Richard Miller, MD 00:00:00 When it comes down to it, social media is, you know, show me the facts you're talking about and let's talk about what they're referencing. And I can have that discussion, you know, whether this is sort of proportion or accurate or just plain, you know, falsehood.

Keith Reynolds 00:00:21 Welcome to Off the Chart, a podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Reynolds, and on behalf of the whole team here at Medical Economics and Physicians Practice, I hope you had a happy holiday and a wonderful New Year. This episode, we're featuring a conversation between medical economics assistant editor Austin Luttrell and Doctor Richard Miller, a psychiatrist with L-1 Adult Behavioral Health in East Greenwich, Rhode Island. They'll be discussing how to talk to patients about health information they get.

Keith Reynolds 00:00:52 From social media.

Austin Littrell 00:01:01 Before we get started, could you. I'll start you off with an easy one here. Could you just, starting with your name? tell me a little bit about yourself and what you do.

Richard Miller, MD 00:01:09 Yeah, sure. Rick Miller, I mean, I guess formerly, you know, with the, known as, Richard Miller. Richard William Miller for credentials. just turned 47 last week. three kids under ten, married for 11 years, currently practicing in Rhode Island. I have licenses in Connecticut. Rhode Island. Michigan and Montana. I currently right now run, an assertive community treatment team at Community Mental Health agency. So we see a lot of folks with schizophrenia, bipolar disorder, primarily those diagnoses, some folks with depression, anxiety and personality disorders. I am the psychiatrist for the team and for the agency. We have a nurse practitioner to supervise. I also work at a few hospitals in the area, during the week or on weekends. Take and call, mostly for supervision or doing some patient care. And I have a private office as well, where I see some long term clients that I've had for years. in addition to doing this stuff, you know, so, probably explains the hair loss and, you know, the lateness, but but I love it.

Richard Miller, MD 00:02:18 It's great. It's great, great time to be in the mental health field. What's going on?

Austin Littrell 00:02:22 Absolutely. Well, thank you again for joining me. And, happy belated.

Richard Miller, MD 00:02:25 Oh. Thanks, Ben. Thanks.

Austin Littrell 00:02:28 so if we could actually just start off with, like, misaligned expectations. Yeah. So how do social media trends tend to lead to these unrealistic patient expectations when it comes to different treatment options?

Richard Miller, MD 00:02:42 Yeah I'm sorry. How do they how do they can you repeat that. How do they misleading expectations lead to kind of yeah.

Austin Littrell 00:02:49 Like how do how does social media trends kind of contribute to these these unrealistic expectations that patients might have for treatment.

Richard Miller, MD 00:02:56 Yeah, absolutely. I mean, I think that's a really important question. And, you know, generic in terms of, you know, not having any specifics, but I think you don't need to because, the reality is, is that, you know, social media is everywhere and people are getting information off of it, whether it's factual, whether it's, you know, opinionated or biased, you know, unfairly biased, you know, like a particular case, you know, I mean, you could probably look for, you know, Google something and find something to, to support your opinion, no matter how inaccurate it might be.

Richard Miller, MD 00:03:33 I think, you know, what it comes down to, it is, you know, people come to my office every day with expectations and, you know, wanting to get better. you know, yesterday, not tomorrow. And it doesn't happen that quickly. Sometimes it's a it's a process. Sometimes medications take longer depending on what you're taking. and I think social media, to a degree, plays a role in, I think, planting a seed that, for example, like, you know, particular medication might do this or recreational marijuana might do that. It's not always accurate. So I think there's some biases in there or messages in there. And I think it creates an unrealistic expectation. and it saturates you and you see it, I mean, the patients coming in every day asking about particular options or stuff they've read about or seen on YouTube. And it's just not true. I mean, I mean, like the amount of work, the 1 or 2 people who knows, but it's not the 95%.

Richard Miller, MD 00:04:32 It's not accurate.

Austin Littrell 00:04:33 Right? could you talk about maybe some things that physicians can do to address requests for inappropriate or unproven treatments that patients might have heard on social media and then kind of bring to them?

Richard Miller, MD 00:04:45 Yeah. I think, it's important to, you know, ask the patient. Hey, where are you getting this from? Tell me about it. What's your understanding of the facts? And then have a discussion as to if they're factual or not. And I think kind of educating the patient to best your ability. so again, a lot of the folks that might not necessarily come in here, but in mental health, people are hungry. They're desperate for treatment, I'd argue, and they want to get better quickly. so they might see something and jump onto it whether it's accurate or not. Who knows? so I think kind of realigning what's realistic. you know, I always give the analogy, you know, you don't walk into a gym and get biceps on day one. Takes a while, you know, you got to go there.

