Have their goals in mind: As a physician, you need to know what your patient wants out of their visit. For example, is it a college athlete who wants to return to their sport? Is it an active mom that wants to be able to play with her kids? Is it an elderly patient that just wants to be able to walk again? These goals play in tremendously with their possible treatment plans, and ultimately lead a physician to choose the one that’s right for them. In a virtual visit it is extremely important to ask the right questions, get to know the patient, and allow them to express themselves as if they were in-person.
One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. Benedict Nwachukwu.
Benedict Nwachukwu, MD MBA, is an orthopedic surgeon and specialist in hip, knee and shoulder surgery. Dr. Nwachukwu is also the Co-CEO of Best-In-Class MD (BICMD), an integrated telehealth platform built to provide consumers with immediate and direct access to leading orthopedic experts for personalized musculoskeletal advice. Dr. Nwachukwu is a surgeon at the Hospital for Special Surgery in Manhattan. He attended college at Columbia University and he obtained his MD and MBA from Harvard Medical School and Harvard Business School, respectively.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
Yes, of course. Thank you for having me. My name is Benedict Nwachukwu, I’m currently an orthopedic surgeon at the Hospital for Special Surgery (HSS). I was born in Nigeria, but immigrated to London with my mom when I was 6 years old. She was a nurse and was recruited to the UK from Nigeria. I developed a love for medicine and specifically orthopedic surgery through my own personal experiences. While I was in medical school, I ruptured my Achilles tendon and was introduced into the world of sports medicine, the life of a surgeon, and the importance of care planning in recovery. As a medical student, I shadowed and studied from some of the best surgeons in the country who inspired me to follow the path I am on today. While I was in medical school I received an MBA — my goal was ultimately to find ways to improve systems for healthcare delivery and access to top notch medical care. Fast forward ten years, I’m now an orthopedic surgeon taking care of sports injuries and I have also started a company with the goal of improving how musculoskeletal care is delivered. This past year I co-founded Best In Class MD with my personal experiences in mind — the idea that anyone and everyone should have access to the best medical minds.
Can you share the most interesting story that happened to you since you began your career?
The NBA Bubble has been one of the most interesting experiences that I have had as a doctor.
The NBA Bubble specifically was a unique place because it was purpose built to allow basketball to be played in the setting of a global pandemic. We had daily testing and contact tracing and at the time of the bubble it was perhaps the safest place in the world from a COVID perspective. For me taking care of the players was a 24/7 job and I loved it. In the morning, training staff could reach out to me about a player that they were concerned about. If there was sufficient concern I would perform an evaluation with the possibility for advanced imaging on site. My afternoons and evenings were spent in game coverage. At the start of the bubble 4 games were being played in a day and I was present for all of them. I was able to treat a variety of orthopedic injuries sustained during the games and I participated in collaborative care models that involved doctors both inside and outside of the bubble. It was an exciting time to leverage the possibilities of telemedicine. Team physicians who were not in the bubble used telemedicine to evaluate their players and co-manage remotely. It was a proving ground for telemedicine but at the highest level of athletic performance. The bubble was also a fascinating time in America given the ongoing social justice movement. As a black surgeon in America it was powerful to see the solidarity and resolve between players, coaches, staff and administration to speak out against social ills.
So many things transpired around that time that I truly believe being a physician in the NBA was a once in a lifetime experience and I was privileged to have been a participant.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
One of my favorite quotes is “Life is a zero-sum game.” For me this means that life’s commitments add up to zero. When you add something, something gets subtracted and when you subtract something there is an opportunity to add something. Life is all about striking a balance — both personally and professionally.
I have managed my life by being mindful of my commitments. I look for opportunities that are valuable and that I can devote my attention to. I like to see things to completion, and when they’re done, I take on more tasks. I am mindful of overextending myself knowing that when too much gets added something gets subtracted and quality of work/relationships can begin to suffer.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
My earliest inspiration was my mom. My mom is a nurse, and I grew up in London with her. I knew how hard it was for her to raise me, and do everything that she did as an immigrant. I just remember thinking, “Mom, your job probably sucks. You come home and you’re exhausted.” But she loved it — she loved her job. I remember patients would give her gifts and she’d bring them home. She’d be so excited to share these stories, and then I would think “Wow, that’s a really cool job.” I went to school in London with the children of well to do men and women but being surrounded by other kids my age in school, it didn’t seem like other parents loved their jobs as much as my mom did. I just wanted to do a job where I could have the same passion that I saw in my mom. When I went to college, I spent time shadowing doctors. I had the opportunity to shadow an orthopedic surgeon at HSS. His patients really appreciated him and his day didn’t seem like just work — seeing his patients back at their 6-month visit and helping them on their road to recovery was exciting. So, small world — I ended up working where I found my passion for orthopedics.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
Sure. Of course, in-person appointments have their benefits for specific situations. Integrated health appointments would be best for in-person appointments — those that we know will require lab work referrals to other departments or medical imaging.
