Inside Reproductive Health, Ep 13

Should Doctors Become Media Personalities? An Interview with Dan Nayot, MD

In this episode, Griffin speaks to Dr. Dan Nayot. Dr. Nayot, an REI in Toronto, Ontario, has established a reputation as a media personality, thanks to his appearance on CTV’s “The Social” and his own show on YouTube, “Ask Dr. Dan.” Griffin and Dr. Nayot discuss the importance of finding your own platform and the importance of creating a five-star experience for each patient.


Griffin Jones: Today, on Inside Reproductive Health, I’m joined by Dr. Dan Nayot, who practices in private medicine at Trio Fertility in Toronto, Ontario. Dr. Nayot studied at the University of Western Ontario for Medical School. He completed his OB-GYN residency at the University of Toronto. He completed his fellowship of REI at the Harvard of the North, McGill University, and then he went on to get his masters at the McGill of Massachusetts, Harvard. He has been on a number of programs and Canadian television, all over the internet, including his own YouTube show, “Ask Dr. Dan.” Dr. Nayot, welcome to the program.

Dan Nayot: Thanks for having me! Happy Valentine’s Day, Griffin.

GJ: Happy Valentine’s Day to you, Dan. I’m excited to have you on the show because I wanted to talk about how REIs become media personalities. I think that’s how you and I met originally. I saw the Canadian View, which I believe is called “The Social” on CTV. They’d tweeted something out and then you and I started talking. How did that come to be?

DN: I think my introduction to public relations came from my wife. She owns a PR agency, so just from osmosis, I’ve been learning about the trends and the different medias. She’s been pushing me to get involved for years and years. I thought I shouldn’t get involved until I became an expert in the field, so I waited through residency and through fellowship, and then it was the (unintelligible). I think the key for her to push me was that she thought I had this talent to take complex issues and simplify into a quick message which I give her a lot of thanks for pushing me. What pushed me was, to me, infertility still has a stigma. I think we need to fight for our patients, add exposure, and I also joined the executive board of Fertility Matters Canada, which is the Canadian version of Resolve. I think getting out there and just talking about infertility and the different facets is really helpful. Long story short, behind every great man, is a great woman. I couldn’t say no to my wife.

GJ: So you should marry a PR expert. That’s the advice we can give to every REI listening.

DN: Yeah. There you go.

GJ: You’re done. Well. I’m wondering now, I was thinking about this as I was getting ready for our interview. It seems like it’s a nicety to be able to reach more people via platforms, but at some point, at what point does it just become the expectation? I think if we’re talking about practicing medicine in the Civil War days, bedside manner matters about zero percent. But now, as everything has ratings, everybody’s talking about things on social media, the commentary on how we’re supposed to treat people in society is taking a political turn, I think the emphasis on being a personable, empathetic physician is no longer a nicety. What do you think about that?

DN: I think, especially in the world of fertility where it’s personalized, it’s very emotionally driven, there’s a private sector to it, I think patient expectations and delivering a five-star experience is now critical. The young REIs have a lot more work when compared to the old REIs, and some of us always joke around that we wish we could do it in a more simplified way, but it’s gonna take us longer. I think our job is not just to listen, diagnose, and come up with a treatment plan. We need to educate, we need to motivate, we need to be transparent, to be organized, to be personalized. It takes a lot of effort, and the job’s evolved, but I think it’s best for the patient.

GJ: That’s so hard though. Is that even possible at scale, because to be an REI, that’s by definition a very rare skill set? In the United States, there’s only about 1100 board-certified REIs, in Canada you’ve got maybe a couple of hundred. In all of North America, you’ve got less than 2000 people who are qualified to do this job and it’s fifteen years of higher ed, and it’s among the most difficult boards in medicine. And then, in parallel to that, being an empathetic, charismatic person who gets ideas across easily and makes people feel listened to-- that’s not a common skill set in and of itself, either. So you’re layering these two things. One is extremely rare, the other is uncommon. You’re combining the two. How is it even feasible that we can expect new doctors to be able to fulfill this pattern?

