Designing for Health: Interview with Sarah Krüg [Podcast]

In the world of design, a tried and true method of crafting clear communication for a given client is to help the stakeholder stop overthinking things by asking them simple questions: In layman’s terms, what would you want me to know about your product? What do you want to say? How would you describe this to a friend? The same methodology can be used in healthcare, where patient advocates can ask unintimidating questions and use data-driven research to rip up patient problems at their root, while helping realize the healthcare experience they desire.

On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, talks with Founder of Health Collaboratory and Executive Director at Cancer 101, Sarah Krüg. They discuss Sarah’s work on things such as The Magic Wand Project, designing in the health space to improve trust, and doing the “Patient-Doctor Tango.”

Listen here:



In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple PodcastsAmazon MusicGoogleiHeartPandoraSpotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Make sure to leave a 5-star rating and write a review to help others find the podcast.

Want to hear more from Dr. Joseph? Order a copy of his book, Designing for Health.


Show Notes: 

[00:00] Intros

[01:15] Sarah Krüg’s background in healthcare

[02:08] The Magic Wand Project

[13:07] The patient shark tank

[20:56] Performing the Patient-Doctor Tango

[22:27] Design fails

[28:47] Developing Healthcare Confessions



Dr. Craig Joseph: Sarah Krüg. Welcome to the pod. It's great to have you.

Sarah Krüg: Thank you so much for having me, Craig.

Dr. Craig Joseph: I am very excited about this talk because we are going to be talking about confessions. We are going to be talking about magic wands. We are going to be talking about Shark Tanks. These are all things I don't generally get to talk about. So I think this is going to be great. Why don't you tell us a little bit about where you are now and how you ended up at this place, where you are doing all these cool things.

Sarah Krüg: Thank you. So I'm a researcher by trade. I'm a patient advocate by choice. I've worked across sectors, started out at a cancer center called Memorial Sloan Kettering with a focus on building disease management pathways. I was at Pfizer for about a decade, starting out on research, transitioned into medical education and patient advocacy. And then today, I wear two hats leading two organizations as CEO of the Health Collaboratory. And that's basically a global innovation hub focused on cultivating trust and bridging gaps across healthcare by amplifying the raw and diverse voices of the patient, the care partner, the clinician in the co-design of healthcare innovations. And then I'm also executive director of Cancer 101, which is a patient advocacy organization that helps patients and their families navigate healthcare in partnership with their healthcare team.

Dr. Craig Joseph: That is, you are a busy, busy person. so, you know, one of the projects that you had told me about, when we were preparing for this talk was the Magic Wand Project, which I first of all, I love the name. can you tell us a little bit about, hey, where that name came from, what you were trying to achieve, and how you achieved it?

Sarah Krüg: So the name, I feel like it's with healthcare doesn't work out for me. I would love to pursue a career in naming projects. I just I like to come up with interesting names. I have an idea book that I carry around and, you know, I have a whole chapter on just names that I want to give to some of our innovations over time. but the majority of our innovations, they stem from a simple question. If you could wave a magic wand and change one thing about healthcare, aside from making it free, what would you change? And so we asked the community that question. We got over 10,000 responses. so we had all this data. There were some interesting responses, some simple, others a bit more complex, and we bucketed the issues into different categories and combine that with, focus group data to really identify the barriers that people were facing. So we wanted to understand what was out there, what was working, what wasn't and why, and where we found gaps. We ended up co-designing solutions with patients. Well, I should say patients, care partners, clinicians. and that's really our secret sauce, ensuring that we don't just create something because we think it's a good idea. We take the time to understand the pain points and then work with patients and others to co-design those innovations. And it doesn't matter what field you want to innovate in. You know, it's just really important that you take the time to understand and listen to your, target audience and then obtain their perspective as you're building the innovation. Because, you know, we all know that if you build it, they don't always come. And yes, I'm a patient advocate, but I'm also a clinician advocate. And there are times we in healthcare develop patient engagement innovations that in turn introduce workflow constraints for the clinician. And then it doesn't work. So clinicians and other important stakeholders have to be involved in order for us to co-design and go beyond a bunch of colorful post-its.

