Improving Patient Outcomes with RPM Programs

This week, we have Dr.Rifai , a certified kidney specialist by the American Board of Internal Medicine (ABIM) in the specialty of Internal Medicine and the sub specialty of Nephrology.

Join us as we discuss the rise of chronic kidney disease (CKD).
Learn the connections between hypertension, diabetes, and kidney health.
Discover how simple habits like blood pressure monitoring and early detection can prevent kidney damage. Managing Kidney Disease with Remote Patient Monitoring (RPM) Programs.

YouTube Video Link to the podcast episode: https://youtu.be/tTU2cq_EZzg

Be sure to follow us on Instagram, Twitter, and LinkedIn @synsormed.

Learn more about what we do at SynsorMed at www.synsormed.com.

Transcript

Introduction and Guest Introduction

Theo Harvey: Hi everyone. This is Theo Harvey. Super excited once again to discuss medical secrets to help you grow your medical practice. And I'm super excited today because I have a great guest, Dr. Rifai. He is a 30 year specialist in nephrology based out of Panama city, Florida. He's really focused on his global outreach, which he calls the virtual nephrologist.

It's about creating common language to help with healthcare education for the common man, to help him guide. in the complex nature of healthcare, especially around nephrology, chronic kidney disease. Dr. Rifai, how are you today? 

Dr.Rifai: Thank you. Thank you. Thank you. And yes, I'm doing fine. And, uh, greeting to all your listeners.

And, um, and I'm excited and honored to be here on your show. 

Theo Harvey: Awesome. Awesome. 

Understanding Chronic Kidney Disease

Theo Harvey: Well, we're going to get right into it because I'm super excited to kind of dig into your specialty and what we're focused in on today. One of the things that we've seen, you know, we work with a lot of nephrologists as well in our remote care as a service practice.

One of the things that we're seeing is the prevalence of just all the, patients that suffer from chronic kidney disease, right? I think there is a sense that there are so many patients that kind of suffer from this chronic condition. One of the statistics I've seen from the CDC, they said about one in seven us adults, around 35 million people have chronic kidney disease.

Up to nine to 10 adults have CKD and are unaware of it. So as a nephrologist or practicing nephrologist, is this similar to what you're seeing? And what should we know about this prevalence of kidney disease in America right now? 

Dr.Rifai: Those statistics, in my opinion, are kind statistics. They do not even reflect What we're saying, if you look at us as humans living over the past 200 years, we have a common disease called urbanization.

The things that great grandparents used to do, we do no longer do now. We don't walk to work. We don't walk to turn on TV on and off. So, we are more people that are prone to have more sedentary lifestyle. That brings in diabetes, which is now, you can see, that is now called the newest global pandemic.

Diabetes, hypertension, or high blood pressure, and obesity. So when you combine those factors, the rate of chronic kidney disease, these two factors, diabetes and hypertension, are the most common risk factors for kidney disease. So now they are on the rise. By default, kidney disease is on the rise. So today, it's 1 in 7, they have kidney disease.

1 in 10 do not know they have kidney disease. 10 years from today, those numbers are going to be worse. The reason is because diabetes is on the rise. Hypertension is on the rise. So in reality, that's why I said these are kind statistics. But these are statistics at this time, but they're going to get worse with time.

Theo Harvey: No, I agree. And, you know, we're seeing that one of the big things with chronic care management's programs, remote patient monitoring, those programs were introduced, I think, in 2015, 2017, because to your point, the rise of these chronic conditions, specifically hypertension, Diabetes. And so if you're seeing those rise is that they're highly correlated to chronic kidney disease.

And that makes so much sense when you kind of think about the problem of the epidemic that's happening right now. So when we kind of look at, you know, what's really happening in the world right now, a lot of patients. They're saying, Hey, you know, I have a problem, but what can I do about it? Then they go see a specialist like you and you dialysis, or you need to do this and you take these medications.

And sometimes it can be so confusing and almost overwhelming. 

Managing Kidney Disease: Prevention and Treatment

Theo Harvey: How are you helping patients understand, like how to manage their disease? And I think this gets into your global mission of understanding like healthcare literacy, right? Explaining what they can do when it comes to taking care of themselves to prevent this epidemic or chronic kidney disease.

Dr.Rifai: Great question, great question. Thank you so very much for bringing this up. The reason is, you know how every person on the face of this earth will have a certain belief about a certain subject. But in kidney disease, the belief is that once you have kidney disease, that means it's dialysis. So that in by itself is a stigma that we have to debunk and we have to tell people kidney disease is five stages.

