Do you remember the last time you had a conversation without a computer, smart phone or tablet present? The last time you looked directly in someone's eyes and sensed their presence? A time when being with someone didn't feel kind of, well, lonely?
How about with your doctor? What was the last doctor-patient conversation you had that was full of attention and empathy?
Technology-Driven Health Care Can Cause Blunders
Technology inserted itself into the doctor-patient relationship long ago. Exam rooms are equipped with computers. Patients can access their records online. Charts get emailed at lightning speed from primary care to specialty care. All of this is convenient, efficient, quick... and devoid of human connection.
It is now going one step further.
I was sitting in a waiting room last week and plastered across from me was a huge poster announcing that the doctor was available for video chat appointments with previously-established patients.
I stared with wide eyes while my mind wandered back seven years. I was sitting in a stark white doctor's office. It was time for my six-month check up for chronic kidney disease, which I'd been managing for the past 10 years. This was the exact type of appointment that would have qualified for video chat.
It was supposed to be quick. They typically were. Read off some lab values. Adjust a medication or two. Answer a question and see you in six months.
This appointment had an added wrinkle when the doctor mentioned that I would one day need a kidney transplant. A what? This was news to me. I knew I had chronic kidney disease. I knew that it could potentially lead to kidney failure, but my function was stable. Transplant had never once been mentioned to me. Not once before.
The full weight of my diagnosis hit me. Time froze. I was alone. Well, not exactly alone. The doctor was there, but I was alone because his back was to me. He was staring at the computer. The prognosis that changed my life was delivered to a computer.
You probably have a story or two of technology getting in the way of health care. There are dozens of them. I personally know two people who received a cancer diagnosis from automatically emailed scan results. They fumbled to understand radiology jargon as they wondered, "Does this mean I have cancer?" No one was there to soften the blow or to help them understand their diagnosis and next steps.
Have we lost our values?
Video chat appointments are just the latest in a trend toward technology and away from face-to-face human interaction. Society has become increasingly separated. We have more contacts as the expense of connection. More chat paid for by communication. More check-ins at the cost of continuity.
Health care needs connection, communication and continuity. It is not something we can do on our own. We need engaged care providers to become engaged ourselves. In 2012, The Schwartz Center for Compassionate Care compiled dozens of studies that all point to the central importance of the doctor-patient relationship. This relationship is the cornerstone that improves health outcomes, lowers costs and inspires a patient's adherence with treatment and medications.
Somewhere along the way, probably about the time everyone began to have a phone glued to their hand, we lost what we value in being with other people. Video chat is a means of increasing the number of appointments a doctor can do in a day. It is prompted by a profit-driven health care marketplace that wants to maximize care offered. Doctors are seeing more patients, but are there measurable improvements in the quality of care and patient satisfaction?
Short office visits rarely allow time for the type of thorough examination and conversation that builds relationships and has a positive impact on care. Placing two monitors and miles between doctor and patient is only going to make this type of vital healing connection improbable.
We need to start by determining what we value in a doctor-patient relationship. Everything else should be worked around that. Technology is a tool, nothing more. It can be used to build on our values or undermine them. We need to balance the convenience of computers with real human one-on-one, look into each other's eyes, connection. It can be done.
Balancing Technology and Relationship
My doctor's prediction seven years ago came to pass. I am now eight months post-kidney transplant. My procedure and hospital stay were a combination of technology and relationship. Both were integrated masterfully. My doctor, surgeons and blessed nurses were patient, caring and connected. No talking to monitors, phoning in appointments or hurried exams. They were consistently engaged; therefore, I was engaged. And the transplant was a splendid success.
That is what I hope we can hold onto. Given past blunders, we have a ways to go with the industry as a whole, but I know that it is possible to integrate technology, maybe even video chat, with compassionate care. We simply need to be sure that we (patients, hospital administrators, doctors, insurance companies, management companies and other care providers) are prioritizing relationship ahead of technological convenience.
Would you video chat your doctor's appointments?