Could mobile apps replace doctors?

A recent post in the DailyDealMedia caught my attention. It was titled “Uprising in Mobile Health Care: Could Medical Apps Replace Doctors?”

The theme of technology versus humanistic aspects of medicine has been the subject of debate for many decades, obviously predating the advent of medical apps.  I find it interesting that the introduction of the referenced PwC study highlights the fact that “Solutions, not technology, are the key to success.”

Another piece on this subject in The Atlantic addressed what I believe is the core issue: “Should (most) doctors become obsolete — or less provocatively, does the practice of medicine need to change? Here, the answer must be yes.”

I will give my own reasons why I think the question of apps replacing doctors is neither feasible nor desired.

1. The adoption of mHealth apps will never reach 100%.  The adoption of new technology in medicine is neither rapid nor ever total. Adoption is a function of awareness, education,  ease of use, challenge to workflow, personal approach to disease diagnosis and management,  and patient relationship and trust.

2. Mobile health apps were never designed to replace doctors.  Apps are tools to increase patient engagement, provide data, and to help patients self-manage their health.  Self-management, however, does not imply an alienation or elimination of the healthcare provider. The article states that “Mobile devices are trying to cram 8 years of doctor’s specialized training in medical school and residency as well as multiple years of direct patient interaction all into an app, and letting the patient run wild with their own conclusions.”  I don’t know of any app developer or patient for that matter, who either believes or desires believes that in the least.

3. Mobile health apps provide data, not care.  Apps are extensions of the patient’s body, providing data to the provider.  The information belongs to the patient. It is shared with the provider in a filtered, useful manner. The apps motivate patients with information, gamesmanship, and ‘Atta boys.’ Some might even suggest a diagnosis.  But the goal is not just to have a medical Siri with extendable ears and eyes. It is to have a well-trained human being who knows the patient take the digitized data and decide how to proceed. Certainly algorithms collated from data derived from many clinical studies, populations, and the individual patient in question will improve accuracy and quality of care, but there are too many variables to wholly depend upon cook book medicine.

4. All patients are not the same.  One would not approach the diagnosis or treatment of a teenager in the same manner as a 90 year-old. Someone with kidney failure has a much higher risk of surgery than someone without it.  Such is the way with apps. Even the prescription of an app should not be standardized.  People with the same diagnosis or symptoms require individualized assessments based on concomitant medications, severity of illness, mobility, co-morbidities, prognosis, extent of caregiver support, and the patient’s wishes.

5. Personalized medicine does not imply the patient becomes the doctor. The eight areas of digital medicine as discussed by Dr. Eric Topol in his book The Creative Destruction of Medicine (wireless sensors, imaging, genomics, Information systems, social networking, the Internet, mobile connectivity, and computing power) will converge and result in personalized medicine.  No longer will a diagnosis trigger the same treatment in everyone. Personalized medicine implies uniqueness of the individual, not the individual becoming his/her own physician.

Skepticism about new technology is expected and healthy. It should not be blindly defended by its developers or investors.  It requires proof of effectiveness, safety, convenience, cost-efficiency, and acceptance by both providers and patients in order to expect its adoption. The DDM article is a bit sensationalized, perhaps by design.  It inspires reflection.  I hope this post does the same.

David Lee Scher is a former cardiologist and a consultant at DLS Healthcare Consulting, LLC.  He blogs at his self-titled site, David Lee Scher, MD.

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  • mata_o_diabo

    who do you sue? the app maker?

  • http://www.thehappymd.com/ Dike Drummond MD

    Thanks for the post Dr. Scher –
    Apps are information delivery vehicles. They are incapable of human interaction and will never replace a doctor when you really need them. Healing is something that takes more than information.

    It is my hope that apps replace some of the scutt work that doctors and their offices can’t or shouldn’t be doing so that we can concentrate on the intense healing encounters and complex problem solving and care coordination that require an MD level of training and experience.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

    • dlschermd

      While I agree with much of your comment, I doApps will replace way more than scut work. They will both empower and engage patients in their own healthcare. They will provide physicians and other providers with more accurate and actionable data as well. As opposed to EHRs which are built around mandates, it is hoped by me and others that most apps will be built around true clinical needs with benefits derived much quicker than from electronic records which will likely take years. Apps will help the care coordination and complex cases in ways that EHRs can’t and will therefore, I believe, be received more positively by providers.

      • http://www.thehappymd.com/ Dike Drummond MD

        Hey dischermd … I don’t think we disagree at all. There are A LOT of things doctors do these days than don’t require an actual doctor to deliver the service. Don’t mistake that for “being a doctor”. You don’t need a doctor to deliver a test result, answer a rhetorical question, deliver a text to motivate someone to exercise or any of a number of things an App can do. And when you NEED a doctor, only a doctor will do. Here’s what I mean.

        - You have a lump the size of a ping pong ball that has come up in your groin in the last ten days.
        - You have been losing weight and having night sweats for a month
        - There is blood in your stool
        I could go on and on here.

        In these instances you NEED A DOCTOR — NOT AN APP because these are situations that call for a human interaction with a specialist in human disease. Apps can handle a lot of what I am calling “scutt work” … all the stuff that does NOT NEED a doctor. And they cannot replace doctors when you REALLY need one.

        My four cents,

        Dike
        Dike Drummond MD
        http://www.thehappymd.com

        • dlschermd

          Yes, Dike, you are correct. I do agree with you. Thanks.

          Best regards,
          David

          David Lee Scher, MD
          DLS HEALTHCARE CONSULTING, LLC

          Website: digitalhealthconsultants.com

          Harrisburg, PA 17112 USA
          Cell: +01-717-503-3578

          Blog: davidleescher.com
          Twitter: @dlschermd
          LinkedIn: http://www.linkedin.com/pub/david-lee-scher-md/27/16a/90

          “The good physician treats the disease. The great physician treats the patient who has the disease.” —Sir William Osler

          “The most exciting breakthrough of the 21st century will not occur because of technology but because of an expanding concept of what it means to be human.” —John Naisbitt

  • virtualCableTV

    The data processing medical records oligopolists control all data and all apps that are prevented from accessing data or integrating with data. They have a strangle hold on those that receive healthcare from the cowardly servants of the fasicst AMA that pretend to provide it.

  • http://www.thehappymd.com/ Dike Drummond MD

    Interesting question mata_o raises in the comment below

    I am 100% certain app makers will get sued down the line. It is precisely because they tout themselves as a technology that “takes the place of your doctor”.

    Imagine this scenario ….If the app tells you to do something and you do it instead of seeing your doctor … then come up with say … cancer .. down the road … some class action lawyer will
    jump all over that. It is part of the healthcare environment. And it won’t matter how many disclaimers they have plastered all over the download page … you know … the things you don’t read before you click the “I agree” button to download the app.

    The “App Chasers” can replace our current crop of ambulance chasers.

    My two cents,

    Dike

    Dike Drummond MD
    http://www.thehappymd.com

  • kholt16

    Another obstacle for mHealth is the amount of wireless spectrum available in the US. mHealth will not have much of a future unless the Federal Communications Commission can free up spectrum this year in anticipation of the looming spectrum crunch by 2016. See http://bit.ly/Mw12wP for more information.