The New “Disrupters” in Healthcare – Patients and Pharmacists | Rajiv Shah | TEDxFargo

you disruption when I say that word what does it make you think about disruption defined is a disturbance or problems that interrupt an event activity or process by its definition it says the word problem but today disruption is a completely different meaning when we think of disruption most people these days we don't think of problems we think of solutions and when we think of disruption we think of technology and how it's completely changing our lives and industries around the world when's the last time you stood at a corner to hail a taxi or went to a store to buy a music CD and how many of you have always wanted to be a hotel yo uber Spotify and Airbnb have completely changed their industries and they've changed the way all of us interact they've done it by putting the power in the hands of the people with a smartphone a tablet or a laptop technology has changed all of our lives and it's only going to change even more as we move forward but as you look up on the screen and see these other companies the one industry that you don't necessarily think of is healthcare but technology is changing healthcare just on the side that we don't see because it's really focused on the efficiency of the system not so much on the patient yet but that's going to change and that change is because patients are going to say I want something that's going to help me what I would like to talk about today and I challenge you to think about disruption in healthcare not just from a technology point of view but from a people point of view patients and pharmacists are the new disruptors in healthcare and let me tell you why we'll start with patients many of you've seen Norman Rockwell paintings of the doctor making house calls has got his black bag his stethoscope he's coming to you at your home you're sick but over the last few decades we've gone from this really personal type of health care to one that's impersonal it's focused on the system you the sick person have to come to me the doctor something a little wrong with that but now put yourself and think about the last time you were sick you feel terrible you want to get seen so you pick up the phone you call the doctor's office you cross your fingers because you hope that the doctors in and you can actually get seen that day you get an appointment you drive to the doctor's office and then you wait and you wait and you wait eventually the doctor comes in to see you talks to you for a few minutes if you're sick enough he might give you a prescription and then you'll go to the pharmacy and wait some more that whole process could take three hours of your day when you feel terrible from a patient perspective that's suboptimal now what's happening in healthcare with transformation with technology is we are bringing healthcare back to the home think about the next time you're sick you can get out of bed or just roll over you turn on your computer you log on to doctor and demand or zip gnosis you answer a few questions and guess what the doctor shows up on your screen the doctor has come to you technology is made the 360 degree transformation of personal to impersonal back to personal again the patient has to be at the center when we think about what's happening in the future with transformation with technology the patient is going to drive this because for the first time in history patients are partners that the doctor knows best way of thinking is gone patients are saying this is my life it's my health it's my business give me the tools I need to get engaged in my kit in my care and they're going to start transforming things like we've never seen before I have a patient named Sarah she came to me because she had uncontrolled diabetes and her kidneys were starting to fail I asked her you know why are your Sugar's so bad and she said I have all these medicines and I don't know which is which I don't know what to do with them some of them make me feel bad but I don't know which one so I just don't take him when I met her she was getting hospitalized four times a year she was a mess quite frankly I asked her have you talked anyone about that she said you know my doctors got 15 minutes with me and ten minutes of that time is sucked up with administrative stuff so there's not enough time to talk to my doctor about the stuff that I want to get across the current team of healthcare the doctor the patient and the nurse who helps us is not adequate it doesn't give patients the options they need to get the care they need to get better so think about the dream team and this is what's happening now and it's going to go all across medicine in my world of kidneys this is what we use because kidney disease patients are complex we have the patient in the middle we have the primary doctor in the specialist we have our nurses and pas but what we've added to this is the health coach either from the insurer or the companies that you work for your family caregiver either you're taking care of someone or someone's taking care of you technology is weaving this all together and the person that most people don't recognize as a member of this team is the pharmacist the pharmacist is the forgotten member of the healthcare team and that's really too bad because if you think about Sarah and her example her issue was medicines who knows more about medicines than a pharmacist I call pharmacists the doctor on the bench and why because they're doctors most people have no idea that pharmacists are doctors but for the last 20 years everyone that's graduated from pharmacy school graduates with a doctorate and pharmacy and with that comes knowledge experience and expertise that I don't have and never will have the doctor on the bench has to get in the game and how are we going to do that because they are the ones who can help our patients because we can't do it ourselves if you think about Sarah what we did for her is we set her up with a pharmacist to do something called medication therapy management where she spent an hour with a doctor with a pharmacist who went over every single medicine how they interact with each other what she might feel like and told her and educated her about this I can't do that but most importantly she got better this problem Sarah's problem not taking her medicines is called medication non-adherence it's considered the biggest fixable problem in healthcare today it's a 300 billion with a B billion dollar problem in this country that's 10% of our total healthcare spent so when you think about who does this affect it affects all of us we talk right now about the cost of healthcare it affects insurers it affects employers it affects you because it's your pocketbook your copay that's being affected by this and utes more importantly affects your health this problem exists for one reason over the last 25 years health care has changed people are so into the power of the pill that every time you go somewhere to the doctor or whatever everyone wants a pill give us more medicine and the drug companies are happy to do that because they're making a ton of money and in many of the cases pills are the right answer but it's an interesting statistic but in 1989 there are 300 million people in this country now there's 350 million in 1989 there was 700 million prescriptions written last year over four billion that's six times as many and why because chronic disease plays a role think of Sarah she's not taking one or two tablets she's taking five or six or seven multiple times a day because she needs to suppose take these meds to get better when I think about how we're going to transform healthcare and what we're going to do we're going to do it as a team and it's this new team that isn't just me when I think of myself and my colleagues as doctors we've been trained that we are the answer to everyone's medical problem we're the solution as much as we want to be we can't be because in today's health care world where we have too many limitations our capacity isn't there what I'm trying to do and what I want to do and I think the future of medicine is going to do is bring that doctor off the bench into the game and instead of playing a support role they're going to be highly a starring role on that patients team to help them get better there are 300,000 pharmacists in this country who are waiting to get into the game and we need to let them so when it I think back to Sarah the last time I saw her she when she came to me her a1c which is a marker of diabetic control was terrible 12% when I saw her last time seven percent which is normal her kidney function had stabilized she looked awesome and the coolest thing she hadn't been in the hospital for 18 months it wasn't dr. Shah who saved her and got her better it was dr. Smith her pharmacist so with technology and the future of technology being driven by patients and pharmacists joining our team in a way like never before these are the new healthcare disruptors thank you you


