January 7, 2014
“The doctor will see you now via your smartphone screen without an hour of waiting, at any time, day or night. It might not be your primary care doctor, but it will be likely be a reputable physician who is conducting part of his or her practice through secure video consults. And those consults will involve doing parts of the standard physical examination remotely. More importantly, they will incorporate sharing your data—the full gamut from sensors, images, labs, and genomic sequence, well beyond an electronic medical record. We’re talking about lots of terabytes of data about you, which will someday accumulate, from the womb to tomb, in your personal cloud, stored and ready for ferreting out the signals from the noise, even to prevent an illness before it happens“
Following on from the best selling Creative Destruction of Medicine Dr Eric Topol’s latest book The Patient Will See You Now is now available on Amazon/Kindle.
Abigail Zuger MD has shared a rather scathing review of the book in today’s New York Times that’s well worth a read:
“Dr. Eric Topol and I appear to practice medicine on two different planets. This fact makes it difficult for me to comment sensibly on his books, let alone critique them. Instead, I read along with mouth slightly agape, marveling at this missive from a far-off place whose atmosphere, physical laws and inhabitants bear no resemblance to the ones I know.
Dr. Topol is a cardiologist who directs the Scripps Translational Science Institute in La Jolla, Calif., and also serves as editor in chief of the website Medscape. His title at Scripps, “Professor of Innovative Medicine,” says it all: Like a fundamentalist preacher heralding the apocalypse, he preaches the end of medicine as we know it and the dawn of rigorous, digitally perfected, accurate and cost-effective care“
I understand some of the criticism as I also have concerns about a mythical future where Digital Health is the Answer to Everything but this is a book about the future so we shouldn’t feel surprised if we find some of it challenging.
For me the criticisms are a reminder of how challenging many Doctors find it working in a technical era that is very different from the one in which they were trained and in which they are expected to continue providing undocumented care with an unviable funding model that hasn’t evolved from the 2000 year old sickcare model with it’s focus on producing ‘visits’.
I think the key that will make Topol’s latest book have more impact and be even more successful than his previous “Creative Destruction of Medicine”is that he now has a much greater appreciation of how healthcare is being impacted by Mobile (the newest mass media) and that this tool driven revolution will be the key driver that will force us to discover new things that cannot be explained never mind served by a Sickcare industry that struggles with even basic documentation:
Jumping to a few of the closing paragraphs and I think I see where the total disconnect exists for Dr Zuger:
“Finally comes the interesting philosophical question of whether all patients really do want — or, indeed, should want — to be their own doctors. You could actually write a book on that question, a book that might penetrate a little closer to the essence of medicine than Dr. Topol ever gets.
Certainly, people who are engaged in their own medical care fare much better than those who are passive and disengaged. But how engaged must a person be? When does engagement become burdensome?“
When you work within a system that involves forever trying to guess at what Patients want (how else do you think it’s possible to manage Patient needs while interrupting them before they’ve had 18 seconds?) it can become second nature to just presume you will always know what Patients want.
Within the Instant Medical History questionnaire that we utilise as part of the remote consults we offer at 3G Doctor a very revealing question that Patients can choose to answer is how much they would like to be engaged in their care. You’d be surprised how much better you can serve a Patient when you just let them tell you how much they want to be involved (I’d Never Admit That to My Doctor. But to a Computer? Sure).
Sick people have a primal need to be cared for; almost always, the sickest patients find that relinquishing the tough decisions to someone else brings huge relief. Healthy people may certainly enjoy monitoring their own physiology, but that activity can take up an awful lot of time. There are many wonderful things to do in this world other than keeping track of your own organs. Sometimes, it just makes sense to have someone do it for you“
I think here there’s a presumption being made that decisions need to be made by someone else (eg. a person and not a compassionately programmed computer that is always on, doesn’t need sleep, etc) and that sick people and their carers somehow find it easy to manage their healthcare needs using out of date tools that don’t even make sense to the born mobile generation.
Check out this post and it should be obvious that just integrating mHealth into how we care for diabetics (eg embedding a mobile phone into a glucometer just like Amazon did with their Kindle reader) we have created a significant step change because:
> the Patient no longer needs to remember when to test (the M2M glucometer device and/or their mobile phone will automatically remind them when it’s required).
> data (the dumb numbers diabetics with unconnected glucometers need to interpret and collect) is automatically turned into actionable information.
> decisions can be made whenever/wherever by the specific individual protocols that carers can set.
> advice can be found and questions can be asked (my simply opening the Diabetes Pal app on a mobile).
> ‘tracking’ becomes redundant because the process of collecting the data just becomes seamless.