You look fine from here.
I almost threw away the November issue of The Atlantic monthly, which has gone the way of PBS’s series Nova in its use of hyperbolic and provocative headlines (Why Kids Sext! Sinkholes: Buried Alive!). Lucky I didn’t, because the issue has, buried beneath headlines about the Red Menace and the technology of adultery, not one but two articles about the doctor-patient relationship. I sincerely hope the editors had sly smiles on their faces when they put an essay about the deterioration of the doctor-patient relationship in the same magazine as a piece about telemedicine.
One of the things that in for years has frustrated patients is when a call to the doctor results in a polite but firm “You’ll have to come in and be seen by the doctor.” Yes but I just need a re-fill of this acne medicine. “Sorry you’ll have to come in.” But I have a rash, it’s the same one I’ve had before, I know what it is… “The doctor needs to see it.” I’ve been on this same dose for 50 years! “You’ll need to see the doctor about that.” I have been both the victim and the perpetrator of this response. The reason the doctor needs to see the patient is so that the doctor can lay eyes and hands on the patient, addressing their complaint as well as quietly making sure it is not something worse, or that is is nothing at all. This is one way to avoid unnecessary medication prescriptions and polypharmacy. Since the imposition of managed care, a visit is required as part of the doctor’s “gateway” management responsibilities. There are extensive medical record requirements and some of those checkboxes can’t be checked over the phone. And, increasingly, making people come in is a protective measure against litigation. As a blanket policy, however, it results in frustration all around.
Enter HealthTap, a four-year old company in which patients can text a medical question at any time and get one of the networks 60,000 doctors to respond right away. The article, The Virtual House Call, written by James Hamblin, himself a physician, describes an encounter of his own with HealthTap, in which he calls in complaining of a sore throat. After answering a number of routine questions,
“I was ready to shine a flashlight in my mouth and lean over my computer’s camera, but I wasn’t asked to do so. He [the doctor] suggested that I stay hydrated, take it easy, and call back in a couple of days if I wasn’t feeling better. Immediately after we disconnected, he documented our encounter for a record that will follow me through future HealthTap visits. His account of my exam, in its entirety, read: ‘Common cold symptoms. On video he didn’t really look sick or in any distress.’ ”
Yup. That’s why I went to med school. So I could look at a computer screen and decide someone doesn’t look sick.
Then, a mere 72 pages later, another provocative headline: “Doctors tell all! And it’s far worse than you think!” Meghan O’Rourke, whose credentials are unclear except that she claims it took 15 years to diagnose her Lyme disease, proceeds on a superficial and largely data-less perusal of some of the popular books published in the last 5 years about the frustration and discontent of doctors and the deterioration of the doctor-patient relationship.
“The subjective experience of illness has always been all but impossible to convey. But systematic changes have intensified a disconnect between patients and doctors that was less glaring some 40 years ago, before technological advances and corporatization began to transform the comparatively low-tech, localized postwar medical system.”
Dr. Hamblin, in his piece, refers to the HealthTap doctor as dressed in a way that indicated he was in a different climate than his “patient”. Well, you don’t get much more disconnected than that.
The doctor-patient relationship is just that, a relationship. It is very hard to have any kind of relationship with someone in a different climate and time zone, let alone one in which life and limb may be involved. Yes, people say that telemedicine might help cover the much-lamented “physician shortage”, but it doesn’t really. It replaces the therapeutic relationship between two humans with an impersonal electronic encounter.
If you’re sick, go see a doctor. Let him lay a hand on you and give you a sympathetic look. Let her doctor you, look in your eyes, recognize the way in which your problem impacts you as an individual. Satisfy yourself that nothing is really wrong, or that something is but here is a human being in front of you who will help you through it. Connect.