On June 11, 2016, James Madara, MD., addressed the American Medical Association's Annual Meeting with some wonderful hyperbole. Dr. Madara is the CEO of the AMA, and he likely felt some pressure to rally the troops (a/k/a physicians) and show that the AMA is advocating for their “side.” And it got attention, with articles trumpeting that Dr. Madara called digital products “modern-day 'snake oil'.” He indeed did.
We do need to give Dr. Madara a little leeway here. The role of the AMA is to represent physicians, and he's the CEO. That being said, consider for the moment that one of the major points Dr. Madara made was to tout how the AMA's predecessors over 100 years ago outed snake oil for the fraud it was, thereby protecting the consuming public. While it was a while ago, the AMA should be rightly proud of that accomplishment.
However, what Dr. Madara did at the June AMA meeting, entertaining as it was, does not deserve equal accolades.
Let's first look at the good parts. What he was calling digital health snake oil were not ALL digital health products. There are products in the market that are either vaporware or that can do outright harm, and he was referring to producers and literature that have oversold what digital products alone can do. For better or worse, it is a largely unregulated arena, and use of such products does not mean never seeing a doctor again. Duly warned.
Dr. Madara continued: “The future is not about eliminating physicians, it's about leveraging physicians.” I could not agree more. We must get them to the sweet spot where they practice at the top of their license, unlike today. Doing less with better results. Moving away from volume production to patient outcomes. But his focus on leveraging physicians brings me to my issue.
The medical profession by and large has ignored the convenience of patients. We all know this. The entire process of just seeing a physician is highly inconvenient. There are, of course, exceptions, and they shine out as such. But the center of the universe in our current system is…them. Physicians might not actually realize that given the enormous pressures they are under.
But from the standpoint of an outside observer, it sure seems that way. Everything about physician care revolves around maximizing what the physician can do in the extraordinarily limited amount of time he or she sees a patient. That world circles around the physician rather than the patient.
That's not entirely the fault of physicians. Our care delivery model and its financing (how payors pay for care) have ensured a model that is anything but patient-centric.
But back to the AMA speech. The digital products Dr. Madara refers to, both good and bad, are attempts by the “market” to benefit patients–namely us. They are efforts to educate us, empower us, and make our health care more convenient…for us. We patients feel anything but empowered with our healthcare. Thus, these digital products are the natural consumer response to a highly inconvenient, largely poor quality medical service in America today.
This should be, after all, about the patient's' convenience and outcomes. From the AMA CEO's comments, it is very unclear whether he appreciates that, because his few nods to technology are limited to technology that advances the physician's convenience. For example: “…digital tools that would simplify and better organize our lives…” He's referring to physicians' lives–not ours. He never mentions the convenience of patients.
Dr. Madara goes on to tout the “Steps Forward” digital modules which are made available via the AMA website. Their purpose? To “…address pain points highlighted by physicians….” Not by patients.
The medical profession is light years behind virtually every other profession when it comes to customer convenience and interaction, much less the use of customer/patient-facing technology. So it's unsurprising that the “customers” are taking matters into their own hands, and at least the digital world is reacting to supply the consumer demand.
Given physician uninvolvement, of course there will be some snake oil. But up to now, most physicians have wanted nothing to do with this sort of technology. It's simply not a focus of the medical profession, and that is my point. That must change, or the digital consumer revolution, which IS coming, will do it without their involvement, diminishing the truly important role physicians play.
Last but not least. Dr. Madara takes shots at electronic medical records, lumping them in with digital snake oil remarks. Here I take great issue on a number of levels.
- Physicians could have been more involved in their design. For whatever reason, they were not. Where was the AMA when EMRs were being designed and introduced? The result is predictable.
- Physicians seem to accept the lack of interoperability as an inevitable part of the treatment landscape. If ATMs can do it, so can EMRs (I'm told it's a bit more difficult in healthcare than in finance, but…). It's outrageous that there's not more of an outcry on our lack of interoperability.
- The inordinate amount of time MDs spend on their computer, albeit apparently true, is a tired red herring. Rather than make EMRs the whipping boy, design better EMRs and focus on better office workflows and business models. Seasoned professionals in other areas (law, accounting, etc.) are not thusly hamstrung. They find ways to make it work. It's a sign of a broken business model if MDs are spending as much time entering data as treating patients.
The truth is that almost every physician cares deeply about patients. But the AMA's comments might lead one to conclude to the contrary. This could be seen as just one more instance where the profession continues to unilaterally dictate care paternalistically rather than collaboratively design it based upon greater patient and family input, and perhaps welcoming apps that do just that.
It would be a very healthy development indeed if the AMA were to focus more on facilitating patient convenience and outcomes and be a tad more receptive to the consumerized digital medical revolution that will soon be upon us, like or not.
Jim Purcell was the CEO of BCBSRI. Prior to that, he was a trial lawyer in healthcare, and today he mediates and arbitrates complex business disputes and is focused on workplace wellbeing. jamesepurcell.com (healthcare) and jimpurcelladr.com(mediation/arbitration).
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