DN: That’s a good question. I think it’s what we should be aiming for, I think it’s something we can teach. You can’t teach certain personality traits, but you can certainly teach what’s considered good medicine over bad. I think having good mentors, getting feedback from your colleagues, from your patients is gonna help. But it might be rare, but I think everybody could do a better job at it, including myself.

GJ: But some people have a personality, and I think of you, I think of a few other people-- these are just women, men if I were at a bar or in a ski lodge, I’d enjoy spending a weekend with them. Other people… maybe a two-minute exchange of hellos after dinner would be just fine. To me, natural personality goes so far. I do put you in that category. You think it can be trained. How can it be trained and how much is natural personality?

DN: Well, I think you made a really good point, but I think the perception is that there’s an optimal way to be with patients. But really, there are patients who probably don’t connect with my personality. I think if I were to re-think the business model, I’d try to match the right personalities of a patient with the right personalities of a physician. For example, I‘m somebody who likes to educate, present the options, present statistics, walk through the logic with patients. And once in a while, I see patients who, at the end of it, are just overwhelmed with information and wish they had a more paternalistic physician who gave them confidence that this is the route they need to take. Although the counterargument to that is that your ability as a physician is to read the patient. If you sense that your patient requires more guidance and fewer options, it’s up to you to pivot. That brings me to another point… some of the most brilliant physicians I know are nowhere near the internet, on media, on sites like Great MDs, but they’re just brilliant. But their ability to interact with patients is a bit different.

GJ: Let’s explore this idea of matching patients and physicians a little better. Lisa Duran talks about this with using a Myers-Briggs test. You have patients take the test, you see who they align with, and they match with a doctor that’s more similar. At smaller practices with one or two physicians, that wouldn’t be an option. But we work with clinics that have twelve doctors or bigger. You could probably cover the four major types of personality quadrants with that many doctors and probably have a lot happier patients. How would this work? How do they get matched? At what part of the process does this take place?

DN: I’ve heard Lisa lecture about this, and I think it’s a brilliant idea. I’ve never seen it actively used. It might be in some clinic, I’ve just never seen it, but I think it’s brilliant. I would assume it would be on the intake questionnaire. Obviously, you should know who the physicians are already and try to match it up. That happens all the time. A lot of times I see patients, and of course, I’m dedicated to helping them, but in the back of my head, I’m thinking, “You know what? Dr. #7 down the hall would serve you so much better than me on so many different levels.”

GJ: So you haven’t seen it yet, neither have I that I can think of off the top of my head-- why not?

DN: I don’t know. I think it takes a really innovative business director to implement it. Yeah. Maybe we should defer to Lisa. Maybe she’s seen it.

GJ: Maybe she has to be a guest on the podcast. I think that’s probably overdue. That brings us into a larger segue, it would have to be an innovative business director to come up with that- or an innovative CEO or an innovative medical director. Just by… if I’m looking at the opposite of that, I’m envisioning some resistance-- “This is just one more thing” or “Can’t we just see the patient as it is?” And I’m thinking there is a lot of resistance to-- this would be a fairly big operational change. You can’t just snap your fingers and match physicians with patients by personality. But if you put in the work to do so, I can see it saving so much headaches down the road.

DN: For physicians, for patients, I know you talk about attrition a lot and drop out, I think this would be a very nice upstream business change you could make to affect them.

GJ: And it’s probably a good segue for what comes when physicians and patients aren’t matched properly and something does go wrong-- then they go online and say, “Dr. So-and-so called me fat,” when the doctor recommended a plan for reducing BMI after he gave a diagnosis of diminished ovarian reserve, and the patient perceived that the doctor called me old, and then they go on Fertility IQ or Google Reviews or Facebook or Rate MDs. That’s a place where you have had a lot of success. I used to look at Rate MDs a lot more before Google and Facebook and Fertility IQ became more popular, but I remember as of a couple of years ago, you were top ten if not top five rated in both star rating and quantity, and you were one or two years out of fellowship. So how does that happen? Because that’s not… you’re not being matched with everybody who likes your personality. That’s just you seeing patients at large and ending up there.

