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DGTL Voices with Ed Marx
Telehealth: Bridging the Gap in Modern Healthcare (ft. Aditi Joshi MD)
00:22:25
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- [00:02]
A
Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marks.
- [00:19]
B
Hey, everyone. Welcome to another edition of Digital Voices. Super excited because our guest today is. Is Dr. Aditi Joshi. Aditi, welcome to Digital Voices.
- [00:30]
A
Thanks, Ed. Nice to be here.
- [00:33]
B
It's so cool because we're in multiple formats now, so traditionally we've been audio only, and now we're video and audio. So this is super fun and I'm really excited about this conversation because you're an author, you're a clinician, you're telehealth leader, all sorts of great attributes about you, but. But the best part is you just this wonderful person. So it's really good to be connected. And so we. We first met. That's sort of how we met, is through your book. I heard about your book, I saw your book. I was like, I need to meet this person. And, you know, again, you're. You're very well known in the space. And after we met, we decided, hey, we, maybe we should write a book together. So we'll talk a little bit about that in a bit. But the most important question, Aditi, that we have on Digital Voices are what songs are on your playlist? What kind of music do you like to. To listen to?
- [01:21]
A
Oh, man. So that's such a good question. I have so many different ones at the moment, maybe because I'm back in Chicago during the holidays and I. Is all of this grunge? I used to listen to a lot of grunge in the 90s when I was in high school. So there's a lot of Pearl Jam, Alison Chains, Soundgarden. So I'm listening to that. Going through a little bit of a nostalgia period.
- [01:41]
B
Yeah, I like that music as well. What about life? Message or mantra? Are there words that sort of guide how you live?
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A
Yeah. So not to be morbid, but what I always think through is this too shall pass away. And not even in this, like I said, morbid way, but also that anything that might be feeling terrible or awful even is going to pass. And even things that are really great, you really want to indulge in them and really be there and present for them, because nothing lasts forever.
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B
Yeah, that's. That's a good frame of reference. So tell us a little bit about yourself.
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A
Who are you?
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B
What story?
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A
Where.
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B
Where did you grow up?
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A
I grew up in Chicago, so one of the suburbs of Chicago. A great city to grow up in. I loved it. You Know, you could go into the city. It was a great, It's a great city. It's beautiful. For anyone who's not been here, it's beautiful. It's got a lot of wonderful events and restaurants, all of the things you want right on the lake. And so, yeah, I was here and I also went to undergrad and medical school here, but after that I never lived here again, but moved to a lot of different places after I graduated med school, went to emergency medicine residency and then I lived in the northeast of the country for about 14 years, which was also great, was Philadelphia and New York, New York being one of my favorite cities ever.
- [02:59]
B
And then you also have some foreign experience.
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A
Yeah, so I live in Paris, which you've always remembered that about me, right? Everyone remembers things, but as you go through meetings and networks, everyone's almost like, oh, yeah, you live in Paris. But yes, moved to Paris about three and a half years ago.
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B
Yeah. What's that like? How's that being there?
- [03:18]
A
It's amazing. It's beautiful. It's a beautiful city, as most people realize. But there's, you get like any place you start to understand it more. I have a lot of friends. It's a very interesting culture. And yeah, it's just, just wonderful food and events. And, you know, being in Europe also makes it a lot easier to travel to other places. So I really enjoy it. I mean, I love it.
- [03:41]
B
Yeah, that is a nice thing about Europe because, you know, United States, if you took a three, three hour trip to the United States, you could still be in Texas, you know, if that's where you started, or even a six hour trip. Whereas in Europe could be in multiple countries during that time. That's really nice. So was there a pivotal moment in your life that sort of changed your trajectory?
- [04:02]
A
Yes, and it's, you know, it's probably like a slow pivot, but, you know, it was probably getting burnout. I got burnouts or I realized that it was pretty bad. In 2012, I was working my first emergency medicine attending job. I lived in New York City. I was working in a hospital in Jersey City, which was very busy. But I think because of that, it really changed the way that I thought of my career because before that I was always, I love emergency medicine. I still still think it's one of the most fascinating subjects around. And I thought I would do it forever. And I found that it was really, really tough to get burnout because it changed the way that I thought of myself, the way I thought about what I wanted to do. With my life. And it really changed, really, my career trajectory after that, because that is where I got into telemedicine in 2013.
- [04:49]
B
Yeah, cool. Yeah, we'll dive. Dive into that. So generally, though, how did you choose healthcare as a career?
