Tuesday, September 22, 2015

Medicine X and the Hopes and Fears of New Health Technology

This week I am on my way to Stanford Medicine X.  I will be moderating a session at this yearly meeting of futurists in health care.  Medicine X describes itself as a “catalyst for new ideas about the future of medicine and health care.”  As described by the organizers, “The “X” is meant to encourage thinking beyond numbers and trends – it represents the infinite possibilities for current and future information technologies to improve health.”     For this sixty-something year old physician, there is something about the term “X” which suggests some meeting of Gen X, Star Wars and IBM Watson.  I admit it the whole premise scares me as I wonder if the technologies we talk about will improve health or suck the humanity out.  Can an app hold your hand and help you feel less afraid as you face death and disability?  At first glance, the humanistic and perhaps even spiritual approach to medicine that I advocate seems to have little place in a room full of young techies who still feel invincible and believe that nothing will stop the inevitable march to automated utopian health care.  Happily, I do know that assessment of this meeting and the attendees is too simplistic, too glib, and yes maybe too jaded to reflect reality. 

One positive aspect of the health care tech and Internet revolution is that it has the potential to give more voice to patients, the individuals this medicine exercise is all about.  At this meeting, the voice of patients is heard with epatients, people representing patient advocacy groups and others who come from the health blogosphere who are present as full participants.  The session I am moderating will feature two physicians (me as moderator included), a clinical psychologist and most importantly a patient.  This is typical of many of the sessions at this meeting and represents an approach that I welcome – one that brings patients front and center in the discussions of the future of medical care.  It creates an atmosphere in which the patient is not merely the recipient of care but a true partner and ultimately owner of his or her own care.  In other words, this has the potential to democratize medicine.

In Thomas Friedman’s book, The Lexus and the Olive Tree which he wrote in 2000, he describes three democratizations associated with globalization driven mainly by the Internet – democratization of technology, finance and information.  Stanford Medicine X represents a fourth democratization – that of healthcare.  As we move away from the paternalism that marked my generation’s approach to medicine, we struggle to find a new model that gives more authority to patients, while not abandoning them to one-size fits all self-service medicine. 

Technology, thus far has not fulfilled that potential.  Instead we have electronic medical records that are designed to maximize hospitals’ ability to capture data for billing.  We have algorithm driven systems that ignore the context of a person’s life so that the mother who must choose between following a physician’s advice and caring for her child is labeled a non-compliant patient.  We have data analytics systems that are technologically elegant that monitor physicians for how they deviate from the guideline and punish them financially and by reputation even if they deviate by following the patient’s needs – which may not be medical.  The technologies now in use tend to restrict care and discourage the type of flexibility and individual creativity that is so necessary to treat complex human beings with all of their medical, emotional, and life needs. 

Technology can be either restricting or empowering.  “Can I move...I’m better when I move?”  I still love that scene from "Butch Cassidy and the Sundance Kid", the classic Paul Newman, Robert Redford film.  That scene represents the first meeting of Butch and Sundance when Butch is testing Sundance to see if he should be part of his group.  He is asked to hold his gun and shoot at a target.  He tries to move around however the person telling him to shoot insists that he “only shoot.”  He misses.  He then asks the perfect question, “Can I move?”  Butch’s assistant replies, “Move – What the hell do you mean move?”  At which point Sundance shoots while moving and hits the target.  Sundance then adds, “I’m better when I move.”

Some of us are better when we can bring our own voice, our own style and our own approach to problems.  Indeed some physicians, while excellent clinicians, may rail against technology driven systems that contain guidelines and algorithms which allow too little room to move.  The real question in my mind as I head west to Palo Alto for the meeting is whether the next generation of technology can better accommodate the challenges of treating complex individuals while actually improving medical care, emotional support and providing the social help that is so critical to health.   I am more optimistic when patients are involved in the discussions as they are at this conference. 

The meeting this year starts tomorrow which is also the Jewish holiday of Yom Kippur.  The holiday is marked by asking forgiveness not only of God, but more importantly from all those people we live with and work with.  In that spirit, I ask forgiveness from all of you.  Because I see myself as part of the changes that have been occurring in health care for more than a decade, I offer my apologies for harm done and opportunities lost.  I offer apologies for the technologies that have led to more confusion, less care and demoralization of patients and doctors alike.  My hope for the coming year, starting with Medicine X, is that we start to get it right and use technology to facilitate care and foster humanism.