There's No App For That
I now live in in the San Francisco Bay Area, a technology hub, with a lot of start-ups and young entrepreneurs designing the next big thing. As part of a start-up Residency myself, I was wondering how to be truly innovative in medicine. So I have been thinking a great deal about the intersection of medicine and technology. At first glance, the outlook is a bit scary: Artificial Intelligence (AI) taking over our profession, being replaced by machines… But, upon further reflection, my view has evolved, and I would like to invite you to start a conversation about technology in medicine; what it can and what it cannot do.
Let me begin by telling you a story of a patient that I saw recently in my clinic.
It seemed like a fairly simple office visit. The patient needed a note to go back to work. She was a recent immigrant who had been working as a dishwasher for the first time in her life and had developed an overuse tendinitis of her wrist. I walked into the room thinking: “this should be quick”. I saw a young woman who seemed to be in a rush to get out of the office; shy, and visibly uncomfortable. She mentioned that her wrist still hurts some, but then she said: “I just need that note...I cannot afford to lose my job”. There was just the slightest desperation in her voice and a fear in her eyes that I could not ignore. Those who already know me easily imagine what came next. Famous three words: “tell me more”. Then the story came of a political refugee, tormented by nightmares, unable to sleep for the past three months, having frequent panic attacks but pretending to be a happy-go-lucky person just to keep her job. She had decided to move out of her current housing and start paying for rent, and this is the reason why she could not lose her job. Well, the quick visit was not that simple after all. This young, courageous woman needed a note to get back to work. She also needed to get connected to multiple social services. She needed care for an undiagnosed PTSD and, most of all, she needed someone on her side.
What would have happened if I had been looking at the keyboard instead of looking in her eyes? Or if she had used a computer to input her chief complaint? “wrist pain resolved”; note back to work? She might have not even been given an appointment.
From the outside, a medical encounter can look like a very mechanistic exchange of information. Patient inputs history, signs and symptoms. The doctor processes the data, performs a physical and test, and the output is an assessment and plan. Patient goes home, does as the doctor says ....all is good. It would make sense to reduce it to that and design AI to carry it through. And entrepreneurs are listening: a good number of medical students are graduating to work on IT start-ups; hundreds of medical apps are available to download every couple of months.
Technology has advanced at an incredible speed, and it will continue to advance in ways unimaginable. New apps to support medical diagnosis, medical decision making, and dictation efficiency. From the patient's point of view, new apps for self-monitoring and self-management are available for anyone with a smart-phone or tablet.
My call to action, has two interconnected components:
First, let's fully embrace technology into our busy clinical lives. Let a computer do what it can do best. How great to have the computer calculate the dose for that baby's antibiotic, warn you about drug interactions, an app that will show you a couple pictures to help you diagnose that rash. Letting your patients input their medical history into their medical record before you even see them. An app that will send your patient's BG, BP, and weight directly into their record and suggest an appropriate medication change based on an algorithm. All of that is already possible and happening. There are many examples of efficiencies that can be gained from the implementation of technology in a clinical environment, which should translate into a rich personal patient interaction; this is what physicians have been trained to do. The gained efficiencies will allow us to have more engaging and deeper interactions with our patients. It will result in better care and more gratifying experiences for both patient and provider, not unlike the interaction that took place in the story I just shared.
The second component of my call to action is to commit the effort to hone the “soft skills” that make our profession an art. An art that complements technology and science to make our profession whole. An art made of the elements of the physician-patient interaction; the parts that technology can't do for us. I know it is possible because I have seen this in action with my trainees. Residents being truly present, accepting and caring; drawing from empathy and compassion. Bringing one’s best self to that moment when a patient is being most vulnerable, to encourage that patient to be more transparent and at ease. Picking up on their undisclosed challenges related to the ups and downs of chronic disease, and facilitating long lasting behavior change.
Our irreplaceable emotional IQ. There is no app for that.
Only you.
by Catalina Triana, MD
Dr. Triana is the Associate Program Director for the Family Medicine Residency Program at John Muir Health, located in Walnut Creek, CA. She has been teaching behavioral medicine, patient-centered communication and primary care counseling skills to family medicine residents and medical students since 2002. She is a Motivational Interviewing Trainer (member of MINT) and is passionate about teaching skills to facilitate health behavior change.