- [04:56]
A
I was one of those people who always wanted to be a doctor, even when I was a kid. If you asked me as a kid, I think I said I wanted to be, you know, like a superhero or whatever kids say. And also a doctor. Always said I wanted to be a doctor. I did think that I would be a surgeon, cardiothoracic when I was in high school. And then when I was in medical school and undergrad, I thought probably general surgery, maybe orthopedics. But when I was a second year of med student, we had a lecture on pathophysiology and toxicology from an emergency medicine doctor. And his lecture was just so interesting and he was so engaging that I thought, oh, maybe this is something I want to do. And I did a rotation in it. And I tell the story because it's not even the medicine. I love the medicine of emergency medicine. But during that shift, you know, there was the medical students, the residents, and the attending was doing rounds and doing the turnover. And instead of just asking medical questions, he started asking literature and trivia questions mixed into it. And that's really why I was like, oh, these are my people. So that's why I chose emergency medicine.
- [05:58]
B
Yeah, no, I love that. And you alluded to this already, Aditi, but you, because of this burnout that you were experiencing, you sort of learned more about telemedicine and then became a leader in that area. So. So tell us more. So what. So what happened at that point? Like, how did you get into telemed and virtual care?
- [06:15]
A
Yeah, I was looking, you know, around 2012, 13, I was looking for other avenues. I was still doing emergency medicine, but as a locum. So a lot less. I saw in a story. It was a company called Doctor on Demand that had just launched. They put a story out. They said they're hiring. And I said. I was like, oh, this sounds interesting. They're doing, like, remote work and they're using tech. So I actually reach out to them, and it turns out that the chief medical office at the time was somebody I knew from Chicago. So this is when people say that you just never know where your life takes you, because I knew him when I was, like, 20. And so he was like, oh, my gosh, how nice to reconnect with you. And so I did join it. I became one of the first doctors that was practicing, eventually their assistant medical director. So I was there for three years and it went from zero patients to just shifts that were overrun with patients. So it really had a really interesting trajectory over those three years. And then from there I was recruited to Thomas Jefferson. Judd Hollander, who is over there, likes to joke that he stole me from them, which he really did. But then I was there for five years and I ran the telemedicine over there, that big academic center. It was an incredible experience. And I always say that it was just like a step different because when people think about their career, sometimes we don't really think through the ideas of it. But what I did find is that going from a startup where there was one type of telemedicine, we were practicing and then going to Jefferson. And I'm really glad I made the decision because then we got to try it out everywhere. Right. We were in every department. We had a number of different specialists. And the beauty of academic centers and you know, this is that you can reach out to a specialist and super specialist in anything. And so you can find out information just. Just by emailing somebody or getting on the phone. And so I found that, like, really great to do. And from there, yes, we. A lot of the televised medicine work ideas stem from that as well.
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B
Yeah, that's really cool. And what, what was it like to leave the. You know, there's a safety in traditional practice and you abandoned that in a sense when you went to telemed, practicing differently. But now, and we're going to talk about what you're doing now, what was that hard to do? You know, that to leave that safety and try something new kind of as entrepreneurial angle.
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A
It was hard and partially because it's so much part of your identity being a physician and practicing in that matter. So giving that up was really difficult. Now I will say I still see patients over telemedicine, but I don't see patients in the emergency room right now. And yes, every so often I feel, I have this like feeling of a loss of identity. But so that's tough just as a personal way. And then, yeah, you know, you do have a lack of safety because you don't really know is this going to work out or pan out. But I will say that there is this idea of safety, being a physician doing it, because there is always a backup. Let's say it doesn't work out. There's this backup that's going on up there, but I don't know, I can't tell you the answer because there's still times that I'm like, what are you doing? Why are you on here? This is not safe. Right. So I don't know if it ever really goes away.
- [09:16]
B
Yeah, I think I'm with you. I'm the same way. I've left my secure, stable career as a CXO and health systems and, and on my own for three plus years now. And it's the same thing. But I have, but I have no regrets. I'm so happy to be independent. I know you are as well. So. Yeah, tell us about what you're doing today.
- [09:35]
A
Yeah, great. So, you know, just from the last couple of years, I did a lot of consulting and I was in different parts of the world too, building out mostly telemedicine, but every so often other types of digital health programs. And throughout that experience, I realized that one of the things that I really enjoyed and really was part of my job since, since the start was getting doctors and other clinicians to feel comfortable using digital tools. And then when I looked at the entire market and I think we're seeing a lot of interesting ways that the investments have changed. We're also seeing interesting ways that health systems have been really needing to focus on the investments that they have already. The economy is taking a bit of a downturn. I think we all know that. And so when I thought about what is going to be most important, I realized it's going to be making sure that the tools that we have, the technology that we already have, is being used to its highest ability. Most of the time people think that we've figured that out, but you know this as being at like all these CSOs everywhere. They haven't. We are like full of pilots. We have these great ideas, but a lot of them die in pilots and they don't really become part of the health system or integrated into medical practice. And so taking that problem, I looked through every playbook, every, everything I've ever done and put together. How is it, do we solve this problem? And so I built a company on solving the problem of using digital tools that we have by clinicians so that health systems croi clinicians use them successfully and want to use them. And the end result, it's indirect, but I think this is the most important part, is that patients actually have access to them because they want to be able to use these tools effectively for their health.
