Dr. Dustyn Williams does so much to improve humanity, it makes the rest of us feel bad.
He is the co-founder of DoseDr, co-founder of Onlinemeded, the internal medicine clerkship director at Tulane Medical School’s LEAD program, board member of Baton Rouge General Hospital’s internal medicine residency program, and an internist that cares for patients.
Full Audio of Interview
Ray: Today we have Dustyn Williams. Dustyn is the co-founder of DoseDr, and Dustyn, thanks for being here.
Dustyn: My pleasure.
Ray: Great. What is DoseDr, and what problem are you aiming to solve?
Dustyn: DoseDr is a full-stack solution that … No, I’m just kidding. It is actually, but what DoseDr is, is a combination of a moment to moment daily treatment tool for a patient to have on the phone. That connectivity to a physician to help them do it right. Diabetes is really hard, especially when you have the most difficult to control diabetes that’s the diabetes that require the use of insulin. Your insulin dose will change day to day, in the day, based on what you’ve eaten, current sugar, the activity you’ve done, and so every day, every patient who uses insulin has to decide, “How much insulin am I gonna put in me right now?” You can imagine that, left to their own devices, most patients, not the ones you know in Silicon Valley, not the people who go for a jog and have to adjust that insulin based on the jogging. It’s going to be the people who don’t have a great education, that don’t have infinite resources, and that gets pretty hard for them. Wouldn’t it be cool if very complex physician instructions that have the dose change minute to minute, day to day, has to have an app that tells them exactly what to do based on some inputs? The first part of the DoseDr is the mobile app. Patient does what they normally do, checks their sugar, gives themselves an insulin, only now, they tell the app what their blood sugar is and the app looks up physician instructions and displays it in ways they understand. They know exactly what to do every day. That information is ported over to our portal, where physicians in the professional medical corporation look at that data, usually every three days, and then together with the patient make titration decisions. What you’ve got is vastly improved adherence to a treatment regiment, and small, frequent titrations in the insulin dose. We rapidly get people who were previously out of control, blood sugars very high, measured by the A1C, under control very quickly without overdoing it.
Ray: Wow. It sounds like you’re taking something that’s very complex for patients that may have a difficult time understanding what to do and combining it with doctors that may not have time to explain exactly how they should do it.
Dustyn: Yes, except we actually supply the physicians, right? It’s not fair to ask a, already overworked clinic doctor, to then log on at the end of the day and look at their diabetic patients. Tried that. Doesn’t work. What we do instead is we make it easy for the physicians so say, “You know what patient, it’s time for DoseDr .” As soon as they do, they get our doctors, which do have the time to analyze information every day, since that’s all they do.
Ray: These doctors are fully employed under DoseDr?
Dustyn: Legally, the thing that’s aside, yes. I say that because we’re not allowed to have practice of medicine, so we have an affiliated professional medical corporation, which uses the DoseDr platform in order to facilitate the treatment and management of the disease. It’s a long winded way of saying, yes, right there. Effectively, Dose Doctors who are doing this on behalf of the company DoseDr, but are unaffiliated technically, for legal purposes.
Ray: Very cool. Tell us about some of the results that you’ve achieved with DoseDr’s platform?
Dustyn: As we started Y Combinator in winter 2016, I went around Louisiana and I begged people to give me patients, right? We get it for free. We said, “Give us the worst of the worst. The people that you absolutely have never gotten under control. The people who must be doing it to themselves, who don’t give a shit. Too dumb to keep up.” I’d asked for the worst of the worst. What happened was, they weren’t dumb, fat, and lazy. What it was is that they didn’t have the tool or the connectivity that they needed to do it right. This is pretty cool. As a physician, saying this is pretty awesome. Basically, within three months time, I was able to achieve what their primary care was unable to do in seven years. We dropped the A1C from 9.4 to 6.3 in three months, and that change is unheard of in medical care. To put it into perspective, for those of you who are not familiar with diabetes, an A1C that is normal is less than five. You have diabetes at 6.5, pre-diabetes at six. The goal was less than seven. We took people who were nine and over, really out of control, and just gave them a tool. It turns out, once they had the tool, they were able to take care of themselves pretty well.
Ray: That sounds pretty amazing. Really amazing.
Dustyn: Yeah, it’s awesome. One of the women was in rural Louisiana and she had this, just outrageous regimen. She said, she thought she was supposed to add five units for every this much of sugar, and no one, no primary care provider ever gave her. She misunderstood the instructions and so it didn’t do anything. She ended up not doing a thing and she ended up in the hospital twice before she started DoseDr. The month before she was in the ED twice, and got admitted once. Somewhere around $5,000-$6,000 in costs and then after starting DoseDr, for the next year, she never went back. She was so used to having blood sugars out of control that she felt like she was hypoglycemic, felt the low blood sugar at higher than normal levels. We actually had to coast her in slower than most people because she was so used to being so high, for so long. Pretty cool.
