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The oxymoron of digital medicine

Will we manage to humanise digital technologies before they erase our humanity?

Giampaolo Collecchia

General practitioner, Massa

Riccardo De Gobbi

General practitioner, Padova

By May 2021August 4th, 2021No Comments
Photo by Lorenzo De Simone

“Philosophy, in any case, always comes on the scene too late to give it. As the thought of the world, it appears only when actuality is already there cut and dried after its process of formation has been completed… When philosophy paints its grey on grey, then has a shape of life grown old. By philosophy’s grey on grey it cannot be rejuvenated but only understood. The owl of Minerva spreads its wings only with the coming of the dusk.”

Georg Wilhelm Friedrich Hegel

The Covid-19 pandemic caused a forced acceleration towards digital healthcare, especially telemedicine. Physical closeness, the pillar of medicine, was experienced as a danger both for patients and their treating doctors. Touching the patients’ body, with its reassuring effect and resulting treatment, was not possible. Touch and proximity were substituted by conversations from a distance, images on the screen and often just phone calls or messaging apps. The risk is that digital medicine might become an oxymoron. (Please see note*)

*The term digital originates from the English word digit (referring to the binary code), which in turn derives from the Latin word digitus, or “finger” (indeed, you use fingers to count). Despite its etymology the notion of digital medicine becomes an oxymoron when applied in practice: human touch versus its opposite and contact versus indirect monitoring, which go alongside the increasing risk to lose the doctor-patient relationship.

A barrier to accessing digital medicine is certainly the digital divide phenomenon, or the tendency to exclude elderly patients because often they do not master online tools. Besides, the phenomenon does not result in inequality around the use of online instruments but it also impacts all the innovation and development opportunities that currently depend on having good Internet access. Therefore the impact is rather wide and it is also reflected in the culture of the society itself by creating a cultural divide between the young and the elderly, the educated and the uneducated, and the rich and the poor, with the consequent problem around how to distribute goods and resources equally.

Thanks to the additional help of caregivers and specialised workers, “virtual” doctors will be able to manage patients affected by chronic conditions, elderly, disabled subjects and people living in hard to reach areas by using wearable vital sign monitoring devices or mobile apps (smartphones, tablets and smartwatches). (Please see note**)

**Wearable devices are made of one or more biosensors. They are usually worn on the wrist and can be viewed through smartphones and Cloud based services via wireless programs such as Bluetooth. They can be inserted in accessories such as watches (smartwatches), bracelets (fitness bands), shoes, belts and bands (smart clothing), and glasses (smartglasses). They enable you to detect and measure different vital signs (heart rate, breathing rate and oxygen saturation, blood pressure, glucose levels and sweating, breathing rate and brainwaves) and information on your lifestyle (physical activity, sleeping cycle, diet and burned calories).

Telemedicine allows doctors to diagnose even minor acute pathologies such as skin lesions, otitis and pharyngotonsillitis. In cases of patients displaying more serious and uncommon issues that require physical contact or in-person observation it will be necessary to conduct a traditional visit.
Such an approach requires important changes, not just around the notions of healthcare and doctor-patient relationship- that are very interconnected by the way- but also around organisational aspects. For example a simple visit conducted on video requires specific methodologies, appropriate spaces, duration and tools (PC, audio and video) as well as a guarantee of privacy by design and safety to avoid any data breach.

It is essential to adopt a multidisciplinary approach involving professional figures such as family nurses, specialists, psychologists, dieticians and personal trainers for physical activity.

In regards to professional responsibilities, according to Article 7 of the so-called Gelli Law, the most recent healthcare legislation, services can also be provided online, meaning through the use of telemedicine tools. To be specific, consultations “from remote” should follow the same rules that apply to visits conducted in traditional ways because the same discipline is practiced in both. In other words, healthcare professionals should always adopt the operational solution that offers the greatest guarantee of proportionality, appropriateness, efficacy and safety, and it is paramount that they assess each specific case to decide whether it is feasible to provide services remotely.

During the Covid-19 pandemic different guidelines were suggested with step-by-step guidelines on how to conduct consultations remotely, looking at various aspects, from the initial preparation for video or just audio calls to the clinical management of the visits and the follow-ups.
It is essential to adopt a multidisciplinary approach involving professional figures such as family nurses, specialists, psychologists, dieticians and personal trainers for physical activity.

The system should utilise shared encrypted IT platforms- connected to electronic patient charts- that are able to manage data coming from different sources in order to provide an overall view of patients and a profile with their clinical and psycho-social information. It is essential that both software programs and medical devices are inter-useable and that they do not depend on apps to send data. There is always the risk of vendor lock-in, whereby the provider locks its device to a certain app and has data ownership. The platform should provide training to both patients and doctors, for example by delivering tutorials.

One wonders if patients are ready to accept this cultural revolution. At least part of the doctor-patient relationship can definitively be preserved, even with the use of video/teleconsultations, particularly when the clinical support has been consolidated over time. The reality is that patients changed too, as they are now influenced by the tendency to only believe information when this can be verified- with tools of “true” knowledge- via technology.

The hope is not so much that technology could change medicine but that medicine could “shape” technology based on its principles: equality, real needs, accessibility and continuity of care.

Conclusion

When it comes to digital culture it’s as important to avoid apocalyptic views of the future, trusting the human rationale, as it is to avoid overly enthusiastic approaches to the potential of technology, acknowledging its limitations.

Medicine definitively cannot (and will not) ever just be digital nor can it be manageable exclusively through sensors or algorithms. The hope is not so much that technology could change medicine but that medicine could “shape” technology based on its principles: equality, real needs, accessibility and continuity of care. This should constitute a true “technological” innovation, with high added value; it should be flexible, powerful and cheap, and centred on the real needs of people.

The alternative to this is losing the game or fully understanding the phenomenon when it is too late and it has already taken place, like the owl of Minerva that arrives when actuality is already there and its process of formation has been completed.

 

Collecchia G, De Gobbi R.
Intelligenza Artificiale e Medicina Digitale. Una guida critica.
Rome: Il Pensiero Scientifico Editing Company, 2020.

 

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