High Tech works when it enables High Touch
Dr Trishan Panch
The growth of digital technology across the economy continues to accelerate. Should clinicians be getting involved in the development of digital technology?
François-Marie Arouet, 18th century French author and iconoclast, better known as Voltaire, quipped, “The art of medicine consists of amusing the patient while nature cures the disease.” How prescient or outdated is Voltaire’s assertion in the era of digital health and AI?
To answer this question it is necessary to look beyond the consultation as the fundamental unit of care delivery and to rather examine clinical processes. At the same time as Voltaire wrote in France, in the United Kingdom, industrialisation was taking the work of artisans and enshrining it in processes executed by humans and machines working in concert to achieve greater productivity. I believe that in the 21st century, as advances in computation, mobile devices and artificial intelligence collide with an improved understanding of the genetic basis of disease and the interaction between genes and the environment, we are faced with the prospect of an “industrial revolution” in medicine. However, I also believe that the art of medicine remains, at least in part, to amuse the patient.
I am reminded of my time as a GP in London. The shared stories, the witnessing and investigating, even the perennial frustrations of tests gone missing and symptoms unexplained. The “whilst I am here Doc,” at the end of an already long consultation. A classic refrain that indicated one had passed the test of listening to, validating and sorting a teaser symptom. That I had now been granted access to the swirling world inside, with experiences felt but only partially understood. It is in these moments that clinicians can uniquely add value.
There is an enduring truth that the practice of medicine is about relationships; relationships which are built on trust, and trust that is built on confidence. Or, more mechanistically, in an ideal world, clinicians establish patients’ confidence in their skills and humanity. On the foundation of this, they can build trust with patients and over time fashion a therapeutic relationship, that allows otherwise complex problems to be revealed with diagnostic clarity. And otherwise unacceptable perturbations to be willfully accepted by the patient and his or her family.
So, how, if at all, can technology help in building these therapeutic relationships? In spite of the aforementioned advances in medical science, the practice of medicine remains bespoke, reactive and notoriously costly. What this means is that individual clinicians, like artisans before the industrial revolution, create therapies de novo for each patient in response to that patient’s complaints, largely through the medium of face-to-face consultation. On the one hand, this is “Cadillac care”; however, the costs of practising in this way are dizzying and the well-documented variability in quality and safety unacceptable. The recent incorporation of guidelines and process management into chronic disease care has improved quality and safety and enabled nurses, physician assistants and community health workers to join the chronic disease management workforce. However, all clinicians are still tasked with collecting, analysing and imparting the information needed by an individual patient in a consultation; as well as establishing and fostering therapeutic relationships. Due to resource constraints, even in the best performing centres, patients typically get one clinician contact per month.
It is important that technologists should work with clinicians to challenge this effective alienation of patients by the health care system. Low touch is simply not good enough for people who are in fragile situations, with complex needs; where the benefits of success and conversely the costs of failure are significant. People need daily and personalised support. There is good news, where mobile technology has been woven into the fabric of care delivery and used by clinicians themselves, patients respond and process efficiency and outcomes can improve. The data generated from these interactions enables the use of emerging AI techniques to create a cycle of continuous improvement.
A simple design principle emerges: technology works best when it simplifies work that is not fun (such as medication adherence, disease monitoring and appointment scheduling) and enables human connections, which are. Technology works when it amuses the patient and enables relationships: high tech works when it enables high touch.
Dr Trishan Panch is a former GP and Co-Founder and Chief Medical Officer of Wellframe – a US based digital health company. He is an Instructor at the Harvard TH Chan School of Public Healthand is the inaugural recipient of Harvard’s Public Health Innovator of the Year award. He serves on the Innovation Advisory Board at Boston Children’s Hospital.
This article is released as part of the Healthcare Leadership Academy (HLA). To find out more about the HLA Annual Conference, click here.