A New Tool to Improve Clinic Visits for Both Patients and Providers – Dr. David Canes, Founder of WellPrept

Shiv Gaglani: Hi, I'm Shiv Gaglani. Patient education is a special interest of ours at Osmosis, and so today on Raise the Line we're looking forward to hearing from Dr. David Canes, a urologist whose passion for patient education led him to develop Wellprept, a doctor-to-patient content delivery platform that increases patient engagement and reduces physician burnout. Dr. Canes is based at the Lahey Hospital & Medical Center Institute of Urology and specializes in urological cancers and robotic surgery. He's also an Associate Professor of Urology at Tufts University School of Medicine. And before we get started, I wanted to give a shout out to Raise the Line guest Dr. Aaron Fritts of the BackTable innovation podcast and urology podcast, who first introduced me to David. So, thanks so much for taking the time to be with us today.

Dr. David Canes: Thanks for inviting me Shiv. This is great.

Shiv Gaglani: So as you know, a lot of our audience are current and future healthcare professionals, many of them likely going into urology or digital health and education. For their sake, would you mind giving us a bit about your background, what got you interested in medicine, and then urology and then ultimately, patient education?

Dr. David Canes: Okay, so the longest story short is I was born in South Africa, and my parents emigrated to Canada when I was just an infant, and then from there to New York, where I grew up for most of my life. There were no physicians in the family. I sort of had a fascination with becoming a doctor when I was very little. I remember going to the pediatrician and being amazed that they could figure out what was going on with me, even though it was something simple, like a sore throat. 

So, that was in the back of my mind the whole time I went to college and I was a fairly typical pre-med student based on an interest in in science. What sealed the deal for me was a volunteer stint in a pediatric ER at Yale New Haven Hospital and there was clearly a satisfaction that you could directly get from the one-on-one patient interaction. I could see that. I sort of had a sense that all jobs must have frustrations, but at least you could go home at the end of the day with a sense of purpose, and that solidified things for me. 

Then as I moved through medical school, you're dumped into gross anatomy in the first week and I was one of these anatomy nerds who stayed after until like midnight dissecting. I was completely enraptured with the whole gross anatomy thing. A lot of decisions are usually difficult for me. I waffle back and forth and I vacillate, but that surgery versus medicine fork in the road you face as a med student was clear as day. I wanted to be a surgeon, no question about that. Then it became a navigation to urology. Somewhat fortuitously, I've met a lot of really influential mentors who were down to earth. We deal with a lot of problems that can be solved, which is very gratifying, and so the rest is history.

Shiv Gaglani: It's definitely a field that I've got a number of connections to. My mother, who was actually on the BackTable urology podcast, Vanita Gaglani, is a physical therapist who specializes in post prostatectomy urinary incontinence, among other things. She has a guy, Dr. Patel in Orlando, who's pretty well known for robotic surgery… 

Dr. David Canes: Yeah, Viv Patel, he's fantastic! 

Shiv Gaglani: …she works closely with him and his patients and then Patrick Welch was a mentor of mine at Hopkins and I think he helped refine the radical prostatectomy procedure in the first place.

Dr. David Canes: Yeah, he made some key insights that made the operation that we do today possible.

Shiv Gaglani: Amazing. So it's definitely a very interesting field. People talk about the instant gratification. Now what got you interested in patient education as a potential field, and give us the story behind starting Wellprept?

Dr. David Canes: Yes, sure, I've always loved teaching. My mother was a teacher, I don't know if that rubbed off in some way. But I've always tutored other students and I've developed ways of explaining complicated things in a manner that tends to resonate, and I think doctors by nature, many of us are teachers. I think when you look at the one-on-one, doctor and patient sitting in an exam room, face-to-face, there is a lot of teaching that goes on. My exam rooms all have whiteboards, and if there's no whiteboard, I'm writing on the crinkly paper on the bed and it's just part and parcel of what I do. 

As far as what happened leading to Wellprept, as you know, a lot of these things are clear in retrospect and in advance, the narrative is not always like this. But back in 2015, 2016, I was burned out. I managed to stay engaged in the OR, so I wasn't completely disconnected, but I found myself in the clinic feeling disconnected. I think there's a lot of other doctors like me, who really love making a connection with another human being who needs your help, and there's nothing quite like that. But if you are repetitively explaining things, you enter an autopilot/cruise control type of mindset, and that is a disconnect. You're no longer in the moment. It's like one step removed, and I noticed that about myself and it really bothered me a lot. 