  1. They have already disrupted healthcare in africa by running down the costs of medicines and encouraging self medication, antibiotic misuse etc

  2. Thank you!

  3. Completely unrelated but the intro music is so cool. Anyone know what it is?

  4. Best Presentation Ever.

  5. About the last thing we need in our badly broken healthcare system is more Rx. We are in an epidemic of overtreatment which is one of the root causes behind our exploding healthcare costs. These drugs alone are NOT the answer.
    The best proven form of medicine (for our chronic illness explosion) is lifestyle.
    The most helpful part of the equation that Dr Shah promotes is the 'health coach.' If you have never tried using one yourself, do yourself a favor.

  6. Health 3.0

  7. Dog of Rockfeller family and gipsy Clinton. Lol

    But lemmings dont care. =))

  8. Boy and how. 2018 is the definite kill the Chronic Pain Patient year. with the Pharmacists pulling the trigger of the CDC loaded Gun… WELL DONE, The HUGE UP SWING IN SUICIDE due to pain is DEFIANTLY driving up the Death Businesses. BUT! here are THE BUT!

  9. Yay! More synthetic chemicals and pharma in our lives! Yay! Team Work! Wohooo!

  10. Interesting, but where is the push for functional athletic fitness and nutritional strategy. I feel that without those components, obesity/diabetes will continue to prevail.

  11. boring!

  12. I am glad that some MDs think this way. Unfortunately, we have yet to have a profitable model for the corporations to make pharmacists more relevant so they can deliver both better clinical patient care with their trainings and better financial bottom line for those corporations. I graduated from pharmacy school almost 2 decades ago and have been practising. When my older brother went to Tufts Medical School and subsequently did his cardiology fellowship in Scripps Green, San Diego, CA, he said one thing to me. He said "You [as a pharmacist] are not important. No one dies when you are not around. People die when I am not around." That was about 9 years ago. He was very well liked by his patients and colleagues. Assuming he is not an odd ball whose mental and social perception lie outside 3 standard deviations from the middle of the bell curve in the medical student community, his perception as a provider of pharmacist is likely shared by many providers of even the younger generations. As optimistic and hopeful as Dr. Shah's talking points , it will take long time for this kind of pointed professional discrimination and denigration to be, at least, mostly, eradicated. Today, a lot, though not all, physicians and medical students have been conditioned to believe they are the top end of the intellectual ladder in medicine and everyone else are below them. In some ways, I have to acknowledge that is true if we compare GPA…etc. etc. But, we know that certainly does not represent the entire equation that represent patient health outcomes, if we are to quantify them….. well, food for thoughts for the readers. Shah is right about one thing. Pharmacist is the "forgotten member of the healthcare team." They are rarely acknowledged in the media.