Kidney disease is five stage and at stage one, we can make a difference for you. So if you're afraid because the stigma or the myth or the belief is that kidney disease is dialysis and you choose not to do anything about it, then you would have lost a great opportunity and time in your favor to really make a difference.

There are many things we kidney doctors can do. That's the reason we are called nephrologists or the nephron, which is the kidney or the unit of the kidney. We're not called dialysis doctors, we're called nephrologists or kidney doctors. So the earlier You know, and you learn about your disease, you learn how to monitor disease, and you learn that there are medications that can delay the progression, they can slow the progression, and in extreme cases it can halt the progression, so people will live with kidney disease rather than die from kidney disease and dialysis.

So, Educate yourself, read about it, read the blood tests that are essential for kidney disease, but definitely do not box yourself as a patient. Kidney disease is dialysis. I'm not going to do anything about it because there's nothing going to be done about it. So I'll wait for it to come to me. That is a wrong thing to do.

The Role of Blood Pressure in Kidney Health

Dr.Rifai: There is a great class of medications called ACE inhibitors and it's cousins, the ARBs, tight blood pressure control. If I have to give one advice that I can feel that I have given you everything that I know as a kidney specialist, if you check your blood pressure every day, if you get your blood pressure to a reasonable, safe range, that is the number one modifiable risk factor that you as a patient can take care of yourself.

It has nothing to do with a doctor. It has nothing to do with Anything other than you take care of yourself, the most important risk factor is good blood pressure control. 

Theo Harvey: I love that, you know, keeping it simple. Sometimes there's so much information, especially because of health, and some of that information can be opposed.

I mean, they have voices out there that are not experts like yourself, trying to confuse patients and confuse people. But if you can kind of keep it simple, and I think that's your mission, right? To kind of say, hey, this is one thing you can control. Get that control back because I think people feel powerless when they feel like they have no control at all.

And I love that, that one thing, getting control of your hypertension. And one way to do that is by monitoring your blood pressure daily and seeing that results, because now you get a sense of what your blood pressure should be. If it's changing in any direction, and we're big proponents of that. My company, SensorMed, we do a lot of that remote blood pressure monitoring because We see the benefits of helping patients control their blood pressure.

As individuals living in the United States, we're about checking data and making sure it makes sense. That's why we like sports. We like to keep score because no one would pay attention if we don't keep scoring sports. So likewise I think it's very similar when it comes to your health metrics. When you talk about to your patients, They're trying to understand like ACE inhibitors.

How would you explain that to them from a fifth grade level? Right. You know, how do you educate them on why it's important to take their medications? Right. Medication compliance is a big issue as well. What are the things that you communicate to help make it simple or simpler for patients to understand the importance of taking their medications around that?

Dr.Rifai: So think about your kidney as a little filter. or a little, uh, cloth ball, and the pressure is going through it and is ripping it apart. And that's literally what happens inside the kidney. The class of medication that are called the ACE inhibitors will relax the flow of blood that is ripping this cloth with high pressure, or like a pressure, water pressure, like a fire hydrant, it will rip it.

And that's exactly what happens. So the medications that are the ACE inhibitors and its cousins, the ARBs, have been proven to reduce that ripping, shearing pressure from inside the kidneys and delay the progression. So when we tell patients, these are not only blood pressure medicines, but they are protective kidney medicines because within the kidneys, The kidney, they reduce the ripping sharing force from the kidney and those are the medications that we know today.

There is other group of medications that help with protection of the kidneys. The data is not as strong, but it is still supported. And they work in a different mechanism, but from a mechanistic standpoint of view, what happens and that's why the blood pressure is very, very important to control. And I'm glad you mentioned this, that your company is reaching out and thank you for you and your company.

But one of the things that I wanted to mention as well, there are guidelines on how to check the blood pressure. It's not like, Oh, let me get, Oh, here's a machine. Let's check my blood pressure. There are guidelines and I have summarized. that guidelines in one of my YouTube videos about how to check the blood pressure and what to record because if you're checking it wrong and you're taking that data to your doctor, the doctor will not be able to make a proper decision because data wrong in.

decision wrong. So there is guidelines that is put out by the CDC and the FDA and all the academic community on how to check the blood pressure and record it and then take, carry that data to your doctor and say, listen, my blood pressure is high. My kidney is being sheared from the inside. Please do something about it.

If you don't bring that to me, I wouldn't know. And that's why we encourage people to take your blood pressure at home every day and record it and bring it to us. And then we'll do something about it. Yeah. 

