The “iPatient”

I read an article from Abraham Verghese in the Wall Street Journal this morning entitled “The Myth of Prevention.” Verghese, author of Cutting for Stone and professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University, was responding to Obama’s recent speech to the American Medical Association on health care reform. Verghese argued that the current health care system incentivizes doctors to perform often unnecessary tests on as many patients as possible in order to make more money from patients. He contrasts this to the image of the doctor in Sir Luke Fildes’s painting “The Doctor” who is dedicated to the care of the patient, staying late into the night by the patient’s side in the patient’s own home.

An interesting point that Verghese raises is the virtualization of the patient into the “iPatient.” Verghese states that:

“A computer cannot take the place of the doctor in Fildes’s painting; an electronic medical record (EMR) may or may not save money (it won’t be anywhere as much as is projected) but what it will do is ensure that we doctors, nurses, therapists, particularly in hospitals will be spending more and mroe time focused on the computer, communicating with each other, ordering and getting tests, buffing and caring for our virtual patient – the iPatient is my term for this phenomenon – while the patient in the bed wonders where everybody is. Having worked exclusively for the last seven years or so in hospitals that have electronic medical records (EMR), I have felt for some time that the patient in the bed has become an icon for the real focus of our attention, the iPatient. Yes, electronic medical records help prevent medication errors and are a blessing in so many ways, but they won’t hold the patient’s hand for you, they won’t explain to the family what is going on.”

I have many colleagues who are working on digital or telehealth care (e.g. Hyoumanity, Amita Telemedicine, and TIER projects). While digital technology allows patients more control over their health care and increases patient access to medical care, it indeed can be seen as a mechanization of personal care. In some regions (e.g. rural) where medical care is limited or unavailable, digital technology can serve as a bridge between providers and patients, allowing a patient in rural India to receive eye treatment that would otherwise be impossible. However, in regions where medical care has been available and provided by a dedicated personal physician, a computer can be seen as imposing a layer of foreign complexity between the doctor and the patient.

Designers of digital technology for health care must consider the relationship between the patient and the doctor and how the technology will impact that relationship. Health care in its truest form is a most intimate human experience. Digital technology cannot at this time replace that experience. Designers of digital tech for health care must design technology that promotes patient-provider interaction, rather than replace it.