Why Patients Lie—and How AI is Helping Doctors See the Truth

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc Have you ever lied to your doctor?

[00:00:23] 57% of patients lie to their doctors, says Dr. Jerome Bouaziz, CEO of One Clinic in Paris Patients don't lie maliciously, but out of discomfort, stigma or fear of judgment whether it's drug use, alcohol, sleep issues or mental health, these omissions can have life-altering consequences on the other side, many doctors avoid asking sensitive questions

[00:00:52] not because they don't care, but because of time constraints or uncertainty about how to handle the answers so in this episode, we're going to talk about prevention how to tackle uncomfortable questions from both sides, patient and doctor and we're also going to talk about a new approach taken by One Clinic

[00:01:17] where patients complete a 60 to 100 question digital questionnaire pre-consultation and then responses are fed into validated clinical scores that the doctor can use and together with an AI supported insight decide if patients need any other interventions apart from the original problem that they visited the doctor for so enjoy today's discussion

[00:01:47] and if you like the show, share it with your colleagues or anyone you feel would be relevant to hear this content and also make sure to subscribe to the podcast wherever you listen to your shows if you will leave a comment or a review wherever you listen to your podcast I will be additionally grateful as this is what keeps the show going it also makes other listeners aware of the show

[00:02:16] and gives us ideas on how to create content in the future so thank you everyone who already did that and those that will take that one minute for some feedback now let's dive in Jerome, hi thank you so much for taking the time for this morning coffee

[00:02:46] here we're in Berlin at the Digital Health Excellence Forum and yesterday you had a presentation on prevention and how prevention is often seen as something that's not worth investing in or is just bringing a loss to the healthcare system and you argue that's not the case at least not in your case so let's talk about cocaine you had that's a strong start yes exactly exactly

[00:03:16] you know you need to you need to somehow yeah start with an engaging topic so the reason I said that was because your talk was about how habits are something that we can influence most and are most important for prevention but habits are also something that people don't want to share or don't want to be honest about in their discussions with doctors when you're asked about how often do you drink alcohol or do you take drugs people won't

[00:03:46] be honest and tell me more about that yeah actually I'm a physician I'm a gynecologist and I felt myself that sometime I'm not confident with asking some question and also this get from experience when you're a young gynecologist you're not confident to start the question about sexuality because you feel that it's maybe not the day to make it maybe it's going to be another time you're not confident then I realized speaking with other physicians that the patient

[00:04:15] is sometimes lying to you and also the physician sometimes is not comfortable to ask the awkward question about personal habit because no one is having a consultation for their habit the start the intuitive health is becoming a big trend for the patient for the industry but it's not the main topic of your visit at the doctor it's acute or chronic but not really that and we realized that

[00:04:44] this is a big stat that 57% of the patient already lie to their doctor and mainly about their habits so we realized that the technology could be in a place where the trust as we were talking about can be different because the technology do not judge you you feel confident to tell because you're not going to have to face someone even if you're going to build a trust relationship with your doctor so we really believe

[00:05:13] that questioning can be more powerful and more impactful if it's not only the physicians that make it we're going to go to that in more detail because you built a model that is used pre-consultation where patients answer a lot of questions for the doctors to get some sort of a risk assessment but I do want to clarify for the audience what I meant with that question yeah why is that important why did you mention that

[00:05:42] because there are many what I call the dirty talk or the dirty question that we're not asking so for example for addiction on a daily base physician will not ask if the patient is consuming drugs or cocaine and actually when we look at the number 25 millions of people are using are known to use cocaine in Europe and we know that a heart attack for the population under 40 years old

[00:06:12] is due to cocaine in one case out of four so it's a massive responsibility in a heart attack for the people that are under 40 years old if you screen someone coming for no matter what and you know they are using cocaine you know that you will have to make something to check out of the heart you will have to make an ECG a stress test to make it even if it's not the subject at all and this is a part of prevention and of course there are many examples

[00:06:41] I took this one to be shocking and that the people realize that there are little questions that can affect the way we're gonna screen you the way the physician will follow you if you never talk about it okay there are a chance that we will do nothing for your heart till you get 50 years old but you are at a higher risk because you've been doing it so trying to understand what are the risk factors it's not a big deal if you have the help most of the time the issue for analyzing

[00:07:11] the risk factor it's not genetic it's time that we don't give to the patient to listen to them it's a well-known fact backed backed by research the social determinants of health relationships mental health have a huge impact on everything sexuality sleep everything on that so how do you as a doctor find the balance between finding out just enough from the patient that you as a GP for example