Theo Harvey: You know, we're seeing that the shift in this, this daily kind of habit forming, just like with obesity, stepping on the scale every day to kind of manage your weight.

better, more effectively. I think this is the way to kind of build those habits, right? Those behavioral changes that can kind of really make positive impact in your health and your well being for the long term. Just like with a continuous glucose monitoring, right? For patients that suffer from pre diabetes or diabetics.

So they didn't kind of see the blood sugar levels, right? Oh, I ate that piece of cake. See how my glucose levels spiked. And so I think this is, this is helping to change behavior. The way you explained it was like really powerful. And I saw that image, you know, I don't want my kid need to be shared, but at the same time, sometimes you forget when you just live in your life, but now when you have these daily reminders and things to do, then it helps monitor what you're doing more effectively, whereas blood pressure, obesity, or your blood sugar.

And also there's a big movement in mental wellness, mindfulness, right? And so doing daily habits around that. So I think that's really important. It's better to have maintenance than doing repairs. That's why you have a car, right? You get your oil change every so often because you don't want your engine to just crap out on you.

And so I think similarly, people have to get in a sense of maintenance when it comes to their healthcare. And I love the way you communicate that. 

The Virtual Nephrologist: A Global Mission

Theo Harvey: So talk to me a little bit about like, you've been in social media. explaining, you know, these type of terms and what made you come up with the virtual nephrologist, right?

To kind of make it a global ambassadorship or just education. What problem were you seeing around helping patients manage their own care and more importantly, helping other doctors communicate that to their patients more effectively? 

Dr.Rifai: This, this subject is so passionate to me, it really kind of tickles my heart from the inside out.

And what I found out throughout the past 25 years of my practice is patients come to me where there is nothing much left for me to do. They come in to me with advanced kidney disease, so advanced that the only thing I talk about is dialysis. Because that shearing force. That damage to the kidneys happened in the preceding 20 years and nobody knew anything about it because Kidney disease is a silent disease until it's way too advanced and Hypertension to some extent is a silent disease unless you check your blood pressure readings So people will not know about their kidney disease till so advanced and I said to myself Well, those patients are not coming to see me Maybe I need to go see them.

I need to go to their hand. I need to go to their pocket. I need to go to their private bedroom and be on their iPhone, be on their tablet, be on their, um, any device to talk to them, to tell them, If you have very, very, very early kidney disease, I can make a difference. I'm not looking to have people come and see me.

I cannot see seven billion people on the face of this earth. will give me professional satisfaction is somebody will watch that video and will say maybe they're in Argentina, maybe they are in Japan, maybe in South Korea, maybe in South Africa. Somebody would watch that video and say, you know what? I heard this doctor somewhere in America.

He said, let's look up early signs of kidney disease. Can I go see my doctor and ask them that question? So that. In by itself, if that patient is in their 50s and they protected themselves and controlled their kidney disease, they live to be 80 and not have to be on dialysis. But if they're in their 50s and they ignore it, by age 55 they're on dialysis.

So I said to myself, you're not coming to see me. I cannot see all the people on the face of this earth. But with the power of social media, both on Facebook, YouTube, and Instagram, I can reach out to them. I can tell the patient in simple language, this is the issue. What is kidney disease, how to check for kidney disease, what are the risk factors for kidney disease, carry it, go to your doctor, say this is me, I want a birthday gift for me, I don't want a cake, I don't want something wrapped in a box, I want you to do these simple two tests for me, creatinine and urine protein, that's it, and these are tests from a financial standpoint of view, they are not prohibitively expensive, they are one of the cheapest tests to do on your blood.

And what you tell yourself, whether I have kidney disease or not, or I put up the video about risk factors for kidney disease. You, I, it's seven risk factors and you check if you're one of those, you have risk factor for kidney disease, your own responsibility. This passion, For reaching out to people came from the pain and the actual heartache that I was able to see when patients come to me and I look him and I say, Sir, Madam, I'm sorry, I cannot do anything for you.

Let's talk about analysis. 20 years ago, I would have been able to. This is not 20 years ago. The reason is now they progressed. It's a silent disease, but even if it's silent, you can still detect it if you do the proper test and early screening. And that's the reason now I feel very empowered to reach people, to be able to reach people in any corner of this earth and tell them, look up, Do you have chronic kidney disease?

We can make a difference for you. 

Theo Harvey: No, I love it. And you know, um, I'm always amazed because some of the busiest people I know are doctors. You only have certain hours that you have free time early in the mornings or evenings and sometimes weekends if you're not working a shift. 

