Season2 Ep8

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Geeta Nayyar, M.D. (“Dr. G,” as she is known), placed bets on health IT early in her career.

In this episode, Dr. G describes how she witnessed firsthand the transition from the old school to the new school, from physical paperwork to the electronic health record (EHR) platforms—while still in medical school in Miami and then as a newly-minted rheumatologist.

“I saw the potential and promise of this better option for connecting data, connecting communications,” Dr. G says in the episode. And as we connect data and communications, we will build trust, which is fundamental in healthcare. “The day-to-day relationship, building the doctor-patient relationship, should be part of the digital transformation.”

Dr. G’s book "Dead Wrong", which grew out of her work to battle misinformation (and build trust) during the COVID-19 pandemic, is set for publication in October 2023.

Listen and follow here:
The following transcript has been edited for length and clarity.

Melanie Marcus: I'm very excited to welcome Dr. Geeta Nayyar, also known as “Dr. G,” to our podcast. When it comes to the impact of technology on healthcare, Dr. G was there at the beginning. She saw firsthand how the medical profession went from physical paper to electronic health records, not that long ago. And she placed her bets early in health IT. As she says, “I saw the potential and promise of this better option for connecting data.” And as we connect data and communications, we build trust—which is fundamental in healthcare. For Dr. G, it's about battling misinformation, which can be life or death, and it's about building trust in the doctor-patient relationship. With that said, let's dive right in.

Geeta Nayyar: Thanks so much for having me, Melanie.

Marcus: This podcast is about finding a better way in healthcare, and your entire career has been about just that. I want to get into your work about the pandemic, your stint at Salesforce and your upcoming book, among other things. But first, let's start where you got started. You're a board-certified rheumatologist. How did you become interested in medicine and specifically rheumatology?

Nayyar: Like everything, it was happenstance. I realized very early on as a young physician that there had to be a better way. And remember, I'm that generation of physicians that went from paper to digital. So, while I was learning to be a doctor, I was learning an electronic health record for the first time. And I saw the potential and the promise of this better option for connecting data, connecting communications, being able to analyze data. And I made a big bet on health technology early in my career.

Marcus: You said that you made the transition [from paper to digital], literally while you were being trained. What did that look like?

Nayyar: It was hard. I also went to medical school in Miami, so had to learn Spanish at the same time. It was a lot at once. But what it does is force you to think critically, because you're in this zone of learning how to be a doctor. You're constantly questioning things. And part of your training is they're constantly questioning you. It was the perfect storm to learn and absorb, but also to ask, what do I want to be? How do I want to contribute? How do I want to show up as a physician? Rheumatology, for me, from a specialty perspective, was very interesting. I love the immune system. Autoimmune diseases are fascinating. We have a family member with an autoimmune disease. The thing about rheumatology is it's a very esoteric space. So, one of the big disconnects in her case was the fact that the data wasn't connected. The pulmonologist didn't know what the cardiologist was doing. The cardiologist didn't know with the endocrinologist was doing, etc. I'm in my training, I'm seeing this electronic health record and I'm thinking, how is this not a better, smoother patient experience?

Marcus: There are so many places to dig in on your career and what you've been doing. But let's start with your book. You have written a book called "Dead Wrong". It's due out in the fall.

Nayyar: This has been a two-year running project. And I'm just so excited to see it come to fruition. We have had so much misinformation and disinformation long before COVID. This is not a COVID book. This is really a call-to-action. It's risen to that level of awareness because of COVID, but misinformation has been ever-present. In the South Asian community, we use ginger and turmeric for everything. It’s supposed to cure cancer. And how many fallacies are there around pregnancy? Is it a boy? Is it a girl? With diabetes, don't you just have to fast and lose weight? There are so many things that confuse people. As a healthcare leader, how do you take the mandate around countering misinformation and incorporate it into your digital transformation strategy?

Marcus: Let's back up. You mentioned a couple of scenarios, but let's focus on the problem.

Nayyar: Whether you're a physician, patient, business leader, no one wants to be the fool. As a healthcare organization, how do you put out the right information? How do you build trust? And as a consumer how do you know what you're reading and sharing impacts your own family and personal health? We haven’t empowered the trusted relationship between the doctor and patient at scale the way we could if we were smart about it. Because at the end of the day, no one is trusting. Forgive me, but no one trusts their pharma company. No one trusts their insurance company. The individual physician is usually the reason you come back despite the horrible waiting room experience. For example: Here are three things I want you to know when facing a lupus diagnosis. Why wouldn’t marketing and communications come up with a blog series for me as the physician? It’s the partnership and the acknowledgment that patients are going to get information. Why not from their doctor?

Marcus: You're speaking my language right now. The marketing, communications and thought leadership to make it understandable for patients. Where is that happening?

