Dr. Eric Cadesky: Alexa, why is my doctor so conflicted about technology?
Credit to Author: Gordon Clark| Date: Fri, 16 Aug 2019 01:00:18 +0000
From life-saving vaccines to in-utero surgery, modern medicine is miraculous. Yet despite all of our advances, access to and delivery of care has barely changed. Our overburdened healthcare system still relies on antiquated communication, such as faxes and paper-based forms. Surely, doctors should eagerly adopt innovation — except we often don’t. We can FaceTime our families, but not our physicians. Texting and email are also rare in healthcare.
So why has there been such an emotional reaction to the use of Alexa in the U.K. National Health Service or the increase in virtual video visits? I believe the answer lies in three questions that must be satisfied before doctors and our patients can meaningfully adopt these tools.
First off, does the technology do good? For example, many of us have experienced long wait times and difficulty accessing primary healthcare. Virtual visits have the potential to connect us to a doctor or health professional that is available and knows us or can view our information. Millions already seek medical advice from websites, chat bots and virtual visits. And while access to some care is better than no care at all, access to care from someone who knows us is best. These platforms are an untapped entry point to attachment and ongoing care rather than the episodic “walk in-style” care currently offered by several services such as Maple, GOeVisit and EQVirtual.
Next we have to ask if the technology itself is good. Doctors swear the Hippocratic Oath to do no harm — and we should hold apps and platforms to the same standard. Analyzing moles, quantifying sleep and personalizing nutrition must be done with at least the same quality of a qualified healthcare professional like a doctor or dietitian. Anything less can lead to dangers such as anxiety over mistaken diagnosis, complacency not to seek needed care, or fragmentation of the patient-doctor relationship. Other important aspects include privacy, security and design that is friendly for patients and healthcare professionals — and this, in turn, justifies the need to include both in the design process.
Finally, is the company good or, at the very least, trustworthy? Despite this low bar, many companies have failed the test, judging by our previous reluctance to use patient health records. Personal health information is valuable and giant companies like Apple, Microsoft and Telus need to earn and keep our trust if we are to divulge medication lists, mental health history and HIV status. And while it is true that we worryingly relinquish confidentiality for the convenience of wifi or that 80 million people have already given away the rights to their personal images to a Russian app that ages your face, the autonomous choice must be ours and companies must be clear on what information they are taking and with whom they are sharing it. Companies must also truthfully declare what they actually provide; for example, what is often called AI is really just a chatbot.
Technology is here and growing exponentially. Rather than fearfully pushing back against progress, this is the perfect time for us to demand a role in design and development so that these tools are used properly to improve access and attachment now to doctors and teams that know us. At its core, the best technology creates and strengthens relationships — a miracle that would improve health for us all.
Dr. Eric Cadesky is a Vancouver family physician and past-president of Doctors of British Columbia, a voluntary association of 14,000 physicians, medical residents and students.
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