Like I said before, getting medical imaging or labs done are more efficient in-person. Think of meeting a patient virtually and telling them they need blood work. Finding the time to go get their blood work instead of doing it quickly in the office can prolong a diagnosis, and it can be stressful for the patient.
On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?
A main concern is a potential for the degradation of the patient-doctor relationship and evaluating bedside manner. The ability for a provider to establish a personal connection with their patients has been shown to improve outcome, therefore providers have to work a little bit harder to establish a personal connection digitally.
Another challenge is the idea of privacy and attentiveness. In person, doctors devote their full attention to their patients in a confidential environment. Telehealth presents the opportunity for distractions, but doctors should still provide the same level of professionalism to their patients as they would in person.
These are some of the situations that can arise when a patient is not in the same space as the doctor. With expert physicians, we have seen that our patients still develop a personal connection and prefer to continue their telehealth experience.
Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)
- Have their goals in mind: As a physician, you need to know what your patient wants out of their visit. For example, is it a college athlete who wants to return to their sport? Is it an active mom that wants to be able to play with her kids? Is it an elderly patient that just wants to be able to walk again? These goals play in tremendously with their possible treatment plans, and ultimately lead a physician to choose the one that’s right for them. In a virtual visit it is extremely important to ask the right questions, get to know the patient, and allow them to express themselves as if they were in-person.
- Understand their lifestyle and the resources they have: Ask your patients about their life. What do they do on a daily basis? Are they active? Do they have a busy work schedule? Most importantly, do they have the resources they need to accurately pursue the selected treatment plan? BICMD recently had a client who was an active mother working from home but had 2 young kids. That played a big role into deciding which treatment would best suit her. Since she had the ability to work from home due to COVID-19, the MD recommended a treatment plan that allowed her to dedicate time to recovery while her husband helped with the kids. This treatment provided better longer-term results, but may not have been possible recommended to her if the provider was unaware of her work and childcare situation.
- Respect their privacy: In-person appointments take place in quiet and private rooms. However, telemedicine presents the opportunity to conduct visits from home. We must give their patients the same privacy that they would otherwise have with an office visit. As a physician, this means conducting the visit in a professional setting — in an office or room that is not shared with anyone else. A successful tele-visit requires the both parties be free from distractions and provides the same level of privacy as an in-person consultation.
- Know their comfort level: If a client is pending a surgery or major treatment, recognize that it is a big commitment that not everyone will be eager to pursue. Whether it’s a fear of surgery or the financial commitment that comes along with it, physicians should be aware of factors playing into a patient’s hesitation. The patient and doctor must work together to discuss all aspects of care planning and the patient must leave the encounter knowing that they were treated as an individual rather than a formula. The best care will come from the time we take to truly get to know our patients and what they’re comfortable doing.
- Be attentive: As a provider conducting a telehealth visit, it’s important to be just as attentive through a computer screen as you are in-person. Muting and turning off email, texts, and other online notifications that may pull at your attention is a must. This means less typing and more eye contact. Before a visit, check your set-up to ensure you have adequate bandwidth, your environment is inviting, your face is well lit, and the camera is positioned in a way so that it appears you are making eye-contact with the patient. It’s easy to get distracted, but patients deserve your undivided attention. If you’re taking notes and looking away from the screen, let them know.
Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
Absolutely. The benefits of telehealth, to me, are endless, but I’ll mention the most significant advantages. For starters, I have personally found telehealth to be an excellent opportunity for medical second opinions. This is what led me to create BICMD with Dr. Riley Williams. Our clients can log in, select the service they desire for their musculoskeletal condition and instantly be matched with an expert on our platform. Second opinions allow individuals to consult another doctor for treatment advice before proceeding with an expensive or life-altering procedure. It provides a peace of mind that in many ways is not possible without telehealth.
Another benefit is that telehealth offers an opportunity for more people to have access to care. Individuals in rural areas often don’t have access to doctors that they need. With BICMD, for example, our clients can have access to the best doctors in the nation for musculoskeletal second opinions. One international client scheduled a consultation with us, wanting a second opinion for a hip condition that greatly impacted their everyday life. This individual had received a previous diagnosis and recommended treatment, but wasn’t confident about the treatment plan. They wanted advice on which treatment to proceed with, and to know if there were any other possibilities, so they met with one of our experts to review medical imaging and determine which plan would best suit their case. From their international home, they were able to meet virtually with a U.S. doctor who was a Sports Medicine expert with tons of experience with the issue at hand. Telehealth has the ability to break down geographic care access barriers.
With traditional in-person appointments, patients often have to travel long distances and wait more than an hour in the office just for a 15-minute appointment. Everything can feel rushed and patients often leave an appointment wondering if the time they dedicated that day for their appointment was worth the output. Telehealth cuts travel costs and waiting time. Our virtual visits also tend to be longer, ranging from 20–40 minutes because both doctors and their patients have more time for a meaningful conversation about their health. Our software presents the doctor with the key questions the patient wants to discuss, provides the doctor with imaging and records directly on their smart device/laptop, and they don’t have to rush between exam rooms and onerous documentation. This provides huge benefits to both sides — clients can meet their doctor from the comfort of their own home on a laptop, tablet or mobile device. No need to pay for travel expenses, and no need to take time off work or arrange for child-care. Doctors can do the same. They can conduct a telehealth visit from their home in the afternoons or during the weekends. They can meet patients when patients are free and both parties are sure to find a time that works best for them. Overall, more quality time can be spent with each patient.
Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
Web-cam is the biggest one. I can meet with my patients face-to-face, and their facial expressions say a lot. Especially with COVID-19, the opportunity to talk to my clients without a mask on makes the interaction more personable. Screen sharing has also been a huge game changer in the orthopedic world. One of the best parts about BICMD is the ability for our clients to upload their X-rays, MRI’s or CT scans securely. Experts on our platform can review them and even share their screen during the virtual consultation, explaining their imaging and pinpointing the problem area.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
Haha, I think I already did! I’ve mentioned BICMD a couple times, and I truly think it’s the perfect system to help my patients. Like I mentioned before, I ruptured my Achilles in medical school. I was lucky enough to have insider access to a true expert for my surgery, and that played a huge role in the creation of BICMD. First of all, I wanted BICMD clients to have this insider access to the best of the best when it came to orthopedic specialists. Second, I wanted them to be educated on their treatment options so they could be confident in the treatment plan they chose. I look back at my injury now and ask myself, “Did I really need surgery?” I had no intention of continuing my basketball career, so I probably could have recovered just as well with a non-operative treatment. However, I did not seek to be truly educated on my condition and treatment option. Every case is so unique — yes, I might see 10 of the same conditions in a given week, but each individual has a different goal, and their treatment options may differ accordingly.
BICMD provides those two very important factors — insider access and personalized musculoskeletal advice. This platform has several other resources that help our clients tremendously. Not only are they getting access to the best of the best, but they’re also getting access fast. With BICMD, our clients can book a consultation almost immediately. BICMD offers 3 services for clients to choose from — a Medical Record Review in which the client uploads their medical records to BICMD and receives a written report within 72 hours from an expert, an On Demand Consultation in which a client and expert conduct a videoconference where medical records are not required, and a Comprehensive Consultation which is a scheduled videoconference and medical record review. Clients have the opportunity to ask their expert questions regardless of whether or not they meet virtually. They also have the option of narrowing down their search of experts to the specific specialty needed, the expert’s geographical proximity, reputation and availability. By choosing the importance of these factors, BICMD takes out the guess-work. Clients are matched to three doctors and are provided with a comprehensive biography of the expert. Once a consultation is booked and medical records are reviewed, clients are provided with a written summary discussing the expert’s advice for the musculoskeletal condition at hand. In my somewhat biased opinion this is a gamechanger for how people access musculoskeletal specialists.
Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?
Oh, definitely. In terms of preparation for the virtual visit, patients can ensure that they have good WiFi, and that they’re able to be seen and heard properly. Most telehealth platforms have features to test camera and audio prior to the visit, so I would suggest taking the time to test it before the visit. The last thing we want is to encounter any technological issues during a virtual consultation that prevents clients from taking full advantage of their time with a doctor. I’d also tell clients to come prepared. Sometimes, they come with a list of questions. This helps them get the most out of their appointment by receiving an answer to each question they have. In the orthopedic world, I like to ask my patients what their goal is. If they are experiencing a musculoskeletal condition, what do they want out of their visit with me? If I can get them back to doing what they love to do, I will! If they have a clear goal in mind, they will get the best results.
The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?
Yeah, I would say that as an orthopedic surgeon I am most excited about a digital approach to healthcare. With app-based technologies for musculoskeletal health, there is an opportunity to better connect consumers to experts in ways that have not been done before, including telemedicine digital coaching and remote monitoring innovations.
Is there a part of this future vision that concerns you? Can you explain?
Sure, there is obviously a concern about the pendulum swinging too far in one direction than the other. As a physician, you don’t want to lose the in-person touch and warm doctor-to-patient element. While digital approaches have many conveniences, I wouldn’t want to leave the face-to-face component behind.
Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I’d inspire a movement where musculoskeletal health benefits are a mandatory employee health benefit. 1 in 2 American workers have a musculoskeletal condition, and the burden of these conditions is comparable to the burden of diabetes, hypertension, and cardiovascular disease. Orthopedic conditions in the manual workforce environment are often ignored, and workers with MSK problems are definitely a population that suffers in relative silence.
How can our readers further follow your work online?
I publish a lot of my work on my company’s website www.bicmd.com. Through our BICMD resources (@bicmdortho for twitter and @bicmdvirtual for instagram) we also publish content from other thought leaders and experts in the orthopedic space. Readers also can visit my website, www.manhattansportsdoc.com, or follow me on Instagram at ben_nwachukwu and Twitter at BenNwachukwuMD. I am very research-oriented and share a lot of findings on my social media accounts.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.