Thanks for being realistic.

Cory, couldn’t agree more re importance of revitalizing primary care providers, along with attending to patients’ needs. Esp for those people with ongoing health issues, a working collaboration is essential, and for that both sides need to be supported.

Love the analogy with the mid-life women suffering from loss of libido!

Healthcare tech designers would certainly do well to remember that the most useful tools need to be designed for patients AND their primary care advisors…because we advise the patients, and are best suited to provide person-centered (as opposed to disease-centered) care.

Leslie,
It’s so exciting to hear someone else talk about the unrealistic expectations on (and of) primary care physicians. It doesn’t matter now how we decide to “solve” the issue of access to decent and affordable health care. No matter who signs the laws or the checks, the “responsibility” for actually instituting ANY healthcare grand plan always lands in the lap of arguably the most demoralized and disintegrating work force in America — primary care doctors. Big organizations think armies of mid-levels are the answer. The tech industry runs about busily one upping each other with “patient engagement” tools.

Digital devices have indeed allowed “everyperson” to topple stagnant industries and unresponsive governments with a swipe of their finger. It’s easy to think then that the answer for health care is to just give the patients free information access and unlimited engagement tools and they will forge a brave new health care. Why not? The internet and mobile devices are indeed the Gutenberg printing press of healthcare. People can now unseat anyone who doesn’t realize that the days of the High Priests and Temples to the Religion of Medicine are gone.

But you don’t need a trusted adviser to create a playlist, or have a 50″ flat screen TV delivered to your door, or even to start a revolution on the other side of the world. However, where will you seek help, comfort or a reprieve when your Google Glass streams the following message from Watson:

“Today is your predicted expiration date. You have 30 minutes to get your *%# together — 35 if you put down that doughnut — 33.89 if you actually swallow the bite you are currently chewing, Lard Butt.”

I could be accused of bias here but it seems that primary care physician re-engagement balanced with patient engagement stands a much greater chance of sustainable revolution in health care. When it comes to our resistance to engaging with tech, primary care docs recount a theme eerily similar to one I hear too often from my mid-life female patients complaining of complete loss of libido. While we would like to see ANY aspect of our once intense desire restored, we watch huge industries role out an ever-greater variety of performance enhancement for our patients/partners. We can grasp cognitively that it is probably easier, faster, cheaper, and sexier than finding a real, safe, sustainable solution for OUR re-engagement. After a while, disengagement becomes preferable to living with constant and unavoidable resentment. And even if the resentment is at the industry or the system, our freshly engaged “partners” can’t help feeling like the resentment is directed at them, making them easy targets for whatever the next “it” thing is. Reducing the impediments to relationship for BOTH parties is the business plan with REAL staying power. And that can be done without getting “permission” from the crumbling top down organizations that try to dress it up but still think they hold the cards.

If I were addressing a roomful of heath care tech designers I’d say “Design the things that make it easy for Primary Care to feel genuinely “attractive”, competent and committed to a real partnership behind the exam room door again. Do that and you will solve the lion’s share of health care cost, decrease a choking sense of resentment destroying a noble and necessary profession, and probably get very rich in the process. But it has to be a genuine relationship enhancer; simple elegant and comfortable, not just another box from Victoria’s Secret.”

Oh, damn…that’s probably an unrealistic expectation, eh?
Cory Annis, MD

hi Cory,
good points you make, and yes, happy to have more clinicians (and others) call themselves cautious techno-optimists!

love the idea of healthcare innovation becoming a space of intergenerational learning and understanding.

well, many doctors are unwittingly creating impediments…what can we expect, the culture & practice of medicine is changing quickly, and also often the expectations that people have are unrealistic. (Now that would be a fun post to write: the various unrealistic expectations that various constituencies have regarding primary care physicians.)

there’s a middle ground where we can all meet and do our best work…we’re finding our way there…

hi Dr. Hersh,
Thanks for the comment and the feedback.

Agree that there may be something of a tradeoff betw quantifying oneself and enjoying life…I’ve been wearing a device for the past few weeks to quantify sleep and exercise, and am rapidly losing interest and even feeling a bit annoyed by the device…even though I know I should get more exercise as eventually that should help improve my sleep.

My point being, I find it hard to do what’s ideal for my health! And as a physician I’ve found it’s often a challenge to support patients long-term with behavioral interventions and chronic disease management…they are busy, tired, and sometimes feeling quite ill. Which is not to say that technology couldn’t help; I think it can. But it’s a big messy problem, supporting real people (as opposed to health nuts) in optimizing their health and well-being. And of course, even harder when people are quite disabled or chronically ill.

I hope you’ll let me know if you come across tech advances that you think are likely to be useful to average boomer caregivers, or older adults with multiple chronic problems.

hi Leslie: Wow, this comment is a like a remarkable blog post in itself!

I had very similar thoughts in reading Vik Khanna’s post. My own father was a bit of a health & fitness nut, yet he died at age 61 of lymphoma…fortunately for him (and for us, I suppose) he was only very ill & physically dependent for a few months, but of course most people — and their families — eventually endure years of diminishing health & progressive disability in the last phase of life.

The family issues are tough. Not only are families spread thin but I worry about people knowing their neighbors less over the coming decades…I do often encounter frail elderly patients who are being assisted by neighbors, but that’s because everyone has been living in the same place for decades…a state of things that we may not have in the future.

Re tech, have you heard of Hoalaha Robotics? They are working on robots to help seniors:
http://gigaom.com/2013/09/09/hoaloha-robotics-founder-on-how-robots-can-serve-a-growing-senior-population/

Re hired caregivers, companies like CareLinx are reducing the bite of the agency middleman…remains to be seen whether it ultimately is much better for families, but seems to provide caregivers with a bigger cut of the money.

thxs again for this lovely thoughtful comment.

Following that same line, if you are still in the phase of your life where it is natural to be convinced of your invulnerability, it is really difficult to imagine, let alone create, software and hardware that is useful and intuitive enough to use when you are sick, physically impaired, in prolonged pain, or dying.

It is such a ripe place for generations of patients, doctors, entrepreneurs, designers, and funders to mentor each other up and down generational divides and across disciplines, something that the digital age is so perfectly ready to facilitate. We just have to remember there is such a humanizing utility to popping our on carefully constructed information bubbles.
Yes…Leslie… a cautious techno-optimist…. can I steal that?
Cory Annis, MD

As always, I enjoyed your post. I am a physician in his mid-fifties who eats well and exercises, quite a bit actually. I have no interest in “quantifying” myself. I would rather enjoy healthy food, exercise vigorously, and otherwise enjoy life. I will confess that I own a Garmin GPS watch, but mainly to show off to my friends on Facebook all the exotic places I go running around the world.

But I agree that the best advances in tech will help us take care of our elders (parents and others) as they inevitably age and develop chronic disease. And help us now-healthy baby boomers whose children will be taking care of us as we age.

Bill Hersh (Informatics Professor)

At this point, I would gladly trade every penny we’ve sunk into HIT for a comparable investment in pediatric and adult immunizations, mental health services, and home health care.