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B
Yeah, that's awesome. Can you share example? You don't have to name the name, but just share an example so that people get, get a sense of.
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A
Absolutely. So, you know, there were. So I was somewhere in the south and I won't give the name. And it's not even because part of it is because I think, well, I'll tell you after. So let me just tell you the story first. But basically they were trying to actually figure out using an AI triage system. They had already bought it, but they were saying that they couldn't get their specialist t use it and they couldn't figure out why. So primary care doctors were using it just to actually get people into the clinic and get the, like the algorithm will tell them what's their general idea of what they're here for. They'd of course, check it with the patients, et cetera. And primary care doctors loved it, they used it. But then they were having the problem. They're like, you know, we are asking the specialist to use it when the primary care doctors want to send some information to them, but we can't get them to use it. And we don't know exactly why. We think that maybe they don't like the technology. They don't believe that what it is doing the right algorithm. So, you know, long story short, we just delved into it and we figured out that the actual idea was that they thought they had to be on call 247 to do this, when in reality the primary care doctors were sending adults, people to the ER if they needed immediate care. They weren't asking them to do it 24 7. They were actually saying, just please look at this within a timeline and then we'll actually refer them to you. And so this sounds so simple. And you know, this is a simple fix, but this is exactly the problem, right? All of these things are happening when you have different departments and different people speaking to each other. And so we went in there and we just fixed it. We said, no, this is the problem. And then, you know, we figured out a way that they could, you know, have the actual ti to make sure that happened and that everybody was on the right page. And it just takes about, you know, structuring and organizing it. And just to my first point, and the reason I don't even like to necessarily say who it is, at least in public, right. If people want a referral, of course, is that, you know, what happens is everybody's saying, oh, well, well, you know, if I look at that, that ex hospital, my hospital's not like that, so we're not going to have that problem. But the reality is everybody has this problem. I don't you know, it, you know, I don't care. So I don't like them to like, assume based on who it is or who they know there, that this is not a problem that is universal. It happens everywhere in some format.
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B
Yeah, I, yeah, I could definitely relate. Yeah, for sure. That's pretty universal. Let's talk about your books. So the first book that you have is on telehealth success. And in there you talk about some of the pillars for success. So for people who are still sort of making adjustments, I think everyone sort of went to telehealth as a result of COVID but we saw a great rollback in the use of it. And I think some of it has to do with maybe not really having, you know, they, they all rushed to it, but they didn't really have these pillars as you define them. Can you talk about some of those?
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A
Absolutely. And I think you're right. You, you know, you do something in an emergency, you don't necessarily set it up in a way that's longstanding. And again, so this goes back to why I'm building this, because I, my first thought was actually for telemedicine, because around the world, this is how happening. But the idea is just, you know, how do you organize? How do you figure out the steps that you need to do? Because let's be honest, not everyone can hire a consultant to do this. And so in those pillars, it's basically just five things you need to think through. First, being the patients, because I think we should all start with patient care. What do they want and what is it? The problems that your system or your clinic has that you're trying to solve. And then you go to the clinicians, which ends up being exactly this whole problem, like how do you get them on board, how do you make it safe, how do you have the right leadership team? And what is your process for getting evidence as well as qa? And then we talk about the technology, but technology is really never the problem. We have more technology than we can, we can use at the moment. And then, you know, the finances. And this goes into not only how do you pay for it, but what are the confines of the health system that you're in and how do you navigate it? And then last is compliance. And, and that's really the catch all for everything that's related to making sure that you stay compliant. It could be legal malpractice, it could be regulations, the governance. And so when, you know, we wrote this out, we thought through what makes programs successful. And these are things you have to think through. Everyone has to think through this.
- [15:32]
B
Yeah, that's great. So I highly recommend the book and we'll put in the show notes but you're working on a new book. So this is. We're recording in December 2025. So super excited because to working on it together. You want to share a little bit about what, what book we're working on.
- [15:46]
A
Yes. This is so exciting. So all of you listening probably know that Ed does this whole series of voices of innovation, gathering voices from different areas or types of industries to figure out what the stories are for innovation in healthcare. And so we are just launching and submissions are open until mid January for Europe. We want to be able to get all the voices and understanding of all of what is going on in innovation and healthcare in Europe specific specifically not eu because we want all of Europe. So we had to change the name for that. And it's been really exciting because you know, I, I live in Europe and you have ties to Europe as well. And we want to be able to collect like take those stories and be able to talk through them and see what is really going on there.
