Virtual healthcare allows us to enlist patients in their own treatment and rehabilitation. For example, even though patients are getting physical therapy, we can provide them with important recovery exercises they can do at home. In addition, we check on patients to determine if they are following post-surgery protocols and offer guidance with exercises on the computer screen.
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. Richard Berger of Rush University Medical Center orthopedic surgeon with a specialty in hip and knee replacement.
Richard Berger, M.D., is a world-renowned orthopedic surgeon at Midwest Orthopedics at Rush and assistant professor at Rush University Medical Center, Chicago. He pioneered a minimally invasive hip and knee replacement that allows for a quicker and less painful recovery than traditional joint replacement. He also was the first in the world to perform outpatient hip and knee replacement surgery and has done over 12,000 surgeries — more than any other surgeon. Patients come from all the world to have surgery from Dr. Berger, and they include elite athletes, politicians and celebrities.
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?
I got my start while pursuing a mechanical engineering degree at MIT. When I was a freshman, I began a research project to analyze human motion and how to make joint replacements perform like natural joints. This began my lifelong passion — helping people with arthritis get back their mobility and alleviate their pain. This led me to medical school, where I continued my research in joint replacements. After a residency and fellowship in joint replacement, I used my engineering degree to develop minimally invasive techniques to replace the hip or knee joints without cutting muscle, tissue or ligaments. Therefore, unlike traditional joint replacement surgery, my patients can recover and return to their lives quickly. Now, elite athletes and active people who want to continue to pursue their passions after joint replacements can do so with no limitations. In addition, my MIT engineering has helped me develop and design surgical instruments and implants used by orthopedic surgeons all over the world.
Can you share the most interesting story that happened to you since you began your career?
I am very fortunate to help over 1400 patients a year and have the pleasure of following patients after surgery and hearing their recovery stories. Many of these stories involve pursuing dreams and achieving goals that they thought were not possible with their arthritic joints.
A patient who comes to mind is a gentleman from Nashville who aspired to climb Mt. Everest. He was struggling with knee arthritis, and so he settled for a helicopter trip to Everest’s base camp. While hobbling around the base of Everest, another climber, a former patient of mine who was heading to the top, gave him what he called life changing advice. “It looks like you have a bum knee” he said. “Go see Dr. Richard Berger in Chicago. I did and now I am going to the top!”
After that, he came to me and I performed knee replacement, he went back to the Everest base camp. And this time without a helicopter — he hiked up with his new knee.
Again, I am very fortunate to be able to help change people’s lives for the better. From elite athletes across the country to schoolteachers around the corner, we give patients their lives back.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
That’s a great question. I am constantly professing this to the many students I teach.
It is: “Treat others like you would want to be treated if you were in their shoes.” That’s the philosophy of my team and our practice. Unfortunately, many medical practices have lost their ability to provide excellent customer service. Any surgery, including joint replacement, can be a difficult time for a patient — so we strive to make it a special experience. The patient in front of us has our undivided attention. We listen carefully to each patient and develop a treatment tailored to an individual’s condition and goals. Some call this a concierge approach: we call it “practicing good medicine and providing quality customer service.”
None of us can 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 father was a huge influence in my life. He taught me the value of hard work. Before he was a New York City police officer, he had a small company that made the Macy’s Department Store holiday windows, creating their animated mannequins for their well-known window displays. I spent many days in our basement watching him perfect the complicated motions and mechanics of each figure. This started my fascination with human motion. I now get pleasure helping people improve their lives by restoring their motion that was lost because of arthritis. He really left a lasting impression on my life — and I hoped that I’ve passed that along to the tens of thousands of patients I have been able to help.
Ok wonderful. Let’s now shift to the 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?
I have a large staff that takes great pride in comforting patients while reducing their fears and anxiety about surgery — which helps to alleviate their pain. Patients will initially talk by phone to one of our patient liaisons who explains the entire process. Then the patient will be greeted by that same teammate at their initial consultation. From delivering snacks, water bottles, information and kindness, we try to make patients feel special. We are there to hold their hand and guide them through the entire process. During the COVID-19 Lockdown, when we were not able to provide the “in-clinic personal touch,” — we learned ways to do it in a virtual manner.
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?
While we can’t do surgery virtually, we can provide excellent pre- and post-surgical care for patients whether in the office or on the computer. With that said, there are some obvious differences — but we have developed ways of accommodating patients virtually.
When I am in the same room as a patient, I use my hands to move the patient’s joint to determine how the patient is handicapped by their arthritis. I watch the patient walk down a hallway, and we look at their x-rays together. Many patients like to meet their doctors and look them in the eyes.