Richard Miller, MD 00:05:27 You got to train the muscles. You got to, you know, get your body in shape. And you didn't take a while to to get out of shape. It takes you a while to get in shape. so kind of like your brain with mental health and depression and lifestyle change. It takes less time, takes an effort. So I think what it comes down to with social media is, you know, show me the effects we're talking about and let's talk about what they're referencing. And I can have that discussion, you know, whether this is sort of distortion or accurate or, just plain, you know, falsehood.

Austin Littrell 00:05:58 And so what kind of goes on when, you know, maybe you not confront, but you're explaining that to a patient and then they start to get frustrated or, there is just that misunderstanding there. How can health care providers manage that frustration or tension? Yeah. you know, when what they think is right from social media conflicts with what's recommended clinically?

Richard Miller, MD 00:06:18 Yeah. I mean, I think it depends on the person.

Richard Miller, MD 00:06:20 I mean, I think they look ultimately in this field, the most important thing is communication. And I think having a therapeutic alliance and working with your patient on a shared treatment decision, working with the patient so that their goals align with your goals and again, may not be 100% overlap, but 75, 80%, 90% would be preferred. and, you know, I would say, getting to where you are able to understand where they're coming from, hearing them, showing that they're heard, and then providing them with, again, reviewing are presenting, whether it's accurate, inaccurate or not. I think honestly, people respond pretty well. I haven't had too many adverse, situations where people have explored that in the office or, you know, you know, chose not to see me again. They just want to be heard. And they, you know, I always appreciate them for their efforts to find things and to educate me or to, you know, show me what not there. But my goal is to then kind of give them reality based and say, look, yeah, some of this is true.

Richard Miller, MD 00:07:28 So that may not be let's talk about this. So acknowledging them, meeting them, validating empathizing.

Austin Littrell 00:07:35 And you touched on that at the end there. Can you go a little bit more into the role that empathy might play in kind of maintaining a long position patient relationship when you know there is that misunderstanding or that frustration?

Richard Miller, MD 00:07:46 Yeah, I mean, I actually just did it. That's why I was running late for his call. I mean, you know, we had an irate family member complaining about something at one hospital workout. And it started this whole chain of events with like, risk management and everything. And I wrote back on it. So there's a lot of misinformation here. So we called the person who was upset, and I had someone else on the call for backup to kind of make sure I was hearing. Right, because I had a long conversation with this guy last night at 9:00. And, he said, no, I don't have any problems. It's like I voiced my concerns to you is like, I think what happened this morning is I had a different person call me, and I just kind of spewed what? I speak to you last night.

Richard Miller, MD 00:08:21 He's like, but we're good. he's like, you know, we have the same treatment goals. I mean, in terms of, you know, family member and and so I think clarification communication is key. What happened with that particular gentleman? He was frustrated that no one had called him about his family member. he was frustrated that it had been a few days. And again, there's a reason for that. You know, I just happened to be walking into the office that day that way. And so I inherited the mess. to the point I think there's a lot of parallels here. People just want to be heard. The worst thing you can do is tell them what they come and tell you is, you know, ridiculous or not important, because then anything else you say, whatever factual might be. They're not going to listen to you.

Sydney Jennings 00:09:12 Say, Keith, this is all well and good, but what if someone is looking for more clinical information?

Keith Reynolds 00:09:17 Well, then they want to check out our sister site, Patient Care Online.

Keith Reynolds 00:09:21 Com the leading clinical resource for primary care physicians. Again that's patient care online.com.

Austin Littrell 00:09:32 Can you talk about the role that shared decision making, could play when navigating patients concerns. that might be rooted in misinformation they got on social media?

Richard Miller, MD 00:09:42 Yeah. I mean I usually use that, with everything. So I mean, not sure if it's still applicable to social media, but, you know, even if I get a court order for a patient and they have to be mandated for treatment, the worst thing you can do is go back and say, okay, you need to do this. You know, like you kind of dictatorial, pointed it. Like for example, I use a lot of injectable agents and, you know, medications that are once per month or once every two months, for example. A lot of patients don't like that because they don't like injections, and they view it as like punitive or like a penalty. So once I come back from court, you know, which in Rhode Island happens to be a Friday, so it's kind of unique.

Richard Miller, MD 00:10:23 I'll then sit down with the patient if they're in the hospital and say, well, look, you know, the judge said you have to take one of these medications. Let's talk. Let's sit down and talk about what? these all are again and options and why I think this one is probably better for you as compared to this other one. So even though I know what I want, it's I mean, there are times where you are just having to make that decision. You have to get security involved and show a force. But that's the 95% of the time. If you sit down and attempt to talk to your patient and show them why you believe this is better than that, they're going to they're going to follow that and they're going to feel empowered and they're going to know and it's going to be a better discussion. So I think shared decision making really is the way to go, going forward.

Austin Littrell 00:11:09 And how can, not just physicians, but I guess just kind of the health care industry in general, more effectively educate patients about treatment plans when considering, you know, that influence that social media might have?

Richard Miller, MD 00:11:23 Yeah.

