About IBD Episode 174 - How Tech is Changing Gastroenterology Featuring Neil D. Parikh, MD

How Tech is Changing Gastroenterology, Featuring Neil D. Parikh, MD

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About IBD Episode 174

Amber and gastroenterologist Dr Neil Parikh discuss technology’s impact on IBD management. Dr Parikh emphasizes the importance of patient diaries and open communication between patients and providers. They also address concerns about data privacy, integrating holistic approaches in patient care, and the potential of wearable technology in gastroenterology.

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Transcript

[Music: IBD Dance Party]

Amber Tresca 0:05
I’m Amber Tresca, and this is About IBD. I’m a medical writer and patient educator who lives with a J pouch due to ulcerative colitis. It’s my mission to educate people living with Crohn’s disease or ulcerative colitis about their disease and to bring awareness to the patient journey.

Welcome to Episode 174

By now, you’ve probably heard of artificial intelligence and how it might affect medicine in the coming decades, but that’s not the only new technology on the horizon for managing IBD and other chronic conditions.

My guest is Dr Neil Parikh. Dr Parikh is a gastroenterologist, but he has some other notable roles, including Chief Innovation Officer at Connecticut GI and podcast host at The Gut Doctor. He tells us about some of the ideas for how tech might be used in gastroenterology, including smart toilets and remote patient monitoring. He also shares his approach to patient care, which includes banishing the laptop from the exam room, offering some vetted resources and encouraging patients to keep good symptom diaries.

For his colleagues, he has some advice on how to better connect with patients, which could lead to improved outcomes. Plus, I asked him about one of my major concerns with artificial intelligence and other tech that used in patient care, which is data privacy.

Dr Parikh, welcome to About IBD.

Neil D. Parikh, MD 1:28
Thank you. Thank you so much for having me.

Amber Tresca 1:29
It was my pleasure. So I want to first get an introduction so our listeners can get a picture of who you are. Would you introduce yourself briefly?

Neil D. Parikh, MD 1:39
Sure. Well, Amber, I’m a third grade basketball coach and also crows first grade soccer….I had to start that way.

Amber Tresca 1:52
Well, I already have questions. So, you know…

Neil D. Parikh, MD 1:55
I’m a slightly better gastroenterologist than a third grade basketball coach. So yeah, my medical trajectory, I’ve been practicing for about 11 years now. I finished my medical training in Mount Sinai in New York, and then my fellowship at Yale for GI. I’m currently Assistant Clinical Professor at UConn, and also a fellow podcaster like you.

Amber Tresca 2:22
Yes, and your show is called The Gut Doctor, aptly named. So I want to talk about that. Let’s hear about why you got started in podcasting. What was the niche you were looking to fill?

Neil D. Parikh, MD 2:36
So I loved listening to podcasts, and I was in charge of education for the whole group, and we are about 90 doctors, 60 advanced practice providers here in Connecticut, and then COVID happened. So Grand Rounds, noon conferences, journal clubs, all became more challenging, and I thought podcasts would be a good forum to educate.

Amber Tresca 3:00
Did you have any background in audio or anything like that? Did you do college radio or anything like that?

Neil D. Parikh, MD 3:06
No, I think I’ve been on one NPR commercial for our group. I like to talk, though, if you can’t tel.l

Amber Tresca 3:15
Well, I am glad that you do, because I enjoy your show very much, obviously. And I’m not just saying that because I was a guest not too long ago. All right, you, you do have a lot of different titles, aside from basketball coach, but one of them is Chief Innovation Officer. And this one really, really intrigues me because, well, first off, I don’t really know what it is, so if you care to give a little bit of an explanation, and then I’m also interested, though, like, what kind of advancements, what kind of innovations are we seeing in digestive health?

Neil D. Parikh, MD 3:52
So yeah, I’m chair of innovation for the GI Alliance, and the Chief Innovation Officer for Connecticut Gi, which is our local practice. Innovation is a great buzzword, right? It gives us the opportunity to really identify what we need to do to provide better patient care. So I lead a team of seven gastroenterologists across the country, where we get together every quarter to talk about what we think will provide better, high quality, cost, effective patient care.