I was not trying to start a company, but I was just trying to fix my own problem and I downloaded the National Comprehensive Cancer Networkguide for prostate cancer. I see a lot of prostate cancer. They have an incredible PDF guide for patients and I said to my secretary, "Hey, you know, anytime a patient is coming for prostate cancer, can you please email this beforehand?" Not everyone read it, but the ones who did…the visits were just a little bit better and the conversation was higher level. It was more personal, there was room to discuss more interesting things, and so I took it to another level. I recorded myself -- very low budget -- explaining robotic prostatectomy. Now I'm going to my secretary, and I'm saying, "Okay, send them this link to the PDF, and the video," which is already getting cumbersome, and she obliged, and the visits were even better. 

So, there was no sort of epiphany, but I do remember this whole proliferation of 'link in bio'. So for example, on the Osmosis Instagram profile, you guys have a link in bio and this is now probably, at least a several hundred million if not a billion dollar industry now proliferating because people want one URL to change into multiple links. When I saw that, I thought, 'Geez, you know, I can use something like that for my educational resources, because it’s easier for my secretary to send one link, and I can organize my resources.' So I capitalized on that. If you could say there was a prototype for Wellprept, that was it. I made a sort of -- maybe it's a stretch to call it an NVP -- but it's sort of an NVP. And then I reached out to about ten colleagues at other hospitals and I built pages for them, these little prototypes, and I said, "Would you try this out in your clinic."

Like any workflow change, it's not for everyone. A few of them were tickled that I made that for them, and they never used it again. But enough doctors tried it and they loved it and a few of them printed their business cards with their QR code on it. And it worked its way into their workflow and at that point, I thought to myself, 'alright, now I'm not just scratching my own itch, there's other people like me, for whom this may really, really help.’ At that point, I decided I'm going to actually hire a software team. I wish I had coding experience, but I don't.

Shiv Gaglani: Well, that's amazing. That's a very classic founder-led story, solving your own problem, doing things that don't scale where you're sending out links and videos, and ultimately the platform. So, give us a sense of the Wellprept traction to date. Is it all urology or do you have content across different specialties, and where do you see it in the next, let's say, one year or five years?

Dr. David Canes: One of the insights that I had early on that was just a hypothesis was that if I handed people a blank slate, that they weren't going to do a single thing with it. I know how busy I am, and it just wasn't going to work. I started in urology, and I compiled resources from all over the web, and that's the interesting thing, Shiv. One of the things that I noticed is -- and I put Osmosis in this category -- there are content creators who have already created brilliant content, subspecialty societies, NCCN, JAMA patient pages, podcasts, but there is no consistent distribution mechanism to get those in front of patients. I'm not saying they don't exist completely, but there's no consistent distribution mechanism. 

So, I compiled resources for every major urologic condition so when a urologist onboards now, their pages are sort of magically pre-seeded with content, and there's a few hundred urologists on there now. I still consider us to be sort of pre-launch. We haven't made some official launch announcement, it's been attraction mostly by word of mouth, which is also very interesting. As it turns out, doctors are excited to share this with other doctors and I wasn't sure how that was going to play out. You know, are people going to keep this as a special secret on their own or are they going to share it? But they tend to tell their pals, like, 'Hey, I've been using this thing, you should try it.' So the plan is to roll that out in specialty by specialty and do a similar thing.

Shiv Gaglani: That's awesome. And agreed, word of mouth is some of the best traction, just not raising funding, but actually generating revenue by creating value for your customers, and then capturing a small amount of that value is probably the best kind of startup advice I tend to give people...showing that kind of organic traction. Tell us about what metrics matter most? Like number of engaged learners, amount of content, interactions, maybe how many times links are sent out, but other things as well. In the introduction we mentioned provider burnout so maybe some customer satisfaction, net promoter scores, or I know Emmi Solutions was big in patient education. We had their former head of patient engagement on the show -- Gerri Baumblatt, who's wonderful -- I can connect you with her at some point.. 

Dr. David Canes: That would be great.

Shiv Gaglani: At the tail end of their company, which really scaled and Wolters Kluwer bought them, they were measuring things like colonoscopy prep. Such as what percentage of patients coming in for colonoscopy procedures were actually fully prepped, so it wouldn't waste their time or the gastroenterologist’s time. So, what are some of the core metrics that drive you and that you're measuring?

Dr. David Canes: I think about this in terms of the patient side, and on the provider side. On the provider side, there are a number of hurdles that the provider has to go through. They have to decide that they need help, they have to find Wellprept, they have to onboard, tweak the pages to their liking, and then actually start showing it to patients. The "ah ha" moment seems to be that the patient comes back in and says, ‘Thank you so much for sending me that,’ and then the provider notices that the visit is better. 

