Technology and the doctor-patient relationship

I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient  relationship has degraded in our culture.

In large part, I believe this is due to technology.

The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit.  Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.

So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient?  In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.

Here’s the problem, though.  Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.

These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.

I can tell you that as I type into my computer while seeing a patient, clicking the right boxes, filling in the right spaces, we both feel the demand on us, and the oppressive requirements of a system that has stopped supporting conversations and looking each other in the eyes when speaking. Many of us take notes and go back, after we can close the door on the patient we just saw, but this adds multiple extra hours to a doctor’s day, and isn’t always practical. After a few hours of patient after patient, you forget the subtle signs you notice when looking at someone — the things you see that the patient doesn’t directly tell you. As a die-hard believer in the human connection, I want to believe that people and interactions and human form, touch, voice, and emotion do make a difference in the pursuit of wellness.

On the other hand, there are benefits to the new technologies, and honestly, I can’t wait to see the Health Kit, and other innovations that help people care for themselves.  As obesity and diabetes rates continue to rise, as Americans continue to over-consume foods that are not supportive of health, we have to admit that something isn’t working. Maybe an app, a kit, a technology can succeed where a doctor simply telling a patient to go on a diet and exercise more has failed. So, as a doctor, I will continue to stroll down memory lane and hold on to the last vestiges of feeling like and acting as a healer.

At the same time, I plan to open my mind to the next generation of people getting healthy through technology.  I’ll use technology if and when I have to, especially when I see it working. However, I will also always be there for my patients when they need a hand to hold or a shoulder to cry on, or even someone to just listen to their heart with an old fashioned stethoscope. I can share the job of healing with technology, but I will never let go of my part in it, either. I hope many other good doctors out there feel the same.

Suzanne Steinbaum is director, women and heart disease, Lenox Hill Hospital, New York City, NY.

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