Digitalization of medicine: some “pros” and some “cons”

The prevalence of comorbidity - the frequency of instances in which a person suffers from more than one disease at the same time - is constantly increasing. There are many reasons for this – perhaps the most important are successes of medicine which keep people alive although they have an illness which in previous times would have killed them.

While the prevalence of comorbidity is on the increase, medicine is fragmented, divided into ever smaller specialties. There are some twenty subspecialties in internal medicine for example, and the situation is similar within other areas previously covered by a single specialty. Competent physicians want to provide the treatment for the disease that brought the patient to them and they want to do this knowing about other diseases which their patient might have or have had. Getting medical records about these other diseases is not simple: it takes time and labour as well as good relations between medical institutions. The result is that treatment is often provided without consulting records held elsewhere.

Digitalization of medicine brings a simple and elegant solution to this. Information about the patient and about treatment provided is entered on electronic records which are then easily available to other physicians who are providing treatment to the patient. A clean “pro” for digitalizing one of the components of the medical encounter, it seems.

Yet, entering information into the electronic records (and sometimes obtaining permissions to do so) takes time and effort and studying the electronic records before providing treatment takes time and extra effort too. In addition to information about the diseases it is expected that staff will complete various documents related to the payment of services and other administrative matters. Medical staff are already complaining about the numbers of records they must produce and about the shortage of time they have to devote to a patient. Insistence that detailed medical records must be produced results in dissatisfaction of staff and in lesser quality of the records. Insistence that in addition staff should fetch the records about treatment elsewhere for the same or another disease is also met with resistance and often remains undone.

Thus, while digitalization of medicine offers new possibilities it also requires extra staff time and effort. If additional staff (and extra time per patient) are not provided the digitalization of medical records might worsen the quality of care because the time given to direct interaction with patients is severely reduced.

New investigational technology born with the digitalization of medicine is also enabling doctors to make more precise diagnoses and to discover anomalies and ailments that were previously often disregarded or missed. This is no doubt an advance and a step towards a better and more comprehensive assessment of patients’ ills, thus a “pro”.

Yet, there is also a dark side to this advance, a “con”. Minor abnormalities discovered by intensive searches - while interesting - usually do not require treatment or if they do the gain of treatment is minimal. The cost of the examination however is high both in terms of time of the technicians and doctors and in terms of investment into the diagnostic machinery. The rapid development of technology also means that the machines which are helpful are not as helpful as their next generation: the cost of updating and maintaining the technology at its most recent level often means that it is necessary to buy new machines. This causes additional expenses and the funds to get them are from the budgetary allocations for other tasks of the service. The usual victim of these transactions are funds for preventive activities: not investing in prevention does not have immediate consequences and the later consequences can always be ascribed to reasons other than the suboptimal functioning of the health service. Finding the right amount of technological support for diagnosis is a challenging task requiring wisdom and a capacity to resist both the lure of advanced technology and the requests of the population keen to use the most advanced technology in diagnosis and treatment.

The use of new technology and of additional machines increases the amount of data about individuals and about populations. The dream of public health specialists is to have all the information about a population because that, in theory, allows comprehensive epidemiological analyses and a better understanding of diseases and of the population which suffers from them. The problem, however - a “con” to the “pro” of having assembled huge amounts of data - is that our capacity to analyse and interpret the results of analysis of “big data” is still in its infancy and the time necessary to engage in learning about big data analyses and about the interpretation of their meaning is usually not sufficient. Thus, the expense of time, effort and money spent to develop the technology of big data collection and to get the information using the new technology is only rarely rewarded by new insights.

The complexity of big data analysis will no doubt also increase the numbers of experts who can handle it: the time and effort necessary to become experts might however lead to a neglect of knowledge and relationships with those who are active in the field in which the data is created.

In an increasing number of instances the use of complex methods and machines to obtain data is not necessary; yet it is done resembling the situation in which two persons sitting next to each other use their phones to have a conversation rather than speaking to one another: the phones are complex, often expensive technological tools which can record the conversation, allow voice analyses of the two persons, change the loudness of the sound signal and do other even more complex manipulations of the voices and the content - although none of this is necessary and it is unlikely that the results of these additional recordings and studies will ever be followed by their use.

In a different field – that of assessing the effects of new medications – regulatory agencies have set the bar high and demand to see results of the effects of medications given to a large number of subjects. The assembly of such data in a single site is not easy and may take a long time. Patients with a particular form of the disease for which the new drug is to be used are not always easy to find and somehow, miraculously, when the studies are done are seen less frequently. Thanks to digital and related technology it is now possible to collect data in several centres so that the necessary numbers of patients included in an effectiveness study can be reached much more rapidly. Digitalization and technology thus allow a much faster assembly of data collected in faraway centres often in different countries, a clear “pro” since the new medications should be brought to the market as soon as possible for both humanitarian and commercial reasons. The “con”, however, is that quality control of the data assembled in different sites by investigators working at great distance from one another is a huge challenge requesting a massive investment to ensure that data stemming from different sources can be analysed together as if it came from the same setting with investigators trained together to achieve the necessary reliability of their assessments.

Undergraduate and postgraduate medical training is expensive and the need to merge previous content with that resulting from the rapid progress of knowledge makes it likely that its cost will grow even further. A logical step to reduce the costs is the introduction of electronic technology into the training. Digitalization makes it possible to provide training at a distance and reduce cost by pre-recorded materials, webinars, easy access data banks and manuals, electronic gadgets and a variety of other tools. This can clearly be counted as a “pro” for digitalization.

The “con”, however, can also be powerful. An important component of education is the provision of professional skills which are best learned by doing under the direct supervision of a competent teacher and the inculcation of attitudes to patients and to medicine’s aims acquired in contact with colleagues and teachers. Both of these components of education are difficult to acquire in distant learning and machine-assisted studies; and without them education for a practicing physician is poor and unsatisfactory.

Regrettably, the lessening attention to the acquisition of skills and attitudes combined with the reliance on the magic of digitalized medical practice has already affected the image of medical services which are increasingly criticised as being dehumanized and devoid of empathy. People who have experienced it turn away from scientific medicine and seek advice and succorance from various practitioners of alternative medicine depriving themselves from the benefits which scientific medicine might have offered them if only it was practiced a bit differently.

Digitalization of the world at large, however, has also another impact on the relationship between doctors and their patients. The latter in many countries consult websites and books on the web and speak to their doctors referring to the best and newest of medicine. Not infrequently they know more about their disease and the relevant scientific discoveries than their doctor because they have read about it and accessed the most modern of knowledge of the subject. This change requires a significant change in the doctor-patient relationship, a change that many a doctor finds difficult to accept and embittering.

The considerations presented above could be complemented by other pages describing other ways in which the digitalization of medicine affected its practice and its future. The main point for writing them is to urge all concerned to understand that digitalization and technological development should at all time be used as a good servant who cannot be a good master and should therefore not be given a chance to be it.