The Struggle of Practicing Medicine in 2016

The goal of this site is to engage healthcare professionals around the country and facilitate new ways of communicating through new uses of available online content. With attention spans shrinking to 140 characters or less, it seems few are reading business websites these days beyond getting the number and making a frustrated call. Our walk-ins are way up even though we specifically request that people don’t walk in. Currently, we are in the process of moving to all-digital processes and requiring online appointments. This doesn’t fit everyone, but it's necessary for us, or we ran the risk of turning into San Francisco’s helpline. We understand that patients are frustrated by limited and confusing choices. Data returned from a Google search result is frequently outdated and inaccurate increasing patient’s frustrations. Messaging via text or social media platforms are becoming the dominant form of communication, while phone calls are becoming a thing of the past.

Care Practice was once regarded as a pioneer in the use of technology and marketing through social media, but the pace of change has been so rapid that we feel like complete novices. The best we can do is stay focused on trying to keep our passwords straight and not making major mistakes with our online profiles that could cost us thousands of dollars. If other doctors are struggling as much as the doctors we know in San Francisco, then it is important we start having conversations around what doctor patient communication is going to look like, because social media and Twitter are not good options.

Smartphones are dramatically altering how we interact:

• These days nobody is answering their phone in San Francisco as we have learned to tune these devices out.
• Just completing the loop of returning one call to a patient often takes days of phone tag.
• It is common for some patients to call the clinic up to five times in one day, and then never pick up a single return call.
• After hours calls require doctors to block their personal cellphone number, which means that few will answer.
• People still think blocked numbers are sales calls, not realizing that spammers are all using 3rd party generated temporary personalized numbers for each sales call.
• That Do Not Call list, yeah, they have figured out a way around that.
• Blocked numbers are often from the police or your doctor. Not accepting blocked calls means doctors using *67 after hours can’t call you.
• Protecting our private cell phone numbers is very important or risk the patient saving that number as your clinic number and using it for the next 3 years.
• Even if we want to leave a message, we can’t. Few cell users have messages set up and the ones that do often have a mailbox that is full.

The Awkward Use of Missed Calls, Emails, and Social Media to interact with our fellow humans:

• We all recall judging friends with thousands of unread emails in their inbox and now we all have unread emails numbering in the thousands.
• The press seems to be writing email epitaphs recently. We have noticed a dramatic drop in response rates to emails as people appear to becoming overwhelmed by the daily influx.
• Interventions are increasingly being mounted for friends in trouble via social media platforms. Usually these are begun after several notice disturbing comments online or statements indicating distress.
• With many of us having 5 email accounts, we often see an email on our phone, and then go home and spend 30 minutes trying to find which inbox it was in on our computer.
• Society is abandoning phone calls and email, so what are we doctors supposed to use to communicate with patients, since those are our two main ways to communicate?
• Patients' dramatic rise in use of social media communications and texting is not possible or secure.
• Patients desperate to contact me are resorting to Facebook and Twitter. I recently had one patient call me 13 times and send 6 messages on Facebook trying to get ahold of me.
• Healthcare organizations, to keep patients, pushed email onto doctors and then posted thousands of email addresses online where bots scrape them and sell them in bulk to spammers.
• We are consistently experiencing one to two major software failures per week.

Systems built to make our lives easier often seem like they are costing us time, money, and our sanity:

• Organizations are going from analog to digital and manual to automated with many unintended consequences.
• Things like CA State EDD disability system and Cures DEA database have moved to online platforms that work intermittently.
• Recently I needed 30 login attempts to complete on disability form online for free. In the past, it would have been five minutes during a visit in my office.
• In the software race, many systems are poorly maintained and code is outsourced overseas in the race to innovate. We don’t find many major sites without substantial errors.
• Offers made to clinics for free beta testing a new product too often function like a poison pill to destroy your clinic. As we have worked on dozens of new technology pieces, we have gotten to the point where we realize early adoption is costly.
• EMR’s have evolved little beyond its roots as a glorified billing software with a few patient features thrown in.
• Big companies are buying little companies. Our scheduling software was bought by Intuit and a year later the founding team was let go. Now we are scrambling to build our own scheduling software as our old system has become unreliable.

Technology has the ability to transform our lives, but it is proving to be a major source of frustration, expense, and distraction for doctors desperate to just practice medicine. We can’t replace genuine human interaction for virtual relationships. Frustrated by the lack of viable options to improve communication with patients, we did the typical San Francisco thing and co-founded a tech company with several patients last year called Orchestra One. Orchestra is a practice management software and app that provides scheduling for a clinic, direct communication with patients via HIPAA compliant messaging, and facilitates easy payment processing. We raised a seed round with Benchmark, Lowercase capital, 500 Startups, and Accomplis. We also had a few individual investors like Reid Hoffman and Al Harrington, a former Warrior starting a fund for professional athletes. Many of our investors can be found in this New York Times article.