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Can the “Doctorless” Patient Model Be Effective?

November 20, 2014
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Earlier this week at the New York eHealth Collaborative's (NYeC) 2014 Digital Health Conference, Eric Topol, M.D., director at the La Jolla, Calif.-based Scripps Translational Science Institute, gave a powerful keynote speech in which he talked mostly about how digital health tools can transform medicine.

Topol gave specific examples of how this is currently happening, and how it will progress in the future. His examples ranged from wearable devices to smartphone-based portable X-rays to the “Uber doc,” a concept that, like the car service, provides on-demand medicine with doctor house calls. Topol has long embraced technology to improve healthcare as well as a patient-centered system; his latest book, slated to come out early next year, is titled, “The Patient Will See You Now: The Future of Medicine is in Your Hands.”

For the most part, I agree with what Topol preaches. As patients/consumers, we are our data, so we should have control over it. If technology is embraced, and patients become more active and engaged in their own health, I can’t see how that won’t lead to better outcomes and lower costs—two of the biggest goals we have a nation. But there were some things Topol discussed that even I—a big believer in technology as a whole as well as a patient-centric healthcare—got skeptical about at first.

For some context, I think technology should serve as a supplemental aid to the doctor/patient relationship, but not ever replace it. During a recent visit with my primary care practitioner, I knew that there were certain questions I had that would be much harder to answer over the phone or via Skype. That being said, I was active and engaged during the visit, and I support the notion of being able to connect with your doctor outside of office hours—just not in place of a visit.

In a broader sense, technology is pretty much taking over the world in scary way. As part of my morning commute into New York City, I walk to the bus stop about eight minutes from my New Jersey apartment. As I approach the stop that often has dozens of people waiting on the street for the next bus, I notice that at times, 90 percent or more of the people have their eyes fixated on their cell phones, paying no attention to what’s going on around them. On the elevator, it’s just as bad. People never look up! I even see people cross the busy Manhattan streets while looking down at their smartphone or typing a text message that apparently can’t be sent three minutes later. I recently read that the average person spends four years of their life looking down at the cell phone—that’s simply incredible. And this isn’t to say that I can’t be guilty of these acts myself—I certainly can, and I’m beginning to make a conscious effort not to be glued to my smartphone in public.

Now, much of the above might not have to do directly with health IT, but I do think there is something to the point that as a society, we are letting technology take over our lives, rather than aid us in our lives. Topol pushes a model that has a nice premise, but seemed to go a little too far for me. During his keynote, he brought up the notion of “textual healing,” implying that people might actually prefer texting their feelings to a therapist rather than going into the office for a face-to-face visit. A few people in the crowd actually gasped when Topol brought this up. I’m not saying that text support can’t be useful, but how can the therapist truly help a patient without seeing him or her in person? In fact I would argue that while technology does have the ability to connect us, the way people rely on it these days, it can also separate us. Call me crazy, but I’ll take a hug over a text.

In the “doctorless” patient model, Topol says that physicians will provide wisdom, guidance and treatment, but are more “along for the ride” than completely dictating the ride. He referenced a Deloitte report that said by the end of the year, one in six doctor’s visits will be virtual. I get this approach and I support it, as long as virtual visits aren’t taking the place of in-person ones. Lack of money and time are two big reasons why virtual visits can be effective, but they shouldn’t be the be-all and end-all.

During the Q&A session of the keynote, an audience member expressed concern about technology taking over the doctor/patient relationship, similar to the concern I am expressing today. Topol’s response was a great one, so naturally, I had to go to social media and Tweet it.

As long as this is the standard, I’m on board. And when I heard this, my skepticism subsided. Ideally, I’d like to be in a world where there is transparency and where the patient and doctor make decisions as a team, based on the data that is in front of them. What’s more, I want a world where you don’t need to schedule a doctor’s appointment to get care. But if people are going to one day think that Skype counts as a face-to-face visit—well, that’s not a world I’m ready for. 

Please feel free to respond in the comment section below or on Twitter by following me at @RajivLeventhal