SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.
Many aspects of medicine have changed over the course of human history. Schools of thought shifted from humorism to evidence-based medicine, while the standard of care evolved from bleeding to our modern cornucopia of interventions.
Yet across centuries, the doctor-patient relationship has remained relatively constant – a physician would physically interact with the patient and then come to conclusions on how to treat him or her. However, new technologies and innovative delivery models have begun to erode this cornerstone of medical practice, raising questions about whether they are ultimately helpful or harmful.
I was first introduced to non-traditional models of medical care the summer after my freshmen year of college. I worked with a doctor who has an extensive background in telemedicine, which broadly implies the use of technology to expand access to medical care. In practice, that might mean seeing patients via videoconference, having patients take pictures of lesions, remote monitoring, or a number of other applications. Moving forward, it may even allow patients to conduct their own physical on a smartphone.
Inspired by my experience, I started to explore other ways we can reach patients without bringing them into the doctor’s office. One strategy is to use social media to engage patients. Another is to make use of retail health clinics – clinics in shopping centers or pharmacies that are equipped to handle one-off, minor medical complaints. (If you’re interested, I have written in more detail about each of these models here, here, and here).
Almost invariably, the first criticism brought against these strategies is that they'll interfere with the doctor-patient relationship. It’s true that they can influence the dynamic between a patient and physician and should be evaluated carefully. But in my experience, critiques tend to overlook three major aspects of technology that actually improve the doctor-patient relationship.
First, new tools in health-care delivery don't replace the physician with a technological brave new world. To the contrary, they create a doctor-patient relationship for patients who otherwise wouldn’t have a doctor at all. Many of these tools are targeted towards patients who live in underserved communities and give them an effective way to communicate with a doctor.
Take rural populations as an example. Suppose a patient has a condition that requires a specialist consult. Do you think the patient would rather: (1) take a day off from his or her job and drive three hours to a tertiary care center; or (2) remotely connect with a specialist who can clear up the problem? Most patients would likely prefer the second scenario, and may defer care if they don’t have that option.
Second, the doctor-patient relationship is especially relevant to patients who have complicated medical issues. If patients are able to handle minor complaints outside of the doctor’s office, physicians will have more time to spend with the patients who need the most help.
Finally, these approaches empower patients to take responsibility for their own health. Once again, let’s consider this in in the context of an example. One common stereotype in medicine is that of the non-compliant patient – maybe someone who has high blood pressure, high cholesterol, etc., but doesn’t take his or her medication, make diet modifications, or exercise. At present, a doctor might require this patient to come in for a check-up every few months. And yet nothing changes.
But if the doctor gives that same patient the tools to monitor their health on a day-to-day basis, the patient may take on a greater sense of ownership for their well-being and start making some changes. As medical students, we regularly hear that we're in an era of patient-centered care. Technological tools that give patients more health information don't hurt the doctor-patient relationship; they serve as another means to connect us.
Medicine is a constantly evolving field. New strategies have the potential to change the way we practice. But it’s worth remembering that a different doctor-patient relationship can be a better doctor-patient relationship.
Akhilesh Pathipati is a second-year medical student at Stanford. He is interested in issues in health-care delivery.
Photo by NEC Corporation of America