A Bygone Era

A Bygone Era

In today’s Wall Street Journal there’s a very well written opinion piece entitled “Turn Off the Computer and Listen to the Patient” penned by Caleb Gardner and John Levinson. The main thrust of this piece is how technology while helpful can interfere with the doctor patient relationship. How technology with all its promise can actually hurt instead of enhance care. This is a compliant we have heard from many in the medical community. That medical decisions are being taken out of their hands and being replaced by computers.

While it would be great if we could back in time, back to when physicians could actually practice medicine, the era of true patient physician interaction, this is wishful thinking. The fact, yes those pesky facts again are this is bygone era which will not make a comeback. The days when a patient and physician are in the same room are coming to an end. The reality when it comes to diabetes is there just isn’t enough endocrinologists to handle the exploding patient population. The same goes for Certified Diabetes Educators, unfortunately the supply of patients with diabetes keeps increasing faster than the number of people becoming CDE’s.

It’s well known that approximately 80% of all patients, Type 1 and Type 2, are treated by a primary care physician, physicians who are not “experts” in diabetes. It is also true that for a multitude of reasons they are forced to do diabetes management by the numbers. That they really don’t have much of a choice when it comes to which drugs to prescribe.

The question we have is; is the changing role of the physician and the emerging role of technology in diabetes really a bad thing. Is it really necessary with the technology we have today for the patient and physician to sit in the same room together?

What most physicians of this bygone era cannot accept are two facts. First for the majority of patient’s diabetes management isn’t overly complex. That for these patient’s diabetes management by the numbers works provided patients are adherent or whatever the politically correct term is today for therapy compliance.

Second, as much as they hate to admit it technology has liberated and empowered the patient. Or put more bluntly they are no longer in control of the patient, their word is no longer taken as gospel. Yes, there are some who must have advice from someone in a white lab coat, who believe their physician is all knowing. However, this is a distinct minority of patient’s thanks in large part to technology. Today when a patient is told to do something or take a new drug they don’t just follow this advice blindly, they head to the internet and Google it.

Now we are in no way saying the physician is giving bad advice or that they don’t have the patients best interest in mind. However, this is the world we now live in, a world where the patient has immediate access to information, many times the exact same information a physician does. There is, for better or worse, an unlimited amount of opinions on how diabetes should be managed, which drugs should be used, etc. Again this is both a good and bad thing but it is the world we live in and it’s not going to change.

As much as technology can empower a patient it can also handicap the patient overloading them with too much information which in turn causes them to tune out. This is why we have always pushed for simplicity when it comes to how diabetes management systems should be designed. These systems should be designed not for highly engaged patients but the majority of patients who want to live their lives with and not for their diabetes.

Now we know we’re going to take hell for what comes next but honestly we don’t care. The ONLY people these systems should be designed to make happy is the PATIENT. Not the ADA, JDRF, CDE’s, physicians or payors. Remember the goal, to engage the patient, to empower them with relevant, actionable information which helps them manage their diabetes more effectively. The ultimate goal being to get these patients to be adherent with their therapy regimen.

This in no way means the physician should be taken out of the loop. Rather it means that the role of the physician is changing and can be actually enhanced with technology. However, the facts yes those pesky facts make it clear that the days of a physician and patient needing to be in the same room are fading away. This isn’t about who’s in control, this is about getting the patient to take an active role in their diabetes management, to take ownership of their diabetes management.

There was a time long ago when physicians made house calls, when they were able to spend more than 8 minutes with a patient. There was time when the physician wasn’t told what to do, a time when they alone could choose which drugs they prescribed. Back in this bygone era patients did not have immediate access to an unlimited amount of information at their fingertips. There were no sophisticated algorithms, data analytics or artificial intelligence. There weren’t thousands of websites or blogs for patients.

Those days are long gone and they aren’t coming back. It’s time for everyone to accept this fact and get on with the business of making these diabetes management systems do what they are supposed to do; help the patient manage their diabetes more effectively.