“It’s worse than that – he’s dead, Jim,” Dr. McCoy would solemnly intone, after waving a small handheld device over the motionless figure in the red velour shirt. Of all the gadgets in the Star Trek universe – some of which (warp drive, transporter) remain science fiction, while others are already passé (communicators like 1990s cell phones, 3” square computer disks) – the one I found most fascinating was the tricorder. Imagine waving something the rough size and shape of a salt shaker over someone and getting a reading of their vital signs, blood chemistries, and even a diagnosis. If you had one of those, who would even need a doctor; you could hold it in front of your own face and figure out what was wrong, and then ask the computer what you should do about it.
Until recently I assumed the tricorder was more like the transporter than the communicator – unrealistic fantasy rather than established technology. Perhaps not. A raft of devices designed to allow people to monitor their own health and self-diagnose is coming to market, some already here. (Google “medical tricorder” and one of the first hits is the Scanadu Scout™, which measures and records vital signs by scanning your forehead. For real.) According to a new book called The Patient Will See you Now from Dr. Eric Topol, a cardiologist and “Professor of Innovative Medicine” at the Scripps Institute, as well as long-time proponent of personalized medicine, the future of medicine lies not with physicians, but with individuals armed with smart phones, miniature electronic sensors, and terabytes of genomic and other data about themselves.
Others, while not disputing the usefulness of some of the new technology, are less certain how soon they will revolutionize health care in the way envisioned by Dr. Topol. For one thing, data are not information: raw data must be processed to be actionable, and context is important. While automated language translation programs are certainly getting better, anyone who has used one knows that communicating to a native Mandarin speaker requires more than drawing on a database of Chinese ideograms. Similarly, humans are more than the sum of a set of physiologic parameters. The best providers don’t treat numbers, they treat patients. Besides, despite all the incredible hassles they complain about, patients seem to value seeing their doctor, which may explain why the annual physical remains a popular ritual despite the lack of evidence for its benefit on health outcomes.
What is missing from the patient-as-own-doctor model is the element of empathy, the communication, caring, and connection that characterizes the ideal of the provider-patient relationship. The tricorder-like gizmos may eventually be able tell you what is wrong with you, but they can’t hold your hand, or give you words of encouragement or sympathy.
As technology advances, the medical profession has an opportunity to increase their value to patients. We like to blame technology – especially the electronic health record – for interfering with the relationship between patients and providers. But it can also be liberating. As rote memorization and manual dexterity, keys to success in medicine in the era before handheld computer devices and robotic surgery, become less important, we can select for and spend more time developing communication and interpersonal skills. Some innovative training programs have shown promising results.
Sir William Osler said “a physician who treats himself has a fool for a patient.” Perhaps a patient who treats herself has a fool for a doctor. But if we can’t figure out and demonstrate how providers can add value in a world of Scanadu™ and Siri, many patients will take their chances without us.