Technology is certainly influencing every aspect of our lives, mostly in a positive way. Today it seems as if there is an “app” for everything. Uber has transformed the taxi business with its app that makes it possible to call for a taxi with your smartphone. But will it impact healthcare?
Robert Graboyes, writing in RealClearHealth, thinks it will. He thinks it will ultimately reshape 21St century medicine. Tom Valenti, writing in TechCrunch, disagrees. He says “there will never be an Uber for healthcare” because “healthcare is not a transaction business; it is a relationship business.”
Graboyes believes “the more aspects of healthcare we can shift from relationship to transaction, the better life will be for patients and doctors alike.” He says the true essence of Uber is this:
“It accumulates a vast amount of information on the microdetails of cities: overlays that information with real-time data on prospective drivers, riders, and road conditions; reduces staggeringly complex decision trees to algorithms; and instantly presents drivers with a manageable number of highly intuitive options. It thus obliterates the learning curves and fixed costs that such information previously demanded. In effect, Uber establishes, digitizes, and stores relationships to make transactions possible.”
Valenti notes a strong relationship with a specific doctor can be quite valuable. Graboyes believes it would actually be a better world if that were less the case – and that is how he believes healthcare Ubers are already saving and improving lives.
Which one do you believe is correct?
I have never met either man but I suspect Mr. Graboyes has thus far enjoyed good health. Perhaps Mr. Valenti has not. There is nothing like an illness to help you appreciate the value of a good relationship with your doctor – or the lack thereof.
Healthcare is changing in this country. In some ways it is better than when I first entered the practice of medicine in 1984. We have improved our understanding of nearly every area of medicine and we can now accomplish things we never dreamed of thirty years ago. We do surgeries through smaller incisions with less recovery time and improved results. We cure diseases that used to take the lives of many and we rehabilitate injuries that used to end promising athletic careers.
But in other ways we are losing ground. It used to be that every doctor who hospitalized a patient also cared for that patient throughout the hospital stay. Today most primary care physicians send their patients to a hospital and then abandon their care to a “hospitalist” whose practice is only the care of those patients in the hospital.
The difference in these two practices of medicine was dramatically clarified for me when a friend was recently hospitalized after he blacked out at my church. Although he has a competent primary care physician, that doctor deferred to a hospitalist when he was hospitalized that Sunday morning.
When I visited my friend the next day I happened to be there when the hospitalist came in to meet him and explain his condition. The ensuing confusion was aggravated by the doctor’s unfamiliarity with my friend, her heavy foreign accent, her poor communication skills, and the anxiety of my friend. Fortunately, I was able to help bridge the gap and bring some understanding to the situation.
It has been my experience that this situation is more commonplace than is generally appreciated. While hospitalists are generally competent, they are also usually foreign trained and speak English as their second language. They usually lack good communication skills with patients and with the referring doctor. This probably represents why they gravitate to their specialty since these same physicians would struggle to succeed in a private practice setting.
This highlights the deficiency of an Uber approach to healthcare. Medicine is not an exact science like mathematics or getting from point A to point B in an unfamiliar city. Relationships build trust and confidence and prior experience with a patient builds competence in treating present and future conditions.
It is unfortunately true that our healthcare system is becoming less personal and good doctor-patient relationships are hard to find. The more this becomes true the more that improvements in data collection and availability at the touch of an app may help to ameliorate this situation. But to suggest this is actually preferable to a close personal relationship with your doctor is naïve in the extreme. I believe the rise of Uber healthcare will accompany a decline in the quality of medicine.
What do you believe? Let me know your thoughts and experiences.