Is technology changing the patient-physician dynamic?

Like virtually all industries, healthcare is gradually embracing digital methods to improve their operations, and Covid-19 has only speeded up the process. The widespread adoption of telemedicine by physicians and general practitioners, for example, has reduced disruption to medical diagnoses and treatments during the pandemic – but is this shift to technology-driven healthcare still benefiting consumers? patients?

Telemedicine services, such as video calls and portable health monitoring devices, have been crucial in maintaining access to care while Covid-19 makes in-person visits widely banned. For those living with conditions that make it difficult to physically visit the clinic or hospital, phone and virtual appointments can also dramatically improve the healthcare experience.

Digital health: improve or disrupt care?

Eleanor, who lives in England, suffers from postural orthostatic tachycardia syndrome, a condition that affects the blood circulation and can cause symptoms such as fatigue, dizziness and pain when standing. She says telemedicine, “if done right”, makes a significant difference in her life.

“With telemedicine, I have the energy to engage, get the most out of my appointment, and I can do some tests at home while the doctor watches,” Eleanor explains. “If I have to go for health care, it could allow services to coordinate and ensure that if I am traveling in an ambulance stretcher, I can have multiple tests in one visit, since I am usually there for hours.

“I need services adapted to my level of disability. Although I have a reliable internet connection, I would always choose an appointment that allows me to submit information in advance, and this is doable without causing me undue hardship.

While the benefits of digital healthcare have been particularly highlighted by the pandemic, the widespread shift to these methods can also negatively impact the patient experience and the quality of care provided.

NHS consultant dermatologist Dr Eugene Ong says that while there are ‘huge opportunities’ for technology to maximize efficiency and data capture in hospitals, digital healthcare is a barrier for those who find some devices difficult to use.

“A lot of patients, especially older patients, sometimes struggle with the technology,” he explains. “A lot of times when you have elderly patients who can’t take pictures, you get a very grainy or poor quality image, and the resolution you get when a patient comes in.

For specialties like dermatology, which rely on sight and touch to make diagnoses, there are also safety concerns related to limiting patients and physicians to virtual appointments.

“For example, during mole checks, we look at the whole body of the patient, and that is often not possible when you can only see an image of one or two of the areas,” says Ong. . “So accidental injury, accidental skin cancer that the patient may not be familiar with, can go unnoticed – this is one of the biggest safety downsides.

“Even in a visual specialty, you rely on literal human touch; you’re relying on something called palpation, where you run your fingers over a rough area, and it can tell you if it’s a precancerous lesion. You won’t get that from an image, so you lose all of these different sensory modalities that can allow you to make a diagnosis.

The human element

The success of primary care relies on communication and trust between patient and physician, but important interactions, and therefore the relationship as a whole, can be compromised by the distance that technology sometimes holds between the two parties.

“Nothing replaces face-to-face consultations, to see the nuances of a person’s expression and what they mean,” says Ong. “History can be done over the phone, but often the non-verbal aspects of patient communication – the expression, whether the patients are happy – is not conveyed very well with telemedicine. Even in a video consultation you can’t see the rest of their body language, you can just see aspects of their face, for example.

In an article published in JAMA Internal Network, the American doctor Paul Hyman deplores that the physical examinations were “torn away” from him while his practice of care is pivoting towards telehealth. “Although I recognize the benefits of telehealth, I find it difficult to find the balance,” he writes. “By trying to keep patients at bay, I lose touch with part of my professional identity. ”

Nowhere is the human interaction between patient and physician arguably more important than in mental health services. The empathy and understanding that many patients seek when disclosing difficult or sensitive information, such as issues with their mental health, can be lost when contact is limited to a phone or video call.

Kirsty Teahan (24), who takes antidepressants, says her monthly phone checks – in place since the start of the pandemic – consist of different doctors “listing the questions they need to ask.” And since the doctor can’t see you in person, she says, it’s easy to lie or leave out details about how you’re doing.

“You’re just talking to a voice on the phone; it’s very impersonal, ”she says. “If something was really bothering you, you just don’t feel like you can [say]because a phone call is not the same as talking to someone face to face. Sometimes I found out they don’t even know what [medication] you’re sure, because they’ve never seen you before.

The lack of constant face-to-face contact with a healthcare professional has changed the way Kirsty feels about doctors and made her reluctant to get in touch and discuss her conditions with them.

“You’re just one person on a piece of paper, because you don’t have regular appointments with a doctor who knows you – you’re just another person on their list. A lot of things that I’ve told the doctors are just undone, because they can’t see how it’s affecting you, and you just feel a little down, ”Kirsty says. “It really feels like they just don’t take your individual situation into consideration.”

How much technology is too much?

Likewise, Ong says valuable information – like a patient’s concerns or expectations for their care – is often lost during telephone consultations.

“Obviously, this will have an impact on the human relationship between a doctor and a patient, especially in dermatology and in other specialties where you build long-term relationships over several years, with patients with chronic diseases”, explains he does.

“If this relationship is compromised in any way, it impacts the patient’s trust in a doctor, or the patient might not be comfortable bringing up something that may be relevant. This creates a barrier in terms of relationship building.

Less widely established, but nevertheless on the horizon, is a cutting-edge technology that seeks to further reduce patient-doctor communication: the chatbot. Chatbots are used for a variety of healthcare purposes, including providing medical information, scheduling appointments, collecting patient data, and submitting prescription requests.

While such technology can be useful alongside traditional healthcare, to help reduce workloads and costs, there are still aspects of healthcare where human quality is expected and needed. Recent analysis of an AI-powered chatbot for cancer patients concluded that “even after we solve the problems and establish the safety or effectiveness of chatbots, the human element in healthcare will not be replaceable” .

Not “one size fits all”

Ong predicts that regular use of telemedicine by physicians will likely continue after the pandemic, and it looks like he will be right; 58% of doctors surveyed by McKinsey say they view telehealth more favorably now than before Covid-19, while 57% would prefer to continue providing virtual care after the pandemic.

So, if digital healthcare is here to stay, how can we ensure that patients are getting the most out of it? Telemedicine is “not a one-size-fits-all solution,” says Ong; care should be tailored to the needs of each patient.

“If a patient is 90 years old and hard of hearing, telemedicine will never work, so the patient has to be seen face to face,” he says. “If you find yourself in a high risk situation where you have to examine a patient’s skin or see a patient completely, then again the telemedicine situation will never work. It must be adapted, according to the preferences of the patients.

Technology has in many ways made healthcare more accessible, accurate and efficient, but it cannot and should not replace face-to-face interaction with a doctor. Rather, healthcare providers must strike a balance between the two – and determine where digital approaches really improve healthcare and where they simply fill in the gaps created by the Covid-19 pandemic and other constraints.

More technology doesn’t always mean more progress, and the impact of digital health on the patient experience should be a key consideration. In the industry’s attempts to make healthcare more and more efficient, this risks sacrificing the human element at the heart of medicine, and thus disrupting the doctor’s ultimate goal: to provide high-quality care. and inspire patients to live better and healthier lives.