However, I can also watch patients walk on a computer screen. I can ask them to move their joint or enlist a family member to help with the exam.
Therefore, as part of our concierge approach to orthopedic surgery, we give our patients a choice of whether they want in-person or telehealth for their pre- and post-surgical consultations. And no matter what they choose, we will be there to support patients. Lockdown was a huge epiphany for me, because when I was forced to stay home, I realized that this was what it was like to live in a world of arthritis, where you can’t move like you want or do the things you love. Imagine how difficult it might be to get to the doctor’s office with severe arthritis. Virtual visits are making it easier for these patients — so they don’t have to prolong surgery.
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.)
In many cases, telehealth can provide more benefits for your patients than in-person visits. Every day my team and I discover new ways that virtual consultations are helping us to better care for our patients.
- First, we can see what’s going on in a patient’s life. This helps us better understand how their joint condition is hindering them. In clinic, patients often don’t disclose how difficult their living situation is. My staff and I use telehealth as a window to see how pain and immobility affects daily activities, such as making meals, washing clothes and cleaning their home. This helps with the diagnosis, and we can make suggestions for altering those activities before and after surgery.
- Second, we can gauge the home environment. We use telehealth to explore the patient’s surroundings. We can ask them for a house tour– assess where the stairs are and how difficult is it to get to the bathroom or navigate the living room. Telehealth gives us an opportunity to observe, and we can recommend ways to make their home safer and easier to navigate. Perhaps moving a piece of furniture or removing a throw rug could keep them from tripping after surgery.
- Next, we get to know the family better. With the advent of virtual healthcare visits, we have more time to spend with family members. We meet the patient’s children, grandchildren and even their pets. We can talk directly and candidly with family members about ways they can help with the recovery process.
- Also, we involve and educate family members and care givers. Thanks to telemedicine, family members from all over the world can now participate in the care of their loved ones. In addition, family members can now attend our virtual surgery prep classes to become better informed and provide better care. Recently we had a “Go to Meeting” with a patient from Mexico and his daughter from France. The family was together for this important meeting — something that was not possible in the past.
- Lastly, virtual healthcare allows us to enlist patients in their own treatment and rehabilitation. For example, even though patients are getting physical therapy, we can provide them with important recovery exercises they can do at home. In addition, we check on patients to determine if they are following post-surgery protocols and offer guidance with exercises on the computer screen.
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?
Telehealth appointments have allowed our team to provide undivided attention to patients without the distractions of a clinic setting. I treat patients from all over the world, and telehealth has opened a door for patients who are limited by travel restrictions, work and family obligations. It truly has become a social equalizer — allowing patients to see the best doctors to treat their condition.
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?
Our team has been using “Go to Meetings”, and it has been extremely effective for providing consultations for patients. We can observe them move and perform activities while assessing their joint conditions. It has also allowed us to enlist and educate family members to help as caregivers.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
It is great the way it is now. Do you remember the Jetsons cartoon? When they needed a doctor, the doctor would immediately appear on the video screen, give a diagnosis and treatment plan. We are doing that today with the current technology.
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?
Patients will get great care from us whether they are in the office or on a virtual visit. I want patients to know they can see us from anywhere in the world. If they are candidates for surgery and living with pain, they now have many options for treatment.
However, if you are not comfortable with the technology, my team is more than happy to help you navigate your way around the virtual appointment application process. But it is easy!
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?
While I am sure there will be some minor advancements in the future, the system we have in place today is fantastic.
Is there a part of this future vision that concerns you? Can you explain?
Humans are social creatures. We like to see smiling faces. Our staff is extremely compassionate, and we genuinely care for our patients. This may be easier to convey in person, so I hate to lose sight of that human contact in the future. However, we spend more time on the virtual visits, which means we thoroughly answer all questions and get to know them better. We don’t take shortcuts; we are dedicated to helping our patient throughout the entire process from arthritis to a new joint replacement.
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. 🙂
Perhaps the greatest reason for my success is my unconventional thinking. I don’t think outside the box — I don’t even see the box.
A great number of Baby Boomers will likely need a hip or knee replacement in the future. There will be a shortage of doctors to meet these increased demands. I have dedicated my career to not only helping patients but paying it forward by training residents to use my minimally invasive procedures, so they too can help patients take back their lives and return to sports and activities they love.
How can our readers further follow your work online?
On my practice website: www.outpatienthipandknee.com there is information about my minimally invasive procedure. It also features many testimonials from patients, including celebrities, elite athletes and the teacher or plumber next door.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.