Dr. Kathy Gregory has been practicing in women’s health for a quarter-century. In that time, she’s started her own practice, seen the rise of electronic medical records and other technology-based care enablers, embraced telehealth, and looked for ways to make care streamlined and effective. Now this early adopter shares why genomics, the branch of molecular biology focused on the structure, function, evolution, and mapping of genomes,will transform women’s healthcare plus how technology continues to support stronger patient/clinician interaction.
When it comes to women’s health, you’ve seen it all. Share a little bit about your professional background.
I’m a gynecologist who’s been practicing in San Francisco for 25 years and in solo practice since 2007. I am an OB/GYN by training but I stopped delivering babies shortly after opening my own group and now focus just on surgery and broader women’s health issues.
And you’re something of an enthusiastic early adopter when it comes to technology in your practice — is that right?
It is! I’ve always been passionate about what technology can bring to care. Anything you can do to get rid of unnecessary steps and frustration — plus improve the quality of care — is a huge win in my mind. That’s out of practicality. Most physicians get about 15 minutes to spend per patient. I want to spend as much of that time with my patient as I can — so that leads you to look for ways to automate things like your workflow, their check-ins, forms that need to be filled out, billing, etc. I was early when it came to electronic medical records and I’ll continue to be early on technologies that make it simpler and easier for staff to do their jobs and patients to sit down and talk with me.
Technology has brought down labor costs, made care better, and improved the patient experience. Those are all huge.
So we’re guessing you’re pretty enthused about telehealth then?
Absolutely. Telehealth offers a huge benefit in terms of patient connection. Think about that in-office experience: my 15 minutes per patient can really get whittled down to seven if there’s an insurance card issue, lengthy check-in process, getting vital signs. But if patients can see me in their own homes, they can take care of much of those details electronically and we get more time together.
Of course, in women’s health, there are some things you have to come into a physical office for. But having a telehealth visit first confirms that need. Plus, much of the time, patients actually don’t have to be in the office to be diagnosed and telehealth saves them the time they would have spent getting here and back home again. I saw that many times in the course of the pandemic. I was able to support patient care, without adverse outcomes or a dip in quality, through email and telehealth video visits.
How will technology change women’s health in the future?
Genomics will be a total game-changer for our decision making. Even a decade ago, we only had two identifiable genes for breast cancer. Today, we know so much more about a patient’s risk factors based on their genetic type. Genomics will make it possible to do more preventive care in the next five to ten years. We’ll know if someone is at greater risk and thus we need to do more regular testing or introduce certain therapies earlier.
You can imagine that genomics might help us understand how you metabolize a certain medicine slowly or quickly, which would guide our choice and dose of medicine to prescribe. And by understanding a person’s familial cancer history, and having that incorporated into decision support tools that also pull from the latest literature, you could see a world in which a technology platform flags a test we should run on a patient, for example.
Genomics will help us start earlier to save lives and avoid preventable illnesses and death. It’s very exciting.
Another hot topic for the clinician community these days: payments. What are your thoughts on fee for service versus pay for performance?
I’ve been fee for service for essentially my entire career and I believe in that model because it aligns all interests. There is so much more to quality than “How many mammograms do you order?” Pay for performance puts pressure on providers to ration care, which I don’t like. And it comes from a faulty line of thinking — that somehow doctors will try to extend care past the number of visits a patient’s condition really warrants. I don’t see that happening. Patients are proactive, they’re well informed, and they pay co-pays every time they come in. They are naturally disincentivized from going to a doctor who can’t handle their care in a reasonable amount of time.
And, ultimately, I’m not convinced pay for performance serves patients better, which is the real test for me.
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