Dr. Craig Joseph: Yeah, I think this is a key point that a lot of people miss, including myself. you know, if you're trying to design a better workflow for, cardiologists, yet you get the, your subject matter expert is the chief of cardiology who, you know, barely practices, and barely follows the, the same workflow that everyone else does. you might get answers, but they may not be the best answers. And so, you know, understanding who your audience is and then getting a representative group, is much easier. It sounds very easy, but in fact, it can be difficult and leads you lead you astray when you design the most amazing thing and no one uses it. And then you wonder why

Sarah Krüg: Absolutely. And so, and I often say that innovation isn't about technology. It's not about the shiny new car. Sometimes it's about paving that smoother path for an old car to travel down and thinking about a back to basics approach. And, you know, one of our, our first co-design projects was tackling one of the Magic One projects manage the free show hospital gown, which makes me feel dehumanized and exposed. And in that project, we brought together, 25 patients who brought in clinicians to talk about accessibility. We brought in fashion designers and seamstresses and looked at previous redesign efforts. And then we engaged in, you know, again, what I call a participatory co-design process and created a new hospital gown, which is a cross between a kimono wrap top and basketball tearaway pants. And we're not going into the hospital gown business. The intent here was to show how easy it is to partner with patients, to co-design a solution based on issues they've identified. and we didn't anticipate we'd get flooded with requests for the new hospital gown because it was just a project to illustrate how easy. But that was a fun project, for sure.

Dr. Craig Joseph: That's great. And certainly it's you know, it's one of those things where you don't really think about a hospital gown until you're a patient and you have to wear one for a long time, and then it becomes, a big ordeal. and so I again, think focusing on the and the right audience, kind of asking people even something that seems minor, hey, especially if you're only going to, you're having a minor procedure, you're only going to be there for, half a day or so. It can be a big thing. And like you said, when you're kind of exposed that you feel very vulnerable. And that is not the feeling that we want when you're engaging with, a healthcare team. So. So, kudos to you for trying to solve that problem and for making it fashionable to solve. You know, we want to look good before that colonoscopy or that, that operation, I think.

Sarah Krüg: Yeah, I think the added touch there with the kimono, was the basketball tearaway pants, where obviously we had to think about things like, if you're in an MRI machine, what are the materials you use, etc... But yeah, that's, something we actually created it and we debuted at, a few conferences. But again, we haven't gone into the hospital gown business just yet.

Dr. Craig Joseph: All right. Well, it's always, you know, there's always a future there. I can just see if you're if you're incredibly successful, people are, faking their way into the hospital simply so they can access your, tear away, kimono combination, that would be great.

Sarah Krüg: Yeah. Now I just have to partner with Dolce and Gabbana, and then we'll be set.

Dr. Craig Joseph: So the Magic Wand Project, one of the things since you got so many requests, one of those was the hospital gown example. Were there other examples of things that came through the Magic Wand Project?

Sarah Krüg: Yeah. So, all of our innovations actually, again, stemmed from the Magic Wand project. So I need a health GPS to help me navigate healthcare. That led to our Prescription to Learn platform, which is, essentially an ecosystem to navigate resources from credible sources in an era of misinformation and just a ton of information, patients don't know where to start. Patient Pathway was another innovation that was geared towards taking guidelines, in cancer and creating a bird's eye view for patients to understand and track their symptoms, track their medications over time, understand treatment options, things of that sort. Patient CliffsNotes was a tool that we created to provide people with simplified education and the initial steppingstones when they're first diagnosed. I call it day one education. So I don't know if you remember the CliffsNotes. I know you didn't use them, Craig, but the CliffsNotes when you were in school, you had a, you know, CliffsNotes for every book or a subject. So we essentially took that concept and created the Patient CliffsNotes to provide, again, simplified education when you're first diagnosed, recognizing that patients don't want to be overwhelmed with a ton of information at that point, they're going through an emotional journey. And so the point was just to provide them with the basics and then layer in additional content over time. And then there's the Tequity tool. So tequity, I refer to the concept of tequity as the moment when health equity and digital literacy collide. It's really an opportunity to democratize health by recognize we all have different preferences. Right? And there's often a misconception that just because I own a smartphone or I have access to the internet, that I have digital literacy, proficiency when it comes to healthcare. And we can't forget again about the fact that we all have different preferences. We may learn in different ways. And so as we explore the next frontier of education and data access, it's important we prioritize those preferences. So we developed the tequity tool, which is focused on capturing how people prefer to receive information based on different healthcare interactions. And it allows people to share their preferences and digital needs around different types of healthcare interactions with their clinicians, so it can be personalized accordingly.