We're tracking pageviews and we know that once a provider starts sharing and the page views, start climbing, they tend to keep using Wellprept. So, we're still formulating dashboards, but that's one thread that we're pulling on right now, because it seems to be a good measure of whether or not someone's going to stick with it. I'm interested in figuring out if it saves time, on the side of the doctor, I suspect – and at least anecdotally from early users -- they say that it does. Then even if it doesn't save time, if the visit takes the same amount of time, but it's more engaging for both parties, that's also important. 

On the patient side we can see, number one, does a patient visit the page more than once? Do they share the page, and what's their dwell time on the page? Google Analytics makes this pretty easy to look at and so far, it looks like patients are going back at least twice, and they spend time on the page. It's early. This is like a baby that's just been born, but I would say the early indications are strong. As you know Shiv, it's not for everyone. I mean, the way I look at this is what are the real tools that help doctors; scribes, templates, order sets, dot phrases, those take some time to set up, and not all doctors do it, right? The ones who do I would characterize them as digitally engaged and those seem to be the ideal customers, if you will, for Wellprept. They're already digitally engaged in other ways.

Shiv Gaglani: That's great. Narrowing down kind of who your early adopters are. I'm sure you're familiar with Crossing the Chasm framework, early adopters, the early majority and then you know, obviously late majority and laggards. There's still people who don't use dictation. Obviously, some people who don't like annotation as a whole may never use it. But that's great, that's really exciting to hear about. Now, when it comes to the engaged patient, this is a topic I love, because ultimately, a lot of our goal at Osmosis is that everyone who cares for someone will learn by Osmosis. We started with medical students at Johns Hopkins, my classmates, but now the goal is to reach and educate a billion people by 2025. Clearly, there aren't a billion doctors and medical students and nursing students. It's really about patients, and we have so many stories and posts about how patients have engaged with some of the content. 

Now, typically, what you get when you go into patient engagement is, especially with COVID, now, the worry about health misinformation. Any clinician has probably had a patient come to them with the wildest theories about things, what they read on the internet. What are your thoughts on cyberchondria and misinformation, and how we can overcome some of that while maximizing the engaged, empowered patient that actually then follows through treatment protocols, takes all the antibiotics, does physical therapy before and after surgery, those kinds of things?

Dr. David Canes: Well, you know, my answer is going to sound a little bit biased. But I think the doctor should be involved in curating and vetting the content. I'm not saying they have to watch every single video from start to finish, but doctors have a pretty good radar for what is appropriate patient education material. This is the kind of feedback that I'm getting back from early access users of Wellprept. It's their page on atrial fibrillation, for example, and they get to pick and choose and doctors are really good at that, because it reflects on them. They don't want to put bad content on a page that has their name on it. So that's one way of tackling this problem. 

A little bit of a grander vision that I have is that this can be at scale. If this scales, then it can be crowdsourced and the best content can rise to the top. The content that gets the most engagement and gets shared the most will win. I think that's something that maybe is missing a little bit although, you know, I'm curious what you've learned from Osmosis. On YouTube, the cream also rises to the top because people are voting with their views and their eyeballs in their watch time.

Shiv Gaglani: It's a good point. I think it's a balance, right? Because clearly what we've seen on some of these social media platforms is sometimes the most like vitriolic or kind of wrong information can rise to the top just based on view count which is why Google changed its algorithm so that for their search engine optimization so there's additional benefit to a page if there's actually people with degrees who are clearly listed as the authors of that content. But that being said, patients often will bring up correctly that just because you have an MD behind your name, or an NP or PA, it doesn't mean you know everything. It doesn't mean that science or medicine knows everything. For instance, pulmonologist used to recommend smoking fifty or sixty years ago for asthma, and clearly our view on that has changed. There are all sorts of examples throughout medical history. So it's nuanced. It's really difficult and I'm sure you're already hearing about some of these things or seeing them in practice.

Dr. David Canes: You're right. I think there's no single answer to your question. There's not going to be one magic bullet. The thing that gets me excited is thinking about the status quo of how patient education happens. Let's just take something as simple as a discharge instruction form. You know, somebody generates a form, it goes through a form committee, it needs to be a certain reading level -- I'm not saying these things are unimportant -- but it puts up roadblocks. In a lot of ways it takes autonomy away from doctors. One solution to burnout is to empower doctors again, and let them make choices, right? Let them choose what they want to show their patients. They're great at it. Innately they want to do good by their patients, and so I know that's slightly tangential to what you're asking, but involving the doctor again in this mix is important to me.

Shiv Gaglani: Yes. Having the autonomy and control is important clearly because that's been a trend of why there has been so much burnout and moral injury, it seems. We have so many current and future healthcare professionals and many of them want to become surgeons like you, or practicing providers, or digital health entrepreneurs. What advice would you give them about approaching their career, especially given all that's happened with the pandemic and other things in society.