[00:07:41] or OBGYN don't become the psychotherapist in the middle of the session and that you also you have to be efficient with the increasing workforce strategies you're right it's a very good point we cannot treat everything we have a limited time and this is what we're trying to do in the team we say you cannot treat everything but you can point the thing and you can start the conversation with the patient you're not gonna be a cardiologist and then a psychologist for every patient

[00:08:10] but just having the time to tell him this is a priority maybe we're gonna organize him this is very helpful and very impactful to make it and we cannot become all super expert and super doctor or in every specialty but just organizing the patient journey on what is his top priority regarding his personal risk factor for me this is prevention and this is not easy it's usually not easy

[00:08:40] to make it when you look at other industry it's very simple it's called CRM you have a need where the customer is and what he will need next there's so much intelligence that are pushing the need for customer but the need for the patient regarding his position when you look at when you're gonna buy something on internet they already know what you need and what's next for you and in medicine actually we could know that you are this kind of a person we have enough data enough ability it's not

[00:09:09] and really I'm really humble about the text that we put it's simple it's not yesterday I was impressed there are people that are doing so huge development and impactful and blockchain that are solving big problem but with this concept of POP personal opportunity of prevention we change the way we receive the patient we consider that every time that you see a patient there are an opportunity and let's say

[00:09:38] that we can look at prevention on two ways there is one way that is doing the full checkup there are centers that are doing it in the US it's more charge a lot they do the longevity screaming and yes the issue is I'm not gonna judge or people that want to make it but this you cannot have a public impact on public health it's really a niche to make it and the other way is to say okay every time that you are in the healthcare system there is

[00:10:08] a connection that we have to give you and back the minimum is to give you what are your opportunities of prevention and it's actually like when you go to Amazon you buy something and they tell you what the other have been buying because it's great so you come for that but you're the kind of person that is not sleeping well that have a family story of other cancer you should also do it and just to tell it is really impactful and I hope next year

[00:10:37] we also will be able to bring the economic impact of doing that the medical we're sure as I presented yesterday about 10,000 patients it's already sure that this impact where we receive the patient let's explain a little bit what one clinic does you're a private provider you offer specialist care from gynecology infertility cardiology dermatology how do you fit inside the French healthcare system

[00:11:06] how are you reimbursed do patients pay out of pocket just to understand that and then we're going to focus on the questionnaire and how to actually capture all the things that patients have to say in an efficient way yeah so we're a private group of physicians where we wanted to make two things we wanted to make integrative medicine and we wanted to take every decision as value-based healthcare decision for me it was really important I was I'm a physician

[00:11:35] I was not an entrepreneur I didn't do any business so I wanted to have a line and a direction when you're a physician you don't know what it is to talk about vision or values for a group what is your vision to give the best care that you can and that's it so the value-based healthcare for me was one of the direction we wanted to take from the beginning and we were trying to conceive with the help of one great team player with us Alba that built it with us to say okay the value is not just giving you

[00:12:05] the good prescription this is easy to give you the good antibiotics or to give you the good treatment this is easy what is the added value that we can make as a group and what is the best care that we can so we decided that for chronic disease for a difficult condition we will build a journey of integrative medicine and in my experience when you see a patient and you tell them oh it would be great to see a psychologist

[00:12:34] or maybe a nutritionist you never know what's going on you don't have the follow-up you don't have the data you don't even know if the patient is going there for many good and bad reasons but you don't know it so physicians give up doing that so we say okay this is going to be our team it's not going to be external we're going to have this team and if one patient is coming to our clinic we're going to decide that this is a medical prescription that our journey of integrative medicine

[00:13:03] is a prescription so if the physician decides that you will need this journey we're going to organize it and we're going to fund it we're private the patient has to pay out of pocket for the consultation the difference between what the social security the insurance is funding and on the other side we offer patients more global care of what we do and our physician there are most of them half in our one clinic and half in

[00:13:32] public system so for the patient we offer always the possibility to be treated in private and if they need surgery or difficult they have always a choice because our team is also working in the public hospital we do bridge with the physician not the technology a patient can decide if he wants to go to the public hospital with the same doctor that he met he wants to go to the private for the physician it's very comfortable because sometimes you know that this kind of case difficult case you prefer to be in

[00:14:02] a stronger team in public hospital and take a longer time than a private thing so they don't have to compromise on that do you ever get scrutinized that you're basically just enabling people to pay to skip the waiting lines I do not I do not I do not because there is no waiting lines for this kind of surgery and the delay between the public and the private will not be the point of judgment so the people

