By Gary Robbins
7:35 A.M. JAN. 4, 2015
Soon, you’ll be able to talk with a doctor on the view screen of your smartphone whenever you want — and instantly send him or her an enormous amount of your health data that was collected by wearable sensors. So says Dr. Eric Topol, chief academic officer for the Scripps Health network and one of the country’s most outspoken advocates for digital medicine.
Topol slams home these points in his new book, “The Patient Will See You Now.” The prominent cardiologist also implores physicians to drop their “doctor knows best” attitude, saying that it alienates patients and undermines health care. “Patients should be equal partners with doctors in their own care,” said Topol, 60, who discussed his book in advance of a free public forum on medicine to be held by U-T San Diego on Thursday at the Museum of Contemporary Art San Diego.
Here’s an edited version of his conversation:
Q: You envision a time when people will broadly use apps and sensors on their smartphones to exam, monitor and, in some cases, diagnose aspects of their health. How soon will this happen?
A: It depends on the outcry of consumers and large employers. They have the most muscle. It won’t happen from within the medical community; there’s no real interest. Things could happen fast if the largest employers — each of which has hundreds of thousands of employees and several billion dollars of health-care costs — say they’re not going to take the status quo anymore.People want to monitor themselves and, in some cases, do diagnosis. Consumers are fed up. They wait, on average, more than two weeks to get an appointment with their primary care doctor, then wait over an hour in the doctor’s office to be seen, and when they finally get in, the visit lasts about seven minutes, during which time the doctor is sitting at the keyboard not looking at them.
There’s a new mentality building around mobile devices. People are saying, “I want what I want, when I want it, where I want it,” whether it’s summoning a car, it’s groceries being delivered to my home or pressing a smartphone app and getting to see a doctor.We’re reaching a tipping point; one out of six visits to the doctor are now virtual visits; they’re done though telemedicine. It’s growing exponentially, through companies like MDLive and American Well. Within seconds, you can be talking to qualified, licensed doctors through a secure video chat for the same cost that you would do it through your insurance plan. This is being adapted at a pace that I could not have predicted. Employees love it because they get to see a doctor right away. Employers love it because it cuts down on unnecessary tests and ER visits. Scripps has this available for its employees.
Q: But are there enough doctors to serve people who want to connect by smartphones or at kiosks whenever they want?
A: There is no doctor shortage. This is a myth. That has been pushed out there for a long time by the American Medical Association and American Association of Medical Colleges. They haven’t rebooted to the virtual world. The projections you hear for a shortage of 100,000 doctors in coming years is way out of line. I think it can be a zero shortage if we leverage technological advances.
Q: But shouldn’t consumers be concerned about the quality of service? There’s a big difference between seeing a doctor in his or her office versus talking to one over a smartphone.
A: The smartphone patient can do a lot of things, like send sensor data to the telemedicine doctor. And they can do a lot of the physical exam themselves. If you have a child with an ear infection, you can download an app, look in the child’s ear and an algorithm gives you a diagnosis right away. Maybe you don’t need to do anything. Maybe you contact your doctor and say, “I have data definitive images that shows my child has an ear infection. Can I get a prescription?” It’s faster and puts more of the health care in the patient’s hands.
Q: What about something more serious, like a heart issue?
A: Almost every patient I see has hypertension. Soon, they will be able to wear a watch that not only tells them what time it is, but also monitors their blood pressure day and night. The data will be graphically summarized every six to 12 hours with a single smartphone screenshot. The software will be easy to read; you can easily see when there were spikes in your blood pressure. It may occur while you’re sleeping or when you’re driving in traffic. Patients can see data in the context of their own life in the real world. This is the kind of information doctors and patients have never had before.
Q: I asked my cardiologist whether he could handle a flow of data like that from me and other patients. He said absolutely not.
A: That’s the problem right there — a lack of respect for how computer processing can make this exceptionally simple, and it is what patients will want. Indeed, recent studies show patients are clamoring for it.
Q: I feel like my doctor respects me. Can you really expect doctors to handle an enormous increase in patient-generated data?
A: Many of my colleagues in the medical community do not have a high regard for the data generated by patients, or their ability to understand it. They don’t appreciate what the algorithms on these mobile devices can do.
Q: Will patients even be allowed to send data? Most doctors don’t communicate with patients by email.
A: That is a problem. About 60 percent of doctors in the U.S. won’t exchange emails with patients. They’re not communicating the way people do in our modern culture. It is an efficient way to do medicine. Doctors says they are afraid of the legal implications, and that they are not reimbursed for their time. But patients understand that they don’t have to have long exchanges. They can just be short notes. I encourage my patients to email me, and when they do, to try to send short notes. Many patients have switched doctors so that they can send their physician an email and receive a response. I’m not just talking about older patients. We now have a generation of digital natives. Younger people certainly expect to have direct electronic contact with their doctors.
Q: You’re asking patients to use apps and sensors on their smartphones to monitors themselves. But is that realistic? Many people find health care to be scary and daunting.
A: I think there is a general lack of regard for what human beings can handle, and what they want. And that people are going to respond to what smartphones will do for them. They’ll get data and insights that will truly help them. There’s an awakening going on that I have not seen in my three decades of medical practice.
Q: Are you talking about a sub-set of patients? You’re an elite doctor in the affluent community of La Jolla.
A: I have patients from all over the socioeconomic spectrum. I think the technology is a great equalizer, and people want to use these devices. People look at their smartphones over 100 times a day. They want to get medical data to help preserve their health.
Q: Do you think elderly people will use this kind of technology?
A: Yes, and this can be a great source of support for them. I have my 93-year-old mother-in-law living with me who is incessantly using her iPad. If she can do it, why can’t other 90-year-olds?
Q: Well, she is living with a cardiologist, right?
A: I didn’t have time to help her learn how to use an iPad. Your response suggests a bit of ageism at work here. The medical community discounts the ability of people of advanced age to learn digital tricks. Older people are worried about their health. They are frail. They will adapt to these apps and sensors if you make them easy and fun. And it may ultimately prove prudent to provide (for free) the mobile devices and service contracts to actually reduce the cost of health care in the future.
Q: So how are you going to change the culture of the medical industry?
A: Doctors are used to the mindset of, “The doctor knows best.” They have been and continue to be the controllers. That’s the history of the medical profession, dating to 2600 B.C. It’s deep and engrained. There has never been a serious challenge to this paternalism — until now. People will generate data, own it and present it to their doctors as part of their medical care.
Q: But we’re not really seeing this mindset taking hold in medical schools, right?
A: No, not yet. But that will change. Medical students will eventually be trained in telemedicine and to appreciate patient-generated data rather than discount it. The physicians of the future understand that medicine is being democratized, just like every other part of life. It is going to happen. It’s inevitable despite the sclerotic nature of the medical community.
Q: Are you saying the view of the medical community is myopic?
A: It is not myopic. It is tied to things like financial reimbursement, and to paternalism, and to knowledge gaps. When we look back in 10 years, we’ll ask, “Why did it take so long for these changes to occur?”