Ray: DoseDr works so well that it even surprised the patients and, it sounds like, the doctor team as well?
Dustyn: Honestly, absolutely. I knew it was going to be good. I knew there was this problem that people didn’t know their … Or didn’t understand their instructions, and doctors couldn’t get the information they needed. We could provide that whole solution, all in one. I knew it was going to be good, but to see the sugar curve come down over three days, and then two weeks, and then constantly go down, and be at goal, and stay there, is amazing. Literally, I’m used to dealing with people who I see every five weeks. They don’t come with instructions, they don’t come with a log book. They actually teach, go really slow with the insulin. You don’t want to overdo it. What happens is that most doctors are either scared of insulin or they’re scared to increase it the right way. Patients go years with uncontrolled blood sugars, which ends up causing them to have heart attacks, strokes, and kidney disease, and amputations. Which sucks for the patients and also for the society. Right? We’re paying for that. You could just control the blood sugar, and that doesn’t happen.
Ray: That sounds pretty good for value based payments, which everyone’s heard about so much as the future of reimbursement in healthcare.
Dustyn: Yeah, absolutely. Conveniently it goes right with it, right? I totally believe in it 100 percent. Fee for service is garbage. It’s a waste. It’s useless, bureaucratic garbage that people do extra in order to get more money. It doesn’t make any sense. It should be based on the quality. Especially for chronic disease.
Ray: Very cool. If someone is listening to this interview, and they know someone with diabetes, or they have diabetes themselves, would Dose Doctor be available for them to use or are there specific sites that you’re launching with right now?
Dustyn: This is a terrible time to do this interview because we just closed the philanthropic, free for everybody arm. You have to be in a state in which we are licensed to practice because we have physicians who are actually doing it. Right now, if you go to the DoseDr app on the, either the Apple, or app store or the Google Play store, you can download the old app and you can onboard it, but it’s really just going to act as a reminder. You won’t be connected with a physician. We’re just about to release the brand new product. Cool, we’re gonna have diabetes, and hypertension, and we’re gonna have all this cool stuff, but we really are going to be at primarily individual sites where we actually have paying customers. We were free for a year and then we decided to shut down right now.
Ray: Well, lucky for those that have already signed up. What does the future hold? What’s the big idea, and where do you think you can take DoseDr in the coming years and decades?
Dustyn: My vision is a true, chronic disease management platform. Those words get thrown around. Right now there’s people trying to do it, but they’re only going half way. They’re not leveraging technology the right way. They don’t have the in the moment information for the patient to know what to do right there. User entered information on … This is all about chronic disease, right? If you got the flu, you’ve got to go see somebody so they can diagnose you with the flu. If you’ve got diabetes and hypertension, I mean, we know what your numbers are. You can check those numbers yourself. Legitimately, what I believe that this can do is essentially say, all chronic diseases can be self-monitored by the patient and then have values entered into an app, sent to physicians who only do this thing, to help titrate chronic disease to get patients to goal faster, and then keep them connected so that they can keep up with the things they need to do year to year, not just day to day. Chronic disease management, reactive apps, stuff that cost the most that’s prevalent to hypertension, diabetes, CHF, COPD. Doctor in your pocket, access to a physician, and then titration until the people are under control to limit the disease progression.
Ray: Very cool. Very cool. Well, last question. For those that don’t know, in addition to being a co-founder of DoseDr, Dustyn is also a co-founder and lead educator for online MedEd. He’s the internal medicine clerk shift director at Tulane Medical School, a core faculty member at Baton Rouge General, and also, a practicing physician that treats patients. Dustin, how do you manage to juggle all of these roles?
Dustyn: I’ll sleep when I’m dead. Sleep is for the weak. In all honesty, I over reach, I over extend. People ask me the question, what makes you happy? It’s, don’t ask me. You don’t want to follow my footsteps. The cool thing about being a doctor, for me, in New Orleans, post Katrina, you go 30-hour days, it’ll be four days in regular days in between, and you get used to just this brutal grind with limited sleep and then you realize that … Well, I did anyway, that the thing that I value more than anything is contribution. I don’t really care about my own personal mental health. I try to keep that in check though. I’m not crazy or suicidal, but I would rather other people benefit from my sacrifice, that I leave something to the world. It’s really the why that drives me. If I don’t sleep, I don’t care. I’m not used to that. So long as I’m using that time effectively, to do something for other people drive a program, or to build online MedEd to train 80,000 clinical students, or build Dose Doctor so that patients can take better care of themselves, my drive is what keeps me going. Although, I am getting tired, I’m probably going to take a vacation soon.
Ray: Well, it sounds like it’ll be much deserved, but DoseDr sounds amazing. We’ll be looking for how these first wave of many patients goes and I think that’s the best way to end the interview. Dustin, thanks so much for the time.
Dustyn: You’re very welcome, Ray. Appreciate it.
Ray: Great, thank you.
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