- [16:29]
B
Yeah. Well, we'll drop information on how to submit. Super easy process, super important because all of the royalties go to benefit those who are less fortunate. So super excited. We'll make an announcement about that specific beneficiary soon. So Aditi, it's clear through, you know, your journey not just growing up, but also as a physician leader and then leading in telemedicine and now you're leading your own companies and helping other organizations. You've got some pretty stellar leadership skills. What do you think are one or two of those skills that help lead to your stellar growth and success to date?
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A
The first I'll say, and this is true for probably all parts of life, is be curious, keep asking questions and never make assumptions of what you know. I think it ends up happening too, you know, and I had to learn this along the way as well, specifically when I was teaching medical students or residents. You also sometimes forget the things that you learned. But when you're teaching or when you're asking questions, it forces you to crack on those assumptions. So that's one thing that is really important. Second, you know, as a leader, I would say that I think the most success that I've had is when I will sit there and try to really delve into what the everyday doctor is doing, the everyday patient is doing, and really go from start to finish. There's no way I can know it a hundred percent but as long as I'm sitting there and I can sit there in it and try to figure out that pathway that has given me more information than simply talking to people. Talking to people, obviously to figure out their pain points is helpful, but you have to really get in there and see what it is. So just be an active participant in whatever you're leading. This is true for everything stupid thing, you know?
- [18:12]
B
Yeah. Full on immersion. Where do you go? What do you do when you feel like your creativity is drained? You're obviously a super creative person. What, what do you do, like in those times where you're like, you just need some mojo?
- [18:24]
A
I do one of two things. If I'm really having like a, you know, it's been like weeks and weeks of weeks of just too much, I will take a day where I just do absolutely nothing, like as lazy as possible. So I will do that. Not very often, but I will do that here and there. Because you can't obviously do that all the time. But I will say that is, that is an okay thing to do and anyone out there feels that way to do it. It's the best. But second, I think on a daily or more often, what I do is if I'm feeling that rut, I will just go take a walk. It is so simple. I know people say that all the time, but it works. I mean, people say it because it works. Especially helps, you know that when I'm living in Paris, I can just find a new street and that'll bring back the creativity and just get you out of your brain for a second, get your body moving, you know, out in the streets.
- [19:08]
B
Yeah, I love that. What's something that your parents made you do when you kid and you sort of rolled your eyes maybe, but now that you look back, you're glad that they did.
- [19:18]
A
Yeah, this is really specific. But, you know, so my parents grew up in. My mom's from Kenya, my daddy's from India. And so we spoke a number of different languages growing up. And they wanted me to learn them and they also wanted me to learn to read and write Sanskrit. So I remember that they would sit there after the dinner table and they would make me pronounce the letters properly. And I'd be like, no, that's what I'm saying. Anyone who's learned a different language will know this. Or anyone speaks a foreign language will know this very well. Because I'm like, no, that's what I'm saying. They're like, no, you're not. And you're not hearing it. So they would make me do this over and over and over again until I could pronounce it properly. I really look back and really, that was a pain. But it is something that I really appreciate for many reasons. I can say my name properly. I can speak in India with the right pronunciation. But second, now that I'm in France and the French also have a couple of different sounds that do not exist in either of those languages. But I have way more muscles in my mouth to speak French differently than people who don't speak other languages. So that really helps.
- [20:19]
B
Yeah, that's very cool. Wow, Aditi, we spoke about a lot of things, everything from grunge music to this two shall pass sort of a philosophy. We learned all about you growing up in Chicago, primarily, and then just how you matured in your career as a physician, working in the ed and then that leading to telemedicine and sort of your expertise there and also with tech adoption and in what you're doing today, helping a lot of other organizations around the world sort of integrate all these different tools. And then we talked about your first book that you've written. And again, we'll put all the information in the show notes and the book that we're writing together, Voices of Innovation Europe and how to participate in that. We talked about leadership. Some of the key skills, like be curious. And the other one, as I interpreted, was dig deep, like, do immersive understanding, not just, you know, theoretical understanding, to. To really know something on a. On a significant level and. And just life in general in Paris a little bit. What did we miss? Or is there anything you want to double down on? I'll give you the last word.
- [21:25]
A
Maybe I'll just send out a message just because I get a lot of questions from physicians in general, but in physicians specifically. And how do you create a career like this or how do you create a life like this? And I just want to say that, you know, you just need to stay excited and just remember you can live your life in many different ways. Just because you learn that it's med school, residency, attending life forever and ever, it doesn't always have to be that way. And so I encourage everybody to really, if you feel that idea or something that you want to change, try it out. There are very few things in life that are not reversible.
- [22:02]
B
Yeah. Love it. Very well said. Thank you so much, Aditi, for being our guest.
- [22:08]
A
Thanks, Ed, for having me. Thank you for listening to Digital Voices. We hope today's conversation sparked ideas, reflection, and connection. Subscribe on YouTube, Apple and Spotify podcasts so you don't miss an episode.