If you are a Star Trek fan, or have watched Starship Troopers, Elysium or other Sci-fi thrillers, then you can identify with this chapter. This was definitely one of my favorites in the book. Before you continue to read, please take a moment to watch (and laugh) this interview of Dr Topol with Stephen Colbert.
I'm a millennial so I clearly identify with the message Dr Topol is trying to convey in this chapter. We live in an era where anything than can be digitalized has been digitalized, including doctors. I am an avid Uber user, and I can’t recall the last time I used a “real taxi”. Can you remember the last time when you went to the video store to rent a DVD? These routine behaviors of yesterday are now obsolete. As went the VCR, so goes the physician.
To begin with, there are a variety of apps that provide a presumed diagnosis in response to user-entered symptoms. Many of these apps are becoming popular and may be at least partly responsible for declining physician visits in the last few years. In fact, you don’t even have to install an app on your mobile; I have seen many patients in clinic convinced they have a disease they researched on Google.
Dr Topol also discusses the wait times to see a primary care doctor. For instance, in Boston, a patient has to wait an average of 66 days, followed by Atlanta (26 days), New York City (28 days) and Seattle (23 days) and how telemedicine can improve this issue.
This chapter also discusses how virtual visits will take over actual patient visits as they are efficient, less costly and do not compromise quality of care. Many of the insurers are already adopting this practice for a monthly fee or per consultation. Some of the barriers to implement telemedicine are local and state laws. For instance, if a doctor is licensed in Texas, is he able to see a patient from Oregon via teleconference?. Another downside is how would you bill for that patient “visit” or consultation? Do you have to perform a thorough physical exam? To address these issues, there is a group of people that are pushing for these reforms and details can be checked here.
Moreover, Dr. Topol also states that a physician does not necessarily need to be physically present to perform a physical exam with new technology. Dr Topol covers this topic extensively in this chapter and he mentions that there are special devices called “add-appters” that can be plugged in the phone (like connecting your headphones or charger) with cameras, microphones and small monitors that can record vital signs in real time, EKGs, etc. Dr. Topol also mentions briefly that we all still use our stethoscopes and some people consider them obsolete as they don’t record information (well, there are electronic stethoscopes, but they only amplify sounds and with a gadget, you may record sounds such as the heartbeat and breaths). It’s clearly being replaced by ultrasound and honestly, I can’t wait to be able to use a wireless, portable ultrasound via my mobile device.
One question is whether this type of virtual medicine practice would keep physicians happy? (Not that current practice is doing such a great job.) Another important point Dr Topol addresses is the physician shortage that by 2025 will be approximately 130,000 and not only within the United States, but worldwide (as per WHO) with an alarming figure of 27.3 million shortage of physician and nurses.
I am not entirely sure why the medical community has not embraced digital and networked solutions or why physicians are so reluctant to adapt this practice; there is clearly an age gap as older physicians are not to keen to go digital. Perhaps it is as simple as the fact that none of these devices replace human touch and compassion.