In terms of advancements, I would say innovation is driven by pain points, right? What is requiring us to change? And I think in GI healthcare in general, it’s access, cost and patient satisfaction. So along those lines, we are trying to find avenues to improve whether that’s non invasive diagnostic technologies using electronic medical records to enhance the patient physician or patient provider interaction, as well as using virtual AI. Scribes to reduce the extra burden on your medical provider so they can focus on providing better care for you.

Amber Tresca 5:07
It’s so interesting because I’ve had physicians that had a person who was a scribe, and sometimes having another person in the room that’s not your care provider is a little tricky, but I always loved it because that meant that I could have eye contact with my physician or my provider, and this other person was responsible for recording everything. And I really love that. And now I am seeing I have a couple of physicians now that are talking into whatever they have, whatever device they have, and it is, it is transcribing it for them. But that’s not new, right? That’s, that’s not a that’s not a novel. Thing is it just, is it better now? Does the AI help?

Neil D. Parikh, MD 5:51
So you’re absolutely right, having a scribe in an office consultation is not new. A lot of specialties, especially the surgical specialties have using it for many years, I think, for someone like me who doesn’t bring a laptop into the office room, what it allows me to do is I tell the patient, hey, my phone is here. The phone is going to listen to our conversation, and the phone is then going to document our conversation, so then I can just focus on you and our assessment plan afterwards.

Amber Tresca 6:21
And that, like completely and absolutely, segues into my next question, because I want to talk for a minute about data privacy, and I think it’s something that we’re we were all aware of in one way or another. But then recently, we’ve had the bankruptcy of 23andme and so that has actually brought up a lot of questions in the IBD community, and a lot of people are asking me specifically because they did a push many years ago where they were providing the test to IBD patients for free. So I and many others took that test for free, not really thinking about the privacy aspects of it.

And then, of course, I encouraged, you know, a male family member to take it so that we could have, you know, kind of a more robust understanding of our genetics. I am going to go in and delete my data, but I want to talk to you and get your insights about either on 23andme or just broadly in general, like how we can think about data protection for patients.

Neil D. Parikh, MD 7:25
So a few years ago, our practice offered genetic testing. We were using patient saliva, and we were just start to build it up. And then again, COVID happened, and we didn’t have the infrastructure in place. Our number one concern at that time was patient data and patient safety, because with genetic data, you always risk compromising the patient’s information if it goes in the wrong hands. You know, we were worried about disability insurance, life insurance, other payers. So I get it.

This is challenging. I know, as a medical office practice, we always are big on patient data. Phi, we take multiple courses every year to train our staff to make sure there’s no pH, I leaks, I will say, from a 23andme standpoint, I’ve never used that. I don’t know their specifics, but I do know they had a very robust emphasis on protecting patient data, especially genetic data.

That being said, I think that about 15 million people’s genetic information. So what to do now? First step I would advise, your listeners, your patients, those with IBD, is go to 23andme the website and see what provisions they are recommending. If that still doesn’t provide you with comfort, you can certainly delete your account. And I believe by delete your account, it should delete any trace of your genetic data as well. And lastly, someone was telling me, there’s a way to opt out from consenting to future investigation with your genetic data without your explicit permission every time.

So I think the concern now is that, as they go bankrupt, whoever in the future owns the company would directly, then own this data, and we would have to hope they’d have the same safeguards in place, right?

Amber Tresca 9:24
I guess too, I worry about malfeasance, and I worry about things like, you know, data breaches, and somebody breaking in, I think, and taking the data, and then, you know, I don’t even know what the end result would be of having all these people’s genetic data, but it does concern me in a way that I didn’t really think about at the time when I took the test, and like I said, it was a very long time ago, and because now our data is compromised so often, and it didn’t happen quite as much then I think it wasn’t really on my radar. And so, but it is now. S

o I do have some, I do have some concerns about that so, but I appreciate your perspective on it, because and also learning that it’s something that you you think about deeply, and that there’s a lot of training going on, because we kind of have to hand over information about our health just to be treated, and that’s out of our hands, and so it can feel it can make us feel a little bit vulnerable. I think.

After the break, Dr Parikh gives his thoughts on patients taking supplements.

