Will mHealth Change the Role of Physician?


     There are many benefits of mHealth technology to physicians It will increase patient engagement, it will provide data and input from patients on a continuum of time (versus the snapshot of office encounters), it is mobile, it will make office or telehealth conferencing more meaningful, and it will improve the physician-patient relationship (see https://davidleescher.com/2011/10/10/five-reasons-why-physicians-will-love-mhealth/ ).  The technology will free up the physician for other tasks, whether it is to see new patients, attend to the increasing mounds of ‘paperwork’, call insurance companies, or go to a long-awaited dentist appointment.

The physician’s role has dramatically evolved in the past few years.  Contributing factors include: the rise of so-called mid-level providers (MLPs: nurse practitioners and physician assistants) as an integral part of healthcare (80% of large medical practices and 40% of small ones employ MLPs), the increasing demand of attention to insurance and quality control regulations, time spent on various hospital and practice management committees, and less time spent with patients (due to the above and shorter patient time slots).  Extreme variability in patient care by physicians is well noted, as is variability that is geographically related.  One recent article in The Atlantic asks the question whether physicians will become obsolete: http://www.theatlantic.com/life/archive/2011/10/are-doctors-becoming-obsolete/246439/.  Technology itself is evolving so dramatically that one may ask oneself if that alone might make a physician obsolete. The X Prize Foundation is offering a $10M prize for the development of the TRICORDER™, a mobile solution that can make a diagnosis, recommend a treatment, and upload data to the cloud.  I submit that even the development of this tool would not eliminate the role of a physician.  The physician’s predominant role is headed towards one of a quality compliance officer, overseeing MLPs and quality control/regulatory issues involved in patient care.  Information coming in from mHealth solutions may ultimately require input by the physician especially addressing actionable alerts.  So the physician, with his/her iPad or iPhone (currently 60% of physicians have one or the other) might be a roaming supervisor and consultant to patients or MLPs.  However, even if a TRICORDER™ is developed, oversight by a physician is necessary to address exceptions to ‘the rules’ which may prove deadly.  In addition, there is certainly no substitute for a detailed history and physical.  I cannot imagine a mobile device that can become a substitute for that. I have experienced this firsthand.  For example, what patients, caregivers, or others described over a phone call is sometimes very different from what is found upon examining the patient.

Wireless technology will paradoxically, with less face to face interactions, increase the physician’s knowledge of a patient’s clinical status.  The reassurance the patient has in knowing that surveillance is much more frequent than the office visit snapshot will improve the relationship with the physician. Managing data will be the predominant vehicle of healthcare itself.  Medical schools will invariably incorporate this in the curriculum.  Physicians will become more like Dr. McCoy on the Starship enterprise than Marcus Welby, MD. But even Dr. McCoy held a patient’s hand and gave human comfort.  We must never forget that part of medicine.

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About davidleescher

David Lee Scher, MD is Founder and Director at DLS HEALTHCARE CONSULTING, LLC, which specializes in advising digital health technology companies, their partners, investors, and clients. As a cardiac electrophysiologist and pioneer adopter of remote patient monitoring, he understood early on the challenges that the culture and landscape of healthcare present to the development and adoption of digital technologies. He is a well-respected thought leader in mobile and other digital health technologies. Scher lectures worldwide on relevant industry topics including the role of tech in Pharma, patient advocacy, standards for development and adoption, and impact on patients and healthcare systems from clinical, risk management, operational and marketing standpoints. He is a Clinical Associate Professor of Medicine at Penn State College of Medicine.
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