Empowering Doctors to Use Social Media

Theo Harvey: I talk to doctors all the time about putting their presence out there on social media.

What advice would you give some of your colleagues who say, hey, I'm passionate too about helping people. Patients, not just my patients, but other patients, right? Because I'm answering the same questions. I feel like I'm not doing enough of what my oath to my responsibility are to patients and what my knowledge is.

How should I get started with social media? What are the things that you did to get started? What are some of the barriers you had to overcome to put your expertise out there and communicate it? So now on the other side, you feel like you're, you're giving back at a high level. What are some of the things that you did to get started in this whole process?

Dr.Rifai: So we're, we're not officially trained to be actors. We're not officially trained to be speakers. We're not officially trained to be techno, but people who will see your eyes, we'll see your passion. We'll see your tone of language. We'll realize whether you're trying to sell them a product or you're trying to sincerely, genuinely give them a loving advice.

You don't have to have complex and sophisticated devices. and a team production team. People will see that. My, my studio is a, is a cell phone and my editing team is my computer and that's it. People see it. That's all what I have, but people see the passion, the sincerity, and that brings something very, very important.

When somebody give an advice, And at the end want to sell you a pill, a juice, a product, a course, you know the purpose of that video is to sell you something and beware as a patient of any of those pills and concoctions and, uh, and so forth that are labeled as reversal of kidney disease. There is no such thing.

Unless it's a, it's an acute renal failure, unless it is an immunological disorder, which is in rare circumstances, but usually the chronic kidney disease is progressive irreversible. So to my colleague, if you want to start, get started. It's very easy. We're smart. We're doctors. We can figure it out, but that's not the point.

The point is how sincere are you? If you're sincere, people immediately will see it, will be able to judge you very easily. On the other hand, if you say, okay, well, uh, thank you very much. This is chronic kidney disease. But by the way, I have this product. Go to my website. Here's a link by each pill is 49.

99. And if you buy 10 of those, I'll give you a discount. Now, you know, this is not. sincere. Whereas, please give yourself a birthday gift of going to the doctor, figure out whether you have kidney disease, and that is music to my heart. Then we'll say, you know what, this guy doesn't want anything from us.

Maybe he wants to be sincere with us and tell us. The other thing is that make sure you maintain all the HIPAA and medical etiquettes. This is the world. Do not be lax regarding the privacy of others. Even if you don't mention names, people may know. Like for example, if you're in a small town and you say, I'm not going to mention their name, but so and so.

Hospital had a triplet. Everybody in town know because they know the triplet doesn't happen or, and so forth. So it's, it's maintained privacy, be sincere, choose what platform, and you will learn. The only way I cannot teach you, you have to walk the path and fall here, trip there, learn this, what I would call, you know, my, when my kids used to play video games, learn that cheat, learn that shortcut.

Until you get to learn how to do it. So I cannot teach, but what I want to give you and tell you is remain sincere. People will see it. Even if you don't look as an actor or, or have the talent of an actor, but people without a doubt, 100 percent can judge sincerity. So be sincere and get the message to help humanity.

Theo Harvey: It comes from a genuine place and people can sense that you don't have to speak super well, have high production values if it's coming from a genuine place and also from a place of expertise. Right. To your point, we see so many influencers out there. You know, we had a recent pandemic. We had so many people come out of Woodward who were experts, right?

And respiratory disease and all this stuff. And you're like, wait a minute, did you go to school? Do you understand the rigors of science? Understand what these white papers and literature is really speaking on. And then to your point, then you come to find out they're selling something. And so what you're selling is.

knowledge, expertise, but more importantly, the power back, you know, giving people power back to take control of their own health. And like you said, you can slow down the progression of some of these diseases that you don't even know you, you had. And so I think that's, that's where people can kind of get the results that they're looking for.

And, and, and. Going from that intention. I always say, sometimes it's hard to know who to trust in this world, you know, and all that. And I have this mnemonic. If you'd like me to share it with you real quick, I call it HIT. So if someone is talking to you and you want to see if you can trust them, do this HIT thing.

H stands for what's their history, right? What's their background? Like, did you go to school to be a doctor? Right. They're talking about. You know, what the things you should take and all that. But look at their background, you know, easily can search that online. I is basically intention, not what's their intention.

Like are they trying to sell you something? Are they coming from genuine place? And T is legitimate talent. Are they talented at this thing? Do you practice being a doctor consistently? And so if you kind of, you know, use that mnemonic that helps me kind of guide what sources I should trust, right. 