DN: That’s very nice of you to say. Well, I mean, I think just talking about RateMD is a two-hour podcast if we diverge. I think as general… I think physicians are kind of scared of something like RateMDs or being judged because you don’t get our side of the story. Sometimes it’s for good reasons and sometimes it’s just truly miscommunication. RateMDs doesn’t measure how well you did on your boards or your pregnancy rates or your intentions. It measures the perception of the patient. I think that all comes down to communication skills and high EQ and being able to…. Why use the word “fat” when what you’re trying to say is, “I’m concerned about your weight and the success rates and the risks,” there’s a better way to say that that might not offend someone. So some ways…

GJ: By the way, that doctor might have articulated that way, but because of some other perception of communication style, that patient walked away thinking, “He called me fat.”

DN: For sure, for sure. I think that on the other hand, it does put MDs under the microscope, which makes us… my analogy is sort of like, I don’t actually know how to cook and I’m far from a chef, but I’m sure if you owned a restaurant and a food critic comes in, you’d put on a five-star experience. When you don’t know who the food critic is, it forces you to do that for every patient. When the patients have that power, it forces everyone to treat everyone exactly the same, which I think is excellent.

GJ: So now we’re at this sort of...I wonder if we’re at a little bit of a curve with online reviews. To your point, twenty years ago, there was a food critic for the Toronto Star, for the tv station… there were a couple. Even in a big city, there were a couple of major food critics. Then, you didn’t know who that person was. Then we got to have platforms like Yelp, Urban Spoon, Google, and all of these different kinds of review platforms where, oh my gosh, this one person said something bad about us. I remember I used to get Southwest and Jet Blue to give me so much stuff when I would be mad about… in the early days of Twitter, my flight would be delayed ten minutes, I’d get so mad, I’d get on Twitter, I’d light them up, and they’d be like, “Sorry, Griffin, here’s free wi-fi, a drink, coupons, whatever.” NOw, my flight could be totally canceled, I’d be stranded for four days, and I’d be like, “Screw you, Southwest,” and they’re like, they don’t care anymore. We’ve turned that corner. I don’t think we’re there yet in our field- at least on a level of physicians being accustomed to it. But are you there personally, where you do want to treat it as though everything that I do can be expressed to the outside world, but at the same time I still know I can’t please everyone and I have to do my job.

DN: I agree with you, and I think the pendulum will swing. There’s not gonna be a Rate My Patients, but there’s probably gonna be a platform that’s some kind of third-party judge in between that’s gonna say, “This was a miscommunication.” Sometimes you go on Rate MDs and say, “Nobody called me back,” but for all you know they had the wrong number and that’s not really fair to the physician. But yeah, I think the pendulum probably will swing, and you know, it is our job to treat everybody in a five-star experience.

GJ: Let’s talk about that a little bit, about just sort of treating everybody as a five-star experience. The way that I’ve adapted that, the axiom, “The customer is always right,” the customer is not always right. The patient is not always right. The patients as the market are always right. In other words, when patients are telling us, “We expect this from billing, we expect this from scheduling, we expect this in response times for physicians.” We use that not as at this one particular time, I should have got there, but if we hear this over and over and over, we need to address the problem in some way. Talk about how you use all the feedback to…

DN: I just wanted to add an example. When you are… sometimes people come in for second opinions. That happens all the time. I give second opinions, my patients go for second opinions, I think that’s great. Sometimes, even though you come up with the exact same diagnosis and conclusion, it’s very apparent that somebody didn’t sit down with the patient to explain something. They didn’t pass their board exams. They don’t know as much about fertility as you. What’s very clear and obvious, you need to sit down and explain. Something as simple as, “You have PCOS,” you know, you might know what it is. Some patients might not know how you came up with the diagnosis. Walk them through it. It does take more time, but at the end of the session, even though it’s the same reproductive outcome, the patient understands the rationale. “The reason they’re saying I move on to egg donation is because of these seven points in my chart. Nobody’s walked me through that.” And I think that’s so important, y’know, closure and having the power in the patients’ hands is so important.