Richard Miller, MD 00:11:23 I mean, I think we have to talk about social media being out there. And you may see things that are, kind of, asynchronous or different than you would, you know, you're not going to see this in a textbook. I mean, it's going to be very different. I would argue that, we have to be alerted and that there's stuff out there like misinformation, which is out there all the time. And so we've been there. It's just more easily visible on YouTube, for example, or maybe Instagram or, you know, whatever it might be as compared to having to find it, you know, on a, you know, a TV station late at night. I think just learning that there's outlets out there that questions that can always talk to the professionals, whether it's myself or their case manager or another doctor friend who they might know just depends. So, kind of again, meeting them where they're at, understanding this is out there and kind of figuring out what the next best steps are.

Austin Littrell 00:12:18 Absolutely. and going forward, what role do you think or what steps can healthcare providers take to really, I guess, improve patient education? yeah. Yeah. I guess with social media being a factor.

Richard Miller, MD 00:12:35 Yeah. I mean, again, I don't have one of these, but I know a few people who do podcast. I mean, you know, like a doctor podcast or psychiatry podcast and kind of educating people and about what's out there and, you know, being able to have them listen to what they need to hear in their own time on their own forum. I think having tools that are out there that, you know, are factual and evidence based and nothing, again, nothing and saying some other stuff or other things or not, but if you're able to publish something or generate something that you know is completely factual, then you know, there's some good stuff out there for your for your patients who rely on if they need it. so I would say, maybe have an avenue in the social media landscape like we're just talking about as a, as a tool, whatever it might be, you know, just something out there where, people out there.

Richard Miller, MD 00:13:30 I mean, my wife does something similar to this where, you know, the little tangent here. she does, some mentoring for postpartum moms, and it's anonymous. I mean, you get the name of the person, but you don't put the location or anything like that. But these are. But yet her she vetted. the point is, these women who are struggling from call and they have, like a weekly discussion, and they know these are vetted people who've been through this and these are experts. And it's not, you know, a declining 800 number. You don't know what you're getting, you know. So I think if we did something like that similar with mental health psychiatry and I think we're getting better about that. but having a good resource that someone can call and know that the information early, you know, instead of years is there that's reliable.

Austin Littrell 00:14:17 And I think that's a great idea. And I do think that there are a lot of health care providers that already kind of have, you know, maybe a tick tock or like you said, a podcast where they are.

Austin Littrell 00:14:25 Yeah, sort of half influencer. Half, half physician.

Richard Miller, MD 00:14:29 yeah. Yeah. I mean, it'd be great. I mean, I have to get my kids to show me how to do that with you, you know? So that's important.

Austin Littrell 00:14:37 Yeah, absolutely. well, I think you answered all the questions that I have for you. is there anything that I didn't ask you that you think is important that you'd like to share?

Richard Miller, MD 00:14:47 Sure is. You know, I think we have a lot of great, medications that are out there. People are a little, you know, might be skittish about what psychiatry has and, you know, old school ways of thinking. And we have a lot of great medications out there. We have some great lines and agents that are out there, you know, specifically or Stata, which is, like injectable schizophrenia available every month or every two months. And the thought of getting a monthly injection, you know, 12 shots a year or six shots a year as compared to 365 pills a year.

Richard Miller, MD 00:15:18 I mean, if you think about that, I mean, from, you know, this is medical economics. So, I mean, numbers are important. And that's one of the things that I always like to emphasize to my patients, you know, look, you have the ability to simply cut down, you know, how much time you're spending taking your medication, thinking about your illness six times a year, 12 times the year as compared to 365? Or if you're taking it twice a day, 730. So I think, you know, just, you know, making sure your readers know there's some great tools that are out there. We've come a long way. Psychiatrists have a long way to go. And, you know, from a numbers perspective, you've taken injection six times a year, you've got most you're spending an hour throughout the entire year getting your shot, and you spent over time with your psychiatrist or case manager doing other stuff rather than trying to find pills. So I think that's important to know.

Austin Littrell 00:16:06 Absolutely. Great. Well, I really appreciate you taking the time here today and talking about this.

Richard Miller, MD 00:16:12 No problem. I appreciate you being flexible. And, you know, I'm eager to read this, and, thank you for your time, sir.

Austin Littrell 00:16:17 Of course. Yeah. Thank you.

Keith Reynolds 00:16:22 Again. That was medical economics assistant editor Austin Luttrell and Doctor Richard Miller, a psychiatrist with L one adult behavioral health. My name is Keith Reynolds. And on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening and ask that you please subscribe to the show on Apple Podcasts and Spotify. Also, if you'd like the best stories Medical Economics and Physicians Practice Publish delivered straight to your email every single day of the week. Subscribe to our newsletters at Medical economics.com and Physicians Practice. Com medical economics, Physicians Practice and Patient Care online are all members of the life sciences family. Thank you.