Dr.Rifai: I love that.

I learned, I learned a lot. I love that. That is actually applies to everything, applies to everything, whether you're selling healthcare, whether you're selling, like, for example, I cannot be a spokesperson for hair products. Uh, but you know, and I cannot say because, you know, I may be a doctor and I may be sincere, but it's just my, my experience and outcome is, uh, is poor.

It's for, but, uh, you know, it's just amazing to see how, like you said, during that time, a lot of people came in with, uh, expertise and that brings a very, very interesting subject. During that time of the pandemic, I was working in the ICU and I've seen it firsthand. So I was seeing those patients and I realized that one of the best thing to do for, you You did a pneumonia is to lay down on your stomach on your hand and knees and cough to get all those secretions out so one day I used my sophisticated studio Which is my handheld camera and the studio is actually the walkway or the driveway of my house Just regular concrete with with grass and I recorded a video on how you should position yourself So you can do just, uh, percussions.

So you can get the secretions out. I made that video, did not want to sell anything. There was no product to sell. There's no advice. There's no booklet, nothing. And that video have circulated the world so many times, translated to seven languages. People started using it and people started to send it to their relatives and said, you have a doctor here in Panama City.

And all what I wanted to do is I wanted to show people sincerely how to position themselves to cough to get rid of that COVID pneumonia. And that was one of the reasons why I learned how sincerity, I did not look like I had any training. The video quality is not the best, but actually it made a difference for people.

Theo Harvey: That's a wonderful story. And so, you know, all the physicians that listen to this podcast are just trying to understand, just start with sincerity. You already answering questions to your patients now, right? A lot of doctors probably got burnt out in that process and feel like they, nothing can change. Or they feel overwhelmed by all of this.

All the changes in healthcare, right? With administration and ways of getting paid and compensated. This is one thing a doctor, I think, or a person who owns a medical practice can take control back, giving your expertise out for free. And you'll be surprised of, I'm sure on your side, you have seen a. bunch of opportunities where people come back to you and communicate and give you, you know, so much more to your life because you have the intention and I've given back to everyone's else.

So I commend you Dr. Rifai and what you're doing and how you're kind of helping patients in this space. This is great. 

Conclusion and Resources

Theo Harvey: So where can they find you? I would love for everyone to find you on social media and things that you're doing out there communicating to the, to the populace. 

Dr.Rifai: If you are in Panama City, everybody knows me.

I've been here for almost 30 years. It's not a local celebrity, but I am just a regular member in the community. A lot of people know me. My kids went to school here and so forth. But if you are all over the world and want to get access to sincere, dependable, accurate, Up to date medical information in language and terminology that is designed for you, the patient, not for doctors, not for nurses, not for healthcare professionals, is for people to understand very easily in a simplistic way.

I am on all social media under the trade name, The Virtual Nephrologist. The website is the hub that gathers all that information. It has it in print. It has it in videos. It has it in brochures and it's all free. I put it out there that is very helpful for my professional satisfaction to see that somebody on some corner of this earth, somewhere in the middle of nowhere, where I cannot take care of them as a doctor, but I can reach out to them and hand them simple information on how to check for kidney disease, how to, Protect their kidneys, how to check their blood pressure and what are the risk factors and prevent them from being on dialysis because it is a preventable disease, it is a controllable, controlled disease.

It is a disease we can make a difference, we can make you live with kidney disease rather than be on dialysis and die from complication of kidney disease. 

Theo Harvey: Giving people back their life, right? You mentioned in your fifties, you know, if you don't know about, you're not doing anything about it, you could be on dialysis in five years, but doing these simple things that Dr.

Rifai is giving you for free, providing to you, he can give you back 30 years. I don't know what better exchange of your time, energy, effort that you need to get back and, or to want to go to his resources. So we'll have all this information in the show notes, the virtual nephrologist, where you can. link up and get more information.

If you think you have CKD or chronic kidney disease, or, or just have questions in general, you'll be a great resource. And we'll have in our show notes below in the YouTube channels and all our other social media channels as well. Dr. Rifai, thank you so much for your time and effort, but everyone, I hope you enjoyed this podcast.

Hope it was informative and can help you as we navigate the new normal of healthcare for you and your patients. Take care. Thank 

Dr.Rifai: you so very much for what you do for humanity and for kidney disease patients that have a special place in my heart as well. Thank you. Awesome. Have a 

Theo Harvey: great 

one.