GJ: So your point about explaining information in such a way that someone needs is pretty in line with we don’t always need to change everything about the experience. I do totally acknowledge that many of our patients are coming to us with unrealistic expectations. I talked about this on another podcast episode with Hannah Johnson from Vios Fertilities. People are used to getting everything instantly. If I can find the stat quickly, I’ll link it in the show notes. Something like 90% of people open a text message within ten minutes. They’re expecting the same level of correspondence from their fertility center, which is totally unrealistic.

It’s our job, also, it doesn’t mean we need to change our process, but we do need to reset those expectations. Whether it’s our fault that they have those expectations or not, it’s in our best interest to reset those expectations when patients… before patients…

DN: I’ll agree with you. The pushback I’ll give you is that we are in a field that’s rapidly evolving. If you don’t evolve, you’re doing a disservice. There are some clinics where a patient phones in for a consult, and they don’t get back to you for a week. Imagine you went to book a restaurant and somebody didn’t call you for three days. You’re going somewhere else immediately. Patients in 2019 expect transparency and accountability-- I’m not saying immediate access, but text messaging, online appointments, think about even… off the top of my head, somebody who comes in to socially freeze their eggs. OK? They go through the process, and they’ve got eleven eggs frozen. Most clinics send the patient home and say, “We’ve got your eggs here.” But it’s 2019. Patients want documentation. They want to see pictures of their eggs, they want to know where they’re stored. I don't think that’s so unreasonable.

GJ: They paid a lot of money for it. Their dreams, hopes, future are resting upon it. And if they have a baby cam to know what’s happening with their kids at all times, they have a house cam to see what’s happening outside of their garage, I think it’s a fair expectation for eggs, also. I think it leads us to a point that I really try to discuss this with clinics when we’re consulting with them, which is it’s my opinion that every single thing that should be automated should be automated. Everything that should not be automated should not be. What I mean is things like scheduling, things like alerts, or any information on the protocol that can be in one place, modules-- that should all be automated so that you can have the time with the patient that should be individualized just tailored to their experience. With physicians, they think, “Well, we don’t want to do something like Engaged MD because we want them to have that time with the nurse.” But the nurse doesn’t need to be explaining injections and that stuff. They can do it at home as long as it’s a physician with them. When they come in and talk to the nurse, it’s going to be about them, about the case. Talk a little more about how automation can be used to increase personalization.

DN: I 100% agree with you, which is why we end up having drinks at every conference. There’s a misconception that automation means not personalization. I don’t think so. Automation is just part of the system. There are parts that can be automated, and that doesn’t take away from the personalization. If you go too far, like if a patient walks into my clinic and I don’t say hello but I hand her a treatment plan of three cycles of IUI and then you do IVF, that’s not personalization. That’s automation. That’s a detriment to the patient and they know you didn’t listen, you weren’t personalized, you weren’t detailed. But things that could be automated that are taking away time you could spend with the patient, I think that’s wonderful.

GJ: So what do you think a lot of this resistance comes from? I’m telling you, Dan, one of the things I feel that I have to solve, that Fertility Bridge has to solve, is real-time patient scheduling. It’s one of the things that drives me nuts. It’s a deeper EMR issue but as a marketer, we’re bringing leads to people, and then sometimes they fall off because they’re entering a contact form on somebody’s website. They get a call back a few days later. They do not want to talk on the freaking phone in the first place, which is why they entered that. They don’t want to go back and forth on the phone with you. They want to be able to just look what’s available, book that, we can collect their payment in advance to make sure they don’t cancel, but we haven’t done that as a field yet. So what is the resistance to a lot of automation that we’re talking about?