Nayyar: It's happening in pockets. You’re seeing this happen a lot in TikTok, where some physicians are building their businesses successfully. One thing we learned during COVID was that everything the surgeon general said was so important. And the thing is, we have a “surgeon general” in every zip code. Physicians have a following, whether it's OB-GYN, pediatrics, etc. So many moms say they will never leave their pediatrician. How do you scale that in a deliberate way? And not in pockets. How do you get the hospital CEO to say this is mission critical? How do you turn that into an appointment? Part of the work I'm doing with Zocdoc, which I'm enjoying, is improving access. Right now, we have a physician workforce shortage. We have a burnout issue. Patients can't get appointments, let alone know where to go and who their insurance will allow them to see. The true way to do this, from a digital transformation standpoint, is hit all those different pain points on the patient journey—pre-visit, visit, post-visit.

Marcus: Can you talk about the role of trust?

Nayyar: Trust is everything. If I don't trust you, I certainly won't listen to you or take your advice. We need to do this better in healthcare. If I don’t see you as relatable, if I don't see you as reachable, if I don't identify a commonality, I won't listen to you. Why do people listen to their hairdresser or their neighbor? Because they're reachable. They're relatable. The messenger matters in healthcare. Every time I drop my daughter off at school, someone will inevitably stop me and say, “Hey, do you know a female gynecologist?” Why is that? Because women think the female gynecologist will understand them better.

Marcus: Trust is a high bar when we have this incredible burnout and provider shortage. Can you talk about that?

Nayyar: Everyone is talking about artificial intelligence. “It's a silver bullet. It's going to replace doctors.” But one of the best ways to use AI, in my opinion, is as this low hanging fruit around physician burnout. How can we make documentation better? How can we automate things to leave the people part to the actual frontline workers? When I think about AI and improving documentation, how can physicians finish their work at clinic and not in the evenings after spending time with their families? It’s the workflow, particularly with AI. The simple things we take off the doctor’s plate, the nurse’s plate, that will make the biggest impact.

Marcus: We are firmly in telemedicine. Where do you see this going?

Nayyar: We've been doing telemedicine long before we were allowed to. The only silver lining to COVID is probably that telemedicine finally got blessed from a regulatory standpoint, and we could do it at scale. If you're having chest pain, don’t do a virtual visit. Right? But if it's a wound check, if it’s a simple counseling question, if it's an access issue and you can't get to the doctor for six months, but go virtually? By all means, that’s better than delaying care. Some people still want the in-person visit. They like to be looked in the eye. Others just want the advice, the prescription, etc. We’re still learning, both on the consumer and provider sides, but there’s ample opportunity for growth in telemedicine.

Marcus: What do you see as the future for telemedicine?

Nayyar: It's just going to be how we practice. Part of the workflow. Monday, Wednesday, Friday it’s telemedicine. Tuesday and Thursday it’s in the office. Babies must be born. Surgeries must be done. There’s a difference in feeling my patient’s joints rather than the patient telling me what their joints feel like. Telemedicine will be hybrid. And it will be different from physician to physician, patient to patient.

Marcus: Let's talk about interoperability. We started out talking about the provider needing a complete medical record. Where are we on interoperability as a whole?

Nayyar: We continue making progress, but ultimately, interoperability is not a tech issue. It's a competition issue. If we wanted everyone connected, we could do it in a heartbeat. But we have stakeholders competing and incentives that make them compete. Why would a hospital share information with another hospital? Why would a retailer share information with another retailer? As a patient, you don't want to do a procedure twice. You don't want to pay for it twice. Instead, you need to be the one who shares your information, your medical record. Ultimately, I think that’s where things will be solved. You can see it now with the patients and families that are organized, have their data together, and are using apps that allow for this.

Marcus: Let’s talk about the pandemic. You were on PBS, CNN and other TV programs during the pandemic, explaining what we needed to do to fight the virus and promoting the vaccine to keep Americans safe. Thank you for lending your voice to that fight. It’s a great example for how communications are so important. What was it like to share your views on vaccinations, masks and public health measures?

Nayyar: It was scary. The data was constantly changing. No professional wants to be wrong, so just staying abreast of all the information was a challenge itself. Making sure you were as up to date as possible in the moment. And there was a lot of confusion, so I had to make sure I chose my words carefully. Sometimes less is more. But you lost some friends. Things got very public. Neighbors, friends and family would voice their opinions and they were not necessarily in line with myself as a physician. I’ve always navigated that dynamic from the standpoint of the doctor-patient relationship, but never from neighbors who saw you on TV. Some said they didn’t like or appreciate what I said. On the flip side, many people came forward to thank me and to share their own stories. “We didn't know what to do and we heard you,” they said. It was a tough time, but many beautiful moments came out of it. Hopefully, we’re stronger for it. Again, my book "Dead Wrong" was inspired by that time. I feel passionate about it. Science needs a PR campaign. How did not knowing facts become cool? That’s what bothered me the most.