You’re listening to me Yap right now. So you know, I have a podcast. Do you know that I also have a website and a newsletter? I want to encourage you to subscribe to the About IBD newsletter. I send it out once a week, and it contains all of the great stuff that I’m seeing other content creators and nonprofits put together in the IBD space. I read or listen to or watch, everything that I put in the newsletter so it is vetted, plus, I include opportunities for patients to participate in research and about all of the great events that take place every week, including support groups, Instagram lives, or webinars that are put out by our great IBD community. I promise you, I don’t waste your time or mine, so I think it’s a valuable resource for everyone in the IBD community. You can sign up with just your email at AIBD newsletter dot about ibd.com or head to about ibd.com you’ll see a link to sign up there or check the show notes. And now back to the show.

Dr Parikh, something that we talk about a lot in the IBD community, or that I see a lot, and you probably do too, is that patients and their providers have trouble connecting at times and speaking maybe the same language. And I know there’s studies on this about how far apart, in particular, IBD patients and their physicians are about the things that matter most to patients and what the doctors think matters most to patients.

So it’s always very interesting. I think sometimes it’s a problem because it’s a IBD or digestive health. It’s very personal. It can be really difficult to even just get somebody in the office and talking in the first place, let alone connecting. So I’m wondering what advice you have? What advice do you have for patients on advocating for themselves when they’re in and working with their healthcare team.

Neil D. Parikh, MD 12:44
Yeah, I guess I have some high tech and low tech solutions.

Amber Tresca 12:48
Love it.

Neil D. Parikh, MD 12:48
We’ll start with low tech. I love patient diaries.

Amber Tresca 12:52
Oh.

Neil D. Parikh, MD 12:53
I think a symptom calendar or bowel movement log, something that during the visit we can refer to and have that data. I know so my providers and my colleagues will say that’s a lot of extra work, but I tell my patients, upload that the day before onto the EHR portal, and I can take a look at that, and we can reference it, because it’s hard. You have 15 to 20 minutes, maybe 25 minutes, if you’re lucky. And not only are we putting a patient on the spot, I’ve been a patient many times. You never remember the right questions and the right data in that visit. Okay, so that’s one.

I also like to bring a knowledge buddy. So I tell my patients, bring in somebody else if you if you can, you know, not only can they listen to what I’m suggesting, they can kind of vouch for what they’ve been seeing their loved one to go through high tech solutions. There are apps out there. They’re actually a variety of apps that do like food tracking, bowel movement tracking. Some of these are AI enabled. Now, those can work.

And then finally, Dr Google. You know, patients always tell me, Oh, I’m sorry I went on the internet first. That doesn’t upset me, except I like them to use vetted resources. You know, like your blog. I use your blog often when talking about IBD patients, saying, Hey, here’s a vetted resource. Go to that, especially after the diagnosis, because if they look that up, they may then come with me with more prepared questions and to the providers listening. I know providers are talking about burnout and you’re worried this is more on your plate.

If we make that 20 minutes more efficient, then your patient may not need to call the office the following week and ask those questions they forgot to. So I think having them go to CERN Crohn’s Colitis Foundation, your blog, vetted resources for IBD as soon as the diagnosis is made, or as soon as you’re going to talk about a drug I often after the procedure will give you. Hey, these are the four or five drugs we may end up using, look them up, find out all the negative or the positive that’s out there that will save us time going forward and again, better streamlined patient care.

Amber Tresca 15:12
Okay, first of all, that I’m a vetted resource. Now all my questions have gone right out of my head, because I’m so I’m so flattered and just humbled by that. So I really appreciate you’re saying that.

Neil D. Parikh, MD 15:24
No, it’s true. I’m not just saying that. I think you want non-MD driven online resources that are still vetted in scientific knowledge. Is that fair?

Amber Tresca 15:38
Yeah, I Well, I mean, this is what I hope to do. So if I’m achieving that goal, that really means a lot to me. Thank you. So do you ask your patients? Okay, print something out or save it on your phone or something like that, and like, let me look at it so I can see what you’re reading.

Neil D. Parikh, MD 15:54
I often will tell my patients, especially IBD, where I think they should go.

Amber Tresca 15:59
Okay.

Neil D. Parikh, MD 16:00
But yes, people definitely bring stuff in. Often, they’ll bring up a supplement or a treatment that I’m not familiar with, and that case, I need to somehow do my research and get back to them.