  13. PHARMACISTS ARE THE VICTIMS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  14. Violation of HIPPA with Sarah/ Sara.

  15. Funding is a major issue. Who is funding the hour with a Pharmacist?

  16. Thank you for sharing your experience.

  17. this is what , Pharm.D can play an important role in health care sector………….and improve the system!!!!!!!

  18. I am a doctor for the past 36 years. When I entered the medical school, patients said "Doctor, you know best" and doctors tried to give them their best. When I was a young physician, a GP, patients had started telling GP's "It's my life & my body and I know my body. You just deliver what I want and everything is going to be fine". And most of the time what the people sought from the 'healer' was self-destruction !!!! But when faced with a specialist, they reverted back to the old kind of doctor patient relationship: "you know the best……". So, I worked hard and became a specialist in Internal Medicine. At some point down the line, "empowered" by the internet, patients began to seek 'self-destruction" from even the specialists. If a GP or a specialist was honest to his professional ethics and refused to yield, they had the option of finding someone else. But they reverted back to the good old paradigm "doctor, you know the best" when faced with surgeons and those physicians who performed invasive procedures. Such physicians are called 'super specialists' in Europe and 'sub specialists' in North America, e.g. all kinds of "….ists" like Cardiologist, Gastroenterologist etc etc. So I had to rejig my professional life all over oncr again to become a Cardiologist. But please be informed: I could have done a lot more for my patients as a GP and I WANTED to be a GP…… alas, destiny willed otherwise. BTW, there is no GP today: even a family physician is called "Specialist in Family Medicine". How much more "disruption" this speaker wants to bring about, only future will tell but I am ready to adapt even at this age. So do millions of my colleagues world over…… quietly & silently.

  19. The doctor used to comer to my house and saved my life as a child. My question: are you working for Dr. Phil? this is a completely wrong idea. I want a hands on doctor period. Not a computer doctor. Then I go get my meds from my much loved pharmacist that I have known for years. My husband was and is a hands on physician he was available all the time. His patient was the center of his life.
    What we need is the administrators out of the way and insurance companies.

  20. We need less disruptions in medical care.  I agree with Dr. Shah that it is the patient's life.  The key to healthcare is that the patient should have the right to make every decision, including decisions the healthcare providers disagree with, and the providers should nevertheless facilitate the patient's wishes.  For some, using a pharmacist for medical advice may seem to be a good idea.  But is the pharmacist doing this for free?  Personally, I want the pharmacist to fill my prescriptions, accurately, and nothing more.  I view the pharmacist as a random person, hired by the local pharmacy, who happens to be on duty when I need a prescription filled.  I don't downplay the pharmacist's knowledge and skill, but he is not my chosen doctor.  The pharmacist does not know me, my medical history, or my needs.  I don't want some pharmacist telling me what I can or cannot have.  A more enlightened view recognizes that allowing the pharmacist to disrupt the medication prescribed by the doctor unnecessarily interferes with the doctor-patient relationship.  If the patient wants the pharmacist's help, I say yes to that.  But I do not want the pharmacist forced on me.  It is easier to dump a doctor than a pharmacist (and thus a pharmacy chain), particularly in these days of highly managed care.  I prefer to let pharmacists do what they do, fill prescriptions, and let me worry about my medications and dosing with my doctor.

  21. Maybe we shouldn't rely so much on medication ?

  22. In their current role, the Doctor of Pharmacy (PharmD.) professional is the most over-educated but under-utilized healthcare provider. They are the medication experts and know so much!!! They need to be included more in the Interprofessional/Interdisciplinary Team. They already have the education, we just need to expand their role. The patient would benefit the most.

  23. Excellent, this is the way forward for the patient to be educated and need to add a Nutritionist and a Dietician to advice on preventive care through eating right.

  24. Thank you!

  25. Although the emphasys on "Pharmacists as new disrupters of health care" is positive, it is dangerous to advance all these informal powers to untrainned non-MD as Pharmacists are, without expecting them to be responsible for the commitment it implies. Talking something different just because of that is sad and potentially dangerous. This is healthcare.

