First, we Devalued Doctors; Now, Technology Struggles to Replace Them

David ShaywitzThe key to driving behavior change, a seasoned marketing executive turned digital health investor told a panel on patient engagement that I moderated this week, is to get beyond the demographics of customers, and to understand the “why” – what are their distinct motivations and drivers?

Customers with similar demographic characteristics might be motivated in very distinct ways, he explained; sophisticated, quantitative market research can help define the different “personalities” present in a particular market.

Healthcare businesses, he emphasized, need to recognize these differences, and customize their approaches based on this nuanced understanding.

On the one hand, it occurred to me he was describing the behavioral component of precision medicine; in the same way it’s important to match an oncology drug with the right biochemical pathway, it’s also essential to customize the motivational approach to the characteristics of each individual.

On the other hand, I realized there was something that seemed a little sad about the idea of developing extensive market analytics and fancy digital engagement tools to simulate what the best doctors have done for years – deeply know their patients and suggest treatments informed by this understanding.

Instead, it seems, we’ve slashed the time physicians get to spend with patients, protocolized and algorithmitized almost every moment of this brief encounter, and insisted the balance of time is used for point-and-click data entry and perhaps a rushed dictation.  We’ve industrialized the physician-doctor encounter – the process and the paperwork — but eviscerated the human relationship; it’s value, unable to translate easily to an excel spreadsheet, was discounted and dismissed.

As I look at the extensive analytic efforts to categorize patients, and the many digital health platforms designed to motivate behavior, it’s hard not to ask whether we’re painfully trying — at scale but without heart — to re-create something we might have been better off not destroying in the first place.

David Shaywitz is based in Mountain View, California. He is Chief Medical Officer at DNAnexus, a Mountain View based company and holds an adjunct appointment, Visiting Scientist, in the Department of Biomedical Informatics at Harvard Medical School.

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4 replies »

  1. To some extent we have to go with the flow. There is a new etiquette I note in “Managing Your Doctor” (see managingyourdoctor.com) when talking to a patient but also recording everything on your electronic record – at least continue a verbal contact, tell them what you’re pulling up on your screen, what their results show etc even if you’re not looking them in the eye.

  2. Well said and sadly true. The premise of Family Medicine was/is to know the patient’s history, family, social context and values. We had developed the tools and the skills we needed to do what we now struggle anew with in the reinvented, patient centered, data driven cookie-cutter medical homes that the Government is making us work in. The reinvented wheel is pretty square, and the Emperor is actually not wearing fancy clothes at all.