DN: Yeah, I mean we’re not the first… every field needs to get consults and book patients in and cancel patients and reschedule. So I don’t think we have to reinvent the wheel here. There are a lot of fields that are doing this really well, why don’t we learn from them and we can focus on the fertility field innovations. There are tons of …

GJ: To get these ideas out with patients, I see you’ve got a show called, “Ask Dr. Dan.” And you’re pretty active on Twitter. Talk about what that’s like for a physician to start becoming a media personality. We started the show to talk about how it’s impacted through online reputation, but before it was you being on The Social on CTV. Now it’s you as the producer- you have other people producing it, of course, but it’s your media platform. What’s the difference, and how does somebody get started?

DN: So, you know, every physician has different objectives for why they’re engaging in media and what platforms. I know you’re trying to push me to Instagram and it’s on my to-do list, but I’ve sort of…

GJ: Welcome to 2013, Dan.

DN: What are we on… Snapchat? What’s the new thing?

GJ: Instagram is still the queen for reaching our patient population. Now I see everybody on it. I had an article four years ago trying to get people on, so now it’s more expensive to advertise and it’s not quite as much of just an instant connection just from the nature of being the only REI on there. But as far as where our patient base is spending their time and attention? Still Instagram, all day.

DN: Right. I zoom out and say, “What is your incentive on being on any of these platforms?” For some people, you’ve got a specific message you’re trying to spread. For some people, it’s exposure and building their own brand for their practice. For some people, it’s just a hobby. You know, we started the show, what I think I have a unique ability to do and what I enjoy doing is to be able to synthesize more complicated things and add my little twist to it. I don’t like to just share news about what people are doing, I like to maybe comment on it. There’s a really interesting study, this is why I think it’s breakthrough, this is why I think it missed the mark, this is why I don’t think it applies to all patients, this is what I think we need to be wary of. Things like that. So I comment on them or a patient presents to me specific problems, I just don’t want a sound bite, I want to tell them the pros and cons of going a certain way. That’s sort of my angle. But I mean there’s lots of REIs who do a lot more media than me and do a better job at it. It just depends on what you want to accomplish.

GJ: But what you describe is exactly what the unique angle that every individual person has, which is just their own perspective. And we know that most REIs have an opinion about something that might be contrarian, they might say, “Well, yes, but…” that “yes, but…” is really valuable in the social media context because it’s what allows the patient to see your unique perspective. Otherwise, we can all publish success rates to make them look the best, we can advertise on cost, but expressing our own way of doing things, our own culture, our own personality, is a differentiating point that other people can’t replicate. I wrote four blog articles in 2018. I wish I’d done a lot more content. I only did four blog articles. But they weren’t top five ways to increase your SEO that literally thousands of people are writing. They were strictly about the state of business in the fertility field that nobody else could give that perspective. Consequently, even though there were only four of them, they were really valuable. To your point, sharing our unique perspective is the differentiator. Because most REIs already have that opinion, it’s a pretty easy segue to start putting it into the world via social. Dan, how would you conclude our talk today-- anything I didn’t ask you about REIs becoming a media personality, whether it’s through a large platform like CTV or whether it’s their own YouTube channel, whether it’s participating more on Great MDs… what haven’t I asked you that you would want the audience to consider?

DN: I think you’re a champion of this and you articulate really well. I think some of the things are what are you trying to accomplish, what is your unique voice, and what do you feel comfortable with? It’s not fair to expect the older generation of REIs to get on the platform, though I know you think that’s no excuse. IN reality, to them, what do they have to gain from it. They’re busy enough, they’re not interested in what rewards you’ll get from it. From the reverse, the new graduates may feel like they’re not experts yet, they don’t want to put their face out there because when you put your face out there, there are critics as well. I think just find your authentic voice and find your platform.

GJ: Dr. Dan Nayot, a good friend of mine, thanks so much for coming on Inside Reproductive Health.

DN: All right! Happy Valentine’s Griffin! Thanks for having me!