Phoning It In Is Better
Finally, a way to prove what everyone suspects already. A study coming not from a medical journal, but from the much-venerated Consumer Electronics Show in Las Vegas. Patients relate LOTS better to frequent communications involving personal electronics (cell phone) than they do to infrequent communications from a human physician and his/her team of physician extenders (nursing staff, physician’s assistants, technicians, etc) and print information. For one thing, this does not exactly sound like a double-blind placebo-controlled study. It is clear to me that when electronic communication is used, these are, simply, for frequent contacts. The real problem, I think, is where we went awry and why we need all this to catch up. The doctor patient relationship has been on the skids for years. Even the most intuitive of people watchers could have guessed that when you have a relationship where interactions are both structured and hurried, not to mention far apart, the relationship follows some kind of entropy – a scientific term for disintegrating or winding down. The “doctor extenders” are of varying quality, as well as varying emotionality and attachment. This means they sometimes help and sometimes don’t. Time and time again I have told patients, “You only have to know the one, or at the most 2 or 3 (usually), diseases you have got to get through life.” When I send them to libraries, give them book titles, magazine references, whatever, it does not happen. Send it to them on their cell phone!! “Here are four months worth of medicine, one month with three renewals,” I would tell my long-suffering patients. ”No, I am not going to give you a year’s worth. Even though I expect they will be normal, you really have to get those blood tests.”
When they get oppositional, I get crusty – Yes, adorable me. “Look, it is your responsibility if you cannot get in there and get them, not mine. I want you to do what is safe and good. I can only tell you. You really need to do this. I am not kidding. I cannot come to your house and remind you or even call you to remind you.”
“I can’t. I think I am taking care of most of the county.” Or then, there is sometimes the cruelest cut of all. “Of course there will be a psychiatrist here when you come back. No, it is unlikely to be me. I do not have any idea who it will be.”
“Call if you have any problems. There will always be someone here.” The problem of course is that they have to get through the front desk. By phone. A couple of the hard-cores would come in to try to talk to the front desk in person. One young woman at the desk is student level, chosen from the (allegedly previously ) hard-core unemployed. One has a questionable handle on the English language. I heard her tell someone once in her native language, which she has no idea how well I can understand, that English is a strange language, as it has too many high- complexity ways to say simple things. The third has a neurological illness that sometimes may include recent memory problems. I suspect she might have some, the poor dear, but I believe it is generally considered impolite to do neurological assessments of the front desk, especially this sweet and loveable woman. Are people still wondering why frequent cell phone contact and even sending folks videos to watch on their cell phones improves “compliance.” I think compliance means the patient doing what the doctor thinks the patient should do. Most doctors do not even have time to tell the patient what they should do.
In more common illnesses, such as diabetes (Type 2, mostly) the interaction between doctor and patient rapidly degenerates into communication with doctor extenders and informational pamphlets. There are a couple of problems with widespread implementation of this very good idea, but they can all be dealt with. They call it the “digital divide.” It is a little hard for older folks to become comfortable with personal technology. Despite my own frequent insistence that I am not yet “older folks,” I will freely admit to struggling with some of the more sophisticated functions of my cell phone. Still, the link above is replete with simple wisdom — keep it personal and relevant and short. These are all non-obvious things for people who grew up writing thank-you notes to relatives by hand.