A How-To Guide For Physicians: Reclaiming Our Credentials and Identities to Flip the Script
Read part 2 of the widely shared, eye-opening and empowering article “It’s Time To Flip The Script.” Dr. Mehnaz Hyder describes JUST HOW all physicians can flip the script to #TakeBackMedicine by leveraging their credentials and professional identity.
A sequel to Dr. Mehnaz Hyder's article "Doctors, It's Time to Flip the Script."
IDENTITY IS EMPOWERING
Imagine the plight of our reluctant warrior finding herself so oddly matched opposite this imposing giant. This is not a fair fight, but it had to be undertaken because the situation has deteriorated to a point where this giant poses a clear existential threat to the people. The giant is fully armored, brandishing a sword, attempting to intimidate with trash-talking, and so massive he would easily crush our warrior even if he were to accidentally tip over. So how does an underdog knock out a sword-wielding giant who is poised to annihilate her? The answer is by not getting into a swordfight! Our underdog has to rely on the strengths she brings to the field and identify her leverage, which in this case was an unassuming gadget right in her pocket all along: a sling. Her identity was one of a sling shooter. The giant took for granted the popular belief that there are no other means to engage except on the terms favorable to him-with a sword. This narrative was a mere illusion. Now our underdog realizes her strength and changes the terms of this fight by using the most powerful advantage she’s got-her identity! The underdog becomes a warrior. At just the right moment a rock launches on its fateful trajectory. The giant never saw it coming.
YOU DO HAVE LEVERAGE, BUT YOU HAVE TO USE IT
Doctors, we don’t really see ourselves as warriors, do we? Our primary role is to serve our patients in a relationship built on trust. But the healthcare giants of today feed off of destroying that trust. They did this by taking possession of our very identity, hijacking the narrative, and rigging the systems against doctors and patients. The giants have amassed so much control that they pose an existential threat to the doctor-patient relationship. We have been forced onto the battlefield even though we never asked for a fight. Yet here we are standing before trash-talking giants, intentionally creating moral injury. We are led to believe that we can never fight back the predators to reclaim our profession simply because they are giants. We have bought into the narrative of our powerlessness. We won’t be able to help our patients from a position of weakness. But we should remember, they couldn’t have become giants without seizing our identities and thereby capturing all of the value we create. If doctors collaborate to reclaim and secure our identities, we can keep third party giants out. We are the ones who know how to practice medicine and how to do it ethically- this is usually why the systems clash with us-we are in their way. That’s why we have the duty to take back our identity. In the wrong hands, our identity is hijacked to harm our patients and we become complicit. The giants utilize every new technology possible to lock in our professional identity. Technology has come a long way from the humble sling. It has finally advanced enough secure identity. The giants have a plan to harness this power, and they are gaining fast. Warrior, it’s your move.
THE ETHICAL SOLUTIONS CAN ONLY BE CREATED BY PHYSICIANS
Physicians have allowed the third party exploitation of the practice of medicine for too long.
In Part 1 of this article, I explained that most third parties in healthcare, even the organizations presumably created to benefit or represent physicians, create barriers in the doctor-patient relationship. We have found that these intrusions lead to physician moral injury and endanger our patients. This makes it clear the only ethical healthcare solution is one where the physician is in charge.
DOCTORS MUST USE TECHNOLOGY TO SECURE THE ETHICAL PRACTICE OF MEDICINE
A new technology called Self Sovereign Identity allows individuals to take ownership of digital identity. This technology is highly secure and preserves privacy in transactions. There needs to be a solution where each physician is able to take possession and control of his or her own identity and data. When physicians control identity, they don’t need permission from third parties to interact 1) with parties that need to see their credentials like payors and hospitals 2) with patients 3) with each other to enable uncensored information sharing and advocacy. A single solution is needed to secure these 3 primary factors which puts the power back into the hands of the physician. There is currently only one company building just that.
HPEC: Humanitarian Physician Empowerment Community
HPEC is a physician-founded startup that uses SSI technology to build a new healthcare ecosystem allowing empowered physicians to own and control their digital identity. It was started by Leah Houston, M.D. an emergency physician who had her professional identity stolen by her previous employer when they continued to bill under her name after she left. As she started investigating this identity theft, she uncovered a web of sinister operations making up the healthcare world designed to keep doctors and patients hijacked by the system. She used her previous knowledge of blockchain technology and founded HPEC to allow doctors and patients to unhinge themselves from predatory third parties by allowing them to own and control their identity and data.
DOCTORS, YOU CAN SERVE AS THE PRIMARY SOURCE OF YOUR IDENTITY
Self-sovereign identity technology leverages blockchain in order to establish collective and participatory truth in identity. This means we as physicians can All physicians with medical licenses and degrees already have a unique identifier, but the physicians are not the source of truth regarding that information- a third party holds that power. Today every time a physician communicates digitally they are dependent on a third party to verify who they are and allow them to communicate. This often keeps critical pieces of information hidden, or hard to find for physicians and puts patient data and physician identity and information at risk every day.
CREDENTIALS ARE LEVERAGE
In order to create this ecosystem, doctors must start by loading their credentials into a digital wallet that determines their professional identity to be verified and permanently designated as “true”. Once this step occurs once on this system, it will never have to happen again. There will be no more redundant paperwork to prove who you are every time you want to leave a job that doesn’t work for you. The act of verifying credentials a single and final time is the power of self-sovereign identity. Your credentials are part of your identity and once you own them, you can finally communicate and transact with autonomy. You no longer give up control to your employer, your specialty board, or a regulator. Only you will be able to give permission for them to be used and only you will be giving permission to bill for your services, meaning if you are employed you will now have the benefit of transparency regarding how much revenue you are generating. This valuable information will help physicians negotiate fair contracts, and prevent fraudulent patient billing. With the physician in control, the health systems or insurance companies' ability to share their professional data with nefarious parties will be eliminated. This will compel insurers, and employers to treat physicians fairly and ethically because they will know that doctors could very easily get up and leave.