Dr. Craig Joseph: I love all of that. The idea of CliffsNotes is great. I don't, again, for the record, know what those are. And when I read, Virgil's The Aeneid, in high school, I assure you that I did not look at, the CliffsNotes So.

Sarah Krüg: How about The Fountainhead? Did you ever.

Dr. Craig Joseph: Ayn Rand? Yes, I did read that, I don't know, did I read, were there CliffsNotes for Ayn Rand?

Sarah Krüg: I think there were. I mean, I don't know either. I just came up with that. Oh.

Dr. Craig Joseph: No, of course not. Yeah. No, neither of us would know about that. However, though the point of, hey, we're just going to talk to you right now about this new diagnosis that you probably know very little about and, and give you the things that you need to know now, but kind of just give you the information that that you want to know without overwhelming you. And that's really complicated, right? Because they're going to, people are going to learn about their diseases very quickly when they get a scary diagnosis or a chronic disease type notification. And yeah, giving them the information that they need at that time and then being able to build on that over time is, sounds pretty straightforward and simple, but I don't think it is. And you have to, like as you mentioned, you have to meet the patients where they are at that time. And so it takes a lot of, a, a thoughtful process. So again, kudos to you for kind of taking on that, that necessary role. If you just if you just go to the internet, who knows what you're going to see, right. I think that's certainly, appropriate. Maybe on week two or week three, once you've got your once you've got your sea legs. But, at the beginning, this could be a big difference.

Sarah Krüg: Absolutely. And the intent also over time, is to start to personalize the type of education that we receive based on even the emotions we're experiencing. Right? Day one, you're in distress. You just found out you have cancer or another health condition. You know, you're distraught and it's in one ear, out the other. And so the idea is to really think about the emotion that patient and or care partners, experiencing and then tailor the type of content they receive layered in. You know, we don't learn French in a day when we're signing up for a class. Why are we expected to learn about our condition so quickly and then make life altering, decisions? And so it's really important we think about the emotional journey. We think about the, learning readiness, the preferences that people have around different types of technology. Not everyone is necessarily comfortable with utilizing their mobile device to consume healthcare. But today, you know, we think about paper at the point of care, and that's almost gone at many institutions. So we really have to think about reaching people where they are and bringing them to where they need to be.

Dr. Craig Joseph: Yeah. That's it sounds like a good use case for generative AI at some point. Right? so you could, you could, have a general template of what you're going to be, what information you're giving. But it's probably very different for a 20-year-old than for a 70 year old. Or someone with a, you know, advanced education versus someone, who, who doesn't have that and kind of, again, focusing and tweaking it so that everyone gets a somewhat personalized experience.

Sarah Krüg: Absolutely. You know, AI is something that we've started to incorporate into our Patient Shark Tank. So Patient Shark Tank is another platform that, we developed to engage different types of people, whether it's education, whether it's socioeconomic status, whether it's race, ethnicity, their preferences around technology. And when we think about engaging patients today, we typically reach out to patient influencers or expert patients who might be on social media. We reach out to patient advocacy organizations; we aggregate data through online communities. We engage volunteers through facts, and those are all important channels. But how do we ensure that we're not leaving the other patients behind, as we're thinking about things like AI or these other innovations we've been talking about? You know, many patients don't go online to share their healthcare experiences or even publicly admit they have a condition. Many are not reaching out to patient advocacy organizations on day one. So how do we ensure that these patients are part of our conversations as well, so that our innovations and our data, they're not biased towards those that are more engaged with these channels. So I created the Patient Shark Tank to amplify, the voice of the patient, the care partner in the design and the development or continuous improvement of healthcare innovation, whether it's tech research, clinical trials, education. And we've engaged over 25,000 patients and care partners across conditions globally. And there are different models we use to engage them. And then we've co-designed, it's a 12-part proprietary scorecard they use to assess the innovations that's used to provide structure to an assessment, but it also gives patients and care partners that opportunity to reflect on their unique experiences, their unique perspectives. And again, although they're expert patients and care partners who are part of the Patient Shark Tank, the majority have an interface with anyone in the healthcare ecosystem outside of the healthcare team. You know, they're not going to conferences, they're not on social media talking about their condition. So as we build out things like generative AI, it's imperative that we bring in the perspectives of those that are typically not as engaged to understand those viewpoints and understand whether or not, you know, there are constraints to utilizing that in healthcare over time.

