Working remotely during the coronavirus pandemic has immersed physicians in technology, perhaps accelerating its integration with medical practice – but not necessarily its acceptance or authenticity. I tend to doubt the veracity of much of what I read in electronic health care records. I also question reports based on data gleaned from large medical databases – for example, summaries about physician compensation and practice trends. Many reports that profile physicians are generated on professional websites independently or with the aid of self-anointed “high-tech” companies. They verge on self-promotion, and the integrity of the data may be compromised and deemed too unreliable to be credible. The adage “you can’t always believe what you read” is truer today than it ever was, and studies have shown that a great deal of medical information on the Internet is incorrect or misinforms the public. Data collected to evaluate practice patterns may be incomplete. The sampling methodology may be biased. “White papers” rarely undergo peer review and often lack statistical review and analysis. Observations frequently substitute for ironclad facts. For example, Doximity pushed out a report – unsolicited, of course – comparing the top specialties chosen by students at my medical school alma mater in 1980 with the top specialties chosen by students in the current graduating class. I noticed a few inconsistencies, so I sounded the alarm to the website’s “support specialist.” The specialist replied, “Thank you so much for your suggestions and feedback about this data report. We have passed your message to our product team for review. We’re always working to make our tools as useful as possible for physicians.” In a Machiavellian moment, I recalled Henry David Thoreau’s prophetic statement in Walden: “Men have become the tools of their tools.” Let’s not let it happen, I said to myself. Then I realized Thoreau’s words have already rung true, considering the alarming number of problems associated with electronic health records – increased provider time, computer downtime, interrupted interactions with patients, lack of standards, and threats to confidentiality. The reliability of the medical record has plummeted due to errors in documentation caused in part by input from multiple users and “copy and paste” errors. In my specialty (psychiatry), virtual mental health startups are the rage. Most are privately funded. The companies seem to be infatuated with technology and boast of their ability to “democratize” mental health services by reaching millions of patients. However, digital mental health care companies feel sterile and can be counterproductive to the benefits of in-person psychiatric treatment. Mental health companies that function 100 percent online may be necessary to access patients in remote locations or when demand is high, but the distance consigns patients – now referred to as “clients” – to the ever-increasing dangers of virtual psychiatric treatment: unanswered pleas for help – occasionally from suicidal patients – and inappropriate prescribing of controlled substances. Working at investor-backed telehealth startups has been chaotic and confusing compared to working at fast-food chains. A whistleblower alleges that policies and practices at one company may have put profits and growth before patient safety. It’s telling that companies that provide virtual psychiatric services embedded legal disclaimers in their websites by explaining that services performed are only administrative, financial, and supportive. The fine print also makes it clear that their services do not address emergencies, and their providers are an addition to, and not a replacement for, local primary care providers. The new breed of tele-mental health companies cites positive outcomes in patients who use their services. Patient testimonials adorn their websites, and once again debatable – surely, not statistically significant measurements – are designated as de facto indicators of clinical improvement. I’m a stickler for medical protocol and accuracy because, after working a dozen years in the pharmaceutical industry, I saw how advertising statements could be easily manipulated and twisted for business purposes and wind up becoming false claims. Claims made by online health care companies – on television, social media, and on their websites – should receive the same scientific scrutiny as pharmaceutical claims when they come before the FDA. All claims of efficacy must be truthful and not misleading, supported by robust statistical analyses. I’m not anti-technology. In fact, I’ve seen first-hand the benefits of technology when used constructively in pharma. The collective shift towards decentralization – conducting a portion or all of the clinical trial at patients’ homes – coupled with investment in technological innovations that make home visits and data collection possible is changing the face of clinical trial development. However, I am against using unproven or inferior technology with glitches that jeopardize patients’ welfare. There is not – and probably will never be – an all-in-one, digital-only technology enterprise that allows providers to enter findings and diagnoses, take advantage of links that connect these with decision support modules and the medical literature, and communicate with colleagues and others taking care of the patient without some semblance of human touch and the eventual need for real-time intervention. Treatment cannot be provided indefinitely in cyberspace. Clinician involvement is crucial for successfully designing and implementing medical applications and electronic health records. Clinicians must likewise step up and be visible in digital environments. Care received totally through online messaging is perilously being promoted as just as good as that provided in the office – despite the huge differences between the two modalities and a bevy of limitations associated with mental health teletherapy. Non-clinician-based digital mental health services like chatbots, video and written content, gamified user exercises, and digital cognitive behavioral therapy programs will never substitute for clinician-based, face-to-face treatment. No matter how much a physician’s job can be replaced or aided by technology, the human touch will always remain a prerequisite for patient care. Source
