Dr. Craig Escudé of Health Risk Screening: “5 Things We Must Do to Improve the US Healthcare System”
Think of yourself as a gardener. Plant good seed in fertile ground, tend to the fertilizing and weeding as needed, and it will thrive…I believe it’s important to vet potential employees thoroughly, looking for signs of self-motivation, creativity and reliability. Once you find the right team member, provide them with a good orientation to their new job, clear job duties and expectations and let them have at it. Initially, re-evaluate frequently and offer constructive feedback.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dr. Craig Escudé.
Dr. Craig Escudé is a board-certified Fellow of the American Academy of Family Physicians and one of the very few Fellows of the American Academy of Developmental Medicine. He is also the president of Health Risk Screening, Inc. He served as medical director of Hudspeth Regional Center in Mississippi and is the founder of DETECT, the Developmental Evaluation, Training and Educational Consultative Team of Mississippi. He has more than 20 years of clinical experience providing medical care for people with IDD and complex medical conditions and is the author of “Clinical Pearls in IDD Healthcare” and the “Curriculum in IDD Healthcare.”
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
After completing my residency in family medicine at the University of Mississippi Medical Center, I began practicing family medicine at a Federally Qualified Health Center in a small town in Mississippi. There was a need at a nearby state mental hospital for nighttime, on-site call coverage. I started working there in 1997 and found that providing healthcare for people with serious mental illness and with intellectual disabilities was my calling. I transitioned to full-time work at the hospital and became the medical director of Hudspeth Regional Center, a residential program for people with severe and profound levels of intellectual and developmental disabilities (IDD).
I quickly learned that medical school had not prepared me for providing healthcare to people with disabilities and began efforts to educate practicing healthcare providers about this important field of medicine. That led to the creation of a program in the state called DETECT; the Developmental Evaluation, Training and Educational Team of Mississippi. I provided education to hundreds of healthcare providers and administrators in the state through this program.
In 2017, an opportunity to work in the field on a national level presented itself. I became president of Health Risk Screening, Inc. (HRS) in 2018. HRS is the sole developer and distributor of the Health Risk Screening Tool (HRST), the most widely used, validated screening instrument for people with disabilities. At HRS, I focus on public relations and the development of educational tools for healthcare providers and supporters of people with disabilities.
Can you share the most interesting story that happened to you since you began leading your company?
How about heartwarming? I gave a lecture to a large group of nurses who work in the field of IDD healthcare about how behaviors can be an underlying sign of illness in people with IDD. A year later I was invited again to speak to the same group. I had a nurse come up to me and tell me about one of her patients. The patient’s support team was “at their wit’s end” regarding his challenging and disruptive behavior. They were in the process of referring him to a psychiatric hospital when the nurse, who had just attended that lecture, recalled my discussion of underlying dental pain as a cause for adverse behavior. They referred him to a dentist and found that he had several undiagnosed dental abscesses. After proper dental care, he returned to his usual, pleasant self. To hear stories that what you do and teach to others has a real impact on reducing pain and suffering in people who often can’t communicate with words is a very humbling thing.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
I went with a physician colleague to evaluate a person with a severe intellectual disability who was noted to have a limp one morning when he got up from bed. We examined his hips, legs and feet and could find nothing wrong. We were discussing ordering several x-rays and an orthopedic referral when I glanced at his shoe. I noticed that there was a sock balled up in the front of his shoe. I removed it and put his shoe back on, and his limp magically resolved!
What happened was that the caregiver who helped get him dressed that morning did not notice the sock in the shoe when she put it on, and he was unable to communicate to anyone what was wrong. This experience emphasizes how easy it is to miss things when treating patients who have a limited ability to communicate with words.
What do you think makes your company stand out? Can you share a story?
What stands out first and foremost, is that our company is made up of people who understand and care about this field. Our employees have over 300 years of cumulative experience in providing direct healthcare and support to people with disabilities. We know the field, and we know our clients. Our mission is to assist vulnerable persons to achieve a health status and quality of life comparable to that of the population at large, and we do it every day with our one-of-a-kind Health Risk Screening Tool and our educational products. Our company’s offerings empower others with knowing how to identify early signs of health destabilization in people who may not be able to recognize it themselves and teaches them when and how to act to reduce health risks.