  26. Technology is definitely a factor that has impacted our society and changed the way many careers are handled, the medical and healthcare field being one. I thought speaker Shah pointed out something that isn't pointed out very often as that in the past doctors went to the patients, and in today's world, sick patients are expected to go to them while possible waiting for hours just to see them for a few minutes, and maybe not even enough time to discuss everything they had intended too. Since technology is a huge factor, why not let it be driven by the patients instead of the medical staff as that I agree the patient is the most important part in any patient to medical staff relationship. Even though the doctor is very important as to give the patient a diagnosis, I agree that pharmacists are just as important as that the prescription given is what is expected to help the patient, and since the pharmacist has a great amount of knowledge about medication, they can help. Incorporating them into the team as to assist to the patient's needs, I feel that getting the patient where they want to be faster, is achievable. DR. Shah makes the statement at the end that "by the future of technology being driven by our patients and pharmacists joining our team, these are the new healthcare disrupters" which sums up most of his talk as that these disrupters are problems that need to be addressed.

  27. There are many disruptions and holes in healthcare and a lot of them have to do with the doctor and patient relationship. Many of the times there happens to be  a miscommunication between the doctor and patient. This miscommunication can cause a lot of problems for the patient. These problems can cost the patient valuable time and money.    Although this problem can be fixed with a better patient to doctor communication system. This communication system can help save time for both the doctor and the patient. Many patients either are confused with medical terms or are completely unknowing of what the situation. If we can improve how we inform patients on their medical condition and medication, we can help include all parts of the medical system and fix the problem in communication. In the case of Rajiv Shaw, he uses the example of the lady with uncontrolled diabetes and kidney failure. The patient did not know how to properly take her medication so she just simply did not take it.    Since she was not taking her medication at all it was making her diabetes and kidney failure worse. So she went and talked to her doctor and he finally told her to talk to her pharmacists. He told her this so the pharmacist could explain how the medication worked and when to take it. After the patient proceeded with the doctors orders, her health had significantly increased since the last time he had seen the patient. Her diabetes had went from twelve percent to seven percent (seven percent being the normal percent according to Dr. Shaw). This simple fix in communication can save the patient time, money, and even their life. So we need to configure a system for a patient to follow so they can get the best possible treatment. But how will the system work? Do we need to include the insurance companies so they cover the multiple doctors the patient has to visit? Do we include the pharmacists immediately if the patient needs a specific medication and needs help to gain the capacity to use the medication correctly? These are all questions we need to ask and figure out a system for patients and doctors to help make the whole process much more simple on both ends of the deal.

  28. bla bla bla talk never gets anything done , only blood  and fighters get things done

  29. Technology has defiantly changed our lives. I agree with Dr. Shah that there is something wrong with the sick people going to see the doctor instead of the doctor going to see the sick person. I think it would be a good idea to bring the doctor to the screen. Instead of having a sick person get up and go to the doctors to wait a few hours, they can just get on their phone or laptop to see the doctor. Like Dr. Shah said, this brings healthcare back to being personal. I think technology could improve our healthcare system if it does work. There doesn't seem to be enough time with their doctors. Usually you only talk to your doctor for fifteen to twenty minutes. There needs to be more time to talk to them and really explain your symptoms. Technology could really improve this by giving patients that time to talk. Pharmacists could help in a way they haven't before and really change healthcare.

  30. I love hearing that "Bringing Healthcare Back to the Home"

  31. Technology is a very huge component of disrupting our society as a whole. It has leaked into disrupting health care, and it will continue to as time progresses. Dr. Shah made a good point in mentioning that when we are ill, WE have to be the ones to go visit the doctor, even feeling as terrible as we may. And once you are at the doctor's office, the wait time is usually long for a 2-minute conversation, which then sends you to another destination to wait; such as the pharmacy. I agree that technology is making healthcare more personal, and patient-centered, but it is not the only thing disrupting healthcare. You can digitally see a doctor from your own home, putting the power in the patient's hands. Personally I still prefer a face-to-face interaction versus online. I think that Dr. Shah really brought to light that Pharmacists are the forgotten doctors of today, and branching together the patient-pharmacist relationship would solve a lot of disruption. The majority of most patients issues deal with their medicines, and pharmacists are the only ones that can shed some light on those issues. Medicine seems to be the solution to every health issue nowadays, and Dr. Shah is spot on when he touches on the fact that we need to bring Pharmacists more in to focus, and utilize them and all their knowledge fully.

  32. he appears a bit nervous. great talk nevertheless.