Amber Tresca 16:12
Right? I’m from the days of I’d be at the library, or when I was in medical publishing, we had, we had a library in the basement, and I would go down there and photocopy articles and bring them into my doctors, but they knew what I did for a living, so I think maybe I was given a little bit of a pass. So I’m glad to hear you say that. I think that’s really helpful for everyone to hear.

I like to turn the question around. We often talk, or I talk a lot, about how patients can better connect with their healthcare providers and better advocate for themselves. But I’m also interested in knowing, what can the providers do? So do you have any advice for your colleagues, and you just gave some, but you have any more on how they can better connect with their patients?

Neil D. Parikh, MD 16:54
And I’m not perfect at all the things I’m gonna suggest right now, what I was just saying, Be open, be humble. We often, and I may be guilty of this, when you bring your stack of papers in, we often like, Oh, my God, this is going to be a lot of work. I have 18 minutes left or 38 minutes left for a consult, if we can get past that prejudice and be humble and open. I really believe the visits become more efficient, and then going forward,

I often encourage my patients, hey, send it to me. Just send it through the HR, so that way I don’t take away that patient’s time during that visit, and I can be better prepared. I mentioned supplements. I think it’s time to be open to integrative approaches. Many patients are turning to holistic approach to healthcare anyway, so don’t belittle that supplement or that literature, because you may not know much about it, and there may not be a randomized control trial on it, but it may work for that patient.

I always like to say that there’s two central tenets when it comes to gastroology and integrative medicine. The first is about 30 to 40% of patients need a pharmaceutical therapeutic approach, and they may need it quickly. You can’t miss that 30 to 40% right? The IBD patient may need steroids, may need a surgical referral, and that needs to be done, but the other 40, 5060, 70% of people may have time to focus on their supplements, their diet, their lifestyle. And I think it’s our job as medical providers to identify which category of patients fall into.

Amber Tresca 18:45
I think it’s important too. I know in the IBD space, patients are out there trying supplements. They’re trying everything, and I think that speaks to a couple of things, one being a dissatisfaction with the medical options or the surgical options that are open to them, and then also the desire to take things in their own hands, maybe between appointments, and try to calm things down before they need to come in and step up therapy or move to something different or whatever.

So I think, with what you’re saying, if, if you’re not engaging your patients on this, they’re doing it anyway. So like you better that you discuss it, and they’ll tell you, I think, what’s going on and what they’re taking and what they’re trying, versus you not knowing at all, because they’re they’re too worried about bringing it up and that you might tell them that it’s it’s no use, or that they shouldn’t be doing it.

Neil D. Parikh, MD 19:46
Yeah, and the second tenant is that patients don’t follow a textbook, right? I say this all the time, so you may not know what’s going to work for them. And so if we’re open to different ideas, it may end up being again, better care, better disease course for that patient,

Amber Tresca 20:06
Yeah, and I’ve been surprised in recent years about how often going to, like IBD conferences, and hearing how many of the people that are presenting are talking about some of the different ways that go beyond, you know, pharmaceuticals and surgery and other things that they’re trying with their patients and having some success. So that’s really exciting for me to hear.

All right, we talked for a minute about maybe some apps you’re using, like AI to transcribe, which is really helpful so you can face your patient and not have a laptop in the room. Um, I do love that. What else? Is there other technology? Are there other there are so many apps out there. What do you think, what kind of technology might be helpful?

Neil D. Parikh, MD 20:51
Yeah. I mean, we mentioned the EHR, right? I think the EHR is the easy first kind of form of technology, the my chart portal or the patient portal, where you can enhance communication between the provider team and the patient. There are apps, and I’m not going into individual ones, because I think it’s very patient specific and also disease specific.

But I think we’re also on the cusp in GI of remote patient monitoring or wearable technologies, right? Cardiology is to get great at this. They have the way to track your rhythms, your heart rate, Gi, I think, is going to get there and get there pretty soon, whether it’s breath testing. Smart toilets were our thing a few little bit ago. Bluetooth enabled, weight scales, wearable technology, remote patient monitoring will be a part of the GI vertical.

Amber Tresca 21:48
I love that. I’m waiting for the day me and many others, I’m sure, for home fecal calprotectin testing, because if I don’t have to bring my sample into the lab, I would be a much happier person.

Neil D. Parikh, MD 22:04
Yeah.

