"Alexa, Can You Be My Family Medicine Doctor?" The Future of Family Medicine in the Coming Techno-World

Allen F. Shaughnessy, PharmD, MMedEd; David C. Slawson, MD; Ashley P. Duggan, PhD

Disclosures

J Am Board Fam Med. 2021;34(2):430-434. 

In This Article

Abstract and Introduction

Abstract

Even before social distancing disrupted normative expectations and prompted an immediate shift to remote doctor/patient interactions, technology companies—Amazon, Apple, and Google—were preparing to disrupt medical care through the innovative use of technology. This article presents a possible scenario for how technology, in the near future, will completely up-end primary care practice. What does face-to-face interaction accomplish that cannot be done remotely? What do family physicians offer that cannot be accomplished by technology? More than just relationship, family medicine brings the therapeutic use of the self to engage with people, an ability to advocate for patients, and the ability to step back and reflect on the power of relationships. In addition, family physicians bring wisdom, making decisions in the liminal state between patient and physician, the resulting product of the human connection but also the ability to manage complexity using the best evidence. The ability to do both gives family medicine physician the skills to leverage but also control the coming big data.

Introduction

That it will ever come into general use, notwithstanding its value, is extremely doubtful; because its beneficial application requires much time and gives a good bit of trouble both to the patient and the practitioner; because its hue and character are foreign and opposed to all our habits and associations.
—From the translator's preface to Laennec's (1835) book on the use of his new invention, the stethoscope [1]

The smartphone was introduced less than 15 years ago. Few of us can imagine getting through the day without ours. Similarly, the stethoscope quickly went from oddity to essential data information tool. The introduction of new technology creates its own necessity.

Tech giants are about to upend primary care practice.[2,3] Do not shoot the messenger—regardless of what we want, changes are going to happen. What will be the impact on family medicine? Will there still be a need for family physicians to do whatever it is that only family physicians do? What is it that family physicians are best at doing? What would be lost if technology is substituted for face-to-face communication in primary care?

Considering technology first prompts some reflection about the role of family medicine physicians. According to a Greek parable, the fox is good at many things. Clever and resourceful on the hunt, it can develop cunning and complex strategies to "outfox" its prey. On the other hand, the hedgehog knows one big thing. When attacked, it rolls up into a little ball of outward-pointing spikes. Does not matter the threat—roll up and wait it out.[4]

Are family physicians foxes, thoughtfully adapting to their patients' needs, the needs of the community, and the ever-changing landscape that is medical practice? Or, are family physicians hedgehogs, doing one big thing that cannot be replaced by other clinicians or new technologies? What will be the role of emerging technologies in considering this question—will technology augment or replace the particular "charism" or way of being of family physicians?

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