A recent post in the DailyDealMedia, caught my attention. It was titled “Uprising in Mobile Health Care: Could Medical Apps Replace Doctors?” The theme of technology versus humanistic aspects of medicine has been the subject of debate for many decades, obviously predating the advent of medical apps. I find it interesting that the introduction of the referenced PwC study highlights the fact that “Solutions, not technology, are the key to success.” Another piece on this subject in The Atlantic addressed what I believe is the core issue “Should (most) doctors become obsolete — or less provocatively, does the practice of medicine need to change? Here, the answer must be yes.” I will give my own reasons why I think the question of apps replacing doctors is neither feasible nor desired.
1. The adoption of mHealth apps will never reach 100%. The adoption of new technology in medicine is neither rapid nor ever total. Adoption is a function of awareness, education, ease of use, challenge to workflow, personal approach to disease diagnosis and management, and patient relationship and trust.
2. Mobile health apps were never designed to replace doctors. Apps are tools to increase patient engagement, provide data, and to help patients self-manage their health. Self-management, however, does not imply an alienation or elimination of the healthcare provider. The article states that “Mobile devices are trying to cram 8 years of doctor’s specialized training in medical school and residency as well as multiple years of direct patient interaction all into an app, and letting the patient run wild with their own conclusions.” I don’t know of any app developer or patient for that matter, who either believes or desires believes that in the least.
3. Mobile health apps provide data, not care. Apps are extensions of the patient’s body, providing data to the provider. The information belongs to the patient. It is shared with the provider in a filtered, useful manner. The apps motivate patients with information, gamesmanship, and ‘Atta boys.’ Some might even suggest a diagnosis. But the goal is not just to have a medical Siri with extendable ears and eyes. It is to have a well-trained human being who knows the patient take the digitized data and decide how to proceed. Certainly algorithms collated from data derived from many clinical studies, populations, and the individual patient in question will improve accuracy and quality of care, but there are too many variables to wholly depend upon cook book medicine.
4. All patients are not the same. One would not approach the diagnosis or treatment of a teenager in the same manner as a 90 year-old. Someone with kidney failure has a much higher risk of surgery than someone without it. Such is the way with apps. Even the prescription of an app should not be standardized. People with the same diagnosis or symptoms require individualized assessments based on concomitant medications, severity of illness, mobility, co-morbidities, prognosis, extent of caregiver support, and the patient’s wishes.
5. Personalized medicine does not imply the patient becomes the doctor. The eight areas of digital medicine as discussed by Dr. Eric Topol in his book The Creative Destruction of Medicine (wireless sensors, imaging, genomics, Information systems, social networking, the Internet, mobile connectivity, and computing power) will converge and result in personalized medicine. No longer will a diagnosis trigger the same treatment in everyone. Personalized medicine implies uniqueness of the individual, not the individual becoming his/her own physician.
Skepticism about new technology is expected and healthy. It should not be blindly defended by its developers or investors. It requires proof of effectiveness, safety, convenience, cost-efficiency, and acceptance by both providers and patients in order to expect its adoption. The DDM article is a bit sensationalized, perhaps by design. It inspires reflection. I hope this post does the same.