Marcus: What did you learn from the process?

Nayyar: Communication is everything. And in every profession and relationship, personal and professional, everything comes down to trust. The human factor. And—I learned this in medical school—is what you do when you make a mistake or don’t know the answer. Say I’m sorry or I don’t know. Being humble. One of the most beautiful things I saw on social media during the pandemic was when Matthew McConaughey hosted Dr. Fauci on his Instagram Live. And he said, “I don't know about COVID, I don't know about viruses, I don't understand them, but I know someone who does.” And, independent of whatever anyone's political views are, the point is that we do have trusted influencers.

Marcus: You’ve already achieved a lot in your career, such as former Chief Medical Officer at both AT&T and Salesforce. How would you sum up your career so far?

Nayyar: I have thrived at the intersection of business, medicine and technology, and that's where I plan to continue focusing. I also enjoy building solid health technology products. And being out in the market as a trusted thought leader. I hope my book takes that to another level so that I can drive more impact at scale in different healthcare organizations. With the book tour, I'll be living out of a suitcase for quite a bit this fall, but I'm so excited.

Marcus: Where do you get your inspiration?

Nayyar: Many different places. But inspiration for me really starts at home. Both my parents are physicians. They've inspired me my whole life. My book is dedicated to them. My parents are now in their late 70s and early 80s, and my dad still rounds at the hospital. He is a very proud, hardworking ICU physician, not because he has to, but because he loves to. He practiced throughout COVID. And my mom was way ahead of her generation, way ahead of her country. She was one of the only women in her medical school class in India. It’s interesting to look at my parents and then at my daughter, who’s 11, figuring out what she wants to be when she grows up. The everyday curiosity she has. I always ask myself how I can inspire her to reach her own potential in life.

Marcus: What excites you most about the future of healthcare?

Nayyar: It’s an exciting time to be in healthcare. We’ve lived through a pandemic. We have new technologies like artificial intelligence that are going to change the game. We’ve opened the floodgates on telemedicine. I think we're just getting started. And we’re changing. It’s slow—slower than anyone wants—but change is happening.

Marcus: Do you still find time to see patients as a doctor?

Nayyar: I do. My dad was so disappointed when I joined the phone company. He’s like, “What do you mean you’re not going to see patients?” I’m on the volunteer faculty at the University of Miami, and I see patients in our clinic in Little Haiti. And that was a tough time during COVID. We had to close and then reopen with telemedicine. It was very humbling. I also enjoy working with medical students. I love the University of Miami, my alma mater, and I see patients a couple times a month when I can.

Marcus: That’s a great way to keep your perspective. One more question: Where do you find the time?

Nayyar: I think that we always find the time for the things we love. We can’t do everything all at the same time. But you say this is the day, and you put it on the calendar and make it happen. But that means something else doesn’t happen that day, right? That’s how I've been doing it my whole life.

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Featured on this podcast

Geeta Nayyar, M.D.

Board Member, American Telemedicine Association

Dr. Geeta Nayyar is the former Chief Medical Officer at AT&T and later Salesforce, where she worked to curb misinformation at the intersection of healthcare and technology. She has been in similar C-level roles at a variety of healthcare organizations, including Greenway Health. Nayyar is a current board member of the American Telemedicine Association and an assistant clinical professor of medicine at Florida International University and George Washington University. She most recently joined the telehealth appointment booking platform Zocdoc as an advisor. A rheumatologist by training, Nayyar received her medical degree at the University of Miami School of Medicine and her MBA at the George Washington University School of Business. She is a nationally recognized leader in health IT. Her book "Dead Wrong" will be released in October 2023. 


Melanie Marcus

Chief Marketing & Customer Experience Officer, Surescripts

Marcus joined Surescripts in 2017, bringing with her more than 20 years of experience working at the intersection of marketing, technology and healthcare. Based in our Arlington, Virginia, office, she loves serving as “chief storyteller” and hosts Surescripts’ award-winning podcast, There’s A Better Way: Smart Talk on Healthcare and Technology, helping people understand how technology unites our fragmented healthcare system. Marcus is passionate about leading an organizational focus on “customer obsession” where we put customer value first as we work to increase patient safety, lower costs and ensure quality care. Marcus currently serves on the Board of Directors for The Sequoia Project and the Brem Foundation to Defeat Breast Cancer. She also serves as NCPDP Foundation's National Advisory Council (NAC) Chair for Role and Value of the Pharmacist.