[00:14:31] come to you because you have a different approach yeah let's talk about that so you mentioned that in the presentation that you had here at the digital health excellence forum that basically you created a system where patients answer 60 to 100 questions tell me a little bit more about that what kind of questions are these I personally think that when it comes of course you need to ask the questions but patients

[00:15:01] are not really that worried about the doctor asking those questions they're more worried about where the answers are going to land and is their next employer going to see that somehow or what if you know there's a data breach and that data gets leaked so tell me more about the questions and the outcomes that you get out of those questions so I'm building it before doing one clinic I built a company of just tele-else I co-founded a company of tele-else and I reached a point that just

[00:15:30] digital was not enough okay so I stopped this my friend continued the company and after three years he ran this company I ran the physical company one thing and we're like we didn't manage too much what is the physical there are parts that you are not doing that we have to do again and we we have to we have to the prevention as this bridge between the digital and the physical and this is very important because the question of trust the question of data is always a question but it's

[00:16:00] different point of view when you see the people that is going to use it the next day so it was very different approach from that we have the same level of cyber and we do all their GPD and everything but the trust that you have because you're going to see someone is very different and if you're not confident you can ask the next day to delay the data you'll be in front of the person to make it it's not that you send an email to erase your file so it's very so far maybe it's going to change but so far it's not

[00:16:30] our main issue of adoption it's more the time that you have to fulfill the question so actually we look at what are the main easy topic that can impact the global health so there are the cardiac the habit the addiction the sleep the sexual the social the activities and all the family risk factors so when the patient is having a consultation we ask him to fulfill it and regarding

[00:16:59] his answer we're going to establish a profile of risk factor and in medicine there are prompts patient reported outcomes and there are also risk factors that every specialty are used to use to take decision but not every physician know what is the best score that the cardiologist is using to know if you need a stress test or not but it's just a question of sharing the knowledge you are in consultation you will know

[00:17:29] not you're a GP you will not look for what is the best score for that and I will fulfill it so we do the job before and we help every physician to have access to this risk factor that I usually use in a daily base by other specialists so when you receive your patient he already had fulfilled questionary regarding his answer we're going to ask him another set of questions to be more in detail of what needs for the patient and the physician when he will open

[00:17:59] his interface he will have the risk factor and the need and already a plan of what is a preventive strategy regarding this personal situation it's a full plan with the objective what are going to be the difficulties for you because can you give me an example so let's say I come in because I have a mall that I'm interested in I fill out this questionnaire what happens next you figure out that I don't have healthy habits like how do you approach the I'll give you the last patient that I had because I think

[00:18:31] had a patient coming for urinary infection okay simple consultation of course you do prevention because you explain how to avoid the next one what are the things that she has to do for drinking the antibiotics if she had fever so you explain everything but it's a short and easy consultation and my value as a senior doctor is not

[00:19:01] when I opened the interface that she already answered all the question I realized that she had difficulty to sleep she had mild obesity and she had a family story of her heart attack I'm not expert at all in sleep risk or whatever so the solution asked her the next question to calculate what is called a bank score to know if she has a risk of discharge of oxygen during the night and it was very high but I don't know anything about

[00:19:31] the oxygen for the sleep and I'm fine with that but then I the system gave

[00:20:01] me a full record with what is going to be her plan so first will be to evaluate her sleep second will be to help her with her weight and also to evaluate if there is diabetes because she never evaluated that so she came for urinary infection she went back for sleep obesity and we realized she has not been doing a smear test for five years so I told her it is not today but we are going to make it so from one little

[00:20:31] consultation she went out with three main things that are very impactful could I make it without the system yes technically speaking I don't have time to make it I don't have the focus and you don't like to ask questions that you don't want to hear the answer or can handle the answer sometimes

[00:21:00] you don't want to get into psychology because you know that if you open this door the consultation is going to be too long for you and you cannot handle it metabolism so you will have a sport session that is organized

[00:21:30] and funding and it's once a week that you will come for that to see which kind of sport you can do we have a team group with nutritionists that you will also come one so she was really talking a lot about the experience and she said I never thought a unary infection could bring me so much good about that and general health yeah and she received a file with all the objectives and what are the difficulties because she said that she has been trying to lose weight but she never had the motivation

[00:22:00] and she cannot do sport so we do leave a rating or a review wherever you get your podcast subscribe to the show or follow us on LinkedIn additionally check out our newsletter you can find it

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