Technology Transforming the Doctor-Patient Relationship

Pam Harrison

November 13, 2014

TAMPA, Florida — The practice of medicine is in the midst of a technology-propelled revolution that places patients in the driver's seat, delegates heard here at the American Society for Clinical Pathology 2014 meeting.

"I think the epatient movement has already begun to change the ecosystem between physicians and patients," presenter Bertalan Meskó, MD, from Semmelweis University in Budapest, Hungary, told Medscape Medical News.

By epatient, Dr Meskó means someone, well, a little like himself.

"At home, I use a small device with which I can do an ECG with my smartphone," he explained, pointing out that he also measures his blood pressure with a small home monitoring device. Dr Meskó routinely calculates the amount of physical activity he gets during the day and the quantity and quality of sleep he gets at night, and is awakened by the gentle vibration of his smartwatch when he acquires the precise amount of sleep to wake feeling refreshed.

Eric Topol, MD, from the Scripps Research Institute in La Jolla, California, said he calls devices like the ones Dr Meskó uses "digital drivers of the democratization of healthcare."

During his keynote address at the recent Health 2.0 Annual Fall Conference in Santa Clara, California, Dr Topol compared what is happening in medicine to the Google self-driving car. "We don't have autonomous driving for people's health, but we are moving quickly to a doctorless patient model for some things," he said.

Dr Topol, who is also editor in chief of Medscape, listed patient diagnostics and monitoring as examples that will "largely be done by the consumer, and the doctor will be involved in treating and healing and care, with a little bit of diagnosis and monitoring."

Device-Enabled Smart Patients

Dr Meskó pointed out that patient-controlled management of chronic conditions hails all the way back to the 1970s, when the self-monitoring of blood glucose became possible. This not only freed patients from the need for regular hospitalizations or medical consultations, it also helped them stay motivated to keep their blood sugars in the target range and adhere to lifestyle changes that are part and parcel of any diabetes management program.

Tighter blood glucose control also reduced the number of diabetes-related complications and the subsequent need for costly revascularization procedures or routine dialysis.

Well-informed epatients are much easier to work with, not harder, said Dr Meskó. "Epatients save physicians time and energy," he explained, because they have more specific questions and their compliance rates are better because they understand why they should do something.

The smartphone is driving much of this "shift in the partnership of patients and doctors," Dr Topol said.

A recent survey, conducted jointly by WebMD and Medscape, is unique because it asked the same questions of 1102 consumers and 1406 physicians, according to Dr Topol. Some answers had a lot to say about how physicians and the public might react to the changes in store for their relationship.

For example, most respondents were receptive to the idea of patients using smartphone technology and apps "to assist in the diagnostic process," although consumers were more enthusiastic than physicians (84% vs 69%).

Over the next few years, the technologies that will find their way into medical practice will be "intuitive" and will require a very short learning curve before they can be easily used, Dr Meskó predicted.

Dr Meskó has disclosed no relevant financial relationships. Dr Topol is editor in chief of Medscape and reports serving or having served as a director, officer, partner, employee, advisor, consultant, or trustee for AltheaDX, AT&T, Biological Dynamics, Cypher Genomics, Dexcom, GenapSys, Gilead Sciences, Google, Illumina, Portola Pharmaceuticals, Quest Diagnostics, and Walgreens.

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