Imagine attending private lectures and taking all your college exams in your professors’ offices individually, one-on-one. Your instructors lecture you, then pepper you with questions, grading your answers and recording your scores. This is not unlike traditional physician visits. Contrast this to attending classroom lectures and taking online multiple choice exams where a computer algorithm or Scantron tallies your answers and calculates your grade. Classroom instruction with standardized testing is much more efficient that private tutoring. Hundreds of students can learn and take their online exams simultaneously. What if medical productivity could be similarly improved?
Inefficient Physician Communication. When you visit your doctor you are engaging in what’s known as synchronous communication. You queue up in a waiting room and later both you and your doctor meet one-on-one in an exam room (at the same time). You may spend five minutes talking to a nurse and then 10 minutes talking to a doctor. A survey found with waiting and travel time, the whole process takes patients about three hours, on average. Furthermore, many doctors see only about 20 to 25 patients a day. The amount of information conveyed during an office visit is limited — as is the amount of information patients retain. Doctors also must take notes and update medical records during the exam. Fiddling with electronic health records further reduces the amount of useful information exchanged during a 10-minute encounter while your doctor hunts for pull-down menus. The way medicine is practiced is inherently labor intensive, not to mention inconvenient for patients.
Synchronous telemedicine is where you call your doctor or he/she calls back and you talk one-on-one. That may be a little more convenient for patients, but it’s still labor intensive. Asynchronous telemedicine is like email (or snail mail for that matter). You email your doctor or call your doctor and leave a message. Your doctor replies via email or by leaving voicemail. Asynchronous communication doesn’t require both parties to be present at the same time to communicate, but the information flow back and forth can be slow and inhibited compared to talking.
Medical Automation. Mercatus scholar, Robert Graboyes, writes about Lemonaid Health, a type of asynchronous telemedicine on steroids. (Lemonaid Health charges a flat $15 for a prescription for handful of common ailments.) He explains some medical services require one-on-one time (think an initial visit for a diagnosis), while others can be quickly performed through a series of interactive processes. The latter are scalable; aided by a computer algorithm, one doctor could oversee the care of many times more patients than possible if limited to one-on-one office visits.
Now for a thought experiment: imagine logging-in on your doctor’s office website, then being examined by answering questions from an interactive menu. The website algorithm then generates a treatment plan based on your responses for a chronic disease like, say, diabetes. Your doctor could review the results and approve your treatment plan, order prescriptions and maybe insert some specific advice much more quickly than using the traditional synchronous communication (office visit) model. At least in theory, a doctor performing the cursory evaluation of the automated treatment plan could be located anywhere in the world.
Computer-aided diagnostic tools for physicians already exists. Most mammograms are initially read by computer algorithms, highlighting areas where there may be problems or uncertain indications for a radiologist to interpret. An alternative method requires two different radiologists to validate individual interpretations. One radiologist using one computer is more efficient than two redundant radiologists using no computer.
Strength in Numbers. Now let me expand on Bob Graboyes’ discussion. Numerous diseases have support groups, where people suffering with the same disease or condition shares stories and exchange information on symptoms, treatments, doctors and so on. Nowadays most support groups are online. Members may never actually meet in person, yet benefit tremendously from interacting with others. Not only can people exchange ideas, the discussion thread is archived online for others to read and learn from long after the initial exchange occurred.
Group therapy is therapy sessions provided to educate a group of patients rather than each individually. It is most common in environments where sharing the experience of others with similar conditions is beneficial or peer pressure is needed to improve outcomes. Overweight people have group therapy: it’s called Weight Watchers. Addicts have group therapy: it’s called Alcoholics Anonymous or Narcotics Anonymous. People with mental health conditions used to have group therapy (simply called, group therapy). Think back to the old Bob Newhart Show in the 1970s. Half a dozen comically-neurotic characters, with a garden variety of mental health issues like depression, anxiety or phobias, would all arrive for a group session at a scheduled time. They would sit around for an hour and each take turns sharing their neuroses while validating each other’s feelings.
I actually attended a group therapy session of sorts the other day. My dog’s veterinary behaviorist charges $150 an hour to evaluate canine behavior problems. Initial evaluations take about two hours. The veterinarian periodically sponsors group sessions where dog owners can come as a group and listen to a presentation on some aspect of dog behavior. The events last about two hours and admission is only $15. Dog owners can learn more from these $15 seminars than most could afford to pay the vet one-on-one.
Interactive Group Therapy. Now imagine rather than a diabetes online support group open to the public, members are enrolled in an exclusive telemedicine group therapy program. Members could share a name or nickname and discuss or message other members privately. However, most interactions would be shared among the entire group. Doctors would monitor the group’s interactions and correct bad information. A physician or nurse practitioner could check metrics that are entered on a periodic basis (weight, blood glucose, activity levels, medications taken, etc.). Based on the inputs and interactions, physicians would review the automated treatment plans, update the medical record and prescribe medications electronically. People who don’t participate might be contacted by others in the group, a nurse or the computer system. Such a system could upload some metrics (e.g. weight and blood glucose levels) using Bluetooth. Members could share recipes, eating habits, exercise regimens and generally support each other’s efforts — all while under medical supervision.
Interactive group therapy could easily work in a Direct Primary Care practice to replace in-person routine physicals and wellness visits. I could sign up with my doctor alongside a thousand other guys. We could watch our doctor’s YouTube videos on wellness, the importance of maintaining proper weight, blood pressure, cholesterol and so on. We could routinely upload information on weight, blood pressure and any concerns we have. Our physician could follow up if needed for a nominal fee. Perhaps once or twice a year we could have blood drawn to check cholesterol, hormones, liver kidney, etc. Any readings out of the normal range would alert the doctor, who could call in a prescription or call us in for a one-on-one evaluation.
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