DIRECT DOCTOR-PATIENT INTERACTIONS KEEP PARASITES OUT.
With HPEC, each time a doctor or a patient interacts with their unique self-sovereign identity the information is kept with the physician and patient directly, and only proof and location of the information is recorded on a blockchain. Only those individuals holding private keys; in this case, the physician who created the record, and the patient to whom the record belongs will ever be able to see the details of that private information. Because of the encrypted nature of this tool, physicians and patients will have direct control over what is and is not shared with any third party. Patients will enjoy a more empowered role in the medical system level with transparency and portability of their medical records and the added ability to prevent the unwanted sale of their data. This will not only restore privacy and trust for the doctor-patient relationship. Data can still be collected and organized, with consent from physicians and patients, in an incorruptible, anonymized, and encrypted way. With an interoperable tool like this, patients will have absolute transparency in care treatment, and price, and will own their data giving them an ability to move between doctors, with ease. Physicians will also have no more friction because the encounter is portable and documented with them rather than with multiple scattered and non-interoperable third-party EHRs.
PHYSICIANS NEED UNCENSORED COMMUNICATION WITH PEERS TO TAKE ACTION
Doctors can start communicating and transacting with each other on this platform. Relying on their sovereign identity, doctors will be able to organize and collectively vote on any matter they deem important. Imagine a built-in digital physician guild that gives physicians a voice to weigh in on an unlimited number of topics. The technology is specifically designed to capture consensus. With a few clicks an idea can become consensus, and consensus can translate to action. Doctors can form groups, networks, and alliances. It’s no coincidence that in the current system physicians are trapped in information silos. The ability to transact, communicate, and come to consensus with other doctors, will allow doctors to capture consensus on important issues and formally negotiate as a large group, potentially represented in the hundreds of thousands.
Here’s a scenario where a negotiation like this might play out. Imagine if oncologists felt very strongly about a treatment that the patient’s insurance refused to cover. They could create a proposal, accept an endorsement from 100 peers and in one stroke deliver a strong message to their favorite insurance company. What if the media got word that 100 oncologists feel strongly about a particular life-saving cancer treatment and the insurance company isn’t budging? Now imagine if a thousand of the insurance company’s cancer patients who needed the life-saving treatment and are registered with their self-sovereign identity and by connecting with their oncologist through HPEC they can digitally endorse their position on this issue. If the insurance company still doesn’t budge, maybe the doctors and patients who weighed in on the issue are willing to take their business to a competitor. Similar negotiations and transactions can be carried about by any cohort of physicians for important topics like physician moral injury and burnout, residency program issues, board certification requirements, laws affecting physicians and patients, and virtually anything that the physician community feels strongly about. Eventually, as digital interactions increase between physicians, we can collaborate to form our own networks and payment systems.
WHAT THE GIANTS HAVE IN MIND FOR THE FUTURE OF PHYSICIAN PROFESSIONAL IDENTITY
If you think all the insurance companies have a lot of power now, wait until you find out that insurance companies have banded together to create their own blockchain network with our data on it, and without our explicit consent. The company is called Synaptic Alliance. Once they share data with each other, they can easily use the powerful technology to multiply their returns from this data. I will leave it for you to decide if this alliance is being formed in the best interest of doctors and patients.
Physician credentials are very powerful. Most doctors are familiar with the Federation of State Medical Boards® that serves as primary source verification of physician credentials via FCVS. They own the Physicians Data Center® but the intended beneficiary of this organization is not necessarily you, the physician whose data is entered into their system. “The FSMB’s Physician Data Center (PDC) is one of the nation’s deepest repositories of health-provider data, with multiple layers of demographic information for more than 1 million physicians.” According to their annual report, they primarily function as a regulatory body. They too have seized the COVID-19 narrative to push the Interstate Medical Licensure Compact (IMLC). Superficially, a universal license sounds like a good idea. But will physicians think about what would happen if this type of license were to become tied to mandatory administrative hurdles that have been proposed by their specialty board partners? Such as MOC®? Who would have more leverage in that situation: the organizations or individual physicians? The Wikipedia article about MOC® lists the FSMB® as one of the major medical organizations that stands to “gain profit from and have expressed support for the Maintenance of Certification”. Their stated mission is “To protect the public from the unprofessional, improper, unlawful or incompetent practice of medicine” yet they and their medical board partners appear to be silent on issues of nonphysicians legislating the privilege of practicing medicine in the same way that physicians do. Do you think there are checks in place that ensure the interests of physicians? Are you convinced that there is no possibility of sharing or leveraging physician data in a way that the physicians would not have wanted? Do you feel your voice is adequately represented in this organization?
ITS TIME TO LEVERAGE OUR IDENTITY THROUGH POWERFUL TECHNOLOGY
A decentralized physician platform is needed where the physicians own their credentials and data, and take back their autonomy from middlemen while restoring trust in the doctor-patient relationship. A physician’s most prized possessions, reputation and ethics, have been marred by the activities of middlemen, causing patients to feel abandoned and doctors to experience moral injury. Physicians should own their professional brand and maintain control of the practice of medicine. It is also the physician’s duty to protect patients from predatory third parties. When physicians are in charge of medicine, they can put the patients first. For the first time in history, technology has advanced to a level where identity can be digitally represented and serve as its own proof. With this technology, physicians will start to control their professional narrative while empowering their patients to have a say in their medical destiny. New technologies can always be adopted, but they should serve doctors and patients, not exploit them. Here is a chance for physicians to use powerful technology to take back our narrative and flip the script from serving third parties to serving patients.