Dr. David Canes: I can tell you the advice that I wish somebody had told me, Shiv. I would ask young doctors and trainees to imagine their future mid-career self. We work so hard to become the type of doctor that we want to be. We don't talk enough about what happens when you arrive there. Okay? So I can tell you I'm mid-career. My practice is exactly what I want it to be. I'm a busy surgeon. I love taking care of patients. Fortunately, most of the time the outcomes are good. But what people don't tell you is that some of the decision-making is not as challenging at a certain point and I don't remember being told this.

I don't want this to sound cynical, but -- this is going to sound strong – there’s a fallacy of lifelong learning. That may seem taboo to say that, we do have lifelong learning, but it is not as steep of a learning curve as it is in the beginning. When you're in medical school, it's a huge learning curve. It's very exciting. Same thing in residency, and early career. But mid-career, while there are advancements in every field, those are incremental, and not all that intellectually challenging to absorb when you have a massive fund of knowledge.

Again, I'm not trying to minimize. We still have challenging surgical cases every now and then. But you have to think about this early on, because we're all, as a breed of doctors, hungry for learning. We love learning new things and part of what I love about the entrepreneurial route is I've had to learn so much. I mean, I'm consuming books and podcasts at 3x speed in every commute and every moment of my day and I love that it doesn't feel like work. That's not for everyone. But I would encourage young doctors to think ‘what's it going to be for me that keeps me interested mid-career? Is it going to be teaching? Is it going to be research?’ Because those are good solutions. Is it going to be hospital committee work, administrative work, entrepreneurial side pursuits…those are all things that keep people invigorated when the clinical stuff is just not as challenging anymore.  It’s still very important, and at the core of what we do. I hope that didn't come across too negative, but I think you see what I mean.

Shiv Gaglani: That's great advice. I mean, certainly, it's one of the reasons why when people rush through just to finish, to get to the destination -- you know, a six-year medical program out of high school -- a lot of times they'll regret it later on because they didn't actually explore these other interests in entrepreneurship or in research and they'll come back and do an MBA later, or an MPH. I think that's really valid advice…to make our learners aware that they should have other things outside of clinical medicine that keep them engaged and learning.

Dr. David Canes: The thing that keeps me in my primary job, keeps me invigorated, is the teaching. Patient care is at the core, but the teaching is new every year because people are coming at it fresh, and that's awesome. It's very exciting. I just think people need to give some thought to this very early because it's hard to suddenly wake up at age forty-five or fifty and then have nothing.

Shiv Gaglani: It's exciting to really reinvent yourself. A theme that we keep putting out on the podcast is how we've had people in their seventies, eighties -- I think our oldest guests is eighty-eight right now -- and they're still starting things, still learning things, creating new things. So, I think it's important to play the long game. 

I know we're coming up on time, so I wanted to be sure to ask you is there anything else about you, your career, Wellprept, medicine as a whole, that you're interested in sharing with our learners?

Dr. David Canes: Yes. I think we should talk about burnout for just a second. I think that when you're early in your career, you need to start putting into place, I'm going to say, productivity hacks. They're not really hacks. You need to put some systems in place in your practice from the very beginning to try and decrease what are repetitive tasks.  So that means making sure that your staff is working at the top of their license to help you, so that your primary job is to see patients, make difficult decisions, and move on. I would just think it doesn't have to be Wellprept. There are other tools, but you can at least consider patient education as one of those things. Patient education right now is the dusty file cabinet with all the handouts, and an acrylic board with dusty brochures, and when done properly, we can harness that to our advantage and to the patient's benefit.

Shiv Gaglani: I love that. That's an inspiring note to end on, especially because the point I always like to make is that we will never have enough endocrinologists in the world to treat all the people with diabetes. However, if we can get a massively engaged population of people, especially in early childhood, to truly understand metabolism, food, the importance of eating healthy and exercise, then we can prevent millions of people from getting diabetes and won't need as many endocrinologists. 

Dr. David Canes: That's a theme that I know you keep hitting on, which is that there's a lot of one-on-one interactions that doctors are used to, but there are ways that we can scale our presence using digital tools to move beyond that old paradigm. That's the way things used to be and moving forward we can scale ourselves, to help patients and to help ourselves.

Shiv Gaglani: I love it. Best of luck with Wellprept. Thanks for all that you're doing not only for patient education and engagement, but obviously day-to-day as a practicing provider and for taking the time to be with us on the Raise the Line podcast, David.

Dr. David Canes: Thanks Shiv. I appreciate it.

Shiv Gaglani: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to Raise the Line and strengthen our healthcare system. We're all in this together. Take care.