Dr. Craig Joseph: Sure. And I think one of the aspects that you've talked about is, is ensuring that you're, you're designing to, to, to improve trust, to allow the, the person that's, leveraging the innovation often the patient or the family, to trust that this tool, this innovation, this workflow, this technology is actually there to help tell me a little bit about what you've done specifically about trust.

Sarah Krüg: So an important piece of evaluating an innovation is evaluating the terms. And conditions that come along with that innovation. And that's typically something we all don't necessarily read. And so what we have patients do is we have them assess the terms and conditions using this scorecard. And then once we are finished with the translation, because oftentimes they don't understand the verbiage using the terms and conditions. Once we translate that and then provide them with the specifics around, scenarios and provide them with additional context, then we ask them whether or not they would potentially utilize that tool. And it helps move the needle as it relates to whether or not they would use that tool because they don't trust it. What would make this more accessible to them? And so the recommendation I often have for, for all organizations developing innovations is a simplify the terms and conditions so that patients don't have to look up terms. And if the legal folks require that you have those legal terms in that in the, you know, 50-page terms and conditions, create the CliffsNotes version, create the simplified version, up top so patients understand patients and their care partners understand what they're signing up to. Because the last thing that you want is for patients to get upset after they've utilized that tool. And I can think of different organizations out there that have gotten in hot water over time, because patients didn't necessarily understand how their data was going to be collected, protected, shared. And I often say that transparency is one of the most disruptive innovations of the 21st century. And so it's critical that people know how their data is being utilized over time and understand the specific nuances around how we define things like research. And I'm not going to name any names, but, you know, I think it's just important for people to be aware of how their data is being utilized. And that starts with the terms and conditions, and that can help build trust over time with healthcare. Because trust is at an all-time low. We actually created something called a trust-ometer that helps assess trust between patients and their doctor, trust between patient and the healthcare system, and then trust in research and science. You know, unfortunately, you know, the silver lining to the pandemic was that everyone started to understand clinical trials, right. The term clinical trials became that household name because it was all over the media. But the unfortunate part is that when people were learning about the vaccine and race to the cure, they also thought that perhaps we were cutting corners, that there was, you know, a lot of things that science was doing that wasn't necessarily in the best interest of the patient. And so that led to a lot of mistrust in healthcare. And the ripple effect is that it didn't just, you know, stay with Covid, per se. It, there was that ripple effect into other parts of healthcare. So trust in healthcare is at an all-time low. You know, I can go I can go off on a tangent on this for days. But it's really important people understand how their data is being utilized.

Dr. Craig Joseph: Yeah. Well I certainly consider transparency core part of, of human centered design. So they understand how an elevator works and so they understand how their, how their data are being shared and, who's seeing what and when and how and sometimes it's, it's limiting. Right? and so it's easier from that third party perspective to, to bury the details in these big legal forms. But, as you point out, it often can come back to bite you. And I think also, the opposite can be true where people are like, oh, well, why are we not sharing this even more? I want others to be able to benefit from what I'm going through so that they may not need to go through it. And, you might be surprised, of the desire of, of people to share information that might be private or personal, if it can be, you know, kind of thrown into a larger, group and, and, and the benefits, the benefits are clear. I think that's often where the problem lies, where I don't really understand what you're going to be doing with this information, nor how it could help people like me.

