The human touch and scientific veracity are lacking in health care technology

Working remotely during the coronavirus pandemic has immersed doctors in the technology, perhaps accelerating its integration with medical practice, but not necessarily its acceptance or authenticity.

I tend to doubt the accuracy of much of what I read in electronic medical records. I also question reports based on data collected from large medical databases, for example summaries on physician compensation and practice trends.

Many physician profiling reports are generated on professional websites independently or with the help of self-styled “high-tech” companies. They are bordering on self-promotion and the integrity of the data can be compromised and deemed too unreliable to be believed.

The saying “you can’t always believe what you read” is truer today than ever, and studies have shown that a great deal of medical information on the Internet is incorrect or misinforming the public.

Data collected to assess practice patterns may be incomplete. Sampling methodology may be biased. White papers are rarely peer-reviewed and often lack statistical review and analysis. Observations often replace irrefutable facts.

For example, Doximity published a report, unsolicited of course, that compared the top specialties chosen by students at my alma mater medical school in 1980 with the top specialties chosen by students in the current class. I noticed some inconsistencies, so I sounded the alarm to the “support specialist” on the website.

The specialist replied: “Thank you very much for your suggestions and comments on this data report. We have forwarded your message to our product team for review. We are always working to make our tools as useful as possible for clinicians.”

In a Machiavellian moment, I was reminded of Henry David Thoreau’s prophetic statement in Walden: “Men have become the tools of their tools.” Let’s not let it happen, I told myself.

Then I realized that Thoreau’s words already rang 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.

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The reliability of the medical record has plummeted due to errors in documentation caused in part by multiple user input and “copy and paste” errors.

In my specialty (psychiatry), virtual mental health startups are all the rage. Most are privately funded. The companies seem to be infatuated with the technology, boasting 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 businesses that operate 100 percent online may be needed to access patients in remote locations or when demand is high, but the distance sends patients, now called “clients,” into the ever-increasing dangers of the virtual psychiatric treatment: unanswered pleas for help -sometimes from suicidal patients- and inappropriate prescription of controlled substances.

Working at investor-backed telehealth startups has been chaotic and confusing compared to working at fast food chains. One whistleblower alleges that a company’s policies and practices may have put profits and growth before patient safety.

Tellingly, companies providing virtual psychiatric services have incorporated legal disclaimers on their websites explaining that the services provided are administrative, financial, and support only. The fine print also makes it clear that their services do not address emergencies and that their providers are in addition to, not a replacement for, local primary care providers.

The new generation of telemental health companies cite positive results in patients using their services. Patient testimonials adorn their websites and, once again, controversial measures (certainly not statistically significant) are designated as de facto indicators of clinical improvement.

I am a stickler for medical protocol and accuracy because, after working a dozen years in the pharmaceutical industry, I saw how advertising claims can easily be manipulated and misrepresented for commercial purposes and end up becoming false claims.

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Claims made by healthcare companies online (on television, social media, and on their websites) should receive the same scientific scrutiny as pharmaceutical claims when submitted to the FDA. All efficacy claims must be truthful and not misleading, supported by sound statistical analysis.

I am not anti-technology. In fact, I have seen firsthand the benefits of technology when used constructively in the pharmaceutical industry. The collective shift toward decentralization (performing part or all of the clinical trial in patients’ homes), coupled with investment in technological innovations that make home visits and data collection possible, is changing the face of clinical trial development. clinical trials.

However, I am against the use of inferior or untested technology with flaws that endanger the well-being of patients. There is not, and probably never will be, an all-in-one, digital-only technology company that allows providers to input findings and diagnoses, tap into links that connect them to decision support modules and medical literature, and communicate with colleagues and other caregivers without a semblance of human contact and the eventual need for real-time intervention. Treatment cannot be provided indefinitely in cyberspace.

Physician involvement is crucial to the successful design and implementation of medical applications and electronic health records. Physicians must also step up and be visible in digital environments. Care received entirely through online messaging is promoted dangerously as well as that provided in the office, despite the vast differences between the two modalities and a number of limitations associated with mental health teletherapy.

Non-physician-based digital mental health services such as chatbots, video and written content, gamified user exercises, and digital cognitive behavioral therapy programs will never replace face-to-face physician-based treatment. No matter how much the work of a doctor may be replaced or assisted by technology, the human touch will always remain a prerequisite for patient care.

Arthur Lazarus is a psychiatrist.

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