By Jill Mari Embry CEO/Founder Balance Innovation Center, LLC
Recently., I went to a memorial service for my mothers doctor. A sad occasion, but also an inspiring, wake-up call. Listening to the dozen or so people that spoke about him , the memory of what the practice of medicine should be was vivid. I remember a few physicians in my life, our pediatrician, the physician I did my med school preceptorship with, that also exemplified the image of what “ being a doctor” meant. The doctor was a pillar in the community he/she was known by many, loved y many. They knew all of their patients by name, their families, every nook and cranny of their being, physical and emotional. They were trusted. They were available (you had their phone number). Did I say, they cared.
Exams were different also. Depending on why you were there, you were poked, palpated, examined Without gloves. Your physician watched you move, looking for aches, bumps, discolorations, etc. . Each visit was an update on any previous visit. And when asked, “How are things going?”, the expectation was that all aspects of your well being were open for discussion, not just what you checked on the form out front. Yes, “What brings you in today?” is important, but the doctor knew that answer because he/she had looked at your chart before entering the exam room If you are old enough, you will remember, in some cases, being told to “when you are dressed, meet me in my office.”
If you saw your doctor out , at church, temple, the grocery, on the golf course, he/she would stop and ask about you and your family.
Today, going to the doctor is a completely different experience. The waiting room is often full. you aren’t sure who you will see. The question “what rings you in today?” is often sincere, since the doctor (or nurse/PA) has not looked at your chart. Often times they come in, sit down at the computer and skimming your chart while talking to you. . .kind of. You are fully clothed. Through your clothes they listen to your lungs, heart, take your blood pressure, only touching your body to take your pulse. Unless you tell them, they do not know that you are bloated, have a rash on your side, a bruise from where you fell last week and a new one popping up from the fall this week. They do not know that if they were to palpate your neck they would find sensitivity at the back of your neck due to stress, brought on by concerns that one of your kids may be using drugs. The headache you came in for, is addressed with, “we need to run some tests. If it is not your regular doctor, the tests may be more extensive, just to cover all bases.
Fron Medscape .com, and NIH.gov the top reasons for patient dissatisfaction with physician visits are:
- Lack of or poor communication
- Physician did not tell the truth or gave insufficient information.
- Not enough time spent
- Poor bedside manner
- Failure to recognize needs and expectation
- Failure of physicians to recognize symbolic or phenomenological aspects of their patients illnesses.
Research shows that physicians can increase patient satisfaction rates by improving the way they interact with patients in five key areas. The list is similar to that of Medscape and NIH surveys.
They all are related to the same thing. Patients want to e heard, listened to and cared about.
As for the doctors, studies of found that they too want to be able to spend more time with and not be driven by the corporatization of medicine to spend less time with patients in their patients , not be dictated by insurance companies on how to care for their patients order to increase the number of patients seen in a given time. (NYT) (Medscape)
Why then, are major tech companies and startups working towards technologies, AI driven, that will decrease the face to face interactions patients have with their physicians. As we saw with the corporatization of medicine both through insurance companies and corporations, non-medical people are deciding what is “best” for patients and physicians, ignoring studies that , clearly, say that both physicians and patients want to spend more time interacting.
In a recent symposium, I gave a talk on areas of AI in medicine that are promising, from a patient perspective. I also emphasized key areas that must be addressed by development companies, as they create AI driven technology. One of these areas is the human aspect of medicine. While companies are working on technology that would minimize the face to face interactions with your doctor, allowing for even more patients to be seen in an hour, we must ask, is this an improvement in patient care or is this an improvement in profitability of health care. By minimizing the need for physicians to have to problem solve, think and remember, areby providing AI diagnostic tools, are we decreasing the need for physicians and decreasing the skills needed. Since those developing AI applications are not medical professionals, thus don’t understand the nuances of caring for a patient, will symptoms, other underlying conditions be missed. And finally, for this article, my greatest concern is that physicians will forget what they have learned when not having to use their brains to retain information. If you think about how many phone numbers you now remember, imagine the same results when physicians don’t have to remember the volumes of information they have accumulated. Then imagine that systems go down, and the diagnostic AI tool used is not available.
Understanding that physicians are overworked, experiencing fatigue and dissatisfaction in the current health care environment, I raise the question, is the solution to dehumanize medicine or is it to bring back some of the human elements of caring for patients that drove so many into becoming doctors in the first place.
One of the largest health care providers in the country, Kaiser Permanente, serving northern California, had over $1.9 billion in profits last year. The largest health insurance provider, United Health Group had profits over $16.4 billion. With the corporatization of health care, profits are a driving factor. Therefore, we must ask ourselves, with each AI application developed for medicine for the betterment of care for patients and physicians or is it for the profitability of corporations.