Sarah Krüg: Oh, absolutely. You know, I we have many patients that are very comfortable sharing their stories and their data openly. They put it up into crowdsourcing platforms. They talk about it at conferences, they talk about it on social media. And those are all very important voices. I think for me, it's just ensuring that as we're developing innovations, we're recognizing, you know, we just we just had a session with people who had prostate cancer. And many of them hadn't even told their family they have prostate cancer. And that was enlightening. And it just it's important to recognize that there are people who aren't as comfortable sharing, but we have to figure out a channel for them to engage. Just because they don't necessarily want to share doesn't mean that they don't want to be engaged. So figuring out how to anonymize their data, anonymize their stories, anonymized their assessments, providing them with a safe space to participate, to co-design. You know, they still want to be part of the conversation. They just have to be provided with channels in which to this.

Dr. Craig Joseph: Yeah. Well, absolutely. Pivoting a little bit, although not that far. You've talk about kind of interactions between, patients and their physicians. You've packaged it up in something that we can all understand. The tango. Now, I have to be clear. I cannot dance, in any way, let alone something like the tango. But maybe you can and you can tell us a little bit about the Patient-Doctor Tango.

Sarah Krüg: Yeah. So, the Patient-Doctor Tango was a talk I gave a few years ago. So I mentioned earlier that I'm not only a patient advocate, but I'm also a clinician advocate. The patient has a life expertise that's just as important as the doctors medical expertise. And only when the two come together and engage in that embrace, or what I refer to as the Patient Doctor Tango, can it lead to that, that that powerful connection and ultimately a flawless performance. So I use tango as an analogy because the key elements of the partner dance are the foundation to the ideal patient doctor relationship. You know, in the ideal patient relationship, life expectancy of the patient that's embraced in partnership with the doctors, medical expertise, which is the essence of participatory medicine, which is the type of medicine where both patient and doctor are equal partners. I've gotten questions from people. Well, what about the nurses? What about the, you know, the other members of the care team? So tango is a two part dance, a two person dance, I should say. So I haven't figured that piece of the puzzle out. I'm still working on the naming for that, but, for now, it's really perfecting that relationship between patient and doctor through the tango.

Dr. Craig Joseph: Fair enough. It is a team sport, but those are the two, two of the major players there, so that absolutely makes sense. So you were doing this the Patient-Doctor Tango talk. And, certainly the ideas are, are, are appreciated and well delivered. But when we were preparing for this, you talked about a design fail that came out of that talk, and I'd love to hear more about that.

Sarah Krüg: So I'm almost too embarrassed to admit this. Not many people know this story, and I can laugh about it now, but it was pretty traumatic. So I was giving this important talk in Europe, Patient-Doctor Tango. I bought a dual voltage curling iron, with an adapter to give my hair a little zhuzh you know, spice it up a little bit, and then two hours before the talk, I'm fully dressed, ready for the presentation. And again, I, I'm going to add a few curls. I sound so vain, but I promise you, I'm not. Anyway, all of a sudden, there's this peculiar odor. Burning plastic. I see smoke. The curling iron is on fire. Throw it down the floor. Put the fire out. I didn't burn down the hotel or my hair, thank goodness. But I look in the mirror, and now I look like Jekyll and Hyde. Now, one side taken straight. The other side curled. Hideous. Run downstairs, the front desk. I asked for nearby salons. They gave me three locations, the first two fully booked. Don't even acknowledge my crisis. The third has an appointment that's running late, and I played five minutes just to make me look normal, I’m about to go on stage. So the stylist quickly curls my hair, holds up the mirror. I have long hair. But my hair is curled so tight it barely passes below my ears. I look like a Shirley Temple poodle, so I'm not sure which is worse. Jekyll and Hyde or Shirley Temple poodle. Running late for the talk. I don't have time to fix it, so I think I'm rushing to a taxi. Come up the curls in the taxi, doing everything in my power to look somewhat like myself. And I barely make it on time. I'm rushed on stage, out of breath, and I give my talk. So I'm traumatized by that experience. I'll never buy a dual-voltage curling iron with an adapter again. That's one design fail that I have to make mention of on this car.

Dr. Craig Joseph: Well, we can't blame you for that. It sounds like you did all the all the right things. Do you have I think, the audience would certainly enjoy pictures. If you want to send them to us, we can post them in the show notes. Is that a no? It seems like that's a no.