What advice would you give to other healthcare leaders to help their team to thrive?
Find good people and then let them do their job. Think of yourself as a gardener. Plant good seed in fertile ground, tend to the fertilizing and weeding as needed, and it will thrive.
I believe it’s important to vet potential employees thoroughly, looking for signs of self-motivation, creativity and reliability. Once you find the right team member, provide them with a good orientation to their new job, clear job duties and expectations and let them have at it. Initially, re-evaluate frequently and offer constructive feedback. If they are unable to meet the expectations of the job, first ensure that they have been instructed clearly of what they are supposed to do, and if so, it’s time to find someone else.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
In order to get good healthcare, you first have to have access to it. One barrier to access is a physical one. We have a lot of rural communities in the US which can make it challenging to see specialists in a timely fashion. Paying for healthcare is another issue. Our payment system consisting of a multitude of third-party payers leads to different costs and different levels of access for different people as well as tremendous amounts of red tape for both patients and providers.
Doing a better job addressing social determinants of health can lead to better overall health, as well. Better access to nutritious food, clean water, a good job and safe neighborhoods where people can get out and exercise are all important to overall health.
I must also mention personal responsibility. No matter what level of access you have to healthcare, even if it’s to the best clinicians in the world, we all have a personal responsibility for our health outcomes. Around 35% of the US population falls into the obese category. Obesity brings with it a plethora of medical, and often, psychological problems.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Move to an integrated care delivery model. Wouldn’t it be great if we could go to the same office and see mental health clinicians as well as medical ones, and in some cases to see both at the same visit? Integrated care reduces depressive symptoms, improves access, reduces the stigma associated with mental health visits and lowers overall healthcare costs. We’ve even seen lower hospitalization rates, emergency department use and lower relative mortality rates in programs utilizing integrated care models.
- Improve education in medical schools, nursing schools, and allied health programs in the area of healthcare for people with intellectual and developmental disabilities. There are millions of people with IDD in the US. Studies have shown that medical students who do not receive any training on or experience with the IDD population have been found to exhibit poorer performance caring for patients with IDD in tasks varying from taking a medical history, conducting physical exams, and ordering laboratory tests. There is evidence that early and frequent experiences with people with disabilities can improve medical students’ knowledge and attitudes about disability, thereby increasing their comfort level in providing care to people with disabilities. Educating providers in this area also spills over into healthcare for people who are aging, especially those with dementia. Their difficulty in communicating their health needs mimics those with intellectual disabilities making them susceptible to the same increased risks. It’s important that we teach healthcare providers the needed skills to meet the healthcare needs of people with disabilities so that anyone with any condition can walk into any office and receive competent healthcare.
- Increase the use of telemedicine. Telemedicine provides access to healthcare in a more efficient way to broader audiences. It reduces the need for travel and can greatly lower overall healthcare costs. Easier access can also translate to people getting care earlier rather than later in the disease process thereby preventing conditions from getting too serious before healthcare is sought. Remote monitoring of chronic healthcare conditions also improves access and outcomes.
- Address the social determinants of health. Not all people have adequate housing, food or even safe water, much less, safe areas for exercise and recreation. It’s hard to think about your health when you are struggling to keep a roof over your head or are worried about being a crime victim in your own neighborhood.
- Simplify payments. That’s so easy to say, but immensely complex. Healthcare billing and payments is an industry of its own, requiring specialized training and experience to accomplish with any degree of proficiency. The time spent on re-submitting, re-processing and refuting legitimate claims is costly and frustrating for consumers, payors and healthcare providers alike.
Ok, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
- Individuals — Take ownership of your health. Stop smoking, maintain a healthy weight, exercise regularly and work with healthcare providers in a cooperative way.