Amber Tresca 22:06
Dr Parikh, you, you know, you started off talking about how you were a basketball coach. I think you said first grade and third grade is that, is that right? Third

Neil D. Parikh, MD 22:16
Third grade basketball. That was my first year, this year, okay, I did a first grade soccer Okay? I’ve been on the bench for T ball. I because I don’t understand the sport perfectly. I’m still so evolving.

Amber Tresca 22:29
Did you play sports in high school or college?

Neil D. Parikh, MD 22:32
I wasn’t good at anything. I played. I played. My parents made me play. I was there, I was on the field. I got most improved trophy, I think four years in a row for a T ball, because I think everyone had to have a trophy at that point.

Amber Tresca 22:46
That’s very funny. What what do you find challenging about the coaching and what do you find rewarding?

Neil D. Parikh, MD 22:55
Obviously, I’m coaching my kids and getting that chance to spend more time with them, especially in a more structured way. But coaching in general, it’s about teamwork, right? It’s I coach with two of my buddies in basketball, and it was teamwork for us, how we worked together in non social setting, and then teamwork with the players. And I think that’s healthcare.

Amber Tresca 23:18
Agree. And in doing all of the kid things. My kids are 15 and 17, and in the volunteering roles that I’ve taken on, if you can find at least one other person that’s in it with you, and if they’re a friend, that’s you know, that’s super helpful. Like you can do anything together. You can run anything together. It makes it so much better. That’s amazing. I love that you are able to find the time to be able or you make the time, like, frankly, right? Like you have to actively make the time to do the coaching.

It’s been lovely to talk to you, and I want to make sure that everybody can find your show. You have a wide variety of topic and guests. You have focused on IBD more than once, for which I’m grateful. I’ll tell you my favorite episode, I think, was where you interviewed your colleague and you did his coloscopy.

Neil D. Parikh, MD 24:12
Yes, a very appreciative colleague.

Amber Tresca 24:15
I just loved it. So tell me more about The Gut Doctor and where everybody can find it.

Neil D. Parikh, MD 24:21
Sure. So it’s available at all, I think natural, standard platforms, Apple, Spotify, Google. I’m thinking about getting onto YouTube, but I haven’t done it yet, and I’m not as fancy as you, so I’m still audio only. I also record at 10 o’clock at night in a makeshift closet. So greatest visual either.

Amber Tresca 24:48
I definitely started in the closet as well, and then just upgraded over the years, and it gets to be a little bit like you just can’t help it because there’s there’s a. Is another microphone. You know, there’s always another gadget. And as a lover of gadgets, it’s just just upgraded it over time, just because you want to be better. But also it’s just, I don’t know, it’s just fun in a way.

Well, I would love to see you do video. I would support that. So I hope that you get there, although I know how much time and energy it takes, and you’ve got a lot of roles and already as a gastroenterologist, and then also as a dad and as a coach. So I wish you all best with the gut doctor and in hopefully, hopefully finding some time to bring some video as well as audio.

Neil D. Parikh, MD 25:39
Amber, this was fantastic. Please i continue what you’re doing. I wasn’t just saying that earlier. I think it’s nice to have resources for our patients, and you’ve been a great one.

Amber Tresca 25:50
Oh, thank you so much. I really appreciate it.

Hey, super listener. Thanks to Dr Parikh for making the time to record with me. Dr Parikh is a fellow podcaster, and his show is called The Gut Doctor. It’s a brilliant name because as a community GI he sees patients with all kinds of digestive conditions. He covers many topics, including colon cancer, diet and nutrition, herbal supplements, and even fitness and IBD, with friend of the show in one of my previous guests, IBDologist, Dr Neil Nandi.

As always, links to a written transcript everyone’s social media handles, and more information on the topics we discussed is in the show notes and on my episode 174 page on about ibd.com thanks for listening, and remember until Next time, I want you to know more about IBD.

About IBD is a production of Mal and Tal Enterprises.

It is written, produced, and directed by me, Amber Tresca.

Mix and sound design is by Mac Cooney.

Theme music is from Cooney Studio. 

Neil D. Parikh, MD 27:02
With the echo. It didn’t come up there. It threw me off a little bit, but I think you enjoyed that.

Amber Tresca 27:07
Yeah.

Neil D. Parikh, MD 27:09
I like challenges.

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