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Medical apps shift control of care from doctors to patients

Eric Topol
Dr. Eric Topol

Q. You discuss the trend toward virtual visits, which you say are cheaper and just as good as in-person visits according to key measures such as misdiagnosis. You predict that physical visits are on their way out. Is there nothing about an in-person visit that is superior to a virtual one?

A. I don’t want to say that. We’ll never give up the in-person visit. Ideally, there’s a level of intimacy there that you can never replace. You’re in the same room with a person, there are things that you pick up and share, and it’s a much more rich experience.

But that’s not the typical experience of a doctor visit today. It’s short, the doctor is pecking away at a keyboard.

In a virtual visit, it’s not going to be just two people video chatting. Increasingly, patients will have information from sensors to share, they’ll have lab work and other data that will be transmitted to the doctor prior to or during the visit. We’re talking about data exchanges, and that will make the virtual visit a different one because it’s a very efficient way to practice medicine. But it’s not for everything.

Q. When will an in-person visit be warranted?

A. Physical visits will not be generally required or used to manage routine chronic conditions such as high blood pressure or diabetes. But for serious conditions and emergencies, or when there is a need for a change of approach, confusion, something that’s not straightforward, a physical visit may be necessary.

Q. With the doctor in the role of consultant to the patient?

A. Yes. There will be oversight of data and treatment by the doctor. Much diagnosis and monitoring will be shifted to the patient if he or she is willing to take it on.

Q. You make the case that if people surrender their personal medical data to be incorporated into big data banks to be analyzed, we might be able to someday predict disease, which would benefit us all. Given the lack of privacy protections at this time, that seems like a big risk to take, don’t you agree?

A. I’m very worried about privacy and security of data. We have to nail down the privacy and security issue, which is possible through both technological approaches and governmental legislation. We’re far from ready for that now. But once that is assured at the highest level, most people are eager to share their medical data provided it is de-identified and has no risk of being re-identified. If properly assembled, a big medical knowledge resource could be extremely beneficial.

Q. You discuss the lack of transparency of medical prices and the roadblocks that creates for patient-managed care. It’s a huge problem, but the solution can’t be as simple as everyone knowing what things cost. Can the health care system as currently organized, dominated by private insurers and employers, really become cost efficient?

A. It could become really efficient. Patients assuming a larger co-pilot role are only part of the story. I can give many examples of patients who get an electrocardiogram through their phone and it saves them a visit to the emergency room. There are lots of ways to cut costs.

But the deeper question you’re getting to is that we still have this fee-for-service system, and doctors are not enamored of patients being in charge. This is their business and this is relinquishing part of that control, what data people are gathering and seeing, and getting some initial interpretation without them. Incentivizing physicians for this would be good, but we don’t yet have a system for that.

By Michelle Andrews, Kaiser Health News


Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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