Lienkie Diedericks 

I don’t need a digital pill to monitor me – I just need to see a doctor

Sometimes patients need to talk to a live human being, says academic Lienkie Diedericks
  
  

Woman blowing her nose
‘I worry that solutions to issues like poor medication-taking focus overly too heavily on digitally inspired sticking plasters, rather than person-centric approaches.’ Photograph: TommL/Getty Images

Over the weekend, I awoke to raging sinusitis. After calling my GP’s surgery, I was told to log an appointment request on their new online system. Navigating the platform was easy enough until I was confronted with a barrage of multiple-choice questions. My mucus wasn’t quite yellow, nor could it be described as green. Yes, my neck was stiff, but surely that didn’t mean meningitis? And if I bend over, I think my headache gets worse … In the end I became more anxious than ill, which I guess is one way of treating a sore throat.

While plugging in my ill-fitting symptoms, I wondered about those with mobility impairment in their hands, or a visual impairment, or a small child demanding their immediate attention. Sometimes all patients need is to talk to a real, live human being – something that is becoming increasingly harder to do in everyday life.

This week also marked the release of the watershed Topol review for the NHS. The report outlines recommendations for the NHS on how to make use of digital tools for better healthcare outcomes. However, I worry that solutions to issues such as drug resistance and poor medication-taking by patients focus too heavily on digitally inspired sticking plasters, rather than person-centric approaches such as increasing the time spent with your GP.

For instance, digital solutions abound for the burgeoning drug resistance crisis. The NHS is opting to monitor prescriptions digitally, while in the US, the Food & Drug Administration has approved the world’s first “digital pill” to monitor whether or when patients take their medication. (The NHS is also interested in digital pills with Lloyds pharmacy piloting a limited rollout in 2013.)

After the social revolution of contraceptive pill, the digital pill promises to transform medical care. Drugs are digitised by embedding a Silicon Valley sensor into a pharmaceutical tablet. When swallowed, the sensor transmits a signal that records the fact that the medication has been taken on to a patch worn by the patient. With the patient’s consent, this patch transmits the data to the patient’s mobile device, their doctor’s, and up to four other people.

If doctors can see exactly how patients are taking their medication, the thinking goes, patients will not be as likely to fail to complete a course, or share drugs with friends and family – both of which are causes of drug resistance and poor health outcomes. Currently in the UK, 50% of patients don’t take their medication properly, costing the NHS more than £500m annually.

But a purely digital approach is not enough. Digitally monitoring medical staff and patients misses a crucial point: prescribing and taking drugs takes place in the context of the doctor-patient relationship. If beliefs about medication and patient concerns are not addressed in a sensitive and engaging way, no amount of digital monitoring will help. Studies suggest that the quality, duration and frequency of interaction between doctor and patient as well as the doctor’s openness to patients’ questions all affect how the patient will follow whatever they’ve been advised. When medics have more time with their patients, they are better able to discuss the benefits and disadvantages of prescriptions, and end up prescribing less.

Of course, this type of relationship between doctors and patients needs time and continuity, two elements that are sorely lacking in the NHS. Medical practitioners are so overworked that some have confessed that the NHS is draining them of their humanity. Not only are they barred from engaging in valuable, empathetic patient care, but they are also pressured into prescribing more antibiotics when working against the clock.

While comprehensive reports such as the Topol review are an encouraging step forward, concerted efforts are needed to show how digital technologies result in concrete contact hours between medical staff and patients.

Eventually, my doctor’s website scheduled a telephone consultation. After a 150-second call with an audibly exhausted GP, I was prescribed antibiotics. Those few minutes were the first and possibly last time we’d ever speak. He was unable to examine me and to check whether I had a bacterial infection. My consultation was a worrisome reminder that medicine is more than an analytic exercise in diagnosis and prescription, it’s an art.

• Lienkie Diedericks is a researcher and PhD candidate at King’s College London

 

Leave a Comment

Required fields are marked *

*

*