it's all sort of like\r\nrenting a zip car, it's a really nice interface to just sort of make an\r\nappointment with your doctor, and you meet up with that doctor in his or her\r\noffice and the doctor's got total freedom to set how much time they spend with\r\nyou.  So, they may only need a half\r\nhour or so, or an hour.  But it's\r\nreally about just establishing a relationship and maintaining a\r\nrelationship.  Because once you've\r\nseen the doctor in person that opens up a whole new world of communication\r\ntools; so you can email or you can video chat, you can IM with your\r\ndoctor.  But your doctor has to get\r\npaid for communications, so he or she charges an hourly rate for\r\ncommunicating.  So, if it takes\r\nyour doctor 15 minutes to reply to an email, that's a quarter of an hour.  It's up to the doctor to have a\r\nmembership fee if they want.  But I\r\ndon't know if that's the future.  I\r\nthink it's just pay as you go. 

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It just changes the way\r\ndoctors are paid.  Doctors right\r\nnow are paid for office visits and procedures and that encourages them to do as\r\nmuch as they can.  If you pay them\r\nan hourly rate that they set, it changes how they practice medicine 

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Question: How does the\r\nrelationship evolve between doctor and patient? 

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

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Question: Are house calls\r\nmore effective than office visits?

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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\r\nhow they interact and see what's in their refrigerator, see if there's Twinkies\r\non the counter.  You can say, well\r\nhey, I don't know if you're really living the best sort of lifestyle for\r\nyou.  However, at the same time, it\r\ndoesn't really -- most people know that they aren't living the best lifestyle\r\nif they aren't living the best lifestyle. \r\nDoctor's aren't really trained to encourage you to change your behavior,\r\nwe're trained from day one to write prescriptions and do procedures.  We're absolutely horrible to get you to\r\nchange your lifestyle.  So, I\r\nactually think that doctors shouldn't be involved in lifestyle changes. For the\r\npast hundred years, our training is fully focused on making a profit off of\r\nsickness.  Which is wrong.  So, I think a whole new profession\r\nneeds to come in and start making a profit off wellness and keeping you out of\r\nthe sickness industry.  The best\r\nway to do that is through most likely just careful listening and careful\r\nunderstanding of the client to understand whether or not they can change\r\ncertain aspects of their lifestyle. 

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

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Question: Does giving out\r\nyour cell phone compromise the traditional doctor / patient relationship?

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Jay Parkinson: Whenever you give patients a number and there's a real person on the\r\nother end that's they're doctor, they're not going to call you at 2:00 in the\r\nmorning unless there's really something wrong.  If they get a 1-800 number to some faceless person, they'll call\r\nat 2:00 in the morning because they just don't care.  But yeah, so the deal is, I think that increasing\r\naccessibility in the doctor patient relationship actually minimizes poor\r\ncommunication because I think there's a certain respect that people have for\r\none another. 

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

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Question: What are some of\r\nthe shortcomings of our current health care system? 

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

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Question: Are there any\r\ncountries getting it right in terms of health care? 

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Jay Parkinson: There's countries like Norway. \r\nThe deal is, Norway has 4.8 million people and Kaiser in California\r\ncovers about 10 million people. \r\nSo, you can't really say are there any countries doing it correctly\r\nbecause that's like apples and oranges. \r\nAre there systems in the United States that are doing it properly?  Absolutely.  Kaiser, Geisinger, Inter Mountain, Bassett in Up State New\r\nYork.   Absolutely.  Those guys are just really, really\r\nnarrowing the proper delivery and payment for healthcare. 

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Question: What are your\r\nviews on universal health care?

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

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Question: Would a shift to\r\nelectronic medical records help the situation?

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

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So, the interfaces are\r\ndesigned like Windows 95, these things were built 15 years ago, these legacy\r\nsystems.  They are built in like\r\nthe Windows 95 era.  They're siloed\r\npieces of bad technology.  So, I do\r\nnot support current electronic medical records being mandated across the United\r\nStates because I think the electronic medical record industry needs to be\r\ndisrupted with today's technology.  

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

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Question: Would Hello Health\r\nencourage more doctors to go into primary care?

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

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

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Question: What would be the\r\nimplications of the death of primary care in the U.S.?

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Jay Parkinson: I don't know, that's going to be really interesting.  I mean, that's the kind of stuff I'm\r\nsort of thinking about right now. \r\nWhat I think is most interesting about the death of primary care and the\r\nrise of the Internet as well, when you think about it, the Internet connecting\r\nme with information and connecting me with patients is actually doing something\r\nreally interesting to the practice of medicine.  You spend about one hour a year with doctors, and about\r\n8,765 without doctors.  So, what\r\ndoes that mean to your life?  Well,\r\ndoctors 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\r\nyour doctor is a sort of consultant that you call on every once in a while,\r\nright? 

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So, that basically means\r\nthere are a ton of tools that are just now springing up that connect us with\r\ngood information, that relevant to you as well as connect us with other\r\npatients that are having similar problems as you.  So, I hope that the Internet can prevent office visits,\r\nespecially primary care visits. \r\nAnd help people take care of themselves better. 

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There's tools now, you can\r\nconnect with doctors via video chat. \r\nI think those tools have serious issues though because nobody really\r\nuses video chat with strangers. \r\nAnd 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\r\nlike this. 

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

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Question: Why aren't our\r\nmethods of developing drugs more advanced?

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

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

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Question: Should we still be\r\ntaking drugs?

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

Recorded on March 9, 2010

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A conversation with the co-founder of Hello Health.

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