- Corporations — Foster healthy working environments, teach and train employees on best practices to maintain good health and safety in the workplace. Encourage telehealth access from offices or places of business. Include good health as a measure of success of your company.
- Communities — Provide safe areas for exercise. Improve broadband internet access to facilitate telehealth visits. Provide land for cooperative gardens to foster healthier eating. Work to improve access to healthy food choices in local stores.
- Leaders — Work to create opportunities for more integrated healthcare systems. Health education leaders should work to incorporate training on IDD healthcare into their programs. Work to simplify and equalize the healthcare payment process. Use your influence to communicate the importance of good health into what you are already doing.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
As I’ve mentioned, one of the biggest areas for improvement in the US is in the delivery of integrated care. People with medical problems such as a heart condition are often deeply affected psychologically when they learn that their activities may now be limited, or their life expectancy shortened. People who experience physical trauma, such as those in a motor vehicle accident, also experience emotional trauma from that accident. Our minds and body are intimately connected. When we treat only one or the other, we are not treating the whole person. In people with intellectual disabilities, all too commonly they are assumed to have a psychological issue when they exhibit adverse behaviors and are placed on psychotropic medications (that make the situation worse) without even looking for an underlying medical or environmental cause. Our clinicians need better training on the connection between medical and mental health and how the two interplay, especially in those with IDD.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider possesses the following traits:
- Good problem-solving skills
- Good technical skills
- Takes care of their own health needs
- Knows everything, always does exactly the right thing and never makes a mistake (see below)
The last one seems to be the expectation by many people for healthcare providers. The constant threat of being sued actually increases the cost of healthcare in the sense that people practice defensive medicine; they order more tests than might be clinically indicated to cover themselves from missing something and being sued. I believe that people who are victims of neglectful healthcare should have the right to damages. I believe that there are clinicians out there who do not practice good medicine. But I also believe that as a society, we are increasingly interested in making someone else responsible for a poor outcome regardless of the cause.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Never think of yourself as an expert, but always keep trying to become one.” Once you consider yourself an expert, you quit learning. There’s always more to learn. Even if you think you know it all about a particular field but aren’t thinking about how you can make it better, you are limiting yourself.
Are you working on any exciting new projects now? How do you think that will help people?
At HRS, we’ve just completed a revolutionary electronic learning course to teach physicians, nurses and allied health professionals about healthcare for people with intellectual and developmental disabilities. It’s called the “Curriculum in IDD Healthcare.” It’s web-based and is perfect for practicing clinicians as well as medical, nursing and allied health students. It’s an ideal program to incorporate into health professional schools as an introduction to IDD healthcare.
Many of the lessons taught in this course are extremely applicable to people who are aging, as well. As many of us age, we lose cognitive abilities, especially if affected by dementia, and we experience some of the same difficulties as those with intellectual disabilities. Behaviors become more of a form of communication than words, and this course teaches many important lessons in this area.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
My primary resources for inspiration are the people around me. Collaboration with other professionals leads to new ideas and increased productivity. We have a lot to learn from each other so I try to talk with leaders and visionaries in the field directly whenever I can.
Besides the leaders, I learn most from people to whom our products are meant to help, and these people don’t write books or host podcasts. Get to know the end-users of your company’s offerings; the real people out there who benefit from what you are trying to do. They are my best teachers.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I believe that anyone should be able to walk or teleconference into any healthcare setting and receive competent, compassionate, and cost-effective healthcare. Having clinicians trained in the fundamentals of healthcare for people with IDD is a big step toward achieving that goal. My primary focus is to ensure that all healthcare providers receive fundamental training in this field.
How can our readers follow you online?
You can follow Health Risk Screening, Inc here:
LinkedIn: https://www.linkedin.com/company/health-risk-screening-inc (they can use this link or go to LinkedIn and search: Health Risk Screening Inc)
Instagram: Our handle is: @healthriskscreeninginc (link reads: https://www.instagram.com/healthriskscreeninginc/ )
Our website is HRSTonline.com.
Thank you so much for these insights! This was so inspiring!
It was my pleasure! Best of health to you and your readers!