  33. Having already known that there were distinct parts, or professions, of the healthcare system, I thank Dr. Shah for pointing out the need to view each profession, and see how they help one another. To an outside view, the interaction we have with pharmacists alone makes it seem like the easiest part; I have to go to the pharmacy and pick up the prescription from them. However, Dr. Shah points out that pharmacists are the ones that know the most about medications, and they fill your containers with the appropriate medicine. Going into a health
    profession myself, I think it is important for all aspiring students going into the healthcare field to know how we influence and interact with each other. I would recommend this lecture to any professor that wants to make sure their students understand the importance that each profession has in benefitting the patient. That is how beneficence is found in Dr. Shah's lecture, by making sure that the listener knows how each healthcare professional's action help benefit the health of their patient.

  34. This talk definitely sparked a dormant flame in me! The topic is right in line with my past efforts as a pharmacist where 5-6 years ago, I saw the need to get out there and promote the value of the pharmacist on the health care team. This was because in the course of my practice as a consultant pharmacist, I had encountered too many avoidable gaps in our health care system that I felt a pharmacist could contribute to help solve in the community – medication illiteracy and non-adherence. I left my job to pursue my goal to educate and empower patients to take control of their health care especially as related to medications. Medication Therapy Management (MTM) was the cornerstone of my unique and innovative business model based on this $300B problem pointed out by Dr. Shah. Being so passionate about this cause, I tried marketing to a variety of targeted health care providers who cared for patients on multiple or complex medication regimens – including hospitals, physician offices, home health agencies, etc. My service offerings were well received but due to a lack of financial sustainability, I had to give up my dream. To this day, the mixed feelings of passion and frustration remain, and I still feel the need is greater than ever for health care systems, managed care companies, health care providers and all involved in the chronic care arena to recognize, fully embrace and utilize the clinical skills that the pharmacist brings to the health care table. The pharmacist possesses a wealth of knowledge on medications as well as the ability to strategically ask the right questions at the right time to the patient served. This is part of the reason why we are one of the most trusted health care professionals by patients. Good talk!

  35. Although I think that the basis of this idea is a good one, I believe that it still has too many kinks to function properly the way people will want it to. The true fact of the matter is that going to a doctor online will not decrease the overall wait time. There will still be large amounts of backlogging involved in the process of seeking medical advice. The real issue, or main disruptor, I see in the healthcare field is lack of education to the patients.
    This is especially true in "Sarah's" case. She wasn't sick because she hadn't been to the doctor, she wasn't sick because it took too long in the waiting room to finally be seen, she was sick because she didn't fully understand the medicine that had been prescribed to her-which is incredibly dangerous. Many medicines don't interact well with each other and can cause adverse effects. Labels on medicine bottles aren't thorough enough to really fully understand their function and direction, with many of them only stating proper dosage, time, and route. As the video stated the few minutes with a doctor a patient gets isn't enough, they need more time and direction-whether that be oral or written.
    I think it is an excellent idea to include the pharmacist into the equation for proper patient care. When you go to pick up a prescription, most of the time all you do is give them your name and then pay for the drug. End of transaction. There is no direction given to the patient from the pharmacist whatsoever and that needs to change. Pharmacists have been on the bench for far too long, it's time to get up and pitch. It's time to truly care for your patients instead of tossing the drugs at them and telling them to have a nice day.

  36. 22/2/55 – it takes 22 days on average to make an appt to see your doc – average wait time from check-in to see your doc is 2 hours – accuracy of diagnosis 55% on average. all of this to the AMA's own admission per Eric Topol. The healthcare system we live in is broken. Bring on new players. Bring on technology. Enable the patient. Great video – keep em coming!

  37. @3:25 go to the pharmacist and wait some more. @9:45 bring the doctor off the bench
    (pharmacist) and have them play a bigger role in patient's healthcare. @10:45 Have the pharmacist spend more time with the patient…… anyone see the flaw in logic here?

  38. Great presentation. A very inspiring outlook on a further integrated healthcare system.

  39. I currently get to do this work at the VA in primary care. We do not even have a pharmacy, so I get to talk with patients and help them reach their A1C, BP goals, etc. We need more of this going on!!

  40. Thanks for helping us get off the bench ! at least in other people eyes.

  41. I am finishing my 4th year of pharmacy school and have been fortunate to work alongside medical students and MDs. It has been an eye opener on how much a pharmacist can play a part in the health of patients. In my experience, the medical students and residents were quite surprised at what a pharmacist/pharmacy student can bring to the team. I also realized that the doctors are a huge component of this team and when all the disciplines work together it yielded great results in the health of the patients. Thanks for the topic Dr. Shah!

  42. Thank you Dr. Shah for recognizing pharmacist as a part of health care team.

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