The last major productivity increase in medical care was the physician’s waiting room. Back in the day house calls were common. If the doctor had to walk, drive or ride a horse to your house that was not a good use of his time. Of course, 100 years ago your doctor couldn’t help much either.
In later years after doctors began working out of an office the doctor’s nurse became a labor-saving arrangement. So-called physician extenders, nurse practitioners (NPs) or physician assistants (PAs), also enhance physician productivity. However, the basic way doctors work has hardly changed since the days when doctors also doubled as barber-surgeons.
The way medicine is practiced is inconvenient for both doctor and patient, and it is labor intensive. During a physician visit you meet with your doctor one-on-one in an exam room. You and your doctor are engaging in what’s called synchronous communication. You are meeting together at the same time. It’s not really an efficient use of his/her time nor an efficient use of patients’ time. Here is what I wrote several years ago:
Imagine attending private lectures and taking all your college exams in your professors’ offices individually, one-on-one. Your instructors lecture you, then pepper you with questions, grading your answers and recording your scores. This is not unlike traditional physician visits. Contrast this to attending classroom lectures and taking online multiple choice exams where a computer algorithm or Scantron tallies your answers and calculates your grade. Classroom instruction with standardized testing is much more efficient than private tutoring. Hundreds of students can learn and take their online exams simultaneously. What if medical productivity could be similarly improved?
With asynchronous communication you don’t have to be in the same place at the same time. This works best as asynchronous telemedicine, like email. Email may not sound terribly efficient but think back when you had to play phone tag with business associates and / or get on a plane to meet them in person. I can email when I get a spare moment and my doctor can reply when they get a spare moment.
Asynchronous telemedicine is like email (or snail mail for that matter). You email your doctor or call your doctor and leave a message. Your doctor replies via email or by leaving voicemail. Asynchronous communication doesn’t require both parties to be present at the same time to communicate, but the information flow back and forth can be slow and inhibited compared to talking.
Or perhaps I could email my doctor and his/her NP or PA could compose a reply reviewed by my doctor before sending it back to me. Or perhaps ChatGPT could compose a reply that my doctor’s NP/PA reviews before forwarding it to the doctor to approve and reply to me. Now for a thought experiment:
[I]magine logging-in on your doctor’s office website, then being examined by answering questions from an interactive menu. The website algorithm then generates a treatment plan based on your responses for a chronic disease like, say, diabetes. Your doctor could review the results and approve your treatment plan, order prescriptions and maybe insert some specific advice much more quickly than using the traditional synchronous communication (office visit) model. At least in theory, a doctor performing the cursory evaluation of the automated treatment plan could be located anywhere in the world.
When I wrote the above paragraph six years ago ChatGPT had not yet been developed, had not passed the medical licensing exam and had not demonstrated the ability to assist your radiologist interpreting X-rays. Technology has advanced, making productivity boosts possible.
Something else that could boost productivity is peer support. A fair amount of chronic disease treatment plans is about education. That is, educating diabetics to better control their condition. It involves a lot of teaching, often more than could be done on a one-on-one basis. It’s called group therapy, but it’s rarely used in medicine because it does not fit the reimbursement/payment model.
Group therapy is therapy sessions provided to educate a group of patients rather than each individually. It is most common in environments where sharing the experience of others with similar conditions is beneficial or peer pressure is needed to improve outcomes. Overweight people have group therapy: it’s called Weight Watchers. Addicts have group therapy: it’s called Alcoholics Anonymous or Narcotics Anonymous. People with mental health conditions used to have group therapy (simply called, group therapy). Think back to the old Bob Newhart Show in the 1970s. Half a dozen comically-neurotic characters, with a garden variety of mental health issues like depression, anxiety or phobias, would all arrive for a group session at a scheduled time. They would sit around for an hour and each take turns sharing their neuroses while validating each other’s feelings.
What if I don’t live in the area? What if I don’t want to attend group meetings? What if I need something beyond moral support. That too is possible with this model. I refer to it as interactive group therapy.
Now imagine rather than a diabetes online support group open to the public, members are enrolled in an exclusive telemedicine group therapy program. Members could share a name or nickname and discuss or message other members privately. However, most interactions would be shared among the entire group. Doctors would monitor the group’s interactions and correct bad information. A physician or nurse practitioner could check metrics that are entered on a periodic basis (weight, blood glucose, activity levels, medications taken, etc.). Based on the inputs and interactions, physicians would review the automated treatment plans, update the medical record and prescribe medications electronically. People who don’t participate might be contacted by others in the group, a nurse or the computer system. Such a system could upload some metrics (e.g. weight and blood glucose levels) using Bluetooth. Members could share recipes, eating habits, exercise regimens and generally support each other’s efforts — all while under medical supervision.
This reminds me of an old friend who teaches college classes in a specialized occupational field. He told me that he schedules lectures online and then online group meetings. He can monitor the group meetings but doesn’t always interact with the students. They are supposed to chat among themselves on assignments. Essentially, they teach each other, and he is there to correct any errors in their approach. Both he and his students can come back later to check for corrections and class discussions that occur later. All interactions are online and available for others in the class to see. His students lived all over the United States. Getting his students online and interacting with each other is a better teacher than him lecturing in an auditorium.
Health care should work this way. In medical forums people interact with each other sharing information. Sometimes a physician makes sure the information is accurate, but there are no individual treatments plans. That requires a trip to your own doctor. Too bad we can’t join an online group of diabetics or other chronic disease sufferers and get real medical care along with the information.