The Future of Medicine Is in Your Smartphone sounds like a preface to his latest book, ‘The Patient Will See You Now’, but it is quite consistent with Dr Topol’s talks of late [TTA 5 Dec]. The article is at once optimistic–yes, we love the picture–yet somewhat unreal. When we walk around and kick the tires…
First, it flies in the face of the increasing control of healthcare providers by government as to outcomes and the shift for good or ill to ‘outcomes-based medicine’. Second, ‘doctorless patients’ may need fewer services, not more, and why should these individuals, who represent the high-info elite at least initially, be penalized by having to pay the extremely high premiums dictated by government-approved health insurance (in the US, ACA-compliant insurance a/k/a Obamacare)–or face the US tax penalties for not enrolling in same? Third, those liberating mass market smartwatches and fitness trackers aren’t clinical quality yet–fine directionally, but real clinical diagnosis needs clinical quality sensors and apps (Dr Kvedar cited here). That requires still another device like an AliveCor snap-on, which is what I suspect his patient in paragraph 5 used.
Finally, Dr Topol misses the mark when it comes to mental health. US psychiatry since the 1990s has had a chronic shortage, particularly geographic, of board-certified doctors (ABBHP.org, also NIMH cited in iHealthBeat), and they are retiring out with few replacements out of fresh med school grads because of everyday hassles like this. Many serious mental health issues, notably among older adults, have physical overlays or causes. In the US, psychiatrists are certified in psychiatry and neurology; de facto they become primary care physicians for their patients not only in the US but also in many countries from my reading. The much-hyped avatars or ‘virtual humans’ can work for the temporarily troubled or the worried well, or as part of chronic care maintenance (include in this the questions included in many telehealth delivery programs and IVR), but those in crisis or at risk of need far more, both in-person care and sustaining care, whether delivered in person or virtually to stabilize–which is why payers hate behavioral health so. Post-discharge programs also fail to utilize behavioral counseling to the degree they should for ‘hot spot’ patients with heart attack, stroke and cardiac surgery (see ‘Unhappy endings’ below).
But the tools are there and are there to be used. Only by use will their validity be tested, and that is one reason why emerging from whiz-bangdom is actually good for devices. One of my predictions for 2015 (to come) will be that certain tools will begin to make real inroads, for instance remote wound management, tele-psychiatry, virtual wellness visits and remote supervision of home care. And Dr T agrees with our Editors’ POVs here when stating “All of this raises serious issues about hacking and personal privacy that haven’t yet been addressed—and the accuracy of all of these tools needs to be tested. People are also right to worry that the patient-doctor relationship could be eroded, diminishing the human touch in medicine. But the transformation is already under way.” Our hack list includes both external threats, internal lack of controls and what this Editor calls Data Terrorism or Data Hostaging for political reasons, fun and profit.
Related content: Dr Topol’s own article (with Stephen R. Quake) on genomic ‘molecular stethoscopes’ in the WSJ. Also a look back at Unhappy endings: where even innovation cannot make a difference: “access and healthcare innovation don’t mean automatic adoption or a positive outcome.”