Dr. Steven Steinhubl is a cardiologist, clinician-scientist, and Director of Digital Medicine at Scripps Translational Science Institute. Prior to Scripps, he was the Director of Cardiovascular Wellness and the Medical Director for Employee Wellness for the Geisinger Healthcare System. He has been principal investigator for or helped lead dozen of large-scale clinical trials and has authored over 200 peer-reviewed manuscripts. The views expressed are the author’s own, and do not necessarily represent the views of Qualcomm.
Multitasking gets a lot of us through the workday. But when you step into a doctor’s examination room, it’s exactly what you don’t want to happen. And yet it does. The reality today is that doctors are in a perpetual time crunch; the average appointment lasts somewhere between 10 and 17 minutes, and the average patient waits around 23 minutes beyond the appointment’s start time. Given all that, it’s hard to imagine doctors focusing completely on you and your concerns, as opposed to, say, typing away on a laptop while they talk to you.
As infuriating as this is to you, the patient, I can assure you that the physician is just as frustrated, if not more. A doctor’s greatest source of satisfaction comes from his or her relationships with patients. Yet, the current systems of care rarely allow for the development of fulfilling doctor-patient relationships. Remember the kindly, smiling doctor in the Norman Rockwell paintings (and, for that matter, Camel cigarette ads) of the 1930s? Back then, 40 percent of all interactions between a patient and physician were in the home. Wouldn’t we all like that level of personal care again?
You might think that mobile health (mHealth, as it’s commonly known), in which connected personal devices take a large portion of care and maintenance out of doctors’ hands, would make the problem worse. But when you take a closer look at how physicians actually spend their time—and how mHealth can change that—you’ll see that the opposite is true. Physicians will go from hurriedly treating 20 or more patients a day to spending quality time with as few as six.
Schedules have become so jam-packed because a handful of common conditions eat up more than their fair share of a doctor’s days. In addition to chronic conditions like diabetes and hypertension, physicians manage a steady stream of walk-ins for upper respiratory tract infections (i.e., colds), urinary tract infections (the most common bacterial infection), and ear infections (the most common pediatric complaint). Clayton Christensen, best-selling author around disruptive innovation and Harvard Business
School professor, has dubbed this type of care ”precision medicine,” referring to conditions that can be easily managed by individuals with less training than doctors (say, nurses or physician assistants) because the cause is understood, a diagnosis is straightforward, and there are well-established treatments available.
Now imagine that all of these conditions could be chiefly managed, perhaps more effectively than they currently are, without the patient ever leaving home.
Fact is, much remote care is already possible. Blood pressure cuffs and glucose meters with wireless tracking and transmission capabilities are already available. In addition, multiple devices are in late-stage development that not only diagnose when you have an upper respiratory tract or urinary tract infection, but also will eventually be able to identify the causative organism and its antibiotic susceptibility. For children with suspected ear infections, there is a scope that clips onto a smartphone’s camera; parents can photograph their child’s ear canal and eardrum and then transmit the images to be diagnosed remotely (and eventually, automatically). With these kinds of technologies, physicians can receive rapid alerts when patients need attention, and send a prescription for the appropriate treatment immediately to the local pharmacy.
This way, patients save time and money spent on a doctor’s visit, and can receive a timely diagnosis without waiting for the next day’s office hours. For people with chronic conditions, wireless medical devices also offer better outcomes; for example, clinical trials studying individuals with high blood pressure have found that self-monitoring, when coupled with timely feedback, is more effective than routine primary care or clinic-managed care.
For us doctors, all this efficiency unburdens us from spending time where our skills and training are unnecessary, and frees us to spend more time with the patients who need our help the most. But before we get ahead of ourselves, an assumption is needed: that a physician’s (and healthcare system’s) reimbursement be uncoupled from how much they do, and instead reward efficiency, customer satisfaction, and best outcomes. The good news is that things are beginning to lean that way: Earlier this year, the U.S. Department of Health and Human Services announced that by 2018, at least 50 percent of Medicare payments must be based on value, not volume. And the Affordable Care Act includes provisions that stress quality care over quantity of patients treated.
Once this becomes the norm, the pressure to speed through appointments will be all but erased. And patients who require the skills of a physician—either because of a collection of symptoms that are not straightforward or because they have a challenging decision to make and they really need informed, personalized input—can spend meaningful time with their doctor, who now has the time and ability to truly practice the art of medicine.