Sarah Krüg: I don't I, I will admit that I do not have pictures of the Shirley Temple or the Jekyll and Hyde. At the time, I didn't think to take pictures, but yeah, yeah, if I did, I would not send them to you.

Dr. Craig Joseph: I appreciate your honesty, although still, I think, the listeners demand it. And so maybe we'll look, if we get a lot of feedback, we'll look into trying to figure out if we can come back and redo that experience for you so that we can find that stylist and get some of those pictures and at least get a little bit of what that taste was, I, I think it'll be great for your career.

Sarah Krüg: Or I could just buy another dual-voltage curling iron and replicate that whole scenario. All right.

Dr. Craig Joseph: But that seems from a safety standpoint, I don't I can't be part of that. And I can't, I can't have you risk your life. I appreciate it, I appreciate the offer, but, no, we shouldn't have you do that. Are there any other design fails that came close that you want to talk about so that we can learn from your almost disastrous occurrences?

Sarah Krüg: Yeah. So I do have another design fail. So I and I have a letter drafted to potentially complain about this one. So, my Siberian Husky, aka Houdini. She loves to ride in the back seat of the car, and she's mastered the skill of opening the back window. And in my husband's car, there's this feature that locks the window, like, childproofing. Yes. but it when it locks the back window, it also locks my window in the passenger seat. And it drives me crazy that every time I want to open the window, I have to ask him to unlock it. So power locking, power locking, passenger seat, window, or door? That should be optional. You know, when I'm in an Uber, it's sometimes a little scary when you're power locked in and trapped as a passenger. So we need to rethink power locking. And why did that just feel like a therapy session?

Dr. Craig Joseph: It's good. and that's, you know, that you're, you're recording a good podcast episode when you feel like you're getting therapy. I will need afterwards. I'll need your insurance card. And there might be a co-pay involved. Yes, we can waive it. Don't worry. Sarah, I'm, I'm trying to be reasonable here with you, but.

Sarah Krüg: But do you want it? Do you have that feature in your car?

Dr. Craig Joseph: I think I do. My dog does not have the intelligence or ability, to open a window, but I see where you're coming from. You know, I do think that mostly we're talking about child proofing, right? And generally, the children that we're trying to keep safe are in the backseat.

Sarah Krüg: Right. Exactly.

Dr. Craig Joseph: So it does seem a little weird that the passenger side and the front seat would be locked unless your husband has specific concerns about your ability, I mean, have you tried to jump out through the window before? Because that's something that we need to know about.

Sarah Krüg: This is such an odd moment for me, because perhaps there is no real power locking of the passenger seat. And it's all been my husband's doing all of that.

Dr. Craig Joseph: I'm not. And just to be clear, I'm not saying that that's the case, but I'm also not saying that's not the case.

Sarah Krüg: Okay. So I'm going to have to look into that. Perhaps I should hold off on sending the letter until I do some more investigative. Yeah.

Dr. Craig Joseph: And also, I'd be interested to know if, I think there's a new TV show called, Stupid Dog Tricks. Something along those lines. Your dog might have some skills to get you on, on national television.

Sarah Krüg: She also does say “I love you.” So I think we would audition for that for sure.

Dr. Craig Joseph: And for sure. Like, this is a no-brainer. Let's. I feel like that's the. That might be one of the most important things that we've learned about today. That your dog can speak and can control the windows in the car.

Sarah Krüg: I'll send you a, a video of her saying “I love you” and my 14 year old, she's now 14 years old. My 14-year-old husky is a liver cancer survivor. She just beat cancer. So yes, she's, I had to figure out a way to work her into the podcast, for sure.

Dr. Craig Joseph: Yeah, well, he's certainly done so. So you had an experience after giving one of your Patient-Doctor Tango talks, that's hard to say, where lots of folks wanted to come up and meet you, but not for the reason that you had thought. Can you tell us a little bit about what happened?

