Efficient medicine

Wednesday, June 29, 2016
by Cameron Shelley

A couple of interesting pieces have appeared describing effects of computerization on medicine.

The Wall Street Journal describes the current state of tele-medicine, that is, medical services that are provided remotely, often by phone or over the Internet.  The practise, it says, is finally living up to its hype.  Doctors are able to consult with their patients by smartphone.  Expert surgeons can perform tricky procedures from a long distance away.  As a result, standards of care have increased.  For example:

In the past year, ICUs monitored by Mercy specialists have seen a 35% decrease in patients’ average length of stay and 30% fewer deaths than anticipated. “That translates to 1,000 people who were expected to die who got to go home instead,” says Randy Moore, president of Mercy Virtual.

Increasing reliance on tele-medicine creates some concerns.  For example, insurance does not always cover tele-medicine procedures, even when similar procedures performed in-person are covered.  

Also, there are concerns that tele-medicine places too much emphasis on convenience versus quality.  For example:

In a study in JAMA Dermatology last month, researchers posing as patients with skin problems sought help from 16 telemedicine sites—with unsettling results. In 62 encounters, fewer than one-third disclosed clinicians’ credential or let patients choose; only 32% discussed potential side effects of prescribed medications. Several sites misdiagnosed serious conditions, largely because they failed to ask basic follow-up questions, the researchers said.

Such concerns are furthered by services that offer transactions billed as social interactions rather than medical consultations.  For example:

Another site, First Opinion, connects users with doctors in India for web chats, but a disclaimer states that these are merely “social interactions.” If a prescription or lab test is warranted, a locally licensed doctor joins the conversation for a $39 fee.

On the whole, such tele-medicine transactions may be easier than visiting a doctor but fail to preserve any doctor-patient relationship.  

Another article discusses how increasing adoption of electronic health records (EHRs) is creating a plethora of 'paperwork' for doctors.  Computerized systems allow doctors to track every aspect of interactions with patients.  Also, insurance companies require forms to be filled out for each prescription, test, or other treatment recommendation that a doctor makes.  The result is that processes that were previously accomplished in seconds in verbal or written form now require several minutes of filling in forms at a computer keyboard.

Doctors report that the electronic paperwork is increasingly tedious and cuts back on the time they can spend with patients.

This seems like just the sort of task that something like Watson could help to deal with!

These issues illustrate trade-offs that typically come with adoption of a new technology, such as the increasing computerization of medicine.  Tele-medicine helps to overcome limitations imposed by location but also undermines and commodifies the traditional doctor-patient relationship.  EHRs help to track patients' conditions but also facilitate growth of bureaucratic procedures.  

Recognizing such trade-offs and responding to them is an important facet of technological progress.