Sarah Krüg: So I gave the Patient-Doctor Tango talk, which was focused again on the cornerstones of improving the patient-doctor relationship. And during the talk, I asked the audience, how many of you have asked Doctor Google a health question you would never ask your doctor? How many of you have lied or withheld a few details during a visit with your doctor? And then I then confessed what I lied to my doctor about, and about 50 people were lined up to talk to me afterwards, not to talk about the Patient-Doctor Tango, which was the whole theme of the talk. But one by one they came up to confess what they had also lied to their doctor about. And so began the Health Confessions Project. So I've been working on this project for several years, where I've collected over 5,000 anonymous confessions of what patients conceal or lie to their doctor about. And as a researcher, I looked at the main trends and then further studies why people were lying and what the potential ripple effects or the consequences of those lies might be. And initially, I was working on a research publication that might wind up in a journal that the layperson might not have access to. And I wanted to get this information into the hands of the average person out there, concealing elements of the truth, because if I could educate them on what they're what, we're all lying about, why we're lying about it, and the potential consequences of those lies, it might empower us all to make better decisions on what to share with the doctor. And that's the premise of the book that I'm working on called Health Confessions.

Dr. Craig Joseph: I love it, and I'll since we're doing the confessing, I will say that I lie about my height. My doctor thinks that I'm 6’2”, and, I hope that doesn't have any impact on my health, but I'm coming clean now, so if my doctor is listening, you know, he knows what to do with that information.

Sarah Krüg: Surely, we can get something juicier than that. But it's interesting that you bring up height, because that was that was something that people lied about. And it's, what people typically are, they say that they're taller and they're really shorter. And then sometimes people lie about weight, but that's on the far left of the spectrum of the lies that we tell.

Dr. Craig Joseph: I also when I told you, I tell them I'm 6’2”, it's because I'm actually 6’5”. So I'm trying— no, anyone that knows me knows I'm quite short, so, yeah, I understand that. I don't, I don't know that I would get away with it, at the doctor, but I, I totally understand some things not wanting to share, and sometimes because they're embarrassing or you think you're going to be judged. Other times, though, you didn't think it was important, and, so I get that, I look forward to kind of hearing more about that when, when your book gets closer.

Sarah Krüg: Yeah. And, you know, it's interesting because, yes. Embarrassment, judgment there. There's all reasons people, don't share certain things, but there's a new one that's surfacing where sometimes people don't want to share things because they're worried that now it's going to go into their medical record and be shared, and then they're worried about where that data will eventually go. So that's a new one that will be important for us to further assess and figure out over time.

Dr. Craig Joseph: Yeah. And that's, you know, is that a feature or a bug of our current electronic health record system? Right. When that's certainly something that most of us didn't worry about when we were recording our interactions on paper, because it was unlikely that that information was going to leave the doctor's office. That's the good news with respect to confidentiality. The bad news is that information didn't leave the doctor's office, and so it wasn't available at the emergency room when you got into a car accident. Or for that super subspecialists that you've seen who could use some of that information. So it's. Yeah, it's a double-edged sword for sure. It's not all, all, all goodness with, easing the easing the ability to kind of exchange information.

Sarah Krüg: Yeah. And it's interesting one of the, and I've finished majority of the book. I've just had this one chapter that's been a, a little bit of an issue to write because again, I'm, I if I present a problem, I like to potentially present solutions. And initially I was trying to solve some of the issues that were coming through as to why people were lying to their doctor. And I've, I've spoken to clinicians that asked me not to publish the book because they were worried that patients who had read it would then now conceal elements of the truth even more because of the technology issue. And so initially, again, trying to solve for that issue, and I spoke to many organizations and couldn't come up with the solution. And so I've decided that I'm just going to put this into the hands of the people, you know, because I think it's important for them to know and understand. And but then we as a healthcare system have to figure out solutions, because if that is one of the stumbling blocks, then that that means that that's something that requires additional co-design, right? Get people involved in co-designing the future of patient portals and the technology that's documenting, you know, their secrets over time.

Dr. Craig Joseph: So true. Well, Sarah Krüg, it has been a pleasure, learning from you and speaking with you. And we look forward to the book's publication. We'll definitely try and get the word out when it comes out. And I think you're a force of good in the world, and I thank you for being there and look forward to all the good stuff that you're going to produce in the future.

Sarah Krüg: Thank you so much, Craig. It was really an honor to be invited, to talk with you. And I look forward to hopefully being invited to another podcast in the near future.

Topics: featured, Healthcare

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